Novel theory of mind task demonstrates representation of minds in mental state inference.

Theory of mind (ToM), the ability to represent the mental states of oneself and others, is argued to be central to human social experience, and impairments in this ability are thought to underlie several psychiatric and developmental conditions. To examine the accuracy of mental state inferences, a novel ToM task was developed, requiring inferences to be made about the mental states of 'Targets', prior participants who took part in a videoed mock interview. Participants also made estimates of the Targets' personality traits. These inferences were compared to ground-truth data, provided by the Targets, of their true traits and mental states. Results from 55 adult participants demonstrated that trait inferences were used to derive mental state inferences, and that the accuracy of trait estimates predicted the accuracy of mental state inferences. Moreover, the size and direction of the association between trait accuracy and mental state accuracy varied according to the trait-mental state combination. The accuracy of trait inferences was predicted by the accuracy of participants' understanding of trait covariation at the population level. Findings are in accordance with the Mind-space theory, that representation of the Target mind is used in the inference of their mental states.

Video-telehealth to support clinical assessment and management of acutely unwell older people in Residential Aged Care: a pre-post intervention study.

BACKGROUND: Older people living in Residential Aged Care (RAC) are at high risk of clinical deterioration. Telehealth has the potential to provide timely, patient-centred care where transfer to hospital can be a burden and avoided. The extent to which video telehealth is superior to other forms of telecommunication and its impact on management of acutely unwell residents in aged care facilities has not been explored previously. METHODS: In this study, video-telehealth consultation was added to an existing program, the Aged Care Emergency (ACE) program, aiming at further reducing Emergency Department (ED) visits and hospital admissions. This controlled pre-post study introduced video-telehealth consultation as an additional component to the ACE program for acutely unwell residents in RACs. Usual practice is for RACs and ACE to liaise via telephone. During the study, when the intervention RACs called the ED advanced practice nurse, video-telehealth supported clinical assessment and management. Five intervention RACs were compared with eight control RACs, all of whom refer to one community hospital in regional New South Wales, Australia. Fourteen months pre-video-telehealth was compared with 14 months post-video-telehealth using generalized linear mixed models for hospital admissions after an ED visit and ED visits. One thousand two hundred seventy-one ED visits occurred over the 28-month study period with 739 subsequent hospital admissions. RESULTS: There were no significant differences in hospital admission or ED visits after the introduction of video-telehealth; adjusted incident rate ratios (IRR) were 0.98 (confidence interval (CI) 0.55 to 1.77) and 0.89 (95% CI 0.53 to 1.47) respectively. CONCLUSIONS: Video-telehealth did not show any incremental benefit when added to a structured hospital avoidance program with nursing telephone support. TRIAL REGISTRATION: The larger Aged Care Emergency evaluation is registered with ANZ Clinical Trials Registry, ACTRN12616000588493.

Supporting residential aged care through a Community of Practice.

Transfers to emergency departments and hospitalizations are common for older people living in residential aged care who experience acute deterioration. This paper shares reflections from 10 years of work across a region in New South Wales, Australia, to develop a new model of care in 141 residential aged care homes. The model successfully reduced emergency department transfers and admissions to hospital. Using an exemplar patient case, the paper describes the Aged Care Emergency Program and associated research outputs. An interprofessional, multiagency Community of Practice supported this work. The authors reflect on the successes and challenges of using a Community of Practice to implement the model of care. We conclude that the Community of Practice, with its iterative evaluation, facilitated change and provided a mechanism for interprofessional practice. Broader systemic change requires clarity in goals of care, shared decision-making, working across sectors, and appropriate resource allocation.

The relationship between alexithymia and theory of mind: A systematic review.

Theory of Mind (ToM), the ability to represent the mental states of oneself and others, is an essential social skill disrupted across many psychiatric conditions. The transdiagnostic nature of ToM impairment means it is plausible that ToM impairment is related to alexithymia (difficulties identifying and describing one's own emotions), as alexithymia is seen across psychiatric conditions. Whilst many studies have examined links between alexithymia and ToM, results are mixed. Therefore, the purpose of this systematic review is to provide a taxonomy of ToM tests and assess their relationship with alexithymia. Tests are grouped according to whether they assess propensity to engage spontaneously in ToM or accuracy of ToM inferences, with tests further subdivided into those that do, and do not, require emotion recognition. A review of 63 suitable studies suggests that alexithymia is often associated with reduced ToM, and inaccurate ToM when tasks require emotion recognition. This latter finding appears due to impaired emotion recognition, rather than ToM impairment per se. Further directions and considerations for future research are discussed.

