HDR Student conference (College of Nursing and Health Sciences)

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https://hdl.handle.net/2328/38440
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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    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.
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    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.
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    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.
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    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.
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    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.
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    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.
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    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.
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    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.
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    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.
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    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.
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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.
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    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.
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    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.
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    Mobile apps supporting healthy family meals: a systematic assessment
    (Flinders University, 2018-11-5) Mauch, Chelsea
    Background: Modern families are facing conflicting demands on their time and resources, which may be at the detriment of child and family diet quality. Mobile apps have the potential to deliver innovative nutrition interventions by providing practical, behavioural support remotely, interactively and in context. This review aimed to identify and assess popular, commercially available mobile apps that offer support for the provision of healthy family food by 1) describing app scope and characteristics, 2) assessing app quality and 3) conducting a behavioural analysis of app content and features. Methods: Searches of commercial app stores between August-November 2017 identified apps addressing the food provision process. Apps were included if they were applicable to parents or families, written in English with a user rating of 4 stars. App quality was assessed using the Mobile App Rating Scale, app content and features were extracted and Behaviour Change Techniques (BCTs) identified. Results: Of 2881 apps screened, 51 (1.8%) were included for assessment, comprising 23 recipe/recipe manager apps, 12 meal planning apps, 10 shopping list apps, four family organizers and two food choice apps. Food choice and family organizer apps scored highest for app quality (mean+SD 3.5+0.6 out of 5), while most apps scored poorly for engagement. App features supporting healthy food provision included meal planners (n=26), shopping lists (n=44) and sharing app content (n=48). Behavioural support features mapped to relatively few BCTs (3.9+1.9 per app). Conclusions: Recipe/recipe manager apps, meal planning apps and family organizers with integrated meal planning and shopping lists, scored well for functionality and incorporated behavioural support features that could be used to address barriers to healthy food provision, although features were focused on planning behaviours. Recommendations: Future apps should prioritize features and content that improve app engagement quality.
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    Evidence of the Complete State Model of Mental Health and Implications on public policy and practice
    (Flinders University, 2018-11-5) Iasiello, Matthew
    The burgeoning economic and societal costs of mental ill-health have necessitated immediate action to reform mental health care in Australia. Current work to reduce the burden of mental illness is largely underpinned by the assumption that mental health and mental illness exist as opposite ends of the same spectrum. However, Keyes' (2005) landmark publication revealed that mental illness and positive mental health (wellbeing) are two separate, correlated, unipolar dimensions. Thus, mental illness and mental health are related concepts, but are not two opposite ends of the same spectrum as was previously thought. This model was named the complete state model of mental health, and posits that an individual has'complete mental health' when they have both a high level of wellbeing and a low level (or no diagnosis) of mental illness. Since Keyes' publication, the model has been investigated through a wide range of approaches, in different contexts, and with various findings and conclusions. A systematic scoping review was performed to amalgamate and synthesise the research on the complete state model, aiming to examine the evidence of the model's validity, and to pragmatically summarise the implications of the model. Results of this scoping review will be presented, with a key focus on the quality of extant literature on the model, and a practical summary of the implications for policy makers and practitioners. By transforming our understanding of the relationship between mental health and mental illness, the complete state model could underpin significant mental health reform in the future.
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    Hypertension management for community dwelling older people with diabetes in Nanchang, China: a cluster randomised controlled trial
    (Flinders University, 2018-11-5) Tu, Qiang
    Background Although China has a large number of older people living with diabetes and hypertension, the primary care system is underdeveloped and so management of these conditions in community care settings is suboptimal. Methods A cluster randomized controlled trial was conducted to randomly allocate 10 wards from four hospitals in Nanchang to either an intervention group (N=5) or a usual care group (N=5). In total, 270 patients were recruited in the study. The intervention included individualized self-care education and medication management prior to discharge and in the 6-month follow-up in community health service centres. A multilevel mixed-effect linear regression model was applied to compare the changes in health outcomes between the intervention and usual care groups. Results The intervention group demonstrated a statistically significant decrease of a mean systolic blood pressure of 10.7 mm Hg (95%CI: -14.2 to -7.1, P<0.001) and a mean diastolic blood pressure of 4.1 mm Hg (95% CI: -6.2 to -2.0, P<0.001) over 6 months as compared to the usual care group. Findings also demonstrated significant improvements of HbA1c, hypertension knowledge, diabetes knowledge, treatment adherence, quality of life, the prevention of adverse events and hospital readmission at 6 months in the intervention group compared to the usual care group. Conclusion A hypertension management program that targeted individualized self-care and medication management improved hypertension control for older people with diabetes in the community care setting.
