Transfers to residential aged care : health professionals’ lived experience of decision making in hospital

Understanding how health professionals make transfer decisions with older people from hospital to residential aged care is important as it sheds light on a previously unexplored phenomenon as well as identifies the barriers and enablers in making these decisions. The literature review revealed a dearth of studies that focused on this particular aspect of transfer decision making in hospitals, which indicated that further research was needed to better understand this complex phenomenon. My study explored the lived experience of doctors, occupational therapists, physiotherapists, registered nurses and social workers in making transfer decisions with older people from hospital to residential aged care. The significance of my study is that it is the first that has examined health professionals’ transfer decision making from a phenomenological perspective. The application of a phenomenological approach informed by Husserl supported an understanding of health professionals’ experiences in making transfer decisions. This included the use of two data collection methods of interviews and observations to explore not only the descriptions of their lived experience in making transfer decisions but also in observing how they made these decisions. My study was conducted in five hospitals in New South Wales, Australia. The findings revealed that health professionals made transfer decisions by exploring options through assessments as well as collaborating with the older patient, family, carers, and the multidisciplinary team. However, this sometimes led to conflict. Overall, the health professionals gathered information and tried to make collaborative, safe transfer decisions, with limited options, under significant time pressures. The implications that arose from these findings for policy makers, hospital administrators and clinicians include the lack of transfer decision assessment tools and education on how to make these decisions along with the difficulties of accessing alternatives to transfer to residential aged care. The recommendations for future practice, research and education that arose from this research include strategies that support older patients’ choice as well as registered nurses’ participation in the transfer decision. Making quality transfer decisions requires both education and the development of comprehensive multidisciplinary transfer assessments which include access to supports

Ageing and disability (osteoarthritis and osteoporosis)

The majority of the population in Australia and New Zealand anticipate a lifetime of independence and good health that allows them to maintain a self-directed lifestyle. However, living a healthy and productive life does not necessarily protect the individual from varying levels of disability later in life due to the natural changes of ageing, life's physical stressors and individual genetic make-up. Osteoarthritis, rheumatoid arthritis a development of osteoarthritis are obesity, misalignment of bones and joints, joint trauma and injury, repetitive occupational joint use and physical inactivity (Rahman et al., 2005, p. 26; Rooney, 2004; Swift, 2012a). John's situation illustrates a number of controllable and non-controllable factors that have placed him at greater risk of developing osteoarthritis. The uncontrollable factors include his age and his genetic disposition or family history. Being male docs reduce his risk but this does not prevent osteoarthritis developing (AIHW, 2010; Rahman et al., 2005; Rooney, 2004). His efforts to control his weight over a lifetime have possibly reduced the onset of disability in the light of other biomechanical factors. John has had a physically strenuous working life as a plumber and has experienced multiple but relatively minor spinal injuries. However, both his occupation and the frequency of back injuries have made him aware of the benefits of body mechanics, weight control, exercise and activity to maintain mobility and independence. Until he retired he was physically active but his recent surgeries and therapy have reduced his exercise capacity and thus increased his risk of disability. While his treatment for cancer has been successful to date, it has constrained his lifestyle and reduced his energy levels

Principles for nursing practice : osteoarthritis and osteoporosis

The majority of the population in Australia and New Zealand anticipate a lifetime of independence and good health that allows them to maintain a self-directed lifestyle. However, living a healthy and productive life does not necessarily protect the individual from varying levels of disability later in life due to the natural changes of ageing, life's physical stressors and individual genetic make-up. Osteoarthritis, rheumatoid arthritis, osteoporosis and back pain affect more than 6.1 mill ion. Australians, mostly among people aged 65 years and over (Australian Institute of Health and Welfare (AIHW) 2014 ). As populations age, more people are likely to experience disability as a result of these conditions. Even if the disability does not interfere with daily function and mobility, in combination with other changes of ageing and age-related diseases, the effects of these conditions and their management can prove to be challenging for the person, their family and health providers, and result in increased levels of disability. In this chapter there will be a discussion of osteoarthritis, rheumatoid arthritis and osteoporosis. There will be a focus on the effects of osteoarthritis and osteoporosis on two older people and their families through the use of case studies. The case studies will assist you to understand how nursing practices can promote health and wellbeing for persons experiencing disability and challenge as a result of these conditions

Experiences of perioperative care among ethnically diverse older adult patients : An integrative review

Background Older people from Culturally and Linguistically Diverse (CALD) backgrounds are increasingly admitted to hospital for acute care reasons, such as surgical procedures. However, there is limited evidence on the perioperative (surgical) experiences and needs of ethnically diverse older adults. Aim To synthesise evidence about the perioperative experiences of older adults from ethnically diverse backgrounds. Methods An integrative review methodology. Findings Eighteen articles were included in the review. Three main themes emerged from the review of the literature; (i) Culturally related factors as drivers to decision-making preoperatively; (ii) Providing culturally responsive and appropriate perioperative information; and (iii) Culturally related considerations for effective self-management postoperatively. Discussion The perioperative needs of ethnic groups are contextualised or informed by culture, ethnicity and linguistics. These needs are not necessarily exclusive to those of ethnically diverse backgrounds. For example, the perceived need for understandable information to make an informed decision would be considered as an essential aspect of perioperative care for any patient. However, the need for understandable information and the complexities of effective communication in perioperative settings are compounded by nuances of culture and language. Conclusion There needs to be culturally appropriate perioperative processes of care, which build on the standard practice. While patient needs are addressed by universal processes, there is a need to expand and utilise approaches that are culturally and linguistically responsive to older adult patients and their family caregivers. The availability of appropriate mechanisms to engage with healthcare in a culturally meaningful way has the potential to reduce health inequities and improve patient experience

