Malnutrition Prevalence in Australian Residential Aged Care Facilities: A Cross-Sectional Study.

Long-term or residential services are designed to support older people who experience challenges to their physical and mental health. These services play an important role in the health and well-being of older adults who are more susceptible to problems such as malnutrition. Estimates of the significance of malnutrition require up-to-date prevalence data to inform government strategies and regulation, but these data are not currently available in Australia. The aim of this study was to collect malnutrition prevalence data on a large sample of people living in residential aged care facilities in Australia. A secondary aim was to examine the relationship between malnutrition and anthropometry (body mass index (BMI) and weight loss). This prevalence study utilised baseline data collected as part of a longitudinal study of malnutrition in 10 Residential Aged Care facilities across three states in Australia (New South Wales, South Australia, and Queensland). The malnutrition status of eligible residents was assessed by dietitians and trained student dietitians using the Subjective Global Assessment (SGA) with residents categorised into SGA-A = well nourished, SGA-B = mildly/moderately malnourished, and SGA-C = severely malnourished. Other data were extracted from the electronic record. Of the 833 listed residents, 711 residents were eligible and had sufficient data to be included in the analysis. Residents were predominantly female (63%) with a mean (SD) age of 84 (8.36) years and a mean (SD) BMI of 26.74 (6.59) kg/m2. A total of 40% of residents were categorised as malnourished with 34% (n = 241) categorised as SGA-B, and 6% (n = 42) SGA-C. Compared to the SGA, BMI and weight loss categorisation of malnutrition demonstrated low sensitivity and high specificity. These findings provide recent, valid data on malnutrition prevalence and highlight the limitations of current Australian practices that rely on anthropometric measures that under-detect malnutrition. There is an urgent need to implement a feasible aged care resident screening program to address the highly prevalent condition of malnutrition in Australia.

A systematic review of online team based learning approaches in health professional education.

AIMS AND OBJECTIVES: The purpose of this study was to systematically review studies related to the use of online Team Based Learning (TBL) platforms with a focus on health professional education. The objectives were to identify best practices, highlight what technological platforms are effective for TBL processes and evaluate educational outcomes in terms of student experience, learning and preference. DESIGN: A systematic review of published TBL research was undertaken between August and October 2021 and supplemented in September 2022. DATA SOURCES: ERIC, PsycINFO, Scopus, Embase, Medline, and Cinahl databases were used. The keywords were identified from researchers' knowledge and PICO/PICo framework. REVIEW METHODS: Titles and abstracts were screened individually by two reviewers for eligibility. Data extraction was undertaken by two researchers independently and checked for consistency by discussion between the two. Articles were appraised using the Mixed Methods Appraisal Tool (MMAT). RESULTS: Out of 656 articles 14 were involved in the final review. All others were rejected due to duplication, ineligibility, or poor quality. The studies were from a range of countries and focussed on a range of health professionals including nursing. Inconsistencies in approaches for TBL, platforms used and mixed results in terms of outcomes were noted. There was no real consensus other than that TBL was equally as effective if carried out online or face-to-face, with no clear differences to outcomes related to satisfaction in online or traditional TBL approaches. CONCLUSIONS: It is recommended that further research is carried out into the outcomes of TBL on learning and experiences of students in health professional courses. The development and appraisal of integrated TBL platforms should be invested in and infrastructure and resources are put in place to support this.

Dietetics student contribution to addressing malnutrition in residential aged care facilities.