Reducing Hospital Transfers from Aged Care Facilities: A Large-Scale Stepped Wedge Evaluation.

BACKGROUND/OBJECTIVES: Older people living in residential aged care facilities (RACFs) experience acute deterioration requiring assessment and decision making. We evaluated the impact of a large-scale regional Aged Care Emergency (ACE) program in reducing hospital admissions and emergency department (ED) transfers. DESIGN: A stepped wedge nonrandomized cluster trial with 11 steps, implemented from May 2013 to August 2016. SETTING: A large regional and rural area of northern and western New South Wales, Australia. PARTICIPANTS: Nine hospital EDs and 81 RACFs participated in the evaluation. INTERVENTION: The ACE program is an integrated nurse-led intervention underpinned by a community of practice designed to improve the capability of RACFs managing acutely unwell residents. It includes telephone support, evidence-based algorithms, defining goals of care for ED transfer, case management in the ED, and an education program. MEASUREMENTS: ED transfers and subsequent hospital admissions were collected from administrative data including 13 months baseline and 9 months follow-up. RESULTS: A total of 18,837 eligible ED visits were analyzed. After accounting for clustering by RACFs and adjusting for time of the year as well as RACF characteristics, a statistically significant reduction in hospital admissions (adjusted incident rate ratio = .79; 95% confidence interval [CI] = .68-.92); P = .0025) was seen (i.e., residents were 21% less likely to be admitted to the hospital). This was also observed in ED visit rates (adjusted incidence rate ratio = .80; 95% CI = .69-.92; P = .0023) (i.e., residents were 20% less likely to be transferred to the ED). Seven-day ED re-presentation fell from 5.7% to 4.9%, and 30-day hospital readmissions fell from 12% to 10%. CONCLUSION: The stepped wedge design allowed rigorous evaluation of a real-world large-scale intervention. These results confirm that the ACE program can be scaled up to a large geographic area and can reduce ED visits and hospitalization of older people with complex healthcare needs living in RACFs.

Health Beliefs of Nurses in Northern Thailand: A Q-Methodology Study.

Introduction: Northern Thailand has a distinct culture and set of health beliefs. Nurses' beliefs influence approaches to care affecting health care outcomes. This study explored the content, origin, and sociocultural influences on health beliefs of Northern Thai nurses and how they influence clinical practice and education. Method: Q-methodology was used in this study. Data were collected with interviews using Q-cards, Q-sort distribution board, and a semistructured interview guide. Results: Data were collected from 30 clinical nurses and 30 nurses working in academia. Q-factor analysis produced three factors accounting for 48% of variance: personal experience, Thai and Buddhist beliefs, and contemporary beliefs. Discussion: Participants who felt strongly rooted in their culture and beliefs were homogeneous in recognizing the need for evidence-based practice. Nurses aware of the nature and sources of their beliefs and those of patients are well-placed to balance maintenance of cultural traditions with the need to provide evidence-based practice.

Understanding how minds vary relates to skill in inferring mental states, personality, and intelligence.

Using a "theory of mind" allows us to explain and predict others' behavior in terms of their mental states, yet individual differences in the accuracy of mental state inferences are not well understood. We hypothesized that the accuracy of mental state inferences can be explained by the ability to characterize the mind giving rise to the mental state. Under this proposal, individuals differentiate between minds by representing them in "Mind-space"-a multidimensional space where dimensions reflect any characteristic of minds that allows them to be individuated. Individual differences in the representation of minds and the accuracy of mental state inferences are explained by one's model of how minds can vary (Mind-space) and ability to locate an individual mind within this space. We measured the accuracy of participants' model of the covariance between dimensions in Mind-space that represent personality traits, and we found this was associated with the accuracy of mental state inference (Experiment 1). Mind-space accuracy also predicted the ability to locate others within Mind-space on dimensions of personality and intelligence (Experiment 2). Direct evidence for the representation of minds in mental state inference was obtained by showing that the location of others in Mind-space affects the probability of particular mental states being ascribed to them (Experiment 3). This latter effect extended to mental states dependent upon representation of trait covariation (Experiment 4). Results support the claim that mental state inference varies according to location in Mind-space, and therefore that adopting the Mind-space framework can explain some of the individual differences in theory of mind. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Understanding individual differences in theory of mind via representation of minds, not mental states.

