Practice Staff Research Articles

놀이중심교육과정 실천을 위한 ‘배움공동체’ 실행연구 -같은 지역 내 어린이집 보육교직원을 중심으로-

This study is an implementation study on the learning community for the practice of the play-oriented curriculum, and is a study on the practice of childcare staff at daycare centers in the same region. For this study, teachers and directors of three national and public daycare centers in the region who practice the play-oriented curriculum participated March 2021 to December 2022 participated. The purpose of the study is to discuss practical issues, focusing on the voices of the field, in what direction the play-oriented curriculum should be established in the childcare field while experiencing the revised Nuri course in 2019. According to the results of the study, first, by starting with the same concern, all participants in the study solved the difficulties of the play-oriented curriculum through a meeting place called a learning community. In essence, they shared empathy and comfort amidst the challenges they collectively faced. These shared experiences paved the way for identifying practical alternatives upon their return to the childcare setting. Second, by sharing each other's play cases and classroom environment as a new perspective, I gained a teacher expertise of reflective thinking by experiencing internal effects that lead to learning for unfamiliar teachers. Third, the experience of the learning community led to practice through thought for all research participants, expanding to be applied to the educational field in various ways. This study implicates valuable insights into the establishment of a play-centered curriculum in the childcare settings in alignment with the goals of the revised Nuri curriculum in 2019.

Assessment of Nursing Staff's Knowledge, Attitude and Practice Regarding Oral Hygiene Care in Intensive Care Unit Patients: A Multicenter Cross-sectional Study.

Oral care is one of the fundamental nursing care procedures used to decrease oral colonization, dental plaque, respiratory infections, patient stay, and cost. The importance of good oral hygiene for patients in intensive care units (ICUs) is well recognized, however, the most effective way to achieve good oral care in the ICU is unclear. Therefore, the aim of this study was to assess the knowledge, attitude, and practice of nursing professionals regarding oral healthcare in ICUs among various medical institutes across India. A questionnaire-based multicentric cross-sectional survey was conducted among registered nursing professionals employed at ICUs of three government tertiary healthcare centers (THC) of India: THC-I, THC-II, and THC-III located in the eastern and northern parts of India between February 2022 and July 2022. A total of 150 nurses completed the questionnaire form (response rate: 62.5%) comprised of 49 (32.7%) males and 101 (67.3%) females with a mean age of 35.69 ± 7.7 years. Nursing officers' knowledge surpassed that of staff nurses regarding the duration of toothbrushing (p = 0.033). Among interinstitutional comparisons, THC-I nurses showed the greatest knowledge regarding the duration of toothbrushing and the mechanism of preventing saliva accumulation to reduce microbial growth (p = 0.013 and p = 0.003, respectively). Based on total work experience, participants were segregated into three groups: Group I (<7 years), group II (7.1-13.9 years), and group III (>14 years). Group II surpassed the knowledge of denture removal during sleep, cleaning after every meal, and storing in personalized air-tight containers (p = 0.001 and p = 0.036, respectively). The majority from group II recommended plain saline as the material for oral hygiene maintenance in ICU patients (p = 0.008). Group III predominantly practiced the ideal handwashing technique pre- and post-patient contact which was statistically significant (p = 0.001). This study observed that a knowledge gap exists among the nurses of the three institutes across India pertaining to the oral hygiene care of ICU patients. Nurse's education and implementation of the proper oral hygiene measures for intubated patients in ICU setup is an essential need. Kumar S, Singh B, Mahuli AV, Kumar S, Singh A, Jha AK. Assessment of Nursing Staff's Knowledge, Attitude and Practice Regarding Oral Hygiene Care in Intensive Care Unit Patients: A Multicenter Cross-sectional Study. Indian J Crit Care Med 2024;28(1):48-57.

