Pain : the views of elderly people living in long term residential care settings

While an individual's beliefs and attitudes have long been considered important factors in how people respond to pain, few studies have attempted to provide in-depth descriptions of the nature of such pain beliefs and attitudes The aim of this research was to investigate the views of pain and pain management practices held by elderly people living in long-term residential care settings Ten 60–90 minute focus group interviews, each involving around five elderly people, were conducted in four large, long-term residential care settings in Brisbane, Australia Categories of beliefs and attitudes regarding pain were identified following analysis of the verbatim transcripts of these interviews Findings suggest that many elderly people living in long-term residential care settings may have become resigned to pain, that they are ambivalent about the benefit of any action for their pain and that they may be reluctant to express their pain Implications of these beliefs and attitudes are discussed

Are we there yet? Early years reform in Queensland : stakeholder perspectives on the introduction of funded preschool programs in long day care services

Australian educators are currently engaging with wide-ranging, national early childhood reform that is reshaping early childhood education and care. The Australian reform agenda reflects many of the early childhood policy directions championed by bodies such as the Organisation for Economic Cooperation and Development and the United Nations Children's Education Fund, and is based on the dual discourse of (i) starting strong and (ii) investing in the early years. However, despite its traction in policy rhetoric and policy there is little empirical evidence of how reform is being played out. This paper reports on research undertaken in collaboration with the Queensland Office for Early Childhood Education and Care to generate sector feedback on one element of the reform agenda, the implementation of universal preschool in Queensland. The study aimed to determine the efficacy of the new policy in supporting the provision of 'approved preschool programs' within long day care services. Drawing together the views and experiences of a range of stakeholders, including peak organisations, service providers, directors, preschool teachers and government policy officers, it provides a situated case study of the implementation of universal preschool, and offers empirical evidence of how this policy is being played out at the local level. The paper identifies the opportunities and challenges in implementing universal preschool in Queensland that may have bearing on early childhood reform in Australia as well as other countries. Discussion of key findings is set within an overview of the ECEC policy agenda in Australia, with a particular focus on the commitment to universal preschool. Les éducateurs australiens s’engagent présentement dans une vaste réforme nationale de la petite enfance qui remodèle l'éducation et l’accueil de la petite enfance. Le programme de la réforme australienne reflète plusieurs des orientations en politique de la petite enfance soutenues par des organismes comme l'Organisation de coopération et de développement économiques (OCDE) et le Fonds des Nations Unies pour les enfants (UNICEF). Il s’appuie sur le double discours de (i) un bon départ et de (ii) l’investissement dans les premières années. Cependant, en dépit de son attrait en rhétorique de politique et en politique il y a peu de données empiriques sur la façon dont la réforme se déroule. Cet article rend compte de la recherche entreprise en collaboration avec le bureau de l'éducation et l’accueil à la petite enfance du Queensland afin d’obtenir une rétroaction du secteur sur un élément de la réforme, la mise sur pied du préscolaire universel dans le Queensland. L'étude visait à déterminer l'efficacité de la nouvelle politique pour soutenir la disposition «programmes préscolaires approuvés» dans les services de garde à temps plein. En regroupant les perspectives et les expériences d'une gamme d’intervenants, y compris d’importantes organisations, des prestataires de service, des directeurs, des enseignants du préscolaire et des fonctionnaires de politique gouvernementale, elle constitue une étude de cas localisée de l'exécution la mise sur pied du préscolaire universel, et fournit des données empiriques sur la façon dont cette politique se met en place au niveau local. L’article identifie les opportunités et les défis liés à l’implantation du préscolaire universel au Queensland, qui pourraient avoir une portée sur la réforme de petite enfance en Australie ainsi que dans d'autres pays. La discussion des principaux résultats est faite en lien avec un aperçu global de la politique d'éducation et d’accueil de la petite enfance en Australie, avec un accent particulier sur l'engagement envers le préscolaire universel. Los educadores australianos actualmente están involucrados en una amplia reforma de la educación temprana nacional que está revolucionando la educación preescolar y los servicios de cuidado. El programa de reforma Australiana refleja muchas de las direcciones políticas relacionadas con la infancia temprana incitadas por organismos como la Organización de Cooperación y Desarrollo Económicos y el Fondo Educacional Infantil de las Naciones Unidas, y se basa en el doble discurso de (i) empezando fuertemente e (ii) invertir en los primeros años. Sin embargo, a pesar de su política de tracción en retórica y política, hay pocos datos empíricos de cómo la reforma se está llevando a cabo. Este documento informa sobre las investigaciones llevadas a cabo en colaboración con la Oficina de Queensland de Educación tempana y cuidados, para generar comentarios del sector, sobre uno de los elementos de la agenda de reforma, la aplicación del preescolar universal en Queensland. El estudio tiene como objetivo determinar la eficacia de la nueva política para apoyar la prestación de "programas preescolares aprovados" dentro se los servicios de guardería y cuidado. Reuniendo los puntos de vista y las experiencias de una serie de interesados, entre ellos algunas organizaciones cumbre, proveedores de servicios, los directores, los maestros preescolares y oficiales de política y gobierno, se logra un estudio simulado de la implementación del preescolar universal, y ofrece evidencia empírica de cómo esta política se está llevando a cabo en el plano local. El documento identifica las oportunidades y desafíos en la implementación del preescolar universal en Queensland, que puede repercutir en la reforma de la indancia temprana en Australia, así como en otros países. La discusión de los resultados claves se encuentra en el interior de una visión de la agenda política de ECEC en Australia, con un enfoque particular en el compromiso con el preescolar universal.

