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Aims: To understand why some nursing homes use hospital avoidance programs more frequently than others. Design: Two hospital avoidance programs, called residential-in-reach services in Victoria, Australia, were evaluated using a qualitative descriptive design. Methods: Between 2014 and 2018, 127 semi-structured interviews were conducted with staff from nursing homes, general practitioners and staff from the residential-in reach services. The interviews took an average of 45 min and transcripts were thematically analysed. Results: Nursing home reliance on residential-in-reach services to manage deteriorating residents was evident in both evaluations. Irrespective of the model of service provision, reliance was associated with: the increased care needs of residents; difficulties accessing timely and appropriate medical care; and the reduced numbers of skilled registered nurses to assess and manage deteriorating residents. Conclusion: The residential-in-reach services are highly regarded by nursing homes. However, some are reliant on these services to provide nursing assessment and management. Using residential-in-reach services to substitute for nursing care, deskills nurses and shifts the cost of providing care from the service provider to other agencies. To provide residents with quality nursing care, the number of skilled registered nurses able to work within their scope of practice needs to be increased in Australian nursing homes. Impact: The findings highlight the challenges of providing care in older people living in aged care. Increasing the number of skilled registered nurses in Australian nursing homes, would support deteriorating residents to stay in familiar surroundings and reduce reliance on external services to provide nursing care.

Background Older people living in residential aged care facilities are at high risk of acquiring infections such as influenza, gastroenteritis, and more recently COVID-19. These infections are a major cause of morbidity and mortality among this cohort. Quality infection prevention and control practice in residential aged care is therefore imperative. Although appointment of a dedicated infection prevention and control (IPC) lead in every Australian residential aged care facility is now mandated, all people working in this setting have a role to play in IPC. The COVID-19 pandemic revealed inadequacies in IPC in this sector and highlighted the need for interventions to improve implementation of best practice. Methods Using mixed methods, this four-phase implementation study will use theory-informed approaches to: (1) assess residential aged care facilities’ readiness for IPC practice change, (2) explore current practice using scenario-based assessments, (3) investigate barriers to best practice IPC, and (4) determine and evaluate feasible and locally tailored solutions to overcome the identified barriers. IPC leads will be upskilled and supported to operationalise the selected solutions. Staff working in residential aged care facilities, residents and their families will be recruited for participation in surveys and semi-structured interviews. Data will be analysed and triangulated at each phase, with findings informing the subsequent phases. Stakeholder groups at each facility and the IMMERSE project’s Reference Group will contribute to the interpretation of findings at each phase of the project. Discussion This multi-site study will comprehensively explore infection prevention and control practices in residential aged care. It will inform and support locally appropriate evidence-based strategies for enhancing infection prevention and control practice.

This mixed methods study explored challenges faced by pastoral care workers. A development phase preceded an on-line survey completed by chaplains and pastoral practitioners (n = 40) employed by a major Australian aged care provider. The survey covered the purpose of pastoral care, key tasks and resources, current and future challenges, and participants' responses to challenges. The biggest issue was heavy demand on participants' time, due to insufficient staff and demanding organisational procedures. A commonly mentioned challenge with future implications was increasing resident acuity. Respondents were dedicated and enthusiastic, despite heavy workloads and occasional difficulty working with care staff or management.

Objective: To identify factors that health and allied health practitioners consider central to excellence in residential aged care facilities (RACFs) with the objective of supporting improvements in monitoring, accountability and service delivery within the sector. Methods: In a qualitative, exploratory designed study, interviews were undertaken with seventeen participants from 10 health and allied health disciplines (general practice, dentistry, pharmacy, psychiatry, psychology, neuropsychology, physiotherapy, speech pathology, occupational therapy and palliative care) with experience of working in Victorian RACFs. The interviews focused on how practitioners perceived excellence within RACFs. Data were analysed thematically. Results: Thematic analysis yielded five themes, which correspond with different dimensions or ways of understanding excellence, including resident well-being, residences as a true home, good practice models, effective management and skilled staff, and unmet needs. Under each of these themes, participants referred to issues closely related to the concerns of their particular professions as well as those more general in nature. Conclusions: The diversity in issues to which participants drew attention highlights the importance of obtaining the perspectives of a broad range of practitioners providing services to RACF residents to achieving excellence in the sector. Commonalities in their responses indicate the potential for a greater level of collaboration among the health and allied health professions.

Despite the prevalence of mental health concerns among those who live in residential aged care, many residential aged care facilities (RACFs) provide little by way of psychological support. Drawing on qualitative data obtained from interviews with residents from across 15 RACFs in Victoria, Australia, this article adds to understandings about the diversity and impact of mental health challenges experienced by residents, and gaps in the knowledge of staff about how to address such. Thus, it also offers evidence of the urgent need for RACFs to provide residents both better access to specialist mental health practitioners and training to care staff on mental health issues.