Effectiveness of Nurse’s Knowledge and Practices Program Toward Care of Patient Undergoing Cardiopulmonary Bypass

Abstract&#x0D; Objective : the aim of the study is to evaluate the effectiveness of nurse’s practices and knowledge program toward care of patient with cardiopulmonary bypass .Methodology: A pre-experimental design (one group pretest- posttest design) was used to carry out this study in three governmental hospitals in Baghdad ( Iraqi Centre for Heart Diseases , Ibn – Albitar Centre for Cardiac Surgery and Ibn – Alnafees Centre for Cardiothoracic and Vascular Surgery ) for the period from 15th of May 2022 into 20th of April 2023.The construction and development of the program and instruments had carry out by the researcher to measured the purposes of the study , twenty two nurses was purposively assigned for the study group . The study instrument consisted from three parts ,socio – demographic data that consist from ( 4 ) items , knowledge part that consist from ( 25 ) items , and observational checklist for practices part that consist from ( 26 ) items . Descriptive and inferential statistics was used to analyse the study data .Results : The results of the study presented that effect of nurses practices and knowledge program toward care of patient with cardiopulmonary bypass was positive with highly significant level between pretest and posttest for knowledge and practices. Conclusion :Nursing care for the patient with cardiopulmonary bypass have been improved related to the enhancement of nursing staff knowledge and practices toward cardiopulmonary bypass.Recommendations : The study recommended to apply this program as apart of continues education in hospital that perform cardiac surgery in Iraq , also encourage the ministry of health to provide educational programs that depending on standards guidelines and advanced research on cardiopulmonary bypass .&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

The Impact of Physical and Environment Factors on Parental Presence for Oral Feeding in New Zealand Neonatal Intensive Care Units.

To identify physical environmental factors influencing family involvement in feeding in New Zealand neonatal units. Infant oral feeding development is critical for both short-term feeding skills and longer term neurodevelopmental outcomes. The neonatal environment is well-known as challenging for neuroprotection due to negative sensory exposure. The impact of environmental factors on oral feeding in New Zealand (NZ) neonatal units is currently unexplored, and knowledge of this could allow for evidence-based unit design. Focused ethnography at five neonatal units, a national survey of NZ neonatal professionals (n = 102), and five focus groups were carried out. Current oral feeding practice, and beliefs, experiences, and opinions of unit staff and family about these practices were explored. Data were analyzed using qualitative content analysis. Units were providing the best experience to families that they could with the resources they had available. Lack of physical space, lack of privacy, limited on-site accommodation for families, and lack of coordination between maternity and neonatal services were identified as impacting on family's comfort and sense of homeliness on the unit. Unit staff used furniture, screens, and external accommodation providers to support families where they could. The physical design of neonatal units in New Zealand provides barriers to family's spending time privately developing oral feeding. Solutions are proposed to increase the size of bedspaces, provide single-family rooms, create greater on-site family accommodation options, combine maternity and neonatal healthcare, and improve family comfort and therefore connection with their infant.

Key Principles Underlying a Research-Practice Alignment in a Federally Qualified Health Center.

Minoritized populations such as racial and ethnic minorities and individuals of less privileged socioeconomic status experience a disproportionate burden of poor hypertension (HTN) control in the United States. Multilevel systems interventions have been shown to improve patient-level outcomes in minoritized populations; however, there remains a large translational gap in implementing these approaches into federally qualified health centers (FQHC), which serve those at highest risk of HTN-related morbidity and mortality. The paucity of purposeful collaborations between academic researchers and practice staff throughout the research process remains a significant roadblock to the timely translation of evidence to practice. This commentary describes the key principles and best practices that underlie the development and sustainment of an equitable research-practice alignment, which is supporting the implementation of multilevel systems intervention for improved HTN care in a large FQHC in Brooklyn, New York. The key principles, which are derived from the central tenants of relationship development and maintenance in community-engaged participatory research, patient-centered outcomes research, and organizational alignment theory include (1) cocreation of a shared mental model, (2) bridging multilevel communication, (3) ensuring mutual accountability, and (4) creating a culture of continuous improvement. Together, the principles guide how the research and practice teams work together to achieve a shared goal of improving the health and well-being of minoritized patients through the provision of high quality, community-oriented HTN care. Best practices to sustain our alignment require an ongoing and deliberate investment in honest and transparent communication by all members.

