Information issues for providers of services to people with dementia living in the community in Australia: breaking the cycle of frustration.

The rising prevalence of dementia and concomitant demands upon dementia services are global issues. In Australia, dementia has attained national health priority status and governments at all levels have implemented service strategies to help manage the complex lives of people with dementia. Despite recognition that information is pivotal to effective dementia service delivery, little is known about the information needs of individual providers and the processes used to transfer information between providers. This qualitative study scoped information issues for key service providers for people with dementia living in the community in southern Tasmania, Australia, including information needs, availability, and transfer. Eleven focus groups were held with general practitioners, residential aged care facility staff, home carers, community health nurses, and aged care-assessment team members. Findings revealed that provider groups shared common, albeit unbeknown to them, information needs (e.g. diagnosis, behaviours, and services) and information concerns (e.g. untrustworthy information and poor information transfer) leading to poor service coordination. General practitioners emerged as a stand-out group with markedly fewer needs and concerns than other providers, a finding of special interest given their pivotal role in dementia diagnosis and referral. Participants were adamant in their view that electronic data bases and single points of entry to dementia services would improve service provision and should be developed. The research highlights complexities and associated frustrations of information transferability, accessibility, and trustworthiness for dementia service providers in the community. Increased understanding of providers' diverse yet interdependent roles could, we believe, play an important part in breaking the cycle of frustration experienced by all participants and thus contribute to system reform.

Multiple views reveal the complexity of dementia diagnosis.

OBJECTIVE: To reveal views about dementia diagnosis derived from a larger study of information needs of carers of people with dementia in Tasmania, Australia. METHODS: Over 100 participants, including family carers, health professionals and dementia service personnel, met as discrete focus groups. Data pertinent to dementia diagnosis were segregated and subjected to across-group comparative analysis. RESULTS: The term dementia held connotations of stigma and futility, despite stated benefits of having a diagnosis. General practitioners were regarded as pivotal but having inadequate diagnostic and treatment options. While most health professionals advocated a longitudinal diagnostic process, this created considerable stress for family carers who sought a speedy process. Without a diagnosis, some dementia-specific services were undeliverable. CONCLUSION: Dementia diagnosis is steeped in deep-rooted difficulties and stressful implications, compounded by carers' differing needs and interests. Better understanding between care providers of their conflicting and consistent views could contribute to better dementia care.

Health professionals' perspectives of providing care to people with dementia in the acute setting: Toward better practice.

This article reports an interpretative research project about the care of patients with dementia admitted to the acute setting with a non-dementia-related illness. Open-ended interviews were conducted with 25 medical, nursing, and other health care professionals drawn from 3 metropolitan teaching hospitals in Australia. Qualitative data analysis generated 5 major themes relating to the built environment and organizational "system" as determinants of practice, the influence of key players, current dementia care management, and ideal dementia care management. Results showed acute care hospitals are not the best place for people with dementia and can negatively influence health outcomes such as functional independence and quality of life. Participants reported attempts to provide best practice but experienced major constraints stemming largely from environmental, sociocultural, and economic issues. Recommendations include the delivery of acute services in tandem with dementia services and a whole organization shift in thinking away from what conveniently suits the institution to thinking that is person-centered and dementia-friendly. With support from executive-level management, nurses can play a leading role in the implementation of practice change.

Nursing research programs gather strength in Australia.

To shed light on programmatic research through direct experience is highly beneficial to nursing scholarship. Following a recent description of a successful Australian program of research centered around people's chronic illness experience we are inspired to continue the commentary (Koch et al 2005). Koch et al's (2005) case study reported on several 'core elements' they believe have contributed to the growth and effectiveness of their program. In this paper we consider some of these in light of current literature and our own challenging experiences within several Australian universities. Koch et al (2005) also makes a not too subtle distinction between dedicated research units independent of universities and research programs emanating from academia, suggesting the former are more productive. While one of the authors in the above paper, a UK scholar and nursing academic, makes interesting observations about this assertion, we contend that his UK perspective fails to capture the urgency of establishing nursing research programs in Australian universities. Consequently, we have chosen to extend the discussion about nursing research programs from the perspective of Australian academe, including comment on building productive relationships, strengthening a track record, research and practice as symbiotic processes, competitive funding strategies, and the integral role of research students. The entire commentary is located in a celebratory context of 20 years of Australian nursing education in the university sector, a context not without controversy. We give consideration to the best way ahead for the future of nursing research programs and hope our ideas spark further sharing of experiences.

Better medication management for Aboriginal people with mental health disorders: a survey of providers.

OBJECTIVE: To explore the experiences and training needs of service providers in relation to medication management for Aboriginal people with mental health disorders. DESIGN: Survey. SETTING: Aboriginal and mainstream health and human service organisations in metropolitan, rural and remote South Australia. SUBJECTS: Aboriginal health workers, nurses, mental health workers, substance misuse workers, managers, liaison officers, social workers, police, pharmacists, general practitioners, community workers, counsellors, paramedics, educators, family support workers and others. RESULTS: The major health service issues for Aboriginal people with mental health disorders and their carers are related to access to, and availability and appropriateness of services. Quality use of medications by Aboriginal clients is influenced by drug and alcohol misuse, cost, compliance, feelings about the value of medicines, sharing of medications and unwanted side-effects. Many workers providing services to Aboriginal people with mental health disorders lack adequate training and/or resources on mental health and safe medication management; yet, are required to provide advice or assistance on these matters. CONCLUSIONS: The survey provides new, reliable evidence relevant to mental health services and medication management for South Australian Aboriginal people. It highlights the major issues impacting on quality of care and service provision, demonstrates the wide range of health and allied workers providing medication advice and assistance to Aboriginal people, and reveals workforce development needs.

Portfolio learning/assessment in nursing and midwifery: an innovation in progress.

This paper describes portfolio projects currently underway within three South Australian settings: an undergraduate general nursing curriculum, a postgraduate perioperative nursing course, and a major general hospital and health service. The projects share a common interest in achieving an organised, useful means for registered nurses and midwives to demonstrate their competence in accord with contemporary professional standards. Their beginnings in international research and experience is described, and the progress of each project tracked to date. Others wishing to develop similar innovations can follow this decision trail and the advice offered. Outcomes to date indicate portfolios hold promise for advancing professional nursing and midwifery practice. Research currently underway on the topic is highlighted.

Missed opportunities in the field: caring for clients with co-morbidity problems.

This discussion paper presents key issues associated with caring for people with concurrent alcohol or drug and mental health problems. By way of anecdotal stories and personal experiences, it draws attention to 'missed opportunities' for effective care of clients within a general hospital and community mental health service. As educators, inicians and students, we are concerned our own attempts to improve the care of these clients may have been less than successful due to various factors, and believe such information is important to share with the wider nursing profession. We hope the paper will stimulate interest amongst general, mental health and drug and alcohol nurses, and researchers and educators to better address the issue of alcohol, drug and mental health co-morbidity in our community.