Статті в журналах з теми "Nursing school administrators Australia Interviews"

Few school districts in the United States have policies relating to do not resuscitate (DNR) orders in the school setting. School administrators are the gatekeepers of policy development. Little is known about administrator attitudes related to DNR orders in the school setting. School nurses need to understand administrator attitudes in order to facilitate DNR policy development. This study explored the attitudes of 15 administrators about DNR orders in the school setting through structured interviews. Administrators were asked their attitudes about DNR orders in the school setting and about DNR policy implementation. The majority of administrators believed that DNR policies should not be developed for the school setting because of the emotions involved and lack of administrator knowledge related to DNR orders. The majority of administrators did agree that having a DNR policy would clarify how staff should respond to DNR orders at school.

Objective: The world-wide demand for skilled Registered Nurses is high, and understanding the reasons why Chinese students leave home to study nursing in Australia is important for institutions, policy makers, and nursing administrators in both China and Australia. This paper explores the factors shaping the decision of six Chinese students to study nursing in Australia and their preference to eventually live and work either in China or Australia.Methods: A three-dimensional space narrative structure approach was used for this study. In-depth interviews and focus group discussions were conducted with six Chinese nursing students whom were studying nursing at universities in Western Australia.Results: Findings revealed that the most important factor that influenced Chinese students’ decision to study nursing in Australia was the possibility for permanent residency.Conclusions: Insights gained from the study are important for a myriad of factors including international nursing relocation, developments in networking and healthcare, and capitalising in education from a global perspective.

AbstractThis research was commissioned by the (then) Department of Environment and Conservation (DEC) to provide recommendations on how to best support Western Australian (WA) secondary schools to engage in education for sustainability (EfS). The research aims were to identify barriers and benefits to being involved in EfS, the support systems required for schools to participate in EfS at secondary school level, and the difficulties that secondary schools experience when implementing EfS programs. A variety of research methods were utilised: semi-structured interviews with non-teaching stakeholders; online questionnaires for teachers, school administrators and students; focus groups and semi-structured interviews with teachers and school administrators; and an expert panel workshop to discuss data and recommendations prior to completion of a final report. Data were collected from 29 schools, 45 teachers and school administrators, 186 students, and various EfS external providers and stakeholders across metropolitan and regional WA. This article focuses on three issues identified in the data that we consider important and under-represented in discourses of EfS in Australia: lack of understanding about what EfS means among educators; lack of meaningful student involvement in EfS in secondary schools; and differing quality in EfS programs offered by external providers. We conclude this article by offering ways to improve EfS in WA secondary schools.

Despite a well-documented need for school health programs (SHPs) among schoolchildren, there is little school health funding in California and limited research on the role of those who manage SHPs. This qualitative study investigated the work of a selected group of school health administrators (SHAs) in California. Study aims were to explore SHA job pathways and responsibilities, the contextual factors influencing their work, and how they get their work done, given limited funding for SHPs. Thirty in-depth, semistructured interviews were conducted with SHAs and their staff, supervisors, and deputy SHAs. The main themes and subthemes are (1) district hierarchies marginalize SHAs and (2) in response to this marginalization, SHAs engage in brokering strategies to get their work done, including (a) raising awareness, (b) cultivating powerful allies, and (c) adjusting to working conditions. Despite structural disempowerment, SHAs have developed strategies to secure political support for SHPs and school nurses.

This article describes the development and pilot testing of a computer-based, multiple-behavior obesity prevention program for adolescents. Using the Transtheoretical Model as a framework, this intervention offers individualized feedback based on readiness to engage in physical activity, to consume fruits and vegetables, and to limit television viewing. Focus groups and interviews with students, teachers, school administrators, and experts guided the development. Forty-five students participated in a baseline intervention session and completed a 16-item acceptability measure. Ratings were positive, with item means ranging from 3.60–4.75 on a 5-point scale. Student responses to open-ended questions aided in the enhancement of the intervention, for which an effectiveness trial begins in September 2006. This formative work demonstrated the acceptability of this school-based intervention approach, which can be promoted and prescribed by school nurses. Further, if found effective, it can be disseminated as an efficient, low-cost, population-based approach designed to address the epidemic of obesity.

Objective: This study aimed to develop a substantive theory on the process of overcoming attrition among returning students in an Associate Degree Nursing program in a private school in Arizona.Methods: A qualitative design was utilized for this study. The Classical Grounded Theory approach provided a systematic process of data collection, analysis and synthesis that led to the emergence of the Attrition to Completion Progression Theory. Theoretical sampling through in-depth interviews of ten participants who experienced temporary attrition and was successfully able to come back to succeed within the program provided a rich source of data and unique perspective of the phenomenon.Results: Four themes emerged from the grounded theory approach. The themes that emerged are: Attrition as an interplay of multiple factors; Ways of coping with attrition; Changes and modifications; and Finding new meanings as the core category. The emergent theory provided an insight into the process that the participants went through and the perceived contributory factors leading to the attrition.Conclusions: Understanding the interplay of these factors paved for a better understanding on how current and future students, faculty, and administrators can prevent attrition and assist returning students to become successful in the program towards completion.

Purpose The purpose of this paper is to report on a study examining the perceptions of secondary principals, deputies and teachers, of deputy principal (DP) instructional leadership (IL), as well as deputies’ professional learning (PL) needs. Framed within an interpretivist approach, the specific objectives of this study were: to explore the extent to which DPs are perceived as leaders of learning, to examine the actual responsibilities of these DPs and to explore the PL that support DP roles. Design/methodology/approach The researchers used multiple perspective case studies which included semi-structured interviews and key school document analysis. A thematic content analysis facilitated qualitative descriptions and insights from the perspectives of the principals, DPs and teachers of four high-performing secondary schools in Sydney, Australia. Findings The data revealed that deputies performed a huge range of tasks; all the principals were distributing leadership to their deputies to build leadership capacity and supported their PL in a variety of ways. Across three of the case study schools, most deputies were frequently performing as instructional leaders, improving their school’s performance through distributing leadership, team building and goal setting. Deputy PL was largely dependent on principal mentoring and self-initiated but was often ad hoc. Findings add more validity to the importance of principals building the educational leadership of their deputies. Research limitations/implications This study relied upon responses from four case study schools. Further insight into the key issues discussed may require a longitudinal data that describe perceptions from a substantial number of schools in Australia over time. However, studying only four schools allowed for an in-depth investigation. Practical implications The findings from this study have practical implications for system leaders with responsibilities of framing the deputies’ role as emergent educational leaders rather than as administrators and the need for coherent, integrated, consequential and systematic approaches to DP professional development. Further research is required on the effect of deputy IL on school performance. Originality/value There is a dearth of research-based evidence exploring the range of responsibilities of deputies and perceptions of staff about deputies’ IL role and their PL needs. This is the first published New South Wales, Australian DP study and adds to the growing evidence around perceptions of DPs as instructional leaders by providing an Australian perspective on the phenomenon. The paper raises important concerns about the complexity of the DP’s role on the one hand, and on the other hand, the PL that is perceived to be most appropriate for dealing with this complexity.

Introduction Care coordination can improve healthcare quality and reduce costs. The objective of this study was to provide a qualitative understanding of the most helpful coordination services as experienced by patients receiving these services to reduce emergent hospital use. Methods Using case study methodology, we conducted focus group conversations with 51 care coordination patients and semi-structured interviews with 29 care coordinators at nine sites throughout Texas. The study team performed constant comparative analysis, beginning with start codes based on prior research. Results On average, focus group participants were 47 years old. The majority of participants reported a high school or General Equivalency Diploma level of education or less (84%), an annual income less than $14,999 (87%), and living with multiple chronic health conditions (60%). The majority (85%) of care coordinators reported backgrounds in nursing or social work. In our analysis, themes of what patients found most helpful fell under a broad social support framework (instrumental, informational, emotional, and advocacy) that care coordinators were uniquely situated to provide. Discussion Our paper adds to existing evidence by providing perspectives of patients with complex medical and non-medical needs about which care coordination services are most helpful. In this sample, patients with high needs describe reliance on professional sources, rather than their own social networks, to address several aspects of social support and to help meet non-health-related, as well as health-related needs. This can inform providers’ approaches to treatment as well as program administrators’ decisions about addressing and prioritizing services in care coordination programs.

Introduction: Nurses should be committed to undertake continuing professional development (CPD) courses to advance nursing practice and guarantee lifelong learning. Online CPD programs may allow nurses to fulfil the demand for specialty competency. Aim: This study focuses on utilising online (CPD) activities to develop cardiac nurses’ ability to perform advanced clinical skills. Method: The study was conducted in one of the largest accredited teaching hospitals in South Australia. The department is staffed by a specialised multi-professional team, some of whom have completed specialised cardiac post-graduation diploma courses in order to meet the complex needs of cardiac patients. To keep the team abreast of the latest developments in practice, the in-service education department at local study setting runs several CPD programs for the cardiology department via varied learning modes, such as online CPD programs, classroom learning and bedside-based learning. The nursing team maintains advanced clinical skills through online CPD, orientation programs, and in-service classroom-based courses. Regarding online CPD courses, electrocardiography interpretation and underwater sealing draining management courses are mandatory courses which all registered nurses must complete while working in medical or surgical cardiac wards. Results: The interview process was conducted in five stages: 1. Determining the type of the interview where in such types of qualitative studies the researcher should focus on the fundamental question of the phenomenological inquiry throughout the unstructured, in-depth interview process. 2. Making initial contact where the researcher established a rapport with the participant and prepared them mentally by giving them the participant information sheet. 3. Context of the interview where interviews be conducted in a quiet room in the School of Nursing in order to maintain participant privacy and anonymity, participants requested to conduct the interviews in their work setting. Nonetheless, the researcher ensured that participant privacy and anonymity was upheld. 4. Selecting the lived experience where Each participant was interviewed once. Interview duration was 15 to 30 minutes. The interviews started with a grand tour question. Grand tour questions are very broad questions asked by the interviewer at the early stage of an interview to obtain a description of the event or experience. 5. All interviews were concluded by thanking the participant and offering them the choice to have a copy of their interview transcript to verify what they had said. The researcher wrote an interview summary after listening to the interviews on the same day. The summary was prepared to help the researcher evaluate the amount of data gathered and identify whether the point of data saturation was reached. In addition, writing the summary helped the researcher reflect on the interview and gain an understanding of the participant experience Conclusion This study explained the process of data collection, describing the setting, nature of participants and process of data collection using phenomenological interview. As the human experience is complex, gathering in-depth data should be systematic to ensure that the researcher has obtained the most sufficient data to explore the essence of the experience.

IntroductionPoverty and deprivation can harm children’s future health, learning, economic productivity and societal participation. The Australian Healthier Wealthier Families project seeks to reduce the childhood inequities caused by poverty and deprivation by creating a systematic referral pathway between two free, community-based services: universal, well-child nursing services, which provide health and development support to families with children from birth to school entry, and financial counselling. By adapting the successful Scottish ‘Healthier Wealthier Children’ model, the objectives of this Australian pilot are to test the (1) feasibility of systematising the referral pathway, and (2) short-term impacts on household finances, caregiver health, parenting efficacy and financial service use.Methods and analysisThis pilot randomised controlled trial will run in three sites across two Australian states (Victoria and New South Wales), recruiting a total of 180 participants. Nurses identify eligible caregivers with a 6-item, study-designed screening survey for financial hardship. Caregivers who report one or more risk factors and consent are randomised. The intervention is financial counselling. The comparator is usual care plus information from a government money advice website. Feasibility will be evaluated using the number/proportion of caregivers who complete screening, consent and research measures, and access financial counselling. Though powered to assess feasibility, impacts will be measured 6 months post-enrolment with qualitative interviews and questionnaires about caregiver-reported income, loans and costs (adapted from national surveys, for example, the Household, Income and Labour Dynamics in Australia Survey); health (General Health Questionnaire 1, EuroQol five-dimensional questionnaire, Depression, Anxiety, Stress Scale short-form); efficacy (from the Longitudinal Study of Australian Children); and financial service use (study-designed) compared between arms.Ethics and disseminationEthics committees of the Royal Children’s Hospital (HREC/57372/RCHM-2019) and South West Sydney Local Health District (2019/ETH13455) have approved the study. Participants and stakeholders will receive results through regular communication channels comprising meetings, presentations and publications.Trial registration numberACTRN12620000154909; prospectively registered. Pre-results.

