Accessing care summaries at point-of-care: Implementation of mobile devices for personal carers in aged care.

Continued development of mobile technology now allows access to information at the point-of-care. This study was conducted to evaluate the use of one such tool on a mobile device, from the carer perspective. Caregivers across 12 aged-care facilities were supplied mobile devices to access a Picture Care Plan (PCP), a specific tool designed around the role of the personal carer. An anonymous questionnaire was subsequently completed by 85 carers with questions relating to participants' experience. Perceived helpfulness of the PCP at the point-of-care was high (87%). A significant number of participants believed the use of the PCP increased resident safety and quality of care (76%). Practical components related to the carrying of the device, network speed and the requirement to maintain communication with senior members of staff to ascertain updates were also expressed by participants. Findings suggest that staff are receptive to adoption of mobile devices to access care directives at the point-of-care and that the technology is useful.

The impact of care practices and health demographics on the prevalence of skin tears and pressure injuries in aged care.

AIMS AND OBJECTIVES: To determine whether differences in care practices and demographics between two long-term aged care facilities affected the incidence of residents' skin wounds. METHODS: A retrospective analysis of care plans and clinical outcomes was conducted for a 6-month period in 2016 at two aged care facilities, N = 39 Home 1 and N = 45 Home 2. Skin tears, pressure injuries and usual care practices and associated health demographics were recorded. RESULTS: Over the 6-month period, 84 residents were found to have a total of 206 aged care acquired skin wounds (skin tears, pressure injuries, haematomas, rashes, infections). The frequency of skin tears or total wounds did not differ between the homes. Several factors were identified that influenced the skin wounds. A reduction in skin tears was associated with the use of heel protectors and antiembolic stockings, whilst a diagnosis of vascular dementia was associated with increased prevalence of skin wounds. Pressure injuries were significantly higher at Home 2. Increased use of strategies to moderate-risk activities, such as tray tables and bed rails, and impaired cognitive function were associated with higher pressure injury prevalence. CONCLUSION: A number of care factors and health demographics influenced the rate of skin wounds. A holistic approach to skin management is needed. RELEVANCE TO CLINICAL PRACTICE: Practices, such as repositioning and skin hygiene, are well known to reduce the incidence of pressure injuries and skin tears; however, there are other care practices that take place in homes as part of usual care that also impact skin wounds that have been largely ignored. This study highlights those care practices, as well as resident characteristics and comorbidities that may increase the risk of skin wounds, requiring further monitoring/mitigating strategies.

The impact of therapeutic massage on adult residents living with complex and high level disabilities: A brief report.

BACKGROUND: Research into the effects of touch in disabled adults in residential care remains largely unexplored in the current literature. Evidence suggests however, that massage therapy may improve mood state, including anxiety and stress, reduce pain and improve sleep/wake behavior and fatigue. These benefits are of importance as they have substantial impact on quality of life. PURPOSE: This pilot study evaluated the effect of therapeutic massage on the quality of life of adults with complex care needs living in residential care. METHODS: Participants were recruited from three residential homes (Queensland, Australia) for 18-65 year olds with severe disability. 25 participants were recruited and received a massage program consisting of five weeks of twice weekly massages. Structured interviews were conducted pre-post intervention. Additionally, mood was ascertained preceding and following each massage session. RESULTS: Mood of participants improved markedly immediately following massage session (p < 0.05) and pre-massage mood was observed to increase over the study period. However, pre- and post-intervention measures indicated massage did not improve pain, sleepiness, depression or stress levels or sustain positive mood three days post-intervention. Participants' satisfaction with their current health significantly improved (Z = -2.51, p = 0.012), as did their satisfaction with their current happiness (Z = -2.06, p = 0.04), suggesting that massage therapy offered some improvement in quality of life. CONCLUSIONS: The results of this pilot indicates that massage may be of benefit to people living with high care needs and represents a practical innovation providing tactile stimulation that may be integrated into care.

Supporting Staff to Identify Residents in Pain: A Controlled Pretest-Posttest Study in Residential Aged Care.

