Search

Background: People with intellectual disabilities living in group homes often have complex health needs, are high health service users and need support from their service provider to access health services. In Australia, little is known about the types and amounts of these supports. Methods: A case study was conducted on a large Western Australian disability provider of group homes to 160 people with intellectual disability. Over an 18‐month period, including during the COVID‐19 pandemic, the study quantified health service use in hospital‐ and community‐based settings, ways by which the person was supported to access health care and the impact on other people supported by the provider. Economic costs of supporting access to health services were estimated. Findings: Overall, the disability provider supported 160 people in accessing health services an average of 23 times each (n = 3617, median = 20, interquartile range = 10–33) over the 18 months. Support included staff attending with the person (96%), following up with guardian/decision‐maker (50%), additional resourcing via overtime or staff backfills (6%) and transport (94%). The average cost of supporting one health visit was estimated at $78.51 AUD (2021). Impact on the person's household included loss of opportunity for housemates (30%), reduced supervision within the home (79%) and longer timeframes to complete care needs (32%). The impact of COVID‐19 restrictions saw a reduction in allied and mental health service use that did not return to prepandemic levels following the cessation of restrictions. Primary care, specialist, outpatient, pathology and emergency service use was also lower in the postrestriction period compared to the prepandemic period. Conclusions: For people living in group homes, the disability provider plays an essential role in supporting health service access, primarily through the provision of support staff and transport. The change in health service utilisation following the COVID‐19 restriction period indicates that altered health system priorities can potentially exacerbate access inequality for people with intellectual disability. Accessible summary: People with intellectual disability frequently need support to go to a health service.Our study looked at how people in group homes receive this support.We found that after COVID‐19 restrictions, people received fewer health services.This is important as we need to make sure that people receive the health services that they need. [ABSTRACT FROM AUTHOR]

Issue Addressed: Outdoor adventure education (OAE) (programs involving outdoor activities such as rock climbing or white‐water canoeing) that participants perceive as risky, conducted in a social support setting, can be utilised by practitioners to elicit changes in educational and psychosocial outcomes to support participant adolescent wellbeing. Methods: This study garnered the opinions of an expert OAE panel on the content of future programs aiming to impact adolescent wellbeing. The panel consisted of local (Western Australia, n = 7), national (Australia, n = 4), and international (Canada, Germany, New Zealand, United Kingdom, United States, n = 7) experts. A two‐round, mixed‐methods Delphi approach was employed. Extensive formative work led to the development of a series of open‐ended questions requiring qualitative responses for round one. Panellists were also asked to respond to 17 statements using Likert scales in the second round. Results: After analysis, a consensus was reached for all statements, with five statements having high consensus and being considered important by panellists. Conclusions: The statement 'Equity for all participants requires flexible delivery and facilitation' had the highest level of agreement amongst panellists. Connections, authentic experiences, and equitable experiences developed as key themes. So What?: Future OAE interventions focused on wellbeing impact could use the findings of this research as a basis for program design. [ABSTRACT FROM AUTHOR]

A hospital‐wide point prevalence study investigated frailty and pain in patients with a cancer‐related admission. Modifiable factors associated with frailty in people with cancer were determined through logistic regression. Forty‐eight patients (19%) with cancer‐related admissions were 2.65 times more likely to be frail and 2.12 more likely to have moderate pain. Frailty and pain were highly prevalent among cancer‐related admissions, reinforcing the need for frailty screening and importance of pain assessment for patients with cancer. [ABSTRACT FROM AUTHOR]

