John Bidewell

Challenges for professional care of advanced dementia.

Qualitative methodology based on action research identified challenges when caring for persons with advanced dementia, as perceived by key professional providers. Data collection was via five focus groups (total n = 24) and 20 follow-up individual interviews. Participants included palliative care, aged care and dementia specialist nurses, medical specialists from an area health service, residential aged care staff and general medical practitioners. Responses emphasized the need for improved knowledge and skills, and clearer policy. Concerns included accurate assessment, especially of pain, owing to the inability of people with advanced dementia to communicate their symptoms. Assessment, managing physical and behavioural symptoms, and communicating with family presented as further challenges. Conclusions are that the need for a palliative approach to care in advanced dementia should be recognized. Aged care staff can deliver palliative care to people with advanced dementia only if the staff receive relevant education and training beyond their generalist competencies.

The value of participatory action research in clinical nursing practice.

This paper demonstrates the value of participatory action research (PAR) and promotes its use by nurses in clinical practice. PAR has gained popularity in nursing and health-care research, offering a way of developing practice-based knowledge that can improve nursing care. PAR is described in detail: what PAR is, how to use PAR in clinical practice, and the steps in the PAR cycle as applied during an exemplar study in which nurses used PAR to address their concerns and develop, implement and evaluate a model of care in an acute medical ward. The authors advocate PAR as a collaborative means to improve the nursing care for patients in varied clinical practice settings.

Procedural pain in neonates in Australian hospitals: A survey update of practices

The study aims to determine whether there has been improved uptake of the evidence for the management of procedural pain in neonates throughout Australia.

Managing dementia agitation in residential aged care

Agitation is a widespread and challenging problem among aged care residents with dementia. This article draws on empirical and theoretical literature to propose a model for preventing and treating agitation non-pharmacologically. A literature review finds agreed, coherent definition and measurement of agitation to be absent despite numerous agitation remedies having been suggested, yet sufficient material to support evidence-based care planning. Agitation is revealed as resulting from a resident’s interactions with the environment or their internal state, giving rise to unmet needs that attentive care can treat. Agitation treatments are reviewed to find no single effective remedy and a lack of quality evaluation. A higher-order, problem-solving approach is proposed. The described system consists of sequential diagnosis, decision making and treatment options, commencing with individualized and institutional preventative measures removing environmental triggers, followed by individual remediation, with residents’ unmet needs receiving priority consistent with patient-centred care.

Parental stress and satisfaction in the non-tertiary special care nursery

AIM This paper is a report of a study examining the effects of using headbox oxygen and continuous oxygen positive airway pressure treatments for respiratory distress on stress and satisfaction of parents with infants in a special care nursery, and the relationship between parental stress and satisfaction. BACKGROUND Continuous positive airway pressure respiratory support is increasingly used in special care nurseries worldwide. Almost nothing is known about effects of different types of respiratory support on the stress and satisfaction of parents with babies in the special care nursery. METHOD Questionnaires were used from August 2004 to June 2006 in five special care nurseries to measure parental stress using an adaptation of the Parental Stressor Scale: Neonatal Intensive Care Unit and 5-point scales to measure overall stress and satisfaction. FINDINGS Questionnaires were returned from 42 parents of babies receiving headbox oxygen and 51 parents of babies receiving continuous positive airway pressure (62% response rate). High stress was commonly reported. Stress did not differ statistically significantly between the two treatments. Parents with babies receiving continuous positive airway pressure were more satisfied compared to the headbox group. Stress and satisfaction were not statistically significantly correlated. CONCLUSION Clinicians need not favour either method of respiratory support when attempting to minimize parental experience of environmental stress. Further research is needed to test parental stress reduction strategies in the special care nursery.

