International Standards for Dementia Workforce Education and Training: A Scoping Review.

BACKGROUND AND OBJECTIVES: The increasing number of people with dementia requires transparency and quality dementia education, training, and care. This scoping review aimed to determine the key elements of national or state-wide standards on dementia education and training that could underpin the development of international standards for dementia workforce training and education. RESEARCH DESIGN AND METHODS: The English-language peer-reviewed and gray literature were searched (2010-20). Key search domains were training, workforce, standards/frameworks, and dementia. RESULTS: Thirteen standards were identified from the United Kingdom (n = 5), the United States (n = 4), Australia (n = 3), and Ireland (n = 1). Most standards focused on training health care professionals with some including people in customer-centric settings, people living with dementia, and informal carers or the general community. Seventeen training topics were identified in 10 or more of the 13 standards. Cultural safety, rural issues, health care professional self-care, digital literacy, and health promotion topics were less commonly reported. The barriers to standards implementation were lack of organizational support, lack of access to relevant training, low staff literacy, lack of funding, high staff turnover, ineffective past program cycles, and inconsistent service delivery. Enablers included a strong implementation plan, funding, strength of partnerships, and building on previous work. DISCUSSION AND IMPLICATIONS: The U.K. Dementia Skills and Core Training Standard, the Irish Department of Health Dementia Together, and the National Health Services Scotland Standard are the recommended strongest standards for underpinning the development of international standards. It is essential that training standards are tailored to the needs of the consumer, worker, and regions.

Attributes That Influence Human Decision-Making in Complex Health Services: Scoping Review.

BACKGROUND: Humans currently dominate decision-making in both clinical health services and complex health services such as health policy and health regulation. Many assumptions inherent in health service models today are underpinned by Ramsey's Expected Utility Theory, a prominent theory in the field of economics that is rooted in rationality. Rational, evidence-based metrics currently dominate the culture of decision-making in health policy and regulation. However, as the COVID-19 pandemic has shown, rational metrics alone may not suffice in making better policy and regulatory decisions. There are ethical and moral considerations and other complex factors that cannot be reduced to evidence-based rationality alone. Therefore, this scoping review was undertaken to identify and map the attributes that influence human decision-making in complex health services. OBJECTIVE: The objective is to identify and map the attributes that influence human decision-making in complex health services that have been reported in the peer-reviewed literature. METHODS: This scoping review was designed to answer the following research question: what attributes have been reported in the literature that influence human decision-making in complex health services? A clear, reproducible methodology is provided. It is reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) standards and a recognized framework. As the topic of interest merited broad review to scope and understand literature from a holistic viewpoint, a scoping review of literature was appropriate here. Inclusion and exclusion criteria were developed, and a database search undertaken within 4 search systems-ProQuest, Scopus, PubMed, and Web of Science. RESULTS: The results span 46 years, from 1976 to 2022. A total of 167 papers were identified. After removing duplicates, 81 papers remained. Of these, 77 papers were excluded based on the inclusion and exclusion criteria. The remaining 4 papers were found to be relevant. Citation tracking was undertaken, identifying 4 more relevant papers. Thus, a total of 8 papers were included. These papers were reviewed in detail to identify the human attributes mentioned and count the frequency of mentions. A thematic analysis was conducted to identify the themes. CONCLUSIONS: The results highlight key themes that underline the complex and nuanced nature of human decision-making. The results suggest that rationality is entrenched and may influence the lexicon of our thinking about decision-making. The results also highlight the counter narrative of decision-making underpinned by uniquely human attributes. This may have ramifications for decision-making in complex health services today. The review itself takes a rational approach, and the methods used were suited to this. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/42353.

Health literacy, dementia knowledge and perceived utility of digital health modalities among future health professionals.