AIMS: To test a model of malnutrition screening and assessment conducted by dietetics students on placement in residential aged care facilities. The secondary aim was to identify possible facilitators and barriers to the implementation of the model. METHOD: The type 1 hybrid effectiveness-implementation trial study design and reporting outcomes were developed using the Consolidated Framework for Implementation Research. An innovative placement model was developed, where students on voluntary placement visited three residential aged care facilities to identify residents at risk of malnutrition using currently available screening tools for older people. Students completed malnutrition assessments for all residents using the subjective global assessment tool. RESULTS: Thirty-two students participated; 31 completed all three sessions, with malnutrition screening completed for 207 residents and malnutrition assessment for 187 residents (July and September 2022). Based on the subjective global assessment, 31% (n = 57) of residents were mildly/moderately malnourished, and 3% (n = 5) were severely malnourished. The Innovation Domain of the Framework was the most important consideration before implementation. CONCLUSION: Whilst previous research documented student learning opportunities in residential aged care facilities, this study provides the first available evidence of the direct contribution students can make to the health of aged care residents through malnutrition screening and assessment. The model enables students to conduct malnutrition screening and assessment feasibly and efficiently in facilities that do not routinely collate and act on these data. With a limited nursing aged care workforce to undertake this vital task, the potential role of student dietitians to fulfil this role must be considered.

Shame, Suffering, and Believing in the Family: The Experiences of Grandmothers of a Grandchild With a Developmental Delay or Disability in the Context of Chinese Culture.

Grandparents are primary resources of caregiving support for parents worldwide, regardless of the cultural background. In Chinese societies, grandmothers often fill the role of supportive caregiver. However, a knowledge gap in the literature exists about how Chinese culture influences caregiving for grandmothers of grandchildren with a disability, particularly in Taiwan. This phenomenological study explored the lived experience of grandmothers caring for a grandchild with a developmental delay or disability in the context of Chinese culture. Twenty-five grandmothers were interviewed. When grandmothers learned of their grandchild's disability, they experienced suffering, which was compounded by the stigma attached to persons with a disability in Chinese cultures, and they also experienced shame and fear of social rejection. Grandmothers' belief in the importance of family gave meaning to their suffering and prompted them to find new ways to deal with everyday difficulties. These findings can guide nurses and health care professionals responsible for supporting grandmothers caring for a child with a disability in the context of Chinese culture.

Volunteers motivations and involvement in dementia care in hospitals, aged care and resident homes: An integrative review.

OBJECTIVE: To review the current literature related to the role of volunteers in dementia care in hospitals, aged care and resident homes. DESIGN: Integrative review method was used to identify and analyse current literature. METHOD: Data extracted included; author, methodology, sample, aims, data collection and analysis, findings, limitations, and comments. The Mixed Methods Appraisal Tool (MMAT) version 2011, was used to appraise the quality of the final articles. DATA SOURCES: Databases searched included CINAHL, Medline, ProQuest Central and PubMed. Keywords and MeSH terms: dementia, cognitive impairment, Alzheimer's disease, volunteers, volunteering, voluntary workers, hospital, acute care, aged care, residents. RESULTS: 14 articles reviewed, and three major themes revealed: volunteer motivation, volunteer involvement, and understanding roles. Recommendations to assist with future volunteer programs in dementia care are presented. CONCLUSION: Volunteer programs are beneficial to patients, family, volunteers, health care, and staff. Research of volunteers' needs, motivations and role required, aiming to improve support and training.

The impact of early-stage dementia on community-dwelling care recipient/carer dyads' capacity to self-manage.

AIMS AND OBJECTIVES: To explore the impact of early-stage dementia on care recipient/carer dyads' confidence or belief in their capacity to manage the behavioural and functional changes associated with dementia and to access appropriate support networks. BACKGROUND: Living with dementia has predominantly been explored from the carer perspective and focused on the stress and burden of supporting a person with dementia. There has been a shift towards a more positive discourse to accommodate the role of self-efficacy in supporting self-management by people living with dementia. However, little has been reported on the dyadic experience of self-efficacy in managing life with dementia. DESIGN: A qualitative study using an interpretive descriptive approach. Semi-structured interviews were conducted with 13 dyads in the early stages of dementia. The collected data underwent a process of thematic analysis. The study followed the COnsolidated criteria for REporting Qualitative research (COREQ) checklist. RESULTS: Dyadic adjustment to dementia was dynamic, involving shifts between loss and adaptation. Threats to self-efficacy, declining autonomy and stigma, were significant causes of concern for both members of the dyad. Dyadic self-efficacy was demonstrated through recognition of and adaptation to dementia-related changes and development of coping strategies to integrate impairment into everyday life. CONCLUSIONS: Solution-focused approaches that improve knowledge and skills enable the dyad to adjust. The considerable impact of stigma on self-efficacy indicates that supportive disclosure strategies developed in mental health may also have a role to play in dementia interventions. RELEVANCE TO CLINICAL PRACTICE: Nurses play a significant role in advising and supporting care recipient/carer dyads with dementia, and a better understanding of the dyadic perspective provides them with essential information to support self-management. A proactive approach including information and support, offered at the beginning of the condition/care trajectory, may have the potential to delay progression into more dependent stages.

