Safe transfer of elderly patients across care settings : the STEP study

Patient safety has become a prime consideration for health care facilities since publication of the report 'To Err is Human' in 1999. Elderly patients are recognised as a high-risk group for errors and adverse events during hospitalisation, particularly as they move between settings to receive care for their comorbid and chronic conditions. With the ageing Australian population, incidence of errors and adverse events during hospitalisation remains of major concern and have significant implications for health care providers, individuals and their families. Commonly reported adverse events include errors involving medications and falls. Loss of patient information has been associated with nursing and medical mismanagement. At transition points, poor communication of medical information is responsible for 50% of all medication errors and 20% of adverse drug events in hospitals. Researchers have developed various strategies to minimise errors and adverse events, with varying results. These strategies include the use of electronic computerised physician order entry, discharge planner and transition coordinators. Despite these strategies, errors and adverse events commonly occur during hospitalisation and the incidence is increasing, particularly for the elderly patients. Therefore, this study seeks to increase knowledge of factors that contribute to errors and adverse events as a result of elderly patients transfer across care sites. It aims to close a gap in the research literature by developing and implementing a practical, low cost strategy that promote communication during care transfer. The overall aim of this thesis is to develop a strategy that promotes safe transfer of elderly patients across care settings (STEP Study)

A mapper’s reflection on Dementia Care Mapping with older residents living in a nursing home

Aim and objective. This paper explores reflection stemming from a Dementia Care Mapper's own learning and development concerning person-centred care with older residents living in a dementia specific nursing home. Background. Dementia Care Mapping has been employed in few Australian residential care facilities to promote person-centred care and the well-being of residents. Reflection has also been used selectively in some practices to improve and evaluate the care process. However, contemporary nursing literature has failed to highlight the usefulness of applying reflection following Dementia Care Mapping with older residents. Method. The mapper's reflections arose from the Dementia Care Mapping observation of five older residents and writing a daily reflective journal. Findings. From the reflection, a dominant major theme emerged named as the Learning Experience from Mapping Residents with two sub-themes entitled Mapper's Identification of Resident's Unique Needs and Mapper's Empowerment of Clinicians. Dementia Care Mapping recommendations from the mapper's experience highlighted effective approaches to conducting Dementia Care Mapping in residential care facilities. Conclusions. The valuable process of reflection to Dementia Care Mapping provided the mapper with clinical insights. Further from the mapper's final reflection, a poem entitled Come Back Mind, Come Back to Me was conceived and penned. Relevance to clinical practice. The mapper's engagement in ongoing reflection incorporated with Dementia Care Mapping has the potential to promote best practice for the care of older people living in aged care facilities.No Full Tex

Effectiveness Of Strategies To Promote Safe Transition Of Elderly People Across Care Settings

No Full Tex

The Provision of Culturally Safe Care for the Sexual and Gender Minority Older Adult in Australian Residential Aged Care Facilities

The global population of those over 65 is rising sharply, underscoring the need for specialised care in aged care services, particularly for sexual and gender minorities who have historically faced marginalisation. This study examines the perceptions of aged care workers in Australian residential aged care facilities regarding the provision of culturally safe care for sexual and gender minority older people through the lens of social capital theory. Employing qualitative methods, 52 interviews explored the barriers and challenges encountered by aged care workers in providing culturally safe care. Key findings include identification of resident sexual orientation and/or gender identity, understanding the history of this population, and the bias and attitudes of staff and other residents. Implications for practice are presented.Full Tex

Tailoring dementia care mapping and reflective practice to empower assistants in nursing to provide quality care for residents with dementia

Objective The study addressed one central aim. This was to explore the experience of Assistants in Nursing being exposed to Dementia Care Mapping coupled with refection to improve older residents care in a residential aged care facility. Design and Setting: A qualitative exploratory design was employed to gain an in-depth understanding of Assistants in Nursing experience of creating new care for older residents using Dementia Care Mapping and feedback. The study was conducted in a dementia specific nursing home, located in urban Sydney, New South Wales, Australia. Subjects: The study participants were ten Assistants in Nursing and five older residents diagnosed with mild to moderate dementia by a Physician. Results: For the first time, the study illuminated the Assistants in Nursing innovative care following Dementia Care Mapping feedback and refection. Their experience was highlighted in three major themes: (i) Reflecting on Care (ii) Creating a Caring Connection and (iii) Empathetic Communication. Conclusion: These Assistants in Nursing valued and used findings from Dementia Care Mapping feedback coupled with refection to improve contemporary practice. In addition, they felt empowered to create new nursing strategies for quality care. The study highlighted the usefulness of providing Assistants in Nursing with these types of educational strategies to encourage the development of creative caring for residents with dementia living in a residential aged care facility

