Nurses' perspectives of recognising and responding to unsafe practice by their peers: A national cross-sectional survey.

AIMS: This study aimed to identify behaviours and cues that nurses recognise as indications of unsafe practice, perceived factors that contribute to unsafe practice and actions nurses take in response. DESIGN: Cross-sectional survey. METHODS: National cross-sectional survey of a random sample of registered nurses (n = 231) in New Zealand, in 2017-2018. The STROBE Checklist was used to report this study. RESULTS: Nurses reported a high rate of episodes of unsafe practices and recognised a range of behaviours and cues that alerted them to the potential for unsafe practice. Several organisational issues were perceived to contribute to unsafe practice occurring. The reporting of episodes of unsafe practice and perceived organisational support was low for nurses compared with managers. CONCLUSION: Failure to recognise and respond to unsafe practice may indicate a tolerance for substandard practice by individual nurses, or by the organisation. Nurses who recognise unsafe practice must be supported by the organisation.

Predictors of dementia knowledge in a rural general public sample.

OBJECTIVES: To investigate dementia knowledge within a rural Australian general public cohort and understand demographic predictors of knowledge in this population. DESIGN: A cross-sectional study comprising quantitative surveys. SETTING: 321 participants were recruited from the Tasmanian general public (February-September 2017). PARTICIPANTS: 28% of participants were from remote or outer regional postcodes; the remainder were from inner regional areas. The median age was 46 years; 35% were male. 30% had participated in prior dementia education, 29% had worked with people living with dementia, and 23% had no identified personal experience of people living with dementia. INTERVENTIONS: No interventions were conducted as part of this study. MAIN OUTCOME MEASURES: Dementia knowledge was assessed using the Dementia Knowledge Assessment Scale. Demographic variables were also collected. RESULTS: Mean dementia knowledge was moderate and participants scored highest on the care considerations subscale. Those with personal experience with a person living with dementia scored significantly higher on all subscales, and overall, than those without. Dementia education, general education, and previous work, care or close relationship with people living with dementia were all significant predictors in a regression model explaining nearly a third of the variance in overall dementia knowledge. CONCLUSION: While personal experience of dementia improves knowledge of the condition, dementia education is the most important predictor. Deficits identified in knowledge of risk factors, and incomplete knowledge about aspects important to quality care, suggest a need for further education for the general public, particularly in the light of the rising prevalence of dementia in ageing rural populations.

Nursing students' preferences for clinical placements in the residential aged care setting.

AIMS AND OBJECTIVES: To examine nursing student placement preferences submitted as online comments to a university's placement management system, to inform strategies for positive residential aged care experiences. BACKGROUND: There are predicted shortages of nurses to service an ageing population. Clinical placements undertaken by undergraduate nursing students help shape their attitudes and are a key determinant of career decision-making, yet there is little research about why students prefer particular placement areas. DESIGN: Analysis of qualitative data from a placement management system. METHODS: Of 6,610 comments received between 2007-2014, 607 related to aged care and were coded according to preferences for being placed in a residential aged care facility, with reasons for this preference thematically coded and quantified. RESULTS: Four hundred and one comments (66.1%) related to students requesting not to be allocated residential aged care for the upcoming placement, primarily due to previous experience in the sector; 104 (17.1%) referred to aged care in a neutral manner, focusing on conflict of interest; 102 (16.8%) related to a request for an aged care placement. CONCLUSIONS: The student nurse comments characterise students as being focused on maximising their learning, while considering prior experience. In some cases, increased exposure to aged care is considered to offer limited learning opportunities, which is concerning and suggests that both the tertiary and aged care sectors have a joint responsibility to pursue recognition of aged care nursing as a specialised, highly skilled role. RELEVANCE TO CLINICAL PRACTICE: Nursing programme providers should ensure curriculum content and exposure to aged care placement clearly identify the complexities of care and provide genuine opportunities for knowledge acquisition and skill development based on multifaceted resident care needs. This will support both those interested in a future aged care career and those undecided.

"I was yelled at, intimidated and treated unfairly": Nursing students' experiences of being bullied in clinical and academic settings.

