Culture, religion, language and the assessment and management of children's pain by expatriate nurses in Saudi Arabia: A qualitative study.

PURPOSE: Unrelieved pain among hospitalized children is a common problem that affects all aspects of children's health and their quality of life. Cultural and language differences between nurses and patients have been shown to impact the quality and safety of nursing care and management for children with pain. The aim of this study was to identify the cultural factors, barriers, and facilitators impacting the assessment and management of children's pain by expatriate nurses in Saudi Arabia. DESIGN AND METHODS: A qualitative descriptive design was employed in this study. A sample of 16 nurses was conveniently recruited and interviewed through face-to-face semistructured interviews. Each interview lasted between 30 and 60 min and was audio-recorded. Content analysis was used to analyze the transcripts. Transcripts were carefully read, significant statements were highlighted, coded, categorized, and clustered thematically. RESULTS: Three main themes were identified, namely, (I) low priority of children's pain, (II) culture and religious challenges, and (III) communication challenges. PRACTICE IMPLICATIONS: Cultural and language differences described by expatriate nurses hindered their care of children with pain. A systematic education for expatriate nurses, children, and families is urgently needed to enhance inter/cross-cultural understandings and improve childcare in Saudi Arabia. This study identifies the unique challenges faced by expatriate nurses in Saudi Arabia. The findings reveal how a lack of knowledge about cultural values and beliefs can lead to misunderstandings and conflicts between nurses, children, and families and can have an impact on childcare and pain. It also highlights the need to improve pain management practices in multicultural healthcare settings, similar to those of Saudi Arabia and neighboring Arab nations, and across the globe.

Estimating the cost of an individualised music intervention for aged care residents with dementia.

BACKGROUND: Individualised music listening has been shown to reduce agitation and improve mood in people with dementia. However, there is a paucity of research describing the cost of implementing such interventions in residential care settings for older people. AIM: To determine the cost of implementing an individualised music intervention for older people with dementia in residential aged care in Australia. METHOD: A simple cost analysis was undertaken to determine the cost of delivering the individualised music intervention to 32 older people with dementia at two residential aged care facilities in New South Wales. The analysis took into consideration the operating, training and delivery costs, as well as the costs of purchasing the music equipment and downloads. RESULTS: The cost of delivering the individualised music intervention was found to be AU$6,623.76 per year - or AU$3.98 per resident per week, at 2017 values. At 2022 values, this equates to an annual cost of AU$7,130.07 (£4,031.85) for 32 residents and a weekly cost of AU$4.28 (£2.42) per resident per week. CONCLUSION: The cost of implementing the individualised music intervention was relatively low compared with the overall cost of residential aged care for older people with dementia.

Individualised music for people living with dementia and the experiences and perceptions of residential aged care staff: A qualitative study.

OBJECTIVE: To explore the experiences and perceptions of staff regarding the use of individualised music for people with dementia living in residential aged care. METHODS: A qualitative descriptive methodology was used. Methods included a focus group and face-to-face interviews, open-ended responses to a pre-post survey and relevant clinical notes about older participants' responses. Qualitative content analysis was used to analyse data. RESULTS: There were four themes: (1) transcendental reminiscing, the calm, the joy and the elation; (2) optimism, excitement and the snowball effect; (3) pitching in for older person, it is not rocket science and the hurdles; and (4) music beyond the intervention. CONCLUSIONS: Overall, the individualised music was a generally positive experience. While some older participants reported discomfort with the use of headphones, staff concerns related to care and accessibility of music equipment.

Disjunction, tension and dissonance within nursing pain care provision for the older hospitalized person: A focused ethnographic insight.