Background: Meeting the complex health needs of an increasing number of older people is a critical workforce challenge for the Australian health and aged care sectors. Nurses are the largest group of registered health care professionals and fundamental to delivering health and aged care in Australia. However, while nursing students encounter increasing numbers of older people in all health and aged care settings, little is known about how they are educationally prepared to care for them. Aim: To investigate the curriculum content and method of teaching the care of older people in Australian Bachelor of Nursing degrees. Methods: A population sample of all Australian nursing schools offering Bachelor of Nursing degrees. Nurse academics involved in subject coordination or curriculum development were recruited. A telephone-assisted survey explored ‘the care of older people’ in Australian undergraduate nursing curricula. Descriptive statistical analyses were undertaken. Results: The response rate was 100%. Curricula were acute care focused with content specific to the care of older people scaffolded across curricula. A variety of teaching and learning methods were reported. Clinical experiences with older people occurred in residential aged care settings, generally in the first year of the degree. Conclusions: Preparation of pre-registration nurses for the care of older people requires improvement in curricula content and clinical experience to equip graduates to provide safe, person-centred care that meets the needs of older Australians.

Objectives Educational initiatives can improve care delivery and the experience of living in residential aged care for people with dementia. This review aimed to determine the impact of nurse and care staff education on measures of functional ability and quality of life for older people with dementia living in care homes. Design Systematic review. Data sources Search of on-line databases in English between January 2000 and January 2017. Review methods Three reviewers used data extraction and critical appraisal tools of the Joanna Briggs Institute to determine methodological quality of research. Results and conclusion Thirty-two studies met the initial inclusion criteria and 13 were retrieved for full appraisal. There was limited impact of nurse and care staff education on residents' agitation, anxiety, mood and quality of life. The most consistent improvement in functional ability due to education may be in the execution of activities of daily living. More successful programs included multi-faceted components (e.g. hands on support, clinical auditing) in conjunction with didactic teaching. There is a need for more rigorous and well-designed studies to test interventions.

Objectives Sexuality remains important to older people and should be recognised as an important part of their overall care. However, this appears to be poorly understood and addressed by many healthcare professionals. This systematic review reports on knowledge and attitudes of health professionals towards sexuality and sexual health of older people, including factors that impact knowledge and perceptions. Review methods and data sources The review, conducted using Joanna Briggs Institute methods, included 23 studies of varied methodology published between January 2004 and January 2015. Results Findings indicated that healthcare professionals often consider older people's sexuality as outside their scope of practice and there is lack of knowledge and confidence in this area. Cultural norms and taboos, length of time spent working with older people, familiarity with the older person, previous training and degree of exposure to people who are not heterosexual were all identified as factors that impact knowledge and attitude. Conclusions Better role modelling and education are needed to improve knowledge and attitudes toward later life sexuality.

Objective To report on the findings of a systematic review which examined the experiences and views of older people aged 65 years and over on health professionals’ recognition of sexuality and sexual health and whether these aspects of the person are incorporated into care. Review methods The review followed the methods laid out by the Joanna Briggs Institute. Eleven electronic databases were searched using the terms sexual*, aged, ageing/aging, attitudes and care in any health-care setting. Only quantitative and qualitative research and opinion papers written in English and offering unique commentary published between January 2004 and January 2015 were eligible. Results A total of 999 papers were initially identified and of these, 148 were assessed by two reviewers. Eighteen studies – seven quantitative, eight qualitative and three opinion papers – met the inclusion criteria and were appraised. The importance of sexuality to well-being, language used, expressing sexuality, discomfort discussing sexuality, inadequate sexuality health education and treatment and deficient communication with health-care professionals were all identified as significant issues in a range of settings. Fourteen categories and five syntheses summarize the 43 findings. Conclusions Sexuality remains important for many older people; however, embarrassment, dissatisfaction with treatment, negative attitudes and seeming disinterest by health professionals can all inhibit discussions. Professionals and health-care services need to adopt strategies and demonstrate characteristics which create environments that are more supportive of sexuality. Issues related to sexuality and sexual health should be able to be discussed without anxiety or discomfort so that older people receive optimal care and treatment.

In Australia, the majority of people with dementia live in the community with informal care provided by family, commonly a spouse. A diagnosis of dementia is a threat to one’s personhood and is often accompanied by perceptions of future dependency, which will involve the inability to carry out conventional roles and complete everyday tasks including making decisions. Being able to make decisions, however, is part of being a ‘person’ and it is through relationships that personhood is defined and constructed. In face-to-face interviews with seven couples (a carer and person with dementia dyad) and two spouse carers, this study explored why, and how, spouse carers support continued involvement in decision-making for people with dementia. The findings highlight the importance of loving and respectful relationships in the development of strategies to support continued decision-making for people with dementia.

Nursing students rate geriatric nursing poorly in career preferences, but aging populations mean more older people require access to health care. Negative attitudes held by nursing students can lead to ageism affecting the quality of care provided. The purpose of this scoping review is to summarize research findings in the published literature relating to factors associated with nursing students’ attitudes toward older people, and the tools used to measure these attitudes. The Joanna Briggs Institute guide for conducting a scoping review was used. Eleven databases and search engines were searched for international peer reviewed research articles published in English between January 2000 and February 2021. Sixteen articles were included in the review. This review highlights areas for affirmative action to improve undergraduate nursing students’ attitudes toward older people to prepare them to work effectively in future health care systems. Positive attitudes were associated with: senior years of study; professional values (caring, professionalism, trust); education regarding care of older adults; knowledge about aging; contact with older family members; comfort communicating with older people; and willingness to work with older people following graduation. It also identified the need for a current, nursing-specific measure of attitudes toward older people.

