ORCID Profile
0000-0002-5951-9419
Current Organisations
City University of Hong Kong
,
Deakin University
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Publisher: Springer Science and Business Media LLC
Date: 03-2023
DOI: 10.1186/S12913-022-09000-3
Abstract: Strict isolation of COVID-19 patients to prevent cross infection may inadvertently cause serious adverse outcomes including psychological harm, limitations to care, increased incidence of delirium, deconditioning and reduced quality of life. Previous research exploring the staff perspective of the effect of isolation on patients is limited. The aim of this study is to understand staff perceptions and interpretations of their experiences of the care and treatment of isolated patients and the impact of isolation on patients, families, and staff. This qualitative, exploratory study is set in a major metropolitan, quaternary hospital in Melbourne, Australia. Data was collected in focus groups with clinical and non-clinical staff and analysed using content analysis. The hospital ethics committee granted approval. Each participant gave informed verbal consent. Participants included 58 nursing, medical, allied health, and non-clinical staff. Six main themes were identified: 1) Communication challenges during COVID-19 2) Impact of isolation on family 3) Challenges to patients’ health and safety 4) Impact on staff 5) Challenging standards of care 6) Contextual influences: policy, decision-makers and the environment. Isolating patients and restricting visitors resulted in good pandemic management, but staff perceived it came at considerable cost to staff and consumers. Innovative communication technology may facilitate improved connection between all parties. Mental health support is needed for patients, families, and staff. Further research using a co-design model with input from patients, families and staff is recommended to determine appropriate interventions to improve care. Preventing the spread of infection is essential for good pandemic management, but the cost to consumers and staff must be mitigated. Preparation for future pandemics must consider workforce preparedness, adapted models of care and workflow.
Publisher: Hindawi Limited
Date: 2016
DOI: 10.1155/2016/5138706
Publisher: Wiley
Date: 31-01-2013
DOI: 10.1111/J.1741-6612.2012.00654.X
Abstract: To investigate processes at the end of life for patients who died in a subacute evaluation and management facility for older people. A retrospective chart audit for patients (n = 55) who died in the previous 2 years was undertaken, recording a number of significant variables. Despite diagnosis of comorbid medical conditions, most participants were admitted for improved functioning or assessment for alternative accommodation. Consistent with this focus, the key contact person was most often an allied health team member. Not For Resuscitation order and/or power of attorney documents on admission were uncommon (<30%) as were referrals to palliative care specialist staff (13%), although an end-of-life discussion was recorded (90%) and often included as a new goal of care (71%). Factors likely to improve end-of-life care include advance care planning, earlier recognition of short prognosis and staff education.
Publisher: Wiley
Date: 04-06-2020
DOI: 10.1111/JAN.14433
Abstract: To describe nurses' decision‐making, experiences and perceptions of escalating deteriorating patients to the treating medical team using urgent clinical review criteria. A qualitative design comprising in idual in‐depth interviews with nurses from a major Australian metropolitan tertiary teaching hospital. A purposive s le of 30 Registered Nurses from nine surgical and medical wards were interviewed in April 2018 using semi‐structured interviews. An inductive thematic analysis was conducted. Identified themes included: detecting the deterioration countering the problem getting a response and challenges faced in the process of escalation. Nurses reported an important awareness, sense of responsibility, and critical thinking to ensure the safe management and escalation of deteriorating patients. However, barriers to escalation necessitated in idual workarounds and organizational structures to mitigate patient risk. This study supports the importance of communication between clinical teams and recognizes that it is crucial to enable a fail‐safe experience for patients and families. Recognition of disciplinary contributions to patients' goals of care is required to better understand and address the prevalence of deteriorating patients. Our study is among the first to explore the actual experience of nurses who articulate balancing uncertainty and managing complex team dynamics on wards for patients experiencing deteriorating health status. The information may assist in determining team training strategies and structures to facilitate patient management during deterioration. This is among the first study to investigate barriers influencing decision‐making of RNs prior to escalation using qualitative methods. This study provides a foundation to inform and develop policies and strategies aimed at ensuring escalation occurs for deteriorating patients.
