Exploring attitudes and barriers toward the use of evidence-based nursing among nurse managers in Taiwanese residential aged care facilities.

This article reports findings from a qualitative study on nurse managers' perspectives of evidence-based practice (EBP) in residential aged care facilities (RACFs) in Taiwan. Six RACFs were randomly selected for inclusion in the study. The sample consisted of the nurse manager from each facility (N = 6) who participated in an in-depth interview. Thematic qualitative content analysis was used to identify patterns of experience. The majority of managers expressed positive attitudes toward research and EBP but reported little experience in its implementation. Barriers to EBP included individual barriers such as lack of motivation and confidence to embrace change. Research-related barriers included difficulty in finding and understanding research articles, and systemic barriers included lack of funding and time, lack of authority, and workplace culture. Some implications of these findings for policy and practice are discussed.

Implementing evidence-based practice in Taiwanese nursing homes: attitudes and perceived barriers and facilitators.

To date, there is a paucity of research investigating nurses' perceptions of evidence-based practice (EBP) in nursing homes, especially in non-Western countries. This descriptive, quantitative study investigated attitudes toward and perceived barriers and facilitators to research utilization among 89 Taiwanese RNs. The majority of nurses expressed positive attitudes toward research and EBP. The most frequently cited barriers were related to insufficient authority to change practice, difficulty understanding statistical analyses, and a perceived isolation from knowledgeable colleagues with whom to discuss the research. EBP facilitators included improved access to computers and Internet facilities in the workplace, more effective research training, and collaboration with academic nurses. These findings are similar to those from research conducted in Western countries and indicate that further education and training in research for nurses working in nursing homes would be beneficial.

Ageing, social capital and the Internet: findings from an exploratory study of Australian 'silver surfers'.

OBJECTIVE: To document the sociodemographic characteristics and online use patterns of older Australian Internet users as part of an exploratory study of the relationship between Internet communication and access to social capital in later life. METHODS: A purposive sample of 154 Internet users aged 55 years or older and not employed full time completed an electronic survey about their social characteristics and patterns of Internet use. A subsample of 30 participated in follow-up in-depth interviews. RESULTS: The majority of participants comprised married, home-owning, English-speaking women and men in good health. They made extensive use of the communication and information functions of the Internet to supplement and enhance their connections with friends and family and their engagement with wider social networks. CONCLUSION: Policy development should be informed by better understanding of the potential and limitations of the Internet as a tool for generating and sustaining social capital in old age.

Dying with dementia: the views of family caregivers about quality of life.

OBJECTIVE: To document the views of family caregivers of persons with dementia about quality of life for their relative during the late and terminal stages of the disease, as part of an exploratory study of best quality care and support. METHODS: Fifteen former caregivers (five wives, five husbands, two sons, three daughters) participated in in-depth semistructured interviews. RESULTS: Participants identified three main sets of indicators of quality of life: the physical body, the physical and social environment and treatment with respect and dignity. The constructs 'quality of life' and 'quality of care' tended to be conflated in the experience of caregivers. An important role for caregivers was to interpret and represent the subjective experience of the person with dementia. CONCLUSION: Quality of life needs to be understood from multiple perspectives. Caregivers' views are a central part of this understanding and should be used to inform future research and service development.

Family care: an exploratory study of experience and expectations among older Chinese immigrants in Australia.

OBJECTIVES: Family caregiving in East Asian cultures is traditionally based on the Confucian ethic of filial piety that mandates total, holistic care for elders. While research suggests changes in 'family care' are occurring in Asian countries themselves, remarkably little is known about immigrant Asian families in Australia. The study aimed to explore the experience of 'family care' among Chinese-speaking older people who have migrated to Australia in later life. METHOD: In-depth interviews were conducted in Cantonese with a convenience sample of five cases, including six older Chinese and analysed inductively for dominant themes. FINDINGS: Although no single model of 'family care' emerged, findings reveal significant departures from the norms of filial piety and an overall 'westernisation' of care practices, both in relation to what families actually do for their parents and what the older people themselves expect. CONCLUSIONS: Transformation of filial culture has implications for policy, service planning and professional practice. It cannot be assumed that elderly Chinese immigrants' needs are being met through traditional family structures.

