Resilience perspective on healthcare professionals' adaptations to changes and challenges resulting from the COVID-19 pandemic: a meta-synthesis

Objective To identify, review and synthesise qualitative literature on healthcare professionals’ adaptations to changes and challenges resulting from the COVID-19 pandemic. Design Systematic review with meta-synthesis. Data sources Academic Search Elite, CINAHL, MEDLINE, PubMed, Science Direct and Scopus. Eligibility criteria Qualitative or mixed-methods studies published between 2019 and 2021 investigating healthcare professionals’ adaptations to changes and challenges resulting from the COVID-19 pandemic. Data extraction and synthesis Data were extracted using a predesigned data extraction form that included details about publication (eg, authors, setting, participants, adaptations and outcomes). Data were analysed using thematic analysis. Results Forty-seven studies were included. A range of adaptations crucial to maintaining healthcare delivery during the COVID-19 pandemic were found, including taking on new roles, conducting self and peer education and reorganising workspaces. Triggers for adaptations included unclear workflows, lack of guidelines, increased workload and transition to digital solutions. As challenges arose, many health professionals reported increased collaboration across wards, healthcare teams, hierarchies and healthcare services. Conclusion Healthcare professionals demonstrated significant adaptive capacity when faced with challenges imposed by the COVID-19 pandemic. Several adaptations were identified as beneficial for future organisational healthcare service changes, while others exposed weaknesses in healthcare system designs and capacity, leading to dysfunctional adaptations. Healthcare professionals’ experiences working during the COVID-19 pandemic present a unique opportunity to learn how healthcare systems rapidly respond to changes, and how resilient healthcare services can be built globally.publishedVersio

A national survey on COVID-19 second-wave lockdowns on older adults' mental wellbeing, health-seeking behaviours and social outcomes across Australia

Abstract Background The impact of severe second lockdown measures on older adults’ wellbeing is unknown. We aimed to (i) identify the impact of the second lockdown that resulted from the second wave of COVID-19 cases on older Australians’ quality of life; (ii) compare the impact of second wave lockdowns in Victoria, Australia’s second most populous State, to those in other States and Territories not in lockdown. Methods A national cross-sectional study of community-dwelling older adults completed online questionnaires for quality of life, social networks, healthcare access, and perceived impact of COVID-19 between July to September 2020. Tobit regression was used to measure the relationships of healthcare service access and social networks with quality of life of older adults in Victoria compared to those in the rest of Australia. Results A total of 2,990 respondents (mean [SD] age, 67.3 [7.0]; 66.8 % female) participated. At time of data collection, Victoria’s second COVID-19 lockdown had been in force for an average 51.7 days. Median quality of life scores were significantly higher in Victoria compared to the rest of Australia (t2,827=2.25 p = 0.025). Being female (95 % CI, -0.051–0.020), having lower educational attainment (95 % CI, -0.089–-0.018), receiving government benefits (95 % CI, -0.054–-0.024), having small social networks (95 % CI, 0.006–0.009) and self-reported physical chronic health conditions were all independent predictors of lower quality of life. Conclusions Longer-term studies are required to provide more robust evidence of the impact as restrictions lift and normal social conventions return

The use of predictive fall models for older adults receiving aged care, using routinely collected electronic health record data : a systematic review

