Melissa Lindeman

Changing Practice in Residential Aged Care Using Participatory Methods

BACKGROUND Residential aged care staff play a significant role in the day-to-day lives of residents yet are faced with many barriers to providing care that promotes resident wellbeing. APPROACH Action research is a useful approach for clarifying issues, identifying education and training needs, and identifying, and in some cases overcoming, organizational barriers to change. The Well for Life project aimed to enhance the social and physical health and well being of residents of aged care settings by empowering the staff of facilities to make change. The project had a particular focus on nutrition and physical activity. This paper reports on the action research group process undertaken during Phase I of the Well for Life project. Five residential aged care settings participated in the action research process facilitated by project staff independent of the facilities. The action plan and outcomes from one of these settings is used to illustrate the process and outcomes. FINDINGS The main findings of the project indicate that using a process that encourages staff involvement in identification of issues and actions can facilitate change in the practice of resident care. The action research groups identified specific gaps in knowledge and skill leading to targeted education that addressed areas of need. The importance of presenting information and learning opportunities for staff in a variety of formats was also recognized, as was the importance of organizational context, management support and empowerment of staff to make change.

“People like numbers”: a descriptive study of cognitive assessment methods in clinical practice for Aboriginal Australians in the Northern Territory

BackgroundAchieving culturally fair assessments of cognitive functioning for Aboriginal people is difficult due to a scarcity of appropriately validated tools for use with this group. As a result, some Aboriginal people with cognitive impairments may lack fair and equitable access to services. The objective of this study was to examine current clinical practice in the Northern Territory regarding cognitive assessment for Aboriginal people thereby providing some guidance for clinicians new to this practice setting.MethodQualitative enquiry was used to describe practice context, reasons for assessment, and current practices in assessing cognition for Aboriginal Australians. Semi-structured interviews were conducted with 22 clinicians working with Aboriginal clients in central and northern Australia. Results pertaining to assessment methods are reported.ResultsA range of standardised tests were utilised with little consistency across clinical practice. Nevertheless, it was recognised that such tests bear severe limitations, requiring some modification and significant caution in their interpretation. Clinicians relied heavily on informal assessment or observations, contextual information and clinical judgement.ConclusionsCognitive tests developed specifically for Aboriginal people are urgently needed. In the absence of appropriate, validated tests, clinicians have relied on and modified a range of standardised and informal assessments, whilst recognising the severe limitations of these. Past clinical training has not prepared clinicians adequately for assessing Aboriginal clients, and experience and clinical judgment were considered crucial for fair interpretation of test scores. Interpretation guidelines may assist inexperienced clinicians to consider whether they are achieving fair assessments of cognition for Aboriginal clients.

Assessment of Indigenous Older Peoples’ Needs for Home and Community Care in Remote Central Australia

The Home and Community Care (HACC) program in Australia provides services which supports older people to live at home. Individual HACC organisations are generally responsible for initial assessment of eligibility and need of clients presenting for services. This paper reports on a project which aimed to develop an understanding of the various approaches to assessment of client needs in Central Australia. The majority of clients in this geographical area are indigenous. The project was initiated in recognition of the primary importance of assessment in determining service access and service delivery and of the particular challenges faced by service providers in remote areas. This paper discusses key project findings including the client group and services provided, initial needs assessment and care planning processes. Evident inconsistencies in practice reflect a variety of complex contextual factors. Staff in remote areas have an inadequate knowledge base to draw upon to assist them with assessment and care planning decisions, and further research and professional development is required.

What primary health care services should residents of rural and remote Australia be able to access? A systematic review of “core” primary health care services

BackgroundThere are significant health status inequalities in Australia between those people living in rural and remote locations and people living in metropolitan centres. Since almost ninety percent of the population use some form of primary health care service annually, a logical initial step in reducing the disparity in health status is to improve access to health care by specifying those primary health care services that should be considered as “core” and therefore readily available to all Australians regardless of where they live. A systematic review was undertaken to define these “core” services.Using the question “What primary health care services should residents of rural and remote Australia be able to access?”, the objective of this paper is to delineate those primary health care core services that should be readily available to all regardless of geography.MethodA systematic review of peer-reviewed literature from established databases was undertaken. Relevant websites were also searched for grey literature. Key informants were accessed to identify other relevant reference material. All papers were assessed by at least two assessors according to agreed inclusion criteria.ResultsData were extracted from 19 papers (7 papers from the peer-reviewed database search and 12 from other grey sources) which met the inclusion criteria. The 19 papers demonstrated substantial variability in both the number and nature of core services. Given this variation, the specification or synthesis of a universal set of core services proved to be a complex and arguably contentious task. Nonetheless, the different primary health care dimensions that should be met through the provision of core services were developed. In addition, the process of identifying core services provided important insights about the need to deliver these services in ways that are “fit-for–purpose” in widely differing geographic contexts.ConclusionsDefining a suite of core primary health care services is a difficult process. Such a suite should be fit-for-purpose, relevant to the context, and its development should be methodologically clear, appropriate, and evidence-based. The value of identifying core PHC services to both consumers and providers for service planning and monitoring and consequent health outcomes is paramount.