Integrating early childhood teachers into long day care : building respectful relationships

Amongst the current reforms in early childhood in Australia is the requirement for four year university degree-qualified teachers to be employed to provide a kindergarten program for four-year-old children in the year prior to school entry. The possibility for long day care to provide a funded kindergarten program, with an early childhood teacher (ECT) presents a change for the field. With this change come challenges, though also opportunities to think in new and different ways about what long day care and working in long day care might look like.

Estimating the robustness of long-haul train plans

In Australia, and elsewhere, the movement of trains on long-haul rail networks is usually planned in advance. Typically, a train plan is developed to confirm that the required train movements and track maintenance activities can occur. The plan specifies when track segments will be occupied by particular trains and maintenance activities. On the day of operation, a train controller monitors and controls the movement of trains and maintenance crews, and updates the train plan in response to unplanned disruptions. It can be difficult to predict how good a plan will be in practice. The main performance indicator for a train service should be reliability - the proportion of trains running the service that complete at or before the scheduled time. We define the robustness of a planned train service to be the expected reliability. The robustness of individual train services and for a train plan as a whole can be estimated by simulating the train plan many times with random, but realistic, perturbations to train departure times and segment durations, and then analysing the distributions of arrival times. This process can also be used to set arrival times that will achieve a desired level of robustness for each train service.

Visual guidance for fixed-wing unmanned aerial vehicles using feature tracking : application to power line inspection

This thesis presents novel vision based control solutions that enable fixed-wing Unmanned Aerial Vehicles to perform tasks of inspection over infrastructure including power lines, pipe lines and roads. This is achieved through the development of techniques that combine visual servoing with alternate manoeuvres that assist the UAV in both following and observing the feature from a downward facing camera. Control designs are developed through techniques of Image Based Visual Servoing to utilise sideslip through Skid-to-Turn and Forward-Slip manoeuvres. This allows the UAV to simultaneously track and collect data over the length of infrastructure, including straight segments and the transition where these meet.

Outdoor worker sun protection project : a comprehensive applied research project to demonstrate the effectiveness of sun protection measures which influence high risk outdoor workers in Queensland to adopt sun safe behaviour practices 2010 – 2013