Practical strategies are needed to improve pain awareness among aged care staff and promote a systematic approach to pain identification using evidence-based tools. The purpose of this study was to evaluate a pain identification tool for use by nursing and nonprofessional staff in residential aged care facilities (RACFs). A controlled pretest-posttest intervention design was conducted in two RACFs in Brisbane, Australia. Completed surveys were returned by 216 staff and 74 residents at baseline and 218 staff and 94 residents at 3-month follow-up. Chart audits were conducted on 308 residents at baseline and 328 at follow-up. Groups were compared on: (1) staff knowledge and attitudes regarding pain, perceived confidence and skills for pain assessment, and perceived quality of pain management; (2) frequency of pain assessments and use of pain interventions; and (3) residents' perceptions of the quality of pain management. Both groups had high knowledge scores and reported high levels of confidence, skills, and perceived quality of pain management at baseline and follow-up. The intervention group showed significant improvement in routine pain assessment and use of nonpharmacological pain interventions. However, due to unexpected changes in control group conditions, both groups increased episodic pain assessment. Overall, staff believed the intervention was clinically useful and fostered a team approach to pain assessment. We found the introduction of pain identification resources with implementation strategies to support frontline staff was partially effective in improving staff and resident outcomes. Nonetheless, our findings confirm the need for change and importance of translational pain research in RACFs.

Longitudinal changes in quality of life and related psychosocial variables in australians with multiple sclerosis.

This study explored changes in quality of life (QOL) and psychosocial variables in a large cohort of people with multiple sclerosis (MS). A total of 1287 Australians with MS were administered self-report questionnaires at baseline and 24 months later to examine the impact of disease severity and duration, perceived stress, self-efficacy, depression, and social support on QOL and self-care. Over the 2-year survey period, MS remained stable for 70% of respondents. Disease severity correlated with social support at baseline but not at 24 months, when the only significant correlation with disease severity was that of the World Health Organization Quality of Life-100 instrument (WHOQOL-100) domain of Level of Independence. Although QOL improved across the WHOQOL-100 domains Physical, Psychological, Level of Independence, Social Relationships, and Environment, decreases were found in the WHOQOL-100 facet overall QOL and well-being as well as self-efficacy over the same time period. Hierarchical multiple regression was used to assess the utility of four control measures. MS disease severity and MS disease duration were entered at Step 1, explaining 16.1% of the variance in QOL. After entry of perceived stress, self-efficacy, social support, and the Depression, Anxiety and Stress Scale-21 (DASS-21) at Step 2, the total variance explained by the model as a whole was 55.8% (F6,1028 = 216.495, P < .001). Thus, even in the presence of stable disease and improvement in some WHOQOL-100 domains, overall QOL and self-efficacy had decreased at 2 years after the collection of baseline data. Loss of self-efficacy, increased stress, and depression are key factors in reduced QOL in people with MS.

Hidden yet visible: methodological challenges researching sexual health in Sudanese refugee communities.

Research addressing sensitive topics with people from small, minority, ethnic communities can present challenges that are difficult to address using conventional methods. This paper reports on the methodological approach used to explore sexual health knowledge, attitudes and beliefs among the Sudanese community in Queensland, Australia. The multiphase, mixed-method study involved young people 16 to 24 years of age participating in a written survey and semi-structured interview and focus-group discussions with the broader Queensland Sudanese community members. Community collaboration, the key factor to the success of this research, optimised the development of a research environment that built trust and facilitated access and subsequent understanding. Research conducted in partnership with the target community can address methodological challenges and produce meaningful information when researching sensitive topics with small but 'highly-visible' populations.

Effects of motivational interviewing intervention on self-management, psychological and glycemic outcomes in type 2 diabetes: a randomized controlled trial.

BACKGROUND: Type 2 diabetes is a serious and growing problem in Taiwan where it is the fifth leading cause of death, and health care costs are 4.3 times higher than for people without diabetes. OBJECTIVES: The purpose of this study was to determine whether participation in a motivational interview for people with type 2 diabetes would improve their self-management, psychological and glycemic outcomes. DESIGN: A randomized controlled trial to assess the effects of the motivational interviewing intervention. SETTINGS: Participants were drawn from the diabetes outpatient clinic of a large teaching hospital in South Taiwan. PARTICIPANTS: A sample of 250 type 2 diabetes people. METHODS: Type 2 diabetes people were randomly allocated into either the motivational interview group or the usual care group from baseline to 3 months follow-up. The intervention was based on motivational interviewing which encompassed a variety of interviewing techniques, and reflected each person's readiness stage to change. The control group was provided with usual care by nursing staff. RESULTS: A total of 250 type 2 diabetic participants were randomized. The retention rate in the intervention group was 83% (n=104). The motivational interview did improve participants significantly in self-management, self-efficacy, quality of life, and HbA1c among diabetes people with appropriate baseline value (<121.24, <174.57, <107.18, and >7.62, respectively) but not in depression, anxiety and stress (F=0.13, p=0.72) compared to the control group at 3 months follow-up. CONCLUSION: The findings provided important evidence concerning the positive effect of motivational interventions in self-management, psychological and glycemic outcomes. This research provided evidence for future clinical practices in diabetes care.

