Understanding Personal Carers\u27 Experiences of Caring for Older People in Pain

Pain is a complex phenomenon that can be challenging for staff working in residential aged care facilities (RACFs) (Fisher et al., 2002; Twycross, 2002). A high prevalence of pain reported by older individuals has been reported and suggests that further study in this area is warranted (Higgins, Madjar & Walton, 2004). Research suggests that a significant barrier to effective pain management in the elderly is the provision of primary care by care staff who have little or no education about pain, pain assessment or pain management (Allcock, McGarry & Elkan, 2002). Studies have identified personal carers as being in a unique position to improve pain management, because of their working relationship with residents (Ferrell, 1996; Horgas & Dunn, 2001). However, there is a lack of literature which specifically examines personal carers\u27 perspectives of providing care to residents in pain on a daily basis. This thesis presents a study of personal carers working in RACFs in regional Western Australia. A descriptive and explorative qualitative approach has been applied to examine the experience personal carers\u27 have had with older residents in pain. A purposive, convenience sampling method allowed access to six personal carers currently employed in regional Western Australia. Data was generated by in-depth interviews focusing on the personal carers\u27 experiences of caring for older people in pain. Interviews were audiotape recorded, transcribed and coded to ensure confidentiality and anonymity of participants. The findings of this study provide an understanding of the complex care needs of older residents in pain and illuminate the role of personal carers in the pain management process. A constant comparison method of analysis was used to develop a central theme and a sub-theme with associated categories. The central theme, Perfect Positioning, emerged from the data to encompass all aspects of the position personal carers have in the pain management process. Five associated categories, Frontline, Knowing the Residents, Emotional Attachment, Teamwork and Rewards for Getting It Right, provide explanation of the pivotal role of personal carers in RACFs in pain management. A sub-theme, Extended Roles, describes the additional responsibilities associated with pain management that are inherent in the personal carers\u27 role. Two related categories, Clinical Judgements and Nagging were identified and highlight the responsibility of personal carers in the pain management process. This study contributes an understanding of the issues related to the experience of caring for older residents in pain. The research findings and recommendations established from this study have implications for clinical practice, education, administration and for future research in the aged care setting

Understanding Nursing Assistants' Experiences of Caring for Older People in Pain: The Australian Experience

This study examined the experiences of nursing assistants (NAs), who have worked with older people in residential aged care facilities (RACFs) who are in pain, to ascertain the role that NAs play in the pain management process. A descriptive, exploratory qualitative approach was used to examine NAs' experiences. Six NAs employed in three RACFs in regional Western Australia participated in the study. In-depth interviews focusing on the NAs experiences of caring for older people in pain were conducted. This study provided an understanding of the care needs of older residents in pain and illuminated the role of NAs in the pain management process. The central role that NAs play in RACFs was highlighted, as were the responsibilities associated with pain management. Nursing assistants may be responsible for initiating and implementing pain management treatments for older residents. This is outside the scope of practice for NAs; therefore, it is imperative that the preparation of NAs give them adequate knowledge to perform this role. As well, it may be timely to consider regulation of this large group of workers who are performing clinical tasks in RACFs

A worksite-based self management program to improve men's health in rural Western Australia: The industry "waist" disposal project

Men in rural areas are at an increased risk of obesity and chronic diseases. A mixed method study tested the feasibility and impact of a multiphase self-management program at reducing risk factors for chronic disease for 87 men across six worksites in regional Western Australia. The intervention was effective at targeting key health outcomes. Applied strategies were acceptable and are transferable to other male groups in rural areas, where access to interventions is often limited

Staying just one step ahead: providing care for patients with motor neurone disease

Introduction: There is limited information about the experiences and educational needs of health professionals who may be required to provide care for people with Motor Neurone Disease(MND) especially in the later stages of the disease. The aim of this study was to determine the experiences of, and need for, education of these health professionals. Methods: Interviews and focus groups were conducted with 31 health professionals with some experience in providing palliative care for people with MND. Thematic content analysis was used to identify common themes. Results: A key theme, Just One Step Ahead, emerged, that describes the central capability health professionals identified as necessary to help individuals plan and prepare for disease and lifestyle changes just before they arise. Two subthemes also emerged: Expertise in MND and Bespoke Communication. Expertise in MND described the required understanding of the disease and the particular individual’s version of the disease to allow the health professional to plan, advise, support and anticipate the needs of the person living with MND. Bespoke Communication was the facility to tailor care messages sensitively and effectively to the range of people involved in care (patients, family, healthcare team members).Conclusions: Care of people with MND requires up-to-date expertise about the disease and skilled communication abilities to manage complexity and change. Timely and focused education and specialist MND support for care providers are essential to tailored and responsive care and a widely available education programme has been developed to address these needs

