ORCID Profile
0000-0003-4159-4493
Current Organisation
National Ageing Research Institute
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Publisher: Wiley
Date: 15-07-2020
DOI: 10.1111/JNU.12269
Publisher: Wiley
Date: 07-2007
Publisher: Wiley
Date: 12-2013
DOI: 10.1111/AJAG.12049
Publisher: Wiley
Date: 07-02-2018
DOI: 10.1111/JEP.12879
Abstract: The risk of developing urinary incontinence (UI) is associated with older age and hip surgery. There has been limited focus on factors that promote evidence-based UI practice in the orthopaedic context. The aim of this study was to evaluate an implementation intervention to support evidence-based practice for UI in patients aged 65 or older undergoing hip surgery. A 3-month intervention was delivered in 2014 to facilitate the implementation of UI knowledge in orthopaedic units in 2 hospitals in Sweden. Each unit appointed a multidisciplinary team of nurses and physiotherapists or occupational therapists to facilitate the implementation. The teams were supported by external facilitators who shared knowledge about UI and implementation science. Interviews, nonparticipant observations, and audits of patient records were performed. Prior to the intervention, there was no use of guidelines regarding UI. The intervention raised the internal facilitators' awareness of UI risks associated with hip surgery. As internal facilitators shared this information with their peers, staff awareness of UI increased. The teams of internal facilitators described needing additional time and support from managers to implement evidence-based UI care. A management initiative triggered by the intervention increased the documentation of UI and urinary problems in 1 unit. To promote evidence-based practice related to safe procedures for older people in hospital care, there is a need to better understand strategies that successfully facilitate knowledge implementation. This study suggests that a multiprofessional team approach is promising for instigating a process towards evidence-based management of UI.
Publisher: Wiley
Date: 03-2011
DOI: 10.1111/J.1741-6612.2010.00449.X
Abstract: The management of incontinence in residential aged care facilities presents staff with considerable challenges. In order to support the residential aged care workforce to provide evidence-based continence care, we developed a suite of evidence-based continence assessment tools and an accompanying educational resource for use in the residential aged care sector. The tools comply with international and accreditation standards. They address urinary and faceal incontinence and other bladder and bowel symptoms. They also include a number of cues to guide staff to assess and manage residents' continence care needs and refer as needed. An evaluation of the tools conducted in 18 residential aged care facilities across three states revealed that staff members found the tools helpful, clear, simple and user-friendly. This paper provides a description of the newly developed suite of continence assessment tools for residential aged care and the accompanying education resources, and presents staff perspectives on their clinical usefulness.
Publisher: Wiley
Date: 18-06-2013
Publisher: Wiley
Date: 30-03-2020
DOI: 10.1002/NAU.24343
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2016
Publisher: Wiley
Date: 21-11-2008
Publisher: Wiley
Date: 21-10-2020
DOI: 10.1002/NAU.24549
Abstract: Evidence‐based guidelines for the management of frail older persons with urinary incontinence are rare. Those produced by the International Consultation on Incontinence represent an authoritative set of recommendations spanning all aspects of management. To summarize the available evidence relating to the management of urinary incontinence in frail older people published since the 5th International Consultation on Incontinence. A series of systematic reviews and evidence updates were performed by members of the working group to update the 2012 recommendations. Along with the revision of the treatment algorithm and accompanying text, there have been significant advances in several areas of the management of lower urinary tract symptoms in frail older people. The committee continues to note the relative paucity of data concerning frail older persons and draw attention to knowledge gaps and research opportunities. Clinicians treating older people with lower urinary tract symptoms should use the available evidence from studies of older people combined with careful extrapolation of those data from younger subjects. Due consideration to an in idual's frailty and wishes is crucial.
Publisher: MDPI AG
Date: 17-01-2022
Abstract: Consumers access health professionals with varying levels of diabetes-specific knowledge and training, often resulting in conflicting advice. Conflicting health messages lead to consumer disengagement. The study aimed to identify capabilities required by health professionals to deliver diabetes education and care to develop a national consensus capability-based framework to guide their training. A 3-staged modified Delphi technique was used to gain agreement from a purposefully recruited panel of Australian diabetes experts from various disciplines and work settings. The Delphi technique consisted of (Stage I) a semi-structured consultation group and pre-Delphi pilot, (Stage II) a 2-phased online Delphi survey, and (Stage III) a semi-structured focus group and appraisal by health professional regulatory and training organisations. Descriptive statistics and central tendency measures calculated determined quantitative data characteristics and consensus. Content analysis using emergent coding was used for qualitative content. Eighty-four diabetes experts were recruited from nursing and midwifery (n = 60 [71%]), allied health (n = 17 [20%]), and pharmacy (n = 7 [9%]) disciplines. Participant responses identified 7 health professional practice levels requiring differences in diabetes training, 9 capability areas to support care, and 2 to 16 statements attained consensus for each capability—259 in total. Additionally, workforce solutions were identified to expand capacity for diabetes care. The rigorous consultation process led to the design and validation of a Capability Framework for Diabetes Care that addresses workforce enablers identified by the Australian National Diabetes Strategy. It recognises ersity, creating shared understandings of diabetes across health professional disciplines. The findings will inform diabetes policy, practice, education, and research.