OBJECTIVE To develop and pilot a short interview tool to be implemented by the Australian Aged Care Quality Agency (AACQA) in residential aged care, to inform prospective consumers about the quality of care and services received-the consumer experience report (CER). METHODS Twenty-four questions addressing the four Aged Care Quality Standards were piloted with 140 residents and 48 representatives (including 27 resident-representative pairs). A method for approximating random selection was also trialled. Fifty-two residents were interviewed twice, one week apart, and each question's usability was rated by 11 surveyors and two interpreters. Selection criteria for questions included consumer preference, test-retest reliability, resident-representative agreement, usability and low missing data. RESULTS Nineteen questions performed well on missing data, 16 on test-retest, 17 on resident-representative agreement and 12 on usability. Ten quantitative and two open-ended questions were selected. CONCLUSIONS The CER questions proved suitable to collect data systematically on consumer experience in residential aged care. AACQA (now the Aged Care Quality and Safety Commission) uses the CER interview to support their audit process, and aggregated results are published online.

Intimacy contributes to our well-being and extends into older age, despite cognitive or physical impairment. However, the ability to enjoy intimacy and express sexuality is often compromised—or even controlled—when one moves into residential aged care. The aim of this study was to identify what factors influence senior residential aged care staff when they make decisions regarding resident intimate relationships and sexual expression. The study used vignette methodology and a postal survey to explore reactions to a fictionalised case study of a couple—Norm and Carol—who develop a close, mutually satisfying relationship. Staff were first asked whether they would intervene in the relationship. Using an innovative approach, several variations to the case study were then presented to explore whether views about intervening changed according to varying contextual factors. Findings indicated that over 90% of respondents initially agreed that the relationship should continue, and only 10% indicated they would intervene. However, when the case study was varied, respondents indicated they were more likely to intervene, particularly if Norm was exhibiting distress in Carol’s presence (89%), but also if Norm was married and his wife was living in the community (40%). Other factors including level of cognitive impairment and family disapproval were also found to influence staff views. This study provides insight into how residential aged care staff make decisions regarding the intimacy and sexuality of older people living in residential aged care and how personal views and values likely guide practice in the absence of formal policies.

The ways in which residential aged care staff conceptualize the identities of residents with dementia has significance for how they support them to make decisions and make decisions on their behalf. This article aims to further understand how staff in residential aged care facilities comprehend who residents “are.” Methods: This qualitative study draws on individual and group interview data with aged care staff from two Australian states concerning decision making for individuals with dementia. It identifies themes relevant to how staff refer to identity in relation to such residents. Results: Staff possess disparate ideas about what things comprise residents’ identities and, accordingly, which sources of knowledge are most relevant to learning about residents. Discussion: This article argues for the application of a multidimensional and temporally inclusive understanding of identity by those who provide care to people with dementia.

ObjectiveTo describe the Australian adult public’s knowledge and experiences regarding substitute decision-making for medical decisions and their preferences for obtaining information about the substitute decision-maker (SDM) role.MethodsThis is a national cross-sectional online survey of the Australian adult public. The survey examined participants’ advance care planning (ACP) awareness and experience, SDM experiences and preferences for obtaining more information about SDM, and participant knowledge about SDM.ResultsOf 1586 people who opened the survey, 1120 (70.6%) were included in the final sample. 13% (n=142) of participants indicated they had acted as an SDM. A median score of two correct responses out of five showed low to moderate knowledge about the SDM role among all participants, with only 33% reporting awareness of SDM laws existing in Australia. While most (59%) participants ranked a health professional as their preferred source of obtaining information about supporting SDMs, few participants who had been an SDM (n=64, 45%) reported obtaining any support in making medical decisions. The median SDM knowledge scores for people who had discussed ACP (3.0 vs 2.0, U=1 45 222, z=6.910, pConclusionsThe Australian public may have low to moderate knowledge about the SDM role and access only minimal support when making challenging medical decisions.