Objective: Dementia affects individuals older than 65 years. Currently, residential aged care facilities (RACF) use psychotropic medications to manage behavioural and neuropsychiatric symptoms of dementia (BPSD), which are recommended for short‐term use and have substantial side effects, including increased mortality. Cannabinoid‐based medicines (CBM) have some benefits that inhibit BPSD and cause minimal adverse effects (AEs), yet limited research has been considered with this population. The study aimed to determine a tolerable CBM dose (3:2 delta‐9‐tetrahydrocannabinol:cannabidiol), and assessed its effect on BPSD, quality of life (QoL) and perceived pain. Methods: An 18‐week randomised, double‐blinded, crossover trial was conducted. Four surveys, collected on seven occasions, were used to measure changes in BPSD, QoL and pain. Qualitative data helped to understand attitudes towards CBM. General linear mixed models were used in the analysis, and the qualitative data were synthesised. Results: Twenty‐one participants (77% female participants, mean age 85) took part in the trial. No significant differences were seen between the placebo and CBM for behaviour, QOL or pain, except a decrease in agitation at the end of treatment in favour of CBM. The qualitative findings suggested improved relaxation and sleep among some individuals. Post hoc estimates on the data collected suggested that 50 cases would draw stronger conclusions on the Neuropsychiatric Inventory. Conclusions: The study design was robust, rigorous and informed by RACF. The medication appeared safe, with minimal AEs experienced with CBM. Further studies incorporating larger samples when considering CBM would allow researchers to investigate the sensitivity of detecting BPSD changes within the complexity of the disease and concomitant with medications. [ABSTRACT FROM AUTHOR]

Aims: To understand nurses' perceptions of volunteer support in health care settings. Background: Increasingly, volunteers provide specialised support to health care service users, requiring volunteers and nurses to work closely together. However, little is known about nurses' perceptions of volunteer support. Methods: A scoping review was conducted following the PRISMA‐ScR checklist. A mixed‐methods convergent integrative approach was taken guided by the JBI framework. Quantitative data were transformed into qualitative data for synthesis and descriptive thematic analysis. Six databases were searched (CINHAL+, EMBASE, PubMed, Scopus, PsycInfo, ProQuest Health and Medical Collection) on 24 January 2022 using terms related to nurses, perceptions, volunteers and care settings, followed by a manual search. The search was limited to English language articles published during 2000–2022. Studies were included if they reported nurses' perceptions of volunteers supporting care within any health care setting. Results: Of the 943 records identified, 12 met the inclusion criteria. All 12 were included in the review following critical appraisal. Five themes were identified: perceived benefits for patients, volunteers providing support for nursing staff, nurses' valuing volunteer support, nurses' understanding of the volunteer role and nurses' understanding of recruitment and training of volunteers. Conclusion: Nurses generally viewed volunteer support positively and perceived that it benefitted patients and assisted nurses. Some nurses raised concerns about the burden of additional supervision of volunteers and lacked knowledge of the volunteer role, recruitment and training. Emerging innovative models of nurse‐led volunteer support can maximise the contribution of volunteers and help overcome barriers to volunteer acceptance. Implications: These findings will inform volunteer policies and provide guidance in developing volunteer support programs. [ABSTRACT FROM AUTHOR]

Issue Addressed: Mental health disorders (MHDs) are prevalent amongst university students with detrimental impacts on individual students, universities and the wider community. There is an urgent need for proactive and preventative strategies to address the mental health crisis in the university population. This study evaluated the efficacy of a 13‐week unit developed to directly educate university students about ways to improve and maintain well‐being. Methods: Fifty‐eight university students from five disciplines participated in a 13‐week elective undergraduate unit "Well‐Being Fundamentals for Success" as part of their degree. The Act Belong Commit mental health promotion campaign framework formed the basis of teaching materials. Outcome well‐being measures were self‐assessed at weeks 1, 6 and 12 using four scales: (1) Warwick‐Edinburgh Mental Well‐being Scale (WEMWBS); (2) Perceived Stress Scale (PSS); (3) Brief Resilience Scale (BRS) and (4) Mindful Attention Awareness Scale (MAAS). Post‐unit group interviews (n = 11) were analysed for key themes. Results: Linear mixed models demonstrated a significant improvement in BRS over the semester; well‐being (WEMBS) and mindful attention (MAAS) did increase but not significantly. There was a significant increase in stress (PSS) over the semester. Key themes that emerged from the group interviews were that (1) University life contributes to well‐being; (2) University life contributes to stress; (3) The well‐being unit helped students see and do things differently; (4) An overall endorsement of the unit. Conclusion: University students' resilience increased over the semester following participation in a curriculum focused on well‐being which featured a combination of theoretical content and experiential workshops. So what? Incorporating mental well‐being curriculum into tertiary education is proactive preventive health strategy which may assist with the increasing prevalence of MHD in Australia. [ABSTRACT FROM AUTHOR]