OBJECTIVES: Studies of dementia knowledge (including dementia risk reduction) in health-care trainees highlight varying levels of understanding across countries and disciplines. This draws attention to the need for a well-trained health workforce with the knowledge to champion and implement such strategies. This study (a) assessed dementia knowledge and health literacy among a sample of Australian health-care students, (b) identified modality preferences of digital health interventions addressing dementia prevention and (c) examined potential relationships among health literacy, dementia knowledge, dementia prevention knowledge and a student's preferences for different digital health modalities. METHODS: A cross-sectional survey assessed dementia knowledge and health literacy in 727 health students across 16 Australian universities representing both metropolitan and regional cohorts. The All Aspects of Health Literacy Scale and the Dementia Knowledge Assessment Scale were administered. Questions about the perceived effectiveness of strategies and preferred digital health modalities for dementia prevention/risk reduction were asked. RESULTS: The students had relatively high health literacy scores. However, dementia knowledge and evidence-based dementia prevention knowledge were average. Only 7% claimed knowledge of available dementia-related digital health interventions. Associations among health literacy, dementia knowledge and dementia prevention, with recommendations for different digital modalities, are presented. CONCLUSIONS: Health-related degrees need to increase dementia knowledge, health literacy and knowledge of effective dementia-related digital health interventions. It is imperative to equip the future health workforce amid an ageing population with increased dementia rates and where evidence-based digital health interventions will increasingly be a source of support.

Human Decision-making in an Artificial Intelligence-Driven Future in Health: Protocol for Comparative Analysis and Simulation.

BACKGROUND: Health care can broadly be divided into two domains: clinical health services and complex health services (ie, nonclinical health services, eg, health policy and health regulation). Artificial intelligence (AI) is transforming both of these areas. Currently, humans are leaders, managers, and decision makers in complex health services. However, with the rise of AI, the time has come to ask whether humans will continue to have meaningful decision-making roles in this domain. Further, rationality has long dominated this space. What role will intuition play? OBJECTIVE: The aim is to establish a protocol of protocols to be used in the proposed research, which aims to explore whether humans will continue in meaningful decision-making roles in complex health services in an AI-driven future. METHODS: This paper describes a set of protocols for the proposed research, which is designed as a 4-step project across two phases. This paper describes the protocols for each step. The first step is a scoping review to identify and map human attributes that influence decision-making in complex health services. The research question focuses on the attributes that influence human decision-making in this context as reported in the literature. The second step is a scoping review to identify and map AI attributes that influence decision-making in complex health services. The research question focuses on attributes that influence AI decision-making in this context as reported in the literature. The third step is a comparative analysis: a narrative comparison followed by a mathematical comparison of the two sets of attributes-human and AI. This analysis will investigate whether humans have one or more unique attributes that could influence decision-making for the better. The fourth step is a simulation of a nonclinical environment in health regulation and policy into which virtual human and AI decision makers (agents) are introduced. The virtual human and AI will be based on the human and AI attributes identified in the scoping reviews. The simulation will explore, observe, and document how humans interact with AI, and whether humans are likely to compete, cooperate, or converge with AI. RESULTS: The results will be presented in tabular form, visually intuitive formats, and-in the case of the simulation-multimedia formats. CONCLUSIONS: This paper provides a road map for the proposed research. It also provides an example of a protocol of protocols for methods used in complex health research. While there are established guidelines for a priori protocols for scoping reviews, there is a paucity of guidance on establishing a protocol of protocols. This paper takes the first step toward building a scaffolding for future guidelines in this regard. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/42353.

The social construction of nurse educator professional identities: Exploring the impact of a community of practice through participatory action research.

AIMS: The aim of the study was to explore whether, and how, professional nurse educator identity is co-constructed by a community of practice. DESIGN: A critical participatory action research (PAR) methodology was used as it extends the principles of action research by seeking purposeful and sustainable social change that recognizes participants as researchers and generators of knowledge. METHODS: Twenty-two sector-based nurse educators employed as either nurse educators or clinical nurse educators participated in the critical PAR. Multiple methods of data generation were pursued in a cyclic and sequential manner consistent in an action research process. Three distinct phases of the research across 2015-2017 involved the generation of data before, during and after the establishment of a nurse educator community of practice. A social constructionist lens of analysis was used to explore the social and relational outcomes. The COREQ checklist was used to appraise the study report. RESULTS: A sustained period of community of practice engagement enhanced the participants' relationships and shifted their perceived professional identities towards being validated nurse educators with a stronger collective sense of their roles. CONCLUSION: For this group of nurse educators, participation in the research resulted in collective meaning-making, praxis, knowledge generation and the co-construction of their professional identities.