AIMS: This study presents an ethnographic insight into the older hospitalized persons' experiences on how nurses provide pain care provision. The older persons' perceptions of culturally mediated barriers and facilitators are presented. DESIGN: Focused ethnography. METHODS: Multi-site across eight acute care units within two tertiary referral hospitals on the east coast of Australia collected over a one-year period from 2014 to 2015. Semi-structured interviews (n = 12) of older persons (11 hr). Twenty-three (23) semi-structured interviews with nine (9) registered nurses (12 hr 38 min). Participant observation (1,041 hr) during day, night and evening shifts. RESULTS: The older person experienced disjunction within pain assessment by the reliance of nurses on objective measurement gained during functional task completion. Tension emerged during pain management when the older person was not included and/or options provided were not deemed effective. For some older persons this meant they undertook a decision to exclude their nurse from involvement in pain management. A thread woven throughout was a lack of communication, continuity of care and input from the older person. CONCLUSION: This study has implications for the provision of nursing care of the older hospitalized person. Dissonance within pain care provision for the older person occurs during episodes of missed pain care. Understanding and insight is gained into aspects of missed communication opportunities between nurses and the experiences of missed pain care of the older person.

Mobile memory clinic: implementing a nurse practitioner-led, collaborative dementia model of care within general practice.

The limited capacity of secondary health services to address the increasing prevalence of dementia within the community draws attention to the need for an enhanced role for nurses working collaboratively with GPs in diagnosing and coordinating post-diagnostic care for patients with dementia. This study investigated the feasibility and acceptability of a nurse practitioner-led mobile memory clinic that was embedded within general practice and targeted to caring for patients and their carers in areas of socioeconomic disadvantage with poor access to specialist health services. Over the period from mid-2013 to mid-2014, 40 GPs referred 102 patients, with the nurse practitioner conducting assessments with 77 of these patients in their homes. Overall, there was a strong interest in this model of care by general practice staff, with the assessment and care provided by the nurse practitioner evaluated as highly acceptable by both patients and their carers. Nonetheless, there are financial and structural impediments to this model of care being implemented within the current Australian health service framework, necessitating further research investigating its cost-effectiveness and efficacy.

Assessing the information quality and usability of My Health Record within a health literacy framework: What's changed since 2016?

BACKGROUND: This study examined the health literacy demands of My Health Record (MyHR) in the context of preparing for a government-announced opt-out system by repeating two studies of health information and usability conducted in 2016. OBJECTIVE: To examine whether Australia's MyHR meets the information and usability needs of people at risk of low health literacy and changes since 2016. METHOD: Content analysis: Informed by the 2016 methods and findings, measures of information quality, themes and target audiences were recorded and reported for each online consumer-facing health information resource. Heuristic evaluation: An evaluation of the MyHR and supporting information website was conducted using a predetermined checklist of usability criteria. A list of usability violations for both websites was identified. RESULTS: Total number of resources grew from 80 in 2016 to 233 in 2018. There was little change since 2016 to average readability levels, target audiences, presentation style, links between resources and usability of MyHR. Compared to 2016, this study demonstrated increases in resources from non-government organisations; video resources; translated resources; and resources with themes of privacy, security and post-registration use. CONCLUSION: This study identified some improvements in information quality since 2016, but gaps remain in information quality and usability which may negatively impact the ability for people with low health literacy to access and use MyHR. IMPLICATIONS: This study provides a framework for ongoing monitoring and evaluation of the suitability of MyHR for people at risk of low health literacy.

Impact of individualised music listening intervention on persons with dementia: A systematic review of randomised controlled trials.

OBJECTIVE: To summarise the evidence regarding the impact of individualised music listening on persons with dementia. METHODS: Six electronic databases (CINAHL, Medline, ProQuest, PsycINFO, Music Periodicals and Cochrane) were searched up to July 2018 for randomised controlled trials (RCTs) evaluating the efficacy of individualised music listening compared to other music and non-music-based interventions. RESULTS: Four studies were included. Results showed evidence of a positive impact of individualised music listening on behavioural and psychological symptoms of dementia (BPSDs) including agitation, anxiety and depression and physiological outcomes. Evidence for other outcomes such as cognitive function and quality of life was limited. CONCLUSIONS: The limited evidence suggests individualised music listening has comparable efficacy to more resource-intensive interventions. However, there was a small number of RCTs and some outcomes were evaluated by a single study. This limits the conclusions drawn, warranting more RCTs evaluating other outcomes beyond the BPSDs.