“We have a very colonial way of thinking…”: Ontario municipalities' climate collaborations with Indigenous Peoples

AbstractThis study examines the development of collaborative governance regimes (CGRs) to solve the pressing issues of climate change between municipalities and Indigenous Peoples in present day Ontario, Canada. Drawing on a survey of Ontario municipalities and key informant interviews with municipal public servants, the article applies an anticolonial informed integrative framework of collaborative governance to examine the barriers and facilitators to those engagements. The analysis that follows draws on lessons learned to identify recommended practices for municipal staff moving forward, followed by the conclusion.

Opportunities to improve opioid use disorder care for hospitalised patients with endocarditis

BackgroundDriven by increased injection opioid use, rates of hospitalisation for infective endocarditis, an infection associated with injection drug use, are increasing. In the USA, 1 in 10 hospitalised patients for...

Implementing patient decision aids into general practice clinical decision support systems: Feasibility study in cardiovascular disease prevention.

Patient decision aids (DA) facilitate shared decision making, but implementation remains a challenge. This study tested the feasibility of integrating a cardiovascular disease (CVD) prevention DA into general practice software. We developed a desktop computer application (app) to auto-populate a CVD prevention DA from general practice medical records. 4 practices received monthly practice reports from July-Nov 2021, and 2 practices use the app with limited engagement. CVD risk assessment data and app use were monitored. The proportion of eligible patients with complete CVD risk assessment data ranged from 59 to 94%. Monthly app use ranged from 0 to 285 sessions by 13 individual practice staff including GPs and nurses, with staff using the app an average of 67 sessions during the study period. High users in the 5-month study period continued to use the app for 10months. Low use was attributed to reduced staff capacity during COVID-19 and technical issues. High users sustained interest in the app, but additional strategies are required for low users. The study will inform implementation plans for new guidelines. This study showed it is feasible to integrate patient decision aids with Australian general practice software, despite the challenges of COVID-19 at the time of the study.

Barriers to Implementing Registered Nurse-Driven Clinical Decision Support for Antibiotic Stewardship: Retrospective Case Study.

Up to 50% of antibiotic prescriptions for upper respiratory infections (URIs) are inappropriate. Clinical decision support (CDS) systems to mitigate unnecessary antibiotic prescriptions have been implemented into electronic health records, but their use by providers has been limited. As a delegation protocol, we adapted a validated electronic health record-integrated clinical prediction rule (iCPR) CDS-based intervention for registered nurses (RNs), consisting of triage to identify patients with low-acuity URI followed by CDS-guided RN visits. It was implemented in February 2022 as a randomized controlled stepped-wedge trial in 43 primary and urgent care practices within 4 academic health systems in New York, Wisconsin, and Utah. While issues were pragmatically addressed as they arose, a systematic assessment of the barriers to implementation is needed to better understand and address these barriers. We performed a retrospective case study, collecting quantitative and qualitative data regarding clinical workflows and triage-template use from expert interviews, study surveys, routine check-ins with practice personnel, and chart reviews over the first year of implementation of the iCPR intervention. Guided by the updated CFIR (Consolidated Framework for Implementation Research), we characterized the initial barriers to implementing a URI iCPR intervention for RNs in ambulatory care. CFIR constructs were coded as missing, neutral, weak, or strong implementation factors. Barriers were identified within all implementation domains. The strongest barriers were found in the outer setting, with those factors trickling down to impact the inner setting. Local conditions driven by COVID-19 served as one of the strongest barriers, impacting attitudes among practice staff and ultimately contributing to a work infrastructure characterized by staff changes, RN shortages and turnover, and competing responsibilities. Policies and laws regarding scope of practice of RNs varied by state and institutional application of those laws, with some allowing more clinical autonomy for RNs. This necessitated different study procedures at each study site to meet practice requirements, increasing innovation complexity. Similarly, institutional policies led to varying levels of compatibility with existing triage, rooming, and documentation workflows. These workflow conflicts were compounded by limited available resources, as well as an implementation climate of optional participation, few participation incentives, and thus low relative priority compared to other clinical duties. Both between and within health care systems, significant variability existed in workflows for patient intake and triage. Even in a relatively straightforward clinical workflow, workflow and cultural differences appreciably impacted intervention adoption. Takeaways from this study can be applied to other RN delegation protocol implementations of new and innovative CDS tools within existing workflows to support integration and improve uptake. When implementing a system-wide clinical care intervention, considerations must be made for variability in culture and workflows at the state, health system, practice, and individual levels. ClinicalTrials.gov NCT04255303; https://clinicaltrials.gov/ct2/show/NCT04255303.