AIMS AND OBJECTIVES: To present findings from a study that explored nursing students' experiences of bullying in clinical and academic settings, the strategies used to negotiate bullying and recommendations for empowering future students. BACKGROUND: Nursing students are identified as a group who are at particular risk of bullying. Numerous studies have examined students' experiences of bullying in clinical contexts by qualified nurses; however, there has been far less attention to the bullying that occurs in academic settings where the perpetrators are university staff and other students. DESIGN: The qualitative findings presented in this paper form one component of a mixed-methods, multisite study that examined the nature and extent of bullying in one cohort of nursing students. METHODS: A convenience sample of 29 first-, second- and third-year undergraduate nursing students from one semimetropolitan Australian university was recruited for semistructured interviews in 2014. Interview data were analysed using NVivo. FINDINGS: Participants described multiple examples of bullying occurring in both clinical and academic settings. Perpetrators included clinicians, facilitators, academics and fellow students. Bullying ranged from incivility to physical attacks. The impact of the bullying was profound; it caused many of the participants to feel anxious and distressed, it undermined their confidence and perception of competence, and it often led them to question their career choice. Strategies described by participants to cope with or manage the bullying included avoidance, trying to "just survive" and seeking support from trusted academic staff, family and friends. No episodes of bullying were formally reported. CONCLUSION: Bullying remains a pervasive phenomenon occurring in both clinical and academic settings. Students are, in many respects, a vulnerable and disempowered population who often fear the consequences of making a formal complaint. Thus, reporting structures and support strategies need to be re-examined, and resilience training is imperative. RELEVANCE TO CLINICAL PRACTICE: Bullying remains a continuing concern in undergraduate nursing degrees. Efforts must be made in clinical and academic settings to heed the advice of undergraduates using broader strategies to address the issues.

Analysis of the Empathic Concern Subscale of the Emotional Response Questionnaire in a Study Evaluating the Impact of a 3D Cultural Simulation.

Abstract Background Empathic concern has been found to decline in health professional students. Few effective educational programs and a lack of validated scales are reported. Previous analysis of the Empathic Concern scale of the Emotional Response Questionnaire has reported both one and two latent constructs. Aim To evaluate the impact of simulation on nursing students' empathic concern and test the psychometric properties of the Empathic Concern scale. Methods The study used a one group pre-test post-test design with a convenience sample of 460 nursing students. Empathic concern was measured pre-post simulation with the Empathic Concern scale. Factor Analysis was undertaken to investigate the structure of the scale. Results There was a statistically significant increase in Empathic Concern scores between pre-simulation 5.57 (SD = 1.04) and post-simulation 6.10 (SD = 0.95). Factor analysis of the Empathic Concern scale identified one latent dimension. Conclusion Immersive simulation may promote empathic concern. The Empathic Concern scale measured a single latent construct in this cohort.

Mixed method integrative review exploring nurses' recognition and response to unsafe practice.

AIM: To determine how nurses recognize and respond to unsafe practice. BACKGROUND: Practice guidelines and standards outline safe practice. Nurses face challenges in recognizing and responding unsafe practice. DESIGN: Whittemore and Knafl's revised framework for integrative reviews guided the analysis. DATA SOURCES: A comprehensive search of literature exploring the identification and response to unsafe practice, was undertaken in CINAHL, Medline, Embase and PsychoINFO databases for the period 2004-2014. REVIEW METHODS: Nineteen articles from 15 studies were included in the review. A mixed method integrative approach was used to review data and draw conclusions. RESULTS: Behaviours and cues that indicate unsafe practice are influenced by organizational and individual characteristics. Individual nurses responses are variable and there are professional and personal costs associated with being reported or reporting unsafe practice. CONCLUSION: The small number of studies reviewed limits the conclusions that can be drawn from the review but suggest that nurses can identify unsafe practice in their peers. Individual nurses' recognition and response to unsafe practice in their peers contributes to patient outcomes and safety. Nurses need awareness training and strategies to respond to unsafe practice and reporting systems that protect reporters from repercussions. Further research investigating organizational factors and individual factors that contribute to a shift in practice across safety boundaries is required.

