Context

Systematic reviews and meta-analyses suggest that community specialist palliative care services (SPCSs) can avoid hospitalizations and enable home deaths. But more information is needed regarding the relative efficacies of different models. Family caregivers highlight home nursing as the most important service, but it is also likely the most costly.

Objectives

To establish whether community SPCSs offering home nursing increase rates of home death compared with other models.

Methods

We searched MEDLINE, AMED, Embase, CINAHL, the Cochrane Database of Systematic Reviews, and CENTRAL on March 2 and 3, 2011. To be eligible, articles had to be published in English-language peer-reviewed journals and report original research comparing the effect on home deaths of SPCSs providing home nursing vs. any alternative. Study quality was independently rated using Cochrane grades. Maximum likelihood estimation of heterogeneity was used to establish the method for meta-analysis (fixed or random effects). Potential biases were assessed.

Results

Of 1492 articles screened, 10 articles were found eligible, reporting nine studies that yielded data for 10 comparisons. Study quality was high in two cases, moderate in three and low in four. Meta-analysis indicated a significant effect for SPCSs with home nursing (odds ratio 4.45, 95% CI 3.24–6.11; P < 0.001). However, the high-quality studies found no effect (odds ratio 1.40, 95% CI 0.97–2.02; P = 0.071). Bias was minimal.

Conclusion

A meta-analysis found evidence to be inconclusive that community SPCSs that offer home nursing increase home deaths without compromising symptoms or increasing costs. But a compelling trend warrants further confirmatory studies. Future trials should compare the relative efficacy of different models and intensities of SPCSs.

Education is the great engine of personal development. It is through education that the daughter of the peasant can become a doctor, that the son of a mineworker can become the head of the mine, that the child of a farm worker can become the president of a great nation.

Nelson Mandela

Access to a ‘good’ education is often argued as deserving of the highest priority. The available research pertaining to the educational experience of Australian Indigenous students, however, too often reflects a picture of profound disadvantage, particularly in relation to their non-Indigenous counterparts. In 2008, Prime Minister Rudd announced $20 million of Federal Government funding for 2000 boarding school places over 20 years, to address chronic levels of academic underachievement and to prepare Indigenous students to become “workplace P-platers” in an attempt to close the education gap between black and white Australians. Education in Australia, however, is tied to white culture, the industrial economy and the means through which white culture survives, so accepting these places may also have a shadow side, in relation to multiple levels of loss and possible cultural alienation.

The purpose of this study is to discover what implications for counselling practice lie in the self-report of the ‘lived experience’ of an adult sample of eight Indigenous participants who, as children, experienced leaving home to attend school. Their experience spans five decades.

A phenomenological method was adopted, using an unstructured interview as the data-gathering instrument and Interpretative Phenomenological Analysis (IPA) to analyse the data. IPA is a qualitative research methodology appropriate for exploring in detail how participants are making sense of their personal and social worlds.

Analysis of participant stories identified eleven subordinate themes, which were clustered under three ordinate themes: recognition, living environment and realism. One super-ordinate theme emerged, “living between two worlds’, which is represented as a never-ending ‘journey’ involving both ‘loss and gain’, highlighting the need for a loss/gain audit to be maintained as many of the positive and negative experiences were felt in the moment, while others had life-long repercussions. Identifying these experiences will enhance the counselling profession’s ability to develop interventions to strengthen the social, psychological and educational attainment of current and future Indigenous students.

Aims: This article describes the clinical audit programme undertaken by all students in the final year of the medical course at the University of Notre Dame, Fremantle, Australia, and examines the educational worth of this approach.

Methods: Data were obtained from curricular documents, including the clinical audit handbook, and from evaluation questionnaires administered to students and supervisors.

Results: The clinical audit programme is based on sound educational principles, including situated and participatory learning and reflective practice. It has demonstrated multi-dimensional benefits for students in terms of learning the complexities of conducting an effective audit in professional practice, and for health services in terms of facilitating quality improvement.

Conclusion: Although this programme was developed in a medical course, the concept is readily transferable to a variety of other health professional curricula in which students undertake clinical placements.