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Improvement in clinicians' perceptions of inpatient urinary continence care following an implementation study: a before and after study using a questionnaire aligned to the Theoretical Domains Framework with practical methods for analysing and presenting barrier and enabler data

2025-12-17T04:14:40Z

Title: Improvement in clinicians' perceptions of inpatient urinary continence care following an implementation study: a before and after study using a questionnaire aligned to the Theoretical Domains Framework with practical methods for analysing and presenting barrier and enabler data Authors: Marsden, D. L.; Boyle, K.; Birnie, J.; Buzio, A.; Dunne, J.; Hill, K.; Lambkin, D.; Lever, S.; Minett, F.; Ormond, S.; Shipp, J.; Steel, J.; Styles, A.; Wiggers, J.; Cadilhac, D. A-M.; Duff, J.; I-SCAMP Project Team Abstract: Background: Although 10-50% of patients in hospital experience urinary continence issues many do not receive guideline-recommended care. We developed and tested a co-created practice-change package that improved then maintained the proportion of symptomatic inpatients receiving a urinary continence assessment, diagnosis, and management plan. In this present study we aimed to categorise clinicians' perceptions of urinary continence care as barriers or enablers, and determine any change after implementation of the package. Methods: Overall, fifteen adult wards (acute = 3, rehabilitation = 7, acute and rehabilitation = 5) in 12 Australian hospitals (large city = 4, regional = 8) participated. All wards were to receive the practice-change package during the study. The selected implementation strategies addressed barriers identified before implementation, and targeted inpatient clinicians. These clinicians were invited to complete a web-based questionnaire before and immediately after the 6-month implementation phase. The questionnaire was aligned to 13/14 domains of the Theoretical Domains Framework. It included 57 subitems covering assessment, diagnosis, management, or general continence care. A 5-point Likert scale was used (e.g. "strongly agree" to "strongly disagree"). To categorise responses, each subitem was dichotomised as positive (e.g. "agree", "strongly agree") or neutral/ negative ("unsure", "disagree", "strongly disagree"). Subitems were classified and colour coded as barriers (< 60% positive responses, red), neutral (60-69% positive, orange) or enablers (> 69% positive, green). Changes from before to after-implementation were assessed. Results: Clinicians from 12 hospitals participated before-implementation (n=291, 82% female, 88% nursing), and from 10/12 hospitals (n=195, 86% female, 94% nursing) after-implementation. Two hospitals withdrew as the start of their implementation phase coincided with the onset of COVID-19. After implementation substantial improvements in perceptions were observed in 7/13 TDF domains: "skills", "knowledge", "memory", "beliefs about capabilities", "emotion", "environmental context and resources", and "social and professional role". Three domains ("goals", "beliefs about consequences" and "reinforcement") were high scoring enablers at both timepoints. Three domains had limited or no change ("social influences", "intentions", "behaviour regulation"). Conclusion: Categorisation and colour-coding of perceptions can assist end-users to quickly understand the data, identify areas for improvement, and changes after-implementation. The results helped to identify and explain which implementation strategies appeared to be successful in changing practice, and which ones need refining.

Palliative Care for People With Very Severe to Extreme Behavioural and Psychological Symptoms of Dementia (BPSD): A Scoping Review

