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.

Where to after Drink Rite: An evaluation of opportunities for police and community promotion of an anti-drink driving message in the licensed venue setting. Report to the National Drug Strategy Law Enforcement Funding Committee

Estimating the prevalence of drink driving is a difficult task. Self‐reported drink driving indicates that drink driving is far more common than official statistics suggest. In order to promote a responsible attitude towards alcohol consumption and drink driving within the Queensland community, the Queensland Police Service, Queensland Health and Queensland Transport developed the ‘Drink Rite’ program (Queensland Police Service information sheet, 2009). However, the feasibility of the program is now in doubt as the National Health and Medical Research Council’s guidelines for alcohol consumption changed in 2009 to state “For healthy men and women, drinking no more than four standard drinks on a single occasion reduces the risk of alcohol‐related injury arising from that occasion” (NHMRC Publication, 2009, p. 51). As such, adhering to the NHMRC guidelines places restrictions on how the existing Drink Rite program can be operated (i.e. by reducing the number of standard drinks provided to participants from eight to four). It is arguable that a reduction in the number of alcoholic drinks provided to participants in the program will result in a large reduction in observed BAC readings. This, in turn, will lead to a potential loss of message content when discussing the variation in the effects of alcohol.

Examining the effectiveness of Police-Citizens Youth Clubs on crime prevention and community safety

PCYCs, individually and as a whole, are highly valued in communities across Queensland. Participants in this evaluation identified numerous benefits of PCYCs, including: providing structured low-cost activities for young people and other community groups; developing positive relationships and trust between young people and police; developing young people into effective citizens; providing a safe place for young people and a hub for whole communities; addressing disadvantages faced by young people; and fostering social inclusion. Depending on the particular activities and programs delivered by a branch, PCYCs have the capacity to minimise risk factors and enhance protective factors relating to young people’s involvement in crime. For example, PCYCs can play an important role in strengthening young people’s engagement with education and family. However, the crime prevention and community safety aims of PCYCs, and measures that might work towards these aims are not widely- or well-understood, or appreciated, by those working in and with PCYCs. The key recommendation of this evaluation is therefore that the crime prevention and community safety aims of PCYCs in Queensland need to be better articulated, understood and reflected in the practice of those working in and with PCYCs. A related key finding is that many of the activities and programs currently provided by PCYCs could be better oriented towards the goals of crime prevention and community safety without major resource implications.

Vote as you go : Blending interfaces for community engagement into the urban space

This paper presents a series of studies on situated interfaces for community engagement. Firstly, we identify five recurring design challenges as well as four common strategies used to overcome them. We then assess the effectiveness of these strategies through field studies with public polling interfaces. We developed two very different polling interfaces in the form of (1) a web application running on an iPad mounted on a stand, allowing one vote at a time, and (2) a playful full-body interaction application for a large urban screen allowing concurrent participation. We deployed both interfaces in an urban precinct with high pedestrian traffic and equipped with a large urban screen. Analysing discoverability and learnability of each scenario, we derive insights regarding effective ways of blending community engagement interfaces into the built environment, while attracting the attention of passers-by and communicating the results of civic participation.

A study protocol: A community pharmacy-based intervention for improving the management of sleep disorders in the community settings

Background Sleep disorders are very common in the community and are estimated to affect up to 45% of the world’s population. Pharmacists are in a position to give advice and provide appropriate services to individuals who are unable to easily access medical care. The purpose of this study is to develop an intervention to improve the management of sleep disorders in the community. The aims are: (1) to evaluate the effectiveness of a community pharmacy-based intervention in managing sleep disorders; (2) to evaluate the role of actigraph as an objective measure in monitoring certain sleep disorders, and; (3) to evaluate the extended role of community pharmacists in managing sleep disorders. This intervention is developed to monitor individuals undergoing treatment and overcome the difficulties in validating self-reported feedback. Method/design This is a community-based intervention, prospective, controlled trial, with one intervention group and one control group, comparing individuals receiving a structured intervention with those receiving usual care for sleep-related disorders at community pharmacies. Discussion This study will demonstrate the utilisation and efficacy of community pharmacy-based intervention to manage sleep disorders in the community, and will assess the possibility of implementing this intervention into the community pharmacy workflow.

