Deborah is the Professor of Aged Care (Dementia) in the Faculty of Health. She has received over $35 million in research funding. Her primary areas of research are palliative care for older people, dementia and health services evaluation in aged care. Deborah was a co-investigator on the development of the Abbey Pain Scale, the most widely used pain scale for people with dementia. She was the lead investigator on the Palliative Approach Toolkit - an evidence based knowledge translation product that has been provided to every residential aged care facility in Australia.
Deborah is President Elect of Palliative Care NSW, Board Director of Carrington Care, Board Director Leigh Place. Deborah is an active member of professional organisations - The Australian Association of Gerontology, Chair of the Palliative Care Nurses Australia Aged Care Special Interest Group, Co-Chair of the Workforce and Education Age and Ageing Clinical Academic Group (SPHERE) and National Policy Chair of Healthy Ageing for the Australian College of Nursing.
Australian Association of Gerontology
Palliative Care NSW
Australian College of Nursing
Can supervise: YES
Moyle, W, Parker, D & Bramble, M 2014, Care of Older Adults A Strengths-based Approach, Cambridge University Press.
By taking a strengths-based approach, this book encourages nursing practice with a focus on individuals' potential and capacities rather than their limits.
Miller-Lewis, L, Tieman, J, Rawlings, D, Parker, D & Sanderson, C 2019, 'Can Exposure to Online Conversations About Death and Dying Influence Death Competence? An Exploratory Study Within an Australian Massive Open Online Course', OMEGA - Journal of Death and Dying.View/Download from: UTS OPUS or Publisher's site
© 2018, The Author(s) 2018. A Massive Open Online Course, Dying2Learn, was designed to foster community death conversations and strengthen community awareness of palliative care and death as a normal process. This exploratory study used a pre–post prospective design to determine if participation in Dying2Learn and exposure to online conversations about death and dying resulted in any significant influence on death competence in 134 participants who completed the Coping-with-Death-Scale both at the beginning and end of the course in 2016. Death competence refers to a range of attitudes and capabilities people have for dealing with death. Results at the end of the course indicated that engagement in Dying2Learn led to significant improvements in death competence scores over time (medium-to-large effect size). The positive impact was greater for those who completed more of the course, and effectiveness did not depend on sociodemographic characteristics. In conclusion, this study found that an online learning platform in the form of a Massive Open Online Course could engage community members in meaningful social discussion about death and dying, and that exposure to these conversations was beneficial for all participants regardless of previous exposure to death. Further exploration is required to determine whether this change in death competence will have an impact on participant's behavior in the community regarding death conversations and preparedness.
Miller-Lewis, L, Tieman, J, Rawlings, D, Sanderson, C & Parker, D 2019, 'Correlates of perceived death competence: What role does meaning-in-life and quality-of-life play?', Palliative and Supportive Care.View/Download from: Publisher's site
© Cambridge University Press 2019. ObjectiveUnderstanding factors that are associated with more adaptive death attitudes and competencies can inspire future health-promoting palliative care strategies and inform approaches to training and development for health professionals. The potential importance of meaning, purpose, quality, and values in life for promoting adaptive death attitudes has been highlighted, but there is limited research in this area, particularly in relation to death competence. The purpose of this cross-sectional study was to develop an understanding of demographic and life-related factors associated with perceived death competence, such as meaning in life and quality of life.MethodDuring the course enrollment period of a Massive-Online-Open-Course about death and dying, 277 participants completed questionnaires on death competence, meaning in life, quality of life, and sociodemographic background.ResultFindings indicated that greater presence of meaning in life, quality of life, age, death experience, and carer experience were each statistically significant unique predictors of death competence scores. Life-related variables were more strongly associated with death competence than demographic variables. Bereavement experience and experience caring for the dying was associated with greater death competence, but there were no differences on death competence between health professionals and the general community. Above all other factors, the presence of meaning in life was the strongest predictor of higher perceived competence in coping with death.Significance of resultsThe findings demonstrate important interconnections between our attitudes about life and death. Knowledge of factors associated with poorer death competence may help identify those at risk of greater distress when facing death, and might prove useful additions to bereavement risk assessments. Understanding factors associated with greater death competence in health professionals an...
Durepos, P, Kaasalainen, S, Sussman, T, Parker, D, Brazil, K, Mintzberg, S & Te, A 2018, 'Family care conferences in long-term care: Exploring content and processes in end-of-life communication', Palliative and Supportive Care, vol. 16, no. 5, pp. 590-601.View/Download from: UTS OPUS or Publisher's site
Copyright © Cambridge University Press 2017 Objective:: End-of-life (EoL) communication in long-term care (LTC) homes is often inadequate and delayed, leaving residents dying with unknown preferences or goals of care. Poor communication with staff contributes to families feeling unprepared, distressed, and dissatisfied with care. Family care conferences (FCCs) aim to increase structured systematic communication around goals and plans for the end of life. As part of the Strengthening a Palliative Approach to Care (SPA–LTC) project, FCCs were implemented in four LTC sites in Ontario, Canada. The purpose of this substudy was to examine FCC content and such guiding processes as documentation and multidisciplinary staff participation. Method:: A total of 24 FCCs were held for residents with a Palliative Performance Scale score of 40% (nearing death). Data were collected from conference forms (i.e., Family Questionnaires, Care Plan Conference Summaries), site-specific electronic chart documents, and fieldnotes. Directed content analysis of data was informed by the Canadian Hospice Palliative Care Association's Square of Care Model, which describes eight domains of care: disease management, physical, psychological, social, practical, spiritual, EoL, and loss/bereavement. Results:: The FCCs addressed an average of 71% of the content domains, with physical and EoL care addressed most frequently and loss/bereavement addressed the least. Two goals and five interventions were documented and planned on average per FCC. Examination of the processes supporting EoL communication found: (1) advantages to using FCC forms versus electronic charts; and (2) high levels of multidisciplinary participation overall but limited participation of personal support workers (PSWs) and physicians. Significance of Results:: Communication around the end of life in LTC can be supported through the use of FCCs. Description of content and FCC processes provides guidance to persons implementing FCCs....