Experiences of the older hospitalised person on nursing pain care: An ethnographic insight.

AIMS AND OBJECTIVES: To present an ethnographic insight into the older hospitalised person (those aged over 65 years) perceptions and experiences of pain care provision by nurses in acute care. BACKGROUND: Pain care provision by nurses remains less than optimal for the older hospitalised person despite numerous evidence-based guidelines. There is a paucity of research providing input from the experiences of the older hospitalised person in relation to their perspectives of pain care provision by nurses in acute care. Pain care research needs more involvement from those older persons with documented diagnoses of dementia, delirium or cognitive impairment, and intellectual disabilities and those in their end stage of palliation. DESIGN: A focused ethnographic study. The consolidated criteria for reporting qualitative research (COREQ) were used to report the findings of this study. METHODS: A focused ethnographic study was conducted in 8 acute care units within 2 large tertiary referral hospitals on the east coast of Australia. Consisting of semi-structured interviews (n = 12) of cognitively intact older persons (11 hr). Twenty-three (23) semi-structured interviews with nine (9) RN participants (12 hr and 38 min). Participant observation period totalled 1,041 hr. RESULTS: The older persons' experiences of receiving pain care were based on a formulaic assessment process focusing on intensity of pain and pain management options provided often lacked their input. The older persons often did not perceive their pain care provision as being of benefit to themselves. The nurses lacked insight and understanding on the nature of pain for the older person. CONCLUSION: Understanding was gained into how the older persons' pain care was hampered due to the lack of appropriate, and meaningful pain care provision and provides insight into why the older hospitalised person continues to experience a less than optimal experience. RELEVANCE TO CLINICAL PRACTICE: Older hospitalised persons can gain continuity of pain care when nurses negotiate with them to repattern or restructure their nursing routines for pain care provision. Older people need inclusion into pain care decisions. All vulnerable older persons require nurses to use an evidence-based pain assessment tool.

Testing psychometric properties of a new instrument 'Promoting Active Ageing in Older People with Mental Disorders Scale' from a cross-sectional study.

BACKGROUND: There is no instrument that measures the promotion of active ageing or the factors that influence the promotion of active ageing in older people with mental disorders living in the community. This study aimed to examine psychometric properties of a new survey instrument. METHODS: A mixed methods exploratory sequential design was used incorporating a cross-sectional survey. The Promoting Active Ageing in Older People with Mental Disorders Scale (PAA-MD) was sent to 579 primary care providers in Yasothon province, Thailand. Construct validity was tested using exploratory factor analysis. The internal reliability was examined using Cronbach's alpha coefficient. RESULTS: The PAA-MD consisted of three sections. Section II found Bartlett's test of sphericity was χ2 (1431) = 26221.167, P < 0.001. Items used theoretical justification to group items into five factors, namely: participation, education, health, leisure, and security. Section III indicated Bartlett's test was χ2 (666) = 23524.074, P < 0.001. Items were grouped into five components, namely: facilitators, barriers, knowledge, skills, resources and support. Internal reliability of sections II and III with Cronbach's alpha was greater than 0.7. The corrected item-total correlation coefficient of all items was greater than 0.30. CONCLUSION: The PAA-MD contains 104 items from three sections. Construct validity was adequate to capture phenomena. Internal reliability revealed good homogeneity.

An integrative review of stakeholder views on Advance Care Directives (ACD): Barriers and facilitators to initiation, documentation, storage, and implementation.

