Who cares for the carer? Codesigning a carer health and wellbeing clinic for older care partners of older people in Australia.

INTRODUCTION: Older carers or 'care partners' of older people experiencing care needs often provide essential support, at times while neglecting their own health and well-being. This is an increasingly frequent scenario due to both demographic changes and policy shifts towards ageing in place. Multiple community stakeholders within the care and support ecosystem hold valuable expertise about the needs of older care partners, and the programme and policy responses that may better support their health and well-being. The aim of this study was to identify the perspectives of stakeholders obtained through the codesign phase of a multicomponent research project investigating new models of care and support for older care partners suitable for the Australian context. METHODS: Principles of codesign were used to engage a purposeful sample of older care partners, health professionals, researchers, policy makers and health service administrators. Participants took part in a series of three codesign workshops conducted remotely via video conferencing. The workshops were supported with briefing material and generated consensus-based summaries, arriving at a preferred service model. FINDINGS: This paper reports the research design and structure of the codesign panels, the range of findings identified as important to support the health and well-being of older carers of older people, and the resulting service model principles. The codesigned and preferred model of care is currently being prepared for implementation and evaluation in Australia. PUBLIC CONTRIBUTION: This study was conducted using codesign methodology, whereby stakeholders including older care partners and others involved in supporting older carers, were integrally involved with design, development, results and conclusions.

Older women's view on frailty and an Emergency Department evidence-based Frailty Intervention Team (FIT) program: An evaluation using the Reach, Effectiveness, Adoption, Implementation, Maintenance RE-AIM framework.

BACKGROUND: Older women have higher levels of frailty resulting in disability and reduced quality of life. Presentation to an Emergency Department (ED) is an opportunity to address frailty and provide tailored interventions to promote function. An ED allied health team integrated frailty assessment and interventions into care through a 'Frailty Intervention Team' (FIT) program. METHODS: A prospective study informed by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework to evaluate the FIT program tailored to female older adults. The purpose of this project was to evaluate the FIT program over a three-month period and use the findings to further develop the intervention. RESULTS: Over three-months, 192 older females (>70 years) were identified with mild frailty and discharged directly home. Ninety percent were offered the FIT program with 83.3 % accepting all recommended frailty management strategies. Ninety percent of patients were satisfied with the FIT program, however staff and patient barriers to provision of frailty services were identified. CONCLUSIONS: The FIT program was largely adopted by staff and accepted by older female patients with mild frailty in the ED. However, program effectiveness was limited by gaps in communication about frailty in the ED and implementation of frailty management strategies after discharge.

Understanding the Role, Quality of Life and Strategies Used by Older Carers of Older People to Maintain Their Own Health and Well-Being: A National Australian Survey.

Introduction: Carers play a critical role in supporting older people with health problems to remain living at home. This study aimed to understand the role and quality of life of older carers of older people and identify strategies used to manage their own health and well-being. Methods: Older carers (aged ≥50 years) of older people (aged ≥65 years) in Australia participated in a cross-sectional survey focused on carer roles, self-rated health, information and activities used to maintain their carer role and health, barriers to accessing health care, and assessment of quality of life (QoL) using the Dementia Quality of Life Scale for Older Family Carers. Multiple regression analysis examined relationships between variables and the QoL outcome. Results: The survey was completed by 189 older carers (mean age: 68 years; SD = 9.3). Most were female (83.5%), 80.2% providing care daily and 47.8% provided ≥six hours care daily. Almost half (45.1%) self-reported their health as average or below. Despite rating ensuring personal health as very important (mean importance 8/10), only 46.3% reported receiving support from their general practitioner for their carer role. The most common barrier to accessing care for themselves was "not having enough time". Factors independently associated with poorer carer QoL were living with the care-recipient, caring for someone with depression/anxiety and poor care-recipient health. Factors independently associated with higher carer QoL were placing high importance on personal health, receiving assistance from a specialist clinic as a carer, and older age. Conclusion: Older carers of older people provide high levels of care and experience reduced quality of life. Innovative approaches that provide integrated care and support for older carers to promote their QoL are urgently needed.