The impact of early psychosocial intervention on self-efficacy of care recipient/carer dyads living with early-stage dementia-A mixed-methods study.

AIM: To evaluate the effect of a targeted community-based psychosocial intervention on self-efficacy outcomes for care recipient/carer dyads living with early-stage dementia. BACKGROUND: There is increasing interest in the role of self-efficacy and self-management structures in determining positive outcomes for people with dementia. The assumption is that care recipient/carer dyads who receive early support to identify and adjust to dementia-related changes will cope better in the long term. DESIGN: An explanatory sequential mixed-method design was employed. Primarily quantitative with qualitative data providing a supportive secondary role to expand on and illuminate the quantitative findings. METHODS: Eighty-eight dyads were recruited and allocated on a regional basis to an intervention or control group. Intervention group dyads received the Early Diagnosis Dyadic Intervention. Control group dyads received two information manuals. Quantitative data were collected at three time points. Qualitative data were collected via evaluation questionnaires and semistructured interviews. RESULTS: Intervention structure, content, and delivery were acceptable to the dyads but few quantitative self-efficacy findings reached statistical significance. Improvements in self-efficacy were evident in the postintervention evaluation qualitative responses where dyads expressed greater confidence in identifying and accessing community support. CONCLUSION: There is an urgent need for effective psychosocial interventions to help reduce the impact of dementia symptoms on patients, carers, and society. This study makes an important contribution to our understanding of the capacity of psychosocial interventions to improve self-efficacy outcomes for care recipient/carer dyads with early-stage dementia while also illustrating the challenges associated with measuring self-efficacy in the early stages of the condition.

I-Kiribati nursing graduates experience of transition from university to residential aged care facilities in Australia.

OBJECTIVE: To explore the experience of international nursing graduates from Kiribati transitioning into practice in RACFs, upon completion of their bachelor of nursing degree in Australia. DESIGN: This study used an interpretive phenomenology design with two focus groups. A thematic analysis of the transcripts from the focus groups generated themes relating to the graduates personal journey through transition. SETTING: This study was conducted with graduates working in residential aged care facilities [RACF]. SUBJECTS: I-Kiribati nursing graduates (N=6) who have been practicing for 1year in RACF. RESULTS: The experience of transition for the I-Kiribati graduates related to challenges faced during this time. Three themes were developed from the analysis: being unsure of expectations, understanding responsibilities of practice, and stepping up to the RN role. The influence of culture was apparent within the three themes. CONCLUSION: Overall, the transition to RACFs for the participants was difficult; however, students described increased confidence to work through professional and cultural challenges. They became more reliant on their own knowledge and skills as they matured as practitioners. Recommendations for improving the transition experience include transitional support and educational workshops related specifically to working in RACF. Tailoring workshops to the specific needs of international graduate nurses would assist their transition in relation to cultural differences.

Community practitioner involvement in collaborative research.

This paper focuses on the benefits and limitations of collaborative research in community-based service settings explored through the implementation of a psychosocial intervention. The study aimed to establish the effectiveness of working with dementia dyads (person with dementia and family caregiver) in the early stages of dementia and to recruit and train an existing practitioner workforce to deliver a psychosocial intervention designed to assist dementia dyads to manage the consequences of dementia. Seven intervention staff participated in post-intervention semi-structured interviews. Whilst staff recruitment and retention proved challenging the degree to which staff demonstrated the required communication skills and competence was an important component in dyad acceptability of the intervention. Participatory factors, collaborative development, selective recruitment, focused training and ongoing specialist support, can assist the implementation of practice-based research. However, intervention staff participation and therefore intervention delivery can be hampered by workplace culture and workforce demands.

