Journal articles on the topic 'Nursing home care Australia'
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Smith, Judy. "The changing face of community and district nursing." Australian Health Review 25, no. 3 (2002): 131. http://dx.doi.org/10.1071/ah020131.
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The Royal District Nursing Service (RDNS) of South Australia provides home- and community-based nursing care to people residing in the Adelaide Metropolitan area. The service is funded predominantly by the Home and Community Care Program. It provides community nursing services in the areas of wound management, palliative care, HIV/AIDS care, continence management, disability care, mental health and dementia care, and diabetes management. In 2000-2001, the service made 439,700 visits to people's homes or saw them in a nurse-led nursing centre. In addition, the nursing staff had 84,000 contacts other than face to face that were related to client care. These contacts include the co-ordination of care with other service providers for new and existing clients of RDNS.
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Ames, David. "Depressive Disorders among Elderly People in Long-Term Institutional Care." Australian & New Zealand Journal of Psychiatry 27, no. 3 (September 1993): 379–91. http://dx.doi.org/10.3109/00048679309075793.
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Depressive disorders are common among old people in residential and nursing homes. Outside Australia the prevalence rate for depressive symptoms in homes ranges from 30–75% while that for depressive disorders defined by psychiatric diagnostic criteria is well over 20% in many nursing home studies. These rates are between two and twenty times higher than those found among the elderly living at home. Evidence from Australia indicates that a problem of similar magnitude exists here. While physical disability is strongly associated with depression in these populations, it is not the only factor likely to be responsible for the initiation and maintenance of depression among those in long-term care. There is an urgent need for studies which will better define likely aetiological and maintaining factors for depression in institutional populations, as well as controlled trials of both pharmacological treatments and environmental improvements. In addition, research is needed to establish whether depression is an independent risk factor for mortality among institutional residents.
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Koritsas, Stella, Sandra Davidson, David Clarke, and Daniel O'Connor. "Diagnosing and Treating Depressions in Nursing Home Residents: Challenges for GPs." Australian Journal of Primary Health 12, no. 3 (2006): 104. http://dx.doi.org/10.1071/py06052.
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Depression is more common in elderly people residing in nursing homes than it is in people of the same age residing in the community. In Australia, general practitioners (GPs) are the primary providers of medical services to the elderly in nursing homes; however, they often under-diagnose and/or inadequately treat depression in this population. The difficulties experienced by GPs are confounded by the breakdown in the continuity of care that is evident when a patient is admitted into a nursing home, by inadequate communication between GPs and nursing home staff, and systems within the nursing home that are not conducive to general practice. This paper discusses the challenges GPs face in diagnosing and treating depression in nursing home residents, and provides suggestions for strategies that may overcome these challenges.
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Anderson, Barbara. "Clinical Records in Nursing Homes — What are They and Why Do we Need Them?" Australian Medical Record Journal 19, no. 3 (September 1989): 105–8. http://dx.doi.org/10.1177/183335838901900304.
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The importance of clinical records to holistic client centre care is highlighted by the outcome standards which nursing homes in Australia now have to meet. The clinical record system therefore must be organised in such a way as to provide evidence that a nursing home is meeting the desired outcome standards. In this paper the author reviews some of the records problems typically encountered by nursing homes and offers potential solutions. The point is made that any nursing home with poor clinical records can expect to have difficulty meeting the outcome standards. (AMRJ, 19(3), 105–108).
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Henderson, Emily J., and Gideon A. Caplan. "Home Sweet Home? Community Care for Older People in Australia." Journal of the American Medical Directors Association 9, no. 2 (February 2008): 88–94. http://dx.doi.org/10.1016/j.jamda.2007.11.010.
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Ibrahim, Joseph Elias, Chebiwot Kipsaina, Cathy Martin, David Leo Ranson, and Lyndal Bugeja. "Variations in death notification of nursing home residents to Australian Coroners." Injury Prevention 25, no. 5 (July 9, 2018): 357–63. http://dx.doi.org/10.1136/injuryprev-2017-042689.
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ObjectivesTo examine the impact of changes to the reporting requirements in coronial legislation on the nature and frequency of nursing home resident deaths reported to Coroners.DesignNational retrospective study of a population cohort of nursing home resident deaths.SettingAccredited Australian nursing homes between July 2000 and June 2013.ParticipantsResidents who died in nursing homes accredited by the Aged Care Standards and Accreditation Agency reported to Coroners.Main outcome measuresWe explored three death-reporting models in the nursing home setting: comprehensive model, selective ‘mechanism of death’ model and selective ‘age of death’ model. These models were examined by manner of death subgroups: natural, falls-related and other external causes using the outcome measure of deaths notified to the Coroner per 1000 residents. We used an interrupted time series analysis using generalised linear regression with a negative binomial probability distribution and a log link function.ResultsThe comprehensive model showed the proportion of reportable deaths due to natural causes far exceeded those from falls and other external cause. In contrast, the selective notification models reduced the total number of reportable deaths. Similarly, the selective ‘age of death’ model showed a decline in the reportable external cause deaths.ConclusionsVariation in the causes, locations and ages of persons whose deaths are legally required to be notified to Coroners impacts the frequency and nature of deaths of nursing home residents investigated by Coroners. This demonstrates that legislation needs to be carefully framed and applied to ensure that the prevention mandate of Coroners in Australia is to be achieved.
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Jain, Briony, Melissa Willoughby, Margaret Winbolt, Dina Lo Giudice, and Joseph Ibrahim. "Stakeholder perceptions on resident-to-resident aggression: implications for prevention." Australian Health Review 42, no. 6 (2018): 680. http://dx.doi.org/10.1071/ah17282.
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Objective Resident-to-resident aggression (RRA) in nursing homes is a matter of serious and profound concern, yet action to eliminate or mitigate RRA is hampered by a paucity of research. The aim of this study was to explore key stakeholders’ knowledge and perceptions of RRA in Australian nursing homes. Methods A qualitative cross-sectional study design was used, and semistructured telephone interviews were conducted. Participants were purposively and conveniently sampled with replacement from a range of aged care, healthcare and legal professional bodies, as well as advocacy organisations. The interview contained 12 closed-ended questions and six open-ended questions about participants’ knowledge, experiences, perceptions and attitudes to RRA. Participant characteristics and responses to closed-ended questions were aggregated and proportions calculated, and thematic analysis was conducted by two independent researchers using a directed content approach. Results Fifteen participants (11 females; 73.3%) in senior management positions were interviewed. All were familiar with the concept of RRA and just over half (n=8; 53.3%) had witnessed an incident. Major themes included the nature and causes of RRA and attitudes and responses to RRA. Potential causes of RRA included maladaptation to nursing home life, transfer of pre-existing issues into the nursing home environment, physical environment and staffing-related issues. RRA was commonly viewed by participants as dangerous and unpredictable or, conversely, as expected behaviour in a nursing home setting. A person-centred care approach was considered most effective for managing and responding to RRA. Conclusion The research demonstrates that understanding perceptions of RRA among key stakeholders is critical to identifying the nature and scope of the problem and to developing and implementing appropriate prevention strategies. What is known about the topic? RRA is common in nursing homes, with potentially fatal consequences for residents involved, and has serious implications for nursing home staff, managers, providers, and regulators. Despite this, the prevalence, impact, and prevention of RRA remains under-recognised and under-researched in Australia. What does this paper add? This is the first Australian study to produce qualitative findings on the knowledge and perceptions of RRA in nursing homes among key stakeholders. This paper reports on the knowledge and perceptions of individuals in senior management and policy roles in aged care and related fields in relation to four themes: nature; causes; attitudes; and responses to RRA. Our findings highlight the complex and multifactorial nature of RRA. What are the implications for practitioners? A movement towards person-centred care that promotes understanding of individual care needs is favoured as an approach to reducing RRA. Increased reporting of both minor and major incidents of RRA will help to identify patterns and inform appropriate responses. However, a cultural shift is first required to recognise RRA as a manageable and preventable health care and adult safeguarding issue.
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Cheluvappa, Rajkumar, and Selwyn Selvendran. "Antipodean Perspectives—Aged Care Nursing and the Multifaceted Role of the Aged Care Nurse." Nursing Reports 12, no. 3 (August 30, 2022): 629–36. http://dx.doi.org/10.3390/nursrep12030062.