Australian chiropractic and osteopathic graduates' perceptions of readiness for transition to practice.

OBJECTIVE: This is the second phase of a project. The aim was to explore Australian chiropractic and osteopathic new graduates' readiness for transition to practice concerning their clinical skills, professional behaviors, and interprofessional abilities. Phase 1 explored final year students' self-perceptions, and this part uncovered their opinions after 6 months or more in practice. METHODS: Interviews were conducted with a self-selecting sample of phase 1 participant graduates from 2 Australian chiropractic and 2 osteopathic programs. Results of the thematic content analysis of responses were compared to the Australian Chiropractic Standards and Osteopathic Capabilities, the authority documents at the time of the study. RESULTS: Interviews from graduates of 2 chiropractic courses (n = 6) and 2 osteopathic courses (n = 8) revealed that the majority had positive comments about their readiness for practice. Most were satisfied with their level of clinical skills, verbal communication skills, and manual therapy skills. Gaps in competence were identified in written communications such as case notes and referrals to enable interprofessional practice, understanding of professional behaviors, and business skills. These identified gaps suggest that these graduates are not fully cognizant of what it means to manage their business practices in a manner expected of a health professional. CONCLUSION: This small study into clinical training for chiropractic and osteopathy suggests that graduates lack some necessary skills and that it is possible that the ideals and goals for clinical education, to prepare for the transition to practice, may not be fully realized or deliver all the desired prerequisites for graduate practice.

Assessing individual readiness for change in healthcare: a review of measurement scales.

PURPOSE: Understanding how individuals respond and adapt to change is essential to assist leaders to manage transformational change effectively. Contemporary health care environments are characterised by frequent and rapid change, often with unrealistic and challenging timeframes. Researchers have employed a range of assessment scales to assess individual readiness for change. Hence, to select the appropriate scale, it is critical to compare the properties of these instruments. A scoping review will be conducted to identify scales that measure an individual's response to change in the healthcare environment. DESIGN/METHODOLOGY/APPROACH: In this article the authors used the PIC (Population or Problem, Interest, and Context) design and undertook a comprehensive literature search conducted in Eric, MEDLINE, EmCare, CINAHL, PsychINFO and PubMed. Management databases were also searched including Business Source Premium (Ebesco) and Business Collection (InfoRMIT). Reference lists were scrutinized, and citation searches were performed of the included studies. The primary outcome was the quality of the literature searches and the secondary outcome was time spent on the literature search when the PIC model was used as a search strategy tool, compared to the use of another conceptualizing tool or unguided searching. FINDINGS: This scoping review identified eight scales used to measure an individual's response to change. This scoping review did not identify any individual change readiness scales specifically designed for use in the healthcare environment. However, two scales (the Acceptance of Change Scale and the Resistance to Change Scale) had applicability across a wide variety of organisational settings. RESEARCH LIMITATIONS/IMPLICATIONS: Scoping reviews do not set out to comprehensively source all relevant literature but rather to ascertain the nature and extent of the published literature in the field. Therefore, it is possible that a systematic review might uncover additional relevant papers. PRACTICAL IMPLICATIONS: This scoping review will assist change leaders to gain a better understanding of the different scales used to measure individual response to change. ORIGINALITY/VALUE: To manage change effectively, change leaders first need to develop an understanding of how individuals respond and adapt to change. Change leaders require the necessary scales to assist them to understand change processes, providing an understanding of where individuals are placed on the change continuum. To the best of the authors' knowledge, this scoping review is the first of its kind to identify and review scales to measure individual response to change.

Chiropractic and osteopathic students' perceptions of readiness for transition to practice: The educational value of university clinic vs community and private clinics.

