Residential Aged Care Facilities Staff Research Articles

Can transfers from residential aged care facilities to the Emergency Department be avoided through improved primary care services? Data from qualitative interviews

To explore the factors that influence the transfer of patients from residential aged care facilities (RACF) to hospital emergency departments (ED), and describe features of improved primary care in RACF that could result in reduced transfer. a. Three focus groups conducted with family and carers of RACF residents, along with RACF, ED and general practice staff. b. Semistructured one-on-one interviews with nine residents of RACF. Five main themes emerged--staffing and skill mix in RACF, treatment options in RACF, end of life decision-making, communication and bureaucratic requirements. Analysis of the semistructured interviews demonstrated parallel concerns with many of the focus groups indicators. There was a strong but not universal preference among residents to minimise RACF to ED transfer. The transfer of residents from RACF to ED is influenced by multiple interrelated factors, and strategies to reduce transfer should address these.

The communication challenges faced in adopting a palliative care approach in advanced dementia

This paper discusses one aspect from the findings of an Australian study aimed at understanding the needs of people with advanced dementia. Specifically, this paper focuses on the communication issues that might potentially inhibit the implementation of a palliative care approach for a person with advanced dementia in a residential aged care facility (RACF). Six focus groups consisting of 34 participants and 24 semistructured interviews were conducted. Participants were drawn from palliative care specialty staff, palliative care volunteers, designated aged or dementia specialist staff from an area health service, general practitioners, RACF staff and family carers. The findings show communication issues identified by the participants were a significant factor impacting on their capacity to adopt a palliative care approach in caring for people with advanced dementia. The findings support the need for education, skill development and networking to occur among the key providers of care in RACFs to ensure the provision of ‘best practice’ palliative care to residents with advanced dementia and their families.

Descriptive, exploratory study of the role of nursing assistants in Australian residential aged care facilities: The example of pain management

This study explored the experiences of nursing assistants (NAs) who work with older people in residential aged care facilities (RACFs), to ascertain their role in Australian RACFs. Experiences with pain management were used as an example to explore their work role. A descriptive, exploratory qualitative approach was used to examine NAs' experiences. Participants included six NAs from three RACFs in regional Western Australia. In-depth interviews focused on the NAs' experiences of providing care to older people in RACFs and in particular their experiences providing pain management for residents. The role of NAs often extends beyond their scope of practice. NAs describe making clinical decisions, initiating clinical care and advocating for residents. NAs represent a majority of the staff in Australian RACFs and they have a significant role in clinical care. There is a need to ensure that NAs are adequately prepared and supported in their role.

Information issues for providers of services to people with dementia living in the community in Australia: breaking the cycle of frustration

The rising prevalence of dementia and concomitant demands upon dementia services are global issues. In Australia, dementia has attained national health priority status and governments at all levels have implemented service strategies to help manage the complex lives of people with dementia. Despite recognition that information is pivotal to effective dementia service delivery, little is known about the information needs of individual providers and the processes used to transfer information between providers. This qualitative study scoped information issues for key service providers for people with dementia living in the community in southern Tasmania, Australia, including information needs, availability, and transfer. Eleven focus groups were held with general practitioners, residential aged care facility staff, home carers, community health nurses, and aged care-assessment team members. Findings revealed that provider groups shared common, albeit unbeknown to them, information needs (e.g. diagnosis, behaviours, and services) and information concerns (e.g. untrustworthy information and poor information transfer) leading to poor service coordination. General practitioners emerged as a stand-out group with markedly fewer needs and concerns than other providers, a finding of special interest given their pivotal role in dementia diagnosis and referral. Participants were adamant in their view that electronic data bases and single points of entry to dementia services would improve service provision and should be developed. The research highlights complexities and associated frustrations of information transferability, accessibility, and trustworthiness for dementia service providers in the community. Increased understanding of providers' diverse yet interdependent roles could, we believe, play an important part in breaking the cycle of frustration experienced by all participants and thus contribute to system reform.

AN EVALUATION OF THE RESPONSE TO POOLE’S ALGORITHM EDUCATION PROGRAMME BY AGED CARE FACILITY STAFF

Aim: To evaluate the response of residential aged care facility staff to the education programme - Poole’s Algorithm: Nursing management of disturbed behaviour in aged care facilities. Design: Descriptive study, aged care setting. Method: Following offers to all facilities in a large area health service, 104 senior staff took the opportunity to participate in train-the-trainer programs and then returned pre and post knowledge evaluation questionnaires for 190 of their own staff that they had trained, using the program, over a three month period. Thirty six of those trainers then shared their views of the usability and effectiveness of the program in focus group interviews. Results: The questionnaire analysis showed statistically significant improvements in overall knowledge for the trainers with 19.2% correct answers pre education and 91.3% correct afterwards, a difference of 71.1%. Overall, the staff trained by the trainers improved from 12.6% correct to 59.5% post education, a difference of 46.8%. In particular, the trainers’ recognition of delirium as a cause for disturbed behaviour improved from 39.4% to 97.15% and the staff from 24.7% to 75.2%. Conclusions: Concern was raised about the poor understanding of mental health problems such as personality and anxiety disorders. Analysis and coding of the focus group transcriptions showed improvements in attitudes and practice. Recommendations are made for the instigation of ongoing train-the-trainer sessions using this program and the replication of this study in the acute and community sectors.