How can dementia diagnosis and care for Aboriginal and Torres Strait Islander people be improved? Perspectives of healthcare providers providing care in Aboriginal community controlled health services.

BACKGROUND: Aboriginal and/or Torres Strait Islander people experience dementia at a rate three to five times higher than the general Australian population. Aboriginal Community Controlled Health Services (ACCHSs) have a critical role to play in recognising symptoms of cognitive impairment, facilitating timely diagnosis of dementia, and managing the impacts of dementia. Little is known about the barriers and enablers to Aboriginal people receiving a timely dementia diagnosis and appropriate care once diagnosed. This study aims to explore, from the perspective of healthcare providers in the ACCHS sector across urban, regional and remote communities, the barriers and enablers to the provision of dementia diagnosis and care. METHODS: A qualitative study involving semi-structured interviews with staff members working in the ACCHS sector. Aboriginal Health Workers, General Practitioners, nurses, practice or program managers, and Chief Executive Officers were eligible to participate. Consenting ACCHS staff completed a telephone interview administered by a trained interviewer. Interviews were audio-recorded, transcribed, and analysed using qualitative content analysis. RESULTS: Sixteen staff from 10 ACCHSs participated. Most participants perceived their communities had a limited understanding of dementia. Symptoms of dementia were usually noticed by the GP or another healthcare worker at the ACCHS who had an ongoing relationship with the person. Most participants reported that their service had established referral pathways with either hospital-based geriatricians, geriatricians located with aged care assessment teams, or specialists who visited communities periodically. Key enablers to high quality dementia care included the use of routine health assessments as a mechanism for diagnosis; relationships within communities to support diagnosis and care; community and family relationships; comprehensive and holistic care models; and the use of tailored visual resources to support care. Key barriers to high quality care included: denial and stigma; dementia being perceived as a low priority health condition; limited community awareness and understanding of dementia; lack of staff education and training about dementia; and numerous gaps in service delivery. CONCLUSIONS: Substantially increased investments in supporting best-practice diagnosis and management of dementia in Aboriginal communities are required. ACCHSs have key strengths that should be drawn upon in developing solutions to identified barriers to care.

The Impact of Social Support Networks on Family Resilience in an Australian Intensive Care Unit: A Constructivist Grounded Theory.

PURPOSE: This article discusses the findings of a grounded theory of family resilience in an Australian intensive care unit (ICU) with a specific focus on families' experiences of their interactions with other members within their own family, and the families of other patients in the ICU. DESIGN: A constructivist grounded theory methodology was adopted. Data were collected using in-depth interviews with 25 family members of 21 critically ill patients admitted to a tertiary-level ICU in Australia. FINDINGS: The core category regaining control represents the families' journey toward resilience when in ICU. The major categories represent facilitators for, and barriers to, regaining control. One of the main facilitators is drawing strength, and it explains the manner with which families receive social support from their own and other family members to help them cope. CONCLUSIONS: This study offers a framework to improve patient- and family-centered care in the ICU by facilitating families' ability to manage their situation more effectively. Social support offered by family members facilitates the families' ability to regain control. An ICU family resilience theoretical framework, situated within the context of the Australian healthcare system, adds to what is currently known about the families' experiences in the ICU. CLINICAL RELEVANCE: The relationships that develop between families in the ICU may provide a source of social support; however, not all families welcome interactions with other ICU families, and it may cause further emotional distress. Further research is warranted to determine whether families suffer a secondary stress reaction from incidental interactions with other patients' families in the ICU. Furthermore, when family members pull together and offer social support to each other, they are better able to regain control. This process contributes to an ICU family resilience framework.

Searching for meaning: A grounded theory of family resilience in adult ICU.