OBJECTIVE: The objective was to determine final-year students' self-perceptions of readiness for transition to practice, professional identity, and experiences of interprofessional clinical practice. Findings will inform the clinical education curriculum. METHODS: We used repeated measures individual case studies with a self-selecting sample from the total final-year student population at 2 chiropractic and 2 osteopathic programs offered by Australian universities. Cases were not compared. Amalgamated data are presented. RESULTS: There were interviews with students in 2 chiropractic programs (n = 15) and 2 osteopathic programs (n = 13). Perceptions indicate that clinical education in university health clinics prepares them for transition to practice through scaffolded supervision of their consultations with reasonably healthy patients. Students perceived that other clinics (community clinics or private practices) prepared their readiness for transition to practice substantially better. Community clinics and private practices allowed students to consult people from diverse socioeconomic and cultural backgrounds and treat complex health care issues, and the model of supervision allows students a degree of autonomy. Students lacked a clear understanding of the behaviors that demonstrate their professionalism. Interprofessional learning activities were ad hoc and opportunistic. CONCLUSION: University health clinics, private practices, and community clinics prepare students for transition to practice in different ways. Most students feel prepared. There is a clear indication that a focused discussion related to the development of students' understanding of competencies related to professionalism and another related to interprofessional clinical education in curriculum are needed.

Responding and adapting to change: an allied health perspective.

PURPOSE: The purpose of this paper is to review the literature on the response and adaption to change of allied health professionals. Understanding how individuals respond and adapt to change is essential to assist leaders to manage transformational change effectively. Contemporary health-care environments are characterised by frequent and rapid change, often with unrealistic and challenging time frames. Individuals operate independently, but also as members of teams, professions and organisations. Therefore, having a sound understanding of individual response to change is important for change leaders. In the Australian context, allied health professionals represent a quarter of the health-care workforce. There is a significant gap in understanding how allied health professionals respond and adapt to change. DESIGN/METHODOLOGY/APPROACH: A scoping review was designed to report on the nature and extent of the literature on the response and adaption to change in the context of allied health professionals. Change leaders in the health-care environment face a number of complex challenges when attempting to facilitate change. While this scoping review did not identify any specific literature on the response and adaption to change of allied health professionals, it did however provide information on change models and factors to take into consideration when implementing a change process. FINDINGS: The results of this scoping review identified findings in two main areas with regard to response and adaptation of allied health to change: a review of change management literature at the organisation level and change management for allied health. Most of the literature described organisational level change management without providing a structural framework for change. At the professional individual level, the literature focused on specific clinical interventions, rather than on the response and adaption to change for allied health. Minimal literature was identified in regard to the response and adaption to change of allied health professionals. In an environment characterised by continuous change and policy reform, a greater understanding of the response and adaption to change by allied health is a priority for research, policy and practice. RESEARCH LIMITATIONS/IMPLICATIONS: This scoping review was undertaken to explore the response and adaption to change of allied health. It sought to identify the factors that may explain why certain disciplines within the allied health professional group responded to change differently. Scoping reviews do not set out to comprehensively source all relevant literature but rather to ascertain the nature and extent of the published literature in the field. Therefore, it is possible that a systematic review might uncover additional relevant papers. However, this scoping review provides a clear indication of the nature and extent of the literature in allied health. SOCIAL IMPLICATIONS: This scoping review will assist change leaders to gain a better understanding of theoretical frameworks of individual, team and organisational change processes and the impacts these have individually and collectively on change processes. ORIGINALITY/VALUE: To the best of the authors' knowledge, this scoping review is the first of its kind to identify the minimal literature available on the way allied health professionals respond and adapt to change.

A realist evaluation of a regional Dementia Health Literacy Project.

BACKGROUND: A Dementia Health Literacy Project was undertaken in the north coast region of NSW, Australia, after it was identified as having a high prevalence of dementia. A Dementia Support Kit was produced with service user engagement to provide useful information to people with dementia and their families. OBJECTIVE: To evaluate the Dementia Health Literacy Project using a realist evaluation framework. SETTING AND PARTICIPANTS: The setting was the region of the north coast of New South Wales. Eight people diagnosed with dementia and their carers, 13 members of social groups of older people in the local area, and 22 local GPs and other health-care and service providers participated in this study. RESULTS: Two context-mechanism-outcome configurations were identified: (a) co-design workshops where the stakeholders' opinions were equally valued (context) led service users to feel listened to and prompted them to provide feedback (mechanism) to develop a practical resource that they would use (outcome); and (b) use of health professionals to distribute the resources (context) that they consider useful and valuable (mechanism) resulted in the target audience receiving the resources (outcome). DISCUSSION AND CONCLUSIONS: The Dementia Health Literacy Project produced a Dementia Support Kit that is likely to provide locally relevant and useful information for people with dementia and their carers. The results highlight the value of the co-design approach in producing and disseminating dementia health literacy resources. Further evaluation is required to confirm the impact of the Kit over time on service users' behaviour and consequently on their health outcomes.