Time to learn

In the first of her monthly columns, Francesca Blackmore outlines the case for optical assistants and other practice staff bolstering their practical clinical knowledge

Improving nutrition care and diet intake for hospitalised older people at risk of malnutrition through a nurse-driven mealtime assistance bundle.

Poor dietary intake is common in hospitalised older people. A targeted mealtime intervention is needed to improve nutrition care and dietary intake, especially for those at risk of malnutrition. This quality improvement project designed, implemented and evaluated a mealtime assistance bundle consisting of care measures driven by the hospital nursing team. The aims were to improve the mealtime care process to promote dietary intake of the hospitalised older people and to improve nursing staff's knowledge, attitude and practice in malnutrition. This project adopted a pre-post design, targeting older people aged 65 years and above, who were admitted to a general medical unit in a regional hospital in Singapore. A mealtime assistance bundle consisting of seven care measures, using the acronym CANFEED, was implemented for older adults at risk of malnutrition. Outcome measures on the amount of dietary intake during meals through chart reviews and surveys of nursing staff using Malnutrition Knowledge, Attitudes and perceived Practices (M-KAP) questionnaire were performed before and after implementation. There were fewer older adults with poor intake in the post-implementation group than the pre-implementation group. Among those at risk of malnutrition, older adults in the post-implementation group had higher average intake of all provided meals as well as the protein-dense main dish. Significant improvements were noted in the total scores rated by the nursing staff in both the Knowledge-Attitude subscale and Practice subscale of the M-KAP questionnaire. Integrating a nurse-driven mealtime assistance bundle into usual care may have positive outcomes on nutritional intake of hospitalised older people at risk of malnutrition, and on knowledge, attitude and practice of hospital nurses in nutrition care. Nurses play a critical role in nutrition care for hospitalised older people. Continuing efforts to improve nutritional intake of hospitalised older people should focus on staff education, building a multidisciplinary food-promoting culture and patient, family and community empowerment. More efficient clinical processes incorporating information technology with the EMR to support better nutrition care of the hospitalised older people are needed.

Implementation strategies for large scale quality improvement initiatives in primary care settings: a qualitative assessment

Background and objectivesThe EvidenceNOW: Advancing Heart Health in Primary Care was designed to assist primary care practices in the US in implementing evidence-based practices in cardiovascular care and building capacity for quality improvement. EvidenceNOW, NCT03054090, was registered with ClinicalTrials.gov on 15/02/2017. The goals of this study were to gain a comprehensive understanding of perspectives from research participants and research team members on the value of implementation strategies and factors that influenced the EvidenceNOW initiative in Virginia.MethodsIn 2018, we conducted 25 focus groups with clinicians and staff at participating practices, including 80 physicians, advanced practice clinicians, practice managers and other practice staff. We also conducted face-to-face and telephone interviews with 22 research team members, including lead investigators, practice facilitators, physician expert consultants, and evaluators. We used the integrated-Promoting Action on Research Implementation in the Health Services (i-PARIHS) framework in our qualitative data analysis and organization of themes.ResultsImplementation strategies valued by both practice representatives and research team members included the kick-off event, on-site practice facilitation, and interaction with physician expert consultants. Remote practice facilitation and web-based tools were used less frequently. Contextual factors that influence quality improvement efforts include leadership support, access to resources, previous quality improvement experience, and practice ownership type (independent compared to health system owned). Many clinicians and staff were overwhelmed by day-to-day activities and experience initiative fatigue, which hindered their ability to fully participate in the EvidenceNOW initiative.ConclusionsThis study provides details on how the practice environment plays an essential role in the implementation of evidence-based practices in primary care. Future efforts to improve quality in primary care practices should consider the context and environment of individual practices, with targeted implementation strategies to meet the needs of independent and health system owned practices. Future efforts to improve quality in primary care practices require strategies to address initiative fatigue among clinicians and practice staff. External support for building capacity for quality improvement could help primary care practices implement and sustain evidence-based practices and improve quality of care.Trial registrationThis project was registered with ClinicalTrials.gov on 15/02/2017 and the identifier is NCT03054090.