Publisher: Wiley
Date: 06-04-2018
DOI: 10.1111/JOCN.14293
Abstract: To explore nursing home staff members' beliefs and expectations about what constitutes "quality continence care" for people living in nursing homes. Most nursing home residents require assistance to maintain continence or manage incontinence. Best practice guidelines promote active investigation of incontinence, treatment of underlying potentially reversible causes, and initial conservative interventions to prevent, minimise and/or treat incontinence. Despite research showing the positive benefits of implementing active interventions, translating the findings of research into practice in nursing homes has been modest. Understanding the perspectives of in iduals who provide continence care may help bridge the gap between evidence and practice. A qualitative exploratory descriptive design. Qualitative interviews were conducted with 19 nursing home staff: eight registered nurses, four enrolled nurses and seven personal care workers working in a nursing home in Australia between 2014-2015. Data were analysed inductively to identify themes and subthemes that described and explained staff beliefs about quality continence care in nursing homes. Participants' understanding and expectations about quality continence care were linked to beliefs about incontinence being an intractable and undignified condition in nursing homes. The key theme to emerge was "protecting residents' dignity" which was supported by the following six subthemes: (i) using pads, ii) providing privacy, (iii) knowing how to "manage" incontinence, (iv) providing timely continence care, (v) considering residents' continence care preferences and (vi) communicating sensitively. The findings provide new insight into the basis for continence care practices in nursing homes. Education about continence care should challenge beliefs that limit continence care practice to cleaning, containing and concealing incontinence. There is a need for a multidimensional framework that is informed by social, psychological and biomedical research about incontinence, research about the fundamental elements of care, care-dependent in iduals' expectations about care, and values about dignity and care. The in-depth exploration led to an understanding of the basis for continence care practices that centre on cleaning, containing and concealing residents' incontinence in some nursing homes. There is a need to review the quality of education for the aged care workforce about incontinence to ensure it equips them with a broad understanding of the fundamentals of care and how to enact dignity in continence care through a resident-centred approach.
Publisher: Wiley
Date: 02-04-2014
DOI: 10.1002/NAU.22602
Abstract: Evidence based guidelines for the management of frail older persons with urinary incontinence are rare. Those produced by the International Consultation on Incontinence represent an authoritative set of recommendations spanning all aspects of management. To update the recommendations of the 4th ICI. A series of systematic reviews and evidence updates were performed by members of the working group in order to update the 2009 recommendations. The resulting guidelines were presented at the 2012 meeting of the European Associatioon of Urology. Along with the revision of the treatment algorithm and accompanying text. There have been significant advances in several areas including pharmacological treatment of overactive bladder. The committee continue to notes the relative paucity of data concerning frail older persons and draw attention to knowledge gaps in this area.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2012
Publisher: SLACK, Inc.
Date: 10-2011
DOI: 10.3928/19404921-20110201-02
Abstract: A growing number of older adults are admitted to hospitals, and information is needed on how age-related functional decline affects nursing care needs of this population. This study compared the functional status at admission and total nursing care needs of three age groups of older inpatients. A 12-month retrospective audit was performed on the records of 225 patients in a private metropolitan hospital. The three groups of patients were matched on diagnosis. Findings revealed that older patients were significantly more dependent, had greater total nursing care needs, and were less likely to be discharged to home, indicating that in addition to medical diagnoses, age-related differences of older patients’ functional status at admission and inpatient nursing care needs should be factored into staff workloads and funding of nursing care. The finding that significantly fewer of the older patients returned home must be considered when reviewing health care policy and services.
