Midwife led randomised controlled trials in Australia and New Zealand: A scoping review.

BACKGROUND: Midwives are the largest workforce involved in caring for pregnant women and their babies, and are well placed to translate research into practice and ensure midwifery priorities are appropriately targeted in researched. Currently, the number and focus of randomised controlled trials led by midwives in Australia and New Zealand is unknown. The Australasian Nursing and Midwifery Clinical Trials Network was established in 2020 to build nursing and midwifery research capacity. To aid this, scoping reviews of the quality and quantity of nurse and midwife led trials were undertaken. AIM: To identify midwife led trials conducted between 2000 and 2021 in Australia and New Zealand. METHODS: This review was informed by the JBI scoping review framework. Medline, Emcare, and Scopus were searched from 2000-August 2021. ANZCTR, NHMRC, MRFF, and HRC (NZ) registries were searched from inception to July 2021. FINDINGS: Of 26,467 randomised controlled trials registered on the Australian and New Zealand Clinical Trials Registry, 50 midwife led trials, and 35 peer-reviewed publications were identified. Publications were of moderate to high quality with scores limited due to an inability to blind participants or clinicians. Blinding of assessors was included in 19 published trials. DISCUSSION: Additional support for midwives to design and conduct trials and publish findings is required. Further support is needed to translate registration of trial protocols into peer reviewed publications. CONCLUSION: These findings will inform the Australasian Nursing and Midwifery Clinical Trials Network plans to promote quality midwife led trials.

Age-friendly interventions in rural and remote areas: A scoping review.

OBJECTIVES: In 2007, the World Health Organization published a guide on age-friendly cities. However, little is known about interventions that have been implemented to promote age-friendly communities in rural and remote areas. This paper presents the findings from a scoping review undertaken to locate available evidence of interventions, strategies, and programs that have been implemented in rural and remote areas to create age-friendly communities. METHODS: This scoping review used the Joanna Briggs Institute (JBI) methodology. RESULTS: A total of 219 articles were included in this review. No intervention studies were referred to as 'age-friendly'. However, there were interventions (mostly healthcare-related) that have been implemented in rural and remote areas with older people as participants. There were also non-evaluated community programs that were published in the grey literature. This review identified the common health interventions in older people and the indirect relevance to the WHO age-friendly framework domains in rural and remote contexts. CONCLUSIONS: The eight age-friendly domains were not explicitly utilised as a guide in the development of interventions for older people in rural and remote settings. Implementation of age-friendly interventions in rural and remote areas requires a multisectoral approach that is tailored to address the specific needs of individual communities. Age-friendly interventions also need to consider socio-ecological factors to adequately and holistically address community needs and ensure long-term sustainability.

Seeking and maintaining connections: A grounded theory study of maintaining spirituality in residential aged care facilities.

BACKGROUND: Moving to a residential aged care facility involves living far from family and a familiar environment, and leaving behind the social support system of relatives, friends, and society. The pressure to find and develop new and meaningful connections in a residential aged care facility can be significant for older adults. OBJECTIVE: To provide a theoretical explanation of how older adults seek and maintain connections in a residential aged care facility. METHODS: A grounded theory study was conducted. A total of 17 residents were recruited from two Nepalese residential aged care facilities using theoretical sampling. Face to face in-depth, semi-structured interviews and observation within interviews were conducted. Data analysis included the process of open, axial, selective coding, and constant comparative analysis as per Corbin and Strauss' variant of grounded theory. RESULTS: This study identified that the process of seeking connections in a residential aged care facility was forward-moving, and involved "identifying sources," "developing connections," and "appraising responses." By seeking connections, residents built new connections. Similarly, the study found that maintaining connections was a continuous process of "sustaining connections with co-residents," "preserving connections with nurses/caregivers," and "continuing connections with inner-self and higher being/s." Maintaining connections led residents to balance shifting connections. Furthermore, it was found that the process of seeking and maintaining connections was conditional on facility arrangement i.e. the way residents were placed, rules, regulations, co-residents' language, gender, religious affiliation, attitudes, the attitudes and practices of nurses/caregivers, decreasing physical abilities of residents, increasing illness of residents, illness or death of co-residents, and retirement or resignation of nurses/caregivers. CONCLUSION: The current study provides unique insights into the process of seeking and maintaining connections in a residential aged care facility. Facility arrangement, rules, regulations, and caregiving practices should resonate with residents' socio-cultural expectations and spiritual belief system to support their process of seeking and maintaining connections. IMPLICATIONS FOR PRACTICE: The findings can be beneficial for managers, nurses, caregivers, and spiritual advisors in developing interventions that promote the development of meaningful connections in a residential aged care facility.