"Everyone's struggling right now": Impact of COVID-19 on addressing food insecurity in rural primary care.

Primary care practices can address food insecurity (FI) through routine screening, practice-based food programmes, and referrals to community resources. The COVID-19 pandemic had disproportionate impacts on health outcomes for food-insecure households. To describe the impact of the COVID-19 pandemic on FI screening and interventions in rural primary care practices in northern New England. We conducted semi-structured interviews with thirteen providers and staff regarding changes to FI screening and interventions, community resources and partnerships, and patient food needs during the pandemic. Themes and exemplar quotations were identified through iterative discussion. Practices reported more frequent informal discussions with patients about FI during the pandemic. Despite limitations in site operations, practices created programmes to distribute food at practice locations or through food deliveries. The adoption of telemedicine had variable impacts on FI screening, creating challenges for some while facilitating screening outside of scheduled visits for others. Practices reported increased food availability due to new or expanded community programmes, but lack of transportation and delivery availability were challenges. New and stronger connections formed between practices and community partners. Increased awareness of FI among both patients and practice staff resulted in decreased stigma. Screening for and addressing FI was a priority for rural primary care practices during the pandemic. The implementation of practice-based FI interventions was supported by stronger practice-community connections and a decrease in stigma. The experiences of providers and staff during the pandemic provide insight into best practices for engaging primary care practices in reducing FI.

Neonatal staff perceptions and attitudes towards Family Integrated Care and Fathers: A Multi-site Survey

An anonymous questionnaire study was conducted to explore the attitudes and current practices of neonatal clinical staff to fathers and Family Integrated Care (FICare) in 2 neonatal units (level 2 and level 3).166 (65%) staff members responded. The majority agreed with parents' involvement in their baby's care, including providing skin-to-skin as soon as possible whilst receiving intensive care. Overall, parental presence for non-invasive procedures was welcomed. Staff strongly valued the role of fathers in caring for their baby and supporting the mother. They recognised the impact of the NICU admission on fathers' well-being.The study found a positive attitude towards the involvement of both parents in their baby's care in intensive care. Staff believed that fathers play an important role during a baby's neonatal admission. Further education and training are required to improve knowledge and support practice, particularly with challenging or complex scenarios.

The faces behind vaccination: unpacking the attitudes, knowledge, and practices of staff of Cameroon’s Expanded program on Immunization

