Using citizen science to empower older adults to improve a food security initiative in Australia.

Food security is an increasing problem for older adults who are living longer and having to stretch their resources further. Initiatives such as subsidized community market days are increasingly important in bolstering food security amongst these groups but there have been few attempts to understand these initiatives from the perspective of community members. This exploratory study examined the utility of a novel citizen science approach to engage older adults in evaluating and improving a local food security initiative. Using the Our Voice methodology, citizen scientists recorded their perceptions of their local Market Day via photographs and audio narratives. Thirteen citizen scientists captured 127 photographs and 125 commentaries. Citizen scientists participated in workshops to discuss, code and synthesize their data, and used their findings to advocate for change. A number of improvements to the Market Day were made by key stakeholders on the basis of citizen scientist recommendations, including improving the processes for sourcing and storing food and changing the layout to improve access. This study demonstrates that citizen science is a useful and feasible approach to engaging community members in capturing data and advocating for change to ensure that local initiatives meet the needs of communities.

Sensory Devices for Older Adults With Behavioral Disturbance in the Emergency Department: A Descriptive Study.

Nonpharmacological strategies are advocated for the management of behavioral disturbance in older adults due to risk of harm from pharmacological therapy; however, limited evidence supports their use in emergency departments (EDs). The current descriptive study was conducted to investigate the use of sensory devices for nonpharmacological management of behavioral disturbance and their perceived impact. Data were collected from the sensory device registry, electronic medical records, and survey. Patient-level data (N = 33) showed that sensory devices, such as tactile blankets or toys and music, can be used in EDs to alleviate behavioral disturbance among older adults. ED staff (n = 22) expressed an interest to increase device supply. A patient and caregiver (n = 2) suggested that the devices be initiated earlier in ED care. Further research is required to strengthen evidence on the impact of these devices on patient outcomes. [Journal of Gerontological Nursing, 47(4), 22-27.].

Teacher-as-actor: Investigating the barriers and facilitators of patient education among hospitalized patients in a cardiology clinical unit.

Patient education enables people with cardiovascular disease to develop self-management behaviors. This study aimed to explore facilitators and barriers to teaching patients in a clinical cardiology unit with a single site qualitative investigation involving 21 registered nurses attending four focus groups. This study identified barriers related to patient factors including individual characteristics and responses to education, comorbidities, acuity, and evolving diagnosis, while for nurses the barriers were lack of knowledge and expertise. Barriers associated with the physical environment included nursing workload issues and lack of resources. Facilitators included patients being engaged in the process of education, prepared, and ready to be educated, while a conducive physical environment was also seen as a facilitator. This study exposed inhibiting and enabling variables associated with the exchange between patients and nurses by viewing the nurse and the patient as actors and audience in a theatrical model where communicating to teach patients is seen as a collaborative art. The nurse who understands the barriers and facilitators to teaching will more likely engage the patient in successful learning and development of self-care behaviors.

Progressive Resistance Plus Balance Training for Older Australians Receiving In-Home Care Services: Cost-Effectiveness Analyses Alongside the Muscling Up Against Disability Stepped-Wedge Randomized Control Trial.

In this article, the authors assessed the cost-effectiveness of center-based exercise training for older Australians. The participants were recipients of in-home care services, and they completed 24 weeks of progressive resistance plus balance training. Transport was offered to all participants. A stepped-wedge randomized control trial produced pre-, post-, and follow-up outcomes and cost data, which were used to calculate incremental cost-effectiveness ratios per quality-adjusted life year gained. Analyses were conducted from a health provider perspective and from a government perspective. From a health-service provider perspective, the direct cost of program provision was $303 per person, with transport adding an additional $1,920 per person. The incremental cost-utility ratio of the program relative to usual care was $70,540 per quality-adjusted life year over 6 months, decreasing to $37,816 per quality-adjusted life year over 12 months. The findings suggest that Muscling Up Against Disability offers good value for the money within commonly accepted threshold values.

Engineering Improved Balance Confidence in Older Adults With Complex Health Care Needs: Learning From the Muscling Up Against Disability Study.