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Healthy ageing refers to the development and maintenance of the functional ability of ageing individuals. Aged care nurses provide nursing care to elderly individuals and usually work in aged care residential facilities, nursing homes, home care services, and/or hospital departments. The registered nurse working in the aged care sector has several important roles. Key roles cover both therapeutic and preventative paradigms, as discussed in this paper. The aged care nurse is also “tasked with” holistic patient-centred care and the promotion of healthy ageing via advocacy and sociocultural roles. This paper examined, described, and analysed the multifaceted role of an aged care nurse from an Australian perspective. We conducted meticulous searches using PubMed, Google Scholar, government guidelines, authoritative body regulations, quality control guidelines, and government portals pertaining to aged care nursing in Australia. This paper relied upon the information garnered from publications, reports, and guidelines resulting from these searches and analyses. Multiple aspects of healthy ageing and holistic aged care nursing are discussed. The key roles of the aged care nurse are enumerated next, in accordance with the code of conduct from the Nursing and Midwifery Board of Australia (NMBA). The NMBA promotes evidence-based, culturally sensitive, consultative, holistic aged care clinical practice that includes input from care recipients, their decision makers, and/or their health care providers. The difficult issue of loneliness is discussed with strategies to ameliorate aspects of this. Good social networks, community interactions, meaningful friendships, and participation in personalised spiritual/religious practices improve the quality of aged care. The key topic of elder abuse and its forms are discussed apropos of aged care nursing. Healthy ageing is promoted by identifying and reporting elder abuse at the earliest. Current Australian law and recent federal legislation changes pertaining to aged care nursing are discussed next. As a result of these legislation changes, several new quality control imperatives (for aged care organisations/facilities) under the Aged Care Quality and Safety Commission (ACQSC) have been implemented. Residential and flexible aged care providers should now have robust ongoing documentation and a well-developed behaviour support plan (BSP) for each care recipient who currently requires or may require restrictive practices, which must be reported under the new serious incident reporting scheme (SIRS). Various strategies to promote healthy ageing and approaches to communicate effectively with aged care recipients are also discussed. Healthy ageing is promoted when age care recipients are empowered with making their own autonomous choices in “major and minor” aspects of life. Finally, approaches to optimise quality aged care nursing care are discussed. The Roper–Logan–Tierney model is one of the models used to assess and optimise nursing care. This is premised on the capability of an ageing individual to accomplish 12 basic activities of daily living.
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Boak, Jennifer, Irene Blackberry, and Tshepo Rasekaba. "Improving Detection of Client Complexity in the Community (Impact): A Study Protocol of a Pragmatic Randomized Controlled Trial." Methods and Protocols 4, no. 4 (October 6, 2021): 70. http://dx.doi.org/10.3390/mps4040070.
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Background: Community-dwelling older clients are becoming increasingly complex. Detecting this complexity in clinical practice is limited, with greater reliance on community nurses’ clinical judgment and skills. The lack of a consistent approach to complexity impacts the level of care and support for older clients to remain in their homes for longer. Objective: To examine the effectiveness of the Patient Complexity Instrument (PCI) in addition to nurses’ clinical judgment to enhance detection of complexity, and subsequent older clients’ resource allocation compared to usual nursing assessment. Design: A pragmatic randomized controlled trial will be conducted within a community nursing service in regional Victoria, Australia. Clients 65 years and over referred to the service who are eligible for Commonwealth Home Support Programme (CHSP) funding will be randomized into Control group: usual nursing assessment or Intervention group: usual nursing assessment plus the PCI. Nurse participants are Registered Nurses currently employed in the community nursing service. Results: This study will explore whether introducing the PCI in a community nursing service enhances detection of complexity and client care resource allocation compared to nurses’ clinical judgment based on usual nursing assessment. Conclusion: This protocol outlines the study to enhance the detection of complexity by nurses delivering care for community-dwelling older people in the regional Australian context. The findings will inform the use of a standardized tool to detect complexity among community-dwelling older Australians.
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Miller, Elizabeth M., and Joanne E. Porter. "Understanding the Needs of Australian Carers of Adults Receiving Palliative Care in the Home: A Systematic Review of the Literature." SAGE Open Nursing 7 (January 2021): 237796082098568. http://dx.doi.org/10.1177/2377960820985682.
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Introduction Caring for someone at home requiring palliative care is an ominous task. Unless the current support systems are better utilised and improved to meet the needs of those carers, the demand for acute hospital admissions will increase as the Australian population ages. The aim of this review was to examine the needs of unpaid carers who were caring for adults receiving palliative care in their home in Australia. Methods: A systematic review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines between 2008–2020. Results: Only Australian papers were selected due to the intent to understand carers’ needs in the Australian context and 17 papers made up the final data set. Four themes emerged: 1) Perceived factors influencing caregiving; 2) Perceived impact and responses to caregiving; 3) Communication and information needs; and 4) Perceptions of current palliative support services and barriers to uptake. Conclusion: Carers reported satisfaction and positive outcomes and also expressed feeling unprepared, unrecognised, stressed and exhausted.
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Reed, Frances M., Les Fitzgerald, and Melanie R. Bish. "District nurse advocacy for choice to live and die at home in rural Australia." Nursing Ethics 22, no. 4 (June 29, 2014): 479–92. http://dx.doi.org/10.1177/0969733014538889.
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Background: Choice to live and die at home is supported by palliative care policy; however, health resources and access disparity impact on this choice in rural Australia. Rural end-of-life home care is provided by district nurses, but little is known about their role in advocacy for choice in care. Objectives: The study was conducted to review the scope of the empirical literature available to answer the research question: What circumstances influence district nurse advocacy for rural client choice to live and die at home?, and identify gaps in the knowledge. Method: Interpretive scoping methodology was used to search online databases, identify suitable studies and select, chart, analyse and describe the findings. Results: 34 international studies revealed themes of ‘the nursing relationship’, ‘environment’, ‘communication’, ‘support’ and ‘the holistic client centred district nursing role. Discussion: Under-resourcing, medicalisation and emotional relational burden could affect advocacy in rural areas. Conclusion: It is not known how district nurses overcome these circumstances to advocate for choice in end-of-life care. Research designed to increase understanding of how rural district nurses advocate successfully for client goals will enable improvements to be made in the quality of end-of-life care offered.
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Li, Mian-Li, Jacqui Allen, Virginia Plummer, and Yan-Ling Dai. "Comparison of research hotspots and trends in long-term care for the elderly between China and Australia: a bibliometric analysis†." Frontiers of Nursing 9, no. 4 (December 1, 2022): 421–30. http://dx.doi.org/10.2478/fon-2022-0053.
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Abstract Objective: To explore the current status and development of long-term care (LTC) research in terms of publications in China and Australia, to identify the major contributing authors and institutions, and to compare the research hotspots and trends between China and Australia in order to encourage informed collaborations and work in future. Methods: We collected bibliometric data on the LTC of the elderly in China and Australia from 2009 to 2020 using Chinese National Knowledge Infrastructure (CNKI) and Web of Science (WOS). CiteSpace software was used to analyze co-authorships, co-institutions, and co-keywords. Results: A total of 826 articles in Chinese and 393 in English were included for analysis. The total number of publications showed an upward trend in both countries. The top 10 productive researchers and institutions in China and Australia were identified, and their collaboration network was revealed. Then, the knowledge maps of cooccurring keywords, respectively, showed the hotspots of “LTC insurance, disabled elderly, combination of medical and health care, nursing home” and “nursing home, dementia, quality of life, intervention” in China and Australia. Strong citation burst keywords illustrated the emerging trends of “combination of medical and health care, healthy aging” in China and “polypharmacy, prevention” in Australia. Conclusions: This article provided an insight into LTC of the elderly in China and Australia, and research in this field is developing rapidly and is being increasingly valued. The findings will be useful for future researchers to facilitate collaboration, identify new topics, and support urgently needed research of LTC in China.
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O'Connor, Margaret, and Janet Philips. "Challenges of implementing voluntary assisted dying in Victoria, Australia." International Journal of Palliative Nursing 26, no. 8 (December 2, 2020): 425–30. http://dx.doi.org/10.12968/ijpn.2020.26.8.425.