The QUT Outdoor Worker Sun Protection (OWSP) project undertook a comprehensive applied health promotion project to demonstrate the effectiveness of sun protection measures which influence high risk outdoor workers in Queensland to adopt sun safe behaviours. The three year project (2010-2013) was driven by two key concepts: 1) The hierarchy of control, which is used to address risks in the workplace, advocates for six control measures that need to be considered in order of priority (refer to Section 3.4.2); and 2) the Ottawa Charter which recommends five action means to achieve health promotion (refer to Section 2.1). The project framework was underpinned by a participatory action research approach that valued peoples’ input, took advantage of existing skills and resources, and stimulated innovation (refer to Section 4.2). Fourteen workplaces (small and large) with a majority outdoor workforce were recruited across regional Queensland (Darling Downs, Northwest, Mackay and Cairns) from four industries types: 1) building and construction, 2) rural and farming, 3) local government, and 4) public sector. A workplace champion was identified at each workplace and was supported (through resource provision, regular contact and site visits) over a 14 to 18 month intervention period to make sun safety a priority in their workplace. Employees and employers were independently assessed for pre- and postintervention sun protection behaviours. As part of the intervention, an individualised sun safety action plan was developed in conjunction with each workplace to guide changes across six key strategy areas including: 1) Policy (e.g., adopt sun safety practices during all company events); 2) Structural and environmental (e.g., shade on worksites; eliminate or minimise reflective surfaces); 3) Personal protective equipment (PPE) (e.g., trial different types of sunscreens, or wide-brimmed hats); 4) Education and awareness (e.g., include sun safety in inductions and toolbox talks; send reminder emails or text messages to workers);5) Role modelling (e.g., by managers, supervisors, workplace champions and mentors); and 6) Skin examinations (e.g., allow time off work for skin checks). The participatory action process revealed that there was no “one size fits all” approach to sun safety in the workplace; a comprehensive, tailored approach was fundamental. This included providing workplaces with information, resources, skills, know how, incentives and practical help. For example, workplaces engaged in farming complete differing seasonal tasks across the year and needed to prepare for optimal sun safety of their workers during less labour intensive times. In some construction workplaces, long pants were considered a trip hazard and could not be used as part of a PPE strategy. Culture change was difficult to achieve and workplace champions needed guidance on the steps to facilitate this (e.g., influencing leaders through peer support, mentoring and role modelling). With the assistance of the project team the majority of workplaces were able to successfully implement the sun safety strategies contained within their action plans, up skilling them in the evidence for sun safety, how to overcome barriers, how to negotiate with all relevant parties and assess success. The most important enablers to the implementation of a successful action plan were a pro-active workplace champion, strong employee engagement, supportive management, the use of highly visual educational resources, and external support (provided by the project team through regular contact either directly through phone calls or indirectly through emails and e-newsletters). Identified barriers included a lack of time, the multiple roles of workplace champions, (especially among smaller workplaces), competing issues leading to a lack of priority for sun safety, the culture of outdoor workers, and costs or budgeting constraints. The level of sun safety awareness, knowledge, and sun protective behaviours reported by the workers increased between pre-and post-intervention. Of the nine sun protective behaviours that were assessed, the largest changes reported included a 26% increase in workers who “usually or always” wore a broad-brimmed hat, a 20% increase in the use of natural shade, a 19% increase in workers wearing long-sleeved collared shirts, and a 16% increase in workers wearing long trousers.

Agreement to and compliance with advice on removing mats or rugs by older people with visual impairments

The article presents a study which investigated the reasons why advice related to the removal of mats or rags by older people with visual impairments had a low rate of acceptance. The researchers speculated that it may have been due to older people's need to maintain a sense of control and autonomy and to arrange their environments in a way that they decided or a belief that the recommended modification would not reduce the risk of falling. A telephone survey of subsample of the participants was conducted in the Visually Impaired Persons (VIP) Trial. All 30 interviewees had rugs or mats in their homes. Of the 30 participants, 20 had moved the rugs or mats as a result of recommendations, and 10 had not.

Visual front-end wars : Viola-Jones face detector vs Fourier Lucas-Kanade

The performance of visual speech recognition (VSR) systems are significantly influenced by the accuracy of the visual front-end. The current state-of-the-art VSR systems use off-the-shelf face detectors such as Viola- Jones (VJ) which has limited reliability for changes in illumination and head poses. For a VSR system to perform well under these conditions, an accurate visual front end is required. This is an important problem to be solved in many practical implementations of audio visual speech recognition systems, for example in automotive environments for an efficient human-vehicle computer interface. In this paper, we re-examine the current state-of-the-art VSR by comparing off-the-shelf face detectors with the recently developed Fourier Lucas-Kanade (FLK) image alignment technique. A variety of image alignment and visual speech recognition experiments are performed on a clean dataset as well as with a challenging automotive audio-visual speech dataset. Our results indicate that the FLK image alignment technique can significantly outperform off-the shelf face detectors, but requires frequent fine-tuning.