Education in Oceania continues to reflect the embedded implicit and explicit colonial practices and processes from the past. This paper conceptualises a cultural approach to education and leadership appropriate and relevant to the Republic of the Marshall Islands. As elementary school leaders, we highlight Kanne Lobal, a traditional Marshallese navigation practice based on indigenous language, values and practices. We conceptualise and develop Kanne Lobal in this paper as a framework for understanding the usefulness of our indigenous knowledge in leadership and educational practices within formal education. Through bwebwenato, a method of talk story, our key learnings and reflexivities were captured. We argue that realising the value of Marshallese indigenous knowledge and practices for school leaders requires purposeful training of the ways in which our knowledge can be made useful in our professional educational responsibilities. Drawing from our Marshallese knowledge is an intentional effort to inspire, empower and express what education and leadership partnership means for Marshallese people, as articulated by Marshallese themselves. Introduction As noted in the call for papers within the Waikato Journal of Education (WJE) for this special issue, bodies of knowledge and histories in Oceania have long sustained generations across geographic boundaries to ensure cultural survival. For Marshallese people, we cannot really know ourselves “until we know how we came to be where we are today” (Walsh, Heine, Bigler & Stege, 2012). Jitdam Kapeel is a popular Marshallese concept and ideal associated with inquiring into relationships within the family and community. In a similar way, the practice of relating is about connecting the present and future to the past. Education and leadership partnerships are linked and we look back to the past, our history, to make sense and feel inspired to transform practices that will benefit our people. In this paper and in light of our next generation, we reconnect with our navigation stories to inspire and empower education and leadership. Kanne lobal is part of our navigation stories, a conceptual framework centred on cultural practices, values, and concepts that embrace collective partnerships. Our link to this talanoa vā with others in the special issue is to attempt to make sense of connections given the global COVID-19 context by providing a Marshallese approach to address the physical and relational “distance” between education and leadership partnerships in Oceania. Like the majority of developing small island nations in Oceania, the Republic of the Marshall Islands (RMI) has had its share of educational challenges through colonial legacies of the past which continues to drive education systems in the region (Heine, 2002). The historical administration and education in the RMI is one of colonisation. Successive administrations by the Spanish, German, Japanese, and now the US, has resulted in education and learning that privileges western knowledge and forms of learning. This paper foregrounds understandings of education and learning as told by the voices of elementary school leaders from the RMI. The move to re-think education and leadership from Marshallese perspectives is an act of shifting the focus of bwebwenato or conversations that centres on Marshallese language and worldviews. The concept of jelalokjen was conceptualised as traditional education framed mainly within the community context. In the past, jelalokjen was practiced and transmitted to the younger generation for cultural continuity. During the arrival of colonial administrations into the RMI, jelalokjen was likened to the western notions of education and schooling (Kupferman, 2004). Today, the primary function of jelalokjen, as traditional and formal education, it is for “survival in a hostile [and challenging] environment” (Kupferman, 2004, p. 43). Because western approaches to learning in the RMI have not always resulted in positive outcomes for those engaged within the education system, as school leaders who value our cultural knowledge and practices, and aspire to maintain our language with the next generation, we turn to Kanne Lobal, a practice embedded in our navigation stories, collective aspirations, and leadership. The significance in the development of Kanne Lobal, as an appropriate framework for education and leadership, resulted in us coming together and working together. Not only were we able to share our leadership concerns, however, the engagement strengthened our connections with each other as school leaders, our communities, and the Public Schooling System (PSS). Prior to that, many of us were in competition for resources. Educational Leadership: IQBE and GCSL Leadership is a valued practice in the RMI. Before the IQBE programme started in 2018, the majority of the school leaders on the main island of Majuro had not engaged in collaborative partnerships with each other before. Our main educational purpose was to achieve accreditation from the Western Association of Schools and Colleges (WASC), an accreditation commission for schools in the United States. The WASC accreditation dictated our work and relationships and many school leaders on Majuro felt the pressure of competition against each other. We, the authors in this paper, share our collective bwebwenato, highlighting our school leadership experiences and how we gained strength from our own ancestral knowledge to empower “us”, to collaborate with each other, our teachers, communities, as well as with PSS; a collaborative partnership we had not realised in the past. The paucity of literature that captures Kajin Majol (Marshallese language) and education in general in the RMI is what we intend to fill by sharing our reflections and experiences. To move our educational practices forward we highlight Kanne Lobal, a cultural approach that focuses on our strengths, collective social responsibilities and wellbeing. For a long time, there was no formal training in place for elementary school leaders. School principals and vice principals were appointed primarily on their academic merit through having an undergraduate qualification. As part of the first cohort of fifteen school leaders, we engaged in the professional training programme, the Graduate Certificate in School Leadership (GCSL), refitted to our context after its initial development in the Solomon Islands. GCSL was coordinated by the Institute of Education (IOE) at the University of the South Pacific (USP). GCSL was seen as a relevant and appropriate training programme for school leaders in the RMI as part of an Asia Development Bank (ADB) funded programme which aimed at “Improving Quality Basic Education” (IQBE) in parts of the northern Pacific. GCSL was managed on Majuro, RMI’s main island, by the director at the time Dr Irene Taafaki, coordinator Yolanda McKay, and administrators at the University of the South Pacific’s (USP) RMI campus. Through the provision of GCSL, as school leaders we were encouraged to re-think and draw-from our own cultural repository and connect to our ancestral knowledge that have always provided strength for us. This kind of thinking and practice was encouraged by our educational leaders (Heine, 2002). We argue that a culturally-affirming and culturally-contextual framework that reflects the lived experiences of Marshallese people is much needed and enables the disruption of inherent colonial processes left behind by Western and Eastern administrations which have influenced our education system in the RMI (Heine, 2002). Kanne Lobal, an approach utilising a traditional navigation has warranted its need to provide solutions for today’s educational challenges for us in the RMI. Education in the Pacific Education in the Pacific cannot be understood without contextualising it in its history and culture. It is the same for us in the RMI (Heine, 2002; Walsh et al., 2012). The RMI is located in the Pacific Ocean and is part of Micronesia. It was named after a British captain, John Marshall in the 1700s. The atolls in the RMI were explored by the Spanish in the 16th century. Germany unsuccessfully attempted to colonize the islands in 1885. Japan took control in 1914, but after several battles during World War II, the US seized the RMI from them. In 1947, the United Nations made the island group, along with the Mariana and Caroline archipelagos, a U.S. trust territory (Walsh et al, 2012). Education in the RMI reflects the colonial administrations of Germany, Japan, and now the US. Before the turn of the century, formal education in the Pacific reflected western values, practices, and standards. Prior to that, education was informal and not binded to formal learning institutions (Thaman, 1997) and oral traditions was used as the medium for transmitting learning about customs and practices living with parents, grandparents, great grandparents. As alluded to by Jiba B. Kabua (2004), any “discussion about education is necessarily a discussion of culture, and any policy on education is also a policy of culture” (p. 181). It is impossible to promote one without the other, and it is not logical to understand one without the other. Re-thinking how education should look like, the pedagogical strategies that are relevant in our classrooms, the ways to engage with our parents and communities - such re-thinking sits within our cultural approaches and frameworks. Our collective attempts to provide a cultural framework that is relevant and appropriate for education in our context, sits within the political endeavour to decolonize. This means that what we are providing will not only be useful, but it can be used as a tool to question and identify whether things in place restrict and prevent our culture or whether they promote and foreground cultural ideas and concepts, a significant discussion of culture linked to education (Kabua, 2004). Donor funded development aid programmes were provided to support the challenges within education systems. Concerned with the persistent low educational outcomes of Pacific students, despite the prevalence of aid programmes in the region, in 2000 Pacific educators and leaders with support from New Zealand Aid (NZ Aid) decided to intervene (Heine, 2002; Taufe’ulungaki, 2014). In April 2001, a group of Pacific educators and leaders across the region were invited to a colloquium funded by the New Zealand Overseas Development Agency held in Suva Fiji at the University of the South Pacific. The main purpose of the colloquium was to enable “Pacific educators to re-think the values, assumptions and beliefs underlying [formal] schooling in Oceania” (Benson, 2002). Leadership, in general, is a valued practice in the RMI (Heine, 2002). Despite education leadership being identified as a significant factor in school improvement (Sanga & Chu, 2009), the limited formal training opportunities of school principals in the region was a persistent concern. As part of an Asia Development Bank (ADB) funded project, the Improve Quality Basic Education (IQBE) intervention was developed and implemented in the RMI in 2017. Mentoring is a process associated with the continuity and sustainability of leadership knowledge and practices (Sanga & Chu, 2009). It is a key aspect of building capacity and capabilities within human resources in education (ibid). Indigenous knowledges and education research According to Hilda Heine, the relationship between education and leadership is about understanding Marshallese history and culture (cited in Walsh et al., 2012). It is about sharing indigenous knowledge and histories that “details for future generations a story of survival and resilience and the pride we possess as a people” (Heine, cited in Walsh et al., 2012, p. v). This paper is fuelled by postcolonial aspirations yet is grounded in Pacific indigenous research. This means that our intentions are driven by postcolonial pursuits and discourses linked to challenging the colonial systems and schooling in the Pacific region that privileges western knowledge and learning and marginalises the education practices and processes of local people (Thiong’o, 1986). A point of difference and orientation from postcolonialism is a desire to foreground indigenous Pacific language, specifically Majin Majol, through Marshallese concepts. Our collective bwebwenato and conversation honours and values kautiej (respect), jouj eo mour eo (reciprocity), and jouj (kindness) (Taafaki & Fowler, 2019). Pacific leaders developed the Rethinking Pacific Education Initiative for and by Pacific People (RPEIPP) in 2002 to take control of the ways in which education research was conducted by donor funded organisations (Taufe’ulungaki, 2014). Our former president, Dr Hilda Heine was part of the group of leaders who sought to counter the ways in which our educational and leadership stories were controlled and told by non-Marshallese (Heine, 2002). As a former minister of education in the RMI, Hilda Heine continues to inspire and encourage the next generation of educators, school leaders, and researchers to re-think and de-construct the way learning and education is conceptualised for Marshallese people. The conceptualisation of Kanne Lobal acknowledges its origin, grounded in Marshallese navigation knowledge and practice. Our decision to unpack and deconstruct Kanne Lobal within the context of formal education and leadership responds to the need to not only draw from indigenous Marshallese ideas and practice but to consider that the next generation will continue to be educated using western processes and initiatives particularly from the US where we get a lot of our funding from. According to indigenous researchers Dawn Bessarab and Bridget Ng’andu (2010), doing research that considers “culturally appropriate processes to engage with indigenous groups and individuals is particularly pertinent in today’s research environment” (p. 37). Pacific indigenous educators and researchers have turned to their own ancestral knowledge and practices for inspiration and empowerment. Within western research contexts, the often stringent ideals and processes are not always encouraging of indigenous methods and practices. However, many were able to ground and articulate their use of indigenous methods as being relevant and appropriate to capturing the realities of their communities (Nabobo-Baba, 2008; Sualii-Sauni & Fulu-Aiolupotea, 2014; Thaman, 1997). At the same time, utilising Pacific indigenous methods and approaches enabled research engagement with their communities that honoured and respected them and their communities. For example, Tongan, Samoan, and Fijian researchers used the talanoa method as a way to capture the stories, lived realities, and worldviews of their communities within education in the diaspora (Fa’avae, Jones, & Manu’atu, 2016; Nabobo-Baba, 2008; Sualii-Sauni & Aiolupotea, 2014; Vaioleti, 2005). Tok stori was used by Solomon Islander educators and school leaders to highlight the unique circles of conversational practice and storytelling that leads to more positive engagement with their community members, capturing rich and meaningful narratives as a result (Sanga & Houma, 2004). The Indigenous Aborigine in Australia utilise yarning as a “relaxed discussion through which both the researcher and participant journey together visiting places and topics of interest relevant” (Bessarab & Ng’andu, 2010, p. 38). Despite the diverse forms of discussions and storytelling by indigenous peoples, of significance are the cultural protocols, ethics, and language for conducting and guiding the engagement (Bessarab & Ng’andu, 2010; Nabobo-Baba, 2008; Sualii-Sauni & Aiolupotea, 2014). Through the ethics, values, protocols, and language, these are what makes indigenous methods or frameworks unique compared to western methods like in-depth interviews or semi-structured interviews. This is why it is important for us as Marshallese educators to frame, ground, and articulate how our own methods and frameworks of learning could be realised in western education (Heine, 2002; Jetnil-Kijiner, 2014). In this paper, we utilise bwebwenato as an appropriate method linked to “talk story”, capturing our collective stories and experiences during GCSL and how we sought to build partnerships and collaboration with each other, our communities, and the PSS. Bwebwenato and drawing from Kajin Majel Legends and stories that reflect Marshallese society and its cultural values have survived through our oral traditions. The practice of weaving also holds knowledge about our “valuable and earliest sources of knowledge” (Taafaki & Fowler, 2019, p. 2). The skilful navigation of Marshallese wayfarers on the walap (large canoes) in the ocean is testament of their leadership and the value they place on ensuring the survival and continuity of Marshallese people (Taafaki & Fowler, 2019; Walsh et al., 2012). During her graduate study in 2014, Kathy Jetnil-Kijiner conceptualised bwebwenato as being the most “well-known form of Marshallese orality” (p. 38). The Marshallese-English dictionary defined bwebwenato as talk, conversation, story, history, article, episode, lore, myth, or tale (cited in Jetnil Kijiner, 2014). Three years later in 2017, bwebwenato was utilised in a doctoral project by Natalie Nimmer as a research method to gather “talk stories” about the experiences of 10 Marshallese experts in knowledge and skills ranging from sewing to linguistics, canoe-making and business. Our collective bwebwenato in this paper centres on Marshallese ideas and language. The philosophy of Marshallese knowledge is rooted in our “Kajin Majel”, or Marshallese language and is shared and transmitted through our oral traditions. For instance, through our historical stories and myths. Marshallese philosophy, that is, the knowledge systems inherent in our beliefs, values, customs, and practices are shared. They are inherently relational, meaning that knowledge systems and philosophies within our world are connected, in mind, body, and spirit (Jetnil-Kijiner, 2014; Nimmer, 2017). Although some Marshallese believe that our knowledge is disappearing as more and more elders pass away, it is therefore important work together, and learn from each other about the knowledges shared not only by the living but through their lamentations and stories of those who are no longer with us (Jetnil-Kijiner, 2014). As a Marshallese practice, weaving has been passed-down from generation to generation. Although the art of weaving is no longer as common as it used to be, the artefacts such as the “jaki-ed” (clothing mats) continue to embody significant Marshallese values and traditions. For our weavers, the jouj (check spelling) is the centre of the mat and it is where the weaving starts. When the jouj is correct and weaved well, the remainder and every other part of the mat will be right. The jouj is symbolic of the “heart” and if the heart is prepared well, trained well, then life or all other parts of the body will be well (Taafaki & Fowler, 2019). In that light, we have applied the same to this paper. Conceptualising and drawing from cultural practices that are close and dear to our hearts embodies a significant ontological attempt to prioritize our own knowledge and language, a sense of endearment to who we are and what we believe education to be like for us and the next generation. The application of the phrase “Majolizing '' was used by the Ministry of Education when Hilda Heine was minister, to weave cultural ideas and language into the way that teachers understand the curriculum, develop lesson plans and execute them in the classroom. Despite this, there were still concerns with the embedded colonized practices where teachers defaulted to eurocentric methods of doing things, like the strategies provided in the textbooks given to us. In some ways, our education was slow to adjust to the “Majolizing '' intention by our former minister. In this paper, we provide Kanne Lobal as a way to contribute to the “Majolizing intention” and perhaps speed up yet still be collectively responsible to all involved in education. Kajin Wa and Kanne Lobal “Wa” is the Marshallese concept for canoe. Kajin wa, as in canoe language, has a lot of symbolic meaning linked to deeply-held Marshallese values and practices. The canoe was the foundational practice that supported the livelihood of harsh atoll island living which reflects the Marshallese social world. The experts of Kajin wa often refer to “wa” as being the vessel of life, a means and source of sustaining life (Kelen, 2009, cited in Miller, 2010). “Jouj” means kindness and is the lower part of the main hull of the canoe. It is often referred to by some canoe builders in the RMI as the heart of the canoe and is linked to love. The jouj is one of the first parts of the canoe that is built and is “used to do all other measurements, and then the rest of the canoe is built on top of it” (Miller, 2010, p. 67). The significance of the jouj is that when the canoe is in the water, the jouj is the part of the hull that is underwater and ensures that all the cargo and passengers are safe. For Marshallese, jouj or kindness is what living is about and is associated with selflessly carrying the responsibility of keeping the family and community safe. The parts of the canoe reflect Marshallese culture, legend, family, lineage, and kinship. They embody social responsibilities that guide, direct, and sustain Marshallese families’ wellbeing, from atoll to atoll. For example, the rojak (boom), rojak maan (upper boom), rojak kōrā (lower boom), and they support the edges of the ujelā/ujele (sail) (see figure 1). The literal meaning of rojak maan is male boom and rojak kōrā means female boom which together strengthens the sail and ensures the canoe propels forward in a strong yet safe way. Figuratively, the rojak maan and rojak kōrā symbolise the mother and father relationship which when strong, through the jouj (kindness and love), it can strengthen families and sustain them into the future. Figure 1. Parts of the canoe Source: https://www.canoesmarshallislands.com/2014/09/names-of-canoe-parts/ From a socio-cultural, communal, and leadership view, the canoe (wa) provides understanding of the relationships required to inspire and sustain Marshallese peoples’ education and learning. We draw from Kajin wa because they provide cultural ideas and practices that enable understanding of education and leadership necessary for sustaining Marshallese people and realities in Oceania. When building a canoe, the women are tasked with the weaving of the ujelā/ujele (sail) and to ensure that it is strong enough to withstand long journeys and the fierce winds and waters of the ocean. The Kanne Lobal relates to the front part of the ujelā/ujele (sail) where the rojak maan and rojak kōrā meet and connect (see the red lines in figure 1). Kanne Lobal is linked to the strategic use of the ujelā/ujele by navigators, when there is no wind north wind to propel them forward, to find ways to capture the winds so that their journey can continue. As a proverbial saying, Kanne Lobal is used to ignite thinking and inspire and transform practice particularly when the journey is rough and tough. In this paper we draw from Kanne Lobal to ignite, inspire, and transform our educational and leadership practices, a move to explore what has always been meaningful to Marshallese people when we are faced with challenges. The Kanne Lobal utilises our language, and cultural practices and values by sourcing from the concepts of jouj (kindness, love), kautiej (respect), and jouj eo mour eo (reciprocity). A key Marshallese proverb, “Enra bwe jen lale rara”, is the cultural practice where families enact compassion through the sharing of food in all occurrences. The term “enra” is a small basket weaved from the coconut leaves, and often used by Marshallese as a plate to share and distribute food amongst each other. Bwe-jen-lale-rara is about noticing and providing for the needs of others, and “enra” the basket will help support and provide for all that are in need. “Enra-bwe-jen-lale-rara” is symbolic of cultural exchange and reciprocity and the cultural values associated with building and maintaining relationships, and constantly honouring each other. As a Marshallese practice, in this article we share our understanding and knowledge about the challenges as well as possible solutions for education concerns in our nation. In addition, we highlight another proverb, “wa kuk wa jimor”, which relates to having one canoe, and despite its capacity to feed and provide for the individual, but within the canoe all people can benefit from what it can provide. In the same way, we provide in this paper a cultural framework that will enable all educators to benefit from. It is a framework that is far-reaching and relevant to the lived realities of Marshallese people today. Kumit relates to people united to build strength, all co-operating and working together, living in peace, harmony, and good health. Kanne Lobal: conceptual framework for education and leadership An education framework is a conceptual structure that can be used to capture ideas and thinking related to aspects of learning. Kanne Lobal is conceptualised and framed in this paper as an educational framework. Kanne Lobal highlights the significance of education as a collective partnership whereby leadership is an important aspect. Kanne Lobal draws-from indigenous Marshallese concepts like kautiej (respect), jouj eo mour eo (reciprocity), and jouj (kindness, heart). The role of a leader, including an education leader, is to prioritise collective learning and partnerships that benefits Marshallese people and the continuity and survival of the next generation (Heine, 2002; Thaman, 1995). As described by Ejnar Aerōk, an expert canoe builder in the RMI, he stated: “jerbal ippān doon bwe en maron maan wa e” (cited in Miller, 2010, p. 69). His description emphasises the significance of partnerships and working together when navigating and journeying together in order to move the canoe forward. The kubaak, the outrigger of the wa (canoe) is about “partnerships”. For us as elementary school leaders on Majuro, kubaak encourages us to value collaborative partnerships with each other as well as our communities, PSS, and other stakeholders. Partnerships is an important part of the Kanne Lobal education and leadership framework. It requires ongoing bwebwenato – the inspiring as well as confronting and challenging conversations that should be mediated and negotiated if we and our education stakeholders are to journey together to ensure that the educational services we provide benefits our next generation of young people in the RMI. Navigating ahead the partnerships, mediation, and negotiation are the core values of jouj (kindness, love), kautiej (respect), and jouj eo mour eo (reciprocity). As an organic conceptual framework grounded in indigenous values, inspired through our lived experiences, Kanne Lobal provides ideas and concepts for re-thinking education and leadership practices that are conducive to learning and teaching in the schooling context in the RMI. By no means does it provide the solution to the education ills in our nation. However, we argue that Kanne Lobal is a more relevant approach which is much needed for the negatively stigmatised system as a consequence of the various colonial administrations that have and continue to shape and reframe our ideas about what education should be like for us in the RMI. Moreover, Kannel Lobal is our attempt to decolonize the framing of education and leadership, moving our bwebwenato to re-framing conversations of teaching and learning so that our cultural knowledge and values are foregrounded, appreciated, and realised within our education system. Bwebwenato: sharing our stories In this section, we use bwebwenato as a method of gathering and capturing our stories as data. Below we capture our stories and ongoing conversations about the richness in Marshallese cultural knowledge in the outer islands and on Majuro and the potentialities in Kanne Lobal. Danny Jim When I was in third grade (9-10 years of age), during my grandfather’s speech in Arno, an atoll near Majuro, during a time when a wa (canoe) was being blessed and ready to put the canoe into the ocean. My grandfather told me the canoe was a blessing for the family. “Without a canoe, a family cannot provide for them”, he said. The canoe allows for travelling between places to gather food and other sources to provide for the family. My grandfather’s stories about people’s roles within the canoe reminded me that everyone within the family has a responsibility to each other. Our women, mothers and daughters too have a significant responsibility in the journey, in fact, they hold us, care for us, and given strength to their husbands, brothers, and sons. The wise man or elder sits in the middle of the canoe, directing the young man who help to steer. The young man, he does all the work, directed by the older man. They take advice and seek the wisdom of the elder. In front of the canoe, a young boy is placed there and because of his strong and youthful vision, he is able to help the elder as well as the young man on the canoe. The story can be linked to the roles that school leaders, teachers, and students have in schooling. Without each person knowing intricately their role and responsibility, the sight and vision ahead for the collective aspirations of the school and the community is difficult to comprehend. For me, the canoe is symbolic of our educational journey within our education system. As the school leader, a central, trusted, and respected figure in the school, they provide support for teachers who are at the helm, pedagogically striving to provide for their students. For without strong direction from the school leaders and teachers at the helm, the students, like the young boy, cannot foresee their futures, or envisage how education can benefit them. This is why Kanne Lobal is a significant framework for us in the Marshall Islands because within the practice we are able to take heed and empower each other so that all benefit from the process. Kanne Lobal is linked to our culture, an essential part of who we are. We must rely on our own local approaches, rather than relying on others that are not relevant to what we know and how we live in today’s society. One of the things I can tell is that in Majuro, compared to the outer islands, it’s different. In the outer islands, parents bring children together and tell them legends and stories. The elders tell them about the legends and stories – the bwebwenato. Children from outer islands know a lot more about Marshallese legends compared to children from the Majuro atoll. They usually stay close to their parents, observe how to prepare food and all types of Marshallese skills. Loretta Joseph Case There is little Western influence in the outer islands. They grow up learning their own culture with their parents, not having tv. They are closely knit, making their own food, learning to weave. They use fire for cooking food. They are more connected because there are few of them, doing their own culture. For example, if they’re building a house, the ladies will come together and make food to take to the males that are building the house, encouraging them to keep on working - “jemjem maal” (sharpening tools i.e. axe, like encouraging workers to empower them). It’s when they bring food and entertainment. Rubon Rubon Togetherness, work together, sharing of food, these are important practices as a school leader. Jemjem maal – the whole village works together, men working and the women encourage them with food and entertainment. All the young children are involved in all of the cultural practices, cultural transmission is consistently part of their everyday life. These are stronger in the outer islands. Kanne Lobal has the potential to provide solutions using our own knowledge and practices. Connie Joel When new teachers become a teacher, they learn more about their culture in teaching. Teaching raises the question, who are we? A popular saying amongst our people, “Aelon kein ad ej aelon in manit”, means that “Our islands are cultural islands”. Therefore, when we are teaching, and managing the school, we must do this culturally. When we live and breathe, we must do this culturally. There is more socialising with family and extended family. Respect the elderly. When they’re doing things the ladies all get together, in groups and do it. Cut the breadfruit, and preserve the breadfruit and pandanus. They come together and do it. Same as fishing, building houses, building canoes. They use and speak the language often spoken by the older people. There are words that people in the outer islands use and understand language regularly applied by the elderly. Respect elderly and leaders more i.e., chiefs (iroj), commoners (alap), and the workers on the land (ri-jerbal) (social layer under the commoners). All the kids, they gather with their families, and go and visit the chiefs and alap, and take gifts from their land, first produce/food from the plantation (eojōk). Tommy Almet The people are more connected to the culture in the outer islands because they help one another. They don’t have to always buy things by themselves, everyone contributes to the occasion. For instance, for birthdays, boys go fishing, others contribute and all share with everyone. Kanne Lobal is a practice that can bring people together – leaders, teachers, stakeholders. We want our colleagues to keep strong and work together to fix problems like students and teachers’ absenteeism which is a big problem for us in schools. Demetria Malachi The culture in the outer islands are more accessible and exposed to children. In Majuro, there is a mixedness of cultures and knowledges, influenced by Western thinking and practices. Kanne Lobal is an idea that can enhance quality educational purposes for the RMI. We, the school leaders who did GCSL, we want to merge and use this idea because it will help benefit students’ learning and teachers’ teaching. Kanne Lobal will help students to learn and teachers to teach though traditional skills and knowledge. We want to revitalize our ways of life through teaching because it is slowly fading away. Also, we want to have our own Marshallese learning process because it is in our own language making it easier to use and understand. Essentially, we want to proudly use our own ways of teaching from our ancestors showing the appreciation and blessings given to us. Way Forward To think of ways forward is about reflecting on the past and current learnings. Instead of a traditional discussion within a research publication, we have opted to continue our bwebwenato by sharing what we have learnt through the Graduate Certificate in School Leadership (GCSL) programme. Our bwebwenato does not end in this article and this opportunity to collaborate and partner together in this piece of writing has been a meaningful experience to conceptualise and unpack the Kanne Lobal framework. Our collaborative bwebwenato has enabled us to dig deep into our own wise knowledges for guidance through mediating and negotiating the challenges in education and leadership (Sanga & Houma, 2004). For example, bwe-jen-lale-rara reminds us to inquire, pay attention, and focus on supporting the needs of others. Through enra-bwe-jen-lale-rara, it reminds us to value cultural exchange and reciprocity which will strengthen the development and maintaining of relationships based on ways we continue to honour each other (Nimmer, 2017). We not only continue to support each other, but also help mentor the next generation of school leaders within our education system (Heine, 2002). Education and leadership are all about collaborative partnerships (Sanga & Chu, 2009; Thaman, 1997). Developing partnerships through the GCSL was useful learning for us. It encouraged us to work together, share knowledge, respect each other, and be kind. The values of jouj (kindness, love), kautiej (respect), and jouj eo mour eo (reciprocity) are meaningful in being and becoming and educational leader in the RMI (Jetnil-Kijiner, 2014; Miller, 2010; Nimmer, 2017). These values are meaningful for us practice particularly given the drive by PSS for schools to become accredited. The workshops and meetings delivered during the GCSL in the RMI from 2018 to 2019 about Kanne Lobal has given us strength to share our stories and experiences from the meeting with the stakeholders. But before we met with the stakeholders, we were encouraged to share and speak in our language within our courses: EDP05 (Professional Development and Learning), EDP06 (School Leadership), EDP07 (School Management), EDP08 (Teaching and Learning), and EDP09 (Community Partnerships). In groups, we shared our presentations with our peers, the 15 school leaders in the GCSL programme. We also invited USP RMI staff. They liked the way we presented Kannel Lobal. They provided us with feedback, for example: how the use of the sail on the canoe, the parts and their functions can be conceptualised in education and how they are related to the way that we teach our own young people. Engaging stakeholders in the conceptualisation and design stages of Kanne Lobal strengthened our understanding of leadership and collaborative partnerships. Based on various meetings with the RMI Pacific Resources for Education and Learning (PREL) team, PSS general assembly, teachers from the outer islands, and the PSS executive committee, we were able to share and receive feedback on the Kanne Lobal framework. The coordinators of the PREL programme in the RMI were excited by the possibilities around using Kanne Lobal, as a way to teach culture in an inspirational way to Marshallese students. Our Marshallese knowledge, particularly through the proverbial meaning of Kanne Lobal provided so much inspiration and insight for the groups during the presentation which gave us hope and confidence to develop the framework. Kanne Lobal is an organic and indigenous approach, grounded in Marshallese ways of doing things (Heine, 2002; Taafaki & Fowler, 2019). Given the persistent presence of colonial processes within the education system and the constant reference to practices and initiatives from the US, Kanne Lobal for us provides a refreshing yet fulfilling experience and makes us feel warm inside because it is something that belongs to all Marshallese people. Conclusion Marshallese indigenous knowledge and practices provide meaningful educational and leadership understanding and learnings. They ignite, inspire, and transform thinking and practice. The Kanne Lobal conceptual framework emphasises key concepts and values necessary for collaborative partnerships within education and leadership practices in the RMI. The bwebwenato or talk stories have been insightful and have highlighted the strengths and benefits that our Marshallese ideas and practices possess when looking for appropriate and relevant ways to understand education and leadership. 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Galczyk (2021) Preschool Parents’ Views of Distance Learning during COVID-19, Early Education and Development, 32:7, 923-939, DOI: 10.1080/10409289.2021.1930936 Muhdi, Nurkolis, & Yuliejantiningsih, Y. (2020). The Implementation of Online Learning in Early Childhood Education During the Covid-19 Pandemic. JPUD - Jurnal Pendidikan Usia Dini, 14(2). https://doi.org/10.21009/jpud.142.04 Ortlipp, M. (2015). Keeping and Using Reflective Journals in the Qualitative Research Process. The Qualitative Report. https://doi.org/10.46743/2160-3715/2008.1579 Paat, Y. F. (2013). Working with Immigrant Children and Their Families: An Application of Bronfenbrenner’s Ecological Systems Theory. Journal of Human Behavior in the Social Environment, 23(8). https://doi.org/10.1080/10911359.2013.800007 Plowman, L., Stephen, C., & McPake, J. (2010). Supporting young children’s learning with technology at home and in preschool. Research Papers in Education, 25(1). https://doi.org/10.1080/02671520802584061 Rona Novick, Suzanne Brooks & Jenny Isaacs (2021) Parental Report of Preschoolers’ Jewish Day School Engagement and Adjustment During the Covid-19 Shutdown, Journal of Jewish Education, 87:4, 301-315, DOI: 10.1080/15244113.2021.1977098 Sandi Ferdiansyah, S. S., & Angin, R. (2020). Pengalaman Mahasiswa Thailand dalam Pembelajaran Daring di Universitas di Indonesia pada Masa Pandemi COVID-19. Journal of International Students, 10(S3). Sonnenschein, S., Stites, M., & Dowling, R. (2021). Learning at home: What preschool children’s parents do and what they want to learn from their children’s teachers. Journal of Early Childhood Research, 19(3). https://doi.org/10.1177/1476718X20971321 Sri Indah Pujiastuti, Sofia Hartati & Jun Wang (2022) Socioemotional Competencies of Indonesian Preschoolers: Comparisons between the Pre-Pandemic and Pandemic Periods and among DKI Jakarta, DI Yogyakarta and West Java Provinces, Early Education and Development, DOI: 10.1080/10409289.2021.2024061 Stone, K., Burgess, C., Daniel, B., Smith, J., & Stephen, C. (2017). Nurture corners in preschool settings: Involving and nurturing children and parents. Emotional and Behavioural Difficulties, 22(4). https://doi.org/10.1080/13632752.2017.1309791 Suzanne M. Egan & Chloé Beatty (2021) To school through the screens: the use of screen devices to support young children's education and learning during the COVID-19 pandemic, Irish Educational Studies, 40:2, 275-283, DOI: 10.1080/03323315.2021.1932551 Thomson, S. (2007). Do’s and don’ts: Children’s experiences of the primary school playground. Environmental Education Research, 13(4). https://doi.org/10.1080/13504620701581588 Vallejo-Ruiz, M., & Torres-Soto, A. (2020). Teachers’ conceptions on the quality of the teaching and learning process in early childhood education. Revista Electronica Educare, 24(3). https://doi.org/10.15359/REE.24-3.13 Widodo, H. P. (2014). Methodological considerations in interview data transcription. International Journal of Innovation in English Language, 3(1). Wijaya, Candra., Dalimunthe, Rasyid Anwar., & Muslim. Parents’ Perspective on The Online Learning Using Zoom Application in Early Childhood Education. JPUD: Jurnal Pendidikan Usia Dini, Volume 15 Number 2. DOI: https://doi.org/10.21009/JPUD.152.06 Winship, M., Standish, H., Trawick-Smith, J., & Perry, C. (2021). Reflections on practice: Providing authentic experiences with families in early childhood teacher education. In Journal of Early Childhood Teacher Education (Vol. 42, Issue 3). https://doi.org/10.1080/10901027.2020.1736695

