'For me, it didn't seem as drastic a step as being controlled by insulin': A qualitative investigation of expectations and experiences of non-insulin injectable therapy among adults with type 2 diabetes.

AIMS: This qualitative study aims to explore beliefs, attitudes and experiences of injectable glucagon-like-peptide-1 receptor agonists (GLP-1RAs) use and discontinuation, as well as attitudes to further injectable treatment intensification, among adults with type 2 diabetes (T2D). METHODS: Nineteen in-depth semi-structured interviews lasting (mean ± standard deviation) 45 ± 18 min were conducted, face-to-face (n = 14) or via telephone (n = 5). Transcripts were analysed using inductive template analyses. Eligible participants were English-speaking adults with T2D who had recently initiated (≤3 years) GLP-1RA treatment. RESULTS: Participants were aged 28-72 years, who predominantly lived in metropolitan areas (n = 15), and had an experience of daily (n = 11) and/or once-weekly (n = 13) GLP-1RA formulations. Six participants had discontinued treatment and seven had trialled two or more formulations. Expectations and experiences of GLP-1RA were related to the perceived: (1) symbolism and stigma of injectable diabetes treatment; (2) ease of injectable administration and device preferences; (3) treatment convenience and social impact; (4) treatment efficacy and benefits, and; (5) negative treatment side effects. Some participants reported increased receptiveness to insulin therapy following their GLP-1RA experience, others emphasised unique concerns about insulin beyond injectable administration. CONCLUSIONS: This study provides a novel understanding of expectations and experience of non-insulin injectables among Australian adults with T2D. Our data suggest expectations may be informed by attitudes to insulin therapy, while perceived treatment benefits (e.g. weight-related benefits, administration frequency) may motivate uptake and ongoing use despite concerns. Experience of GLP-1RA injections may impact receptiveness to future insulin use.

What Injured Workers With Complex Claims Look For in Online Communities: Netnographic Analysis.

BACKGROUND: Improved understanding of social constructs around injury may help insurance case managers to understand how best to support people after injury. OBJECTIVE: This study sought to explore what people who sustain work-related injuries may seek from online communities. The study highlights potential opportunities for improved engagement with insurance case management practice. METHODS: An observational netnographic analysis was undertaken on anonymous, publicly available messages posted on Australian message boards. All research data were drawn from anonymous, online communities. A person (author SM) with experience of making a claim through an Australian workers' compensation system and online engagement was involved in study conception, design, and analysis. Data were analyzed using NVivo12 in an iterative, multistage process including coding, journaling, and member checking. A total of 141 people were engaged in discussion across 47 threads housed on 4 Australian forums. RESULTS: In this qualitative study, themes emerged from the data, describing how injured workers use online communities to help make decisions, get support, and solve problems. The key motivators for action and engagement were seeking information, connection, or justice. Establishment of relationships was a key mediator of each of these parameters. CONCLUSIONS: Some work-related injuries may involve medical and medicolegal complexity as well as changed lifestyle and routine during convalescence and recovery. The mechanism used by some injured workers to seek information and problem solve suggests a capacity for self-management and self-care after work-related injury. Netnography provides information on a community that may not regularly engage with research because of the complexity of their situation and their vulnerability.

Patient perspectives and experiences of sexual health conversations and cardiovascular disease: A qualitative study.

