Ethical dilemmas : balancing choice and risk with a duty of care in extending personalisation into the care home

The article reports the perspectives of senior care staff as part of a study exploring personalisation in care homes. Behind the conceptual sword and shield of 'choice and control' associated with personalisation in the United Kingdom (UK) lie irreconcilable flaws, thrown into sharp relief in this context. Personalisation, which originated in community-based social services, has recently been extended into UK care homes. This service development has been stimulated by a desire to promote a humane response to caring for an ageing population, whilst containing costs. Seemingly promoting a relational approach, personalisation also entails consumerist underpinnings, with consequent tensions resulting in weakened policy mechanisms. Discussing findings pertaining to 'food and eating', the article illustrates the complex interplay between supporting resident capabilities with poor staff ratios; when choice is not really choice at all; balancing choice, risk and the duty of care; and responding to diverse perspectives about what matters. This complexity reflects the highly skilled nature of care work as promoted by care ethicists. The tensions permeated care home life and found parallels in the wider system of care. Honesty about the limitations of choice and control is essential to achieve ethical care in care homes. The care home constitutes fertile ground for exposing and exploring the shortcomings of the 'logic of choice' and for advancing a more relational, inclusive and sustainable conceptualisation of personalisation

Testing times: exploring everyday life with dementia through narrative-in-action

This thesis explores the ongoing accomplishment of ordinary life with dementia and asks how older people variously negotiate and make sense of the obstacles, dilemmas and opportunities of everyday life as lived. The thesis responds to persistent calls to recognise the heterogeneity of people living with dementia and to challenge predominantly negative cultural stereotypes. It draws together parallel developments in contemporary dementia studies, namely the extension of social citizenship into the realm of the ordinary and fresh critiques of the biomedicalisation of ageing, particularly the rapid expansion of its technologies into the domain of cognitive impairment. In different ways, these developments bring a more overtly political impetus to the research agenda. The research study takes the form of ‘narrative-in-action’ (Alsaker et al, 2009), a mode of Narrative Inquiry that combines Paul Ricoeur’s (1984) early narrative theorising with ethnographic methods. The study expands the theoretical underpinnings of this methodology by engaging more deeply with Ricoeur’s (1992) elaboration of the dynamic relationships between narrative and life, narrative and temporality, and incorporating critical insights from narrative gerontology. The resultant methodology facilitates an understanding of experiences as expressed in practice and through time by embodied, emotional, relational persons. The study explores the everyday life of three couples, one man and one woman (aged 78-85 years) residing at home in a small Scottish town. This entailed meeting regularly with each person or couple over a period of six or seven months and participating in their choice of everyday activities. The length and intensity of involvement required careful deliberation about the creation and ongoing negotiation of uniquely constructed relationships that altered and deepened as the study progressed. Narrative analysis engaged with events, happenings and the various shifting and patterned meanings made within the flow of actions in different settings and over time, and was informed by Ricoeur’s (1984, 1992) notions of mimesis, emplotment and narrative identity. The resultant narratives offer a nuanced understanding of different ways of living with dementia in later life. They illustrate how meanings were made in different situations and over time, depicting diverse implicit or purposeful ways of resisting the dominant cultural narrative of loss and contributing to ordinary social life. These distinctions were manifest in the dynamic, dialogic configuration of identities. Despite these differences, the spectre of testing coloured each narrative, extending its reach into recollections of the past and also influencing the ways in which future possibilities were embraced, discounted or denied. This spectre also impacted upon the larger task of trying to make meaning of life as a whole in the face of ageing and memory loss. The thesis augments current conceptualisations of citizenship-as-practice in dementia studies through the construct of recognition. It also highlights the potential of the narrative-in-action methodology to enrich the notion and study of ‘narrative citizenship’ (Baldwin, 2008); in this study, it facilitates an understanding of later life with dementia that is optimistic but not naïve. Taken together the narratives illuminate the risks of prescribing how people should respond to a diagnosis based on observations of how some individuals adapt successfully. Finally, the thesis concludes that unless we attend to productive as well as repressive forms of power, there may be increasingly testing times ahead for us all

