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Dadich A, Kearns R, Harris-Roxas B, Ni Chroinin D, Boydell K, Ní Shé É, Lim D, Gonski P, Kohler F. What constitutes brilliant aged care? A qualitative study of practices that exceed expectation. J Clin Nurs 2023; 32:7425-7441. [PMID: 37314051 DOI: 10.1111/jocn.16789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/17/2023] [Accepted: 05/29/2023] [Indexed: 06/15/2023]
Abstract
AIM This study aimed to explore what constitutes brilliant aged care. BACKGROUND Although many aged care services do not offer the care that older people and carers need and want, some perform better. Rather than focus on problems with aged care, this study examined brilliant aged care-practices that exceeded expectation. DESIGN The methodology for this study was informed by grounded theory, underpinned by constructionism to socially construct meaning. METHODS This study invited nominations for a Brilliant Award via a survey, and interviews with the nominees via web conference. After receiving survey responses from 10 nominators, interviews were conducted with 12 nominees. Data were analysed using reflexive thematic analysis and documented according to COREQ guidelines to optimise rigour and transparency. RESULTS According to participants, brilliant aged care involved being relationally attuned to older people, a deep understanding of the older person, recognition of aged care as more than a job, innovative practices and permission to reprioritise. CONCLUSIONS This study suggests that, in aged care, brilliance happens. It emphasises the importance of meaningful connections and relationships in aged care, where thoughtful acts acknowledge an older person's value and humanity as well as creativity and innovation. RELEVANCE TO CLINICAL PRACTICE For those who manage and deliver aged care, the findings suggest that small practice changes can make a positive difference to older people. Brilliant aged care can involve acts of empathy; enthusiasm for aged care; innovative practices, even those that are small scale; and reprioritising workplace tasks to spend time with older people. For policymakers, this study highlights the need to recognise and raise the profile of the pockets of brilliance within the aged care sector. This might be achieved via awards and other initiatives that serve to celebrate and learn from brilliance in its myriad forms. PATIENT OR PUBLIC CONTRIBUTION The nominees, who included carers, were invited to participate in workshops with other carers and older people to co-design a model of brilliant aged care, during which workshop participants discussed and critiqued the findings constructed from the data.
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Affiliation(s)
- Ann Dadich
- School of Business, Western Sydney University, Parramatta, New South Wales, Australia
| | - Rachael Kearns
- Institute for Culture and Society, Western Sydney University, Penrith, New South Wales, Australia
| | - Ben Harris-Roxas
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Danielle Ni Chroinin
- South Western Sydney Local Health District, University of New South Wales, Liverpool, New South Wales, Australia
| | | | - Éidín Ní Shé
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David Lim
- School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
| | - Peter Gonski
- South Eastern Sydney Local Health District & University of New South Wales, Sydney, New South Wales, Australia
| | - Friedbert Kohler
- HammondCare Health, South Western Sydney Local Health District & University of New South Wales, Prairiewood, New South Wales, Australia
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Dadich A, Rodrigues J, De Bellis A, Hosie A, Symonds T, Prendergas J, Bevan A, Collier A. Patient safety for people experiencing advanced dementia in hospital: A video reflexive ethnography. DEMENTIA 2023:14713012231168958. [PMID: 37032597 DOI: 10.1177/14713012231168958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
BACKGROUND Patient safety for people experiencing dementia in acute hospitals is a global priority. Despite national strategies as well as safety and quality guidelines, how safety practices are enacted within the complexities of everyday work are poorly understood and articulated. METHODS Using video reflexive ethnography, this 18-month study was conducted within an inpatient geriatric evaluation and management unit for people experiencing dementia and/or delirium in Australia. Patients, family members, and staff members participated by: allowing researchers to document fieldwork notes and video-record their practices and/or accounts thereof; and/or interpreting video-recordings with researchers to co-analyse and make sense of the data. RESULTS Safe care for people experiencing advanced dementia involved: negotiating risk via leadership, teamwork, and transparency; practice-based learning through situated adaptation; managing personhood versus protocols by doing the 'right' thing; joyful and meaningful work; as well as incorporating patient and family voices to do safety together. CONCLUSION Patient safety for people experiencing dementia requires continuous responsiveness and prioritising in the context of multiple risks by a staff collective with a shared purpose. Ongoing research to better understand how the nuances of patient safety unfold in everyday complex clinical realities in diverse contexts and with key stakeholders is required.
