ORCID Profile
0000-0002-5300-8802
Current Organisations
Curtin University
,
Australian National University
,
La Trobe University
,
NPUAP, EPUAP and PPPIA
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Publisher: Wiley
Date: 08-06-2018
DOI: 10.1002/NUR.21878
Abstract: Pressure injuries are a significant health concern in all clinical settings. The current body of research on pressure injuries reported in the literature presents primarily low level evidence. The purpose of the current study was to identify and prioritize pressure injury research issues. The approach entailed evidence scoping and implementing a formal consensus process using a modified nominal group technique based on the Research and Development/University of California at Los Angeles appropriateness method. Sixteen Australian pressure injury experts participated in five consensus voting rounds in May to June 2015. From 60 initial research issues, the experts reached agreement that 26 issues are a priority for future pressure injury research. The highest priorities were strategies to assess skin and tissues, appropriate outcome measures for indicators of pressure injury healing and recurrence, heel pressure off-loading and shear reduction strategies, economic cost of pressure injuries and their management and effectiveness of skin moisturizers and barrier products. Developing a prioritized research agenda, informed by clinical and academic pressure injury experts, can assist in reducing the burden of pressure injuries by identifying topics of the highest need for further research. A web-based nominal group voting process was successful in engaging expert decision-making and has wide-reaching international appeal in facilitating cost-effective consensus methodologies. The priority list generated from this research is currently used in Australia to inform government investment in pressure injury research.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2006
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2010
Publisher: Wiley
Date: 2007
DOI: 10.1002/NUR.20200
Abstract: This article reports on a systematic review of the strategies, practices, and organizational characteristics that promote constructive staff-family relationships in the care of older adults in the health care setting. Research evidence points to the need to address power and control issues, communication, and collaborative approaches to care. Interventions designed to promote family-staff relationships are more likely to achieve maximum benefit when implemented with accompanying information sharing, education, and managerial support.
Publisher: Mark Allen Group
Date: 02-05-2015
Publisher: Springer Science and Business Media LLC
Date: 12-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2004
Publisher: Wiley
Date: 14-03-2014
DOI: 10.1111/TCT.12076
Abstract: The Australian general practitioner (GP) teaching workforce will need to expand in order to provide for the increasing number of medical students and doctors-in-training. Understanding factors that motivate GPs to become involved in teaching in their clinical practice environments is important for developing recruitment and retention strategies. Thirty-one semi-structured interviews were conducted with a cross section of GP teachers and were subjected to thematic analysis. Themes were identified and further classified as motivations and prerequisites for teaching. The desire to update clinical knowledge was the most frequently mentioned motivation for teaching, and was described as a strategy for GP teachers to preserve clinical competence through the opportunity to learn new aspects of medicine from junior colleagues. Other motivations included personal fulfillment and enjoyment of teaching, the opportunity to pass on general practice skills and knowledge, promoting general practice as a career, and fulfilling a sense of responsibility to the profession and community. Peers, students and patients also influenced the decision to teach. Most GPs identified that time, workload, availability of space and adequate financial remuneration were prerequisites for teaching. Practice owners also often determined the GP teachers' capacity to teach. To increase the recruitment and retention of GP teachers, it is recommended that teaching organisations give more recognition to teaching as a clinical professional development activity, place more emphasis on GPs' personal enjoyment, professional responsibility and pride in teaching, and increase engagement with practice owners.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2010
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2016
Publisher: BMJ
Date: 12-2016
Publisher: BMJ
Date: 28-09-2016
DOI: 10.1136/BMJQS-2015-004357
Abstract: Patient participation in healthcare is recognised internationally as essential for consumer-centric, high-quality healthcare delivery. Its measurement as part of continuous quality improvement requires development of agreed standards and measurable indicators. This systematic review sought to identify strategies to measure patient participation in healthcare and to report their reliability and validity. In the context of this review, patient participation was constructed as shared decision-making, acknowledging the patient as having critical knowledge regarding their own health and care needs and promoting self-care/autonomy. Following a comprehensive search, studies reporting reliability or validity of an instrument used in a healthcare setting to measure patient participation, published in English between January 2004 and March 2014 were eligible for inclusion. From an initial search, which identified 1582 studies, 156 studies were retrieved and screened against inclusion criteria. Thirty-three studies reporting 24 patient participation measurement tools met inclusion criteria, and were critically appraised. The majority of studies were descriptive psychometric studies using prospective, cross-sectional designs. Almost all the tools completed by patients, family caregivers, observers or more than one stakeholder focused on aspects of patient-professional communication. Few tools designed for completion by patients or family caregivers provided valid and reliable measures of patient participation. There was low correlation between many of the tools and other measures of patient satisfaction. Few reliable and valid tools for measurement of patient participation in healthcare have been recently developed. Of those reported in this review, the dyadic Observing Patient Involvement in Decision Making (dyadic-OPTION) tool presents the most promise for measuring core components of patient participation. There remains a need for further study into valid, reliable and feasible strategies for measuring patient participation as part of continuous quality improvement.
Publisher: Wiley
Date: 10-2006
DOI: 10.1111/J.1365-2702.2006.01385.X
Abstract: The objectives of this systematic review were to determine the most effective tools for the assessment and diagnosis of sleep problems, as well as identify the most effective strategies for the promotion of sleep within this population. Experiencing reduced sleep quality is often associated with normal ageing, however this may be exacerbated for residents of aged care facilities. External factors such as noise, light and night-time nursing may impact negatively upon sleeping patterns. Eleven electronic databases and the reference lists and bibliographies of included studies were searched. Papers were grouped according to type of intervention or assessment tool and presented in a narrative summary. The review identified many interventions to promote sleep. Multidisciplinary strategies such as combining a reduction in environmental noise, reduction of night-time nursing care and promotion of daytime activity, are likely to be most effective for promoting sleep in the population of interest. The use of sedating medications is cautioned, as their long-term efficacy in promoting sleep is questionable. Wrist actigraphy was found to be the most accurate objective sleep assessment tool. Lack of sleep, disturbed sleep and the overuse of medications especially sedations reduce the quality of life for older people. Effective, safe sleep interventions should be promoted and practised by nurses.