Experience of nurses caring for child with hematopoietic stem cell transplantation in general pediatric ward: a descriptive phenomenological approach.

BACKGROUND: Most studies on hematopoietic stem cell transplantation (HSCT) have focused on patients, survivors, or their family members, such as siblings and parents. Little attention has been paid to nurses caring for HSCT pediatric patients and in particular in a Taiwanese context. OBJECTIVE: The objective of this study was to explore nurses' lived experience caring for HSCT children in isolation within a general pediatric ward. METHOD: A Husserlian phenomenological approach informed the exploration of the meaning and essence of the nurses' caring experience. Data were collected using semistructured interviews. RESULTS: Twelve nurses were interviewed. Analysis of interviews yielded 3 main themes: being worried about ruining transplantation success, feeling loss of control in handling suffering, and reflecting upon the value of HSCT. CONCLUSIONS: Nurses felt the stress of caring for HSCT children because of the heavy workload and the pressure of responsibility. Witnessing the suffering of patients/families was particularly stressful. However, nurses were helped to overcome this stress by looking at the value and meaning of HSCT. IMPLICATIONS FOR PRACTICE: Nurses need practical support from nursing leaders in terms of carefully organizing patient care, controlling the nurse-to-patient ratio, and offering a safe work environment by providing systematic formal training on HSCT and receiving proper supervision. Understanding and learning are gained from nurses who are able to seek meaning from HSCT through appreciating every caregiving effort and through valuing how their nursing role contributes to the quality of patients' care.

The experiences of rural and remote families involved in an inter-hospital transfer to a tertiary ICU: a hermeneutic study.

BACKGROUND: Inter-hospital transfers are necessary for critically ill patients to improve their chance of survival. Rural and remote families experience significant disruption to family life when critically ill patients are required to undergo a transfer to a tertiary hospital. What is not known is how ICU staff can assist these families who are involved in an inter-hospital transfer to a tertiary ICU. PURPOSE: To gain an understanding of rural and remote critical care families' experiences during an inter-hospital transfer to a tertiary ICU. METHOD: A hermeneutic phenomenological approach was adopted informed by the philosophical world views of Heidegger and Gadamer. Data collection occurred by in-depth conversational interviews from a purposeful sample of seven family members. Interview transcripts, field notes and diary entries formed the text which underwent hermeneutic analysis. FINDINGS: Being confused, being engaged, being vulnerable and being resilient emerged as significant aspects of the rural and remote family members' experience during a transfer event. CONCLUSION: A better understanding of the experiences of rural and remote families during an inter-hospital transfer journey can inform the practice of ICU nurses. This study highlights the specific experiences of rural and remote families during an inter-hospital transfer journey to a tertiary ICU. It also informs nurses of the meaningful ways in which they can support these families with the uncertainty and chaos experienced as part of this journey.

Fathers of children with disabilities: encounters with health professionals in a Chinese context.

AIMS: The aim of this study was to examine the experiences of fathers of developmentally disabled children during interactions with health professionals in Taiwan. BACKGROUND: The role of Chinese fathers in raising a disabled child has been neglected because most studies on the impact of parenting a child with disabilities in this culture have primarily focused on mothers. DESIGN: A hermeneutic phenomenological approach was undertaken to recover and interpret fathers' experiences. METHOD: Sixteen fathers living with their disabled child (0-18 years old) were purposively recruited from a teaching hospital in central Taiwan. Data were collected using in-depth interviews and journal notes. All participants were interviewed twice. Interviews lasted from 50-100 minutes, and all were recorded. RESULTS: Three shared meanings were attributed to fathers' interactions with health professionals: (1) experiencing no supportive communication, (2) missing the critical time for disability management and (3) being excluded from medical decision making. CONCLUSIONS: Fathers in Taiwan commonly rely on health professionals to solve their child's health problems owing to their perceived power to cure and their professional authority in Chinese society. However, fathers felt powerless and hopeless when they received unclear information and incorrect diagnoses, which delayed appropriate treatment. Expressions of dissatisfaction and possessing a sense of futility were common experiences related to exclusion in a paternalistic healthcare system. RELEVANCE TO CLINICAL PRACTICE: Taiwanese clinicians' attitudes and parental-professional relationships challenge an exploration of ethics and standards of medical care shaped by Chinese culture. Ways of promoting parental inclusion in decision making and care, in particular father's inclusion, need to be explored. Recognition of the Chinese mother and father and their differing parental healthcare experiences are important to understand to ensure improvement in encounters with health professionals and the maximisation of positive health outcomes.