Objective Substitute decision makers (SDMs) can be required to make difficult health care decisions on behalf of individuals lacking decision-making capacity. Online resources may be helpful in preparing and supporting SDMs. This study systematically explored the frequency, content and usability of Australian online resources containing health care substitute decision-making content written for consumers. Methods In April 2019, Google searches were conducted to identify online resources containing health care substitute decision-making content for consumers. Analysis comprised mapping resource characteristics, including target audience (individual-specific, SDM-specific, mixed) and thematic analysis of content. Usability was assessed using the Patient Education Materials Assessment Tool (PEMAT). Results Of the 61 resources identified, the most frequent were webpages (57%), individual-specific (43%) and those produced by government organisations (31%). Only 15 resources (24%) were written for SDMs. Content themes identified were: defining the scope of the SDM role (93%); recommended traits or characteristics of SDMs (80%); instructions or principles regarding standards for decision making (75%); duties of SDMs (70%); and supports (46%), rights (16%), barriers (8%) and benefits (5%) for SDMs. The median (interquartile range) PEMAT scores (out of 100) were 66 (27) for understandability and 60 (55) for actionability. Conclusions SDMs have a vital role in making decisions for people lacking decision-making capacity. Online resources are a potential source of information and support for SDMs in Australia. This study identified key gaps in availability, content and usability of existing SDM resources, highlighting the need for the further development of such resources. We suggest that future resource development include SDMs in the design and evaluation processes. What is known about the topic? An aging population and a greater need for decisions to be made on behalf of others who lack capacity means that health care substitute decision-making is occurring more frequently. Appointing one or more SDMs may occur as part of the advance care planning process. However, being a healthcare SDM can be difficult and stressful. People frequently use the Internet to search for health-related information. What does this paper add? This paper systematically examined the frequency, content and usability of existing Australian online resources with substitute decision-making content written for a consumer audience in English, and identified key gaps in online resources available to support SDMs. What are the implications for practitioners? Although there is a need for resources written for SDMs, authors of online resources need to pay careful attention to the purpose, content and usability of their resource. Future resource development should include input from SDMs and involve them in evaluation to assess whether the resources meet target audience needs.

The prevalence of dementia will continue to increase with the ageing of the population. Many people living with dementia will reach a stage where surrogate decision-makers-mostly family carers-will need to make a range of decisions on their behalf. The aim of this study was to learn from surrogate decision-makers how they can be most effectively supported in this role. The study employed a qualitative design using semi-structured face-to-face or telephone interviews with a purposive sample of 34 surrogate decision-makers of people living with dementia. Transcripts of participant interviews were reviewed using a thematic approach to analysis. Four main themes were identified from this analysis: needing greater community awareness of dementia and its impact; intervening early in cognitive decline; relying on health professionals for ongoing support; and seeking and using support from wherever is relevant for each person. Based on this analysis and a review of the literature, we propose a wholistic set of recommendations for the support of surrogate decision-makers. Healthcare professionals need to help family carers understand the likely trajectory of dementia, including the significance of surrogate decision-making. They can support the person living with dementia and their surrogates to undertake advance care planning and they can act as empathic guides during this process. Health and community care organisations need to provide a "key worker" model wherever possible so that the person living with dementia and their surrogate decision-maker do not have to seek support from multiple staff members or organisations. Carer support programmes can routinely include information and resources about surrogate decision-making. Community and government organisations can help people prepare for the possibility of becoming surrogate decision-makers by promoting a greater public awareness and understanding of both dementia and advance care planning.

Background We aimed to examine Australians’ knowledge, attitudes and experiences regarding the role of substitute decision-makers (SDMs). SDMs may also be known as ‘surrogate’ or ‘proxy’ decision-makers. Methods A national survey was distributed via an online panel in September 2018 to 1,484 adults aged 18 years and over. Quotas on age, gender and jurisdiction (based on 2017 Australian Census data) aimed to maximise representativeness. Results Of the 1,058 survey completers (response rate=71.3%), the majority (67%) did not know there were laws about substitute decision-making and 12% had previously made medical decisions on behalf of someone else. Seventy-four percent of those with SDM experience (n=97) agreed that making medical decisions on someone’s behalf can be a difficult and stressful experience compared to 56% of those without SDM experience (n=589). Moreover, only 38% of those without SDM experience indicated they would feel confident in the role of SDM. When asked their preferred source for receiving SDM information, 59% of all respondents ranked health professional as their first preference, followed by discussion with family or friends (23%), traditional media (7%), new media (6%) or an event (3%). Only 16% indicated that appointing a SDM was a priority at the time of completing the survey. Conclusion(s) Among a representative sample of Australians it was relatively common to have acted in the role of SDM and most who had perceived the role as challenging. Further education and support is needed to clarify roles, relevance and benefits in appointing and preparing SDMs.

Objective To report on the conceptualisation of a model for residential aged care in Australia. Methods Three-stage approach involving initial model conceptualisation; extensive consultation with stakeholders to test and develop the model for feasibility and acceptability; and examination of whether the model addresses circumstances that arise in scenarios of organisational failure. Results A model consisting of five domains relevant to the experience of older adults living in residential aged care-health care; social inclusion; rights; personal care and re-ablement; and dementia management. Conclusions This proposed model of residential aged care takes as its purpose the provision of person-centred care to older people with complex health issues, requiring end-of-life care, and/or living with dementia. This includes supporting dignity of risk and quality of life and enabling older adults to thrive.