Publisher: Wiley
Date: 08-02-2017
DOI: 10.1111/JAN.13241
Abstract: A discussion of the methodology used to develop the Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. (2014). International experts representing National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance developed the second edition of this clinical guideline. Discussion paper - methodology. A comprehensive search for papers published up to July 2013 was conducted in 11 databases and identified 4286 studies. After critical appraisal, 356 studies were included and assigned a level of evidence. Guideline recommendations provide guidance on best practice in pressure ulcer prevention and treatment. Understanding the development process of a guideline increases the meaningfulness of recommendations to clinicians. Five hundred and seventy five recommendations arose from the research and its interpretation. The body of evidence supporting each recommendation was assigned a strength of evidence. A strength of recommendation was assigned to recommendation statements using the GRADE system. Recommendations are primarily supported by a body of evidence rated as C (87% of recommendations), representing low quality and/or indirect evidence (30%) and expert opinion (57%). Two hundred and forty seven recommendations (43%) received a strong recommendation ('Do it'). Recommendations were developed with consideration to research of the highest methodological quality evidence and studies that add to clinical insight and provide guidance for areas of care where minimal research has been conducted. Recommendations in the guideline reflect best practice and should be implemented with consideration to local context and resources and the in idual's preferences and needs.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2010
Publisher: Hindawi Limited
Date: 04-05-2016
DOI: 10.1155/2016/8212837
Abstract: Background. Obesity is a leading cause of morbidity and mortality in the Australian community, and general practitioners (GPs) are commonly approached by patients for assistance in losing weight. Previous studies have shown that GPs have low self-efficacy and low outcome expectation when it comes to managing overweight and obese patients, which affects their willingness to initiate and continue with weight counselling. This qualitative survey study aimed to explore the factors influencing confidence and behaviour in obesity management in GPs. Method. Twelve GPs recruited to deliver a pilot of an obesity management program participated in semistructured interviews, and interpretive analysis underpinned by social cognitive theory was performed on the transcripts. Results. Analysis identified five main themes: (1) perceived knowledge and skills, (2) structure to management approach, (3) the GP-patient relationship, (4) acknowledged barriers to weight loss and lifestyle change, and (5) prior experience and outcome expectation. Conclusions. GPs are likely to welcome tools which provide a more structured approach to obesity management. Shifting away from weight and BMI as sole yardsticks for success or failure and emphasising positive lifestyle changes for their own sake may improve GP self-efficacy and allow for a more authentic GP-patient interaction.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2006
DOI: 10.11124/01938924-200604090-00001
Abstract: Modern healthcare philosophy espouses the virtues of holistic care and acknowledges that family involvement is appropriate and something to be encouraged due to the role it plays in physical and emotional healing. In the aged care sector, the involvement of families is a strong guarantee of a resident's well-being. The important role family plays in the support and care of the older adult in the residential aged care environment has been enshrined in the Australian Commonwealth Charter of Residents' Rights and Responsibilities and the Aged Care Standards of Practice. Despite wide acknowledgement of the importance of family involvement in the healthcare of the older adult, many barriers to the implementation of participatory family care have been identified in past research. For older adults in the healthcare environment to benefit from the involvement of their family members, healthcare professionals need an understanding of the issues surrounding family presence in the healthcare environment and the strategies to best support it. The objectives of the systematic review were to present the best available evidence on the strategies, practices and organisational characteristics that promote constructive staff-family relationships in the care of older adults in the healthcare setting. Specifically this review sought to investigate how staff and family members perceive their relationships with each other staff characteristics that promote constructive relationships with the family and interventions that support staff-family relationships. A literature search was performed using the following databases for the years 1990-2005: Ageline, APAIS Health, Australian Family and Society Abstracts (FAMILY), CINAHL, Cochrane Library, Dare, Dissertation Abstracts, Embase, MEDLINE, PsycINFO and Social Science Index. Personal communication from expert panel members was also used to identify studies for inclusion. A second search stage was conducted through review of reference lists of studies retrieved during the first search stage. The search was limited to published and unpublished material in English language. The review was limited to studies involving residents and patients within acute, subacute, rehabilitation and residential settings, aged over 65 years, their family and healthcare staff. Papers addressing family members and healthcare staff perceptions of their relationships with each other were considered for this review. Studies in this review also included those relating to interventions to promote constructive staff-family relationships including organisational strategies, staff-family meetings, case conferencing, environmental approaches, etc. The review considered both quantitative and qualitative research and opinion papers for inclusion. All retrieved papers were critically appraised for eligibility for inclusion and methodological quality independently by two reviewers, and the same reviewers collected details of eligible research. Appraisal forms and data extraction forms designed by the Joanna Briggs Institute as part of the QARI and NOTARI systematic review software packages were used for this review. Family members' perceptions of their relationships with staff showed that a strong focus was placed on opportunities for the family to be involved in the patient's care. Staff members also expressed a theoretical support for the collaborative process, however, this belief often did not translate to the staff members' clinical practice. In the studies included in the review staff were frequently found to rely on traditional medical models of care in their clinical practice and maintaining control over the environment, rather than fully collaborating with families. Four factors were found to be essential to interventions designed to support a collaborative partnership between family members and healthcare staff: communication, information, education and administrative support. Based on the evidence analysed in this systematic review, staff and family education on relationship development, power and control issues, communication skills and negotiating techniques is essential to promoting constructive staff-family relationships. Managerial support, such as addressing workloads and staffing issues introducing care models focused on collaboration with families and providing practical support for staff education, is essential to gaining sustained benefits from interventions designed to promote constructive family-staff relationships.