Coping with COVID-19. Work life experiences of nursing, midwifery and paramedic academics: An international interview study.

BACKGROUND: The COVID-19 global pandemic was declared in March 2020. By June 2022, the total deaths worldwide attributed to COVID-19 numbered over 6.3 million. Health professionals have been significantly impacted worldwide primarily those working on the frontline but also those working in other areas including nursing, midwifery, and paramedic higher education. Studies of occupational stress have focused on the clinical health professional roles but scant attention has been drawn to the pressures on university-based academic staff supporting and preparing professionals for frontline health work. DESIGN AND OBJECTIVES: This qualitative study sought to explore the challenges experienced by health academics (nurses, midwives and paramedics), during COVID-19 and identify strategies enlisted. SETTING AND PARTICIPANTS: Six Australian and two United Kingdom universities collaborated, from which 34 health academics were individually interviewed via video or teleconference, using six broad questions. Ethical approval was obtained from the lead site and each participating University. DATA ANALYSIS: Thematic analysis of the data was employed collaboratively across institutions, using Braun and Clarke's method. RESULTS: Data analysis generated four major themes describing academics': Experiences of change; perceptions of organisational responses; professional and personal impacts; and strategies to support wellbeing. Stress, anxiety and uncertainty of working from home and teaching in a different way were reported. Strategies included setting workday routine, establishing physical boundaries for home-working and regular online contact with colleagues. CONCLUSIONS: The ability of nursing, midwifery and, paramedic academic staff to adapt to a sudden increase in workload, change in teaching practices and technology, while being removed from their work environment, and collegial, academic and technological supports is highlighted. It was recognised that these changes will continue post-COVID and that the way academics deliver education is forever altered.

Understanding Nurse Characteristics that Influence Assessment and Intention to Treat Pain in Postoperative Patients: An Integrative Literature Review.

OBJECTIVES: An understanding of nurse characteristics that influence pain management, which are potentially amenable to change, can help to refine and improve nurse education and practice, resulting in better patient outcomes. The purpose of this review was to identify nurse characteristics that influence their assessment of and intention to treat postoperative pain. DESIGN: Integrative literature review. DATA SOURCES: A systematic search of electronic databases (CINAHL, Scopus, PsycINFO, Medline, and Embase), using these constructs "pain assessment", "pain management", "postoperative pain", "nurses", "cultural beliefs" and "nurses' perceptions" was conducted for the period 2000 to October 2020. REVIEW/ANALYSIS METHODS: Following a systematic screening process, the included articles were analyzed and synthesized to identify themes and subthemes. RESULTS: A total of 40 articles were included with three main themes identified: nurse knowledge; nurse sociocultural factors, personal beliefs and attitudes, and other characteristics; and believing or doubting the patient. There was evidence that targeted education interventions can improve nurse knowledge and nurses' clinical practice in relation to pain management. What was less clear was which nurse attitudes and biases influenced their pain management practice or how these could be changed. CONCLUSIONS: More studies are needed to investigate the influence of cultural characteristics on pain assessment and management. There is a need for further quantitative studies that explore the relationship between nurse characteristics and their pain management practice. Intervention studies using innovative educational approaches that change attitudes and biases, and improve practice are needed.

Measurement properties of self-report instruments to assess health literacy in older adults: a systematic review.

BACKGROUND: High health literacy (HL) is important to optimise health outcomes, particularly for older people (who are substantial consumers of health services) and their adult caregivers. The aim of this systematic review was to evaluate measurement properties of HL instruments tested with these population groups. MATERIALS AND METHODS: Six databases (MEDLINE (OVID); CINAHL; EMBASE (OVID); PsycInfo; Scopus; Cochrane Library) were searched for studies evaluating eight measurement properties of HL tools administered to older people or their caregivers. Only studies evaluating multi-domain self-report HL tools were included in analyses, using the COSMIN methodology. RESULTS: From 4261 unique papers located, 11 met inclusion criteria; six reported measurement properties of three HL self-report tools administered to older people (HLQ, eHEALS, and HeLMS) so are reported in this review, none involved caregiver samples. The HLQ and HeLMS were rated "moderate," and eHEALS "low" for tool development. The HLQ, examined in four included studies, had the highest ratings and quality of evidence across the three measurement properties investigated in included papers. CONCLUSION: The HLQ was the most highly rated self-report HL tool of just three tested with older people. Further studies evaluating measurement properties of self-report HL tools used with older people and/or their caregivers are needed.Implications for rehabilitationHealth literacy is important to optimise health outcomes of interventions for older people and their adult caregivers.Few studies have evaluated measurement properties of self-report / multi-domain health literacy tools for this population.The Health Literacy Questionnaire (HLQ) had the highest ratings and quality of evidence across the three measurement properties investigated in included studies, and is recommended for use in rehabilitation settings.