AIM: This study aimed to explore the experiences of individuals discussing sexual well-being with healthcare professions within the context of their cardiac illness to determine their sexual health information needs. BACKGROUND: Cardiovascular disease is the leading cause of morbidity and mortality worldwide and known to have a detrimental impact on sexual health. Despite sexual health being recognised as a fundamental component of well-being, it may be a neglected aspect of care within the context of cardiovascular disease. DESIGN: A qualitative exploratory study conducted in accordance with COREQ guidelines. METHODS: We conducted semi-structured interviews with participants (n = 13) aged between 30-77 years who had been diagnosed with a cardiovascular disease. Data were transcribed and subject to thematic analysis. RESULTS/FINDINGS: Analysis revealed two major themes-Sexual healthcare information and expectations: I expect them to tell me and Experiences of sexual adversity: it's really scary. Although participants expected and welcomed information in relation to their illness and sexual health, this was rarely received. Subsequently, when some participants experienced sexual adversity including erectile dysfunction, they felt anxious and distressed which impacted their intimated relationships. It was often when participants sought information associated with adversity that information was provided and this was primarily in relation to medication associated with assisting dysfunction. CONCLUSION: Individuals who have cardiovascular disease may require sexual health care. Nurses are well placed to provide information and education associated with cardiovascular disease and associated sexual well-being to promote positive outcomes for individuals and minimise distress around sexual adversity. RELEVANCE TO CLINICAL PRACTICE: Findings highlight the importance of providing clear and accurate information about sexual well-being and function to patients experiencing cardiovascular disease. Provision of information should be considered an essential and routine aspect of care with patients being afforded opportunities to discuss concerns associated with their sexual well-being.

Indigenous Australian perspectives on incorporating the social determinants of health into the clinical management of type 2 diabetes.

INTRODUCTION: Type 2 diabetes mellitus and social disadvantage are related. In Australia, this association is most pronounced among Indigenous Australians (Aboriginal and Torres Strait Islander peoples). Indigenous Australians are among the most socially disadvantaged in the country, having the worst social determinants of health (SDoH). SDoH are typically addressed at a population level, and not on an individual or a clinical level. However, the SDoH-related needs of individuals also require attention. The adverse link between type 2 diabetes and SDoH suggests that simultaneous consideration at an individual, clinical level may be beneficial for type 2 diabetes care and self-management. Identifying and addressing SDoH-related barriers to type 2 diabetes self-management may augment current care for Indigenous Australians. This study aimed to combine the perspectives of Indigenous Australians with type 2 diabetes and Indigenous health workers to explore the SDoH-related barriers and facilitators to self-managing type 2 diabetes, and how SDoH could be incorporated into the usual clinical care for Indigenous Australians with type 2 diabetes. METHODS: Under the guidance of a cultural advisor and Indigenous health workers, seven Indigenous Australians with type 2 diabetes and seven Indigenous health workers from rural and remote north Queensland, Australia, participated in a series of semi-structured, in-depth face-to-face interviews and yarning circles. A clinical yarning approach to data collection was used, and both an inductive and a deductive data analysis were applied. Data were analysed, and themes were identified using NVivo v12. RESULTS: Study participants described a holistic view of health that innately includes SDoH. Specific to type 2 diabetes care, participants identified that culturally responsive service delivery, suitable transport provision, an infinite flexible approach to accommodate for individuals' unique social circumstances, appropriate client education and appropriate cultural education for health professionals, support mechanisms and community support services were all essential components. These were not seen as separate entities, but as interrelated, and all were required in order to incorporate SDoH into care for Indigenous Australians with type 2 diabetes. CONCLUSION: SDoH are implicit to the Indigenous Australian holistic view of health. Consequently, an approach to type 2 diabetes care that complements this view by simultaneously considering SDoH and usual type 2 diabetes clinical management could lead to enhanced type 2 diabetes care and self-management for Indigenous Australians.

Prevalence of Frailty in Older Men and Women: Cross-Sectional Data from the Geelong Osteoporosis Study.

