The Perioperative Nurse Surgeon's Assistant: Issues and challenges associated with this emerging advanced practice nursing role in Australia.

AIMS: The aim of this study was to obtain Perioperative Nurse Surgeon's Assistants' views about their emerging new role in contemporary nursing practice in Australia. BACKGROUND: Internationally advanced practice nursing has led to a range of specialist roles aimed at delivering higher quality, efficient nursing care. In 2005 an Australian university developed the Perioperative Nurse Surgeon's Assistant graduate education and training program to provide nurses with an opportunity to gain advanced practice knowledge and extended skills specifically in the perioperative setting. DESIGN: This study was a qualitative research design that used online surveys and in-depth interviews to explore the issues and challenges associated with the introduction of the (currently non-accredited) Perioperative Nurse Surgeon's Assistant role in Australia. METHODS: Experienced Australia perioperative nurses who had undertaken graduate education and training in this field were recruited for this study. Data were collected between August and October 2011. An inductive thematic analysis was used to interpret the findings. RESULTS: Eighteen nurses completed the online survey and six were interviewed (n = 24). Nurses cited their commitment to professional development and the delivery of high quality patient care, along with surgeons' encouragement for them to complete specialist clinical training, as key reasons for undertaking Perioperative Nurse Surgeon's Assistant education and training. CONCLUSIONS: The Perioperative Nurse Surgeon's Assistant role led to greater job satisfaction and autonomy, and assisted nurses to better meet the needs of patients, surgeons and clinical perioperative teams. Without formal recognition of the Perioperative Nurse Surgeon's Assistant role its future in the Australian health care system is under threat.

The 2013 Australian dietary guidelines and recommendations for older Australians.

BACKGROUND: Dietary guidelines are designed to assist people to make appropriate food choices to reduce their risk of diet-related diseases. In 2013, the Australian Dietary Guidelines were updated and now includes food group recommendations for two groups of older Australians (51-70 years and 70+ years), where previously only one older age group existed (60+ years). OBJECTIVE: The aim of this article is to raise awareness among general practitioners (GPs) about the latest Australian Dietary Guidelines and to identify relevant resources that will help GPs provide up-to-date dietary advice for older patients. DISCUSSION: The 2013 Australian Guide to Healthy Eating visually represents the proportions of the five food groups recommended for daily consumption. The Recommended Dietary Intake for some nutrients is higher for older people, compared with the general adult population. Older people often turn to their GP for nutritional advice.

Patients' recollection and understanding of informed consent: a literature review.

OBJECTIVE: To explore patients' recollection and understanding of the proposed medical procedures for which they have consented. METHODS: Six databases were searched from January 1995 to March 2013 for articles using the MeSH terms 'informed consent', 'patients' and 'comprehension', and the free text search term 'patient understanding'. This search identified 354 articles. Once duplicates (n = 213) were removed, the remaining 141 articles were screened, resulting in 13 high-quality studies that met the inclusion criteria. RESULTS: When asked to reflect on the consenting process, between 21% and 86% of patients were able to recall the potential risks and complications of their medical procedure. The degree of understanding of the consenting process decreased with age. Some patients were of the opinion that the primary purpose of the consent procedure was to protect hospitals and doctors. PATIENTS: Level of education, literacy and language competency, combined with physicians' ability to effectively explain the medical procedure and the inherent risks and complications, were important determinants of patients' capacity to provide fully informed consent. The use of education materials delivered in written form or embedded in an interactive multimedia process led to improvements in patients' understanding of the implications of surgery. CONCLUSIONS: This review found that patients' recollection and understanding of the medical procedure, risks and complications is often low, particularly among older individuals. The use of interactive multimedia and written material that are easy-to-read and comprehend, and prepared for individual patients has been shown to increase patient awareness, recollection and understanding of the consenting procedure.

Factors that impact residents' transition and psychological adjustment to long-term aged care: a systematic literature review.