Publisher: Wiley
Date: 18-05-2007
Publisher: Elsevier BV
Date: 06-2020
Publisher: Wiley
Date: 24-10-2005
DOI: 10.1111/J.1365-2648.2005.03608.X
Abstract: The aim of this paper is to present a systematic review assessing the effectiveness of timed voiding for the management of urinary incontinence in adults. Despite the widespread use of systematic voiding programmes, their effectiveness is unclear, and the evidence for timed voiding has not been subject to rigorous and systematic evaluation. The impact on psychosocial factors and cost is also untested. The physiological basis for timed voiding is also poorly established. The systematic review incorporated the methodology of the Cochrane Collaboration. All randomized or quasi-randomized controlled trials that addressed timed voiding for the management of urinary incontinence in adults were searched, appraised, analysed and summarized. The date of the latest search was 2002. Data were extracted independently and appraised according to the level of concealment of random allocation prior to formal entry few and identifiable withdrawals and dropouts and an analysis based on an intention to treat. The relative risk for dichotomous data was calculated with 95% confidence intervals. Where data were insufficient to support quantitative analysis, a narrative overview was undertaken. Two trials of timed voiding met the inclusion criteria. In both, timed voiding was combined with other strategies. Participants were predominantly cognitively and physically impaired older women who resided in nursing home settings. Within-group improvements for the intervention groups were reported for both trials. One trial additionally reported a statistically significant reduction in night-time incontinence for the intervention group. The quality of the trials was modest and interpretation was limited by the potential for bias associated with inadequate concealment, missing data and no analysis by intention to treat. Terms used to describe voiding programmes that involve a fixed interval of voiding are variable. No conclusions can be drawn at this point about the effectiveness of timed voiding for the management of urinary incontinence in adults.
Publisher: Elsevier BV
Date: 08-2011
Publisher: Wiley
Date: 19-04-2004
Publisher: Informa UK Limited
Date: 09-2014
Abstract: Abstract Background: Continence care commonly disrupts sleep in residential aged care facilities, however, little is known about what staff do when providing continence care, and the factors that inform their practice. Aims: To describe nurses' and personal care workers' beliefs and experiences of providing continence care at night in residential aged care facilities. Methods/design: Eighteen nurses and personal care workers were interviewed about continence care, and 24 hours of observations were conducted at night in two facilities. Results/Findings: Most residents were checked overnight. This practice was underpinned by staffs' concern that residents were intractably incontinent and at risk of pressure injuries. Staff believed pads protected and dignified residents. Decisions were also influenced by beliefs about limited staff-to-resident ratios. Conclusion: Night-time continence care should be audited to ensure decisions are based on residents' preferences, skin health, sleep/wake status, ability to move in bed, and the frequency, severity and type of residents' actual incontinence.
Publisher: Emerald
Date: 06-08-2020
DOI: 10.1108/JHOM-02-2020-0031
Abstract: The purpose of this study is to explore the factors that influence the reporting of adverse events related to elder abuse and neglect in nursing homes from nursing home leaders' perspectives. Good leadership requires in-depth knowledge of the care and service provided and the ability to identify and address problems that can arise in clinical practice. A qualitative explorative design with data triangulation was used. The s le consisted of 43 participants from two levels of nursing home leadership, representing six municipalities and 21 nursing homes in Norway. Focus group interviews were undertaken with 28 ward leaders and in idual interviews with 15 nursing home directors. The constant comparative method was used for the analyses. Both ward leaders and nursing home directors described formal and informal ways of obtaining information related to elder abuse and neglect. There were differences between their perceptions of the feasibility of obtaining formal reports about abuse in the nursing home. Three main categories of influencing factors emerged: (1) organisation structural factors, (2) cultural factors and (3) abuse severity factors. A main finding is that in its present form, the Norwegian adverse event reporting system is not designed to detect abuse and neglect. This paper provides an in-depth understanding of patient safety and factors related to reporting elder abuse in nursing homes in Norway.