Evaluating the provision of Further Enabling Care at Home (FECH+) for informal caregivers of older adults discharged home from hospital: protocol for a multicentre randomised controlled trial.

INTRODUCTION: There are personal and societal benefits from caregiving; however, caregiving can jeopardise caregivers' health. The Further Enabling Care at Home (FECH+) programme provides structured nurse support, through telephone outreach, to informal caregivers of older adults following discharge from acute hospital care to home. The trial aims to evaluate the efficacy of the FECH+ programme on caregivers' health-related quality of life (HRQOL) after care recipients' hospital discharge. METHODS AND ANALYSIS: A multisite, parallel-group, randomised controlled trial with blinded baseline and outcome assessment and intention-to-treat analysis, adhering to Consolidated Standards of Reporting Trials guidelines will be conducted. Participants (N=925 dyads) comprising informal home caregiver (18 years or older) and care recipient (70 years or older) will be recruited when the care recipient is discharged from hospital. Caregivers of patients discharged from wards in three hospitals in Australia (one in Western Australia and two in Queensland) are eligible for inclusion. Participants will be randomly assigned to one of the two groups. The intervention group receive the FECH+ programme, which provides structured support and problem-solving for the caregiver after the care recipient's discharge, in addition to usual care. The control group receives usual care. The programme is delivered by a registered nurse and comprises six 30-45 min telephone support sessions over 6 months. The primary outcome is caregivers' HRQOL measured using the Assessment of Quality of Life-eight dimensions. Secondary outcomes include caregiver preparedness, strain and distress and use of healthcare services. Changes in HRQOL between groups will be compared using a mixed regression model that accounts for the correlation between repeated measurements. ETHICS AND DISSEMINATION: Participants will provide written informed consent. Ethics approvals have been obtained from Sir Charles Gairdner and Osborne Park Health Care Group, Curtin University, Griffith University, Gold Coast Health Service and government health data linkage services. Findings will be disseminated through presentations, peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER: ACTRN12620000060943.

Testing the reliability of the Health Literacy Questionnaire with carers of older adults receiving hospital care.

OBJECTIVE: To determine the re-test reliability of the Health Literacy Questionnaire (HLQ) with carers of older adults discharged from hospital or attending the outpatient clinic. METHODS: Carers completed the HLQ twice by telephone and rated the acceptability of completing the tool. Tool completion time was recorded. Correlations were calculated between the test occasions using intraclass correlation coefficients (ICC) and 95% confidence intervals. RESULTS: Fifty-one carers of older patients participated. The HLQ showed good reliability (ICC = 0.75-0.90) for seven of the nine scales and moderate reliability (0.50-0.74) for the other two scales. Median completion time was 16.5 minutes (range 9-50), and acceptability was rated as 9.5/10. CONCLUSION: The HLQ is a reliable tool for use with carers of older adults attending hospital. However, the length of time for completion of the HLQ may limit its feasibility for use by hospital staff and carers, given the high stress and time pressures of acute care.

Pilot study of the effectiveness of a Mindful Self-Care and Resiliency program for rural doctors in Australia.