Publisher: MDPI AG
Date: 22-08-2022
DOI: 10.3390/NU14163445
Abstract: Honey is proposed to be the oldest natural sweetener and it is a standard component of several dietary patterns. Recent evidence suggests that replacing sugars, such as fructose, with honey has potential health benefits. In this study, we determined the effects of honey supplementation in mice on cardiometabolic and inflammatory markers and changes in gut microbiota and metabolomic profiles. We compared mice fed a honey diet (1 or 2 g/kg) with those fed an analog diet (mixed fructose, glucose, and sucrose (FSG) solutions) at exact dosages for one month. We found the same blood glucose fluctuating trends for honey- and FGS-fed mice. The honey diets resulted in less weight gain and fewer ballooned hepatocytes. Additionally, honey diets decreased the total serum cholesterol and TNF-α and increased the antioxidant enzyme activity. Each diet type was associated with distinct gut microbiota and metabolomics profiles. Systems biology analysis revealed that Lactococcus spp., Lachnospiraceae spp., and oleamide had the strongest correlations with lipid metabolic networks. Although in an animal model, this study provides a good understanding of the potential benefits of choosing honey rather than mixed sugars in regular dietary patterns.
Publisher: Wiley
Date: 06-03-2019
DOI: 10.1111/JAN.13963
Abstract: To describe nurses' decision-making, practices and perceptions of patient involvement in medication administration in acute hospital settings. Medication errors cause unintended harm to patients. Nurses have a major role in ensuring patient safety in medication administration practices in hospital settings. Investigating nurses' medication administration decision-making and practices and their perceptions of patient involvement, may assist in developing interventions by revealing how and when to involve patients during medication administration in hospital. A descriptive exploratory study design. Twenty nurses were recruited from two surgical and two medical wards of a major metropolitan hospital in Australia. Each nurse was observed for 4 hr, then interviewed after the observation. Data were collected over six months in 2015. Observations were captured on an electronic case report form interviews were audio-recorded and transcribed verbatim. Data were analysed using descriptive statistics and content and thematic analysis. Ninety-five medication administration episodes, of between two and eight episodes per nurse, were observed. A total of 56 interruptions occurred with 26 of the interruptions being medication related. Four major themes emerged from the interviews: dealing with uncertainty facilitating, framing and filtering information managing interruptions and knowing and involving patients. Nurses work in complex adaptive systems that change moment by moment. Acknowledging and understanding the cognitive workload and complex interactions are necessary to improve patient safety and reduce errors during medication administration. Knowing and involving the patient is an important part of a nurses' medication administration safety strategies.
Publisher: Wiley
Date: 23-10-2020
DOI: 10.1111/INM.12804
Publisher: Wiley
Date: 23-07-2018
DOI: 10.1111/JOCN.14553
Abstract: To explore allied health staff perceptions on the role of nurses in subacute care wards. A consequence of earlier discharge from acute hospitals is higher acuity of patients in subacute care. The impact on nurses' roles and required skill mix remains unknown. In the same way, nurses' integration into the rehabilitation team is ambiguous. Descriptive qualitative inquiry. Semistructured interviews conducted with 14 allied health staff from one subacute care facility in Melbourne, Australia. Interviews were audio-recorded and transcribed verbatim. Analysis using the framework approach. Three main themes were evident: (a) the changing context of care: patient acuity, rapid patient discharge and out-dated buildings influenced care (b) generalist as opposed to specialist rehabilitation nurses: a ide between traditional nursing roles of clinical and personal care and a specialist rehabilitation role and (c) interdisciplinary relations and communication demonstrated lack of respect for nurses and integrating holistic care into everyday routines. Allied health staff had limited understanding of nurses' role in subacute care, and expectations varied. Power relationships appeared to h er teamwork. Failure to include nurses in team discussions and decision-making could hinder patient outcomes. Progressing patients to levels of independence involves both integrating rehabilitation into activities of daily living with nurses and therapy-based sessions. Promotion of the incorporation of nursing input into patient rehabilitation is needed with both nurses and allied health staff. Lack of understanding of the nurses' role contributes to lack of respect for the nursing contribution to rehabilitation. Nurses have a key role in rehabilitation sometimes impeded by poor teamwork with allied health staff. Processes in subacute care wards need examination to facilitate more effective team practices inclusive of nurses. Progressing patients' independence in rehabilitation units involves activities of daily living with nurses as much as therapy-based sessions.
