Collaborative care : the role of practice nurses

Background
Comorbid depression can occur with diabetes and heart disease. This article reports on a feasibility study focusing on additional roles for practice nurses in detecting and monitoring depression with other chronic diseases.
Method
A convenience sample of six practices in southeast Australia was identified. Practice nurses received training via a workshop, which included training in the use of the Patient Health Questionnaire, to detect depression.
Results
The 332 patients who participated in the project each received a comprehensive health summary to assist with self management. Depression was identified in 34% of patients in this convenience sample. After 18 months implementation, practice nurses were strongly in favour of continuing the model of care. General
practitioners gave highly favourable ratings for effectiveness and willingness to continue this model of care.
Discussion
Practice nurses can include depression monitoring alongside systematic care of diabetes and heart disease. A randomised trial is currently underway to compare the clinical outcomes of this model with usual care.

Training frontline workers : drug education from theory to practice

This study investigated the effectiveness of alcohol and other drug education by examining practice change in workers when they returned to their workplace, identifying barriers to and supports for that practice change. The influencing characteristics of the individual, their team environment and their organisation have also been identified.

Children’s preferences for group musical activities in child care centres : a cross-cultural study

This paper reports on a cross-cultural research study of children’s preferences for group musical activities in child care centres. A total of 228 young children aged 4–5 years in seven child care centres in Hong Kong and in the Adelaide City of South Australia participated in the study. Both qualitative and quantitative data were collected via a mixed method approach. Result showed that dancing/moving was children’s most preferred musical activity in centres. Significant differences were found between children’s cultural contexts and their preferences for three activities: (1) Singing; (2) Listening; and (3) Playing instruments. Qualitative data further revealed the social phenomena of these two cultural contexts which influenced children’s preferences. Implications for the curriculum planning of early childhood music education arising from these findings are discussed.

Fostering relationships between infants, toddlers and their primary caregivers in child care centres in Australia

The chapter provides a synthesis of theory and research in relation to relationships between babies, toddlers and their caregivers in child care centres. The themes addressed include attachment theory and how this is taken account of by caregivers, the importance of secure relationships that recognize and build on the first transition from home to child care centres. In addition, the use of primary caregiving gropus is investigated whereby the caregivers establish close reciprocal relationships with babire, toddlers and their families.

Collaborative care skills training workshops : helping carers cope with eating disorders from the UK to Australia

Purpose

The Collaborative Care Skills Training workshops, developed by Treasure and associates aim to improve the well-being, coping strategies and problem-solving skills of carers of someone with an eating disorder. Evidence has demonstrated the effectiveness of the workshops in the UK where it was developed. The aim of this pilot study was to examine whether conducting the workshops in different contexts by facilitators trained in its delivery could lead to similar impact.
Methods

The workshops were conducted with 15 carers in VIC, Australia and delivered by experienced health professionals trained in its content and delivery. A non-experimental research design with repeated measures was implemented. Quantitative data were collected at pre-and post-intervention and 8 weeks after completion of the workshops.
Results

Participation led to significant reductions in carers’ reported expressed emotion, dysfunctional coping, distress, burden and accommodation and enabling of the eating disorder behaviour, which were maintained at the 8-week follow-up.
Conclusion

Results suggest the workshops are effective in reducing carer distress and burden as well as modifying unhelpful emotional interactional styles when caring for family members with an eating disorder. The content of the workshops and its delivery, once experienced facilitators have received training, are transferable to other contexts.

Using social network analysis to identify key child care center staff for obesity prevention interventions: a pilot study

Introduction. Interest has grown in how systems thinking could be used in obesity prevention. Relationships between key actors, represented by social networks, are an important focus for considering intervention in systems. Method. Two long day care centers were selected in which previous obesity prevention programs had been implemented. Measures showed ways in which physical activity and dietary policy are conversations and actions transacted through social networks (interrelationships) within centers, via an eight item closed-ended social network questionnaire. Questionnaire data were collected from (17/20; response rate 85%) long day care center staff. Social network density and centrality statistics were calculated, using UCINET social network software, to examine the role of networks in obesity prevention. Results. “Degree” (influence) and “betweeness” (gatekeeper) centrality measures of staff inter-relationships about physical activity, dietary, and policy information identified key players in each center. Network density was similar and high on some relationship networks in both centers but markedly different in others, suggesting that the network tool identified unique center social dynamics. These differences could potentially be the focus of future team capacity building. Conclusion. Social network analysis is a feasible and useful method to identify existing obesity prevention networks and key personnel in long day care centers.

Physical environments, policies and practices for physical activity and screen-based sedentary behaviour among preschoolers within child care centres in Melbourne, Australia and Kingston, Canada

Characteristics of preschool and child care centres have previously been shown to be associated with children's health behaviours such as physical activity and screen-based sedentary behaviour. This paper investigates differences in physical environments, policies and practices between child care centres in Melbourne, Australia and Kingston, Canada which may be associated with such behaviours.

Effective family partnerships in early childhood education and care: An investigation of the nature of interactions between educators and parents

This Doctoral dissertation presents findings of a research study exploring the nature of the interactions between early childhood educators and parents as they reflect a framework of partnership centred on mutuality, trust, reciprocity and shared decision making. Examining the nature of the relationships. In examining the interactions , the study found that while mutuality, trust and reciprocity were evident in the interactions between the parents and the educators, shared decision making, where parents were mutual partners in the decision making around their child, was not evident.