Publisher: American College of Physicians
Date: 20-10-2015
DOI: 10.7326/L15-5148-4
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2004
DOI: 10.11124/01938924-200402101-00001
Abstract: Modern health care philosophy espouses the virtues of holistic care and acknowledges that family involvement is appropriate and something to be encouraged due to the role it plays in physical and emotional healing. In the aged care sector, the involvement of families is a strong guarantee of a resident's wellbeing. The important role family plays in the support and care of the older adult in the residential aged care environment has been enshrined in the Australian Commonwealth Charter of Residents' Rights and Responsibilities and the Aged Care Standards of Practice. Despite wide acknowledgement of the importance of family imvolvement in the health care of the older adult, many barriers to the implementation of participatory family care have been identified in past research. For older adults in the health care environment to benefit from the involvement of their family members, health care professionals need an understanding of the issues surrounding family presence in the health care environement and the strategies to best support it. The objectives of the systematic review were to present the best available evidence on the strategies, practices and organisational characteristics that promote constructive staff-family relationships in the care of older adults in the health care setting. Specifically this review sought to investigate how staff and family members perceive their relationships with each other staff characteristics that promote constructive relationships with the family and interventions that support staff-family relationships. A literature search was performed using the following databases for the years 1990-2005: Ageline, APAIS Health, Australian Family & Society Abstracts (FAMILY), CINAHL, Cochrane Library, Dare, Dissertation Abstracts, Embase, MEDLINE, PsycINFO, and Social Science Index. Personal communication from expert panel members was also used to identify studies for inclusion. A second search stage was conducted through review of reference lists of studies retrieved during the first search stage. The search was limited to published and unpublished material in English language. The review was limited to studies involving residents and patients within acute, subacute, rehabilitation and residential settings, aged over 65 years, their family and health care staff. Papers addressing family members and health care staff perceptions of their relationships with each other were considered for this review. Studies in this review also included those relating to interventions to promote constructive staff-family relationships including organisational strategies, staff-family meetings, case conferencing, environmental approaches etc. The review considered both quantitative and qualitative research and opinion papers for inclusion. All retrieved papers were critically appraised for eligibility for inclusion and methodological quality independently by two reviewers, and the same reviewers collected details of eligible research. Appraisal forms and data extraction forms designed by the Joanna Briggs Institute as part of the QARI and NOTARI systematic review software packages were used for this review. Family members' perceptions of their relationships with staff showed that a strong focus was placed on opportunities for the family to be involved in the patient's care. Staff members also expressed a theoretical support for the collaborative process, however this belief often did not translate to the staff members' clinical practice. In the studies included in the review staff were frequently found to rely on traditional medical models of care in their clinical practice and maintaining control over the environment, rather than fully collaborating with families. Four factors were found to be essential to interventions designed to support a collaborative partnership between family members and health care staff: communication, information, education and administrative support. Based on the evidence analysed in this systematic review, staff and family education on relationship development, power and control issues, communication skills and negotiating techniques is essential to promoting constructive staff-family relationships. Managerial support, such as addressing workloads and staffing issues introducing care models focused on collaboration with families and providing practical support for staff education, is essential to gaining sustained benefits from interventions designed to promote constructive family-staff relationships.
Publisher: Wiley
Date: 11-08-2022
DOI: 10.1111/IWJ.13667
Abstract: In 2019, the third and updated edition of the Clinical Practice Guideline (CPG) on Prevention and Treatment of Pressure Ulcers/Injuries has been published. In addition to this most up-to-date evidence-based guidance for clinicians, related topics such as pressure ulcers (PUs) ressure injuries (PIs) aetiology, classification, and future research needs were considered by the teams of experts. To elaborate on these topics, this is the third paper of a series of the CPG articles, which summarises the latest understanding of the aetiology of PUs/PIs with a special focus on the effects of soft tissue deformation. Sustained deformations of soft tissues cause initial cell death and tissue damage that ultimately may result in the formation of PUs/PIs. High tissue deformations result in cell damage on a microscopic level within just a few minutes, although it may take hours of sustained loading for the damage to become clinically visible. Superficial skin damage seems to be primarily caused by excessive shear strain/stress exposures, deeper PUs/PIs predominantly result from high pressures in combination with shear at the surface over bony prominences, or under stiff medical devices. Therefore, primary PU/PI prevention should aim for minimising deformations by either reducing the peak strain/stress values in tissues or decreasing the exposure time.
Publisher: Wiley
Date: 09-2009
DOI: 10.1111/J.1365-2702.2008.02685.X
Abstract: This paper examined the available evidence concerning hospital discharge practices for frail older people and their family caregivers and what practices were most beneficial for this group. Hospital discharge practices are placing an increasing burden of care on the family caregiver. Discharge planning and execution is significant for older patients where inadequate practices can be linked to adverse outcomes and an increased risk of readmission. Literature review. A review of English language literature published after 1995 on hospital discharge of frail older people and family carer's experiences. Results. Numerous factors impact on the hospital discharge planning of the frail older person and their family carer's that when categorised focus on the role that discharge planning plays in bridging the gap between the care provided in hospital and the care needed in the community, its potential to reduce the length of hospital stay, the impact of the discharge process on family carer's and the need for a coordinated health professional approach that includes dissemination of information, clear communication and active support. The current evidence indicates that hospital discharge planning for frail older people can be improved if interventions address family inclusion and education, communication between health care workers and family, interdisciplinary communication and ongoing support after discharge. Interventions should commence well before discharge. Relevance to clinical practice. An awareness of how the execution of the hospital discharge plan is perceived by the principal family carer of a frail older person, will allow nurses and others involved with the discharge process to better reconcile the family caregivers' needs and expectations with the discharge process offered by their facility. The research shows there is a direct correlation between the quality of discharge planning and readmission to hospital.
