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1
Mee, Jenny. "Australian home care quality : a political tango." Thesis, Federation University Australia, 2020. http://researchonline.federation.edu.au/vital/access/HandleResolver/1959.17/179509.
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The performance of Australian home care and how it is enacted has been significantly impacted by the economic and political challenges since the announcement of the Aged Care Reforms in July 2012 and the launch of the National Disability Insurance Scheme in July 2013. As a result, the home care business arena has changed, and the effects are being felt as the marketplace shifts, and businesses adapt to new policy directions. The purpose of this research study was to investigate the social context of Australian home care, and to collect information regarding how home care (under the various auspices of government funded and privately funded) service provision is enacted in terms of quality during this time of change. The qualitative research process for this study involved critical reflexive practice and face-to-face semi-structured interviews of 10 home care business leaders from the states of Queensland and Victoria. In listening to the voices of the participants, this research study sought to develop new discursive approaches in order to understand the practice of caring for the Australian community’s most vulnerable people – those who are frail, aged, and for those who have ill-health or a disability. The analytical framework adopted for this study used a post-structural discourse analysis, which was informed by the work of French philosopher Michel Foucault and other contemporary theorists. The philosophical framework of governmentality and discourse analysis helped to situate the voice of the participants at a time when new ideas and the ways of conducting the business of home care are emerging. In using this approach to analyse the data, it became apparent that the discursive practices that had been instituted by government in the home care sector had been constructed to remove progressive inclusionary policies that were contrary to the democratic principles of governing. The research study’s findings reveal the problematic changes that impact on business but more so for consumers as the rules are interpreted. By using the metaphor of ice dancing, the study problematized the leadership of government and the challenges participants faced in maintaining quality service provision in the home care arena. What emerged was the dance of a political tango. These leaders in the arena revealed the importance of knowing when to lead and when to push back. Like the different genres of tango, there are different ways of viewing the world of home care and performing in its different spaces, and there are other ways of viewing quality in caring service provisions. By participating in the research, the participants highlighted the need of being inclusive to hearing and seeing all performers in the arena of home care regardless of social or geographical positioning. This research concludes that hearing and acting on the voices from the wider home care arena continues to be necessary in order to inform future policy direction for quality performance improvements for Australia’s consumers of home care and to move away from home care traditions of governing and ruling. The research additionally advocates for more inclusive governing approaches through more even distribution of power in consultative processes, research, oversight in the marketplace and access to resources for all groups. This thesis is a contribution to creating a new political dance in the space of Australia’s home care politics.Doctor of Philosophy
2
Brown, Katrina. "Unwrapping packages: Power politics and place in the delivery of community aged care." Thesis, University of Ballarat, 2010. http://researchonline.federation.edu.au/vital/access/HandleResolver/1959.17/31539.
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The thesis analyses the delivery of the Community Aged Care Packages Program, revealing the flaws in the program’s design and the consequences of this programmatic design for service providers in rural VictoriaDoctor of Philosophy
3
Van, Loggerenberg Valerie. "Australian volunteers in the health sector : antecedents to volunteers' intention to leave /." Murdoch University Digital Theses Program, 2008. http://wwwlib.murdoch.edu.au/adt/browse/view/adt-MU20090409.113755.
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Wynaden, Dianne Gaye. "The primary carer's experience of caring for a person with a mental disorder in the Western Australian community: a grounded theory study." Thesis, Curtin University, 2002. http://hdl.handle.net/20.500.11937/883.
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One in five Australians has a mental disorder and it is estimated that one in four families have a member who has a mental disorder. Since the 1960s there has been an 80 percent decrease in Australian institution-based mental health care. The majority of people who have a mental disorder are now treated in their local community and many of them live with their families. The change in the delivery of mental health care has seen the family emerge as one of the most important supports to their ill family member. While the changes in the delivery of mental health care have been based on human rights concerns, changes in mental health legislature, and economic factors, the multi-dimensional experience of being a primary carer of a person with a mental disorder remains relatively unexplored. The need for empirical evidence on the primary carer's experience is noted in both the scientific literature and from carers themselves and the principal aim of conducting this research was to address the identified need. This qualitative study, using grounded theory methodology, presents the findings of interviews with 27 primary carers and memos documented throughout the study. In addition, existing literature of relevance to the findings of this study is presented. A substantive theory of seeking balance to overcome being consumed is presented in this thesis. Using the grounded theory method the constant comparative analysis of data revealed that the basic social psychological problem shared by all participants was the experience of "being consumed". The problem of being consumed consisted of two stages: "disruption of established lifestyle" and a "sustained threat to self-equilibrium". Six conditions were identified as influencing participants' experience of being consumed.In order to address the problem of being consumed, participants engaged in a basic social psychological process of "seeking balance". When participants were engaged in this process they moved from a state of being consumed to one whereby they established and consolidated a balanced life perspective that incorporated their caregiving role. The process of seeking balance consisted of three phases: "utilising personal strategies to reduce the problem of being consumed', "restoring self- identity", and "reaching out to make a difference". In addition, data analysis identified the presence of a three phase sub-process entitled "trying to make sense of what was happening". Phases one of the core and sub- processes occurred primarily in the period prior to the time when a psychiatric diagnosis was made on the affected family member. Participants became engaged in the remaining two phases of the core and sub-processes when they became aware that their affected family member had a mental disorder. At the time of being interviewed for this study some participants were not yet engaged in the final phase of the process of seeking balance. Participants' experience of seeking balance was not related to the length of their caregiving experience but rather to their experience of seeking balance and the conditions influencing that process. Four conditions were identified as influencing participants' experience of seeking balance.This thesis presents the substantive theory of seeking balance to overcome being consumed. While the findings support existing scientific literature, the substantive theory also presents a new insight on caring from the primary carer's perspective. In particular, the findings challenge health professionals to actively pursue strategies to reduce carers' experience of being consumed. The findings of this study have implications for service provision and clinical practice, policy and planning, research, education, the general population, mental health consumers, and carers.
