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.

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.

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.

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.

Predicting the progressive resistance and balance training response of community-dwelling older adults accessing aged care support services: A stepped-wedge randomised controlled trial.

OBJECTIVE: To quantify the variation in body composition, physical function and cognitive health changes resulting from the Muscling Up Against Disability (MUAD) resistance and balance training program and the potential for baseline characteristics to predict the magnitude of training-related response. METHODS: The study represented a secondary analysis of a stepped-wedge randomised controlled trial involving 245 community-dwelling adults receiving Australian Government-funded aged care services who performed 26 weeks of supervised progressive resistance and balance training (PRBT). The primary outcome was the proportion of response that described the number of individuals expected to make any positive change due to the intervention and not external factors. RESULTS: For all outcomes, the observed average change in the PRBT group was more favourable than the control. Analyses identified that most participants completing the PRBT program would be expected to respond positively to the intervention (86%-99%) with respect to their physical performance (SPPB summary, grip strength, chair stand and isometric knee strength). A smaller proportion completing the PRBT program group would be expected to respond positively in aspects of body composition (45%-60%) or cognitive function (44%-84%). The strongest predictors of positive change were baseline physical function, whereby those with the poorest baseline function experienced the greatest benefits. CONCLUSIONS: This study strongly supports the promotion of PRBT as a standard component of any care plan for community-dwelling older adults, especially those with low levels of physical function.

Measurement Development for Japanese Clients' Experiences during Adult Day Care Service Use (The J-AdaCa Tool).

Adult day care (ADC) is among the most common services in the Japanese long-term care context, but information on how such care is offered remains scarce. This study aimed to develop a measurement tool to assess the richness of clients' experiences regarding their ADC service use. Through a collaboration with ADC administrators and staff, semi-structured interviews were conducted with three ADC clients (in one ADC agency), and a questionnaire survey (17 items about clients' and their families' experiences within ADC) was applied to 360 ADC clients (in 11 ADC agencies). Principle component analysis showed four factors regarding experience of ADC use: "Social participation", "Hygiene and health", "Exercise and eating habits", and "Family support". These positive experiences might be effectively provided if stakeholders refer to clients' needs during ADC experiences, and their effective provision may relate to better care outcomes.

Validation of CARE-Q in residential aged-care: rating of importance of caring behaviours from an e-cohort sub-study.

AIM AND OBJECTIVE: To validate the Caring Assessment Report Evaluation Q-sort questionnaire in the residential aged-care setting. Based on this determination, to conclude with what degree of confidence the questionnaire can be used to determine the ranking of the importance of caring behaviours amongst aged-care nurses and residents in residential aged-care. BACKGROUND: Perceptions of caring may be context specific. Caring in residential aged-care may stand in contrast to the sense of caring understood and practiced in other settings. DESIGN: Self-administered survey. METHODS: Residents from three not-for-profit aged-care facilities, across both high-care (nursing-home) and low-care (hostel care) were surveyed relying on the Caring Assessment Report Evaluation Q-sort questionnaire. A sub-sample of registered and enrolled nurses working in residential aged-care and registered with the Nurses & Midwives e-cohort study completed the same survey. RESULTS: Although the Caring Assessment Report Evaluation Q-sort questionnaire showed good internal consistency for the sample of nurses, the results for the residents were more erratic. Both groups displayed large ranges for the inter-item correlations. The results of the Mann-Whitney U-test indicated that the nurses rated the Comforts, Anticipates and Trusting relationship as significantly more important than the residents. Both groups rated the Explains and facilitates subscale as least important. All subscales, however, received median scores greater than, or equal to, six (seven-point, Likert scale) indicating that all were considered important overall. CONCLUSION: Based on poor Cronbach's alpha coefficients, negative inter-item correlations and qualitative observations, without further development within the residential aged-care facility the free response format version of the Caring Assessment Report Evaluation Q-sort may not be an appropriate measure to use with residential aged-care residents. More research needs to be conducted into how residents and nurses are interpreting the items in the Caring Assessment Report Evaluation Q-sort. RELEVANCE TO CLINICAL PRACTICE: There will always remain a need for nurses to enact behaviours that are meaningful to residents (and patients generally).