Abstract Background The coronavirus disease 2019 (COVID-19) has severely influenced various aspects of human life, particularly education. This study aimed to explain the impact of the COVID-19 pandemic on nursing education from administrators, educators, and students’ perspectives. Methods This qualitative study with a conventional content analysis approach was conducted from June to October 2020 at a nursing school in Tehran. Thirteen participants were enrolled using purposive sampling. Data collection was through in-depth and semi-structured interviews and continued until reaching data saturation. Nursing administrators, educators, and students constructed interviews to understand nursing education changes during the pandemic. All interviews were recorded, transcribed, reviewed, coded, and analyzed using the Graneheim and Lundman methods. Results Interviewed respondents included administrators and professors (n = 6) and nursing students (n = 7). The respondents reported five main topic areas: (1) safe management in ambiguous situations; (2) perceived situations; (3) adaptive coping; (4) educational facilitators and challenges, and (5) continuing education in an uncertain context. The central theme was “close conflict of education with COVID-19”. Conclusions The current study noted instability and challenges placed on nursing education during the pandemic. Opportunities were addressed during the pandemic to improve the nursing training process using planning, scientific management, emerging technology, innovative educational opportunities, and comprehensive support from institutional stakeholders. Clear guidelines and recommendations are needed to ensure medical education safety during the pandemic.

Bathroom access and use in conjunction with biological urge to void is an important part of optimal bladder health. School settings are uniquely positioned to influence the development of bladder habits. The aim of this study was to identify barriers and facilitators to high school bathroom use for adolescent women. A qualitative study design was used to conduct semi-structured interviews focused on experiences with bathroom use while at school. Thirty adolescent women were interviewed, and transcripts were analyzed using thematic analysis methods. Barriers included unpleasant bathroom environments, lack of privacy, and school/teacher policies. Facilitators included clean, private bathrooms and menstruation. Improving bathroom cleanliness, privacy, and eliminating policies aimed at controlling bathroom access may reduce barriers to bathroom use. School nurses have a unique role in educating teachers, administrators, and students about the importance of clean bathrooms and policies that support bathroom use in conjunction with biological urge.

This study identified custodial grandparents’ perception of sources of stress that may affect their health and better understand their needs. Findings from this qualitative study are based on thematic analysis of interviews with 10 custodial grandparents. The following themes emerged: 1) grandparents’ stress from perceived lack of readiness to care for grandchildren; 2) need for effective communication between and among family members; 3) sufficiency of financial and legal resources; 4) access to community resources, and 5) raising grandchildren reenergizes and revitalizes grandparents’ physical and mental health. These findings provide insight into the stressful aspects of the role of raising grandchildren. Understanding stressors affecting custodial grandparents and their grandchildren will help school nurses, social workers, teachers, school administrators and other professionals collaborate to address their challenges.

Background School-based COVID-19 testing is a potential strategy to facilitate the safe reopening of schools that have been closed due to the pandemic. This qualitative study assessed attitudes toward this strategy among four groups of stakeholders: school administrators, teachers, parents, and high school students. Methods Focus groups and interviews were conducted in Los Angeles from December 2020 to January 2021 when schools were closed due to the high level of COVID transmission in the community. Results Findings indicated similarities and differences in attitudes toward in-school COVID-19 testing. All groups agreed that frequent in-school COVID-19 testing could increase the actual safety and perceived safety of the school environment. School administrators expressed pessimism about the financial cost and logistics of implementing a testing program. Parents supported frequent testing but expressed concerns about physical discomfort and stigma for students who test positive. Teachers and parents noted that testing would prevent parents from sending sick children to school. Students were in favor of testing because it would allow them to return to in-person school after a difficult year of online learning. Conclusion In-school COVID-19 testing could be a useful component of school reopening plans and will be accepted by stakeholders if logistical and financial barriers can be surmounted and stigma from positive results can be minimized.

Abstract Objective: Identify and analyze the institutional links of secondary schools to cope with school violence. Methods: Qualitative, descriptive and exploratory study, based on the concept of social network. Twelve secondary school administrators and coordinators were interviewed. The links established between the schools and other institutions were mapped using minimum maps of social institutional external network and semi-structured interviews. Data were analyzed through thematic content analysis. Results: The category "Mapping institutional links" showed important deficiencies in the institutional links between the studied schools and other sectors to cope with school violence. Conclusion: In methodological terms, the study considers social and institutional networks to cope with contemporaneous phenomena and presents important contributions to nursing, warning to current health needs of adolescents.

Arts programs are increasingly recognized for their role in promoting student development and cohesive school communities. Yet, most Australian schools are left to navigate a landscape characterized by shifting policy goals and external providers of diverse quality and intent. Drawing on interviews with 27 stakeholders from 19 Catholic primary schools in Melbourne, Australia, we explored key approaches to arts provision in this context, and conditions that hinder and support it. Approaches varied markedly, from school-wide programs embedded across the curriculum, to one-off incursions. Conditions consistently affecting provision ranged from leadership support to a community’s view of the arts. Programs regularly relied on individuals passionate about arts to go beyond their paid roles, yet this frequently jeopardized sustainability. Overall, the approaches identified, and conditions affecting their sustainability, reveal a lack of value for school arts at policy and administration levels. This lack of value is not demonstrated in the provision of other traditional school activities like math or literacy, which begs consideration by policymakers and school administrators.