Few studies have investigated the prevalence of frailty in the Australian general population. This study determined the prevalence of frailty in a population-based sample of older adults and examined the relationship between frailty and comorbid conditions. Men (n = 347) and women (n = 360) aged ≥ 60 year from the Geelong Osteoporosis Study (GOS) were assessed between 2016-2019 and 2011-2014, respectively. Frailty was identified using a modified Fried frailty phenotype. Prevalence estimates were standardised to the 2011 Australian population. Kruskal-Wallis test and χ2 test were used to analyse data. For women, mean standardised prevalence estimates were 18.3% (14.1-22.5) for frail, 54.1% (47.3-60.8) pre-frail and 22.9% (18.9-26.8) robust. Corresponding estimates for men were 13.1% (9.8-16.3) frail, 47.8% (42.0-53.6) pre-frail and 27.3% (22.7-31.8) robust. Women who were frail were older, shorter, tended to have a higher body mass index (BMI) and used more medications compared to other groups. Compared to robust women, those who were frail were more likely to have cardio-metabolic (OR 3.5 (0.7-20.0)), pulmonary (OR 3.5 (1.5-8.4)) and musculoskeletal (OR 10.1 (2.1-48.0)) conditions. Frail men were older, had a higher BMI and were more likely to have musculoskeletal conditions (OR 5.8 (2.8-12.3)) and tended to be from a lower SES. No further associations were observed. This study reported the prevalence of frail and pre-frail individuals in a population-based sample of Australian men and women. Frailty was associated with musculoskeletal conditions for both men and women; however, associations with cardio-metabolic and pulmonary comorbidities were evident in women only.

The development and validation of instruments to measure dignity-protective continence care for care-dependent older people in residential aged care facilities: A study protocol.

AIMS: To develop and validate two instruments to measure dignity-protective continence care for care-dependent older people in residential aged care facilities: one instrument to be completed by care recipients and another for healthcare professionals. METHODS: The first phase of the project will involve a review of literature to identify the attributes of "dignity-protective continence care" for older people, which will be used to design the initial drafts of the instruments. Thereafter the Delphi survey technique will be used to establish the face and content validity of the draft instruments with three purposive samples; (a) care recipients (care-dependent older people with decisional capacity), (b) formal carers (nurses and personal care workers from residential aged care facilities, and (c) healthcare professionals with gerontological expertize in the management of incontinence. After instrument development, a large cross-sectional survey of care recipients and formal carers will be conducted to establish the internal consistency and construct validity of the instruments. This will be followed by a series of tests to establish their test-retest reliability. CONCLUSION: The completed research will result in two reliable and valid instruments that will support broader efforts to ensure that care practices in residential aged care facilities do not violate the dignity of care-dependent older people with continence care needs, and allow care partners and providers to act upon the results.

Palliative and End-of-Life Care: Vital Aspects of Holistic Diabetes Care of Older People With Diabetes.

Palliative and end-of-life care and advance care planning are important components of holistic diabetes management, especially for older people with a long duration of diabetes and comorbidities who experience unpleasant symptoms and remediable suffering. Many diabetes clinicians do not have conversations about advance care planning with people with diabetes, often because they are reluctant to discuss these issues and are not familiar with palliative care. This article outlines palliative, terminal, and end-of-life care for older people with type 1 or type 2 diabetes and suggests when to consider changing the focus on tight blood glucose control to a focus on safety and comfort. It proposes strategies to incorporate palliative and end-of-life care into personalized holistic diabetes care, determined with older people with diabetes and their families through shared decision-making.

Translating dignity principles into practice for continence care for older people in care homes: A study protocol.

AIM: To develop, implement, evaluate, and disseminate an evidence-based, person-centred education program to protect the dignity of care-dependent older people with dementia and continence care needs in care homes. DESIGN: A mixed method two-phase design underpinned by integrated knowledge translation. METHODS: An education program that frames dignity as the main goal of continence care will be co-designed with a purposive sample of care home staff who provide or supervise continence care for care-dependent older people with dementia in care homes and resident relatives. The program will then be implemented and evaluated in a representative sample of care home staff to determine its clinical relevance, feasibility, acceptability, and effects on staff ratings of dignity in continence care; self-reported continence care practices and the person centeredness of the environment. Data analysis will include descriptive statistics (survey data) and thematic analysis (focus groups). Funding obtained November 2018. Ethics approval obtained May 2019. DISCUSSION: This protocol outlines a mixed methods integrated knowledge translation protocol designed to translate principles about dignity into practice to improve the care of older people who are at risk of violations to their dignity in care homes. The outcome will be a contextually appropriate, evidence-based education program that protects the dignity of care-dependent older people who have dementia and continence care needs. IMPACT: Based on a sound theoretical model, the education program will be contextually appropriate for use in the care homes setting and contribute to improving the overall quality and safety of care in this setting. It could also support and inform continence care for other individuals who are care dependent. Adopting an integrated knowledge translation approach to the design and delivery of the education program and piloting it will ensure the program is contextually relevant and sustainable.

