PDF 266kB - QUT ePrints

2 downloads 0 Views 260KB Size Report
Catalogue from Homo Faber 2007. QUT Digital Repository: ... Richardson, 2002) Rosenberg, 1992; Russell & Sander, 1998a, 1998b; Scott, 1992;. vanderPloeg ...
QUT Digital Repository: http://eprints.qut.edu.au/

This is the author version published as: This is the accepted version of this article. To be published as :

This is the author version published as:   Rosenberg, John P. and Yates, Patsy (2010) Health promotion in  palliative care : the case for conceptual congruence. Critical Public  Health, 20(2). pp. 201‐210.  Catalogue from Homo Faber 2007

Copyright 2010 Routledge, Taylor & Francis Group 

TITLE: Health Promotion in Palliative Care – The Case for Conceptual Congruence.

RUNNING TITLE: Health promotion in palliative care.

AUTHORS: Dr John P. Rosenberg RN PhD University of Queensland / Blue Care Research and Practice Development Centre 56 Sylvan Rd Toowong QLD 4066 Australia

Professor Patsy M. Yates RN PhD Director of Research, School of Nursing Queensland University of Technology Victoria Park Rd Kelvin Grove QLD 4059 Australia

CORRESPONDING AUTHOR: Dr John P. Rosenberg University of Queensland / Blue Care Research and Practice Development Centre 56 Sylvan Rd Toowong QLD 4066 Australia Telephone: +61 7 4720 5313

Fax: +61 7 4720 5332 Email: [email protected]

Health Promotion in Palliative Care – The Case for Conceptual Congruence

ABSTRACT:

This discussion paper provides a critical review of the literature relevant to the conceptual foundations of health promoting palliative care. It explores the separate emergence and evolution of palliative care and health promotion as distinct concerns in health care, and reviews the early considerations given to their potential convergence. Finally, this paper examines the proposal of health promoting palliative care as a specific approach to providing end of life care through a social model of palliative care. Research is needed to explore the impact for communities, health care services and policy when such an approach is implemented within palliative care organisations.

KEYWORDS: Palliative care; health promotion; conceptual congruence; social models of health.

Introduction.

At first glance, health promotion and palliative care may appear to be conceptually incongruent fields. Palliative care aims to achieve the best possible quality of life for dying people and their families (Palliative Care Australia, 2004), while health promotion aims to assist people to live as healthily as possible (World Health Organization, 1986). Yet a growing body of literature claims that individual and collective benefits may be attained with the integration of these two fields (Buckley, 2002; Clough, 2002; D'Onofrio & Ryndes, 2002; Faulkner, 1993; Kellehear, 1999a, 1999b, 2005; Lloyd, 2000; Maslen, 1998; Rao, Anderson, & Smith, 2002; Richardson, 2002) Rosenberg, 1992; Russell & Sander, 1998a, 1998b; Scott, 1992; vanderPloeg, 2001; Weaver, 2004; Zeefe, 1996). This article draws upon this body of literature to provide a closer examination of how the elements of health promotion can be applied to palliative care and demonstrate the case for their conceptual congruence.

In origins, apart.

Palliative care originally emerged, at least in part, as a response to the perceived neglect of dying people by the dominant biomedical model of health care in parts of the Western world during the post-war period (Moore, 2004). This model was criticised for its removal of sick and dying persons from their social contexts (Bunton & Macdonald, 2002), subsequently undertaking diagnoses and treatments that failed to correspond to the day to day reality of health and illness experienced by “ordinary people” (Moore, 2004, p.304). The grassroots social movement historically known as

the modern hospice movement sought to restore “an holistic approach to patient care, the family as the focus of care, and importance of multidisciplinary collaboration on a day to day basis” (Hockley, 1997, p.84).