Abstract Background An academic environment is the first place that nursing students are introduced to ethics related to nursing and healthcare. In this study, we explored the nursing faculty members’ point of view regarding noncompliance with these academic ethics. Methods This study was a qualitative descriptive study conducted in 2018. Faculty members at a nursing school were selected through purposeful sampling. Data was collected using semi-structured interviews. The interviews were digitally recorded and transcribed verbatim. Data collection and data analysis were conducted simultaneously. Data saturation was ensured with 11 interviews. The interview transcripts were analyzed using a qualitative content analysis method introduced by Elo and Kyngäs. Results The participants were six women and five men with 12.72 ± 6.64 years of experience as nursing instructors. After data analysis, seven categories were identified: discrimination, violence, misuse, out-of-date instruction and knowledge, conflicts of evaluation, hypocrisy, and disorganization. Conclusion The findings of this study indicated the existence of noncompliance regarding academic ethics. It is recommended that faculty members be informed about possible instances of ethical noncompliance in academia. There is a need to develop strategies to promote a faculty’s compliance with academic ethics. Academic administrators need to emphasize the importance of ethics in academia and use further methods to enhance academic ethics.

Abstract Background An academic environment is the first place that nursing students are introduced to ethics related to nursing and healthcare. In this study, we explored the nursing faculty members’ point of view regarding noncompliance with these academic ethics. Methods This study was a qualitative descriptive study conducted in 2018. Faculty members at a nursing school were selected through purposeful sampling. Data was collected using semi-structured interviews. The interviews were digitally recorded and transcribed verbatim. Data collection and data analysis were conducted simultaneously. Data saturation was ensured with 11 interviews. The interview transcripts were analyzed using a qualitative content analysis method introduced by Elo and Kyngäs. Results The participants were six women and five men with 12.72 ± 6.64 years of experience as nursing instructors. After data analysis, seven categories were identified: discrimination, violence, misuse, out-of-date instruction and knowledge, conflicts of evaluation, hypocrisy, and disorganization. Conclusion The findings of this study indicated the existence of noncompliance regarding academic ethics. It is recommended that faculty members be informed about possible instances of ethical noncompliance in academia. There is a need to develop strategies to promote a faculty’s compliance with academic ethics. Academic administrators need to emphasize the importance of ethics in academia and use further methods to enhance academic ethics.

The American Academy of Pediatrics recognizes recess as an essential part of overall child development in schools, impacting children’s cognitive, socioemotional and physical health and development. However, recess is often removed from the school curriculum in exchange for more classroom activities. The Centers for Disease Control and Prevention (CDC) and SHAPE America developed Strategies for Recess in Schools to promote high-quality recess through specific actions, yet is not known how these are successfully implemented, particularly, in underserved settings. This formative research study examined the implementation of the CDC strategy in an urban, inner-city charter elementary school to identify barriers and facilitators to successful recess implementation from the perspective of various stakeholders. Thirteen in-depth interviews and focus group discussions were conducted with parents, teachers, recess monitors, and school administrators. Interviews were recorded, transcribed, and coded for thematic analysis, supported by group discussion and analytic memos. Results suggested that although stakeholders recognized the importance of recess, the implementation of the CDC strategy was neither uniformly understood nor implemented, suggesting that additional frameworks may be helpful in implementing the CDC strategy in schools in underserved communities.

In 2013, the Chicago Public Schools district received funding from the Division of Adolescent and School Health at the Centers for Disease Control and Prevention (CDC) to implement a series of strategies aimed to reduce HIV, STIs (sexually transmitted diseases), and related risk behaviors among students. One such set of strategies included “safe and supportive environments” (SSE), aimed to support lesbian, gay, bisexual, transgender, questioning, and other LGBTQ+ students. SSE strategies included professional development and technical assistance provided to K–12 school staff (teachers, administrators, social workers, etc.) to implement the following practices: support for transgender and gender nonconforming students in accordance with district guidelines, use of LGBTQ+ inclusive curricula, posting of signs and symbols of support, and creation of Genders and Sexualities Alliance student clubs. To monitor progress and performance, both quantitative and qualitative process measure data were collected. Quantitative data consisted of key metrics such as number of staff trained and surveillance data collected through school health profiles in collaboration with the CDC. Qualitative data were gathered to understand barriers and facilitators to implementation of SSE practices via interviews with 55 school staff members and four focus groups with 31 high school students. Results indicated an increased uptake of all SSE activities across the 5-year funding period. Findings also reveal additional needed supports, such as increased availability and offering of professional development for all staff, support for staff in engaging parents, and ensuring the LGBTQ+ inclusive sexual health education curriculum is experienced as such by students. Current work to address these needs is described.

Abstract Background Simulation based learning (SBL) is a technique where teachers recreate “real life” clinical experiences for health care teams for purposes of gaining clinical skills in a safe environment. There is evidence that SBL is superior to the traditional clinical teaching methods for acquisition of clinical skills. Although it is well established in resource rich settings, there is limited experience in resource limited settings and there is uncertainty regarding how SBL will be perceived among the stakeholders in medical education. As part of the steps leading to implementation of a SBL program at a university in Uganda, we sought to describe the perceptions of various stakeholders regarding the introduction of SBL methodology into learning at a medical school in Uganda. Methods We conducted a formative qualitative assessment using key informant interviews (KIIs) among faculty members and university administrators and focus group discussions (FGDs) among medical and nursing students at Mbarara University of Science and Technology. Data were collected till saturation point and were transcribed and analyzed manually using open and axial coding approaches to develop themes. Results We conducted seven KIIs and three FGDs. Overall, findings were categorized into five broad themes: 1. Motivation to adopt simulation-based learning 2. Prior experience and understanding of simulation-based education 3. Outcomes arising from introduction of medical simulation 4. Drawbacks to establishment of medical simulation; and 5. Potential remedies to the drawbacks. Overall, our data show there was significant buy-in from the institution for SBL, stakeholders were optimistic about the prospects of having a new method of teaching, which they perceived as modern to complement the traditional methods. There was significant knowledge but very limited prior experience of medical simulation. Also, there was some concern regarding how students and faculty would embrace training on lifeless objects, the human resources needed and sustainability of simulation-based learning in the absence of external funding. Conclusion Stakeholders perceive SBL positively and are likely to embrace the learning methods. Concerns about human resource needs and sustainability need to be addressed to ensure acceptability.

I am very pleased to welcome readers to Volume 5(2) of the International Journal for Educational Integrity. Before introducing the current issue, I would like to begin with a couple of announcements. The 4th Asia-Pacific Conference on Educational Integrity: Creating an Inclusive Approach will be held at the University of Wollongong, in New South Wales, Australia, from 28-30 September. The conference is built around a stimulating, discussion-centred format on a range of topics from plagiarism to values in teaching and learning, and the broader educational context. Presentation proposals and registrations are still being accepted. For full details, please go the conference website: http://www.uow.edu.au/conferences/4APCEI_2009/home.html Shortly after 4APCEI, the Center for Academic Integrity will hold its Annual Conference. Creating a culture of integrity: Research and best practices will be held at Washington University in St Louis, Missouri, USA, from 16-18 October. Proposals relating to current trends in academic integrity, data on the success rates of various approaches to academic integrity initiatives, innovative new approaches and models of best practices are invited. For full details, please go the conference website: http://www.academicintegrity.org/conferences/2009_Conference/index.php This edition of the IJEI includes two full papers and four reviews of recently published books on issues relating to educational integrity. Brian Martin opens the journal with an expansive essay which elaborates on the little explored topic of 'academic patronage'. Martin defines academic patronage as the bias and discrimination that occurs through decisions made, processes used, assistance given to individuals and personal interactions in academia. After providing careful descriptions of the various forms of academic patronage, Martin uses the example of honours thesis examining to illustrate some of the tensions inherent in a practice with "considerable potential for patronage". While acknowledging the value of mentoring, such as supporting research students, and providing training, advice, references and job opportunities, Martin makes the case that academic patronage has the potential to undermine the meritocratic foundation of academia. In the second paper of this issue, Malcolm Rees and Lisa Emerson share a revised version of their presentation from the 3rd International Plagiarism Conference at Northumbria University in June 2008. Based on structured interviews with nine staff members at Massey University in New Zealand, Rees and Emerson extend the research on electronic detection of plagiarism by exploring the impact that the text-matching software program, Turnitin, has had on assessment practice. They asked staff if their use of Turnitin in traditional text-based assessments had resulted in alternative assessment approaches to reduce incidences of plagiarism, and to encourage students to work effectively with secondary source material. Although the authors found that seven of the nine staff members surveyed had not changed their assessment practices, two cases of innovative practice were identified and are showcased in the paper. The last 12 months has seen the publication of some truly outstanding books on academic integrity, and the second part of the current issue provides reviews of four of these texts. I was fortunate to be given a sneak preview of Cheating in School: What we know and what we can do (Stephen F. Davis, Patrick F. Drinan and Tricia Bertram Gallant) due to be released in August this year by Wiley-Blackwell. Julianne East from La Trobe University in Melbourne reviews Rebecca Moore Howard’s and Amy Robillard’s Pluralizing plagiarism: Identities, Contexts, Pedagogies, published by Boynton/Cook last year; Ursula McGowan from the University of Adelaide, South Australia, reviews Pedagogy, not policing: Positive approaches to academic integrity at the university (Tyra Twomey, Holly White and Ken Sagendorf), published earlier this year by the Graduate School Press at Syracuse University; and Ruth Walker from the University of Wollongong, New South Wales, reviews Caroline Eisner’s and Martha Vicinus’ edited collection Originality, Imitation and Plagiarism: Teaching Writing in the Digital Age (2008). These books, all published in the U.S., provide diverse perspectives on the multi-faceted topic of academic integrity. What brings them together is the clear commitment from each of the authors to move away from a simplistic and/or punitive focus on student plagiarism to examine the broader educational context. Academic integrity is the commitment to five fundamental values: honesty, trust, fairness, respect and responsibility (Center for Academic Integrity 2009). This view of integrity as a "clustering of values beyond honesty" (Davis, Drinan & Bertram Gallant, 2009, forthcoming, p. 26), involves much more than a commitment from students not to cheat. The Center for Academic Integrity (CAI) makes explicit that academic integrity is multi-dimensional and is enabled by all those in the educational enterprise, from students to parents, instructors and administrators. It is for this reason that the CAI’s counterpart and sponsor of this journal, the Asia Pacific Forum on Educational Integrity (APFEI), prefaces 'integrity' with 'educational' rather than'academic'. From the first conference in 2003, we have attempted to encapsulate the complex aspects and numerous stakeholders of integrity across the various educational sectors, with a clear intention not to limit the topic to universities (Bretag & Green, 2009, under review). It is evident from the books reviewed in this issue that the field of academic/educational integrity is attracting researchers with a sophisticated understanding of the issues that go well beyond student plagiarism, writing practices or even research ethics. Tracey Bretag, Editor IJEI References Bretag, T. & Green, M. (2009, under review). Determining outcomes for academic misconduct: Is it more important to be consistent or fair? Paper submitted for review to the 4th Asia-Pacific Conference on Educational Integrity: Creating an Inclusive Approach, University of Wollongong, 28-30 September 2009. Center for Academic Integrity (2009). Retrieved May 28, 2009 from http://www.academicintegrity.org/index.php Davis, S. F., Drinan, P. F. & Bertram Gallant, T. (2009, forthcoming). Cheating in school: What we know and what we can do. MA, USA: Wiley Blackwell, Malden.

Welcome to the last issue of the IJEI for 2013. It has been an exciting year with numerous conferences and research on academic integrity around the world. Auckland University of Technology kicked off the year with the Fraud, Fakery and Fabrication: Academic and research integrity conference, the International Center for Academic Integrity held their annual conference in San Antonio on 28 February, the National Roundtable and Australian National Speaking Tour for the Exemplary Academic Integrity Project was also held in late February and early March, the 3rd World Conference on Research Integrity was held in Montreal in May, the Plagiarism across Europe and Beyond Conference shared the results of the 'Impact of policies for plagiarism in higher education across Europe' project in Brno, Czech Republic in June, and the 6th Asia Pacific Conference on Educational Integrity showcased the work of Australian Office for Learning and Teaching commissioned projects on academic integrity in Sydney in October. With so much interest and research on this topic across a range of countries and contexts, it is perhaps not surprising that the current issue is an eclectic mix of reflective, conceptual, empirical and case study work from researchers spanning six countries, including the United Arab Emirates, Norway, Australia, Sweden, Indonesia and the UK. The issue covers diverse topics extending from the development of academic skills, to motivations and predictors of student plagiarism, systems to reduce plagiarism and the responsibility of universities to provide marketing information based on ethical principles of honesty and trustworthiness. Student groups represented include secondary school, undergraduate and postgraduate. Radhika Iyer-O'Sullivan, formerly of the British University in Dubai, analyses faculty feedback, samples of student writing and Turnitin Similarity Reports to determine if teaching critical reading as a threshold concept results in critical thinking and subsequently improved critical writing skills. While the sample was small and the results inconclusive, Iyer-O'Sullivan makes the case that teaching critical reading assists students to understand the importance of using supporting evidence to develop a convincing academic argument. Håvard Skaar and Hugo Hammer from Oslo and Akershus University College, Norway use a mixed-methods approach to explore secondary school students' plagiarism of internet sources in essay writing. The survey of 67 students indicated that 75% of students reported plagiarising from online sources and that plagiarism accounted for 25% of the total amount of text. Students with a higher grade in written Norwegian plagiarised less than those with a lower grade, and students more conversant with appropriate citation practices plagiarised less than those students less familiar with referencing conventions. Qualitative feedback from interviews with 29 students indicated that the students wanted to spend as little time and effort as possible on the assessment task and that plagiarism was chosen as a writing strategy, with little reflection on the moral aspects on this decision. In contrast, Rebecca Awdry, from the University of Canberra, and Rick Sarre, from the University of South Australia, found that the university students in their study expressed strong ethical positions in relation to plagiarism, arguing that it was cheating and dishonest. Awdry and Sarre explored students' motivations to plagiarise using a mixed methods approach, and analysed the data through the prism of criminological theory. The authors conclude that while rational choice theory provides some insight into student breaches of academic integrity, there is an apparent disconnect between the way that academics view students' behaviour and how students themselves express their motivations. In agreement with key writers in the field (Bertram Gallant, McCabe, Bretag et al.), Awdry and Sarre conclude that higher education providers should focus less on detection and punishment and more on developing a values-based culture of integrity. Based on a sample of 362 undergraduate psychology students, and in the context of the Indonesian government's position that any form of plagiarism "is a serious offense that may even be classified as an illegal action", Ide Bagus Siaputra, from Universitas Surabaya, explores the proposition that "regardless of the presence or absence of opportunities and the severity of the potential sanctions, some individuals seem to be prone to plagiarism". Siaputra builds on the work of Williams, Nathanson and Paulhus (2010), to propose five variables as predictors of plagiarism, including procrastination, performance, personality, perfectionism, and achievement motivation, and names the model 'the 4PA of plagiarism'. Findings from the author's study indicate that procrastination was the key predictor of plagiarism, followed by achievement motivation. Looking to provide a multi-pronged response to student plagiarism, Ken Larsson and Henrik Hansson from Stockholm University, Sweden share the results of an innovation at their university. The digital system called SciPro was developed to support independent student thesis work, decrease the burden on supervisors for feedback on basic skills, and reduce plagiarism. The system includes a number of modules which facilitate management, communication and learning. According to the authors, SciPro works to prevents plagiarism by providing: 1) clear instructions about rules and regulations for students and supervisors; 2) an online peer-review system; 3) transparent online communication and file storage of accumulated manuscripts; and 4) a final seminar module enabling automatic generation of originality reports from Turnitin when students upload their final thesis manuscripts. Larsson and Hansson report that the implementation of SciPro has resulted in substantial improvements in policy development, successful integration of anti-plagiarism software, and an increased awareness of plagiarism issues. The final paper in the issue reminds us that academic integrity is an issue which underpins every aspect of the educational enterprise and goes well beyond plagiarism in student assessment. Educational psychologist, John Bradley, from the UK, offers a typology of nine misleading data-based marketing claims based on his examination of UK university prospectuses. Bradley's analysis leads him to assert that marketing of higher education should aspire to higher ethical standards than marketing in general because of the high stakes involved for a potentially vulnerable group, and because the reputation of the university is founded on having high standards of scholarship. Rather than rely on external regulators to ensure the authenticity of marketing claims, the author advocates a system of voluntary peer review of university marketing prospectuses based on the principles of research and publication ethics. I trust you will enjoy this varied issue which will interest teachers, researchers, policymakers, administrators and marketers of education, in both secondary and tertiary contexts. Volume 10(1) of the IJEI, to be published in June 2014, will include the best reviewed papers from the Plagiarism Across Europe and Beyond Conference, Czech Republic 2013, along with appropriate papers submitted via the IJEI platform. Tracey Bretag, IJEI Editor Email: tracey.bretag@unisa.edu.au