Publisher: Wiley
Date: 10-11-2006
DOI: 10.1111/J.1365-2648.2006.04097.X
Abstract: This paper reports a comparison of the data analysis and outcomes from four Cochrane systematic reviews on bladder training and voiding programmes for the management of urinary incontinence using metastudy descriptive techniques to inform clinical practice, generate new ideas and identify future research directions. Bladder training is used for cognitively and physically able adults to regain continence by increasing the time interval between voids. Prompted voiding, habit retraining and timed voiding, collectively known as voiding programmes, are generally used for people with cognitive and physical impairments in institutional settings. Bladder training and voiding programmes feature as common clinical practice for the management of urinary incontinence. A synopsis of four Cochrane systematic reviews that included randomized controlled trials on bladder training, prompted voiding, habit retraining and timed voiding was undertaken using metastudy techniques for the synthesis of qualitative research, and has provided a discursive comparison and contrast of the meta-data analysis and outcomes of these reviews. Frequency of incontinence was the most common and constant outcome measure of effectiveness in the reviews. Limited data were available on other health outcomes, change in dependency status, quality of life and cost-effectiveness. The systematic review on bladder training included different types of urinary incontinence, whereas those on voiding programmes did not differentiate the type of incontinence. There is evidence on the effectiveness of bladder training but long-term follow up studies are needed. Evidence on the effectiveness of voiding programmes is limited and not available for many outcomes. Future research needs to consider the theory underpinning interventions for bladder training and voiding programmes for urinary incontinence and should incorporate recognized 'quality' research designs, established outcomes and long-term follow up. It is unclear whether health outcomes for people with comorbidities, cognitive and physical impairments will improve if extensive diagnostic and assessment investigations are undertaken.
Publisher: Wiley
Date: 21-11-2008
Publisher: John Wiley & Sons, Ltd
Date: 25-08-2000
Publisher: Wiley
Date: 23-09-2021
DOI: 10.1002/NAU.24795
Abstract: Urinary incontinence is a common problem among older adults that is often complicated by many nuanced ethical considerations. Unfortunately, there is a lack of guidance for healthcare professionals on how to navigate such concerns. This International Continence Society white paper aims to provide healthcare professionals with an ethical framework to promote best care practices in the care of older adults with urinary incontinence.
Publisher: Springer Science and Business Media LLC
Date: 12-03-2020
DOI: 10.1186/S12913-020-5047-4
Abstract: The definition and understanding of elder abuse and neglect in nursing homes can vary in different jurisdictions as well as among health care staff, researchers, family members and residents themselves. Different understandings of what constitutes abuse and its severity make it difficult to compare findings in the literature on elder abuse in nursing homes and complicate identification, reporting, and managing the problem. Knowledge about nursing home leaders’ perceptions of elder abuse and neglect is of particular interest since their understanding of the phenomenon will affect what they signal to staff as important to report and how they investigate adverse events to ensure residents’ safety. The aim of the study was to explore nursing home leaders’ perceptions of elder abuse and neglect. A qualitative exploratory study with six focus group interviews with 28 nursing home leaders in the role of care managers was conducted. Nursing home leaders’ perceptions of different types of abuse within different situations were explored. The constant comparative method was used to analyse the data. The results of this study indicate that elder abuse and neglect are an overlooked patient safety issue. Three analytical categories emerged from the analyses: 1) Abuse from co-residents: ‘A normal part of nursing home life’ resident-to-resident aggression appeared to be so commonplace that care leaders perceived it as normal and had no strategy for handling it 2) Abuse from relatives: ‘A private affair’ relatives with abusive behaviour visiting nursing homes residents was described as difficult and something that should be kept between the resident and the relatives 3) Abuse from direct-care staff: ‘An unthinkable event’ staff-to-resident abuse was considered to be difficult to talk about and viewed as not being in accordance with the leaders’ trust in their employees. Findings in the present study show that care managers lack awareness of elder abuse and neglect, and that elder abuse is an overlooked patient safety issue. The consequence is that nursing home residents are at risk of being harmed and distressed. Care managers lack knowledge and strategies to identify and adequately manage abuse and neglect in nursing homes.
Publisher: Springer Science and Business Media LLC
Date: 27-03-2019
Publisher: Elsevier BV
Date: 07-2020
Publisher: Wiley
Date: 28-11-2019
DOI: 10.1111/JOCN.15099
Abstract: The proposed study aimed to answer the following question: What communication issues do nurses find challenging when caring for people with life-limiting illness? Evidence suggests that attitudes, skills and knowledge about how nurses communicate effectively with patients and their families could be improved. However, the literature predominantly focuses on nurses working in oncology and the medical profession. A qualitative descriptive design was used. Focus groups were conducted with 39 nurses from three wards within a regional healthcare organisation in Victoria, Australia. Data were analysed using thematic content analysis. The COREQ checklist was used to document reporting of the study. In their view, nurses have the potential to develop a strong bond with patients and their families. Three key themes were identified: (a) feeling unskilled to have difficult conversations with patients who have life-limiting illness (b) interacting with family members adds complexity to care of patients who have life-limiting illness and (c) organisational factors impede nurses' capacity to have meaningful conversations with patients and their families. Caring for in iduals with life-limiting illness is complex and often occurs in an emotionally charged environment. However, nurses report being h ered by time restraints and lack of information about the patient's condition and goals of care. Limitations in conversation structure and a comprehensive range of core communication skills affect their ability to confidently engage in conversations, particularly when they are responding to prognostic questions. Whilst nurses are responsible for performing technical skills, they can maximise care by developing a trusting relationship with patients and their relatives. Increased acuity limits the time nurses have to talk with patients. In addition, they lack confidence to deal with difficult questions. Specific training may increase nurses' confidence and efficiency when communicating with patients and their families.