The human ability to make inferences about the minds of conspecifics is remarkable. The majority of work in this area focuses on mental state representation ('theory of mind'), but has had limited success in explaining individual differences in this ability, and is characterized by the lack of a theoretical framework that can account for the effect of variability in the population of minds to which individuals are exposed. We draw analogies between faces and minds as complex social stimuli, and suggest that theoretical and empirical progress on understanding the mechanisms underlying mind representation can be achieved by adopting a 'Mind-space' framework; that minds, like faces, are represented within a multidimensional psychological space. This Mind-space framework can accommodate the representation of whole cognitive systems, and may help to explain individual differences in the consistency and accuracy with which the mental states of others are inferred. Mind-space may also have relevance for understanding human development, intergroup relations, and the atypical social cognition seen in several clinical conditions.

Cost analysis of an integrated aged care program for residential aged care facilities.

Objective To compare annual costs of an intervention for acutely unwell older residents in residential age care facilities (RACFs) with usual care. The intervention, the Aged Care Emergency (ACE) program, includes telephone clinical support aimed to reduce avoidable emergency department (ED) presentations by RACF residents. Methods This costing of the ACE intervention examines the perspective of service providers: RACFs, Hunter Medicare Local, the Ambulance Service of New South Wales, and EDs in the Hunter New England Local Health District. ACE was implemented in 69 RACFs in the Hunter region of NSW, Australia. Analysis used 14 weeks of ACE and ED service data (June-September 2014). The main outcome measure was the net cost and saving from ACE compared with usual care. It is based on the opportunity cost of implementing ACE and the opportunity savings of ED presentations avoided. Results Our analysis estimated that 981 avoided ED presentations could be attributed to ACE annually. Compared with usual care, ACE saved an estimated A$921214. Conclusions The ACE service supported a reduction in avoidable ED presentations and ambulance transfers among RACF residents. It generated a cost saving to health service providers, allowing reallocation of healthcare resources. What is known about the topic? Residents from RACFs are at risk of further deterioration when admitted to hospital, with high rates of delirium, falls, and medication errors. For this cohort, some conditions can be managed in the RACF without hospital transfer. By addressing avoidable presentations to EDs there is an opportunity to improve ED efficiency as well as providing care that is consistent with the resident's goals of care. RACFs generate some avoidable ED presentations for residents who may be more appropriately treated in situ. What does this paper add? Telephone triaging with nursing support and training is a means by which ED presentations from RACFs can be reduced. One of the consequences of this intervention is 'cost avoided', largely through savings on ambulance costs. What are the implications for practitioners? Unnecessary transfer from RACFs to ED can be avoided through a multicomponent program that includes telephone support with cost-saving implications for EDs and ambulance services.

An assistant workforce to improve screening rates and quality of care for older patients in the emergency department: findings of a pre- post, mixed methods study.

BACKGROUND: Older people who present to the Emergency Department (ED) experience high rates of prevalent and incident delirium. This study aimed to determine whether an assistant workforce in the ED could effectively conduct screening to inform assessment and care planning for older people as well as enhance supportive care activities for prevention of delirium. METHODS: Using a pre-post design, data was collected before and after the introduction of Older Person Technical Assistants (OPTAs) in the ED. OPTA activity was recorded during the intervention period and a medical record audit undertaken prior to and 9 months after implementation. Data were analysed using descriptive statistics for OPTA activities. Weighted Kappa scores were calculated comparing concordance in screening scores between OPTAs and Aged Services Emergency Team Registered Nurses. Changes in the rates of documented screening and supportive care were analysed using Chi-square tests. Focus groups were conducted to explore clinicians' experiences of the OPTA role. RESULTS: Three thousand five hundred fourty two people were seen by OPTAs in 4563 ED Presentations between 1st July 2011 and 2012. The reproducibility of all screening tools were found to be high between the OPTAs and the RNs, with Kappas and ICCs generally all above 0.9. The medical record audit showed significant improvement in the rates of documented screening, including cognition from 1.5 to 38% (p < 0.001) and review of pain from 29 to 75% (p < 0.001). Supportive care such as being given fluids or food also improved from 13 to 49% (p < 0.001) and pressure care from 4.8 to 30% (p < 0.001). This was accomplished with no increase in ED length of stay among this age group. Focus group interviews described mixed responses and support for the OPTA role. CONCLUSIONS: An assistant workforce in an ED setting was found to provide comparable screening results and improve the rates of documented screening and supportive care provided to older people with or at risk of developing delirium in the ED. There is a need for a shared philosophy to the care of older people in the ED. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registration number is ACTRN12617000742370. It was retrospectively registered on 22nd May 2017.