Hearing loss and its impact on residents in long term care facilities: Asystematic review of literature.

The prevalence of age-related hearing loss is high among older adults. Growing longevity and the older profile of aged care residents is likely to result in an increasing incidence of hearing loss among this cohort. This review reports on the findings of a systematic search of the academic databases CINAHL, Medline, PsychInfo and Scopus undertaken to investigate the hearing experiences of residents of aged care facilities. Twenty-two studies met the inclusion criteria. Our analysis revealed clear barriers and facilitators to optimal hearing experiences and indicated the importance of the physical and social environment for effective communication. Under-detection of hearing loss and underuse of hearing aids were prevalent. The findings highlight the importance of addressing these issues for this cohort's quality of life. Future trends that may impact on training needs are considered and recommendations are made.

Clinical exercise physiology students learning with older adults: an innovative simulation-based education programme.

In this paper, we report on a series of placements for clinical exercise physiology students in a simulation-based education environment with older, independent adults. The purpose of these placement opportunities was to help prepare students to work confidently and competently with older adults in primary healthcare settings. The effectiveness of these placements was measured through semi-structured interviews with the students, their supervisors and the volunteer patients, and also by analysing the content of the students' written reflection assignments. A combination of directed content analysis, informed by the research objectives and imposed upon the data, and conventional content analysis, in which codes were developed from themes emerging from the data, was adopted. Coding was based on units of meaning. Overall, the placement aims were met. Students reported increased confidence in communicating with older adults and in using the tools of their trade. This innovative simulation-based education experience helped students gain an understanding of their developing professional identities. However, the data show that some students still failed to recognise the value and importance of communication when working with older adults. The older adults reported that they enjoyed interacting with the students and believed that they had helped the students gain a positive impression of the cognitive and physical abilities of older adults. These older adults had also gained insight into the benefits of exercise physiology in terms of their own wellbeing. This paper demonstrates the benefits of engaging community support in developing healthcare workers and provides guidelines for replication of these innovative simulation-based education experiences. The paper is limited to reporting the social and community engagement benefits for older adults and the learning opportunities for the clinical exercise physiology students. Further research is needed to demonstrate the health gains for older adults who participate in such programmes.

Factors that impact residents' transition and psychological adjustment to long-term aged care: a systematic literature review.

AIM: To identify the factors that impact residents' transition and adjustment to long-term aged care and influence their relocation experience. BACKGROUND: The transition to long-term aged care can be an emotional and stressful event for older people as well as their families and carers. The challenges triggered by relocation derive from home being on the move. The concept of home and Bridges' three stages of transition framework provide conceptual models for better understanding the needs and aspiration of older people who are in the process of this late life transition. METHOD: We searched Academic Search Premier, Cinahl, Medline, PyscINFO, Psychology and Behavioral Sciences Collection and Scopus databases for observational, descriptive studies published between January 1995 and July 2013 using subject headings and free-text search terms including adjustment, nursing homes, relocation and transition. RESULTS AND DISCUSSION: The search identified 348 potentially relevant articles. Once duplicates were removed, 214 articles were screened for inclusion in this review; 42 articles were assessed for eligibility, resulting in 19 high-quality observational, descriptive studies that met the inclusion criteria. Key determinants of residents' relocation experience include the extent to which they were able to exert control over the decision to move to an aged care facility, preserve their autonomy, and retain meaningful social relationships. Encouraging the development of new relationships with other residents and staff is an important role for staff to play. Providing residents with opportunities to talk about their feelings, their life experience, and their involvement in the decision to relocate to an aged care facility can help them in their transition to an aged care facility. Preadmission screening that provides staff with an understanding of personal, lifestyle and cultural needs that might facilitate improved transition may also be beneficial in care planning. CONCLUSION AND IMPLICATIONS: An understanding of the factors that impact residents' transition to long-term aged care, and their experience of relocation will assist aged care providers to create the conditions to ease adjustment anxiety and to facilitate a person's transition into his/her 'last home'.