OBJECTIVE: Rural doctors are difficult to recruit and retain. Burnout and stress in the medical workforce fluctuates according to location. Overall, doctors have an elevated risk of depression and suicide compared to the general population and other professionals. Higher levels of occupational stress also effect patient care, levels of work satisfaction and relationships with others. This study evaluated the effectiveness, acceptability, feasibility and sustainability of the Mindful Self-Care and Resiliency Program. DESIGN: This was a sequential mixed-method study involving the collection of both quantitative and qualitative data. SETTING: The study was conducted in Emerald, Queensland. PARTICIPANTS: Thirteen doctors took part in the program with seven providing pre and post survey responses. Qualitative data were collected via semi-structured telephone interviews with an additional four rural doctors. Intervention The Mindful Self-Care and Resiliency program consisted of a 4-hour face-to-face session and three 1-hour video-conference follow up sessions. Main outcome measures Burnout, negative affect, well-being and psychological strain were assessed using self-report measures before and after taking part in the program. Results The majority (six out of seven) of the doctors showed reductions in burnout, psychological strain and negative affect following participation in the program. The qualitative data indicated that all doctors gained new skills: self-awareness, reflection and self-care. They also reported improved interaction with colleagues and patients, to whom they passed on their new learning. Conclusion This preliminary investigation of the effectiveness and feasibility of Mindful Self-Care and Resiliency for rural doctors indicates that the program has promise in improving the emotional well-being of this occupational group. Although this study captured approximately one-third of the Emerald workforce, further research with a larger sample is required to confirm these findings.

The influence of adaptive challenge on engagement of multidisciplinary staff in standardising aseptic technique in an emergency department: A qualitative study.

AIMS AND OBJECTIVES: To explore the challenge of engaging multidisciplinary staff in standardising aseptic technique (AT) in an emergency department (ED) in an Australian tertiary hospital, and to better understand the enablers and barriers to implementing practice change within this setting. BACKGROUND: Healthcare-associated infections are the most common complication for patients in acute care. A clinical practice framework developed in the United Kingdom (UK) standardised AT practice to reduce potential infection risk. One Australian tertiary hospital drew upon this framework to similarly improve clinical practice. It was understood that standardising practice would require some practitioners only to revisit and demonstrate AT principles already embedded in their practice, while others would be challenged to adopt a new approach. DESIGN: Qualitative, descriptive research design. METHODS: Data were collected through focus groups held before and after implementation of the AT programme. Data were analysed using the framework method. The (COREQ) checklist was followed. RESULTS: Four emergent themes described the influence of motivation on individuals' beliefs and attitudes towards practice change, relationships within the ED context, delivery of education and management directives. CONCLUSION: Implementing practice change is more than just providing technical knowledge and includes changing individuals' beliefs and attitudes. An understanding of adaptive challenge can assist in implementing practice change that involves the multidisciplinary team. RELEVANCE TO CLINICAL PRACTICE: Results provide evidence as to how the adaptive challenge framework could be a suitable approach to manage potential enablers and barriers to implementing change within a multidisciplinary team in an acute hospital.

Assessment of functional health literacy in Brazilian carers of older people.

Individuals with low health literacy have less knowledge of their own health condition. Carers play a key role in older people's activities of daily living. OBJECTIVE: to evaluate the performance of carers of older people using the S-TOFHLA (Short Test of Functional Health Literacy in Adults) and to identify caregiver characteristics associated with low functional health literacy. METHODS: a cross-sectional study was conducted. The S-TOFHLA, a sociodemographic instrument, the Mini-Mental State Exam and the Patient Health Questionnaire-2 were applied to 80 carers of older patients routinely followed by doctors from the Primary Health Care Sector of the City of Botucatu, São Paulo. The multivariate analysis used an ordinal logistic regression model with test (S-TOFHLA) scores as the dependent variable. The level of statistical significance adopted was 0.05. RESULTS: the individuals had a mean age of 54.6 (± 11.7); 27% of the carers evaluated had inadequate levels of health literacy (S-TOFHLA ≥54). A higher proportion of individuals with low education had inadequate or marginal health literacy (p<0.001). CONCLUSION: nearly 1/3 of the carers had marginal or inadequate levels of health literacy. These results highlight the difficulties of many carers in understanding health information.