AIM: To identify the factors that impact residents' transition and adjustment to long-term aged care and influence their relocation experience. BACKGROUND: The transition to long-term aged care can be an emotional and stressful event for older people as well as their families and carers. The challenges triggered by relocation derive from home being on the move. The concept of home and Bridges' three stages of transition framework provide conceptual models for better understanding the needs and aspiration of older people who are in the process of this late life transition. METHOD: We searched Academic Search Premier, Cinahl, Medline, PyscINFO, Psychology and Behavioral Sciences Collection and Scopus databases for observational, descriptive studies published between January 1995 and July 2013 using subject headings and free-text search terms including adjustment, nursing homes, relocation and transition. RESULTS AND DISCUSSION: The search identified 348 potentially relevant articles. Once duplicates were removed, 214 articles were screened for inclusion in this review; 42 articles were assessed for eligibility, resulting in 19 high-quality observational, descriptive studies that met the inclusion criteria. Key determinants of residents' relocation experience include the extent to which they were able to exert control over the decision to move to an aged care facility, preserve their autonomy, and retain meaningful social relationships. Encouraging the development of new relationships with other residents and staff is an important role for staff to play. Providing residents with opportunities to talk about their feelings, their life experience, and their involvement in the decision to relocate to an aged care facility can help them in their transition to an aged care facility. Preadmission screening that provides staff with an understanding of personal, lifestyle and cultural needs that might facilitate improved transition may also be beneficial in care planning. CONCLUSION AND IMPLICATIONS: An understanding of the factors that impact residents' transition to long-term aged care, and their experience of relocation will assist aged care providers to create the conditions to ease adjustment anxiety and to facilitate a person's transition into his/her 'last home'.

Focus group interviews with older Australians to explore their awareness of the national age-adjusted dietary recommendations and their suggestions for assisting them to meet these dietary targets.

Promoting a healthy, nutritious diet is central to the goal of assisting individuals to age well. This study used focus groups to explore older people's awareness of the current age-adjusted nutrient recommendations and age-adjusted core food groups, and to capture their views about these dietary guidelines. Thematic analysis was applied to aggregate data into categories of frequently occurring responses. Data were collected from five focus groups: a total of 29 participants, aged 60-98 years of age. Analysis of responses revealed that participants were generally unaware of government-endorsed dietary guidelines or nutrient recommendations for older people. Their suggestions for assisting older people to meet these age-adjusted dietary targets included: targeted media campaigns to raise awareness about older people's nutrient requirements; the need for practical meal plans that do meet their dietary needs; and the removal of barriers to supermarket food choices, such as problems with opening jars and excessive packaging.

Older Australians' views about the impact of ageing on their nutritional practices: findings from a qualitative study.

AIM: To explore older people's views about how getting older has influenced their dietary practices. METHODS: Focus groups with independently living residents aged 60 years and older in northern NSW, Australia. An inductive approach to thematic analysis was used. RESULTS: Five focus groups (n= 29) were conducted. The majority of participants were women (79%), mean age 73 years. The main findings were that reduced ability to eat large meals; health maintenance and disease management; food messages; food taste and convenience; and living arrangements appear to impact food choices and eating behaviour in this sample. CONCLUSION: In the presence of reduced and/or modified food intake, older people might benefit from an understanding of the concept of nutrient density in order to help them attain and maintain nutritional adequacy. Lifelong exposure to food messages (sometimes conflicting) resulted in many participants feeling confused about appropriate dietary practices for this age group.

Effects of person-centered care on residents and staff in aged-care facilities: a systematic review.

