Sophie Dilworth

Patient and health professional's perceived barriers to the delivery of psychosocial care to adults with cancer: a systematic review

To explore the barriers experienced and perceived by health professionals and patients in the delivery of psychosocial care to adults with cancer.

Finding a Way Forward: A Literature Review on the Current Debates around Clinical Supervision

Abstract Nursing research increasingly calls for clinical supervision to support nurses and improve nursing practice. Despite this, clinical supervision is not well established in healthcare organisations. This paper employs a critical interpretive approach to review the clinical supervision literature. The review discusses the current debates and challenges exploring possible ways of moving beyond the current criticisms and limitations in the literature. The review concludes that despite some confusion about the quantifiable outcomes, clinical supervision presents a professionally enriching activity that provides a forum for sharing of knowledge and generation of shared understandings of health care. Through this shared experience it is possible that innovative and creative approaches to health care will be born.

Feeling let down: an exploratory study of the experiences of older people who were readmitted to hospital following a recent discharge

Abstract Background: Readmission of older people to hospital following a recent discharge may be an indicator of gaps in services either prior to or after discharge. Aims and objectives: To explore the experiences of older people who have been readmitted to hospital following recent discharge to their homes. Design: A qualitative descriptive study. Method: In-depth interviews were conducted with three older people who were discharged from a large tertiary referral hospital in NSW Australia and readmitted. Interviews were conducted within the hospital setting in a private room. An interview guide was used to explore the reasons for admission and readmission to hospital and experiences upon discharge to home. In particular the researchers were interested in the events that led to readmission. Data were analysed thematically. Results: Three main themes emerged including: being left out, being cared for and feeling let down. Conclusion: While this study was undertaken in only one hospital with only three older people the findings provide valuable insight into their experiences. Nurses need to be proactive in ensuring and promoting a person-centred approach to the care and treatment of older people.

Clinical pharmacist review: A randomised controlled trial

To determine if medication review by a clinical pharmacist of older patients in the ED impacted on admission to hospital and other outcomes.

A multi-organisation aged care emergency service for acute care management of older residents in aged care facilities

This case study describes a multi-organisation aged care emergency (ACE) service. The service was designed to enable point-of-care assessment and management for older people in residential aged care facilities (RACFs). Design of the ACE service involved consultation and engagement of multiple key stakeholders. The ACE service was implemented in a large geographical region of a single Medicare Local (ML) in New South Wales, Australia. The service was developed over several phases. A case control pilot evaluation of one emergency department (ED) and four RACFs revealed a 16% reduction in presentations to the ED as well as reductions in admission to the hospital following ED presentation. Following initial pilot work, the ACE service transitioned across another five EDs and 85 RACFs in the local health district. The service has now been implemented in a further 10 sites (six metropolitan and four rural EDs) across New South Wales. Ongoing evaluation of the implementation continues to show positive outcomes. The ACE service offers a model shown to reduce ED presentations and admissions from RACFs, and provide quality care with a focus on the needs of the older person.

Nurse-led ED support for Residential Aged Care Facility staff: An evaluation study

OBJECTIVES To evaluate the impact of a nurse-led telephone support service to Residential Aged Care Facilities (RACFs) on a range of measures relating to the transfer of acutely unwell residents to the Emergency Department (ED) of a large tertiary referral hospital in New South Wales, Australia over a 9 month period. METHODS A pre- and post-intervention design determined the impact of the telephone service, associated clinical guidelines and education. Data from 4 intervention RACFs using the nurse-led telephone service were compared with 8 control RACFs. Data included the older patients triage category, presenting problem(s), transfer rates from RACFs, ED admissions, and overall hospital length of stay. Interviews and focus groups with staff from RACFs and EDs were conducted to ascertain their experiences. RESULTS Reduced presentations of older people to the ED from the 4 pilot RACFs occurred. High levels of satisfaction among staff in RACFs were reported.

Examining clinical supervision as a mechanism for changes in practice: a research protocol

AIM This paper describes the research protocol for a study exploring if and how clinical supervision facilitates change in practice relating to psychosocial aspects of care for Health Professionals, who have been trained to deliver a psychosocial intervention to adults with cancer. BACKGROUND There is a recognized need to implement care that is in line with clinical practice guidelines for the psychosocial care of adults with cancer. Clinical supervision is recommended as a means to support Health Professionals in providing the recommended psychosocial care. DESIGN A qualitative design embedded within an experimental, stepped wedge randomized control trial. METHODS The study will use discourse analysis to analyse audio-recorded data collected in clinical supervision sessions that are being delivered as one element of a large randomized control trial. The sessions will be attended primarily by nurses, but including physiotherapists, radiation therapists, occupational therapists. The Health Professionals are participants in a randomized control trial designed to reduce anxiety and depression of distressed adults with cancer. The sessions will be facilitated by psychiatrists experienced in psycho-oncology and the provision of clinical supervision. DISCUSSION The proposed research is designed specifically to facilitate exploration of the mechanisms by which clinical supervision enables Health Professionals to deliver a brief, tailored psychosocial intervention in the context of their everyday practice. This is the first study to use discourse analysis embedded within an experimental randomized control trial to explore the mechanisms of change generated within clinical supervision by analysing the discourse within the clinical supervision sessions.

Experiences of older people following the introduction of consumer-directed care to home care packages: A qualitative descriptive study

To explore the experiences of older people receiving home care package (HCP) support following the introduction of consumer‐directed care (CDC) by the Australian government on 1 July 2015.

Implementing a psychosocial intervention in cancer care: an examination of the change process through a discourse analysis of clinical supervision

How patients make use of a specialist nurse function in head and neck cancer: an empirical study

Exploring the Situational Complexities associated with Practice Change in the Delivery of a Psychosocial Intervention

How patients make use of a specialist nurse function in head and neck cancer: an empirical study