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This systematic review of qualitative studies explored interventions to improve student nurses' knowledge, attitudes or willingness to work with older people. Student nurses are likely to encounter older people in all health and aged care settings, however, research demonstrates that few have career aspirations in gerontological nursing. Qualitative systematic review method based on the Cochrane Handbook for Systematic Reviews of Interventions. Search of Medline, Embase, PsycINFO, EBSCOhost and Scopus yielded 1841 articles which were screened to include primary research about educational interventions to improve student nurses' knowledge, attitudes and/or willingness to work with older people. Data extraction was performed on the 14 included studies, and data were analysed using directed content analysis. The Mixed Methods Appraisal Tool (MMAT) was used the assess the quality of the studies. Educational interventions included theory or practice courses, or a combination of theory and practice. While most interventions changed nursing students' negative attitudes towards older people, few increased their willingness to work with them. Practice courses had the most significant impact on willingness to work with older people. Quality assessment revealed methodical limitations. More research is needed to better understand the elements of practice interventions that enhance student nurses' knowledge, attitudes, and willingness to work with older people, so that they can be replicated. [ABSTRACT FROM AUTHOR]

Social participation in older age has been positively associated with enhanced health and wellbeing. This project examined key aspects of social participation for older people living in the community to identify what was most important for maintaining social participation in the event they transitioned to living in a nursing home. We conducted interviews and focus groups with 36 older people, aged 65 years or older living in the community in Victoria, Australia, between 2020 and 2022. Interview transcripts were analysed thematically. Participants discussed their understanding of the importance of social participation and what helped maintain it. Findings demonstrated the key importance of relationships, both old and new, in maintaining social participation, and to the preservation of a sense of identity. An important facilitator to maintaining relationships was having a physical place to go to interact. Barriers to social participation included diminishing social networks and life transitions. The impacts of the COVID‐19 pandemic were commonly referred to by all participants, outlining the obvious impediments to maintaining relationships (e.g., social isolation associated with lockdowns) and how that affected social participation. Conversely, some participants outlined the positive impact the restrictions had on their connection with friends and family. These perspectives outline the importance of being able to maintain relationships through life transitions, like a pandemic or moving into a nursing home, to optimise opportunities for social participation. Findings from this study will be relevant for aged care providers as they implement services to optimise social participation for older people who transition to living in nursing homes. [ABSTRACT FROM AUTHOR]

This research sought to explore the meaning of, preferences for, and involvement in social participation for older people living in nursing homes in Victoria, Australia. A qualitative descriptive study using semistructured interviews with twenty older people living in four geographically and ethnically diverse nursing homes was conducted between 2020 and 2022. Interview transcripts were thematically analysed. All the older people had been very socially active before moving into aged care and had participated in leisure and volunteering activities. Five themes emerged from the data analysis related to the meaning of, preferences for, and involvement in activities for social participation. The meaning of social participation among these older people varied. Some participated in group activities to keep active and busy, while others were content with interests of their own. Social participation in group activities provided older people with a connection to others and assisted in maintaining existing, or developing new, relationships. However, the ability to participate in group activities that offered opportunities for social participation was limited by age-related decline for some older people. The COVID-19 pandemic restrictions constrained activities, which provided opportunities for social participation for some older people living in nursing homes, but not all. These perspectives highlight the need for individualised person-centred opportunities for social participation in nursing homes. Group activities should enable older people to remain active and facilitate social connections that provide meaning and purpose. Respect for individual choice is important, as older people are not a homogeneous group, and opportunities to pursue individual activities should be facilitated. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to explore how health service boards understand care quality for older people living in public sector residential aged care services. Methods: Semi-structured interviews were undertaken with board members from six Victorian public health services responsible for the governance of 15 residential aged care services comprising over 850 beds. Transcripts were thematically analysed. Results: Eleven board members were interviewed. While committed to their governance and monitoring role, analysis suggests board members have a limited understanding of the residential aged care environment. They rarely visit and the information they receive about residential aged care is primarily clinical data (quality indicators) as well as sub-committee and staff reports. In addition to quality indicator data and reports, accreditation and complaints are used to measure care quality. Conclusion: Board members vary in their understanding of care quality in residential aged care settings. The exclusive focus on clinical indicators and accreditation as measures of quality reinforces this understanding. Visiting residential aged care services would provide understanding of the care environment and context for the information they receive. The provision of other metrics, such as consumer advocacy reports and residents' and families' experiences of care, would further assist board members to monitor care quality in these settings. What is known about the topic? Recent high-profile reports into serious failings in Australian public sector residential aged care services (PSRACS) raise concerns about the capability of health service boards to ensure residents receive quality care. What does this paper add? Findings provide a description of the focused and limited information that board members in six public health services receive about PSRACS. What are the implications for practitioners? To assist boards to monitor the care quality in PSRACS, we recommend boards visit PSRACS to see first-hand the care environment and to listen to the views of staff, residents and families. [ABSTRACT FROM AUTHOR]