Setting the Bar for Social Work in Scotland

Scottish policy ambitions include the formation of a National Care Service, the embedding of human rights and delivery of “The Promise” to Scotland’s children. For social work, the vision requires ‘a skilled and valued workforce’ with ‘a focus on prevention, early intervention and enablement.26. Several issues have been identified as precluding this vision. In particular, high caseloads have been reported as making it difficult for social work staff to achieve best practice and support people effectively23 . Setting the Bar set out to establish an evidence-based indicative caseload limit for social work staff in Scotland, with consideration given as to how this might be used. This report presents the findings

Using social marketing to promote cold and flu prevention behaviors on an Australian university campus

Background: Cold and influenza transmission is a serious public health issue for universities. This case study describes a coordinated social marketing campaign that incorporated health messages and products. It was designed to motivate behavior change to prevent the spread of colds and influenza on a university campus. Methods: The aims of this multi-component intervention were to raise awareness of the importance of individual behavior in preventing the spread of colds and flu and to encourage staff and students to adopt three simple habits: hand washing, cough or sneeze in sleeve, and stay at home if sick. A repeated, cross-sectional survey design assessed the following pre- and post-campaign: salience of colds and flu; perceived severity of, and susceptibility to, colds and flu; beliefs about effective prevention strategies; and engagement in preventative behaviors. Campaign message and product recall were assessed post-campaign. Results: Campaign message recall was high (over 80% of staff and 70% of students); fewer staff (one-third) or students (one-quarter) recalled campaign products. Few pretest-posttest differences were observed in perceived susceptibility or severity. Recognition of cough or sneeze into your sleeve as an effective prevention strategy increased pre- to post-campaign (a percentage increase of 39.6% for staff and 25.1% for students); campaign exposed respondents were significantly more likely than unexposed to rate this strategy as effective post-campaign. Substantial pretest-posttest percentage increases in the top ranked prevention strategies were found for the three core messages: hand washing (51% for students); cough in sleeve (59.2%, staff; 71.1%, students); and stay at home if sick (120%, staff). Conclusions: This setting-based intervention clearly reached staff and students with the primary messages. Success can be attributed to using consumer insight to develop multiple marketing messages and strategies, rather than a single- strategy communication campaign

A novel assay for analysis of the regulation of the function of human osteoclasts

BACKGROUND: Very little is known of the regulation of the function of human osteoclasts, largely due to the virtual impossibility of obtaining human osteoclasts ex vivo. It has recently become possible to generate human osteoclasts in vitro, by incubation of peripheral blood mononuclear cells (PBMCs) in macrophage colony-stimulating factor (M-CSF) and receptor activator of nuclear factor-κB ligand (RANKL). However, the assays at present available do not distinguish clearly between the distinct effects of agents on differentiation and function. MATERIALS AND METHODS: We developed a novel assay for resorptive function of human osteoclasts that minimizes inter-assay variability by using each culture as its own baseline, and that minimizes the confounding effects of agents on differentiation by assessing resorptive function over a short test period. In this assay, the development of resorptive activity is monitored in sample cultures. When resorption is underway, bone resorption (measured as the release of the C-terminal telopeptide degradation product of type I collagen (CTX-I) into the supernatant) is compared before vs after incubation for 1–24 h in test agent. RESULTS: Using this assay, we found that changes in bone resorption could be detected using substantially fewer cultures per variable. Moreover, we could detect effects of agents on resorption within 1 h of addition, a time sufficiently short that a change in release is likely to reflect an effect on function rather than on differentiation. CONCLUSION: The assay makes it possible to distinguish the effects of agents on osteoclastic function, independent of their effects on differentiation

Advancing science by enhancing learning in the laboratory (ASELL)