Background: Falls in older adults remain a pressing health concern. With advancements in data analytics and increasing uptake of electronic health records, developing comprehensive predictive models for fall risk is now possible. We aimed to systematically identify studies involving the development and implementation of predictive falls models which used routinely collected electronic health record data in home-based, community and residential aged care settings. Methods: A systematic search of entries in Cochrane Library, CINAHL, MEDLINE, Scopus, and Web of Science was conducted in July 2020 using search terms relevant to aged care, prediction, and falls. Selection criteria included English-language studies, published in peer-reviewed journals, had an outcome of falls, and involved fall risk modelling using routinely collected electronic health record data. Screening, data extraction and quality appraisal using the Critical Appraisal Skills Program for Clinical Prediction Rule Studies were conducted. Study content was synthesised and reported narratively. Results: From 7,329 unique entries, four relevant studies were identified. All predictive models were built using different statistical techniques. Predictors across seven categories were used: demographics, assessments of care, fall history, medication use, health conditions, physical abilities, and environmental factors. Only one of the four studies had been validated externally. Three studies reported on the performance of the models. Conclusions: Adopting predictive modelling in aged care services for adverse events, such as falls, is in its infancy. The increased availability of electronic health record data and the potential of predictive modelling to document fall risk and inform appropriate interventions is making use of such models achievable. Having a dynamic prediction model that reflects the changing status of an aged care client is key to this moving forward for fall prevention interventions

Built to last? Barriers and facilitators of healthcare program sustainability : a systematic integrative review

Objective: To identify barriers and facilitators associated with the sustainability of implemented and evaluated improvement programs in healthcare delivery systems. Data sources and study setting: Six academic databases were searched to identify relevant peer-reviewed journal articles published in English between July 2011 and June 2022. Studies were included if they reported on healthcare program sustainability and explicitly identified barriers to, and facilitators of, sustainability. Study design: A systematic integrative review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Study quality was appraised using Hawker’s Quality Assessment Tool. Data collection/extraction methods: A team of reviewers screened eligible studies against the inclusion criteria and extracted the data independently using a purpose-designed Excel spreadsheet. Barriers and facilitators were extracted and mapped to the Integrated Sustainability Framework (ISF). Frequency counts of reported barriers/facilitators were performed across the included studies. Results: Of the 124 studies included in this review, almost half utilised qualitative designs (n = 52; 41.9%) and roughly one third were conducted in the USA (n = 43; 34.7%). Few studies (n = 29; 23.4%) reported on program sustainability beyond 5 years of program implementation and only 16 of them (55.2%) defined sustainability. Factors related to the ISF categories of inner setting (n = 99; 79.8%), process (n = 99; 79.8%) and intervention characteristics (n = 72; 58.1%) were most frequently reported. Leadership/support (n = 61; 49.2%), training/support/supervision (n = 54; 43.5%) and staffing/turnover (n = 50; 40.3%) were commonly identified barriers or facilitators of sustainability across included studies. Forty-six (37.1%) studies reported on the outer setting category: funding (n = 26; 56.5%), external leadership by stakeholders (n = 16; 34.8%), and socio-political context (n = 14; 30.4%). Eight studies (6.5%) reported on discontinued programs, with factors including funding and resourcing, poor fit, limited planning, and intervention complexity contributing to discontinuation. Conclusions: This review highlights the importance of taking into consideration the inner setting, processes, intervention characteristics and outer setting factors when sustaining healthcare programs, and the need for long-term program evaluations. There is a need to apply consistent definitions and implementation frameworks across studies to strengthen evidence in this area

The prioritisation of care in residential aged care facilities: a multistakeholder approach