Publisher: Wiley
Date: 26-07-2018
DOI: 10.1111/JAN.13779
Abstract: To evaluate use of an evidence-based discharge tool, the Post-Anaesthetic Care Tool and its impact on nursing assessment, communication, and management of patients in the postanaesthetic care unit. Postanaesthetic care unit nurses manage patients immediately after surgery and make clinical decisions on discharge readiness. There is a lack of evidence-based guidance on assessing, documenting, and communicating the patient's postoperative experience. The Post-Anaesthetic Care Tool, which includes instructions for assessing discharge readiness and incorporates the ISOBAR acronym, was developed following a comprehensive systematic review and expert consultation. This quasiexperimental, multicentre, nonrandomized study was conducted in three postanaesthetic care units in Australia. Participants were nurses providing care to adults postgeneral anaesthesia. Episodes of care were observed before (N = 723) and after (N = 694) introduction of the evidence-based tool. Statistical methods (Chi-Square and Mann-Whitney U-Tests) were undertaken to analyse nursing assessment, communication, and management outcomes before and after implementation of the Post-Anaesthetic Care Tool. The Post-Anaesthetic Care Tool was associated with statistically significant improvements in the frequency of nursing assessment and responsiveness to complications including pain, nausea/vomiting and hypothermia. After the tool's introduction, nurses requested more medical reviews. This was associated with increased recognition of clinical deterioration and significant improvements in clarity of handover from the postanaesthetic care unit to the ward. The structured discharge tool, Post-Anaesthetic Care Tool, was associated with improved nursing management of patients in the postanaesthetic care unit and enabled early identification and response to clinical concerns.
Publisher: Elsevier BV
Date: 05-2016
DOI: 10.1016/J.NEDT.2016.02.012
Abstract: Sexuality remains important to older people and should be recognised as an important part of their overall care. However, this appears to be poorly understood and addressed by many healthcare professionals. This systematic review reports on knowledge and attitudes of health professionals towards sexuality and sexual health of older people, including factors that impact knowledge and perceptions. The review, conducted using Joanna Briggs Institute methods, included 23 studies of varied methodology published between January 2004 and January 2015. Findings indicated that healthcare professionals often consider older people's sexuality as outside their scope of practice and there is lack of knowledge and confidence in this area. Cultural norms and taboos, length of time spent working with older people, familiarity with the older person, previous training and degree of exposure to people who are not heterosexual were all identified as factors that impact knowledge and attitude. Better role modelling and education are needed to improve knowledge and attitudes toward later life sexuality.
Publisher: Springer Science and Business Media LLC
Date: 19-03-2014
Publisher: Elsevier BV
Date: 04-2017
Publisher: Wiley
Date: 05-2004
Publisher: Elsevier BV
Date: 08-2018
DOI: 10.1016/J.NEDT.2018.04.019
Abstract: Educational initiatives can improve care delivery and the experience of living in residential aged care for people with dementia. This review aimed to determine the impact of nurse and care staff education on measures of functional ability and quality of life for older people with dementia living in care homes. Systematic review. Search of on-line databases in English between January 2000 and January 2017. Three reviewers used data extraction and critical appraisal tools of the Joanna Briggs Institute to determine methodological quality of research. Thirty-two studies met the initial inclusion criteria and 13 were retrieved for full appraisal. There was limited impact of nurse and care staff education on residents' agitation, anxiety, mood and quality of life. The most consistent improvement in functional ability due to education may be in the execution of activities of daily living. More successful programs included multi-faceted components (e.g. hands on support, clinical auditing) in conjunction with didactic teaching. There is a need for more rigorous and well-designed studies to test interventions.
Publisher: Elsevier BV
Date: 02-2022
DOI: 10.1016/J.JTV.2021.10.008
Abstract: Consumer engagement is a requirement of high quality clinical guidelines. Developing strategies to engage consumers and incorporate the perspectives of in iduals with or at risk of pressure ulcers/injuries and their informal caregivers was one priority in the recent update of the EPUAP/NPIAP/PPPIA's Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The aims were to determine the goals of in iduals and caregivers for pressure ulcer/injury care, priorities for pressure ulcer/injury education and biggest problems related to pressure ulcers/injuries. An online, anonymous, international 10-item survey, accessible in nine languages was provided to in iduals and their caregivers from April to October 2018. Descriptive statistics were used for quantitative data and a thematic analysis approach was used to analyse qualitative data. There were 1233 in iduals from 27 countries who completed the survey. Overall, in iduals and caregivers had similar goals of care. Reducing the size of pressure ulcer/injury was selected more often as a care goal than complete healing. In iduals, compared to caregivers, considered managing pain more important. Qualitative data analysis identified five themes including knowledge, attitudes, and skills risk factors for pressure ulcer/injury accessing pressure ulcer/injury care quality of life for patients and caregivers and the pressure ulcer/injury. The consumer survey provided consumer engagement and perspective that was incorporated into guideline development, including consideration during evaluation of the relevance and acceptability of recommendations, and assignment of recommendation strength ratings.