A locus on the long arm of chromosome 1 as a possible cause of essential hypertension

None of the genes responsible for essential hypertension has been identified. Recent work in genetically hypertensive rats has shown linkage of blood pressure with alleles of the renin gene. Since the renin gene is a member of a conserved synteny group that in humans spans chromosome 1q21.3-32.3 and includes the gene for antithrombin III (AT3), we used linkage studies to examine the relationship between alleles of AT3 and hypertension in a family having 10 affected members. From the lod score obtained at a recombination fraction of zero the odds for linkage of AT3 and hypertension in this family were calculated as 6:1 in favour of linkage. This result provides grounds for further examination of the possible role of the 1q23 locus in the aetiology of essential hypertension.

The impact of interface modality on police officers' visual behaviour when using an in-vehicle system

Background Standard operating procedures state that police officers should not drive while interacting with their mobile data terminal (MDT) which provides in-vehicle information essential to police work. Such interactions do however occur in practice and represent a potential source of driver distraction. The MDT comprises visual output with manual input via touch screen and keyboard. This study investigated the potential for alternative input and output methods to mitigate driver distraction with specific focus on eye movements. Method Nineteen experienced drivers of police vehicles (one female) from the NSW Police Force completed four simulated urban drives. Three drives included a concurrent secondary task: imitation licence plate search using an emulated MDT. Three different interface methods were examined: Visual-Manual, Visual-Voice, and Audio-Voice (“Visual” and “Audio” = output modality; “Manual” and “Voice” = input modality). During each drive, eye movements were recorded using FaceLAB™ (Seeing Machines Ltd, Canberra, ACT). Gaze direction and glances on the MDT were assessed. Results The Visual-Voice and Visual-Manual interfaces resulted in a significantly greater number of glances towards the MDT than Audio-Voice or Baseline. The Visual-Manual and Visual-Voice interfaces resulted in significantly more glances to the display than Audio-Voice or Baseline. For longer duration glances (>2s and 1-2s) the Visual-Manual interface resulted in significantly more fixations than Baseline or Audio-Voice. The short duration glances (<1s) were significantly greater for both Visual-Voice and Visual-Manual compared with Baseline and Audio-Voice. There were no significant differences between Baseline and Audio-Voice. Conclusion An Audio-Voice interface has the greatest potential to decrease visual distraction to police drivers. However, it is acknowledged that an audio output may have limitations for information presentation compared with visual output. The Visual-Voice interface offers an environment where the capacity to present information is sustained, whilst distraction to the driver is reduced (compared to Visual-Manual) by enabling adaptation of fixation behaviour.

Does a functional activity programme improve function, quality of life, and falls for residents in long term care? Cluster randomised controlled trial

Objective To assess the effectiveness of an activity programme in improving function, quality of life, and falls in older people in residential care. Design Cluster randomised controlled trial with one year follow-up. Setting 41low level dependency residential carehomes in New Zealand. Participants 682 people aged 65 years or over. Interventions 330 residents were offered a goal setting and individualised activities of daily living activity programme by a gerontology nurse, reinforced by usual healthcare assistants; 352 residents received social visits. Main outcome measures Function (late life function and disability instruments, elderly mobility scale, FICSIT-4

