Cm Stirling

Factors affecting volunteering among older rural and city dwelling adults in Australia

In the absence of large scale Australian studies of volunteering among older adults, this study compared the relevance of two theoretical approaches—social capital theory and sociostructural resources theory—to predict voluntary activity in relation to a large national database. The paper explores volunteering by older people (aged 55+) in order to assess differences in volunteering in the Australian context. A model was developed that comprised social capital variables (organizational membership, religious affiliation, marital status, and migrant status) and sociostructural variables (education, work status, income, gender, and health status). Logistic regression analyses assessed the relationship between these variables and volunteering, and the interaction effects with two key factors relevant to the Australian context, age cohort and locality. Overall, these results suggest (a) that reliance on bivariate analysis for understanding volunteering may hide a more complex picture associated with older people volunteering, and (b) that neither social capital theory nor sociostructural resource theory adequately predicts volunteering by older Australians, but that generational theories may provide added strength to future analyses.

Delivering patient decision aids on the Internet: definitions, theories, current evidence, and emerging research areas

BackgroundIn 2005, the International Patient Decision Aids Standards Collaboration identified twelve quality dimensions to guide assessment of patient decision aids. One dimension—the delivery of patient decision aids on the Internet—is relevant when the Internet is used to provide some or all components of a patient decision aid. Building on the original background chapter, this paper provides an updated definition for this dimension, outlines a theoretical rationale, describes current evidence, and discusses emerging research areas.MethodsAn international, multidisciplinary panel of authors examined the relevant theoretical literature and empirical evidence through 2012.ResultsThe updated definition distinguishes Internet-delivery of patient decision aids from online health information and clinical practice guidelines. Theories in cognitive psychology, decision psychology, communication, and education support the value of Internet features for providing interactive information and deliberative support. Dissemination and implementation theories support Internet-delivery for providing the right information (rapidly updated), to the right person (tailored), at the right time (the appropriate point in the decision making process). Additional efforts are needed to integrate the theoretical rationale and empirical evidence from health technology perspectives, such as consumer health informatics, user experience design, and human-computer interaction.Despite Internet usage ranging from 74% to 85% in developed countries and 80% of users searching for health information, it is unknown how many individuals specifically seek patient decision aids on the Internet. Among the 86 randomized controlled trials in the 2011 Cochrane Collaboration’s review of patient decision aids, only four studies focused on Internet-delivery. Given the limited number of published studies, this paper particularly focused on identifying gaps in the empirical evidence base and identifying emerging areas of research.ConclusionsAs of 2012, the updated theoretical rationale and emerging evidence suggest potential benefits to delivering patient decision aids on the Internet. However, additional research is needed to identify best practices and quality metrics for Internet-based development, evaluation, and dissemination, particularly in the areas of interactivity, multimedia components, socially-generated information, and implementation strategies.

Why carers use adult day respite: a mixed method case study

BackgroundWe need to improve our understanding of the complex interactions between family carers’ emotional relationships with care-recipients and carers use of support services. This study assessed carer’s expectations and perceptions of adult day respite services and their commitment to using services.MethodsA mixed-method case study approach was used with psychological contract providing a conceptual framework. Data collection was situated within an organisational case study, and the total population of carers from the organisation’s day respite service were approached. Fifty respondents provided quantitative and qualitative data through an interview survey. The conceptual framework was expanded to include Maslow’s hierarchy of needs during analysis.ResultsCarers prioritised benefits for and experiences of care-recipients when making day respite decisions. Respondents had high levels of trust in the service and perceived that the major benefits for care-recipients were around social interaction and meaningful activity with resultant improved well-being. Carers wanted day respite experiences to include all levels of Maslow’s hierarchy of needs from the provision of physiological care and safety through to the higher levels of belongingness, love and esteem.ConclusionThe study suggests carers need to trust that care-recipients will have quality experiences at day respite. This study was intended as a preliminary stage for further research and while not generalizable it does highlight key considerations in carers’ use of day respite services.

Caring for the carer: a systematic review of pure technology-based cognitive behavioral therapy (TB-CBT) interventions for dementia carers

Background: Face-to-face delivery of CBT is not always optimal or practical for informal dementia carers (DCs). Technology-based formats of CBT delivery (TB-CBT) have been developed with the aim to improve client engagement and accessibility, and lower delivery costs, and offers potential benefits for DCs. However, research of TB-CBT for DCs has maintained heavy reliance on therapist involvement. The efficacy of pure TB-CBT interventions for DCs is not currently established Methods: A systematic review of trials of pure TB-CBT intervention for DCs from 1995 was conducted. PsycINFO, Cochrane Reviews, Scopus and MedLine databases were searched using key terms related to CBT, carers and dementia. Four hundred and forty two articles were identified, and inclusion/exclusion criteria were applied; studies were only retained if quantitative data was available, and there was no active therapist contact. Four articles were retained; two randomized and two waitlist control trials. Methodological and reporting quality was assessed. Meta-analyses were conducted for the outcome measures of caregiver depression. Results: Meta-analysis revealed small significant post-intervention effects of pure TB-CBT interventions for depression; equivalent to face-to-face interventions. However, there is no evidence regarding long-term efficacy of pure TB-CBT for DCs. The systematic review further identified critical methodological and reporting shortcomings pertaining to these trials Conclusions: Pure TB-CBT interventions may offer a convenient, economical method for delivering psychological interventions to DCs. Future research needs to investigate their long-term efficacy, and consider potential moderating and mediating factors underpinning the mechanisms of effect of these programs. This will help to provide more targeted interventions to this underserviced population.

