The caregiving perspective in heart failure: a population based study

Background: Heart failure (HF) is a frequent condition in the elderly and mortality is high. This study sought to describe the profile of those providing care in the community and their needs. Methods: The South Australian Health Omnibus is an annual, random, face-to-face, cross sectional survey conducted within the state. Having standardized data to the whole population, the study describes the subset of the population who identify that they actively cared for someone at the end of life with HF in the five years before survey administration

An online survey of Australian physicians reported practice with the off-label use of nebulised frusemide

BACKGROUND: Off-label prescribing is common in palliative care. Despite inconsistent reports of the benefit of nebulised frusemide for breathlessness, its use continues to be reported. METHODS: An online survey was emailed to 249 members of the Australian and New Zealand Society of Palliative Medicine to estimate the use of nebulised frusemide for breathlessness by Australian physicians involved in palliative care in the previous 12 months. RESULTS: There were 52/249 (21%) respondents to the survey. The majority (44/52; 85%) had not prescribed nebulised frusemide in the previous 12 months. The most common (18/44; 43%) reason for not prescribing nebulised frusemide was a belief that there was not enough evidence to support its use. Whilst only a few respondents (8/52; 15%) reported having used nebulised frusemide, all that had used it thought there was at least some benefit in relieving breathlessness. CONCLUSION: This report adds to the series of case studies reporting some benefit from nebulised frusemide in relieving breathlessnes

Selected Precision Agriculture studies in oil palm: a 10-year summary

Precision Agriculture (PA) embodies a holistic field management strategy that allows adjustment of crop input use and cultivation methods, including seed, fertilizer, pesticide and water application, variety selection, planting, tillage and harvesting, to match varying soil, crop and other field attributes. PA involves mapping and analyzing field variability, and linking such variability to management actions. This contrasts with conventional agriculture that is based on uniform treatment(s) across a field. Oil palm is an excellent candidate for PA implementation simply because it consumes a large amount of chemical and physical inputs. However, a major constraint in implementing PA strategies on a detailed scale for oil palm is the typically large plantation size. The agronomic challenge of increasing oil palm yield productivity hinges on three primary issues: 1) fertilization, 2) cropping practices such as planting density, ground cover, pruning and drainage, and 3) pest and disease management. This paper presents a 10-year Abstract of selected PA studies carried out in Malaysian and Indonesian oil palm plantations. These studies are: spatial variability of soil fertility across topography, removal of spatial effects to improve interpretation of data from fertilizer trials, development of a non-destructive oil yield and oil quality estimation protocol, stand density assessment using remote sensing, spatial variability of soil organic carbon across different crop ages, spatial variability of orange spotting disease, discriminating between potassium deficiency and orange spotting disease symptoms using remote sensing, estimating fresh fruit bunch yields using remote sensing, and estimating palm oil quality and yield using proximal sensing

Developing targeted health service interventions using the PRECEDE-PROCEED model: two Australian case studies

 This paper provides an overview of the applicability of the PRECEDE-PROCEED Model to the development of targeted nursing led chronic illness interventions. Background. Changing health care practice is a complex and dynamic process that requires consideration of social, political, economic, and organisational factors. An understanding of the characteristics of the target population, health professionals, and organizations plus identification of the determinants for change are also required. Synthesizing this data to guide the development of an effective intervention is a challenging process. The PRECEDE-PROCEED Model has been used in global health care settings to guide the identification, planning, implementation, and evaluation of various health improvement initiatives. Design. Using a reflective case study approach, this paper examines the applicability of the PRECEDE-PROCEED Model to the development of targeted chronic care improvement interventions for two distinct Australian populations: a rapidly expanding and aging rural population with unmet palliative care needs and a disadvantaged urban community at higher risk of cardiovascular disease. Results. The PRECEDE-PROCEED Model approach demonstrated utility across diverse health settings in a systematic planning process. In environments characterized by increasing health care needs, limited resources, and growing community expectations, adopting planning tools such as PRECEDE-PROCEED Model at a local level can facilitate the development of the most effective interventions. Relevance to Clinical Practice. The PRECEDE-PROCEED Model is a strong theoretical model that guides the development of realistic nursing led interventions with the best chance of being successful in existing health care environments