Publisher: Wiley
Date: 20-01-2015
DOI: 10.1111/TCT.12224
Abstract: The Prevocational General Practice Placement programme (PGPPP) aims to provide junior doctors with professional, well-supervised, educational rotations in general practice. There is a paucity of literature evaluating the educational effectiveness of the PGPPP. This study aims to compare general practice rotations with hospital rotations, with respect to teaching and support, acquisition of skills and knowledge, and role autonomy. All junior doctors who participated in a PGPPP rotation were invited to complete a voluntary anonymous online survey using the Postgraduate Hospital Educational Environment Measure (PHEEM) inventory. The PHEEM presents Likert scales grouped into four subscales for participants to rate statements about their rotations. Surveys were completed at the end of the year in which doctors undertook a PGPPP rotation, and covered all rotations. These survey findings were used to compare general practice and hospital rotations. In all four subscales of teaching, clinical skills, social support and role autonomy, the general practice rotation performed as well as, or better than, hospital rotations in the areas of emergency, medicine, and surgery. General practice outperformed all other rotations in 15 out of 20 statements across all subscales. This study demonstrates the educational value of a general practice placement in comparison with hospital placements. Expansion of the PGPPP should be considered to provide all junior doctors with the benefits of exposure to generalist skills in the community.
Publisher: Wiley
Date: 09-11-2016
DOI: 10.1111/COB.12167
Abstract: Therapeutic alliance is a well-recognized predictor of patient outcomes within psychological therapy. It has not been applied to obesity interventions, and Bordin's theoretical framework shows particular relevance to the management of obesity in primary health care. This cross-sectional study of a weight management programme in general practice aimed to determine if therapeutic alliance was associated with patient outcomes. The Working Alliance Inventory short revised version (WAI-SR) was administered to 23 patients and 11 general practitioners (GPs) at the end of a 6-month weight management programme. Use of the WAI-SR indicated that the strength of therapeutic alliance varied between different patient-GP relationships in this pilot intervention. A robust therapeutic alliance was strongly associated with patient engagement in the weight management programme indicated by number of appointments. It was also associated with some general health and quality of life outcomes. These are promising results that require confirmation with larger studies in primary health care. The measurement of therapeutic alliance using the WAI-SR may predict patient attendance and outcomes in obesity interventions in primary healthcare settings.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2006
DOI: 10.1111/J.1479-6988.2006.00053.X
Abstract: Background Modern healthcare philosophy espouses the virtues of holistic care and acknowledges that family involvement is appropriate and something to be encouraged due to the role it plays in physical and emotional healing. In the aged care sector, the involvement of families is a strong guarantee of a resident's well-being. The important role family plays in the support and care of the older adult in the residential aged care environment has been enshrined in the Australian Commonwealth Charter of Residents' Rights and Responsibilities and the Aged Care Standards of Practice. Despite wide acknowledgement of the importance of family involvement in the healthcare of the older adult, many barriers to the implementation of participatory family care have been identified in past research. For older adults in the healthcare environment to benefit from the involvement of their family members, healthcare professionals need an understanding of the issues surrounding family presence in the healthcare environment and the strategies to best support it. Objectives The objectives of the systematic review were to present the best available evidence on the strategies, practices and organisational characteristics that promote constructive staff-family relationships in the care of older adults in the healthcare setting. Specifically this review sought to investigate how staff and family members perceive their relationships with each other staff characteristics that promote constructive relationships with the family and interventions that support staff-family relationships. Search strategy A literature search was performed using the following databases for the years 1990-2005: Ageline, APAIS Health, Australian Family and Society Abstracts (FAMILY), CINAHL, Cochrane Library, Dare, Dissertation Abstracts, Embase, MEDLINE, PsycINFO and Social Science Index. Personal communication from expert panel members was also used to identify studies for inclusion. A second search stage was conducted through review of reference lists of studies retrieved during the first search stage. The search was limited to published and unpublished material in English language. Selection criteria The review was limited to studies involving residents and patients within acute, subacute, rehabilitation and residential settings, aged over 65 years, their family and healthcare staff. Papers addressing family members and healthcare staff perceptions of their relationships with each other were considered for this review. Studies in this review also included those relating to interventions to promote constructive staff-family relationships including organisational strategies, staff-family meetings, case conferencing, environmental approaches, etc. The review considered both quantitative and qualitative research and opinion papers for inclusion. Data collection and analysis All retrieved papers were critically appraised for eligibility for inclusion and methodological quality independently by two reviewers, and the same reviewers collected details of eligible research. Appraisal forms and data extraction forms designed by the Joanna Briggs Institute as part of the QARI and NOTARI systematic review software packages were used for this review. Findings Family members' perceptions of their relationships with staff showed that a strong focus was placed on opportunities for the family to be involved in the patient's care. Staff members also expressed a theoretical support for the collaborative process, however, this belief often did not translate to the staff members' clinical practice. In the studies included in the review staff were frequently found to rely on traditional medical models of care in their clinical practice and maintaining control over the environment, rather than fully collaborating with families. Four factors were found to be essential to interventions designed to support a collaborative partnership between family members and healthcare staff: communication, information, education and administrative support. Based on the evidence analysed in this systematic review, staff and family education on relationship development, power and control issues, communication skills and negotiating techniques is essential to promoting constructive staff-family relationships. Managerial support, such as addressing workloads and staffing issues introducing care models focused on collaboration with families and providing practical support for staff education, is essential to gaining sustained benefits from interventions designed to promote constructive family-staff relationships.
