Nicole Shepherd

Anarcho-environmentalists - Ascetics of late modernity

This article explores experiences of environmental activism from the viewpoint of members of a radical environment group. It is based on data collected during eight months of participant observation and through semistructured interviews with ten core members and two ex-members. Working on personal feelings, attitudes, beliefs, and behaviors (self-work) was central to the strategy for social change employed by this group. Drawing on Webers sociology of religion, this article explores the way the high expectation the activists had of themselves matched Webers typification of the rationally active ascetic. It is argued that asceticism is an enduring element of Western culture that takes different forms in response to historical conditions. In this case, we see a form of secular asceticism that responds to the conditions of late modernity.

Reasons doctors provide futile treatment at the end of life: a qualitative study

Objective Futile treatment, which by definition cannot benefit a patient, is undesirable. This research investigated why doctors believe that treatment that they consider to be futile is sometimes provided at the end of a patients life. Design Semistructured in-depth interviews. Setting Three large tertiary public hospitals in Brisbane, Australia. Participants 96 doctors from emergency, intensive care, palliative care, oncology, renal medicine, internal medicine, respiratory medicine, surgery, cardiology, geriatric medicine and medical administration departments. Participants were recruited using purposive maximum variation sampling. Results Doctors attributed the provision of futile treatment to a wide range of inter-related factors. One was the characteristics of treating doctors, including their orientation towards curative treatment, discomfort or inexperience with death and dying, concerns about legal risk and poor communication skills. Second, the attributes of the patient and family, including their requests or demands for further treatment, prognostic uncertainty and lack of information about patient wishes. Third, there were hospital factors including a high degree of specialisation, the availability of routine tests and interventions, and organisational barriers to diverting a patient from a curative to a palliative pathway. Doctors nominated family or patient request and doctors being locked into a curative role as the main reasons for futile care. Conclusions Doctors believe that a range of factors contribute to the provision of futile treatment. A combination of strategies is necessary to reduce futile treatment, including better training for doctors who treat patients at the end of life, educating the community about the limits of medicine and the need to plan for death and dying, and structural reform at the hospital level.

What does “futility” mean? An empirical study of doctors’ perceptions

Objective: To investigate how doctors define and use the terms “futility” and “futile treatment” in end‐of‐life care.

Supporting recovery: challenges for in-home psychiatric support workers

Purpose – The concept of recovery is well accepted internationally as a guiding vision for mental health services. The purpose of this paper is to highlight the challenges faced by in-home psychiatric support workers in implementing this vision in their work with clients with severe psychiatric disability. Design/methodology/approach – The findings reported here are based on interviews with 27 support workers and ten managers of organisations providing support services. These were collected as part of evaluations of two supported housing programmes carried out between 2010 and 2011. Findings – Challenges faced by support workers coalesced around two areas: first, balancing the need to provide care with the need to promote autonomy and second, developing an effective working relationship while working mainly within a clients’ home. Practical implications – These challenges for support workers highlight tensions within the recovery vision that are not easily resolved. To ensure high quality, recovery-orient...

An evaluation of a benchmarking initiative in extended treatment mental health services

AIM To evaluate the effectiveness of a benchmarking initiative in facilitating quality improvement and reform in extended care mental health services. METHOD Individual interviews and focus group discussions were conducted with 84 staff in 22 extended care mental health services that had previously participated in a State-wide benchmarking exercise in Queensland, Australia. RESULTS Staff reported positive outcomes from participation in the benchmarking exercise. Information derived from benchmarking provided a different perspective on the strengths and weaknesses of individual services and an opportunity to learn from peer services. Staff in 86% of the services identified issues that needed to be addressed and 64% of services had implemented one or more service improvement projects in response to shortcomings identified through the benchmarking exercise. CONCLUSIONS The collection and reporting of performance data through a process of benchmarking was successful in facilitating service improvement in most of the participating facilities. Engaging services in all stages of the process was considered useful in converting benchmarking data into knowledge that was able to be applied at the local service level.

People with dementia getting lost in Australia: Dementia‐related missing person reports in the media

This study aimed to understand the circumstances in which people with dementia become lost, and the outcomes of these incidents.

Futile Treatment in Hospital: Doctors’ Intergroup Language

Treatment that will not provide significant net benefit at the end of a person’s life (called futile treatment) is considered by many people to represent a major problem in the health sector, as it can waste resources and raise significant ethical issues. Medical treatment at the end of life involves a complex negotiation that implicates intergroup communication between health professionals, patients, and families, as well as between groups of health professionals. This study, framed by intergroup language theory, analyzed data from a larger project on futile treatment, in order to examine the intergroup language associated with futile treatment. Hospital doctors (N = 96) were interviewed about their understanding of treatment given to adult patients at the end of life that they considered futile. We conducted a discourse analysis on doctors’ descriptions of futile treatment provided by themselves and their in-group and out-group colleagues. Results pointed to an intergroup context, with patients, families, and colleagues as out-groups. In their descriptions, doctors justified their own decisions using the language of logic, ethics, and respect. Patients and families, however, were characterized in terms of wishing and wanting, as were out-group colleagues. In addition, out-group doctors were described in strongly negative intergroup language.

Governing through freedom: mental health care in the age of empowerment

ABSTRACT Mental health care has undergone several waves of reforms since the start of the asylum era. The current era has been shaped by the recovery movement, which seeks to increase the autonomy of service users. I analyze the implementation of recovery-oriented program of supported housing for people with serious mental illness. Policy documents and interviews with 95 staff involved in delivering this program were analyzed using a conceptual framework informed by the governmentality literature. I explore the contradictions that emerged between the recovery vision and the implementation of the program in three areas: promoting freedom of choice, encouraging independence and community life. I suggest that the next wave of reforms in mental health care could incorporate the principle of solidarity by creating communities that offer meaningful opportunities for participation.

Training for in‐home psychiatric disability support workers

Purpose – Support workers who provide in‐home support to people with psychiatric disability are becoming a significant part of the mental health workforce. Research is needed to establish the optimum level and content of training they need to effectively carry out their role.Design/methodology/approach – This paper reports on this paper is to draw on the results of a survey of 104 support workers and interviews with 18 support workers and eight managers in Queensland, Australia, who provide in‐home support for people with psychiatric disability. The authors describe the training undertaken by these workers and their perceptions of the adequacy of this training in relation to the challenges of their work.Findings – The majority of support workers felt they had adequate training, though many expressed the desire to know more about mental illness symptoms, medications and the concept of recovery. Support workers nominated motivating their clients and managing challenging behaviour as the most difficult aspec...