Background For people living with dementia, the capacity to make important decisions about themselves diminishes as their condition advances. As a result, important decisions (affecting lifestyle, medical treatment and end of life) become the responsibility of someone else, as the surrogate decision-maker. This study investigated how surrogate decision-makers make important decisions on behalf of a person living with dementia. Methods Semi-structured interviews were conducted with 34 family members who had formally or informally taken on the role of surrogate decision-maker. Thematic analysis of interviews was undertaken, which involved identifying, analysing and reporting themes arising from the data. Results Analysis revealed three main themes associated with the process of surrogate decision-making in dementia: knowing the person's wishes; consulting with others and striking a balance. Most participants reported that there was not an advance care plan in place for the person living with dementia. Even when the prior wishes of the person with dementia were known, the process of decision-making was often fraught with complexity. Discussion Surrogate decision-making on behalf of a person living with dementia is often a difficult process. Advance care planning can play an important role in supporting this process. Healthcare professionals can recognise the challenges that surrogate decision-makers face and support them through advance care planning in a way that suits their needs and circumstances.

Objective The support and service needs of people with dementia and their carers are not always addressed in rural regions, yet family carers play an important role in supporting the person living with dementia to remain living in their own home. This study sought to identify and prioritise service and support needs of people with dementia and carers. Design A two-phase mixed methods study involving qualitative focus groups and a survey. Setting A rural region in Victoria, Australia. Participants People living with dementia, carers and health professionals. Results Focus groups identified 12 areas of need. A follow-up survey reached consensus on the priority areas for service improvement. These included diagnosis and information access, dementia training, community understanding and carer support. Conclusion Living in a rural region imposes significant challenges on people with dementia and carers. We need to find ways to address gaps in service provision for carers and people with dementia in rural settings and examine their applicability in other rural regions more broadly.

Background Dementia is one of the most prevalent conditions in older adults in residential aged care. Dementia has a significant impact on a person’s ability to eat, drink and participate in mealtime activities. Dementia impacts memory, appetite, gross and fine motor skills, communication skills, mood and social behaviours, all of which can decrease the person’s ability to engage in a meal. Objectives The objective was to review the literature on strategies to promote mealtime function in people with dementia living in residential aged care and assess their effectiveness. The review considered studies reporting outcome measures that related to nutritional status, communication, behaviour and eating skills and ability. Design Systematic review using the Joanna Briggs Institute review methods. Data sources Seven databases (MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, EMBASE, Current Contents, PsycINFO and Allied and Complementary Medicine Database) were searched for research published 2000–2017 in English. Eligible studies included quantitative studies reporting a mealtime intervention delivered to people with dementia in residential aged care compared with standard care reporting nutritional, behavioural or functional outcomes, including observation studies with no comparator. Review methods Studies were screened and independently appraised by two reviewers using Joanna Briggs Institute (JBI) critical appraisal tools based on study design. Data was extracted from eligible studies using JBI extraction tables that assess study design, population characteristics, intervention and comparator, outcome measures and findings. Results related to mealtime function were tabulated and reported in narrative format. Results 136 studies were identified, of which 20 were eligible for inclusion. Studies reported strategies related to: food presentation; meal styles; environment adaptations; skills training; music therapy and animal-assisted therapy. Outcomes included measures of nutritional status, communication and behavioural and psychological symptoms of dementia. Low quality evidence suggested that playing music and introducing fish to the dining room may improve the food intake of people with dementia by a small amount. Montessori and spaced retrieval programs also demonstrated some positive impact on eating skills and nutritional intake. Animal-assisted therapy also demonstrated small statistically significant improvements in weight and body mass index. Conclusion There is insufficient evidence to highly recommend any specific intervention to improve mealtime functional ability in people with dementia. Further research is required through robust study designs using valid and reliable outcome measures to demonstrate clinically significant effects for mealtime interventions.

Objective To examine the extent and scope of written policies about sexuality and sexual health for older people living in Australian residential aged care facilities. Methods Postal survey sent to all 2766 Australian residential aged care facilities. Respondents were asked to indicate whether the facility had written policies on sexuality and sexual health and to return copies. Content analysis was performed on policies returned. Results Surveys were returned by 1094 facilities. Less than one-quarter reported having a policy regarding sexuality (n = 237/1049; 23%) or sexual health (n = 129/985; 13%). Less than one-tenth (n = 74/1049; 7%) returned a written policy; only two-thirds of these policies were dedicated to sexuality or sexual health. Conclusion Most residential aged care staff do not have access to policies on sexuality or sexual health to guide their practice resident intimacy and sexual health needs are at risk of being ignored.

Background: Advance care planning aims to ensure that care received during serious and chronic illness is consistent with the person’s values, preferences and goals. However, less than 40% of people with dementia undertake advance care planning internationally. Aim: This study aims to describe the perspectives of people with dementia and their carers on advance care planning and end-of-life care. Design: Systematic review and thematic synthesis of qualitative studies. Data sources: Electronic databases were searched from inception to July 2018. Results: From 84 studies involving 389 people with dementia and 1864 carers, five themes were identified: avoiding dehumanising treatment and care (remaining connected, delaying institutionalisation, rejecting the burdens of futile treatment); confronting emotionally difficult conversations (signifying death, unpreparedness to face impending cognitive decline, locked into a pathway); navigating existential tensions (accepting inevitable incapacity and death, fear of being responsible for cause of death, alleviating decisional responsibility); defining personal autonomy (struggling with unknown preferences, depending on carer advocacy, justifying treatments for health deteriorations); and lacking confidence in healthcare settings (distrusting clinicians’ mastery and knowledge, making uninformed choices, deprived of hospice access and support at end of life). Conclusion: People with dementia and their carers felt uncertain in making treatment decisions in the context of advance care planning and end-of-life care. Advance care planning strategies that attend to people’s uncertainty in decision-making may help to empower people with dementia and carers and strengthen person-centred care in this context.

