Wendy Moyle

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.

Views of job satisfaction and dissatisfaction in Australian long-term care

Summary • The existing job satisfaction literature has tended towards an overemphasis on job satisfaction instruments. • In the study reported here the views of 27 nurses and assistants-in-nursing, collected through focus group interviews, were examined to determine the factors that contribute to workplace satisfaction and dissatisfaction in long-term care of older people. • Content analysis of focus group interview data revealed that job satisfaction was related to workplace flexibility, residents, working within a team environment and dedication to the service of optimal resident care. Dissatisfaction was linked to working with unskilled or inappropriately trained staff, laborious tasks such as documentation, staffing levels, tensions within role expectations and the increasing need to be available for overtime. • In spite of different role expectations, long-term nursing home care is reported to be a very satisfying area in which to work. However, care managers need to put in place strategies for building improved job satisfaction and workplace incentives to encourage graduates to consider long-term care opportunities. • Limitations of the study include the small number of participants, bias towards one organization and lack of generalizability of the results. • However, the findings confirm many earlier job satisfaction studies and further support the need to consider these issues in relation to recruitment and retention in long-term care.

Breastfeeding Duration in an Australian Population: The Influence of Modifiable Antenatal Factors:

Despite well-documented health benefits of breastfeeding for mothers and babies, most women discontinue breastfeeding before the recommended 12 months to 2 years. The purpose of this study was to assess the effect of modifiable antenatal variables on breastfeeding outcomes. A prospective, longitudinal study was conducted with 300 pregnant, Australian women. Questionnaires containing variables of interest were administered to women during their last trimester; infant feeding method was assessed at 1 week and 4 months postpartum. Intended breastfeeding duration and breastfeeding self-efficacy were identified as the most significant modifiable variables predictive of breastfeeding outcomes. Mothers who intended to breastfeed for < 6 months were 2.4 times as likely to have discontinued breastfeeding at 4 months compared to those who intended to breastfeed for > 12 months (35.7% vs 87.5%). Similarly, mothers with high breastfeeding self-efficacy were more likely to be breastfeeding compared to mothers with low self-efficacy (79.3% vs 50.0%). J Hum Lact. 20(1):30-38.

A randomized controlled trial exploring the effect of music on agitated behaviours and anxiety in older people with dementia

Objectives: This study, as part of a larger programme of research, sought to investigate the effect that participation in a 40-min live group music programme, involving facilitated engagement with song-singing and listening, three times a week for eight weeks, had on agitation and anxiety in older people with dementia. Methods: A randomized cross-over design, with music and reading control groups, was employed. Forty-seven participants with mild – moderate dementia, from two aged care facilities in Queensland, Australia, were recruited. Participants were assessed three times on the Cohen-Mansfield Agitation Inventory – Short Form (CMAI-SF) and the Rating Anxiety in Dementia Scale (RAID). Results: A sub-analysis of 24 participants attending ≥50% of music sessions found a significant increase in the frequency of verbal aggression over time, regardless of group (F(2,46) = 3.534, p < 0.05). A series of multiple regressions found cognitive impairment, length of time living in the facility and gender to be predictors of agitation overall and by subtype. Conclusion: Participation in the music programme did not significantly affect agitation and anxiety in older people with dementia. Both the music and reading group activities, however, gave some participants a ‘voice’ and increased their verbalization behaviour. Agitation was found to be predicted by a number of background factors (namely level of cognitive impairment, length of time in the facility and gender). Future studies would benefit more from in-depth participant assessment prior to study commencement, helping to moderate the influence of low scores, and by undertaking interventions at times when assessed symptoms are most prevalent.

Acute care management of older people with dementia: a qualitative perspective

AIM AND OBJECTIVES This Australian study explored management for older people with dementia in an acute hospital setting. BACKGROUND As the population ages, increasing numbers of older people with dementia are placed into an acute care hospital to manage a condition other than dementia. These people require special care that takes into account the unique needs of confused older people. Current nursing and medical literature provides some direction in relation to best practice management; however, few studies have examined this management from the perspective of hospital staff. DESIGN A descriptive qualitative approach was used. METHOD Data were collected using semi-structured audio-taped interviews with a cross section of thirteen staff that worked in acute medical or surgical wards in a large South East Queensland, Australia Hospital. RESULTS Analysis of data revealed five subthemes with the overarching theme being paradoxical care, in that an inconsistent approach to care emphasised safety at the expense of well-being and dignity. A risk management approach was used rather than one that incorporated injury prevention as one facet of an overall strategy. CONCLUSION Using untrained staff to sit and observe people with dementia as a risk management strategy does not encourage an evidence-based approach. Staff education and environmental resources may improve the current situation so that people with dementia receive care that takes into account their individual needs and human dignity. RELEVANCE TO CLINICAL PRACTICE Nurses can assist older people with dementia by encouraging evidence-based care practices to become the part of hospital policy.