In a trajectory similar to the evolution of palliative care, health promotion emerged during the latter decades of the 20th Century from growing concern with the overemphasis in health care upon disease and its diagnosis, treatment and cure (World Health Organization, 1978). The emergent view was that the dominant biomedical model failed to adequately embrace whole population issues and the complex interrelationships between the physical, psychological and social components of health and wellbeing, through its artificial dissociation of the disease from the person, and the person from their social context (Bunton & Macdonald, 2002). In devising five key action areas for the improvement of health shown in Table 1, the watershed Ottawa Charter for Health Promotion (World Health Organization, 1986) represented an area of strategic action to promote the physical, social and personal aspects of health and wellbeing. Significantly, it explicitly asserted that responsibility for health promotion rests not simply with the health sector but with governments, social and economic sectors, industry and the media, and communities themselves. [INSERT TABLE 1]

In evolution, distinct.

By the end of the 1990s, the modern hospice movement was no longer viewed in its previously rebellious terms, understood instead to be “not an alternative to other care but…a complementary and vital part of total patient management” (Faull, 1998, p.1).

By then known as ‘palliative care’, the care of dying people had been largely reintegrated into mainstream health care systems. Some expressed concern that such integration represents a threat to the founding principles of hospice and palliative care through its routinisation and medicalisation (Clark & Seymour, 1999; Hart, Sainsbury, & Short, 1998). This perceived overemphasis by palliative care practitioners on pain and symptom management was criticised as ‘symptomatology’ (Kearney, 1992), or a set of medico-nursing interventions provided at the expense of psychosocial interventions (Kellehear, 1999a). Indeed, it has been suggested that the palliative care profession continues to focus upon individualised responses to need rather than social change: Dying, death and loss are defined as personal problems rather than targets of social change in community attitudes, values and behaviour. This reinforces the view that clinical rather than community skills should take priority in palliative care education and training (Kellehear, 2005, p.9).

Five deficiencies of contemporary approaches to palliative care are described by Kellehear (1999b), shown in Table 2. [INSERT TABLE 2 HERE]

Across the same timeframe, the Ottawa Charter goals were being endorsed and refined at subsequent WHO Health Promotion conferences, with a progressive shift from local to global perspectives of health promotion (Talbot & Verrinder, 2005). Firstly, the Jakarta Declaration on Leading Health Promotion into the 21st Century (World Health Organization, 1997) emphasised the broad application of health in society and the consequent need to strategise beyond the health sector to attain levels of health. It presented an alternative paradigm of health care that countered the dominant biomedical model, endorsing instead the notion of partnership between

members of the community with the health care professions in order to achieve health. Further, the Jakarta Declaration reiterated the importance of the social and environmental contexts in which individuals live, work and find leisure. Therefore, effective strategies for health could no longer be targeted solely at changing the health behaviours of individuals, but must also include action at social, environmental and political levels. Secondly, where earlier documents demonstrated a transition from the health of individuals to the health of societies, the Bangkok Charter for Health Promotion in a Globalized World (World Health Organization, 2006) sought progress towards the health of the global community. Whilst reiterating what had been written previously about health promotion, the Bangkok Charter presented a robust set of strategies for global development of health, undertaking to ensure that the promotion of health is “central to the global development agenda, a core responsibility for all of government, a key focus of communities and civil society, a requirement for good corporate practice” (World Health Organization, 2006, p.1). Increasingly, the focus of health promotion moved from individual to collective to systemic responsibility.

In concert, considered.

Does the end of life [possess] the characteristics of a public health priority? Firstly, in absolute terms, death has a universal incidence… (Rao et al., 2002, p.215).