Palliative Approach for Aged Care

In Australia, many people ageing in their own homes are becoming increasingly frail and unwell, approaching the end of life. A palliative approach, which adheres to palliative care principles, is often appropriate. These principles provide a framework for proactive and holistic care in which quality of life and of dying is prioritised, as is support for families. A palliative approach can be delivered by the general practitioner working with the community aged care team, in collaboration with family carers. Support from specialist palliative care services is available if necessary. The Guidelines for a Palliative Approach for Aged Care in the Community Setting were published by the Australian Government Department of Health and Ageing to inform practice in this area. There are three resource documents. The main document provides practical evidence based guidelines, good practice points, tools, and links to resources. This document is written for general practitioners, nurses, social workers, therapists, pastoral care workers, and other health professionals and responded to needs identified during national consultation. Evidence based guidelines were underpinned by systematic reviews of the research literature. Good practice points were developed from literature reviews and expert opinion. Two ‘plain English’ booklets were developed in a process involving consumer consultation; one is for older people and their families, the other for care workers. The resources are intended to facilitate home care that acknowledges and plans for the client’s deteriorating functional trajectory and inevitable death. At a time when hospitals and residential aged care facilities are under enormous pressure as the population ages, such a planned approach makes sense for the health system as a whole. The approach also makes sense for older people who wish to die in their own homes. Family needs are recognised and addressed. Unnecessary hospitalisations or residential placements and clinically futile interventions are also minimised

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Proceedings of the 13th annual conference of INEBRIA

CITATION: Watson, R., et al. 2016. Proceedings of the 13th annual conference of INEBRIA. Addiction Science & Clinical Practice, 11:13, doi:10.1186/s13722-016-0062-9.The original publication is available at https://ascpjournal.biomedcentral.comENGLISH SUMMARY : Meeting abstracts.https://ascpjournal.biomedcentral.com/articles/10.1186/s13722-016-0062-9Publisher's versio

Developing a sustainable model of rural cancer care: The Western Australian Cancer Network project

Problem: Cancer-related mortality is higher in rural areas than in urban centres. One of the contributing factors is limited access to treatment options in rural areas. Design: An evaluation of the effectiveness of the Western Australian Cancer Network (CanNET WA) pilot project was undertaken using qualitative methods and document analysis. Setting: CanNET WA was established in the Great Southern region of Western Australia. Key measures for improvement: Three measures were assessed: impact of the CanNET WA on consumers, care providers and changes to systems and processes. Strategies for change: CanNET WA comprised a number of initiatives that together led to an improvement in cancer care. These included a multidisciplinary cancer team, improved access to visiting medical specialists, formal links with tertiary cancer centres, increased primary health involvement in cancer care and increased education regarding cancer care for local health care providers. Effects of change: Changes in the three key outcome measures were reported. Consumers had greater choice of treatment options and had more involvement in decision making. Health professionals reported improvements in care coordination and in peer support related to the new multidisciplinary cancer care team, and improved links with tertiary cancer centres in Perth. Systemic changes included mapping of referral pathways and tumour-specific care pathways. Lessons learnt: CanNET WA has demonstrated the need for coordinated cancer care for rural people that offers care locally whenever possible. The success of the project paved the way for the rollout of the CanNET WA concept into other regional areas of Western Australia

Spreading and fingering in a yield-stress fluid during spin coating

International audienceWe study the deformation, spreading, and fingering of small droplets of a yield-stress fluid subjected to a centrifugal force on a rotating substrate. At low rotation rates and for small enough droplets, the droplets deform elastically but retain their essentially circular contact line. For large enough droplet volumes and rotation speeds, however, one or more fingers eventually form and grow at the edge of the drop. This fingering is qualitatively different from the contact line instability observed in other fluids, and appears to be a localized phenomenon that occurs when the stress at some point on the perimeter of the drop exceeds the yield stress

Outcomes following inpatient rehabilitation of lower limb amputees [Conference Abstract]

Introduction: Lower-limb amputations are a serious adverse consequence of lifestyle related chronic conditions and a serious concern among the aging population in Australia. Lower limb amputations have severe personal, social and economic impacts on the individual, healthcare system and broader community. This study aimed to address a critical gap in the research literature by investigating the physical functioning and social characteristics of lower limb amputees at discharge from tertiary hospital inpatient rehabilitation. Method: A cohort study was implemented among patients with lower limb amputations admitted to a Geriatric Assessment and Rehabilitation Unit for rehabilitation at a tertiary hospital. Conventional descriptive statistics were used to examine patient demographic, physical functioning and social living outcomes recorded for patients admitted between 2005 and 2011. Results: A total of 423 admissions occurred during the study period, 313 (74%) were male. This sample included admissions for left (n = 189, 45%), right (n = 220, 52%) and bilateral (n = 14, 3%) lower limb amputations, with 15 (3%) patients dying whilst an inpatient. The mean (standard deviation) age was 65 (13.9) years. Amputations attributed to vascular causes accounted for 333 (78%) admissions; 65 (15%) of these had previously had an amputation. The mean (SD) length of stay in the rehabilitation unit was 56 (42) days. Prior to this admission, 123 (29%) patients were living alone, 289 (68%) were living with another and 3 (0.7%) were living in residential care. Following this amputation related admission, 89 (21%) patients did not return to their prior living situation. Of those admitted, 187 (44%) patients were discharged with a lower limb prosthesis. Conclusion: The clinical group is predominately older adults. The ratio of males to females was approximately 3:1. Over half did not return to walking and many were not able to return to their prior accommodation. However, few patients died during their admission