Film as cooperative endeavour: The promises for people living with dementia, their relatives, caregivers and aged care staff.

Creative expression by people living with dementia and their families and carers can improve communication and relationships and strengthen relational personhood. The transition to residential aged care from living at home with dementia is a time of 'relocation stress", and a time when additional psychosocial supports like these might be particularly beneficial. This article reports on a qualitative study that explored how a co-operative filmmaking project functioned as a multifaceted psychosocial intervention, and explored its potential impacts on relocation stressors. Methods included interviews with people living with dementia who were involved in the filmmaking, and their families and close others. Staff from a local day centre and residential aged care home also took part in interviews, as did the filmmakers. The researchers also observed some of the filmmaking process. Reflexive thematic analysis techniques were used to generate three key themes in the data: Relationship building; Communicating agency, memento and heart; Being visible and inclusive. The findings reveal challenges regarding privacy and the ethics of public screenings, as well as the pragmatics of using short films as a communication tool in aged care settings. We conclude that filmmaking as a cooperative endeavour holds promise to mitigate relocation stressors by: improving family and other relationships during challenging times for family and for people living with dementia; providing opportunities for new self-narratives derived from relational subjectivities; supporting visibility and personhood; and improving communication once in residential aged care. This research has relevance for communities who are looking to support dynamic personhood and improve the care of people living with dementia.

'Surrounding yourself with beauty': exploring the health promotion potential of a rural garden appreciation group.

Gardening has the potential to enhance health and well-being, through increased physical activity and social connectedness. However, while much is known about the benefits of garden activities, less is known about the potential health implications of more passive forms of engagement with gardens, for example, viewing gardens. In addition, much garden research is undertaken in urban settings, leaving little known about potential health impacts for rural populations. The present study explored these research gaps by gaining an understanding of the experiences and perspectives of members of a gardening appreciation group in rural Australia: The Colac Horticultural and Marvellous Property Appreciation Society (CHAMPAS). A phenomenological, qualitative methodology was applied, using semi-structured interviews for data collection. Eleven participants were selected using purposive and snowball sampling and the data were analysed by applying interpretive, reflexive thematic analysis. Four main themes and supporting sub-themes were generated. The four main themes were: (i) motivations for maintaining participation in CHAMPAS; (ii) social connections and friendships, formed from membership; (iii) sense of community and structure of CHAMPAS and (iv) the perceived health and well-being benefits of continued involvement in this group. This study found that members perceived health and well-being benefits stemmed from CHAMPAS facilitation of social connectedness, function as a community group and a way for members to share a love for home gardening. This study provides insights into the perceived and potential health-promoting effects of garden appreciation groups for rural populations.

There are many health and well-being benefits of gardening. However, research is predominantly focused on the active practice of gardening in urban environments, and little is known about the passive activity of garden appreciation, nor about the benefits of this activity in rural areas. This paper explores the health promotion potential of garden appreciation groups through the experiences of members of a rural group called CHAMPAS. Eleven members of CHAMPAS were asked to talk about what kept them attending, and what health and well-being benefits the group provided them. The study found that CHAMPAS benefits stemmed from its function as a social group and a way for members to share a love for home gardening. The findings suggest that garden appreciation groups potentially provide health promotion benefits for people in rural areas. A recommendation of this paper is to undertake further research to map and analyse these benefits across rural Australia.

The use of telehealth in the provision of after-hours palliative care services in rural and remote Australia: A scoping review.