The application and tailoring of Colaizzi's phenomenological approach to a hospital setting

Husserl's descriptive phenomenology is a popular methodology in health research as it provides a way to understand people's experiences. Positioned in Husserl's phenomenology, Colaizzi's approach offers a way to analyse data and develop trustworthy findings. However, it can pose methodological and practical challenges

Retention and academic performance of undergraduate nursing students with advanced standing : a mixed-methods study

Background: Undergraduate nursing students enter university through a variety of pathways. For some students this includes the granting of advanced standing based on recognition of prior qualifications. The impact of advanced standing on nursing students' transition, retention and success at university is not well understood. Objectives: The aim of this study was to examine the retention, academic success and experiences of students who commenced their undergraduate nursing studies with advanced standing. Design, setting, participants, methods: A sequential exploratory mixed methods design was used in this study, which involved undergraduate nursing students enrolled at a multi-campus university in Australia. Nursing students who enrolled in 2014 and did not opt out of program level research were included in the study. Results: Students with advanced standing were older (mean 31.6 versus 25.8 years, p < 0.001) and more likely to discontinue their studies at the end of Semester One (97% versus 95%, p = 0.015) than standard-entry students. Advanced standing was also shown to be an independent predictor of low GPA [OR: 1.69 (95% CI: 1.06 to 2.69]. Most students with advanced standing commenced directly into second year (45%) missing first year student connections and programs. Students reported feeling apprehensive, forgotten and ill-prepared for the expectations of university. Some showed significant strength and resilience while others were struggling to cope with the workload with minimal knowledge or understanding of supports available to them. Conclusions: The widening participation agenda is a commendable strategy however, students who enter university with advanced standing need targeted support to promote their transition, retention and success at university

Access to food choices by older people in residential aged care : an integrative review

Background: There is increasing concern regarding autonomy and quality of life for older people living in residential aged care. Failure to provide food choices and suitable dining environments has been reported to negatively impact their nutritional status, undermining their sense of autonomy and quality of life. Aim: This paper presents an integrative review of studies on food choices in residential aged care and explores the relationships between food choices, autonomy and quality of life. Methods: Search of nine databases CINAHL, PubMed, Scopus, PsycINFO, ProQuest, Cochrane, Embase, AMED, and Social Science Citation Index, identified nine primary articles. The Critical Appraisal Skill Program tool was used to examine the quality of these articles. Findings: Three key themes were identified: (1) Prevalence of food choices and catering for residents’ preference; (2) Importance of food choices to nutritional status; (3) Impact of food choices on autonomy and quality of life. The importance of increasing staff awareness and a need to develop aged care regulation to ensure adequate food choices provided. Discussion: The importance of increasing staff awareness regarding the interrelatedness of respecting older people's food choices, autonomy and quality of life is identified. The needs of determining aged care regulation and accreditation standards were also highlighted. Conclusion: Failure to provide satisfying food choices impacts older people's quality of life. However, the strength of the relationships between food choices, autonomy and quality of life requires further study

Perspectives of residents and staff regarding food choice in residential aged care : a qualitative study

Aims and objectives: To explore the experiences of food choice and meal service in residential aged care facilities and its impact on autonomy, self-determination and quality of life from the perspectives of both residents and staff. Background: Globally, residential aged care is a principal provider of care for older people who can no longer live independently at home. Within this setting, lack of food choice has been identified as a significant factor impacting on residents' self-determination, sense of autonomy and quality of life. Design: This study used an exploratory descriptive qualitative approach guided by self-determination theory. Method: A total of 14 participants (seven residents and seven staff members) from two Australian residential aged care facilities were recruited through purposive and snowball sampling with assistance from one independent contact nurse at each facility. In-depth, semi-structured interviews were conducted, digitally recorded and transcribed. The COREQ checklist was used in this qualitative study. Results: Three main themes were identified from the interview data provided by residents and staff, which were as follows: (a) catering for the masses; (b) organisational barriers to providing choice; and (c) food impacts well-being. Conclusions: This study explored the experiences of food choice and service in residential aged care facilities, from the perspectives of both residents and staff. Results of interviews highlighted the importance of providing adequate food choice which has become an enduring issue that requires more attention and commitment to make a positive change for residents living in residential aged care facilities. Relevance to clinical practice: Nurses and other staff working in residential aged care facilities need to be aware of the importance of providing adequate food choice, including for residents who require modified diets. As advocates for residents, nursing staff must address the persistent lack of food choice. However, this will require a radical change in organisational culture and strong leadership