Being concerned: caregiving for Taiwanese mothers of a child with cerebral palsy.

AIMS AND OBJECTIVES: This article explores the Chinese social context and provides insight into Taiwanese mothers' challenging experiences when a disabled child is born into their families. BACKGROUND: International research indicates that barriers to maternal caregiving for a disabled child revolve around challenging relationships. Giving birth to a disabled child creates a huge challenge for mothers in Chinese society. DESIGN: Data were collected using in-depth interviews and journaling methods. A hermeneutic phenomenological approach, informed by the philosophical world views of Heidegger and Gadamer, provided theoretical guidance in revealing and interpreting mothers' experiences. METHOD: Interviews were carried out with a purposeful sample of 15 mothers who were primary caregivers for a child aged between 0-18 years who was diagnosed with cerebral palsy and used Mandarin or Taiwanese as their primary language. RESULTS: Shared meanings revealed four modes of being concerned: (1) experiencing burden as a sole primary caregiver; (2) managing the challenges by balancing demands; (3) being marginalised by others; and (4) encountering limited or no professional support. CONCLUSIONS: Taiwanese mothers face the strain of managing barriers to caregiving in contexts in which their children are not supported or acknowledged as being important contributors to family and Chinese society at large. This study highlights how the family can be important to caregiving mothers in traditional Chinese family life. Poor support and dynamics will emerge when family members regard disability as a loss of face or a stigma. RELEVANCE TO CLINICAL PRACTICE: By learning from Taiwanese mothers who accommodate barriers to caregiving on a daily basis, nurses can seize the impetus to explore ways of reconceptualising nursing practice with families and people with disabilities. The aim is to explore ways that will ultimately align intentions and caring processes and foster coping and positive reward in caring, thereby creating a context that is stress reducing and therapeutic.

Dementia and loneliness: an Australian perspective.

AIM: To explore the perceptions of loneliness according to people with early-stage dementia, living in community and long-term care and also the views of their family carers. BACKGROUND: Research that specifically explores the influence of loneliness on dementia is limited and indicates the prevalence of loneliness and the negative relationship between loneliness and cognitive decline. There is a paucity of research that explores loneliness from the perspective of the person with dementia. DESIGN: A descriptive exploratory qualitative approach was used. METHODS: Data were collected through semi-structured audio-taped interviews. A purposive sample of 70 people with a diagnosis or probable dementia and 73 family carers were recruited from community and long-term care from South East Queensland, Australia. RESULTS: Four themes were identified: staying connected to others; losing the ability to socially engage; experiencing loneliness; and overcoming loneliness. The results emphasise the importance of familiar human relationships in reducing the feelings of loneliness in people experiencing dementia. CONCLUSIONS: People with dementia are at risk of loneliness, but placing them with unfamiliar people and environments may not improve their situation. RELEVANCE TO CLINICAL PRACTICE: Better refinement of care that takes into account the potential for loneliness and an understanding of premorbid social tendency may assist in the implementation of individualised and evidence-based strategies to assist people with dementia to lead a better quality of life. To maintain well-being, the social needs of the person with dementia as well as the family need to be considered.

Why carers of frail older people are not using available respite services: an Australian study.