Perspectives about dignity during acute care for older people and their relatives: A qualitative study.

AIMS AND OBJECTIVES: The aim of the study was to enhance understanding about dignified care from older peoples' and their carers' perspectives. The information will contribute to the development of a tool to measure older peoples' dignity during hospitalisation. BACKGROUND: Older people are a vulnerable cohort at risk of loss of dignity during acute hospitalisation arising from environmental, behavioural and patient factors. It is not clear how older people and their relatives define dignified care in acute care settings. DESIGN: An interpretative descriptive method was used. METHODS: A purposive sample of older people (at least 65 years) who had been hospitalised in acute care and subsequently transferred to sub-acute care, and their relatives, were invited to participate. The study was undertaken in one sub-acute ward in a regional healthcare organisation in Victoria, Australia. Individual interviews were audio-recorded then transcribed. Data were analysed using thematic content analysis. The COREQ checklist was used to document reporting of the study. RESULTS: Individual interviews were conducted: 24 patients and 12 relatives. Three main themes were identified: "Involve me in decisions about my care and treatment," "Keep me safe when I am vulnerable" and "Treat me as an individual and with respect." Older people want to be involved in decisions about their care and treatment and to receive adequate, suitable information. They feel vulnerable during hospitalisation and want to feel safe when speaking up about concerns. Individual acknowledgement is an important aspect of dignity. CONCLUSIONS: Older people and their relatives identified specific elements of care that uphold or threaten dignity during acute hospitalisation. Nurses play a major role in upholding dignity for older people in hospital. RELEVANCE TO CLINICAL PRACTICE: Clinicians may benefit from systematic dignity-related training. Specific strategies to enhance older persons' dignity, including communication skills training and continence management need to be developed, implemented and evaluated.

Challenges for nurses when communicating with people who have life-limiting illness and their families: A focus group study.

AIMS AND OBJECTIVES: The proposed study aimed to answer the following question: What communication issues do nurses find challenging when caring for people with life-limiting illness? BACKGROUND: Evidence suggests that attitudes, skills and knowledge about how nurses communicate effectively with patients and their families could be improved. However, the literature predominantly focuses on nurses working in oncology and the medical profession. DESIGN: A qualitative descriptive design was used. METHODS: Focus groups were conducted with 39 nurses from three wards within a regional healthcare organisation in Victoria, Australia. Data were analysed using thematic content analysis. The COREQ checklist was used to document reporting of the study. RESULTS: In their view, nurses have the potential to develop a strong bond with patients and their families. Three key themes were identified: (a) feeling unskilled to have difficult conversations with patients who have life-limiting illness; (b) interacting with family members adds complexity to care of patients who have life-limiting illness; and (c) organisational factors impede nurses' capacity to have meaningful conversations with patients and their families. CONCLUSIONS: Caring for individuals with life-limiting illness is complex and often occurs in an emotionally charged environment. However, nurses report being hampered by time restraints and lack of information about the patient's condition and goals of care. Limitations in conversation structure and a comprehensive range of core communication skills affect their ability to confidently engage in conversations, particularly when they are responding to prognostic questions. RELEVANCE TO CLINICAL PRACTICE: Whilst nurses are responsible for performing technical skills, they can maximise care by developing a trusting relationship with patients and their relatives. Increased acuity limits the time nurses have to talk with patients. In addition, they lack confidence to deal with difficult questions. Specific training may increase nurses' confidence and efficiency when communicating with patients and their families.