Publisher: Elsevier BV
Date: 08-2018
Publisher: Elsevier BV
Date: 12-2014
DOI: 10.1016/J.COLEGN.2013.08.006
Abstract: While family caregivers may temporarily relinquish responsibility for daily care to health professionals for the period of hospitalization, new expectations and demands are placed upon them. Family caregivers can be asked to commit to new relationships with health professionals, contribute to care decisions and discharge planning. For the caregivers of older patients these new expectations may be challenging, and contribute to feelings of burden and increased stress. The aim of this qualitative descriptive study was to explore the experience of family caregivers when their relative is an inpatient in this outer Melbourne geriatric evaluation and management facility. This study found that the burden associated with the experience of caregiving continued despite the hospitalization of their relative. The challenges faced by families included communicating with health professionals, and being asked to contribute to care decisions, in particular those regarding discharge planning, and managing conflict. In conclusion, the issues and challenges faced by family caregivers needs to be acknowledged and considered as an extension of patient care planning.
Publisher: Wiley
Date: 09-08-2017
DOI: 10.1111/JOCN.13869
Abstract: The aim was to explore the experiences of people with dementia in subacute geriatric rehabilitation hospitals to critically evaluate the care received by such patients. Globally, the number of people with dementia is growing and is expected to impact progressively more on health systems. People with dementia can become deconditioned and deteriorate in cognitive function while in hospital. The unfamiliar environment and people can cause the person to become disorientated, which then leads to behavioural symptoms which complicate care. Critical ethnography. Methods included observation with field notes and 30 audio-recorded conversational interviews with patients with dementia in an Australian subacute care setting. Data were collected in May-December 2014, transcribed verbatim and analysed using thematic analysis. The central theme identified that patients with dementia described a liminal experience and felt like outsiders in the hospital environment. This was supported by the subthemes of not understanding why they were being kept in hospital, feeling lost in the space, bored, anxious about discharge plans and lacking intersubjective relationships. Many felt imprisoned by the locked wards. There was little evidence of nursing care delivered in an empathetic person-centred way. Nurses were busy and engaged with the patients only superficially. People with dementia can have a liminal experience and feel like outsiders in this environment, which does not cater for the specific needs of this patient group. It should be acknowledged that people with dementia require additional resources. A caring nurse-patient relationship is fundamental to the patient experience. Nurses require further support and education about dementia in order to deliver quality care to this patient group. These findings will influence nurse leaders to advocate for improved resources for nurses to provide appropriate care for patients with dementia in subacute geriatric hospitals. The clinical practice of nurses needs to be supported with education, pyschological and material support to improve the therapeutic environment for patients with cognitive impairment resulting from dementia.
Publisher: Wiley
Date: 22-02-2017
DOI: 10.1111/JOCN.13429
Abstract: To identify and examine existing research exploring how people with dementia and nurses view acute hospital care. Admission to hospital can be traumatic for a person with dementia due to an inability to cope with unfamiliar environments, faces and routines. Adverse behavioural and health outcomes can result. Dementia adds complexity to patient care. Inability to deliver appropriate care is a source of stress and frustration for nurses. Integrative review of the literature 2005-2015 reporting the experience of people with dementia and nurses caring for them in an acute hospital setting (n = 24). Hospitals focus on acute medical care consequently people with dementia are considered low priority and a disruption to normal routine. Risk management often takes priority over patient dignity. People with dementia are stigmatised. Families have significant roles to play in the care of a person with dementia in hospital but are often excluded. Nurses struggle to complete even basic patient care, and focus on tasks often at the expense of specific patient needs. Support for nurses is lacking. The job satisfaction of nurses caring for people with dementia is poor. Nurses require improved education and support to care for patients with dementia. Hospitals must focus on genuine caring concurrently with rapid discharge requirements, risk mitigation and fiscal restraint. More research is needed to inform the development of appropriate care for people with dementia in hospitals. Nurses must understand the complex needs of people with dementia in hospital. Nurse education about dementia, practical support, strong clinical leadership and role-modelling is needed. Empathy for patients regardless of diagnosis must remain a core attribute of nurses. Current hospital culture requires wider system review to mitigate against stigmatisation of patients with dementia.