OBJECTIVE: To examine the views and experiences of patients and their health care providers on developing advance care planning (ACP) and advance care directives (ACD); and determine barriers and facilitators to ACD development, storage, and use, including implications for people with communication disability. METHOD: An integrative review of 93 studies, analysed according to their content themes. RESULTS: Content themes encapsulated the initiation, documentation, and implementation stages of ACP/ACD. Lack of guidance for initiating and supporting ACP/ACD impedes discussions, and both patients and healthcare providers avoid discussions owing to fear of dying and reluctance to think about end-of-life. CONCLUSIONS: There are several barriers and facilitators to the initiation of ACP discussions, documentation and implementation of ACD, and little research exploring the views of legal professionals on the development, storage, or use of ACP documents. Further research is needed to explore the timing and responsibility of both legal and health professionals in initiating and supporting ACP discussions. PRACTICE IMPLICATIONS: It is important for healthcare providers to raise ACP discussions regularly so that patients have time to make informed advance care decisions. Storage of the document in an electronic health record might facilitate better access to and implementation of patients' end-of-life care decisions.

Nurses' Knowledge and Attitude toward Pediatric Pain Management: A Cross-Sectional Study.

BACKGROUND: Pain in infants and children is often poorly assessed and managed. Although there are many studies on this subject, none have been conducted in the Arab world, including the Kingdom of Saudi Arabia, where nurses are largely expatriates. AIMS: To examine the knowledge and attitudes of nurses working with infants and children in the Kingdom of Saudi Arabia regarding pain management. DESIGN: Descriptive cross-sectional survey. SETTINGS: Five government hospitals in Riyadh region of the Kingdom of Saudi Arabia. PARTICIPANTS/SUBJECTS: Registered nurses caring for infants and children. METHODS: A convenience sample of 410 nurses working at five Saudi Arabian government hospitals was surveyed using the Pediatric Nurses' Knowledge and Attitudes Survey Regarding Pain (PNKAS-Shriners Revision). Data were analyzed using descriptive (frequency, percentage, mean, and standard deviation) and inferential statistics, including Pearson correlation, independent t test, and one-way analysis tests. RESULTS: Poor overall knowledge and attitudes regarding pediatric pain management was evident in this study. The mean correct score achieved by nurses was 18.1 ± 4.0 out of 40 or 45.2% ± 10.0% of a possible score of 100%. A weak but statistically significant correlation was found between years of pediatric nursing experience and total score (r = -0.129, p = .009). CONCLUSIONS: We concluded that intensive education on pediatric pain and its management is urgently needed for nurses working in the Kingdom of Saudi Arabia.

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.

Tai chi and yoga in residential aged care: Perspectives of participants: A qualitative study.

AIMS AND OBJECTIVES: This qualitative study examined the appropriateness and acceptability of 14-week modified tai chi and yoga programmes in an Australian residential aged care (RAC) setting by exploring experiences and perspectives of frail older residents and staff participants. BACKGROUND: Older persons in RAC have limited opportunities for physical activity. Tai chi and yoga are mindfulness-based exercise interventions that have been used to promote physical and psychological health of older adults in community settings. While research on tai chi and yoga interventions in community settings is promising, there is limited research regarding the interventions' appropriateness and acceptability for frail older residents in residential care settings in Australia. DESIGN: Descriptive and qualitative component of a mixed-methods study. METHODS: All residents who participated in the modified yoga and tai chi interventions and staff who supported them were invited. A total of 19 individuals comprising 16 residents and three staff members participated in three focus group interviews. The interviews were audio-recorded, transcribed and analysed thematically using a qualitative descriptive approach. RESULTS: Nine themes that reflected the uniqueness of the programmes' mind-body approach are presented: (a) novel, new and exciting; (b) smoothness, rhythm and flow; (c) slow and mindful; (d) gentle but rewarding; (e) moving whole body; (f) perceived benefits; (g) worthwhile; (h) feeling alive; and (i) calming and relaxing. CONCLUSIONS: The modified programmes of tai chi and yoga was acceptable, appropriate, enjoyable and helpful. Both tai chi and yoga appear to provide appropriate physical exercise and opportunities for older persons to enhance their quality of life through interaction of physical, emotional and intellectual wellness domains. RELEVANCE TO CLINICAL PRACTICE: The 14-week modified programmes of tai chi and yoga could be applied to frail older RAC population to promote health and active ageing.