Intercultural communications in remote Aboriginal Australian communities: What works in dementia education and management?

Abstract Dementia education and management is a major challenge nationally. However in the remote Aboriginal context, where the prevalence of dementia is five times greater than the national rate, the challenge is made more complex by cultural and linguistic differences between providers and consumers. This paper presents findings from the evaluation of a targeted dementia awareness resource piloted in three Aboriginal languages as well as English. It focuses on the intercultural communication aspects of the evaluation adding to the limited body of knowledge about communications with speakers of Australian Aboriginal languages. It identifies elements of effective intercultural communication in dementia education, implications for health literacy and considers the difference that culturally safe intercultural communication can make to a single issue such as dementia awareness.

Assessment staff in home and community care services: issues of learning and professional identity in Australia

Home and Community Care (HACC) is a funding programme of the Commonwealth and State governments of Australia which supports the vast majority of community care services. Gaining access to basic community care services is via an assessment process undertaken by workers in roles that may be comprised partially or solely of assessment and care planning tasks. Arguably, the role of assessor in the HACC programme has become increasingly professionalised in recent years, and the complexity and demands of the role have increased. However, to date, little information has been available about the composition of this workforce, making initiatives to improve practice difficult to plan and implement. This paper reports findings of research from Victoria in which interviews were conducted with a range of key informants, and staff employed in client assessment roles. Results indicate considerable diversity on issues such as: the professional backgrounds of HACC assessment staff; the education, training and support they receive; how they learn their role; and what they draw upon to assist decision-making. A significant theme to emerge is that the nature of their practice derives substantially from the local contexts in which they work. In the absence of a single profession or narrative that guides their practice, they draw from a diverse range of knowledge sources. The significance of the workplace as a site of professional learning, which may provide the basis for the development of a new qualification for this workforce, is highlighted, as is the need for a professional body for this group of workers.

The (mis)matching of resources and assessed need in remote Aboriginal community aged care

To examine processes of aged‐care needs assessment for Aboriginal people in remote central Australia to assist development of appropriate models of aged care.

Cross cultural education in suicide prevention: Development of a training resource for use in Central Australian Indigenous communities

Abstract The DVD ‘Suicide Story’ was developed by the Life Promotion Program of the Mental Health Association of Central Australia as a training resource for use in suicide prevention workshops targeting Central Australian Indigenous communities. The literature suggests there are currently limited suicide prevention training programs that include meaningful and effective education resources for Indigenous Australians, particularly those that have been evaluated. An evaluation was conducted by the Centre for Remote Health to assess participants’ perceptions about the ‘Suicide Story’ training resource in order to provide feedback for further improvements, assist with future distribution, and inform the development of the Train the Trainer workshops and a training manual. Evaluation results indicated that the DVD increased trainees’ knowledge and confidence to respond to someone at risk of suicide. It was also recognised that applying the principles of cultural safety within the area of suicide prevention will lead to initiatives that are more informed, more applicable, and ultimately more effective. The overall recommendation was that the training resource is delivered within the context of a well facilitated suicide prevention workshop, including support and involvement of local cultural consultants and Indigenous implementers.

You've got to make it relevant: barriers and ways forward for assessing cognition in Aboriginal clients

BackgroundReliable cognitive assessment for non-western cultures is difficult given that mainstream tests typically rely on western concepts, content and values. Despite recognition of the scarcity of appropriate tests for Aboriginal people over many years, limited practical development has occurred. This study aimed to identify barriers to assessment for clinicians working with Aboriginal people in a remote context, and evaluate characteristics of assessments that clinicians considered to be more or less appropriate and thereby identify potential ways forward.MethodsSemi-structured interviews with 22 health professionals working with Aboriginal clients in central and northern Australia enquired about cognitive assessment practices for Aboriginal people. Themes related to common barriers, useful approaches and areas of need are reported.ResultsResults demonstrated that engagement, diversity and the lack of appropriate resources were seen as the most significant barriers to effective assessment. Appropriate tools should be visually engaging, brief, portable, relevant, focus on identifying strengths and cater to diversity whilst also being standardised and scientifically valid.ConclusionsDespite the obvious challenges, further development is required to increase available resources and evidence base. Specifically, assessments suitable for younger populations and measuring substance misuse related impairments and change over time in a clinical setting were highlighted as important areas of need. A comprehensive assessment should include collection of data from multiple sources with clear interpretation guidelines.

Nutrition and older indigenous australians: service delivery implications in remote communities. A narrative review.

To describe the nutritional status of older Indigenous people, barriers to achieving optimal nutrition, and the effectiveness of programs aimed at improving nutrition in older Indigenous people in remote communities.