Psychosocial interventions for dementia patients in long-term care

BACKGROUND Psychosocial interventions in long-term care have the potential to improve the quality of care and quality of life of persons with dementia. Our aim is to explore the evidence and consensus on psychosocial interventions for persons with dementia in long-term care. METHODS This study comprises an appraisal of research reviews and of European, U.S. and Canadian dementia guidelines. RESULTS Twenty-eight reviews related to long-term care psychosocial interventions were selected. Behavioral management techniques (such as behavior therapy), cognitive stimulation, and physical activities (such as walking) were shown positively to affect behavior or physical condition, or to reduce depression. There are many other promising interventions, but methodological weaknesses did not allow conclusions to be drawn. The consensus presented in the guidelines emphasized the importance of care tailored to the needs and capabilities of persons with dementia and consideration of the individuals life context. CONCLUSIONS Long-term care offers the possibility for planned care through individualized care plans, and consideration of the needs of persons with dementia and the individual life context. While using recommendations based on evidence and consensus is important to shape future long-term care, further well-designed research is needed on psychosocial interventions in long-term care to strengthen the evidence base for such care.

A Randomized Controlled Trial Exploring the Effect of Music on Quality of Life and Depression in Older People with Dementia

This randomized controlled trial investigated the effect of live music on quality of life and depression in 47 older people with dementia using the Dementia Quality of Life and Geriatric Depression Scale. The control/reading group reported higher mid-point feelings of belonging than the music group (F(1, 45) = 6.672, p < .05). Sub-analyses of ≥ 50 per cent music session attendance found improvements in self-esteem over time (F(2, 46) = 4.471, p < .05). Participants with scores that were suggestive of increased depressive symptoms had fewer depressive symptoms over time (F(2, 22) = 8.129, p < .01). Findings suggest music and reading activities can improve self-esteem, belonging and depression in some older people with dementia.

Seeking connection: family care experiences following long-term dementia care placement.

AIM To outline the experiences of family caregivers in Brisbane, Australia who have placed a relative with dementia into long-term care. BACKGROUND Whilst the aged care literature in Australia highlights the rising numbers of people with dementia admitted to long-term care, empirical research exploring family and staff relationships and their influence on quality of care remains limited. International research demonstrates that the transition to long-term care is stressful for families and the person with dementia, often resulting in ongoing family and staff conflict. DESIGN The study utilised a descriptive qualitative design. METHODS A purposive sample of 10 participants from a large study that tested an education intervention took part in the qualitative phase of this mixed method, sequential design study. Semi-structured interviews and confirmatory thematic analysis were used to identify family caregiver experiences following placement of their relative in long-term care. RESULTS The findings emphasise the increasing isolation and burden of care felt by families prior to admission, which often is perpetuated during long-term care placement and may present as dissatisfaction with care. CONCLUSIONS Improving staff-family relationships has the potential to reduce conflict and to improve the long-term care environment, relieve the pressure of work overload, decrease staff frustration and reduce negative reactions to family caregivers. RELEVANCE TO CLINICAL PRACTICE The findings highlight the crucial need for long-term care facilities to support families, as well as the person with dementia, through the transition to the care environment. The resulting improved family relationships with staff, based on negotiation and increasing knowledge of dementia care, can then provide potential to develop more specialised evidence-based dementia care and service delivery.

Factors influencing quality of life for people with dementia: A qualitative perspective

Objectives: An exploration and understanding of quality of life (QOL) can help to enhance understanding and respect for people with dementia and assist in improving care and treatment of this population. This study sought to understand the factors that influence QOL for people living with dementia in long-term care (LTC), including an understanding of how they perceived they were valued. Methods: In-depth interviews were conducted with 32 older people with dementia from one service provider and across four large care settings, in two Australian states. Results: While these residents were either satisfied or dissatisfied with elements of their life, the factors influencing a positive QOL were related to their relationship with family and other people, and ‘things’ such as needing some control over their life and, more importantly, needing to contribute to their community. Participants reported feeling of little use and therefore of limited value to society. Conclusion: This study proposes a need to understand how relationships might be maintained and strengthened following a move into LTC and highlights the importance of control and its influence on feeling valued.

Best practice for the management of older people with dementia in the acute care setting: a review of the literature

Aim.  This paper reviews the theoretical and research-based literature related to the management of people with chronic confusion as a consequence of dementia in the acute care setting. Background.  People aged 65 years and over are at increased risk of poor outcomes when admitted to the acute care setting as a result of comorbity and mismanagement of their chronic confusion. The challenge of caring for people with dementia in acute care is one that requires special attention. Results.  The theoretical literature outlines a number of principles of care necessary for best practice in the care of people with dementia. A number of different models of care are reported in the literature and some evaluative research has been undertaken to assess the benefits of the different models. Conclusion.  There are a number of interventions that if put into place in acute care may improve care of people with dementia and reduce the burden of care. There is emerging evidence that interventions such as staff education, skilled expertise, standardized care protocols and environmental modification help to meet the needs of people with dementia in acute hospital settings. This paper adds to our current understanding of management of dementia in the acute care setting, an area that demonstrates the need to move from descriptive to intervention studies to ensure evidence for care of persons with a dementing condition.