Incontinence-associated dermatitis: A cross-sectional prevalence study in the Australian acute care hospital setting

The purpose of this cross-sectional study was to identify the prevalence of incontinence and incontinence-associated dermatitis (IAD) in Australian acute care patients and to describe the products worn to manage incontinence, and those provided at the bedside for perineal skin care. Data on 376 inpatients were collected over 2 days at a major Australian teaching hospital. The mean age of the sample group was 62 years and 52% of the patients were male. The prevalence rate of incontinence was 24% (91/376). Urinary incontinence was significantly more prevalent in females (10%) than males (6%) (χ2  = 4·458, df = 1, P = 0·035). IAD occurred in 10% (38/376) of the sample group, with 42% (38/91) of incontinent patients having IAD. Semi-formed and liquid stool were associated with IAD (χ2  = 5·520, df = 1, P = 0·027). Clinical indication of fungal infection was present in 32% (12/38) of patients with IAD. Absorbent disposable briefs were the most common incontinence aids used (80%, 70/91), with soap/water and disposable washcloths being the clean-up products most commonly available (60%, 55/91) at the bedside. Further data are needed to validate this high prevalence. Studies that address prevention of IAD and the effectiveness of management strategies are also needed.

Implementation of sustainable evidence-based practice for the assessment and management of pain in residential aged care facilities

Pain is common in residential aged care facilities (RACFs). In 2005, the Australian Pain Society developed 27 recommendations for good practice in the identification, assessment, and management of pain in these settings. This study aimed to address implementation of the standards and evaluate outcomes. Five facilities in Australia participated in a comprehensive evaluation of RACF pain practice and outcomes. Pre-existing pain management practices were compared with the 27 recommendations, before an evidence-based pain management program was introduced that included training and education for staff and revised in-house pain-management procedures. Post-implementation audits evaluated the program's success. Aged care staff teams also were assessed on their reports of self-efficacy in pain management. The results show that before the implementation program, the RACFs demonstrated full compliance on 6 to 12 standards. By the project's completion, RACFs demonstrated full compliance with 10 to 23 standards and major improvements toward compliance in the remaining standards. After implementation, the staff also reported better understanding of the standards (p < .001) or of facility pain management guidelines (p < .001), increased confidence in therapies for pain management (p < .001), and increased confidence in their training to assess pain (p < .001) and recognize pain in residents with dementia who are nonverbal (p = .003). The results show that improved evidence-based practice in RACFs can be achieved with appropriate training and education. Investing resources in the aged care workforce via this implementation program has shown improvements in staff self-efficacy and practice.

An evidence-based program to improve analgesic practice and pain outcomes in residential aged care facilities

Pain is common in individuals living in residential aged care facilities (RACFs), and a number of obstacles have been identified as recurring barriers to adequate pain management. To address this, the Australian Pain Society developed 27 recommendations for comprehensive good practice in the identification, assessment, and management of pain. This study reviewed preexisting pain management practice at five Australian RACFs and identified changes needed to implement the recommendations and then implemented an evidence-based program that aimed to facilitate better pain management. The program involved staff training and education and revised in-house pain-management procedures. Reviews occurred before and after the program and included the assessment of 282 residents for analgesic use and pain status. Analgesic use improved after the program (P<.001), with a decrease in residents receiving no analgesics (from 15% to 6%) and an increase in residents receiving around-the-clock plus as-needed analgesics (from 24% to 43%). There were improvements in pain relief for residents with scores indicative of pain, with Abbey pain scale (P=.005), Pain Assessment in Advanced Dementia Scale (P=.001), and Non-communicative Patient's Pain Assessment Instrument scale (P<.001) scores all improving. Although physical function declined as expected, Medical Outcomes Study 36-item Short-Form Survey bodily pain scores also showed improvement (P=.001). Better evidence-based practice and outcomes in RACFs can be achieved with appropriate training and education. Investing resources in the aged care workforce using this program improved analgesic practice and pain relief in participating sites. Further attention to the continued targeted pain management training of aged care staff is likely to improve pain-focused care for residents.

Supporting residents’ expression of sexuality : the initial construction of a sexuality assessment tool for residential aged care facilities

Background: Sexuality is a key component of quality of life and well-being and a need to express one’s sexuality continues into old age. Staff and families in residential aged care facilities often find expressions of sexuality by residents, particularly those living with dementia, challenging and facilities often struggle to address individuals’ needs in this area. This paper describes the development of an assessment tool which enables residential aged care facilities to identify how supportive their organisation is of all residents’ expression of their sexuality, and thereby improve where required. Methods: Multi-phase design using qualitative methods and a Delphi technique. Tool items were derived from the literature and verified by qualitative interviews with aged care facility staff, residents and families. The final item pool was confirmed via a reactive Delphi process. Results: A final item pool of sixty-nine items grouped into seven key areas allows facilities to score their compliance with the areas identified as being supportive of older people’s expression of their sexuality in a residential aged care environment. Conclusions: The sexuality assessment tool (SexAT) guides practice to support the normalization of sexuality in aged care homes and assists facilities to identify where enhancements to the environment, policies, procedures and practices, information and education/training are required. The tool also enables facilities to monitor initiatives in these areas over time.