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Wynaden, Dianne Gaye. "The primary carer's experience of caring for a person with a mental disorder in the Western Australian community: a grounded theory study." Curtin University of Technology, School of Nursing and Midwifery, 2002. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=15910.
Full textAbstract:
One in five Australians has a mental disorder and it is estimated that one in four families have a member who has a mental disorder. Since the 1960s there has been an 80 percent decrease in Australian institution-based mental health care. The majority of people who have a mental disorder are now treated in their local community and many of them live with their families. The change in the delivery of mental health care has seen the family emerge as one of the most important supports to their ill family member. While the changes in the delivery of mental health care have been based on human rights concerns, changes in mental health legislature, and economic factors, the multi-dimensional experience of being a primary carer of a person with a mental disorder remains relatively unexplored. The need for empirical evidence on the primary carer's experience is noted in both the scientific literature and from carers themselves and the principal aim of conducting this research was to address the identified need. This qualitative study, using grounded theory methodology, presents the findings of interviews with 27 primary carers and memos documented throughout the study. In addition, existing literature of relevance to the findings of this study is presented. A substantive theory of seeking balance to overcome being consumed is presented in this thesis. Using the grounded theory method the constant comparative analysis of data revealed that the basic social psychological problem shared by all participants was the experience of "being consumed". The problem of being consumed consisted of two stages: "disruption of established lifestyle" and a "sustained threat to self-equilibrium". Six conditions were identified as influencing participants' experience of being consumed.In order to address the problem of being consumed, participants engaged in a basic social psychological process of "seeking balance". When participants were engaged in this process they moved from a state of being consumed to one whereby they established and consolidated a balanced life perspective that incorporated their caregiving role. The process of seeking balance consisted of three phases: "utilising personal strategies to reduce the problem of being consumed', "restoring self- identity", and "reaching out to make a difference". In addition, data analysis identified the presence of a three phase sub-process entitled "trying to make sense of what was happening". Phases one of the core and sub- processes occurred primarily in the period prior to the time when a psychiatric diagnosis was made on the affected family member. Participants became engaged in the remaining two phases of the core and sub-processes when they became aware that their affected family member had a mental disorder. At the time of being interviewed for this study some participants were not yet engaged in the final phase of the process of seeking balance. Participants' experience of seeking balance was not related to the length of their caregiving experience but rather to their experience of seeking balance and the conditions influencing that process. Four conditions were identified as influencing participants' experience of seeking balance.
This thesis presents the substantive theory of seeking balance to overcome being consumed. While the findings support existing scientific literature, the substantive theory also presents a new insight on caring from the primary carer's perspective. In particular, the findings challenge health professionals to actively pursue strategies to reduce carers' experience of being consumed. The findings of this study have implications for service provision and clinical practice, policy and planning, research, education, the general population, mental health consumers, and carers.
6
Paul, David. "Casting shadows and struggling for control : silence, resistance and negotiation in Australian Aboriginal health." University of Western Australia. School of Primary, Aboriginal and Rural Health Care, 2007. http://theses.library.uwa.edu.au/adt-WU2008.0015.
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Self determination has been recognised as a basic human right both internationally and, to an extent, locally, but it is yet to be fully realised for Aboriginal Peoples in Australia. The assertion of Aboriginal community control in Aboriginal health has been at the forefront of Aboriginal peoples' advocacy for self determination for more than thirty years. Aboriginal Community Controlled Health Services and their representative organisations have been the site of considerable resistance and contestation in the struggles involved in trying to improve Aboriginal health experiences. Drawing on some of these experiences I explore the apparent inability of policy and decision makers to listen to systematic voices calling for change from the Aboriginal Community Controlled Health sector. It is government inability to act more fully on clear and repeated messages that is a source of much disquiet within representative Aboriginal organisations. Such disquiet is grounded in a belief that colonial notions continue to influence decision making at policy, practice and research levels resulting in a significant impediment to the realisation of self determination and associated human rights in Aboriginal health matters and Aboriginal Affairs more broadly.
7
Bullen, Heatheranne. "Pandemic Influenza at Oodnadatta, 1919 : Aspects of treatment and care in a multiracial community." Thesis, Federation University Australia, 2018. http://researchonline.federation.edu.au/vital/access/HandleResolver/1959.17/169879.
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On 24 January 1919, a thirty-two-year-old nurse from Sydney, Jean Williamson, disembarked at the railway station at Oodnadatta in the far north of South Australia to commence her new role as sister in charge of the Australian Inland Mission (AIM) hostel. On 18 April that year, Williamson greeted thirty-four-year-old minister from Melbourne, Coledge Harland, who had arrived by train to take up a three-year post as padre for the AIM’s central Australian parish. Just over a month later, an influenza pandemic that had already killed untold numbers of people worldwide reached the isolated township. Drawing on primary documents, including an extensive collection of previously unseen photographs, letter and diaries from Harland and Williamson, this thesis examines the management and care of pandemic influenza at Oodnadatta from May to late July 1919. Intercultural aspects of the management and care of European, Afghan, Chinese and Aboriginal patients are examined in the context of the health and lifestyle of local residents, nursing practices, medicines, foods, accommodation and the contribution of individuals, groups and their roles. This intimate microhistory sheds light on a relatively unknown, yet important group of people in Australia’s frontier history: the missioners and others who cared for seriously ill Aboriginal and non-Aboriginal patients at Oodnadatta, provided culturally sensitive care that afforded respect, dignity and compassion to all. At the time, the gravity of the world wide situation and the sheer need to provide care saw individual efforts go unnoticed; however, in hindsight, it is possible to see and appreciate the significance of what they achieved under the most difficult of circumstances.Masters by Research
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Helen, Maureen. "Other people's country: A memoir; and, Developing a trustworthy narrator: An essay." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2006. https://ro.ecu.edu.au/theses/1796.
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This thesis comprises two interrelated sections. The first section is a substantial piece of creative writing, which l have cailed 'Other People's Country: A Memoir, in the genre of travel memoir, and an essay. The memoir borrows techniques from fiction, drama and poetry to tell a story of a middle-aged, middle-class city nurse, who travels to a remote settlement at the edge of the Western Desert of Western Australia to provide health care for a fluctuating population of around 400 people, for whom English is a third or fourth language.
Writing that includes stories about vulnerable people from another culture, whose lives have touched those of the writer, demands sensitivity to differences, as well as an ethical approach. Writing about Aboriginal people also demands an awareness of what is appropriate when writing about cultural material. To achieve the voice of a trustworthy narrator is a challenge that faces all writers of narrative non-fiction, including memoir. The truth is subjective; perception is unreliable; memory can be distorted; error slips in unwittingly; deliberate falsification is possible. In spite of all this, a writer of memoir makes a contract with the reader that the story is significant, and that it is the writer's truth, told as honestly as possible. The pivotal concern of this thesis is the question, 'What are some of the important considerations for a memoirist who is attempting to develop the voice of an ethical and trustworthy narrator writing about experiences encountered when living and working within an unfamiliar culture?
The second part of the thesis is an essay which develops a theoretical framework in response to some of the major dilemmas I encountered in this undertaking. It embraces memory, aspects of Aboriginal vulnerability, and ethics through which to explore the concepts of truth and honesty in memoir-writing.
9
Alexander, Kathy. "Promoting health at the local level : a management and planning model for primary health care services /." Title page, contents and introduction only, 1994. http://web4.library.adelaide.edu.au/theses/09PH/09pha376.pdf.
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Davis, Kierrynn, University of Western Sydney, Faculty of Social Inquiry, and School of Social Ecology. "Cartographies of rural community nursing and primary health care: mapping the in-between spaces." THESIS_FSI_SEL_Davis_K.xml, 1998. http://handle.uws.edu.au:8081/1959.7/470.
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This postmodern feminist ethnographies research aimed to explore the everyday meanings of primary health care (PHC) held by rural community nurses. Secondly, the research aimed to explore the everyday meanings of care held by the clients of the rural community nurses who participated in the study. The representation of this research is written in four voices which converse with each other to varying degrees in each chapter. This writing strategy is a deliberate one aimed at destabilising the usual approach to representation of research. It is also a strategy which seeks methodological coherence. The third aim therefore is to deliberately trouble the acceptable grounds concerning how nursing research is represented. The research utilised dialogical (conversational)and participant observation methods concerning the everyday meanings of nurses and their clients.The meanings I made of the information were created from a deconstruction of the texts. These texts included fieldnotes of participant observations and transcripts of conversations with nurses and their clients. The form of deconstruction utilised was informed from multiple sources and involved three levels of analysis. A realist interpretation was followed by an oppositional interpretation and then a reconstructive movement. The results revealed that rural community nurses practice is both spatio-temporally contextualised and metaphorically situated in an in-between space. This in-between space is situated between margin and the centre. Rural community nurses working on the margins traverse this space in order to overcome further marginalisation whilst working with Indigenous Australians and the aged. Moreover, the in-between space encompasses and creates opportunities to mutually exchange the gift of desire that being - empowering and compassionate relationships with clients and colleagues. Futhermore, whilst rural community nurses are strongly committed to the philosophy of PHC, their evryday working life is discursively constructed by powerful discourses which result in oppositional tensions. The tensions and the 'in-between' space allow the rhetoric of PHC to be resisted and reframed. Consequently, the oppositional constructs of their practice were displaced. Moreover, this necessitated the negotiation of space and place, and required the reconstruction of subjectivity, intersubjectivity and becomingDoctor of Philosophy (PhD)
11
De, Voe Jennifer. "New national approaches to community health : a comparative analysis of historical case studies from Australia and the United States." Thesis, University of Oxford, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.367771.
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Thomas, G. S. "Land care by design : landscape planning method for facilitating community action plans to rehabilitate Australia's rural lands." Thesis, Queensland University of Technology, 1992.
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13
Stehlik, Daniela Anna. "Making the invisible visable : an analysis of the Home and Community Care Program : a socialist-feminist perspective." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1991. https://ro.ecu.edu.au/theses/1118.