Publisher: Wiley
Date: 03-04-2020
DOI: 10.1111/INM.12723
Publisher: RCN Publishing Ltd.
Date: 24-06-2011
DOI: 10.7748/NOP2011.07.23.6.22.C8586
Abstract: To explore and compare call bell response times in two wards in a geriatric evaluation and management facility before and after the introduction of a suite of interventions aimed at decreasing patient falls. Data on call bell response times were collected over two periods. The first were before implementation of falls prevention initiatives. Data were retrieved from the call bell system that detailed the time taken to respond to every call bell activation. A second period of data collection was conducted six months after implementation of the initiatives. Prioritising call bell response and raising staff awareness improved response to patient calls. There was a slight decrease in falls although call bell activations did not decrease. Strong leadership is necessary from nurse managers to stress the importance of prompt call bell response. Visual surveillance of high-risk fallers is important as they are generally unable to ring for assistance when required.
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.AJIC.2018.11.018
Abstract: There is little information regarding consumer knowledge of health care-associated infection (HAI). Furthermore, it is unclear how meaningful publicly reported HAI data is to consumers, how they may use it, and the most appropriate format for data presentation. The purpose of this study was to explore consumer knowledge and attitudes toward HAI and public reporting. A qualitative study design, characterized by a series of semistructured interviews, was undertaken with purposively selected, adult elective surgical inpatients at a large metropolitan acute hospital. Interviews were digitally recorded and transcribed verbatim. Analysis of the data were conducted using thematic analysis. Twenty interviews were conducted. The 5 major themes identified were: (1) awareness through experience, (2) focus on current illness, (3) patient contribution to infection prevention, (4) sources and mode of information, and (5) influence on choice of hospital. We found broad variation in knowledge, sources of information, and preferences for the type and delivery of information. A significant cohort of participants preferred not to be informed, whereas others were neutral or only mildly interested. If public reporting of HAI data is to be aimed at consumers, further engagement with consumers is crucial to ensure the information provided is fit for purpose.
Publisher: Wiley
Date: 16-02-2016
DOI: 10.1111/JOCN.13141
Abstract: This article aims to: Discuss the inclusion of the perspectives of people with dementia in research. Consider the major challenges involved in the process of interviewing people with dementia. Provide recommendations for those involved in interviewing people with dementia in hospital. People with dementia are frequent consumers of health care and often have a poor experience in hospital but have been largely excluded from direct participation in research until recently. Limited understanding of the specific communication needs of people with dementia restricts access to the person's viewpoint. Recommendations for interviewers which consider the specific requirements of people with dementia are presented. This is a discursive article drawing on the experience of interviewing people with dementia in three separate studies. The conclusions that will be discussed are recommendations for researchers which were formulated following examination of the reflective journals written during the data collection phases of the studies and analysis of the data from the perspective of interviewer performance. Six main issues have been identified and discussed with reference to Habermas's theory of communicative action. Interviewing people with dementia requires specific skills including an ability to be emotionally sensitive and respectful of the person. This engagement can be challenging and complex for the interviewer. It is vital that genuine engagement and mutual recognition are established before the interview is attempted. A more meaningful research outcome is likely to be the result. The suggestions outlined here are relevant to a variety of people who are in contact with people with dementia in clinical settings. Developing the skills of researchers in this area needs a commitment by organisations to promote the inclusion of the perceptions of people with dementia in research and in discussions about their own care.