Patient safety content and delivery in pre-registration nursing curricula: A national cross-sectional survey study.

BACKGROUND: Patient safety is a core principle of health professional practice and as such requires significant attention within undergraduate curricula. However, patient safety practice is complex requiring a broad range of skills and behaviours including the application of sound clinical knowledge within a range of health care contexts and cultures. There is very little research that explores how this is taught within Australian nursing curricula. OBJECTIVES: To examine how Australian nursing curricula address patient safety; identify where and how patient safety learning occurs; and describe who is responsible for facilitating this learning. DESIGN: A cross-sectional study. SETTING: Eighteen universities across seven Australian States and Territories. PARTICIPANTS: The sample consisted of 18 nursing course coordinators or those responsible for the inclusion of patient safety content within a Bachelor of Nursing course at Australian universities. METHODS: An online survey was conducted to evaluate the patient safety content included and teaching methods used in Australian pre-registration nursing curricula. RESULTS: Approaches to teaching patient safety vary considerably between universities where patient safety tended to be integrated within undergraduate nursing course subjects rather than explicitly taught in separate, stand-alone subjects. Three-quarters of the surveyed staff believed patient safety was currently being adequately covered in their undergraduate nursing curricula. CONCLUSION: Although there is consensus in relation to the importance of patient safety across universities, and similarity in views about what knowledge, skills and attitudes should be taught, there were differences in: the amount of time allocated, who was responsible for the teaching and learning, and in which setting the learning occurred and was assessed. There was little indication of the existence of a systematic approach to learning patient safety, with most participants reporting emphasis on learning applied to infection control and medication safety.

Knowing how to get things done: Nurse consultants as clinical leaders.

BACKGROUND: Clinical leaders drive healthcare performance in the provision of safe, high-quality patient care by influencing others and augmenting change. Clinical leadership features strongly in nurse consultant roles and holds potential to strengthen the nurse consultant's place in healthcare teams, making their contribution as clinical leaders more recognisable. This study explores how clinical leadership is enacted through the nurse consultant role, providing understanding of the elements that influence their effectiveness as clinical leaders. DESIGN: This study presents qualitative findings from a larger sequential mixed-method study conducted in a large Local Health District in New South Wales, Australia. METHODS: Focus groups were held with nurse consultants, managers and other stakeholders from a variety of context including acute, primary and community care settings across metropolitan and rural locations. An online discussion forum was provided for nurse consultants unable to attend focus groups. Transcript data were analysed using iterative theming techniques. RESULTS: A total of 26 nurse consultants, 20 managers and 16 other stakeholders participated in focus groups and 22 nurse consultants contributed to the discussion forum. The role of the nurse consultant as clinical leader was a dominant feature, manifested through the following four themes: knowing and being known, being a collaborator, being a utility player and working across and within. CONCLUSIONS: Nurse consultants are cogent clinical leaders, recognised and valued for their contribution to interprofessional teams and service delivery. The nurse consultant role is seen as having a broad sphere of influence and is able to action change through clinical leadership. RELEVANCE TO CLINICAL PRACTICE: Findings give organisational leaders and other healthcare professional's greater understanding of nurse consultants as clinical leaders. This informs how nurse consultants are appointed and positioned and how they can be supported in fulfilling their clinical leadership potential.

Sun protective behaviors at an outdoor entertainment event in Australia.

