Finding a place for personal growth in an Australian community singing group for older people

As in many countries, Australia is faced with an aging population. This creates challenges for the maintenance of well-being which can be enhanced by active engagement in society. Music engagement encompasses a range of social participation and has the potential to recognise the contribution of older people to their local communities. Engagement in music by older people (50+) is positively related to individual and community well-being.  Music participation can contribute to a better quality of life, particularly in relation to health and happiness. The possible forms of music engagement are myriad.

This paper focuses on two members of a mixed voluntary singing group formed by older residents of an outer suburban community in Melbourne, Australia.  This study frames music as a positive way for older people to find a place for personal growth and fulfilment in a singing group. This phenomenological qualitative single case study focuses on two members of a small singing ensemble, the Skylarkers, formed to perform at retirement villages, nursing homes and facilities for senior citizens. In this study, data were gathered by interviews and analysed using interpretative phenomenological analysis.

Two significant themes emerged. The first concerned the nature of the choir and its fluid membership and notions of self-identity. The second theme concerns the validation offered to individual members by active music participation through which they gained a sense of purpose, fulfilment and personal growth. This emphasis is unusual in discussions of community music engagement that ordinarily identify the importance of social connections. Groups such as the Skylarkers provide a place for members to continue their active engagement with music performance and music learning.

Challenges in managing elderly people with diabetes in primary care settings in Norway

Objective
To explore the experiences and clinical challenges that nurses and nursing assistants face when providing high-quality diabetes-specific management and care for elderly people with diabetes in primary care settings.

Design
Focus-group interviews.

Subjects and setting
Sixteen health care professionals: 12 registered nurses and four nursing assistants from nursing homes (10), district nursing service (5), and a service unit (1) were recruited by municipal managers who had local knowledge and knew the workforce. All the participants were women aged 32–59 years with clinical experience ranging from 1.5 to 38 years.

Results
Content analysis revealed a discrepancy between the level of expertise which the participants described as important to delivering high-quality care and their capacity to deliver such care. The discrepancy was due to lack of availability and access to current information, limited ongoing support, lack of cohesion among health care professionals, and limited confidence and autonomy. Challenges to delivering high-quality care included complex, difficult patient situations and lack of confidence to make decisions founded on evidence-based guidelines.

Conclusion
Participants lacked confidence and autonomy to manage elderly people with diabetes in municipal care settings. Lack of information, support, and professional cohesion made the role challenging.

Diabetes and risk of physical disability in adults: a systematic review and meta-analysis

Background
According to previous reports, the risk of disability as a result of diabetes varies from none to double. Disability is an important measure of health and an estimate of the risk of disability as a result of diabetes is crucial in view of the global diabetes epidemic. We did a systematic review and meta-analysis to estimate this risk.

Methods
We searched Ovid, Medline, Embase, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature up to Aug 8, 2012. We included studies of adults that compared the risk of disability—as measured by activities of daily living (ADL), instrumental activities of daily living (IADL), or mobility—in people with and without any type of diabetes. We excluded studies of subpopulations with specific illnesses or of people in nursing homes. From the studies, we recorded population characteristics, how diabetes was diagnosed (by doctor or self-reported), domain and definition of disability, and risk estimates for disability. We calculated pooled estimates by disability type and type of risk estimate (odds ratio [OR] or risk ratio [RR]).

Results
Our systematic review returned 3224 results, from which 26 studies were included in our meta-analyses. Diabetes increased the risk of mobility disability (15 studies; OR 1·71, 95% CI 1·53—1·91; RR 1·51, 95% CI 1·38—1·64), of IADL disability (ten studies; OR 1·65, 95% CI 1·55—1·74), and of ADL disability (16 studies; OR 1·82, 95% CI 1·63—2·04; RR 1·82, 95% CI 1·40—2·36).

Interpretation
Diabetes is associated with a strong increase in the risk of physical disability. Efforts to promote healthy ageing should account for this risk through prevention and management of diabetes.

Funding
Monash University, Baker IDI Bright Sparks Foundation, Australian Postgraduate Award, VicHealth, National Health and Medical Research Council, Australian Research Council, Victorian Government.

