A mixed-methods study on the pharmacological management of pain in Australian and Japanese nursing homes.

BACKGROUND: Understanding how analgesics are used in different countries can inform initiatives to improve the pharmacological management of pain in nursing homes. AIMS: To compare patterns of analgesic use among Australian and Japanese nursing home residents; and explore Australian and Japanese healthcare professionals' perspectives on analgesic use. METHODS: Part one involved a cross-sectional comparison among residents from 12 nursing homes in South Australia (N = 550) in 2019 and four nursing homes in Tokyo (N = 333) in 2020. Part two involved three focus groups with Australian and Japanese healthcare professionals (N = 16) in 2023. Qualitative data were deductively content analysed using the World Health Organization six-step Guide to Good Prescribing. RESULTS: Australian and Japanese residents were similar in age (median: 89 vs 87) and sex (female: 73% vs 73%). Overall, 74% of Australian and 11% of Japanese residents used regular oral acetaminophen, non-steroidal anti-inflammatory drugs or opioids. Australian and Japanese healthcare professionals described individualising pain management and the first-line use of acetaminophen. Australian participants described their therapeutic goal was to alleviate pain and reported analgesics were often prescribed on a regular basis. Japanese participants described their therapeutic goal was to minimise impacts of pain on daily activities and reported analgesics were often prescribed for short-term durations, corresponding to episodes of pain. Japanese participants described regulations that limit opioid use for non-cancer pain in nursing homes. CONCLUSION: Analgesic use is more prevalent in Australian than Japanese nursing homes. Differences in therapeutic goals, culture, analgesic regulations and treatment durations may contribute to this apparent difference.

Understanding how general practice nurses support adult lifestyle risk reduction: An integrative review.

AIM: To review the literature exploring how general practice nurses support lifestyle risk reduction. DESIGN: Integrative literature review. SOURCES: CINAHL, Emcare, MEDLINE, Proquest and Scopus were searched for peer-reviewed primary research published in English from 2010 to 2022. METHODS: Sixteen papers met the inclusion criteria and were assessed for methodological quality using the Mixed Methods Appraisal Tool. Findings were extracted and thematically analysed. RESULTS: Four themes described general practice nurses: (1) Establishing relational connections; (2) Empowering active participation; (3) Engaging mutual motivation and (4) Enabling confident action. General practice nurses used complex interpersonal, risk communication and health coaching skills to build collaborative partnerships that supported patients' self-determination and self-efficacy. While mutual motivation and confidence were reciprocally enabling, gaps in skills, experience and knowledge plus time, resource and role constraints limited general practice nurses' ability to support lifestyle risk reduction. CONCLUSION: General practice nurses play a key role in lifestyle risk reduction. Ongoing education, funding, organizational and professional support are needed to enhance their commitment, confidence and capacity. IMPACT: What problem did the study address? While general practice nurses play a key role in health promotion and risk reduction, their potential is yet to be fully realized. Research examining methods by which nurses working in general practice support lifestyle risk reduction is limited. What were the main findings? Successful interactions depended on personal, professional, organisational and systemic factors which either enhanced or inhibited relational quality, shared decision-making, mutual commitment, and nurses' confidence and capacity to address lifestyle risks. Targeted professional development and peer mentoring are needed to build proficient practice. Where and on whom will the research have impact? Understanding how general practice nurses support risk reduction can inform policy and identify training and support needs to advance their skills and role. Research exploring synergies between themes may illuminate this process.

The experiences of nurses using noninvasive ventilation: An integrative review of the literature.

BACKGROUND: Noninvasive ventilation (NIV) is a common treatment delivered in critical care and is imperative in the management of many acute respiratory illnesses. Nurses are integral to the initiation and management of NIV, but there is a paucity of evidence on the experiences of nurses in this role. OBJECTIVES: The aim of this integrative review was to examine the current available research focused on nurses' experiences of using NIV across a variety of healthcare settings. METHODS: Database searches were conducted using EBSCOhost (health) databases, MEDLINE, and Science Direct. Search terms used were combinations of 'nurs∗' or 'experience∗' with 'noninvasive ventilation', 'non invasive ventilation', 'BiPAP', 'CPAP', or 'positive airway pressure'. Inclusion criteria were studies that focused on the experiences of nurses using NIV, were peer reviewed and published in English, and had research designs (collected and analysed quantitative and/or qualitative data). The studies that met the inclusion criteria were individually examined and rated in accordance with the Joanna Briggs Institute Critical Appraisal Checklist for critical and interpretive research. RESULTS: The literature search returned a possible 279 matches which were shortlisted based on the title and then again by abstract content before being reviewed in full. After application of inclusion/exclusion criteria, eight articles with a mix of qualitative and quantitative study designs were included in the review. The themes of education, communication, and guideline utilisation were common to many of the findings from both interviews and surveys. CONCLUSION: The research examined in this literature review reported some difficulties associated with NIV use including limited education, communication, and variable guideline use. Despite this, nurses were generally able to use NIV to provide positive patient outcomes. CLINICAL TRIAL REGISTRATION NUMBER: NA.

