Institutional thickening and innovation: reflections on the remapping of the Great Bear Rainforest

The information, practices and views in this article are those of the author(s) and do not necessarily reflect the opinion of the Royal Geographical Society (with IBG). © 2016 Royal Geographical Society (with the Institute of British Geographers) As a response to forest conflict, contemporary remapping refers to re-evaluations of resource values, new and diverse forms of governance among stakeholders, and compromises within patterns of land use that give greater emphasis to environmental and cultural priorities. This paper elaborates the processes of remapping by examining the role of institutional innovation in conflict resolution, with particular reference to the iconic Great Bear Rainforest of British Columbia. After years of conflict and protest, peace in the Great Bear Rainforest was heralded by an interim agreement in 2006, with final ratification likely in 2016. Conceptually, a four-legged stakeholder model identifies the main institutional interests and their interactions through learning and bargaining. New forms of governance were created to bring the stakeholders together in constructive dialogue and then to reach and implement acceptable bargains. Analytically, the paper examines how this agreement has worked in practice by reflecting on the emergence of novel institutions that integrate the interests of key stakeholders. The discussion identifies six bilateral negotiations between: industrial and environmental interests; federal and provincial governments and aboriginal peoples; government and environmental interests; government and industry; industry and aboriginal peoples; and environmental groups and local communities. The remapping process has produced a thickening architecture of institutions that remain experimental even as they seek to promote sustainability, resilience and legitimacy

Identifying longitudinal sustainable hierarchies in activities of daily living

© 2017 Elsevier B.V. Activities of daily living serve as an indicator of progression in disability and rehabilitation. It is know that some of the measurement scales used show hierarchical properties indicating that activities of daily living are lost and gained in a consistent pattern. Few studies have investigated the extent to which these patterns are sustained across time and across a range of disability. The study aimed to investigate the hierarchical properties of the activity of daily living items in the ValGraf functional ability scale, to establish if there is a hierarchy of items in the scale and to study the sustainability of the hierarchy over time. Secondary analysis of a retrospective database from 13,113 people over 65 years in 105 nursing homes in northern Italy, between 2008 and 2013 was conducted. Data were gathered 6-monthly and analysed using Mokken scaling to identify a hierarchy of items in the scale and if this was sustainable over time. A sustainable hierarchy of items was observed running in difficulty from urinary incontinence to feeding. The hierarchical structure of the activities of daily living observed in the present study is stable over time meaning that changes in total score for these items can be compared meaningfully across time

Enhancing independent eating among older adults with dementia: A scoping review of the state of the conceptual and research literature

BackgroundAddressing eating difficulties among older individuals with dementia living in nursing homes requires evidence-based interventions. However, to date, there is limited evidence of effective interventions designed to maintain and/or increase independent eating. In a field in which evidence is still lacking, a critical analysis of the state of research describing its main features can help identify methodological gaps that future studies should address. Hence, the aim of this study was to map the state of the research designed to maintain and/or promote independent eating in older individuals with dementia living in nursing homes.MethodsA scoping review was performed by following the Preferred Reporting Items for Systematic Reviews and Meta-analyses. Reviews and conceptual analyses performed with different methodological approaches, published in indexed journals, and written in English were included. Keywords Were searched for in the MEDLINE, the Cumulative Index of Nursing and Allied Health, and in the Scopus databases to identify papers published up to 31 May 2018.Results17 reviews were included, assessing interventions’ effectiveness (n = 15) and providing conceptual frameworks for eating/mealtime difficulties (n = 2). Conceptual frameworks supporting interventions’ effectiveness have rarely been described in available studies. Moreover, interventions tested have been categorized according to non-homogeneous frameworks. Their effectiveness has been measured against (1) eating performance, (2) clinical outcomes, and (3) adverse event occurrence.ConclusionAn increased use of conceptual frameworks in studies, as well as greater clarity in intervention categorization and outcomes, is necessary to enhance the reviews’ value in providing useful cumulative knowledge in this field. Interventions delivered should embody different components that integrate individual, social, cultural, and environmental factors, while when evaluating an intervention’s effectiveness, eating performance, clinical outcomes and adverse events should be considered. Together with more robust studies, involving clinicians could prove to be useful, as their knowledge of practice developed from direct experience can help develop innovative research questions

Functional decline in residents living in nursing homes : a systematic review of the literature

Objectives To describe the functional dependence progression over time in older people living in nursing homes (NHs). Design A systematic review of the literature was performed. Studies involving individuals 65 years and older living in NHs, describing their functional decline, improvement or stability in activities of daily living (ADLs), were eligible. The search strategy was applied in MedLine, Cochrane, CINAHL, and SCOPUS databases; aimed at identifying an unbiased and complete list of studies, searching by hand was also performed. The methodological quality of the 27 studies included was assessed. Results Functional trajectories were documented mainly through multicenter study design including sample size ranging from 2 to 9336 NHs, from 1983 to 2011 throughout a single or multiple follow-ups (>20). The average rate of decline was expressed in different metrics and periods of time: from 3 months with a decline of −0.13 points of 28, to 6 months (−1.78 points of 2829) to 1.85 years (−0.5 points of 6). Eating and toileting were the most documented ADLs and the decline is approximately 0.4 points and 0.2 to 0.4 points of 5 a year, respectively. Among the covariates, individual factors, such as cognitive status, were mainly considered, whereas only 13 studies considered facility-level factors. Conclusions Findings report the slow functional decline mainly in women living in US NHs, in years when residents were admitted with a low or medium degree of functional dependence. Considering that in recent years residents have been admitted to NHs with higher-level functional dependence, studies measuring each single ADL, using standardized instruments capable of capturing the signs of decline, stability, or improvement are strongly recommended. Among the covariates, evaluation of both individual and facility-level factors, which may affect functional decline, is also suggested