BACKGROUND: Accessing quality palliative care, especially at the end of life is vital in reducing physical and emotional distress and optimising quality of life. For people living in rural and remote Australia, telehealth services can be effective in providing access to after-hours palliative care. OBJECTIVE: To review and map the available evidence on the use of telehealth in providing after-hours palliative care services in rural and remote Australia. METHOD: Scoping review using Arksey and O'Malley methodological framework. Findings are reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Scopus, Web of Science, CINAHL Complete, Embase via Ovid, Emcare via Ovid, and Medline via Ovid databases were searched. Peer-reviewed studies and grey literature published in English from 2000 to May 2021 were included. RESULTS: Twelve studies were included in the review. Four main themes were identified: 1) Stakeholder perceptions of service; 2) benefits to services and users; 3) service challenges; and 4) recommendations for service improvement. CONCLUSION: Telehealth can connect patients and families with healthcare professionals and enable patients to continue receiving care at home. However, challenges relating to patients, service, staff skills, and experience need to be overcome to ensure the success and sustainability of this service. Improved communication and care coordination, better access to patient records, and ongoing healthcare professional education are required. IMPLICATIONS: Protocols, comprehensive policy documents and standardized operating procedures to guide healthcare professionals to provide after-hours palliative care is needed. Ongoing education and training for staff is crucial in managing patients' symptoms. Existing service gaps need to be explored and alternative models of after-hours palliative care need to be tested.

Experiences of gardening during the early stages of the COVID-19 pandemic.

Gardening has the potential to improve health and wellbeing, especially during crises. Using an international survey of gardeners (n = 3743), this study aimed to understand everyday gardening experiences, perspectives and attitudes during early stages of the COVID-19 pandemic in 2020. Our qualitative reflexive thematic and sentiment analyses show that during the first months of the COVID-19 pandemic, gardening seemed to create a safe and positive space where people could socially connect, learn and be creative. Participants had more time to garden during the pandemic, which led to enhanced connections with family members and neighbours, and the ability to spend time in a safe outdoor environment. More time gardening allowed for innovative and new gardening practices that provided enjoyment for many participants. However, our research also highlighted barriers to gardening (e.g. lack of access to garden spaces and materials). Our results illustrate the multiple benefits of gardening apparent during COVID-19 through a lens of the social-ecological model of health.

Tracing memories and meanings of festival landscapes during the COVID-19 pandemic.

COVID-19 has deeply affected mass gatherings and travel and, in the process, has transformed festivals, festival landscapes, and people's sense of place in relation to such events. In this article we argue that it is important to better understand how people's memories of festival landscapes are affected by these larger shifts. We worked from the premise that information-rich cases could provide some initial insights in this respect. To that end, we interviewed seven individuals who are regular and longstanding in their engagement with festivals in one place, lutruwita/Tasmania, the island state of Australia. Key findings suggest that pandemic experiences mediate the range of meanings participants give to festival landscapes and their interpretations of such landscapes can be described as attachments and detachments, encounters, and reorientations. We conclude by proposing that participants' efforts to draw on memories, reflect on emotional geographies, and recast autobiographies help them adjust to crises, rethink their ways of moving to and from festival sites, and reframe their sense of place in relation to significant cultural events. Such insights have application beyond both the island state and the participants involved.

Use of telehealth in the provision of after-hours palliative care services in rural and remote Australia: A scoping review protocol.

INTRODUCTION: After-hours services are essential in ensuring patients with life limiting illness and their caregivers are supported to enable continuity of care. Telehealth is a valuable approach to meeting after-hours support needs of people living with life-limiting illness, their families, and caregivers in rural and remote communities. It is important to explore the provision of after-hours palliative care services using telehealth to understand the reach of these services in rural and remote Australia. A preliminary search of databases failed to reveal any scoping or systematic reviews of telehealth in after-hours palliative care services in rural or remote Australia. AIM: To review and map the available evidence about the use of telehealth in providing after-hours palliative care services in Australian rural and remote communities. METHODS: The proposed scoping review will be conducted using the Arksey and O'Malley methodological framework and in accordance with the Joanna Briggs Institute methodology for scoping reviews. The reporting of the scoping review will be guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). This review will consider research and evaluation of after-hours services using telehealth for palliative care stakeholders in rural and remote Australia. Peer reviewed studies and grey literature published in English from 2000 to May 2021 will be included. Scopus, Web of Science, CINAHL Complete, Embase via Ovid, PsycINFO via Ovid, Emcare via Ovid, Medline via Ovid, and grey literature will be searched for relevant articles. Titles and abstracts will be screened by two independent reviewers for assessment against the inclusion criteria. Data will be extracted and analysed by two reviewers using an adapted data extraction tool and thematic analysis techniques. Diagrams, tables, and summary narratives will be used to map, summarise and thematically group the characteristics of palliative care telehealth services in rural and remote Australia, including stakeholders' perceptions and benefits and challenges of the services.