Sharing and valuing older Aboriginal people's voices about social and emotional wellbeing services: a strength-based approach for service providers.

Objective: Over the last decade, the literature relating to older Aboriginal and Torres Strait Islander people's preferences for social and emotional wellbeing services has grown. However, little evidence exists in relation to older Aboriginal and Torres Strait Islander people's experiences of services relating to social and emotional wellbeing. This paper highlights older Aboriginal and Torres Strait Islander people's experiences of social and emotional wellbeing services in Australia and then uses these key findings of the research, along with the literature, to develop a strength-based approach for service providers.Methods: Yarning was the preferred research method for the older Aboriginal community. In total, 16 older Aboriginal people, including eight women and eight men participated in the research yarning sessions. A modified version of an existing thematic analysis process supported yarning members to participate in each stage of the research, including data analysis.Results: The themes emerging from the voices of the yarning members are they couldn't give a damn about them, You've got to get the right one and ticking the box. The themes focus on negative, positive and preferred experiences of social and emotional wellbeing service provision.Conclusion: The key findings and related literature contribute to the development of a strength-based approach, which supports the implementation of responsive and effective services that address Elders, older peoples and their communities' social and emotional wellbeing issues and aspirations.

Increasing the social participation of older rural residents: Opportunities offered by "OPTEACH".

PROBLEM: The issues addressed in this article are two-fold. Firstly, education about ageing is predominantly textbook-based. Secondly, many rural older people face social isolation which impacts their health. In addressing the first issue, we discovered that our project, Older Persons Teaching and Empowering Aged Care Students (OPTEACH), has the potential to have a positive impact on the second issue. DESIGN: We run university education sessions involving older people. Since such sessions present unique challenges, we obtained a grant to develop resources to assist educators and support rural older people to become "OPTEACHers." SETTING: OPTEACH was undertaken in several rural communities in New South Wales and included staff and residents at residential aged care facilities and community-dwelling rural older people. KEY MEASURES FOR IMPROVEMENT: Our previous work had highlighted a need for educator resources that would facilitate "ageing" being taught in a way that both involved and respected older people. Our ethos centres on the "co-creation" of knowledge, and having older peoples' unique contributions recognised and celebrated. STRATEGIES FOR CHANGE: Resources to assist with planning and being involved in OPTEACH education sessions are available at www.opteach.com.au. They will support a growing community of "OPTEACHers," with beneficial flow-on effects for rural older people. EFFECTS OF CHANGE: We seek to provide practical support to both educators and older people to provide "real life" education on the experience of ageing. NEXT STEPS: Further evaluation is needed, yet we anticipate a positive impact on self-esteem, community "connectedness" and quality of life for older rural "OPTEACHers" as the approach gains momentum.

PARTNERSHIPS FOR LEARNING AND MENTORING IN AGED CARE.

It is well known that the Australian population is ageing (Australian Bureau of Statistics, 2013). This ageing population has led to an increase in chronic and complex diseases, leading to a range of challenges for healthcare providers (Hunter & Levett-Jones, 2010), yet 75% of residential aged care facilities report skills shortages.

'I'd rather die happy': residents' experiences with food regulations, risk and food choice in residential aged care. A qualitative study.

BACKGROUND: Food regulations exist to protect older people in residential aged care, leading to the restriction of potentially hazardous foods. The impacts of malnutrition, resident centred care and the importance of maintaining individual autonomy for older people are well documented. By contrast, there is scant literature describing residents' perceptions of food regulations and food risks in the residential aged care setting. AIMS: The aim of this study is to explore resident perceptions of food choice and food restrictions in residential aged care. METHODS: Using a qualitative, hermeneutic phenomenological design, semi-structured interviews were conducted with six participants recruited from two residential aged care facilities. Interviews were audio-taped, transcribed verbatim and thematically analysed. RESULTS: The following key themes emerged in this study: participants were largely unaware of food regulations and risks, yet expressed the desire to make their own choices. Participants provided contradictory accounts of their experiences with food in residential aged care, which emphasises the ongoing challenge of meeting individual preferences. CONCLUSION: These themes warrant further investigation, particularly in relation to the impact of food regulations on food choice and the meaning of risk to older people in residential aged care. This research provides new insight into the perceptions of residents regarding their individual autonomy and independence against legislated risk minimization strategies. Impact statement This article raises the issue of risk taking and food choices from the perspective of residents in a residential aged care facility.

