Improving wound management for residents in Residential Aged Care Facilities: National dissemination and implementation of the evidence based Champions for Skin Integrity Program

Overview The incidence of skin tears, pressure injuries and chronic wounds increases with age [1-4] and therefore is a serious issue for staff and residents in Residential Aged Care Facilities (RACFs). A pilot project funded in Round 2 of the Encouraging Best Practice in Residential Aged Care (EBPRAC) program by the then Australian Government Department of Health and Ageing found that a substantial proportion of residents in aged care facilities experienced pressure injuries, skin tears or chronic wounds. It also found the implementation of the evidence based Champions for Skin Integrity (CSI) model of wound care was successful in significantly decreasing the prevalence and severity of wounds in residents, improving staff skills and knowledge of evidence based wound management, increasing staff confidence with wound management, increasing implementation of evidence based wound management and prevention strategies, and increasing staff awareness of their roles in evidence based wound care at all levels [5]. Importantly, during the project, the project team developed a resource kit on evidence based wound management. Two critical recommendations resulting from the project were that: - The CSI model or a similar strategic approach should be implemented in RACFs to facilitate the uptake of evidence based wound management and prevention - The resource kit on evidence based wound management should be made available to all Residential Aged Care Facilities and interested parties A proposal to disseminate or rollout the CSI model of wound care to all RACFs across Australia was submitted to the department in 2012. The department approved funding from the Aged Care Services Improvement Healthy Ageing Grant (ACSIHAG) at the same time as the Round 3 of the Encouraging Better Practice in Aged Care (EBPAC) program. The dissemination involved two crucial elements: 1. The updating, refining and distribution of a Champions for Skin Integrity Resource Kit, more commonly known as a CSI Resource Kit and 2. The presentation of intensive one day Promoting Healthy Skin “Train the Trainer” workshops in all capital cities and major regional towns across Australia Due to demand, the department agreed to fund a second round of workshops focussing on regional centres and the completion date was extended to accommodate the workshops. Later, the department also decided to host a departmental website for a number of clinical domains, including wound management, so that staff from the residential aged care sector had easy access to a central repository of helpful clinical resource material that could be used for improving the health and wellbeing of their older adults, consumers and carers. CSI Resource Kit Upgrade and Distribution: At the start of the project, a full evidence review was carried out on the material produced during the EBPRAC-CSI Stage 1 project and the relevant evidence based changes were made to the documentation. At the same time participants in the EBPRAC-CSI Stage 1 project were interviewed for advice on how to improve the resource material. Following this the documentation, included in the kit, was sent to independent experts for peer review. When this process was finalised, a learning designer and QUT’s Visual Communications Services were engaged to completely refine and update the design of the resources, and combined resource kit with the goal of keeping the overall size of the kit suitable for bookshelf mounting and the cost at reasonable levels. Both goals were achieved in that the kit is about the same size as a 25 mm A4 binder and costs between $19.00 and $28.00 per kit depending on the size of the print run. The dissemination of the updated CSI resource kit was an outstanding success. Demand for the kits was so great that a second print run of 2,000 kits was arranged on top of the initial print run of 4,000 kits. All RACFs across Australia were issued with a kit, some 2,740 in total. Since the initial distribution another 1,100 requests for kits has been fulfilled as well as 1,619 kits being distributed to participants at the Promoting Healthy Skin workshops. As the project was winding up a final request email was sent to all workshop participants asking if they required additional kits or resources to distribute the remaining kits and resources. This has resulted in requests for 200 additional kits and resources. Feedback from the residential aged care sector and other clinical providers who have interest in wound care has been very positive regarding the utility of the kit, (see Appendix 4). Promoting Healthy Skin Workshops The workshops also exceeded the project team’s initial objective. Our goal of providing workshop training for staff from one in four facilities and 450 participants was exceeded, with overwhelming demand for workshop places resulting in the need to provide a second round of workshops across Australia. At the completion of the second round, 37 workshops had been given, with 1286 participants, representing 835 facilities. A number of strategies were used to promote the workshops ranging from invitations included in the kit, to postcard mail-outs, broadcast emailing to all facilities and aged care