Nunan, S, Brown Wilson, C, Henwood, T & Parker, D 2018, 'Fall risk assessment tools for use among older adults in long-term care settings: A systematic review of the literature', Australasian Journal on Ageing, vol. 37, no. 1, pp. 23-33.View/Download from: Publisher's site
© 2017 AJA Inc. Objective: To conduct a systematic review of published fall risk assessment tools (FRATs) tested for predictive validity among older adults in long-term care (LTC). Methods: A systematic search was conducted using five databases. Only studies reporting on sensitivity and specificity values, conducted in LTC on populations primarily aged over 60 years, were considered. Results: Fifteen papers were included and three different categories of FRATs emerged: multifactorial assessment tools, functional mobility assessments and algorithms. Several FRATs showed moderate-to-good predictive validity and reliability, with the Modified Fall Assessment Tool and the Peninsula Health Falls Risk Assessment Tool (PHFRAT) also demonstrating good feasibility. Conclusion: Evidence for the best choice of FRAT for use in LTC remains limited. Further research is warranted for the PHFRAT, recommended for use in LTC by best practice guidelines, before its establishment as the tool of choice for these clinical settings.
Tieman, J, Miller-Lewis, L, Rawlings, D, Parker, D & Sanderson, C 2018, 'The contribution of a MOOC to community discussions around death and dying.', BMC palliative care, vol. 17, no. 1, p. 31.View/Download from: UTS OPUS or Publisher's site
BACKGROUNDAdvances in medicine have helped many to live longer lives and to be able to meet health challenges. However death rates are anticipated to increase given the ageing population and chronic disease progression. Being able to talk about death is seen to be important in normalising death as part of life and supporting preparedness for death. Massive Open Online Courses (MOOCs) provide opportunities for the community to engage in collaborative learning. A 5 week MOOC was developed covering four main topics (language and humour, representations of death, medicalisation of dying, and digital dying) aiming: To enable participants to openly and supportively discuss and learn about issues around living, death and dying, To explore the normally unheard opinions and views of Australians around death and dying, and To determine what effect online learning and discussions offered through the MOOC had on participants' feelings and attitudes towards death and dying.METHODSData was captured on engagement rates in the various MOOC activities. Death Attitudes were measured by five items representing the MOOC's learning objectives and completed at enrolment and conclusion. MOOC Satisfaction was measured with six items at the end of the MOOC. Descriptive statistics were produced for each variable and Chi-Square Tests of Independence assessed the extent of the relationship between categorical variables. Socio-demographic variables were examined as predictors of the outcome variables of MOOC engagement, MOOC satisfaction, and death attitudes. Ethical approval was received from Flinders University Social and Behavioural Research Ethics Committee (Project No. 7247).RESULTSOne thousand one hundred fifty six people enrolled in the Dying2Learn MOOC with 895 participating in some way. Enrolees were primarily female (92.1%). Age ranged from 16 to 84 (mean=49.5, SD=12.3). MOOC satisfaction scores were high. Responses to the experience...
Older people living in residential aged care often experience complex persistent pain because of the presence of multiple comorbidities and geriatric syndrome. Complex persistent pain is associated with physical, psychological and emotional burdens. All of these factors can result in existential suffering. Current pain management in aged care is targeted at passive strategies. More consideration needs to be given to how assessment and management of pain in this population can be improved, using a biopsychosocial model, to decrease unnecessary suffering.
Xu, X, Parker, D, Shi, Z, Byles, J, Hall, J & Hickman, L 2018, 'Dietary Pattern, Hypertension and Cognitive Function in an Older Population: 10-Year Longitudinal Survey', Frontiers in Public Health, vol. 6, no. 201, pp. 1-13.View/Download from: UTS OPUS or Publisher's site
Background: There is a paucity of studies that have explored the association between dietary pattern and cognitive function, and whether there is an interaction between dietary pattern and hypertension in relation to older people's cognitive functioning.
Methods: We analyzed data from the China Health and Nutrition (CHNS) survey. Dietary data have been collected since 1991, and cognitive function interview data were collected between 1997 and 2006. We analyzed ten years of data, including 4,847 participants with 10,658 observations (aged 55 years). Exploratory factor analysis was used to identify dietary patterns. Cognitive function measures include cognitive global scores and verbal memory scores. Linear mixed models were used to investigate the association between dietary patterns, hypertension and cognitive function.
Results: Three dietary patterns were identified by factor analysis, named 'Traditional Chinese,' 'Protein-rich,' and 'Starch-rich' dietary pattern. A Protein-rich dietary pattern (high intake of milk, eggs and soymilk) was significantly associated with higher cognitive global scores and verbal memory scores, while the starch-rich dietary pattern (high intake of salted vegetable and legumes) was significantly associated with lower cognitive global and verbal memory scores. In addition, we found that participants with hypertension were independently associated with significant low cognitive function.
Conclusion: The study reinforces the importance of diet in preventing cognitive decline among the older population. Identification of older populations who had hypertension should be targeted in intervention studies to maintain their cognitive health.
Meller, N, Parker, D, Hatcher, D & Sheehan, A 2018, 'Grief experiences of nurses after the death of an adult patient in an acute hospital setting: An integrative review of literature', Collegian.View/Download from: UTS OPUS or Publisher's site
© 2018 Australian College of Nursing Ltd Objective: This integrative review explores current published literature examining grief experiences of nurses who work in hospital settings after the death of a patient in their care and the factors that may impact nurses experiencing grief within the workplace. Background: Healthcare workers such as nurses are required to be competent, skilled and resilient in preparation for the emotional variables and professional responsibilities when managing a patient death. There are publications exploring nurse's grief experiences in palliative care, paediatric nursing or oncology settings, but to date, there is limited relevant literature identifying or exploring grief experiences of nurses working in other speciality areas in a hospital setting after the death of a patient in their care. Methods: Comprehensive online database searches of CINAHL, EBSCO Host, PubMED, MEDLINE, Scopus, Joanna Briggs Institute (JBI) and Google Scholar was undertaken using key terms of articles published between 1990–2017. Screening of 317 articles resulted in 5 included for this review. Data analysis was guided by Whittemore and Knafl's five stage process. Findings: Three main themes were identified were 'the impact of formative death events in clinical practice' 'managing personal grief reactions and the factors that influenced these reactions' and 'the significance of colleague support when experiencing a patient death'. Conclusion: Personal grief responses displayed by a nurse after a patient has died can have both a positive and negative influence on their professional behaviour in the workplace. It also has the potential for grief complications for individual nurses, which highlights the importance of workplace support for nurses when making clinical decisions after the death of a patient.