BackgroundImmunization is regarded as one of the most cost-effective public health interventions in global health. However, its cost-effectiveness depends greatly on the knowledge and skills of vaccinators. With the growing complexity of immunization programs, the need for a well-trained vaccination workforce cannot be overemphasized. In this study, we assessed the knowledge, attitudes, and practices among vaccination staff in Cameroon.MethodsThrough a descriptive cross-sectional design, we used structured questionnaires and observation guides to collect data from vaccination staff in health facilities that were selected by a multistage sampling method. Data were analyzed using STATA 13 software.ResultsOverall, we collected data from Expanded Program on Immunization focal staff in 265 health facilities across 68 health districts. Over half (53%) of the surveyed facilities were found in rural areas. Nearly two-thirds of health facilities had immunization focal staff with knowledge gaps for each of the four basic immunization indicators assessed. In other words, only 37% of staff knew how to estimate coverages, 36% knew how to inteprete the EPI monitoring curve, 35% knew how to prepare vaccine orders, and 37% knew how to estimate vaccine wastage. In terms of practices, staff waited for more than ten children to be present before opening a 20-dose vaccine vial in 63% of health facilities, and more than five children to be present before opening a 10-dose vaccine vial in 80% of surveyed facilities. Provision of vaccine-specific information (informing caregiver about vaccine received, explanation of benefits and potential side effects) during immunization sessions was suboptimal for the most part.ConclusionThis study suggests marked deficits in immunization knowledge among vaccination staff and exposes common attitudes and practices that could contribute to missed opportunities for vaccination and hinder vaccination coverage and equity in Cameroon. Our findings highlight the urgent need to invest in comprehensive capacity building of vaccination staff in Cameroon, especially now that the immunization program is becoming increasingly complex.

Staff’s insights into fall prevention solutions in long-term care facilities: a cross-sectional study

BackgroundFalls are one of the most common and serious health issues in long-term care facilities (LTCFs), impacting not just residents, but staff and the healthcare system. This study aimed to explore LTCF staff’s current practices around falls prevention, and their suggested solutions for better falls prevention.MethodsIn the southwest of Ireland, a descriptive cross-sectional study was conducted in 13 LTCF sites, across a range of provider types and facility sizes. A survey, measuring staff knowledge, skills and attitudes, was distributed in physical and online formats. Staff suggestions for prioritising fall and fall-related injury prevention activities, and current staff practices regarding fall incidents were also sought. Content analysis was used to analyse responses, mapping categories and subcategories to the refined theoretical domains framework (TDF) and to an existing fall prevention guideline.ResultsThere were 155 respondents (15% response rate), from staff of the LTCFs. Environmental reviews and modifications (aligned to the TDF environmental context and resource domain) were the most common suggestions for preventing both falls and fall-related injuries. Other common suggestions for preventing falls were staff education, monitoring of residents, and using alarm/calling systems, while few staff members, across all roles, reported assessing residents, exercises, reviewing medications, and vitamin D supplements. For preventing fall-related injuries, suggestions included protective equipment, hip protectors and alarm/calling systems. Staff used a standardised approach when responding to a fall incident, with intensive and holistic post-fall control measures. HCAs focussed on transferring residents safely, while nurses of all grades focused more on post-fall assessment. Respondents believed that staff education, communication, increasing staffing levels and enhancing specialist care could support their practice.ConclusionNoting the low response rate, the results suggest an awareness gap regarding some evidence-based, resident-focussed falls prevention solutions, such as pro-active fall-risk assessment, exercise, medication review, and Vitamin D supplements. These aspects should be included in future fall prevention education programmes in LTCFs.

Improving access to general practice for and with people with severe and multiple disadvantage: a qualitative study.

People with severe and multiple disadvantage (SMD) who experience combinations of homelessness, substance misuse, violence, abuse, and poor mental health have high health needs and poor access to primary care. To improve access to general practice for people with SMD by facilitating collaborative service improvement meetings between healthcare staff, people with lived experience of SMD, and those who support them; participants were then interviewed about this work. The Bridging Gaps group is a collaboration between healthcare staff, researchers, women with lived experience of SMD, and a charity that supports them in a UK city. A project was co-produced by the Bridging Gaps group to improve access to general practice for people with SMD, which was further developed with three inner-city general practices. Nine service improvement meetings were facilitated at three general practices, and six of these were formally observed. Nine practice staff and four women with lived experience of SMD were interviewed. Three women with lived experience of SMD and one staff member who supports them participated in a focus group. Data were analysed inductively and deductively using thematic analysis. By providing time and funding opportunities to motivated general practice staff and involving participants with lived experience of SMD, service changes were made in an effort to improve access for people with SMD. These included prioritising patients on an inclusion patient list with more flexible access, providing continuity for patients via a care coordinator and micro-team of clinicians, and developing an information-sharing document. The process and outcomes improved connections within and between general practices, support organisations, and people with SMD. The co-designed strategies described in this study could be adapted locally and evaluated in other areas. Investing in this focused way of working may improve accessibility to health care, health equity, and staff wellbeing.