Despite the shared chronology between, and similar precursors for palliative care and health promotion, there is little evidence of any explicit consideration of their congruence until the 1990s. Kellehear’s book Health Promoting Palliative Care (1999b) was the first substantial attempt to theoretically and systematically integrate

these two parallel but distinct fields. In his application of the principles of health promotion to the core concerns of palliative care, Kellehear explored the core concerns of palliative care, citing the WHO definition of palliative care, the key action areas of the Ottawa Charter, and the foundational work of Saunders (1987) and others, emphasising the centrality of holism as a response to the multidimensional nature of care at the end of life. In a routinised and medicalised health care system, he called for a broad debate on the ways in which a health promoting approach to palliative care might be implemented in theory and practice. Critical of the discrepancy between rhetoric and reality, Kellehear referred to a number of examples that illustrate the overemphasis on physical – and, to a lesser extent, psychological – symptomatology at the expense of the social and spiritual domains, referring to the concerns expressed by Kearney (1992). A health promoting approach to palliative care, Kellehear claimed, addresses five underdeveloped aspects of conventional palliative care: •

Social science and public health components.



The social aspects of care.



Early stage care.



Active treatment of disease.



Life-threatening illness (not just terminal care).

(Kellehear, 1999b, p.9)

Whilst Kellehear’s work has been the most comprehensive in calling for the integration of health promotion into palliative care, other authors have argued for the inclusion of public health perspectives and health promotion components in palliative care. It can be readily seen that some elements of the Ottawa Charter are familiar to

the practice of palliative care – such as creating supportive environments and developing personal skills. Indeed, the key action area of developing personal skills makes explicit mention of lifelong learning for people preparing themselves for all of life’s stages. 1 Others have discussed the impact of healthy public policy upon end of life care and the potential improvement of access to palliative care services (Clough, 2002; D'Onofrio & Ryndes, 2003). In particular, Scott (1992) and Gallagher’s (2001) attention to the need for education of the public demonstrated a clear attempt at the integration of a health promotion approach to palliative care. Each author saw education as the primary tool in informing and equipping members of the public for their involvement in palliative care – albeit only when the need arises. In other words, the reference point for both authors in promoting educational activities in the general public about death and dying related specifically to the possible need for palliative care services in the future. This contrasts somewhat with the notion of death education, where the personal skills requiring development are not limited to caregiving or anticipated need.

Public health has explored in detail the relationship between human health and wellbeing with social and environmental factors (Talbot & Verrinder, 2005). Rao and colleagues (Rao et al., 2005; Rao et al., 2002) have been asserting the need for the concrete inclusion of a public health foundation in palliative care service planning. They argue that connecting health to the community, providing information and establishing partnerships will raise death awareness, empowering the community to contribute to debate of issues of quality of life at the end of life as a sound basis for end of life care. Indeed, in their study of public health priorities for end of life

1

Authors’ emphasis

initiatives, Rao and colleagues (2005) identified five areas of public health activity that are directly relevant to the provision of palliative care: •

Public education.



Patient, family and caregiver education.



Research, epidemiology and evaluation.



Professional education.



Policy and planning.

Importantly, these areas are accompanied by a set of recommendations for action; for example, in the public education cluster, Rao et. al (2005) describe strategies to raise public awareness of palliative care, increase the use of advanced health directives, integrate end of life issues into chronic disease educational materials, and operate some form of information clearing house for end of life issues.

Establishing conceptual congruence. The goal of wholeness sought by palliative care and the promotion of optimal health have close conceptual associations. The concept of wholeness for people at the end of life presents few philosophical hurdles to commentators on palliative care. Suffering is regarded as a complex, subjective experience, the amelioration of which produces an optimal state in a person even in the presence of incurable illness (Woodruff, 1996). Saunders (1987) described good palliative care in terms now commonly ascribed to holism, namely that care should be directed from the time of diagnosis at the physical, psychological, social and spiritual dimensions of a person’s experience, by a team comprehensively representing the various disciplines with the expertise to address these areas of need. Contemporary understandings of health recognise the impact of disease, illness and health-related issues upon all aspects of human

existence (McMurray, 2003) and, notably, the role of participation of individuals, communities and societies in determining their own health outcomes (World Health Organization, 2006).

