This qualitative research study aims to document the lived experiences of several primary-aged Māori students, and the impact on their caregivers, when these students have been stood down, suspended or excluded from their school. In order to contextualise the students’ narratives, data from primary school site personnel, the principals and Board of Trustees chairperson of the students’ schools were gathered. The research also involved interviews with Ministry of Education and Group Special Education personnel, to gain an understanding of the Ministry’s perspective on how it meets the differing needs of students, caregivers and schools. An analysis of the two schools’ policy and procedures, and relevant documents, with regard to stand-down, suspension and exclusion of primary-aged students was also undertaken. Qualitative research methodologies enabled me to explore the lived experiences of these young people excluded from primary school, from the subjects’ own frame of reference. Data were collected using participant observations, document analysis, and in-depth semi-structured interviews. Kaumātua support for both the researcher, and the whānau involved, was sought with the aim of ensuring that the research proceeded in culturally appropriate and safe ways. The research aimed to keep the students’ stories central to the discussions. One of the key themes that emerged from the students’ narratives was the impact of being repeatedly framed by focusing solely on their behaviour. The impact of institutionalised racism evident within these educational life histories highlights the children’s struggle to persevere and survive in what they describe as hostile, racist, uncaring school environments. A key issue as outlined by the caregivers in this study has been the lack of understanding and support from or genuine partnership with their children’s education providers. The caregivers spoke of the effect that the disciplinary exclusion had on their relationship with their child and on their lives. Eventually the caregivers too become angry about, disengaged from and disillusioned with an education system that allows young people to be removed from schools, based solely on their behaviour. The themes that emerged from discussions with schools centred on lack of support and follow-up from government agencies. School personnel were critical of the length of time it took to access support packages from the Ministry of Education. They discussed the impact of Tomorrow’s Schools, particularly the current legislation on stand-downs, suspensions and exclusions. School personnel suggest their ability to manage high needs students is further complicated by the existence of kiwi suspensions and geographical school zones. This thesis stresses that it is critical for the students’ voices to remain central to discussions concerning their own education, so their creative ideas for possible solutions can help to create pathways forward.

SAMMANFATTNING Antalet multisjuka äldre ökar på vårdenheterna. Hjälpbehovet är ofta stort då många inkommer undernärda, uttorkade, har konfusion eller inte klarar utföra dagliga aktiviteter självständigt. De multisjuka patienterna har ofta fler åkommor med en eller fler organsvikter och kan kräva akuta insatser. Enligt socialstyrelsen är inte egenvården väldokumenterad i journalsystemen trots det ökade behovet. Antalet äldre multisjuka ökar samtidigt som det allt vanligare förekommer hospitalisering och komplikationer i vårdandet. Studien syftade till att beskriva hur sjuksköterskor uppmuntrade till egenvården för äldre personer. Data inhämtades från strukturerade intervjuer som analyserades utifrån kvalitativ innehållsanalys. I resultatet presenterades fem kategorier och åtta subkategorier som framkom i analysen av intervjuerna. Dessa presenterades enligt följande: klinisk blick, sjuksköterskornas inhämtning av information, hinder för god egenvård, tidsbrist, metoder som ökar individens strategier för god egenvård, organisatoriska ramar, övertro på sig själv och sin förmåga, för liten tro på sig själv och sin förmåga, att möta patientens hinder, integritet, autonomi, förändring i egenvårdsförmåga, teamet som hjälpmedel och resurs. I resultatet framkom det att vård och omvårdnad bör ses som ett komplement till egenvården. Sjuksköterskan har en stor uppgift att observera och undersöka patientens förmåga. Det framkom även att målen behövde vara gemensamma för patient, sjuksköterska, det geriatriska teamet samt verksamheten. Sjukvården behöver anpassa arbetssätt och verksamhetsmål så att de gynnar patientens egenvård. Sjuksköterskorna behöver se betydelsen av individens motivation och förmågor samt använda det geriatriska teamet och de gemensamma målen som resurs.