Publisher: SAGE Publications
Date: 27-07-2016
Abstract: Hospital admission of a person with dementia can have a significant impact on the family carer, who temporarily relinquishes caring to health professionals. A descriptive qualitative design using in-depth interviews with a conversational approach was used to elicit data. Adjusting to the change in the carer’s role can be challenging and result in feelings of helplessness, loneliness, loss of control and being undervalued. Family support can assist with the transition but family conflict increases anxiety. Good communication between clinicians and the carer is vital. The carer should be included in decision-making as the ‘expert' in the care of the person with dementia. This article discusses findings of a larger study specifically related to the emotional support required for the carers of people with dementia, who are admitted to hospital. The carer and the patient must be considered as a dyad in relation to discharge planning.
Publisher: Elsevier BV
Date: 05-2022
Publisher: Wiley
Date: 21-06-2019
DOI: 10.1111/JAN.14087
Abstract: The aim of this study was to identify patient preferences for involvement in medication management during hospitalization. A qualitative descriptive study. This is a study of 20 inpatients in two medical and two surgical wards at an academic health science centre in Melbourne, Australia. Semi-structured interviews were recorded and analysed using content analysis. Three themes were identified: (a) 'understanding the medication' established large variation in participants' understanding of their pre-admission medication and current medication (b) 'ownership of medication administration' showed that few patients had considered an alternative to their current regimen only some were interested in taking more control and (c) 'supporting discharge from hospital' showed that most patients desired written medication instructions to be explained by a health professional. Family involvement was important for many. There was significant ersity of opinion from participants about their involvement in medication management in hospital. Patient preferences for inclusion need to be identified on admission where appropriate. Education about roles and responsibilities of medication management is required for health professionals, patients and families to increase inclusion and engagement across the health continuum and support transition to discharge. Little is known about patient preferences for participation in medication administration and hospital discharge planning. In idual patient understanding of and interest in participation in medication administration varies. In accordance with in idual patient preferences, patients need to be included more effectively and consistently in their own medication management when in hospital.
Publisher: Wiley
Date: 16-01-2014
DOI: 10.1111/OPN.12014
Abstract: A metropolitan geriatric evaluation and management (GEM) facility in Australia was undergoing expansion, and consideration for the needs of in iduals with dementia and their family carers was identified as important in planning the new facility. Existing literature revealed that people in hospital value privacy, minimal noise, family amenities and homeliness, but these findings did not consider the perspectives of the person with dementia specifically. The aim was to elicit the perspectives of current inpatients with dementia, and their family carers, about the environment/design features that they believe are necessary for people with dementia, and their family carers. This qualitative study utilised in-depth semi-structured interviews to obtain information from current inpatients with dementia and their family carers. Participants described how the care received was more important than the physical environment however, participants also valued homeliness, privacy for the patient and for conversations, a shared space without a television and a connection to the outside. Participants described how accommodating carers, providing quiet spaces and appropriate amenities were also important. While participants valued care over the physical surroundings, they also offered valuable information about their experience in the ward environment. Despite cognitive difficulties, people with dementia were able to provide useful information about the environment within which they were being cared. Consumer opinions about hospital design/environment should be considered as an important source of data. Privacy and personal space for people with dementia and their family carers, a connection with the outside environment , and the needs of carers and visitors are all important considerations when designing healthcare environments.
