HDR Student conference (College of Nursing and Health Sciences)

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College of Nursing and Health Sciences at Flinders University are pleased to present the inaugural HDR Student conference. This is an annual event to provide HDR students an opportunity to present their research work, network with students and academic staff, meet their milestone expectations of oral presentations, and participate in professional development activities.

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Food service satisfaction in aged care facilities: Development of a toolkit of instruments for the measurement of change
(Flinders University, 2018-11-5) Pankhurst, Morgan
Introduction: Although the average life span of Australian citizens is increasing, the final ten years may be accompanied by illness and disability thereby increasing the demand for residential aged care. Satisfaction with food service is a major factor in overall satisfaction and is important for the resident, resident's family, staff, cooks and management of the facility. There are currently limited valid and reliable tools available for measuring this construct and most tools investigate only the resident's perspective. As nursing homes are a complex system, a key gap is investigating other stakeholders that contribute to the food service setting as ultimately, this impacts the experience of the resident. Methods: Mixed method study underpinned by systems theory utilising qualitative interviews with stakeholders to develop quantitative instruments for measuring satisfaction. Transcripts will be analysed thematically to understand the factors (themes) relevant to stakeholders. Items for each questionnaire will be developed and content validity determined through an expert panel. Ethics approval has been obtained to recruit participants in nursing homes across Australia. Each instrument will undergo test/retesting and factor analysis will be conducted using SPSS to refine the tool. Implications: The development of a tool kit of instruments to measure change will enable residential aged care facilities to monitor quality improvement and detect areas of dissatisfaction within the food service system. Further, the revised Aged Care Quality Standards have a focus on stakeholder engagement and require homes to provide evidence of same, this tool kit will provide a valid and reliable way of ensuring this criteria is met.
The application of rigour in ethnographic methods to achieve an in-depth exploration of care planning with people on treatment orders
(Flinders University, 2018-11-5) Dawson, Suzanne
Community treatment orders (CTOs) remain contested in their efficacy and rationale for use in mental health care. Regardless of the debate, consumers, carers and clinicians are frequently required to engage within this context of forced care. CTO legislation states that treatment and care should be recovery-focussed, though care is often coercive. Positive gains for individuals come at a cost. This study seeks to understand the interpersonal and broader systems issues that impact on the care planning process. Carspeckena's Critical Ethnography, combining critical social theory with ethnographic methods, provided a rigorous theoretically-based structure for data collection and analysis. Ethnographic methods (including observation, focus groups and interviews) provided a detailed account of the multi-perspectives of people on CTOs, their families, and treating clinicians, over an 18-month period in a community mental health team in Adelaide, Australia. This paper will explore the research process of conducting an ethnographic study within the researchers' own work setting. Data collection and first stage analysis occurred concurrently, with coding of early observations informing the next stage of data collection, individual interviews. Concepts central to the rigour of an ethnographic study (immersion in the field, researcher positioning, and reflexivity) will be discussed, with illustrations of both successes and challenges.
Developing a Dignity in Care Questionnaire for older people (and their carer) when in hospital
(Flinders University, 2018-11-5) Heuzenroeder, Louise
Background The Dignity in Care Campaign, undergirded by the 10 Principles of Dignity in Care, has been strongly supported by clinicians and consumers in the United Kingdom. Surprisingly, the Campaign does not include a questionnaire for patients (and carers) to report on their experience of care, according to the 10 Principles of Dignity in Care. Objectives The questionnaire is being developed to enable older patients (and their carers) to measure their experience of receiving care according to the 10 Principles of Dignity in Care. Methods The research will utilise an exploratory sequential design in a four-stage process that includes a Delphi panel to assist in the development of the questionnaire, a pilot test of the questionnaire, extensive data collection to undertake reliability and validity testing and the development of an implementation plan. Results A Delphi panel of consumers, carers, clinicians, policy and instrument experts participated in three rounds of deliberations to develop the items to be included in the first draft of the questionnaire. This version of the questionnaire has been pilot tested with older patients (and their carers) at the Royal Adelaide Hospital. The questionnaire has been revised following the pilot test, and this post pilot version be used to collect data to test the validity and reliability of the questionnaire. Conclusions The Dignity in Care questionnaire has the potential to be used as a measure to report on the implementation of the first recommendation of the Clinical Guidelines for Dementia in Australia, which state The 10 Principles of Dignity in Care should be used as the standard by which care is delivered and evaluated.