Feasibility and acceptability of wrist actigraph in assessing sleep quality and sleep quantity: A home-based pilot study in healthy volunteers

Purpose This study aimed to determine the feasibility and acceptability of actigraphy to monitor sleep quality and quantity in healthy self-rated good sleeper adults at home-based settings. Method Sixteen healthy volunteers (age > 18) were invited to participate. Each participant was provided with a wrist actigraph device to be worn for 24-hour/day for seven consecutive days to monitor their sleep-wake patterns. Actigraphy data were downloaded using-proprietary software to generate an individual-sleep report. Participants also completed a set of self-reported Health Related Quality of Life (HRQOL) using WHO (five) Well Being Index (WBI) questionnaires. Results Actigraphy was well accepted by all participants. Only 43.8% of the participants achieved normal total sleep time (TST) and 62.5% had a mean sleep efficiency value below the normal range. Despite a reduced quality of sleep among the participants, the self-reported HRQOL scores produced by the WHO-5 WBI showed a “fair” to “good” among the participants. Conclusions To maintain healthy well-being, it is vital to have efficient and quality sleep. Insufficient and poor sleep may contribute to various health problems and hazardous outcomes. People often believe they have normal and efficient sleep, not realising they may be developing poor sleep habits. This study found that actigraphy can be easily utilized to monitor sleep-wake patterns at home-based settings. We proposed that actigraphy could be adapted for use in the primary care settings (e.g. community pharmacy) to improve the sleep health management in the community.

Teachers-as-writers: Writing information texts in English and vernacular

Our contribution to this volume is not on the work of the teacher who inspires the child writer, but the teacher as the writer and illustrator of multilingual texts for classroom use that inspires the child reader. This chapter focuses on a first time teacher writer from Fiji, Bereta , who participated in a two day writing workshop known as the Information Text Awareness Project (hereafter ITAP). This chapter commences with an overview of the ITAP which was conducted in Nadi, Fiji, in 2012 with Bereta and 17 teachers from urban, semi-urban and rural contexts within the Nadi educational district. The politics of presenting Western ways of knowing to teachers from diverse cultural and linguistic contexts via a Western pedagogical approach is explored in the second section. We believe that this work involves a moral dimension that needs careful consideration. The third section outlines the eight stages of ITAP where teacher writers such as Bereta produced an English and a vernacular information text for use in their classrooms. The outline of the eight stages of ITAP is justified with links to the research literature. The final section recounts Bereta’s interview data where she talks about using the newly created English and vernacular information texts in the classroom and the community’s response to her inaugural publications. The findings may be of interest to those seeking to establish an adult writing cooperative to produce English and vernacular information texts for classroom use.

Community uses of co-creative media. Digital storytelling and Co-creative Media : The role of community arts and media in propagating and coordinating population-wide creative practice

This report describes a dynamic ‘Co-creative Media System’ that is emerging in the social space bounded by the following institutional pillars: • major cultural institutions (including screen culture agencies, libraries, museums, galleries and public service broadcasters) • the Community Arts and Cultural Development sector (historically supported through various programs of the Australia Council for the Arts) • the community broadcasting sector • the Indigenous media sector, and • the higher education sector. It illustrates how this system activates the immense creative potential of the Australian population through the ongoing development and application of participatory storytelling methods and media.

‘A contributing life’: Living a contributing life as ‘a person’, ‘an artist’ and ‘an artist with a mental illness’

The Australian National Mental Health Commission, recently adopted a focus on ‘a contributing life’ to acknowledge the importance of full and meaningful participation in community life. This concept compels new conversations about the complex nature of every day and whole of life experiences for people with lived experience of mental illness. This article reflects on narratives by eight artists with lived experience of mental illness, in Australia to understand how opportunities are available through art for people with lived experience of mental illness to lead a contributing life. A twelve month study gained insight of how participants saw themselves, made meaning and sense of their experiences, and how each person asserted their choice to be an artist. This article shares a common premise held by the participants to choose a “way of life as ‘who I am’”. This declaration emphasised the relevance of living a contributing life as ‘a person’, ‘an artist’ and ‘an artist with a mental illness’. A number of conceptual issues are raised in light of the findings, not least how opportunities for participation are framed and available, or otherwise, to live a contributing life.

Pivotal people, pivotal journeys: Interim report on the impact of a fundraising study tour on CEOs and their organisations

A longitudinal qualitative study was conducted with CEOs of 12 fundraising organisations across Australia to answer the question - how mights a change in the CEO's fundraising knowledge improve fundraising activity and outcomes for their organisation? The CEOs along with the inaugural Australian Grantmaker of the Year, Caitriona Fay from Perpetual and lead researcher Dr Wendy Scaife travelled to San Antonio, Texas, USA to attend the annual Association of Fundraising Professionals (AFP) conference in March 2014. Participants identified five main success factors for such group learning initiatives about fundraising: - Getting away from the day to day business of running the organisation - Informal, social time to debrief and get to know others - Diversity of organisations whereby no one was in direct competition to others - Commitment, openness and willingness of individuals to participate - Group facilitation This research has been supported by the Perpetual Foundation – Trustees Endowment, The Edward Corbould Charitable Trust, and the Samuel and Eileen Gluyas Charitable Trust under the management of Perpetual Trustee Company Ltd.

