What factors influence nursing home use of hospital avoidance programs? An interview study.

AIMS: To understand why some nursing homes use hospital avoidance programs more frequently than others. DESIGN: Two hospital avoidance programs, called residential-in-reach services in Victoria, Australia, were evaluated using a qualitative descriptive design. METHODS: Between 2014 and 2018, 127 semi-structured interviews were conducted with staff from nursing homes, general practitioners and staff from the residential-in reach services. The interviews took an average of 45 min and transcripts were thematically analysed. RESULTS: Nursing home reliance on residential-in-reach services to manage deteriorating residents was evident in both evaluations. Irrespective of the model of service provision, reliance was associated with: the increased care needs of residents; difficulties accessing timely and appropriate medical care; and the reduced numbers of skilled registered nurses to assess and manage deteriorating residents. CONCLUSION: The residential-in-reach services are highly regarded by nursing homes. However, some are reliant on these services to provide nursing assessment and management. Using residential-in-reach services to substitute for nursing care, deskills nurses and shifts the cost of providing care from the service provider to other agencies. To provide residents with quality nursing care, the number of skilled registered nurses able to work within their scope of practice needs to be increased in Australian nursing homes. IMPACT: The findings highlight the challenges of providing care in older people living in aged care. Increasing the number of skilled registered nurses in Australian nursing homes, would support deteriorating residents to stay in familiar surroundings and reduce reliance on external services to provide nursing care.

Loss, Unresolved Trauma and Gaps in Staff Knowledge: A Qualitative Study on Older Adults Living in Residential Aged Care.

Despite the prevalence of mental health concerns among those who live in residential aged care, many residential aged care facilities (RACFs) provide little by way of psychological support. Drawing on qualitative data obtained from interviews with residents from across 15 RACFs in Victoria, Australia, this article adds to understandings about the diversity and impact of mental health challenges experienced by residents, and gaps in the knowledge of staff about how to address such. Thus, it also offers evidence of the urgent need for RACFs to provide residents both better access to specialist mental health practitioners and training to care staff on mental health issues.

'You become their advocate': The experiences of family carers as advocates for older people with dementia living in residential aged care.

AIMS: The aim of this study was to identify features of well-performing residential aged care services (RACS) as experienced by family carers. BACKGROUND: Family carers can have an integral role in residential aged care providing social support and are well-placed to engage with staff and monitor care. DESIGN: A qualitative descriptive design was used. Semi-structured face-to-face and telephone interviews were conducted with family carers of current or past residents of Australian RACS between November 2018 and January 2019. Interview transcripts were analysed thematically. RESULTS: Rather than reporting features of well-performing RACS, participants shared stories of sub-standard care, dysfunctional management and poor resident-staff-family interactions. An overarching theme emerged of 'having to be an advocate' for residents' needs, which covered four major categories: organisational accountability (including transparency and individualised care), good communication, connection and trust. Combined, these constitute what carers perceive are the necessary conditions for determining the features of a well-performing RACS. CONCLUSION: Family carers need to feel confident and trust RACS staff when they hand over the role of carer for their relative with dementia. RELEVANCE TO CLINICAL PRACTICE: This study provides insight into the needs and challenges of family carers when they relinquish the care of an older relative with dementia. Strategies to build confidence and trust between RACS and family carers are essential. Aged care nurses can play a pivotal role to support this through the development of open communication and relational connections with residents and their families.

Risk-scoring systems for predicting preterm birth with the aim of reducing associated adverse outcomes.

BACKGROUND: Identification of pregnancies that are higher risk than average is important to allow the possibility of interventions aimed at preventing adverse outcomes like preterm birth. Many scoring systems designed to classify the risk of a number of poor pregnancy outcomes (e.g. perinatal mortality, low birthweight, and preterm birth) have been developed, but they have usually been introduced without evaluation of their utility and validity. OBJECTIVES: To determine whether the use of a risk-screening tool designed to predict preterm birth (in combination with appropriate consequent interventions) reduces the incidence of preterm birth and very preterm birth, and associated adverse outcomes. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2015). SELECTION CRITERIA: All randomised or quasi-randomised (including cluster-randomised) or controlled clinical trials that compared the incidence of preterm birth between groups that used a risk-scoring instrument to predict preterm birth with those who used an alternative instrument, or no instrument; or that compared the use of the same instrument at different gestations. The reports may have been published in peer reviewed or non-peer reviewed publications, or not published, and written in any language. DATA COLLECTION AND ANALYSIS: All review authors planned to independently assess for inclusion all the potential studies we identified as a result of the search strategy. However, we did not identify any eligible studies. MAIN RESULTS: Searching revealed no trials of the use of risk-scoring systems for preventing preterm birth. AUTHORS' CONCLUSIONS: The role of risk-scoring systems in the prevention of preterm birth is unknown.There is a need for prospective studies that evaluate the use of a risk-screening tool designed to predict preterm birth (in combination with appropriate consequent interventions) to prevent preterm birth, including qualitative and/or quantitative evaluation of their impact on women's well-being. If these prove promising, they should be followed by an adequately powered, well-designed randomised controlled trial.