Optical and biomechanical factors, associated with near work and myopia

Near work may play an important role in the development of myopia in the younger population. The prevalence of myopia has also been found to be higher in occupations that involve substantial near work tasks, for example in microscopists and textile workers. When nearwork is performed, it typically involves accommodation, convergence and downward gaze. A number of previous studies have examined the effects of accommodation and convergence on changes in the optics and biometrics of the eye in primary gaze. However, little is known about the influence of accommodation on the eye in downward gaze. This thesis is primarily concerned with investigating the changes in the eye during near work in downward gaze under natural viewing conditions. To measure wavefront aberrations in downward gaze under natural viewing conditions, we modified a commercial Shack-Hartmann wavefront sensor by adding a relay lens system to allow on-axis ocular aberration measurements in primary gaze and downward gaze, with binocular fixation. Measurements with the modified wavefront sensor in primary and downward gaze were validated against a conventional aberrometer using both a model eye and in 9 human subjects. We then conducted an experiment to investigate changes in ocular aberrations associated with accommodation in downward gaze over 10 mins in groups of both myopes (n = 14) and emmetropes (n =12) using the modified Shack-Hartmann wavefront sensor. During the distance accommodation task, small but significant changes in refractive power (myopic shift) and higher order aberrations were observed in downward gaze compared to primary gaze. Accommodation caused greater changes in higher order aberrations (in particular coma and spherical aberration) in downward gaze than primary gaze, and there was evidence that the changes in certain aberrations with accommodation over time were different in downward gaze compared to primary gaze. There were no obvious systematic differences in higher order aberrations between refractive error groups during accommodation or downward gaze for fixed pupils. However, myopes exhibited a significantly greater change in higher order aberrations (in particular spherical aberration) than emmetropes for natural pupils after 10 mins of a near task (5 D accommodation) in downward gaze. These findings indicated that ocular aberrations change from primary to downward gaze, particularly with accommodation. To understand the mechanism underlying these changes in greater detail, we then extended this work to examine the characteristics of the corneal optics, internal optics, anterior biometrics and axial length of the eye during a near task, in downward gaze, over 10 mins. Twenty young adult subjects (10 emmetropes and 10 myopes) participated in this study. To measure corneal topography and ocular biometrics in downward gaze, a rotating Scheimpflug camera and an optical biometer were inclined on a custom built, height and tilt adjustable table. We found that both corneal optics and internal optics change with downward gaze, resulting in a myopic shift (~0.10 D) in the spherical power of the eye. The changes in corneal optics appear to be due to eyelid pressure on the anterior surface of the cornea, whereas the changes in the internal optics (an increase in axial length and a decrease in anterior chamber depth) may be associated with movement of the crystalline lens, under the action of gravity, and the influence of altered biomechanical forces from the extraocular muscles on the globe with downward gaze. Changes in axial length with accommodation were significantly greater in downward gaze than primary gaze (p < 0.05), indicating an increased effect of the mechanical forces from the ciliary muscle and extraocular muscles. A subsequent study was conducted to investigate the changes in anterior biometrics, axial length and choroidal thickness in nine cardinal gaze directions under the actions of the extraocular muscles. Ocular biometry measurements were obtained from 30 young adults (10 emmetropes, 10 low myopes and 10 moderate myopes) through a rotating prism with 15° deviation, along the foveal axis, using a non-contact optical biometer in each of nine different cardinal directions of gaze, over 5 mins. There was a significant influence of gaze angle and time on axial length (both p < 0.001), with the greatest axial elongation (+18 ± 8 μm) occurring with infero-nasal gaze (p < 0.001) and a slight decrease in axial length in superior gaze (−12 ± 17 μm) compared with primary gaze (p < 0.001). There was a significant correlation between refractive error (spherical equivalent refraction) and the mean change in axial length in the infero-nasal gaze direction (Pearson's R2 = 0.71, p < 0.001). To further investigate the relative effect of gravity and extraocular muscle force on the axial length, we measured axial length in 15° and 25° downward gaze with the biometer inclined on a tilting table that allowed gaze shifts to occur with either full head turn but no eye turn (reflects the effect of gravity), or full eye turn with no head turn (reflects the effect of extraocular muscle forces). We observed a significant axial elongation in 15° and 25° downward gaze in the full eye turn condition. However, axial length did not change significantly in downward gaze over 5 mins (p > 0.05) in the full head turn condition. The elongation of the axial length in downward gaze appears to be due to the influence of the extraocular muscles, since the effect was not present when head turn was used instead of eye turn. The findings of these experiments collectively show the dynamic characteristics of the optics and biometrics of the eye in downward gaze during a near task, over time. These were small but significant differences between myopic and emmetropic eyes in both the optical and biomechanical changes associated with shifts of gaze direction. These differences between myopes and emmetropes could arise as a consequence of excessive eye growth associated with myopia. However the potentially additive effects of repeated or long lasting near work activities employing infero-nasal gaze could also act to promote elongation of the eye due to optical and/or biomechanical stimuli.

