Diabetes Capabilities for the Healthcare Workforce Identified via a 3-Staged Modified Delphi Technique.

Consumers access health professionals with varying levels of diabetes-specific knowledge and training, often resulting in conflicting advice. Conflicting health messages lead to consumer disengagement. The study aimed to identify capabilities required by health professionals to deliver diabetes education and care to develop a national consensus capability-based framework to guide their training. A 3-staged modified Delphi technique was used to gain agreement from a purposefully recruited panel of Australian diabetes experts from various disciplines and work settings. The Delphi technique consisted of (Stage I) a semi-structured consultation group and pre-Delphi pilot, (Stage II) a 2-phased online Delphi survey, and (Stage III) a semi-structured focus group and appraisal by health professional regulatory and training organisations. Descriptive statistics and central tendency measures calculated determined quantitative data characteristics and consensus. Content analysis using emergent coding was used for qualitative content. Eighty-four diabetes experts were recruited from nursing and midwifery (n = 60 [71%]), allied health (n = 17 [20%]), and pharmacy (n = 7 [9%]) disciplines. Participant responses identified 7 health professional practice levels requiring differences in diabetes training, 9 capability areas to support care, and 2 to 16 statements attained consensus for each capability-259 in total. Additionally, workforce solutions were identified to expand capacity for diabetes care. The rigorous consultation process led to the design and validation of a Capability Framework for Diabetes Care that addresses workforce enablers identified by the Australian National Diabetes Strategy. It recognises diversity, creating shared understandings of diabetes across health professional disciplines. The findings will inform diabetes policy, practice, education, and research

Exploring Diabetes Competencies: Engaging with Colleagues using the Delphi Method

Background: A 20% increase in adult diabetes is anticipated by 2030 when 58% of the CDE workforce will have reached retirement age. Fundamental to increasing equity in safe diabetes healthcare access across the health spectrum is a competent, flexible and adaptive workforce. Higher demand for healthcare professionals with both diabetes and non-medical prescribing competencies warrants a more efficient means of developing the workforce. Aim: To develop a Capability Framework by accessing the opinion of a diverse range of diabetes expert healthcare professionals and academics, of different disciplines and work settings. Method: The qualitative research used an online Delphi method informed by consultation and focus groups to gain consensus. A Consultation Group was engaged to inform the Delphi survey development phase. A pilot Delphi survey was administered via Qualtrics, an online platform, to six diabetes experts to test Qualtrics features and confirm questions captured the intended information. An expert panel from across Australia commenced the final Delphi survey. Analysed data obtained from the Delphi survey formed a list of competencies under nine capabilities. An Expert Advisory Group was engaged to review the positioning of competencies, wording and omissions. Further, ‘member checking’ will ensure the trustworthiness of results. The Delphi expert panel ranks the importance of the identified competencies for each of the capability areas until consensus achieved. Results: Fifty-seven diabetes experts from nursing, dietetics, podiatry, pharmacy, exercise physiology and academic backgrounds were recruited to the project and administered the Delphi survey. The Delphi method captured demographic data and comprehensive lists of skills, knowledge and attributes required by health professionals working at basic to expert levels in diabetes care. Discussion: Using Delphi as a method enables ease of access and reach to the breadth of diabetes healthcare professionals across the nation. Also, it allows for re-examining the understanding of valuable information

Capability Framework for Diabetes Care: A health workforce investment

Background: Diabetes has become more prevalent, and technologies and medicines used to manage it more complex. Over a quarter of consumers accessing health services daily have diabetes and access health professionals with varying levels of diabetes-specific knowledge and training. Consequently, they receive conflicting advice, which leads to consumer disengagement. Aim: To develop a national consensus framework to guide their training by identifying capabilities required by health professionals to deliver diabetes care. Method: A 3-staged modified-Delphi technique gained agreement from a purposefully recruited panel of Australian diabetes experts from various disciplines and work settings. The Delphi technique consisted of (Stage-I) a consultation period, including a semi-structured consultation group and pre-Delphi pilot, (Stage-II) a 2-phased online Delphi survey, and (Stage-III) an external appraisal period, including a semi-structured focus group and health professional regulatory and training organisations survey. Descriptive statistics and measures of central tendency were calculated to determine participant and quantitative data characteristics and consensus. Content analysis using emergent coding was used for qualitative content. Results: Eighty-four diabetes experts were recruited from nursing and midwifery (n=60[71%]), allied health (n=17[20%]), and pharmacy (n=7[9%]) disciplines. Participant responses identified 7 health professional practice levels requiring differences in diabetes training, 9 capability areas to support care (assessment, diabetes self-management education, therapeutic relationships, communication, counselling, quality use of medicines and diabetes technologies, research/quality), and 2 to 16 statements attained consensus for each capability, 259 in total. Three sets of attributes underpinned the capabilities: support excellent communication, collaboration and advocacy; strive for excellence and promote health professionals’ health and wellbeing to foster their adaptability in dynamic environments. Conclusion: The rigorous consensus methodology led to the design and validation of a Capability Framework for Diabetes Care, which addresses workforce enablers identified by the Australian National Diabetes Strategy. It recognises diversity, creating shared understandings of diabetes across health professional disciplines