An observational study was conducted to examine the use of sun protective hats, clothing, and sunglasses of people attending an outdoor entertainment event in an area of high-to-extreme ultraviolet radiation in New South Wales, Australia. Armidale is unique, as it is a highly-elevated area, almost 1000 m above sea level, and temperatures are often mild with very high-to-extreme levels of ultraviolet radiation. Four trained data collectors observed attendees as they entered the event, and recorded their use of sun protective hats, clothing, and sunglasses. While more than half of the attendees wore sun protective hats, only 14% wore sun protective clothing. Broad-brimmed hats were considered sun protective, while sun protective clothing was defined by shirts with at least three-quarter-length sleeves. Females were more likely to wear both a sun protective hat and clothing than males, and children were less protected than adults. Legislative changes are required to ensure that organizers of outdoor events have a legal responsibility to provide a safe environment for attendees, including strategies to help reduce ultraviolet radiation exposure.

Motherhood in the shade of migration: A qualitative study of the experience of Syrian refugee mothers living in Turkey.

Turkey receives the largest number of Syrian refugees in the world. Some of these refugee women become mothers in Turkey. This paper reports on a qualitative, descriptive study that investigated the experience of seven Syrian women migrants who gave birth in Turkey, and explores their experiences of transition to motherhood in a foreign country. The research identified that aspects of transition can be clustered under five main themes: difficulties during the pregnancy period, giving birth in a foreign country, problems of refugee mothers, milestones in life of refugee mothers, and influence of cultural beliefs of refugee mothers on baby care. Key findings revealed that the women in the study had negative experiences related to being pregnant and having a baby in a foreign country. In addition to identifying challenges associated with migration, such as language barriers, racism, discrimination, poverty, and separation from their culture and family, the study highlighted the fears and difficulties experienced by refugee mothers, the cultural beliefs of refugee women about caring for their babies, and turning points in the life of refugee mothers.

How do nurse consultant job characteristics impact on job satisfaction? An Australian quantitative study.

BACKGROUND: There is a direct link between job satisfaction, nurses' job performance and improved patient outcomes. Understanding what job characteristics influence job satisfaction is vital if health organizations are to optimize individual employee satisfaction and performance. This is particularly necessary in the Nurse Consultant role, which is a multifaceted role that has evolved to meet the dynamic and changing needs of health services. This study aims to examine how job characteristics influence Nurse Consultant job satisfaction and identify differences across metropolitan and rural contexts. METHODS: This paper presents quantitative findings that are part of a larger prospective cross sectional mixed method study. An online survey consisting of a variety of job characteristic factors was administered to all NCs working in a large Local Health District in New South Wales, Australia over an 8-week period in 2010. Descriptive analysis identified NC's perceptions of job satisfaction and job characteristics in their current role and factor and regression analysis identified relationships between these factors. RESULTS: Job satisfaction was identified as high (mean 4.3) and is strongly correlated with job autonomy, role clarity, role conflict and job support. A high level of role clarity has a moderating effect on the relationship between job autonomy and job satisfaction. CONCLUSIONS: Study findings inform how we prepare nurses for the NC role and how managers engage with and support NCs in their role taking into account context. Understanding the factors that influence job satisfaction and role effectiveness gives managers valuable information to assist in positioning and supporting these roles to maximize effectiveness across integrated and contemporary models of health care delivery.

Development of advanced practice competency standards for dietetics in Australia.

AIM: This study aimed to explore the work roles, major tasks and core activities of advanced practice dietitians in Australia to define the Competency Standards for advanced practice. METHODS: A qualitative approach was used to review advanced dietetic practice in Australia involving experienced professionals, mostly dietitians. Four focus groups were conducted with a total of 17 participants and an average of 20 years experience: 15 dietitian practitioners plus 2 employers (1 dietitian and 1 non-dietitian). The focus groups explored the key purpose, roles and outcomes of these practitioners. Data from the focus groups were confirmed with in-depth interviews about their core activities with a purposive sample of 10 individuals recently recognised as Advanced Accredited Practising Dietitians. Data from both focus groups and interviews were analysed adductively to identify key themes. RESULTS: The key theme that emerged to define advanced dietetics practice was leadership, with four subthemes that described in more detail the major work roles and outcomes of advanced practice. These subthemes identified that advanced practitioners were (i) outcome-focused, having impact; (ii) influence others and advocate; (iii) innovate and embrace change; and (iv) inspire others and are recognised for their practice. These outcomes were conceptualised within a broad generalist framework to generate revised Competency Standards. CONCLUSIONS: This study confirmed that leadership rather than specialist practice skills is the key determinant of advanced practice.