Experiences of older people following the introduction of consumer-directed care to home care packages: A qualitative descriptive study.

OBJECTIVE: To explore the experiences of older people receiving home care package (HCP) support following the introduction of consumer-directed care (CDC) by the Australian government on 1 July 2015. METHODS: Thirty-one older people with existing HCP support from two service providers in regional New South Wales, Australia, participated in a face-to-face interview and/or a qualitative survey. RESULTS: Analysis revealed the theme of Choices: Preferences, constraints, balancing and choosing. Participants described choosing to live at home with HCP support; however, they were constrained by poor communication and information about service changes and options, personal budgets and access to future care. HCP services remained largely unchanged during transition to CDC. CONCLUSION: Many aspects of the initial implementation of CDC were challenging for older people. Clear, relevant and timely communication and information about CDC and its consequences for consumers appear to be needed to enhance CDC.

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.

Promoting active ageing in older people with mental disorders living in the community: An integrative review.

AIM: To critically synthesize the evidence in relation to the promotion of active ageing in older people, including those with mental disorders. BACKGROUND: Approximately 15% of older people aged 60 and above are experiencing a mental disorder. However, they are commonly unrecognized from health care providers. DESIGN: This study is an integrative review. Articles published between January 2002 and March 2017 in English and in Thai were identified through searches of the databases CINAHL, MEDLINE, EMBASE, PsycINFO, and Thai LIS, as well as through manual searching. Methodologically high-quality research articles were included if they addressed the promotion of active ageing and related concepts, the impact of mental disorders on active ageing and related concepts, the perspective of older people regarding active ageing, and issues related to working with older people with mental health problems living in the community. RESULTS: A total of 18 articles were included. The findings show that there is little evidence regarding the promotion of active ageing in older people with mental disorders. Older people with mental disorders were less likely to achieve successful ageing compared with those without mental disorders, suggesting they need support from health care providers. However, there are several barriers to care and working with older people with mental disorders at the community level. CONCLUSION: Of concern is that health professionals focus on the physical health of older people while mental health issues are overlooked.

A content analysis of the consumer-facing online information about My Health Record: Implications for increasing knowledge and awareness to facilitate uptake and use.

BACKGROUND: Low health literacy, low levels of positive belief and privacy and security concerns have been identified as a significant barrier to personal electronic health record uptake and use. An important tool for overcoming these barriers is the consumer-facing information which accompanies the system. My Health Record (MyHR) is the Australian national e-health record system, for which a large suite of online resources exists to facilitate consumer registration and use. This study uses a number of different measures of health resource quality to assess the MyHR online consumer-facing information and identify any gaps or areas for improvement. OBJECTIVE: To analyse the quality and content of the online consumer-facing resources which support the uptake and use of MyHR. METHOD: Australian information resources aimed at healthcare consumers about the MyHR were included in this study. A comprehensive search using Internet search engines was conducted to locate all online consumer-facing resources about MyHR from both government and non-government sources. Readability (measured by Flesch-Kincaid grade level), year of publication/review, publishing organisation type, presentation style, linked websites, target audience, and themes were identified as important measures of health information quality, and these were recorded and reported on for each resource. RESULTS: Eighty resources met the inclusion criteria. The mean Flesch-Kincaid grade level was 11.8. Most resources were created by Australian government sources ( n = 55), and the most common target audience was the general public ( n = 65). Registration ( n = 51), privacy/security ( n = 49), and benefits of use ( n = 46) were the most common resource themes. CONCLUSION: The authors identified a number of gaps and areas for improvement in the provision of consumer-facing information about MyHR. Readability is too high for the general Australian population, and there are few translated resources, which means that the information provided does not cater to people with low literacy levels, communication disability, and/or difficulties in understanding written English. The target audiences for resources do not reflect priority groups that were identified during the MyHR development processes. There are also gaps in information provision about how consumers can use MyHR as a tool to meaningfully engage with health professionals and services to support their own person-centred care.