Community palliative care nurse experiences and perceptions of follow-up bereavement support visits to carers

Community (district) nurses (CNs) are well positioned to provide follow-up home visits to bereaved families and carers of their recently deceased palliative clients. An Australian survey of CNs (n = 58, response rate 29%) described their experiences of bereavement support visits, perceptions of their role in bereavement care and their professional support needs. Although positive experiences were commonly reported, with 95% of participants considering bereavement follow-up visits as consistent with their role, 53% found the visits difficult for reasons such as the nurse or client not understanding the purpose, the CN‘s excessive personal identification with the clients situation, the emotional intensity of visits, and lack of confidence or skills despite prior training. The nature and quality of the CN‘s prior relationship with the bereaved family was an important determinant of the visits’ success. Results highlight the value of bereavement support visits, while identifying professional development needs. Managing emotionally intense episodes should receive priority in preparing CNs for this challenging role.

Developing cultural competence through self-reflection in interprofessional education: Findings from an Australian university

ABSTRACT Interprofessional education and cultural competence are both necessary for health professionals working in interprofessional teams serving diverse populations. Using a pre–post-survey case series design, this study evaluates a novel learning activity designed to encourage self-reflection and cultural competence in an Australian interprofessional education context. Undergraduate health professional students in a large subject viewed three 7–15 minute videos featuring interviews with persons of a minority cultural, linguistic, or sexual group who were living with a disability or managing a health condition. Immediately afterwards, students in interprofessional groups completed a structured activity designed to promote interprofessional and cultural reflection. A localised version of a validated scale measured cultural competence before and after the learning activity. Results suggest the value of video-based learning activities based on real-life examples for improving cultural competence. Despite initially rating themselves highly, 64% of students (n = 273) improved their overall cultural competence, though only by M = 0.13, SD = 0.08, of a 5-point rating-scale interval. A nuanced approach to interpreting results is warranted; even slight increases may indicate improved cultural competence. Suggestions for improving the effectiveness of video-based cultural competence learning activities, based on qualitative findings, are provided. Overall the findings attest to the merit of group discussion in cultural competence learning activities in interprofessional education settings. However, the inclusion of group discussions within such learning activities should hinge on group dynamics.

Developing best practice guidelines for institutional ethics committees (IECs) in Great Sydney mission impossible

In 1999 the authors submitted to the local Health Research Ethics Committee (HREC) for approval a research proposal to investigate Institutional Ethics Committee (IEC) policies and practices in Greater Sydney, Australia. The submission to the HREC followed previous successful submissions to the Scientific Advisory Committee, which is a sub-committee of the HREC and the IEC of the University of Western Sydney, Nepean. The local HREC refused to approve the proposal. In this paper we describe the studys background, its aims, expected outcomes and its design. We also describe the scientific and ethical review process to which the research proposal was subjected. Finally, we speculate upon the reasons the proposals progress has been, in our view, inappropriately impeded. These illustrate with pressing irony precisely those issues the proposed research sought to explore and address.

Participant perceptions of a community-based lifestyle intervention: The CHIP

ISSUE ADDRESSED The Coronary Health Improvement Project (CHIP) is a community-based educational initiative designed to improve cardiovascular fitness and other health indicators associated with common, lifestyle-related health disorders in developed societies. Evaluations of the CHIP since the late 1990s, though yielding positive statistical results for change in participant physical health indicators, have not included qualitative assessments of the CHIP experience from the perspectives of CHIP participants. METHODS Data were obtained using a mixed methods survey design via a questionnaire completed by 79 respondents (71% female) who had participated in Australian CHIP programs. Responses were analysed using descriptive statistics and thematic analysis. RESULTS Participants commonly undertook the CHIP to fulfil their lifestyle and health aspirations and to target specific health conditions. Improved diet, enhanced exercise and weight loss were the most commonly reported benefits. Participation in the CHIP involves a process of conviction (involving risks and motivation), connection (involving support and reinforcement), challenge (involving control and struggle) and change (involving more and less). CONCLUSION This study offers a model of a change process generated from the perspectives of participants of the CHIP in Australia. Not all participants found CHIP lifestyle recommendations straightforward to adopt, as some encountered resistance from within themselves or from family and friends.