Impact of e-mentoring on online conversations by adolescents with complex communication needs
(Flinders University, 2018-11-5) Grace, Emma
Introduction: Adolescents with complex communication needs (CCN) have limited use of natural speech for communication and use a range of augmentative and alternative communication (AAC) methods. They experience difficulties in face-to-face conversations. Enhancing participation in everyday life is a key goal of AAC interventions. Methodology: This mixed methods research explored changes in social media use and participation in online conversations by adolescents with CCN following an e-mentoring intervention. Methods: Four mentees and two mentors with CCN participated in the four month e-mentoring intervention. Multiple baseline single case experimental design was used to investigate the effects of the intervention on participation in online conversations. Online conversations of the mentees were collected before, during and after the e-mentoring intervention over a period up to 34 weeks. Measures of goal attainment were used to describe changes in social media use. Computer Mediated Discourse Analysis (CMDA) was used to investigate changes in participation in online conversation. Fidelity measures of the mentoring intervention were also collected. Results: Participants demonstrated improvements in their social media use goals and in hours spent in online conversations following the intervention. CMDA demonstrated increases in conversational turns and functions following the intervention. Conclusion: This research demonstrates the feasibility of e-mentoring interventions for adolescents with CCN. Variability in the data compromised the ability to interpret the effect of the intervention. Increases in participation in online conversations were observed for some measures. Implications: These findings provide evidence that online conversations are a valuable context for providing AAC interventions and reinforce our understanding of the complex and inter-directional relationships between activity, participation, environmental and personal factors.
Contextualising and defining child abuse - How nurses' experiences, values and beliefs influence their assessment of children
(Flinders University, 2018-11-5) Lines, Lauren
Aims and Objectives To report on how nurses' experiences, values and beliefs impact upon their assessment of child abuse and neglect. Background To reduce harm to children, nurses must be able to identify and address child abuse and neglect. It is not known how nurses' experiences, cultural values and beliefs influence their assessment of abuse and neglect. Design Qualitative research design using social constructionism. Methods Twenty-one in-depth semi-structured interviews were conducted with nurses who work with children. EQUATOR guidelines for qualitative research (COREQ) were used to report this research. Results Nurses who work with children had difficulty defining abuse and needed to contextualise abuse within the child's unique situation. To understand the complexity of their role, nurses compared and contrasted the level of abuse experienced by the child with their own values and beliefs which stemmed from their personal and professional experiences of parenting. Assessments were particularly challenging when nurses were faced with cultural values and practices different from their own. Conclusions Assessments of abuse and neglect are inextricably linked to nurses' personal values and beliefs which they developed from their personal background and context. As such, nurses are working from their own values base rather than always taking an evidence-informed approach to assessing for abuse and neglect. Relevance to clinical practice Nurses who work with children can make a difference for children experiencing abuse and neglect. There was inconsistent evidence that nurses explicitly reflect on how their personal values and beliefs influence their practice. We propose that this is a missing aspect of child safe practice. Including reflection on the impacts of personal and professional values and beliefs on the ability to implement evidence-informed approaches will increase nurses' capacity to maintain a child-focus.
The Health Action Process Approach model for understanding parents' reflective motivation towards reducing unhealthy foods
(Flinders University, 2018-11-5) Johnson, Brittany
Aim This study aimed to understand the relationships between, and relative importance of, constructs of the Health Action Process Approach (HAPA) model and children's intake of unhealthy foods. Background Parents play a key role in shaping children's eating habits and are an ideal target for interventions to reduce children's currently excessive unhealthy food intake. To change provision behaviours parents need to be sufficiently motivated, in addition to having the knowledge and resources. The HAPA model is a framework covering important aspects of behaviour change motivation. Methods Australian parents completed a cross-sectional online survey containing parent motivation, child dietary intake and socio-demographics, using validated tools. Structural equation modelling was performed based on the HAPA model, including constructs of risk perception, outcome expectancies, self-efficacy, intention and planning. Results Four hundred and ninety-five parents completed the online survey. Model of fit statistics (CMIN 210.033, df 83, p<0.001; CFI 0.956; TLI 0.936; RMSEA 0.056, PCLOSE 0.153; SRMR 0.0601) supported the HAPA model as a suitable model, with parental motivation accounting for 9.2% of children's unhealthy food intake. The largest relationships were seen between self-efficacy constructs (action to maintenance, beta .69; maintenance to recovery, beta .70), and between maintenance self-efficacy to planning (beta .82). Secondary intervention targets identified were intention (to planning, beta .21) and planning (to intake, beta -.32). Conclusion The HAPA model is a promising framework for examining parental motivation towards limiting unhealthy food provision. Future interventions should include strategies to enhance parent's self-efficacy, intention and plans for reducing unhealthy foods.