Cone signals and activity in myopia and emmetropia

Myopia (short-sightedness) is a common ocular disorder of children and young adults. Studies primarily using animal models have shown that the retina controls eye growth and the outer retina is likely to have a key role. One theory is that the proportion of L (long-wavelength-sensitive) and M (medium-wavelength-sensitive) cones is related to myopia development; with a high L/M cone ratio predisposing individuals to myopia. However, not all dichromats (persons with red-green colour vision deficiency) with extreme L/M cone ratios have high refractive errors. We predict that the L/M cone ratio will vary in individuals with normal trichromatic colour vision but not show a systematic difference simply due to refractive error. The aim of this study was to determine if L/M cone ratios in the central 30° are different between myopic and emmetropic young, colour normal adults. Information about L/M cone ratios was determined using the multifocal visual evoked potential (mfVEP). The mfVEP can be used to measure the response of visual cortex to different visual stimuli. The visual stimuli were generated and measurements performed using the Visual Evoked Response Imaging System (VERIS 5.1). The mfVEP was measured when the L and M cone systems were separately stimulated using the method of silent substitution. The method of silent substitution alters the output of three primary lights, each with physically different spectral distributions to control the excitation of one or more photoreceptor classes without changing the excitation of the unmodulated photoreceptor classes. The stimulus was a dartboard array subtending 30° horizontally and 30° vertically on a calibrated LCD screen. The m-sequence of the stimulus was 215-1. The N1-P1 amplitude ratio of the mfVEP was used to estimate the L/M cone ratio. Data were collected for 30 young adults (22 to 33 years of age), consisting of 10 emmetropes (+0.3±0.4 D) and 20 myopes (–3.4±1.7 D). The stimulus and analysis techniques were confirmed using responses of two dichromats. For the entire participant group, the estimated central L/M cone ratios ranged from 0.56 to 1.80 in the central 3°-13° diameter ring and from 0.94 to 1.91 in the more peripheral 13°-30° diameter ring. Within 3°-13°, the mean L/M cone ratio of the emmetropic group was 1.20±0.33 and the mean was similar, 1.20±0.26, for the myopic group. For the 13°-30° ring, the mean L/M cone ratio of the emmetropic group was 1.48±0.27 and it was slightly lower in the myopic group, 1.30±0.27. Independent-samples t-test indicated no significant difference between the L/M cone ratios of the emmetropic and myopic group for either the central 3°-13° ring (p=0.986) or the more peripheral 13°-30° ring (p=0.108). The similar distributions of estimated L/M cone ratios in the sample of emmetropes and myopes indicates that there is likely to be no association between the L/M cone ratio and refractive error in humans.

Performance of a cognitive, but not visual, secondary task interacts with alcohol-induced balance impairment in novice and experienced motorcycle riders

The appropriateness of applying drink driving legislation to motorcycle riding has been questioned as there may be fundamental differences in the effects of alcohol on driving and motorcycling. It has been suggested that alcohol may redirect riders’ focus from higher-order cognitive skills such as cornering, judgement and hazard perception, to more physical skills such as maintaining balance. To test this hypothesis, the effects of low doses of alcohol on balance ability were investigated in a laboratory setting. The static balance of twenty experienced and twenty novice riders was measured while they performed either no secondary task, a visual (search) task, or a cognitive (arithmetic) task following the administration of alcohol (0%, 0.02%, and 0.05% BAC). Subjective ratings of intoxication and balance impairment increased in a dose-dependent manner in both novice and experienced motorcycle riders, while a BAC of 0.05%, but not 0.02%, was associated with impairments in static balance ability. This balance impairment was exacerbated when riders performed a cognitive, but not a visual, secondary task. Likewise, 0.05% BAC was associated with impairments in novice and experienced riders’ performance of a cognitive, but not a visual, secondary task, suggesting that interactive processes underlie balance and cognitive task performance. There were no observed differences between novice vs. experienced riders on static balance and secondary task performance, either alone or in combination. Implications for road safety and future ‘drink riding’ policy considerations are discussed.

Nurses' experiences of practice and political reform in long-term aged care in Australia : implications for the retention of nursing personnel

Keywords gerontological nursing;health care reform;health policy;long-term care;recruitment and retention Aim  The aim of the study was to explore registered nurses’ experiences in long-term aged care in light of the political reform of aged care services in Australia. Background  In Australia, the aged care industry has undergone a lengthy period of political and structural reform. Despite reviews into various aspects of these reforms, there has been little consideration of the effect these are having on the practice experiences and retention of nursing staff in long-term care. Methods  In this critical hermeneutic study, 14 nurses from long-term care facilities in Australia were interviewed about their experiences during the reform period. Results  The data revealed a sense of tension and conflict between nurses’ traditional values, roles and responsibilities and those supported by the reforms. Nurses struggled to renegotiate both their practice roles and values as the reforms were implemented and the system evolved. Nursing management support was an important aspect in mediating the effect of reforms on nursing staff. Conclusion  This research highlights both the tensions experienced by nurses in long-term aged care in Australia and the need to renegotiate nursing roles, responsibilities and values within an evolving care system. This research supports a role for sensitive and proactive nursing management during periods of industry reform as a retention strategy for qualified nursing personnel.