Resuscitation status and characteristics and outcomes of patients transferred from subacute care to acute care hospitals: A multi-site prospective cohort study.

AIMS AND OBJECTIVES: To examine the relationship between resuscitation status and (i) patient characteristics; (ii) transfer characteristics; and (iii) patient outcomes following an emergency inter-hospital transfer from a subacute to an acute care hospital. BACKGROUND: Patients who experience emergency inter-hospital transfers from subacute to acute care hospitals have high rates of acute care readmission (81%) and in-hospital mortality (15%). DESIGN: This prospective, exploratory cohort study was a subanalysis of data from a larger case-time-control study in five Health Services in Victoria, Australia. There were 603 transfers in 557 patients between August 2015 and October 2016. The study was conducted in accordance with the STrengthening the Reporting of OBservational studies in Epidemiology guidelines. METHODS: Data were extracted by medical record audit. Three resuscitation categories (full resuscitation; limitation of medical treatment (LOMT) orders; or not-for-cardiopulmonary resuscitation (CPR) orders) were compared using chi-square or Kruskal-Wallis tests. Stratified multivariable proportional hazard Cox regression models were used to account for health service clustering effect. FINDINGS: Resuscitation status was 63.5% full resuscitation; 23.1% LOMT order; and 13.4% not-for-CPR. Compared to patients for full resuscitation, patients with not-for-CPR or LOMT orders were more likely to have rapid response team calls during acute care readmission or to die during hospitalisation. Patients who were not-for-CPR were less likely to be readmitted to acute care and more likely to return to subacute care. CONCLUSIONS: Two-thirds of patients in subacute care who experienced an emergency inter-hospital transfer were for full resuscitation. Although the proportion of patients with LOMT and not-for-CPR orders increased after transfer, there were deficiencies in the documentation of resuscitation status and planning for clinical deterioration for subacute care patients. RELEVANCE TO CLINICAL PRACTICE: As many subacute care patients experience clinical deterioration, patient preferences for care need to be discussed and documented early in the subacute care admission.

Mapping Cancer incidence across Western Victoria: the association with age, accessibility, and socioeconomic status among men and women.

BACKGROUND: Cancer is a leading burden of disease in Australia and worldwide, with incidence rates varying with age, sex and geographic location. As part of the Ageing, Chronic Disease and Injury study, we aimed to map the incidence rates of primary cancer diagnoses across western Victoria and investigate the association of age, accessibility/remoteness index of Australia (ARIA) and area-level socioeconomic status (SES) with cancer incidence. METHODS: Data on cancer incidence in the study region were extracted from the Victorian Cancer Registry (VCR) for men and women aged 40+ years during 2010-2013, inclusive. The age-adjusted incidence rates (per 10,000 population/year), as well as specific incidence for breast, prostate, lung, bowel and melanoma cancers, were calculated for the entire region and for the 21 Local Government Areas (LGA) that make up the whole region. The association of aggregated age, ARIA and SES with cancer incidence rates across LGAs was determined using Poisson regression. RESULTS: Overall, 15,120 cancer cases were identified; 8218 (54%) men and 6902 women. For men, the age-standardised rate of cancer incidence for the whole region was 182.1 per 10,000 population/year (95% CI 177.7-186.5) and for women, 162.2 (95% CI: 157.9-166.5). The incidence of cancer (overall) increased with increasing age for men and women. Geographical variations in cancer incidence were also observed across the LGAs, with differences identified between men and women. Residents of socioeconomically disadvantaged and less accessible areas had higher cancer incidence (p < 0.001). CONCLUSION: Cancer incidence rates varied by age, sex, across LGAs and with ARIA. These findings not only provide an evidence base for identifying gaps and assessing the need for services and resource allocation across this region, but also informs policy and assists health service planning and implementation of preventative intervention strategies to reduce the incidence of cancer across western Victoria. This study also provides a model for further research across other geographical locations with policy and clinical practice implications, both nationally and internationally.

