Jeanine Blackford

Managing Shame and Stigma: Case Studies of Female Carers of People With AIDS in Southern Thailand

The authors of this article discuss the effects of shame and stigma on female caregivers of people living with AIDS in southern Thailand. They conducted a longitudinal ethnographic case study over 8 months and collected data using interviews, observations, field notes, and journaling. The authors performed qualitative content analysis and narrative analysis. Public judgment was created in a moral climate, framed by Buddhist precepts of correct and honorable behavior, with different levels of tolerance and stigmatization between men and women. Women caregivers engaged in concealing practices, deception, and withdrawal from social relationships to manage the effects of shame and stigma.

Advance care planning in residential aged care facilities.

Abstract A person’s right to self-determination in health care is now a fundamental principle of health care provision. As a consequence Advance Care Planning (ACP) is a critical issue in health care including palliative care as it is seen as a way of ensuring a person’s right to participate not only in future health care choices but in end of life decision making. To date there have been few reports of successful ACP programs. In 2004 and 2005 a program of advance care planning, known as Respecting Patient Choices was introduced in 17 residential aged care facilities in metropolitan Melbourne, Australia. This program information for residents and families as well as changes to organisational processes to ensure that residents have opportunity for self-determination in their future health care.This paper will report on the lessons learnt from this implementation and identify strategies which foster sustainability of ACP.

Is an advance care planning model feasible in community palliative care? A multi‐site action research approach

AIM This article reports a study to determine the feasibility of an advance care planning model developed with Australian community palliative care services. BACKGROUND An effective advance care planning programme involves an organizational wide commitment and preparedness for health service reform to embed advance care planning into routine practice. Internationally, such programmes have been implemented predominantly in aged and acute care with more recent work in primary care. METHODS A multi-site action research was conducted over a 16-month period in 2007-2009 with three Victorian community palliative care services. Using mixed method data collection strategies to assess feasibility, we conducted a baseline audit of staff and clients; analysed relevant documents (client records, policies, procedures and quality improvement strategies) pre-implementation and post-implementation and conducted key informant interviews (n = 9). SETTINGS AND PARTICIPANTS Three community palliative care services: one regional and two metropolitan services in Victoria, Australia. RESULTS The services demonstrated that it was feasible to embed the Model into their organizational structures. Advance care planning conversations and involvement of family was an important outcome measure rather than completion rate of advance care planning documents in community settings. Services adapted and applied their own concept of community, which widened the impact of the model. Changes to quality audit processes were essential to consolidate the model into routine palliative care practice. CONCLUSION An advance care planning model is feasible for community palliative care services. Quality audit processes are an essential component of the Model with documentation of advance care planning discussion established as an important outcome measure.

Nurses of NESB working in a multicultural community

Abstract Ensuring that the cultural composition of the nursing population reflects the multicultural mix of the general population assumes that culturally appropriate care will occur when people of non-English background (NESB) are encountered in nursing practice. In a feminist praxis study involving twenty-six nurse participants, seven of whom were of NESB, the nurses discovered that the structure of the health care institution not only overlooked the cultural and linguistic needs of children and NESB families, but also created a dominant Anglo-Australian health culture that taught NESB nurses to ignore the traditions and practices of their NESB culture. This paper will explore the nurses’ discovery of their own collusion in sustaining an Anglo-Australian health care culture.

Exploring bereavement care in inpatient settings.

Abstract This paper compares the attitudes and practices of health professionals to the provision of family-centred bereavement care in different Australian inpatient settings: palliative care services, acute care and long stay residential aged care settings. Semi-structured interviews (88) were conducted with doctors, nurses, pastoral carers and allied health staff. Comprehensive bereavement care was not being provided or resourced in the acute and aged care hospitals to the same level as that provided in palliative care services. Residential care provided continuity of care and good support for grieving relatives and other residents. A structured bereavement program is needed in all inpatient settings with palliative care patients, along with resource and education support for health professionals.

Tracking the route to sustainability: a service evaluation tool for an advance care planning model developed for community palliative care services

AIMS AND OBJECTIVES The study aim was to develop a service evaluation tool for an advance care planning model implemented in community palliative care. BACKGROUND Internationally, advance care planning programmes usually measure success by completion rate of advance directives or plans. This outcome measure provides little information to assist nurse managers to embed advance care planning into usual care and measure their performance and quality over time. An evaluation tool was developed to address this need in Australian community palliative care services. DESIGN Multisite action research approach. METHODS Three community palliative care services located in Victoria, Australia, participated. Qualitative and quantitative data collection strategies were used to develop the Advance Care Planning-Service Evaluation Tool. RESULTS The Advance Care Planning-Service Evaluation Tool identified advance care planning progress over time across three stages of Establishment, Consolidation and Sustainability within previously established Model domains of governance, documentation, practice, education, quality improvement and community engagement. The tool was used by nurses either as a peer-assessment or self-assessment tool that assisted services to track their implementation progress as well as plan further change strategies. CONCLUSION The Advance Care Planning-Service Evaluation Tool was useful to nurse managers in community palliative care. It provided a clear outline of service progress, level of achievement and provided clear direction for planning future changes. RELEVANCE TO CLINICAL PRACTICE The Advance Care Planning-Service Evaluation Tool enables nurses in community palliative care to monitor, evaluate and plan quality improvement of their advance care planning model to improve end-of-life care. As the tool describes generic healthcare processes, there is potential transferability of the tool to other types of services.