Sarc-F and muscle function in community dwelling adults with aged care service needs: baseline and post-training relationship.

BACKGROUND: This study sought to better understand the psychometric properties of the SARC-F, by examining the baseline and training-related relationships between the five SARC-F items and objective measures of muscle function. Each of the five items of the SARC-F are scored from 0 to 2, with total score of four or more indicative of likely sarcopenia. METHODS: This manuscript describes a sub-study of a larger step-wedge, randomised controlled 24-week progressive resistance and balance training (PRBT) program trial for Australian community dwelling older adults accessing government supported aged care. Muscle function was assessed using handgrip strength, isometric knee extension, 5-time repeated chair stand and walking speed over 4 m. Associations within and between SARC-F categories and muscle function were assessed using multiple correspondence analysis (MCA) and multinomial regression, respectively. RESULTS: Significant associations were identified at baseline between SARC-F total score and measures of lower-body muscle function (r =  - 0.62 to 0.57; p ≤ 0.002) in 245 older adults. MCA analysis indicated the first three dimensions of the SARC-F data explained 48.5% of the cumulative variance. The initial dimension represented overall sarcopenia diagnosis, Dimension 2 the ability to displace the body vertically, and Dimension 3 walking ability and falls status. The majority of the 168 older adults who completed the PRBT program reported no change in their SARC-F diagnosis or individual item scores (56.5-79.2%). However, significant associations were obtained between training-related changes in SARC-F total and item scores and changes in walking speed and chair stand test performance (r =  - 0.30 to 0.33; p < 0.001 and relative risk ratio = 0.40-2.24; p < 0.05, respectively). MCA analysis of the change score data indicated that the first two dimensions explained 32.2% of the cumulative variance, with these dimensions representing whether a change occurred and the direction of change, respectively. DISCUSSION: The results advance our comprehension of the psychometric properties on the SARC-F, particularly its potential use in assessing changes in muscle function. Older adults' perception of their baseline and training-related changes in their function, as self-reported by the SARC-F, closely matched objectively measured muscle function tests. This is important as there may be a lack of concordance between self-reported and clinician-measured assessments of older adults' muscle function. However, the SARC-F has a relative lack of sensitivity to detecting training-related changes, even over a period of 24 weeks. CONCLUSIONS: Results of this study may provide clinicians and researchers a greater understanding of how they may use the SARC-F and its potential limitations. Future studies may wish to further examine the SARC-F's sensitivity of change, perhaps by adding a few additional items or an additional category of performance to each item.

The built environment and older adults: A literature review and an applied approach to engaging older adults in built environment improvements for health.

AIMS AND OBJECTIVES: This paper presents a review of the literature about the built environment as it impacts the health of older people. It then introduces the gerontological nurse and researcher to the Our Voice framework for engaging older people as citizen scientists in order to empower them as agents of change in improving their local built environment and ultimately advancing community health. BACKGROUND: Community-level strategies to promote successful ageing in place are critical both to optimising health outcomes and containing healthcare costs. Such strategies must take into account the influence of the built environment both on individual health behaviours and on overall community health. At the same time, the perspectives and experiences of older people themselves ought to inform policies and practices in a systematic way. DESIGN: Integrative literature review. METHOD: A wide scan of English language articles published in the EMBASE, PubMed and CINAHL bibliographic databases was conducted. Additional articles were sourced by mining relevant reference lists (i.e., snowball sampling). Papers included were published between 2005 and 2016. RESULTS: Three distinct components emerged from the review: the impact of the built environment on health-in particular the health of older persons; citizen science and its applicability for older people research; and the promise of the Our Voice citizen science framework to activate changes in the built environment that improve older peoples' health. CONCLUSION: The ageing of the world's population brings with it an increased population-level risk of chronic disease and disability. We present the Our Voice framework, developed by researchers at Stanford University, as a promising strategy for engaging and empowering older people as citizen scientists, as a framework to apply to gerontological nursing and improving community health. IMPLICATIONS FOR PRACTICE: Gerontology nurses are encouraged to: (i) Recognise the impact of the built environment and other community-level factors on the health of their patients. (ii) Encourage older adults to take an active role in documenting features of their environments that promote or hinder healthy living. (iii) Support policies and programmes that promote healthy environments.