Placed at the centre of the palliative care endeavour are the recipients of care, and their families and carers, with sympathetic stakeholders in the wider public enrolled in the kind of local activism that has borne many hospice and palliative care services (Small, 2003). Byock, Norris, Curtis and Patrick (2001) have undertaken substantial work towards facilitating a transition in end of life care from a focus upon individuals, to a robust engagement with the community – that is, social – approach. These authors saw the community’s affiliation with end of life issues as having a reciprocal effect – the community members’ perspectives of death and dying inform their engagement, whilst their engagement reshapes their perspectives. In an American study, consumer stakeholders identified the preservation of social relationships at the end of life as a priority (D’Onofrio & Ryndes, 2003). The study’s authors suggested that public health approaches could bring about improvement to care at the end of life through its whole population perspective and emphasis upon policy development. To achieve this, public health systems would need to acknowledge death as the outcome of chronic disease and ageing, find new means to measure quality of dying, and consider a re-evaluation of resource allocation policies.

In the Charter for the Normalisation of Death, Dying and Bereavement (International Work Group on Death, Dying and Bereavement, 2005) an argument for the congruence of these fields is made. The authors of this charter implied that when this conceptual congruence is embraced, the transition of dying people from active into

palliative care can take place in a less disruptive and potentially traumatic way because of its highly contextualised nature. This is identified elsewhere, with the preservation of social networks (including family) being seen as a priority for recipients of palliative care services and a validation of the desirability of social models of care that facilitate this (D’Onofrio & Ryndes, 2003). Critics of conventional models of palliative care have argued that current approaches to service provision lack this perspective which highlights the need for the integration of health promoting principles and practice into palliative care organisations (Kellehear, 1999a, 1999b; Rao et al., 2002).

Health promotion is proposed as an approach to end of life care that embraces the core concerns of palliative care that is amenable to the application of health promotion principles and practices. Health promoting palliative care provides social models of care based upon a conceptual perspective that promotes optimal health even in the presence of incurable disease, utilising palliative care philosophy to inform the development of organisational mission, values and strategic directions, and the Ottawa Charter to supply parameters for determining the scope of goals and objectives. In Table 3, this author (Rosenberg, 2007) has built on Kellehear’s core concerns for health promoting palliative care shown above by aligning the five key action areas of the Ottawa Charter for Health Promotion (1986) alongside new descriptions of their application to palliative care organisations. [INSERT TABLE 3]

Further work by Kellehear with Bateman and Rumbold (2003) developed Practice Guidelines for Health Promoting Palliative Care, summarised in Table 4. These guidelines offer a profile of a number of organisational features of a health promoting

palliative care organisation. It is suggested that, in addition to the provision of death education and support for consumers of palliative care services, strategies should also target the structures and processes of the organisation. Staff support programs, nonclinical partnerships, social research, policy initiatives, and staffing profiles were all suggested elements of a health promoting workplace. [INSERT TABLE 4 HERE]

Conclusion. It is worth reiterating that the premise of conceptual congruence is implicit in the Ottawa Charter for Health Promotion (World Health Organization, 1986) in asserting the promotion of health and wellbeing of all of life’s stages. 2 Whilst this has not always been evident in the practice of public health and health promotion (Stjernsward, 2007), this congruence is demonstrated in the literature reviewed here. However, whilst conceptually these numerous perspectives demonstrate how health promotion principles and practice might be integrated into palliative care organisations, there remains a gap in evidence of the impact of such a transition. Whilst this transition represents a substantial paradigmatic shift and involves the reconceptualisation of some features of conventional palliative care services, the conceptual congruence demonstrated underpins an approach to end of life care that enables the combination of health promotion and palliative care to the benefit of individuals, communities and the professions providing palliative care. Further research is needed to understand how the concepts described in this review can be translated in the service provision setting, and what impact such an approach may have for communities and palliative care services.