An evaluation of Snoezelen(®) compared to 'common best practice' for allaying the symptoms of wandering and restlessness among residents with dementia in aged care facilities.

Snoezelen has become an increasingly popular therapy in residential aged care facilities in Australia and elsewhere, despite no conclusive evidence of its clinical efficacy. This paper reports on an evaluation of the use of Snoezelen compared to 'common best practice' for allaying the dementia related behaviors of wandering and restlessness in two residential aged care facilities in Victoria, Australia. Sixteen residents had their behavior and responses to Snoezelen or 'common best practice' observed and recorded over three time periods. The Wilcoxon signed-rank test showed there was a significant improvement in behaviors immediately after the intervention and after 60 min. However, no significant differences were found between residents receiving Snoezelen and 'common best practice' interventions for the reduction of the dementia related behaviors.

Individualised, flexible postnatal care: a feasibility study for a randomised controlled trial.

BACKGROUND: Postnatal care in hospital is often provided using defined care pathways, with limited opportunity for more refined and individualised care. We explored whether a tertiary maternity service could provide flexible, individualised early postnatal care for women in a dynamic and timely manner, and if this approach was acceptable to women. METHODS: A feasibility study was designed to inform a future randomised controlled trial to evaluate an alternative approach to postnatal care. English-speaking women at low risk of medical complications were recruited around 26 weeks gestation to explore their willingness to participate in a study of a new, flexible model of care that involved antenatal planning for early postpartum discharge with additional home-based postnatal care. The earlier women were discharged from hospital, the more home-based visits they were eligible to receive. Program uptake was measured, women's views obtained by a postal survey sent at eight weeks postpartum and clinical data collected from medical records. RESULTS: Study uptake was 39% (109/277 approached). Most women (n=103) completed a postnatal care plan during pregnancy; 17% planned to leave hospital within 12 hours of giving birth and 36% planned to stay 48 hours. At eight weeks postpartum most women (90%) were positive about the concept and 88% would opt for the same program again. Of the 28% who stayed in hospital for the length they had planned, less than half (43%) received the appropriate number of home visits, and only 41% were given an option for the timing of the visit. Most (62%) stayed in hospital longer than planned (probably due to clinical complications); 11% stayed shorter than planned. CONCLUSIONS: Women were very positive about individualised postnatal care planning that commenced during pregnancy. Given the hospital stay may be impacted by clinical factors, individualised care planning needs to continue into the postnatal period to take into account circumstances which cannot be planned for during pregnancy. However, individualised care planning during the postnatal period which incorporates a high level of flexibility may be challenging for organisations to manage and implement, and a randomised controlled trial of such an approach may not be feasible.

A heutagogical approach to building the residential aged care workforce capability and capacity.

OBJECTIVE: This paper reports on the design and implementation of an interactive online education package for the diverse Australian residential aged care workforce, in response to the findings of the Royal Commission into Aged Care Quality and Safety. A decade of reports has consistently highlighted the need for an educated workforce to care for the increasingly frail older people with complex care needs living in residential aged care. Cost, availability and timing of education have been identified as barriers to uptake of education for this workforce. METHODS: A heutagogical approach was used to design an evidence-based, modular, online education package for nurses, care workers and allied health practitioners working in the residential aged care sector. The subject matter was developed by experts and the education divided into modules. A key challenge was to design a package that was inclusive of the diversity of educational needs in this workforce. The package does not provide assessments on completion of the modules, relying solely on the motivation of the individual learner. RESULTS: This online education package provides choice and self-determination for users in their learning journey. Collaborating with experts to develop an online education program that is learner-driven, challenges the conventions of education. Users can navigate the package at their pace; choose the modules they have identified as knowledge gaps or are of interest; and complete the education in their own time. CONCLUSION: As expected, most users are care workers and nurses and the five modules of the Dementia program are the most popular.