BACKGROUND: Several residential aged-care facilities have replaced the institutional model of care to one that accepts person-centered care as the guiding standard of practice. This culture change is impacting the provision of aged-care services around the world. This systematic review evaluates the evidence for an impact of person-centered interventions on aged-care residents and nursing staff. METHODS: We searched Medline, Cinahl, Academic Search Premier, Scopus, Proquest, and Expanded Academic ASAP databases for studies published between January 1995 and October 2012, using subject headings and free-text search terms (in UK and US English spelling) including person-centered care, patient-centered care, resident-oriented care, Eden Alternative, Green House model, Wellspring model, long-term care, and nursing homes. RESULTS: The search identified 323 potentially relevant articles. Once duplicates were removed, 146 were screened for inclusion in this review; 21 were assessed for methodological quality, resulting in nine articles (seven studies) that met our inclusion criteria. There was only one randomized, controlled trial. The majority of studies were quasi-experimental pre-post test designs, with a control group (n = 4). The studies in this review incorporated a range of different outcome measures (ie, dependent variables) to evaluate the impact of person-centered interventions on aged-care residents and staff. One person-centered intervention, ie, the Eden Alternative, was associated with significant improvements in residents' levels of boredom and helplessness. In contrast, facility-specific person-centered interventions were found to impact nurses' sense of job satisfaction and their capacity to meet the individual needs of residents in a positive way. Two studies found that person-centered care was actually associated with an increased risk of falls. The findings from this review need to be interpreted cautiously due to limitations in study designs and the potential for confounding bias. CONCLUSION: Typically, person-centered interventions are multifactorial, comprising: elements of environmental enhancement; opportunities for social stimulation and interaction; leadership and management changes; staffing models focused on staff empowerment; and assigning residents to the same care staff and an individualized philosophy of care. The complexity of the interventions and range of outcomes examined makes it difficult to form accurate conclusions about the impact of person-centered care interventions adopted and implemented in aged-care facilities. The few negative consequences of the introduction of person-centered care models suggest that the introduction of person-centered care is not always incorporated within a wider "hierarchy of needs" structure, where safety and physiological need are met before moving onto higher level needs. Further research is necessary to establish the effectiveness of these elements of person-centered care, either singly or in combination.

Creating the conditions for self-fulfilment for aged care residents.

In 1991 the United Nations General Assembly adopted the Principles for Older Persons as a framework for international policy responses to population ageing. These principles promote independence, participation, care, self-fulfilment and dignity as legitimate entitlements of all older people. Although these principles, or variations of them, are embedded in standards of best-practice in residential aged care facilities, the literature shows that in reality institutional care can deny older people opportunities to exercise some of these entitlements. More specifically, residential aged care facilities can deprive older people of access and support to pursue opportunities for the full development of their potential, i.e. their entitlement to self-fulfilment. This discussion article explores the influence of institutional care on older people's ability to exercise their entitlement to self-fulfilment. We identify the characteristics of a 'good life' in institutional care, according to aged care residents themselves. The Eden Alternative is presented as a model of aged care that aims to create the conditions for a 'good life' and self-fulfilment for aged care residents.

Action learning enhances professional development of research supervisors: an Australian health science exemplar.

The worldwide academic workforce is ageing. At the same time, health and human services workforces are expanding. The preparation of educators to fill gaps in expertise and to position the health sciences for future growth is an urgent need. The findings from a recent action learning project that aimed to enhance the professional growth and development of higher degree researcher student supervisors in a School of Health and Human Sciences are presented. Seven early career researchers and the facilitator met for two hours every two to three weeks over 4 months between April and July 2010, in a rural and regional university in New South Wales, Australia. The processes initiated were a combination of experiential knowledge, referral to relevant published reports, use of an effective supervision checklist, and critical conversations. Learning outcomes centered on higher degree management and supervision pedagogy, communities of practice, knowledge translation, and the establishment of a research culture. The contextual barriers and implications of the methodology and learning outcomes for the professional development of health and human science practitioners, researchers and educators is also discussed.

Effective leadership, teamwork and mentoring--essential elements in promoting generational cohesion in the nursing workforce and retaining nurses.