A cost-effectiveness analysis of a telephone-linked care intervention for individuals with Type 2 diabetes

AIM: To assess the cost-effectiveness of an automated telephone-linked care intervention, Australian TLC Diabetes, delivered over 6 months to patients with established Type 2 diabetes mellitus and high glycated haemoglobin level, compared to usual care. METHODS: A Markov model was designed to synthesize data from a randomized controlled trial of TLC Diabetes (n=120) and other published evidence. The 5-year model consisted of three health states related to glycaemic control: 'sub-optimal' HbA1c ≥58mmol/mol (7.5%); 'average' ≥48-57mmol/mol (6.5-7.4%) and 'optimal' <48mmol/mol (6.5%) and a fourth state 'all-cause death'. Key outcomes of the model include discounted health system costs and quality-adjusted life years (QALYS) using SF-6D utility weights. Univariate and probabilistic sensitivity analyses were undertaken. RESULTS: Annual medication costs for the intervention group were lower than usual care [Intervention: £1076 (95%CI: £947, £1206) versus usual care £1271 (95%CI: £1115, £1428) p=0.052]. The estimated mean cost for intervention group participants over five years, including the intervention cost, was £17,152 versus £17,835 for the usual care group. The corresponding mean QALYs were 3.381 (SD 0.40) for the intervention group and 3.377 (SD 0.41) for the usual care group. Results were sensitive to the model duration, utility values and medication costs. CONCLUSION: The Australian TLC Diabetes intervention was a low-cost investment for individuals with established diabetes and may result in medication cost-savings to the health system. Although QALYs were similar between groups, other benefits arising from the intervention should also be considered when determining the overall value of this strategy.

Conservation communication camp : come with ideas, leave with a plan

IUCN´s core work involves generating knowledge and tools to influence policy and practice for nature conservation. Whilst it appears that we are collectively making progress in some areas, we acknowledge the need to improve our communication processes and practices to ´move to action´ in this regard. We need to extend the influence of the science and the knowledge beyond the documents to achieve effective impact and action. The training course will focus on the process of getting the conservation messages out to a wider audience. This interactive and participatory training course will develop the skills and knowledge needed to communicate effective conservation messages for a range of IUCN internal and external audiences. The course will cover: • what is communication for conservation? • the communication planning process (developing your communication objectives) • identifying and understanding your target audiences • developing your conservation message • choosing your communication media and • evaluating the effectiveness of your communication strategies. A unique feature of the training course will be the use of Web 2.0 tools in innovative conservation communications e.g. use of social media in concept branding and social marketing. In the spirit of the Forum´s objective of ´Sharing know how´, each participant will bring a current conservation issue to the training course and will leave with their own communication plan. Potentially, the training course adopts a cross-thematic approach as the issues addressed could be drawn from any of the IUCN´s program themes. Primarily though, the training course´s best fit is with the ´Valuing and Conserving Biodiversity´ theme since it will provide concrete and pragmatic solutions to enhancing the implementation of conservation measures through participatory planning and capacity building.

What women want : qualitative analysis of consumer evaluations of maternity care in Queensland, Australia

Background Maternity care reform plans have been proposed at state and national levels in Australia, but the extent to which these respond to maternity care consumers’ expressed needs is unclear. This study examines open-text survey comments to identify women’s unmet needs and priorities for maternity care. It is then considered whether these needs and priorities are addressed in current reform plans. Methods Women who had a live single or multiple birth in Queensland, Australia, in 2010 (n 3,635) were invited to complete a retrospective self-report survey. In addition to questions about clinical and interpersonal maternity care experiences from pregnancy to postpartum, women were asked an open-ended question “Is there anything else you’d like to tell us about having your baby?” This paper describes a detailed thematic analysis of open-ended responses from a random selection of 150 women (10% of 1,510 who responded to the question). Results Four broad themes emerged relevant to improving women’s experiences of maternity care: quality of care (interpersonal and technical); access to choices and involvement in decision-making; unmet information needs; and dissatisfaction with the care environment. Some of these topics are reflected in current reform goals, while others provide evidence of the need for further reforms. Conclusions The findings reinforce the importance of some existing maternity reform objectives, and describe how these might best be met. Findings affirm the importance of information provision to enable informed choices; a goal of Queensland and national reform agendas. Improvement opportunities not currently specified in reform agendas were also identified, including the quality of interpersonal relationships between women and staff, particular unmet information needs (e.g., breastfeeding), and concerns regarding the care environment (e.g., crowding and long waiting times).