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As the population of Australia ages, social policy and human service practice in the field of aged care is increasingly important and relevant. The Home and community Care (H.A.C.C.) Program was established in 1985 by the Labor Government as a response to a demand for more community services for the frail aged and was designed to reduce the incidence of institutionalisation by increasing home care services. In this way the Home and Community Care Program is seen as linchpin in the Federal Government's initiative to create an efficient and cost-effective aged care policy to contend with the future growth of Australia's ageing population. This thesis argues that there are several assumptions intrinsic to the H.AC.C. Program that are potentially jeopardising and undermining its usefulness. These assumptions are based on familial ideology and nostalgic conceptualizations of 'the community’ and 'the family'. In addition, these assumptions also involve stereotypic attitudes to women as primary carers and nurturers that ignore, to a great degree, the needs of women themselves. These assumptions, combined with an increasingly neo-conservative view about a reduction in the role of the State and a corresponding increase in family responsibility in welfare, have major implications for Australian women. This socialist-feminist analysis argues that women who are providing care for aged spouses or relatives are doing essential, hard and stressful work, work which is unpaid and often unacknowledged, and that the Australian welfare system is now structured around the invisible labour of such women. Consequentially, the assumption that a social policy program such as H.A.C.C. makes, that is, that there will always be women who care, requires further analysis. This research has revealed that such assumptions have implications for the future development of social policy for the aged in Australia and on the future roles of women in this country. Particular questions which this thesis addresses include, firstly, who actually provides care? Empirical research indicates that the majority of care is provided by one individual, usually the spouse, daughter or daughter-in law. Secondly, what are the assumptions underlying the development and implementation of Home and Community Care social policy in relation to the social construction of caring? Such assumptions are found to include, that the H.A.C.C. Program is premised upon an erroneous concept of the 'community' and consequentially 'community care' and that traditional 'family' and familial values are a precondition to H.A.C.C. service delivery. A socialist-feminist critique offers a deeper analysis of such assumptions by disclosing that the Home and Community Care policies assume that service delivery can be best undertaken by extending the traditional domestic role of women, thus utilising them as an unpaid, or poorly paid, labour force. This analysis also discloses the explicit rejection of the informal service system as having any real economic significance but rather being viewed as ‘complementary’ to the formal service system. Finally, there are future implications of such assumptions for women as primary carers, services users or paid staff within the H.A.C.C. Program which require urgent cognisance in order to develop a future aged care policy in Australia that avoids exploitation of women.
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McConigley, Ruth. "Providing education and support for rural palliative care nurses in Western Australia: An intervention study." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2004. https://ro.ecu.edu.au/theses/1655.
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Rural palliative care nurses (RPCNs) in Western Australia (WA) are a small population, who have embraced the specialist palliative care role since the first palliative care service in rural WA began in 1990. However, there are some challenges involved with being a specialist nurse in a generalist health care setting. fu particular, there is a suggestion in the literature that RPCNs may be professionally isolated, may be prone to burnout, and may therefore experience decreased job satisfaction and may consider leaving the palliative care field.
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Summers, Michael. "Great expectations : a policy case study of four case management programs in one organisation /." Connect to thesis, 2007. http://repository.unimelb.edu.au/10187/2182.
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Four different case management programs delivered by UnitingCare Community Options (UCCO) in the eastern suburbs of Melbourne were examined against the expectations of case management as a policy solution to a range of perceived policy problems at the micro-, meso- and macro-levels. The micro-level expectations were related to client and family experiences of the service system and outcomes. At the meso-level expectations were focused on perceived service delivery problems such as poor matching of services to the needs of ‘complex’ clients including a lack of integration, flexibility and responsiveness to clients’ needs and preferences. Perceived macro-level policy problems were concerned with a variety of issues including increasing rates of institutionalisation, increasing costs to governments, lack of economic efficiency and the desire to create market or quasi-market conditions in the community care service delivery sector. (For complete abstract open document)
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Hill, Heather, and heatherhill@hotkey net au. "TALKING THE TALK BUT NOT WALKING THE WALK: BARRIERS TO PERSON CENTRED CARE IN DEMENTIA." La Trobe University. School of Public Health, 2004. http://www.lib.latrobe.edu.au./thesis/public/adt-LTU20041215.100826.
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While the concept of person-centred care in dementia has been around for 15 years or more and has attracted much interest and enthusiasm, aged care facilities continue to have difficulty in actually implementing and maintaining person-centred practices. In this study I explore the experience of one aged care facility in order to identify the barriers to changing care practice. The research took place in an ethno-specific (Jewish) aged care facility, Star of David, which was in the process of setting up a program for its residents with dementia based on person-centred principles. The methodology used in the research study was ethnographic, involving participant observation and interview, with a particular focus on a limited number of participants: four residents and their families, four senior staff, four personal care attendants and the executive director. Interviews were also conducted with staff members from three other aged care facilities. The findings showed that Star of David was unable to bring about substantial change in its care practices, while the external interviews and the literature suggest that other facilities have similar difficulties. I identify three major types of barrier: procedural barriers within the institution itself; (government) policy; and barriers relating to hegemonic values and beliefs which underpin established health care practice. These three types of barrier interact with and reinforce one another. I conclude that if we are to change care practice in institutions, we must address all of these barriers at the same time. Finally, I suggest that person-centred care itself, which continues to place emphasis on professional service provision, may only be the beginning of necessary change. In order to be truly person-centred, we need to move towards a more community based or public health approach which recognizes the need of all persons to be treated both as significant individuals and accepted as part of a community.
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Ingram, Colin Barry. "Parks, people and planning: local perceptions of park management on the Ningaloo Coast, North West Cape, Western Australia." Thesis, Curtin University, 2008. http://hdl.handle.net/20.500.11937/1073.
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Attaining the ‘appropriate’ balance between human use of national parks and their protection is a topic of considerable public, scientific and business interest and is thus an important focus for research. An increasingly affluent and mobile western society has made tourism the world’s largest industry; an industry with a significant reliance on the attractions of protected areas such as national parks and their wildlife. Regional communities have benefited from protected areas through local tourism expenditure and government recognition of the economic and social values realized from protected areas. High levels of visitation, and the management of this human use require effective management. But tensions arise when park managers invoke policies and management prescriptions to mitigate the adverse affects of human use. These actions and the way they are implemented can have an alienating impact on local communities, particularly those with a direct business dependency on park tourism. This thesis explores the notion that truly sustainable management of national parks can only be achieved if park managers and communities living adjacent to parks work together in a partnership to meet each other’s needs and through this process, foster the long-term environmental, social and economic benefits that can be derived from these parks. This thesis documents how a local community perceives its park managers and thereby the impact that park management has on local communities. It then seeks to identify the opportunities for park managers and communities to improve the way they view each other and the skills, attitudes and approaches necessary to create the environment for a sustainable relationship and can deliver sustainable outcomes for both parties.Three methods were employed to progress this research; an extensive review of literature and theory on relevant aspects of the people and parks relationship; the use of a case study of communities adjacent to parks on the Ningaloo Coast; and, qualitative and quantitative surveys to inform those case studies. A resident perception survey of the Exmouth and Coral Bay communities was conducted in August 2005. At the same time key stakeholder representatives were interviewed. Secondary quantitative data on the areas economy and demographics was also collected to triangulate aspects of the primary data. The Ningaloo coast community’s perception of park management has been adversely affected by a recent (2004) management planning process for Ningaloo Marine Park that culminated in significant constraints being placed on recreational fishing access. Both the planning process and the decision have been the focus of community anger. Currently the levels of trust and respect within the community for the park agency and its management performance are low. Despite evidence that the parks of the Ningaloo coast make important social and economic contributions to the local communities of this area, the local community holds negative perceptions of the social and economic impacts of park management, and are influenced strongly by the local community’s attitudes, perceptions and feelings towards the park agency. The park agency’s inability to consult, involve and communicate with the local community (to the satisfaction of the local community) contributes to these attitudes, feelings and perceptions.Key findings include; the prevailing norms and belief systems within the park agency reinforce the classic managerial paradigm; park management fails to accommodate broader social and economic measures, which diminishes trust and undermines attempts to foster community involvement and stewardship; ineffectual leadership, poor communication and outmoded approaches to planning and community engagement, local apathy to involvement in park planning and a lack of community education in regard to the promotion of park values, programs and activities compound this situation. The Ningaloo coast has the potential to provide an exceptionally bright future for its local communities, based largely on the inherent natural and cultural values of Ningaloo Marine Park, Cape Range National Park and other associated reserves. Whether the potential to develop community stewardship of the parks of the Ningaloo coast is fully met depends largely on the willingness of park management to relinquish some of its power, establish a suitable governance model in order to work collaboratively with the community and communicate effectively with it in order to achieve sustainable futures for both the park and the community.
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Hatton, Jacinta. "Fear of falling and its relationship to depression and anxiety in older adults living in the community and in extended care facilities in Australia." Thesis, Hatton, Jacinta (2016) Fear of falling and its relationship to depression and anxiety in older adults living in the community and in extended care facilities in Australia. Professional Doctorate thesis, Murdoch University, 2016. https://researchrepository.murdoch.edu.au/id/eprint/35039/.
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One of the most common psychological costs of falls in older adults is the development of a fear of falling, which can then result in an increased risk of future falls. The purpose of this research was to examine the relationships between fear of falling and two of the most common psychological disorders in later life; depression and anxiety. To extend on previous research, study one aimed to investigate the relationships between fear of falling, depression and anxiety in an Australian community-dwelling population using quantitative analysis. Due to the limited number of studies examining fear of falling in the extended care population, study two was an exploratory investigation of the above relationships in this population using both quantitative and qualitative analysis. A total of 80 community-dwelling older adults and 47 extended care older adults completed the questionnaires. A further 12 older adults participated in the interviews. The findings, overall, extended on previous research, where anxiety was consistently associated with fear of falling constructs in both the community and extended care populations. In contrast, associations between fear or falling and depression were variable within and across studies, depending on the fear of falling measurement that was used. In addition, an important finding from the qualitative analysis revealed that older adults may view their feelings as a “concern” rather than a “fear”, supporting recent suggestions to revise how fear of falling is described. The clinical implications were discussed in terms of the importance for clinicians who work with older adults with mood disorders to screen for fear of falling and address this in clinical interventions. Furthermore, results suggest that assessment should include both an interview and questionnaires in order to capture all fall-related psychological concerns.
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Ingram, Colin Barry. "Parks, people and planning: local perceptions of park management on the Ningaloo Coast, North West Cape, Western Australia." Curtin University of Technology, School of Media, Society and Culture, Dept. of Social Sciences, 2008. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=18012.