What is the impact on the role of Practice Nurse of the trial of Health Care Homes and the shift to bundle payments?
(Flinders University, 2018-11-5) Verrall, Claire
Using a case study approach, my PhD will examine the impact of the Australian Federal Government's trial of Health Care Homes (HCH) (2018-2019) on the role of practice nurses using Alford's (1975) structural interest theory as the analytical lens. HCH is the most recent in a raft of reforms instigated by the Federal government over the last two decades in an attempt streamline care coordination and re-orientate general practice towards population focused multidisciplinary care of the chronically ill. Underlying the study are three assumptions. Firstly, the Federal government has attempted to reform general practice through a series of policy initiatives, none of which have fully achieved policy objectives. One example has been the funding of primary care organisations such as Divisions of General Practice, Medical Locals and Primary Health Care Networks. This has been coupled with the introduction of specific Medical Benefit Schedule items to encourage GPs to enhance and care of patients with chronic conditions; e.g. enhanced primary care packages which later became chronic disease management. The second assumption argues that these two policy directions have impacted on the professional status and position of practice nurses, mostly contributing to an expanded and enhanced role. The third assumption aligns with Alford's theory that various structural interests obstruct health reform. While Alfords theory has been aligned to a number of reforms, few have examined the impact on the role of the practice nurse as the three structural interest groups work to ensure the reforms meet their interests.
Assessing the access and value of online health information resources
(Flinders University, 2018-11-5) Adams, Amanda
Introduction: User-based evaluations of usability undertaken during development of online health information and evidence resources generates valuable feedback identifying user interface issues, information architecture inconsistencies or navigation difficulties. Problem identification form the basis of iterative prototype improvements and dependence lies within user characteristics of user-testers whose recruitment is inherently skewed toward highly experienced, motivated and technological savvy individuals. Diversity in experience, attitudes, socioeconomic status, dis/ability, age and geographic location provides opportunity to identify ranges of usability and accessibility issues. Whilst outcomes from user-based evaluation methods are widely reported within the literature for e-devices, software and websites for user experience (UX), there is limited research on new modes of online resources such as online health toolkits (OHT). Objectives: The purpose of this research is assessing the role of usability and accessibility evaluations undertaken during development of OHT and investigating the influence of user characteristics on access and value of UX within the palliative care domain. METHODS Three independent studies will be conducted. The first is a systematic mapping review of the literature classifying current evaluation methods undertaken during development of OHT. The second examines application of a website evaluation model to the development of a palliative care online toolkit investigating outcomes as measures of UX. The final study will investigate how levels of user-testers digital readiness influence concepts and knowledge of palliative care and implications of interface design. Implications: Expected outcomes will inform a standardised approach for development of OHT, providing development, evaluation and implementation guidance producing valuable, useable and accessible online health information sources improving the UX.
Exploring Women's Experience of Wellbeing in the Cyclone Shelters of Bangladesh
(Flinders University, 2018-11-5) Chowdury, Tazrina
Background- Bangladesh has a small land area of 147,570 sq. km with a population of 160.80 million, comprising 80.50 million males and 80.30 million females. The total coastal area of Bangladesh is about 47,201 sq. km, almost 32% of the country, accommodating almost 50 million people, majority living below poverty line. This cause a huge group of population exposed to frequent cyclones. Cyclone evacuation centres have been built for affected people. But in many cases these shelters fail to ensure safety, security and basic needs of evacuees. As Bangladesh is among the lowest positioned countries in gender equity, women tend to be more vulnerable in these shelters. So, it is important to understand, from the women's perspective, what it is like to be an evacuee in a shelter and therefore in what ways this experience can be improved. Methodology- As phenomenology describes existential phenomena such as the experience of living in an evacuation centre and illuminates what it is like, phenomenology would be a suitable methodological approach and philosophical framework of the research. Methods/Design- Adult women who have lived experience of staying in cyclone shelters will be recruited from the study area for in-depth interviews. Identities of the participants will be kept confidential and participants will have their freedom to discontinue their participation at any point without further consequences. Thematic analysis will be used to interpret interviews and process the interviews to extract findings. Participants' experiences would be segmented and specified with significant phrases based on their used terms to describe an event or experience. Conclusion- This research will produce knowledge that assists the Government of Bangladesh to improve the existing cyclone preparedness, relief and rehabilitation plans and will provide directions for further research in the field of women and disaster resilience.