Islam and development: exploring the invisible aid economy

The study of Islam since the advent of 9/11 has made a significant resurgence. However, much of the work produced since then has tended to focus on the movements that not only provide aid to their fellow Muslims, but also have political and at times violent agendas. This tendency has led to a dearth of research on the wider Muslim aid and development scene. Focusing on the role and impact of Islam and Islamic FBOs, an arena that has come to be regarded by some as the 'invisible aid economy', Islam and Development considers Islamic theology and its application to development and how Islamic teaching is actualized in case studies of Muslim FBOs. It brings together contributions from the disciplines of theology, sociology, politics and economics, aiming both to raise awareness and to function as a corrective step within the development studies literature.

Introduction: The invisible aid sector

The study of Islam since the advent of 9/11 has made a significant resurgence. However, much of the work produced since then has tended to focus on the movements that not only provide aid to their fellow Muslims, but also have political and at times violent agendas. This tendency has led to a dearth of research on the wider Muslim aid and development scene.

Focusing on the role and impact of Islam and Islamic FBOs, an arena that has come to be regarded by some as the ‘invisible aid economy’, Islam and Development considers Islamic theology and its application to development and how Islamic teaching is actualized in case studies of Muslim FBOs. It brings together contributions from the disciplines of theology, sociology, politics and economics, aiming both to raise awareness and to function as a corrective step within the development studies literature.

‘Knowledge aid’ as instrument of regulation: World Bank’s non-lending higher education support for Ethiopia

In the context of low-income countries, the role of donors in public policymaking is of great importance. Donors use a combination of lending and non-lending instruments as pathways of influence to shape policy directions in aid-recipient countries. This paper reports some findings from a doctoral study on the role of the World Bank in the recent higher education (HE) policy reform process in Ethiopia. It focuses on the nature and impact of non-lending assistance by the Bank to the Ethiopian HE subsystem. Based on an interpretive policy analysis of sector reviews and advisory activities of the Bank, and selected national HE policy documents, the following findings are highlighted. First, as a ‘knowledge institution’, the World Bank produces, systematises and disseminates knowledge through policy advice, policy reports, analytical sector reviews, and thematic conferences and workshops. Second, knowledge aid from the Bank not only has a profound discursive effect on shaping Ethiopian HE policy reform priorities in accordance with its neoliberal educational agenda but also undermines the knowledge production capacity of the nation. The paper also argues that, for an effective education policy support, the Bank needs to shift its modality of engagement from knowledge aid to research capacity building. 

Round the bend : a history of psychiatric nursing in Victoria

This feature length documentary explores the development of psychiatric nursing from the early colonial beginnings in 1848 through to the post-institutional present. The film commences with a montage of photos, film and narrative that documents the period until 1930s.

The period from the 1930s to the present is described chronologically in oral histories provided by personal interviews with psychiatric nurses. The interviews include a number of key psychiatric nurse leaders who were instrumental in bringing about significant changes to nursing practice and education, and were also at the forefront of leading major reforms to service delivery in Victoria such as the community mental health movement.

The oral histories provide an account of the history of this unique area specialty of nursing. At times confronting and challenging, the film also highlights the significant contribution of psychiatric nursing to the development of humanistic, person-centered philosophies of care in mental health. The narratives are woven together with photographs and film footage of historical artifacts and institutions.

Ethical challenges associated with providing continence care in residential aged care facilities : findings from a grounded theory study

