Communication surrounding initiation and withdrawal of non-invasive ventilation in adults with motor neuron(e) disease: Clinicians’ and family members’ perspectives

Introduction: International guidelines recommend that health care clinicians communicate with people with MND and their family members about non-invasive ventilation (NIV) and percutaneous gastrostomy tube (PEG) prior to or at the onset of respiratory symptoms. This study sought to discover the degree to which these recommendations are followed in practice. Methods: Interpretive Description methodology was employed. Nineteen clinicians experienced in caring for people with MND, six relatives of recently deceased people with MND and one person with MND participated in semi-structured in-depth interviews. Clinicians’ accounts of NIV and PEG related communications were compared to family member participants’ recollections of their own discussions with clinicians. Data were analysed thematically. Results: Six major themes emerged that together capture the factors that impact practitioner-patient-family communications about NIV and PEG. Some clinicians were unaware of MND guidelines particularly communicating the burdens or possible withdrawal of NIV or found them challenging to implement. Consequently, family participants reported that they and their relatives with MND found clinicians’ communication on these topics inadequate. This led to them ‘topping up’ their knowledge from less authoritative sources, predominantly the internet. Discussion: Clinicians’ lack of awareness of the international guidelines and discomfort about discussing the benefits and burdens of NIV and PEGs means some people with MND and their families may be unprepared for the consequences of using and ceasing NIV

Does general practice Google?

BACKGROUND: Searching websites during consultations with patients has been anecdotally reported to be useful by some medical practitioners. We aimed to investigate how and to what extent medical practitioners use the internet to aid clinical consultations. METHODS: A descriptive study of general practitioners in the Osborne Division of General Practice, Perth, Western Australia (N=132), using a postal questionnaire sent in May and June 2007. RESULTS: Ninety-three percent of those surveyed had broadband access. The majority used the computer for clinical tasks such as prescribing, ordering tests and writing letters. Fifty-six percent used the internet during consultations. The search engine 'Google' was the most commonly cited website. The most frequently mentioned reason for internet use was finding medical information for patients. DISCUSSION: Computers are now available in most general practices. The internet has impacted upon the traditional doctor-patient relationship. More research is needed into how GPs can better search and use the information available on the internet

Communication surrounding initiation and withdrawal of non-invasive ventilation in adults with motor neuron(e) disease : Clinicians’ and family members’ perspectives

Introduction International guidelines recommend that health care clinicians communicate with people with MND and their family members about non-invasive ventilation (NIV) and percutaneous gastrostomy tube (PEG) prior to or at the onset of respiratory symptoms. This study sought to discover the degree to which these recommendations are followed in practice. Methods Interpretive Description methodology was employed. Nineteen clinicians experienced in caring for people with MND, six relatives of recently deceased people with MND and one person with MND participated in semi-structured in-depth interviews. Clinicians’ accounts of NIV and PEG related communications were compared to family member participants’ recollections of their own discussions with clinicians. Data were analysed thematically. Results Six major themes emerged that together capture the factors that impact practitioner-patient-family communications about NIV and PEG. Some clinicians were unaware of MND guidelines particularly communicating the burdens or possible withdrawal of NIV or found them challenging to implement. Consequently, family participants reported that they and their relatives with MND found clinicians’ communication on these topics inadequate. This led to them ‘topping up’ their knowledge from less authoritative sources, predominantly the internet. Discussion Clinicians’ lack of awareness of the international guidelines and discomfort about discussing the benefits and burdens of NIV and PEGs means some people with MND and their families may be unprepared for the consequences of using and ceasing NIV

Creating cultural empathy and challenging attitudes through Indigenous narratives

The poorer health status of Indigenous Australians has been largely attributed to social disadvantage and their marginalisation within mainstream society (Marmot, 2011). This includes access to health care, as well as proximity to health services, availability and cultural appropriateness of health services, transport availability, health insurance, the affordability of health services and patient proficiency in English (AIHW, 2011). The interpersonal attitudes and behaviours of non-Indigenous health providers, both conscious and unconscious, are also known to contribute to disparities in treatment, impairment of communication between health providers and patients, and consequently, patients’ mistrust of the health system due to negative past experiences (Geiger, 2001). This project collected stories from Indigenous people about their experiences with health care services. Their stories serve to enhance relationships and understanding between diverse peoples, and give Indigenous Australians a voice in health curricula across Australian universities and in agencies delivering health services