A snapshot of social activities programs in residential aged care facilities in Victoria: A brief report.

OBJECTIVES: To capture current opportunities for social participation for older people living in residential aged care in Victoria, Australia. METHODS: A postal survey of all 766 Victorian residential aged care facilities. Respondents were asked to outline the nature of social participation opportunities available to residents, any potential barriers to inclusion and organisational commitments such as funding allocations and staff fractions. RESULTS: Surveys were returned by 153 facilities, representing a response rate of 20%. All facilities had a dedicated social program, although just over half (57%; 87 of 153) offered the social program over the weekend, usually on a Saturday morning only (90%). Barriers to older people's opportunities for social participation included their ineligibility to continue attending external community programs once entering residential aged care (86%), their illness (71%), carer availability (50%) and lack of funding (42%). Funding for almost all programs (128 of 153; 84%) was described as internal and ad hoc, and staff allocations for the program were almost entirely fractional. Only 12 (8%) facilities reported that they had a dedicated full-time coordinator for the social participation program. CONCLUSIONS: Social participation programs are available in Victorian residential aged care facilities. However, limited funding and staff allocations reduce the opportunities for older people to engage in meaningful social participation with others.

Public health service board members' understanding of care quality in residential aged care services.

Objective The objective of this study was to explore how health service boards understand care quality for older people living in public sector residential aged care services. Methods Semi-structured interviews were undertaken with board members from six Victorian public health services responsible for the governance of 15 residential aged care services comprising over 850 beds. Transcripts were thematically analysed. Results Eleven board members were interviewed. While committed to their governance and monitoring role, analysis suggests board members have a limited understanding of the residential aged care environment. They rarely visit and the information they receive about residential aged care is primarily clinical data (quality indicators) as well as sub-committee and staff reports. In addition to quality indicator data and reports, accreditation and complaints are used to measure care quality. Conclusion Board members vary in their understanding of care quality in residential aged care settings. The exclusive focus on clinical indicators and accreditation as measures of quality reinforces this understanding. Visiting residential aged care services would provide understanding of the care environment and context for the information they receive. The provision of other metrics, such as consumer advocacy reports and residents' and families' experiences of care, would further assist board members to monitor care quality in these settings.

Intracervical procedures and the risk of subsequent very preterm birth: a case-control study.

OBJECTIVE: To investigate the relation of prior intracervical procedures with very preterm birth. DESIGN: A population-based case-control study. SETTING: The study was conducted in Australia between 2002 and 2004. SAMPLE: Three hundred and forty-five women having a medically indicated and 236 having a spontaneous singleton birth between 20 and 31 weeks of gestation and 796 women selected randomly from all those giving birth at ≥37 weeks of gestation. METHODS: Interview data were analysed using logistic regression. MAIN OUTCOME MEASURE: Very preterm birth. RESULTS: Very preterm birth was significantly associated with having any intracervical procedure [adjusted odds ratio (AOR) 2.07; 95% confidence interval (CI) 1.6-2.7], in particular curettage associated with abortion (AOR 1.80; 95% CI 1.2-2.6). Assisted reproductive technology procedures were significantly associated with medically indicated very preterm birth (AOR 3.07; 95% CI 1.8-5.3) and treatments for precancerous cervical changes were significantly associated with spontaneous very preterm birth, as follows: conization/cone biopsy (AOR 3.33; 95% CI 1.8-6.2) and cauterization/ablation (AOR 2.27; 95% CI 1.4-3.8). Suction aspiration for abortion, abnormal Pap smear without treatment and abortion without instrumentation were not associated with very preterm birth. CONCLUSIONS: Intracervical procedures are associated with very preterm birth. Notably, curettage rather than any other procedure associated with abortion appears to be implicated in the risk. The introduction of infection during cervical procedures may be the common link with risks found. Changing clinical practice in the management of abortion and human papillomavirus vaccination may lead to lowering the risks of very preterm birth.

The use of multi-sensory interventions to manage dementia-related behaviours in the residential aged care setting: a survey of one Australian state.