How patient and community involvement in diabetes research influences health outcomes: A realist review.

BACKGROUND: Patient and public involvement in diabetes research is an international requirement, but little is known about the relationship between the process of involvement and health outcomes. OBJECTIVE: This realist review identifies who benefits from different types of involvement across different contexts and circumstances. Search strategies Medline, CINAHL and EMBASE were searched to identify interventions using targeted, embedded or collaborative involvement to reduce risk and promote self-management of diabetes. People at risk/with diabetes, providers and community organizations with an interest in addressing diabetes were included. There were no limitations on date, language or study type. DATA EXTRACTION AND SYNTHESIS: Data were extracted from 29 projects using elements from involvement frameworks. A conceptual analysis of involvement types was used to complete the synthesis. MAIN RESULTS: Projects used targeted (4), embedded (8) and collaborative (17) involvement. Productive interaction facilitated over a sufficient period of time enabled people to set priorities for research. Partnerships that committed to collaboration increased awareness of diabetes risk and mobilized people to co-design and co-deliver diabetes interventions. Cultural adaptation increased relevance and acceptance of the intervention because they trusted local delivery approaches. Local implementation produced high levels of recruitment and retention, which project teams associated with achieving diabetes health outcomes. DISCUSSION AND CONCLUSIONS: Achieving understanding of community context, developing trusting relationships across sectors and developing productive partnerships were prerequisites for designing research that was feasible and locally relevant. The proportion of diabetes studies incorporating these elements is surprisingly low. Barriers to resourcing partnerships need to be systematically addressed.

Characteristics and outcomes of emergency interhospital transfers from subacute to acute care for clinical deterioration.

OBJECTIVE: To describe characteristics and outcomes of emergency interhospital transfers from subacute to acute hospital care and develop an internally validated predictive model to identify features associated with high risk of emergency interhospital transfer. DESIGN: Prospective case-time-control study. SETTING: Acute and subacute healthcare facilities from five health services in Victoria, Australia. PARTICIPANTS: Cases were patients with an emergency interhospital transfer from subacute to acute hospital care. For every case, two inpatients from the same subacute care ward on the same day of emergency transfer were randomly selected as controls. Admission episode was the unit of measurement and data were collected prospectively. MAIN OUTCOME MEASURES: Patient and admission characteristics, transfer characteristics and outcomes (cases), serious adverse events and mortality. RESULTS: Data were collected for 603 transfers in 557 patients and 1160 control patients. Cases were significantly more likely to be male, born in a non-English speaking country, have lower functional independence, more frequent vital sign assessments and experience a serious adverse event during first acute care or subacute care admissions. When adjusted for health service, cases had significantly higher inpatient mortality, were more likely to have unplanned intensive care unit admissions and rapid response team calls during their entire hospital admission. CONCLUSIONS: Patients who require an emergency interhospital transfer from subacute to acute hospital care have hospital admission rates and in-hospital mortality. Clinical instability during the first acute care admission (serious adverse events or increased surveillance) may prompt reassessment of patient suitability for movement to a separate subacute care hospital.

Revision joint replacement surgeries of the hip and knee across geographic region and socioeconomic status in the western region of Victoria: a cross-sectional multilevel analysis of registry data.