Cartoons for e-health informatics

Not only is Hepatitis B serology often misunderstood because of its complex serological implications, but advances in medical science have revolutionised screening and treatment of hepatitis B. To maximise such evolution however, this new information must be relayed effectively and efficiently to current and future medical professionals. Cartoons have been well regarded as a teaching tool in a variety of different settings as is the use of web based technology. Therefore the delivery of a cartoon based learning tool, accessed via on-line learning modules was considered a novel and potentially effective way of disseminating new knowledge. To increase health professionals’ understanding of hepatitis B serology and skill in interpreting the tests that indicate the appropriate treatment, a cartoon series was developed. The cartoons are located on an online educational website and include characters that represent the different antibodies and antigens associated with hepatitis B. The cartoon characters are involved in a series of adventures that represent the various phases of hepatitis B infection, and the paper describes their development. Subsequent research demonstrated that exposure to the online cartoon based learning tool indicates that they are a fun and useful way to increase knowledge

Engaging Australian Aboriginal narratives to challenge attitudes and create empathy in health care: A methodological perspective

Background: Unconscious bias and negative attitudes towards minority groups have detrimental effects on the way health care is, or is not, provided to these groups. Recognition of racist attitudes and behaviours as well as understanding clients’ experiences of health and health care are pivotal to developing better health care strategies to positively impact on the quality and safety of care provided to Indigenous people. Indigenous research demands inclusive research processes and the use of culturally appropriate methodologies. This paper presents a methodological account of collecting narratives which accurately and respectfully reflect Aboriginal Australians’ experiences with health care in Western Australia. The purpose of these narratives is to provide health students and professionals with an opportunity to ‘walk-in the shoes’ of Aboriginal people where face-to-face interaction is not feasible. Methods: With the incorporation of Indigenous peoples’ voices being an important link in cultural safety, the project was led by an Indigenous Reference group, who encouraged active participation of Aboriginal people in all areas of the project. Using a phenomenological approach and guided by the Indigenous Reference group, yarning data collection was implemented to collect stories focusing on Aboriginal people’s experiences with health care services. An open-access, on-line website was established to host education resources developed from these “yarns”. Results: Yarning provided a rich source of information on personal experiences and encouraged the story provider to recognise their facilitative role in the research process. While the methodology used in this project was lengthy and labour-intensive it afforded a respectful manner for story collection and highlighted several innate flaws when Western methods are applied to an Indigenous context. Conclusion: Engagement of an Indigenous Reference Group was pivotal to designing an appropriate methodology that incorporated the voices of Aboriginal people in a multimedia resource of Aboriginal narratives. However further research is warranted to understand how the resources are being used and integrated into curricula, and their impact on students and health care outcomes

Creating Cultural Empathy and Challenging Attitudes Through Indigenous Narrative Project

The gap in life expectancy between Indigenous and non-Indigenous Australians is too large to ignore. This has been attributed to social and economic disadvantage, access to health care and lack of cultural appropriateness of health services and providers. Creating culturally secure healthcare requires that we explore new ways for health professionals to relate to Aboriginal people. This article describes the development, implementation and early results from the Creating cultural empathy and challenging attitudes though Indigenous narrative project. The purpose of the project is to collect and trial narrative resources to engage students in stories of Indigenous people’s perceptions and experience of healthcare. Storytelling has a long tradition within Indigenous culture and narrative approaches can be successful in engaging students changing attitudes. These stories are intended to trigger classroom discussions to encourage students to reflect on their own assumptions and values and to enhance empathy, thereby enabling future health providers to improve their management of Indigenous patients. Key to this project has been working collaboratively with Indigenous people as active participants in the project with roles as project leads, team members, Indigenous Reference Group members, external evaluators and providers of the narratives

Maintaining social and emotional wellbeing among older adults during periods of increased social isolation: Lessons from the COVID-19 pandemic