Indivíduos com baixo alfabetismo em saúde têm menos conhecimento sobre sua própria condição de saúde. Cuidadores desempenham um papel fundamental nas atividades de vida diária dos idosos. OBJETIVO: avaliar o desempenho de cuidadores de pessoas idosas usando o "S-TOFHLA (Short Test of Functional Health Literacy in Adults)" e identificar características do cuidador associadas ao baixa alfabetismo em saúde. MÉTODOS: um estudo transversal foi conduzido. O S-TOFHLA, um instrumento sociodemográfico, o Miniexame do Estado Mental e o "Patient Health Questionnaire - 2" foram aplicados a 80 cuidadores de pacientes idosos rotineiramente acompanhados por médicos do Setor de Atenção Primária à Saúde da cidade de Botucatu, São Paulo. A análise multivariada utilizou um modelo de regressão logística ordinal com os escores do S-TOFHLA como variável dependente. O nível de significância estatística adotado foi de 0,05. RESULTADOS: os indivíduos tiveram idade média de 54,6 (± 11,7) anos; 27% dos cuidadores avaliados apresentavam níveis inadequados de alfabetização em saúde. Uma proporção maior de indivíduos com baixa escolaridade apresentou alfabetização em saúde inadequada e limítrofe (p<0,001). CONCLUSÃO: aproximadamente 1/3 dos cuidadores apresentaram níveis limítrofes e inadequados de alfabetização em saúde. Esses resultados destacam as dificuldades de muitos cuidadores em compreender informações sobre saúde.

Assessment of functional health literacy in Brazilian carers of older people / Avaliação do analfabetismo funcional em saúde em cuidadores de idosos brasileiros

ABSTRACT. Individuals with low health literacy have less knowledge of their own health condition. Carers play a key role in older people's activities of daily living. Objective: to evaluate the performance of carers of older people using the S-TOFHLA (Short Test of Functional Health Literacy in Adults) and to identify caregiver characteristics associated with low functional health literacy. Methods: a cross-sectional study was conducted. The S-TOFHLA, a sociodemographic instrument, the Mini-Mental State Exam and the Patient Health Questionnaire-2 were applied to 80 carers of older patients routinely followed by doctors from the Primary Health Care Sector of the City of Botucatu, São Paulo. The multivariate analysis used an ordinal logistic regression model with test (S-TOFHLA) scores as the dependent variable. The level of statistical significance adopted was 0.05. Results: the individuals had a mean age of 54.6 (± 11.7); 27% of the carers evaluated had inadequate levels of health literacy (S-TOFHLA ≥54). A higher proportion of individuals with low education had inadequate or marginal health literacy (p<0.001). Conclusion: nearly 1/3 of the carers had marginal or inadequate levels of health literacy. These results highlight the difficulties of many carers in understanding health information.

RESUMO. Indivíduos com baixo alfabetismo em saúde têm menos conhecimento sobre sua própria condição de saúde. Cuidadores desempenham um papel fundamental nas atividades de vida diária dos idosos. Objetivo: avaliar o desempenho de cuidadores de pessoas idosas usando o "S-TOFHLA (Short Test of Functional Health Literacy in Adults)" e identificar características do cuidador associadas ao baixa alfabetismo em saúde. Métodos: um estudo transversal foi conduzido. O S-TOFHLA, um instrumento sociodemográfico, o Miniexame do Estado Mental e o "Patient Health Questionnaire - 2" foram aplicados a 80 cuidadores de pacientes idosos rotineiramente acompanhados por médicos do Setor de Atenção Primária à Saúde da cidade de Botucatu, São Paulo. A análise multivariada utilizou um modelo de regressão logística ordinal com os escores do S-TOFHLA como variável dependente. O nível de significância estatística adotado foi de 0,05. Resultados: os indivíduos tiveram idade média de 54,6 (± 11,7) anos; 27% dos cuidadores avaliados apresentavam níveis inadequados de alfabetização em saúde. Uma proporção maior de indivíduos com baixa escolaridade apresentou alfabetização em saúde inadequada e limítrofe (p<0,001). Conclusão: aproximadamente 1/3 dos cuidadores apresentaram níveis limítrofes e inadequados de alfabetização em saúde. Esses resultados destacam as dificuldades de muitos cuidadores em compreender informações sobre saúde.