Abstract Objective Public health research is an endeavour that often involves multiple relationships, far-reaching collaborations, divergent expectations and various outcomes. Using the Tall Girls Study as a case study, this paper will present and discuss a number of methodological, ethical and legal challenges that have implications for other public health research. Approach The Tall Girls Study was the first study to examine the long-term health and psychosocial effects of oestrogen treatment for tall stature. Results In undertaking this study the research team overcame many hurdles: in maintaining collaboration with treating clinicians and with the women they had treated as girls - groups with opposing points of view and different expectations; using private practice medical records to trace women who had been patients up to forty years earlier; and exploring potential legal issues arising from the collection of data related to treatment. Conclusion While faced with complex challenges, the Tall Girls Study demonstrated that forward planning, ongoing dialogue between all stakeholders, transparency of processes, and the strict adherence to group-developed protocols were keys to maintaining rigour while undertaking pragmatic research. Implications Public health research often occurs within political and social contexts that need to be considered in the planning and conduct of studies. The quality and acceptability of research findings is enhanced when stakeholders are engaged in all aspects of the research process.

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. [ABSTRACT FROM AUTHOR]

Abstract Background Concerns have been raised in Australia and internationally regarding the quality and effectiveness of hospital postnatal care, although Australian women receiving postnatal care in the private maternity sector rate their satisfaction with care more highly than women receiving public maternity care. In Victoria, Australia, two-thirds of women receive their maternity care in the public sector and the remainder in private health care sector. A statewide review of public hospital postnatal care in Victoria from the perspective of care providers found many barriers to care provision including the busyness of postnatal wards, inadequate staffing and priority being given to other episodes of care; however the study did not include private hospitals. The aim of this study was replicate the review in the private sector, to explore the structure and organisation of postnatal care in private hospitals and identify those aspects of care potentially impacting on women's experiences and maternal and infant care. This provides a more complete overview of the organisational structures and processes in postnatal care in all Victorian hospitals from the perspective of care providers. Methods A mixed method design was used. A structured postal survey was sent to all Victorian private hospitals (n = 19) and key informant interviews were undertaken with selected clinical midwives, maternity unit managers and obstetricians (n = 11). Survey data were analysed using descriptive statistics and interview data analysed thematically. Results Private hospital care providers report that postnatal care is provided in very busy environments, and that meeting the aims of postnatal care (breastfeeding support, education of parents and facilitating rest and recovery for women following birth) was difficult in the context of increased acuity of postnatal care; prioritising of other areas over postnatal care; high midwife-to-woman ratios; and the number and frequency of visitors. These findings were similar to the public review. Organisational differences in postnatal care were found between the two sectors: private hospitals are more likely to have a separate postnatal care unit with single rooms and can accommodate partners' over-night; very few have a policy of infant rooming-in; and most have well-baby nurseries. Private hospitals are also more likely to employ staff other than midwives, have fewer core postnatal staff and have a greater dependence on casual and bank staff to provide postnatal care. Conclusions There are similarities and differences in the organisation and provision of private postnatal care compared to postnatal care in public hospitals. Key differences between the two sectors relate to the organisational and aesthetic aspects of service provision rather than the delivery of postnatal care. The key messages emerging from both reviews is the need to review and monitor the adequacy of staffing levels and to develop alternative approaches to postnatal care to improve this episode of care for women and care providers alike. We also recommend further research to provide a greater evidence-base for postnatal care provision.