Objective: To investigate factors contributing to the decision for a working age adult experiencing non‐specific low back pain (NSLBP) to seek care at an Australian metropolitan tertiary ED. Methods: Participants triaged with NSLBP were recruited from one metropolitan tertiary Australian ED. We employed a qualitative descriptive methodology using semi‐structured interviews to collect data. The short‐form Orebro musculoskeletal pain screening questionnaire was administered pre‐interview and used to inform discussion of psychosocial factors in the interview. Results: Patient perception and interpretation of their low back pain symptoms was the most important participant decision‐making factor. This was part of the care‐seeking decision for all participants. Convenience of care accessed in the ED was also important with many participants aiming to avoid multiple appointments in primary care settings while in pain or attending ED because it was close to home. Participants expected high‐quality care in the ED and often did not identify an alternative in primary care they believed could provide an equivalent standard of care. Few participants were advised to attend ED by a GP or physiotherapist, but when given, this advice was a critical factor. Conclusions: Patient beliefs about NSLBP are important drivers of ED care seeking. Evidence‐based guidelines recommend screening for red flags and then addressing pain and disability through engagement with patient concerns and providing a management plan/pathway. In the ED setting, addressing the anxieties of these patients and re‐interpreting the significance of their pain may be a path to providing time efficient high‐value care. [ABSTRACT FROM AUTHOR]

Background: Adults with intellectual disability experience high rates of falls making falls prevention an important health need. The purpose of the study was to seek perspectives of older adults with intellectual disability and their caregivers to (a) explore the experiences of older adults with intellectual disability when seeking healthcare services after a fall and (b) identify enablers and barriers when taking up evidence‐based falls recommendations. Method: A qualitative exploratory study was undertaken as part of a prospective observational cohort study. Semi‐structured interviews were conducted with a purposeful sample. Data were analysed thematically using Colaizzi's method. Results: Seventeen interviews were conducted (n = 21). Emergent themes demonstrated that participants had limited knowledge about falls prevention. Enablers included individualizing falls prevention strategies. Barriers included not being offered access to established falls prevention pathways. Conclusion: There is an urgent need to develop high‐quality falls prevention services for older adults with intellectual disability. [ABSTRACT FROM AUTHOR]

Background: Health services in Tasmania, Victoria and now Western Australia are changing to goals‐of‐care (GOC) advance care planning (ACP) documentation strategies. Aim: To compare the clinical impact of two different health department‐sanctioned ACP documentation strategies. Methods: A non‐blinded, pre–post, controlled study over two corresponding 6‐month periods in 2016 and 2017 comparing the current discretional not‐for‐resuscitation (NFR) with a new, inclusive GOC strategy in two medical/oncology wards at a large private hospital. Main outcomes were the uptake of ACP forms per hospitalisation and the timing between hospital admission, ACP form completion and in‐patient death. Secondary outcomes included utilisation of the rapid response team (RRT), palliative and critical care services. Results: In total, 650 NFR and 653 GOC patients underwent 1885 admissions (mean Charlson Comorbidity Index = 3.7). GOC patients had a higher uptake of ACP documentation (346 vs 150 ACP forms per 1000 admissions, P < 0.0001) and a higher proportion of ACP forms completed within the first 48 h of admission (58 vs 39%, P = 0.0002) but a higher incidence of altering the initial ACP level of care (P = 0.003). All other measures, including ACP documentation within 48 h of death (P = 0.50), activation of RRT (P = 0.73) and admission to critical (P = 0.62) or palliative (P = 0.81) care services, remained similar. GOC documentation was often incomplete, with most sub‐sections left blank between 74 and 87% of occasions. Conclusion: Despite an increased uptake of the GOC form, overall use remained low, written completion was poor, and most quantitative outcomes remained statistically unchanged. Further research is required before a wider GOC implementation can be supported in Australia's healthcare systems. [ABSTRACT FROM AUTHOR]