AIMS AND OBJECTIVES: To describe the use of multi-sensory interventions in residential aged care services (RACS) for the management of dementia-related behaviours in residential aged care in Victoria, Australia. BACKGROUND: The popularity of multi-sensory interventions has spread worldwide, including for use in residential aged care, despite limited evidence to support their efficacy. DESIGN: This study reports the findings of the first stage of a two-stage project that was undertaken to describe and evaluate the use of multi-sensory interventions for the management of dementia-related behaviours in all residential aged care facilities in Victoria, Australia. METHODS: A computer-assisted telephone interview survey was developed and administered to residential aged care facilities in Victoria, Australia, to collect descriptive data on the use of multi-sensory interventions for the management of dementia-related behaviours. RESULTS: A diverse and eclectic range of multi-sensory interventions are currently being used by residential aged care facilities. The findings suggest the use of multi-sensory interventions are used in an ad hoc manner, and there is no universal definition of multi-sensory interventions, little formal training for staff administering the interventions and no guideline for their use, nor evaluation of their impact on residents' behaviour. CONCLUSION: Multi-sensory interventions have been widely adopted for use in RACS in Victoria, Australia, and are currently being used without formal guidelines and little evidence to support their use in clinical practice. RELEVANCE TO CLINICAL PRACTICE: In the absence of a formal definition of what constitutes a multi-sensory intervention, training for staff and careful assessment and monitoring of residents who receive multi-sensory interventions, we recommend further research and development of policy and procedures to safe guard the use of multi-sensory interventions for people with dementia.

How do health and allied health practitioners perceive excellence in residential aged care? An exploratory qualitative study.

OBJECTIVE: To identify factors that health and allied health practitioners consider central to excellence in residential aged care facilities (RACFs) with the objective of supporting improvements in monitoring, accountability and service delivery within the sector. METHODS: In a qualitative, exploratory designed study, interviews were undertaken with seventeen participants from 10 health and allied health disciplines (general practice, dentistry, pharmacy, psychiatry, psychology, neuropsychology, physiotherapy, speech pathology, occupational therapy and palliative care) with experience of working in Victorian RACFs. The interviews focused on how practitioners perceived excellence within RACFs. Data were analysed thematically. RESULTS: Thematic analysis yielded five themes, which correspond with different dimensions or ways of understanding excellence, including resident well-being, residences as a true home, good practice models, effective management and skilled staff, and unmet needs. Under each of these themes, participants referred to issues closely related to the concerns of their particular professions as well as those more general in nature. CONCLUSIONS: The diversity in issues to which participants drew attention highlights the importance of obtaining the perspectives of a broad range of practitioners providing services to RACF residents to achieving excellence in the sector. Commonalities in their responses indicate the potential for a greater level of collaboration among the health and allied health professions.

Risk scoring systems for predicting preterm birth with the aim of reducing associated adverse outcomes.

BACKGROUND: Identification of pregnancies that are higher risk than average is important to allow the possibility of interventions aimed at preventing adverse outcomes like preterm birth. Many scoring systems designed to classify the risk of a number of poor pregnancy outcomes (e.g. perinatal mortality, low birthweight, and preterm birth) have been developed, but they have usually been introduced without evaluation of their utility and validity. OBJECTIVES: To determine whether the use of a risk-screening tool designed to predict preterm birth (in combination with appropriate consequent interventions) reduces the incidence of preterm birth and very preterm birth, and associated adverse outcomes. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (December 2010), CENTRAL (The Cochrane Library 2010, Issue 4), MEDLINE (1966 to 17 December 2010), EMBASE (1974 to 17 December 2010), and CINAHL (1982 to 17 December 2010). SELECTION CRITERIA: All randomised or quasi-randomised (including cluster-randomised) or controlled clinical trials that compared the incidence of preterm birth between groups that used a risk scoring instrument to predict preterm birth with those who used an alternative instrument, or no instrument; or that compared the use of the same instrument at different gestations. The reports may have been published in peer reviewed or non-peer reviewed publications, or not published, and written in any language. DATA COLLECTION AND ANALYSIS: All review authors planned to independently assess for inclusion all the potential studies we identified as a result of the search strategy. However, we identified no eligible studies. MAIN RESULTS: Extensive searching revealed no trials of the use of risk scoring systems to prevent preterm birth. AUTHORS' CONCLUSIONS: The role of risk scoring systems in the prevention of preterm birth is unknown.There is a need for prospective studies that evaluate the use of a risk-screening tool designed to predict preterm birth (in combination with appropriate consequent interventions) to prevent preterm birth, including qualitative and/or quantitative evaluation of their impact on women's well-being. If these prove promising, they should be followed by an adequately powered, well-designed randomised controlled trial.

What's in a name: integrative medicine or simply good medical practice?