AIM: The purpose of this study was to explore the limiting and motivating factors that influence carers' use of respite services and the ability of currently available respite services to meet the needs of carers of frail older people. BACKGROUND: The development of community carer support services, their availability and usage and the common barriers that affect or impact on carers' use of community services in general and respite services in particular need to be examined to ensure they meet client needs. DESIGN: A qualitative descriptive approach informed by critical social theory was used to expose the inequities inherent in community services. METHODS: A qualitative examination of carer relationships with respite services was informed and guided by critical theory. Sixteen carers took part in four focus groups. A purposeful sampling strategy was adopted to engage with carers not currently using respite services. Study participants were recruited from a state-wide carer support organisation and a community service organisation in Queensland, Australia. RESULTS: Three themes emerged from the data: 'Commitment' characterised by reciprocity, role definition and role frustration, 'Needing Help' discussed in terms of trust, confidence in service, fear and resistance, and 'Support' discussed in relation to informal networking, misinformation and lack of knowledge. CONCLUSION: This study improves our understanding of the caring role, its significance in carer's lives and how this shapes their formal service expectations and use. The findings suggest that further investigation of the factors involved in carers' service expectations and service-seeking is warranted to develop a deeper understanding of how care giving influences the ways carers seek help from formal services. RELEVANCE TO CLINICAL PRACTICE: Service delivery changes towards a model of care, which engages and promotes user control and fosters genuine participatory relations between informal and professional carers may improve uptake of respite services.

Life stories and biography: a means of connecting family and staff to people with dementia.

AIMS: This article assesses the Family Biography Workshop (FBW) designed to support family and staff to co-construct the history of the person with dementia in residential care. BACKGROUND: Family-staff conflict in residential dementia care is a major stressor that disturbs effective relationships and contributes to stress. Biographical research has been found to improve communication and promote family-staff relations. Few studies focus on family biography as an approach that promotes positive relations that translate into inclusive care interactions. DESIGN: A qualitative descriptive approach was used to assess the influence of participation in the FBW and the impact of developing biographical knowledge on family-staff caregiver attitudes, perceptions of roles, conflict and the subsequent management of stress using participatory care practices. METHODS: The FBW process involved seven family caregivers, seven staff and one researcher working collaboratively through a series of six weekly two-hour sessions, designed to help them build a biography of the person with dementia. RESULTS: For family caregivers, reviving memories of their relatives as 'whole' persons enabled some to 'stand outside' and see beyond the disease-saturated context. For staff, 'opening possibilities' of 'seeing' the resident within the family context empowered them to engage in genuine participatory practices. Residents benefited from being connected as staffs''know how' in initiating and engaging developed. CONCLUSION: Future research will examine the effects of the FBW on the dynamics of family-staff roles and relationships. This research aims to reduce stress from role inadequacy, task burden, poor relationships and improve staff attitudes towards family participation. RELEVANCE TO CLINICAL PRACTICE: This study substantiated the FBW by revealing understanding of the meaning of biography work for family and relatives in care; providing effective support that empowered staff to confidently relate; and fostering engagement in inclusive care practices that encouraged residents' initiatives.

Cerebral palsy: experiences of mothers after learning their child's diagnosis.

AIM: This study is a report of a study describing mothers' experience of learning that their child has been diagnosed with cerebral palsy. BACKGROUND: Learning a child's diagnosis of disability is a crisis for parents. Their reactions include shock, refusal to accept the diagnosis, anger, fear, and uncertainty about the extent of disability and associated impairment. Knowledge about parental reactions is based on studies conducted in western countries, many of which do not apply to Taiwan where Confucianism strongly influences cultural perspectives of family and disability. METHOD: In this phenomenological study, data were collected in 2005-2006 using in-depth interviews and journaling with 15 Taiwanese mothers of children diagnosed with cerebral palsy. Hermeneutic analysis was undertaken of interview transcripts and journal notes. FINDINGS: Four shared meanings associated with learning of their child's diagnosis were revealed: feeling out of control and powerless, mistrusting healthcare professionals, release and confirmation, and feeling blamed for not following traditional practices. Mothers experienced a loss of their 'ideal' child when their child was diagnosed with cerebral palsy. Expectations of 'normal' motherhood and fulfilling societal anticipation of giving birth to a healthy child were lost. Maintaining their husband's family honour and prosperity, as well as saving face in their community were threatened. Mixed feelings of disbelief, rejection, self-blame and sadness were compounded by uncertainty about their child's future. CONCLUSION: To promote better understanding of the child's condition, emotional support and information should be provided to the mother and family, both when informing them of the diagnosis and in the period after diagnosis.

