Development and feasibility testing of an education program to improve knowledge and self-care among Aboriginal and Torres Strait Islander patients with heart failure

Background/Aim There is a 70% higher age-adjusted incidence of heart failure (HF) amongst Aboriginal and Torres Strait Islander people, three times more hospitalisations and twice as many deaths than non-Aboriginal people. There is a need to develop holistic yet individualised approaches in accord with the values of Aboriginal community healthcare to support patient education and self-care. The aim of this study was to re-design an existing HF educational resource (Fluid Watchers-Pacific Rim©) to be culturally safe for Aboriginal and Torres Strait Islander peoples, working in collaboration with the local community, and to conduct feasibility testing. Methods This study was conducted in two phases and utilised a mixed methods approach (qualitative and quantitative). Phase 1 of this study used action research methods to develop a culturally safe electronic resource to be provided to Aboriginal HF patients via a tablet computer. A HF expert panel adapted the existing resource to ensure it was evidence-based and contained appropriate language and images that reflects Aboriginal culture. A stakeholder group (which included Aboriginal workers and HF patients, as well as researchers and clinicians) then reviewed the resources and changes were made accordingly. In Phase 2, the new resource was tested on a sample of Aboriginal HF patients to assess feasibility and acceptability. Patient knowledge, satisfaction and self-care behaviours were measured using a before and after design with validated questionnaires. As this was a pilot test to determine feasibility, no statistical comparisons were made. Results - Phase 1: Throughout the process of resource development, two main themes emerged from the stakeholder consultation. These were the importance of identity, meaning that it was important to ensure that the resource accurately reflected the local community, with the appropriate clothing, skin tone and voice. The resource was adapted to reflect this and of the local community voiced the recordings for the resource. The other theme was comprehension; images were important and all text was converted to the first person and used plain language. - Phase 2: Five Aboriginal participants, mean age 61.6 ± 10.0 years, with NYHA Class III and IV heart failure were enrolled. Participants reported a high level of satisfaction with the resource (83.0%). HF knowledge (percentage of correct responses) increased from 48.0 ± 6.7% to 58.0 ± 9.7%, a 20.8% increase and results of the self-care index indicated that the biggest change was in patient confidence for self-care with a 95% increase in confidence score (46.7 ± 16.0 to 91.1 ± 11.5). Changes in management and maintenance scores varied between9275 patients. Conclusion By working in collaboration with HF experts, Aboriginal researchers and patients, a culturally safe HF resource has been developed for Aboriginal and Torres Strait Islander patients. Engaging Aboriginal researchers, capacity-building, and being responsive to local systems and structures enabled this pilot study to be successfully completed with the Aboriginal community and positive participant feedback demonstrated that the methodology used in this study was appropriate and acceptable; participants were able to engage with willingness and confidence.

Apprehending the void: Using animation to interpret the genius loci of the Peel Island Lazaret

This practice-led research project harnesses the plasmatic nature of animation (Eisenstein 1989) to embody the in-between state of being of the Peel Island Lazaret on the island of Teerk Roo Ra in Moreton Bay, Queensland. In this project the genius loci of this place is expressed through the development of a series of creative works that employs the unique transformative quality of animation to push and pull at the boundary lines between what can be apprehended as the ‘real’ and the ‘imaginary’. Drawing on the physical approach of Czech surrealist animator Jan Švankmajer and cultural theories from Australian writer Ross Gibson, this study re-members and re-imagines the site of the Lazaret as a liminal, uncanny place. This study investigates how conceptions of place are overlaid by aspects of history, memory and the imagination and these discoveries contribute to the currently limited academic discourse around place and place-making in animation practice in Australia.

Nocturne

Chris Denaro is a Brisbane-based animator whose work incorporates a blend of physical stop motion and digital motion graphics. This exhibition, Nocturne, uses animation to embody the genius loci of the former Peel Island Lazaret on the island of Teerk Roo Ra in Moreton Bay, Queensland. This project developed a form of animation that harnesses animation’s plasmatic quality to express an in-between state of being, and examines the capacity of animation to push and pull at the boundary lines between what can be apprehended as the ‘real’ and the ‘imaginary’. The Nocturne constructions cycle forever, with no beginning and no end,only a slightly familiar hypnotic rhythm to describe a continual process of adaptation and renewal. These artworks consider the animation loop as a mental state, rather than a sequence of events which illustrate a narrative. The loop can also be an anxious, compulsive place, divorced from the linear nature of reality, hypnotised in a trance like repetition. Nocturne investigates how conceptions of place are overlaid by aspects of history, memory and the imagination.