Ethical challenges associated with providing continence care in residential aged care facilities : findings from a grounded theory study

A person-centred approach to care in residential aged care facilities should uphold residents’ rights to independence, choice, decision-making, participation, and control over their lifestyle. Little is known about how nurses and personal care assistants working in these facilities uphold these ideals when assisting residents maintain continence and manage incontinence. The overall aim of the study was to develop a grounded theory to describe and explain how Australian residents of aged care facilities have their continence care needs determined, delivered and communicated. This paper presents and discusses a subset of the findings about the ethical challenges nurses and personal care assistants encountered whilst providing continence care. Grounded theory methodology was used for in-depth interviews with 18 nurses and personal care assistants who had experience of providing, supervising or assessing continence care in any Australian residential aged care facility, and to analyse 88 hours of field observations in two facilities. Data generation and analysis occurred simultaneously using open coding, theoretical coding, and selective coding, until data were saturated. While addressing the day-to-day needs of residents who needed help to maintain continence and/or manage incontinence, nurses and personal care assistants struggled to enable residents to exercise choice and autonomy. The main factor that contributed to this problem was that the fact that nurses and personal care assistants had to respond to multiple, competing, and conflicting expectations about residents’ care needs. This situation was compounded by workforce constraints, inadequate information about residents’ care needs, and an unpredictable work environment. Providing continence care accentuated the ethical tensions associated with caregiving. Nurses’ and personal care assistants’ responses were mainly characterised by highly protective behaviours towards residents. Underlying structural factors that hinder high quality continence care to residents of aged care facilities should be urgently addressed

Patients' functioning as predictor of nursing workload in acute hospital units providing rehabilitation care: a multi-centre cohort study

<p>Abstract</p> <p>Background</p> <p>Management decisions regarding quality and quantity of nurse staffing have important consequences for hospital budgets. Furthermore, these management decisions must address the nursing care requirements of the particular patients within an organizational unit. In order to determine optimal nurse staffing needs, the extent of nursing workload must first be known. Nursing workload is largely a function of the composite of the patients' individual health status, particularly with respect to functioning status, individual need for nursing care, and severity of symptoms. The International Classification of Functioning, Disability and Health (ICF) and the derived subsets, the so-called ICF Core Sets, are a standardized approach to describe patients' functioning status. The objectives of this study were to (1) examine the association between patients' functioning, as encoded by categories of the Acute ICF Core Sets, and nursing workload in patients in the acute care situation, (2) compare the variance in nursing workload explained by the ICF Core Set categories and with the Barthel Index, and (3) validate the Acute ICF Core Sets by their ability to predict nursing workload.</p> <p>Methods</p> <p>Patients' functioning at admission was assessed using the respective Acute ICF Core Set and the Barthel Index, whereas nursing workload data was collected using an established instrument. Associations between dependent and independent variables were modelled using linear regression. Variable selection was carried out using penalized regression.</p> <p>Results</p> <p>In patients with neurological and cardiopulmonary conditions, selected ICF categories and the Barthel Index Score explained the same variance in nursing workload (44% in neurological conditions, 35% in cardiopulmonary conditions), whereas ICF was slightly superior to Barthel Index Score for musculoskeletal conditions (20% versus 16%).</p> <p>Conclusions</p> <p>A substantial fraction of the variance in nursing workload in patients with rehabilitation needs in the acute hospital could be predicted by selected categories of the Acute ICF Core Sets, or by the Barthel Index score. Incorporating ICF Core Set-based data in nursing management decisions, particularly staffing decisions, may be beneficial.</p

Timed Voiding for the Management of Urinary Incontinence in Adults (review)

Aim: The aim of this paper is to present a systematic review assessing the effectiveness of timed voiding for the management of urinary incontinence in adults. Background: Despite the widespread use of systematic voiding programmes, their effectiveness is unclear, and the evidence for timed voiding has not been subject to rigorous and systematic evaluation. The impact on psychosocial factors and cost is also untested. The physiological basis for timed voiding is also poorly established. Methods: The systematic review incorporated the methodology of the Cochrane Collaboration. All randomized or quasi-randomized controlled trials that addressed timed voiding for the management of urinary incontinence in adults were searched, appraised, analysed and summarized. The date of the latest search was 2002. Data were extracted independently and appraised according to the level of concealment of random allocation prior to formal entry; few and identifiable withdrawals and dropouts and an analysis based on an intention to treat. The relative risk for dichotomous data was calculated with 95% confidence intervals. Where data were insufficient to support quantitative analysis, a narrative overview was undertaken. Results: Two trials of timed voiding met the inclusion criteria. In both, timed voiding was combined with other strategies. Participants were predominantly cognitively and physically impaired older women who resided in nursing home settings. Within-group improvements for the intervention groups were reported for both trials. One trial additionally reported a statistically significant reduction in night-time incontinence for the intervention group. The quality of the trials was modest and interpretation was limited by the potential for bias associated with inadequate concealment, missing data and no analysis by intention to treat. Conclusion: Terms used to describe voiding programmes that involve a fixed interval of voiding are variable. No conclusions can be drawn at this point about the effectiveness of timed voiding for the management of urinary incontinence in adults.<br /