Gardening can relieve human stress and boost nature connection during the COVID-19 pandemic.

The COVID-19 pandemic has severely disrupted social life. Gardens and yards have seemingly risen as a lifeline during the pandemic. Here, we investigated the relationship between people and gardening during the COVID-19 pandemic and what factors influenced the ability of people to garden. We examined survey responses (n = 3,743) from gardeners who reported how the pandemic had affected personal motivations to garden and their use of their gardens, alongside pandemic-related challenges, such as food access during the first wave of COVID-19 (May-Aug 2020). The results show that for the respondents, gardening was overwhelmingly important for nature connection, individual stress release, outdoor physical activity and food provision. The importance of food provision and economic security were also important for those facing greater hardships from the pandemic. While the literature on gardening has long shown the multiple benefits of gardening, we report on these benefits during a global pandemic. More research is needed to capture variations in public sentiment and practice - including those who do little gardening, have less access to land, and reside in low-income communities particularly in the global south. Nevertheless, we argue that gardening can be a public health strategy, readily accessible to boost societal resilience to disturbances.

Where birds felt louder: The garden as a refuge during COVID-19.

During the COVID-19 pandemic, many countries experienced something of a boom in interest in gardening. Gardens have long been considered as refuges into which we retreat to escape various struggles and challenges. In this study we examine the characteristics and functions of the garden as a refuge during the period of increased garden interest associated with the COVID-19 pandemic. Analysis of qualitative results about garden experiences from 3,743 survey respondents revealed intertwining garden and emotional geographies. Utilising non-representational and therapeutic landscape theories, we found multifarious and heightened experiences of non-material aspects of gardens; that is, the sensory and emotional aspects. People experienced, for example, a sense of joy, beauty, and reassurance, a greater attunement to the natural world and an increased sense of nature connection than they had at other times: birds felt louder. These heightened sensory and emotional experiences had therapeutic benefits, across age and geographical spectrums, during these difficult times. This research improves our understandings of the positive potential of non-material aspects of gardens in the creation of therapeutic landscapes in and beyond COVID-19.

'I used to be a gardener': Connecting aged care residents to gardening and to each other through communal garden sites.

OBJECTIVE: To explore residential aged care facility (RACF) residents' use of communal garden sites as spaces for gardening and social connection. METHODS: Phenomenological inquiry using semi-structured interviews with 13 residents, family members and staff of a rural RACF. RESULTS: Interest, ability and willingness to engage in communal garden sites were evident but limited by multiple factors. Data highlighted the complexities of accessing gardens, gardening and other people. An enduring identity as a gardener provided a framework for maintaining a link between gardening, finding meaning and maintaining a sense of self. CONCLUSION: Communal garden sites can improve quality of life and enable connectedness for RACF residents. However, a range of personal, attitudinal, institutional and resource-related challenges create barriers to gardening, and in the RACF isolation and inactivity persist. We conclude that these challenges might be overcome through provision of physical and emotional support for positive risk-taking, autonomy and access to the outside to continue gardening.

Trust, Connection and Equity: Can Understanding Context Help to Establish Successful Campus Community Gardens?