The purpose of this study was to determine the effect of dietary vitamin E reduction on blood cholesterol levels (LDL and total cholesterol). Eight healthy older adults between the ages of 40 and 60 volunteers were used for the study. Subjects acted as their own controls during the two week baseline period in which they ate their normal diet and kept precise diet records [three day diet recalls which were analyzed for vitamin E content using the Diet Analysis program (Food Processor version 8)]. A vitamin E reduction diet was created for each individual using the same Diet Analysis program. This vitamin E reduction diet was designed to significantly reduce the amount of dietary vitamin E intake of each subject while keeping calories relatively similar throughout a period of three weeks. Fasting blood draws and three day diet recalls were collected every week. Vitamin E intake, total calories, HDL, LDL, TG, and glucose values over the course of this study were compared with a one-way ANOVA using repeated measures. Post-hoc testing using Duncan and Scheffe comparisons were made to indicate any statistically significant difference. Significance was set at p<0.05 and all values were reported as x ± SEM. The averaged three day vitamin E intake was reduced by 55% (20.3 ± 2.6 mg to 11.2 ± 2.1 mg). There was no significant change in total cholesterol, LDL, HDL, or triglycerides from baseline to the conclusion of the study.The results suggest that short term reduction of dietary vitamin E has no effect on total or LDL cholesterol. / School of Physical Education

This investigation, comprising two studies, examined the number of barriers to physical activity (Study 1) and barrier strength (Study 2) reported by middle-aged and older adults using a social ecological framework (McLeroy et al., 1988). Researchers were interested in assessing age group (45-54; 55-64; 65-74 yrs) by physical activity group (active, less active) effects for barrier responses using analyses of variance. In Study 1, 180 participants completed a physical activity level survey (Godin & Shephard, 1985) and answered open-ended questions about barriers. Results indicated that 45-54 yr-olds reported more barriers overall, and more intrapersonal barriers than older groups. Less active 45-54 yr-olds reported more organizational-interpersonal barriers than the other groups. Descriptive analyses of coded themes demonstrated that common intrapersonal barrier sub-themes cited by younger adults related to family commitments, while sub-themes reported by middle-aged and older adults related to having a health problem or an injury. In the organizational-interpersonal category, the most common barrier sub-theme related to the workplace. In Study 2, 116 participants completed a survey assessing weekly physical activity and barrier strength for items pertaining to ecological categories and barrier sub-factors. Results showed that less active adults reported each of intrapersonal, interpersonal, and physical environment barriers more strongly than active adults, irrespective of age; the intrapersonal category was relatively the most constraining for our participants. In terms of barrier sub-factors, results showed that significantly higher barrier strength scores are most often associated with physical activity level (i.e., less active), and only occasionally associated with age group. The overall investigation can provide valuable information for improving physical activity interventions for middle-aged and older adults.

This minithesis provides an ethnographic account of the life world of older people in the community of Belhar in the Cape Peninsula, which was historically categorised as a &lsquo / coloured&rsquo / community during the implementation of the Group Areas Act. By content analysing newspaper articles published in the early 1980s and specifically during the implementation of the Group Areas Act I found that many of the residents reported that they lived in fear of their lives, in what was once known as a &lsquo / prestige suburb&rsquo / . At the present time the community of Belhar is an intensely gang-infested area. From preliminary research done by myself at a senior citizen centre in Belhar, the high incidence of violence was a recurring theme throughout discussions with older people. In fact when I posed the question Why do you come to the centre five days a week? to a group of older people they answered without hesitation It is unsafe for an older person to be alone during the day. Answers like these to many of the questions that I posed would almost always be followed with Things were better then. It also was apparent that the older people in this community remember (or perhaps reconstruct) the past in the context of their present living situation. This became the leading theme in my study and is also the background against which I had formulated my research questions. However this study not only focused on the impact of the high incidence of violence on the community of older people but also essentially looked at elderly residents&rsquo / everyday lived experiences in Belhar. The research sample consisted of twenty elderly residents and four key informants. The latter provided mainly infrastructural data on the community. Primary data was collected by using ethnographic techniques of inquiry which included participant observation and unstructured interviews. Results revealed that older people occupy a liminal space both in the community and in their households. I also found that the elderly stroke victim is twice silenced and marginalized due to the constraints brought on by their chronic illness and their status as an older person in the community.