BACKGROUND: Residents of rural and regional areas, compared to those in urban regions, are more likely to experience geographical difficulties in accessing healthcare, particularly specialist services. We investigated associations between region of residence, socioeconomic status (SES) and utilisation of all-cause revision hip replacement or revision knee replacement surgeries. METHODS: Conducted in western Victoria, Australia, as part of the Ageing, Chronic Disease and Injury study, data from the Australian Orthopaedic Association National Joint Replacement Registry (2011-2013) for adults who underwent a revision hip replacement (n = 542; 54% female) or revision knee replacement (n = 353; 54% female) were extracted. We cross-matched residential addresses with 2011 census data from the Australian Bureau of Statistics (ABS), and using an ABS-derived composite index, classified region of residence according to local government areas (LGAs), and area-level SES into quintiles. For analyses, the control population (n = 591,265; 51% female) was ABS-determined and excluded adults already identified as cases. Mixed-effects logistic regression was performed. RESULTS: We observed that 77% of revision hip surgeries and 83% of revision knee surgeries were performed for residents in the three most socially disadvantaged quintiles. In adjusted multilevel models, total variances contributed by the variance in LGAs for revisions of the hip or knee joint were only 1% (SD random effects ±0.01) and 3% (SD ± 0.02), respectively. No differences across SES or sex were observed. CONCLUSIONS: No differences in utilisation were identified between SES groups in the provision of revision surgeries of the hip or knee, independent of small between-LGA differences.

Integrative review: Patient safety among older people with diabetes in home care services.

AIMS: To identify diabetes specific patient safety domains that need to be addressed to improve home care of older people; to assess research from primary studies to review evidence on patient safety in home care services for older people with diabetes. DESIGN: An integrative review. DATA SOURCES: Domains for patient safety in diabetes home care settings were identified by conducting two searches. We performed searches in: CINAHL, Medline, Embase, and Cochrane Library for the years 2000-2017. REVIEW METHODS: The first search identified frameworks or models on patient safety in home care services published up to October 2017. The second search identified primary studies about older people with diabetes in the home care setting published between 2000-2017. RESULTS: Data from the 21 articles populated and refined 13 predetermined domains of patient safety in diabetes home care. These were used to explore how the domains interact to either increase or reduce risk. The domains constitute a model of associations between aspects of diabetes home care and adverse events. The results highlight a knowledge gap in safety for older persons with diabetes, influenced by e.g. hypoglycaemia, falls, pain, foot ulcers, cognitive impairment, depression, and polypharmacy. Moreover, providers' inadequate diabetes-specific knowledge and assessment skills contribute to the risk of adverse events. CONCLUSION: Older persons with diabetes in home care are at risk of adverse events due to their reduced ability to self-manage their condition, adverse medication effects, the family's ability to take responsibility or home care service's suboptimal approaches to diabetes care.

Exploring patient preferences for involvement in medication management in hospitals.

AIM: The aim of this study was to identify patient preferences for involvement in medication management during hospitalization. DESIGN: A qualitative descriptive study. METHODS: This is a study of 20 inpatients in two medical and two surgical wards at an academic health science centre in Melbourne, Australia. Semi-structured interviews were recorded and analysed using content analysis. FINDINGS: Three themes were identified: (a) 'understanding the medication' established large variation in participants' understanding of their pre-admission medication and current medication; (b) 'ownership of medication administration' showed that few patients had considered an alternative to their current regimen; only some were interested in taking more control; and (c) 'supporting discharge from hospital' showed that most patients desired written medication instructions to be explained by a health professional. Family involvement was important for many. CONCLUSION: There was significant diversity of opinion from participants about their involvement in medication management in hospital. Patient preferences for inclusion need to be identified on admission where appropriate. Education about roles and responsibilities of medication management is required for health professionals, patients and families to increase inclusion and engagement across the health continuum and support transition to discharge. IMPACT STATEMENT: Little is known about patient preferences for participation in medication administration and hospital discharge planning. Individual patient understanding of and interest in participation in medication administration varies. In accordance with individual patient preferences, patients need to be included more effectively and consistently in their own medication management when in hospital.

Nurses' decision-making, practices and perceptions of patient involvement in medication administration in an acute hospital setting.