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Background: Staff working in community palliative care services are accustomed to the intimate conversations that a patient being at home can engender. Being at home can provide a safe space for a patient to express difficulties, including expressing a desire for hastened death. With the implementation of voluntary assisted dying in Victoria in mid-2019, palliative care services have needed to review and adapt policies and practices to incorporate this new procedure. While it was anticipated that a small percentage of people would request access to voluntary assisted dying, in the wake of such significant change, there were numerous implications for palliative care services to consider. This paper describes both the organisational and individual changes undertaken by one community-based palliative care service, in anticipation of legalised assistance in dying. The range of responses to the issues raised are discussed, in preparation for, and in the early days of, voluntary assisted dying.
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Miller, Elizabeth M., Joanne E. Porter, and Rebecca Peel. "Palliative and End-of-Life Care in the Home in Regional/Rural Victoria, Australia: The Role and Lived Experience of Primary Carers." SAGE Open Nursing 7 (January 2021): 237796082110362. http://dx.doi.org/10.1177/23779608211036284.
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Introduction Palliative support services (generalist or specialist) can provide much-needed assistance to carers who are providing palliative and end-of-life care in their homes, but access to such services in regional and rural areas of Australia is poorly understood. Objectives This study aimed to explore the role and lived experience of primary carers who are providing palliative and end-of-life care in the home in regional/rural Victoria, Australia. Methods Nine female participants, of whom six were bereaved between 7 and 20 months were interviewed using a semistructured interview technique. Each interview was audio-recorded, transcribed verbatim, and analyzed thematically. Results Two themes emerged: “ Negotiating healthcare systems” which described the needs for multidisciplinary supports and “ The caring experience” which discussed daily tasks, relationships, mental and physical exhaustion, respite, isolation, medication management, and grief and loss. Findings show that regional/rural carers have an added burden of travel stress as well as feeling overwhelmed, isolated, and physically and emotionally exhausted. Carers would benefit from greater flexibility for short-term respite care. The engagement of specialist palliative care services assisted the participants to navigate the health care system. Some participants did not understand the value of palliative care, highlighting the need for general practitioners to conduct early conversations about this with their patients. Education is needed to build capacity within the primary palliative care workforce, confirming the importance of timely referrals to a specialist palliative care practitioner if pain or symptom control is not effectively managed. Conclusion Providing palliative and end-of-life care in the home is an exhausting and emotionally draining role for unpaid, primary carers. Multiple supports are needed to sustain primary carers, as they play an essential role in the primary health care system.
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Hunt, Roger W., Katina D’Onise, Anh-Minh Thi Nguyen, and Kamalesh Venugopal. "Where Patients With Cancer Die: A Population-Based Study, 1990 to 2012." Journal of Palliative Care 34, no. 4 (November 28, 2018): 224–31. http://dx.doi.org/10.1177/0825859718814813.
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Aims:To describe changes in the place of death of patients with cancer from 1990 to 2012, and to identify issues for their end-of-life care.Materials and Methods:Population-based descriptive study, with analyses of place of death patterns, using the South Australian Cancer Registry records of 86 257 patients with cancer who died from 1990 to 2012.Results:From 1990 to 2012, the proportion of cancer deaths in hospital decreased from 63.4% to 50.9%, and in nursing homes increased from 8.2% to 22.5%. After the year 2000, the proportions in hospices and at home were both below 15%. Multivariate analyses showed that young patients with cancer were more likely to die in a hospice or at home, compared to elderly patients with cancer who were more likely to die in a nursing home; the likelihood of dying in a hospice increased with socioeconomic status; patients with a short survival time or a hematological malignancy were more likely to die in a metropolitan hospital.Conclusions:Compared to most other countries, the proportion of cancer deaths at home was low, and many patients would not have died at their preferred place. The trend for more cancer deaths to occur in nursing homes is likely to continue, but nursing homes generally lack the resources and skilled staff to provide quality palliative care. Models of palliative care delivery should take account of patient preferences, the growth of terminal cancer care in nursing homes, and apparent inequities.
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McSweeney, K., and D. W. O'Connor. "Depression among newly admitted Australian nursing home residents." International Psychogeriatrics 20, no. 4 (August 2008): 724–37. http://dx.doi.org/10.1017/s104161020800700x.
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ABSTRACTBackground: This research concerns the prevalence and course of depression in newly admitted nursing home residents. We attempted to recruit consecutive admissions into the study, irrespective of cognitive status, enabling a comparison of the prevalence and course of depression experienced by cognitively intact residents and those exhibiting all levels of cognitive impairment.Method: Depression was assessed at one month, three months and six months post-admission. The assessment of mood in this study entailed the conduct of a semi-structured clinical interview, which encompassed DSM-IV criteria and Cornell Scale for Depression in Dementia (CSDD) items.Results: Recruitment difficulties resulted in a sample of 51 newly admitted residents, drawn from six nursing homes located in Victoria, Australia. Of particular interest, throughout the duration of the study, only the cognitively impaired were diagnosed with major depression (MD). One month post-admission, 24% of the sample were diagnosed with MD, and a further 20% evidenced a non-major depressive disorder. At the second and third assessments, MD was observed in 14% and 15% of residents, respectively. For residents who completed all three assessments, there was no appreciable change in the proportion diagnosed with a depressive disorder, nor was there a change in the levels of depressive symptomatology.Conclusion: Although subject to limitations, the current study indicated that clinical depression in nursing home facilities most often occurs in residents who also exhibit pronounced cognitive impairment. These depressions are unlikely to remit spontaneously. Accordingly, care staff and general practitioners must be trained in the identification of depression in dementia, and any interventions implemented in these facilities should be tailored to meet the unique needs of this group.
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Bugeja, Lyndal, Marta H. Woolford, Melissa Willoughby, David Ranson, and Joseph E. Ibrahim. "Frequency and nature of coroners’ recommendations from injury-related deaths among nursing home residents: a retrospective national cross-sectional study." Injury Prevention 24, no. 6 (September 22, 2017): 418–23. http://dx.doi.org/10.1136/injuryprev-2017-042370.
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BackgroundCoroners are tasked with the investigation of unnatural and unexpected deaths. In Australia, the coroner’s role also includes making recommendations for promoting interventions to improve public safety. However, the coroners’ role in public health and safety in the aged care setting is an underexplored area of research.ObjectivesTo describe the frequency and nature of coroners’ recommendations for prevention of harm from injury-related deaths among nursing home residents in Australia.SettingAccredited nursing homes in Australia.SubjectsNursing home residents whose deaths resulted from external causes occurring between 1 July 2000 and 31 December 2013 and notified to a coroner.MeasurementsCoroners’ recommendations were identified and extracted from the National Coronial Information System. Descriptive statistical techniques were used to calculate the frequency and proportion of recommendations made. The nature of recommendations was quantified using a method comprising seven elements derived from internationally accepted and applied public health conceptual models of mortality causation and prevention.ResultsCoroners made recommendations about the prevention of harm in 53 of the 3289 (1.6%) external cause deaths of nursing home residents. Recommendations were most frequently made for deaths resulting from falls; however, the rate of recommendations per 1000 deaths was highest for thermal mechanisms and complications of clinical care. Most recommendations described the ‘countermeasure’ element, but rarely specified a timeframe for implementation.ConclusionCoroners’ recommendations need to be further enhanced in the age care setting. The development of national and international guidelines on best practice in the formulation of effective recommendations should be undertaken.
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Baxter, Rebecca, Per-Olof Sandman, Sabine Björk, Qarin Lood, and David Edvardsson. "Illuminating Meanings of Thriving for Persons Living in Nursing Homes." Gerontologist 60, no. 5 (November 27, 2019): 859–67. http://dx.doi.org/10.1093/geront/gnz142.