Postgraduate education in gerontology in the Asia-Oceania region.

This paper provides an overview of opportunities for graduate education in Gerontology in the Asia-Oceania Region. It locates emerging demand in a demographic context, highlighting high rates of growth in the aged population within the Region and growing awareness of governments of the need for appropriate planning. An important component of infrastructure development will be professional access to specialised education about ageing. Of postgraduate programs currently available, most are offered by Australian universities. The trend among providers is towards flexible delivery by distance education using a variety of models, including traditional print-based independent study, cross-national partnerships using block or blended teaching models, and predominantly online education. An innovative model developed by a leading local provider, The University of Sydney, is described. StudyAgeOnline is a Web-supported postgraduate coursework program in ageing and aged care for practising health professionals in which short courses can be undertaken as stand-alone modules or build towards a Masters degree. We describe a typical module and discuss how learning and teaching strategies have been designed for practical relevance in a multi-professional and multi-cultural "virtual classroom."

Doubling the cloak of (in)competence in client/therapist interactions.

Cultural competence is used (often implicitly) to make decisions in human service settings. When therapists make decisions about whether or not a particular service will be offered, they place themselves in a position where their own competence can be judged. Using narrative data on independence and the elderly, we apply Edgerton's idea of the cloak of competence to demonstrate this doubling effect.

Health promotion for socially disadvantaged groups: the case of homeless older men in Australia.

There is extensive evidence that health promotion routinely benefits those who are already most socioeconomically advantaged. While the government's healthy ageing policy recognizes that improving health outcomes will require a range of strategies involving different target groups, recommendations focus on the issues and needs of the comfortable majority. This paper examines the scope and relevance of health promotion for one disadvantaged minority with extensive health needs: homeless older men. In an ethnographic study of older men (> or = 50 years of age) living alone in the inner city (Sydney), 32 men were identified as homeless and are the focus of this paper. Face to face semi-structured interviews were used to record the men's accounts of their everyday lives, including their health and use of services. The conditions in which these men were living were observed and recorded, and the researchers were aware of health and other services available in the geographic area. All informants were living on or below the poverty line. They reported a range of health conditions, for which many accessed available mainstream and specialist health services. Some obstacles to accessing services were noted. Information relevant to widely endorsed prescriptions for 'healthy ageing' also emerged. These included physical activity (especially walking), healthy eating, social activity and adopting healthy lifestyle habits. Findings highlight the extent to which these men lack the basic requirements for healthy ageing, notably adequate incomes and housing. At the same time, within the constraints of the lifestyle they lead, they are motivated to maintain their health and independence. While there are limits to what can be achieved for such people at a local level of service delivery, it is possible to identify feasible health promotion goals and service strategies.

Independence as a practice issue in occupational therapy: the safety clause.

This article reports findings from interviews that explored the meanings occupational therapists attach to independence as a value and a therapeutic goal in interactions with elderly clients. Through a historical review of the literature, we trace the changing use of this term and identify two analytically distinct concepts associated with it: independence as self-reliance in activity and independence as autonomy, self-determination, or choice. We show how the latter has emerged in contemporary service contexts to represent an ideal of client-centered practice for persons with chronic disabilities, such as frail elderly clients. Using a "critical incident" interview approach with 12 Australian occupational therapists, we identified the therapists' explicit and implicit understandings of independence as a value concept and practice issue. Our findings suggest that a mismatch often exists between idealized and practice-based talk about independence and that therapists narrativize this opposition around what we call "the safety clause." That is, therapists invoke concerns about safety and duty of care as a caveat to implementing their independence ideals and justifying the retention of professional control. We identify key issues that therapists need to address if the rhetoric of independence-related client-centered practice is to be achieved in reality.