Publisher: John Wiley & Sons, Ltd
Date: 30-08-2000
Publisher: Wiley
Date: 12-12-2012
DOI: 10.1111/J.1471-6712.2011.00959.X
Abstract: In iduals in residential aged care facilities experience urinary incontinence more than any other single population. Despite these factors, the impact of the condition on their quality of life, their perspectives of living with the condition, and their preferences for care have received little research attention. To provide a descriptive overview of research about the impact of urinary incontinence on residents' quality of life residents' perspectives of having urinary incontinence and their preferences for continence care'. A descriptive review of literature. A broad search was undertaken for qualitative and quantitative research that evaluated residents' quality of life related to urinary incontinence their perspectives on having urinary incontinence, and their preferences for managing it. Data were displayed in tabular format, summarized, and described. Ten studies were identified and reviewed (six qualitative and four quantitative). They reveal many residents' value having independent bowel and bladder function, but believe that incontinence in inevitable and intractable. Some adopt self management strategies, however considerable barriers hinder their ability to maintain continence and manage incontinence. Residents often have low expectations, and hence decline further evaluation and treatment. Some express satisfaction with continence care even if this care is not consistent with their preferences. Little is known about how cognitively impaired residents perceive their condition. However some in iduals with cognitive impairment respond with acute anxiety when carers' attempt to provide continence care. Residents' perspectives on incontinence and preferences for continence care relate to low expectations for improvement. Such misconceptions should be addressed and residents and their family members should be given a range of options from which to choose. As urinary incontinence impacts on residents' quality of life, it is also important that continence care is delivered in a participative and sensitive way.
Publisher: Wiley
Date: 26-01-2004
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2006
DOI: 10.1097/00152192-200611000-00006
Abstract: This article describes the application and evaluation of a clinical nursing leadership model to enhance continence care in an inpatient rehabilitation setting for older adults. Multiple strategies were employed to optimize the uptake and sustainability of 3 practice initiatives: (1) establishment of an enhanced role for ward-based nurses to provide clinical support to patients and other staff for the management of incontinence, (2) a new method for nursing assessment and management of bowel elimination, and (3) a framework for improved discharge care of patients with incontinence. Evaluation data indicated a high level of acceptance of the role of the ward-based continence resource nurses, improved assessment and management of bowel elimination, and enhanced discharge care for patients with incontinence. These initiatives were sustainable during a 2-year period after their introduction, despite the gradual withdrawal of the clinical leader.
Publisher: Wiley
Date: 31-05-2021
DOI: 10.1111/JOCN.15842
Abstract: As places of both residence and work, what constitutes “good quality care” in residential aged care requires consideration of staffs’ perspectives. A meta‐synthesis of the qualitative literature was conducted exploring residential aged care staff perspectives on “quality of care.” Six electronic databases were searched for articles that met the screening inclusion criteria. This meta‐synthesis was informed by the Preferred Reporting Items for Systematic reviews and Meta‐Analyses guidelines, and included studies were critically appraised using JBI SUMARI. Two independent reviewers conducted thematic network mapping and analysis of included articles, with oversight from three additional reviewers. Forty‐seven articles were included, with findings summarised into four organising themes and nine basic themes. The four organising themes about quality care from staff perspectives include direct care, professional values and competence, the care environment and organisational/regulatory factors. Staff describe a wide range of factors that they perceived to influence the quality of care. Some may feel motivated to leave employment in aged care, due to organisational pressures that make staff unable to uphold what they perceive as an acceptable standard of care. There is tension between professional values and organisation/regulatory factors—regulation should be enacted at a level that supports good practice and staff's moral integrity. This review found that while person‐centred care is now well established as the benchmark of quality care in residential aged care homes, achieving it in reality remains challenged by limitations on staff members’ time, resources and sometimes their competencies and the regularity of their employment.