Full textAbstract:
Attaining the ‘appropriate’ balance between human use of national parks and their protection is a topic of considerable public, scientific and business interest and is thus an important focus for research. An increasingly affluent and mobile western society has made tourism the world’s largest industry; an industry with a significant reliance on the attractions of protected areas such as national parks and their wildlife. Regional communities have benefited from protected areas through local tourism expenditure and government recognition of the economic and social values realized from protected areas. High levels of visitation, and the management of this human use require effective management. But tensions arise when park managers invoke policies and management prescriptions to mitigate the adverse affects of human use. These actions and the way they are implemented can have an alienating impact on local communities, particularly those with a direct business dependency on park tourism. This thesis explores the notion that truly sustainable management of national parks can only be achieved if park managers and communities living adjacent to parks work together in a partnership to meet each other’s needs and through this process, foster the long-term environmental, social and economic benefits that can be derived from these parks. This thesis documents how a local community perceives its park managers and thereby the impact that park management has on local communities. It then seeks to identify the opportunities for park managers and communities to improve the way they view each other and the skills, attitudes and approaches necessary to create the environment for a sustainable relationship and can deliver sustainable outcomes for both parties.Three methods were employed to progress this research; an extensive review of literature and theory on relevant aspects of the people and parks relationship; the use of a case study of communities adjacent to parks on the Ningaloo Coast; and, qualitative and quantitative surveys to inform those case studies. A resident perception survey of the Exmouth and Coral Bay communities was conducted in August 2005. At the same time key stakeholder representatives were interviewed. Secondary quantitative data on the areas economy and demographics was also collected to triangulate aspects of the primary data. The Ningaloo coast community’s perception of park management has been adversely affected by a recent (2004) management planning process for Ningaloo Marine Park that culminated in significant constraints being placed on recreational fishing access. Both the planning process and the decision have been the focus of community anger. Currently the levels of trust and respect within the community for the park agency and its management performance are low. Despite evidence that the parks of the Ningaloo coast make important social and economic contributions to the local communities of this area, the local community holds negative perceptions of the social and economic impacts of park management, and are influenced strongly by the local community’s attitudes, perceptions and feelings towards the park agency. The park agency’s inability to consult, involve and communicate with the local community (to the satisfaction of the local community) contributes to these attitudes, feelings and perceptions.
Key findings include; the prevailing norms and belief systems within the park agency reinforce the classic managerial paradigm; park management fails to accommodate broader social and economic measures, which diminishes trust and undermines attempts to foster community involvement and stewardship; ineffectual leadership, poor communication and outmoded approaches to planning and community engagement, local apathy to involvement in park planning and a lack of community education in regard to the promotion of park values, programs and activities compound this situation. The Ningaloo coast has the potential to provide an exceptionally bright future for its local communities, based largely on the inherent natural and cultural values of Ningaloo Marine Park, Cape Range National Park and other associated reserves. Whether the potential to develop community stewardship of the parks of the Ningaloo coast is fully met depends largely on the willingness of park management to relinquish some of its power, establish a suitable governance model in order to work collaboratively with the community and communicate effectively with it in order to achieve sustainable futures for both the park and the community.
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Rahman, Md Mijanur. "Modelling trajectories of aged care use among older Australian women." Thesis, 2020. http://hdl.handle.net/1959.13/1411949.
Full textAbstract:
Research Doctorate - Doctor of Philosophy (PhD)Background: A substantial growth in the number of older people needing care has raised enormous challenges to the health and social care system in many countries including Australia. The structure and dynamics of the Australian aged care system are not yet able to develop a sustainable system for delivering an appropriate model of care. The current aged care system is complex and older Australians experience multifaceted journeys through the fragmented systems to meet their care needs. Research evidence is limited about how different parts of the system intersect and how an individual transitions from one level of care to another in accordance with changing needs over time. There is also a lack of understanding of how individual and social circumstances and supports might predispose older people to use care, or enable them to use appropriate care when they need it. To fill these knowledge gaps, this study aims to assess patterns and trajectories of different types of aged care use over time and to examine the movements of older women between different levels of aged care use according to their changing needs and circumstances throughout later life. Methods: This study utilised data from the older cohort (born between 1921-26) of the Australian Longitudinal Study on Women’s Health and linked aged care and National Death Index data from 2001 to 2014. The sample consisted of 11,245 women who survived to 2001 and did not opted out of linkage of survey data to aged care information. To address the research objectives, we applied the following statistical methods: 1) k-median cluster analysis to assess patterns of home and community care use; 2) repeated measures latent class analysis to identify latent patterns of aged care use over time; 3) competing risk survival analysis to identify risk factors for the time from first home and community care (HACC) use to residential aged care (RAC) admission; 4) multi-trajectory modelling to assess the trajectories of care need in RAC; and 5) Markov multi-state modelling to estimate the transition rates and probabilities, and length of stay at each level of aged care use. Results: The results reveal a significant diversity in the patterns of HACC use, with a majority of older women living at home independently, requiring only low-level use of a few basic services, while one quarter have complex care needs requiring greater use of multiple services. Women were most likely to enter aged care by first using HACC. Significant variation in the latent patterns of aged care use was also observed, with around two-thirds of women not using any services or using a limited basic community care services until age 85-90. Only a small proportion of women were increasingly dependent on RAC as they age. Having complex use of HACC was associated with delayed admission to RAC, after adjusting for individual characteristics. Substantial variation was observed among residents in RAC in terms of the trajectories of care needs over time across three domains of the Aged Care Funding Instrument including activities of daily living, behaviour, and complex healthcare needs. Multiple morbidities were associated with membership of an increased complex healthcare needs group. Transition to either HACC or RAC was associated with several demographic and health-related factors including living in regional/remote areas, having difficulties in managing income, having low scores in physical functioning, and having falls with injury. Conclusion and Implication: Women spend a substantial period of their later life with care and support from either HACC or RAC. Our findings highlight the importance of providing a range of services to meet the diverse care needs of older women, especially in the community setting. Our findings can facilitate appropriate care planning, service delivery, and future capacity design of the aged care system in Australia.