OBJECTIVE: Integrative medicine, a popular movement in the USA and Europe, is taught in many US medical schools. This study describes how Australian doctors define integrative medicine, what motivates them to work in integrative medicine and the incorporation of complementary and alternative medicines (CAM) into their practice. METHODS: Semi-structured interviews were conducted between May and December 2009 with 23 doctors in two Australian states working in integrative medicine. A thematic analysis of interview transcripts was undertaken. RESULTS: Doctors' interpretations of the term 'integrative medicine' varied considerably. All maintained a strong belief in the usefulness of conventional medicine, while a holistic and patient-centred approach, promoting well-being, was central to their practice. Doctors' motivations for choosing an integrative approach to their practice of medicine also varied, but personal and professional experiences of alternative approaches to illness were influential in this decision. The nature of their clinical practice was also diverse; few doctors in this sample practice or professionally use CAM; a small number were happy to advise patients on the use of different modalities while even less referred to complementary practitioners. CONCLUSIONS: The concept and practice of integrative medicine among the doctors interviewed were diverse. This has implications for the Royal Australian College of General Practitioners inclusion criteria for the membership of their integrative medicine chapter. More broadly, the findings have implications for all medical practice and the education of medical students, as much of what integrative medicine doctors do may be considered simply as 'good medical practice'.

Looking back in time: conducting a cohort study of the long-term effects of treatment of adolescent tall girls with synthetic hormones.

OBJECTIVE: Public health research is an endeavour that often involves multiple relationships, far-reaching collaborations, divergent expectations and various outcomes. Using the Tall Girls Study as a case study, this paper will present and discuss a number of methodological, ethical and legal challenges that have implications for other public health research. APPROACH: The Tall Girls Study was the first study to examine the long-term health and psychosocial effects of oestrogen treatment for tall stature. RESULTS: In undertaking this study the research team overcame many hurdles: in maintaining collaboration with treating clinicians and with the women they had treated as girls - groups with opposing points of view and different expectations; using private practice medical records to trace women who had been patients up to forty years earlier; and exploring potential legal issues arising from the collection of data related to treatment. CONCLUSION: While faced with complex challenges, the Tall Girls Study demonstrated that forward planning, ongoing dialogue between all stakeholders, transparency of processes, and the strict adherence to group-developed protocols were keys to maintaining rigour while undertaking pragmatic research. IMPLICATIONS: Public health research often occurs within political and social contexts that need to be considered in the planning and conduct of studies. The quality and acceptability of research findings is enhanced when stakeholders are engaged in all aspects of the research process.

Modelling prior reproductive history to improve prediction of risk for very preterm birth.

In published studies of preterm birth, analyses have usually been centred on individual reproductive events and do not account for the joint distributions of these events. In particular, spontaneous and induced abortions have often been studied separately and have been variously reported as having no increased risk, increased risk or different risks for subsequent preterm birth. In order to address this inconsistency, we categorised women into mutually exclusive groups according to their reproductive history, and explored the range of risks associated with different reproductive histories and assessed similarities of risks between different pregnancy histories. The data were from a population-based case-control study, conducted in Victoria, Australia. The study recruited women giving birth between April 2002 and April 2004 from 73 maternity hospitals. Detailed reproductive histories were collected by interview a few weeks after the birth. The cases were 603 women who had had a singleton birth between 20 and less than 32 weeks gestation (very preterm births including terminations of pregnancy) and the controls were 796 randomly selected women from the population who had had a singleton birth of at least 37 completed weeks gestation. All birth outcomes were included. Unconditional logistic regression was used to assess the association of very preterm birth with type and number of prior abortions, prior preterm births and sociodemographic factors. Using the complex combinations of prior pregnancy experiences of women (including nulligravidity), we showed that a history of prior childbirth (at term) with no preterm births gave the lowest risk of very preterm birth. With this group as the reference category, odds ratios of more than two were associated with all other prior reproductive histories. There was no evidence of difference in risk between types of abortion (i.e. spontaneous or induced) although the risk increased if a prior preterm birth had also occurred. There was an increasing risk of very preterm birth associated with increasing numbers of abortions. This method of data analysis reveals consistent and similar risks for very preterm birth following spontaneous or induced abortions. The findings point to the need to explore commonalities rather than differences in regard to the impact of abortion on subsequent births.

Modelling sequence of prior pregnancies on subsequent risk of very preterm birth.