Prelude: 2020 in Words Each year the Australian National Dictionary Centre, based at the Australian National University (ANU), selects “a word or expression that has gained prominence in the Australian social landscape”. In 2020, “iso” took out first place, with “bubble” following close behind. On the Centre’s website, Senior Researcher Mark Gywnn explains that “iso” was selected not only for its flexibility, merrily combining with other words to create new compound words (for instance “being in iso”, doing “iso baking” and putting on “iso weight”), but also because it “stood out as a characteristically Aussie abbreviation” (Australian National Dictionary Centre). Alongside the flexibility of the word “iso” and its affinity with the Australian English tradition of producing and embracing diminutives, iso’s appeal might well be that it does not carry the associations that the word “bubble” has acquired in the time of COVID. While COVID-19 has put many of us in various forms of “iso”, the media imagery—and indeed experiences—of many older people living in residential aged care during COVID has shifted some of the associations of the word “bubble”, heightening its associations with fragility and adding vulnerability and helplessness into the mix. 2020 was not the first time “bubble” has appeared in the Australian word of the year list. In 2018 “Canberra bubble” took out the first spot. What interests us about bubble’s runner-up position behind “iso” in 2020’s word of the year is what this might also reveal about the way ideas of independence vs dependence, and youthfulness vs aged underlie and inflect new usages of these words. In the era of COVID-19, the buoyancy of “iso” is tied to its association with a particular kind of Aussie-youth-speak, while the sense of heaviness and negative resonances that now accompany the word bubble are tied to its associations with the experiences of those in aged care. In 2020 “bubble”—a word that has primarily been associated with children and the child-like (bubble baths, bubble tea)—took on new associations and overtones. As the pandemic unfolded, “bubble” also became intertwined with media depictions of and popular discourses around those in later life, many of whom experienced “iso” much more brutally than the easy-Aussie-speak of “iso” would convey. There is much less play—and a lot less mingling—in the Australian National Dictionary Centre description of new uses of the word “bubble”: “a district, region, or a group of people viewed as a closed system, isolating from other districts, regions, or groups as a public health measure to limit the spread of Covid-19”. There have been various kinds of “closed system[s]”, isolated groups and regions constructed in the management of the pandemic, but there is one group—and one kind of location—that has been “bubbled” in quite specific ways. While the sectioning off and isolating of older age people in the name of protecting their health has often been ineffectively—and in some places, disastrously—managed in terms of disease prevention, it has been very effective in reducing the rights and voices of those it acts in the name of. Speaking from Ireland but commenting on the situation in the UK and parts of Europe, Anne Fuchs and colleagues write that “the discursive homogenization and ‘frailing’ of the over 65s meant that people in this category were an object of public discourse rather than participants in the debate” (2). In many instances the “bubbling” of older people, particularly those in aged care residences, has served to both isolate and render largely voiceless the residents of these care homes. Although the global impact of COVID-19 on the aged has been significant, including across many affluent societies, it has been particularly disastrous in Australia. At the time of writing (1 January 2021), of the 909 COVID-related deaths in Australia to date, 693 have been of people aged 80 or over: in other words, more than 75% of COVID-related deaths in Australia have been of people over 80. According to the federal government’s records of COVID-19 deaths by age group and sex, 685 of these deaths have been of aged care residents. It is not surprising therefore that many speak of the heavy impact of COVID-19 on older people as a form of genocide. Public discourse and government policies and priorities around COVID-19 have thrown into relief and exacerbated some of the deeply troubling ways that older people, particularly those living in aged care residences, are not recognised or treated as “equal partners in our future” (Royal Commission into Aged Care 1). Both the management of and public discourse around COVID-19 have highlighted and escalated the forms of ageism, especially ageism around later life, that have become embedded in Australian culture. In late 2019 the Royal Commission into Aged Care Quality and Safety released its Interim Report, titled simply Neglect. In the Foreword, the commissioners write: the Australian community generally accepts that older people have earned the chance to enjoy their later years, after many decades of contribution and hard work. Yet the language of public discourse is not respectful towards older people. Rather, it is about burden, encumbrance, obligation and whether taxpayers can afford to pay for the dependence of older people. (Royal Commission into Aged Care 1) Written and released before the COVID-19 pandemic, the Interim Report highlighted the “fundamental fact that our aged care system essentially depersonalises older people” (Royal Commission into Aged Care 6) and identified many ways “the aged care system fails to meet the needs of our older, often very vulnerable, citizens” (Royal Commission into Aged Care 1). In 2020 we saw some of the effects of these failures in the often disastrous mismanagement of disease transmission prevention in many aged care residences in Australia. Equally troubling, the resulting deaths have at times been accompanied by a general acceptance of the loss of so many in later life to COVID-19. The fact that these deaths are often regarded as somehow more inevitable, or as less significant than the deaths of others, is an indication of how deeply “Australia has drifted into an ageist mindset that undervalues older people and limits their possibilities” (Royal Commission into Aged Care 1). It assumes that one’s later-life years are of less significance and value (to oneself, to the community) than one’s younger years. At various times in the pandemic, sizable parts of the global population have been variously asked, advised, or required by their governments to remain within their household or residential “bubble”. These COVID-related “bubbles” are more buoyant for some. Jackie Gulland has written a feminist analysis of the ways that the UK COVID-19 lockdown rules are premised on “neo-liberal assumptions about the family as autonomous and sufficient for the provision of reproductive labour” (330). In many places the requirement to stay within one’s “household bubble” both assumes that the home is safe for all, and that most care and dependency requirements are provided and received within a household. As Gulland’s essay demonstrates, the idea of the household bubble constructs an image or idea of who and what constitutes a household, and which relationships “count”. Drawing on critiques of neo-liberal and able-ist ideas about autonomy by feminist and disability scholars, Gulland “shows how the failure of policymakers to take account of interdependency has made lockdown more difficult for carers and those in receipt of care” (330). In this essay we look at some of the ways that the required and/or imagined COVID-19 bubbles for people in later life are thought of differently to the COVID-19 bubbles that younger, and mixed age, households are imagined as forming. This is particularly the case, we argue, for those in aged care residences. Younger and mixed age COVID bubbles often include extended or linked households (as we will discuss below in relation to the idea of the compassionate bubble) and function as a bubble that can link and enclose. In contrast, COVID bubbles in and for aged care and those in later life, work to isolate and separate. They function as bubbles that close off and shut out, as if placing the older person and older people behind glass (in some cases, quite literally). Likewise, while the COVID-19 bubbles for the “general” population (a category from which those in later life are often excluded) are regarded as temporary structures that will in time be dissolved to re-allow social movement and intermingling, the later life and aged care COVID-19 bubble is imagined very differently. This is because it is overlaid upon a pre-existing conception of later life—and in particular the fourth age—as itself a kind of bubbled existence, a fragile state held somewhat separate and apart from the general population and moving inexorably toward death—a bubble that pops. Bubbling the Fourth Age The idea that later life can be divided into different stages and ages has a long history, although the shape, meaning and valuing of different ages in later life is historically specific. Back in the late 1980s the Cambridge historian Peter Laslett proposed that rather than falling into three main stages—childhood, adulthood and old age—there are in fact four stages and that “later life can be divided into a ‘third age’ and a ‘fourth age’” (Gilleard and Higgs, “The Fourth Age” 368). Laslett’s distinction between a third age (active and characterised by personal fulfillment) and a fourth age (for Laslett an age of infirmity) has become increasingly significant in both age studies and in the provision and imagining of aged care. While the third age is increasingly depicted as something that, when managed “successfully”, can expand and fill with rich experiences and rewards (assuming one has the economic and social privilege and mobility to embrace these rich offerings—see Katz and McHugh cited in Zeilig, “Critical Use of Narrative”), the fourth age, on the other hand, is associated with frailty, increased dependence, vulnerability, precarity (see Lloyd; Gilleard and Higgs; and Morganroth Gullette on the fourth age). Of course, experiences of vulnerability, dependency and precarity run throughout the life course and cannot be reduced to chronological age. However, the distinction between a third and fourth age tends to assume that once one “leaves” the third age, it is a one-way path to “the three ‘Ds’: decrepitude, dependence, and death” (Laslett). The fourth age becomes associated with those aspects of ageing that are culturally rejected and pushed aside—in particular physical dependence which, as in much able-ist thinking, is rendered abject. As Morganroth Gullette has argued, a “savage contradiction” underlies and fuels this distinction, as “fantasies of the longevity bonanza proliferate alongside growing terrors of living too long” and becoming a “‘burden’” (21). In other words, those aspects of ageing—indeed those aspects of being human—that are seen as undesirable and/or abject are associated with the fourth age and imagined as somehow exclusive to it: they are placed elsewhere, contained in a fourth age “bubble”. The understanding of the fourth age as a kind of bubble is evident in and enabled by various kinds of cultural representations and institutional discourses around later life, including the kind of language used (particularly language connoting precarity and fragility and liminality) and recurrent media imagery in which people in their “fourth age” are depicted as mentally and physically out of reach (for instance isolated behind glass). Legislation around the movements of residents, visitors, and staff in aged care residence does not simply create “protective” bubbles around aged care residences but also constructs and imagines these residences and their inhabitants as “bubbled”, removed, and voiceless. Vulnerability, ephemerality, precarity and decline have become increasingly significant in representations of and discourses around ageing. Much of the media coverage of those in later life, particularly those living in aged care residences, has further fuelled what Sally Chivers has called the “nursing home specter” and delivered, in heightened and often spectacularised form, the “life-course narrative that dominant culture provides—an unliveable mind and unrecognizable body, mountainous expense” (Morganroth Gullette, 24). The discourse on ageing is characterised by the use of metaphor and metonymy, of which “the bubble” or “bubbling” is only one notable example. The culture of fear that surrounds the fourth age stems from the presumption that ageing inevitably leads to decay and decline in quality of life, and that the experience of ageing is characterised by various forms of physical and cognitive deterioration, such as dementia. Cultural gerontologist Hannah Zeilig has drawn attention to the pervasive use of metaphors—in both medical journals and mass media reports—to describe the experience of living with dementia. These metaphors attempt to capture and simplify the complexities of being, speaking, and knowing experienced by people with dementia. They are frequently used to communicate these experiences to people who do not live with dementia. The cultural metaphors of dementia are potent examples of ageism. They are not neutral in their connotations or implicit value judgements. These metaphors reveal wider social anxieties around ageing, despite the fact that people in their 40s and 50s can have dementia (Dementia Australia). As Zeilig has pointed out, many of these metaphors have presented a negative framing of dementia, describing the rising numbers of dementia diagnoses in apocalyptic, biblical terms such as “plague”, “crisis”, and “epidemic” (“Cultural Metaphor” 260). While this hyperbole may be grounded in statistics and the realities of an ageing population, it has nevertheless been alarming. This rhetoric has often been a necessary tactic for dementia organisations as part of their efforts to secure media coverage, raise public awareness of dementia, and lobby for increased government and private investment in funding research and support services. Despite these noble intentions, this rhetoric can risk excluding or marginalising the voices of people living with dementia. Some of the metaphors that have been used to describe dementia are particularly dehumanising and stigmatising, such as the perception of Alzheimer’s disease as a form of “living death”. This conception of Alzheimer’s, which Susan M. Behuniak has observed in both scholarly and popular discourse, elicits strong negative emotional responses of revulsion and fear. It constructs people with Alzheimer’s as abject zombie-like figures living a half-life or twilight existence. These trends in dementia discourse that Zeilig and Behuniak identified in the first half of the 2010s are also apparent in media imagery and discourse about older people in the COVID-19 pandemic. Much like the cultural narratives of dementia, these representations often reinforce the fourth age’s association with forms of vulnerability, decline and decay that are rendered abject. In contrast to this negative framing of both dementia and the fourth age, the trope of “living in a bubble” can also present a more ambivalent conception of both living with dementia and, by extension, the sociocultural experience of living in the fourth age during the time of COVID-19. “Bubbling” can serve a protective function for the person living with dementia by reducing sensory overload and cognitive confusion that may lead to anxiety and emotional distress. In dementia care, bubble wands and bubble wrap are two of the most commonly used tools in sensory therapy for reducing anxiety and agitation, and providing comfort (DailyCaring). These examples remind us of the materiality of the bubble, which functions as both cultural trope and material condition that affects people’s lives (to borrow from Helen Deutsch and Felicity Nussbaum, cited in Vivian Sobchack’s essay on metaphor and materiality). Within the diversity and range of caring practices encompassed by the trope of “bubbling”, there is clear potential for the bubble to be enabling, rather than disabling, if it is used to enhance quality of life and wellbeing for older people, rather than to separate, marginalise and isolate. Despite the multivalent possibilities of the bubble for enhancing quality of life for people with dementia, the bubble’s association with precarity has been heightened by its deployment to protect older people during the COVID-19 pandemic. This is a source of ambivalence around the COVID-19 bubble, a public health response that is acknowledged as having both protective and harmful effects. It involves “bubbling” older people, especially those living in residential care, by physically isolating them and limiting their contact with family and friends to conversations mediated by digital technology or a windowpane. By restricting physical and direct contact with the outside world in order to reduce and contain transmission of the virus, the COVID-19 bubble is intended to protect the physical health of older adults. But as Karra Harrington and Martin J. Sliwinski caution, this can also risk the cognitive health and mental wellbeing of older people by creating social isolation. These concerns about the negative health impacts of the COVID-19 bubble compound the existing popular understanding of late life as isolated and isolating, perpetuating the ageist assumptions that characterise the social imaginary around the fourth age. Creating Compassionate Bubbles The distress of separation caused by COVID-19 lockdowns and restrictions is felt by all generations, not just older people. Recognising the costs to our emotional and mental wellbeing of living in isolation to protect our bodies and our communities from viral invasion, Australian epidemiologist Mary-Louise McLaws has called for “a compassionate germ bubble”, modelled on New Zealand’s concept of an extended bubble that allows close contacts beyond one household. This alternative approach to “bubbling” is designed to strike a better balance between physical and mental health. Writing during Melbourne’s strict and prolonged lockdown following a second wave of cases in the winter of 2020, McLaws argued that “a compassionate germ bubble may foster resilience by reducing a sense of isolation for people living alone and friends, extended family and partners distressed by the separation”. There have been a number of creative and compassionate responses to the necessity of the COVID-19 bubble for protecting those most vulnerable to the virus. Aged care residences have developed innovative ways to safely maintain in-person visits and provide opportunities for face-to-face contact between residents and their families and friends. One example reported in the Australian media (Steger) is “The Window of Love” in Perth, which demonstrates the positive potential of the bubble—represented here as a pane of glass bordered by a painted frame—for facilitating social connection and supporting wellbeing despite restrictions on physical contact. The media reporting of these innovations tends to spectacularise the residents of these homes, reinforcing their fragility and vulnerability as they are framed behind plastic or glass. In December 2020, international media outlets The Guardian, RTE News, and Star Media posted a Reuters video story on their respective YouTube channels about a “hug bubble” created in an aged care home in Jeumont, France. This inflatable plastic tunnel allows physical touch between those living in the home and those outside it through hermetically sealed sleeves. Separating the resident from their visitors is a clear plastic sheet, which is disinfected by staff in between each visit. Recognising the importance of physical contact for wellbeing, nursing staff reported that the hug bubble has brought comfort to the residents, whose previous contact with family and friends since the outbreak of COVID-19 in March 2020 had been limited to video calls or talking through a window. Viewer comments reveal divergent responses to this media story across all three YouTube channels. Some viewers applaud the innovation while others disparage the hug bubble as “cruel” and “disgraceful”. Other comments register viewers’ ambivalence, recognising the good intentions behind the idea while despairing at the need for it. Several comments offer a snapshot of the cynical, often incoherent views about the pandemic commonly found on social media platforms like Facebook and Twitter, while also demonstrating the persistence of ageist attitudes that regard the elderly as a burden. These negative responses are striking in contrast with the positive framing of the original media report, which is presented as a “feel good” human interest story through brief interviews with family members and nursing home staff, reflecting on the residents’ experiences using the hug bubble. This positive framing is reinforced by the gentle music track accompanying the video posted on the RTE News channel. Beyond the institutional context of aged care residences, many families and communities have also engineered solutions to reduce the stress of separation. Craving physical contact after months of isolation, they have embraced the materiality and tactility inherent in the bubble trope. People have improvised using household objects, such as plastic sleeves attached to transparent shower curtains, to build “cuddle curtains”, and “hug machines” to enable safe—and playful—physical contact. These innovations and adaptations tap into the bubble’s playful qualities, while also “going viral” as families document their creativity, delight and joy through their own video stories shared on YouTube. As we move into the second year of the COVID-19 pandemic, with case numbers and the death toll continuing to climb globally, the concept of the COVID-19 bubble and its role in protecting the community will continue to be debated, refined and reconfigured in both public health responses and media discourse. Despite Australia’s relatively good fortune in terms of total number of COVID-related deaths compared to other Western nations such as the US and the UK, the disproportionately high number of deaths among Australians in aged care is a sobering reminder of the systemic failures in Australia’s aged care residences. As we move in and out of periods of social isolation, restrictions and lockdowns, it will become increasingly important to address the mental health impacts of “living in a bubble” and to consider creative, compassionate alternatives that challenge ageism and maintain quality of life for fourth age Australians. *** As COVID-19 and its management continue to reshape our world(s) and our relations to each other, its impacts continue to be unevenly felt, particularly for those in later life. For this reason, it becomes increasingly important to be alert to the ways in which “bubbling” the fourth age in response to COVID-19 risks reinforcing a homogenising view of older people as vulnerable and isolated, defenceless against viral invasion and voiceless in expressing agency and maintaining social connection. This essay responds to Hannah Zeilig’s earlier call to “radically rethink the ways in which age and ageing have been culturally configured” (“Critical Use of Narrative” 16). One of the purposes of this essay has been to critically assess some of the ways that the relatively new discourse of a fourth age—as somehow both qualitatively and quantifiably different to and separate from the third age—entails a homogenising view of older people. This view has enabled forms of ageism that have often been particularly brutal in their impact during the pandemic. In this essay we have argued that popular conceptions of and public health discourse and policy around the fourth age have often enabled—or, at the very least, supported—forms of ageism. This ageism has been further heightened through both the discourse and the imagery of the COVID-19 bubble. The fourth age, we argued, has often been understood as bubble-like: as a “stage” of life when one is somehow separated from the larger community and culture. The fourth age is configured as physically fragile and precarious, transient and temporary, ephemeral, and enclosed in—and as—its own world. Created in the name of protecting “our most vulnerable”, the bubble in the time of COVID-19 has heightened these pre-existing social anxieties around the fourth age. The challenge, as we move into the second year of the pandemic in Australia, is to find new ways of protecting the health and wellbeing of people in later life, while creating opportunities for connection, agency and play that are supported, rather than hindered, by the COVID-19 bubble. References Australian National Dictionary Centre. “2020 Word of the Year.” Canberra: School of Literature, Languages and Linguistics, ANU College of Arts and Social Sciences, Australian National University. 17 Nov. 2020. 12 Jan. 2021 <https://slll.cass.anu.edu.au/centres/andc/news/2020-word-year>. Behuniak, Susan M. “The Living Dead? The Construction of People with Alzheimer’s Disease as Zombies.” Ageing & Society 21 (2011): 70–92. Chivers, Sally. “‘Blind People Don’t Run’: Escaping the ‘Nursing Home Specter’ in Children of Nature and Cloudburst.” Journal of Aging Studies 34 (2015): 134–41. “COVID-19 Deaths by Age Group and Sex.” Australian Government Department of Health: Coronovirus (COVID-19) Current Situation and Case Numbers. 1 Jan. 2021 <https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coronavirus-covid-19-current-situation-and-case-numbers#cases-and-deaths-by-age-and-sex>. DailyCaring. “6 Alzheimer’s Sensory Activities Reduce Anxiety without Medication.” 12 Jan. 2021 <https://dailycaring.com/6-alzheimers-sensory-activities-reduce-anxiety-without-medication/>. Dementia Australia. “What Is Dementia?” 12 Jan. 2021 <https://www.dementia.org.au/about-dementia/what-is-dementia>. Fuchs, Anne, Desmond O'Neill, Mary Cosgrove, and Julia Langbein. “Report on COVID-19 – Reframing Ageing Webinar 12 June 2020.” Preprint. Aug. 2020. DOI: 10.13140/RG.2.2.34508.44161. Gilleard, Chris, and Paul Higgs. “Aging without Agency: Theorizing the Fourth Age.” Aging and Mental Health 14.2 (2010): 121–28. Gilleard, Chris, and Paul Higgs. “Ageing Abjection and Embodiment in the Fourth Age.” Journal of Aging Studies 25.2 (2011): 135–42. Gilleard, Chris, and Paul Higgs. “The Fourth Age and the Concept of a ‘Social Imaginary’: A Theoretical Excursus.” Journal of Aging Studies 27 (2013): 368–76. Gulland, Jackie. “Households, Bubbles, and Hugging Grandparents: Caring and Lockdown Rules during COVID-19.” Feminist Legal Studies 28 (2020): 329–39. Harrington, Karra, and Martin J. Sliwinski. “The Loneliness of Social Isolation Can Affect Your Brain and Raise Dementia Risk in Older Adults.” The Conversation 4 Aug. 2020. 12 Jan. 2021 <https://theconversation.com/the-loneliness-of-social-isolation-can-affect-your-brain-and-raise-dementia-risk-in-older-adults-141752>. Laslett, Peter. A Fresh Map of Life: The Emergence of the Third Age. London: Weidenfeld and Nicolson, 1989. Lloyd, Liz. “The Fourth Age.” Routledge Handbook of Cultural Gerontology. Eds. Julia Twigg and Wendy Martin. London: Routledge, 2015. 20 Dec. 2020 <https://www.routledgehandbooks.com/doi/10.4324/9780203097090.ch33>. McLaws, Mary-Louise. “What Is the COVID ‘Bubble’ Concept, and Could It Work in Australia?” The Conversation 1 Sep. 2020. 12 Jan. 2021 <https://theconversation.com/what-is-the-covid-bubble-concept-and-could-it-work-in-australia-144938>. Morganroth Gullette, Margaret. “Aged by Culture.” Routledge Handbook of Cultural Gerontology. Eds. Julia Twigg and Wendy Martin. London: Routledge, 2015. 28 Dec. 2020 <https://www.routledgehandbooks.com/doi/10.4324/9780203097090.ch3>. Royal Commission into Aged Care Quality and Safety. Neglect. Interim Report Volume 1. Canberra: Commonwealth Government of Australia, 31 Oct. 2019. 12 Jan. 2021 <https://agedcare.royalcommission.gov.au/publications/interim-report>. Sobchack, Vivian. “A Leg to Stand On: Prosthetics, Metaphor, and Materiality.” In The Prosthetic Impulse: From a Posthuman Present to a Biocultural Future. Cambridge: MIT Press, 2006. 17–41. Steger, Sarah. “Coronavirus Crisis: Oryx Communities Aged Care Home Creates ‘Window of Love’ to Help Residents Stay Connected to Families.” The West Australian 5 Apr. 2020. 12 Jan. 2021 <https://thewest.com.au/news/coronavirus/coronavirus-crisis-oryx-communities-aged-care-home-creates-window-of-love-to-help-residents-stay-connected-to-families-ng-b881510245z>. Zeilig, Hannah. “The Critical Use of Narrative and Literature in Gerontology.” International Journal of Ageing and Later Life 6.2 (2011): 7-37. ———. “Dementia as a Cultural Metaphor.” The Gerontologist 54.2 (2013): 258–67. ———. “What Do We Mean When We Talk about Dementia? Exploring Cultural Representations of ‘Dementia’.” Working with Older People 19.1 (2015): 12–20.