Objectives: To ascertain the research priorities of staff working in Victorian residential aged care services (RACS). Method: In October 2016, all 754 Victorian RACS were asked to list three most important research priorities in a confidential postal survey. Descriptive statistics and content analysis were used to analyse the data. Results: One hundred and sixty-two (21.5%) RACS participated. Research priorities, in order of importance, were grouped thematically as workforce issues, strategies to manage residents with dementia and funding to the sector. Staffing numbers and mix, particularly nurse-to-resident ratios, dominated workforce issues. The management of responsive behaviours was highlighted as a pressing clinical issue, and insufficient funding to the sector impacted on most issues reported. Conclusions: The research priorities identified were inter-related. Some were already well researched, suggesting RACS staff have little time and/or limited access to research evidence to inform the care and management of residents, possibly because of inadequate staffing and funding.

This paper considers the significance of how staff in residential aged care facilities interpret the non-verbal communication and behaviour of residents vis-a-vis their assessments of residents’ preferences and ability to participate in decision-making. It highlights the risks associated with staff members’ failure to interpret residents’ non-verbal communication and behaviour with reference to residents’ backgrounds and prior experiences. It also considers how non-verbal communication implemented by staff may impact residents’ emotional state and, as a consequence, decision-making abilities. Drawing on interview data with aged care staff from Queensland and Victoria, it demonstrates that care staff in residential facilities appear to rely heavily on non-verbal signals in assessing the decision-making capacity and preferences of residents with dementia. It also indicates that many staff fail to consider residents’ non-verbal communication and behaviour with due consideration of residents’ individual histories.

Aim To assess the internal reliability and validity (content and criterion) of the Older Patients in Acute Care Survey (OPACS) as a measure of nurses’ knowledge, attitudes and practices regarding care of older hospitalized patients in Australia. Design Cross‐sectional survey. Method A convenience sample of final year nursing students at an Australian university in October 2014 completed the OPACS (N = 191). Internal reliability was assessed using Cronbach's alpha, content validity using exploratory factor analysis and criterion validity using correlations between the OPACS and Palmore's Facts on Aging Quiz and the Caring Efficacy Scale. Results Despite good internal reliability on both OPACS subscales, exploratory factor analysis of the 36 items representing behaviours and the 50 items on knowledge and attitudes failed to load strongly on their corresponding factors. Analyses of criterion validity suggested the OPACS scales are measures of attitude.

AIM To identify organisational characteristics and practices that promote or inhibit the recognition of sexuality in the care of older people in health and aged care settings. BACKGROUND Sexuality in old age is poorly understood by health professionals and rarely addressed in care planning and delivery. Nurse managers are ideally placed to lead organisations in promoting a culture of acceptance that enables the expression of sexuality. EVALUATION A search for research/expert opinion papers published from January 2004 to February 2017 was undertaken. Two reviewers performed data extraction and appraisal of 34 included studies using Joanna Briggs Institute tools. The primarily qualitative research was analysed to identify 152 findings that were organised into 22 categories and combined into four syntheses. KEY ISSUE(S) An organisation's philosophies frame the way older people's sexuality is perceived. Cultivating a culture and environment of acceptance, engagement and knowledge and delivering care in a way that promotes opportunity for safe and private expression of sexuality are key enabling factors. CONCLUSION(S) Organisations and nurse leaders can support and facilitate older adults' expression of their sexuality through the review and development of philosophies, policies, procedures, staff attitudes and knowledge and the creation of a conducive environment. IMPLICATIONS FOR NURSING MANAGEMENT Nurse managers play a pivotal role in developing a sexuality-positive organisational ethos by ensuring policies, care practices, the environment and amenities are supportive of the expression of sexuality and by role modelling attitudes of respect and inclusivity.

The current study explored the perceptions of direct care staff working in Australian residential aged care facilities (RACFs) regarding the organizational barriers that they believe prevent them from facilitating decision making for individuals with dementia. Normalization process theory (NPT) was used to interpret the findings to understand these barriers in a broader context. The qualitative study involved semi-structured interviews ( N = 41) and focus groups ( N = 8) with 80 direct care staff members of all levels working in Australian RACFs. Data collection and analysis were conducted in parallel and followed a systematic, inductive approach in line with grounded theory. The perceptions of participants regarding the organizational barriers to facilitating decision making for individuals with dementia can be described by the core category, Working Within the System , and three sub-themes: (a) finding time , (b) competing rights , and (c) not knowing . Examining the views of direct care staff through the lens of NPT allows possible areas for improvement to be identified at an organizational level and the perceived barriers to be understood in the context of promoting normalization of decision making for individuals with dementia. [Res Gerontol Nurs. 2015; 8(6):286–292.]