Skill development for volunteering in rural communities

This paper examines the skills required of volunteers in the voluntary sector organisations that operate in three rural Tasmanian communities. It reports how volunteers acquire those skills and reveals the challenges faced by voluntary sector organisations in rural communities whose industries and, following from this, community members have a low‐qualification profile. Training for volunteers in these rural communities must take account of motivations for volunteering, rural context, preferred learning styles, education and training, and the volunteers’ confidence as learners.

An investigation of factors that impact patients’ subjective experience of nurse‐led clinics: a qualitative systematic review

Aims and objectives To systematically review the qualitative evidence on factors that affect the experience of patients attending nurse-led clinics and compare with key elements of person-centred care. Background As the number of nurse-led clinics increases in response to health system needs, evaluation has focused on clinical outcomes and cost. Patient experiences are less researched and yet, they are an important influence on clinical outcomes and an indicator of person-centred care. A detailed review of existing research in this area is needed. Design A systematic review of primary, qualitative literature was conducted using the Joanna Briggs Institute methodology of meta-aggregation. Methods Published research from 1990–2012 was located using CINAHL, PubMed, Medline and PsycINFO. Reference lists were searched and analysed. Two reviewers assessed the papers for methodological quality using instruments from the Joanna Briggs Institute to critically appraise, extract data and meta-aggregate findings. Results Eleven studies met all inclusion criteria. Three meta-synthesis statements were derived from 46 findings aggregated to nine categories. The key themes relating to establishment of a therapeutic relationship, effective communication, and clinical skills and collaboration mapped closely to the person-centred care framework. Conclusion Concepts central to person-centred care proved to be factors impacting patients’ subjective experience. Further research is warranted to meet the challenge to transform the key concepts of the person-centred care model into everyday nursing practice. Relevance to clinical practice Knowledge of patients’ feelings and the importance of person-centred, individualised care may contribute to development of future training and re-training programs in basic nursing skills. This is significant in that it contributes to future positive patient experience.

The nurse practitioner–client therapeutic encounter: an integrative review of interaction in aged and primary care settings

AIMS To review the key features of the nurse practitioner-client interaction in the thera-peutic encounter to inform the development of nurse practitioner-led memory clinics. BACKGROUND Nurse practitioners spend significant time interacting with clients and their families/caregivers yet there is limited research on this interaction during therapeutic encounters in aged and primary care contexts. DESIGN Integrative review. DATA SOURCES Electronic search of CINAHL, Embase, Medline, PsychINFO, PubMed, Scopus, Web of Science 2004-2013; hand search of the Journal of Advanced Nursing, Journal of the American Academy of Nurse Practitioners and Journal of Clinical Nursing. REVIEW METHODS Integrative literature review using Whittemore and Knafls methodology. RESULTS Ten published studies were included, representing over 900 nurse practitioners and their clients. Three key factors of nurse practitioner-client interaction were identified: nurse practitioner expertise and the influence of the therapeutic encounter context; affirming exchange as a bedrock of communication; and high levels of client engagement. In aged and primary care settings, where the therapeutic encounter requires and allows longer consultations, such as nurse practitioner-led memory clinics, patient-centred approaches can engage clients in consultations using a biopsychosocial framework, resulting in improved client satisfaction and, potentially, increased adherence to treatment plans. Nurse practitioners who are open and respectful, who encourage patients to provide more information about their lives and condition and are perceived by the client to be empathetic, are providing affirmation to the client. CONCLUSION Affirming interactions are a key feature of successful therapeutic encounters when time and context do not allow or warrant the full repertoire of patient-centred communication.

Collective Agency for Service Volunteers A Critical Realist Study of Identity Representation

Policy makers promote volunteering in part because it is a powerful mechanism for expanding local community services. Volunteers, however, are subject to processes and power dynamics within organizations, which limit their collective agency. This article reports key findings of a study of rural ambulance volunteers’ agency. The study demonstrated that collective identity is part of the ensemble of power that allows volunteers’ interests to be marginalized within organizations. Findings highlighted barriers for volunteers who were unhappy with the organizational support they received. A critical realist analysis revealed that rural location and community discourses underpinned the volunteers’ lack of collective agency.

The will to mobility: life-space satisfaction and distress in people with dementia who live alone

ABSTRACT Increasing numbers of people with dementia reside in single-person households, yet little is known of their experiences and priorities. This exploratory Australian study elicited perceptions of seven people with dementia living alone, regarding their domestic environment and its surroundings. The general aim was to identify unmet service needs in this vulnerable population. Drawing upon the theoretical concepts of ‘the will to mobility’ and ‘life-space’, we identified four factors of particular salience to our respondents. These were access to public space, social distance and proximity, changing meanings of space and objects, and imaginative co-presence. Participants provided useful insights into a soon-to-be-common scenario in which increased numbers of people with dementia will be living without a resident carer. The findings have implications for the development of more personalised and targeted dementia care in the domestic setting, more inclusive public planning and more extensive public education programmes.

Postgraduate nursing student knowledge, attitudes, skills, and confidence in appropriately referencing academic work.

Preventing plagiarism is an ongoing issue for higher education institutions. Although plagiarism has been traditionally seen as cheating, it is increasingly thought to be the result of poor referencing, with students reporting difficulties citing and referencing bibliographic sources. This study examined the academic knowledge, attitude, skills, and confidence of students in a school of nursing to understand poor referencing. A cross-sectional quantitative and qualitative survey was distributed to postgraduate (N = 1,000) certificate, diploma, and masters students. Quantitative data gathered demographics, cultural and linguistic background, and use of technology. Thematic analysis discovered patterns and themes. Results showed participants understood requirements for referencing; half indicated poor referencing was due to difficulty referencing Internet sources or losing track of sources, and many lacked confidence in key referencing tasks. Despite this, 50% did not make use of referencing resources. Overall, these data suggest incorrect referencing is rarely intentional and predominantly caused by skills deficit.