Older Adults Using Our Voice Citizen Science to Create Change in Their Neighborhood Environment.

Physical activity, primarily comprised of walking in older adults, confers benefits for psychological health and mental well-being, functional status outcomes and social outcomes. In many communities, however, access to physical activity opportunities are limited, especially for older adults. This exploratory study engaged a small sample (N = 8) of adults aged 65 or older as citizen scientists to assess and then work to improve their communities. Using a uniquely designed mobile application (the Stanford Healthy Neighborhood Discovery Tool), participants recorded a total of 83 geocoded photos and audio narratives of physical environment features that served to help or hinder physical activity in and around their community center. In a facilitated process the citizen scientists then discussed, coded and synthesized their data. The citizen scientists then leveraged their findings to advocate with local decision-makers for specific community improvements to promote physical activity. These changes focused on: parks/playgrounds, footpaths, and traffic related safety/parking. Project results suggest that the Our Voice approach can be an effective strategy for the global goals of advancing rights and increasing self-determination among older adults.

Stepping across the line: information sharing, truth telling, and the role of the personal carer in the Australian nursing home.

The author draws on an Australian study using multiple qualitative methods to investigate truth telling in aged care. Thematic analysis of data from five nursing homes involving 23 personal care assistants revealed participants' role understanding as influencing their perceptions about truth telling in practice. Five themes emerged: role as the happy comfort carer, division of labor, division of disclosure, role tension and frustration, and managing the division of disclosure. Role emphasis on comfort and happiness and a dominant perception that telling the truth can cause harm mean that disclosure will be withheld, edited, or partial. Participants'role understanding divides labor and disclosure responsibility between the personal carer and registered nurse. Personal carers' strategies for managing the division of disclosure include game playing, obfuscation, lying (denial), and the use of nonverbals. These perceptions about personal carer role, information sharing, and truth telling are paramount for understanding and improving nursing home eldercare.

Canadian Nurses' Perspectives on Prostate Cancer Support Groups: A Survey Study.

BACKGROUND: Prostate cancer support groups (PCSGs) are community-based organizations that offer information and psychosocial support to men who experience prostate cancer and their families. Nurses are well positioned to refer men to a range of psychosocial resources to help them adjust to prostate cancer; however, little is known about nurses' perspectives on PCSGs. OBJECTIVE: The aim of this study was to describe nurses' views about PCSGs as a means to making recommendations for advancing the effectiveness of PCSGs. METHODS: A convenience sample of 101 Canadian nurses completed a 43-item Likert-scale questionnaire with the additional option of providing comments in response to an open-ended question. Univariate descriptive statistics and content analysis were used to analyze the quantitative and qualitative data, respectively. RESULTS: Participants held positive views about the roles and potential impact of PCSGs. Participants strongly endorsed the benefits of support groups in disseminating information and providing support to help decrease patient anxiety. Online support groups were endorsed as a practical alternative for men who are reluctant to participate in face-to-face groups. CONCLUSIONS: Findings suggest that nurses support the value of Canadian face-to-face and online PCSGs. This is important, given that nurses can help connect individual patients to community-based sources providing psychosocial support. IMPLICATIONS FOR PRACTICE: Many men benefit from participating in PCSGs. Aside from positively endorsing the work of PCSGs, nurses are important partners for raising awareness of these groups among potential attendees and can directly contribute to information sharing in face-to-face and online PCSGs.

