Health risk behaviours and health care needs among people with psychiatric illness

This paper presents findings from two studies. Study 1 explored differences between people with psychiatric illness (PPI) (N=144) and the general population (N=151) in levels of low-fat diet, exercise and smoking. Study 2 investigated barriers and health care needs of PPI (N=60). The prevalence of overweight, cigarette smoking and sedentary lifestyle were significantly greater among PPI than the general population. Major predictors were limited social support, knowledge of correct dietary principles, lower self-efficacy, psychiatric symptomatology and various psychotropic drugs. The findings demonstrated that PPI over-used medical services but under-used preventive services due to inaccessibility, lower satisfaction and knowledge of services.

Care needs and functional status of older acute care patients

A growing number of older adults are admitted to hospitals, and information is needed on how age-related functional decline affects nursing care needs of this population. This study compared the functional status at admission and total nursing care needs of three age groups of older inpatients. A 12-month retrospective audit was performed on the records of 225 patients in a private metropolitan hospital. The three groups of patients were matched on diagnosis. Findings revealed that older patients were significantly more dependent, had greater total nursing care needs, and were less likely to be discharged to home, indicating that in addition to medical diagnoses, age-related differences of older patients’ functional status at admission and inpatient nursing care needs should be factored into staff workloads and funding of nursing care. The finding that significantly fewer of the older patients returned home must be considered when reviewing health care policy and services.

Primary health-care costs associated with special health care needs up to age 7 years: Australian population-based study.

We studied infants and children with and without special health care needs (SHCN) during the first 8 years of life to compare the (i) types and costs to the government's Medicare system of non-hospital health-care services and prescription medication in each year and (ii) cumulative costs according to persistence of SHCN.

Compliance to exercise-oncology guidelines in prostate cancer survivors and associations with psychological distress, unmet supportive care needs, and quality of life

Objective The purpose of this study was to determine prevalence of Australian prostate cancer survivors meeting contemporary exercise-oncology guidelines and identify associations with distress, unmet supportive care needs, and quality of life. Methods A population-based cohort of 463 prostate cancer survivors who were on 10.8 months post-curative therapy was assessed for compliance with current exercise guidelines for cancer survivors, motivational readiness for physical activity, psychological distress, unmet supportive care needs, and quality of life. Results Only 57 men (12.3%) reported sufficient exercise levels (150 min of moderate intensity or 75 min of strenuous exercise per week and twice weekly resistance exercise), 186 (40.2%) were insufficiently active, and 220 (47.5%) were inactive. Among inactive men, 99 (45.0%) were in the contemplation or preparation stage of motivation readiness. Inactive men had higher global distress (p=0.01) and Brief Symptom Inventory-Anxiety (p<0.05) than those who were insufficiently active. Total Supportive Care Needs and International Prostate Cancer Symptom scores were higher in inactive than insufficiently and sufficiently active men (p<0.05). Lack of physical activity contributed to poorer quality of life. Conclusions Only a small proportion of Australian prostate cancer survivors met contemporary exercise-oncology recommendations despite increasing recognition of exercise to improve patient outcomes. Strategies are urgently required to increase prostate cancer survivors' participation in aerobic and resistance exercise training.

Improving the quality of life for patients' with co-morbidities requiring acute care

Reduced mortality rates in the Western world have created an increase in people with co-morbidities who have the potential to require acute care hospital services. These patients' chronic conditions often require complex needs that may not always be met by an acute care focus. This has created a precedent for nurses concerned with the holistic care and quality of life for these patients. This paper aims to describe the experiences of patients with co-morbidities who were admitted to hospital with an acute illness. This exploratory descriptive design selected patients in acute care who had more than one co-morbidity for approximately five years. Data was obtained from a purposive sample of twelve patients within two weeks of being discharged home using a semi-structured interview approach. Data analysis was conducted utilising Nvivo software to process the Colaizzi [1978] method. The theme clusters revealed a lack of continuity and co-ordinated care of the patients' co-morbidities during the acute admission and in discharge planning. It was seen that combinations of chronic conditions and treatments affected these patients' experience of acute care and thereafter, where conceptualisations of co-morbidity failed to accurately capture the underlying health care needs of these patients. These findings have implications for a comprehensive and considered approach to these patients' health care needs and quality of life whilst developing an improved understanding of co-morbidity for nursing. Recommendations for further research conclude this paper.