networks and to articles and paid advertising in aged care journals. The most effective method, by far, was directly phoning the facilities. This enabled the caller to contact the relevant staff member and enlist their support for the workshop. As this is a labour intensive exercise, it was only used where numbers needed bolstering, with one venue rising from 3 registrants before the calls to 53 registrants after. The workshops were aimed at staff who had the interest and the capability of implementing evidence-based wound management within their facility or organisation. This targeting was successful in that a large proportion (68%) of participants were Registered Nurses, Nurse Managers, Educators or Consultants. Twenty percent were Endorsed Enrolled Nurses with the remaining 12% being made up of Personal Care Workers or Allied Health Professionals. To facilitate long term sustainability, the workshop employed train-the-trainer strategies. Feedback from the EBPRAC-CSI Stage 1 interviews was used in the development of workshop content. In addition, feedback from the workshop conducted at the end of the EBPRAC-CSI Stage 1 project suggested that change management and leadership training should be included in the workshops. The program was trialled in the first workshop conducted in Brisbane and then rolled out across Australia. Participants were asked to complete pre and post workshop surveys at the beginning and end of the workshop to determine how knowledge and confidence improved over the day. Results from the pre and post surveys showed significant improvements in the level of confidence in attendees’ ability to implement evidence based wound management. The results also indicated a significant increase in the level of confidence in ability to implement change within their facility or organisation. This is an important indication that the inclusion of change management/leadership training with clinical instruction can increase staff capacity and confidence in translating evidence into practice. To encourage the transfer of the evidence based content of the workshop into practice, participants were asked to prepare an Action Plan to be followed by a simple one page progress report three months after the workshop. These reports ranged from simple (e.g. skin moisturising to prevent skin tears), to complex implementation plans for introducing the CSI model across the whole organisation. Outcomes described in the project reports included decreased prevalence of skin tears, pressure injuries and chronic wounds, along with increased staff and resident knowledge and resident comfort. As stated above, some organisations prepared large, complex plans to roll out the CSI model across their organisation. These plans included a review of the organisation’s wound care system, policies and procedures, the creation of new processes, the education of staff and clients, uploading education and resource material onto internal electronic platforms and setting up formal review and evaluation processes. The CSI Resources have been enthusiastically sought and incorporated into multiple health care settings, including aged care, acute care, Medicare Local intranets (e.g. Map of Medicine e-pathways), primary health care, community and home care organisations, education providers and New Zealand aged and community health providers. Recommendations: Recommendations for RACFs, aged care and health service providers and government  Skin integrity and the evidence-practice gap in this area should be recognised as a major health issue for health service providers for older adults, with wounds experienced by up to 50% of residents in aged care settings (Edwards et al. 2010). Implementation of evidence based wound care through the Champions for Skin Integrity model in this and the pilot project has demonstrated the prevalence of wounds, wound healing times and wound infections can be halved.  A national program and Centre for Evidence Based Wound Management should be established to: - expand the reach of the model to other aged care facilities and health service providers for older adults - sustain the uptake of models such as the Champions for Skin Integrity (CSI) model - ensure current resources, expertise and training are available for consumers and health care professionals to promote skin integrity for all older adults  Evidence based resources for the CSI program and similar projects should be reviewed and updated every 3 – 4 years as per NH&MRC recommendations  Leadership and change management training is fundamental to increasing staff capacity, at all levels, to promote within-organisation dissemination of skills and knowledge gained from projects providing evidence based training Recommendations for future national dissemination projects  A formal program of opportunities for small groups of like projects to share information and resources, coordinate activities and synergise education programs interactively would benefit future national dissemination projects - Future workshop programs could explore an incentive program to optimise attendance and reduce ‘no shows’ - Future projects should build in the capacity and funding for increased follow-up with workshop attendees, to explore the reasons behind those who are unable to translate workshop learnings into the workplace and identify factors to address these barriers.