Objective: Older adults are vulnerable to isolation and poor emotional wellbeing during COVID-19, however, their access to appropriate supports is unknown. The aim of this study was to explore older adults’ experiences accessing social and emotional support during the COVID-19 pandemic in Australia. Method: Ten older adults from Western Australia (Australia) aged 68 to 78 years participated in individual semi-structured interviews between December 2020 and January 2021. Responses were investigated using thematic analysis. Results: Three key themes emerged: adaptability and self-sufficiency; informal support-seeking; and digital and online technologies. Older adults were adaptable to COVID-19 restrictions; however, some were anxious about reconnecting with their social networks once restrictions had eased. Older adults relied on their informal support networks to maintain their social and emotional wellbeing during lockdown. Digital platforms (e.g., Zoom, social media) enabled older adults to stay connected with others, yet some older people were unable or reluctant to use technology, leaving them vulnerable to social isolation. Conclusions: Older adults are resilient to the challenges of COVID-19. Informal supports and digital technologies are important to maintaining social and emotional wellbeing during lockdown. Local governments and community groups may benefit from increased funding to deliver services that promote social connectedness during times of crisis

Maintaining social and emotional wellbeing among older adults during periods of increased social isolation: lessons from the COVID-19 pandemic [dataset]

Older adults are vulnerable to isolation and poor emotional wellbeing during COVID-19, however, their access to appropriate supports is unknown. The aim of this study was to explore older adults’ experiences accessing social and emotional support during the COVID-19 pandemic in Australia. Ten older adults from Western Australia (Australia) aged 68 to 78 years participated in individual semi-structured interviews between December 2020 and January 2021. Responses were investigated using thematic analysis. Three key themes emerged: adaptability and self-sufficiency; informal support-seeking; and digital and online technologies. Older adults were adaptable to COVID-19 restrictions; however, some were anxious about reconnecting with their social networks once restrictions had eased. Older adults relied on their informal support networks to maintain their social and emotional wellbeing during lockdown. Digital platforms (e.g., Zoom, social media) enabled older adults to stay connected with others, yet some older people were unable or reluctant to use technology, leaving them vulnerable to social isolation. Older adults are resilient to the challenges of COVID-19. Informal supports and digital technologies are important to maintaining social and emotional wellbeing during lockdown. Local governments and community groups may benefit from increased funding to deliver services that promote social connectedness during times of crisis. What is already known about this topic: (1) Older adults are vulnerable to social isolation and poor mental health during COVID-19. (2) Older adults are less likely to seek and receive help for their emotional and social health than younger age groups. (3) Barriers to accessing appropriate supports include physical health problems, stigma, negative attitudes towards help-seeking and system-level factors. What this topic adds: (1) Older adults were able to adapt well to COVID-19 restrictions and relied on informal supports to maintain their wellbeing. (2) Older adults with limited social networks and poor access to and/or knowledge of digital technologies are at the greatest risk of social and emotional declines. (3) Telephone “warm” lines, volunteering opportunities, and programs to improve digital literacy may help to protect older adults’ social and emotional wellbeing during times of crise

What makes a space safe? Consumers\u27 perspectives on a mental health safe space

The provision of community-based space for people experiencing a mental health crisis is regarded as a favourable alternative to the emergency department. However, the only non-emergency department safe spaces in Western Australia are located within hospitals or hospital grounds. This qualitative study asked mental health consumers in Western Australia with experience of presentation at the emergency department during a mental health crisis to describe what a safe space would look and feel like. Data were collected through focus groups and thematically analysed. The findings present the voices of mental health consumers through the framework of health geography and the therapeutic landscape. These participants articulated important physical and social features of a therapeutic safe space and their symbolism as inclusive, accessible places where they would experience a sense of agency and belonging. Participants also expressed a need for trained peer support within the space to complement the skilled professional mental health team. Participants\u27 experiences of the emergency department during mental health crises were described as contrary to their recovery needs. The research reinforces the need for an alternative to the emergency department for adults who experience mental health crises and provides consumer-led evidence to inform the design and development of a recovery-focused safe space