Women in Universities Women have been fighting for the right to participate in universities since 1873, when Sophia Jex Blake went to court with her fight to enrol at Edinburgh University. In rejecting her application, one of the judges stated: It is a belief, widely entertained, that there is a great difference in the mental constitution of the two sexes, just as there is in their physical conformation. The powers and susceptibilities of women are as noble as those of men; but they are thought to be different, and, in particular, it is considered that they have not the same power of intense labour as men .... (Scutt 224) In Australia, from the 1850s to the 1880s, both the University of Sydney and The University of Melbourne refused to admit women as students. In 1879, the Chancellor of the University of Sydney suggested that: The best course to be taken by advocates of advanced education for women, would be to found some sort of affiliated college for them in the vicinity of the University ... if there really be a widespread wish on the part of young women for a higher education ..." (Scutt 228). Having finally won the right to study at university in 1881, and to enter the academic workforce, women are still finding many of the old prejudices remain. Numerous studies have demonstrated that women's experiences in academe are qualitatively different from men's and that women are systematically paid lower salaries than men of equivalent academic achievement, age and length of service (Bagilhole 431-47; Loder 713-4; McElrath 269-81;). Studies have shown that differences in the experiences of male and female faculty are largely explained by gender (Booth & Burton 312-33; Everett 159-75; Over & Lancaster 309-18; Ready 7) and sex discrimination is highlighted as an ongoing contributor to the inequity (Allport 5-8; Hall & Swadener 1; Tuohy 8). A recent UNESCO-Commonwealth (http://www.unesco.org/) report states that: ... in spite of advances which women have made in many areas of public life in the past two decades, in the area of higher education management they are still a long way from participating on the same footing as men. With hardly an exception, the global picture is one of men outnumbering women at about five to one at middle management level and at about twenty to one at senior management level (Singh 4). The introduction in Australia of Sex Discrimination legislation (http://www.hreoc.gov.au/sex_discrimination/) in 1984 and more recently, Affirmative Action policies ( http://www.austlii.edu.au/) in employment and promotion rounds in some universities has not improved women's situation to the extent expected. In 1978, women held 16% of full time academic posts while gaining 25% of all higher degrees and 30% of undergraduate degrees (Commonwealth Government statistics cited by Over and McKenzie 61-71). In 1999, 54% of students were women yet women's participation in academe had only increased to 35% (DETYA) (http://www.deet.gov.au/). Women are mainly employed at the lowest academic levels. In 1999, 72% of women were employed at Levels A and B (Associate Lecturer/Lecturer) compared to 46% of men, with only 8% of women reaching Levels D and E (Associate Professor/Professor) compared to 26% of men. Women continue to be clustered in the traditionally female areas of Health, Education and Arts while few seem to have successfully broken through the barriers in the traditionally male areas of Engineering, Architecture or Agriculture (DETYA) (http://www.deet.gov.au/). Business has traditionally been viewed as a male preserve but enrolments have increased to the point where women almost equal men. However, the staff ratio of men to women remains very low at 70/30 (DETYA) (http://www.deet.gov.au/). The slow growth rate for women in academe belies the fact that more women than men are now completing university degrees. The purpose of this study was to determine how well the experiences of academic women in the male-dominated faculties of business and commerce, reflect the literature on women in universities, in general. Previous empirical studies have found inequitable treatment of women without necessarily exploring the processes of discrimination. The Study This study involved interviews with academic women who had been employed in faculties of business and commerce for at least five years. The research used the 'snowballing' technique: participants initially comprised women known to me but as these women told female colleagues of my study I was given the names of other women who were willing to participate. Participants comprised twenty-one women from three universities in Western Australia, two universities in New South Wales and one Victorian university. One woman had recently left academe and started her own business because of discriminatory practices she had encountered and another was contemplating leaving. In each university, women comprised a minority of the faculty and felt disadvantaged in some way. A semi-structured interview was used to explore with the women the issues that had been identified from previous studies of sex discrimination in the academic profession. Open-ended questions were used and the interviews conducted face to face, or, in the case of those interstate, via telephone or email. The women spoke frankly about their experiences. Findings and Discussion Promotion Each of the women in this study said that their university had established an internal promotion policy based on merit. However, they felt the greatest problem they had encountered in gaining promotion was in determining the criteria upon which they would be judged each year, and in meeting those criteria. "I have been chasing promotion for over five years. At first I was told that I would not be promoted until I got my masters degree so I worked really hard to complete it but then a male colleague was promoted without a masters. Once I got the masters I was told I needed to publish to be promoted but in the next year someone else was promoted without any publications. You go all out to meet the criteria each year but in the next year the promotions committee changes and so do the criteria for that year"(Lecturer applying for Senior Lecturer position). The promotion procedure at one university was explained by a Senior Lecturer who had served on promotion committees on two occasions. "There are about ten criteria upon which promotion can be based. When the applications are received we all get together to determine which are the criteria to be applied. In the last promotion round only four of the ten criteria were used so only people satisfying those criteria were selected." When asked whether the criteria were the same as the previous year she replied: "Last year there was more emphasis on qualifications and publications. This year community involvement and involvement in university affairs were judged as more important ... it varies from year to year". On questioning about the promotion procedures at their universities, women stated they were largely dissatisfied with the process, that they were presumed to be satisfied with their lot while the men were actively encouraged to apply. "I was told not to bother to apply (for a senior lecturer position) as I would not get it ... that there was a queue of people to be promoted before me - (named males) - and until they were promoted, I would not be considered" (Lecturer). "The position was advertised with a specific male applicant in mind and specifically excluded me by stating that the appointee must have supervisory experience. Women in my department are not given the opportunity to supervise students so I didn't even bother applying."(Lecturer aspiring to a Senior Lecturer position). One woman, upon inquiring why she was not promoted, was told that she should be grateful to have tenure and asked why she wanted to be promoted, anyway. "They would never have said that to a male, they would have expected a male to be working towards promotion" (Associate Lecturer). All women interviewed stated that they had problems keeping up with the 'goal posts' which moved from year to year. The 'moving of the goal posts' is one means by which universities are able to maintain the position of women at lower levels. Unsurprisingly, some women said they felt that promotion at their university was based on politics rather than merit. However, defining merit in universities is problematic. According to Burton (430), definitions of what is meritorious depend upon the power of particular groups to define it and, as a result, can change. The narrow view of merit is 'the best person for the job' which Burton (113) describes as an "overwhelming tendency to select in your own image". Burton (430) and Allport (5) claim universities define merit along male cultural lines with current selection, remuneration and career progression practices strongly influenced by an underlying gender bias. Burton (430) argues that there is still a tendency for work to be ranked as 'men's' or women's work with lower status attributed to the latter and an assumption that different skills and abilities are needed for each. Over and McKenzie (61-71) claim that women are disadvantaged by the fact that invalid merit criteria are applied to them which men as a group are more likely to satisfy. They state that the academic careers of most women do not fit the stereotypic male experience and it is mainly men who decide whether women should be promoted. At one university in the study, the merit criteria for senior lecturer include the requirement that aspirants have a number of overseas conference presentations. "Some of us are single working mothers and overseas conference attendance is out of the question because who's going to mind our children while we are away? The senior males were astonished when I mentioned that this was a problem for me. It had never occurred to them" (Associate Lecturer on why women at her university do not apply for promotion). Family Responsibilities The women commented on the numerous difficulties they had encountered in combining an academic career with responsibility for children. They felt that certain male faculty members perceived married women with children as lacking in career commitment, whereas married men with families were viewed as being more stable and committed to their careers. One married woman claimed that when she needed to go home to tend a sick child, her male Head of Department told her she should "get her priorities right". In 1992, Family Responsibility provisions were added to the Sex Discrimination Act (http://scaleplus.law.gov.au/html/pasteact/0/171/top.htm). However, it would appear that individual practice doesn't always follow as a result of changes in policy. Equal Pay On the subject of equal pay for equal work, the women said that they were often paid lower wages than their male colleagues despite having higher qualifications and equivalent teaching and research experience. Some women felt that the barriers between academic levels were used to artificially maintain the wage gap between men and women, regardless of qualifications and ability. This was felt to be particularly the case between the levels of Associate Lecturer (Level A) and Lecturer (Level B). "They find excuses to keep you at Associate Lecturer so that they can pay you less to do the same work that you would be doing as a lecturer ... lecturing, coordinating units and so on"(Associate Lecturer). "There are no men below Lecturer in my Department, either lecturing or with Masters degrees. As soon as they get their Masters they are promoted to Lecturer.... I'm coordinating units as an Associate Lecturer while some male lecturers have less responsibility' (Associate Lecturer with Masters degree and publications) Two women said that they had been performing higher level duties (Level B) for up to five years while working on their Masters but their university refused to pay them at the higher level until they had completed their degree. Even when they satisfied all the requirements for the Masters degree and had a letter from their supervisor saying they had satisfied all the requirements, the university refused to pay them until they had actually graduated, which was some time later. Shortly afterwards their university took on two men to perform the same duties, paying these at the higher level even though they had not completed a masters degree. One former lecturer claimed that she was employed at a time when there was a large turnover of staff in her department. A number of new staff were appointed of whom she was the only female. Although she and the other new staff were all employed at Lecturer Level B, it wasn't until later on that she discovered that the men were appointed at the top of the Lecturer salary scale while she was appointed at the bottom, with a salary differential of about10 000pa. This was despite the fact that both she and the men had similar qualifications and work experience at commencement. Teaching Loads Another complaint by women concerned inequitable teaching loads. An analysis in one Business School showed that women had higher teaching loads while men were given more time off for research. The women complained that the supervision of post-graduate students was divided up between the men, and women were excluded. Since research publication and student supervision are usually the most highly ranked criteria in academic promotion rounds, women who are not given the opportunity to participate in these areas are disadvantaged when applying for promotion. This problem is compounded since women are overwhelmingly employed at the lower levels where responsibility for the majority of teaching takes place. This leaves them with little time left to devote to research even if given the opportunity. The women also said they were often pressured into taking on higher duties than those prescribed in the Position Classification Standards for their level. They tended to acquiesce because of their need to prove they were better than men to gain promotion. One woman said that the extra administrative duties she had been given meant that she had less time for research which actually reduced her prospects for tenure and promotion. She said she didn't dare complain as the men in her department would use it as an excuse to question her commitment to her job. Conclusion An examination of women's perceptions and experiences in the workplace can help us understand the informal processes that work against women. The experiences of the women discussed in this paper provide an insight into the subtle processes that continue to operate in some higher education institutions to prevent women from reaching their full potential. Although equal opportunity legislation (http://www.hreoc.gov.au/about_the_commission/legislation/index.html) has been enacted to prevent discrimination and disadvantage to women, the implementation of policy does not always filter through to the operational levels. It is still possible to circumvent legislation in subtle ways, perhaps without even being aware that these practices are discriminative. The women in this study spoke frankly about their experiences and the difficulties they had encountered in gaining equal recognition to men, with very few satisfied that they were receiving equitable treatment. The women felt that their work was not valued as highly as that of the men they worked with and they were given less opportunities for advancement. Overall, the interviews with the women revealed interesting insights into their experiences in pursuing academic careers and in trying to gain recognition for their achievements. The collective experiences of the women provide an insight into the subtle ways in which disadvantage can be engendered. The findings of this study have serious implications for university administrators, particularly deans and heads of schools. There are many well-qualified women academics and universities cannot afford to overlook the valuable contribution these women can make to teaching, research and university governance. References Allport, Caroline. "Improving Gender Equity: Using Industrial Bargaining". NTEU Frontline4.1 (1996): 5-8. Bacchi, Carol. "The Brick Wall: Why So Few Women Become Senior Academics". Australian Universities Review36.1 (1993): 36-41. Bagilhole, Barbara. "Survivors in a Male Preserve: A Study of British Women Academics' Experiences and Perceptions of Discrimination in a UK University". Higher Education26 (1993): 431-47. Booth, Alison, and Jonathon Burton. "The Position of Women in UK Academic Economics". The Economic Journal110.464 (2000): 312-33. Burton, Clare. "Merit and Gender: Organisations and the Mobilisation of Masculine Bias." Australian Journal of Social Issues22 (1987): 424-35. Burton, Clare. An Equity Review of Staffing Policies and Associated Decision-making at Edith Cowan University. Report commissioned by ECU. 1994. DETYA. Selected Higher Education Statistics. 1999. Everett, James. "Sex, Rank and Qualifications at Australian Universities". Australian Journal of Management19.2 (1994): 159-75. Hall, Elaine, and Beth Blue Swadener. "Chilly Climate: A Study of Subtle Sex Discrimination at a State University". Initiatives (Online)59.3 (2000): 1. Loder, Natasha. "US Science Shocked by Revelations of Sexual Discrimination". Nature405.6787 (2000): 713-4. McElrath, Karen. "Gender, Career Disruption and Academic Rewards". Journal of Higher Education63.3 (1992): 269-81. Over, Ray, and Sandra Lancaster. "The Early Career Patterns of Men and Women in Australian Universities". The Australian Journal of Education28.3 (1984): 309-18. Over, Ray, and Beryl Mckenzie. "Career Prospects for Women in Australian Universities". Journal of Tertiary Educational Administration7.1 (1985): 61-71. Ready, Tinker. "West Coast US Recognizes Academic Gender Bias". Nature Medicine 7.1 (2000): 1. Scutt, Jocelyn. The Sexual Gerrymander.The Law Printer, 1994. Singh, Jasbir. "Women and Management in Higher Education: A Commonwealth Project." A.C.U. Bulletin of Current Documentation. 133 (1998): 2-8. Tuohy, John. "Sex Discrimination Infects Med Schools: Women Say Bias Blocks Chances for Advancement". USA Today2000. 8. Links http://www.unesco.org/ http://www.deet.gov.au/ http://www.hreoc.gov.au/sex_discrimination/ http://www.hreoc.gov.au/about_the_commission/legislation/index.html http://www.austlii.edu.au/cgibin/disp.pl/au/legis/cth/consol%5fact/aaeofwa 1986634/?query=title+%28+%22affirmative+action%22+%29 http://scaleplus.law.gov.au/html/pasteact/0/171/top.htm Citation reference for this article MLA Style Ellis-Newman, Jennifer. "Women and Work" M/C: A Journal of Media and Culture 4.5 (2001). [your date of access] < http://www.media-culture.org.au/0111/Ellis-Newman.xml >. Chicago Style Ellis-Newman, Jennifer, "Women and Work" M/C: A Journal of Media and Culture 4, no. 5 (2001), < http://www.media-culture.org.au/0111/Ellis-Newman.xml > ([your date of access]). APA Style Ellis-Newman, Jennifer. (2001) Women and Work. M/C: A Journal of Media and Culture 4(5). < http://www.media-culture.org.au/0111/Ellis-Newman.xml > ([your date of access]).