Yang, L, Jiang, Y, Xu, S, Bao, L, Parker, D, Xu, X & Li, J 2018, 'Evaluation of frailty status among older people living in urban communities by Edmonton Frail Scale in Wuhu, China: a cross-sectional study.', Contemporary nurse, vol. 54, no. 6, pp. 630-639.View/Download from: Publisher's site
BACKGROUND:Few studies have explored the factors that are associated with frailty among older people. OBJECTIVE:To investigate the frailty status and examine the sociodemographic factors that are associated with of older peoples' frailty status in China. DESIGN:Cross-sectional study. METHODS:We used convenience sampling to recruit the participants (aged 60 and above) from four communities in an urban area of Wuhu, Anhui, China. Participants completed a questionnaire which included the Edmonton Frail Scale (EFS) and sociodemographic factorsWe used convenience sampling to recruit the participants (aged 60 and above) from four communities in an urban area of Wuhu, Anhui, China. Participants completed a questionnaire which included the Edmonton Frail Scale (EFS) and sociodemographic factors. RESULTS:Of 306 participants, the percentage of participants with a robust score (0-4) on the EFS was 71.9%, 14.1% had an apparently vulnerable score (5-6), and 14.0% had a frail score (7-17). Age, chronic disease status and marital status were significantly associated with frailty. CONCLUSIONS:There are a high percentage of frail older Chinese adults in the urban area. The present study findings could provide better understanding of the factors associated with frailty status of this population.
Burston, A, Eley, R, Parker, D & Tuckett, A 2017, 'Validation of an instrument to measure moral distress within the Australian residential and community care environments', International Journal of Older People Nursing, vol. 12, no. 2.View/Download from: UTS OPUS or Publisher's site
© 2016 John Wiley & Sons Ltd Aim and objectives: The aim of this study was to gain insight into the experience of moral distress within the aged care workforce. The objective of this study was to use and validate an existing instrument to measure moral distress within the aged care setting. Background: Moral distress, a phenomenon associated with worker satisfaction and retention, is common within nursing. Instruments to measure moral distress exist; however, there are no validated instruments to measure moral distress within an aged care setting. Design and method: An existing instrument, the Moral Distress Scale (Revised) was identified and amended. Amendments were subject to expert review for face and content validity. Data were collected from aged care nurses working in residential and community aged care, in Australia. Reliability was assessed using Cronbach's alpha with exploratory factor analysis undertaken for construct validity. Results: 106 participants completed the survey, 93 (87.7%) identified as female and 13 (12.3%) male. Participants ranged in age from 21 to 73 years, with a mean time working in nursing of 20.6 years. The frequency component of the instrument demonstrated an alpha of 0.89, the intensity component 0.95 and the instrument as a whole 0.94. Three factors were identified and labelled as: Quality of Care, Capacity of Team and Professional Practice. Mean scores indicate a low occurrence of moral distress, but this distress, when experienced, was felt with a moderate level of intensity. Primary causes of moral distress were insufficient staff competency levels, poor quality care because of poor communication and delays in implementing palliation. Conclusion: The instrument demonstrates validity and reliability within the Australian aged care setting. Further analysis with larger populations is required to support these findings. Implications for practice: Australian aged care workers do experience moral distress. They suffer adverse con...
Practicing within a moral framework is expected professionally and framed within documents such as the Code of Ethics for Nurses in Australia (Nursing & Midwifery Board of Australia, 2013a) and Code of Professional Conduct for Nurses in Australia (Nursing & Midwifery Board of Australia, 2013b). The challenge is for the profession to embrace our role as moral agents, actively educate staff and provide forums for multi-disciplinary teams to discuss and debate ethical challenges in practice.
Rawlings, D, Miller-Lewis, L, Collien, D, Tieman, J, Parker, D & Sanderson, C 2017, 'Lessons Learned from the Dying2Learn MOOC: Pedagogy, Platforms and Partnerships', Education Sciences, vol. 7, no. 3, pp. 1-10.View/Download from: UTS OPUS or Publisher's site
(1) Background: Massive Open Online Courses (MOOCs) are becoming more commonplace in the delivery of free online education and a Dying2Learn MOOC was offered by a team at Palliative and Supportive Services, Flinders University, South Australia; (2) Methods: Working with the OpenLearning platform developer, a research study and MOOC evaluation were embedded in the course, and content was delivered in innovative ways without compromising pedagogical approaches; (3) Results: This MOOC provided the facilitators with the opportunity to view education as an intervention, with testing undertaken, including measuring attitudinal change. Research, clinical and community partnerships were developed or reaffirmed and the value of ongoing partnerships with developers in creating platforms and tools that can expand the options for online learning is highlighted. Opportunities for future health professional and consumer education were also explored; (4) Conclusion: MOOCs can provide innovative opportunities to redesign educational approaches, which can be achieved by working with new technologies and with platform developers, while still adhering to pedagogical principles.
Rawlings, D, Tieman, JJ, Sanderson, C, Parker, D & Miller-Lewis, L 2017, 'Never say die: death euphemisms, misunderstandings and their implications for practice', International Journal of Palliative Nursing, vol. 23, no. 7, pp. 112-118.View/Download from: UTS OPUS or Publisher's site
A Massive Open Online Course (MOOC) on death and dying was conducted to open the dialogue around
death and dying. In one activity, participants were asked to engage with language and to think of alternative words (or
euphemisms) that are used to describe death. Aim: To reflect from a nursing perspective how language enables and sometimes
disguises important messages and conversations. Methods: Four hundred and seventy one participants provided 3053
euphemisms. Findings: Euphemisms were varied, with many providing commentary on their purpose and use. Discussion: As
a society we have become quite creative in the use of euphemisms, but need to be mindful of misunderstandings and
misinterpretations which can cause embarrassment and distress in clinical situations. Conclusion: This paper describes some
of the euphemisms that were provided, examining why they are used and how their use can be easily misconstrued in daily life
and in clinical practice.
