Maggie Jamieson

New Ways for Occupational Scientists to Tackle “Wicked Problems” Impacting Population Health

It is time for more occupational scientists to begin addressing complex socio-environmental problems, such as climate change and obesity. Such daunting problems are considered wicked as they have been defying the traditional research methods used to solve them. Therefore, occupational scientists who choose to focus on population health problems need to adopt new ways of doing research. Effective contributions to and imaginative solutions for population health require occupational scientists to develop transdisciplinary partnerships, align themselves with public healths fifth wave and new integrative model of health, and think more creatively about the future.

School canteens: A systematic review of the policy, perceptions and use from an Australian perspective

Aim This review aimed to identify current research related to the use of school canteens in Australia, with a focus on their food and drink policy. In Australia, approximately 25% of 5–17-year olds are considered overweight and obese. Up to 41% of energy intake for children aged between 4 and 18 years is found to come from discretionary foods. The structured nature of the school environment provides an ideal environment to address childhood obesity and encourage a culture of healthy eating. Methods A systematic review of three key nutrition databases: ‘CINAHL’, ‘Academic search complete’ and ‘Medline’ (inception to 2015) was conducted. Inclusion criteria were: Australian, peer-reviewed studies; studies regarding the purchase of food from school canteens; canteen studies involving students aged 5–18 years, school principals, parents, canteen managers, Parent and Citizen Association members and teachers. Results The search identified 2741 studies with 12 meeting the inclusion criteria. In the main, studies were descriptive in nature with data summarised into four categories: (i) characteristics of canteens; (ii) canteen use and food availability; (iii) stakeholder perceptions and the role of school canteens; and (iv) compliance with policies and the barriers to healthy food implementation. Overall, compliance with healthy canteen policies was low, guidelines were rarely adhered to in terms of product provision and children had preferences for non-healthy foods. Conclusions Strategies to improve compliance, overcome the challenges and encourage stakeholder buy-in are necessary if food habits are to be changed and healthy cultures developed within the school environment.

Factors determining eligibility and access to subacute rehabilitation for elderly people with dementia and hip fracture

With hip fracture and dementia increasing in incidence in the global ageing population, there is a need for the development of specific procedures targeting optimal treatment outcomes for these patients. This paper looks primarily at the factors that limit access to subacute rehabilitation services as a growing body of evidence suggests that access to timely inpatient rehabilitation increases functional outcomes for patients both with dementia and without. Information was gathered by searching electronic data bases (SCOPUS, Medline, CINAHL, Health Source Nursing/Academic Addition, Psychinfo and the Cochrane Library) for relevant articles using the search terms dementia OR Alzheimer* AND hip fracture AND subacute rehabilitation OR convalescence for the period 2005–2015. Abstracts were scanned to identify articles discussing eligibility and access. A total of nine papers were identified that directly addressed this topic. Other papers discussing success or failure of rehabilitation and improved models of care were also reviewed. Barriers to access discussed in the literature include information management, management of comorbidities, attitudes, resource availability, and the quality of evidence and education. By identifying these factors we can identify strategic points of intervention across the trajectory of prevention, treatment and rehabilitation that may improve outcomes for this growing group of vulnerable patients. Emerging best practice for these patients is also discussed.

Views from health professionals on accessing rehabilitation for people with dementia following a hip fracture

The literature reports that rehabilitation for elderly patients with mild-to-moderate dementia who have a hip fracture improves functional outcomes. However, access to rehabilitation may be difficult due to misconceptions about the ability of these patients to engage in and benefit from rehabilitation. Additionally, people who are admitted from residential care may not have the same options for rehabilitation as those admitted from home. This study sought to understand from expert clinicians how and why decisions are made to accept a person with dementia post-fracture for rehabilitation. In this Australian-based qualitative study, 12 health professionals across a state and territory were interviewed. These clinicians were the primary decision makers in accepting or rejecting elderly patients with dementia post-fracture into rehabilitation. Three key themes emerged from the data: criteria for accessing rehabilitation, what works well and challenges to rehabilitation. The participants were unanimous in the view that access to rehabilitation should be based on the ability of the patient to engage in a rehabilitation programme and not assessed solely on cognition. In terms of clinical care, a coherent rehabilitation pathway with integration of geriatric and ortho-geriatric services was reported as ideal. Challenges remain, importantly, the perception of some health care staff that people with dementia have limited capability to benefit from rehabilitation. Rehabilitation for this growing group of patients requires multiple resources, including skilled practitioners, integrated clinical systems and staff education regarding the capabilities of people with dementia. Future research in this area with patients with moderate-to-severe dementia in residential care is warranted.