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Abstract Background and Objectives Thriving has been described as a multidimensional concept that can be used to explore place-related well-being; however, there has been limited research into the meaning of thriving in aged care. This study aimed to illuminate meanings of thriving as narrated by persons living in nursing homes. Research Design and Methods Narrative interviews were conducted with 21 persons residing in a rural Australian nursing home. The interviews were audio-recorded, transcribed, and interpreted using a phenomenological hermeneutic approach. Results Meanings of thriving could be understood as: Striving toward acceptance of being in a nursing home while maintaining a positive outlook; Feeling supported and cared for while maintaining a sense of independence; Balancing opportunities for solitude and company while living with others; and, Feeling a sense of home while residing in an institutional environment. The meanings of thriving, as presented through the interpretive lens of Gaston Bachelard’s “Poetics of Space,” encompassed having access to literal, metaphorical, and symbolic doors, as well as having the freedom to open, close, and use these doors however the person wishes. Discussion Exploring meanings of thriving in nursing homes could contribute towards understanding and implementing positive life-world constructs in research and practice. These findings could be used to inform and enhance person-centered care practices by maximizing opportunities for persons residing in nursing homes to have options and choices, and the agency to make decisions where possible, in relation to their everyday care and living environment.
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O'Connor, Daniel W., Joanne Griffith, and Kate McSweeney. "Changes to psychotropic medications in the six months after admission to nursing homes in Melbourne, Australia." International Psychogeriatrics 22, no. 7 (March 4, 2010): 1149–53. http://dx.doi.org/10.1017/s1041610210000165.
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ABSTRACTBackground: Nursing home residents are often prescribed large numbers of psychotropic medications. Previous studies suggest that antipsychotic medications are often unnecessary and can be withdrawn without ill effects. Depression, in contrast, is believed to be under-recognized and under-treated.Method: A six-month audit was carried out of the antipsychotic, antidepressant, anxiolytic and hypnotic medications prescribed to 166 newly admitted residents of a convenience sample of seven nursing homes in Melbourne, Australia.Results: Over the six-month period, antidepressants were started in 6% of all cases and stopped in 2% of treated cases. Antipsychotics were added in 5% of all cases and stopped in 15% of treated cases. Residents were switched from one antidepressant to another in 5% of treated cases and from one antipsychotic to another in 4%. Benzodiazepine use was relatively modest.Conclusions: Judging from epidemiological data, treatment revisions were almost certainly insufficient to address residents’ mental health needs. We discuss ways of harnessing existing nursing and pharmacy resources to ensure better care for aged residents.
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Braithwaite, Valerie, John Braithwaite, Diane Gibson, and Toni Makkai. "Progress in assessing the quality of Australian nursing home care." Australian Journal of Public Health 16, no. 1 (February 12, 2010): 89–97. http://dx.doi.org/10.1111/j.1753-6405.1992.tb00032.x.
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Wilkes, Lesley M., and Barbara Beale. "Palliative care at home: Stress for nurses in urban and rural New South Wales, Australia." International Journal of Nursing Practice 7, no. 5 (October 2001): 306–13. http://dx.doi.org/10.1046/j.1440-172x.2001.00267.x.
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Hansen, Emily, Andrew Robinson, Peter Mudge, and Geoff Crack. "Barriers to the provision of care for people with dementia and their carers in a rural community." Australian Journal of Primary Health 11, no. 1 (2005): 72. http://dx.doi.org/10.1071/py05010.
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This article describes results from a community initiated qualitative research project investigating barriers to the provision of care for people with dementia (PWD) and their carers. The study was conducted in a rural remote Tasmanian community ("Cape Coastal"). Focus group discussions were held with family member carers of PWD, members of the Aged Care Assessment Team (ACAT), nurses employed in the local hospital and a local nursing home, community health nurses and local general practitioners. In addition, two semi-structured interviews were conducted with a dementia support worker allocated to service the region and a single family member carer. Barriers to the effective provision of care for PWD and their carers were identified. These were: distance and isolation; perceptions of geographic and professional boundaries including issues of medical dominance; and gaps in health care provider and carers? knowledge about dementia and dementia services. These results demonstrate that while Cape Coastal has many points in common with other rural and remote communities in Australia and in Canada and the United States (Australian Institute of Health and Welfare [AIHW], 2002), it is important to recognise local context when planning and providing services for PWD and other chronic diseases.
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Stevens, Stella, and Nerina Vecchio. "Substitution across professions within the home care sector: an investigation of nursing and allied health services." Australian Health Review 33, no. 1 (2009): 19. http://dx.doi.org/10.1071/ah090019.
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Objective: The service type offered by a home care agency contracted by the Queensland government is not based on the qualifications of the worker providing the service, but the service itself. This allows agencies to substitute certain levels and categories of labour in order to provide a service to meet their contract obligations. This study investigated evidence of labour substitution between nursing and allied health services. Methods: Correlation and regression analysis was performed on the data collected from 218 clients of a branch of a community-based service agency operating nationally in Brisbane, Australia, during April, May and June 2005. Results: The results of the regression analysis revealed that when either allied health or nursing time rose by 10%, all else held constant, it was predicted that the other would fall by 4%. The subcategories, registered/enrolled nursing and physiotherapy, appeared to drive the inverse relationship between nursing and allied health service time. Registered/ enrolled nursing service time was more sensitive to changes in physiotherapy rather than the other way around. Conclusions: The higher labour turnover among allied health staff compared with the nursing staff reported by the agency implies a substitution of labour between the two professions to ensure that the needs of clients are met. Health policy makers and health care professional educators need to acknowledge that workforce shortages will inevitably reshape professional boundaries. Leaving labour-force substitution undiscussed and unplanned may compromise the quality and safety of care.
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Schmied, Virginia, Cathrine Fowler, Chris Rossiter, Caroline Homer, Sue Kruske, and The CHoRUS team. "Nature and frequency of services provided by child and family health nurses in Australia: results of a national survey." Australian Health Review 38, no. 2 (2014): 177. http://dx.doi.org/10.1071/ah13195.
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Objective Australia has a system of universal child and family health (CFH) nursing services providing primary health services from birth to school entry. Herein, we report on the findings of the first national survey of CFH nurses, including the ages and circumstances of children and families seen by CFH nurses and the nature and frequency of the services provided by these nurses across Australia. Methods A national survey of CFH nurses was conducted. Results In all, 1098 CFH nurses responded to the survey. Over 60% were engaged in delivering primary prevention services from a universal platform. Overall, 82.8% reported that their service made first contact with families within 2 weeks of birth, usually in the home (80.7%). The proportion of respondents providing regular support to families decreased as the child aged. Services were primarily health centre based, although 25% reported providing services in other locations (parks, preschools).The timing and location of first contact, the frequency of ongoing services and the composition of families seen by nurses varied across Australian jurisdictions. Nurses identified time constraints as the key barrier to the delivery of comprehensive services. Conclusions CFH nurses play an important role in supporting families across Australia. The impact of differences in the CFH nursing provision across Australia requires further investigation. What is known about the topic? Countries that offer universal well child health services demonstrate better child health and developmental outcomes than countries that do not. Australian jurisdictions offer free, universal child and family health (CFH) nursing services from birth to school entry. What does this paper add? This paper provides nation-wide data on the nature of work undertaken by CFH nurses offering universal care. Across Australia, there are differences in the timing and location of first contact, the frequency of ongoing services and the range of families seen by nurses. What are the implications for practitioners? The impact for families of the variation in CFH nursing services offered across Australia is not known. Further research is required to investigate the outcomes of the service provision variations identified in the present study.
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Shah, Ajit, Edmond Chiu, David Ames, Susan Harrigan, and Dean McKenzie. "Characteristics of Aggressive Subjects in Australian (Melbourne) Nursing Homes." International Psychogeriatrics 12, no. 2 (June 2000): 145–61. http://dx.doi.org/10.1017/s1041610200006281.
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Background: Aggressive behavior is common in nursing homes for the elderly. It causes distress to carers and can lead to hospitalization, overmedication, and physical restraint. Method: A 6-month prospective study examining the characteristics of aggressive subjects in 11 nursing homes in Melbourne using validated, reliable instruments. Results: During the study, 121 and 143 subjects were rated aggressive on the Rating Scale for Aggressive Behavior in the Elderly and the Staff Observation Aggression Scale, respectively. Aggressive behavior was associated with younger age, men, subsequent mortality, and prescription of psychotropic drugs including neuroleptics, antidepressants, and benzodiazepines. Conclusions: Educational programs in the use of psychotropic drugs directed at staff involved in the care of nursing home residents may be of value because these drugs have modest efficacy, have significant side effects, and may simply sedate the patient rather than treat aggressive behavior.
