Lorraine Venturato

Solution Focused Teaching: A Transformative Approach to Teaching Nursing

Nurses work in complex health care systems, which today are based not only on medical treatment and cure, but also on enabling individuals and strengthening communities. This paper describes a curriculum approach to teaching nursing in an Australian university which seeks to prepare students for this environment. Underpinned by transformative education principles, and termed Solution Focused Nursing, specific teaching and learning strategies are discussed. A goal is to cultivate critical thinkers and knowledge workers, that is, nurses who are not only able to work skillfully, strategically, and respectfully with clients, but who also demonstrate discernment, optimism, and vision about nursing and health care.

Assessing quality of life of older people with dementia: a comparison of quantitative self-report and proxy accounts

AIMS This article reports on a study of quality of life of older people with dementia, as assessed by the person with dementia, family carer and care staff. BACKGROUND People with dementia can give meaningful assessments of their quality of life, but these often differ from proxy ratings. In understanding this discrepancy, the influence of age, extent of cognitive impairment and activity limitation has been investigated. A lack of conclusive associations between quality of life ratings and these variables indicates a need for further research. METHODS Fifty-eight triads comprising the person with dementia, family carer and member of care staff from four long-term care facilities were surveyed on the quality of life-Alzheimers Disease questionnaire between August and December 2007. RESULTS There was an important difference in the quality of life-Alzheimers disease questionnaire total mean scores between groups, with the person with dementia providing the highest ratings. Level of impairment in activities of daily living had an important effect on quality of life ratings, with proxies, particularly care staff, providing lower ratings when there was greater activity limitation. This was not replicated for assessments made by the person with dementia. Age or level of cognitive impairment did not influence any ratings. CONCLUSION People with dementia can give assessments of their quality of life. However, discrepancy in ratings, with greater activity limitation affecting proxy ratings but not those made by the person with dementia, indicates the importance of including both self-report and proxy measures in research and care planning.

Quality of life and dementia: The voice of the person with dementia

Although we know that quality of life (QOL) can greatly influence a persons well-being, the measurement of QOL in individuals with dementia has, unfortunately, been largely ignored as a result of conceptual, logistical and measurement difficulties inherent in this population. To enable the voice of the person with dementia to be heard, a triangulated approach was adopted using survey data that aimed to assess the quality of life-Alzheimers disease (QOL-AD) in Australian residential aged care and unstructured interviews with a small sample of participants (n = 33). This article presents the survey results and demonstrates there were significant differences in QOL-AD scores between length of stay in the care setting groups, interpersonal relationship quality and self-esteem. Groups with greater physical impairment had lower QOL scores. It is concluded that the participants in this study were able to provide meaningful commentary on their QOL and that the findings may be useful when planning education of care staff and may contribute to theoretical models of dementia care.

Care staff attitudes and experiences of working with older people with dementia.

Aim:  To determine care staff attitudes to dementia, assess levels of job satisfaction and explore how these attitudes and experience may relate to each other.

Beyond ‘doing’: Supporting clinical leadership and nursing practice in aged care through innovative models of care

Abstract Contemporary health care environments are increasingly challenged by issues associated with the recruitment and retention of qualified nursing staff. This challenge is particularly felt by residential aged care providers, with registered nurse (RN) numbers already limited and resident acuity rapidly rising. As a result, aged care service providers are increasingly exploring creative and alternative models of care. This article details exploratory research into a pre-existing, alternative model of care in a medium sized, regional residential aged care facility. Research findings suggest that the model of care is complex and multi-faceted and is an example of an integrated model of care. As a result of the implementation of this model of care a number of shifts have occurred in the practice experiences and clinical culture within this facility. Results suggest that the main benefits of this model are: (1) increased opportunities for RNs to engage in clinical leadership and proactive care management; (2) improved management and communication in relation to work processes and practices; and (3) enhanced recruitment and retention of both RNs and care workers.

Use of Complementary and Alternative Medicine among adult patients for depression in Taiwan

BACKGROUND This descriptive exploratory study investigated the prevalence and type of Complementary and Alternative Medicine (CAM) use among older Taiwanese patients with a diagnosis of depression. METHOD Self-report questionnaire. RESULTS A convenience sample of 206 in-patients (98% response rate) completed the survey. Nearly 70% (69.9%) reported using at least one form of CAM in the past 12 months. Twenty-one kinds of CAM were identified in the treatment of depression, the most common being herbal medicines, spiritual healing, and folk remedies. Only one-third (35.4%, n=73) had discussed CAM use with their psychiatrists. Participants with mild to moderate depression tended to use more CAM than participants with severe depression (GDS-SF: Cramers V=-.233; HDRS: Cramers V=.201). CONCLUSIONS This study confirms the high prevalence of CAM use among older adults with a diagnosis of depression in Taiwan. The popularity of CAM appears to be a consequence of peoples preference for a more holistic approach to health care. CAM use needs to be explicitly discussed between patients and health professionals as part of ongoing assessment, patient education and management.