Exploration of the family's role and strengths after a young woman is diagnosed with breast cancer: views of women and their families.

PURPOSE: This exploratory descriptive study examined the role and strengths of the family when supporting the younger woman (<50 years) after a diagnosis of breast cancer. The perspectives of women and family members were sought. METHOD: Participants were recruited from oncology outpatient units in Australia. Semi-structured interviews guided by the Family Resiliency Framework were undertaken with 14 young women with breast cancer and 11 family members who reflected on the roles of family. Transcripts were analysed individually and in family groupings. RESULTS: Women with breast cancer and their family members experienced a range of emotions during the treatment period. Roles within the family changed as members responded to their circumstances. Analysis of interview transcripts identified the following primary themes; 'just being there', 'paradox of help' and 'buffer from society'. A secondary theme related to support, specifically 'the changing role of support for family members', highlighting the strengths and experiences of family. CONCLUSION: Recognition needs to be given to the complexity of changing roles experienced by young women with breast cancer and their families. Young women with breast cancer require unique forms of support because of the nature of their experience. Family roles were shaped through a shared sense of commitment and open communication amongst members. Families may demonstrate a range of strengths but are also vulnerable during this stressful period. Health professionals need to be aware of the possible needs of families, assess their adaptation to changing circumstances, and intervene through the provision of information, and counselling to enhance coping.

Nursing education: a case study of a Bachelor of Science Nursing programme in Abu Dhabi, United Arab Emirates.

AIM: The aim of the present study was to report the process and outcomes of a collaborative venture to offer a Bachelor of Science Nursing programme in Abu Dhabi. BACKGROUND: An international educational collaboration between the Abu Dhabi government in the United Arab Emirates (UAE) and Griffith University (GU) Australia, successfully established a College of Health Sciences offering a Bachelor of Science Nursing (pre- and post-registration). METHODS: The report was written to reflect the chronological order of events as the Bachelor of Science Nursing programme was rolled out in Abu Dhabi commencing in 2007. RESULTS: The results of this initiative included the successful delivery of the programme and the gaining of initial accreditation in Abu Dhabi. CONCLUSION: The paper presents important insights into the collaborative nature of the agreement and the unique outcomes; dual awards from UAE and Australia. IMPLICATIONS FOR NURSING MANAGEMENT: The success of this initiative required ongoing commitment from the collaborating partners. The programme required ongoing support from the School of Nursing and Midwifery in Australia. Griffith University provided the Head of School and Deputy Head of School for Abu Dhabi and the curriculum. The academic and administrative support from Australia was significant and must be incorporated into any business plan when planning such a venture.

The multiple sclerosis work difficulties questionnaire.

BACKGROUND: A better understanding of the workplace difficulties experienced by people with multiple sclerosis (PwMS) may be critical to developing appropriate vocational and rehabilitative programs. OBJECTIVE: We aimed to assess the factor structure, internal consistency and validity of the new Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ). METHODS: Work difficulty items were developed and reviewed by a panel of experts. Using the MSWDQ, cross-sectional self-report data of work difficulties were obtained in addition to employment status and MS disease information, in a community-based sample of 189 PwMS. RESULTS: Exploratory Maximum Likelihood Factor Analysis on the draft questionnaire yielded 50 items measuring 12 factors. Subscale internal consistencies ranged from 0.74 to 0.92, indicating adequate to excellent internal consistency reliability. The MSWDQ explained 40% of the variance in reduced work hours since diagnosis, 40% of the variance in expectations about withdrawing from work, 34% of the variance in expectations about reducing work hours, and 39% of the variance in expectations about changing type of work due to MS. CONCLUSION: The MSWDQ is a valid and internally reliable measure of workplace difficulties in PwMS. Physical difficulties, as well as cognitive and psychological difficulties were important predictors of workplace outcomes and expectations about future employment.

Nurse-led telephone interventions for people with cardiac disease: a review of the research literature.

BACKGROUND: Nurse-led telephone follow-up offers a relatively inexpensive method of delivering education and support for assisting recovery in the early discharge period; however, its efficacy is yet to be determined. AIM: To perform a critical integrative review of the research literature addressing the effectiveness of nurse-led telephone interventions for people with coronary heart disease (CHD). METHODS: A literature search of five health care databases; Sciencedirect, Cumulative Index to Nursing and Allied Health Literature, Pubmed, Proquest and Medline to identify journal articles between 1980 and 2009. People with cardiac disease were considered for inclusion in this review. The search yielded 128 papers, of which 24 met the inclusion criteria. RESULTS: A total of 8330 participants from 24 studies were included in the final review. Seven studies demonstrated statistically significant differences in all outcomes measured, used two group experimental research design and valid and reliable instruments. Some positive effects were detected in eight studies in regards to nurse-led telephone interventions for people with cardiac disease and no differences were detected in nine studies. DISCUSSION: Studies with some positive effects generally had stronger research designs, large samples, used valid and reliable instruments and extensive nurse-led educative interventions. CONCLUSION: The results suggest that people with cardiac disease showed some benefits from nurse-led/delivered telephone interventions. More rigorous research into this area is needed.