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Affiliation(s)
- Ann Dadich
- School of Business, 6489Western Sydney University, Parramatta, NSW, Australia
| | - Jade Rodrigues
- School of Business, 6489Western Sydney University, Parramatta, NSW, Australia
| | - Anita De Bellis
- College of Nursing and Health Sciences, 1065Flinders University, Adelaide, SA, Australia
| | - Annmarie Hosie
- School of Nursing and Midwifery, 3431University of Notre Dame Australia, Darlinghurst, NSW, Australia
| | - Tamsin Symonds
- 6677Southern Adelaide Local Health Network, Bedford Park, SA, Australia
| | - Justin Prendergas
- 6677Southern Adelaide Local Health Network, Bedford Park, SA, Australia
| | - Alan Bevan
- 1066University of Adelaide, Adelaide, SA, Australia
| | - Aileen Collier
- Research Centre for Palliative Care, Death, and Dying (RePadd), 1065Flinders University, Adelaide, SA, Australia
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Giulia O, Francesca N, Emma MM, Gianluca C, Milko Z, Giuseppe A, Fiona T, Loredana S, Annamaria B. Fundamental care: An evolutionary concept analysis. J Adv Nurs 2022; 79:2070-2080. [PMID: 36226779 DOI: 10.1111/jan.15451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/29/2022] [Accepted: 08/30/2022] [Indexed: 11/27/2022]
Abstract
AIM To report an analysis of the concept of fundamental care in the literature. DESIGN An evolutionary concept analysis. DATA SOURCES PubMed and CINAHL Complete databases were consulted using the key terms: fundamental care, fundamentals of care, essential care, basic nursing care and basic care revised. Articles published from 2008 to 2022, in English and Italian, in scholarly/peer-reviewed nursing journals were included. METHODS Rodgers's Evolutionary Method of concept analysis was used. Our thematic analysis yielded common themes related to the concept, antecedents, attributes and consequences of fundamental care. RESULTS A total of 50 articles were analysed. Thirty-eight attributes were identified, such as integration of care, patient and family centred care and trusting relationship; eight antecedents including nursing care, nursing practice and care context; and 17 consequences including the safety, quality and consistency of care. CONCLUSION This review of literature reveals that there is no consistent definition of the concept of 'fundamental care'. Findings from this exploration of the literature emphasized the importance of communication, the contextual environment, leadership influence and nurse-patient relationship in providing effective and high-quality fundamental care. Our definition of this concept may help nurse leaders in practice, research, education, management and policy to promote and enhance the application of fundamental care. IMPACT What problem did the study address? While numerous studies examine fundamental nursing care, various terms are used with no consensus on definitions emerging. Given the relevance of this topic, reaching a clear and agreed definition of fundamental care is essential. What were the main findings? Fundamental care encompasses the importance of communication, the contextual environment, leadership influence and nurse-patient relationship in providing effective and high-quality care. Where and on whom will the research have an impact? This definition of fundamental care will assist nurse leaders and researchers to promote and enhance the examination and application of fundamental care in clinical practice to ensure better care outcomes across all healthcare settings.
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Affiliation(s)
- Ottonello Giulia
- Department of Health Sciences, University of Genoa, Genova, Italy
| | | | - Musio Maria Emma
- Department of Health Sciences, University of Genoa, Genova, Italy
| | - Catania Gianluca
- Department of Health Sciences, University of Genoa, Genova, Italy
| | - Zanini Milko
- Department of Health Sciences, University of Genoa, Genova, Italy
| | - Aleo Giuseppe
- Department of Health Sciences, University of Genoa, Genova, Italy
| | - Timmins Fiona
- UCD School of Nursing, Midwifery and Health Systems, UCD, Dublin, Ireland
| | - Sasso Loredana
- Department of Health Sciences, University of Genoa, Genova, Italy
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Dadich A, Boydell KM, Habak S, Watfern C. Positive Organisational Arts-Based Youth Scholarship: Redressing Discourse on Danger, Disquiet, and Distress during COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5655. [PMID: 34070519 PMCID: PMC8199347 DOI: 10.3390/ijerph18115655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/25/2021] [Accepted: 05/01/2021] [Indexed: 02/06/2023]
Abstract
This methodological article argues for the potential of positive organisational arts-based youth scholarship as a methodology to understand and promote positive experiences among young people. With reference to COVID-19, exemplars sourced from social media platforms and relevant organisations demonstrate the remarkable creative brilliance of young people. During these difficult times, young people used song, dance, storytelling, and art to express themselves, (re)connect with others, champion social change, and promote health and wellbeing. This article demonstrates the power of positive organisational arts-based youth scholarship to understand how young people use art to redress negativity via a positive lens of agency, peace, collectedness, and calm.