"I DONT REALLY LIKE THE MILL; IN FACT, I HATE THE MILL": Changing Youth Vocationalism Under Fordism and Post-Fordism in Powell River, British Columbia

Forest towns in British Columbia  are  in  the  throes   of.  a profound  restructuring  (Hayter  2000). The  most  recent  turn  of  the screw,  the  US  imposition   of  a  27%  import  tax   on   softwood  lumber    (May  2002),  is  only  the  latest  twist  in  a  twenty-year history scarred by volatility and industrial  downsizing.  Persistent  job  losses due  to  technological  change,  corporate   rationalization,   increased international  competition,  trade  conflicts,  and   resource   depletion have  progressively  undone   the  fabric   of  BC   forest   communities, especially on the  coast. But while  a plethora  of policies, schemes,  and programs  have  been  initiated  to  help  those  worst  affected,  little attention  has been paid to high  school youth who  have  yet to enter the job market  (Hay  1993 ; Barnes  and Hayter  1992,1995a,  and  1995b; Barnes, Hayter,  and Hay  1999; Hayter  2000, 288-320; Egan and  Klausen  1998). Historically, high  school students\u27job  expectations  were  directly  tied to  a  buoyant  resource  economy,  which,  in  turn,  helped  to  define the  culture  of  the  resource  town  itself  But  in  this  era  of economic  downsizing   and  industrial  restructuring,   those   expectations    are increasingly  frustrated. The  purpose  of this  paper  is  to  examine how  the  new  economic  reality  of  forest   towns   has   influenced  not only the  expectations  of high  school students  but  also  the  content and  philosophy  of  high  school  programs

Negative prompts aimed at maintaining eating independence in nursing home residents: purposes and implications -A critical analysis

Background:Psychological abuse of older people is difficult to recognise; specifically, nursing home residents have been documented to be at higher risk of psychological abuse during daily care, such as during feeding. Healthcare professionals adopt positive and negative verbal prompts to maintain residents’ eating independence; however, negative prompts’ purposes and implications have never been discussed to date.Research aims:To critically analyse negative verbal prompts given during mealtimes as forms of abuse of older individuals and violation of ethical principles.Research design:This is a secondary analysis of three cases of negative prompts that emerged in a large descriptive study based upon focus group methodology and involving 13 nursing homes and 54 healthcare professionals.Participants and research context:This study included 3 out of 13 nursing homes caring for residents with moderate/severe functional dependence in self-feeding mainly due to dementia; in these nursing homes, we conducted three focus groups and 13 healthcare professionals participated.Ethical considerations:This study was conducted in accordance with the Human Subject Research Ethics Committee guidelines after being approved by the Review Board of the Trust.Findings:With the intent of maintaining self-feeding independence, negative verbal prompts have been reported as being used by nursing home teams. By critically analysing these negative prompts, it turned out they could trigger intimidation, depression and anxiety and thus could be considered as forms of abuse; moreover, negative prompts can threaten the ethical principles of (1) autonomy using a paternalist approach, (2) beneficence and non-maleficence as with the intent to act in the best interests of residents (to maintain self-feeding independence) they are harmed in their dignity and (3) justice, given that residents who received negative prompts are treated differently from those who received positive prompts.Discussion:Eating should be a pleasant experience with a positive impact on physiological, psychological and social well-being. However, negative prompting can lead to abuse and violation of basic ethical principles, destroying the healthcare professional resident and relative relationships strongly dependent on trust.Conclusion:Negative verbal prompting must be avoided

Interventions maintaining eating Independence in nursing home residents: a multicentre qualitative study

BACKGROUND: Despite 32 years of research and 13 reviews published in the field, no intervention can be considered a gold standard for maintaining eating performance among residents with dementia. The study aim was to highlight the interventions derived from tacit knowledge and offered daily in assisting eating by healthcare professionals (HCPs) in nursing homes (NHs). METHOD: A multicentre descriptive qualitative study was performed in 2017. Thirteen NHs admitting residents with moderate/severe functional dependence in eating mainly due to dementia, were approached. A purposeful sample of 54 HCPs involved on a daily basis in assisting residents during mealtime were interviewed in 13 focus groups. Data analysis was conducted via qualitative content analysis. RESULTS: The promotion and maintenance of eating performance for as long as possible is ensured by a set of interventions targeting three levels: (a) environmental, by 'Ritualising the mealtime experience by creating a controlled stimulated environment'; (b) social, by 'Structuring effective mealtime social interactions'; and (c) individual, by 'Individualising eating care' for each resident. CONCLUSIONS: In NHs, the eating decline is juxtaposed with complex interventions regulated on a daily basis and targeting the environment, the social interactions, and the residents' needs. Several interventions that emerged as effective, according to the experience of participants, have never been documented before; while others are in contrast to the evidence documented. This suggests the need for further studies in the field; as no conclusions regarding the best interventions have been established to date