AIM: To explore families' experiences of their interactions in an Australian adult intensive care unit (ICU) to develop a grounded theory that can be used by critical care nurses to improve patient- and family-centred care (PFCC). BACKGROUND: Families in ICU play an important role in the patient's recovery and outcomes. However, families are at risk of significant psychological morbidity due to their experiences in ICU. Although many ICU patients can make their own decisions, a large proportion are unconscious or chemically sedated and unable to contribute to decisions about their care, leaving the decision-making role to the family. Therefore, the families' psychosocial and emotional well-being must be supported by implementing evidence-based interventions that align with a PFCC approach. This study describes the findings of a grounded theory of family resilience in ICU, of which the core category is Regaining control. The focus of this paper is on the major category: Searching for meaning. METHODS: We adopted a constructivist grounded theory method. Twenty-five adult family members (n = 25) of 21 patients admitted unexpectedly to an ICU in metropolitan Australia were recruited. In-depth interviews were used to collect the data, and the analytical processes of constructivist grounded theory underpinned the development of a core category and related subcategories. RESULTS: When adult family members experience the unexpected admission of a relative to ICU, they move towards a state of being beyond emotional adversity and regaining control when facilitated to search for meaning in their situation. When families were able to make sense of their situation and find a purpose by contributing to their relative's recovery, it encouraged them to cope and be resilient. CONCLUSIONS: Our findings can be used to promote PFCC in ICU, which considers a collaborative approach to meet the patient's needs while providing emotional and psychosocial support to their families.

Barriers to families' regaining control in ICU: Disconnectedness.

BACKGROUND: The nature of interactions between health care professionals and families may have a significant impact on families' experience and outcomes of critical illness. The value of encouraging positive relationships with families is well documented; however, it is argued that the lack of theoretical frameworks to guide practice in this area may be a barrier to improving patient- and family-centred care. AIMS: The study on which this paper is based aimed to understand families' experiences of their interactions when a relative is admitted unexpectedly to an Australian intensive care unit and to generate a substantive theory that represents families' interactions that can be used to guide critical care nursing practice when caring for patients' families in this context. DESIGN AND METHODS: A grounded theory methodology was adopted for the study. Data were collected between 2009 and 2013 using in-depth interviews with 25 family members of 21 critically ill patients admitted to a metropolitan, tertiary-level intensive care unit (ICU) in Australia. FINDINGS: A core category of regaining control has been generated from our study. This paper focuses on Disconnectedness, which leads to increased emotional vulnerability and is also a barrier to families' regaining control. Families feel disconnected when staff emotionally and physically disengage from them, when staff interact insensitively and in a manner that offers families limited hope. CONCLUSION: Our findings offer an in-depth understanding of staff engagement with families and its impact on the families' ability to regain control. Although some themes have been previously identified in the literature in isolation, the interrelationships of the categories within a theoretical framework to represent family resilience in the context of an ICU situated in the Australian health care system are a novel finding. RELEVANCE TO CLINICAL PRACTICE: The findings can be used to support patient- and family-centred care interventions in the ICU.

Development of an optimised key worker framework for people with dementia, their family and caring unit living in the community.

BACKGROUND: In Australia, dementia is a national health priority. With the rising number of people living with dementia and shortage of formal and informal carers predicted in the near future, developing approaches to coordinating services in quality-focused ways is considered an urgent priority. Key worker support models are one approach that have been used to assist people living with dementia and their caring unit coordinate services and navigate service systems; however, there is limited literature outlining comprehensive frameworks for the implementation of community dementia key worker roles in practice. In this paper an optimised key worker framework for people with dementia, their family and caring unit living in the community is developed and presented. METHODS: A number of processes were undertaken to inform the development of a co-designed optimised key worker framework: an expert working and reference group; a systematic review of the literature; and a qualitative evaluation of 14 dementia key worker models operating in Australia involving 14 interviews with organisation managers, 19 with key workers and 15 with people living with dementia and/or their caring unit. Data from the systematic review and evaluation of dementia key worker models were analysed by the researchers and the expert working and reference group using a constant comparative approach to define the essential components of the optimised framework. RESULTS: The developed framework consisted of four main components: overarching philosophies; organisational context; role definition; and key worker competencies. A number of more clearly defined sub-themes sat under each component. Reflected in the framework is the complexity of the dementia journey and the difficulty in trying to develop a 'one size fits all' approach. CONCLUSIONS: This co-designed study led to the development of an evidence based framework which outlines a comprehensive synthesis of components viewed as being essential to the implementation of a dementia key worker model of care in the community. The framework was informed and endorsed by people living with dementia and their caring unit, key workers, managers, Australian industry experts, policy makers and researchers. An evaluation of its effectiveness and relevance for practice within the dementia care space is required.