How do persons with dementia experience 'epistemic injustice'?
(Flinders University, 2018-11-5) Young, Jessica
Whenever we hear a speaker assert something, we form judgments both about the credibility of the speaker and of what they said. When a hearer attributes too little credibility to a speaker, perhaps due to a prejudice they hold, the speaker is said to suffer an injustice. This kind of injustice is epistemic in nature: the speaker is harmed in their capacity as a 'knower'. Philosopher Miranda Fricker (2007) calls this 'epistemic injustice'. This theoretical concept has had recent uptake across health fields, including in dementia care. Whilst the concept is a useful tool to considering the injustice a person may experience, Fricker offers only a theoretical exploration of how epistemic injustice might manifest in everyday life, often using literary examples. Similarly, the existing work in epistemic injustice and dementia often relies on anecdotal evidence to support claims about the injustice persons with dementia experience. The aim of this paper is to demonstrate that one way to confirm, elaborate or indeed challenge the assumptions embodied in the concept of epistemic injustice would be to look to analysis of everyday interactions involving persons with dementia, using a Conversation Analytic approach. Heritage (2013), in his work on 'the epistemics of interaction', offers an empirically grounded method to exploring how interactants negotiate their relative epistemic positions ... in and through turns at talk and sequences of interaction (p. 556). There appears to be a compatibility between the concepts of epistemic injustice and epistemics of interaction. Although the concepts come from disparate fields of thought (i.e., philosophy and conversation analysis), both are concerned with how persons do or do not do justice to each other. Considered together, these concepts may illuminate how epistemic injustice manifests in the everyday lives of persons with dementia.
A novel driving scale for adults experiencing amblyopia and/or strabismus: Psychometric evaluation by Rasch analysis
(Flinders University, 2018-11-5) Kumaran, Sheela
Aim: To evaluate the psychometric properties of a novel driving scale for adults experiencing amblyopia and/or strabismus using Rasch measurement theory. Background: To develop item banks that measure quality of life dimensions, important to adults with amblyopia and/or strabismus, an extensive qualitative study was conducted in Australia and India. Among other findings, the study identified several impacts in driving, which were articulated into country-specific surveys by item refinement and revision processes. This abstract presents the psychometric validation of this scale for the Indian population. Methods: The 18-item driving scale was administered to adults in India, aged over 18 years. Rasch analysis (using Winsteps version 3.92.1) was used to assess the psychometric properties of the scale: functioning of response categories, measurement precision (PSI), fit statistics, dimensionality, targeting and differential item functioning (DIF). Results: Two hundred and thirty two participants (male: 72%, median age: 24 year; range: 18-48 years) completed the survey. The scale had a PSI of 2.44. Two misfit items were fixed by iteratively muting erroneous person responses to each item. Variance explained by the measure was 64%. The eigen value was 2.98 and 5 items loaded over 0.40; however the disattenuated correlations between the item clusters was >0.80, indicating that the items are measuring the same thing. This was further verified by splitting the scale into two and correlating person measures (spearman correlation = 0.78; 61% of the variance was shared by the measures). The final scale had ordered thresholds, PSI, 2.52 and targeting, 2.51 logits. Two items showed notable DIF based on ocular diagnosis. Conclusion: The 18-item driving scale displays valid Rasch- based psychometric properties except for targeting. Implications: The Rasch validated driving scale could be used to measure and compare driving abilities of individuals with amblyopia and/or strabismus.
Contextualising acute coronary syndrome standards and guidelines for Aboriginal people residing in Central Australian and Top End Aboriginal communities.
