'We just do the dirty work': dealing with incontinence, courtesy stigma and the low occupational status of carework in long-term aged care facilities.

AIMS AND OBJECTIVES: To systematically examine, describe and explain how continence care was determined, delivered and communicated in Australian long aged care facilities. BACKGROUND: Incontinence is a highly stigmatising condition that affects a disproportionally large number of people living in long-term aged care facilities. Its day-to-day management is mainly undertaken by careworkers. We conducted a Grounded theory study to explore how continence care was determined, delivered and communicated in long-term aged care facilities. This paper presents one finding, i.e. how careworkers in long-term aged care facilities deal with the stigma, devaluation and the aesthetically unpleasant aspects of their work. DESIGN: Grounded theory. METHODS: Eighty-eight hours of field observations in two long-term aged care facilities in Australia. In addition, in-depth interviews with 18 nurses and careworkers who had experience of providing, supervising or assessment of continence care in any long-term aged care facility in Australia. RESULTS: Occupational exposure to incontinence contributes to the low occupational status of carework in long-term aged care facilities, and continence care is a symbolic marker for inequalities within the facility, the nursing profession and society at large. Careworkers' affective and behavioural responses are characterised by: (1) accommodating the context; (2) dissociating oneself; (3) distancing oneself and (4) attempting to elevate one's role status. CONCLUSION: The theory extends current understandings about the links between incontinence, continence care, courtesy stigma, emotional labour and the low occupational status of carework in long-term aged care facilities. RELEVANCE TO CLINICAL PRACTICE: This study provides insights into the ways in which tacit beliefs and values about incontinence, cleanliness and contamination may affect the social organisation and delivery of care in long-term aged care facilities. Nurse leaders should challenge the stigma and devaluation of carework and careworkers, and reframe carework as 'dignity work'.

Assessing pain in older people in residential aged care facilities

The recognition of pain in older people can be complicated by thepresence of dementia and misconceptions that pain is a part ofageing. Older people in residential aged care facilities should beassessed regularly for the presence of pain and managed accordingly.

Rationality of power and the Australian CACPs program

Presents an analytical study of the development and implementation of the Australian Community Aged Care Packages Program. Undertaken from a critical perspective, it also critiques the role of power in shaping and legitimising what is to be counted as "rational" within social policy-making in present liberal democracies.

Fostering resilience later in life: a narrative approach involving people facing disabling circumstances, carers and members of minority groups

Over the last two decades, the concept of resilience has become the focus of a growing body of gerontological research. However, there is a dearth of qualitative research that explores how socio-economic and socio-cultural factors shape older people's resilience. This study addresses this gap and explores the concept of resilience through the lens of 25 Australians from a variety of backgrounds, investigating the resilience strategies they employed in the face of different challenging life events. A qualitative narrative methodology involving one focus group and semi-structured interviews was employed. A stratified convenience sample of 34 people aged 60 and over participated in semi-structured interviews between 2009 and 2011. The study describes the meaning participants assigned to the term resilience, and focuses on the range of resilience responses and strategies they employed, bringing to light some key commonalities and differences. The study's findings suggest that access to economic and cultural resources and the nature of the adversity older people face can shape and limit their resilience strategies. The article outlines how the concept of resilience could be incorporated into aged care practice and argues that resilience-focused interventions that potentially broaden the resilience repertoire of older people should be explored within an aged care context.

Maximising baby boomer engagement in volunteering: a case study from enquiry to implementation

A community aged care service, with the assistance of other stakeholders, initiated a qualitative practice-oriented research project to interview baby boomers about their plans for retirement and their interests in volunteering. The project looks to reshape baby boomer volunteering for our aged care services. Our findings highlight that baby boomers are looking for meaningful, diverse and flexible volunteer opportunities. This will require organisations to adapt their volunteer programs and develop the required infrastructure (improved advertising, assessment and volunteer support approaches) to cater for the volunteering needs of baby boomers. This paper highlights the process, findings, initial efforts and future challenges to engaging baby boomers in volunteer work. It is recognised that further research is required in what is not a homogenous group.

Community Care in Australia

Access and equity are guiding principles for community care in Australia. Community care in Australia is universally provided through Australia's Medicare system, which assures all people access to needed services. The largest community care system, the Home and Community Care Program (HACC), serves frail older and disabled people. The HACC program is undergoing steady reform to provide more seamless transitions of care for people from home care to residential care whether permanent or for respite purposes. Community health services provide a wide range of center-based and outreach services that any person may access and that are provided on the basis of need. Nevertheless, pressures for greater privatization of services cause tensions, and access is jeopardized further by shortages, particularly in rural areas, of aged care nurses, allied health personnel, and medical practitioners.