Background: There is little information on how the quality of oral health services in long-term care (LTC) facilities is conceptualized or assessed. Objectives: This study aims to develop a model for assessing the quality of oral healthcare services in LTC facilities. Methods: This study is divided into four main steps. Firstly, I examined literature for existing concepts relating to program evaluation and quality assessment in healthcare to build a theoretical framework appropriate to dental geriatrics. Secondly, I explored as an ethnographic case study a comprehensive oral healthcare program within a single administrative group of 5 LTC facilities in a large metropolis by interviewing 33 participants, including residents and their families, nursing staff, administrators and dental personnel. I also examined policy documents and made site visits to identify other attributes influencing the quality of the program. Thirdly, I drafted the assessment model combining a theoretical framework with empirical information from the case study. And lastly, I tested the feasibility and usability of the model in another dental geriatric program in northern British Columbia. I applied the assessment model by conducting 15 interviews with participants in the program, made site-visits to the 5 facilities, and reviewed documents on the development and operation of the program. Results: A combination of theory-based evaluation and quality assurance provided six sequential and iterative steps for quality assessment of oral health services in LTC. The empirical information supported the theoretical framework that a program of oral healthcare in a LTC context should be assessed for quality from multiple perspectives; it should be comprehensive; and it should include the three main attributes of quality - capacity, performance, and outcomes. Participants revealed 20 quality indicators along with suggested program objectives which encompass eight quality dimensions such as effectiveness, efficiency, and patient-centered. Conclusion: The model provides a unique system for assessing the quality of dental services in LTC facilities that seems to meet the needs of dental and non-dental personnel in LTC.

Lifespan developmental theory suggests that midlife is an important stage where men typically re-evaluate major areas of their life including career, self/masculine identity and primary relationships. Midlife is also seen as a period where the desire to pass on what one has learned, or regeneration, becomes important. These aspects of midlife can be looked at from several perspectives including Jung's theory of personality type which has since been interpreted and extended by Katherine Briggs and Isabel Myers to form the basis of the Myers-Briggs Type Inventory. It can be concluded that personality type does impact on the male midlife experience and thus has implications for counsellors working with men in midlife. / Thesis (PhD)--University of South Australia, 2006.

Thesis (MAppSc) -- University of South Australia, 1997

The residential aged care industry in Australia has been undergoing change on multiple fronts since the introduction of the Aged Care Act 1997. Some of the sources of this change have been new regulatory systems such as accreditation and certification, concerns about financial viability, problems with recruitment and retention of staff, new models of care and increasing acuity of care provided. Facility Managers of aged care homes are at the forefront of managing these changes. In spite of their central position within the industry, there has been almost no research on the general role and functions of Facility Managers and even less that focuses on their role in the management of change. Using a constructivist methodology, this study set out to address this lack of research and to develop a range of practical proposals concerning the management of change in the sector. The research questions the study sought to answer were: 1. How is the role of managing change perceived and understood within the overall role of Facility Managers? 2. How is the role of managing change approached by Facility Managers? 3. How do Facility Managers learn to manage change? 4. Do Facility Managers need to be supported in their efforts to manage change and, if so, how should that support be provided, and by whom? Data for the project came from one-to-one interviews with two groups: a randomly chosen cross-section of Facility Managers and a purposive sample of senior stakeholders within the sector. Thematic analysis was used to draw out patterns and themes in the interview transcripts, and to develop interpretations and connections to the literature. The study found that there is not a clear understanding of how the management of change fits into the role of Facility Managers, and that the management of change is an issue that is in the background of management thinking and practice in the sector. The change management aspects of the Facility Manager's role have been largely ignored or taken for granted. This can lead to stress on the individual manager as well as reducing the effectiveness of the change process. There are many ways that Facility Managers can be better supported in the management of change, and the study presents a number of proposals to help achieve this. These focus on general principles and competencies underlying the management of change, an analytical model of change management, and management development practices supporting the management of change.

