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Introduction: Staff shortages and retention are the major challenges in residential aged care facilities (RACFs). This study aimed to explore migrant care workers’ perceptions of job demands, their coping strategies, and employment intentions to leave or stay in the sector. Methods: Using a descriptive qualitative research design, semi-structured interviews were conducted with n = 20, RACF migrant care workers from Filipino, Indian, and Nigerian backgrounds in Perth, Western Australia, from April to December 2019. Data were thematically analyzed. Results: Motivating factors included the availability of care work in RACFs, and positive cultural norms associated with caring for older family members. Participants experienced a combination of resettlement and workplace challenges specifically, limited support network, communication challenges, and racial discrimination. Relevance to Practice: Work challenges that are compounded by post-migration stressors should be recognized and addressed in the design and implementation of the aged care workforce reforms to attract and retain migrant care workers.

Background Nursing students’ positive attitudes towards ageing and older people are central to developing person-centred care. Perceptions about older people are influenced by social and generational values and beliefs, including a general understanding that older people need to be cared for. Nursing students often undertake early clinical placements in aged care settings, where residents’ needs are complex, yet the nursing experience is often considered ‘basic’ care. Illustrating that older people have rich personal histories and are valuable contributors to society can balance students’ perceptions and expectations and outcomes of clinical placements. Educational interventions using photo-elicitation and in-depth dialogue may surface students’ assumptions and challenge their misperceptions of older people before the first clinical placement. Aim To examine the impact of the innovative Depth of Field: Exploring Ageing © (DOF) resource as preparation for nursing students’ clinical placement in residential aged care facilities. Methods Mixed methods, block randomised controlled study with first year students. Students attending clinical laboratory groups received either usual preparation (control, n = 108) or DOF plus usual preparation (intervention, n = 99). Pre/post surveys included: Geriatric Attitudes Scale (GAS) and demographics. Eight students from the intervention group participated in focus groups post-clinical. Findings Groups were similar at baseline. There were statistically significant changes following the intervention (p ≤ .05) for 9/13 individual GAS items and difference in overall mean scores (intervention group: M = 0.26; SD = 0.27; control group: M = 0.01; SD = 0.27). Focus group themes included: preconceptions toward older people; feelings of being emotionally unprepared; and perceptions of the DOF intervention in preparing students to connect with the older person. Discussion The DOF vignette provided opportunity for students to preflect on ageing. Translation to practice was evidenced with students seeing beyond residents’ physical care requirements to the value of connecting with the older person’s story to facilitate person-centred care. Conclusions The DOF intervention assisted students to adopt positive attitudes and a broader perspective of older people, as preparation for placement in residential aged care facilities.

Introduction: Migrant care workers are a growing portion of the aged care workforce in high-income countries. This study investigated the impacts of acculturation stress on the well-being of migrant care workers. Method: A cross-sectional national survey was conducted among migrant care workers ( n = 272) across five Australian states and one territory using the Riverside Acculturation Stress Inventory (RASI) and Depression Anxiety Stress Scale (DASS 21). Results: Acculturation stress was high ( M = 38.4; SD = 14.1; 38.9% scored ≥40 out of 75), but respondents scored in the normal to mild ranges (85% to 93%) on the DASS 21 scale. Enrolled and registered nurses had the highest acculturation stress levels when compared with other occupational roles. Ethnicity, F(4, 254) = 11.0, p < .001; occupational roles, F(3, 254) = 3.0, p = .03; and self-reported English proficiency, F(1, 254) = 4.17, p = .04, were statistically significant. Conclusions: Addressing acculturation stress may improve job satisfaction and retention among migrant care workers.