Publisher: Springer Science and Business Media LLC
Date: 12-2020
DOI: 10.1186/S12913-020-05969-X
Abstract: Elder abuse in nursing homes is a complex multifactorial problem and entails various associations across personal, social, and organisational factors. One way leaders can prevent abuse and promote quality and safety for residents is to follow up on any problems that may arise in clinical practice in a way that facilitates learning. How nursing home leaders follow up and what they follow up on might reflect their perceptions of abuse, its causal factors, and the prevention strategies used in the nursing home. The aim of this study was to explore how nursing home leaders follow up on reports and information regarding staff-to-resident abuse. A qualitative explorative design was used. The s le comprised 43 participants from two levels of nursing home leadership representing six municipalities and 21 nursing homes in Norway. Focus group interviews were conducted with 28 care managers, and in idual interviews took place with 15 nursing home directors. The constant comparative method was used for the analyses. Nursing home leaders followed up incidents of staff-to-resident abuse on three different levels as follows: 1) on an in idual level, leaders performed investigations and meetings, guidance, supervision, and occasionally relocated staff members 2) on a group level, feedback, openness, and reflection for shared understanding were strategies leaders used and 3) on an organisational level, the main solutions were to adjust to available resources, training, and education. We found that leaders had difficulties defining harm and a perceived lack of power to follow up on all levels. In addition, they did not have adequate tools for evaluating the effect of the measures that were taken. Nursing home leaders need to be clear about how they should follow up incidents of elder abuse on different levels in the organisation and about their role in preventing elder abuse. Evaluation tools that facilitate systematic organisational learning are needed. Nursing homes must operate as open, blame-free cultures that acknowledge that incidents of elder abuse in patient care arise not only from the actions of in iduals but also from the complex everyday life of which they are a part and in which they operate.
Publisher: Springer Science and Business Media LLC
Date: 29-07-2020
DOI: 10.1186/S12877-020-01673-X
Abstract: Although codes of conduct, guidelines and standards call for healthcare practitioners to protect patients’ dignity, there are widespread concerns about a lack of attention to the dignity of older people who need assistance with toileting, incontinence or bladder or bowel care in health or social care settings that provide long-term care. Incontinence and care dependence threatens patient dignity. The aim of this research was to explore, describe and explain the concept of dignity as it relates to continence care for older people requiring long-term care. The first four steps of Rodgers evolutionary method of concept analysis were followed. First, a comprehensive and systematic search of databases and key guidelines about continence care was undertaken to identify empirical research about dignity and continence care in older people in facilities that provide permanent residential or inpatient care of older people for day-to-day living. Data were extracted on the authors, date, s le, country of origin, and key definitions, attributes, contexts and consequences from each included record. Findings were inductively analysed and grouped according to whether they were the key attributes and antecedents of dignity in relation to continence care or the consequences of undignified continence care. Of 625 articles identified, 18 were included in the final analysis. Fifty in idual attributes were identified that were categorised in 6 domains (respect, empathy, trust, privacy, autonomy and communication). A further 15 were identified that related to the environment (6 physical and 9 social). Key consequences of undignified continence care were also identified and categorised into 3 levels of impact (resident/family member, staff or organisation). This research resulted in a conceptual understanding of dignity that can be used as a value or guiding principle in an ethic of care for older people who need assistance with toileting, incontinence or bladder or bowel care in long-term care settings.
Publisher: Elsevier BV
Date: 02-2009
Publisher: Wiley
Date: 12-2009
DOI: 10.1111/J.1741-6787.2009.00162.X
Abstract: This case study describes a quality initiative to minimize restraint in an Australian residential aged care facility. The process of improving practice is examined with reference to the literature on implementation of research into practice and change management. The differences between planned and emergent approaches to change management are discussed. The concepts of resistance and attractors are explored in relation to our experiences of managing the change process in this initiative. The importance of the interpersonal interactions that were involved in facilitating the change process is highlighted. Recommendations are offered for dealing with change management processes in clinical environments, particularly the need to move beyond an in idual mind-set to a systems-based approach for quality initiatives in residential aged care.
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.GERINURSE.2017.03.014
Abstract: International guidelines promote active investigation and treatment of incontinence however, these guidelines do not fully accommodate the psychosocial aspects associated with providing continence care i.e. the caregiving dynamics. The author developed a new framework that aims to support nurses and care workers in their efforts to identify and meet the continence care needs of in iduals with complex health conditions who are dependent on another person for assistance to manage incontinence or to maintain continence. The framework is underpinned by two core concepts: 'dignity' and 'care', and is characterized by a focus on: empathic continence care personhood in dementia therapeutic communication authentic partnership in continence care acknowledging stigma, social taboos and courtesy stigma and the need for a foundational continence assessment. This paper describes the Dignity in Continence Care Framework and suggests strategies for its use in the future education of nurses and care workers about continence care.