Abstract Introduction Most countries including Australia are experiencing an ageing of their population, with an increasing proportion of frail older persons requiring hospitalisation from acute illness. The aging process places the older person at risk of geriatric syndromes, such as falling, dependency in performance of Activities of Daily Living and instrumental Activities of Daily Living, confusion, bladder and bowel incontinence. New or deteriorating geriatric syndromes are a frequent occurrence among hospitalized older patients. Hospital associated factors associated with these outcomes include complications of medical therapies; polypharmacy and excessive bed rest. Few studies have been conducted into factors predicting risk of negative outcomes in older patients admitted to medical units of acute care teaching hospitals. If available, a screening tool with few predictive factors, able to be administered close to the time of admission could be used to identify patients at lower and higher risk. It is imperative that such a tool is developed empirically and tested for its accuracy in identifying patients at high risk. Aims of the research The first aim was to identify the proportion of patients aged ≥ 70 years, admitted to acute care medical units that experienced a negative outcome. These outcomes included falls during hospitalisation, presence of new or a significant decline in existing pressure ulcers, significant decline in independently performing Activities of Daily Living (ADLs), requiring increased care needs at discharge, readmission to hospital with 28 days of the index hospitalisation, bladder and bowel incontinence, and delirium. The second aim was to identify factors predicting the risk of two of these negative outcomes: requiring a higher level of care at discharge, and experiencing a decline in independently performing ADLs. Based on the predictive factors, two screening tools to identify patients at risk were developed and validated. Method A prospective cohort study of 413 acute general medical patients, aged ≥ 70 years and consecutively admitted to an acute care metropolitan 700-bed teaching hospital was conducted. Consenting patients expected to remain in hospital for more than 48 hours were included. Patients were excluded if they were admitted to intensive or coronary care units, admitted for terminal care only or were transferred from a general medical to another unit within 24 hours of admission to the ward. Trained research nurses assessed patients and used the interRAI Acute Care instrument to collect information on candidate predictive variables and negative outcomes. Patients were assessed within 36 hours of admission and at discharge to obtain information on predictive variables and negative outcomes. Patients were also followed daily to identify any instances of transient negative outcomes during hospitalisation and at 28 days following discharge to identify any instances of readmission to hospital. The 413 cases were randomly split into 309 cases in the development cohort and 104 cases in validation cohort. Logistic regression models were used to identify the predictive factors independently associated with two negative outcomes, requiring a higher level of care at discharge and experiencing a decline in independently performing ADLs. Findings At least one negative outcome was experienced by 53% of the development and 63% of the validation cohort. The most common negative outcomes experienced were: delirium (27%; 23%), a significant decline in ADLs (19%, 22%), requiring a higher level of care at discharge (16%, 16%), and readmission to hospital within 28 days of discharge (17%, 28%) in the development and validation cohorts respectively. The logistic regression analysis identified four independent factors associated with requiring higher levels of care at discharge: ‘short term memory problems’ (OR 4.21, 95% CI 1.79, 9.89; p=0.001); ‘dependence in toilet use’ (OR 3.51, 95% CI 1.14, 10.84; p=0.029); ‘dependence in hygiene’ (OR 2.76, 95% CI 1.16, 6.56; p=0.021), and ‘use of community services prior to admission’ (OR 2.41, 95% CI 1.12, 5.16; p= 0.024). A screening tool developed to assess patients at lower and higher risk had a sensitivity, specificity, positive predicted value (PPV) and negative predictive value (NPV) of 77.27%, 73.66%, 36.56% and 94.29% respectively. Reasonable accuracy was evident when tested in the validation sample. Sensitivity, specificity, PPV and NPV were 60%, 76.32%, 33.33% and 90.63% respectively. Predictive factors associated with a significant decline in ADLs were: ‘history of falling’(OR 2.21, 95% CI 1.12, 4.36; p= 0.023), ‘no interest in things enjoyed normally’ (OR 4.30, 95% CI 1.92, 9.64; p=0.000), ‘dependence in management of finances’ (OR 3.93, 95% CI 1.63, 9.48; p =0.002) and ‘hearing problems’ (OR 2.38, 95% CI 1.05, 5.39; p =0.038). The screening tool had sensitivity, specificity, PPV and NPV in the development cohort of 74.55%, 69.13%, 36.6% and 92% respectively and 45%, 65.79%, 25.7% and 82% respectively in the validation sample. Conclusion The tools require further validation in larger samples in diverse settings. Future research should focus on developing a screening tool that could predict risk of a number of negative outcomes to enhance the provision of quality patient care.