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Affiliation(s)
- Ann Dadich
- School of Business, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Katherine M. Boydell
- Black Dog Institute, University of New South Wales (UNSW), Sydney, NSW 2031, Australia; (K.M.B.); (S.H.); (C.W.)
| | - Stephanie Habak
- Black Dog Institute, University of New South Wales (UNSW), Sydney, NSW 2031, Australia; (K.M.B.); (S.H.); (C.W.)
| | - Chloe Watfern
- Black Dog Institute, University of New South Wales (UNSW), Sydney, NSW 2031, Australia; (K.M.B.); (S.H.); (C.W.)
- Arts & Design, University of New South Wales (UNSW), Sydney, NSW 2052, Australia
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Hung, PhD, RN L, Dahl, BMT K, Peake G, Poljak L, Wong L, Mann, LLD J, Wilkins-Ho, MD M, Chaudhury, PhD H. Implementing Silent Disco Headphones in a Hospital Unit: A Qualitative Study of Feasibility, Acceptance, and Experience Among Patients and Staff. SAGE Open Nurs 2021; 7:23779608211021372. [PMID: 34159257 PMCID: PMC8186118 DOI: 10.1177/23779608211021372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 05/11/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Music is so widely available and inexpensive in the modern world; it is a common option for stress reduction, comfort and enjoyment. Silent disco headphones are used among young people; however, no study has yet investigated whether it is feasible to use these headphones to support mental health and well-being among older people with dementia in hospital settings. OBJECTIVE The study's main objective is to explore whether music delivered by silent disco headphones was feasible and acceptable to a sample of inpatients staying in an older adult mental health unit of a large urban hospital. METHODS We employed a video-ethnographic design in data collection, including conversational interviews and observations with video recording among ten patient participants in a hospital unit. A focus group was conducted with ten hospital staff on the unit. RESULTS Our analysis identified three themes that represented experiences of patients and staff: (1) perceived usefulness, (2) perceived ease of use, and (3) attitude. Patient participants reported the music delivered by the headphones brought positive benefits. Witnessing the positive effects on patients influenced the staff's view of how music could be used in the clinical setting to support patients' well-being. CONCLUSIONS The music delivered by the silent disco headphones in an older adult mental health unit was found to be an acceptable and feasible intervention for patients. Leadership support is identified as an enabling factor in supporting technology adoption in the clinical setting. The findings can be used to inform practice development and future research.