A person-centred approach to care in residential aged care facilities should uphold residents’ rights to independence, choice, decision-making, participation, and control over their lifestyle. Little is known about how nurses and personal care assistants working in these facilities uphold these ideals when assisting residents maintain continence and manage incontinence. The overall aim of the study was to develop a grounded theory to describe and explain how Australian residents of aged care facilities have their continence care needs determined, delivered and communicated. This paper presents and discusses a subset of the findings about the ethical challenges nurses and personal care assistants encountered whilst providing continence care. Grounded theory methodology was used for in-depth interviews with 18 nurses and personal care assistants who had experience of providing, supervising or assessing continence care in any Australian residential aged care facility, and to analyse 88 hours of field observations in two facilities. Data generation and analysis occurred simultaneously using open coding, theoretical coding, and selective coding, until data were saturated. While addressing the day-to-day needs of residents who needed help to maintain continence and/or manage incontinence, nurses and personal care assistants struggled to enable residents to exercise choice and autonomy. The main factor that contributed to this problem was that the fact that nurses and personal care assistants had to respond to multiple, competing, and conflicting expectations about residents’ care needs. This situation was compounded by workforce constraints, inadequate information about residents’ care needs, and an unpredictable work environment. Providing continence care accentuated the ethical tensions associated with caregiving. Nurses’ and personal care assistants’ responses were mainly characterised by highly protective behaviours towards residents. Underlying structural factors that hinder high quality continence care to residents of aged care facilities should be urgently addressed.

The show must go on’ : older entertainers making music in the community in Melbourne, Australia

Globally countries are faced with an aging population and Australia is no different. This creates challenges for the maintenance of well-being which can be enhanced by active engagement in society. There is extensive research that confirms that engagement in music by older people is positively related to individual and community wellbeing. Music engagement encompasses a range of social participation and has the potential to recognise the contribution of older people to their local communities. Music participation can contribute to a better quality of life, particularly in relation to health and happiness. There are many possible forms of music engagement. This study is part of an on-going Deakin University and Monash University research project, Well-being and ageing: community, diversity and the arts in Victoria. This article focuses on three members of a mixed voluntary singing group formed by older residents of an outer suburban community in Melbourne, Australia. This group, The Skylarkers, were established in 1999 as a four-part choir. Over the years the nature of the choir has changed under subsequent music directors. Since 2009 the group has focused on music theatre repertoire and performance style. Membership of the group is fluid reflecting changing life circumstances of the members but the ensemble is resilient. This small amateur music theatre group is based in suburban Melbourne, rehearses weekly and performs regularly at retirement villages, nursing homes and facilities for senior citizens. This article presents a phenomenological qualitative single case study of members of the Skylarkers. In this study, interview data were gathered in 2011-2012 and analysed using interpretative phenomenological analysis. Two significant themes emerged that concern musical self-identity and gaining a sense of purpose and fulfilment. The Skylarkers are more than a choir; they are an amateur entertainment troupe that engages with each other and the wider community. This resilient group holds true to the motto ‘the show must go on’.

Teleconsultation/telediagnosis using teledentistry technology: a pilot feasibility study

This study assessed the feasibility of ateledentistry model for teleconsultation and telediagnosis inResidential Aged Care Facilities. Study feasibility was definedby the ability to develop remote treatment plans. Reliability ofthe remote assessments was assessed by comparing with thoseperformed by traditional face-to-face oral examinations. Anintraoral camera was operated by trained teledentistryassistants with the aim of screening residents for oral diseasesand pathological conditions. The model was supported bytraning and an instructional kit for the introral cameraoperators. The structure, content and delivery of the program,was evaluated. Residents’ views about the structure, contentand delivery of the program were also evaluated. A total of 50residents participated in this assessment. Results indicated thatthe proposed teledentistry approach for oral health screeningis feasible and reliable as an alternative to traditional oralhealth examination. Residents expressed high levels ofsatisfaction with the teledentistry service. This study providesan innovative solution towards closing the service delivery gapin the provision of sustainable oral health care services tounderserviced populations (e.g., nursing homes, rural areas).

Development of mental health first aid guidelines for deliberate non-suicidal self-injury: a Delphi study

BACKGROUND: It is estimated that around 4% of the population engages, or has engaged, in deliberate non-suicidal self-injury. In clinical samples, the figures rise as high as 21%. There is also evidence to suggest that these figures may be increasing. A family member or friend may suspect that a person is injuring themselves, but very few people know how to respond if this is the case. Simple first aid guidelines may help members of the public assist people to seek and receive the professional help they require to overcome self-injury.