Apart from its negative literary connotations, the notion of adaptation generally carries an optimistic connotation in the sense that it is most often associated with an improved outcome in the face of challenging circumstances. However, this is not an inevitable response to an adaptive imperative: there are often indicators of significant failure to adapt. In short, there is often evidence of maladaption. Examples include the spiralling rates of heart disease, obesity and adult-onset diabetes that have characterised richer western populations over the past half-century. Arguably, the West as a whole has failed to adapt to the health opportunities provided by plentiful food supplies. Instead, a growing dietary emphasis upon refined carbohydrates (including simple sugars) and animal-sourced protein (including dairy foods) is harming these populations. This paper applies the metaphors of adaptation and maladaptation to the development of a new sense of self following a diagnosis of heart disease. There is a range of evidence to suggest that newly-diagnosed heart patients resist accepting the implications of lifestyle-related heart disease. Such a lack of acceptance can impact upon short-term health, exercise and diet priorities, as well as upon long-term life expectancy. While this paper does not describe a medical, but a cultural approach to the well-adapted self as heart patient, it is also important to stress that there is a significant range of heart conditions that are not lifestyle related. Counterproductively, the links increasingly made between lifestyle choices and heart disease mean that many heart patients feel “punished” by people with healthy hearts who seem to assume that the patient is to “blame”. Nonetheless, there are few heart patients who cannot positively impact their health and recovery prospects by improving lifestyle choices. Ladwig and his research team argue that the challenge lies in getting heart patients to take their illness seriously without precipitating a traumatically negative view of the experience of illness. Such a negative view may, in itself, facilitate poor outcomes. These perspectives indicate that issues of communication and identity—that is, cultural imperatives—are important determinants of a healthy recovery. This paper records and analyses recent research relating to heart patients who are members of an online support community, HeartNET. HeartNET is an experimental Website funded by two Australian Research Council Linkage Grants (2004-10), with the National Heart Foundation (WA Division) as the industry partner. The authors/researchers speculate that engagement in the HeartNET online community enables the positive adaptation of an individual’s sense of self (rather than the fostering of a maladaptive identity, including a denial of the implications of heart disease that can lead to behaviours which promote morbidity). Early indications are that supportive online interactions can foster the development of a positive persona of a “heart patient“. At the optimistic end of the response-spectrum, a positive heart patient is a person who is keenly motivated to maximise their health and—if possible—halt or reverse (see, for example, Esselstyn) the progress of their disease. Such a response can be constituted and enhanced via supportive online interactions. Insofar as medical commentators theorise about reactions to a life-changing health diagnosis, this tends to be in terms of self-image (see, for example, Petrie et al.) and sometimes includes Kubler-Ross’s stages of grief: Denial, Anger, Bargaining, Depression and Acceptance. The results reported here look instead at issues of adapting to a new identity as “heart patient” that potentially involves positive commitment to improved health, partly as a result of giving and receiving social support. The rationale behind this perspective is influenced by significant evidence that compliance with the therapeutic regimes recommended and prescribed by physicians is lacking. It is speculated that patients are enacting a denial of the importance of the health challenges confronting them. For example, Hugtenburg et al. found that “of 232 first-time chronic medicine prescriptions [repeats], 132 were not collected at all (46.1%) or too late (11%).” Noting that 46% of the 232 prescriptions studied were for cardiovascular drugs (353), Hugtenburg et al. conclude that “This kind of non-compliance may result in an increased health risk as well as constituting a waste of a large amount of money” (352). Clearly, more emphasis needs to be placed on communicating constructively with patients and supporting the evolution and reconstitution of an identity that includes positive constructions of self-as-heart-patient and that works to facilitate recovery. The Website that enables the HeartNET community was developed by the National Heart Foundation (WA Branch: NHFWA) and Edith Cowan University (ECU) as part of an ARC-Linkage grant, 2004-6 “Evaluating the effectiveness of online support in building community, promoting healthy behaviours and supporting philanthropy”. The first three months of the Website’s operation (when the tiny number of postings trickled away and then dried up completely) are reported in Bonniface et al. (“Affect”) and graphed below (see Figure 1). They followed on from a careful process of recruitment via databases of existing heart patients that were held by the NHFWA and supportive cardiologists. Participants were approached to gain ethical consent, and would-be Website participants were matched with people who had equivalent heart illness, but who weren’t invited to join the HeartNET community, thus acting as comparisons. Baseline data was collected to compare “before” the HeartNET intervention with the yet-to-be collected “after” data. The idea was to see if there were differences between the online and offline groups that could be attributed to Website activity. Instead, the first version of the supposed-community remained stillborn, and it wasn’t until the Website was thrown open to all comers that it began to thrive. This was a preliminary indication that an invitation to participate in a therapeutic community was not effective, by itself, in encouraging communication with people who shared important health-related experiences. While Website engagement might have fitted comparatively well into a (Kubler-Ross) Bargaining approach to heart patients’ illnesses (“I’ll help others, and they’ll help me”) the default position appeared to be non-engagement, possibly an indication of the patients having become “stuck“ in the first stage of grief, Denial. Even though the initial HeartNET participants were well established as heart patients, and had all been diagnosed some time earlier, it is possible that they preferred to ignore the implications of this for their health. Figure 1 records the patterns of postings made by the 68 people who agreed to join the HeartNET Web community and who signed and returned the ethical consent forms. Of the 68 people recruited, only 53 logged on (despite phone calls to every individual) and of the 53 who logged into the site, only 22 posted (Bonniface et al. “Affect”). The heaviest week’s traffic was 40 postings in Week 4. By Week 12, activity had ceased entirely. The decision to relaunch had been taken a fortnight earlier and the first iteration of the Website was closed down. Figure 1, reprinted from Bonniface et al (“Affect”) The relaunch of the Website made it available for anyone interested in participating, and membership and traffic both grew exponentially. Amongst other innovations were “newbie” icons (to indicate new members to be welcomed and nurtured), guest status (to “try before you buy”), and symbols to indicate whether the member was a heart patient, a family member or supporter, or an administrator. In due course a “ratings system“ was added to indicate the total number of member-postings to date, so that people could gauge an individual’s commitment and contribution to the community. People contributing up to 150 posts to discussion boards were allotted from one to five stars, while Superstar status indicated 1000-plus posts. One of the major differences between the group of heart patients invited to participate in the site’s first iteration, and the group that ultimately launched the Website as a viable and vibrant community, is that the second-stage members were generally recently diagnosed. The research team speculate that they were actively reconstituting their identities as heart patients, and they and their families consequently had many matters and issues they wanted to discuss. In effect, the people who joined the relaunched site were “learning“ to be heart patients. Weis et al., investigating a pharmaceutically-sponsored Website for MS sufferers, argued that “users are diverse” and “communication needs change over time [as the disease progresses]” (146). They found that, of the 943 users who responded to their online survey, indications were that participants used “the website the most during early stages of the disease” (135). However, one area the HeartNET research is investigating is whether a community-member whose persona includes “care and support for my Web community“ will continue to participate even after the first information-seeking phase of their illness is over. Support offered for new heart patients by cardiologists, hospital staff, other specialists and general practitioners is an important part of the enculturation of the self-as-heart-patient, but it leaves unexplored the more personal work of reconstituting the individual’s identity as a person with heart disease (or as a supporter of such a person). It also leaves unaddressed the sense of “aloneness“ that HeartNET members say they feel until they are able to talk regularly with people who understand exactly what they are going through, as a result of having already “been there“ themselves. Although health professionals, family and friends are supportive, that support is only occasionally able to cut through the isolation. Extracts from two (separate) interviews are typical of the kinds of comments made: Murphy: I mean the support from Sandra and the family was all great but—to actually talk to other people who know what you’re feeling and … Yes, nothing against family and friends but they’re [other patients are] going through the same thing, they know what you’re feeling and … you know. Margo: I found friends were pains. It was like “well, okay, but you’re better now, they fixed you.” Well I looked at her and I said, ‘“You’re never fixed, but [it’s] something you live with for the rest of your life that doesn’t go away. …’ The implication is that heart patients have a differential need to communicate with others about their experience of heart disease, and that the communicative imperative is greatest in the first stages of being a heart patient, soon after diagnosis. For the well-established patients invited to contribute to the original HeartNET Website, their status as people-with-heart-disease was no longer problematic. Consequently, they had little to say and very few incentives to revisit the adaptive processes of personal identity construction. People who are used to their status as a heart patient may be theorised as having very different information needs and behaviours compared with the newly diagnosed. There is evidence that at least some of these well established patients were prompted to engage when new patients who needed support joined the site in the second iteration. However, those who are never given the opportunity to interact and learn from others may take longer to reach a level of adaptation. Even worse, they may adopt maladaptive behaviours encompassing issues of denial or self-sabotage—such as rejecting medications or increasing behaviours which progress morbidity, such as smoking and excessive alcohol consumption. Patients’ denial of the implications of heart disease is recognised as a major medical problem. Cooper et al. (234) cite evidence from Petrie et al. that “only a third of eligible patients under 65 years old attended cardiac rehabilitation” while noting that “Ades et al. showed uptake as low as 21% in eligible patients over 62 years”. In another study of patients who did/did not adhere to their pharmacological treatment regime, Horwitz et al. found that “Compared with patients with good adherence, patients with poor adherence were twice as likely to have died within a year of follow-up.” They argue that “adherence may need to be viewed more broadly as encompassing a cluster of health-related behaviours that may influence the outcome of treatment.” The argument advanced in our paper is that such a broader view should also encompass necessary adaptation strategies which introduce positive influences to the formation of patient identity. Compliance with therapeutic and medical regimes has been linked to increased self esteem (Burkhart and Rayens), and the combination of compliance with a positive patient identity may well multiply beneficial health outcomes. Whereas currently a majority of recovering heart patients may be inferred as resisting a revised self-identity that takes their diagnosis and health challenges seriously, the HeartNET Website may offer an effective enticement to positive behavioural change. Bonniface et al. (“Shuffling buddies”) have demonstrated that engagement with HeartNET can influence attitudes to (and involvement in) exercise. The hypothesis regarding identity adaptation is that active HeartNET members, through Website engagement, consistently indicate a willingness to acknowledge their changed health status and work to develop a reconstituted identity as a person with a heart condition who is proactively maximising positive outcomes (and helping others to do so at the same time). This is particularly the case where the online engagement feeds into the offline world: where “shuffling buddies“ have developed mutually supportive walking and exercise regimes, involving social events, consistent with their commitment to health-enhancing activity. Adaptation strategies delivered online offer new ways to counter the maladaptive processes which can follow diagnosis. By using the raw materials of social support and Website engagement, patients can chart new and positive ways in which they progress from denial and bargaining to health-promoting acceptance. For those established patients, online engagement may progress the stages of grief beyond the level of acceptance to the end goal of “support” as they pass on their knowledge, empathy and understanding of illness to the newly diagnosed. References Ades, Philip, M. L. Waldman, W. J. McCann, and S. O. Weaver. “Predictors of Cardiac Rehabilitation Participation in Older Coronary Patients.” Archives of Internal Medicine 152.2 (1992): 1033-5. Bonniface, Leesa, Lelia Green, and Maurice Swanson. “Affect and an Effective Online Therapeutic Community.” M/C Journal 8.6 (2005). 22 Apr. 2007 . Bonniface, Leesa, Arshad Omari, and Maurice Swanson. “Shuffling Buddies—How an Online Community Supports Healthier Lifestyle Choices: An Early Indication of Physical Activity and Exercise Outcomes from the HeartNET Intervention.” Proceedings of the Fifth International Conference on Cultural Attitudes towards Technology and Communication. Eds. F Sudweeks, H Hrachovec and C Ess. Estonia, Tartu: School of Information Technology, Murdoch University, 2006. 90-101. Burkhart, Patricia, and Mary Rayens. “Self-Concept and Health Locus of Control: Factors Related to Children’s Adherence to Recommended Asthma Regimen.” Pediatric Nursing 31.5 (2005): 404-9. Campbell, Colin, and Thomas Campbell. The China Study: Startling Implications for Diet, Weight Loss and Long-Term Health. Dallas, TX: Benbella Books, 2004. Cooper, A., G., Lloyd, J. Weinman, and G. Jackson. “Why Patients Do Not Attend Cardiac Rehabilitation: Role of Intentions and Illness Beliefs.” Heart 82.2 (1999): 234-6. Horwitz, Ralph, Catherine Viscoli, Lisa Berkman, Robert Donaldson, Sarah Horwitz, Carolyn Murray, David Ransohoff, and Jody Sindelar. “Treatment Adherence and Risk of Death after a Myocardial Infarction.” The Lancet 336 (1990): 542-5. Hugtenburg, J. G., A. T. G. Blom, and S. U. Kisoensingh. “Initial Phase of Chronic Medication Use; Patients’ Reasons for Discontinuation.” British Journal of Clinical Pharmacology 61.3 (2005): 352-4. Kubler-Ross, Elisabeth. On Death and Dying: What the Dying Have to Teach Doctors, Nurses, Clergy, and Their Own Families. New York: Macmillan, 1969. Ladwig, Karl-Heinz, Andreas Schoefinius, Gerhard Dammann, Reinhold Danner, Rolf Gurtler, and Robert Hermann. “Long-Acting Psychotraumatic Properties of a Cardiac Arrest Experience.” American Journal of Psychiatry 156.6 (1999): 912-9. Esselstyn, C.B. Jr. Prevent and Reverse Heart Disease. New York: Penguin Group, 2007. Petrie, Keith, John Weinman, Sharpe Norman, and Judith Buckley. “Role of Patients’ View of Their Illness in Predicting Return to Work and Functioning after Myocardial Infarction: Longitudinal Study.” British Medical Journal 312 (1996): 1191-4. Weis, Robert, Keith Stamm, Craig Smith, Michael Nilan, Fiona Clark, Joan Weis, and Kate Kennedy. “Communities of Care and Caring: The Case of Mswatch.Com.” Journal of Health Psychology 8.1 (2003): 135-48. Citation reference for this article MLA Style Green, Lelia, Leesa Bonniface, and Tami McMahon. "Adapting to a New Identity: Reconstituting the Self as a Heart Patient." M/C Journal 10.2 (2007). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0705/13-bonnifacegreenmcmahon.php>. APA Style Green, L., L. Bonniface, and T. McMahon. (May 2007) "Adapting to a New Identity: Reconstituting the Self as a Heart Patient," M/C Journal, 10(2). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0705/13-bonnifacegreenmcmahon.php>.