Discharge communication from inpatient care: an audit of written medical discharge summary procedure against the new National Health Service Standard for clinical handover

OBJECTIVE: To audit written medical discharge summary procedure and practice against Standard Six (clinical handover) of the Australian National Safety and Quality Health Service Standards at a major regional Victorian health service. METHODS: Department heads were invited to complete a questionnaire about departmental discharge summary practices. RESULTS: Twenty-seven (82%) department heads completed the questionnaire. Seven (26%) departments had a documented discharge summary procedure. Fourteen (52%) departments monitored discharge summary completion and 13 (48%) departments monitored the timeliness of completion. Seven (26%) departments informed the patient of the content of the discharge summary and six (22%) departments provided the patient with a copy. Seven (26%) departments provided training for staff members on how to complete discharge summaries. Completing discharge summaries was usually delegated to the medical intern. CONCLUSIONS: The introduction of the National Service Standards prompted an organisation-wide audit of discharge summary practices against the external criterion. There was substantial variation in the organisation's practices. The Standards and the current audit results highlight an opportunity for the organisation to enhance and standardise discharge summary practices and improve communication with general practice.

Organisational challenges to delivering child investigative interviewer training via e-learning

This article examined organisational challenges arising from the implementation of a new training course for investigative interviewers of vulnerable witnesses. The course was delivered via e-learning (computer exercises) and also involved mock interviews conducted over the telephone. Thematic analysis was conducted of: (a) trainees’ anonymous written feedback submitted to an online discussion forum on the training programme’s website, (b) trainees’ responses to face-to-face questions during semi-structured qualitative interviews, and (c) correspondence between trainees and trainers regarding the training programme. Despite unanimous support for the new training programme, three challenges were identified: limited allocated work time to complete the training, conflicting work practices arising from staggered course enrolment, and difficulties associated with computer and technical skills. These organisational challenges must be addressed to ensure that any future evaluation of the programme on skill performance provides a true indication of the programme’s impact on skill development. From a managerial perspective, organisational challenges need to be addressed in order to maximise the accessibility, completion and long-term success of an e-learning training model for interviewers.

End of life care - the importance of advance care planning

Background: Communication about end of life care may involve difficult conversations for patients, family members and health professionals. However, a lack of understanding of a person's wishes about their future care may result in a loss of dignity for the person, and additional distress for their family members and health professionals and burden to the healthcare system. Objective: This article discusses the barriers to advance care planning and provides some guidance for the general practitioner in undertaking advance care planning with patients and their families. Tips for initiating end of life discussions with patients and families utilising the 'PREPARED' acronym, and ensuring appropriate care delivery are included. Discussion: Involving patients and their family members in advance care planning may be challenging and time consuming for GPs. However, there are a number of resources to support this activity in relation to training, communication support and Medicare item funding.

Collaborative care skill training workshop: how Australian carers support a loved one with an eating disorder

This study examined the impact of participating in the CollaborativeCare Skill Training Workshops on carers’ coping strategies, expressedemotion (EE), burden, distress, confidence in their loved one’scapacity to change, as well as the previously unexplored dimensionof accommodating and enabling of their loved one’s eatingdisorder behaviour. A non-experimental research design wasimplemented and 77 carers from Victoria, Australia participated inthe study and completed questionnaires at pre-and postinterventionand an 8-week follow-up. Significant reductionsoccurred in accommodation and enabling of some eating disorderbehaviours, as well as in carers’ maladaptive coping, EE, eatingdisorder-specific burden and psychological distress. Increasedconfidence that their loved one could change was also observed.These changes were maintained at a follow-up. Results suggestthat the workshop can be effective in decreasing carer use ofmaladaptive coping, carer distress and burden. Notably, it targetsand had contributed to reducing factors associated withmaintaining eating disorders such as accommodation and enablingof certain eating behaviours and high levels of EE. Modification tothe content of the workshop may be required to improve carers’adaptive coping and reduce certain behaviours whichaccommodate and enable the eating disorder.

Intensive care nurses' perceptions of brain death

Research during the last 2 decades has revealed significant confusion or lack of acceptance and inconsistent application of the brain death concept within the medical and nursing professions. The aim of this naturalistic and descriptive study was to investigate the extent to which a sample of 40 Australian intensive care nurses regarded brain death as a meaningful conception of death. In contrast with the majority of the literature pertaining to health care professionals' perceptions of brain death which has focused upon clinical knowledge, the study elicited the expression of personal beliefs. The study utilised a structured interview method with nurses from seven metropolitan intensive care units (ICUs). Transcript analysis revealed five categories of perception constituting a spectrum ranging from complete acceptance to complete rejection, with almost half (48%, n=19) the sample regarding the brain dead patient as less than completely meaningfully dead.

Rather than supporting the literature's suggestion that non-acceptance of the medico-legally recognised brain death notion is, necessarily, evidence of professional ignorance, the findings suggest the participants holding these perceptions were generally well-informed about brain stem function and brain death diagnosis. The study affirms the importance of supportive workplace environments which facilitate the expression of dissonant perceptions and proposes that educators and managers must acknowledge these dissonances.