OBJECTIVE: To investigate the associations of balance confidence with physical and cognitive markers of well-being in older adults receiving government-funded aged care services and whether progressive resistance plus balance training could positively influence change. DESIGN: Intervention study. SETTING: Community-based older adult-specific exercise clinic. PARTICIPANTS: Older adults (N=245) with complex care needs who were receiving government-funded aged care support. INTERVENTIONS: Twenty-four weeks of twice weekly progressive resistance plus balance training carried out under the supervision of accredited exercise physiologists. MAIN OUTCOME MEASURES: The primary measure was the Activity-specific Balance Confidence Scale. Secondary measures included the Short Physical Performance Battery; fall history gathered as part of the health history questionnaire; hierarchical timed balance tests; Geriatric Anxiety Index; Geriatric Depression Scale; Fatigue, Resistance, Ambulation, Illness, Loss of Weight scale; and EuroQoL-5 dimension 3 level. RESULTS: At baseline, better physical performance (r=.54; P<.01) and quality of life (r=.52; P<.01) predicted better balance confidence. In contrast, at baseline, higher levels of frailty predicted worse balance confidence (r=-.55; P<.01). Change in balance confidence after the exercise intervention was accompanied by improved physical performance (+12%) and reduced frailty (-11%). Baseline balance confidence was identified as the most consistent negative predictor of change scores across the intervention. CONCLUSIONS: This study shows that reduced physical performance and quality of life and increased frailty are predictive of worse balance confidence in older adults with aged care needs. However, when a targeted intervention of resistance and balance exercise is implemented that reduces frailty and improves physical performance, balance confidence will also improve. Given the influence of balance confidence on a raft of well-being determinants, including the capacity for positive physical and cognitive change, this study offers important insight to those looking to reduce falls in older adults.

Do you use social media? A study into new nursing and midwifery graduates' uptake of social media.

Social media use is expanding rapidly, so too is its use within hospitals and amongst healthcare professionals. This study describes the use of social media by Australian and New Zealand nursing and midwifery graduates of the Graduate e-Cohort study; there were 112 (93%) respondents from a 2014 sample of 121 nurses and midwives. Findings suggest that the professional peak body goal of using social media as a vehicle for professional education requires consideration of the social media platforms that are actually being used by new graduates. We recommend that work by the respective professions at both an undergraduate and graduate level needs to focus on the implications of social media use or policy and practice to ensure that everyone is aware of when and how to engage in social media platforms and what to do and how to behave when using social media.

Experiences of Australian and New Zealand new nursing and midwifery graduates looking for employment.

The aim of this research is to describe the experiences of Australian and New Zealand nursing and midwifery students looking for employment after graduation. This qualitative study draws from 2008, 2009 and 2010 responses provided by 197 recently graduated Australian and New Zealand nurses and midwives to, Describe your experiences gaining employment as a nurse or midwife after graduation. Two themes were inductively derived, Taking what you can get and I had a job lined up. Within the taking what you can get theme, respondents efforts to gain employment as a nurse or midwife after graduation were challenged by limited choices round the type of clinical practice available and/or job insecurity. In contrast, for respondents in the I had a job lined up theme, employment after graduation was linked to job offers during student's clinical placements and/or hospitals where they completed their final practicum. Understanding and better facilitating the transition of new nurse/midwife graduates to healthcare institutions are vitally important to sustaining the nursing workforce.

Exploring factors affecting registered nurses' pursuit of postgraduate education in Australia.

The aim of this study was to explore the factors influencing registered nurses' pursuit of postgraduate education in specialty nursing practice in Australia. Despite the increased requirement for postgraduate education for advanced practice, little has been reported on the contributory factors involved in the decision to undertake further education. The Nurses' Attitudes Towards Postgraduate Education instrument was administered to 1632 registered nurses from the Nurses and Midwives e-Cohort Study across Australia, with a response rate of 35.9% (n = 568). Data reduction techniques using principal component analysis with varimax rotation were used. The analysis identified a three-factor solution for 14 items, accounting for 52.5% of the variance of the scale: "facilitators," "professional recognition," and "inhibiting factors." Facilitators of postgraduate education accounted for 28.5% of the variance, including: (i) improves knowledge; (ii) increases nurses' confidence in clinical decision-making; (iii) enhances nurses' careers; (iv) improves critical thinking; (v) improves nurses' clinical skill; and (vi) increased job satisfaction. This new instrument has potential clinical and research applications to support registered nurses' pursuit of postgraduate education.

'Why nurses are leaving the profession lack of support from managers': What nurses from an e-cohort study said.

The shortage of nurses is known. We explored nurses' reasons for leaving the profession based on responses from an e-newsletter of the Nurses and Midwives e-cohort Study. Qualitative content analysis of data from email responses (n = 66) showed 'Lack of support' as a social work value describing their manager's lack of support, unsupportive relationships within their work group, and a health-care system putting business principles before care resulting in job dissatisfaction and nurse turnover. These findings are examples of a 'complex'/'wicked' problem and as such will resist simple solutions to the presenting issues. The dialogic process such as Open Space Technology and Talking Circles should be considered as potentially suitable to the needs of nurses.

"The pure hard slog that nursing is . . .": a qualitative analysis of nursing work.