The prevalence and intractability of preterm birth is known as is its association with reproductive history, but the relationship with sequence of pregnancies is not well studied. The data were from a population-based case-control study, conducted in Victoria, Australia. The study recruited women giving birth between April 2002 and April 2004 from 73 maternity hospitals. Detailed reproductive histories were collected by interview a few weeks after the birth. The cases were 603 women having a singleton birth between 20 and <32 weeks gestation (very preterm births including terminations of pregnancy). The controls were 796 randomly selected women from the population having a singleton birth of at least 37 completed weeks gestation. Unconditional logistic regression was used to assess the association of very preterm birth with sequence of pregnancies defined by their outcome (prior abortion - spontaneous or induced, and prior preterm or term birth) with adjustment for sociodemographic factors. The outcomes of each prior pregnancy, stratified by pregnancy order, and starting with the pregnancy immediately before the index or control pregnancy, were categorised as one of abortion, preterm birth or term birth. We showed that each of these prior pregnancy events was an independent risk of very preterm birth. This finding does not support the hypothesis of a neutralising effect of a term birth after an abortion on the subsequent risk for very preterm birth and is further evidence for the cumulative or increasing risk associated with increasing numbers of prior abortions or preterm births.

A statewide review of postnatal care in private hospitals in Victoria, Australia.

BACKGROUND: Concerns have been raised in Australia and internationally regarding the quality and effectiveness of hospital postnatal care, although Australian women receiving postnatal care in the private maternity sector rate their satisfaction with care more highly than women receiving public maternity care. In Victoria, Australia, two-thirds of women receive their maternity care in the public sector and the remainder in private health care sector. A statewide review of public hospital postnatal care in Victoria from the perspective of care providers found many barriers to care provision including the busyness of postnatal wards, inadequate staffing and priority being given to other episodes of care; however the study did not include private hospitals. The aim of this study was replicate the review in the private sector, to explore the structure and organisation of postnatal care in private hospitals and identify those aspects of care potentially impacting on women's experiences and maternal and infant care. This provides a more complete overview of the organisational structures and processes in postnatal care in all Victorian hospitals from the perspective of care providers. METHODS: A mixed method design was used. A structured postal survey was sent to all Victorian private hospitals (n = 19) and key informant interviews were undertaken with selected clinical midwives, maternity unit managers and obstetricians (n = 11). Survey data were analysed using descriptive statistics and interview data analysed thematically. RESULTS: Private hospital care providers report that postnatal care is provided in very busy environments, and that meeting the aims of postnatal care (breastfeeding support, education of parents and facilitating rest and recovery for women following birth) was difficult in the context of increased acuity of postnatal care; prioritising of other areas over postnatal care; high midwife-to-woman ratios; and the number and frequency of visitors. These findings were similar to the public review. Organisational differences in postnatal care were found between the two sectors: private hospitals are more likely to have a separate postnatal care unit with single rooms and can accommodate partners' over-night; very few have a policy of infant rooming-in; and most have well-baby nurseries. Private hospitals are also more likely to employ staff other than midwives, have fewer core postnatal staff and have a greater dependence on casual and bank staff to provide postnatal care. CONCLUSIONS: There are similarities and differences in the organisation and provision of private postnatal care compared to postnatal care in public hospitals. Key differences between the two sectors relate to the organisational and aesthetic aspects of service provision rather than the delivery of postnatal care. The key messages emerging from both reviews is the need to review and monitor the adequacy of staffing levels and to develop alternative approaches to postnatal care to improve this episode of care for women and care providers alike. We also recommend further research to provide a greater evidence-base for postnatal care provision.

Research priorities in residential aged care services: A statewide survey.

OBJECTIVES: To ascertain the research priorities of staff working in Victorian residential aged care services (RACS). METHOD: In October 2016, all 754 Victorian RACS were asked to list three most important research priorities in a confidential postal survey. Descriptive statistics and content analysis were used to analyse the data. RESULTS: One hundred and sixty-two (21.5%) RACS participated. Research priorities, in order of importance, were grouped thematically as workforce issues, strategies to manage residents with dementia and funding to the sector. Staffing numbers and mix, particularly nurse-to-resident ratios, dominated workforce issues. The management of responsive behaviours was highlighted as a pressing clinical issue, and insufficient funding to the sector impacted on most issues reported. CONCLUSIONS: The research priorities identified were inter-related. Some were already well researched, suggesting RACS staff have little time and/or limited access to research evidence to inform the care and management of residents, possibly because of inadequate staffing and funding.