Measuring the impact of a 3D simulation experience on nursing students' cultural empathy using a modified version of the Kiersma-Chen Empathy Scale.

AIMS AND OBJECTIVES: To determine the effect of immersive 3D cultural simulation on nursing students' empathy towards culturally and linguistically diverse patients. BACKGROUND: Accelerated globalisation has seen a significant increase in cultural diversity in most regions of the world over the past forty years. Clinical encounters that do not acknowledge cultural factors contribute to adverse patient outcomes and health care inequities for culturally and linguistically diverse people. Cultural empathy is an antecedent to cultural competence. Thus, appropriate educational strategies are needed to enhance nursing students' cultural empathy and the capacity to deliver culturally competent care. DESIGN: A one-group pretest, post-test design was used for this study. The simulation exposed students to an unfolding scene in a hospital ward of a developing county. METHODS: A convenience sample of second-year undergraduate nursing students (n = 460) from a semi-metropolitan university in Australia were recruited for the study. Characteristics of the sample were summarised using descriptive statistics. T-tests were performed to analyse the differences between pre- and post simulation empathy scores using an eight item modified version of the Kiersma-Chen Empathy Scale. RESULTS: Students' empathy towards culturally and linguistically diverse patients significantly improved after exposure to the 3D simulation experience. The mean scores for the Perspective Taking and Valuing Affective Empathy subscales also increased significantly postsimulation. CONCLUSIONS: The immersive 3D simulation had a positive impact on nursing students' empathy levels in regards to culturally and linguistically diverse groups. Research with other cohorts and in other contexts is required to further explore the impact of this educational approach. RELEVANCE TO CLINICAL PRACTICE: Immersive cultural simulation experiences offer opportunities to enhance the cultural empathy of nursing students. This may in turn have a positive impact on their cultural competence and consequently the quality of care they provide to culturally and linguistically diverse patients.

Development and reliability testing of the quality clinical placement evaluation tool.

AIMS AND OBJECTIVES: To develop and test the content and face validity, and reliability of the quality clinical placement evaluation tool. BACKGROUND: The importance of clinical experience during undergraduate nursing degrees is undisputed. To date, tools available to measure quality of clinical placements have focused on single perspectives, that of the undergraduate or that of the supervising nurse. The quality clinical placement evaluation tool was proposed to provide an assessment of clinical placement experiences informed by supervising ward nurses and undergraduate stakeholders. DESIGN: The study employed a cross-sectional design. METHODS: The internal validity of an existing instrument was evaluated by an expert panel and modified for use in the acute care sector. Surveys were completed by undergraduate students (n = 48) and supervising ward nurses (n = 47). Factor analysis was used to identify themes drawn from the literature and explore redundancy of items. Reliability was assessed using Cronbach's alpha for internal consistency and test-retest (five to seven days apart). RESULTS: Reliability testing showed good internal consistency for the tool; test-retest reliability testing results were moderate to good for students and fair to moderate for nurses. Factor analysis identified three core themes related to supervising ward nurse responses that could also be applied to undergraduate nurses. The domains identified were the following: welcome and belonging; support to meet learning needs; and confidence and competence: reflections on learning. CONCLUSIONS: The quality clinical placement evaluation has shown statistically acceptable levels of reliability and validity for measuring the quality of clinical placement from perspectives of undergraduates and supervising ward nurses. RELEVANCE TO CLINICAL PRACTICE: The tool provides tertiary institutions, acute care facilities, wards and individuals with the means to capture views of the quality of clinical placement which can also be used to undertake comparisons over time and between sites.

"I'm still in the lap of the gods I don't know whether I'm going to improve or not": listening to people with dementia or cognitive impairment and their support people, talking about inpatient rehabilitation experiences.