Accessible Summary: People with intellectual disability do not often take part in research. When people with intellectual disability are thinking about taking part in research, it is important that they are given support to participate in the decision‐making. This study describes how an informed consent process was developed for people with intellectual disability and how it is working in a current study. Abstract: Background: People with intellectual disability encounter substantial healthcare discrepancies, yet are under‐represented in research. While people with intellectual disability can make valuable contributions to research and consequently improve their quality of life, researchers encounter multiple challenges including them in research. One challenge is to support them in making an informed decision to participate in research. Therefore, the aim of this study was to describe and reflect on a consent procedure used while gaining informed consent, when recruiting potential participants into an ongoing study. Methods: A systematic and holistic consent procedure, underpinned by ethical guidelines, was developed and used alongside recommended strategies to engage people with intellectual disability in a research study. Results: Only three participants (7.5%) were deemed capable of consenting independently, while 37 participants (92.5%) required the support of a proxy. Of these 37 participants, 22 participated in the consent process, while 15 depended mainly on their caregiver to make decisions for them. Adapted communication strategies were found to facilitate a person who has an intellectual disability's participation in the consent procedure. The adapted written information sheets were of secondary importance. Conclusion: The consent procedure was a respectful means of determining a person's capacity to consent and indicating where there was a need for proxy consent. Appropriate communication strategies and the inclusion of familiar caregiver(s) were critical components for facilitating the person with an intellectual disability to participate in the consent procedure. [ABSTRACT FROM AUTHOR]

Objective: To determine patient satisfaction and experience after robot‐assisted radical prostatectomy (RARP) for prostate cancer, using a convergent mixed‐method qualitative analysis approach. Patients and Methods: 412 patients who underwent RARP between January 2014 and June 2016 were mailed questionnaires and invited to participate in focus groups. Qualitative data was thematically analysed using NVivo. Descriptive statistics were obtained from the questionnaire using SPSS. Results: 214 patients responded (52% of sample size) of whom 97.6% were satisfied and 91.1% would likely recommend RARP. Key themes from the qualitative data highlighted the psychosocial impacts of the diagnosis and RARP process. The importance of early recovery, the benefits of pelvic floor exercises and educational resources were emphasised. Conclusion: Patients were overwhelmingly satisfied with RARP, largely due to relevance and timeliness of the information and support provided both before and after surgery. With an increased understanding of the factors and outcomes that are most important to patients regarding all aspects of hospital care, we can create more targeted care pathways. Key themes will help inform the implementation of an enhanced recovery after surgery (ERAS) protocol to further improve recovery and early return to function. [ABSTRACT FROM AUTHOR]

Objective To determine applicability of environment assessment tools in guiding minor refurbishments of Australian residential aged care facilities. Method Studies conducted in residential aged care settings using assessment tools which address the physical environment were eligible for inclusion in a systematic review. Given these studies are limited, tools which have not yet been utilised in research settings were also included. Tools were analysed using a critical appraisal screen. Results Forty-three publications met the inclusion criteria. Ten environment assessment tools were identified, of which four addressed all seven minor refurbishment domains of lighting, colour and contrast, sound, flooring, furniture, signage and way finding. Only one had undergone reliability and validity testing. Conclusion There are four tools which may be suitable to use for minor refurbishment of Australian residential aged care facilities. Data on their reliability, validity and quality are limited. [ABSTRACT FROM AUTHOR]