(Flinders University, 2018-11-5) Lawrence, Monica
Introduction: The National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Management of Acute Coronary Syndrome 2016 (in consultation with the Australian and New Zealand Society of Cardiac and Thoracic Surgeons) provide guidelines for the management of myocardial revascularisation. In addition, the European System for Cardiac Operative Risk Evaluation (euroSCORE I and II) are models used to calculate risk of mortality 30 days post cardiac surgery. The euroSCORE I and II have been validated for European, Japanese and North American populations; however, they have not been validated for Aboriginal and Torres Strait Islander populations and there is still much debate on whether they can be attributed to this, and other Indigenous populations. This study aims to explore the contextual factors (barriers and enablers) informing the guidelines for cardiac surgery and revascularisation for Aboriginal and Torres Strait Islander people residing in central Australian and Top End Northern Territory communities. Subsequently, recommendations will be put forward for culturally effective cardiac pathways of care. Methodology: This study uses an Indigenous research methodology, through the lens of the Essential Service Standards for Equitable National Cardiovascular Care (ESSENCE) framework, to better understand Aboriginal world views and experiences of cardiac surgery. Data collection: Semi-structured and/or open-ended questions will be posed 30-90 days post-discharge from Flinders Medical Centre and used to elicit free flowing narratives and storytelling once the participant is back residing in their community. Analysis: Indigenous narrative analysis, by means of storytelling, will be used to develop themes and codes for the purpose of identifying "experience" commonalities and distinctions and mapped to relevant acute coronary syndrome (ACS) and revascularisation standards and guidelines. Conclusion: The practical outcomes of the proposed study will identify cultural service gaps to make recommendations aligned to revised recommendations for new ACS and revascularisation standards, guidelines and care pathways for Aboriginal and Torres Strait Islander populations.
Registered Nurses' experiences of End-of-Life (EOL) care in the acute setting in Singapore
(Flinders University, 2018-11-5) Manikam, Ambelorfam
Background: Singapore is a multi-cultural society and has a resident population of 5.3 million people, 3.8 million citizens who are permanent residents and 1.5 million non-residents. Generally, the health of Singaporeans has been good. However, it is estimated 65% of the population spend time in hospital in their final year of life and about 61% die in hospitals. A review of the literature highlighted that EOL care can be stressful and the complexity surrounding death and dying can cause emotional and psychological distress to nurses. There is also a dearth of qualitative studies on nurses' EOL care practices and experiences within the context of acute care. Given the paucity of studies in the local and acute care context there is a need to understand Registered Nurses care practices and experiences on EOL care in acute hospitals. Aim: The primary aim of this study is to understand the EOL care practices and experiences among the Registered Nurses working in acute hospitals in Singapore. Methodology: The Hermeneutic Phenomenology underpinning Hans-George Gadamer's philosophy guided this study. Data was collected on 16 Registered Nurses using the purposeful sampling method following ethics approval. Data was collected over a period of eight months using semi-structured interviews. Each interview lasted for 45 minutes. Fleming's et al 2003 five stages of analysis were used as they were able to retain the philosophical underpinnings of Gadamer who does not offer a framework of analysis. Findings: Three themes emerged from the analysis of each interview. They were confronting challenges; understanding EOL care; and managing care effectively. Confronting challenges supporting sub-themes were (i)experiencing emotional labour; and (ii) barriers to providing palliative care. Understanding EOL care and its supporting sub-themes were (i) building connections; (ii) providing support to patients and family; and (iii) fulfilling wishes. Managing care effectively and its supporting themes were (i) open communication; (ii) working as a team; (iii) palliative team support; (iv) addressing training needs; and (v) personal coping. Conclusion: This study has led to an in-depth understanding of care practices and experiences of Registered Nurses in the context of an acute care setting in Singapore. The findings identified the need for continuous Education in End-of-Life and Palliative Care for Registered Nurses in acute hospitals. There is also a need to have a strong support system to address the physical and mental well-being of all registered nurses caring for the dying in the acute care settings. The findings also suggest there is a need to shift the misconception and continuously educate the family and patients about the principles of palliative care.
The Voice of the Older Person with advanced dementia in residential aged care (RAC): What does it mean for a resident to have their voice in RAC?
(Flinders University, 2018-11-5) Simpson, Julie
The voice of the person with advanced dementia is a significant aspect of how they live their daily life in a residential aged care home. Some studies investigate an aspect of the person's voice such as being embodied, or expressing their storied identity. However, there is a dearth of literature considering the person's own experience of their voice, and their perspectives on having their voice. Moreover, an integrated, multi-dimensional approach to understanding their voice has not been undertaken. This research took place within two memory support houses in two residential aged care homes, with people with advanced dementia becoming active participants. The aims were to explore how these people express their voices; and what are the meanings they give to having their voice. In addition, family and diverse staff members were interviewed about how the person with advanced dementia expresses their voice; and how they seek to promote the voices of people with advanced dementia.