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Mitchell, Jillian Mary Graham. "A matter of urgency! remote Aboriginal women's health : examining the transfer, adaptation and implementation of an established holistic Aboriginal Well Women's Health program from one remote community to another with similar needs and characteristics /." 2007. http://catalogue.flinders.edu.au/local/adt/public/adt-SFU20070725.112610/index.html.
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March, Geoffrey John. "From medicines supplier to patient care practitioner implementation and evaluation of two practice models in Australian community practices." 2005. http://arrow.unisa.edu.au:8081/1959.8/25037.
Full textAbstract:
The Australian health system is undergoing substantial changes in response to consumer demands, rising health costs and consequent shifts in government policies. This thesis explored ways community pharmacists could implement new styles of practice. Results indicate that pharmacists can assist consumers to better manage their medications and reduce harm, but it requires a different practice approach to that currently offered. This research has contributed to the establishment of the nation program, Home Medications Review.thesis (PhDPharmacy)--University of South Australia, 2005.
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Kordes, Doris. "The arts of care in an asylum and a community 1925-2004: Kenmore Hospital, New South Wales and Canberra, the Australian Capital Territory." Phd thesis, 2009. http://hdl.handle.net/1885/155196.
Full textAbstract:
This thesis examines the arts of care in an asylum in New South
Wales (NSW) and a mental health community in the Australian
Capital Territory in twentieth-century Australia, and describes
and compares a range of governmental responses for responding to
persons deemed to be in need of care. The thesis explores
similarities between twentieth-century Australian care techniques
and the key principles underpinning a ‘care system’ that was
developed over 200 years ago. It proposes three twentieth-century
care regimes, each one characteristic of a certain period: Herd
Care, set in an asylum era that emphasised custodialism and
confinement (1925-1958); Therapeutic Community, a period during
which the asylum was reconfigured into a facilitative community
(1959-1983); and Community Care, beginning around 1983, when NSW
asylums were ‘rationalised’, their care techniques fragmented
and outsourced in diverse settings generally referred to
collectively as the mental health community.
Some of the dynamics, continuities and ruptures in
twentieth-century care regimes are analysed. Chapters describe
the landscapes of care. They explore how environmental settings
have been designed to reinforce the care regimes in which they
are mobilised and how they ‘make up’ the possibilities for
action of the subject of care. The dynamics of care between care
providers and their recipients are examined. Some of the
continuities and discontinuities of meanings associated with
‘family’ and ‘community’ in each of the care regimes are
observed. Fieldwork findings are combined with the cultural
narrative of psychiatric primitivism to consider why subjects
have been deemed in need of care, at times in need of protection
and training and at other times in need of discipline and
restraint. The new possibilities for action that have emerged in
Australian twentieth-century mental health governance are
considered, when subjects of care have been encouraged to learn
how to be free
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Wilson, Leah Ruth. "Resident and resident-related committees and meetings in South Australian aged care hostels / Leah Ruth Wilson." 2003. http://hdl.handle.net/2440/21959.
Full textAbstract:
"February 20, 2003"Includes bibliographical references (leaves 586-603)
xvii, 603 leaves : ill. ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Investigates the level of resident participation in decision-making in aged care hostels in South Australia.
Thesis (Ph.D.)--University of Adelaide, Dept. of Psychology, 2003
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Senior, Kate Adèle. "A Gudbala Laif? : health and wellbeing in a remote Aboriginal community - what are the problems and where lies responsibility?" Phd thesis, 2003. http://hdl.handle.net/1885/109708.
Full textAbstract:
The the sis is a study of a single community, its health, expectations and
aspirations. It is a study of understand in g and responsibility in the
context of dependence. The primarily ethnographic work for this thesis
was undertaken in Ngukurr over thirteen months between 1999 and
2002. Ngukurr is a remote town on the south east border of Arnhem Land in
Australia’s Northern Territory. Its long term residents are Aboriginal
people. The thesis presented here examines these people’s
understanding of health and illness in their community and their
attainment of a good life. My study focuses on issues around people’s
engagement with and disengagement from, the management of their
health and health service delivery.
My thesis is guided by the following questions:
• how do people assess their health status?
• how a republic health services perceived?
• what expectations does the community have about the type and
quality of the services provided ?
• do people seek an active role in the management of their
health ?
People’s attitudes to and expectations for their health are examined in
the context of a history of direct welfare dependence till the mid nineteen
seventies; followed by local self government in which fiscal and
administrative responsibility were held by Government or outside
individuals. The evidence for health status, morbidity, and mortality among the
remote indigenous population is significantly worse than non indigenous
Australians and h a s been the subject of extensive Commonwealth and
State health programs to little obvious effect.
The literature I survey shows that people in poor communities rate their
health more highly than the objective data suggests. Ngukurr residents
rate their health in a similar way, b u t their apparent satisfaction masks
complex beliefs about illness and concerns about health.