Publisher: Oxford University Press (OUP)
Date: 17-10-2017
Abstract: Primary health care requires new approaches to assist patients with overweight and obesity. This is a particular concern for patients with limited access to specialist or allied health services due to financial cost or location. The Change Program is a toolkit that provides a structured approach for GPs working with patients on weight management. To assess the acceptability and feasibility of a GP-delivered weight management programme. A feasibility trial in five Australian general practices with 12 GPs and 23 patients. Mixed methods were used to assess the objective through participant interviews, online surveys and the NOrmalization MeAsure Development (NoMAD) tool based on Normalization Process Theory. Content analysis of interviews is presented alongside Likert scales, free text and the NoMAD tool. The Change Program was acceptable to most GPs and patients. It was best suited to patient-GP dyads where the patient felt a strong preference for GP involvement. Patients' main concerns were the time and possible cost associated with the programme if run outside a research setting. For sustainable implementation, it would have been preferable to recruit a whole practice rather than single GPs to enable activation of systems to support the programme. A GP-delivered weight management programme is feasible and acceptable for patients with obesity in Australian primary health care. The addition of this structured toolkit to support GPs is particularly important for patients with a strong preference for GP involvement or who are unable to access other resources due to cost or location.
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/AH15153
Abstract: Objectives The aim of the present secondary analysis of data collected in a grounded theory study was to explore the perceptions of Registrars and new Fellows to practice ownership and management. Methods Focus groups and interviews with Registrars and recent Fellows were undertaken to explore the desire to become an owner, facilitators and barriers to practice ownership and delivery models for practice ownership education. A secondary thematic analysis was conducted to understand emerging concepts related to perceptions of general practice ownership. Results A surprisingly strong theme of fear was evident across focus group and interview participants. Expressed fear was specifically related to financial concerns, lack of relevant knowledge and skills and concern over balancing different roles. Moderating factors included previous life and educational experiences, as well as role modelling. Conclusions Graduation of a cohort of new general practitioners (GPs) who express fear towards practice ownership is concerning. Creating more positive learning environments and opportunity for open discussion regarding practice management and ownership is an important step in providing adequate support for new GPs to give serious consideration to career options. What is known about the topic? The traditional model of general practice ownership has been for a doctor to own and/or manage the practice. Fewer new GPs are taking on the role of owning a general practice, and disinterest has been presumed to play a significant role in this trend. It has been reported that current curricula provide insufficient focus on providing learning opportunities for general practice trainees on ownership and management models however, recent research has shown that general practice trainees have a strong interest in receiving this knowledge during their training. What does this paper add? The present qualitative research evaluated the emotional response that general practice trainees (Registrars) expressed when they considered practice ownership. GP Registrars expressed fear when asked about the prospect of owning their own practice. This may be influenced by the role modelling they receive during their training. What are the implications for practitioners? Supervisors involved in general practice training should ensure their trainees have the opportunity to learn about practice ownership during their training. Supervisors should also be aware that their own behaviour and attitudes towards practice ownership is observed by their trainees and it can colour the emotional response the trainee has when considering owning a practice.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2010
Publisher: Elsevier BV
Date: 08-2019
DOI: 10.1016/J.IJNURSTU.2019.04.005
Abstract: Dementia is one of the most prevalent conditions in older adults in residential aged care. Dementia has a significant impact on a person's ability to eat, drink and participate in mealtime activities. Dementia impacts memory, appetite, gross and fine motor skills, communication skills, mood and social behaviours, all of which can decrease the person's ability to engage in a meal. The objective was to review the literature on strategies to promote mealtime function in people with dementia living in residential aged care and assess their effectiveness. The review considered studies reporting outcome measures that related to nutritional status, communication, behaviour and eating skills and ability. Systematic review using the Joanna Briggs Institute review methods. Seven databases (MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, EMBASE, Current Contents, PsycINFO and Allied and Complementary Medicine Database) were searched for research published 2000-2017 in English. Eligible studies included quantitative studies reporting a mealtime intervention delivered to people with dementia in residential aged care compared with standard care reporting nutritional, behavioural or functional outcomes, including observation studies with no comparator. Studies were screened and independently appraised by two reviewers using Joanna Briggs Institute (JBI) critical appraisal tools based on study design. Data was extracted from eligible studies using JBI extraction tables that assess study design, population characteristics, intervention and comparator, outcome measures and findings. Results related to mealtime function were tabulated and reported in narrative format. 136 studies were identified, of which 20 were eligible for inclusion. Studies reported strategies related to: food presentation meal styles environment adaptations skills training music therapy and animal-assisted therapy. Outcomes included measures of nutritional status, communication and behavioural and psychological symptoms of dementia. Low quality evidence suggested that playing music and introducing fish to the dining room may improve the food intake of people with dementia by a small amount. Montessori and spaced retrieval programs also demonstrated some positive impact on eating skills and nutritional intake. Animal-assisted therapy also demonstrated small statistically significant improvements in weight and body mass index. There is insufficient evidence to highly recommend any specific intervention to improve mealtime functional ability in people with dementia. Further research is required through robust study designs using valid and reliable outcome measures to demonstrate clinically significant effects for mealtime interventions.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2010
DOI: 10.1111/J.1744-1609.2010.00165.X
Abstract: This paper is an update to a systematic review that presents the best available evidence on the factors that are most effective in promoting constructive staff-family relationships in the care of older people in the institutional healthcare setting. Systematic review. The updated review supports findings from the earlier review. Additional evidence points to the importance of monitoring care, family involvement in decision-making, staff upholding the uniqueness of the older person, trust, the involvement of the multidisciplinary care team and family dynamics as factors underpinning effective staff-family relationships. A number of factors critical to the development and maintenance of positive staff-family relationships in the institutional setting have been identified. The delivery of quality care is predicated on staff having an understanding of these factors.