Talking about falls: a qualitative exploration of spoken communication of patients’ fall risks in hospitals and implications for multifactorial approaches to fall prevention

BackgroundInpatient falls are the most common safety incident reported by hospitals worldwide. Traditionally, responses have been guided by categorising patients’ levels of fall risk, but multifactorial approaches are now recommended....

Supporting family carers in general practice: a scoping review of clinical guidelines and recommendations

BackgroundIncreasing numbers of family carers are providing informal care in community settings. This creates a number of challenges because family carers are at risk of poor physical and psychological health outcomes, with consequences both for themselves and those for whom they provide care. General Practitioners (GPs), who play a central role in community-based care, are ideally positioned to identify, assess, and signpost carers to supports. However, there is a significant gap in the literature in respect of appropriate guidance and resources to support them in this role.MethodsA scoping review was undertaken to examine clinical guidelines and recommendations for GPs to support them in their role with family carers. This involved a multidisciplinary team, in line with Arksey & O’Malley’s framework, and entailed searches of ten peer-reviewed databases and grey literature between September-November 2020.ResultsThe searches yielded a total of 4,651 English language papers, 35 of which met the criteria for inclusion after removing duplicates, screening titles and abstracts, and performing full-text readings. Ten papers focused on resources/guidelines for GPs, twenty were research papers, three were review papers, one was a framework of quality markers for carer support, and one was an editorial. Data synthesis indicated that nine (90%) of the guidelines included some elements relating to the identification, assessment, and/or signposting of carers. Key strategies for identifying carers suggest that a whole practice approach is optimal, incorporating a role for the GP, practice staff, and for the use of appropriate supporting documentation. Important knowledge gaps were highlighted in respect of appropriate clinical assessment and evidence-based signposting pathways.ConclusionOur review addresses a significant gap in the literature by providing an important synthesis of current available evidence on clinical guidelines for GPs in supporting family carers, including strategies for identification, options for assessment and potential referral/signposting routes. However, there is a need for greater transparency of the existing evidence base as well as much more research to evaluate the effectiveness and increase the routine utilisation, of clinical guidelines in primary care.

I-RAT: A discussion support system to rapidly assess economic and environmental impacts of different sugarcane irrigation practices

Water pollution and climate change are among the greatest threats to the iconic Great Barrier Reef (GBR). To improve the GBR’s long-term outlook, making improvements on these fronts is required. Owing to the complex interactions between soils, climate, and farm management, a tool is needed to guide agricultural land managers about which management practice changes are more likely to deliver improved water quality and climate resilience outcomes whilst maintaining profitability. Using concepts drawn from social studies of science and technology, a ‘discussion’ support system (DSS) named Irrigation Rapid Assessment Tool (i-RAT) was developed through participatory processes designed to enhance co-learning from the development of this DSS. i-RAT is a rapid assessment-visualisation tool in an interactive web application (https://i-rat.net) to visualise the impacts of changed irrigation practices for sugarcane farmers and extension staff. Specifically, i-RAT compares these impacts regarding farm economics, water quality, productivity, carbon and nitrogen cycles, and greenhouse gas emission. The core of i-RAT is the sugarcane module from the Agricultural Production Systems sIMulator (APSIM) modelling platform. i-RAT was first developed for the Burdekin sugarcane growing region in Queensland (Australia’s largest sugarcane producing region). Various soil types and management scenarios representing farming practices in the Burdekin region were used for simulations (1971–2021) to generate a datacube. In this paper, we describe how fundamental learnings about more (drought) resilient farming systems and more sustainable irrigation practices can be extracted from i-RAT. Details of the participatory approach with research and industry partners that informed the design and function of i-RAT and how APSIM was set up and parameterised are described. A ‘what-if’ analysis demonstrated the i-RAT features and application.