Caregivers' experiences of a home support program after the hospital discharge of an older family member: a qualitative analysis.

BACKGROUND: The ageing global population has seen increasing numbers of older people living with chronic health problems, declining function, and frailty. As older people seek to live out their years at home, family members, friends and neighbours (informal caregivers) are increasingly relied upon for support. Moreover, pressured health systems and shorter hospital length of stay mean that informal caregivers can find themselves supporting the older person who is still unwell after discharge. The Further Enabling Care at Home (FECH) program was developed as a nursing outreach intervention designed to systematically address support needs of family caregivers of older people after hospital discharge to sustain their home-based caregiving. The objective of this study was to explore the experiences of informal caregivers who participated in the FECH program after an older family member's discharge from hospital. METHODS: The study employed a qualitative descriptive design. Caregivers of older people discharged home from a Medical Assessment Unit in an Australian hospital who were included in the program were interviewed to explore their experiences and perceptions of the FECH program. Data were audio-recorded, transcribed, and subjected to thematic analysis. RESULTS: Twenty-one family caregivers (81% female, aged 25-89 years) participated in the interviews. Themes emerging were 'The experience of caregiving'; 'The experience of receiving FECH program support'; and 'Caregivers' suggestions for improvement'. Caregivers indicated that reflective discussions with the FECH nurse enabled them to recognise the complexity of the caregiving role and determine aspects where they needed support. Caregivers valued guidance from the FECH nurse in accessing information and resources, which helped them to feel more connected to support, more prepared to care for the older person and themselves, and more secure in the caregiving role. CONCLUSIONS: Caregivers' experiences indicated that the structured reflective FECH discussions prompted thought and provided guidance in navigating health and care systems. The FECH program appears to offer a means to address the practical, physical and psychosocial needs of informal caregivers as partners in person-centred health and social care. TRIAL REGISTRATION: ANZCTR Trial ID: ACTRN126140011746773 .

The cost-effectiveness of a telephone-based intervention to support caregivers of older people discharged from hospital.

BACKGROUND: A telephone intervention for caregivers of older people discharged from hospital was shown to improve preparedness to care, reduce caregiver strain and caregiver distress. No cost-effectiveness analysis has been published on this, or similar interventions. The study aims addressed here were to examine whether positive outcomes for caregivers resulting from the Further Enabling Care at Home (FECH) program changed the use and costs of health services by patients; and to assess cost-effectiveness. METHODS: A single-blind randomised controlled trial compared FECH to usual care. FECH involved a specially trained nurse addressing support needs of caregivers of older patients discharged from hospital. A minimum clinically important difference in preparedness to care was defined as an increase in Preparedness for Caregiving scale score of ≥ two points from baseline. Designated data collection was at: Time 1, within four days of discharge; Time 2, 15-21 days post-discharge; and Time 3, six weeks post-discharge. A last observation carried forward approach to loss to follow-up was used, with a sensitivity analysis including only those who completed all time points. Patient use of hospital, emergency department (ED) and ambulance services were captured for 12 weeks post-discharge using administrative data. Costs included nurse time supporting caregivers, resources used by the nurse, and time taken training the nurse to deliver FECH. Cost-effectiveness was assessed using decision trees for preparedness for caregiving. RESULTS: Sixty-two intervention dyads and 79 controls provided complete data. A significantly greater proportion of intervention group caregivers reported improved preparedness to care to Time 2 (36.4% v 20.9%, p = 0.029), though this was not sustained to Time 3. The intervention cost $AUD268.28 above usual care per caregiver. No significant differences were observed in health service use between groups. The incremental cost-effectiveness ratio for each additional caregiver reporting improved preparedness to care at Time 2 was $AUD1,730.84. CONCLUSIONS: To our knowledge this is the first work to calculate the cost-effectiveness of a telephone-delivered intervention designed to support caregivers of older people post-discharge, and will support decision-making regarding implementation. Further research should examine different settings, and assess impacts on health service use with larger samples and a longer follow-up. TRIAL REGISTRATION: Australian and New Zealand Clinical Trial Registry: ACTRN12614001174673 . Registered 07/11/2014.