Despite recent increases in nurse recruitment in Australia, the current nursing workforce is still below the predicted numbers for the future demands. The combination of an ageing workforce, high nursing staff turnover and an inability to attract and retain nurses is eroding the capacity of the health care sector to appropriately respond to the care needs of the community. Currently, the nursing workforce may have as many as four generations working together. Differences in employment needs and values, work ethics, attitudes towards authority, and professional aspirations, contribute to some of the cross-generational problems that emerge and the turnover of nursing staff. Strategies to improve the retention rates of nurses need to focus on building a cohesive workforce by utilising the strengths and skill sets that characterise different generations of nurses, and creating the conditions in which nurses across all generations feel supported and valued. The aim of this article is to explain how effective leadership, teamwork and mentoring can assist efforts to promote generational cohesion and address the decline in the number of nurses in the workforce.

The management of loneliness in aged care residents: an important therapeutic target for gerontological nursing.

Social engagement and meaningful relationships are critical determinants of the quality of life of older people. Human beings have an intrinsic need for social connections and an engagement with the social environment. Deficits in the quality of these social relationships lead to feelings of isolation and loneliness in older people. Loneliness can have serious physiological and health implications. It is well established that loneliness is a risk factor for poor physical and mental health, comparable in size to obesity, a sedentary lifestyle and possibly even smoking. The aim of this article is to present an argument for the management of loneliness in aged care residents as an important therapeutic target in gerontological nursing. To date little is known about the effectiveness of intervention strategies designed to alleviate loneliness in aged care residents. Nurses can address this deficit in our understanding by evaluating the impact of loneliness intervention strategies.

Establishing the Eden Alternative™ in Australia and New Zealand.

The Eden Alternative™ is a philosophy of personal, organisational and environmental transformation founded by Dr. William Thomas, a Harvard trained geriatrician. He wanted to create a living environment in existing aged care institutions to eliminate loneliness, helplessness and boredom from the lives of residents, which he argued were the plagues of ageing that account for the bulk of their suffering. The Eden Alternative™ is a contemporary approach to long-term care, designed to combat these plagues of ageing, by incorporating companionship, a sense of purpose, variety and spontaneity into the day-to-day experience of aged care residents. Creating a warm, loving and caring 'home' that enriches the lives of all who live and work in it, is the overarching goal of The Eden Alternative™. The locus of decision-making is with the resident, which ensures the right of each resident to a life worth living. This exemplar outlines the inception and growth of The Eden Alternative™ in Australia and New Zealand.

Treating primary insomnia - the efficacy of valerian and hops.

OBJECTIVE: To evaluate the efficacy of valerian and hops in the treatment of primary insomnia. METHODS: The AMED and MEDLINE databases were searched for primary sources of literature published between 1950 and 2009, using keywords: herbal medicine, medicinal plants, herbal, Valeriana officinalis, valerian, Humulus lupulus, hops, sleep, insomnia. Studies were included if they evaluated the efficacy of valerian or hops in improving primary insomnia in adults: sixteen studies met the inclusion criteria. Twelve of these found that the use of valerian, on its own, or in combination with hops, is associated with improvements in some sleep parameters (eg. sleep latency and quality of sleep). However, these results need to be interpreted cautiously as there were significant differences in design between the studies. CONCLUSION: Further randomised, double blind, placebo controlled trials are needed before such herbal treatments can be confidently recommended for the treatment of primary insomnia.

Enhancing resilience in registered aged care nurses.

AIM: To identify the factors that impact the resilience of registered aged care nurses, that is their capacity to adapt to the physical, mental and emotional demands of working in aged care facilities. METHOD: This study explored the lived experience of nine registered nurses working in residential aged care facilities on the Sunshine Coast, Queensland, who were asked to reflect on the phenomenon of resilience in the workplace. RESULTS: This study found that clinical expertise, a sense of purpose in a holistic care environment, a positive attitude and work-life balance are important determinants of resilience in aged care nurses. CONCLUSIONS: Resilience in nurses in residential aged care facilities is enhanced when they are able to maintain long-term, meaningful relationships with residents. Collegial support that provides opportunities to debrief and validate experiences as well as the use of humour to defuse stress promotes well-being and builds resilience in the workplace.