Final report of the the&nbsp;Advancing Science by Enhancing Learning in the Laboratory (ASELL) project.&nbsp;Most researchers agree that the laboratory experience ranks as a significant factor that influences students&rsquo; attitudes to their science courses. Consequently, good laboratory programs should play a major role in influencing student learning and performance. The laboratory program can be pivotal in defining a student\u27s experience in the sciences, and if done poorly, can be a major contributing factor in causing disengagement from the subject area. The challenge remains to provide students with laboratory activities that are relevant, engaging and offer effective learning opportunities.The Advancing Science by Enhancing Learning in the Laboratory (ASELL) project has developed over the last 10 years with the aim of improving the quality of learning in undergraduate laboratories, providing a validated means of evaluating and improving the laboratory experience of students, and effective professional development for academic staff. After successful development in chemistry and trials using the developed principles in physics and biology, the project, with ALTC funding, has now expanded to include those disciplines.The launching pad for ASELL was a multidisciplinary workshop held in Adelaide in April, 2010. This workshop involved 100 academics and students, plus 13 Deans of Science (or delegates), covering the three enabling sciences of biology, chemistry and physics. Thirty-nine undergraduate experiments were trialled over the three days of the workshop. More importantly, professional development in laboratory education was developed in the 42 academic staff that attended the workshop.Following the workshop, delegates continued to evaluate, develop and improve both individual experiments and whole laboratory programs in their home institutions, mentored by the ASELL Team. Some highlights include: - more than 15,000 student surveys carried out by delegates during 2010/11- 10 whole lab programs were surveyed by delegates- 4 new ASELL-style workshops, conducted by ASELL-trained delegates were run in 2010/11- more than 100 ASELL-tested experiments available on the website (www.asell.org)- ASELL workshops conducted in Philippines, Ireland in 2010, and planned in the USA and Thailand for 2011- significant improvement in student evaluation of whole laboratory programs and individual experiments measured in universities using the ASELL approach- high profile of ASELL activities in the Australian Council of Deans of Science (ACDS)- research project on the misconceptions of academic staff about laboratory learning completed- significant research on student learning in the laboratory, and staff perceptions of student learning have been carried out during 2010/11- research results have been benchmarked against staff and students in the USA.The biggest unresolved issue for ASELL is one of sustainability in the post-ALTC funding era. ASELL will make a series of recommendations to the ACDS, but the future of the program depends, to a large part, on how the ACDS responds. <br /

Caring Conversation Framework to promote person centred care:synthesising qualitative findings from a multi- phase programme of research

Background Little is known about how to support practitioners to enhance their interpersonal conversations to be more compassionate, person centred and relational with others. The Caring Conversations (CC) framework was empirically derived to address this issue and comprises seven attributes (be courageous, connect emotionally, be curious, consider other perspectives, collaborate, compromise and celebrate). Objective This paper synthesises the qualitative findings from a multi-phase programme of research, which implemented the CC framework across a variety of health and social care settings (acute hospitals, community, and residential care). It explores the perceived impact of the CC framework on staff and their practice. Methods Secondary analysis was conducted on the qualitative findings in the final reports of 5 studies, involved in the implementation of the CC framework. Results The analysis showed consistent positive outcomes for staff in their interactions with patients, families and others; including greater self-awareness during interactions, development of stronger relationships, and more open dialogue that supports relational practice. The secondary analysis confirmed the applicability of the framework across a number of different settings, strengthened confidence in its value, generated fresh insights to inform further research, and developed a deeper insight into the attributes of the framework and its application. Conclusions Policy and research advocate compassionate care and relational practice, but do not state how this can be delivered in practice. By synthesising the findings from 5 studies undertaken in a variety of different settings, we can be more confident in the value of the CC framework to ensure best practice

Development of the research lifecycle model for library services

Can the niche services of individual librarians across multiple libraries be developed into a suite of standard services available to all scientists that support the entire research lifecycle

Identifying Novel Library Liaison Roles in Academic Health and Life Sciences

Objective: To identify services offered by library liaisons serving academic health and life science schools and programs. Establishing an understanding of available services can inform the development of current and emerging liaison roles. Methods: Nine health sciences librarians and three life sciences librarians individually created lists of services which they currently provide in their liaison work, and those they would provide given additional resources and/or demonstrated constituent interest. The resulting lists were collected and service activities were grouped into conceptual clusters such as reference, outreach, and teaching activities. The responses were then analyzed for overlap among current and potential services. Results: An impressive quantity and variety of services were provided by liaisons, spanning more than 75 services in 18 categories. In addition, liaisons suggested the adoption of a large quantity and variety of potential services. Many of the services listed go beyond the librarian as simply a service provider, instead casting the liaison in the role of research or teaching partner and faculty peer. Implications: These results support the reimagining of the librarian’s role in academic health and life sciences environments. The next step will be to identify new roles of highest potential use to constituents in the health and life sciences. This process has already begun and data collection is ongoing