Linda Jaffray

Evaluating the effects of mindfulness-based interventions for informal palliative caregivers: A systematic literature review.

Background: There is a need to identify proactive, evidence-based interventions to support informal palliative caregivers. Mindfulness-based interventions, evidenced in the literature as providing physical and mental health benefits for diverse populations, may have application in the setting of palliative caregiving. Aim: To describe, evaluate and synthesise the peer-reviewed literature on the effects of mindfulness-based interventions for informal palliative caregivers. Design: A Systematic Literature Review according to the Preferred Reporting Items for Systematic Review and Meta Analyses guidelines and a Narrative synthesis. Data sources: The Cochrane Library, CINAHL, MEDLINE, PsycINFO and EMBASE databases, searched from inception to February 2014 and references of included studies. Results: A total of 13 articles, reporting 10 studies (n = 432 participants) were included. All studies were conducted in the last 5 years. Dementia caregivers were the most frequently researched population (n = 7). Results suggest that mindfulness-based interventions are feasible and acceptable to offer to informal palliative caregivers and may provide benefit, particularly in terms of reducing depression and caregiver burden and increasing quality of life. However, effects were not as robust as findings in the wider mindfulness intervention literature. Conclusion: This is the first systematic literature review on this topic. Results suggest both feasibility and potential benefit. Further qualitative research is required to explore the outcomes identified by informal caregivers themselves as the reduced magnitude of effect may suggest that we are not measuring the right outcomes in this context. This would inform more sensitive outcome measures for future intervention studies and guide the development and application of mindfulness-based models in this area.

Utilisation of beds on the general medical unit by 'non-acute medical' patients: a retrospective study of incidence and cost in two Tasmanian regional medical hospital units

Demand for healthcare services threatens to overwhelm the Australian healthcare system. Public hospitals have the largest component of expenditure growth and as such represent the largest opportunity for efficiency gains. Utilisation of inpatient hospital beds and in particular those on general medical units has not been studied in Australia.

Realist Review to Inform Development of the Electronic Advance Care Plan for the Personally Controlled Electronic Health Record in Australia

INTRODUCTION Australia has invested heavily to introduce an opt-in personally controlled electronic healthcare record (PCEHR), which incorporates an element of advance care planning (ACP). A further investment of

Nursing competencies needed for electronic advance care planning in community

10 million AUD has been made to increase capability to a fully integrated electronic ACP (eACP). Australia has an aging population, the majority of whom will live, be cared for, and die in the community. ACP in the community setting can support older people to navigate their illness trajectories and health decision-making. Sharing this information with care providers across different healthcare settings is crucial. MATERIALS AND METHODS The eACPs was conceptualized as a complex social intervention. We conducted a realist review of the literature to explore evidenced-based models of eACP for community-dwelling older people, with chronic, life-limiting illness. A scoping search identified gray literature; a systematic search for empirical evidence was conducted of eight databases, including PubMed and Google Scholar. RESULTS Seventeen articles were included, along with 71 other documents. Realist synthesis based on data collected using original abstraction forms was used to develop a model to explain what worked for whom and in what circumstances. Electronic physician reminders and information to patients increased ACP completions. However, there were no precedents for transferring ACPs into a national PCEHR. CONCLUSIONS We developed a model informed by six core themes from the literature: information sharing, process, initiating conversations, dignity of life (individualized approach), education (individual and community), and collaborative practice (engagement). End-of-life care that is consistent with older peoples values and preferences requires robust care processes and efficient information sharing across the healthcare continuum.

Making a case for telehealth: measuring the carbon cost of health-related travel

Advance care planning implementation occurs across the world using different legislative frameworks, different language to describe both the process and the outcome, and different models to develop these plans. Many countries are in the process of developing personally controlled electronic health records. Including advance care plans as part of this record is proposed in Australia. The Electronic Advance Care Plan (eACP) in Community project aimed to develop a model that will engage community dwelling older adults with chronic lifelimiting illnesses in the process of advance care planning that is person-centred, evidence-based and has a focus of dignity of life. A systematic review was conducted to identify models of advance care planning information sharing and to examine the nurses’ role. A realist review comprising a metasynthesis of 8 qualitative studies and 9 quantitative studies was conducted. Nursing competencies need to be developed to include the medico-legal framework around advance care plan development, as well as information technology competencies and communication competencies so that nurses around the world are better informed for end-of-life care planning and practice in a digital world. - See more at: http://dl4.globalstf.org/?wpsc-product=nursing-competencies-needed-for-electronic-advance-care-planning-in-community#sthash.S3cVvh6u.dpuf