Objective To develop a psychometrically sound tool for measuring the knowledge of nursing and care staff about the experience, assessment and management of pain in older people (including people with dementia) for use in the residential aged care setting. Methods The Pain in Older Adults Knowledge Survey (POAKS) was developed and tested in two phases. Phase 1 involved developing an initial item pool with good content validity based on a review of the research literature and a modified Delphi technique involving national and international experts. A pool of 24 items was developed for testing. Initial testing of the psychometric properties of the POAKS with 30 university employees led to refinement and final wording of items. Phase 2 involved testing of the psychometric properties of the POAKS with 279 respondents, including first year (n = 176) and third year (n = 70) nursing students and staff in a residential aged care service (n = 33). Results Results established the content validity and internal consistency of the POAKS and supported its use as an instrument to measure nursing staff knowledge about the experience, assessment and management of pain in older people. Conclusions The POAKS will enable residential aged care facilities to measure the level of knowledge among nursing and care staff about pain in older people (including people with dementia). The measure provides a basis for the development and implementation of educational interventions to address knowledge gaps that may impact on the quality of care provided.

Background:Dementia is a chronic illness without cure or effective treatment, which results in declining mental and physical function and assistance from others to manage activities of daily living. Many people with dementia live in long term care facilities, yet research into their quality of life (QoL) was rare until the last decade. Previous studies failed to incorporate important variables related to the facility and care provision or to look closely at the daily lives of residents. This paper presents a protocol for a comprehensive, multi-perspective assessment of QoL of residents with dementia living in long term care in Australia. A secondary aim is investigating the effectiveness of self-report instruments for measuring QoL.Methods:The study utilizes a descriptive, mixed methods design to examine how facility, care staff, and resident factors impact QoL. Over 500 residents with dementia from a stratified, random sample of 53 facilities are being recruited. A sub-sample of 12 residents is also taking part in qualitative interviews and observations.Conclusions:This national study will provide a broad understanding of factors underlying QoL for residents with dementia in long term care. The present study uses a similar methodology to the US-based Collaborative Studies of Long Term Care (CS-LTC) Dementia Care Study, applying it to the Australian setting.

Background In studies involving people with dementia, researchers have historically defaulted to seeking consent from a proxy, the assumption being that people with dementia are unable to provide their own informed consent. This choice denies people with dementia a voice in the consent process, thus disregarding their autonomy and agency. Recently, other options for improving the consent process have been explored. Objective This study aimed to determine whether nursing home residents with dementia could demonstrate an ability to provide their own informed consent as determined by the Evaluation to Sign Consent instrument. Methods As part of a larger study on the quality of life of nursing home residents, the Evaluation to Sign Consent was administered to 392 people diagnosed with dementia. Data on demographic variables, such as gender and age, as well as level of cognitive impairment, were also collected. Results Just over one-fifth (22%) of the residents with dementia were judged as having the capacity to provide their own informed consent to participate in this specific research project. Consistent with existing literature, capacity to consent was significantly, and negatively, associated with cognitive impairment. Conclusion This study demonstrates that assuming all people diagnosed with dementia are unable to provide informed consent for research on the basis of cognitive test scores, or on clinical assessment alone, potentially denies them the autonomy to make a decision that they may be capable of making. Research involving people with mild-to-moderate dementia needs to consider evaluating whether potential participants have the capacity to provide their own consent.

Many people living with dementia eventually lose the capacity to make their own decisions and will rely on another person – a surrogate decision maker – to make decisions on their behalf. It is important – especially with the increasing prevalence of dementia – that the role of surrogate decision maker is understood and supported. This qualitative study explored the experiences of 34 surrogate decision makers of persons living with dementia in Australia. Face-to-face and telephone interviews were conducted over six months in 2014. Five themes were identified: becoming the only – or main – surrogate decision maker; growing into the role of surrogate decision maker; dealing with the stress of making decisions; having to challenge healthcare professionals; and getting support – or not – from family members. An overarching construct tying the themes together is the description of the participants’ experience as being on a difficult and unpredictable journey. Healthcare professionals can provide support by acting as empathic guides on this journey.

Living in an aged care facility does not diminish the importance of sexuality or the need to express it. To promote an optimal quality of life for people living in aged care, aged care organizations need policies which clearly and consistently address the sexuality needs and activities of residents. This presentation reports data from a sexuality survey sent to all Australian aged care facilities (n = 2,766), which indicated that meaningful sexuality policies are lacking and policy frameworks inadequate. The policy landscape as depicted by our data will be examined in light of the introduction of a best practice Sexuality Assessment Tool (SexAT) for aged care facilities. Organizational support for sexuality with respect to policy development, residents’ needs, staff education and training, information and support for residents and families and the environment, safety and risk management will be discussed.