AIMS: To describe nurses' decision-making, practices and perceptions of patient involvement in medication administration in acute hospital settings. BACKGROUND: Medication errors cause unintended harm to patients. Nurses have a major role in ensuring patient safety in medication administration practices in hospital settings. Investigating nurses' medication administration decision-making and practices and their perceptions of patient involvement, may assist in developing interventions by revealing how and when to involve patients during medication administration in hospital. DESIGN: A descriptive exploratory study design. METHODS: Twenty nurses were recruited from two surgical and two medical wards of a major metropolitan hospital in Australia. Each nurse was observed for 4 hr, then interviewed after the observation. Data were collected over six months in 2015. Observations were captured on an electronic case report form; interviews were audio-recorded and transcribed verbatim. Data were analysed using descriptive statistics and content and thematic analysis. RESULTS: Ninety-five medication administration episodes, of between two and eight episodes per nurse, were observed. A total of 56 interruptions occurred with 26 of the interruptions being medication related. Four major themes emerged from the interviews: dealing with uncertainty; facilitating, framing and filtering information; managing interruptions and knowing and involving patients. CONCLUSION: Nurses work in complex adaptive systems that change moment by moment. Acknowledging and understanding the cognitive workload and complex interactions are necessary to improve patient safety and reduce errors during medication administration. Knowing and involving the patient is an important part of a nurses' medication administration safety strategies.

The role of religion and spirituality in coping with kidney disease and haemodialysis in Thailand.

BACKGROUND: People with chronic kidney disease (CKD) face various problems including psychological, socioeconomic and physical effects associated with CKD and its treatment. They need to develop strategies to help them cope with CKD and life challenges. Religion and spirituality are important coping strategies, but their role in helping people cope with CKD and haemodialysis (HD) in Thailand is relatively unknown. AIMS: To investigate the role of religion and spirituality in coping with CKD and its treatment in Thailand. DESIGN: An exploratory, qualitative approach was undertaken using semistructured individual interviews. METHOD: Purposive sampling was used to recruit participants. Face-to-face, in-depth individual interviews using open questions were conducted during January and February 2012. Interviews were audio-recorded and transcribed verbatim. Data were analysed using the framework method of qualitative data analysis. FINDINGS: Twenty people receiving HD participated: age range 23-77 years, mean 53.7 (±16.38 SD). Ten were women. Participants reported use of religious and spiritual practices to cope with CKD and its treatment, including religious and spiritual explanations for developing CKD, karmic disease, making merit, reading Dharma books, praying and chanting to save life and making a vow to Pran-Boon. CONCLUSION: Religion and spirituality provide powerful coping strategies that can help Thai people with CKD overcome the associated distress and difficulties. Religion and spirituality cannot be separated in Thai culture because Thai people are both religious and spiritual.

Integrating palliative care with usual care of diabetic foot wounds.

Palliative care is a philosophy and a system for deciding care and can be used alone or integrated with usual chronic disease care. Palliative care encompasses end-of-life care. Palliative care aims to enhance quality of life, optimize function and manage symptoms including early in the course of chronic diseases. The purposes of this article are to outline palliative care and discuss how it can be integrated with usual care of diabetic foot wounds. Many people with diabetes who have foot wounds also have other comorbidities and diabetes complications such as cardiovascular and renal disease and depression, which affect medicine and other treatment choices, functional status, surgical risk and quality of life. Two broad of diabetic foot disease exist: those likely to heal but who could still benefit from integrated palliative care such as managing pain and those where healing is unlikely where palliation can be the primary focus. People with diabetes can die suddenly, although the life course is usually long with periods of stable and unstable disease. Many health professionals are reluctant to discuss palliative care or suggest people to document their end-of-life care preferences. If such preferences are not documented, the person might not achieve their desired death or place of death and health professionals and families can be confronted with difficult decisions. Palliative care can be integrated with usual foot care and is associated with improved function, better quality of life and greater patient and family satisfaction.