An evaluation of a mental health screening and referral pathway for community nursing care : nurses' and general practitioners' perspectives

Aims and objectives. To evaluate a feasible, best practice mental health screening and referral clinical pathway for generalist community nursing care of war veterans and war widow(er)s in Australia.
Background. War veterans commonly experience mental health difficulties and do not always receive required treatment, as can also occur for war widow(er)s. Whenever opportunity arises, such as during community nursing care, it is vital to identify mental health problems in a health promotion framework.
Design. A clinical pathway was developed by literature review and consultation and then trialled and evaluated using mixed methods – quantitative and qualitative.
Methods. Community nurses who trialled the pathway completed an evaluation survey and attended focus groups. General practitioners responded to an evaluation survey.
Results. Most nurses found the pathway clear and easy to understand but not always easy to use. They emphasised the need to establish trust and rapport with clients prior to implementing the pathway. It was sometimes difficult to ensure effective referral to general practitioners for clients who screened positive for a mental health problem. When referral was accomplished, general practitioners reported adequate and useful information was provided. Some general practitioners also commented on the difficulty of achieving effective communication between general practitioners and nurses.
Conclusions. Nurses and some general practitioners found the pathway useful for their practice. They offered several suggestions for improvement by simplifying the trialled pathway and accompanying guidelines and strategies to improve communication between nurses and general practitioners. This study adds understanding of how community nurses might productively screen for mental health difficulties.
Relevance to clinical practice. The trialled pathway, which was modified and refined following the study, is an evidence-based
resource for community nurses in Australia and similar contexts to guide practise and maximise holistic care for war veterans and war widow(er)s and possibly other client groups.

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

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

Impact of nursing information systems on residential care provision in an aged care provider

The challenge of an ageing population has placed a great pressure on the Australian aged care sector in the coming decades. Technology-enabled solutions such as health information systems (HIS) can be seen as a way to improve care quality, safety and process efficiency. Compared to the overall healthcare sector, the adoption of HIS in the aged care sector has been slower. One reason for this is that aged care providers are not well informed therefore not yet convinced of the positive impacts of technology solutions on their service provision. This paper reports findings from an evaluation of the impact of HIS adoption at an aged care provider in Victoria. The evaluation was conducted in two distinct areas, residential aged care and residential disability services. Overall, the findings show positive impacts of the system on individual work of the care staff and on service provision of the organisation as well as suggesting opportunities for improvement in later implementation stages. The evaluation will also inform other aged care and disability service providers of the benefits of HIS and useful lessons in adoption of technology solutions.

An evaluation of a national program to implement the cornell scale for depression in dementia into routine practice in aged care facilities

Background: Screening tools have been recommended for use in aged care to improve the detection and treatment of depression. This study aimed to evaluate the impact of a program for the routine implementation of the Cornell Scale for Depression in Dementia in Australian facilities, to determine whether use of the instrument by nurses led to further monitoring of depressive symptoms, medical referral, and changes in treatments prescribed for depression.
Methods: A file review was completed for 412 participants out of a total of 867 older people (47.5%) who resided in ten aged care facilities. The review examined Cornell Scale assessment data, medication charts, medical history, nursing progress notes, and resident care plans. Nursing staff who administered the Cornell Scale to each participant were also interviewed, and ten facilitymanagers took part in an interview to determine barriers to the effective implementation of the instrument.
Results: The Cornell Scale had been administered to 46.8% of the sample in the previous 12 months, with 25% of these participants scoring 9–13 and 27% scoring 14 and above. Less than one third of the residents with high scores were monitored by the staff following the assessment. Only 18% of residents with high scores were referred for further assessment of depression, while 10% received a treatment change.
Conclusions: The absence of a protocol for responding to high Cornell Scale scores limited the potential of this program to result in widespread improved treatment of depressed older people. The use of the Cornell Scale by aged care nurses with limited training raised concern.

Intentions to quit work among care staff working in the aged care sector

Purpose of the Study: The aged care industry experiences high rates of staff turnover. Staff turnover has significant implications for the quality of care provided to care recipients and the financial costs to care agencies. In this study, we applied a model of intention to quit to identify the contextual and personal factors that shape aged care staff’s intention to quit.

Design and Methods: A sample of 208 aged care staff, including nurses, personal care assistants, allied health professionals, and managers completed a self-report questionnaire. The questionnaire assessed intention to quit, organizational commitment, job satisfaction, self-esteem, stressors, stress, and supervisor support.

Results: The findings largely supported the model. Specifically, job commitment, job satisfaction, and work stressors directly influenced intentions to quit, although work stressors and supervisor support demonstrated numerous indirect associations on quitting intentions.

Implications: The findings suggest that aged care service providers can modify aged care workers’ intentions to quit by reducing job stressors and increasing supervisor support.

End-of-life care for aged care residents presenting to emergency departments

Background: The number of patients from Aged Care presenting to acute care is increasing, many of whom have a life limiting illness.

Aims: To identify differences in relation to Aged Care Residents presenting to Emergency departments who died during a hospital admission compared to those who were referred to the hospital based palliative care.

Methods: Review of a stratified random sample of 90 Aged Care residents transferred to acute care who died during admission in 2009; half the sample received palliative care. Comparisons were made with regard to age; gender; co-morbidities; symptoms, investigations and active treatment; prior admissions and costs.

Results: The median age of patients was 87.5 years, 61% were female and 38% had three or more admissions in the year prior to death. Patients with a length of stay of four or more days were 2.98 times (CI, 95%:1.11-8.03) and patients with agitation were 3.08 (CI 95%:1.10- 8.64) times more likely to be referred to palliative care. Patients who received palliative care had significantly fewer investigations or active treatment in the 24 hours prior to their death (p< 0.01) and palliated patients had significantly lower average costs per day of admission ($1022, SD=$441) compared to those who were not palliated ($ 831; SD= $ 1041) (p< 0.001).

Discussion: Our study indicates there is a difference between dying patients who received palliative care compared to those who did not in an acute care setting. Further research into the outcomes of patients discharged back to Aged Care facilities for palliative care warrants investigation.

Staff-focused interventions to increase referrals for depression in aged care facilities: a cluster randomized controlled trial

Objective: 

A study protocol to investigate the management of depression and challenging behaviors associated with dementia in aged care settings

Background: