Structured interdisciplinary bedside rounds, in-hospital deaths, and new nursing home placements among older inpatients.

Purpose: Ineffective interdisciplinary communication is linked to many adverse consequences of hospitalization. This study evaluated the effect of SIBR, a model of care that encourages interdisciplinary communication and patient and family participations, on in-hospital deaths and new nursing home (NH) placements.

Materials And Methods: This before-after study included 3,673 consecutive inpatients of mean age 83.

Functional deterioration in the month before hospitalisation is associated with in-hospital functional decline: an observational study.

Introduction: Functional deterioration preceding acute hospital admission may be associated with poorer in-hospital outcomes. We sought to investigate the association between functional decline in the month preceding admission and in-hospital outcomes.

Materials And Methods: Consecutive patients admitted under geriatric medicine over 5 years were prospectively included.

Predictors on admission of functional decline among older patients hospitalised for acute care: A prospective observational study.

Objective: We sought to investigate the incidence of, and factors associated with, in-hospital functional decline among older acute hospital patients.

Methods: We conducted a prospective observational study of consecutive patients admitted under geriatric medicine over 5 years. The primary outcome measure was functional decline between admission and discharge, representing deterioration in any of the following: Modified Barthel Index (MBI), independence in Timed Up and Go test or walking, and/or need for walking aid.

The Impact of Being a Migrant from a Non-English-Speaking Country on Healthcare Outcomes in Frail Older Inpatients: an Australian Study.

The purpose of this prospective study of 2180 consecutive index admissions to an acute geriatric service was to compare in-hospital outcomes of frail older inpatients born in non-English-speaking counties, referred to as culturally and linguistically diverse (CALD) countries in Australia, with those born in English-speaking countries. Multivariate logistic regression was used to model in-hospital mortality and new nursing home placement. Multivariate Cox proportional hazards regression was used to model length of stay.

Structured interdisciplinary bedside rounds do not reduce length of hospital stay and 28-day re-admission rate among older people hospitalised with acute illness: an Australian study.

Objective Structured interdisciplinary bedside rounds (SIBR) are being implemented across many hospitals in Australia despite limited evidence of their effectiveness. This study evaluated the effect of SIBR on two interconnected outcomes, namely length of stay (LOS) and 28-day re-admission. Methods In the present before-after study of 3644 patients, twice-weekly SIBR were implemented on two aged care wards.

Decision-making on behalf of people living with dementia: how do surrogate decision-makers decide?

Background: For people living with dementia, the capacity to make important decisions about themselves diminishes as their condition advances. As a result, important decisions (affecting lifestyle, medical treatment and end of life) become the responsibility of someone else, as the surrogate decision-maker. This study investigated how surrogate decision-makers make important decisions on behalf of a person living with dementia.

Frailty in an older inpatient population: using the clinical frailty scale to predict patient outcomes.

Objective: To evaluate the impact of frailty, measured using the Canadian Study of Health and Aging Clinical Frailty Scale, on outcomes of older people hospitalized with acute illness.

Method: Consecutive patients were randomly allocated to a model development sample or a model validation sample. Multivariate analyses were used to model in-hospital mortality, new nursing home placement, and length of stay.

Qualitative research on dementia in ethnically diverse communities: fieldwork challenges and opportunities.

Australia, like other ethnically diverse societies, needs to provide culturally appropriate health care to all its citizens. One way of facilitating this is to ensure that health services research adequately reflects the circumstances and needs of culturally and linguistically diverse (CALD) communities within the population. This article discusses the fieldwork phase of a qualitative research project on dementia caregiving in 4 CALD communities in south west Sydney, Australia.

A Literature Review on Care at the End-of-Life in the Emergency Department.

The hospitalisation and management of patients at the end-of-life by emergency medical services is presenting a challenge to our society as the majority of people approaching death explicitly state that they want to die at home and the transition from acute care to palliation is difficult. In addition, the escalating costs of providing care at the end-of-life in acute hospitals are unsustainable. Hospitals in general and emergency departments in particular cannot always provide the best care for patients approaching end-of-life.

Culturally and linguistically diverse (CALD) families dealing with dementia: an examination of the experiences and perceptions of multicultural community link workers.

