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Background: With the introduction of consumer‐directed care in the Australian community aged care sector, there are more opportunities for occupational therapists to provide evidence‐based services that meet consumer needs. There is also an increasing requirement for health professionals to promote their interventions to consumers. Particularly for the implementation of new programs within organisations. However, occupational therapists have historically neglected widely promoting the role of occupational therapy services for older people. This study examines the perceptions of occupational therapists and their managers in promoting their service; the Care of People in their Environment (COPE) Program. Methods: This study utilised a qualitative interpretative description; including 28 in‐depth interviews. Purposeful sampling ensured a variety of occupational therapists from different health contexts. Thematic analysis captured key emergent themes related to promoting occupational therapy interventions and implementation. Results: Many occupational therapists were apprehensive about promoting or selling their services and interventions. Greater levels of confidence in promoting the program were present when the program aligned with traditional models of service delivery and organisational processes. Occupational therapists described having limited opportunity to directly promote the program to consumers as community case managers were mostly the main contact at the organisation. There was limited consideration of promotion strategies and therefore limited enactment of strategies by organisations. Not‐for‐profit and non‐government organisations recognise that the changed community aged care market provided new business opportunities. Conclusion: With changes in the Australian aged care system, occupational therapy has great opportunity to provide diverse, evidence‐based interventions driven by the needs of consumers. Reframing the notion of 'selling', to empowering consumers to be more informed about their options, will allow occupational therapists to build confidence in their promotional skills. Promoting evidence‐based programs will have positive outcomes for the visibility, professional identity and recognition of occupational therapy. [ABSTRACT FROM AUTHOR]

Aims and objectives To establish validity of a clinical leadership framework for aged care middle managers (The Aged care Clinical Leadership Qualities Framework). Background Middle managers in aged care have responsibility not only for organisational governance also and operational management but also quality service delivery. There is a need to better define clinical leadership abilities in aged care middle managers, in order to optimise their positional authority to lead others to achieve quality outcomes. Design A Delphi method. Methods Sixty-nine experts in aged care were recruited, representing rural, remote and metropolitan community and residential aged care settings. Panellists were asked to rate the proposed framework in terms of the relevance and importance of each leadership quality using four-point Likert scales, and to provide comments. Three rounds of consultation were conducted. The number and corresponding percentage of the relevance and importance rating for each quality was calculated for each consultation round, as well as mean scores. Consensus was determined to be reached when a percentage score reached 70% or greater. Results Twenty-three panellists completed all three rounds of consultation. Following the three rounds of consultation, the acceptability and face validity of the framework was confirmed. Conclusions The study confirmed the framework as useful in identifying leadership requirements for middle managers in Australian aged care settings. The framework is the first validated framework of clinical leadership attributes for middle managers in aged care and offers an initial step forward in clarifying the aged care middle manager role. Relevance to clinical practice The framework provides clarity in the breadth of role expectations for the middle managers and can be used to inform an aged care specific leadership program development, individuals' and organisations' performance and development processes; and policy and guidelines about the types of activities required of middle managers in aged care. [ABSTRACT FROM AUTHOR]

Abstract: Background: Dementia care mapping and person centred care are well-accepted as processes for improving care and well-being for persons with dementia living in the residential setting. However, the impact of dementia care mapping and person centred care on staff has not been well researched. Objectives: The impact of person centred care and dementia care mapping compared to each other and to usual dementia care on staff outcomes was examined in terms of staff burnout, general well-being, attitudes and reactions towards resident behavioural disturbances, perceived managerial support, and quality of care interactions. Design: A cluster-randomised, controlled trial. Settings: The study was conducted between 2005 and 2007 in 15 residential aged care sites in the Sydney metropolitan area, Australia, with comparable management structures, staffing mix and ratios, and standards of care. Participants: 194 consenting managers, nurses, therapists and nurse assistants working in the participating sites. Methods: Intervention care sites received training and support in either person centred care (n =5) or dementia care mapping (n =5); control sites continued with usual dementia care (n =5). Staff outcomes of those three groups were assessed before, directly after the four month intervention (post) and after a further four months (follow-up). The primary outcome measures were the Maslach Burnout Inventory-Human Services Survey and the 12-item General Health Questionnaire. Analysis involved repeated measures analyses of variance for each of the outcome measures and adjustment for potential confounders to limit bias. Results: The Maslach Burnout Inventory-Human Services Survey results showed that change over time in emotional exhaustion scores differed between the three groups. Post-hoc analyses for each group separately revealed that the only significant time effect was in the dementia care mapping group (p =0.006), with emotional exhaustion scores declining over time. At baseline, more perceived support from management was associated with less emotional exhaustion (r s =0.26, p =0.004, n =122) and less depersonalisation (r s =0.21, p =0.023, n =122), but not for any of the other outcome measures. Conclusions: This study has shown that person centred approaches of care, in particular with dementia care mapping, may contribute to reducing staff job related burnout. The findings also highlight a potentially important role of managerial support and a whole of system approach. [Copyright &y& Elsevier]