I demonstrate that the community believes that outside influences are
more important than personal actions as a cause of poor health, that
there is little respect for the community’s view of health or health
services, and in consequence there is little point in taking personal or
collective responsibility.
Ngukurr residents are not disinterested in health. They are acutely
aware of the patterns of morbidity and mortality in their community and
consider these to have a negative impact on their quality of life. Their
ability to bring about changes in these patterns is limited by different
paradigms of health and illness which sometimes appear as fatalism,
powerlessness in the non-Aboriginal domain, loss of confidence due to
poor communication with non indigenous providers, and consequent low
expectations with regard to personal and community health.
This creates a challenge for current policies to devolve management
responsibility for health services to local communities. Policy makers
should make considerable efforts to u n d e rs tan d local health beliefs and
value systems and ensure that changes are appropriate, rather than
making changes in health systems based on non-indigenous
understandings of needs.
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Simpson, G. J. "Social services, community and equality : a perspective on the provision and use of child care." Phd thesis, 1985. http://hdl.handle.net/1885/123997.
Full textAbstract:
The Federal government in Australia has become increasingly
involved since World War II, in the development of social
policy initiatives through the provision of social
services. By promoting social services, as distinct from
measures designed to redistribute income, successive
Federal administrations have sought to redress the problem
of poverty which has become a prominent social and
political issue in Australia since the late 1960's.
The Federal Government, particularly under the Whitlam
Labor Administration between 1972-75, adopted the premise
that by improving the access of the poor to social services
and promoting community participation in social service
delivery, there would be greater participation in the
decision making process and greater equality of opportunity
in the Australian community.
This study examines the effectiveness of this strategy
through an analysis of Federal sponsorship of community
child-care services. These services have an established
history of community participation and have also been the
focus of specific Federal policy initiatives designed to
improve social and economic opportunity among those most in
need. To assess the effectiveness of this strategy, a literature
review of developments in the provision of Federally
sponsored community-based child care services between 1972
and 1984 is presented. A household survey of child care
use and need provides an opportunity to examine the actual
impact of Federal child care programs on 330 families with
pre-school aged children. A case study describing the
emergence and development of a community association and
its efforts to gain access to child care services is used
to highlight a number of central issues surrounding the
promotion of the notion of 'community' as a strategy for
the delivery of services to families with special needs.
Data presented in this research suggests that major problems
exist for the proponents of social policy initiatives which
focus on the promotion of community social service
provisions. In the case of Federally sponsored child care
programs, the services provided appear to have had little
impact on promoting greater equality of opportunity among
families with pre-school aged children.
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Chapman, Ysanne 1948. "Dimensions of sadness - expanding awareness of community nurses' practice in palliative care / Ysanne B. Chapman." 1999. http://hdl.handle.net/2440/19482.
Full textAbstract:
Bibliography: leaves 252-270.275 leaves ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Events of sadness from their daily routine are described by sixteen participants and retold as stories. Inspired by philosophical and methodological ideology situated firmly within the interpretive paradigm, an analysis of these stories is undertaken using an interpretive, hermeneutical lens.
Thesis (Ph.D.)--University of Adelaide, Dept. of Clinical Nursing, 1999
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Clarke, Beverley. "Coastcare, Australia's community-based coastal management program: an effective model of integrated coastal management?" Thesis, 2003. http://hdl.handle.net/2440/90990.
Full textAbstract:
This thesis critically assesses Coastcare's role in contibuting to an integrated and
participatory approach to coastal management in Australia. Coastcare, one of
Australia's suite of coastal programs under the National Heritage Trust, had the
principle objective of engaging local community in managing the coast.
Coastcare represented an internationally unique example of an operational
Integrated coastal managernent (ICM) initiative. The Program fulfilled the
requirements of an integrated approach including intergovernmental co-operation,
financial commiûnent and community involvement. ICM has been adopted
internationall¡ during the last decade, as a sound approach for ecologically
sustainable development and for coastal resource use planning. Despite the
acceptance and abundance of ICM eftorts around the world, little critical analysis
of programs is available. Many of the most complex aspects of integration - the
development of relationships and trust between agency and community were
beginning to emerge through Coastcare.
This thesis demonstrates that within each of the states and the Northern Territory
the Coastcare program functioned quite distinctly âs a consequence of the
existence and prominence of individual state coastal policies, state coastal agency
commitment to the program, finances available to buttress the program beyond
the state/CoÍrmonwealth formula as well as social, cultural and demographic
features.
Coastcare's contribution to a participatory style of management is assessed by this
thesis. Stakeholder interview responses were analysed according to an evaluation
framework, based on the principles of participatory democracy, and designed to
assess different elements of community participation. This thesis concludes that
one of Coastcare's greatest strengths lies in its active capacity building. The
active engagement of groups undertaking localised works has raised awareness of
coastal processes and coastal management governance and systems.
The study contributes to a greater understanding of the processes of an integrated
approach to coastal management by providing a detailed analysis of the various
pathways of communication and cooperation between Program stakeholders
(Commonwealth, state and local government, the program team and community)
that have developed through Coastcare. Factors assisting the three tiers of
government and community working together are explored along with the barriers
that impeded progress of the Program. Its achievements will contribute towards a
greater understanding of sustainable approaches to coastal managementThesis (Ph.D.) -- University of Adelaide, Dept of Geographical and Environmental Studies, 2003