Noninvasive ventilation for acute exacerbations of asthma: A systematic review of the literature.

BACKGROUND: Asthma is a chronic disease characterised by reversible airway obstruction caused by bronchospasm, mucous and oedema. People with asthma commonly experience acute exacerbations of their disease requiring hospitalisation and subsequent utilisation of economic and healthcare resources. Noninvasive ventilation has been suggested as a treatment for acute exacerbations of asthma due to its ability to provide airway stenting, optimal oxygen delivery and decreased work of breathing. OBJECTIVES: This paper is a systematic review of the available published research focused on the use of noninvasive ventilation for the treatment of acute exacerbations of asthma to determine if this treatment provides better outcomes for patients compared to standard medical therapy. METHOD: Database searches were conducted using EBSCOhost, MEDLINE and PubMed. Search terms used were combinations of 'noninvasive ventilation', 'BiPAP', 'CPAP', 'wheez*' and 'asthma'. Articles were included if they were research papers focused on adult patients with asthma and a treatment of noninvasive ventilation, and were published in full text in English. Included articles were reviewed using the National Health and Medical Research Council (Australia) evidence hierarchy and quality appraisal tools. RESULTS: There were 492 articles identified from the database searches. After application of inclusion/exclusion criteria 13 articles were included in the systematic review. Studies varied significantly in design, endpoints and outcomes. There was a trend in better outcomes for patients with acute asthma who were treated with noninvasive ventilation compared to standard medical therapy, however, the variability of the studies meant that no conclusive recommendations could be made. CONCLUSION: More research is required before noninvasive ventilation can be conclusively recommended for the treatment of acute exacerbations of asthma.

Enhancing Connectedness Through Peer Training for Community-Dwelling Older People: A Person Centred Approach.

Social interaction and connectedness is important to the mental health and wellbeing of older people. The aim of this research study was to facilitate and increase opportunities for social connectedness for older people living in regional areas through the use of technology training. Weekly technology training sessions were conducted at a Seniors Citizen's Club with a peer trainer (an experienced, retired computer teacher) and sessions were attended not only by the six study participants, but also by other club members, with up to 15 club members participating in sessions. Data analysis involved all documents generated by the project, including the individual interviews, researcher observations of training sessions, reports from the peer trainer and weekly diaries maintained by participants. Findings demonstrated that computer training at the Senior Citizens Club helped participants build group cohesion and to form tiered connections with partners, family, and friends with whom they no longer live. When the trainer is seen as a peer, and training is person-centred, older people are more receptive to learning, exploring, and experimenting with technology. Although only six people were involved in the in-depth evaluation part of the study, voluntary training with the trainer in the absence of any funding continues even to this present time. The outcome of this research reinforces the potential for technology facilitated tiered connectivity to enhance the quality of life for older people living in regional and rural Australia.

The Impact of a Participatory Care Model on Work Satisfaction of Care Workers and the Functionality, Connectedness, and Mental Health of Community-Dwelling Older People.

This study describes and evaluates an innovative program designed to reduce functional decline among seniors, using a participatory care approach and integrated health teams. The evaluation provides older people and community support workers (CSWs) with the opportunity to share their experiences of being involved with an innovative program to reduce functional decline (mobility, skin integrity, nutrition, mental health, continence) of older, community dwelling adults implemented by a Nursing Service in a major capital city in Australia. As part of the program, CSWs were trained to provide care that aimed to reduce functional decline, and improve the quality of life for the care recipients. Data were collected through in-depth interviews with older people receiving care and a focus group (FG) was conducted with CSWs. Seven themes emerged during data analysis: 1) functionality/independence; 2) prevention; 3) confidence; 4) connection; 5) the approach; 6) care plans; and 7) the role of the CSWs. The relationship built between care giver and receiver and the mutual respect facilitated through adopting a participatory care approach was crucial. This relationship-focused care contributed to improved functionality and consequently quality of life for the older person, and for the CSW professional it contributed to their development, improved satisfaction with their role, and increased pride in the difference they make in the lives of their clients. Opportunities for improvement of the program included ensuring that participants understood the rationale for all aspects of the program, including regular reminders, as well as the use of regular reviews of individual outcomes.

Conceptualisations and perceptions of the nurse preceptor's role: A scoping review.