Illness and demographic correlates of chronic pain among a community-based sample of people with multiple sclerosis.

OBJECTIVE: To investigate the prevalence, nature, and correlates of pain among a community-based sample with multiple sclerosis (MS). DESIGN: A cross-sectional survey and structured pain interview. SETTING: Community. PARTICIPANTS: People with MS (N=219) recruited through systematic sampling from a randomly ordered MS society membership database. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Pain presence or absence, pain intensity (numeric rating scales), pain quality (McGill Pain Questionnaire), pain location(s) and extent (pain drawing), pain duration and frequency, provoking and relieving pain factors, and pain management techniques. RESULTS: Pain was common with some 67.1% of the sample reporting pain during the 2 weeks preceding the study. Comprehensive pain assessment revealed that a substantial subset of these subjects experience chronic pain conditions characterized by moderate-to-severe pain intensity. Among those with pain, 75% reported pain in 3 or more locations, with participants reporting an average of 4.0+/-1.8 distinct pain sites. Women and people with more severe MS-related disability were significantly more likely to report both the presence of pain and greater pain intensity. In contrast, being in a married or in a de facto relationship and longer time since MS diagnosis were significantly associated with lower pain intensity. CONCLUSIONS: Given the high prevalence and nature of pain experienced by people with MS, health care providers need to approach pain with a priority similar to that given to other MS-related problems such as mobility and functional independence. Women and people with more severe MS-related disability appear to be at particular risk for significant pain problems and therefore these groups warrant particular attention, such that routine clinical assessment should trigger routine pain assessment.

Biopsychosocial correlates of adjustment to pain among people with multiple sclerosis.

OBJECTIVES: The objective of this study was to examine the extent to which pain-related beliefs and coping strategies predicted measures of adjustment to pain among people with multiple sclerosis (MS), over and above that accomplished by demographic and clinical variables. METHODS: Participants were a community-based sample of people with chronic MS-related pain (N=105) who completed postal surveys and standardized interviews that included measures of demographic and MS-related variables, typical pain intensity, psychologic functioning, pain interference, pain beliefs, and coping strategies. RESULTS: Pain-specific beliefs and coping strategies were associated with and explained a significant proportion of the variance in adjustment to pain (24% to 34%) among people with MS, over and above that accomplished by demographic and disease-related variables and pain intensity. Compatible with previous studies, greater endorsement of pain constancy and catastrophizing were significant predictors of poorer adjustment, whereas perceived ability to decrease pain and increasing behavioral activities in response to pain were related to positive adaptation. DISCUSSION: These findings provide support for the premise that psychosocial factors remain central in disability-related pain and suggest the possibility that interventions targeting these variables would reduce the negative impact of pain among people with MS.

Understanding chronic pain complicating disability: finding meaning through focus group methodology.

Although extensive literature exists on the experiences of people living with chronic nonmalignant pain as a primary condition, little is known about the phenomenon of pain as it is experienced by the person with a chronic disabling condition. This focus group study explored the experience of disability-related pain among 32 people with multiple sclerosis (MS) living in the community. Thematic analysis of transcripts revealed 4 broad conceptualizations of the experience of living with chronic MS-related pain. The first theme, pain is pervasive, described the overwhelming and intrusive presence of pain in daily life. Participants related the physical, emotional, and social consequences of living with chronic, disability-related pain, which caused them great loss and restriction. The second theme resonated around feelings that nobody understands. The participants sought understanding and validation of their pain experiences by family, friends, and healthcare professionals and struggled with difficult issues concerning the legitimacy and invisibility of their pain. The third theme, I'm fine, referred to the propensity of participants to keep pain private from others. In part because of its contested nature, participants at times concealed their pain from others to avoid conflict and maintain some semblance of their former lives. The final theme that emerged was always a factor in the equation. The participants shared how MS had transformed their worlds into ones in which pain and discomfort had become a normal part of everyday life, requiring careful negotiation and planning to undertake activities and prevent exacerbation. It is vital that healthcare providers give people with MS opportunities to talk about pain and pain-related concerns, validate their experiences, and provide interventions that enable self-management. Clinicians are encouraged to challenge their own meanings and expectations about disability-related pain so that therapeutic interventions can be facilitated.