Publisher: Elsevier BV
Date: 07-2020
DOI: 10.1016/J.AUCC.2019.06.002
Abstract: When a relative is admitted to the intensive care unit (ICU), stress, anxiety, and failure to cope may place families, and the patient, at risk for adverse psychological outcomes. Family participation in patient care may improve patient and family outcomes. However, to date, little is known about how families perceive and participate in patient care in ICU, and there is limited research to guide clinicians about supporting family participation in this context. To describe family perspectives of participation in patient care in adult ICU. Using a qualitative design, observation and interview data were collected from a convenience s le of 30 family members in the ICU at two metropolitan hospitals in Melbourne, Australia. An independent third party was used to recruit potential participants. Naturalistic observations and semi-structured interviews explored families' actions and perceptions of participation. Data were integrated and subject to thematic analyses. The major theme Families as part of the healthcare team reflected family perspectives of their own significant contribution to supporting their relative's recovery while they were in ICU. Families' perception of their participation in patient care was characterised by three sub-themes: 1) Motivators for family participation 2) Family roles during recovery and 3) Influences on family participation. Families' perceived reassurance and companionship as important contributions to patient care. Families perceived their contribution to the patient's psychosocial and emotional well-being to be one of the most important aspects of participation. Nevertheless, their role in the healthcare team was influenced by several motivational factors. Results of this study can inform further research to test the effectiveness of clinical practice and educational interventions aligned with family preferences to promote participation and enhance patient and family-centered care in ICU.
Publisher: Elsevier BV
Date: 2022
Publisher: Informa UK Limited
Date: 30-09-2015
DOI: 10.1080/13607863.2014.962008
Abstract: Transitioning from the primary caregiver to the visitor in a long-term care facility may be challenging for the caregiver they are required to surrender their caring duties to the medical and nursing staff. The aim of this study was to explore the experiences of caregivers during their transition from day-to-day caregiver of a person with dementia to a visitor in a long-term care facility. This study utilised a qualitative descriptive design. Twenty caregivers of people with dementia were recruited from the one Aged Rehabilitation and Geriatric Evaluation and Management facility, located in Victoria, Australia. Semi-structured interviews were used to explore the caregiver's experiences. Interviews were analysed using thematic analysis. The interview data revealed that the participants were undergoing similar experiences. The findings revealed that it was difficult for the caregiver to transition to their new role of visitor negative reactions of grief, loss of motivation and loneliness were also coupled with positive feelings of relief and the reassurance that their relative or friend would be well cared for and safe within the long-term care facility. The findings offer insight into the experiences felt by caregivers when their relative or friend with dementia is admitted to hospital. Implications of this study include the need to improve the transition process for the caregiver by allowing them to be involved in the decision-making process, keeping them informed of care decisions, and importantly, providing emotional support to help the caregiver positively adapt to this transition.
Publisher: Wiley
Date: 27-06-2012
DOI: 10.1111/J.1748-3743.2011.00282.X
Abstract: In a Melbourne metropolitan health network, patients with dementia can have difficulty settling into a subacute rehabilitation facility after transfer from the acute hospital. To understand how older patients with mild to moderate dementia experienced the transfer from acute to subacute care and settling-in period. A descriptive design was used. Eight patients with mild to moderate dementia were recruited, one to 5 days after transfer. A qualitative method using in-depth interviews was used. The data were analysed using content analysis. Four main themes were identified: 'Settling into a new environment', 'staff attitudes to people with dementia', 'loss of control' and 'family support'. Person-centred care that comes from the perspective of respect for the in idual transcends all these issues. People with dementia require more support to settle after transfer. Family involvement can assist in facilitating a smooth transition. Nurses who understand the specific needs of patients with dementia can develop ways of working with patients to ensure person-centred care. More conversations with people with dementia are needed to investigate how this can be achieved. Orientation procedures should ensure that support for people with dementia is optimized during the settling-in phase.
Publisher: Informa UK Limited
Date: 27-08-2014
DOI: 10.1080/07481187.2012.738773
Abstract: A qualitative study of staff experiences of end-of-life care for older people in a subacute rehabilitation facility was undertaken using three focus groups with senior multidisciplinary staff (5), junior nurses (8), and junior allied health staff (7). Content analysis revealed four major themes: being a key contact person the quality of end-of-life care referring to off-site service providers and differing perspectives. These data have implications for multidisciplinary practice including staff education and capacity to change focus of care in facilities for older people dedicated to rehabilitation rather than palliation or end-of-life care.
Publisher: Elsevier BV
Date: 06-2020
Location: United States of America
No related grants have been discovered for Robin Digby.