Primary care doctor and nurse utilisation rates for billed consultations across the Comprehensive Care Primary Health Organisation.

AIM: To examine socio-demographic trends in doctor and nurse utilisation rates for invoiced consultations across Comprehensive Care Primary Health Organisation (PHO). METHOD: De-identified enrolled patient information and Service Utilisation Reporting data for invoiced consultations were extracted from all general practices for January 2013-December 2016. Utilisation rates were calculated using the number of enrolled patients as the denominator. RESULTS: Data for 3,657,873 invoiced consultations across 66 general practices were analysed, including 2,941,624 doctor and 716,249 nurse consultations. Average utilisation rates were 3.1 visits per patient year for doctors and 0.7 visits for nurses, with considerable variability between practices. Utilisation rates were higher for females (3.3 visits for doctors; 0.8 for nurses), older adults (5.0-6.9; 1.3-1.6 visits) and patients residing in the most socially deprived quintile (3.3; 1.6 visits). European patients had the highest doctor utilisation rates (3.2 visits), while Maori and Pacific patients had the highest nurse utilisation rates (1.1 and 1.3 visits, respectively). CONCLUSION: Females, older adults and people residing in socially deprived areas utilise primary care more frequently according to invoiced consultation data. Analysis of all other consultations, including immunisations, Accident Corporation Claims and non-billed services is needed to more accurately capture utilisation rates, particularly for nurses, to better inform national decision-making, workforce planning and funding assumptions.

What is known about the spirituality in older adults living in residential care facilities? An Integrative review.

AIM: To synthesize evidence regarding the spiritual needs and care of older adults living in residential care facilities from the perspectives of older adults and nurses or caregivers. DESIGN: Integrative review of literature. DATA SOURCES: Literature search was conducted using CINAHL Plus with Full Text via EBSCO, Scopus, PubMed, PsychInfo, Web of Science, and ProQuest Social Science Databases from March to December 2017. REVIEW METHODS: This integrative review utilised the Whittemore and Knafl framework and PRISMA in the selection of eligible articles. Quality of the articles was evaluated using the Mixed Method Appraisal Tool. RESULTS: Seven articles were reviewed and analysed. There is limited evidence \and no agreed definition of spiritual needs and care of older adults living in residential care facilities. Spiritual needs of older adults in residential care facilities is a psycho-social, religious and existential construct. Spiritual care in residential care facilities is linked to information gathering, religious guidance, maintaining family connections, providing companionship, discussing end of life issues, and providing counseling. Older adults highly value the role of nurses and caregivers in fulfilling their spiritual needs and providing spiritual care. However, nurses and caregivers perceived arranging a referral to a religious advisor as the main aspect of spiritual care. Therefore, nurses', caregivers', and older adults' views on spiritual care differed to some extent. CONCLUSION: The practical aspects of spiritual needs assessment and spiritual care provision requires further investigation, which is essential to improve the effectiveness of service delivery in residential care facilities.

Independence and well-being in later life: three New Zealand studies.

This paper argues that social gerontology is an appropriate methodological lens to investigate independence and well-being in later life and goes on to overview three diverse and independent pieces of research which cross disciplinary boundaries, geographic locations and philosophical terrains. A comparative analysis of the results from these studies identifies that health, economic status and social support influence the concepts of independence and well-being in older people. Nurses, particularly those working in primary health care, are likely to be the first point of contact for many older adults and need to operationalise a holistic assessment framework in order to address all components of ageing that influence independence and well-being in this group of people.