Location monitoring of physical activity and participation in community dwelling older people: a scoping review.
(Flinders University, 2018-11-5) Gough, Claire
Background Community participation and physical activity are important for the health of older adults. This review aimed to identify studies which have measured physical activity and community participation in older adults with Global positioning systems. Methods This scoping review searched key databases using predetermined subject headings and keywords. Two independent reviewers selected studies based on a systematic procedure. The screening process included strict eligibility criteria following current guidelines. Inclusion criteria for studies were: participants aged over 50 years, living independently in the community that reported on physical activity and/or participation inclusive of physical and social activity, and including a quantitative measure of location. All searches were limited to English. The primary review question was: What studies have monitored the location of physical activity in an older population? with secondary enquiries investigating the types of global positioning system devices, barriers and facilitators for activity and community participation. Results The search returned 3536 articles (following duplicate removal) and 42 met the inclusion criteria. Studies from 11 countries published over an 11-year period were included. Participants were mainly healthy (n = 22) followed by having a cognitive impairment (n = 9). There were 13 different global positioning system devices used, assessing a variety of outcomes (n = 17). Fourteen studies identified facilitators and barriers to participation and physical activity in an older population. The most common facilitators were safety, weather and access to multi-purpose facilities. The most common barriers were weather, safety, low income/high deprivation areas and use of motor vehicles. Conclusion This scoping review identified a variety of locational monitoring of older people using global positioning devices.
The impact of the Exceptional Care Education Program: An evaluation using institutional ethnography
(Flinders University, 2018-11-5) Yu, Stephen
Introduction: The Northern Adelaide Local Health Network (NALHN) leadership team is committed to achieving a positive culture of engagement and communication to enhance patient-centred care. Reports of perceived negative staff attitudes, inefficient sharing of information with patients and inadequate treatment have raised concerns about a 'disconnect' between the practices of some healthcare professionals and NALHNs vision of care delivery. These concerns led the NALHN leadership team to request the development of an Exceptional Care Education Program (ECEP) for staff. Aim: The aim of the ECEP was to improve healthcare delivery through reinforcement of the values of NALHN. This study will evaluate the impact of the ECEP on the healthcare professionals, and is funded by NALHN. Methodology: This study uses institutional ethnography (IE). IE seeks to examine the social relations and social organisations from the standpoint of the people within the institution. Through the exploration of the participants' workplace, together with their knowledge of the organisational culture, IE can provide an understanding of how the practices of healthcare professionals are coordinated within the institutional processes. By using IE, this study aims to gather evidence about the impact of the ECEP on: healthcare professionals' understanding of their role; the translation of the program's goals into practice; and the work culture that may influence the behaviour of healthcare professionals in patient care delivery. Methods: Phase 1 includes observation and interviews with healthcare professionals and review of documents informing healthcare delivery; Phase 2 involves interviews with key stakeholders of the ECEP. Implications: The significance of this study will emerge from findings that probe the underlying factors influencing healthcare professionals' delivery of patient care. Findings from this proposed study may inform policy changes and healthcare professionals' work culture.
Exploring the care needs of stroke survivors and family carers in hospital to home transition
(Flinders University, 2018-11-5) Chen, Langduo
Background Hospital to home transition is the most stressful period for stroke survivors and family carers, especially in the context of shortened hospital stay and early discharge. They face enormous challenges to adapt to home care environments for continuing recovery. They also encounter great difficulties in exploring suitable rehabilitation and care services. Studies on determining and meeting their care needs and expectations in this transition period are much needed to enhance consumer-directed transition care. Aim To explore stroke survivors' and family carers' experiences, perspectives and expectations in transition care and rehabilitation. The objectives are: 1. to explore enablers and barriers in transition care from the perspectives of stroke survivors and family carers in a global context; 2. to understand the experience, perceptions and expectations of stroke survivors and family carers during hospital to home transition in an Australian context; 3. to understand healthcare professionals' perspectives of approaches to identify and meet transition care and rehabilitation needs of the consumers; 4. to develop an evidence-informed hospital to home transition care model and pathways to enhance consumer-directed transition care and rehabilitation services. Study plan A two-stage study will be conducted. In Stage 1, a systematic review using meta-synthesis of qualitative studies will be undertaken to address objectives 1 and 4. In Stage 2, a qualitative study informed by Gadamer's phenomenological hermeneutics will be conducted to address objectives 2-4. In-depth interviews with stroke survivors and family carers, and focus groups with healthcare professionals involved in transition care and rehabilitation services will be applied to collect data.