Capabilities required by health professionals to deliver diabetes care identified through Delphi technique

Background: On any given day, up to 35% of consumers, using healthcare services across Australia have diabetes. They will encounter many health professionals with different levels of diabetes knowledge and expertise and they are likely to disengage with health services when health messaging is inconsistent. Ultimately, diabetes care is everybody’s business. Aims: To inform a capability framework for diabetes care. Methods: Consensus building used a two-phased, four-round, Delphi technique via online Qualtrics. Literature and a consultation group informed the Delphi questions. Thematic analysis used approaches by Luborsky (1994) and an Expert Advisory Group(EAG) supported member checking. Results: Eighty diabetes health professionals contributed as either a pre-Delphi consultation, pilot, Delphi expert panel, EAG or focus group member; including, nurses (n=56, 70%) and allied health(n=24, 30%). Identification of nine broad capabilities with relevant competencies. Capabilities for non-diabetes specific roles focused on awareness; diabetes-specific roles were denoted by exemplification or leading. These included: -Displays/Exemplifies clinical assessment capacities -Supports/Leads diabetes self-management education -Builds therapeutic relationships -Communicates with influence (and leadership) -Supports/Leads counselling to achieve the best outcomes -Supports/Exemplifies quality use of medicines -Displays/Exemplifies quality use of diabetes technology -Supports/Leads care coordination -Achieves quality/Lead and cultivates quality. Responses to prompts to define non-medical prescribing high-lighted that 18% of the Delphi panel members did not understand the term ‘non-medical prescribing’ and 86% indicating they managed medicines routinely. Conclusions: All health professionals require diabetes capabilities to support diabetes care. Implementing a framework that promotes consistency in curricula development across the nation has the potential to prepare the healthcare workforce better for diabetes care and develop a more responsive healthcare workforc

Habit retraining for the management of urinary incontinence in adults (Review)

BackgroundHabit retraining is toileting assistance given by a caregiver to adults with urinary incontinence. It involves the identification of an incontinent person\u27s natural voiding pattern and the development of an individualised toileting schedule which pre-empts involuntary bladder emptying.ObjectivesTo assess the effects of habit retraining for the management of urinary incontinence in adults.Search strategyWe searched the Cochrane Incontinence Group specialised register (9 May 2002), MEDLINE (January 1966 to February 2004), EMBASE (January 1980 to Week 18-2002), CINAHL (January 1982 to February 2001), PsychINFO (January 1972 to August 2002), Biological Abstracts (January 1980 to December 2000), Current Contents (January 1993 to December 2001) and the reference lists of relevant articles. We also contacted experts in the field, searched relevant websites and hand searched journals and conferenceproceedings.Selection criteriaAll randomised or quasi-randomised controlled trials comparing habit retraining delivered either alone or in conjunction with another intervention for urinary incontinence in adults.Data collection and analysisData extraction and quality assessment were undertaken by at least two people working independendy of each other. Any differences were resolved by discussion. The relative risks for dichotomous data were calculated with 95% confidence intervals. Where data were insufficient for a quantitative analysis, a narrative overview was undertaken.Main resultsThree trials with a total of 337 participants met the inclusion criteria, describing habit retraining combined with other approaches compared with usual care. Participants were primarily care-dependent elderly women with concurrent cognitive and/or physical impairment, residing in either a residential aged-care facility or in their own home. Outcomes included incidence and/or severity of urinary incontinence, the prevalences of urinary tract infection, skin rash and skin breakdown, cost and caregiver preparedness, role strain and burden. Caregivers found it difficult to maintain voiding records and to implement the toileting program. A 61% compliance rate was reported in one trial .There were no statistically significant differences in the incidence and in the volume of incontinence between groups. Within group analyses did however show improvements on these measures. Reductions were also reported for the intervention group in one study for skin rash, skin breakdown and in caregivers\u27 perceptions of their level of stress. Descriptive data on the. intervention suggests that habit retraining is a labour-intense activity. Electronic loggers, used as an adjunct to caregiver-delivered wet/dry checks, were reported as providing more accurate data than that from caregiver conducted wet/dry checks. To date, no analysis of the time and resources associated with these comparisons is available.Reviewers\u27 conclusionsData on habit retraining are few and of insufficient quality to provide a firm basis for practice.<br /