Community Service Charities

Using the first Annual Information Statements (AIS) filed with the Australian Charities and Not-for-profits Commission (ACNC), this factsheet describes community service charities that are based in QLD. They have been selected from charities that have a main activity of either aged care activities; civic and advocacy activities; economic, social and community development; emergency and relief; employment and training; housing activities; income support and maintenance; law and legal activities; mental health and crisis intervention; or social services.

Enriching architectural design education through interactive displays and local community engagement

Designers have a social responsibility to deal with the needs, issues, and problems that their clients and communities are confronted with. Students of design require opportunities to reflect on their role as social facilitators to develop an attitude towards community engagement through different phases and aspects of their careers. However, current design courses are challenged by compressed timeframes and fragmented scenarios of different academic requirements that do not actively teach community engagement. This paper outlines a participatory and technological approach that was employed to address these issues within the teaching of Architecture and Urban Design at the Queensland University of Technology, Brisbane, Australia. A multi-phase community based research project with actual stakeholders was implemented over a two-year period. Approximately 150 students in the final year of the Bachelor of Design-Architecture; 10 students in the Master of Architecture and 15 students in the Master of Design-Urban Design have informed and influenced each others’ learning through the teaching and research nexus facilitated by this project. The technical approach was implemented in form of a bespoke digital platform that supported the display and discussion of digital media on a series of interactive touch walls. The platform allowed students to easily upload their final designs onto large interactive surfaces, where visitors could explore the media and provide comments. Through the use of this technical platform and the introduction of neogeography, students have been able to broaden their level of interaction and support their learning experience through external structured and unstructured feedback from the local community. Students have not only been exposed to community representatives, but they also have been working in parallel on a specific case study providing each other, across different years and courses, material for reflection and data to structure their design activities.

Life-course determinants of bone mass in young adults from a transitional rural community in India: The Andhra Pradesh Children and Parents Study (APCAPS)

Background: Undernutrition and physical inactivity are both associated with lower bone mass. Objective: This study aimed to investigate the combined effects of early-life undernutrition and urbanized lifestyles in later life on bone mass accrual in young adults from a rural community in India that is undergoing rapid socioeconomic development. Design: This was a prospective cohort study of participants of the Hyderabad Nutrition Trial (1987–1990), which offered balanced protein-calorie supplementation to pregnant women and preschool children younger than 6 y in the intervention villages. The 2009–2010 follow-up study collected data on current anthropometric measures, bone mineral density (BMD) measured by dual-energy X-ray absorptiometry, blood samples, diet, physical activity, and living standards of the trial participants (n = 1446, aged 18–23 y). Results: Participants were generally lean and had low BMD [mean hip BMD: 0.83 (women), 0.95 (men) g/cm2; lumbar spine: 0.86 (women), 0.93 (men) g/cm2]. In models adjusted for current risk factors, no strong evidence of a positive association was found between BMD and early-life supplementation. On the other hand, current lean mass and weight-bearing physical activity were positively associated with BMD. No strong evidence of an association was found between BMD and current serum 25-hydroxyvitamin D or dietary intake of calcium, protein, or calories. Conclusions: Current lean mass and weight-bearing physical activity were more important determinants of bone mass than was early-life undernutrition in this population. In transitional rural communities from low-income countries, promotion of physical activity may help to mitigate any potential adverse effects of early nutritional disadvantage.

Systematic and Day-to-Day Effects of Chemical-Derived Population Estimates on Wastewater-Based Drug Epidemiology

Population size is crucial when estimating population-normalized drug consumption (PNDC) from wastewater-based drug epidemiology (WBDE). Three conceptually different population estimates can be used: de jure (common census, residence), de facto (all persons within a sewer catchment), and chemical loads (contributors to the sampled wastewater). De facto and chemical loads will be the same where all households contribute to a central sewer system without wastewater loss. This study explored the feasibility of determining a de facto population and its effect on estimating PNDC in an urban community over an extended period. Drugs and other chemicals were analyzed in 311 daily composite wastewater samples. The daily estimated de facto population (using chemical loads) was on average 32% higher than the de jure population. Consequently, using the latter would systemically overestimate PNDC by 22%. However, the relative day-to-day pattern of drug consumption was similar regardless of the type of normalization as daily illicit drug loads appeared to vary substantially more than the population. Using chemical loads population, we objectively quantified the total methodological uncertainty of PNDC and reduced it by a factor of 2. Our study illustrated the potential benefits of using chemical loads population for obtaining more robust PNDC data in WBDE.

Community uses of co-creative media digital storytelling and co-creative Media: The role of community arts and media in propagating and coordinating population-wide creative practice

How is creative expression and communication extended among whole populations? What is the social and cultural value of this activity? What roles do formal agencies, community-based organisations and content producer networks play? Specifically, how do participatory media and arts projects and networks contribute to building this capacity in the contemporary communications environment? The latest issue of CSJ article in a special issue on “Broadening Digital Storytelling Horizons” edited by Burcu Simsek.