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Gill, Gerard, Kate Blackmore, Dominic P Geraghty, and Des FitzGerald. "The impact of residential socio-economic profile on medical service utilisation and nursing home attendance claims by older Australians." Australian Journal of Primary Health 10, no. 3 (2004): 137. http://dx.doi.org/10.1071/py04058.
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In other developed countries, older persons in deprived personal circumstances make increased use of primary care and nursing homes compared with those less disadvantaged. The influence of living in a more deprived area on the use of these services by older residents has not been so well studied. This study appraises if older Australians living in more disadvantaged locations have similar increased service usage. Retrospective analyses of fee-for-service data from 1 October 2001 to 30 September 2002 for all Medicare and Department of Veterans? Affairs claimants aged 77 years and over, not admitted to residential aged care, were undertaken. Data were analysed by age, gender and quartile of disadvantage of postcode of residence as categorised by the Australian Bureau of Statistics 1996 Census Index of Relative Socio-economic Disadvantage. The main outcome measures were: mean number of claims for general practitioner primary medical care (GP) services; longer GP consultations; specialist consultations; rate of GP health assessments; and, first claims for GP nursing home attendances. Mean number of claims for GP primary medical care services generally decreased as the disadvantage of postcode increased. Men aged 77-79 years were an exception, with no difference in the mean across quartiles of disadvantage. The mean number of claims for longer primary care consultations and all specialist consultations also decreased as the disadvantage of postcode increased. Claims for GP health assessments were more frequent as the disadvantage of the residential postcode increased. Claim rates for first nursing home attendance items by men did not differ across the range of disadvantage. This lack of difference was also seen for women aged 77-79 years. Claims for first nursing home attendance items by women aged 80 or more years decreased as the disadvantage of postcode increased. This study concluded that there are fewer claims for medical and nursing home services by older Australians living in more disadvantaged postcodes. Whether this represents under-provision of medical care leading to sub-optimal health outcomes needs further examination.
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Pu, Lihui, Wendy Moyle, Cindy Jones, and Michael Todorovic. "468 - Can a Robotic Seal Called PARO Manage Chronic Pain in People with Dementia Living in Nursing Homes?" International Psychogeriatrics 32, S1 (October 2020): 190. http://dx.doi.org/10.1017/s1041610220003208.
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AbstractObjective: To evaluate the effect of interaction with a robotic seal (PARO) for pain management in nursing home residents living with dementia.Methods: Registered with the Australian New Zealand Clinical Trials Registry (ACTRN 12618000082202), a pilot randomized controlled trial followed by semi-structured interviews were conducted between January 2018 and January 2019. Forty-three residents aged ?65 years living with dementia and chronic pain were recruited from three nursing homes in Australia. Participants were randomized to either a PARO group (individual, non-facilitated, 30-minute sessions, five days per week for six weeks) or a usual care group using a computer-generated random number. Observational pain behaviors were rated by researchers using the Pain Assessment in Advanced Dementia (PAINAD) scale and staff-rated pain levels were measured by the numeric rating scale. Medications regularly prescribed and as needed were quantified by the Medication Quantification Scale-III (MQS-III). Generalized estimating equation model and thematic analysis were used to analyze the data.Results: Participants in the PARO group had significantly lowered level of observed pain (-0.514, 95% confidence interval [CI] -0.774 to -0.254, p<0.001) and used fewer PRN medications (-1.175, 95% CI - 2.205 to -0.145, p=0.025) than those in usual care after controlling for age, gender, cognitive function and medications at baseline. There were no significant differences in staff-rated pain levels and regularly scheduled medications between the two groups. Interviews also indicated that the PARO intervention may reduce the pain experience through distraction and reminiscence of previous positive memories. Limitations of weight, voice and characteristics of PARO were identified.Conclusions and Implications: PARO shows promise in reducing pain and medications for nursing home residents living with dementia and chronic pain. This intervention might be incorporated into daily practice as an alternative to manage pain in people with dementia. Care staff need to balance the benefits and limitations of incorporating social robots into their clinical practice and residents’ individualized preferences need to be considered. Larger randomized controlled trials with longer time frames are warranted to further test the use of PARO in long-term care settings.
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Jones, Catherine, Jennifer Fraser, and Sue Randall. "An evaluation of training to prepare nurses in a home-based service to care for children and families." Journal of Child Health Care 24, no. 4 (October 15, 2019): 589–602. http://dx.doi.org/10.1177/1367493519881572.
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Evaluation of training was conducted for a paediatric hospital-in-the-home service in Sydney, Australia. Community nurses with no paediatric training or experience were employed and undertook a training program. The aim was to assess the degree to which the training had prepared them to care for children and families in their homes. A mixed-methods design was employed. Overall, the following aspects of the training were well received by the community nurses: paediatric resuscitation, growth and development, clinical deterioration and child protection. Each topic provided basic knowledge and skills in the speciality. The participating nurses generally reached a ‘competent’ level of practice as defined by Benner (2000). Further training and development is recommended. Where paediatric nursing practice is isolated from acute paediatrics services, opportunities must be provided to improve safe levels of practice for children of all ages.
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Fan, Lijun, Bill Lukin, Jingzhou Zhao, Jiandong Sun, Kaeleen Dingle, Rhonda Purtill, Sam Tapp, and Xiang-Yu Hou. "Cost analysis of improving emergency care for aged care residents under a Hospital in the Nursing Home program in Australia." PLOS ONE 13, no. 7 (July 3, 2018): e0199879. http://dx.doi.org/10.1371/journal.pone.0199879.
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Chapman, Michael, Nikki Johnston, Clare Lovell, Liz Forbat, and Wai-Man Liu. "Avoiding costly hospitalisation at end of life: findings from a specialist palliative care pilot in residential care for older adults." BMJ Supportive & Palliative Care 8, no. 1 (August 5, 2016): 102–9. http://dx.doi.org/10.1136/bmjspcare-2015-001071.
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ObjectivesSpecialist palliative care is not a standardised component of service delivery in nursing home care in Australia. Specialist palliative care services can increase rates of advance care planning, decrease hospital admissions and improve symptom management in such facilities. New approaches are required to support nursing home residents in avoiding unnecessary hospitalisation and improving rates of dying in documented preferred place of death. This study examined whether the addition of a proactive model of specialist palliative care reduced resident transfer to the acute care setting, and achieved a reduction in hospital deaths.MethodsA quasi-experimental design was adopted, with participants at 4 residential care facilities. The intervention involved a palliative care nurse practitioner leading ‘Palliative Care Needs Rounds’ to support clinical decision-making, education and training. Participants were matched with historical decedents using propensity scores based on age, sex, primary diagnosis, comorbidities and the Aged Care Funding Instrument rating. Outcome measures included participants’ hospitalisation in the past 3 months of life and the location of death.ResultsThe data demonstrate that the intervention is associated with a substantial reduction in the length of hospital stays and a lower incidence of death in the acute care setting. While rates of hospitalisation were unchanged on average, length of admission was reduced by an average of 3.22 days (p<0.01 and 95% CI −5.05 to −1.41), a 67% decrease in admitted days.ConclusionsThe findings have significant implications for promoting quality outcomes through models of palliative care service delivery in residential facilities.
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Cohen, Lynne, Moira O’Connor, and Amanda Marie Blackmore. "Nurses’ attitudes to palliative care in nursing homes in Western Australia." International Journal of Palliative Nursing 8, no. 2 (February 2002): 88–98. http://dx.doi.org/10.12968/ijpn.2002.8.2.10244.
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Laparidou, Despina, Ffion Curtis, Withanage Iresha Udayangani Jayawickrama, Dedunu Weligamage, Marishona Ortega, and Aloysius Niroshan Siriwardena. "EP13 Perceptions and experiences of residents and relatives of emergencies in care homes: systematic review and meta-synthesis." Emergency Medicine Journal 38, no. 9 (August 19, 2021): A6.2—A6. http://dx.doi.org/10.1136/emermed-2021-999.13.