Obtaining information from family caregivers to inform hospital care for people with dementia: A pilot study.

AIM: We aimed to implement a systematic nurse-caregiver conversation, examining fidelity, dose and reach of implementation; how implementation strategies worked; and feasibility and mechanisms of the practice change. BACKGROUND: Appropriate hospital care for people living with dementia may draw upon: information from the patient and family caregiver about the patient's perspective, preferences and usual support needs; nursing expertise; and opportunities the nurse has to share information with the care team. Within this context, planned nurse-caregiver communication merits further investigation. METHODS: In Phase I, we established the ward staff's knowledge of dementia and Alzheimer's disease, prepared seven nurse change leaders, finalised the planned practice change and developed implementation plans. In Phase II, we prepared the ward staff during education sessions and leaders supported implementation. In Phase III, evaluations were informed by interviews with change leaders, follow-up measures of staff knowledge and a nurse focus group. Qualitative data were thematically analysed. Statistical analyses compared nurses' knowledge over time. RESULTS: Planned practice change included nurses providing information packs to caregivers, then engaging in, and documenting, a systematic conversation. From 32 caregivers, 15 received information packs, five conversations were initiated, and one was completed. Knowledge of dementia and Alzheimer's disease improved significantly in change leaders (n = 7) and other nurses (n = 17). Three change leaders were interviewed, and six other nurses contributed focus group data. These leaders reported feeling motivated and suitably prepared. Both nurses and leaders recognised potential benefits from the planned conversation but viewed it as too time-consuming to be feasible. CONCLUSIONS: The communication initiative and implementation strategies require further tailoring to the clinical setting. A caregiver communication tool may be a helpful adjunct to the conversation. Implementation may be enhanced by more robust stakeholder engagement, change leader inclusion in the reference group and an overarching supportive framework within which change leaders can operate more effectively. IMPLICATIONS FOR PRACTICE: Nurse-caregiver communication in this context requires inititatives tailored to the clinical setting with input from all stakeholders.

Bed Moves, Ward Environment, Staff Perspectives and Falls for Older People with High Falls Risk in an Acute Hospital: A Mixed Methods Study.

BACKGROUND: Falls remain an important problem for older people in hospital, particularly those with high falls risk. This mixed methods study investigated the association between multiple bed moves and falls during hospitalisation of older patients identified as a fall risk, as well as safety of ward environments, and staff person-centredness and level of inter-professional collaboration. METHODS: Patients aged ≥70 years, admitted through the Emergency Department (ED) and identified at high fall risk, who were admitted to four target medical wards, were followed until discharge or transfer to a non-study ward. Hospital administrative data (falls, length of stay [LoS], and bed moves) were collected. Ward environmental safety audits were conducted on the four wards, and staff completed person-centredness of care, and interprofessional collaboration surveys. Staff focus groups and patient interviews provided additional qualitative data about bed moves. RESULTS: From 486 ED tracked admissions, 397 patient records were included in comparisons between those who fell and those who did not [27 fallers/370 non-fallers (mean 84.8 years, SD 7.2; 57.4% female)]. During hospitalisation, patients experienced one to eight bed moves (mean 2.0, SD 1.2). After adjusting for LoS, the number of bed moves after the move to the initial admitting ward was significantly associated with experiencing a fall (OR 1.56, 95% CI 1.11-2.18). Ward environments had relatively few falls hazards identified, and staff surveys indicated components of person-centredness of care and interprofessional collaboration were rated as good overall, and comparable to other reported hospital data. Staff focus groups identified poor communication between discharging and admitting wards, and staff time pressures around bed moves as factors potentially increasing falls risk for involved patients. Patients reported bed moves increased their stress during an already challenging time. CONCLUSION: Patients who are at high risk for falls admitted to hospital have an increased risk of falling associated with every additional bed move. Strategies are needed to minimise bed moves for patients who are at high risk for falls.