Aim To investigate if, when and how assessments regarding residents' sexual health and needs occur within Australian residential aged care facilities. Method A census of all Australian residential aged care facilities was conducted. A survey developed specifically for the project was posted to all 2766 residential aged care services in Australia. Eight weeks were allowed for the return of surveys. Results A total of 1094 completed surveys were returned, representing a 39.7% response rate. The type of information most often collected concerned disruptive sexual behaviour, and assessments most frequently occurred following disruptive behaviour. One-quarter of facilities reported having a sexual health/needs assessment form, although only 10 facilities provided evidence of this. Conclusion Survey responses indicated that sexual health and needs are not routinely assessed in residential aged care, and facilities do not commonly have a dedicated sexual health/needs assessment form to guide them through an assessment process.

The Australian Government Aged Care Quality and Safety Commission (prior to January 2019 known as the Australian Aged Care Quality Agency) is responsible for accreditation of Australian aged care services which are audited against the Australian Accreditation Standards. Accreditation reports are publicly available. Prior to 2017, some clients were interviewed about their experiences, but the resulting information could not represent the client experience within a service due to low numbers, biased sampling, and an unsystematic approach to asking questions. La Trobe University was engaged to develop and pilot an interview tool to measure client experience for use in accreditation. Potential questions were identified through a literature review, mapped against the Accreditation Standards, and workshopped with an expert reference group. Twenty-four questions and a visual analogue were then piloted. Consumer groups and groups of Indigenous and culturally diverse clients in residential aged care homes were consulted. The perspective of Quality Agency surveyors was sought on the questions’ usability. Statistical analyses sought to identify questions that minimised missing data, were responded to similarly by residents and their representatives, and elicited stable responses on retest. Twelve questions were identified as optimal. The 10 quantitative questions proved to reflect a single underlying dimension (consumer experience) and, when summed and explored through regression analyses, differentiated services significantly. The consumer experience interview tool is now used in all accreditation audits in Australia. Results are then used to generate consumer experience reports, which are published online and can support consumer choice of a residential aged care home.

As the Australian population ages the demand for nursing care which focuses on responding to the needs of the older person will increase. Few newly graduated Registered Nurses (RNs) currently enter the aged care workforce and few select a career in caring for older people; yet older people are the largest patient group in most health care environments. This research, conducted by the Australian Hartford Consortium of Gerontological Nursing Excellence (Aus-HCGNE), explored how care of the older person is currently taught in Australian schools of nursing (SoN). The interview guide included questions about: whether care of the older person is taught in separate subjects or integrated across the curriculum; academics’ qualifications; subject content; and aged care clinical placements. The head of each of the 33 Australian schools of nursing was contacted, invited to participate and asked to nominate the appropriate academics (undergraduate/curriculum co-ordinators) who would be the most appropriate person to participate in the interview. These academics were then contacted, written informed consent was obtained, interviews were scheduled and completed. This research is timely given the current Royal Commission into Aged Care Quality and Safety in Australia, one focus of which is nurses in residential aged care in respect to numbers, education and competence. This research will be completed by mid-2019. The results will be fed back to SoN to inform the development of their curricula and the preparation of future RNs who will undoubtably need to be expert in the care of older people across the health sector.

Objectives: This qualitative study canvassed residents’ perceptions of the needs and barriers to the expression of sexuality in long-term care. Methods: Sixteen residents, including five with dementia, from six aged care facilities in two Australian states were interviewed. Data were analysed using a constant comparative method. Results: Four categories describe residents’ views about sexuality, their needs and barriers to its expression: ‘It still matters’; ‘Reminiscence and resignation’, ‘It’s personal’, and ‘It’s an unconducive environment’. Discussion: Residents, including those with dementia, saw themselves as sexual beings and with a continuing need and desire to express their sexuality. The manner in which it was expressed varied. Many barriers to sexual expression were noted, including negative attitudes of staff, lack of privacy and limited opportunities for the establishment of new relationships or the continuation of old ones. Interviewees agreed that how a resident expressed their sexuality wa...

The ability to make choices and decisions, and to have those decisions upheld, is central to self-determination. For people living with a diagnosis of dementia, however, it can be difficult to remain involved in decision making. While many studies show that people with mild or moderate dementia have the ability to participate in decision making, there are also indications that the attitudes of those around them, including health professionals and family carers, can sometimes be a barrier, and there is generally little understanding about the nature of decision making for this population. This small pilot study draws on van Manen's approach to phenomenology to explore the essence of decision making for people living with dementia. The findings highlight the importance of remaining central to decision making, and the key role that subtle support from carers plays in enabling this.

Sexuality is a sensitive topic that can be awkward and difficult to research qualitatively. When the research participants are older people living in residential aged care, some of whom have dementia, the process can be even more challenging. In this article, we outline the difficulties encountered in conducting face-to-face qualitative interviews with older people in residential aged care as part of a research project on sexuality conducted in the states of Victoria and Queensland, Australia. We explore issues surrounding ethics and recruitment and considerations for accessing residents with cognitive impairment, difficulties with the interview process, and the collection of meaningful data from participants. We provide advice and recommendations for future researchers on how to potentially minimize problems associated with conducting qualitative face-to-face interviews on sexuality with older people in residential aged care.