Building creative connections: An analysis of a creative arts widening participation program

Widening participation or outreach agendas have been a major part of higher education policy since the early 2000s. These policies and programs seek to increase marginalised groups’ access to further study through activities, tutoring programs, workshops, and other provisions. Some programs openly state their intention to assist people from low socioeconomic backgrounds to become more civically engaged and socially mobile by improving their education, which creates an immediate link between education and social capital (see Morley 2012; Hillmert and Jacob 2010). Social capital refers to the ‘connections among individuals’ and the consequent value of the things they do together (Putnam 2000; Gauntlett 2011). Media and creative arts widening participation programs, arguably, are better equipped to build social capital than any other form of outreach, due to their relationship-building capacity (Gauntlett 2011; Kinder and Harland 2004). This article analyses Queensland University of Technology’s Creative Industries Widening Participation Program. It investigates social capital and its relationship with higher education in outreach initiatives in order to identify how media and creative arts widening participation programs have the capacity to influence the attitudes of low socioeconomic background students towards higher education.

Modern energy access to all in rural India: An integrated implementation strategy

Expanding energy access to the rural population of India presents a critical challenge for its government. The presence of 364 million people without access to electricity and 726 million who rely on biomass for cooking indicate both the failure of past policies and programs, and the need for a radical redesign of the current system. We propose an integrated implementation framework with recommendations for adopting business principles with innovative institutional, regulatory, financing and delivery mechanisms. The framework entails establishment of rural energy access authorities and energy access funds, both at the national and regional levels, to be empowered with enabling regulatory policies, capital resources and the support of multi-stakeholder partnership. These institutions are expected to design, lead, manage and monitor the rural energy interventions. At the other end, trained entrepreneurs would be expected to establish bioenergy-based micro-enterprises that will produce and distribute energy carriers to rural households at an affordable cost. The ESCOs will function as intermediaries between these enterprises and the international carbon market both in aggregating carbon credits and in trading them under CDM. If implemented, such a program could address the challenges of rural energy empowerment by creating access to modern energy carriers and climate change mitigation. (C) 2011 Elsevier Ltd. All rights reserved.

Bolsa Familia Program and school enrolment: An analysis of the 2010 Brazilian demographic census

The Bolsa Família Program goal is to promote social development and poverty reduction, through the direct transfer of conditional cash, in association with other social programs. This study aims to analyze whether Bolsa Família had an association with children’s school attendance, which is one of the educational conditions of the program. Our main hypothesis is that children living in households receiving Bolsa Família had greater chances of attending school. Data from the Ministry of Social Development and Combating Famine indicated that children living in households with Bolsa Família had greater school enrolment levels. By using data from the 2010 Demographic Census, collected by the Brazilian Institute of Geography and Statistics (IBGE), some descriptive analyzes and binary logistic regression models were performed for different thresholds of household per capita income. These estimates were made by comparing children who lived in households receiving Bolsa Família to those children not receiving the program. We took into consideration characteristics about the household, mothers, and children. The results were clustered by the municipality of residence of the child. In all income thresholds, children benefi ting from Bolsa Família were more likely to be enrolled in school, compared to children not receiving the benefi t.

Comportamento empreendedor e o capital cultural: impacto do ambiente social nas características do comportamento empreendedor de empresários na cidade do Rio de Janeiro

Este trabalho tem o intuito de observar a relação entre as características do comportamento empreendedor (CCEs) e a origem sociocultural de empreendedores da cidade do Rio de Janeiro. Mais especificamente, este trabalho traz à luz as teorias de David McClelland, adotada pelo Sebrae através da metodologia do programa Empretec e a teoria de Pierre Bourdieu sobre Capital Cultural. O estudo traz em sua metodologia uma análise da origem sociocultural de empreendedores, seu contexto educacional, seu histórico familiar, seu grau de escolaridade, seus hábitos de consumo de produtos culturais e seu nível de internacionalização, correlacionando-os com as 10 CCEs propostas por McClelland: Busca de Oportunidades e Iniciativa, Persistência, Correr Riscos Calculados, Exigência de Qualidade e Eficiência, Comprometimento, Busca de Informações, Estabelecimento de Metas, Planejamento e Monitoramento Sistemáticos, Persuasão e Rede de Contatos, Independência e Autoconfiança. A metodologia aplicada foi baseada em pesquisa bibliográfica, em pesquisa de campo, dividida entre aplicação de questionários presenciais e online e em métodos quantitativos de análise de dados. Como resultados de campo, pode-se observar uma significante diferença entre os perfis socioeconômicos, culturais e educacionais de empreendedores de dentro e de fora de comunidades carentes no Rio de Janeiro. Confirmou-se um grau superior de Capital Cultura nos empreendedores externos às comunidades, observados através da renda, do grau de escolaridade, da escolaridade familiar, do acesso a bens culturais, do consumo de informação e do nível de internacionalização. Além destas constatações, a pesquisa revelou haver indícios que sustentem a existência de influência do Capital Cultural nas seguintes CCEs: Busca de Oportunidade e Iniciativa, Exigência de Qualidade e Eficiência, Correr Riscos Calculados, Estabelecimento de Metas, Persuasão e Redes de Contato e Independência e Autoconfiança.