2

Researchers’ emphasis

REFERENCES

Buckley, J. (2002). Holism and a health-promoting approach to palliative care. International Journal of Palliative Nursing, 8(10), 505-508. Bunton, R., & Macdonald, G. (2002). Health Promotion - disciplines, diversity and developments (2 ed.). London: Routledge. Byock, I., Norris, K., Curtis, J. R., & Patrick, D. L. (2001). Improving end of life experience and care in the community: a conceptual framework. Journal of Pain and Symptom Management, 22(3), 759-772. Clark, D., & Seymour, J. (1999). Reflections on Palliative Care. Buckingham: Open University Press. Clough, A. (2002). Community care policy and end of life care: one patient's story. British Journal of Community Nursing, 7(3), 153-157. D'Onofrio, C., & Ryndes, T. (2003). The relevance of public health in improving access to end of life care. In B. Jennings, T. Ryndes, C. D'Onofrio & M. A. Baily (Eds.), Access to Hospice Care: Expanding Boundaries, Overcoming Barriers (Supplement ed.). New York: The Hastings Center. Faulkner, M. (1993). Promoting a healthy bereavement. Journal of Community Nursing, 18, 23. Faull, C. (1998). The History and Principles of Palliative Care. In C. Faull, Y. Carter & R. Woof (Eds.), Handbook of Palliative Care. Oxford: Blackwell Science. Gallagher, R. (2001). Using a trade-show format to educate the public about death and survey public knowledge and needs about issues surrounding death and dying. Journal of Pain and Symptom Management, 21(1), 52-58.

Hart, B., Sainsbury, P., & Short, S. (1998). Whose dying? A sociological critique of the "good death". Mortality, 3(1), 65-77. Hockley, J. (1997). The evolution of the hospice approach. In D. Clark, J. Hockley & S. H. Ahmedzai (Eds.), New Themes in Palliative Care. Buckingham: Open University Press. International Work Group on Death Dying and Bereavement. (2005). Charter for the normalisation of dying, death and loss: draft statement. Mortality, 10(2), 157161. Kearney, M. (1992). Palliative medicine - just another specialty? Palliative Medicine, 6, 39-46. Kellehear, A. (1999a). Health Promoting Palliative Care: developing a social model of practice. Health Promotion Journal of Australia, 9(1), 30-34. Kellehear, A. (1999b). Health Promoting Palliative Care. Oxford: Oxford University Press. Kellehear, A. (2005). Compassionate Cities: Public Health and End-of-Life Care. London: Routledge. Kellehear, A., Bateman, G., & Rumbold, B. (2003). Practice Guidelines for Health Promoting Palliative Care. Melbourne: La Trobe University. Lloyd, L. (2000). Dying in old age: promoting well-being at the end of life. Mortality, 5(2), 171-188. Maslen, G. (1998). Death education for the dying. Campus Review, 8(45), 18-24. McMurray, A. (2003). Community Health and Wellness: A Socioecological Approach (2nd ed.). Marrickville: Elsevier.

Moore, S. (2004). Health, Medicine and the Body. In M. Haralambos, M. Holborn & R. Heald (Eds.), Sociology: Themes and Perspectives (6th ed.). London: Collins. Palliative Care Australia. (2004). What is palliative care? Retrieved 22 Oct., 2004, from http://www.pallcare.org.au/pca_aboutpalliativecare.html Rao, J. K., Alongi, J., Anderson, L. A., Jenkins, L., Stokes, G.-A., & Kane, M. (2005). Development of Public Health Priorities for End-of-Life Initiatives. American Journal of Preventive Medicine, 29(5), 453-460. Rao, J. K., Anderson, L. A., & Smith, S. M. (2002). End of life is a public health issue. American Journal of Preventive Medicine, 23(3), 215-220. Richardson, J. (2002). Health promotion in palliative care: the patients' perception of therapeutic interaction with the palliative nurse in the primary care setting. Journal of Advanced Nursing, 40(4), 432-440. Rosenberg, J. (1992). Palliative care in the home - a surprising component of primary health care? Paper presented at the Primary Health Care: Development and Diversity Conference, Sydney. Rosenberg, J.P. (2007). A study of the integration of health promotion principles and practice in palliative care organisations. Unpublished PhD thesis. Queensland University of Technology, Brisbane. Russell, P. S., & Sander, R. (1998a). Health promotion: focus on care of the dying. International Journal of Palliative Nursing, 4(6), 266-270. Russell, P. S., & Sander, R. (1998b). Palliative care: promoting the concept of a healthy death. British Journal of Nursing, 7(5), 256-261. Saunders, C. (1987). What's in a name? Palliative Medicine, 1, 57-61.