PURPOSE: People with dementia often experience poor outcomes in hospital and prolonged lengths of stay. They are sometimes labelled as having "poor rehabilitation potential". This study aimed to understand the inpatient rehabilitation experiences of people with dementia or cognitive impairment, and their support people, to inform future work to improve rehabilitation access and outcomes. MATERIALS AND METHODS: An exploratory qualitative study from an interpretivist perspective. Participants were inpatients of a geriatric rehabilitation unit in Australia, and their chosen support people. Semi-structured interviews were audio-recorded and transcribed. An analytical framework was developed and indexed to the dataset, followed by charting and thematic analysis. RESULTS: Ten people with dementia or cognitive impairment and nine support people participated (n = 19). Four themes were identified representing an interpretation of the analysis intended to inform clinical practice: Support patients to engage in the rehabilitation process; create a hospitable environment; recognise and work with care partners; and ensure staff have adequate dementia knowledge. CONCLUSIONS: Practical, emotional, process-related, and dementia-specific factors may influence the experiences of people living with dementia or cognitive impairment when participating in inpatient rehabilitation. Future research could investigate whether improvements focused on these factors might enhance quality of care for people with dementia.

People living with dementia may require tailored support to engage in the rehabilitation process effectively.Safe, kind, and comfortable environments provide a strong foundation for good rehabilitation care for people with dementia or cognitive impairment.Involving family as care partners may be essential for some people living with dementia.Dementia knowledge for the geriatric rehabilitation workforce may improve clinical outcomes.

Needs of older people living with dementia in low and middle-income Asian countries: A scoping review.

BACKGROUND: Population ageing in low and middle-income Asian countries is associated with increased prevalence of dementia. The proportion of people with dementia in countries such as Bangladesh and Thailand are increasing. People with dementia can have complex care and health service needs. If these needs are not adequately met, this can result in a decreased quality of life and burden on the health system. There is considerable research into the needs of people with dementia in high-income countries. However, research on the needs of people living with dementia in low and middle-income countries remains underexplored. The aim of this study was to review and summarise the literature on the health and social care needs of older people with dementia in low and middle-income Asian countries. METHODS: Five online databases (PubMed, Scopus, Web of Science, CINAHL and PsycINFO) and google scholar were searched. The databases were searched using a selection of key words. PRISMA-ScR approach was followed in reporting the process. KEY FINDINGS: We extracted eight studies related to the health and social care needs of people with dementia that met our inclusion criteria. From the available literature, needs were categorised across five categories: (i) social, cognitive, and mental health needs; (ii) physical needs; (iii) care and service needs; (iv) knowledge-related needs; and (v) spiritual care needs. CONCLUSION: While eight papers were located which discussed the needs of people with dementia across a range of domains, this review demonstrates a deficit in the current evidence-base about the health and social care needs of people living with dementia in low and middle-income Asian countries. Further research is needed to identify health and care needs of people with dementia and how these needs are being met.

Film as cooperative endeavour: The promises for people living with dementia, their relatives, caregivers and aged care staff.

Creative expression by people living with dementia and their families and carers can improve communication and relationships and strengthen relational personhood. The transition to residential aged care from living at home with dementia is a time of 'relocation stress", and a time when additional psychosocial supports like these might be particularly beneficial. This article reports on a qualitative study that explored how a co-operative filmmaking project functioned as a multifaceted psychosocial intervention, and explored its potential impacts on relocation stressors. Methods included interviews with people living with dementia who were involved in the filmmaking, and their families and close others. Staff from a local day centre and residential aged care home also took part in interviews, as did the filmmakers. The researchers also observed some of the filmmaking process. Reflexive thematic analysis techniques were used to generate three key themes in the data: Relationship building; Communicating agency, memento and heart; Being visible and inclusive. The findings reveal challenges regarding privacy and the ethics of public screenings, as well as the pragmatics of using short films as a communication tool in aged care settings. We conclude that filmmaking as a cooperative endeavour holds promise to mitigate relocation stressors by: improving family and other relationships during challenging times for family and for people living with dementia; providing opportunities for new self-narratives derived from relational subjectivities; supporting visibility and personhood; and improving communication once in residential aged care. This research has relevance for communities who are looking to support dynamic personhood and improve the care of people living with dementia.

Supporting health behaviour change in chronic obstructive pulmonary disease with telephone health-mentoring: insights from a qualitative study.