Dignity, dining and dialogue: reviewing the literature on quality of life for people with dementia

AIM To review contemporary literature on quality of life for people with dementia. BACKGROUND One of the consequences of population ageing is the predicted increase in the incidence of dementia. While we can as yet do little to affect the course of the disease, health care professionals are well-placed to intervene to affect quality of life and quality of care for people with dementia. RESULTS Research into quality of life for people with dementia has grown markedly over the last decade, in line with evolving conceptual and theoretical understandings of this complex concept. While much of the literature continues to focus on assessment and measurement of quality of life, emerging areas of interest are noted, including dialogue associated with personhood; dignity; and dining and mealtime experiences. CONCLUSION Literature on quality of life for people with dementia is as diverse as the concept itself. Established and emerging areas of research suggest that this diversity will continue into the future as we strive to better understand quality of life for people with dementia in all its complexity.

Promoting value in dementia care: Staff, resident and family experience of the capabilities model of dementia care

Objectives: This Australian study examined individual experiences of the implementation of the Capabilities Model of Dementia Care (CMDC) and subsequent outcomes for the care of residents with dementia living in long-term care. Furthermore, this study aimed to explore those factors that facilitated and inhibited the implementation of the new model of care. Methods: The CMDC was developed and then tested in a non-randomised clinical trial. Staff, residents and family experiences of their involvement and perceptions of the model were captured at the end of 12 months. Semi-structured interviews and focus groups were conducted with the 25 participants (12 nursing staff, 6 residents with dementia, 7 family members). Questions varied depending on the participant group but were designed to assess experiences of and changes to care during the intervention. Inductive thematic analysis was used to identify the experiences of the implementation of the CMDC. Results: Five themes included: general reflections on nursing care, implementation of the CMDC intervention, positive outcomes of the CMDC intervention, challenges in the implementation of the CMDC, difficulty sustaining care and tensions between participants’ perspectives of care. Conclusion: Positive change resulted from implementation of the CMDC, however, staff mentorship was identified as a key to sustaining changes in practice.

Identifying outcomes associated with co-managed care models for patients who have sustained a hip fracture: an integrative literature review.

AIMS AND OBJECTIVES The aim of this integrative literature review is to identify themes associated with improved patient outcomes related to orthogeriatric co-managed inpatient unit models of care for patients who had sustained a hip fracture. APPROACH An integrative literature review was undertaken from 2002-July 2013 using electronic databases with specific search terms. METHODS The theoretical framework of Whittemore and Knafl was used to guide the review. This framework was chosen as it allows for the inclusion of varied methodologies and has the capability to increase informed evidence-based nursing practice. RESULTS Five distinct themes relating to outcomes emerged from the analysis, which were: time from admission to surgery; complications; length of stay; mortality and initiation of osteoporosis treatment. CONCLUSION The analysis of this integrative literature review clearly indicates the need for national and international sets of agreed outcome measures to be adopted to facilitate the comparison of models of care. This would significantly improve the way in which outcomes and costs are reported, further enhancing international partnerships as the health care team strive to achieve overall improvements in the management of older people presenting to hospital with hip fracture.

Assessing quality of life of older people with dementia in long-term care: a comparison of two self-report measures.

AIMS AND OBJECTIVES This study sought to compare two well-known and well-used self-report quality of life questionnaires in terms of completion rates, reliability and assessment of quality of life. BACKGROUND People with dementia have a meaningful experience of quality of life and several disease-specific instruments have been designed to capture self-report assessments. DESIGN A quantitative survey design, with a convenience sample of older people with dementia from four long-term care facilities. METHOD Sixty-one participants were recruited for survey on the Dementia Quality of Life questionnaire and the Quality of Life in Alzheimers Disease questionnaire. RESULTS The Quality of Life in Alzheimers Disease questionnaire had a higher rate of completion (98·4%) than the Dementia Quality of Life questionnaire (68·9%). Those unable to complete the latter measure had significantly greater cognitive impairment (F(1,59) = 30·35, p < 0·001) than those completing the measure. Internal reliability was good for the Quality of Life in Alzheimers Disease questionnaire (0·86), but there were varying levels found for the five Dementia Quality of Life questionnaire subscales (0·79-0·48). The Quality of Life in Alzheimers Disease questionnaire was significantly correlated with all the Dementia Quality of Life questionnaire subscales and overall item. CONCLUSIONS Although it is recognised that there is no superior instrument in assessing quality of life, this study found both the Quality of Life in Alzheimers Disease questionnaire and Dementia Quality of Life questionnaire to be useful self-report instruments. RELEVANCE TO CLINICAL PRACTICE Assessment of quality of life should include the perspective of the person with dementia. The Quality of Life in Alzheimers Disease questionnaire and Dementia Quality of Life questionnaire appear to measure similar aspects of quality of life. Where assessments are sought from participants with more advanced cognitive and functional impairment, it may be favourable to employ the Quality of Life in Alzheimers Disease questionnaire.