Dismantling worker categories: the primary duty of care, and worker consultation, participation and representation, in the model Work Health and Safety Bill 2009

Late in 2009, the Australian Workplace Relations Ministers' Council endorsed the model Work Health and Safety Bill 2009, which is to be adopted by all Australian governments (federal, state and territory) from 01 January 2012. This paper describes and analyses two key sets of provisions in this model legislation. The first establishes a 'primary' duty of care imposed not on 'employers' but on persons conducting a business or undertaking, and owed to all kinds of workers engaged, directed or influenced by the person conducting the business or undertaking. The second encompasses broad duties on all persons conducting a business or undertaking to consult with workers who carry out work for the business or undertaking and who are directly affected by a work health and safety issue, and to facilitate the election of health and safety representatives representing all workers who carry out work for the business or undertaking. These provisions arguably make a significant contribution to solving a problem faced by occupational safety and health regulators around the world – modifying regulation to accommodate all forms of precarious work.

Flood victim’s heartbreak : ‘don’t be complacent about the risk’

"No one had higher stakes in the findings of the Queensland Floods Commission of Inquiry than Grantham father Matthew Keep, whose mother, mother-in-law and baby daughter, Jessica, died at Grantham that terrible day in January. For seven months he has read every statement, submission, running log, disaster management plan and media article available. As he has comforted his grieving wife, Stacy, helped care for his two young children Madison, 5, and Jacob, 4, who amazingly survived the flood, and welcomed a new baby into the family, Matthew has searched for answers for himself and his community. Why were authorities not able to warn people in seven towns in Toowoomba and the Lockyer Valley that the worst flash flooding in at least a century was about to strike, killing 22 people? How could such a sudden and catastrophic flood claim three members of his family within minutes?"

Optimising the education and care experiences of children with 'difficult' temperament

This thesis asked whether more temperamentally reactive or difficult children are more sensitive to Early Childhood and Care (ECEC) environments than less reactive children. The aim was to assess what forms of ECEC provision best support more reactive children. The study analysed data from the national Effective Early Educational Experiences (E4Kids). Children with reactive temperament had less behavioural difficulties in classrooms with higher quality instruction but more when instructional quality was low. The findings underscore the importance of higher quality ECEC environments for temperamentally vulnerable children and the possibility that temperamentally reactive children are "barometers" of ECEC quality more generally.

Organisational culture, leadership behaviour and job satisfaction among primary health care professionals in Saudi Arabia : a mixed-methods study

The purpose of this study was to improve individual and organisational performance in primary health care (PHC) by identifying the relationship between organisational culture, leadership behaviour and job satisfaction. The study used a sequential explanatory mixed methods design, to investigate the relationships between organisational culture, leadership behaviour, and job satisfaction among 550 PHCC professionals in Saudi Arabia. From surveying the PHC professionals, the results highlighted the importance of human caring qualities, including praise and recognition, consideration, and support, with respect to their perceptions of job satisfaction, leadership behaviour, and organisational culture. As a consequence a management framework was proposed to address these issues.

Foundations for the future : A long-term plan for Australian ecosystem science

Abstract: Australia’s ecosystems are the basis of our current and future prosperity, and our national well-being.A strong and sustainable Australian ecosystem science enterprise is vital for understanding and securing these ecosystems in the face of current and future challenges. This Plan defines the vision and key directions for a national ecosystem science capability that will enable Australia to understand and effectively manage its ecosystems for decades to come.The Plan’s underlying theme is that excellent science supports a range of activities, including public engagement, that enable us to understand and maintain healthy ecosystems.Those healthy ecosystems are the cornerstone of our social and economic well-being.The vision guiding the development of this Plan is that in 20 years’ time the status of Australian ecosystems and how they change will be widely reported and understood, and the prosperity and well-being they provide will be secure. To enable this, Australia’s national ecosystem science capability will be coordinated, collaborative and connected.The Plan is based on an extensive set of collaboratively generated proposals from national town hall meetings that also formthe basis for its implementation. Some directions within the Plan are for the Australian ecosystem science community itself to implement, others will involve the users of ecosystem science and the groups that fund ecosystem science.We identify six equal priority areas for action to achieve our vision: (i) delivering maximum impact for Australia: enhancing relationships between scientists and end-users; (ii) supporting long-termresearch; (iii) enabling ecosystem surveillance; (iv) making the most of data resources; (v) inspiring a generation: empowering the public with knowledge and opportunities; (vi) facilitating coordination, collaboration and leadership. This shared vision will enable us to consolidate our current successes, overcome remaining barriers and establish the foundations to ensure Australian ecosystem science delivers for the future needs of Australia..

A descriptive study of wandering-related boundary transgression in persons with severe dementia in residential aged care

This thesis described the characteristics of wandering-related boundary transgression in people with severe dementia in residential aged care. To explore all aspects of this common dementia-related behaviour that takes the person who wanders into out of bounds and hazardous areas, a two phase study with an interpretive and an observational phase was conducted. Study findings have provided evidence that will be used to develop strategies to help dementia carers to more effectively manage this behaviour in the future while maintaining the mobility and dignity of the person with dementia.

Yeerongpilly TOD Master Plan

Urban Design Master Plan for Government site adjacent to the State Tennis Centre and Yeerongpilly Station.