BACKGROUND: Adoption and maintenance of healthy behaviours is pivotal to chronic disease self-management as this influences disease progression and impact. This qualitative study investigated health behaviour changes adopted by participants with moderate or severe chronic obstructive pulmonary disease (COPD) recruited to a randomised controlled study of telephone-delivered health-mentoring. METHODS: Community nurses trained as health-mentors used a patient-centred approach with COPD patients recruited in general practice to facilitate behaviour change, using a framework of health behaviours; 'SNAPPS' Smoking, Nutrition, Alcohol, Physical activity, Psychosocial well-being, and Symptom management, through regular phone calls over 12 months. Semi-structured interviews in a purposive sample sought feedback on mentoring and behaviour changes adopted. Interviews were analysed using iterative thematic and interpretative content approaches by two investigators. RESULTS: Of 90 participants allocated to health-mentoring, 65 (72%) were invited for interview at 12-month follow up. The 44 interviewees, 75% with moderate COPD, had a median of 13 mentor contacts over 12 months, range 5-20. Interviewed participants (n=44, 55% male, 43% current smokers, 75% moderate COPD) were representative of the total group with a mean age 65 years while 82% had at least one additional co-morbid chronic condition. Telephone delivery was highly acceptable and enabled good rapport. Participants rated 'being listened to by a caring health professional' as very valuable. Three participant groups were identified by attitude to health behaviour change: 14 (32%) actively making changes; 18 (41%) open to and making some changes and 12 (27%) more resistant to change. COPD severity or current smoking status was not related to group category. Mentoring increased awareness of COPD effects, helping develop and personalise behaviour change strategies, even by those not actively making changes. Physical activity was targeted by 43 (98%) participants and smoking by 14 (74%) current smokers with 21% reporting quitting. Motivation to maintain changes was increased by mentor support. CONCLUSIONS: Telephone delivery of health-mentoring is feasible and acceptable to people with COPD in primary care. Health behaviours targeted by this population, mostly with moderate disease, were mainly physical activity and smoking reduction or cessation. Health-mentoring increased motivation and assisted people to develop strategies for making and sustaining beneficial change. TRIAL REGISTRATION: ACTR12608000112368.

Quality clinical placements for undergraduate nursing students: a cross-sectional survey of undergraduates and supervising nurses.

AIM: This article is a report of a mixed method study of the quality of clinical placements for second year undergraduate nursing students in an acute care hospital. BACKGROUND: In response to the current and predicted workforce shortages, greater numbers of nursing undergraduate places are being offered at tertiary institutions. This means that requests for clinical places in hospitals to support undergraduate students has risen. Little is known about the impact of increased numbers on the quality of clinical placement as a learning experience and this is of concern as demand grows and the means of assessing capacity is still unknown. METHODS: A 5-point Likert Scale questionnaire, including free text fields, was administered to undergraduates (n = 178), clinical facilitators (n = 22) and supervising ward nurses (n = 163) at two time points in 2009. The survey targeted the quality of the clinical placement in four domains: welcoming and belongingness; teaching and learning; feedback; confidence and competence. Findings. The findings demonstrated consistently high scoring of the clinical placement experience by both undergraduates and registered nurses. There were higher ratings of levels of support from clinical facilitators compared to supervising ward nurses evident in data associated with the items on the questionnaire relating to teaching and learning. CONCLUSION: The results are indicative of the professional commitment of nursing staff to support the next generation of nurses. The findings also give a mechanism to communicate outcomes of undergraduate support to nurses in practice, and highlight steps which can be taken to ensure high quality clinical placement continues.

Entering a world of uncertainty: community nurses' engagement with information and communication technology.

Achieving adoption, use, and integration of information and communication technology by healthcare clinicians in the workplace is recognized as a challenge that requires a multifaceted approach. This article explores community health nurses' engagement with information and communication technology as part of a larger research project that investigated the delivery of self-management support to people with chronic obstructive pulmonary disease. Following a survey of computer skills, participants were provided with computer training to support use of the project information system. Changes in practice were explored using action research meetings and individual semistructured interviews. Results highlight three domains that affected nurses' acceptance, utilization, and integration of information and communication technology into practice; environmental issues; factors in building capacity, confidence, and trust in the technology; and developing competence. Nurses face individual and practice challenges when attempting to integrate new processes into work activities, and the use of participatory models to support adoption is recommended.