Scott, J. F. (1992). Palliative care education in Canada: attacking fear and promoting health. Journal of Palliative Care, 8(1), 47-53. Small, N. (2003). The changing National Health Service, user involvement and palliative care. In B. Monroe & D. Oliviere (Eds.), Patient Participation in Palliative Care: A Voice for the Voiceless. Oxford: Oxford University Press. Stjernsward, J. (2007). Palliative Care: The Public Health Strategy. Journal of Public Health Policy, 28(1), 42-55). Talbot, L. & Verrinder, G. (2005) Promoting Health: The Primary Health Care Approach (3rd ed.). Sydney: Churchill Livingstone. vanderPloeg, W. (2001). Health promotion in palliative care: an occupational perspective. Australian Occupational Therapy Journal, 48, 45-48. Weaver, A. W. (2004). Family Health Promotion during Life-Threatening Illness and at the End of Life. In P. J. Bomar (Ed.), Promoting Health in Families (3rd ed.). Philadelphia: Elsevier Inc. Woodruff, R. (1996). Palliative Medicine (2nd ed.). Heidelberg: Asperula. World Health Organization. (1978). The Declaration of Alma-Ata. Geneva: WHO. World Health Organization. (1986). The Ottawa Charter for Health Promotion. Geneva: WHO. World Health Organization. (1997). The Jakarta Declaration on Leading Health Promotion into the 21st Century. Geneva: WHO. World Health Organization. (2006). The Bangkok Charter for Health Promotion in a Globalized World. Geneva: WHO. Zeefe, L. R. (1996). Death Education: Teaching Staff, Patients, and Families about the Dying Process. In D. C. Sheehan & W. B. Forman (Eds.), Hospice and

Palliative Care: Concepts and Practice. Sudbury: Jones and Bartlett Publishers.

TABLE 1: FIVE KEY ACTION AREAS FOR HEALTH PROMOTION •

Build public policy



Create supportive environments



Strengthen community action



Develop personal skills



Reorient health services

(Ottawa Charter for Health Promotion, World Health Organization, 1986)

TABLE 2: FIVE CORE CONCERNS OF HEALTH PROMOTING PALLIATIVE CARE •

Provide education and information for health, death and dying.



Provide social support at both personal and community levels.



Encourage interpersonal reorientation.



Encourage reorientation of palliative care services.



Combat death-denying health policies and attitudes. Kellehear, 1999, pp.19-20)

TABLE 3: TRANSITIONING HEALTH PROMOTION ELEMENTS TO PALLIATIVE CARE KEY ACTION

HEALTH PROMOTION

IN PALLIATIVE CARE

AREAS TO

DESCRIPTION

ORGANISATIONS

Building public

Health is on the agenda of

Concerned with the participation

policies that

all policy makers, who must

of organisations in the

support health

consider the health

development and/or uptake of

consequences of policy

public policy relating to palliative

decisions. Obstacles to the

care and the support of dying

adoption of healthy public

people.

SUPPORT HEALTH

policies need to be identified and removed. Creating

Health cannot be separated

Concerned with the ways in

supportive

from other societal goals. A

which organisations contribute to

environments

sociological basis for health

the creation of supportive

embraces the links between

environments to enhance well-

people and their

being for consumers and

environment.

employees of the palliative care service.