Seizing possibilities for positive family caregiving in nursing homes.

AIMS: This paper explores the ways family members reconstruct meaning through seizing possibilities for positive caregiving in nursing homes. BACKGROUND: The importance of the ability of family caregivers to adapt and accommodate has been well documented in international family caregiving research. Through engagement in caregiving activities, families learn to modify, adapt and accommodate to changes in their situation and relationships. The support family caregivers experience in learning to accommodate change is crucial in enabling them to reconstruct positive aspects of caregiving in a long-term aged care context. METHOD: In this study, a hermeneutic phenomenological approach was adopted informed by the philosophical world views of Heidegger and Gadamer. Data collected by in-depth interviews and participant observations, from a purposeful sample of 14 family caregivers, underwent hermeneutic analysis. RESULTS: Five shared meanings associated with seizing possibilities for positive caregiving were revealed: accommodating new and different ways of caring; feeling a part of the nursing home community; seeing the whole picture; learning to care in stress-reducing ways and learning to seize possibilities for self. CONCLUSION: This paper illustrates how families, through caregiving experience in nursing homes, learn to become active managers, negotiating, accommodating and redeveloping a sense of future viewed with hope, strength and positive anticipation. RELEVANCE TO CLINICAL PRACTICE: By highlighting what is attributed significance by families, a critical examination of the difficult issues which obstruct the development of meaningful partnerships among nurses, family and their relatives is facilitated. In particular, an examination of tensions at an ideological level supports the need for future research to focus its efforts on examining the ways of implementing nursing care that facilitates partnerships that incorporate and build upon positive and equal relations among staff, families and residents in the context of the nursing home setting.

Nurses' experiences of practice and political reform in long-term aged care in Australia: implications for the retention of nursing personnel.

AIM: The aim of the study was to explore registered nurses' experiences in long-term aged care in light of the political reform of aged care services in Australia. BACKGROUND: In Australia, the aged care industry has undergone a lengthy period of political and structural reform. Despite reviews into various aspects of these reforms, there has been little consideration of the effect these are having on the practice experiences and retention of nursing staff in long-term care. METHODS: In this critical hermeneutic study, 14 nurses from long-term care facilities in Australia were interviewed about their experiences during the reform period. RESULTS: The data revealed a sense of tension and conflict between nurses' traditional values, roles and responsibilities and those supported by the reforms. Nurses struggled to re-negotiate both their practice roles and values as the reforms were implemented and the system evolved. Nursing management support was an important aspect in mediating the effect of reforms on nursing staff. CONCLUSION: This research highlights both the tensions experienced by nurses in long-term aged care in Australia and the need to re-negotiate nursing roles, responsibilities and values within an evolving care system. This research supports a role for sensitive and proactive nursing management during periods of industry reform as a retention strategy for qualified nursing personnel.

Searching for value: the influence of policy and reform on nurses' sense of value in long-term aged care in Australia.

Contemporary literature on long-term aged care focuses heavily on issues associated with the recruitment and retention of nursing staff, such as job satisfaction and attitudes towards caring for older people. This paper aims to highlight one aspect of a larger study of registered nurses' experiences in long-term aged care in Australia and the influence that government policy and reform has in shaping that experience. This insight into aspects of nurses' everyday experience also contributes to a broader understanding of job satisfaction in long-term care. Findings from this study suggest that registered nurses experience tension in their search for value in their practice, which incorporates professional, political and social mediators of value and worth. These issues are discussed in relation to the impact of policy and reform on nurses' sense of value in long-term aged care and highlight the need for sensitive policy initiatives that support issues of value in nursing practice.