Campus community gardens (CCGs) can potentially improve student health and wellbeing, mitigate social and ecological problems, and nurture university-community relationships. However, CCGs are located in complex socio-political and ecological settings and many community gardens struggle or fail. However, few studies have assessed the socio-political/ecological context of a garden setting prior to its development to understand the potential barriers and enablers of success. Our study assessed the socio-spatial context of a proposed CCG at a student university accommodation site. We engaged diverse university and community stakeholders through interviews, focus groups and a survey to explore their perceptions of the space generally and the proposed garden specifically. Visual observations and public life surveying were used to determine patterns of behavior. Results confirmed known problems associated with an underutilized site that provides little opportunity for lingering or contact with nature; and unknown barriers, including socially disconnected stakeholders and community distrust of the university. The research also uncovered positive enablers, such as stakeholder appreciation of the social, wellbeing and ecological benefits that a CCG could deliver. Our findings suggest that an in-depth exploration of a proposed garden context can be an important enabler of its success.

Green spaces, dementia and a meaningful life in the community: A mixed studies review.

Engagement in green spaces impacts positively on wellbeing and quality of life. However, little is known about the impacts of green space engagement specifically for people living with the experience of dementia in the community; people with a heightened need to maintain a quality life. In this mixed study review, we explore existing evidence for quality of life impacts of contact with green spaces by people living with dementia in the community. Findings show that gardens and horticultural programs, green care farms, parks, urban woodlands and neighbourhood outdoor environments can impact positively in several ways. Four key mechanisms are identified: Engaging in meaningful activities; Empowerment; Positive risk taking; and Reinforcing Identity. These findings provide conceptual links between psychosocial understandings of the relationships between nature and wellbeing with rights-based dementia discourses. We conclude that evidence specific for people living with dementia in the community setting is growing and there is potential for green spaces to enable an active and meaningful community-life, despite cognitive decline. This is worthy of consideration by policy makers, practitioners and carers. Future studies can broaden this field of research and include investigations into lesser-explored aspects of quality of life, such as spirituality, and methods that incorporate the voices of people living with dementia.

A systematic review and quality appraisal of bereavement care practice guidelines.

Bereavement care practice guidelines assist in delivering high-quality bereavement care. However, the quality of published guidelines is unknown. A systematic review was conducted to identify and evaluate the quality of the process used to develop bereavement care practice guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. A keyword search was conducted in MEDLINE-Complete, CINAHL-Complete, Health-Source (Nursing/Academic Edition), Psychology and Behavioral Sciences Collection, and an internet search engine in October 2017. Sixteen guidelines with differing scope and purpose but similar core values were identified from the grey literature and then appraised at high quality (n = 1), moderate quality (n = 4), or low quality (n = 11). The domains "clarity of presentation" and "scope and purpose" achieved the highest scores (mean ± SD 71.0 ± 27.6% and 64.4 ± 37.5%, respectively), while "editorial independence" showed the lowest mean score (9.2 ± 13.3%). While few of the bereavement care practice guidelines met the AGREE II quality standards related to their development process, neither the quality of the content of each guideline nor the in-context application was assessed by the AGREE II instrument. Ongoing development of practice guidelines may benefit from consideration and application of the framework outlined in the AGREE II or similar appraisal instrument.

Implementing an outreach headspace mental health service to increase access for disadvantaged and rural youth in Southern Tasmania.

PROBLEM: Barriers, including distance and lack of transport, make it difficult for young people to access mental health services such as headspace. DESIGN: A collaborative mental health outreach service initiative with outcome measures assessed at baseline and after 2 years. SETTING: The service was designed and implemented by headspace Hobart and Pulse Youth Health Service based in Glenorchy, Tasmania, Australia. KEY MEASURES FOR IMPROVEMENT: Number of rural and socio-economically disadvantaged young people accessing the outreach service. Wait time to see a mental health clinician. STRATEGIES FOR CHANGE: Organisational leadership and adoption of co-design principles. Staff and youth from both services were engaged in planning and implementation. Regular service reviews were undertaken by representatives from both organisations. EFFECTS OF CHANGE: Numbers of young people from rural and socio-economically disadvantaged areas accessing the service increased. Wait times to see a mental health clinician were reduced by a minimum 10 working days. LESSONS LEARNT: Staff engagement was vital in supporting and promoting the new outreach service. The risk of diluting the headspace model fidelity was ameliorated by collaborating with an existing, complimentary youth health service. The success of the service has resulted in four more outreach sites. Although administration resources are stretched, the outreach model offers an opportunity to increase access to youth-friendly mental health services for young people from disadvantaged and rural areas of Southern Tasmania.