Falls among older people are a significant global socioeconomic problem, and older adults have low levels of self-perceived risk and a lack of willingness to take up existing falls prevention strategies. We believe that given the challenges of delivering falls prevention information, meaningful engagement of community members would create solutions based on an understanding of what would work best for that community. A World Cafe community forum sought the opinions of 70 community-dwelling older people about their preferences on how they would best receive and seek falls prevention information that could prevent falls within their age group. Participants evaluated the café as a highly positive experience and felt that learning occurred by way of interaction and 'sharing of ideas.' Local communities could develop this participatory approach to engage older people in leading the translation of falls prevention evidence into practice. [ABSTRACT FROM AUTHOR]

bulsara c., ward a. & joske d. (2004) Journal of Clinical Nursing 13, 251–258 Haematological cancer patients: achieving a sense of empowerment by use of strategies to control illness The role that empowerment plays through involving haematological cancer patients and their families in their treatment and care is undeniable. It encompasses the implementation of various strategies to achieve a sense of empowerment. This phenomenological study sought to identify core strategies used by cancer patients regardless of their illness stage and prognosis who exhibited a strong sense of empowerment in coping with their condition. A phenomenological approach using an in depth interviewing technique was used to identify the common factors which patients and spouses believed could enable them to achieve a measure of control in managing their illness. These measures were referred to as coping strategies. It was decided to conduct a purposive study and re-interview seven of 12 patients who had previously participated in a pilot Haematology Shared Care project and who had developed a high level of ability in coping with their illness. At the patient's discretion, spouses were invited to participate and to contribute to the interview. Three spouses participated in the interviewing process. Common strategies emerged regardless of the patient's stage of illness and prognosis. Informants identified the determination to remain in control of the illness and treatment side effects, having the support of family and significant others, illness acceptance and maintaining hope as crucial to their sense of empowerment. It is hoped that clinicians will gain a deeper understanding of the varied and numerous strategies used by cancer patients in coping with their illness. This understanding will ensure that by encouraging these strategies, patients and their families will be supported by health professionals to achieve a greater sense of empowerment. As this and other studies have shown, working alongside health professionals contributes to empowerment for both the cancer patient and significant others in their lives. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusions To determine ED clinician's current management for five common minor self‐limiting fractures (MSLF) and evaluate practice against evidence‐informed direct discharge pathway (DD) protocols.A survey was provided to doctors, nurse practitioners and advanced scope physiotherapists working in seven metropolitan, public health EDs in Perth, Australia. The relative odds of ED location (e.g. which facility) and clinician level factors (e.g. country of initial training, years of ED experience, profession) on recommending care completely consistent with evidence informed direct discharge pathway protocols were estimated.Two hundred sixty‐two clinicians completed the survey. There was variability in practice across all sites, with most reported care assessed at 60%–76% consistency with individual elements of DD care provision. Highest consistency was seen in lower limb immobilisation and DVT prophylaxis. Lowest consistency was seen in weight bearing advice, pain management and (boxer's) fracture reduction and immobilisation. There were very low levels of complete consistency, ranging from 9% (boxer's fracture) to 25% (radial head fracture). Two factors were associated with increased odds of completely consistent care: (i) clinician experience working in ED, with greater duration of practice associated with increased odds ratios (OR range, 1.6–3.3); and (ii) profession, where advanced scope physiotherapy was associated with increased odds ratios (OR range, 3.2–25.0).Survey results suggested system wide variation in ED fracture management practice and target areas for service improvement. Avenues for service improvement could include hospital wide agreed management plans for specific fractures and support for less experienced clinicians. [ABSTRACT FROM AUTHOR]

The author discusses a survey of self medication practices of older patients in Western Australia, with particular focus on their preferences to receive medication information and advice from pharmacists rather than general practitioners (GPs). The increasing importance of pharmacists in ensuring medication safety, patient compliance, and continuity of care in the elderly population is noted.

A letter to the editor is presented in response to the article "The quality of medication information in Australia: the need for more clinical expertise and accountability," by J. R. Stockigt in the February 2009 issue.