Investigating the feasibility of promoting and sustaining delivery of cardiac rehabilitation in a rural community.

INTRODUCTION: Members of rural communities face the dual burden of high rates of cardiovascular disease and barriers to accessing cardiac rehabilitation programs (CRPs). While rural healthcare providers recognise the need for local delivery of such programs, they are constrained by funding and resource limitations. METHODS: This research sought to explore the feasibility, acceptance and support for the delivery of a secondary prevention CRP in a rural community. Eight local participants were recruited to a pilot CRP following cardiac surgery, diagnosis of cardiovascular disease and/or identification by health practitioners as being at risk of developing cardiovascular disease. The key measures of success were the ability of the team to provide a program based on self-management principles, with a local and collaborative focus. The Health Education Impact Questionnaire (HeiQ) was used to measure the effectiveness and outcomes of the CRP. Qualitative data were also used in order to enhance understandings of the efficacy of CRPs in rural settings from the participant perspective. RESULTS: The delivery of a pilot program that engaged local healthcare providers in partnerships with local residents was successful. Local provision was clearly a positive aspect of the program. Participants described the program as supportive, holistic and convenient, providing new information in a framework that supported self-management. The program encouraged local collaboration that enabled continuation of the program. CONCLUSIONS: Local support from health professionals and participants provided strong motivation for attendance; however, the location of the program in a rural setting did not remove all travel barriers. Adhering to the principles of empowerment inherent in a self-management approach to rehabilitation meant accepting fluctuating attendance as individuals managed priorities in their lives.

Engaging general practice nurses in chronic disease self-management support in Australia: insights from a controlled trial in chronic obstructive pulmonary disease.

The growing burden of chronic disease will increase the role of primary care in supporting self-management and health behaviour change. This role could be undertaken to some extent by the increased practice nurse workforce that has occurred over recent years. Mixed methods were used to investigate the potential for general practice nurses to adopt this role during a 12-month randomised controlled study of telephone-delivered health mentoring in Tasmanian practices. Nurses (general practice and community health) were trained as health mentors to assist chronic obstructive pulmonary disease patients to identify and achieve personal health related goals through action plans. Of 21% of invited practices that responded, 19 were allocated to health mentoring; however, general practice nurses were unable to train as health mentors in 14 (74%), principally due to lack of financial compensation and/or workload pressure. For five general practice nurses trained as health mentors, their roles had previously included some chronic disease management, but training enhanced their understanding and skills of self-management approaches and increased the focus on patient partnership, prioritising patients' choices and achievability. Difficulties that led to early withdrawal of health mentors were competing demands, insufficient time availability, phone calls having lower priority than face-to-face interactions and changing employment. Skills gained were rated as valuable, applicable to all clinical practice and transferable to other health care settings. Although these results suggest that training can enhance general practice nurses' skills to deliver self-management support in chronic disease, there are significant system barriers that need to be addressed through funding models and organisational change.

Nurses' recognition and response to unsafe practice by their peers: A qualitative descriptive analysis.

BACKGROUND: Unsafe practice is an important issue for the nursing profession however few studies have sought to identify how nurses recognise and respond to unsafe practice. OBJECTIVES: To identify the behaviours and cues that registered nurses recognise as indications of unsafe practice, perceived factors that contribute to unsafe practice and action nurses take in response. DESIGN: Qualitative descriptive study. SETTINGS: New Zealand health care settings. PARTICIPANTS: New Zealand registered Nurses (n = 13). METHODS: Data were collected via semi-structured interviews and analysis was conducted using constant-comparative and thematic analysis. RESULTS: Nurses identified a range of behaviours, cues, contributing factors and responses to unsafe practice. Three themes emerged from the data: Uncertainty, 'sensing' unsafe practice and disrupted professionalism. CONCLUSION: Understanding the challenges nurses face every day in recognising and responding to unsafe practice in increasingly complex nursing contexts is key to understanding how unsafe practice may be further addressed in clinical practice. Nurses in this study recognised overtly unsafe behaviour and subtle cues as indications of unsafe practice. Participants also identified factors which they perceived contributed to the occurrence of unsafe practice including high workloads and poor skill mix as well as organisational cultures that failed to support safe practice.