Barriers to regaining control within a constructivist grounded theory of family resilience in ICU: Living with uncertainty.

AIMS AND OBJECTIVES: To discuss families' experiences of their interactions when a relative is admitted unexpectedly to an Australian intensive care unit. BACKGROUND: The overwhelming emotions associated with the unexpected admission of a relative to an intensive care unit are often due to the uncertainty surrounding the condition of their critically ill relative. There is limited in-depth understanding of the nature of uncertainty experienced by families in intensive care, and interventions perceived by families to minimise their uncertainty are not well documented. Furthermore, the interrelationships between factors, such as staff-family interactions and the intensive care unit environment, and its influence on families' uncertainty particularly in the context of the Australian healthcare system, are not well delineated. DESIGN: A grounded theory methodology was adopted for the study. METHODS: Data were collected between 2009-2013, using in-depth interviews with 25 family members of 21 critically ill patients admitted to a metropolitan, tertiary-level intensive care unit in Australia. RESULTS: This paper describes the families experiences of heightened emotional vulnerability and uncertainty when a relative is admitted unexpectedly to the intensive care unit. Families uncertainty is directly influenced by their emotional state, the foreign environment and perceptions of being 'kept in the dark', as well as the interrelationships between these factors. CONCLUSION: Staff are offered an improved understanding of the barriers to families' ability to regain control, guided by a grounded theory of family resilience in the intensive care unit. RELEVANCE TO CLINICAL PRACTICE: The findings reveal in-depth understanding of families' uncertainty in intensive care. It suggests that intensive care unit staff need to focus clinical interventions on reducing factors that heighten their uncertainty, while optimising strategies that help alleviate it. Families are facilitated to move beyond feelings of helplessness and loss of control, and cope better with their situation.

Evidence-based occupational therapy for people with dementia and their families: What clinical practice guidelines tell us and implications for practice.

BACKGROUND/AIM: The first evidence-based Clinical Practice Guidelines and Principles of Care for People with Dementia in Australia have been released. The Guidelines detail a number of important evidence-based recommendations for occupational therapists. The aim of this paper is (1) to provide an overview of Guideline development, and (2) to describe the evidence supporting a recommendation for occupational therapy. Common characteristics of effective occupational therapy programmes for people with dementia are described. METHODS: Guideline development involved adaptation of existing high-quality guidelines developed overseas and 17 systematic reviews to ensure that the most recent high-quality evidence was included. One of the systematic reviews involved examining the evidence for interventions to promote independence in people with dementia. Specifically, we looked at the evidence for occupational therapy and its effect on activities of daily living, quality of life and carer impact. RESULTS: A total of 109 recommendations are included in the Guidelines. Occupational therapy was found to significantly increase independence in activities of daily living and improve quality of life. Effective occupational therapy programmes involve: environmental assessment, problem solving strategies, carer education and interactive carer skills training. CONCLUSION: Occupational therapists working with people with dementia in community settings should ensure that their time is spent on those aspects of intervention that are shown to be effective.

Clinical practice guidelines for dementia in Australia.

About 9% of Australians aged 65 years and over have a diagnosis of dementia. Clinical practice guidelines aim to enhance research translation by synthesising recent evidence for health and aged care professionals. New clinical practice guidelines and principles of care for people with dementia detail the optimal diagnosis and management in community, residential and hospital settings. The guidelines have been approved by the National Health and Medical Research Council. The guidelines emphasise timely diagnosis; living well with dementia and delaying functional decline; managing symptoms through training staff in how to provide person-centred care and using non-pharmacological approaches in the first instance; and training and supporting families and carers to provide care.