Ethnic aged discrimination and disparities in health and social care : a question of social justice

Older overseas-born Australians of diverse cultural and language backgrounds experience significant disparities in their health and social care needs and support systems. Despite being identified as a 'special needs' group, the ethnic aged in Australia are generally underserved by local health and social care services, experience unequal burdens of disease and encounter cultural and language barriers to accessing appropriate health and social care compared to the average Australian-born population. While a range of causes have been suggested to explain these disparities, rarely has the possibility of cultural racism been considered. In this article, it is suggested that cultural racism be named as a possible cause of ethnic aged disparities and disadvantage in health and social care. It is further suggested that unless cultural racism is named as a structural mechanism by which ethnic aged disparities in health and social care have been created and maintained, redressing them will remain difficult.

A qualitative study of primary health care access, barriers and satisfaction among people with mental illness

Research has found that a substantial proportion of individuals with mental illness have high morbidity and mortality rates, and high under-diagnosis of major physical illnesses. Furthermore, people with a mental illness tend not to seek out or utilise health care services. The reasons for the negative attitudes and behaviour towards health care services among this population have not been investigated. This paper presents findings from a study that investigated the health care service needs of people with mental illness (n = 20), and views from health care providers (n = 16) regarding access to these services by people with a mental illness. Results indicated that psychiatric patients identified a range of barriers to their health care usage and low levels of health care satisfaction. These views were shared with health care professionals. Reasons for these findings and strategies to address these problems so that there is better access to health care services for people with mental illness are discussed.

Health care provider and consumer understandings of cultural safety and cultural competency in health care : an Australian study

There is increasing recognition in Australia that racial and ethnic minority groups experience significant disparities in health and health care compared with the average population and that the Australian health care system needs to be more responsive to the health and care needs of these groups. The paper presents the findings of a year long study that explored what providers and recipients of health care know and understand about the nature and implications of providing culturally safe and competent health care to minority racial and ethnic groups in Victoria, Australia. Analysis of the data obtained from interviewing 145 participants recruited from over 17 different organizational sites revealed a paucity of knowledge and understanding of this issue and the need for a new approach to redress the status quo.

A suite of evidence-based continence assessment tools for residential aged care

The management of incontinence in residential aged care facilities presents staff with considerable challenges. In order to support the residential aged care workforce to provide evidence-based continence care, we developed a suite of evidence-based continence assessment tools and an accompanying educational resource for use in the residential aged care sector. The tools comply with international and accreditation standards. They address urinary and faceal incontinence and other bladder and bowel symptoms. They also include a number of cues to guide staff to assess and manage residents’ continence care needs and refer as needed. An evaluation of the tools conducted in 18 residential aged care facilities across three states revealed that staff members found the tools helpful, clear, simple and user-friendly. This paper provides a description of the newly developed suite of continence assessment tools for residential aged care and the accompanying education resources, and presents staff perspectives on their clinical usefulness.

Coproduction in practice : participatory action research to develop a model of community aged care

Coproduction has become synonymous with innovative approaches to public service delivery in European Union countries as well as in Australia. Coproduction has the potential to bring together individuals, communities, and organisations in a process to collaboratively develop new models and services which improve public services. Yet, Australian policy makers and practitioners who would like to deploy coproduction within the context of older adult social care can only draw on a handful of papers and reports that could guide implementation. This paper fills this gap by reporting on the implementation of a multi-stakeholder coproduction approach to the development of a consumer directed care model for older people with complex health issues. The paper describes and critically highlights methodological challenges encountered during the 12 month-long participatory action research phase of a larger project involving older people with complex care needs, their carers, and government and non-government stakeholders. The paper outlines key considerations regarding (1) the involvement of older people with complex needs, (2) collaboration with industry partners, (3) engagement of government representatives, and (4) reflects on implementing participatory research projects within a context of outsourcing and interlinked supply chains. While not all challenges encountered could be resolved, the coproduction approach was successful in bringing together a wide range of stakeholders with competing agendas in an iterative process geared to resolve a plethora of concerns raised by older people, carers and services providers. This paper provides an example for others seeking to use coproduction and participatory methods to provide person-centred care services for older people.