2025-06-27T04:30:51Z

Title: Palliative Care for People With Very Severe to Extreme Behavioural and Psychological Symptoms of Dementia (BPSD): A Scoping Review Authors: Gallop, M.; Ford, J.; Bowman, A.; Mullen, A.; Schwebel, D.; Johnson, A.; Fernandez, R. Abstract: Aim: To explore current evidence regarding the provision of palliative care for individuals with very severe to extreme behavioural and psychological symptoms of dementia (BPSD) in a hospital setting. Design: Scoping review. Reporting method: The PRISMA-ScR reporting guideline. Methods: The JBI guidelines for scoping reviews were followed. A data extraction form assisted in the identification of key findings via a process of content analysis. Data sources: Studies were obtained from bibliographic databases of PubMed, CINAHL, and PsycINFO. Results: This review included six articles, and nine categories emerged from the findings. Symptom assessment and management, pain assessment challenges, atypical presentation of end-stage dementia, complex prescribing and treatment practices, principles of person-centred care, collaboration; training for health care professionals; emotional impact on staff; and family and caregivers. Conclusions: This scoping review highlighted a significant gap in the literature regarding palliative care for people living with very severe to extreme BPSD in hospital settings. This review highlighted key differences in the presentation of people with BPSD needing palliative care. There is a need for tailored models of care, specialised training and education for health professionals, families, and carers, and recognition of dementia as a terminal illness. Implications for the profession and/or patient care: The results of this review provide valuable insights into the level of understanding about the unique palliative care needs for people experiencing very severe to extreme BPSD, making an important contribution to the planning and development of future models of care. Impact: Mapping the available literature highlights a paucity of research in palliative care for people with very severe to extreme BPSD in hospital settings. There is a need for rigorous research studies and models of care developed and informed by the evidence for this small population necessitating unique care needs.

Learning to be a midwife in the clinical environment; tasks, clinical practicum hours or midwifery relationships

2025-03-27T23:55:57Z

Title: Learning to be a midwife in the clinical environment; tasks, clinical practicum hours or midwifery relationships Authors: Ebert, L.; Tierney, O.; Jones, D. Abstract: Discussions continue within the midwifery profession around the number of and type of clinical experiences required to ensure competent midwifery graduates. Introduction of the three year Bachelor of Midwifery in Australia, almost two decades ago, was intended to reduce the pressure students were under to complete their academic requirements whilst ensuring students developed midwifery practice that encapsulates the philosophical values of midwifery. Currently, midwifery students are mandated to achieve a minimum number of clinical skills and Continuity of Care Experience (CCE) relationships in order to register upon completion of their degree. To achieve these experiences, universities require students to complete a number of clinical practicum hours. Furthermore students are required to demonstrate competent clinical performance of a number of clinical skills. However, there is no evidence to date that a set number of experiences or hours ensures professional competence in the clinical environment. The aim of this paper is to promote discussion regarding the mandated requirements for allocated clinical practicum hours, specified numbers of clinical-based skills and CCE relationships in the context of learning to be a midwife in Australia. Keywords: Clinical education; Competency; Continuity of Care Experience; Midwifery; Midwifery relationships; Work Integrated Learning.

An exploration of emergency nurses' understanding of the ageing process and knowledge of their older patient: A comparison between regional and metropolitan nurses in Australia.

2025-03-17T02:38:45Z

Title: An exploration of emergency nurses' understanding of the ageing process and knowledge of their older patient: A comparison between regional and metropolitan nurses in Australia. Authors: Deasey, D.; Kable, A.; Jeong, S. Abstract: Aims: The aims of the present study were to report and compare regional and metropolitan Australian ED nurses' knowledge and understanding of age related characteristics of the older person. Background: ED nurses, who have a duty of care to deliver best practices for managing the older person, can be challenged due to the complexities and co-morbidities associated with older person presentations in the ED. Nurses in regional areas may have limited access to continuing education programmes and limited opportunities to attend such programmes. Design: A cross-sectional survey using previously validated instruments (OPACS and Palmore's Facts of Ageing Quiz) was conducted to measure emergency nurses knowledge and perceptions of physical, physiologic, and age related characteristics of older people; and aspects of hospitalisation that affect older people. Methods: Members of the College of Emergency Nursing Australasia (CENA) were invited to participate in the present study. There were 371 (39%) completed and valid surveys returned. Results: The OPACS results indicate that 66% of ED nurses had a basic knowledge about physical aspects and hospitalisation issues that affect older people. There were 59% correct responses for the Palmore's Facts of Ageing Quiz items measuring knowledge of physiologic and age related characteristics of older people. There were few differences between regional and metropolitan nurses. Conclusion: Increased knowledge of ageing is required for emergency nurses to continue to provide adequate care to older patients presenting to the ED to avoid adverse outcomes for these people. Keywords: Emergency nurse; Knowledge; Older person.