Kaasalainen, S, Sussman, T, Bui, M, Akhtar-Danesh, N, Laporte, RD, McCleary, L, Wickson Griffiths, A, Brazil, K, Parker, D, Dal Bello-Haas, V, Papaioannou, A & O Leary, J 2017, 'What are the differences among occupational groups related to their palliative care-specific educational needs and intensity of interprofessional collaboration in long-term care homes?', BMC Palliative Care, vol. 16, no. 1, pp. 1-8.View/Download from: UTS OPUS or Publisher's site
© 2017 The Author(s). Background: The purpose of this study was to compare the differences across occupational groups related to their end-of-life care-specific educational needs and reported intensity of interprofessional collaboration in long-term care (LTC) homes. Methods: A cross-sectional survey, based on two questionnaires, was administered at four LTC homes in Ontario, Canada using a modified Dilman's approach. The first questionnaire, End of Life Professional Caregiver Survey, included three domains: patients and family-centered communication, cultural and ethical values, effective care delivery. The Intensity of Interprofessional Collaboration Scale included two subscales: care sharing activities, and interprofessional coordination. In total, 697 LTC staff were given surveys, including personal support workers, support staff (housekeeping, kitchen, recreation, laundry, dietician aids, office staff), and registered staff (licensed nurses, physiotherapists, social workers, pharmacists, physicians). Results: A total of 317 participants completed the survey (126 personal support workers, 109 support staff, 82 registered staff) for a response rate of 45%. Significant differences emerged among occupational groups across all scales and subscales. Specifically, support staff rated their comfort of working with dying patients significantly lower than both nurses and PSWs. Support staff also reported significantly lower ratings of care sharing activities and interprofessional coordination compared to both registered staff and personal support workers. Conclusions: These study findings suggest there are differing educational needs and sense of interprofessional collaboration among LTC staff, specific to discipline group. Both the personal support workers and support staff groups appeared to have higher needs for education; support staff also reported higher needs related to integration on the interdisciplinary team. Efforts to build capacity within support staff re...
Parker, D, Maresco-Pennisi, D, Clifton, K, Shams, R & Young, J 2016, 'Practice nurse involvement in the management of adults with type 2 diabetes mellitus attending a general practice: results from a systematic review.', International journal of evidence-based healthcare, vol. 14, no. 2, pp. 41-52.View/Download from: UTS OPUS or Publisher's site
Using the methodology of the Joanna Briggs Institute, a systematic review of current research was performed to determine if the addition of management by nurses had been more effective in improving clinical outcomes of patients with type 2 diabetes attending a general practice compared with standard care.A three-step literature search was conducted for suitable English studies with quantitative clinical outcomes that had been published from January 1990 to May 2014. Randomised controlled trials (RCTs) were particularly sought after; however, other research designs were considered. Articles were assessed by two independent reviewers for methodological validity, prior to inclusion in the review, using standardised critical appraisal instruments from the Joanna Briggs Institute. When possible, quantitative data were pooled in statistical meta-analysis.Seven studies were of suitable quality and relevance for the review: these included three randomised control trials; two cluster- RCTs; a cluster, nonrandomised, controlled before-after study; and a cluster observational cohort study. These studies yield evidence that nurse management in addition to standard general practitioner care leads to modest improvements in blood pressure and total cholesterol levels in adults with type 2 diabetes attending a general practice.Meta-analysis identified modest, significant improvements amongst participants in nurse management interventions (NMIs) in the following clinical outcomes: mean SBP, mean DBP and mean total cholesterol. The majority of outcomes studied did not show any advantage to adding NMIs to general practitioner care. Two studies reported significant improvements of participants with poor control in mean haemoglobin A1c. An RCT that investigates the effect of NMIs on patients, with poor control in regard to clinical outcomes and cost effectiveness, is recommended.
Petriwskyj, A, Parker, D, Brown Wilson, C & Gibson, A 2016, 'What Health and Aged Care Culture Change Models Mean for Residents and Their Families: A Systematic Review.', The Gerontologist, vol. 56, no. 2, pp. e12-e20.View/Download from: UTS OPUS or Publisher's site
A range of commercialized programs are increasingly being adopted which involve broad culture change within care organizations to implement person-centered care. These claim a range of benefits for clients; however, the published evidence for client and family outcomes from culture change is inconclusive and the evidence for these specific models is difficult to identify. The purpose of this review was to identify and evaluate the peer-reviewed evidence regarding consumer outcomes for these subscription-based models.The review followed the Joanna Briggs Institute procedure. The review considered peer-reviewed literature that reported on studies conducted with health and aged care services, their staff, and consumers, addressed subscription-based person-centered culture change models, and were published in English up to and including 2015. The review identified 19 articles of sufficient quality that reported evidence relating to consumer outcomes and experience.Resident outcomes and family and resident satisfaction and experiences were mixed. Findings suggest potential benefits for some outcomes, particularly related to quality of life and psychiatric symptoms, staff engagement, and functional ability. Although residents and families identified some improvements in residents' lives, both also identified problematic aspects of the change related to staff adjustment and staff time.Outcomes for these models are at best comparable with traditional care with limited suggestions that they result in poorer outcomes and sufficient potential for benefits to warrant further investigation. Although these models may have the potential to benefit residents, the implementation of person-centered principles may affect the outcomes.