Interprofessional education in practice: Evaluation of a work integrated aged care program

Health professional clinical education is commonly conducted in single discipline modes, thus limiting student collaboration skills. Aged care residential facilities, due to the chronic and complex health care needs of residents, provide an ideal placement to provide a collaborative experience. Interprofessional education is widely acknowledged as the pedagogical framework through which to facilitate collaboration. The aim of the evaluation was to assess student attitudes towards collaboration after active involvement in an interprofessional education program. Students studying nursing, occupational therapy, and aged care were invited to complete a version of the Readiness for Interprofessional Learning Scale before and after participating in a three-week pilot interprofessional program. A positive change in student attitudes towards other health professionals and the importance of working in interprofessional teams was reported with significant differences between two statements indicated: Learning with health-care students before qualifications would improve relationships after qualifications; and I learned a lot from the students from the other disciplines. The innovative pilot project was found to enhance student learning in interprofessional teams and the aged care environment. Further development of this and similar interprofessional programs is required to develop sustainable student projects that have health benefits for residents in aged care residential facilities.

Carers: The navigators of the maze of care for people with dementia—A qualitative study

Background Dementia is a challenge in our society, with individuals accessing services across multiple settings. Carers are navigating and delivering care services in the home. This research sought to investigate the experiences of people with dementia and their carers when transitioning home from hospital. Methods This study used a qualitative descriptive design, employing in-depth interviews with 30 carers recruited through networks known to one state branch of Alzheimer’s Australia. Emerging themes were validated in one focus group. Results During the hospital stay carers experienced a paradox: being required to deliver care yet perceiving that they were being ignored in regard to decisions about care. The time in hospital was considered by some carers to be stressful, as they were concerned about the safety of the person with dementia. Many reported that discharge home was rarely planned and coordinated. Returning home carers found re-establishing and/or accessing new services challenging, with available services often inappropriate to need. Conclusion The paradox of the care experience in the acute setting, whereby the carer was either invited, or sought, to deliver care, yet was excluded in staff decisions about that care, challenges the current communication and coordination of care. For people with dementia and their carers, there is a need for a coordinated seamless service that enables continued unbroken care and support from acute care to home. Carers also need support navigating the wide range of services available and importantly both carers and care providers may need to understand service boundaries. Recommendations This study highlights the need to acknowledge the expertise of the carer, and their need for support. Enabling a smooth discharge from hospital and support to navigate care access in the community is paramount. These experiences provide insight into gaps in service provision and modifying existing services may lead to improved experiences.

Transformational change in healthcare: an examination of four case studies

Objectives Healthcare leaders around the world are calling for radical, transformational change of our health and care systems. This will be a difficult and complex task. In this article, we examine case studies in which transformational change has been achieved, and seek to learn from these experiences. Methods We used the case study method to investigate examples of transformational change in healthcare. The case studies were identified from preliminary doctoral research into the transition towards future sustainable health and social care systems. Evidence was collected from multiple sources, key features of each case study were displayed in a matrix and thematic analysis was conducted. The results are presented in narrative form. Results Four case studies were selected: two from the US, one from Australia and one from the UK. The notable features are discussed for each case study. There were many common factors: a well communicated vision, innovative redesign, extensive consultation and engagement with staff and patients, performance management, automated information management and high-quality leadership. Conclusions Although there were some notable differences between the case studies, overall the characteristics of success were similar and collectively provide a blueprint for transformational change in healthcare. What is known about the topic? Healthcare leaders around the world are calling for radical redesign of our systems in order to meet the challenges of modern society. What does this paper add? There are some remarkable examples of transformational change in healthcare. The key factors in success are similar across the case studies. What are the implications for practitioners? Collectively, these key factors can guide future attempts at transformational change in healthcare.

New sources of value for health and care in a carbon-constrained world

Background Due to the climate crisis, it is increasingly evident that countries will have to decarbonize. Healthcare, which has a large carbon footprint and uses vast quantities of resources, will have to undergo significant transformation. In this research, we sought the ideas of leading thinkers in the field, to address the question of how health systems can provide high‐quality care in a carbon‐constrained world. Methods Semi‐structured, qualitative in‐depth interviews with 15 healthcare thought leaders from Australia, the UK, the USA and New Zealand. The interviews were transcribed and analysed by matrix display and thematic analysis. Results ‘Green’ initiatives such as improving energy efficiency and implementing travel plans will be insufficient to achieve the scale of decarbonization required. According to the thought leaders in our study, it is likely that greater carbon and resource savings will come from thinking much more broadly about innovative models of care and using ‘new’ sources of ‘value’ such as ‘people’ and ‘relationships’. Conclusions Using human resources and human interactions as low‐carbon sources of value in healthcare are promising models.