Living, loving, dying: Insights into rural compassion.

OBJECTIVE: To improve understandings of the enablers and barriers to maintaining good quality of life for people dying, caring and grieving in rural areas. DESIGN AND SETTING: In-depth interviews designed on participatory research principles were held with bereaved carers living in a small community in rural Tasmania. Participants had cared for someone until their death within the 3-year period prior. PARTICIPANTS: Nineteen participants comprising 18 bereaved former carers and one person with a life-limiting illness, and all but four were over retirement age. STUDY AIM: To explore experiences of end-of-life care in a rural community. RESULTS: Participants discussed the challenges they experienced during end-of-life caring, including transport into the city for treatment, and access to basic and specialised services. However, they also reported positive aspects of formal and informal palliative care, and described experiences of personable, expert, flexible and innovative caregiving. CONCLUSIONS: The rural location enabled personalised and innovative expressions of care. This research adds new insight into rural end-of-life palliation, as a complex intersection of supererogation, innovation and place-driven care.

The landscape of dementia inclusivity.

A supported community gardening program became appealing and therapeutically beneficial to people living with the impacts of dementia and their carers, despite not targeting either cohort specifically. This paper discusses how this program provides insights into the landscape of dementia inclusivity. The gardens involved were spaces that allowed positive risk-taking opportunities, respectful intersubjectivity and active citizenship. Our research findings indicate that a meaningful response to the rising incidence of dementia may be to build upon social and geographical attributes of community gardens. Understanding the multifaceted nature of a dementia inclusive landscape will enable authentic engagement and rights-based support for people living with the impacts of dementia.

'It's not therapy, it's gardening': community gardens as sites of comprehensive primary healthcare.

Using a participatory research framework, researchers at the Centre for Rural Health, University of Tasmania, explored the potential of Community Gardens to function as comprehensive primary healthcare (CPHC) environments. Community gardeners, coordinators, volunteers and Neighbourhood House coordinators discussed their understandings of the health benefits of community gardens, how they contribute to broad CPHC aims and the barriers and enablers to greater CPHC contributions in the future. This research identifies therapeutic features of Community Gardens and explores the correlations between these and CPHC. It is concluded that there are strong synergies between the aims and activities of Community Gardens and CPHC. To augment the therapeutic capacity of these sites requires adequate resourcing and skill development, suitable design, funding and policy support, along with innovative partnerships with health professionals.

End-of-Life care in a community garden: Findings from a Participatory Action Research project in regional Australia.

This article presents findings from research that explored how a community garden might function as a place of end-of-life and bereavement support. Adopting Participatory Action Research (PAR) methods, and informed by Third Place theory and notions of therapeutic landscape, creative consultations were held in the Garden and people's homes. The findings provide insights into the nature of informal care as it is played out in the liminal garden space, between home and institution. The results illuminate the therapeutic landscape of community gardens, and contribute new understandings to the fields of PAR, health geography and end-of-life care.

Community gardens as sites of solace and end-of-life support: a literature review.

In a pilot project, members of a community garden explored how they might provide better end-of-life support for their regional community. As part of the project, a literature review was undertaken to investigate the nexus between community gardens and end-of-life experiences (including grief and bereavement) in academic research. This article documents the findings of that review. The authors discovered there is little academic material that focuses specifically on community gardens and end-of-life experiences, but nonetheless the two subjects were seen to intersect. The authors found three points of commonality: both share a need and capacity for a) social/informal support, b) therapeutic space, and c) opportunities for solace.