PURPOSE: To explore nurses' perceptions of the nature of nursing work as a factor that contributes to attrition from the profession. DESIGN: A nonpurposive sample of nurses from the Nurses and Midwives e-cohort Study in Australia, New Zealand, and the United Kingdom provided electronic responses about reasons for leaving the profession. Data were then subjected to qualitative content analysis. FINDINGS: Nurses at the "coal face," that is, those who actually do the work of nursing, in real working conditions, express dissatisfaction in relation to hygiene factors relating to the nature of nursing work and attribute these to nurses leaving the profession: workload, shift work, violence, and financial remuneration. CONCLUSIONS: Nurses' satisfaction with work and motivation to work are being sorely tested. There is manifest tension between the core concepts of nursing-compassion and care-and a system of work that actively precludes nurses from being able to exhibit these virtues and fails to reward them. Workload, shift work, violence, and financial remuneration are drivers of attrition and need to be addressed. CLINICAL RELEVANCE: Implications from this study are fourfold: determination of nursing workload, mitigating the impact of shift work, providing safe work environments, and adequate financial remuneration.

Qualitative understanding of an international learning experience: what Australian undergraduate nurses and midwives said about a Cambodia placement?

The aim of this study is to report the experiences of three groups of Australian undergraduate nursing and midwifery students undertaking an international learning experience in Cambodia. Relying on an interpretative research design using qualitative content analysis, data were drawn from a sub-group of undergraduate third-year bachelor and dual degree nursing/midwifery students at a Queensland university, Australia. Students from a clinical placement in Siem Reap, Cambodia for a 4-week period in the January of 2010-2012 completed a formal expression of interest, and at three time intervals a questionnaire comprising open-ended questions. The evaluation by the undergraduate nursing/midwifery students of the clinical experience in Cambodia is understood through two core themes: global citizen/better citizen, personal/professional development. The findings have implications for university curriculum developers interested in the internationalization of nursing and midwifery programmes to ensure students are well equipped to practice in diverse multicultural and global health systems.

Moral distress in nursing: contributing factors, outcomes and interventions.

Moral distress has been widely reviewed across many care contexts and among a range of disciplines. Interest in this area has produced a plethora of studies, commentary and critique. An overview of the literature around moral distress reveals a commonality about factors contributing to moral distress, the attendant outcomes of this distress and a core set of interventions recommended to address these. Interventions at both personal and organizational levels have been proposed. The relevance of this overview resides in the implications moral distress has on the nurse and the nursing workforce: particularly in regard to quality of care, diminished workplace satisfaction and physical health of staff and increased problems with staff retention.

What makes a healthier nurse, workplace or leisure physical activity? Informed by the Australian and New Zealand e-Cohort Study.

AIM AND OBJECTIVE: To investigate health differences between nurses who report meeting the daily physical activity recommendations in or away from the workplace. BACKGROUND: Adhering to the national physical activity recommendations has known health benefits. Whilst often considered a workplace active profession, data are emerging of poor health amongst nurses. However, health differences between workplace or leisure-time physically active nurses are understudied. DESIGN: The investigation is an observation study of Australian and New Zealand nurses. Data were generated from the longitudinal, population-based, observational e-Cohort nursing survey. METHODS: Data were informed and groups defined by the self-reported minutes per day of moderate physical activity collected from a large international survey of practicing nurses (n = 2264). Groups were: Group (G) 1--high workplace (≥30 minutes/day)/high leisure (≥30 minutes/day), G2--high workplace/low leisure (<30 minutes/day), G3--low workplace/low leisure (<30 minutes/day) and G4--low workplace/high leisure. RESULTS: G2 had a high BMI and were younger than G4. G4 were significantly more active away from work and more likely to report cycling to work than G2. In contrast, G2 were most likely to have taken sick days because of their health (χ(2) = 19·101), have difficulty sleeping most of the time and have a medical history of diagnosed anxiety and depression. CONCLUSIONS: This study shows that improved well-being can be achieved in nursing cohort through leisure-time physical activity. RELEVANCE TO CLINICAL PRACTICE: This research shows that nurse should consider leisure-time physical activity necessary to maintain and prolong health and that workplace activity is not a sufficient stimulus. This has important implications for workforce planners and administrators.

The experience of lying in dementia care: a qualitative study.

This analysis examines the practice of care providers in residential aged care lying to residents with dementia. Qualitative data were collected through multiple methods. Data here represents perceptions from registered and enrolled nurses, personal care assistants, and allied health professionals from five residential aged care facilities located in Queensland, Australia. Care providers in residential aged care facilities (RACFs) lie to residents with dementia. Lying is conceptualized as therapeutic whereby the care provider's intent is to eliminate harm and also control behaviour. Care providers of residents with dementia in RACFs need guidance around lying. An ethical framework cognisant of an ethical theory of good and ethical theory of right supplemented by a theory of virtue is proposed. A complimentary four stage communication strategy that promotes truth telling as a first option while also recommending the lie as a suitable strategy is also promoted.