METHODS: This research was conducted using the Delphi methodology, a method of reaching consensus in a panel of experts. Experts recruited to the panels included 26 professionals, 16 people who had engaged in self-injurious behaviour in the past and 3 carers of people who had engaged in self-injurious behaviour in the past. Statements about providing first aid to a person engaged in self-injurious behaviour were sought from the medical and lay literature, but little was found. Panel members were asked to respond to general questions about first aid for NSSI in a variety of domains and statements were extracted from their responses. The guidelines were written using the items most consistently endorsed by the consumer and professional panels.

RESULTS: Of 79 statements rated by the panels, 18 were accepted. These statements were used to develop the guidelines appended to this paper.

CONCLUSION: There are a number of actions which are considered to be useful for members of the public when they encounter someone who is engaging in deliberate, non-suicidal self-injury. These guidelines will be useful in revising curricula for mental health first aid and NSSI first aid training programs. They can also be used by members of the public who want immediate information about how to assist a person who is engaging in such behaviour.

First aid for depression: a Delphi consensus study with consumers, carers and clinicians.

BACKGROUND: It is unclear how members of the public can best support individuals who are developing a depressive episode before appropriate professional help is received. METHODS: To assess expert consensus, we used the Delphi Method. An expert panel consisting of 167 mental health consumers, carers and clinicians was recruited from developed English-speaking countries. A 99-item questionnaire about how to help someone with depression was developed from a variety of resources. The panel members rated each item according to whether they believed the statement should be included in the first aid recommendations. The results were analysed by comparing consensus rates across the three groups. Three rounds were required to consolidate consensus levels. RESULTS: Sixty-four items were endorsed by > or =80% of panel members from all three groups as essential or important. These items were grouped under the following headings: recognising and acknowledging depression; approaching someone who may be depressed; how to be supportive; what is not helpful for a person who may have depression; whether to encourage the person to seek professional help; whether to encourage the person to use self-help strategies; what to do if the person does not want help. LIMITATIONS: These recommendations may not be applicable outside developed English-speaking countries. CONCLUSIONS: By informing the content of training courses, these recommendations will improve the provision of first aid to individuals who are developing a depressive episode and facilitate the uptake of appropriate professional help.

Understanding feedback report uptake: process evaluation findings from a 13-month feedback intervention in long-term care settings

BACKGROUND: Long-term care settings provide care to a large proportion of predominantly older, highly disabled adults across the United States and Canada. Managing and improving quality of care is challenging, in part because staffing is highly dependent on relatively non-professional health care aides and resources are limited. Feedback interventions in these settings are relatively rare, and there has been little published information about the process of feedback intervention. Our objectives were to describe the key components of uptake of the feedback reports, as well as other indicators of participant response to the intervention. METHODS: We conducted this project in nine long-term care units in four facilities in Edmonton, Canada. We used mixed methods, including observations during a 13-month feedback report intervention with nine post-feedback survey cycles, to conduct a process evaluation of a feedback report intervention in these units. We included all facility-based direct care providers (staff) in the feedback report distribution and survey administration. We conducted descriptive analyses of the data from observations and surveys, presenting this in tabular and graphic form. We constructed a short scale to measure uptake of the feedback reports. Our analysis evaluated feedback report uptake by provider type over the 13 months of the intervention. RESULTS: We received a total of 1,080 survey responses over the period of the intervention, which varied by type of provider, facility, and survey month. Total number of reports distributed ranged from 103 in cycle 12 to 229 in cycle 3, although the method of delivery varied widely across the period, from 12% to 65% delivered directly to individuals and 15% to 84% left for later distribution. The key elements of feedback uptake, including receiving, reading, understanding, discussing, and reporting a perception that the reports were useful, varied by survey cycle and provider type, as well as by facility. Uptake, as we measured it, was consistently high overall, but varied widely by provider type and time period. CONCLUSIONS: We report detailed process data describing the aspects of uptake of a feedback report during an intensive, longitudinal feedback intervention in long-term care facilities. Uptake is a complex process for which we used multiple measures. We demonstrate the feasibility of conducting a complex longitudinal feedback intervention in relatively resource-poor long-term care facilities to a wider range of provider types than have been included in prior feedback interventions.