IntroductionThis article addresses the experience of designing and conducting life-writing workshops for a group of clients with severe mental illness; the aim of this pilot study was to begin to determine whether such writing about the self can aid in individual ‘recovery’, as that term is understood by contemporary health professionals. A considerable amount has been written about the potential of creative writing in mental health therapy; the authors of this article provide a brief summary of that literature, then of the concept of ‘recovery’ in a psychology and arts therapy context. There follows a first-hand account by one of the authors of being an arts therapy workshop facilitator in the role of a creative practitioner. This occurred in consultation with, and monitored by, experienced mental health professionals. Life-Writing as ‘Therapeutic’ Life-story or life-writing can be understood in this context as involving more than disclosure or oral expression of a subject’s ‘story’ as in psycho-therapy – life-story is understood as a written, structured narrative. In 2001, Wright and Chung published a review of the literature in which they claimed that writing therapy had been “restimulated by the development of narrative approaches” (278). Pennebaker argues that “catharsis or the venting of emotions” without “cognitive processing” has little therapeutic value and people need to “build a coherent narrative that explains some past experience” in order to benefit from writing” (Pennebaker, Telling Stories 10–11). It is claimed in the Clinical Psychology Review that life-writing has the therapeutic benefits of, for example, “striking physical health and behaviour change” (Esterling et al. 84). The reasons are still unclear, but it is possible that the cognitive and linguistic processing of problematic life-events through narrative writing may help the subject assimilate such problems (Alschuler 113–17). As Pennebaker and Seagal argue in the Journal of Clinical Psychology, the life-writing processallows one to organise and remember events in a coherent fashion while integrating thoughts and feelings ... This gives individuals a sense of predictability and control over their lives. Once an experience has structure and meaning, it would follow that the emotional effects of that experience are more manageable. (1243)It would seem reasonable to suggest that life-writing which constructs a positive recovery narrative can have a positive therapeutic effect, providing a sense of agency, connectedness and creativity, in a similar, integrating manner. Humans typically see their lives as stories. Paul Eakin stresses the link between narrative and identity in both this internal life-story and in outwardly constructed autobiography:narrative is not merely a literary form but a mode of phenomenological and cognitive self-experience, while self – the self of autobiographical discourse - does not necessarily precede its constitution in narrative. (Making Selves 100)So both a self-in-time and a socially viable identity may depend on such narrative. The term ‘dysnarrativia’ has been coined to describe the documented inability to construct self-narrative by those suffering amnesia, autism, severe child abuse or brain damage. The lack of ability to achieve narrative construction seems to be correlated with identity disorders (Eakin, Fictions in Autobiography 124). (For an overview of the current literature on creative and life-writing as therapy see Murphy & Neilsen). What is of particular relevance to university creative writing practitioners/teachers is that there is evidence, for example from Harvard psychiatrist Judith Herman and creative writing academic Vicki Linder, that life-narratives are more therapeutically effective if guided to be written according to fundamental ‘effective writing’ aesthetic conventions – such as having a regard to coherent structure in the narrative, the avoidance of cliché, practising the ‘demonstrate don’t state’ dictum, and writing in one’s own voice, for example. Defining ‘Recovery’There remains debate as to the meaning of recovery in the context of mental health service delivery, but there is agreement that recovery entails significantly more than symptom remission or functional improvement (Liberman & Kopelowicz). In a National Consensus Statement, the Substance Abuse and Mental Health Services Administration (SAMHSA) unit of the US Department of Health and Human Services in 2005 described recovery (in general terms) as being achieved by the enabling of a person with a mental illness to live meaningfully in a chosen community, while also attempting to realize individual potential. ‘Recovery’ as a central concept behind rehabilitation can be understood both as objective recovery – that is, in terms of noting a reduction in objective indicators of illness and disability (such as rates of hospital usage or unemployment) and a greater degree of social functioning – and also as subjective recovery. Subjective recovery can be ascertained by listening closely to what clients themselves have said about their own experiences. It has been pointed out (King, Lloyd & Meehan 2) that there is not always a correspondence between objective indicators of recovery and the subjective, lived experience of recovery. The experience of mental illness is not just one of symptoms and disability but equally importantly one of major challenge to sense of self. Equally, recovery from mental illness is experienced not just in terms of symptoms and disability but also as a recovery of sense of self … Recovery of sense of self and recovery with respect to symptoms and disability may not correspond. (King, Lloyd & Meehan; see also Davidson & Strauss)Symptoms of disability can persist, but a person can have a much stronger sense of self or empowerment – that is still recovery. Illness dislocates the sense of self as part of a community and of a self with skills and abilities. Restoring this sense of empowerment is an aim of arts therapy. To put it another way, recovery is a complex process by which a client with a mental illness develops a sense of identity and agency as a citizen, as distinct from identification with illness and disability and passivity as a ‘patient’. The creative arts have gone well beyond being seen as a diversion for the mentally ill. In a comprehensive UK study of creative arts projects for clients with mental illness, Helen Spandler et al. discovered strong evidence that participation in creative activity promoted a sense of purpose and meaning, and assisted in “rediscovering or rebuilding an identity within and beyond that of someone with mental health difficulties” (795). Recovery is aided by people being motivated to achieve self-confidence through mastery and competence; by learning and achieving goals. Clearly this is where arts therapy could be expected or hoped to be effective. The aim of the pilot study was not to measure ‘creativity’, but whether involvement in what is commonly understood as a creative process (life-writing) can have flow-on benefits in terms of the illness of the workshop participant. The psychologists involved, though more familiar with visual arts therapy (reasonably well-established in Australia – in 2006, the ANZAT began publishing the Australian and New Zealand Journal of Art Therapy), thought creative writing could also be valuable. Preparation for and Delivery of the Workshops I was acutely aware that I had no formal training in delivering a program to clients with mental health illness. I was counselled during several meetings with experienced psychologists and a social worker that the participants in the three workshops over two weeks would largely be people who had degrees of difficulty in living independently, and could well have perceptual problems, could misjudge signals from outside and inside the group, and be on medication that could affect their degree of engagement. Some clients could have impaired concentration and cognition, and a deficit in volition. Participants needed to be free to leave and rejoin the workshops during the afternoon sessions. Attendance might well fall as the workshops progressed. Full ethical clearance was attained though the University of Queensland medical faculty (after detailed description of the content and conduct of the proposed workshops) and consent forms prepared for participants. My original workshop ‘kit’ to be distributed to participants underwent some significant changes as I was counselled and prepared for the workshops. The major adjustment to my usual choice of material and approach was made in view of the advice that recounting traumatic events can have a negative effect on some patients – at least in the short term. For the sake of both the individuals and the group as a whole this was to be avoided. I changed my initial emphasis on encouraging participants to recount their traumatic experiences in a cathartic way (as suggested by the narrative psychology literature), to encouraging them to recount positive narratives from their lives – narratives of ‘recovery’ – as I explain in more detail below. I was also counselled that clients with mental health problems might dwell on retelling their story – their case history – rather than reflecting upon it or using their creative and imaginative ability to shape a life-story that was not a catalogue of their medical history. Some participants did demonstrate a desire to retell their medical history or narrative – including a recurring theme of the difficulty in gaining continuity with one trusted medical professional. I gently guided these participants back to fashioning a different and more creative narrative, with elements of scene creation, description and so on, by my first listening intently to and acknowledging their medical narrative for a few minutes and then suggesting we try to move beyond that. This simple strategy was largely successful; several participants commented explicitly that they were tired of having to retell their medical history to each new health professional they encountered in the hospital system, for example. My principal uncertainty was whether I should conduct the workshops at the same level of complexity that I had in the past with groups of university students or community groups. While in both of those cohorts there will often be some participants with mental health issues, for the most part this possibility does not affect the level or kind of content of material discussed in workshops. However, within this pilot group all had been diagnosed with moderate to severe mental illness, mostly schizophrenia, but also bipolar disorder and acute depression and anxiety disorders. The fact that my credentials were only as a published writer and teacher of creative writing, not as a health professional, was also a strong concern to me. But the clients readily accepted me as someone who knew the difficulty of writing well and getting published. I stressed to them that my primary aim was to teach effective creative writing as an end in itself. That it might be beneficial in health terms was secondary. It was a health professional who introduced me and briefly outlined the research aims of the workshop – including some attempt to measure qualitatively any possible benefits. It was my impression that the participants did not have a diminished sense of my usefulness because I was not a health professional. Their focus was on having the opportunity to practice creative writing and/or participate in a creative group activity. As mentioned above, I had prepared a workshop ‘kit’ for the participants of 15 pages. It contained the usual guidelines for effective writing – extracts from professional writers’ published work (including an extract from my own published work – a matter of equity, since they were allowing me to read their work), and a number of writing exercises (using description, concrete and abstract words, narrative point of view, writing in scenes, show don’t tell). The kit contained extracts from memoirs by Hugh Lunn and Bill Bryson, as well as a descriptive passage from Charles Dickens. An extract from Inga Clendinnen’s 2006 account in Agamemnon’s Kiss: selected essays of her positive interaction with fellow cancer patients (a narrative with the underlying theme of recovery) was also valuable for the participants. I stressed to the group that this material was very similar to that used with beginning writers among university students. I described the importance of life-writing as follows: Life-writing is simply telling a story from your life and perhaps musing or commenting on it at the same time. When you write a short account of something chosen from your life, you are making a pattern, using your memory, using your powers of description – you are being creative. You are being a story-teller. And story-telling is one very important thing that makes us humans different from all other animals – and it is a way in which we find a lot of meaning in our lives.My central advice in the kit was: “Just try to be as honest as you can – and to remember as well as you can … being honest and direct is both the best and the easiest way to write memoir”. The only major difference between my approach with these clients and that with a university class was in the selection of possible topics offered. In keeping with the advice of the psychologists who were experts in the theory of ‘recovery’, the topics were predominantly positive, though one or two topics gave the opportunity to recount and/or explore a negative experience if the participant wanted to do so: A time when I was able to help another personA time when I realised what really mattered in lifeA time when I overcame a major difficultyA time when I felt part of a group or teamA time when I knew what I wanted to do with my lifeA time when someone recognised a talent or quality of mineA time I did something that I was proud of A time when I learned something important to meA memorable time when I lived in a certain house or suburbA story that begins: “Looking back, I now understand that …”The group expressed satisfaction with these topics, though they had the usual writing students’ difficulty in choosing the one that best suited them. In the first two workshops we worked our way through the kit; in the third workshop, two weeks later, each participant read their own work to the group and received feedback from their peers and me. The feedback was encouraged to be positive and constructive, and the group spontaneously adopted a positive reinforcement approach, applauding each piece of writing. Workshop DynamicsThe venue for the workshops was a suburban house in the Logan area of Brisbane used as a drop-in centre for those with mental illness, and the majority of the participants would be familiar with it. It had a large, breezy deck on which a round-table configuration of seating was arranged. This veranda-type setting was sheltered enough to enable all to be heard easily and formal enough to emphasise a learning event was taking place; but it was also open enough to encourage a relaxed atmosphere. The week before the first workshop I visited the house to have lunch with a number of the participants. This gave me a sense of some of the participants’ personalities and degree of engagement, the way they related to each other, and in turn enabled them to begin to have some familiarity with me and ask questions. As a novice at working with this kind of client, I found this experience extremely valuable, especially as it suggested that a relatively high degree of communication and cognition would be possible, and it reduced the anxiety I had about pitching the workshops at an appropriate level. In the course of the first workshop, the most initially sceptical workshop participant ended up being the most engaged contributor. A highly intelligent woman, she felt it would be too upsetting to write about negative events, but ultimately wrote a very effective piece about the empowerment she gained from caring for a stray cat and locating the owner. Her narrative also expressed her realisation that the pet was partly a replacement for spending time with her son, who lived interstate. Another strong participant previously had written a book-length narrative of her years of misdiagnoses and trauma in the hospital system before coming under the care of her present health professionals. The participant who had the least literacy skills was accepted by the group as an equal and after a while contributed enthusiastically. Though he refused to sign the consent form at the outset, he asked to do so at the close of the first afternoon. The workshop was comprised of clients from two health provider organisations; at first the two groups tended to speak with those they already knew (as in any such situation in the broader community), but by the third workshop a sense of larger group identity was being manifested in their comments, as they spoke of what ‘the group’ would like in the future – such as their work being published in some form. It was clear that, as in a university setting, part of the beneficial effect of the workshops came from group and face to face interaction. It would be more difficult to have this dimension of benefit achieved via a web-based version of the workshops, though a chat room scenario would presumably go some way towards establishing a group feeling. Web-based delivery would certainly suit participants who lacked mobility or who lived in the regions. Clearly the Internet is a vital social networking tool, and an Internet-based version of the workshops could well be attempted in the future. My own previous experience of community digital storytelling workshops (Neilsen, Digital Storytelling as Life-writing) suggests that a high degree of technical proficiency can not be expected across such a cohort; but with adequate technical support, a program (the usual short, self-written script, recorded voice-over and still images scanned from the participants’ photo albums, etc) could make digital storytelling a further dimension of therapeutic life-writing for clients with mental illness. One of the most useful teaching techniques in a class room setting is the judicious use of humour – to create a sense of sharing a perspective, and simply to make material more entertaining. I tested the waters at the outset by referring to the mental health worker sitting in the background, and declaring (with some comic exaggeration) my concern that if I didn’t run the workshop well he would report adversely on me. There was general laughter and this expression of my vulnerability seemed to defuse anxiety on the part of some participants. As the workshop progressed I found I could use both humorous extracts of life-writing and ad hoc comic comments (never at the expense of a participant) as freely as in a university class. Participants made some droll comments in the overall context of encouraging one another in their contributions, both oral and written. Only one participant exhibited some temporary distress during one of the workshops. I was allowing another participant the freedom to digress from the main topic and the participant beside me displayed agitation and sharply demanded we get back to the point. I apologised and acknowledged I had not stayed as focused as I should and returned to the topic. I suspect I had a fortunate first experience of such arts therapy workshops – and that this was largely due to the voluntary nature of the study and that most of the participants brought a prior positive experience of the workshop scenario, and prior interest in creative writing, to the workshops. Outcomes A significantly positive outcome was that only one of the nine participants missed a session (through ill-health) and none left during workshops. The workshops tended to proceed longer than the three hours allotted on each occasion. Post-workshop interviews were conducted by a psychologist with the participants. Detailed data is not available yet – but there was a clear indication by almost all participants that they felt the workshops were beneficial and that they would like to participate in further workshops. All but one agreed to have their life-writing included in a newsletter produced by one of the sponsors of the workshops. The positive reception of the workshops by the participants has encouraged planning to be undertaken for a wide-ranging longitudinal study by means of a significant number of workshops in both life-writing and visual arts in more than one city, conducted by a team of health professionals and creative practitioners – this time with sophisticated measurement instruments to gauge the effectiveness of art therapy in aiding ‘recovery’. Small as the workshop group was, the pilot study seems to validate previous research in the UK and US as we have summarised above. The indications are that significant elements of recovery (in particular, feelings of enhanced agency and creativity), can be achieved by life-writing workshops that are guided by creative practitioners; and that it is the process of narrative construction within life-writing that engages with or enhances a sense of self and identity. NoteWe are indebted, in making the summary of the concept of ‘recovery’ in health science terms, to work in progress by the following research team: Robert King, Tom O'Brien and Claire Edwards (School of Medicine, University of Queensland), Margot Schofield and Patricia Fenner (School of Public Health, Latrobe University). We are also grateful for the generous assistance of both this group and Seiji Humphries from the Richmond Queensland Fellowship, in providing preparation for the workshops. ReferencesAlschuler, Mari. “Lifestories – Biography and Autobiography as Healing Tools for Adults with Mental Illness.” Journal of Poetry Therapy 11.2 (1997): 113–17.Davidson, Larry and John Strauss. “Sense of Self in Recovery from Severe Mental Illness.” British Journal of Medical Psychology 65 (1992): 31–45.Eakin, Paul. Fictions in Autobiography: Studies of the Art of Self-Invention. Princeton: Princeton UP, 1985.———. How Our Lives Become Stories: Making Selves. 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