What is the effectiveness of the support worker role for people with dementia and their carers? A systematic review.

BACKGROUND: Dementia is progressive in nature and the associated functional decline inevitably leads to increasing dependence on others in areas of daily living. Models of support have been developed and implemented to assist with adjusting to living with memory loss and functional decline; to navigate the health and aged care system; and to access services. We undertook a systematic review of international literature on key worker type support roles to identify essential components and ascertain how the role can be best utilised to assist community-dwelling people with dementia and their carers. This review of support roles is the first to our knowledge to include both quantitative and qualitative studies and all models of support. METHOD: A systematic review of studies written in English and published between January 2003 and December 2014. Data sources were Medline, PsychInfo and CINAHL, internet, expert consultation and reference lists of included studies. After screening articles to ensure that they reported on a key worker type support role, involved carers and or people with dementia living at home and removing duplicates, eligible papers were appraised and evaluated. RESULTS: Thirty six studies were eligible for inclusion in the review. Eligible studies were divided into type of support roles and study type. The heterogeneity of included studies and high risk of bias made a meta-analysis inappropriate and it was therefore difficult to draw overall conclusions. However, essential components shared across support worker models that demonstrated a positive impact on carer burden and improved quality of life included: long term intervention, face to face contact, individualised education and support based on needs, multi-disciplinary teams, collaborative input, health/clinical background of support workers, ongoing follow up and inter professional and inter-sectoral collaborations. There was a lack of studies assessing cost-effectiveness. CONCLUSIONS: Studies that include a high quality evaluation of holistic, tailored models of support that identify which components of support produce the most valuable outcomes to assist people with dementia and their carers and families to continue to live meaningful lives are needed. There is also a need for a cost effectiveness evaluation of support worker roles. TRIAL REGISTRATION: PROSPERO international prospective register of systematic reviews: PROSPERO 2014 CRD42014013992 .

Senior staff perspectives of a quality indicator program in public sector residential aged care services: a qualitative cross-sectional study in Victoria, Australia.

OBJECTIVE: The aims of the present study were to describe the views of senior clinical and executive staff employed in public sector residential aged care services (RACS) about the benefits and limitations of using quality indicators (QIs) for improving care, and to identify any barriers or enablers to implementing the QI program. METHODS: A cross-sectional qualitative study using semistructured interviews and direct observation of key informants involved in the QI program was performed across 20 public sector RACS in Victoria, Australia. Participants included senior clinical, executive and front-line staff at the RACS. The main outcome measures were perceived benefits and the enablers or barriers to the implementation of a QI program. RESULTS: Most senior clinical and executive staff respondents reported substantive benefits to using the QIs and the QI program. A limited number of staff believed that the QI program failed to improve the quality of care and that the resource requirements outweighed the benefits of the program, resulting in disaffected staff. CONCLUSIONS: The QIs and QI program acted as a foundation for improving standards of care when used at the front line or point of care. Senior executive engagement in the QI program was vital to successful implementation.

Evaluation of a support worker role, within a nurse delegation and supervision model, for provision of medicines support for older people living at home: the Workforce Innovation for Safe and Effective (WISE) Medicines Care study.