Khalil, H, Peters, M, Godfrey, CM, McInerney, P, Soares, CB & Parker, D 2016, 'An Evidence-Based Approach to Scoping Reviews.', Worldviews on evidence-based nursing, vol. 13, no. 2, pp. 118-123.View/Download from: UTS OPUS or Publisher's site
Scoping reviews are used to assess the extent of a body of literature on a particular topic, and often to ensure that further research in that area is a beneficial addition to world knowledge. The aim of this paper reports upon the development of a methodology for scoping reviews based upon the Arksey and O'Malley framework, the Levac, Colquhoun, and O'Brien, and the Joanna Briggs Institute methods of evidence synthesis.A working group consisting of members of the Joanna Briggs collaborating organizations met to discuss the proposed framework for the methodology and develop a draft for the scoping review methodology based on the Arksey and O'Malley framework and the work of Levac et al. This was followed by a workshop attended by other members of the organizations consisting of 30 international researchers to discuss the proposed methodology. Further refinement of the methodology was undertaken as a result of the feedback received from the workshop.The development of the methodology focused on five stages of the protocol and review development. These were identifying the research question by clarifying and linking the purpose and research question, identifying the relevant studies using a three-step literature search in order to balance feasibility with breadth and comprehensiveness, careful selection of the studies to using a team approach, charting the data and collating the results to identify the implications of the study findings for policy, practice, or research.The current methodology recommends including both quantitative and qualitative research, as well as evidence from economic and expert opinion sources to answer questions of effectiveness, appropriateness, meaningfulness and feasibility of health practices and delivery methods. The proposed framework has the potential to provide options when faced with complex concepts or broad research questions.
Parker, D, Clifton, K, Tuckett, A, Walker, H, Reymond, E, Prior, T, McAnelly, K, Jenkin, P, Israel, F, Greeve, K & Glaetzer, K 2016, 'Palliative care case conferences in long-term care: views of family members.', International journal of older people nursing, vol. 11, no. 2, pp. 140-148.View/Download from: UTS OPUS or Publisher's site
This paper examines the use of structured Palliative Care Case Conferences in long-term care. The issues families bring to the Palliative Care Case Conference, their level of distress prior to the conference, the extent to which these issues are addressed by staff and family satisfaction with this process are described.In most developed countries, up to 30% of older people die in long-term care. A palliative approach generally refers to the resident and family as the 'unit of care'. Interventions, which include family in palliative care, are required in this setting.Descriptive and thematic results from the intervention arm of a pre-post, sequential mixed method study.Examination of documents of 32 resident/family dyads participating in a Palliative Care Case Conference, and interviews with the residents' family postintervention.Main concerns raised by family members prior to a Palliative Care Case Conference were physical and medical needs, pain, end-of-life care planning and nutrition and hydration. Families rated a high level of concern, 7.5 on a 10-point rating scale, prior to the Palliative Care Case Conference. A formalised Palliative Care Case Conference process ensured issues relating to end-of-life care planning, pastoral care, pain and comfort and physical and medical needs were well documented by staff. Issues relating to care processes and the family role in care were less well documented. All families, interviewed postintervention, recommended Palliative Care Case Conferences; and over 90% of families felt their issues were addressed to their satisfaction. Families also reported an increased understanding of the resident's current and future care.The Palliative Care Case Conference in long-term care provides an important platform for family to voice concerns. Palliative Care Case Conference documentation indicates that staff are attending to these issues, although more reference to concerns relating to care processes and the family role could be made...
Petriwskyj, A, Parker, D, Brown Wilson, C & Gibson, A 2016, 'Evaluation of Subscription-based Culture Change Models in Care Settings: Findings From a Systematic Review.', The Gerontologist, vol. 56, no. 4, pp. e46-e62.View/Download from: UTS OPUS or Publisher's site
Person-centered culture change models to which aged care service providers subscribe are gaining increasing traction. It has been suggested that culture change initiatives broadly are subject to a range of issues. It is difficult, however, to draw out from the existing literature specific information about the scope and quality of evidence regarding subscription-based approaches. The purpose of this study was to identify and review the peer-reviewed literature regarding these subscription-based models.The review used the Joanna Briggs Institute process and tools. Studies reporting on subscription-based person-centered culture change models in health and aged care, published in peer-reviewed literature in English up to and including 2015 were identified and assessed. In all, 28 articles reporting on 33 studies were included in the review.There was no single model for which a significant body of evidence was identified, and approaches to outcomes were fragmented. Research approaches varied. Rigor and reporting were of concern; however, strengths of the evidence base included generally adequate sample sizes and the use of multiple methods including large data sets and standardized scales.Despite their structured approaches, research and evaluation for subscription-based models are limited, ad hoc, and fragmented. A more comprehensive program of research that is embedded in the implementation process is needed. Recommendations include use of longitudinal study designs, attention to implementation and contextual factors, and measurement of both process and outcomes across the full range of culture change domains.
Reymond, L, Cooper, K, Parker, D & Chapman, M 2016, 'End-of-life care: Proactive clinical managment of older Australians in the community', Australian Family Physician, vol. 45, no. 1-2, pp. 76-78.View/Download from: UTS OPUS
Due to the changing demographics of ageing and death in Australia, general practitioners (GPs) are caring for greater numbers of people with advanced chronic conditions that will soon lead to death. GPs play a pivotal role in proactively preparing these people for end of life.
This article introduces GPs to a framework of care, based on a palliative care approach, which supports proactive management of end-of-life care for older Australians living in the community.
Embedding the above framework into routine practice can help GPs deliver care, aligned with patients' preferences, at the right time and in the right place. Experience has shown that implementing proactive management of end-of-life care can increase satisfaction with GP care and help GPs meet the clinical, legal and ethical challenges associated with caring for older patients with advanced progressive conditions.
Burston, A, Eley, R, Parker, D & Tuckett, A 2016, 'MORAL DISTRESS.', Australian nursing & midwifery journal, vol. 24, no. 6, p. 24.
Australia has an ageing nursing workforce with many nurses due to retire (Health Workforce Australia, 2014). Coupled with increasing service demands, the need for workers will outstrip the supply (CEPAR - ARC Centre of Excellence in Population Ageing Research, 2014).