Dementia is a chronic illness involving increasing levels of care, often provided by family members, particularly in culturally and linguistically diverse (CALD) communities. Multicultural community link workers are often the primary service providers assisting families to access health and welfare services and as such have extensive experience of, and possess in-depth knowledge about, CALD family care-giving for dementia. While research has been undertaken on dementia in CALD communities, this research has not focused on the experiences and perceptions of these multicultural workers with regards to CALD family care-giving.

Experiences and perceptions of culturally and linguistically diverse family carers of people with dementia.

Dementia incidence rates are rapidly increasing among culturally and linguistically diverse (CALD) Australians, and there is very little local research to inform practice. In response, a qualitative study employing focus group methods was undertaken with carers from 4 CALD communities-Arabic-speaking, Chinese-speaking, Italian-speaking and, Spanish-speaking. The study examined the experiences and perceptions of these family carers with regard to their caregiving for a person living with dementia (PLWD).

Supporting family carers through telephone-mediated group programs: opportunities for gerontological social workers.

Telephone-mediated group programs are an important but under-utilized medium for reaching frail or disabled older persons' family carers who are in need of support. The primary purpose and style of group programs can range across a broad spectrum-encompassing educational, supportive and therapeutic types. Gerontological social workers are the members of the multidisciplinary care team whose training, experience and supervision makes them most suitable for facilitating this broad range of group types.

Dying with dementia: the views of family caregivers about quality of life.

Objective: To document the views of family caregivers of persons with dementia about quality of life for their relative during the late and terminal stages of the disease, as part of an exploratory study of best quality care and support.

Methods: Fifteen former caregivers (five wives, five husbands, two sons, three daughters) participated in in-depth semistructured interviews.

Results: Participants identified three main sets of indicators of quality of life: the physical body, the physical and social environment and treatment with respect and dignity.

Increasing the profile of the care of the older person in the ED: a contemporary nursing challenge.

The numbers of frail older persons using emergency departments are already considerable and will continue to increase over time. There are a number of issues related to the assessment and care of older patients that are significantly different to other patient groups. The traditional emergency department (ED) model focusing on rapid triage, treatment and throughput does not meet the needs of many older patients, who have complex presentations, and require comprehensive assessment and referral.

Management of change for nurses: lessons from the discipline of organizational studies.

Aim: This paper explores the literature on change management from the discipline of organizational studies to provide insights that nurse managers can use in their professional practice.

Background: The paper will benefit nurse managers by extending the nursing discourse on change management to include wider theoretical and academic perspectives.

Key Issues: Important aspects of change management explored are the roles of power and political behaviour, how much change can be planned and controlled, how to combine top-down and bottom-up approaches to change, the role of emotions in the change management process, a comparison of prescriptive and analytical approaches to understanding change, and the connection between theory and practice in managing change.

Developing more flexible approaches to respite for people living with dementia and their carers.

A vital aspect of the care of people living with dementia is the provision of respite services, which allow family caregivers a break from the caring role. The flexibility of such services has consistently been identified as a major factor in whether families make use of them. This study of dementia respite services explores the notion of flexibility and then presents a comprehensive checklist that respite service providers can use to assess the flexibility of their service.

Working with organizations to implement dementia awareness training for public contact staff.

People with dementia living in the community interact with a range of people who provide services to the public. Within these interactions, there may be communication problems associated with symptoms of the person's dementia. Problems include memory loss, difficulty communicating clearly, inability to grasp complex ideas, and problems handling money.

Extending the role of nurses in staff development by combining an organizational change perspective with an individual learner perspective.

Nurses in staff development have a strong focus on developing programs that support the needs of individual learners. They are much less focused on ways that their programs may support ongoing practice change in the workplace. This article outlines a number of characteristics of staff development programs that are trying to incorporate an organizational change perspective.

Falls and injury reduction in residential aged care: translating research into practice.

Falls and falls-related injuries are a major problem in residential aged care. While there are many factors contributing to falls in this group, there are also a number of strategies that can help reduce falls and associated injuries. While programs to prevent falls must be multifactorial and multidisciplinary, nurses in residential aged care will play a central role in setting up and coordinating such programs.