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BackgroundMedical emergencies in care homes, both residential and nursing care homes, are common and costly, often resulting in calls to an out-of-hours general practitioner (GP) or Emergency Medical Services (EMS). Ambulance attendance frequently results in conveyance to hospital and the concomitant high costs and risks of, often prolonged, hospitalisation. Previous reviews have focussed on various stakeholder perceptions of transfer to hospital. The aim of this systematic review was to provide a comprehensive synthesis of the perceptions and experiences of care home residents and their family members, who have experienced medical emergencies in a care home setting.MethodsWe searched five electronic databases, supplemented with internet searches and forward and backward citation tracking from the included studies and review articles. Data were synthesised thematically following the Thomas and Harden approach. The CASP Qualitative Checklist was used to assess the quality of the included studies of this review.ResultsThe search strategy identified 6,140 citations. After removing duplicates and excluding citations based on title and abstract, and full-text screening, ten studies from four countries (Australia, Canada, UK, and US) were included in the review and meta-synthesis. All included studies were considered of acceptable quality. Through an iterative approach, we developed six analytical themes. 1. Infrastructure and process requirements in care homes to prevent and address emergencies; 2. The decision to transfer to hospital – a perfect storm; 3. Challenges of transfer and hospitalisation for older patients; 4. Good communication vital for desirable outcomes; 5. Legal, regulatory and ethical concerns; and 6. Trusting relationships enabled residents to feel safe.ConclusionsThe emergency care experience for care home residents can be enhanced by ensuring resources, staff capacity and processes for high quality care. Building trusting relationships underpinned by good communication and attention to ethical practice were also identified as important factors.
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Llewellyn-Jones, Robert H., Karen A. Baikie, Sally Castell, Carol L. Andrews, Anne Baikie, C. Dimity Pond, Simon M. Willcock, John Snowdon, and Chris C. Tennant. "How to Help Depressed Older People Living in Residential Care: A Multifaceted Shared-Care Intervention for Late-Life Depression." International Psychogeriatrics 13, no. 4 (December 2001): 477–92. http://dx.doi.org/10.1017/s104161020100789x.
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Objective: To describe a population-based, multifaceted shared-care intervention for late-life depression in residential care as a new model of geriatric practice, to outline its development and implementation, and to describe the lessons learned during the implementation process. Setting: A large continuing-care retirement community in Sydney, Australia, providing three levels of care (independent living units, assisted-living complexes, and nursing homes). Participants:) The intervention was implemented for the entire non-nursing home population (residents in independent and assisted living: N = 1,466) of the facility and their health care providers. Of the 1,036 residents who were eligible and agreed to be interviewed, 281 (27.1%) were classified as depressed according to the Geriatric Depression Scale. Intervention Description: The intervention included: (a) multidisciplinary collaboration between primary care physicians, facility health care providers, and the local psychogeriatric service; (b) trainning for primary care physicians and other facility health care providers about detecting and managing depression; and (c) depression-related health education/promotion programs for residents. Conclusions: The intervention was widely accepted by residents and their health care providers, and was sustained and enhanced by the facility after the completion of the study. It is possible to implement and sustain a multifaceted shared-care intervention for late-life depression in a residential care facility where local psychogeriatric services are scarce, staff-to-resident ratios are low, and the needs of depressed to residents are substantial.
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Donovan, Leigh A., Penelope J. Slater, Angela M. Delaney, Sarah J. Baggio, and Anthony R. Herbert. "Building capability in paediatric palliative care and enhancing education through the voice of parents: the Quality of Care Collaborative Australia." Palliative Care and Social Practice 16 (January 2022): 263235242211288. http://dx.doi.org/10.1177/26323524221128835.
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Background: The greater proportion of children with a life-limiting condition (LLC) and their families want to remain at home as much as possible. Building capability in paediatric palliative care (PPC) for generalist health and social care professionals in nonmetropolitan regions through the Quality of Care Collaborative Australia (QuoCCA) has improved access to palliative care for families, regardless of where they live. Aim: To understand the experience of families whose child has received specialist PPC, to ensure future service capability development is informed by lived experience. Design: A retrospective, descriptive study in which parents participated in a semi-structured telephone interview guided by Discovery Interview methodology. Inductive thematic analysis identified the major learnings from participants. Participants: Parents caring for a child referred to the specialist PPC service, who received a pop-up visit and whose child is stable or who are more than 6 months bereaved. Results: Eleven parents ( n = 9 mothers; n = 2 fathers) of children with an LLC ( n = 5) or whose child had died ( n = 6) participated in an interview. The overarching themes and subthemes were as follows: (1) burden of suffering, in which parents described grieving for the life once anticipated, confronting many life transitions and seeking quality of life for their child and (2) umbrella of support, in which parents built partnerships with professional support, activated a network of care around their family and sought responses to their whole family’s needs. Conclusion: Parents caring for a child with an LLC described significant personal, familial, social and existential adjustments. This study integrates a relational learning approach with QuoCCA education grounded in the relationships between children, families and professionals. Learning from lived experience in PPC education enhances the preparedness of generalist health and social care professionals to join a child and their family throughout their various life transitions and facilitates the goal to remain at home within their community for as long as possible. Education in PPC is an imperative component of service models, enabling regional services to gain confidence and capability in the context of a dying child and their family, empowered and informed through the voice of the family. Plain Language Summary Enhancing palliative care for children through education informed by the experience of families It is often the wish of many children/young people with a life-limiting condition to stay at home with their families as much as possible. It is important that specialist palliative care services provide training and mentoring to the family’s local care professionals to support the delivery of good care, particularly those in rural and remote areas. This article aims to integrate the lived experience of families with palliative care education, so that the education reflects and addresses the needs that they express. Parents were interviewed by telephone using a method called Discovery Interviews. This is an open interview process, guided by a spine that describes the main points of palliative care. Parents can openly talk about their experience, focusing on the areas that are important to them. Interviews were studied by four researchers, and emerging themes were discussed and summarised. The study included parents whose child/young person was receiving support from specialist palliative care and bereaved parents whose child had died more than 6 months ago. In total, eleven parents (nine mothers and two fathers) were interviewed, five participants had children currently receiving palliative care and six were bereaved. The overarching themes were as follows: Burden of suffering, in which parents described grieving for the life they had expected, confronting transitions and seeking good quality of life for their child. Umbrella of support, in which parents built partnerships with care teams and activated a network of care to address the needs of their whole family. This study allowed the families’ perspectives to be integrated into the palliative care education of care professionals in the family’s local area. The lived experience of families prepared care professionals to support families with the care of their child/young person, allowing them to remain at home as long as possible.
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Courtney, Mary, Maria T. O'Reilly, Helen Edwards, and Stacey Hassall. "Benchmarking clinical indicators of quality for Australian residential aged care facilities." Australian Health Review 34, no. 1 (2010): 93. http://dx.doi.org/10.1071/ah09663.
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To undertake exploratory benchmarking of a set of clinical indicators of quality care in residential care in Australia, data were collected from 107 residents within four medium-sized facilities (40–80 beds) in Brisbane, Australia. The proportion of residents in each sample facility with a particular clinical problem was compared with US Minimum Data Set quality indicator thresholds. Results demonstrated variability within and between clinical indicators, suggesting breadth of assessment using various clinical indicators of quality is an important factor when monitoring quality of care. More comprehensive and objective measures of quality of care would be of great assistance in determining and monitoring the effectiveness of residential aged care provision in Australia, particularly as demands for accountability by consumers and their families increase. What is known about the topic?The key to quality improvement is effective quality assessment, and one means of evaluating quality of care is through clinical outcomes. The Minimum Data Set quality indicators have been credited with improving quality in United States nursing homes. What does this paper add?The Clinical Care Indicators Tool was used to collect data on clinical outcomes, enabling comparison of data from a small Australian sample with American quality benchmarks to illustrate the utility of providing guidelines for interpretation. What are the implications for practitioners?Collecting and comparing clinical outcome data would enable practitioners to better understand the quality of care being provided and whether practices required review. The Clinical Care Indicator Tool could provide a comprehensive and systematic means of doing this, thus filling a gap in quality monitoring within Australian residential aged care.
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Wong, Aaron Kee Yee. "The extended care unit: A feasible economic solution for longer-term palliative inpatients." Journal of Clinical Oncology 34, no. 26_suppl (October 9, 2016): 143. http://dx.doi.org/10.1200/jco.2016.34.26_suppl.143.