Design challenges for electronic medication administration record systems in residential aged care facilities: A formative evaluation

Introduction Electronic medication administration record (eMAR) systems are promoted as a potential intervention to enhance medication safety in residential aged care facilities (RACFs). The purpose of this study was to conduct an in-practice evaluation of an eMAR being piloted in one Australian RACF before its roll out, and to provide recommendations for system improvements. Methods A multidisciplinary team conducted direct observations of workflow (n=34 hours) in the RACF site and the community pharmacy. Semi-structured interviews (n=5) with RACF staff and the community pharmacist were conducted to investigate their views of the eMAR system. Data were analysed using a grounded theory approach to identify challenges associated with the design of the eMAR system. Results The current eMAR system does not offer an end-to-end solution for medication management. Many steps, including prescribing by doctors and communication with the community pharmacist, are still performed manually using paper charts and fax machines. Five major challenges associated with the design of eMAR system were identified: limited interactivity; inadequate flexibility; problems related to information layout and semantics; the lack of relevant decision support; and system maintenance issues.We suggest recommendations to improve the design of the eMAR system and to optimize existing workflows. Discussion Immediate value can be achieved by improving the system interactivity, reducing inconsistencies in data entry design and offering dedicated organisational support to minimise connectivity issues. Longer-term benefits can be achieved by adding decision support features and establishing system interoperability requirements with stakeholder groups (e.g. community pharmacies) prior to system roll out. In-practice evaluations of technologies like eMAR system have great value in identifying design weaknesses which inhibit optimal system use.

Nocturne #39

Creative Work as part of the Nocturne series

Natural convection in rectangular cavities at high Rayleigh number

Natural convection in rectangular two-dimensional cavities with differentially heated side walls is a standard problem in numerical heat transfer. Most of the existing studies has considered the low Ra laminar regime. The general thrust of the present research is to investigate higher Ra flows extending into the unsteady and turbulent regimes where the physics is not fully understood and appropriate models for turbulence are not yet established. In the present study the Boussinesq approximation is being used, but the theoretical background and some preliminary results have been obtained[1] for flows with variable properties.

The laminar boundary layer regime for natural convection of air in a square cavity

Numerical predictions are obtained for laminar natural convection of air in a square two dimensional cavity at high Rayleigh numbers. Proper resolution of the core reveals weak multi-cellular structure which varies in a complex manner as the effects of convection are increased. The end of the steady laminar regime is numerically estimated to occur at Ra=2.2x10^8.

Laminar and turbulent natural convection in rectangular cavities

A computer program has been developed for the prediction of buoyancy-driven laminar and turbulent flow in rectangular air-filled two-dimensional cavities with differentially heated side walls. Laminar flow predictions for a square cavity and Rayleigh numbers from Ra = 10^3 up to the onset of unsteady flow have been obtained. Accurate solutions for Ra = 5 x 10^6, 10^7, 5 x 10^7 and 10^8 are presented and an estimate for the critical Rayleigh number at which the steady laminar flow becomes unsteady is given for this geometry. Numerical predictions of turbulent flow have been obtained for RaH~0(10^9 -10^11 ) and compared with existing experimental data. A previously developed second moment closure model (Behnia et al. 1987) has been used to model the turbulence. Results indicate that a second moment closure model is capable of predicting the observed flow features.

Laminar and turbulent natural convection in rectangular cavities

"This chapter discusses laminar and turbulent natural convection in rectangular cavities. Natural convection in rectangular two-dimensional cavities has become a standard problem in numerical heat transfer because of its relevance in understanding a number of problems in engineering. Current research identified a number of difficulties with regard to the numerical methods and the turbulence modeling for this class of flows. Obtaining numerical predictions at high Rayleigh numbers proved computationally expensive such that results beyond Ra ∼ 1014 are rarely reported. The chapter discusses a study in which it was found that turbulent computations in square cavities can't be extended beyond Ra ∼ O (1012) despite having developed a code that proved very efficient for the high Ra laminar regime. As the Rayleigh number increased, thin boundary layers began to form next to the vertical walls, and the central region became progressively more stagnant and highly stratified. Results obtained for the high Ra laminar regime were in good agreement with existing studies. Turbulence computations, although of a preliminary nature, indicated that a second moment closure model was capable of predicting the experimentally observed flow features."--Publisher Summary