BACKGROUND: Support with managing medicines at home is a common reason for older people to receive community nursing services. With population ageing and projected nurse shortages, reliance on nurses may not be sustainable. We developed and tested a new workforce model: 'Workforce Innovation for Safe and Effective (WISE) Medicines Care', which enabled nurses to delegate medicines support home visits for low-risk clients to support workers (known as community care aides [CCAs]). Primary study aims were to assess whether the model increased the number of medicines support home visits conducted by CCAs, explore nurses', CCAs' and consumers' experiences with the CCAs' expanded role, and identify enablers and barriers to delegation of medicines support. METHODS: A prospective before-after mixed-methods study was conducted within a community nursing service that employed a small number of CCAs. The CCAs' main role prior to the WISE Medicines Care model was personal care, with a very limited role in medicines support. CCAs received training in medicines support, and nurses received training in assessment, delegation and supervision. Home visit data over two three-month periods were compared. Focus groups and interviews were conducted with purposive samples of nurses (n = 27), CCAs (n = 7) and consumers (n = 28). RESULTS: Medicines support visits by CCAs increased from 43/16,863 (0.25 %) to 714/21,552 (3.3 %) (p < 0.001). Nurses reported mostly positive experiences, and high levels of trust and confidence in CCAs. They reported that delegating to CCAs sometimes eliminated the need for duplicate nurse and CCA visits (for people requiring personal care plus medicines support) and enabled them to visit people with more complex needs. CCAs enjoyed their expanded role and were accepted by clients and/or carers. Nurses and CCAs reported effective communication when medicine-related problems occurred. No medication incidents involving CCAs were reported. Barriers to implementation included the limited number of CCAs employed in the organisation and reluctance from some nurses to delegate medicines support to CCAs. Enablers included training and support, existing relationships between CCAs and nurses, and positive staff attitudes. CONCLUSIONS: Appropriately trained and supervised support workers can be used to support community nurses with providing medicines management for older people in the home care setting, particularly for those who are at low risk of adverse medication events or errors. The model was acceptable to nurses, clients and carers, and may offer a sustainable and safe and effective future workforce solution to provision of medicines support for older people in the home care setting.

An evaluation of Snoezelen(®) compared to 'common best practice' for allaying the symptoms of wandering and restlessness among residents with dementia in aged care facilities.

Snoezelen has become an increasingly popular therapy in residential aged care facilities in Australia and elsewhere, despite no conclusive evidence of its clinical efficacy. This paper reports on an evaluation of the use of Snoezelen compared to 'common best practice' for allaying the dementia related behaviors of wandering and restlessness in two residential aged care facilities in Victoria, Australia. Sixteen residents had their behavior and responses to Snoezelen or 'common best practice' observed and recorded over three time periods. The Wilcoxon signed-rank test showed there was a significant improvement in behaviors immediately after the intervention and after 60 min. However, no significant differences were found between residents receiving Snoezelen and 'common best practice' interventions for the reduction of the dementia related behaviors.

Clinical experience and follow-up with large scale single-nucleotide polymorphism-based noninvasive prenatal aneuploidy testing.

OBJECTIVE: We sought to report on laboratory and clinical experience following 6 months of clinical implementation of a single-nucleotide polymorphism-based noninvasive prenatal aneuploidy test in high- and low-risk women. STUDY DESIGN: All samples received from March through September 2013 and drawn ≥9 weeks' gestation were included. Samples that passed quality control were analyzed for trisomy 21, trisomy 18, trisomy 13, and monosomy X. Results were reported as high or low risk for fetal aneuploidy for each interrogated chromosome. Relationships between fetal fraction and gestational age and maternal weight were analyzed. Follow-up on outcome was sought for a subset of high-risk cases. False-negative results were reported voluntarily by providers. Positive predictive value (PPV) was calculated from cases with an available prenatal or postnatal karyotype or clinical evaluation at birth. RESULTS: Samples were received from 31,030 patients, 30,705 met study criteria, and 28,739 passed quality-control metrics and received a report detailing aneuploidy risk. Fetal fraction correlated positively with gestational age, and negatively with maternal weight. In all, 507 patients received a high-risk result for any of the 4 tested conditions (324 trisomy 21, 82 trisomy 18, 41 trisomy 13, 61 monosomy X; including 1 double aneuploidy case). Within the 17,885 cases included in follow-up analysis, 356 were high risk, and outcome information revealed 184 (51.7%) true positives, 38 (10.7%) false positives, 19 (5.3%) with ultrasound findings suggestive of aneuploidy, 36 (10.1%) spontaneous abortions without karyotype confirmation, 22 (6.2%) terminations without karyotype confirmation, and 57 (16.0%) lost to follow-up. This yielded an 82.9% PPV for all aneuploidies, and a 90.9% PPV for trisomy 21. The overall PPV for women aged ≥35 years was similar to the PPV for women aged <35 years. Two patients were reported as false negatives. CONCLUSION: The data from this large-scale report on clinical application of a commercially available noninvasive prenatal test suggest that the clinical performance of this single-nucleotide polymorphism-based noninvasive prenatal test in a mixed high- and low-risk population is consistent with performance in validation studies.