OBJECTIVES: The practice of nursing is a substantially different undertaking to supervising nursing students. A clear conceptualisation of the preceptor role reveals its scope, expectations and responsibilities. The aim of this scoping review is to investigate what is known in the pertinent literature about preceptors' experiences of their supervision practices and their perceptions of what makes a good workplace environment that enables good preceptorship and is conducive to student learning. DESIGN AND DATA SOURCES: The literature scoping review design by Arksey and O'Malley was adopted for this literature review study because it enables researchers to chart, gather and summarise known literature on a given topic. Databases searched included Scopus, Ebsco, Informit and VOCEDplus. REVIEW METHOD: To answer our research question what is known about how undergraduate nursing student preceptors' supervision practices are conceptualised and perceived we posed four analysis questions to our literature set: (1) How do the articles conceptualise preceptorship? (2) What pedagogical frameworks are used to understand preceptorship? (3) What are the messages for preceptorship practices? (4) What are the recommendations for future research? RESULTS: A total of 25 articles were identified as eligible for this study. The results are ordered into four sections: theoretical conceptualisations of the preceptorship role, pedagogical framework, messages about preceptoring and recommendations for further research. CONCLUSION: The discourse of preceptorship is not underpinned by a strong theoretical and pedagogical base. The role of preceptors has not been expanded to include theoretical perspectives from socio-cultural practice and social learning paradigms.

Factors influencing the development and implementation of advanced radiographer practice in Australia - a qualitative study using an interpretative phenomenological approach.

INTRODUCTION: The purpose of this study was to explore the factors influencing the implementation or the lack of implementation of advanced practitioner role in Australia. METHODS: This study uses an interpretative phenomenological approach to explore the in-depth real life issues, which surround the advanced practitioner as a solution to radiologist workforce shortages in Australia. Research participants are radiographers, radiation therapists and health managers registered with the Australian Institute of Radiography (AIR) and holding senior professional and AIR Board positions with knowledge of current advanced practice. RESULTS: In total, seven interviews were conducted revealing education, governance, technical, people issues, change management, government, costs and timing as critical factors influencing advanced practice in Australia. CONCLUSIONS: Seven participants in this study perceived an advanced practice role might have major benefits and a positive impact on the immediate and long-term management of patients. Another finding is the greater respect and appreciation of each other's roles and expertise within the multidisciplinary healthcare team. Engagement is required of the critical stakeholders that have been identified as 'blockers' (radiologists, health departments) as well as identified allies (e.g. emergency clinicians, supportive radiologists, patient advocacy groups). The research supports that the AIR has a role to play for the professional identity of radiographers and shaping the advanced practice role in Australia.

'Two dead frankfurts and a blob of sauce': the serendipity of receiving nutrition and hydration in Australian residential aged care.

BACKGROUND: This paper explores the serendipity of residents accessing adequate food and fluids in aged care facilities. It draws on the findings of two discrete but interrelated research projects conducted in 2009 and 2011 relating to the experience of living in, or having a friend or family member living in, residential aged care. METHODS: Participants were recruited through media outlets. Indepth interviews with participants were audiotaped, transcribed verbatim and thematically analysed. FINDINGS: This paper discusses a theme that was iterated by participants in both projects that is, the difficulty residents in aged care facilities experienced in receiving adequate and acceptable food and fluids. Unacceptable dining room experiences, poor quality food and excessive food hygiene regulations contributed to iatrogenic malnutrition and dehydration. Implications for staffing, clinical supervision, education of carers and the impact of negative attitudes to older people are discussed. CONCLUSION: The inability of dependent residents in aged care facilities to receive adequate nourishment and hydration impacts on their health and their rights as a resident, and is an ongoing issue in Australian residential aged care.

Forced into exile: the traumatising impact of rural aged care service inaccessibility.

INTRODUCTION: The shortage of residential aged care places is especially acute in rural areas and this results in many older people who live in these areas being forced to leave their home communities to access care in distant communities. This article reports on one aspect of a larger study that explored family and caring community members' experiences when someone they cared for needed to access residential aged care away from their rural communities. METHODS: This qualitative research project, informed by phenomenology, was conducted in rural communities of New South Wales (NSW), Australia. Participants were recruited from media coverage of the proposed research. Indepth interviews were conducted, audiotaped and transcribed. Thematic analysis was undertaken by two researchers independently analysing the themes and then cross-checking these to ensure their strength. RESULTS: The 21 interviews conducted revealed that inaccessibility of residential aged care places caused many to experience loss, loneliness and a sense of social disconnectedness. The affected rural older person is exiled from their home community only to return to be buried. There are implications for the family and the rural community who are distanced by kilometres, transport and finances and, more significantly, by the emotional ties that bind families, friends and communities. CONCLUSION: The participants whose experiences were explored in this article described a sense of being in exile when residential aged care services are inaccessible in their local communities. The sense of exile is felt not only by the person moving away but also by their family, friends and neighbours. For this reason, rural residential aged care service delivery should be based on the identified needs of the older person and those who love and care for them.