Aim: To examine views of Australian consumers, service providers and policy representatives on important characteristics and outcomes for community care., Method: Interviews, with 32 consumers (one person with dementia (PWD) and 31 carers), 32 service providers and four policy representatives, were analysed thematically., Results: Outcomes important to consumers and service providers were that PWD can stay at home safely with personalised activities and socialisation; and that carers receive emotional support, respite and continue paid employment. Consumers and service providers said it was important that community care services were flexible and reliable and provided adequate hours of care and there was continuity of appropriate and well-trained staff. Overall responses of policy representatives were congruent with consumers and service providers but did not comprehensively cover the issues., Conclusions: Community care policies and service practices need to be re-examined to make sure that they are person-centred and reflect consumer needs, for instance by integrating client and carer services and providing appropriate activities for PWD., (© 2012 The Authors. Australasian Journal on Ageing © 2012 ACOTA.)

Aim: To assess the feasibility and the effects of a multi-component education toolkit that used the Aged Care Funding Instrument behaviour (ACFI-BEH) scores to trigger care planning for older people experiencing behavioural and psychological symptoms of dementia (BPSD)., Method: Forty-six older people and 209 staff and managers from five Sydney metropolitan residential aged care (RAC) facilities participated in this pre-post intervention pilot study., Results: The face validity and accessibility/acceptability of the toolkit was established, but potential utility of the ACFI-BEH in informing care planning was proven to be negligible. The ACFI-informed education toolkit did not lead to statistically significant improvements in care planning practice or reduce the severity/frequency of the targetted BPSD. Care plan quality remained low post intervention, with between 31% (N = 12/39) and 65% (N = 13/20) of care plans not addressing the persons' BPSD, nor utilising the ACFI information in relation to BPSD., Conclusion: This study has underscored the problems associated with current care planning practice in RAC settings and the need for developing strategies to ensure quality and safe care through individualised care planning practices. Our study processes, results and lessons discussed in this paper could assist future research on this type of research in RAC settings.

Purpose: Literature suggests that quality of life (QOL), quality of care (QOC) and Behavioural and Psychological Symptoms of Dementia (BPSD) can be improved by relatively simple and inexpensive person-centred approaches to nursing care practices (PCC) and modifications to physical environment (PCE). Most research on this topic is observational and few randomised controlled trials have included an economic evaluation of PCC and PCE together. The PerCEN study aims to confirm the value of evidence-based nursing by evaluating the efficacy and cost effectiveness of implementing PCC and PCE in residential dementia care services. This article describes the PerCEN study protocol (ANZCTR 12608000095369)., Design/methods: The 3-year study commenced in 2009 in 38 eligible government-accredited residential dementia care homes in New South Wales, Australia. Study participants include 605 consented residents over 60 years of age with dementia and 380 consenting permanent direct-care staff. The study employs a factorial, group-randomised, cohort design with stratification to evaluate the main effects of PCC and PCE and their joint effects (PCC + PCE), compared with Usual Care (UC) and Usual Environment (UE) on QOL, QOC and BPSD in dementia., Results: The primary outcomes analysis will use a mixed-model analysis of covariance to determine the effects of PCC and PCE on resident QOL and BPSD, and QOC, adjusting for stratification and other potential confounders. The incremental cost of providing PCE and PCC over UC and UE will be calculated; costs and outcomes will be presented as a cost-consequence analysis and cost-effectiveness ratios will be estimated as a cost per unit change in resident QOL and BPSD., Implications: This cluster-randomised trial will rigorously test Kitwood's Social-Psychological Theory of Personhood in Dementia (Kitwood & Bredin 1992). The results will provide timely and solid evidence that can inform policy and nursing practice development in improving the person's QOL and QOC, and reducing BPSD., (Copyright ©2010 Sigma Theta Tau International.)