Introducing the bio-psycho-social-physical model of dementia through a collective case study design.

AIMS AND OBJECTIVES: To provide evidence for the development of a physical domain attached to the well-known bio-psycho-social model of dementia. The objectives were to develop a set of international case studies that followed a trajectory approach, from prevention to end-of-life care. BACKGROUND: In the UK the bio-psycho-social model has informed the shape of the National Institute for Health and Clinical Excellence and the Social Care Institute for Excellence 'dementia' guideline. However, limited attention has been paid to outlining and describing a physical domain of dementia, a discrepancy that informed the rationale for this study. DESIGN: A collective case study design was used to address the research aim and objectives. METHODS: Case studies from along the trajectory of dementia were provided by an international team of contributors from an inter-disciplinary background comprising nursing (general and mental health), social work and social science. RESULTS: The team's synthesis and analysis of the six case studies generated five repeating themes with each theme becoming components of a 'physical' domain of dementia. The five identified physical components were: (1) physical well-being, (2) physical health and examination, (3) physical care, (4) physical treatment and (5) physical environment. CONCLUSIONS: The development of a bio-psycho-social-physical model of dementia presents a holistic and culturally sensitive approach to understanding the experience of living with dementia, and to providing care and support in a variety of situations and contexts. RELEVANCE TO CLINICAL PRACTICE: The physical domain of dementia has particular relevance to nursing and nursing practice, such as providing physical care at the end-of-life. The interplay between the biological-psychological-social-physical domains of dementia and the trajectory of dementia could form the basis of clinical decision-making and practice.

The use of multi-sensory interventions to manage dementia-related behaviours in the residential aged care setting: a survey of one Australian state.

AIMS AND OBJECTIVES: To describe the use of multi-sensory interventions in residential aged care services (RACS) for the management of dementia-related behaviours in residential aged care in Victoria, Australia. BACKGROUND: The popularity of multi-sensory interventions has spread worldwide, including for use in residential aged care, despite limited evidence to support their efficacy. DESIGN: This study reports the findings of the first stage of a two-stage project that was undertaken to describe and evaluate the use of multi-sensory interventions for the management of dementia-related behaviours in all residential aged care facilities in Victoria, Australia. METHODS: A computer-assisted telephone interview survey was developed and administered to residential aged care facilities in Victoria, Australia, to collect descriptive data on the use of multi-sensory interventions for the management of dementia-related behaviours. RESULTS: A diverse and eclectic range of multi-sensory interventions are currently being used by residential aged care facilities. The findings suggest the use of multi-sensory interventions are used in an ad hoc manner, and there is no universal definition of multi-sensory interventions, little formal training for staff administering the interventions and no guideline for their use, nor evaluation of their impact on residents' behaviour. CONCLUSION: Multi-sensory interventions have been widely adopted for use in RACS in Victoria, Australia, and are currently being used without formal guidelines and little evidence to support their use in clinical practice. RELEVANCE TO CLINICAL PRACTICE: In the absence of a formal definition of what constitutes a multi-sensory intervention, training for staff and careful assessment and monitoring of residents who receive multi-sensory interventions, we recommend further research and development of policy and procedures to safe guard the use of multi-sensory interventions for people with dementia.

Hospital discharge: recommendations for performance improvement for family carers of people with dementia.