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143 Background: Many inpatient palliative care units (PCUs) in Australia require patients who cannot go home, but remain stable after 2 weeks, to be discharged to nursing homes (NHs). This involves moving between 5 locations (home, acute hospital, PCU, NH transition bed, NH), in the final weeks of life. We propose an “Extended Care Unit” (ECU) to avoid unnecessary moves for such patients. This study aimed to investigate the feasibility of the proposed ECU, including identifying demand, admission criteria, length of stay, and hospital costs. Methods: Using a retrospective, observational design, we censored all inpatients on a single day from the largest tertiary referral centre in the state. 475 files were reviewed. ECU admission criteria used were: prognosis < 90 days, unable to return home, and NH referral process commenced. Two predictive mortality scores were calculated. Total cost was calculated based on average bed cost over 12 months. ECU bed costs were based subacute aged care bed costings. Results: Fifteen (3%) patients met ECU admission criteria. 80% (n = 12) died within 90 days. 60% were transferred between ≥ 4 places. After fulfilling ECU admission criteria, a further 279 acute and PCU bed days were used. If an ECU were available, hospitals would save $207.70 per patient per bed day. Conclusions: The ECU model is a feasible economic solution for this demographic of patients whose needs are currently poorly met. We provide evidence of clear demand, with significant cost savings. Effective admission criteria to identify suitable patients for the ECU are also proposed.
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Mackenzie, Lynette A., and Julie E. Byles. "Circumstances of Falls With Fractured Femur in Residents of Australian Nursing Homes: An Analysis of Falls Reports." Journal of Aging and Health 30, no. 5 (February 5, 2017): 738–57. http://dx.doi.org/10.1177/0898264317690667.
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Objective: This study aimed to explore the circumstances and characteristics of falls with fractured femur reported in nursing homes. Method: Mixed methods were used. There were reports on 401 eligible falls from 88 residential care facilities in the Hunter region of Australia. A falls report form was developed for the study and was completed by nursing staff. Information was collected about the circumstances of falls with fractured femur and resident data. Descriptive and qualitative analyses were used. Results: Falls with fractured neck of femur were associated with being ambulant, having dementia, increasing age, and a high falls risk assessment. Themes from the falls report data were resident-related factors, organizational or environmental issues, and activities at the time of the fall. Discussion: Falls in residential care settings are very complex and difficult to prevent. Attention should be given to the needs of recently admitted residents and management of the facility environment.
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van Weel, Joel M., Emma Renehan, Kaye E. Ervin, and Joanne Enticott. "Home care service utilisation by people with dementia—A retrospective cohort study of community nursing data in Australia." Health & Social Care in the Community 27, no. 3 (November 13, 2018): 665–75. http://dx.doi.org/10.1111/hsc.12683.
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Horne, Maria, Jane Youell, Laura J. E. Brown, Paul Simpson, Tommy Dickinson, and Christine Brown-Wilson. "A scoping review of education and training resources supporting care home staff in facilitating residents’ sexuality, intimacy and relational needs." Age and Ageing 50, no. 3 (March 3, 2021): 758–71. http://dx.doi.org/10.1093/ageing/afab022.
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Abstract Background Having positive intimate, sexual and relational experiences is an important issue for older adults in care settings, yet little is known on the extent to which nursing staff and care workers have received education or training in addressing and meeting these needs among older residents. This scoping review aimed to identify and examine what education and training resources exist to assist nursing staff and care workers to meet their residents’ needs in this area. Methods and analysis Using the Arksey and O’Malley framework, we systematically searched papers and grey literature to identify education interventions and resources that aimed to facilitate care home staff to meet their residents’ sexuality, intimacy and relational needs. Results Eleven studies (one dissertation) and three education resources met the inclusion criteria; most were conducted in the USA and Australia. Across the studies and resources identified, the education content was mixed and the methodology, presentation, design and duration varied widely. The focus of the education interventions and resources was to increase knowledge and improve and/or change attitudes towards the: (i) sexual expression of older people living in residential aged care, (ii) sexuality and ageing and (iii) expression of sexuality in people with dementia. Conclusion Few education interventions and training resources were identified. The findings suggest that education interventions can improve knowledge and/or change care staff attitudes, in the short-term, towards older people’s sexuality, intimacy and relational needs in care home settings, which can lead to facilitating staff to enhance person-centred care in this area of need.
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Ramanan, Mahesh, Aashish Kumar, Chris Anstey, and Kiran Shekar. "Non-home discharge after cardiac surgery in Australia and New Zealand: a cross-sectional study." BMJ Open 11, no. 12 (December 2021): e049187. http://dx.doi.org/10.1136/bmjopen-2021-049187.
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ObjectiveTo determine the proportion of patients surviving their cardiac surgery who experienced non-home discharge (NHD) over a 16-year period in Australia and New Zealand (ANZ).DesignRetrospective, multicentre, cross-sectional study over the time period 01 January 2004 to 31 December 2019.SettingAdult patients who underwent cardiac surgery from the Australia New Zealand Intensive Care Society Adult Patient Database (APD).ParticipantsAdult patients (age 18 and above) who underwent index coronary artery bypass grafting, cardiac valve surgery or combined valve/coronary surgery.ExposureThe primary exposure variable was the calendar year during the which the index surgery was performed.OutcomeThe primary outcome was NHD after the index surgery. NHD included discharge to locations such as nursing home, chronic care facility, rehabilitation and palliative care.ResultsWe analysed 252 924 index cardiac surgical admissions from 101 discrete sites with a median age of 68 years (IQR 60–76), of which 74.2% (187 662 out of 252 920) were males. Of these, 4302 (1.7%) patients died in hospital and 213 011 (84.2%) were discharged home, 18 010 (7.1%) were transferred to another hospital and 17 601 (7%) experienced NHD. In Australia, 14 457 (6.4%) of patients progressed to NHD, compared with 3144 (11.7%) in New Zealand. The rate of NHD increased significantly over time (adjusted OR per year=1.06, 95% CI, 1.06 to 1.07, p<0.001). Increasing age, female sex, non-elective surgery, surgery type and Acute Physiology and Chronic Health Evaluation III Score were all associated with significant increase in NHD.ConclusionsThere was significant increase in NHD after cardiac surgery over time in ANZ. This has significant clinical relevance for informed consent discussions between healthcare providers and patients, and for healthcare services planning.
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Boakes, Jolee, Deborah Gardner, Kevin Yuen, and Susan Doyle. "General Practitioner Training in Palliative Care: An Experiential Approach." Journal of Palliative Care 16, no. 2 (June 2000): 11–19. http://dx.doi.org/10.1177/082585970001600203.
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With the rising incidence of cancer and with more terminally ill patients wishing to be cared for at home, it is clear that there is a growing need for general practitioners (GPs) who are skilled in providing palliative care. In an attempt to improve the palliative care knowledge and skills of GPs in Western Australia and the quality of care they provide, a 14-week training program was developed by the Silver Chain Nursing Association and the Perth South Eastern Division of General Practice. The program used experiential learning techniques, such as a clinical attachment and mentoring. Research has shown that performance-based rather than cognitive education methods have a greater impact on practice outcomes. The program was evaluated by an external body and found to have achieved its objectives. The results of the evaluation are discussed, together with their implications for postgraduate education.
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Crotty, Maria, Julie Halbert, Lynne C. Giles, Robert Birks, Kylie Lange, and Craig H. Whitehead. "Using the Nursing Home Behaviour Problem Scale in an Australian residential care setting." Australasian Journal on Ageing 23, no. 3 (September 2004): 150–55. http://dx.doi.org/10.1111/j.1741-6612.2004.00038.x.
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O'Connor, Margaret, Stacey Palfreyman, and Felice Borghmans. "Reflections on establishing a nurse practitioner role across acute hospital and home-based palliative care settings in Australia." International Journal of Palliative Nursing 24, no. 9 (September 2, 2018): 436–42. http://dx.doi.org/10.12968/ijpn.2018.24.9.436.
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Crock, Elizabeth, and Judy-Ann Butwilowsky. "The HIV Resource Nurse Role at the Royal District Nursing Service (Melbourne): Making A Difference for People Living with HIV/AIDS in the Community." Australian Journal of Primary Health 12, no. 2 (2006): 83. http://dx.doi.org/10.1071/py06026.