Why are elderly individuals at risk of nutritional deficiency?

The older population is the single largest demographic group at disproportionate risk of inadequate diet and malnutrition. Ageing is associated with a decline in a number of physiological functions that can impact nutritional status, including reduced lean body mass and a resultant decrease in basal metabolic rate, decreased gastric secretion of digestive juices and changes in the oral cavity, sensory function deficits, changes in fluid and electrolyte regulation and chronic illness. Medication, hospitalization and other social determinants also can contribute to nutritional inadequacy. The nutritional status of older people is an important determinant of quality of life, morbidity and mortality. This review critically examines the factors that contribute to the development of poor nutritional status in older people and considers the consequences of malnutrition.

Predictors of dietary and health supplement use in older Australians.

OBJECTIVE: This study aimed to identify the health conditions and symptoms that predicted dietary and health supplement use in older Australians. DESIGN: Almost 2,500 Australians aged 65 years and over were randomly selected from the 2000 Australian Electoral Commission roll. All states and territories were proportionally represented in the sample. Data were obtained using a self-administered postal survey. SUBJECTS: Approximately 1,200 individuals (51% males and 49% females) aged between 65-98 years completed the survey. RESULTS: At the time of survey, 43% (n=548) reported using some form of supplement. Supplement use was significantly associated with gender (female) and chronic musculoskeletal ailments such as arthritis, osteoporosis and generalised back or neck problems. A diagnosis of hypertension or a heart condition were significant barriers to supplement use in this sample. The most common potential drug-supplement interaction was between calcium supplements and antihypertensives. CONCLUSION: Older supplement users may be of the opinion that supplements offer relief from the pain and suffering associated with their medical problems. If so, current supplement patterns would indicate that they are misguided. Nurses have an important role to play in encouraging older individuals to disclose their use of supplements to all health professionals involved in their continuing care.

Health characteristics of older Australian dietary supplement users compared to non-supplement users.

The aim of this study was to measure the prevalence of dietary and health supplement use among Australians aged 65 years and over, and to contrast the health differences between supplement users and non-supplement users. Data was obtained from 1,263 randomly selected older Australians, who provided general demographic data, in addition to information related to their health, symptoms experienced and uses of medication, including dietary supplements. Supplement use was reported by 43% of the sample (52% of females and 35% of males). This investigation has revealed distinct differences in the health profile of older supplement users compared to non-users. Although there was no difference in the number of visits to medical doctors or self-rated health status between supplement users and non-supplement users, supplement users were more likely to report arthritis and osteoporosis, and experience more symptoms and consume more medication than non-supplement users. In contrast, there was a reduced likelihood of taking a supplement for those with hypertension and by those using blood pressure medication and heart tablets. These results suggest that older dietary supplement users may benefit from education and professional advice to assist them make appropriate and informed choices, particularly if they expect these preparations to attenuate their health concerns.

Wading through the quagmire: making sense of dietary supplement utilization.

Since the 1980s, numerous studies conducted in the United States have attempted to estimate the prevalence of supplement use among the population (e.g., the National Health and Nutrition Survey and the National Health Interview Surveys). Despite these efforts, the true extent of supplement use is unclear. The literature pertaining to the prevalence of supplement use refers to a confusing array of ambiguous terms. Forming accurate conclusions about supplement use is confounded by differences in terminology and methodology between studies. Direct comparisons between studies are therefore inherently problematic. The emphasis in future investigations should be on standardizing the study design; recording data on daily, weekly, or even monthly use in order to establish the safety and efficacy of supplement use; and adopting a consistent, uniform definition of the term supplement.