UNLABELLED: BACKGROUND; It is acknowledge that discharge planning benefits both consumers and hospitals. What is not widely understood is the experience that the family carer of a person with a dementia has and whether the hospitals meet their in-hospital and post-hospital needs. OBJECTIVE: To explore whether metropolitan and rural hospital discharge practices meet the needs of the family carer of a person with dementia. RESULTS: Although this and other research indicates that a continuum of care model is beneficial to family caregivers, no evidence has been identified that family carers currently experience this type of quality planning. Family carers were often unaware of the existence of a hospital discharge plan and were rarely engaged in communication about the care of their family member with a dementia or prepared for discharge. CONCLUSION AND RECOMMENDATIONS; Discharge planning processes for family carers of people with dementia could be substantially improved. It is recommended that hospitals develop policy, process and procedures that take into account the family carer's needs, develop key performance indicators and adopt best practice standards that direct discharge planning activities and early engagement of the family carer in healthcare decisions. It is recommended that health professionals be educated on communication, consultation and needs of family carers.

Psychometric evaluation of the English language Person-centred Climate Questionnaire--staff version.

AIM: The present study aimed to evaluate psychometric properties of the English language Person-centred Climate Questionnaire--staff version (PCQ-S). BACKGROUND: Person-centred care emphasizes the individual's perspective in the care process. However, the concept is subject to some debate and few measurement tools exist. METHODS: During 2 months in 2007, the Swedish PCQ-S was translated to English and distributed to a sample of Australian hospital staff (n = 52). Psychometric evaluation using statistical estimates of validity and reliability were performed. RESULTS: The 14-item questionnaire showed high reliability as Cronbach's alpha was satisfactory for the total scale (0.89), and for the four subscales: 0.87, 0.79, 0.82 and 0.69. Test-retest reliability were evaluated in a subsample of 40 staff and resulted in P-values >0.05 between mean scores of the PCQ-S at test and retest, r-values between 0.6 and 0.9, and a two-way mixed effects model, single measures intra-class correlations of 0.75 with a confidence interval of 0.58-0.86. Validity of the scale needs further evaluation. CONCLUSIONS AND IMPLICATIONS FOR NURSING MANAGEMENT: The English PCQ-S makes possible studies of associations between person-centredness and different organizational systems, environments, staff characteristics and health and managerial styles. However, scale validity needs further evaluation.

Psychometric evaluation of the English Language Person-Centered Climate Questionnaire--Patient version.

The aim of this study was to evaluate psychometric properties of a questionnaire measuring to what extent the climate of health care settings are perceived as being person-centered. The English Person-Centered Climate Questionnaire-Patient version (PCQ-P) was distributed to a sample of hospital patients (n = 108) and data were subjected to psychometric evaluation using statistical estimates of validity and reliability. Content and construct validity of the PCQ-P was satisfactory in literature reviews and factor and item analysis. Cronbach's alpha was satisfactory for the total scale (0.90) and also for sub-scales: safety = 0.96 and hospitality = 0.89. The intraclass correlation coefficient indicating test-retest reliability was 0.70 with a 95% confidence interval ranging between 0.63 and 0.77. Even though the sample should be considered, the results indicate that the PCQ is a valid and reliable contribution for assessing to what extent the climate of health care settings are perceived to be person-centered by patients.

Partnering with people with dementia and their care partners, aged care service experts, policymakers and academics: A co-design process.

OBJECTIVE: To describe the co-design process in a project that "evaluated how the key worker role can best support people living with dementia in the community setting." METHODS: People with dementia, care-partners, aged-care service experts, policymakers and academics utilised a co-design process to undertake a systematic literature review and a qualitative evaluation study. RESULTS: The development of a successful co-design process that includes people living with dementia and their care-partners ("consumers") at all stages of the research process and addresses their individual needs. CONCLUSIONS: The co-design approach utilised in this project provided support, for consumers living in the community to be fully involved in the research design, conduct and plans for dissemination and implementation of the findings. Consequently, the research outcomes are based on solid evidence and consumer need. Additionally, a successful model for supporting consumers to facilitate their involvement in all aspects of the research process, was developed.