Petriwskyj, A, Parker, D, O'Dwyer, S, Moyle, W & Nucifora, N 2016, 'Interventions to build resilience in family caregivers of people living with dementia: a comprehensive systematic review.', JBI database of systematic reviews and implementation reports, vol. 14, no. 6, pp. 238-273.View/Download from: Publisher's site
Recent studies have indicated that family caregivers of people with dementia have higher rates of depression, anxiety and hopelessness, as well as higher levels of burden, stress and distress. Not all caregivers, however, succumb to the negative effects of caring. Caregivers who are able to recover from, resist or adapt to the physical and psychological demands of caring can be considered "resilient".The objective of this review was to examine the existing evidence regarding interventions for building resilience in family caregivers of people living with dementia.This review considered studies that included family caregivers of people with dementia.Studies investigating interventions to build resilience in family caregivers were considered by the review. For qualitative studies, the phenomena of interest were family caregivers' experiences of the interventions including factors affecting implementation and their subjective experience of outcomes.Studies conducted in any cultural or geographical context and any settings including participants' homes in the community, residential aged care or hospital, medical or allied health practice were considered for inclusion.Quantitative studies incorporating experimental and descriptive study designs and qualitative studies, including, but not limited to, phenomenology, grounded theory, ethnography, action research and feminist research were considered for inclusion.Quantitative studies were included that contained either objective or subjective outcome measures (or a combination of both). In cases in which proxy measures of resilience were used, only those papers that explicitly related the aims of the intervention and the measurement of outcomes to resilience itself were considered for inclusion. Proxies could include, but were not limited to, self-efficacy, locus of control, perceived burden, psychological wellbeing, strength, coping, positive adjustment and resourcefulness. Qualitative studies were similarly considered ...
Tuckett, AG, Hodgkinson, B, Rouillon, L, Balil-Lozoya, T & Parker, D 2015, 'What carers and family said about music therapy on behaviours of older people with dementia in residential aged care.', International journal of older people nursing, vol. 10, no. 2, pp. 146-157.View/Download from: UTS OPUS or Publisher's site
This study sought to evaluate the effectiveness of group music therapy (MT) intervention on behaviours of older people with dementia.Reported here are qualitative data from five, semi-structured focus groups; two comprising a total of seven family members and three comprising a total of 23 staff members.A number of core themes emerged: temporality, effect and policy with a number of subthemes. The MT effect is tempered by the temporality of (i) the older person's dementia state, (ii) the session and (iii) the psychosomatic effect on the older person. Music therapy is perceived to (i) evoke memories and facilitate reminiscence, (ii) act as a diversion (has an instrumental value) and it is contentious to discount the (iii) dichotomy between music and therapist in terms of the overall effect. Finally, policymakers need to know that MT is (i) highly prized and more, not less, MT is recommended.Findings from this study illustrate that the timing of the MT session has consequences for the workflow in the residential aged care facility; MT has a psychosomatic effect and participants here evaluate this as temporal. Care providers and family members acknowledge the instrumental value of MT and its helping with cognition and exercise. They have mixed views about the effects of the music and the effect on the older person by the therapist but most definitely want policymakers to ensure more, not less, planned and better funded MT is part of ongoing care in the residential aged care context. Areas for future research and policy are also highlighted.These views on group MT in residential aged care can initiate critical reflection on current practices and systems. Research is needed exploring the timing and scheduling of MT sessions at different times in the day for older person with dementia exhibiting negative behaviours.
Tuckett, A, Parker, D, Clifton, K, Walker, H, Reymond, E, Prior, T, Jenkin, P, Israel, F, Greeve, K & Glaetzer, K 2015, 'What general practitioners said about the palliative care case conference in residential aged care: An Australian perspective. Part 2', Progress in Palliative Care, vol. 23, no. 1, pp. 9-17.View/Download from: UTS OPUS or Publisher's site
© W. S. Maney & Son Ltd 2015. Objective: To examine the views of general practitioners (GPs) on providing a palliative approach in residential aged care and in particular their experiences with the palliative care case conference. Background: The national project sought to implement and evaluate a comprehensive evidence-based palliative approach in residential aged care.Methods: A purposive sample of 11 GPs acrossWestern Australia (2), South Australia (6) and Queensland (3) participated in face-to face, semi-structured interviews. Qualitative content analysis was used to generate the core categories.Results: The evaluation by the GPs of the palliative care case conference in residential aged care is explained through three core themes: people, place, and performance. Understanding what GPs say about the performance or 'doing' a palliative care case conference can purposefully inform practice and policy. What GPs say about the people involved and the place in which they work, namely the residential aged care facility, is provided in Part I of this two part series.Conclusion: The views of GPs, on providing a palliative approach in residential aged care facilitates, offer a critical reflection on current practices and systems.
Petriwskyj, A, Parker, D, O'Dwyer, S, Moyle, W & Nucifora, N 2015, 'Interventions to build resilience in family carers of people living with dementia: a systematic review protocol.', JBI Database of Systematic Reviews and Implementation Reports, vol. 13, no. 7, pp. 44-61.View/Download from: UTS OPUS or Publisher's site
Peters, MDJ, Godfrey, CM, Khalil, H, McInerney, P, Parker, D & Soares, CB 2015, 'Guidance for conducting systematic scoping reviews.', International journal of evidence-based healthcare, vol. 13, no. 3, pp. 141-146.View/Download from: UTS OPUS or Publisher's site
Reviews of primary research are becoming more common as evidence-based practice gains recognition as the benchmark for care, and the number of, and access to, primary research sources has grown. One of the newer review types is the 'scoping review'. In general, scoping reviews are commonly used for 'reconnaissance' - to clarify working definitions and conceptual boundaries of a topic or field. Scoping reviews are therefore particularly useful when a body of literature has not yet been comprehensively reviewed, or exhibits a complex or heterogeneous nature not amenable to a more precise systematic review of the evidence. While scoping reviews may be conducted to determine the value and probable scope of a full systematic review, they may also be undertaken as exercises in and of themselves to summarize and disseminate research findings, to identify research gaps, and to make recommendations for the future research. This article briefly introduces the reader to scoping reviews, how they are different to systematic reviews, and why they might be conducted. The methodology and guidance for the conduct of systematic scoping reviews outlined below was developed by members of the Joanna Briggs Institute and members of five Joanna Briggs Collaborating Centres.