Finding your voice: key elements to consider when writing for publication.

The dissemination of nursing knowledge rests on optimizing the accessibility of such knowledge among nurses and all other healthcare professionals. Nursing publications of all types, including research, case studies, reports, literature reviews, clinical audits, reflections on practice and letters to the editor, are important mechanisms for sharing knowledge and experience. Nurses need to publish their knowledge and experiences to inform and reflect on nursing practice. Barriers to writing for publication include inexperience and lack of know how. This article provides guidance for the novice writer.

Supportive and palliative care needs identified by multiple sclerosis patients and their families.

AIM: To identify the supportive needs of individuals with multiple sclerosis (MS) and their families. DESIGN, SAMPLE AND METHOD: In-depth interviews were carried out with people living with MS in the community, their family members and health professionals. The data were transcribed verbatim and recurring themes identified. FINDINGS: The analysis of interviews revealed four themes: disbelief and devastation; losses and forced life choices; tracking down services and information; and sadness and relief. CONCLUSION: Given the duration, range of symptoms and distress often associated with MS, the findings of this research raise the important question of the role of palliative services in supporting the person with MS and his/her family.

Multiple sclerosis and continence issues: an exploratory study.

The study described in this article aimed to identify issues relating to incontinence and assess the impact of referral to a continence adviser on the lives of people with multiple sclerosis (MS). The study design used an in-depth, two-phase anonymous mail survey within a general community as nominated by the participants. Fifty-six people participated in phase 1 and eleven people completed phase 2. The results indicated that incontinence is a problem for the vast majority of participants--people with MS. One-third of the eligible participants took up the option of a consultation, assessment and treatment from a continence nurse. Reasons for not taking up the visit from the continence nurse included 'managing OK', 'didn't think it would help', 'embarrassed' and 'too busy'. Increasing awareness of urinary incontinence in the community is important and education needs to focus on at-risk groups in presenting the range of options available to assist people experiencing incontinence.

Teaching people with Parkinson's disease about their medication.

PD is a progressive neurodegenerative disorder affecting an estimated 78,000 Australians. Predominantly it affects older people, although or younger. Medications to treat PD are aimed at controlling symptoms as there is no known cure. A regime of PD medications may involve taking doses at frequent intervals and adverse reactions are common. Education of the person with PD, their close carers and family that covers medications, observational techniques and dealing with side effects, along with unpredictable worsening of PD symptoms, may result in improvement in quality of life. When the person with PD has realistic expectations about PD drug therapy then the ability to cope with the physical disability caused by symptoms may be improved. It is important to educate about any possible interaction with commonly taken drugs including dietary supplements and over-the-counter medication. Before a medication education session, nurse activities should include assessment of the person with PD and their support network, development of an appropriate education plan and subsequent implementation, followed by evaluation. Ongoing nursing support at each clinic visit can provide opportunity for evaluation. An individualised session guided by the principles of adult learning theory may provide a successful tool for use in the education of people with PD as well as healthcare professionals. A large amount of available information and untested educational material does not address the educational needs of people with PD with regard to their medications. There is a need for further research in this area. The effectiveness of a one-on-one educational session about PD medication supported by printed, individualised PD medication information may provide more appropriate education and lead to improved quality of life. It is the focus of a planned research study.

The impact of very premature birth on the psychological health of mothers.

BACKGROUND: The birth of a very premature infant is a critical event in the life of a family and studies have shown that mothers of these infants are at greater risk of psychological distress than mothers of full-term infants. STUDY DESIGN: A total population study of mothers of preterm infants born at less than 32-week gestation at a tertiary referral hospital. SUBJECTS AND METHODS: Sixty-two mothers of very preterm infants (<32 weeks) participated in the present study which examines correlates of maternal depressive symptomatology at 1 month following very premature birth. Information was obtained from structured questionnaires completed by mothers at 1 month after infant admission to neonatal intensive care. RESULTS: Forty percent of the mothers reported significant depressive symptoms on the Edinburgh Postpartum Depression Scale (EPDS). Logistic regression analysis indicated that high maternal stress resulted in an increased likelihood of depressive symptoms (OR 1.15, CI 1.04-1.26, p<0.01). Higher levels of maternal education (p<0.05), and increased perception of support from nursing staff (OR 1.06, CI 0.88-1.00, p<0.05) resulted in decreased likelihood of depressive symptoms. CONCLUSIONS: The birth and subsequent hospitalisation of a very premature infant evokes considerable psychological distress in mothers. These results have implications for policy development in order to enhance family centred care in the neonatal intensive care.