Publisher: Wiley
Date: 08-12-2018
DOI: 10.1111/OPN.12182
Abstract: To describe and critically analyse the thinking that led to the concept of an association between incontinence, care dependence and elder abuse. Coercive or abusive continence care practices include chastising a person for their incontinence and overriding their attempts to resist continence care. Neglect in continence care is characterised by withholding or delaying responding to requests for help to maintain continence or to manage incontinence, and restricting a person's access to toileting assistance, incontinence aids or hygiene care. Contemporary biomedical understandings about incontinence and influencing concepts from the fields of sociology, psychology and nursing were analysed to inform the design of a conceptual model that elucidates possible associations between incontinence, care dependence and elder abuse. Ideas generated from an analysis of the concepts led to the development of a model termed the "Model of Attributes to Abuse of Dependent Elders in Continence Care" (MADE-CC). The MADE-CC theorises factors that cause and contribute to abuse in continence care. Carer factors include physical and emotional exhaustion, frustration related to the inability to control or predict incontinence, resentment associated with constraints imposed by care dependence, disgust associated with physical contact with urine/faeces, limited knowledge and skills about incontinence and ethical conflicts concerning care. Care recipient factors include frequent and severe incontinence, cognitive impairment and a history of physical or psychological trauma. Social factors that are theorised include the stigmatised nature of incontinence, social taboos and cultural norms and the private nature of continence care. The MADE-CC illuminates the potential risk of elder abuse posed by incontinence and care dependence. It should be used to improve ethical care of older people and stimulate debate about everyday ethics in the care of older people who are care dependent and to optimise their participation in decisions about their health and well-being. Nurses and carers should be aware of the multiple interrelated factors that contribute to the risk of elder abuse in the caregiving encounter, including the role of emotions.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2013
Publisher: Elsevier BV
Date: 03-2021
DOI: 10.51893/2021.1.OA7
Abstract: Objective: Examine values, preferences and goals elicited by doctors following goals-of-care (GOC) discussions with critically ill patients who had life-limiting illnesses. Design: Descriptive qualitative study using four-stage latent content analysis. Setting: Tertiary intensive care unit (ICU) in South Western Victoria. Participants: Adults who had life-limiting illnesses and were admitted to the ICU with documented GOC, between October 2016 and July 2018. Intervention: The iValidate program, a shared decision-making clinical communication education and clinical support program, for all ICU registrars in August 2015. Main outcome measures: Matrix of themes and subthemes categorised into values, preferences and goals. Results: A total of 354 GOC forms were analysed from 218 patients who had life-limiting illnesses and were admitted to the ICU. In the categories of values, preferences and goals, four themes were identified: connectedness and relational autonomy, autonomy of decision maker, balancing quality and quantity of life, and physical comfort. The subthemes — relationships, sense of place, enjoyment of activities, independence, dignity, cognitive function, quality of life, longevity and physical comfort — provided a matrix of issues identified as important to patients. Relationship, place, independence and physical comfort statements were most frequently identified longevity was least frequently identified. Conclusion: Our analysis of GOC discussions between medical staff and patients who had life-limiting illnesses and were admitted to the ICU, using a shared decision-making training and support program, revealed a framework of values, preferences and goals that could provide a structure to assist clinicians to engage in shared decision making.
Publisher: Wiley
Date: 13-09-2016
DOI: 10.1111/AJAG.12218
Abstract: Most residents in residential aged-care facilities are incontinent. This study explored how continence care was provided in residential aged-care facilities, and describes a subset of data about staffs' beliefs and experiences of the quality framework and the funding model on residents' continence care. Using grounded theory methodology, 18 residential aged-care staff members were interviewed and 88 hours of field observations conducted in two facilities. Data were analysed using a combination of inductive and deductive analytic procedures. Staffs' beliefs and experiences about the requirements of the quality framework and the funding model fostered a climate of fear and risk adversity that had multiple unintended effects on residents' continence care, incentivising dependence on continence management, and equating effective continence care with effective pad use. There is a need to rethink the quality of continence care and its measurement in Australian residential aged-care facilities.