Geelong community's priorities and expectations of public health care

Abstract This thesis set out to achieve the following objectives: (1) To identify the priorities and expectations that the Geelong community has of its public health care system. (2) To determine if there is a common view on the attributes of a just health system. (3) To consider a method of utilising the data in the determination of health care priority setting in Barwon Health. (4) To determine a model of community participation which enables ongoing input into the decision making processes of Barwon Health. The methodology involved a combination of qualitative and quantitative research. The qualitative work involved the use of focus groups that were conducted with 64 members of the Geelong community. The issues raised informed the development of the interview schedule that was the basis of the quantitative study, which surveyed a representative sample of 400 members of the Geelong community. Prior to reporting on this work, the areas of distributive justice, scarcity and community participation in health care were considered. The research found that timely access to public hospitals, emergency care and aged care services were the major priorities; for many people, the cost was less relevant than a quality service. Shorter waiting times and increased staffing levels were strongly supported. Increased taxes were nominated as the best means of financing the health system they sought. Community based services were less relevant than hospital services but health education was supported. An egalitarian approach to resource distribution was favoured although the community was prepared to discriminate in favour of younger people and against older people. There was strong support for the community to be involved in decision making in the public health care system through surveys or focus groups but very little support was given to priorities being determined by politicians, administrators and to a lesser extent, medical professionals.

Understanding women's breast screening behaviour: a study carried out in South East London, with women aged 50-64 years

Objective To understand low uptake of breast cancer screening through exploring the personal reasoning underlying women's attendance or non-attendance, and identifying differences between those who attend and those who decline.

Design Cross-sectional survey.

Setting Community and home environments of women eligible for breast screening aged 50—64 years, living in South East London. Method Structured, self-completed or assisted-completion questionnaires.

Results The decision to attend or decline screening is rational and personally justifiable, engaging factors linked to emotions and attitude. Attitudes about breast screening and perceived personal importance of breast screening are the strongest predictors of attendance and non-attendance. There are differences between ethnic groups in perceptions of breast screening. Regular attendance at screening is associated with ethnicity, although consistent avoidance of mammography is not. Inconvenience is an important factor in missing appointments, and tends to be prolonged rather than specific to the time or day of the pre-booked invitation. GP and health worker advice are good persuaders towards attendance. Pain and anxiety during mammography are notable dissuaders against re-attending.

Conclusion Appropriate service provision requires consideration of local factors, as well as the medical needs of the population eligible for breast screening. Lay perceptions of potential personal costs of attending or not attending breast screening are important for guiding health promotion. Information providers should consider the language needs of a culturally and educationally mixed community. Health care professionals are well placed to encourage uptake of breast screening through disseminating information that promotes attendance, both within and outside the breast screening service.

A literature review of the application of the geriatric depression scale, depression anxiety stress scales and post-traumatic stress disorder checklist to community nursing cohorts

Aims and objectives. To explore through literature review the appropriateness of three common tools for use by community nurses to screen war veteran and war widow(er) clients for depression, anxiety and post-traumatic stress disorder.

Background. War veterans and, to a lesser extent, war widow(er)s, are prone to mental health challenges, especially depression, anxiety and post-traumatic stress disorder. Community nurses do not accurately identify such people with depression and related disorders although they are well positioned to do so. The use of valid and reliable self-report tools is one method of improving nurses' identification of people with actual or potential mental health difficulties for referral to a general practitioner or mental health practitioner for diagnostic assessment and treatment. The Geriatric Depression Scale, Depression Anxiety Stress Scales and Post-traumatic Stress Disorder Checklist are frequently recommended for mental health screening but the appropriateness of using the tools for screening war veteran and war widow(er) community nursing clients who are often aged and have functional impairment, is unknown.

Design. Systematic review.

Conclusions. Current literature informs that the Geriatric Depression Scale accurately predicts a diagnosis of depression in community nursing cohorts. The three Depression Anxiety Stress Scales subscales of depression, anxiety and stress are valid; however, no studies were identified that compared the performance of the Depression Anxiety Stress Scales in predicting diagnoses of depression or anxiety. The Post-traumatic Stress Disorder Checklist predicts post-traumatic stress disorder in community cohorts although no studies meeting the selection criteria included male participants.

Relevance to clinical practice. This review provides recommendations for the use of the Geriatric Depression Scale, Depression Anxiety Stress Scales and The Post-traumatic Stress Disorder Checklist based on examination of the published evidence for the application of these screening tools in samples approximated to community nursing cohorts. Findings and recommendations would guide community nurses, managers and health planners in the selection of mental health screening tools to promote holistic community nursing care.

Promoting social inclusion of frail older people living in the community

The increasingly diverse needs and wants of Australia's ageing population, like those in many other societies, are drawing attention to aged care as an increasingly important area of broader health and social policy. Active qgeing and a focus on enabling people to remain living in their own homes in the community are two of the key components of this policy shift.

The policy shift towards active ageing recognises and aims to support the desires of older people to remain active members of their communities as they age. Active ageing is 'the process of optimising opportunities for physical, social and mental wellbeing throughout the life-course, in order to extend healthy life expectancy, productivity and quality oflife in older age' (AIPC 2008: 26).

According to the World Health Organization (WHO), the rights, needs, preferences and capacities of older people should be central to active ageing policies, and these should be framed by a life-course approach to ageing (WHO 2002). The development of age-friendly communities, social inclusion and engagement are emerging as key policy issues in the context of an ageing population.

Recent research demonstrates the importance of a sense of belonging in maintaining a sense of identity and increasing the wellbeing of an individual. The sense of belonging that comes about through community engagement also plays a role in successful adjustment to ageing, including prolonging good health and reduced risk of entry into residential aged care.

Nutritional risk in community dwelling older adults.

This research investigated nutritional risk in older adults living in the community. A key finding was that a different healthy weight range should be applied to older adults, which has important implications for nutritional assessment. Recommending a higher BMI for older adults has now been incorporated into some National nutritional guidelines.