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    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.
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    Goal setting with older adults: Client and staff experiences in Transition Care Program
    (Flinders University, 2018-11-5) Baker, Nicky
    Goals are a fundamental component of health care and promote person-centred practice by encouraging collaborative discussions and shared decision making. Transition Care Program (TCP) is a federally funded, goal-orientated, therapy-focussed program that provides additional time after an acute health event for older adults to improve functional ability and decide on final discharge destination. This research investigated the client and staff experiences of goals in TCP through interviews and focus groups. Through thematic analysis, clear intrinsic and extrinsic facilitators were identified, including the visceral pull of 'home' and the effectiveness of explicit, consistent goal language. Client-related barriers emerged, such as the physical, cognitive and emotional effects of fatigue. These were compounded by service barriers. This research provides opportunity to improve person-centred care for older adults by integrating consistent language, addressing service barriers in clinical practice and incorporating client goals into the service KPIs.
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    Thanatology: Theories on death, dying and end-of-life care
    (Flinders University, 2018-11-5) Adesina, Tomi
    During the middle ages, death and life were considered to coexist. Death evoked no great fear or awe since it was familiar, unhidden and inevitable. Over the centuries, with the growth of religion, there occurred a change in the attitude towards death to one of fear and also fascination. In the nineteenth century, as science increasingly gained ground in western industrial societies, death was no longer viewed as a part of life, but rather a break with life. Death was equated with uncertainty and disorder. In keeping with the scientific view of the time, the solution to the disorder of death and dying was perceived as a need for control. In achieving control, death and dying increasingly became medicalised and hence, an increase in presentations to emergency departments. Today, a significant number of people either die in emergency departments or are dead on arrival. Despite the significant amount of contact with dying patients, accepting death and the provision of quality end of life care within the emergency department remains difficult because of the focus on medical treatment, resuscitation and interventions. This presentation will focus on the history and principles of palliative care, and theories on death and dying. This theoretical knowledge will underpin the research into nurses and doctors' perspectives of death and dying in emergency departments.
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    The use of complementary and alternative medicine for breast cancer management in Asian countries
    (Flinders University, 2018-11-5) Christina, Juliana
    Complementary and Alternative Medicine (CAM) is a group of non-pharmacological therapies that are used together with or might be used in place of conventional oncology treatment. CAM usage is very common among women with breast cancer in Asian countries. However, studies investigating women experiences in the use of CAM for breast cancer management are limited. An integrative literature review of the literature was conducted to explore the use of CAM for breast cancer management in Asian countries. The included studies were assessed for trustworthiness, value and relevance using the Joanna Briggs Institute critical appraisal tools. The findings from the reviewed studies were synthesised using thematic analysis method. Thirty four articles from 12 Asian countries met the inclusion criteria. The main categories were the prevalence and reasons of using CAM, factors related to the use of CAM, types of CAM used and 'the information sources'. Women in Asian countries use CAM as an adjunct therapy to support medical care. CAM also has been utilised in Asian countries as a main therapy to treat breast cancer. Age, education, income and the cancer stages were found to be associated with this usage. Further research is required to explore women's subjective experience, knowledge, and attitudes regarding their use of CAM for breast cancer treatment as well as the perspectives of those providing CAM, as the perspectives have not been explored in Indonesia. This presentation will discuss the integrative literature review in detail.