Publisher: Elsevier BV
Date: 04-2021
Publisher: Informa UK Limited
Date: 10-02-2012
Publisher: Wiley
Date: 21-08-2020
DOI: 10.1111/JAN.14481
Publisher: Wiley
Date: 10-11-2006
DOI: 10.1111/J.1365-2648.2006.04098.X
Abstract: This paper reports a comparison of four Cochrane systematic reviews on bladder training and voiding programmes for the management of urinary incontinence using metastudy descriptive techniques. It presents a synopsis of findings on theory and methods for interventions. From the mid-1970s bladder training, prompted voiding, habit retraining and timed voiding have been developed and form the basis of nursing practice for the management of urinary incontinence in adults in institutional and community settings. A synopsis of four Cochrane systematic reviews was undertaken using metastudy techniques developed for qualitative research and has provided a discursive comparison and contrast of the selection and appraisal of primary research, meta-theory and meta-method. All programmes share a therapeutic focus on voiding and the degree and active participation of the client and caregiver. Bladder training focuses on the restoration of continence, while prompted voiding, habit retraining and timed voiding focus on the avoidance of incontinence. Bladder training and prompted voiding share the two characteristics of cognitive behavioural modification and active client participation. Habit retraining and timed voiding pre-empt episodes and avoid incontinence using operant conditioning rather than modifying behaviour. Variability of methods and operational terminology makes comparison between studies difficult. Use of cognitive behavioural approaches and operant conditioning need to be better understood in relation to future theory, interventions and study design. Bladder training is aimed at people who are cognitively and physically able, while the other voiding programmes are mainly used with for people with cognitive and physical impairments reliant on caregivers. The theoretical approaches underpinning bladder training and voiding programmes, their components and suitability for patients need to be re-considered when designing future studies. There is a need for long-term follow-up in future studies. Future trials should adhere to recognized standards of good practice and incorporate outcomes from existing systematic reviews to enable future meta-analysis to be undertaken. Metastudy techniques for the synthesis of qualitative research provide useful methods for the descriptive synopsis of quantitative systematic reviews.
Publisher: Springer Science and Business Media LLC
Date: 16-10-2018
Publisher: Elsevier BV
Date: 12-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2010
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2020
Publisher: Cambridge Media
Date: 08-2021
Publisher: Wiley
Date: 07-06-2016
DOI: 10.1111/JOCN.13292
Abstract: To systematically examine, describe and explain how continence care was determined, delivered and communicated in Australian long aged care facilities. Incontinence is a highly stigmatising condition that affects a disproportionally large number of people living in long-term aged care facilities. Its day-to-day management is mainly undertaken by careworkers. We conducted a Grounded theory study to explore how continence care was determined, delivered and communicated in long-term aged care facilities. This paper presents one finding, i.e. how careworkers in long-term aged care facilities deal with the stigma, devaluation and the aesthetically unpleasant aspects of their work. Grounded theory. Eighty-eight hours of field observations in two long-term aged care facilities in Australia. In addition, in-depth interviews with 18 nurses and careworkers who had experience of providing, supervising or assessment of continence care in any long-term aged care facility in Australia. Occupational exposure to incontinence contributes to the low occupational status of carework in long-term aged care facilities, and continence care is a symbolic marker for inequalities within the facility, the nursing profession and society at large. Careworkers' affective and behavioural responses are characterised by: (1) accommodating the context (2) dissociating oneself (3) distancing oneself and (4) attempting to elevate one's role status. The theory extends current understandings about the links between incontinence, continence care, courtesy stigma, emotional labour and the low occupational status of carework in long-term aged care facilities. This study provides insights into the ways in which tacit beliefs and values about incontinence, cleanliness and contamination may affect the social organisation and delivery of care in long-term aged care facilities. Nurse leaders should challenge the stigma and devaluation of carework and careworkers, and reframe carework as 'dignity work'.
Publisher: SAGE Publications
Date: 22-01-2021
Abstract: There is increasing interest in harnessing aged care residents’ perspectives to drive quality improvement in aged care homes. We conducted a systematic review of qualitative evidence including literature examining residents’ descriptions of “quality of care” in aged care homes, using database searches and screening records according to eligibility criteria. Three independent reviewers conducted quality assessment of forty-six eligible articles and performed thematic synthesis of articles’ findings. We distinguish nine key themes describing factors influencing quality care: staffing levels, staff attitude, continuity, routine, environment, decision-making and choice, dignity of risk, activities, and culture and spirituality. While many themes were consistent across studies, residents’ prioritization of them varied. Aged care home residents have differing conceptions of quality care as well as heterogeneous and dynamic needs and preferences. Care providers are best able to facilitate quality care when intentional efforts are made to recognize this and tailor delivery of services the in idual residents.
No related grants have been discovered for Joan Ostaszkiewicz.