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The care of people living with HIV/AIDS in the home and community can be complex and challenging, requiring high levels of knowledge, skill, preparedness and, importantly, the ability to engage with people belonging to marginalised groups. In 2003, the Royal District Nursing Service (RDNS) HIV/AIDS Team in Victoria, Australia, developed the new role of HIV Resource Nurse at two RDNS centres in Melbourne serving high numbers of people living with HIV/AIDS. Drawing from two case studies and interviews with two HIV Resource Nurses from one of the centres, this paper describes this practice innovation. Benefits (including a positive impact on client engagement with services, client care, relationships with other health care workers and job satisfaction) are outlined, along with challenges in the implementation and evolution of the role. Strategies to sustain and develop the HIV Resource Nurse role are proposed.
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Braithwaite, J. "Regulating nursing homes: The challenge of regulating care for older people in Australia." BMJ 323, no. 7310 (August 25, 2001): 443–46. http://dx.doi.org/10.1136/bmj.323.7310.443.
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Elliott, Rohan A., Cik Yin Lee, Christine Beanland, Dianne P. Goeman, Neil Petrie, Barbara Petrie, Felicity Vise, and June Gray. "Development of a clinical pharmacy model within an Australian home nursing service using co-creation and participatory action research: theVisitingPharmacist (ViP) study." BMJ Open 7, no. 11 (November 2017): e018722. http://dx.doi.org/10.1136/bmjopen-2017-018722.
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ObjectiveTo develop a collaborative, person-centred model of clinical pharmacy support for community nurses and their medication management clients.DesignCo-creation and participatory action research, based on reflection, data collection, interaction and feedback from participants and other stakeholders.SettingA large, non-profit home nursing service in Melbourne, Australia.ParticipantsOlder people referred to the home nursing service for medication management, their carers, community nurses, general practitioners (GPs) and pharmacists, a multidisciplinary stakeholder reference group (including consumer representation) and the project team.Data collection and analysisFeedback and reflections from minutes, notes and transcripts from: project team meetings, clinical pharmacists’ reflective diaries and interviews, meetings with community nurses, reference group meetings and interviews and focus groups with 27 older people, 18 carers, 53 nurses, 15 GPs and seven community pharmacists.ResultsThe model was based on best practice medication management standards and designed to address key medication management issues raised by stakeholders. Pharmacist roles included direct client care and indirect care. Direct care included home visits, medication reconciliation, medication review, medication regimen simplification, preparation of medication lists for clients and nurses, liaison and information sharing with prescribers and pharmacies and patient/carer education. Indirect care included providing medicines information and education for nurses and assisting with review and implementation of organisational medication policies and procedures. The model allowed nurses to refer directly to the pharmacist, enabling timely resolution of medication issues. Direct care was provided to 84 older people over a 15-month implementation period. Ongoing feedback and consultation, in line with participatory action research principles, informed the development and refinement of the model and identification of enablers and challenges.ConclusionsA collaborative, person-centred clinical pharmacy model that addressed the needs of clients, carers, nurses and other stakeholders was successfully developed. The model is likely to have applicability to home nursing services nationally and internationally.
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Harvey, Peter W. "The Australian Royal Commission into the Aged Care Industry 2019." Journal of Aging Research and Healthcare 2, no. 4 (January 30, 2019): 1–6. http://dx.doi.org/10.14302/issn.2474-7785.jarh-19-2608.
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In the light of various complaints about the quality of care provided by and operation of aged care facilities across Australia, the Commonwealth Government has announced a Royal Commission into the activities of the sector. As the proportion of Australians over 65 continues to grow with the ageing of the ‘Baby Boomer’ generation, more Australians are seeking secure aged care arrangements to meet their increasingly complex living and healthcare needs. We hear much comment today about the concept of healthy ageing and the importance of older people staying connected to and active in their communities. Not only does this ongoing connectivity support better lifestyles and health status, it provides an avenue for older people to contribute to the support of others once their more formal working lives are concluded. Unfortunately, the gap between the rhetoric and the reality of ageing in Australia is strained and it appears that much about the operations of the aged care sector today is less than satisfactory. While some well-funded retirees can afford comfortable and fulfilling living arrangements, many others are left in less ideal circumstances. With aged care organisations currently building the next generation of ‘hotel’ style living arrangements for cashed up self-funded retirees, others are being left behind financially and in terms of the quality of their care. At the same time, maltreatment and abuse of residents is coming to light, as in the ‘Oakden Nursing Home’ situation in South Australia, for example. Consequently, the Federal Government has now launched a formal inquiry into the activities of organisations running aged care facilities in Australia. The inquiry is designed to assess the operation of this industry with a focus on the economics of aged care centres, the quality of care, the food and recreational activities provided and the challenge of staffing these facilities to keep residents safe and well as they age in dignity.
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Poulos, Roslyn, Roderick Macleod, Damian Harkin, Andrew Cole, and Christopher Poulos. "A10-C A Palliative Care Home Support Program in New South Wales (NSW), Australia – Design and Evaluation." Journal of Pain and Symptom Management 52, no. 6 (December 2016): e12. http://dx.doi.org/10.1016/j.jpainsymman.2016.10.017.
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Davison, Tanya E., Marita P. McCabe, Lucy Busija, and Annette Graham. "329 - A psychological needs-based intervention to reduce depression in newly admitted nursing home residents." International Psychogeriatrics 32, S1 (October 2020): 88. http://dx.doi.org/10.1017/s104161022000229x.
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Background:Depression is common in nursing homes, with newly admitted residents at a particularly high risk. Current prevention and treatment approaches have failed to impact on the high rates of depression and new approaches are required. We have developed a novel intervention that addresses individual psychological needs in newly admitted residents, which is implemented in collaboration with residents and facility staff. The Program to Enhance Adjustment to Residential Living (PEARL) is a 5-session intervention based on Self-Determination Theory that aims to tailor care to enhance residents’ autonomy, competence and relations.Methods:A cluster randomised controlled trial was conducted to determine the effectiveness of PEARL in reducing depression in newly admitted nursing home residents, compared to a treatment as usual control condition. A total of 216 residents with normal cognition or mild-moderate cognitive impairment, living in 42 nursing homes in Melbourne, Australia, participated in the study. The sample included 76 men and 140 women, aged 62-99 years (M = 85.5, SD = 7.3). The primary outcome was level of depressive symptoms, assessed using the Cornell Scale for Depression in Dementia at baseline and at 8, 16 (primary endpoint), and 31 weeks follow-up. Multi-level modelling, accounting for within-facility clustering and repeated assessments, was used to determine the effectiveness of the intervention, employing an intention-to-treat approach.Results:At 16-weeks, fewer symptoms of depression were observed among those in the intervention group (M = 7.0, SD = 5.6) than in the control group (M = 8.6, SD = 6.5). Multi-level modelling of unadjusted data showed a significant condition (intervention, control) by time (T1, T2, T3) interaction (p = .021), indicating that the PEARL intervention led to a reduction in the occurrence of depressive symptoms. The treatment effect was maintained at 31 weeks follow-up (p = .004).Discussion:This study provides evidence that an intervention designed to address newly admitted residents’ individual psychological needs reduced symptoms of depression in subsequent months. This brief, simple intervention may be suitable for broad implementation across long-term care settings. However, future research to determine if the intervention can be implemented by trained facility staff in situ is warranted.
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Padiglione, Alexander A., Elizabeth Grabsch, Rory Wolfe, Kimberly Gibson, and M. Lindsay Grayson. "The Prevalence of Fecal Colonization With VRE Among Residents of Long-Term–Care Facilities in Melbourne, Australia." Infection Control & Hospital Epidemiology 22, no. 9 (September 2001): 576–78. http://dx.doi.org/10.1086/501955.
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AbstractA point-prevalence survey performed among residents of eight nursing homes in Melbourne, Australia, found a rate of fecal VRE colonization of 3.1% (9/292; 95% confidence interval, 1.1-5.1), allvanBEnterococcusfaecium.This is a higher rate than in the general community (3.1% vs 0.2%). Many residents (16%) had been inpatients in acute-care hospitals in the previous 3 months.