Background and objectives In high-income countries, an increasing number of people living with dementia in residential aged care facilities are being cared for by an increasingly multicultural workforce. The purpose of this review was to investigate migrant aged care workers' dementia care experiences and to identify enablers and challenges that influence their retention. Research design and methods Utilizing Arksey and O' Malley's approach, PubMed, Scopus, CINAHL, Web of Science, and EMBASE were searched for peer-reviewed studies published from 2000 to November 2018. Selection criteria were studies with original research, focusing on dementia care among migrant aged care workers, and conducted in high-income countries. Results Seventeen articles were identified incorporating 13 (76.47%) qualitative, 1 (5.88%) quantitative, and 3 (17.65%) mixed method designs. A limited understanding of dementia and experiences of dementia care were reported among some migrant care workers in residential aged care facilities. The identified enablers to retention were the availability of organization support services; professional development opportunities; reciprocity and mutual respect between migrant care workers, care recipients, and coworkers; and good working conditions. Factors such as discrimination from care recipients and coworkers and limited understanding of workplace culture were identified as barriers to migrant care workforce retention. Discussion and implications Migrant care workers are valuable contributors to the aged care workforce. It is important to consider their cultural perceptions of dementia in relation to care provision. In addition, their exposure to occupational psychosocial risk factors in conjunction with the challenges associated with resettlement and dementia care needs to be addressed.

When people with dementia are hospitalised, their capacity to communicate with the staff may be limited, compounding risks of distress and other adverse outcomes. Opportunities for carers to share relevant information to inform appropriate person-centred care are also limited. This four-phase mixed methods study aimed to develop an evidence-based family carer–staff communication form, the Focus on the Person form, to address this concern. In Phase I, a literature review plus consultation with clinicians and carers informed form development. In Phase II, the professionally formatted form was piloted by 31 family carers, who were then interviewed about their experiences. These data, combined with data from 30 hospital staff members who participated in Phase III focus groups, led to final, Phase IV, refinements of the form. The form now provides an opportunity for families to inform the person-centred care of people with dementia in hospital, potentially improving outcomes for this vulnerable group.

This study explored how culture shapes relationships in aged care and the extent to which the residential aged care sector supports a cohesive multicultural workforce. An exploratory methodology utilising semi-structured questionnaires collected data from 58 participants comprising: staff who provide direct care to residents; managers; and family members from six residential care facilities in Perth, Western Australia. Communication issues emerged as an over-arching theme, and included interpersonal communication, the effect of cultural norms on communication and the impact of informal and formal workplace policies relating to spoken and written language. Sixty percent of participants from a culturally and linguistically diverse (CaLD) background had experienced negative reactions from residents with dementia, linked to visible cultural difference. They used a range of coping strategies including ignoring, resilience and avoidance in such situations. CaLD participants also reported prejudicial treatment from non-CaLD staff. The findings highlight the need for organisations to incorporate explicit processes which address the multiple layers of influence on cross cultural communication: internalised beliefs and values; moderating effects of education, experience and social circumstance; and factors external to the individuals, including workplace culture and the broader political economy, to develop a cohesive multicultural workplace.

Previous findings of studies on the impact of physical illness on caregiver health have been inconsistent. The authors wanted to determine whether physical disability, as determined by the SF-12 survey that provides information on both physical and mental health problems, contributes to caregiver stress.The authors interviewed 91 primary caregivers (aged 38-85 years) of persons with dementia who had been referred by their family physicians for the first time for formal support services or memory evaluation. Caregivers completed the SF-12 version of the Medical Outcomes Study Short Form Health Survey that generates Mental Component Summary (MCS) and Physical Component Summary (PCS) scores and reported on caregiver stress and concurrent medical conditions and medications.Most caregivers reported stress (76.9%), having medical conditions (72.4%), or taking medications (67%). The MCS but not the PCS scores were significantly lower than community norms, indicating an excess of disability due to mental health problems. Nevertheless, 40.7% had PCS scores indicating some degree of physical disability. Using multiple logistic regression analysis, PCS scores but not the presence of medical problems were independently associated with caregiver stress.Chronic disability as assessed by SF-12 PCS scores is independently associated with caregiver stress. These data suggest that caregivers of persons with dementia should be assessed for disabling physical conditions and mental health problems. In addition, reducing the impact of physical disability could ameliorate caregiver stress.