Access to international capital markets: recent developments in Central America and the Caribbean

The objective of this report is to analyze the impact of recent global financial trends on the access to private external financing by Central American and Caribbean (CAC) economies, as well as their performance in international capital markets in recent years. The CAC economies, like many other countries in the world, were not immune to the negative consequences of the global economic and financial crisis of 2008. In fact, their openness, export driven growth and linkages to advanced economies, particularly to the U.S., as well as size, made them more vulnerable than other Latin American countries to the negative effects of the crisis. In addition, their recovery was hindered by their weak linkages to the larger emerging market countries that drove global growth in the post-crisis recovery. As China and other emerging market economies begin to slowdown, however, and the U.S. and other advanced economies show signs of a strengthening recovery, the linkages to advanced economies may once again become a source of strength.

Trabalho flexível e capital social: um estudo de caso sobre a ação dos agentes comunitários de saúde em Araraquara

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Desenvolvimento local e capital social: uma análise interdisciplinar do processo de indução do DLIS no Estado de Roraima

Uma nova tendência em termos de ações para o desenvolvimento vem se configurando. Trata-se de ações que levam em conta o território e seus atores. Nesse âmbito, insere-se a metodologia de indução do Desenvolvimento Local Integrado e Sustentável (DLIS). Esse Programa de política pública se constitui uma estratégia participativa de indução do desenvolvimento, pela qual se mobilizam recursos das comunidades, que em parceria com o Estado (em seus três níveis) e o mercado, realizam diagnósticos, identificam potencialidades e vocações, elaboram planos integrados de desenvolvimento, na perspectiva de envolvimento dos sujeitos como proponentes e protagonistas da ação social em seus territórios. Com este trabalho, buscou-se compreender a multidimensionalidade do processo de DLIS, no estado de Roraima, procurando, ao mesmo tempo, o estabelecimento de um nexo causal entre as trajetórias sócio-econômicas (resultados) do DLIS e o capital social. A pesquisa se enquadrou na modalidade qualitativa. Adotou-se como estratégia metodológica o estudo de caso, envolvendo os municípios de Rorainópolis, Uiramutã, Baliza e Pacaraima. Três dimensões analítico-contextuais foram adotadas, quais sejam: conceitual, de implementação e de impacto. Na avaliação do capital social, as variáveis participação, confiança, cooperação e redes foram consideradas. Na interpretação dos dados, as seguintes abordagens foram utilizadas: análise contextual, análise descritiva, análise das diferenças de proporções e análise de correspondência. Os resultados da pesquisa revelaram que alguns conceitos e categorias adotados pelo Programa, embora relevantes, apresentam alguma ordem de problema. Dois municípios, Rorainópolis e Uiramutã, foram considerados municípios de bons resultados. Isso porque atenderam a um conjunto de questões que expressavam condições desejáveis para que o desenvolvimento local integrado e sustentável, em suas múltiplas dimensões, se efetivasse. Por seu turno, os municípios de Baliza e Pacaraima foram classificados como municípios de maus resultados. Os resultados do DLIS em Rorainópolis e Uiramutã estão associados ao capital social (relação positiva). A despeito da extensa literatura que trata da relevância desse tema, não se têm, ainda, instrumentos satisfatórios para medir capital social. Nesse contexto, entendese que estes resultados representam, de fato, uma aproximação.

Uma proposta de aperfeiçoamento do PNLD como política pública: o livro didático como capital cultural do aluno/família

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)