The role of culture in quality improvement in the intensive care unit: a literature review

Improving the quality of patient care and patient outcomes is a major concern internationally. In a developing health care system, implementing quality improvement is challenging due not only to resource and workforce issues but also cultural factors. Using the method of a focussed literature review, this paper discusses the importance of assessing a societal view of culture, social mores and customs, and power relationships in quality improvement activities using the intensive care unit as an exemplar. We conclude that implementing quality improvement strategies in a developing health care system needs to address the broader perspectives of social and cultural systems particularly hierarchical relationships and issues of non-disclosure

Caring for Others, but Not Themselves: Implications for Health Care Interventions in Women with Cardiovascular Disease

Cardiovascular disease is the largest killer of women internationally and women often suffer inferior outcomes following an acute cardiac event as compared to men. A gendered approach to investigating cardiovascular disease in women incorporates the unique social, cultural, and economic circumstances that being a woman brings to the health encounter. The multiple roles enacted by many women may be important factors in this health discrepancy. In order to more fully understand the impact of the roles of women on health, a questionnaire was administered to participants of the Heart Awareness for Women group cardiac rehabilitation program which assessed women's role perceptions followed by discussions. We found that caregiving can be both positive and negative. It gives a sense of purpose, meaning, and community connection as well as burden and conflict. Emphasis must be placed on promoting strategies in women to achieve a balance between caregiving responsibilities and prioritisation of cardiovascular health

Palliative care nurses\u27 recognition and assessment of delirium symptoms: A qualitative study using critical incident technique

Delirium is prevalent in palliative care inpatient settings and management is often challenging. Despite nurses’ integral patient care role, little is known about palliative care nurses’ capacity to recognise, assess and respond to patients’ delirium symptoms. Objective: To explore the experiences, views and practices of inpatient palliative care nurses in delirium recognition and assessment. Settings and participants: 30 nurses from nine Australian specialist palliative care inpatient services. Design and methods: Critical incident technique (CIT) guided a series of semi-structured interviews. Prior to interviews participants were given a vignette of a palliative care inpatient with an unrecognised hypoactive delirium, to prompt their recollection and recounting of a similar clinical incident. Clearly recalled and described incidents were analysed using thematic content analysis. Findings: 20 of 30 participants recalled and described 28 relevant delirium incidents. Two themes and six sub-themes provide a general description of participants’ experiences, views and practice in delirium recognition and assessment. Participants experience distress related to caring for patients with delirium and express compassion and empathy for delirious patients. Enhancing their delirium knowledge, strengthening collaborative multidisciplinary team relationships and better communication are important supports. Some participants, usually those in advance practice roles, describe more comprehensive assessment capabilities that incorporate clinical expertise with whole person awareness, yet systematic and structured delirium screening and assessment processes and application of the delirium diagnosis criteria are largely missing. Use of ambiguous terminology to describe delirium symptoms contributes to ineffective practice

Transitioning from caregiving to widowhood

Context Older women commonly assume a caregiving role for their husbands at the end of life and are more vulnerable to poorer health, well-being, and social and economic challenges. Objectives The aim of this study was to ascertain older women\u27s experiences of spousal caregiving at the end of life and the ways in which this experience impacts on the transition to widowhood. Methods Longitudinal, in-depth, semistructured interviews were conducted with older women three times over a one-year period after the death of their husbands. This report focuses on the initial interviews that examined the transition from caregiving to widowhood. Transcripts were analyzed using interpretive phenomenological analysis methods. Participants were community-dwelling women older than 65 years who had recently been caregivers for their husbands who died within the past two years. Results Older women caregivers described their caregiver role as taxing, particularly in light of their own chronic conditions that they failed to prioritize and address. They did not ask for help in managing their roles and health problems, but quietly endured. Hence, they did not communicate their needs or strains explicitly. The degree of perceived adequacy of communication and interaction with health professionals were important factors impacting on their bereavement. Conclusion It is imperative for health professionals to appreciate that older women caregivers may need more supportive interaction and information during the end-of-life caregiving, they may have expectations of communication, and they may deny or fail to focus on their own health issues. A patient/family/carer-centered approach could negate this oversight and improve the outcomes for these women as they transition into widowhood