Creating the conditions for self-fulfilment for aged care residents.

In 1991 the United Nations General Assembly adopted the Principles for Older Persons as a framework for international policy responses to population ageing. These principles promote independence, participation, care, self-fulfilment and dignity as legitimate entitlements of all older people. Although these principles, or variations of them, are embedded in standards of best-practice in residential aged care facilities, the literature shows that in reality institutional care can deny older people opportunities to exercise some of these entitlements. More specifically, residential aged care facilities can deprive older people of access and support to pursue opportunities for the full development of their potential, i.e. their entitlement to self-fulfilment. This discussion article explores the influence of institutional care on older people's ability to exercise their entitlement to self-fulfilment. We identify the characteristics of a 'good life' in institutional care, according to aged care residents themselves. The Eden Alternative is presented as a model of aged care that aims to create the conditions for a 'good life' and self-fulfilment for aged care residents.

The management of loneliness in aged care residents: an important therapeutic target for gerontological nursing.

Social engagement and meaningful relationships are critical determinants of the quality of life of older people. Human beings have an intrinsic need for social connections and an engagement with the social environment. Deficits in the quality of these social relationships lead to feelings of isolation and loneliness in older people. Loneliness can have serious physiological and health implications. It is well established that loneliness is a risk factor for poor physical and mental health, comparable in size to obesity, a sedentary lifestyle and possibly even smoking. The aim of this article is to present an argument for the management of loneliness in aged care residents as an important therapeutic target in gerontological nursing. To date little is known about the effectiveness of intervention strategies designed to alleviate loneliness in aged care residents. Nurses can address this deficit in our understanding by evaluating the impact of loneliness intervention strategies.

Future time orientation predicts academic engagement among first-year university students.

BACKGROUND: Enhancing student engagement is considered an important strategy for improving retention. Students' Time Perspective is an under-researched factor that may significantly influence student engagement. AIMS: This study examines interrelationships between elements of student engagement and relationship with Time Perspective. We propose that there are significant relationships between psychological and behavioural elements of student engagement. We also posit that time orientation is an important factor in facilitating psychological and behavioural elements of student engagement. SAMPLE: Participants (N=347) were first-year undergraduate students who had completed one semester of study and re-enrolled for a further semester of study at an Australian university. METHODS: Participants were surveyed using instruments designed to measure Academic Application, Academic Orientation (McInnis, James, & Hartley, 2000), Time Perspective (Zimbardo & Boyd, 1999), the shortened version of the Study Process Questionnaire (Fox, McManus, & Winder, 2001) and hours spent preparing for class. RESULTS: There were interrelationships between the elements of student engagement (e.g. Academic Application) with productive educational behaviours (e.g. deep approach to learning). Students' perceptions of time appeared as a key factor mediating levels of Academic Application and Academic Orientation. Orientation to the Future emerged as a significant predictor of these elements of engagement. CONCLUSIONS: Future orientation emerged as an important factor mediating students' academic engagement in these students who completed one semester of study. Interventions focusing on the development of time perspective may be helpful in encouraging and supporting academic engagement and, ultimately, persistence in higher education.

Deaf people communicating via SMS, TTY, relay service, fax, and computers in Australia.

Despite the expansion of Deaf people's use of communication technology little is published about how they use electronic communication in their social and working lives and the implications for their concepts of identity and community. Australia is an ideal research base because the use of a range of technologies is widespread there. To gain access to a wide age range of people who identify as Deaf, members of the national organization, the Australian Association of the Deaf, were surveyed by mail. Results showed that Short Message Service (SMS), telephone typewriters (TTY), voice/TTY relay services, fax, and e-mail were used regularly. Deaf users are discerning of the purposes for which they use each method: SMS for social and personal interactions, TTY for longer communications and (via the relay service) with people and services without TTYs, fax for business and social contact, and computers for personal and business e-mails as well as Web browsing, accessing chat rooms, word processing, games, and study.