Community expectations of a village for people living with dementia.

Small-scale models of dementia care are a progressive approach to improve care for people living with dementia. These models intend to provide a home-like environment with a small number of residents in each living unit, easy access to services and facilities, a dedicated team of staff and flexible routines. This study was undertaken during the construction phase of a new village and provided a unique opportunity to explore expectations of the village among the local community. Twelve community members participated in two sequential online focus groups over a 2-month period. Focus group discussions were recorded, transcribed and analysed using a reflexive thematic analysis approach. Knowledge of the village varied and was informed by familiarity with other village developments and local marketing about the new village. The findings indicate that the community expect the village to provide residents with optimum dementia care, a safe and enabling physical environment and a vibrant daily life where they are engaged in 'normal' activities. While participants expected the village to be self-contained, they also anticipated strong connections with the wider community. Participants acknowledged that the community need dementia education to ensure these interactions are positive. Community expectations of a new village development for people living with dementia are largely positive and often idealistic. Organisations need to consider these expectations when developing new small-scale facilities and be mindful of how they market these developments to foster realistic expectations. While community enthusiasm about dementia care is encouraging, education is needed to ensure the success of the model.

Interdisciplinary Perspectives on Restraint Use in Aged Care.

Restraint use in Australian residential aged care has been highlighted by the media, and investigated by researchers, government and advocacy bodies. In 2018, the Royal Commission into Aged Care selected 'Restraint' as a key focus of inquiry. Subsequently, Federal legislation was passed to ensure restraint is only used in residential aged care services as the 'last resort'. To inform and develop Government educational resources, we conducted qualitative research to gain greater understanding of the experiences and attitudes of aged care stakeholders around restraint practice. Semi-structured interviews were held with 28 participants, comprising nurses, care staff, physicians, physiotherapists, pharmacists and relatives. Two focus groups were also conducted to ascertain the views of residential and community aged care senior management staff. Data were thematically analyzed using a pragmatic approach of inductive and deductive coding and theme development. Five themes were identified during the study: 1. Understanding of restraint; 2. Support for legislation; 3. Restraint-free environments are not possible; 4. Low-level restraint; 5. Restraint in the community is uncharted. Although most staff, health practitioners and relatives have a basic understanding of restraint, more education is needed at a conceptual level to enable them to identify and avoid restraint practice, particularly 'low-level' forms and chemical restraint. There was strong support for the new restraint regulations, but most interviewees admitted they were unsure what the legislation entailed. With regards to resources, stakeholders wanted recognition that there were times when restraint was necessary and advice on what to do in these situations, as opposed to unrealistic aspirations for restraint-free care. Stakeholders reported greater oversight of restraint in residential aged care but specified that community restraint use was largely unknown. Research is needed to investigate the extent and types of restraint practice in community aged care.

Green spaces, dementia and a meaningful life in the community: A mixed studies review.

Engagement in green spaces impacts positively on wellbeing and quality of life. However, little is known about the impacts of green space engagement specifically for people living with the experience of dementia in the community; people with a heightened need to maintain a quality life. In this mixed study review, we explore existing evidence for quality of life impacts of contact with green spaces by people living with dementia in the community. Findings show that gardens and horticultural programs, green care farms, parks, urban woodlands and neighbourhood outdoor environments can impact positively in several ways. Four key mechanisms are identified: Engaging in meaningful activities; Empowerment; Positive risk taking; and Reinforcing Identity. These findings provide conceptual links between psychosocial understandings of the relationships between nature and wellbeing with rights-based dementia discourses. We conclude that evidence specific for people living with dementia in the community setting is growing and there is potential for green spaces to enable an active and meaningful community-life, despite cognitive decline. This is worthy of consideration by policy makers, practitioners and carers. Future studies can broaden this field of research and include investigations into lesser-explored aspects of quality of life, such as spirituality, and methods that incorporate the voices of people living with dementia.