Purpose: The surgical resident experience with trauma has changed. Many residents are exposed to predominantly nonoperative patient care experiences while on trauma rotations. Data from a large multicenter study were analyzed to estimate surgical resident exposure to trauma laparotomy, diagnostic peritoneal lavage (DPL), and focused abdominal sonography for trauma (U/S). Methods: Centers completed a self-report questionnaire on their institutional demographics, admissions, and procedure for a 2-year period (1998-1999). Results: A total of 82 trauma centers that provide resident teaching were included. The included centers represent over 247,000 trauma admissions. The majority of trauma centers (65.9%) had > 80% blunt injury. Although all centers performed laparotomies, other results were more variable. For U/S, 24.2% performed none at all and 47.0% performed fewer than two U/S examinations per month. For DPLs, 3.8% performed none and 66.7% performed fewer than two per month. Assuming 1 night of 4 on call, the average surgical resident training at a trauma center performing > 80% blunt trauma has the potential to participate in only 15 trauma laparotomies, 6 diagnostic peritoneal lavages, and 45 ultrasound examinations per year. In addition, the resident will care for an average of 500 blunt trauma patients before performing a splenectomy or liver repair. Conclusion: Surgical resident experience on most trauma services is heavily weighted to nonoperative management, with a relatively low number of procedures, little experience with DPL, and highly variable experience with ultrasound. These data have serious implications for resident training and recruitment into the specialty.

Objective: To test the impact of feedback on the proposed management of standardised patients presenting with behavioural change with a diagnosis of dementia in Australian primary care. Materials and methods: A video vignette study was performed with Australian general practitioners (GPs) in 2013. Participants viewed six pairs of matched videos depicting people presenting changed behaviour in the context of a dementia diagnosis in two phases. In both phases GPs indicated their diagnosis and management. After phase 1, GPs were offered feedback on management strategies for the patients depicted. Analyses focused on identification of change in management between the two phases of the study. Factors impacting on the intention to coordinate care for such patients were tested in a questionnaire based on the Theory of Planned Behaviour. Results: Forty-five GPs completed the study. There was significant improvement in the proposed management of three of the six scenarios after the intervention. Older GPs were more likely to refer appropriately (OR=1.11 (1.01 to 1.23), p=0.04.). Overall referral to support agencies was more likely after the intervention (OR=2.52 (1.53 to 4.14), p

This article examines environmental narratives for their potential to contribute to the restoration of ecosystem health in areas recently degraded by agricultural activities, including Australian rural landscapes. Environmental narratives encompass oral environmental histories and other anecdotal sources of knowledge and perceptions that are bounded by the narrator's experiences, observations, and attachment to place. They are analogous to indigenous knowledge. Environmental narratives can make a significant contribution to ecological restoration. We argue that restoration ecologists should acknowledge the rigor of ecological knowledge gained through detailed observation of landscapes over lengthy time periods by nonscientists. Accordingly, we advocate a view of knowledge that permits multiple perspectives: local, indigenous, and scientific. Ecological restoration in fragmented agricultural landscapes is as much a cultural as a biophysical process. It requires an understanding of and respect for cultural attributes of landscapes, including the beliefs, values, and perceptions people hold about their local environment, such as a sense of loss felt for particular landscape components, features, or functions. Recent work in Australia shows environmental narratives emerging as a practical means of integrating these biophysical and cultural aspects in ecological restoration.

The position of electrocardiographic ST-segment elevation in acute myocardial infarction (MI) is related to the region of infarction, but the relationship between the initial ST-segment elevation and the eventual loss of QRS voltage remains uncertain. The authors examined body surface map data in 76 patients with acute anterior wall MI to clarify this relationship. The patients had no evidence of previous MI, no subsequent MI, and did not receive thrombolytic therapy or other acute interventions. Maps were recorded on admission to the hospital, every 24 hours during the hospital stay, and again at follow-up examinations 6-48 months after the index MI. The region of ST-segment elevation on the initial body surface map was compared to the region of developed voltage loss in the QRS complex as measured by the integral 0-30, 0-40, 0-80, and 30-80 ms body surface maps subsequently recorded 24 hours, 48 hours, and over 6 months after the initial body surface map. There was a relationship between the position of the ST-segment elevation and the loss of the QRS segment voltages, which was pronounced early after acute MI and diminished months after the MI. The region of ST-segment elevation in the initial body surface map predicts the QRS loss. In the integral QRS0-30 map versus the initial ST-segment map the mean correlation coefficient was -0.54 +/- 0.33 with a median value of -0.67. The integral QRS0-40 map and ST-segment map had a mean correlation coefficient of 0.60 +/- 0.29 and median of 0.66. The mean correlation coefficient is less for the integral QRS0-80 map and nonexistent in the integral QRS30-80 map. This method may be useful for monitoring acute interventions in acute MI.