Karen Clifton

Watermemories: a swimming club for adults with dementia.

The purpose of this article is to describe the conceptual model and implementation strategies of an evidence-based, aquatic exercise program specifically targeting individuals with dementia-The Watermemories Swimming Club (WSC). Physical exercise not only improves the functional capacity of people with dementia but also has significant effects on other aspects of quality of life such as sleep, appetite, behavioral and psychological symptoms, depression, and falls. Additionally, exercise can improve a persons overall sense of well-being and positively enhance their sociability. The WSC was designed to increase physical exercise while being easy to implement, safe, and pleasurable. Many challenges were faced along the way, and we discuss how these were overcome. Implications for nurses are also provided.

What general practitioners said about the palliative care case conference in residential aged care: An Australian perspective. Part 1

Abstract Objective To examine the views of general practitioners on providing a palliative approach in residential aged care and in particular their experiences with the palliative care case conference. Background The national project sought to implement and evaluate a comprehensive evidence-based palliative approach in residential aged care. Methods A purposive sample of 11 general practitioners (GPs) across Western Australia (2), South Australia (6), and Queensland (3) participated in face-to-face, semi-structured interviews. Qualitative content analysis was used to generate the core categories. Results The evaluation by the GPs of the palliative care case conference in residential aged care is explained through three core themes: people, place, and performance. Understanding what GPs say about the people involved and the place in which they work, namely the residential aged care facility, can purposefully inform practice and policy. What GPs say about the performance or ‘doing’ a palliative care case conference is provided in Part II of this two part series. Conclusion The views of GPs, on providing a palliative approach in residential aged care facilitates, offer a critical reflection on current practices and systems.

The effectiveness of nurse-led care in general practice on clinical outcomes in adults with type 2 diabetes

Background In Australia, diabetes was identified as a national health priority area in 1996; nevertheless the prevalence of type 2 diabetes has increased dramatically since then. Nurses have been working within Australian general practices for several decades but only in recent years has the role of the practice nurse in primary health care increased. Objectives This review aims to identify the effectiveness of nurse‐led care in general practice as compared to general practitioner care on clinical outcomes in adults with type 2 diabetes. Inclusion criteria Types of participants Participants were adults (aged >18 years), with diabetes type 2 attending a general/family practice. Types of intervention Interventions of interest include nurse‐led care in general practice in which the nurse is identified as taking a lead role in the care of patients with type 2 diabetes compared to general practitioner‐led care. Types of studies To evaluate the effectiveness of nurse‐led diabetes care in general practice, this review sought randomised controlled trials as the study design of choice. Other research designs such as controlled clinical trials, interrupted time series and controlled before and after designs were also considered. Types of outcomes The outcomes of interest were clinical outcomes including changes in systolic and diastolic blood pressure, body mass index, cholesterol levels, HbA1c (glycated haemoglobin) and fasting blood glucose. Search strategy A three step literature search was conducted for English language articles from January 1990 to December 2011. Methodological quality Quantitative papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardised critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument. Data collection Quantitative data was extracted from papers included in the review using the standardised data extraction tool from the Joanna Briggs Institute. The data extracted included specific details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives. Data synthesis Data from quantitative papers, where possible, were pooled in statistical meta‐analysis using the Meta‐Analysis of Statistics Assessment and Review Instrument. Additionally, RevMan 5 was used for presenting forest plots of the meta‐analysis. Results The electronic search yielded 804 potentially relevant papers of which 49 papers appeared to satisfy the criteria for inclusion and full texts of these papers were assessed against the inclusion criteria by two independent reviewers. From these papers, five were included in the review, four randomised control trials and one quasi‐experimental study. These articles provided evidence that nurse‐led care improves blood pressure and cholesterol levels for patients with type 2 diabetes attending a general practice. Conclusions There is some evidence to support the use of nurse‐led care in general practice for patients with type 2 diabetes. Implications for Practice If nurse‐led care is implemented in the care of people with type 2 diabetes consideration needs to be given to the use of clinical algorithms, goal setting, individualised care plans, self management and follow up of lifestyle risk factors. Implication for Research More randomised controlled trials are required to assess the efficacy of nurse‐led care including cost effectiveness.

Practice nurse involvement in the management of adults with type 2 diabetes mellitus attending a general practice: results from a systematic review

Aim:Using the methodology of the Joanna Briggs Institute, a systematic review of current research was performed to determine if the addition of management by nurses had been more effective in improving clinical outcomes of patients with type 2 diabetes attending a general practice compared with standard care. Methods:A three-step literature search was conducted for suitable English studies with quantitative clinical outcomes that had been published from January 1990 to May 2014. Randomised controlled trials (RCTs) were particularly sought after; however, other research designs were considered. Articles were assessed by two independent reviewers for methodological validity, prior to inclusion in the review, using standardised critical appraisal instruments from the Joanna Briggs Institute. When possible, quantitative data were pooled in statistical meta-analysis. Results:Seven studies were of suitable quality and relevance for the review: these included three randomised control trials; two cluster- RCTs; a cluster, nonrandomised, controlled before-after study; and a cluster observational cohort study. These studies yield evidence that nurse management in addition to standard general practitioner care leads to modest improvements in blood pressure and total cholesterol levels in adults with type 2 diabetes attending a general practice. Conclusion:Meta-analysis identified modest, significant improvements amongst participants in nurse management interventions (NMIs) in the following clinical outcomes: mean SBP, mean DBP and mean total cholesterol. The majority of outcomes studied did not show any advantage to adding NMIs to general practitioner care. Two studies reported significant improvements of participants with poor control in mean haemoglobin A1c. An RCT that investigates the effect of NMIs on patients, with poor control in regard to clinical outcomes and cost effectiveness, is recommended.

Guest commentary: Residential aged care: The de facto hospice for New Zealand's older people

Providing palliative care for people living in residential aged care facilities (RACFs) has become a key focus for many developing countries including Australia [1]. The paper by Connolly et al. [2] raises the question of whether RACFs are operating as de facto hospices for older people in New Zealand. Their two main messages are that: RACF mortality is high; and training and resources in this sector should reflect this.