The E-health Literacy Demands of Australia's My Health Record: A Heuristic Evaluation of Usability.

Background: My Health Record is Australia's electronic personal health record system, which was introduced in July 2012. As of August 2017, approximately 21 percent of Australia's total population was registered to use My Health Record. Internationally, usability issues have been shown to negatively influence the uptake and use of electronic health record systems, and this scenario may particularly affect people who have low e-health literacy. It is likely that usability issues are negatively affecting the uptake and use of My Health Record in Australia. Objective: To identify potential e-health literacy-related usability issues within My Health Record through a heuristic evaluation method. Methods: Between September 14 and October 12, 2016, three of the authors conducted a heuristic evaluation of the two consumer-facing components of My Health Record-the information website and the electronic health record itself. These two components were evaluated against two sets of heuristics-the Health Literacy Online checklist and the Monkman Heuristics. The Health Literacy Online checklist and Monkman Heuristics are evidence-based checklists of web design elements with a focus on design for audiences with low health literacy. During this heuristic evaluation, the investigators individually navigated through the consumer-facing components of My Health Record, recording instances where the My Health Record did not conform to the checklist criteria. After the individual evaluations were completed, the investigators conferred and aggregated their results. From this process, a list of usability violations was constructed. Results: When evaluated against the Health Literacy Online Checklist, the information website demonstrated violations in 12 of 35 criteria, and the electronic health record demonstrated violations in 16 of 35 criteria. When evaluated against the Monkman Heuristics, the information website demonstrated violations in 7 of 11 criteria, and the electronic health record demonstrated violations in 9 of 11 criteria. The identified violations included usability issues with the reading levels used within My Health Record, the graphic design elements, the layout of web pages, and a lack of images and audiovisual tools to support learning. Other important usability issues included a lack of translated resources, difficulty using accessibility tools, and complexity of the registration processes. Conclusion: My Health Record is an important piece of technology that has the potential to facilitate better communication between consumers and their health providers. However, this heuristic evaluation demonstrated that many usability-related elements of My Health Record cater poorly to users at risk of having low e-health literacy. Usability issues have been identified as an important barrier to use of personal health records internationally, and the findings of this heuristic evaluation demonstrate that usability issues may be substantial barriers to the uptake and use of My Health Record.

Home care packages: insights into the experiences of older people leading up to the introduction of consumer directed care in Australia.

This paper reports phase one, conducted from March to June 2015, of a two-phase, qualitative descriptive study designed to explore the perceptions and experiences of older people before and after the introduction of consumer directed care (CDC) to home care packages (HCP) in Australia. Eligible consumers with a local HCP provider were mailed information about the study. Data collection occurred before the introduction of CDC and included face-to-face, in-depth interviews, summaries of interviews, field notes and reflective journaling. Semi-structured questions and 'emotional touchpoints' relating to home care were used to guide the interview conversation. Line-by-line data analysis, where significant statements were highlighted and clustered to reveal emergent themes, was used. Five older people, aged 81 to 91 years, participated in the study. The four emergent themes were: seeking quality and reciprocity in carer relationships; patchworking services; the waiting game; and technology with utility. Continuity of carers was central to the development of a trusting relationship and perceptions of care quality among older consumers. Care coordinators and workers should play a key role in ensuring older people receive timely information about CDC and their rights and responsibilities. Participants' use of contemporary technologies suggests opportunities to improve engagement of HCP clients in CDC.