Part II. rigour in qualitative research: complexities and solutions.

Anthony G Tuckett outlines the strategies and operational techniques he used to attain rigour in a qualitative research study through relying on Guba and Lincoln's trustworthiness criterion. Research strategies such as use of personal journals, audio recording and transcript auditing, and operational techniques including triangulation strategies and peer review, are examined.

Applying thematic analysis theory to practice: a researcher's experience.

This article describes an experience of thematic analysis. In order to answer the question 'What does analysis look like in practice?' it describes in brief how the methodology of grounded theory, the epistemology of social constructionism, and the theoretical stance of symbolic interactionism inform analysis. Additionally, analysis is examined by evidencing the systematic processes--here termed organising, coding, writing, theorising, and reading--that led the researcher to develop a final thematic schema.

What carers and family said about music therapy on behaviours of older people with dementia in residential aged care.

AIM: This study sought to evaluate the effectiveness of group music therapy (MT) intervention on behaviours of older people with dementia. METHOD: Reported here are qualitative data from five, semi-structured focus groups; two comprising a total of seven family members and three comprising a total of 23 staff members. RESULTS: A number of core themes emerged: temporality, effect and policy with a number of subthemes. The MT effect is tempered by the temporality of (i) the older person's dementia state, (ii) the session and (iii) the psychosomatic effect on the older person. Music therapy is perceived to (i) evoke memories and facilitate reminiscence, (ii) act as a diversion (has an instrumental value) and it is contentious to discount the (iii) dichotomy between music and therapist in terms of the overall effect. Finally, policymakers need to know that MT is (i) highly prized and more, not less, MT is recommended. CONCLUSION: Findings from this study illustrate that the timing of the MT session has consequences for the workflow in the residential aged care facility; MT has a psychosomatic effect and participants here evaluate this as temporal. Care providers and family members acknowledge the instrumental value of MT and its helping with cognition and exercise. They have mixed views about the effects of the music and the effect on the older person by the therapist but most definitely want policymakers to ensure more, not less, planned and better funded MT is part of ongoing care in the residential aged care context. Areas for future research and policy are also highlighted. IMPLICATIONS FOR PRACTICE: These views on group MT in residential aged care can initiate critical reflection on current practices and systems. Research is needed exploring the timing and scheduling of MT sessions at different times in the day for older person with dementia exhibiting negative behaviours.

Qualitative research sampling: the very real complexities.

In this article Anthony Tuckett discusses the complexities of qualitative research sampling. He analyses a research experience, together with the rationales for and limitations of qualitative research sampling. Further, he examines the reality of establishing and maintaining a purposeful/theoretical sample and how data saturation symbiotically interacts with constant comparison to guide sampling. Additionally sample limitations are countered. This paper is aimed at novice and experienced researchers in nursing interested in the practical reality of research, who are also mindful of the necessity for rigour.

Collecting qualitative data: Part II. Group discussion as a method: experience, rationale and limitations [corrected].

This article discusses the experience, rationale for and limitations of the group discussion as a method for collecting qualitative data. The researcher defines the group discussion as a focused group depth discussion' premised on a review of the focus group literature. A number of strengths are proposed for and the limitations are countered in the use of the group discussion as a method for collecting qualitative data.

Collecting qualitative data: part I: Journal as a method: experience, rationale and limitations.

This article discusses the experience, rationale for and limitations of the journal, namely--research participant's personal journal and the researcher's field journal as a method for collecting qualitative data. Numerous strengths are proposed for and limitations are countered in the use of the journal as a method. This methods paper is aimed at nursing academics, authors and nursing students interested in the practical reality of research but who are also mindful of the necessity for rigour. A second paper will discuss the experience, rationale for and limitations of the group discussion as a suitable method for collecting qualitative data.