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Affiliation(s)
- Lillian Hung, PhD, RN
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin Dahl, BMT
- Willow 5, Older Adult Program, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Gail Peake
- Willow 5, Older Adult Program, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Luka Poljak
- CEAN Community Engagement Advisory Network, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Lily Wong
- CEAN Community Engagement Advisory Network, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Jim Mann, LLD
- CEAN Community Engagement Advisory Network, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Michael Wilkins-Ho, MD
- Willow 5, Older Adult Program, Vancouver General Hospital, Vancouver, British Columbia, Canada
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Hosie A, Phillips J, Lam L, Kochovska S, Noble B, Brassil M, Kurrle S, Cumming A, Caplan GA, Chye R, Ely EW, Lawlor PG, Bush SH, Davis JM, Lovell M, Parr C, Williams S, Hauser K, McArdle S, Jacquier K, Phillipson C, Kuwahata L, Kerfoot J, Brown L, Fazekas B, Cheah SL, Edwards L, Green A, Hunt J, Attwood R, Assen T, Garcia M, Wilcock J, Agar M. A Multicomponent Nonpharmacological Intervention to Prevent Delirium for Hospitalized People with Advanced Cancer: A Phase II Cluster Randomized Waitlist Controlled Trial (The PRESERVE Pilot Study). J Palliat Med 2020; 23:1314-1322. [PMID: 32343634 DOI: 10.1089/jpm.2019.0632] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: Delirium is a common debilitating complication of advanced cancer. Objective: To determine if a multicomponent nonpharmacological delirium prevention intervention was feasible for adult patients with advanced cancer, before a phase III (efficacy) trial. Design: Phase II (feasibility) cluster randomized controlled trial. All sites implemented delirium screening and diagnostic assessment. Strategies within sleep, vision and hearing, hydration, orientation, mobility, and family domains were delivered to enrolled patients at intervention site admission days 1-7. Control sites then implemented the intervention ("waitlist sites"). Setting: Four Australian palliative care units. Measurements: The primary outcome was adherence, with an a priori endpoint of at least 60% patients achieving full adherence. Secondary outcomes were interdisciplinary care delivery, delirium measures, and adverse events, analyzed descriptively and inferentially. Results: Sixty-five enrolled patients (25 control, 20 intervention, and 20 waitlist) had 98% delirium screens and 75% diagnostic assessments completed. Nurses (67%), physicians (16%), allied health (8.4%), family (7%), patients (1%), and volunteers (0.5%) delivered the intervention. There was full adherence for 5% patients at intervention sites, partial for 25%. Both full and partial adherence were higher at waitlist sites: 25% and 45%, respectively. One-third of control site patients (32%) became delirious within seven days of admission compared to one-fifth (20%) at both intervention and waitlist sites (p = 0.5). Mean (standard deviation) Delirium Rating Scale-Revised-1998 scores were 16.8 + 12.0 control sites versus 18.4 + 8.2 (p = 0.6) intervention and 18.7 + 7.8 (p = 0.5) waitlist sites. The intervention caused no adverse events. Conclusion: The intervention requires modification for optimal adherence in a phase III trial.
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Affiliation(s)
- Annmarie Hosie
- School of Nursing Sydney, The University of Notre Dame Australia, Darlinghurst, New South Wales, Australia.,St. Vincent's Health Network Sydney, Darlinghurst, New South Wales, Australia.,IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Jane Phillips
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Lawrence Lam
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Slavica Kochovska
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Beverly Noble
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Meg Brassil
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Susan Kurrle
- Northern Clinical School, Hornsby Ku-ring-gai Health Service, University of Sydney, Hornsby, New South Wales, Australia
| | - Anne Cumming
- Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
| | - Gideon A Caplan
- Prince of Wales Hospital, Geriatric Medicine, Randwick, New South Wales, Australia.,UNSW Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | - Richard Chye
- St. Vincent's Health Network Sydney, Darlinghurst, New South Wales, Australia.,UNSW Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | - Eugene Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University, Nashville, Tennessee, USA.,Tennessee Valley Veteran's Affairs Geriatric Research Education Clinical Center (GRECC), Nashville, Tennessee, USA
| | - Peter G Lawlor
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Palliative Care, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Shirley H Bush
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Palliative Care, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Jan Maree Davis
- Department of Palliative Care, Calvary Health Care Kogarah, Kogarah, New South Wales, Australia
| | - Melanie Lovell
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,HammondCare, Greenwich Hospital, Greenwich, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Cynthia Parr
- HammondCare, Greenwich Hospital, Greenwich, New South Wales, Australia
| | - Sally Williams
- The Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - Katherine Hauser
- The Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - Susan McArdle
- The Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - Karen Jacquier
- The Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - Carl Phillipson
- The Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | | | | | - Linda Brown
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Belinda Fazekas
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Seong Leang Cheah
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Layla Edwards
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Anna Green
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Jane Hunt
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Robyn Attwood
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Teresa Assen
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Maja Garcia
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Julie Wilcock
- Ingham Institute, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Meera Agar
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,Ingham Institute, Liverpool Hospital, Liverpool, New South Wales, Australia
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