Challenges and Feasibility of Co-Design Methods for Improving Parent Information in Maternity Care.

This study explored the feasibility of using experience-based co-design methods (EBCD), based on participatory action principles, to improve service delivery regarding parent information needs within a metropolitan postnatal maternity unit. Data were collected from January 2018 to March 2019 from parents and staff using surveys, video interviews, a focus group and ward observations of episodes where parents were provided information. Participants included postnatal mothers who had recently given birth, their partners and hospital staff. Survey results (n = 31) were positive regarding content and satisfaction with information delivery. Data from the staff focus group (seven participants) and in-depth video interviews with mothers (n = 4) identified common themes, including challenges to information delivery due to time pressures, the value of breastfeeding advice and environmental influences. Overall, parents were satisfied with the information delivered; however, inconsistencies were present, with time pressures and other environmental factors reported as influencing the process. Staff and parents both identified the amount of content being delivered in such a short time frame as a major challenge and tailoring information was difficult due to individual experiences and circumstances. Additional resources or alternative methods are suggested for conducting future studies to capture patient experience within a similar busy hospital setting.

Effects of mobile mindfulness on emergency department work stress: A randomised controlled trial.

OBJECTIVE: High-occupational stress among ED staff has a detrimental impact on both staff wellness and patient care. The objective of the study is to determine whether 4 weeks of smartphone app-guided mindfulness practice reduces stress levels of ED staff. METHODS: This two-arm randomised controlled trial was conducted in two Australian EDs in 2019-2020. Eligible participants were randomly assigned (1:1) to either an App group or a Wait to Treat group to practice daily 10 min app-guided mindfulness for 4 weeks. Online surveys were collected for both groups at three time periods: before (T1), immediately after (T2) and 3 months after cessation (T3). Then the Wait to Treat group received the same intervention, followed by surveys immediately after the intervention (T4) and 3 months later (T5). Primary outcome was measured using the Perceived Stress Scale. Secondary outcomes were measured using the Maslach Burnout Inventory (three subscales: emotional exhaustion, depersonalisation and personal accomplishment), Mindfulness Attention Awareness Scale and Warwick-Edinburgh Mental Well-being Scale. Both intention-to-treat and per-protocol analysis were performed. Repeated measurement data were analysed by the linear mixed model. RESULTS: Of 148 enrolled participants 98 completed all the surveys, but only half (48%) reported continuous use of the app. Based on the results of the intention-to-treat analysis, there was a statistically significant improvement of perceived stress levels (F = 15.70, P < 0.001), all three components of burnout (emotional exhaustion [F = 14.22, P < 0.001], depersonalisation [F = 3.62, P = 0.030], personal accomplishment [F = 7.51, P < 0.001]), mindfulness (F = 8.83, P < 0.001) and wellbeing levels (F = 10.71, P < 0.001) from pre-intervention to 3 months later with small effect sizes. CONCLUSION: Results of the present study demonstrate that brief mindfulness training via innovative digital technology had a small positive effect in improving emergency staff stress, burnout, mindfulness and wellbeing.

Effectiveness of social activity interventions for improving sleep among older people: a systematic review protocol.

OBJECTIVE: The objective of this review is to evaluate the effectiveness of social activity interventions for improving sleep among older people. INTRODUCTION: Sleep is one of the most important functions for humans because it assists in maintaining health. Sleep disturbance is common in older people. Social activity has shown to be associated with better sleep in the older population; however, the effectiveness of these interventions is unclear. INCLUSION CRITERIA: This review will consider studies that include people aged 60 years or older. Any type of social activity intervention will be included. Outcomes will include both objective (eg, sleep time) and subjective sleep measures (eg, subjective sleep satisfaction). This review will consider both experimental and quasi-experimental study designs. METHODS: MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, Cochrane Library, and Ichushi web will be searched for eligible studies. Sources of unpublished studies and gray literature to be searched include OpenGrey and ProQuest Dissertations and Theses. Studies published in any language will be considered. No date filter will be applied. Titles and abstracts will be screened by two independent reviewers who will then assess the full text of selected citations against the inclusion criteria. Eligible studies will be critically appraised by the reviewers using the JBI critical appraisal instruments. Where possible, studies will be pooled using meta-analysis. Where statistical pooling is not possible, the findings will be presented in narrative form. The degree of certainty of the evidence on sleep outcomes will be assessed using the GRADE approach. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPEPO CRD42022315454.