The potential of ‘peer’clinical supervision to improve nursing practice

Objective: this paper reports on the experience of two researchers who worked with nurses to trial a reflective model of ‘peer clinical supervision’. The model had been successfully used for professional development in education. The research aims were to evaluate the models suitability for professional development in nursing, and as an educational tool in post-graduate nursing programmes. Setting: the research was undertaken in the cardiac unit at the Royal Childrens Hospital Melbourne, Australia. Design: eight nurses volunteered to participate. Using peer clinical supervision the nurses decided to examine the practice of conducting painful procedures on children to determine whether they could be managed to minimize the childs distress. Findings: it was demonstrated that peer clinical supervision was an effective model in assisting nurses to examine their practice. It was discovered that the structuring of nursing roles and practices when conducting painful procedures interfered with the opportunity for the child to receive comfort from their parent or a designated staff member/caregiver. Conclusion: the reflective model of peer clinical supervision proved to be a usefulstrategy, but required modifications for the nursing context. Following the modifications it was adopted for use in a pilot paediatric intensive care nursing course to assist nurses in their learning and contribute to their professional development.

Support interventions for caregivers of physically disabled adults: a systematic review.

In developing countries family caregivers are an important community-based resource who provide care for physically disabled adults. Substantial caregiving commitment is known to adversely affect caregiver health and thereby their capacity to provide ongoing care. This systematic review focused on support interventions for caregivers using Thailand as an example. From 1964 to 2011 international and Thai electronic databases and relevant grey literature were searched. Six English papers and 34 Thai papers published between 1990 and 2010 were found. The Critical Appraisal Skills Programme (CASP) tool was modified to appraise methodological quality. All nurse-led interventions mainly focused on improving caregiving capacity; nearly half considered caregiver health. Only 15 interventions were community-based. Despite variable research quality all studies showed benefits for caregivers, care recipients, and healthcare services. In developing countries without healthy caregivers physically disabled adults would not receive care. There is an urgent need for further investment in community-based research to develop effective interventions designed to promote caregiver health and help them maintain their role.

Management of the acute cardiac patient in the Australian rural setting: A 12 month retrospective study

BACKGROUND Rural cardiac patients may require transfer to tertiary health services for ongoing acute cardiac management. The time required to transfer is a consideration in determining appropriate clinical care. There is little published data reporting acute cardiac management in the Australian regional setting that reviews factors determining transfer to a tertiary centre. PURPOSE This paper reports the findings of a quantitative, retrospective study conducted to identify demographic differences and potential predictors to urban transfer for ongoing acute cardiac management for patients presenting to a regional hospital with suspected acute myocardial infarction. METHODS Using a purpose designed tool an audit of 204 files from June 2009 to July 2010 was conducted for all patients admitted to a regional hospital having a discharge diagnosis of acute myocardial infarction or angina. Patient demographics, clinical outcomes, concordance with treatment guidelines, and possible predictors of treatment decisions were investigated. FINDINGS Patients younger than 65 years (p<0.001), unemployed (p<0.01) and with acute electrocardiograph changes (p<0.01) were more likely to be transferred to a tertiary centre. Treatment guidelines concordance for acute cardiac care ranged from 70% to 79% for all patients. CONCLUSIONS Although presenting patients were treated in a timely manner consistent with national guidelines, to be younger, unemployed or have electrocardiograph changes was a greater predictor to urban transfer. It is unknown if these differences in transferring or not to a tertiary centre contribute to poorer long-term cardiac outcomes for rural patients. Further evaluations are warranted.

Editorial - Back to our roots : Palliative care in the clinical setting

7 Volume 27, Issue 1, December 2007 CN For the last ten years I have been involved in conducting research in palliative care across a variety of health care sectors in the Australian context. I have come to regard myself as a recent participant in palliative care after reading Lewis’ (2007) book on Medicine and care of the dying:A modern history. His chapter on the development of palliative care services provides a comprehensive outline of the history of palliative care globally. Lewis highlights the remarkable achievements of palliative care champions across the western world. The efforts of many to recognise the needs of the dying and provide appropriate care, as articulated and practiced by Dame Cicely Saunders in the United Kingdom, created a ripple of change and led to a holistic philosophy of palliative care. Lewis’s book demonstrates how far we have come to enact this philosophy and improve care of the dying. These champions of a systematic approach to care of the dying pressured health professionals and governments alike to broaden the focus of health care from cure to care.Through my own Australian research I have witnessed the influence of federal and state governments on increasing the availability of palliative care through a policy of ‘mainstreaming’.This policy aims to ensure that palliative care is available for all Australians rather than only for individuals located in urban areas close to a hospice or community palliative care service. It is evident that such an approach to care has also been adopted in other countries such as Sweden and UK. In Australia in the late 1990s when ‘mainstreaming’ began there was concern among the palliative care community that their philosophy and principles would be diluted, misinterpreted or even abandoned, in other health care sectors. Certainly the research Professor Street and I (Street & Blackford 2001) conducted at that time suggested that there were some inherent dangers in expecting all practitioners to provide palliative care within their own health care setting. It was evident that practitioners working in palliative care units located in acute care settings grappled with providing high quality endof-life care within an overarching philosophy of cure at all costs. In aged care facilities there was conflict with a philosophy of ‘living in place’ when a person was dying. In practice, living in place meant that health professionals needed to recognise that the aged care facility was now the elderly person’s home. This encompassed the principles of the rights of older people to choose their care and be involved in decision making. Yet what happens when a person no Back to our roots: Palliative care in the clinical setting