Pupil dilation as a measure of listening effort in hearing science
(Flinders University, 2018-11-5) Baldock, Jennifer
Listening effort' can be defined as the mental exertion required to attend to, and understand, an auditory message. The framework for effortful listening (FUEL) (developed in 2016) describes multiple factors that may affect the amount of listening effort that an individual must expend including: hearing status, motivation, level of fatigue and memory capacity. Recently, there has been a surge in interest around the concept, definition and measurement of listening effort. Excessive listening effortful is frequently reported in audiology clinics. Individuals with hearing impairments typically must expend more effort when listening than normal hearing individuals. This effort is further exacerbated in conditions that are acoustically adverse (e.g. those with background noise) and can result in stress and fatigue. In research settings, measurement of task-evoked pupil dilation provides a powerful tool to measure the listening effort that specific auditory tasks require. Presently, there is no objective measure of listening effort available for clinical use. However, task-evoked pupil dilation has the potential to fill this gap. This presentation will introduce the concept of listening effort, review the history of the measurement of task-evoked pupil dilation and its application to hearing sciences and discuss potential clinical applications.
Quality and cultural safety in burns care for Aboriginal and Torres Strait Islander children
(Flinders University, 2018-11-5) Fraser, Sarah
Burn injury is a significant burden across Australia; especially for Aboriginal children. Gaps concerning quality and cultural safety of existing models of care that prescribe best practice are evident. It is not clear if or how these models of care inform practice, nor what other constructs contribute, and whether these are best for care of Aboriginal children. This study investigates factors informing burn care and explores how clinicians in burn teams use guidance documents and if so whether they are appropriate for care of Aboriginal children. Interface research methodology in a qualitative study design, incorporating both Indigenous and Western biomedical knowledges was used to guide this research. Semi-structured interviews were conducted with individuals in burn teams in six sites across Australia. Interviews were audio recorded and transcribed. Aboriginal and non-Indigenous researchers analysed data. We found burn care in Australia is informed by complex factors including evidence, resources and resourcing, clinician decision making processes and beliefs, and models of care. A Western biomedical health paradigm governs policy for burn care, that participants report is not always aligned with Aboriginal families' concepts of health. Within this paradigm, allocation of resources informs the provision (or not) of care; as does expert information and direction from senior clinicians. Participants reported jurisdictional specific models of burn care developed using service and team experience, population data and other scientific evidence inform care. There is a need for changes in the way evidence informs policy and practice in burn care for Aboriginal children so it incorporates Indigenous constructs of health and wellbeing. Attributing importance to cultural competence with explicit guidance in documents that guide burn care may support service and clinician cultural competence. System resources targeting good burn care for Aboriginal children are required.
An empowerment approach to supporting self-care management skills for people with Type 2 Diabetes Mellitus in Indonesia: Research proposal
(Flinders University, 2018-11-5) Yulia, Yulia
An empowerment approach to supporting self-care management skills for people with Type 2 Diabetes Mellitus in Indonesia: Research proposal. Background: Indonesia currently has 10.3 million people with Type 2 diabetes mellitus (T2DM) making it one of the top ten countries globally, with projections that the number will increase to 16.7 million by 2045. People with T2DM require support to manage their disease. Little is known about how patients with T2DM are supported by health care professionals (HCPs) in Indonesia. Previous studies on patient empowerment interventions have focused on the micro-level of providing patient health education with less involvement of care teams in designing interventions. Objectives: This study aims to explore the existing approaches used in the care of people with T2DM and propose a model of patient care framed by an empowerment approach. Methodology: A two phase single case study strategy will be used. Phase one will explore the existing T2DM care in supporting patients' self-care management skills across three levels of health care services. Data collection will comprise of direct observations of interactions between patients, their families and HCPs, a review of clinical guideline documents and health education programs, and interviews with patients, their families, and HCPs. Thematic data analysis will be conducted at this phase. Results from phase one will inform the phase two development of an alternative model of T2DM care in supporting patients' self-care management skills. Phase two will include focus groups with expert HCPs working with people with T2DM to seek consensus for a newly developed patient empowerment approach. Summary: This presentation will outline this case study proposal in detail

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