Tailoring Dementia Care Mapping and Reflective Practice to empower Assistants in Nursing to provide quality care for residents with dementia

Objective: The study addressed one central aim. This was to explore the experience of Assistants in Nursing being exposed to Dementia Care Mapping coupled with reflection to improve older residents care in a residential aged care facility. Design and Setting: A qualitative exploratory design was employed to gain an in depth understanding of Assistants in Nursing experience of creating new care for older residents using Dementia Care Mapping and feedback. The study was conducted in a dementia specific nursing home, located in urban Sydney, New South Wales, Australia. Subjects: The study participants were ten Assistants in Nursing and five older residents diagnosed with mild to moderate dementia by a Physician. Results: For the first time, the study illuminated the Assistants in Nursing innovative care following Dementia Care Mapping feedback and reflection. Their experience was highlighted in three major themes: (i) Reflecting on Care (ii) Creating a Caring Connection and (iii) Empathetic Communication. Conclusion: These Assistants in Nursing valued and used findings from Dementia Care Mapping feedback coupled with reflection to improve contemporary practice. In addition, they felt empowered to create new nursing strategies for quality care. The study highlighted the usefulness of providing Assistants in Nursing with these types of educational strategies to encourage the development of creative caring for residents with dementia living in a residential aged care facility.Griffith Health, School of Nursing and MidwiferyFull Tex

Tailoring dementia care mapping and reflective practice to empower assistants in nursing to provide quality care for residents with dementia

Objective: The study addressed one central aim. This was to explore the experience of Assistants in Nursing being exposed to Dementia Care Mapping coupled with reflection to improve older residents care in a residential aged care facility. Design and Setting: A qualitative exploratory design was employed to gain an in depth understanding of Assistants in Nursing experience of creating new care for older residents using Dementia Care Mapping and feedback. The study was conducted in a dementia specific nursing home, located in urban Sydney, New South Wales, Australia. Subjects: The study participants were ten Assistants in Nursing and five older residents diagnosed with mild to moderate dementia by a Physician. Results: For the first time, the study illuminated the Assistants in Nursing innovative care following Dementia Care Mapping feedback and reflection. Their experience was highlighted in three major themes: (i) Reflecting on Care (ii) Creating a Caring Connection and (iii) Empathetic Communication. Conclusion: These Assistants in Nursing valued and used findings from Dementia Care Mapping feedback coupled with reflection to improve contemporary practice. In addition, they felt empowered to create new nursing strategies for quality care. The study highlighted the usefulness of providing Assistants in Nursing with these types of educational strategies to encourage the development of creative caring for residents with dementia living in a residential aged care facility

Older folks in hospitals: the contributing factors and recommendations for incident prevention

Objectives: To identify the most common errors and adverse events and their contributing factors among the older patients admitted to hospital and examine recommendations from an expert review panel for prevention and reduction of the adverse events. Background: Older patients are at an increased risk of errors and adverse events while hospitalized. The increasing evidence suggests that understanding the risks factors that contribute to these errors and adverse events facilitates the education of health professionals and the reduction and preventions of the harm. Method: A retrospective audit of the Incident Information Management System and Root Cause Analysis databases from July 1, 2005, to June 30, 2006, was undertaken in 1 large tertiary metropolitan hospital in New South Wales, Australia. Results: Of the 643 incidents identified, falls (n = 309), medication errors (n = 136), and clinical management (n = 104) were the most common errors among older patients, and the failure of clinicians to follow policies and procedures and poor communication between clinicians contributed to these incidents. Conclusions: Although systems are in place for incident reporting and analysis of the contributing factors, improvement depends upon clinicians taking responsibility for anticipating and moderating risk using previous data to identify system weaknesses and monitoring improvements especially in hospitalized older patients