Abstract Background Studies exploring the use of complementary and alternative medicine (CAM) to enhance fertility are limited. While Australian trends indicate that women are using CAM during pregnancy, little is known about women's use of CAM for fertility enhancement. With the rising age of women at first birth, couples are increasingly seeking assisted reproductive technologies (ART) to achieve parenthood. It is likely that CAM use for fertility enhancement will also increase, however this is not known. This paper reports on an exploratory study of women's use of CAM for fertility enhancement. Methods Three focus groups were conducted in Melbourne, Australia in 2007; two with women who used CAM to enhance their fertility and one with CAM practitioners. Participants were recruited from five metropolitan Melbourne CAM practices that specialise in women's health. Women were asked to discuss their views and experiences of both CAM and ART, and practitioners were asked about their perceptions of why women consult them for fertility enhancement. Groups were digitally recorded (audio) and transcribed verbatim. The data were analysed thematically. Results Focus groups included eight CAM practitioners and seven women. Practitioners reported increasing numbers of women consulting them for fertility enhancement whilst also using ART. Women combined CAM with ART to maintain wellbeing and assist with fertility enhancement. Global themes emerging from the women's focus groups were: women being willing to 'try anything' to achieve a pregnancy; women's negative experiences of ART and a reluctance to inform their medical specialist of their CAM use; and conversely, women's experiences with CAM being affirming and empowering. Conclusions The women in our study used CAM to optimise their chances of achieving a pregnancy. Emerging themes suggest the positive relationships achieved with CAM practitioners are not always attained with orthodox medical providers. Women's views and experiences need to be considered in the provision of fertility services, and strategies developed to enhance communication between women, medical practitioners and CAM practitioners. Further research is needed to investigate the extent of CAM use for fertility enhancement in Australia, and to explore the efficacy and safety of CAM use to enhance fertility, in isolation or with ART.

Aims: The aim of this study was to identify features of well‐performing residential aged care services (RACS) as experienced by family carers. Background: Family carers can have an integral role in residential aged care providing social support and are well‐placed to engage with staff and monitor care. Design: A qualitative descriptive design was used. Semi‐structured face‐to‐face and telephone interviews were conducted with family carers of current or past residents of Australian RACS between November 2018 and January 2019. Interview transcripts were analysed thematically. Results: Rather than reporting features of well‐performing RACS, participants shared stories of sub‐standard care, dysfunctional management and poor resident–staff–family interactions. An overarching theme emerged of 'having to be an advocate' for residents' needs, which covered four major categories: organisational accountability (including transparency and individualised care), good communication, connection and trust. Combined, these constitute what carers perceive are the necessary conditions for determining the features of a well‐performing RACS. Conclusion: Family carers need to feel confident and trust RACS staff when they hand over the role of carer for their relative with dementia. Relevance to clinical practice: This study provides insight into the needs and challenges of family carers when they relinquish the care of an older relative with dementia. Strategies to build confidence and trust between RACS and family carers are essential. Aged care nurses can play a pivotal role to support this through the development of open communication and relational connections with residents and their families. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Older people living in the community use complementary medicine (CM) to manage the symptoms of chronic illness; however, little is known about CM use by older people living in care settings. Using focus groups and individual interviews, this study explored the use of CM from the perspective of 71 residents, families, and health professionals from six residential aged-care facilities in Victoria, Australia. Residents used CM to manage pain and improve mobility, often covertly, and only with the financial assistance of their families. Facility policies and funding restrictions constrained CM use at the individual and facility level. An absence of evidence to support safety and efficacy coupled with the risk of interactions made doctors wary of CM use in older people. These findings have relevance for the large number of CM using “baby-boomers” as they move into residential aged-care. [ABSTRACT FROM AUTHOR]