Women's Risk of Food Insecurity

Women are at high risk of becoming food insecure. While emergency food relief assistance is available, an underlying clientele culture and stigma combined with entrenched societal power inequality and gender role identification create barriers for women to access safe and nutritious food. This commentary aims to discuss this issue and provide suggestions on what needs to be done to ensure that those at highest vulnerability are food secure. within the household or those they are caring for, placing themselves as risk of poor physical and mental health [3,5,7]. Food security is defined as ‘when all people at all times have physical and economic access to sufficient safe and nutritious food that meets individual dietary needs and food preferences for an active and healthy life’ [1]. Underpinned by four dimensions: food availability; food access; food utilization; and, the stability or vulnerability of the previous 3 pillars, food insecurity is a global problem and impacts vulnerable people, in particular women [1]. Power inequalities, such male control [5] and domestic or intimate partner violence [3] further exacerbate the risk of women becoming food insecure. These situations create an environment of economic and/or physical abuse, and instill gender role identification. For those that leave, homelessness, poverty and a reliance on relief assistance ensues [3,5]. Being food insecure not only means experiencing hunger or undernourishment, but exists on many levels from being mildly food insecure whereby there are difficulties in obtaining adequate nutrition food for oneself or family members to experiencing severe food insecurity [10]. Where Do Vulnerable Women Access Food? Initially women sacrifice their needs for others [3,5,7]; any food that is purchased has to be cheap and last until the next pay or income support is received. In many cases healthy food, although preferred, is not a feasible choice due to cost and product life [5]. When there are few choices for food access, emergency relief may seem the only solution. Emergency relief assistance is defined as “the provision of financial and material aid to people in immediate need, or a referral to link people with specialist community services” [11]. Food is a major component of emergency relief assistance and in this context is recognized as a mechanism to foster engagement and communication and is seen by some as a symbol of security and safety [12]. The emergency relief sector comprises a variety of levels. At the coalface there are numerous religious, community, government and welfare organizations that provide clients with a safe refuge, food and individualized services such as health appointments, job interviews, budgeting and cooking skills [12]. In Australia, many of these organizations receive donated food from local food businesses and food rescue organizations such as Food bank. Collectively, it is these organizations that are increasingly Context Women due to a range of socio-economic conditions, such as domestic violence, poor employment and education may be more vulnerable to insecurity in their daily lives [1-4]. In the United States (US), it has been noted that female-led households have a high prevalence of household insecurity, 30.2% compared to 11% in the general population [4], with often poor economic and social implications, for example, women are more likely to live in a food insecure household than men, with women who are alone or are single parents at a higher risk of food insecurity than married women [2,5]. Such women may be vulnerable to food insecurity, due to low income, lack of support and the drive to put their children and others before themselves [5-8]. Due to the fluidity of individual food security and the lack of academic reporting regarding women and food insecurity in Australia, it is difficult to ascertain the exact numbers of women experiencing food insecurity in Australia. However, other measures such as poverty, a strong predictor for food insecurity, can be used to indicate the extent of the problem. In 201112, approximately 14.7% of Australian women experienced poverty [9] and thus were at risk of or experienced food insecurity. In Australia 46% of the workforce is female, however their average weekly full-time wage is18.2% lower than for men and they are more likely to be employed in part-time positions [8], thus reducing their earning capacity and placing them at risk of poverty, a primary determinant of food insecurity [6]. Lower income means a reprioritization of funds, food is replaced by accommodation costs, utility bills and other urgent costs, such as medical expenses [5]. As primary caregivers and mothers, women reallocate what food and resources they have to ensure household members remain healthy and free of illness. By internalizing the care giving role, women sacrifice their own hunger and prioritize other members either

Co-operative working in aged care: The Cooperative for Healthy Ageing Research and Teaching Project.

The objective of this study was to describe the partnership mechanisms that supported teaching and research in aged care, in one of the 16 funded projects under the auspices of the Teaching and Research in Aged Care Service project. Located in ACT and southern NSW, the Co‐operative for Healthy Ageing Research and Teaching (CHART) was comprised of eleven partners from the residential care sector, higher education, and hospital and non‐government sectors.