Strengthening

Communities set their own

Related to the nature of the

community

health priorities, make

engagement of organisations with

action

decisions, and plan and

the wider community, beyond the

implement strategies to

recipients of palliative care

promote their

services, to promote community

empowerment. Community

action towards improved support

development enhances

of people at the end of life.

participation in, and direction of health matters. Developing

The enhancement of life

Concerned with organisations’

personal skills

skills through personal and

participation in the development

social development

of personal skills to assist

promotes people exercising

individuals to deal with issues

control over their health

around death and dying. Includes

throughout life.

both health care professionals and primary caregivers.

Reorienting

Responsibility for health

Related to the activities of

health services

promotion within the health

organisations in reorienting their

care system rests with all

members to a health promoting

participants. Health

approach, and has a particular

services must move beyond

focus on the holistic needs of its

clinical and curative

client population, and changes in

services to support

organisational attitudes.

individuals and communities for a healthier life. Health research, professional education and training are necessary strategies for refocusing

health services toward the needs of the whole person.

TABLE 4: PRACTICE GUIDELINES FOR HEALTH PROMOTING PALLIATIVE CARE Guideline

Evidence

1.1

Extend the activities or complement existing support groups

Two

with additional adult learning groups:

programs

◦ Small groups of 5-7 people

per year

◦ Weekly reading material ◦ Reading includes individuals’ health care but flexible to group’s needs ◦ Death education ◦ Limited durations of 6-8 weeks ◦ Patients only groups; carers only groups 1.2

AND/OR Offer opportunities for one-on-one patient

As needed

information sessions with a health educator about life changes, health maintenance, and death education. 2

Demonstrated evidence of death education for:

At least two

◦ Patients ◦ Staff ◦ Caregivers ◦ Community (including talks, publication, media) 3

Demonstrated evidence of education in social approaches to care for: ◦ Staff (including volunteers) such as in-service education and higher education

At least two

◦ Caregivers ◦ Community (including talks, publication, media) 4

Demonstrated evidence of non-clinical partnerships (with the

At least a)

aim of understanding prevention, harm-minimisation, early

and one

intervention, community development, participatory health care,

other

health ecology and the Ottawa Charter: ◦ Membership of Health Promotion / Public Health Associations ◦ Regular meetings with Community Health Agencies ◦ Annual attendance at a public health conference by some staff/volunteers 5

Education resource material for clients and professionals,

Library

including literature / audiovisual material concerning:

evident

◦ Death education ◦ Alternative therapies ◦ Health promotion ◦ Spirituality 6

Social Research: ◦ Partnerships concerned with social issues ◦ Staff reading groups or journal clubs focussing on social issues ◦ Actual social research projects ◦ Promotion and encouraging of staff toward future education in social science fields

7

Policy:

◦ Evidence of regular submissions to: ◦ Local members of parliament ◦ Government committees of inquiry ◦ Departments of human services ◦ Local municipal councils 8

Staffing Profile:

Proportion

◦ Employment of socially trained professionals (eg: social

of funding

worker, pastoral care) ◦ Access to health promotion / health education worker ◦ Staff profile reflecting cultural and social profile of community 9

Evidence of health promoting settings ◦ Minimisation of impact of clinical settings ◦ Environments that recognise and enhance individual identity ◦ Environments that provide opportunities for community access and participation ◦ Environments that provide genuine opportunities for health improvements

10

Demonstrated community development program: ◦ Regular partnered and cooperative activities ◦ Local government engagement ◦ Local media engagement ◦ Local schools, workplaces, churches engagement ◦ Local community sporting, service and political groups

allocation

engagement ◦ Raising awareness about death, dying, loss and caring

(From Kellehear, Bateman and Rumbold, 2003; used with permission)