Scott, TL, Mittelman, MS, Beattie, E, Parker, D & Neville, C 2015, 'Translating Training in the NYU Caregiver Intervention in Australia: Maintaining Fidelity and Meeting Graduate Standards in an Online Continuing Professional Education Setting', Educational Gerontology, vol. 41, no. 10, pp. 710-722.View/Download from: UTS OPUS or Publisher's site
© 2015, Copyright © Taylor & Francis Group, LLC. The aim of this study was to develop an Internet-based self-directed training program for Australian healthcare workers to facilitate learning and competence in delivery of a proven intervention for caregivers of people with dementia: The New York University Caregiver Intervention (NYUCI). The NYUCI is a nonpharmacological, multicomponent intervention for spousal caregivers. It is aimed at maintaining well-being by increasing social support and decreasing family discord, thereby delaying or avoiding nursing home placement of the person with dementia. Training in the NYUCI in the United States has, until now, been conducted in person to trainee practitioners. The Internet-based intervention was developed simultaneously for trainees in the U.S. and Australia. In Australia, due to population geography, community healthcare workers, who provide support to older adult caregivers of people with dementia, live and work in many regional and rural areas. Therefore, it was especially important to have online training available to make it possible to realize the health and economic benefits of using an existing evidence-based intervention. This study aimed to transfer knowledge of training in, and delivery of, the NYUCI for an Australian context and consumers. This article details the considerations given to contextual differences and to learners' skillset differences in translating the NYUCI for Australia.
Hudson, PL, Girgis, A, Mitchell, GK, Philip, J, Parker, D, Currow, D, Liew, D, Thomas, K, Le, B, Moran, J & Brand, C 2015, 'Benefits and resource implications of family meetings for hospitalized palliative care patients: research protocol', BMC PALLIATIVE CARE, vol. 14.View/Download from: UTS OPUS or Publisher's site
Petriwskyj, A, Gibson, A, Parker, D, Banks, S, Andrews, S & Robinson, A 2014, 'Family involvement in decision making for people with dementia in residential aged care: a systematic review of quantitative literature.', International journal of evidence-based healthcare, vol. 12, no. 2, pp. 64-86.View/Download from: UTS OPUS or Publisher's site
AIM: Ensuring older adults' involvement in their care is accepted as good practice and is vital, particularly for people with dementia, whose care and treatment needs change considerably over the course of the illness. However, involving family members in decision making on people's behalf is still practically difficult for staff and family. The aim of this review was to identify and appraise the existing quantitative evidence about family involvement in decision making for people with dementia living in residential aged care. METHODS: The present Joanna Briggs Institute (JBI) metasynthesis assessed studies that investigated involvement of family members in decision making for people with dementia in residential aged care settings. While quantitative and qualitative studies were included in the review, this paper presents the quantitative findings. A comprehensive search of 15 electronic databases was performed. The search was limited to papers published in English, from 1990 to 2013. Twenty-six studies were identified as being relevant; 10 were quantitative, with 1 mixed method study. Two independent reviewers assessed the studies for methodological validity and extracted the data using the JBI Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). The findings were synthesized and presented in narrative form. RESULTS: The findings related to decisions encountered and made by family surrogates, variables associated with decisions, surrogates' perceptions of, and preferences for, their roles, as well as outcomes for people with dementia and their families. CONCLUSIONS: The results identified patterns within, and variables associated with, surrogate decision making, all of which highlight the complexity and variation regarding family involvement. Attention needs to be paid to supporting family members in decision making in collaboration with staff.
Petriwskyj, A, Gibson, A, Parker, D, Banks, S, Andrews, S & Robinson, A 2014, 'A qualitative metasynthesis: family involvement in decision making for people with dementia in residential aged care.', International journal of evidence-based healthcare, vol. 12, no. 2, pp. 87-104.View/Download from: UTS OPUS or Publisher's site
AIM: Involving people in decisions about their care is good practice and ensures optimal outcomes. Despite considerable research, in practice family involvement in decision making can be challenging for both care staff and families. The aim of this review was to identify and appraise existing knowledge about family involvement in decision making for people with dementia living in residential aged care. METHODS: The present Joanna Briggs Institute meta-synthesis considered studies that investigate involvement of family members in decision making for people with dementia in residential aged care settings. While quantitative and qualitative studies were included in the review, this article presents the qualitative findings. A comprehensive search of studies was conducted in 15 electronic databases. The search was limited to papers published in English, from 1990 to 2013. Twenty-six studies were identified as relevant for this review; 16 were qualitative papers reporting on 15 studies. Two independent reviewers assessed the studies for methodological validity and extracted the data using the standardized Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). The findings were synthesized using JBI-QARI. RESULTS: The findings related to the decisions encountered and made by family surrogates, family perceptions of, and preferences for, their role/s, factors regarding treatment decisions and the collaborative decision-making process, and outcomes for family decision makers. CONCLUSION: Results indicate varied and complex experiences and multiple factors influencing decision making. Communication and contacts between staff and families and the support available for families should be addressed, as well as the role of different stakeholders in decisions.