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.JTV.2019.01.001
Abstract: The European Pressure Ulcer Advisory Panel, the Pan Pacific Pressure Injury Alliance, and the National Pressure Ulcer Advisory Panel are updating the 'Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline' (CPG) in 2019. The aim of this contribution is to summarize and to discuss the guideline development protocol for the 2019 update. A guideline governance group determines and monitors all steps of the CPG development. An international survey of consumers will be undertaken to establish consumer needs and interests. Systematic evidence searches in relevant electronic databases cover the period from July 2013 through August 2018. Risk of bias of included studies will be assessed by two reviewers using established checklists and an overall strength of evidence assigned to the cumulative body of evidence. Small working groups review the evidence available for each topic, review and/or draft the guideline chapters and recommendations and/or good practice statements. Finally, strength of recommendation grades are assigned. The recommendations are rated based on their importance and their potential to improve in idual patient outcomes using an international formal consensus process. Major methodological advantages of the current revision are a clear distinction between evidence-based recommendations and good practice statements and strong consumer involvement. The 2019 guideline update builds on the previous 2014 version to ensure consistency and comparability. Methodology changes will improve the guideline quality to increase clarity and to enhance implementation and compliance. The full guideline development protocol can be accessed from the guideline website (www.internationalguideline.com/).
Publisher: Mark Allen Group
Date: 02-05-2015
DOI: 10.12968/IJPN.2015.21.5.225
Abstract: It is important to develop an in idualised plan of care for people at the end of life to prevent pressure ulcers, and to treat them if they do occur. This article discusses patient and risk assessment, prevention and care for pressure ulcers for the palliative care patient and the recommendations given in the palliative care section of the Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline ( National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance, 2014 ).
Publisher: Wiley
Date: 08-10-2015
DOI: 10.1111/HEX.12418
Publisher: BMJ
Date: 2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2004
DOI: 10.11124/01938924-200402040-00001
Abstract: The promotion of sleep in older adults is a significant issue in high-level residential aged care facilities, with as many as 67% of residents experiencing disruptions to their sleep patterns. Not only do health concerns such as cognitive impairment, pain and incontinence impact upon this population's sleep quality and quantity, but environmental factors including noise, light and night-time nursing care also affect sleep of those residing in institutions. In order to address the issue of sleep disruption, assessment and diagnosis of sleep problems and implementation of interventions that are effective in promoting sleep are essential. The objective of this review was to determine the most effective tools for the assessment and diagnosis of sleep in older adults in high-level aged care. The review also sought to determine the most effective strategies for the promotion of sleep in this population. Outcome measures for this review were: indicators of improved sleep quality and quantity, including an improvement in daytime functioning and improved night-time sleep reduction in use of hypnotics and sedatives and increased satisfaction with sleep. A literature search was performed using the following databases for the years 1993-2003: AgeLine, APAIS Health, CINAHL, Cochrane Library, Current Contents, Dissertation Abstracts International, Embase, Medline, Proquest, PsycInfo, Science Citations Index. A second search stage was conducted through review of reference lists of studies retrieved during the first search stage. The search was limited to published and unpublished material in English language. The review was limited to papers addressing sleep diagnosis, assessment and/or management in adults aged 65 or over who were residing in high-level aged care. The review included randomised controlled trials (RCTs) and, due to the limited number of RCTs available, non-RCTs, cohort and case control studies and qualitative research were also considered for inclusion. Research was included if it addressed the assessment, diagnosis or management of sleep using outcome measure of improved night-time sleep or daytime function, improvements in resident satisfaction with sleep or reduction in medication use associated with sleep. The types of interventions considered by this review were alternative therapies including massage, aromatherapy and medicinal herbs behavioural or cognitive interventions biochemical interventions environmental interventions pharmacological interventions and related nocturnal interventions such as continence care. Instruments and strategies to diagnose and assess the sleep of older high-level care residents, including objective and subjective assessment tools, were considered by this review. All retrieved papers were critically appraised for eligibility for inclusion and methodological quality independently by two reviewers, and the same reviewers collected details of eligible research. Papers were grouped according to the type of intervention or type of assessment tool used and findings were presented in a narrative summary. Wrist actigraphy was found to be the most accurate objective sleep assessment tool for use in the population of interest, and issues surrounding its use are presented. Although no subjective sleep assessment tools were identified in this review, the evidence suggested that subjective reports of sleep quality are an important consideration in sleep assessment. Evidence suggested that behavioural observations may be an effective assessment strategy when conducted on a frequent basis. The review found no evidence on the effectiveness of any assessment tools for the diagnosis of specific sleep problems in older adults. The use of multidisciplinary strategies including reduction of environmental noise, reduction of night-time nursing care that disrupts sleep and daytime activity is likely to be the most effective strategy for the promotion of sleep in older high-level care residents. The use of sedating medications did not appear to have a substantial effect in promoting sleep, and health practitioners in high-level aged care should consider their use cautiously.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2013
Abstract: Patient safety depends on nurses' clinical judgment. In post-anaesthetic care, objective scoring systems are commonly used to help nurses assess when a patient is ready to go back to the ward or be discharged home after day surgery. Although there are several criteria used to assess patient readiness for discharge from the post-anaesthetic care unit, evaluation of the validity and reliability of these criteria is scarce. This article presents key findings from a systematic review conducted to identify the essential components of an effective and feasible scoring system to assess patients following surgical anaesthesia for discharge from the post-anaesthetic care unit. The protocol for the systematic review of quantitative studies investigating assessment criteria for discharge of adult patients from the post-anaesthetic care unit was approved by the Joanna Briggs Institute and conducted consistent with the methodology of the Institute. Twelve databases and grey literature, such as conference proceedings, were searched for published studies between 1970 and 2010. Two reviewers independently assessed study eligibility for inclusion. Reference lists of included studies were appraised. Eight studies met the inclusion criteria only one was a randomised controlled trial. Variables identified as essential when assessing a patient's readiness for discharge from the post-anaesthetic care unit were conscious state, blood pressure, nausea and vomiting, and pain. Assessment of psychomotor and cognitive recovery and other vital signs were also identified as relevant variables to consider. There was limited high-quality research regarding criteria to assess patient readiness for discharge from the post-anaesthetic unit. The key recommendations, with moderate to high risk of bias, include that assessment of specific variables (pain, conscious state, blood pressure, and nausea and vomiting) should be made before patient discharge. These key findings have informed a subsequent study to reach international consensus on effective assessment criteria and a project to test the clinical reliability of a tool for use by nurses in assessing patient readiness for discharge from post-anaesthetic care.