Objective: The Serious and Continuing Illness Policy and Practice Study (SCIPPS) aims to improve the care and support for patients with chronic illness and their family carers. Here we describe the carers' contribution to the self-management partnership and discuss the policy and practice implications that are relevant to improving the support available for informal care in Australia., Design: A secondary analysis of SCIPPS data. Fourteen carers of patients between 45 and 85 years with chronic heart failure, chronic obstructive pulmonary disease and diabetes were conveniently sampled from western Sydney and the Australian Capital Territory. Semi-structured interviews were conducted. Data were analysed using qualitative content analysis., Results: Key roles that carers perform in the self-management partnership included: home helper; lifestyle coach; advocate; technical care manager; and health information interpreter. Two negative consequences of juggling these roles included: self-neglect and conflict., Conclusions: Rigid eligibility criteria limit carers' access to essential support programs which underestimates and undervalues their contributions to the self-management partnership. Support services should focus on the development of practical skills to perform the caregiving roles. In addition, health professionals require support to work more effectively with carers to minimise the conflict that can overshadow the care and self-management partnership.

The increasing prevalence of chronic disease is a driver of health system reform in most economically advanced nations. A consistent theme within these reforms is building greater patient-centredness into the health care delivery. This study aims to develop an in-depth understanding of the experience of patients and family carers affected by chronic illness that will be the basis on which to propose policy and health system interventions that are patient-centred. Participants struggled with the ongoing tasks of balancing their lives with the increasing demands and intrusion of chronic illness. Their attempts to achieve a balance were seriously hampered by fragmented services, complexity in navigating health services, relationships with health professionals and others, and co-morbidity. Future policy directions include designing models of care and infrastructure that enable patients and their family carers to balance life and illness, and aligning patient-centred care not only within health services but also with community and social support services.

Dementia Care Mapping (DCM) is increasingly being promoted world-wide as a useful approach in assisting staff to improve the well-being of residents with dementia. While DCM is employed as an outcome measure of well-being and as a process to assist staff improve quality of care, it has not been subject to the rigorous scrutiny of a controlled trial to establish its efficacy as an outcome measure, or as an intervention. In 2005 the authors were awarded an Australian Health Minister's Grant to conduct a randomised control trial of DCM in 15 residential dementia care units across the city of Sydney, Australia. This paper reports on a pilot study conducted with 35 dementia care residents in three secure residential care units in the state of New South Wales, Australia, prior to the controlled trial. The main aims of the pilot were to determine the sensitivity of DCM against the validated baseline and outcome measures selected for the trial and to evaluate the utility of the research plan. The utility of the research plan was established. Whilst a significant improvement was shown in staff interactions with residents over time, there was no evidence that DCM improved the residents' quality of life and well-being in relation to physical and cognitive functioning, although there was a reduction in the residents' levels of agitation and depression. While as a research tool DCM needs further refinement to match the strength of validated outcome measures that more accurately assess the residents' well-being, DCM procedures improved staff's attention to monitoring and attending to the residents' well-being.

This article reports on a study designed to determine whether demographic characteristics of patients such as age, gender and cultural background were associated with different perceptions of the importance of and satisfaction with various aspects of nursing care. In addition, patients, their family/carer and nurses from wards specializing in aged care were compared with general medical wards to determine if there were differences in these perceptions. Results demonstrated that patients who were older (aged > 80 years), female and from aged care wards perceived that physical aspects of nursing care were more important than did patients who were younger (aged 65-80 years), male and from medical wards. Older patients and those from aged care wards were more satisfied with physical care. Nurses need to be aware of these differences and focus on physical aspects of care to ensure patient satisfaction better health outcomes.