Thesis by publication.Bibliography: pages 214 - 227Chapter 1 Introduction -- Chapter 2 Integrative Review -- Chapter 3 Study Protocol -- Chapter 4 Staff Members Prioritisation of Care -- Chapter 5 Influences of Staff Members Prioritisation Decisions -- Chapter 6 Family Members Prioritisation of Care -- Chapter 7 Residents'-- Prioritisation of care -- Chapter 8 Discussion.Background: Neglect is a prominent concern in respect of older persons living in residential aged care facilities (RACFs). This thesis focuses on unfinished care which is a specific type of neglect encompassing prioritisation (internal process), rationing (action) and missed care(outcome). When faced with inadequate resources, healthcare workers must prioritise care by deciding what aspects of care are more or less important/urgent. Prioritisation can lead to rationing of care in which lower priority tasks are traded-off in favour of higher priorities, which can ultimately result in missed care; care that is omitted, delayed or left undone. Rationale: Research on unfinished care in RACFs has predominantly focused on either rationing or missed care, with only two studies having investigated care prioritisation. In order to prevent missed care and subsequent negative consumer outcomes, a greater understanding of care prioritisation is needed. Previous research on prioritisation in RACFs has elicited the views of clinical staff members only and has not considered the perspectives of non-clinical staff members, residents and family members. Objective: In order to address these knowledge gaps, this thesis aimed to investigate the prioritisation of care in RACFs from the perspectives of key stakeholders. Research Articles: This thesis contains six articles. Article I is an integrative review that synthesised the empirical literature on unfinished care in RACFs and identified knowledge gaps that guided the research project. Article II is a study protocol that outlined the research materials, methods, data collection processes and analyses. Articles III-VI are empirical studies that explored care prioritisation from the perspectives of staff members (Articles III and IV), family members (Article V), and residents (Article VI).Methods and participants: The research involved a card sorting activity using Q methodology, a think-aloud task, post-sorting interviews, semi-structured interviews and a demographic questionnaire. Participants were 32 staff members, 27 family members and 38residents from five Australian RACFs. Research findings: Findings revealed the situations in which prioritisation dilemmas arose for staff members, the types of care that were prioritised by each participant group, how each group prioritised care, and what influenced their prioritisation decisions. Contributions of the thesis: The thesis provides insights into participants' experiences of prioritisation, unmet needs and missed care, and outlines systemic problems in RACFs that hinder safe, high-quality and person-centred care. This information led to the development often key recommendations for improving care in RACFs. The discussion chapter outlines specific contributions of the thesis to knowledge gaps, methodology, theory and practice, and presents implications for policymakers, care providers and consumers.Mode of access: Internet.1 online resource ( 248 pages

The effects of hearing loss on preferences for shared decision making in residential aged care: a mixed methods approach

Theoretical thesis.Bibliography: pages 81-92.Chapter 1. Introduction -- Chapter 2. Narrative literature review -- Chapter 3. Methods -- Chapter 4. Findings: RQ1 medical care - preferences for information and decision making -- Chapter 5. Findings: RQ2 everyday care - preferences for information and decision making -- Chapter 6. Discussion and conclusion.Hearing loss is associated with communication breakdown in residential aged care. A review of the literature found that the effects of hearing loss on residents’ preferences for shared decision making remain unknown. The aim of the thesis is to assess how hearing loss affects residents’ preferences for receiving information, and making decisions, in terms of their medical and everyday care. An exploratory mixed methods study was conducted, involving interviews and surveys, with 26 residents. Interviews covered five parts: demographic details; self-perceived hearing loss; and, preferences for receiving information and decision making about medical and everyday care. Statistical analysis, thematic analysis using the Framework Method, and inductive content analysis, were employed to analyse data. Participants demonstrated strong preferences for receiving information and involvement in decision making, in both medical and everyday contexts. Despite strong preferences for receiving information, some participants, including three with hearing loss, expressed dissatisfaction with the communication they received. Participants’ with hearing loss reinforced the importance of family involvement in decision making processes. The findings offer direction for future research by emphasising the need to better understand the communication strategies employed by residents with hearing loss, and the role that family members play in shared decision making.Mode of access: World wide web1 online resource (xv, 113 pages

Frailty in primary care: challenges, innovations, and future directions

Abstract Frailty is one of the biggest challenges to healthy ageing, and yet our understanding and management of frailty is in its infancy. In this editorial we outline challenges, innovations and future directions in frailty research in primary care, and invite contributions to BMC Primary Care’s “Frailty in Primary Care” Collection

Scoping review protocol for training on providing oral health care for non-dental staff working in residential aged care facilities

This is a registration of a scoping review protocol for investigating the current evidence about training on providing oral health care for non-dental staff working in residential aged care facilities