Publisher: John Wiley & Sons, Ltd
Date: 18-04-2007
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2011
DOI: 10.11124/01938924-201109410-00001
Abstract: Aim This systematic review investigates the essential components of an effective and feasible scoring system to assess patients following anaesthesia and surgery, thereby enhancing patient safety through timely and appropriate discharge from the Post-Anaesthetic Care Unit. The findings of the evidence synthesis will be used to inform the development of a Post-Anaesthetic Care Unit discharge tool.Methods A systematic review of quantitative research conducted in adult populations on post-anaesthetic discharge assessment strategies utilised in post-anaesthetic care units following any type of surgical procedure. An extensive literature search was constructed to identify all relevant studies published between 1970 and 2010. Studies were appraised and data was extracted by two reviewers using the standardised critical appraisal and data extraction tools from the Joanna Briggs Institute.Results A total of eight studies were included in the review. One randomised controlled trial and four observational studies provided evidence on the effectiveness and feasibility of discharge assessment tools. All studies identified pain, conscious state, and nausea and vomiting as important variables to consider in assessing a patient's readiness for discharge from the post-anaesthetic care unit. Two additional observational studies and a retrospective records analysis investigated the recovery of patients in the post-anaesthetic care unit, providing data on psychomotor and cognitive recovery following anaesthetic.Conclusion There was general agreement amongst the studies that post-anaesthetic care unit discharge assessment should consider levels of pain, conscious state, and nausea and vomiting. Although vital signs were included in all the discharge assessment tools, there was variation in the specific vital signs included within tools, with blood pressure being the only vital sign consistently used. The value of including urine output, oral intake or psychomotor testing in assessing readiness for post-anaesthetic care unit discharge was inconclusive and therefore requires further investigation.Implications for practice Based on the evidence from studies at moderate to high risk of bias analysed in this systematic review, the following recommendations are considered important for the assessment of the readiness of adult patients to be discharged from the post-anaesthetic care unit:• Assessment of pain, conscious state, blood pressure and nausea and vomiting should be made before discharging a patient. Assessment of other vital signs should be considered before discharging a patient from post-anaesthetic care unitImplications for research The synthesised evidence suggests there is limited consensus on criteria for post-anaesthetic care unit discharge assessment and further investigation using sound methodologies is required, especially with regard to patient outcomes. The following recommendations can be made:• Further research should investigate the validity and reliability of assessment variables on post-anaesthetic care unit discharge tools, the implementation of validated post-anaesthetic care unit discharge criteria for assessment of patient readiness for discharge, and, the relationship between post-anaesthetic care unit discharge assessment and patient safety.
Publisher: Mark Allen Group
Date: 06-2016
DOI: 10.12968/JOWC.2016.25.SUP6.S1
Abstract: It is well documented that the prevalence of venous leg ulcers (VLUs) is increasing, coinciding with an ageing population. Accurate global prevalence of VLUs is difficult to estimate due to the range of methodologies used in studies and accuracy of reporting. 1 Venous ulceration is the most common type of leg ulceration and a significant clinical problem, affecting approximately 1% of the population and 3% of people over 80 years of age 2 in westernised countries. Moreover, the global prevalence of VLUs is predicted to escalate dramatically, as people are living longer, often with multiple comorbidities. Recent figures on the prevalence of VLUs are based on a small number of studies, conducted in Western countries, and the evidence is weak. However, it is estimated that 93% of VLUs will heal in 12 months, and 7% remain unhealed after five years. 3 Furthermore, the recurrence rate within 3 months after wound closure is as high as 70%. 4 -6 Thus, cost-effective adjunct evidence-based treatment strategies and services are needed to help prevent these ulcers, facilitate healing when they occur and prevent recurrence. The impact of a VLU represents social, personal, financial and psychological costs on the in idual and further economic drain on the health-care system. This brings the challenge of providing a standardised leg ulcer service which delivers evidence-based treatment for the patient and their ulcer. It is recognised there are variations in practice and barriers preventing the implementation of best practice. There are patients not receiving appropriate and timely treatment in the initial development of VLUs, effective management of their VLU and preventing recurrence once the VLU has healed. Health-care professionals (HCPs) and organisations must have confidence in the development process of clinical practice guidelines and have ownership of these guidelines to ensure those of the highest quality guide their practice. These systematic judgments can assist in policy development, and decision making, improve communication, reduce errors and improve patient outcomes. There is an abundance of studies and guidelines that are available and regularly updated, however, there is still variation in the quality of the services offered to patients with a VLU. There are also variations in the evidence and some recommendations contradict each other, which can cause confusion and be a barrier to implementation. 7 The difference in health-care organisational structures, management support and the responsibility of VLU management can vary in different countries, often causing confusion and a barrier to seeking treatment. These factors further complicate the guideline implementation process, which is generally known to be a challenge with many diseases. 8
Publisher: Wiley
Date: 15-06-2011
Publisher: Wiley
Date: 02-05-2020
DOI: 10.1111/WRR.12823
No related grants have been discovered for Emily Haesler.