Parker, D 2014, 'Moving from research generation to knowledge translation in end-of-life care in long term care.', Palliative medicine, vol. 28, no. 9, pp. 1079-1080.View/Download from: Publisher's site
Parker, D & Clifton, K 2014, 'Guest commentary: Residential aged care: the de facto hospice for New Zealand's older people.', Australasian journal on ageing, vol. 33, no. 2, pp. 72-73.View/Download from: Publisher's site
Froggatt, K & Parker, D 2014, 'Guest editorial: development of palliative care in long term-care facilities: a new evidence base.', International journal of older people nursing, vol. 9, no. 2, pp. 91-92.View/Download from: Publisher's site
Tuckett, A, Parker, D, Clifton, K, Glaetzer, K, Greeve, K, Israel, F, Jenkin, P, Prior, T, Reymond, E & Walker, H 2014, 'What general practitioners said about the palliative care case conference in residential aged care: An Australian perspective. Part 1', Progress in Palliative Care, vol. 22, no. 2, pp. 61-68.View/Download from: UTS OPUS or Publisher's site
Objective: To examine the views of general practitioners on providing a palliative approach in residential aged care and in particular their experiences with the palliative care case conference. Background: The national project sought to implement and evaluate a comprehensive evidence-based palliative approach in residential aged care. Methods: A purposive sample of 11 general practitioners (GPs) across Western Australia (2), South Australia (6), and Queensland (3) participated in face-to-face, semi-structured interviews. Qualitative content analysis was used to generate the core categories. Results: The evaluation by the GPs of the palliative care case conference in residential aged care is explained through three core themes: people, place, and performance. Understanding what GPs say about the people involved and the place in which they work, namely the residential aged care facility, can purposefully inform practice and policy. What GPs say about the performance or 'doing' a palliative care case conference is provided in Part II of this two part series. Conclusion: The views of GPs, on providing a palliative approach in residential aged care facilitates, offer a critical reflection on current practices and systems. © W. S. Maney & Son Ltd 2014.
Fox, B, Hodgkinson, B & Parker, D 2014, 'The effects of physical exercise on functional performance, quality of life, cognitive impairment and physical activity levels for older adults aged 65 years and older with a diagnosis of dementia: a systematic review', JBI Database of Systematic Reviews and Implementation Reports, vol. 12, no. 9, pp. 158-276.View/Download from: UTS OPUS or Publisher's site
Petriwskyj, A, Parker, D, Robinson, A, Gibson, A, Andrews, S & Banks, S 2013, 'Family involvement in decision making for people with dementia in residential aged care: A systematic review of quantitative and qualitative evidence', JBI Database of Systematic Reviews and Implementation Reports, vol. 11, no. 7, pp. 131-282.View/Download from: UTS OPUS or Publisher's site
Background The involvement of people in decisions about their care is recognized as both good practice and important in ensuring optimal outcomes. However, despite a considerable history of research attention to aspects of this issue, in practice family involvement in decision making can be challenging for care staff and families alike. Objectives The qualitative and quantitative objective of this review was to scope the extant knowledge about family involvement in decision making for people with dementia living in residential aged care. Inclusion criteria Types of participants This review considered studies that included people with dementia who were living in residential aged care, their families and care staff. Types of intervention(s)/phenomena of interest This review considered studies that investigated involvement of family members in decision making for people with dementia in a residential aged care setting. Types of studies The quantitative component of the review considered both experimental and descriptive study designs. The qualitative component considered studies that focused on qualitative data including designs such as phenomenology, grounded theory, ethnography, action research and feminist research. Types of outcomes This review considered studies that investigated or discussed who the decision makers were in care for people with dementia and how decisions were made, what processes assisted families in decision making and what were the barriers or facilitators to collaborative decision making by families, as well as the impact of decision making processes on family members and the impact of collaborative decision making with family members on the person with dementia. Search strategy A comprehensive search of research studies that were published in English was conducted in 15 electronic databases. The search strategy was limited to papers published in or after 1990. Methodological quality Quantitative and qualitative studies selected for retrieva...
Reitinger, E, Froggatt, K, Brazil, K, Heimerl, K, Hockley, J, Kunz, R, Morbey, H, Parker, D & Husebo, BS 2013, 'Palliative care in long-term care settings for older people: Findings from an EAPC Taskforce', European Journal of Palliative Care, vol. 20, no. 5, pp. 251-253.View/Download from: UTS OPUS
Parker, D, Clifton, K, Shams, R & Young, J 2012, 'The effectiveness of nurse-led care in general practice on clinical outcomes in adults with type 2 diabetes', JBI Database of Systematic Reviews and Implementation Reports, vol. 10, no. 38, pp. 2514-2558.View/Download from: UTS OPUS or Publisher's site
© the authors 2012. Background: In Australia, diabetes was identified as a national health priority area in 1996; nevertheless the prevalence of type 2 diabetes has increased dramatically since then. Nurses have been working within Australian general practices for several decades but only in recent years has the role of the practice nurse in primary health care increased. Objectives: This review aims to identify the effectiveness of nurse-led care in general practice as compared to general practitioner care on clinical outcomes in adults with type 2 diabetes.
Petriwskyj, A, Robinson, A, Parker, D, Banks, S & Andrews, S 2012, 'Family involvement in decision making for people with dementia in residential aged care: A systematic review of quantitative and qualitative evidence [Protocol]', JBI Database of Systematic Reviews and Implementation Reports, vol. 10, no. 42, pp. 1-17.View/Download from: UTS OPUS or Publisher's site
© 2012, Joanna Briggs Institute. All rights Reserved. Review question/objective The qualitative and quantitative objective of this review is to scope the extant knowledge about family involvement in decision making for people with dementia living in residential aged care. More specifically, the review question/s are *Who are the decision makers for people with dementia living in residential care? *What is the experience of decision making for family members in the residential care setting? *What are the barriers or facilitators to decision making by families? *What is the impact of decision making processes on family members? *What is the impact of collaborative decision making with family on the person with dementia? *What processes or strategies do family decision-makers use?
Strand, H & Parker, D 2012, 'Effects of multidisciplinary models of care for adult pre-dialysis patients with chronic kidney disease: a systematic review.', International journal of evidence-based healthcare, vol. 10, no. 1, pp. 53-59.View/Download from: UTS OPUS or Publisher's site
AIM: To compare the effectiveness of multidisciplinary care with traditional medical care on the progression of chronic kidney disease (CKD) in adult pre-dialysis patients (stages 3-5). METHODS: Eleven databases were searched for articles published between January 1990 and July 2009. The Joanna Briggs Institute-Meta Analysis of Statistics Assessment and Review Instrument was used to assess the methodological quality of retrieved articles and extract data. RESULTS: Only four articles out of 927 were included in the systematic review. Two reported the results of randomised controlled trials and two reported observational studies. The data were not presented in a format that allowed a meta-analysis to be performed and therefore a narrative summary of these articles is presented. CONCLUSION: Multidisciplinary care is deemed to be effective in delaying the progression of CKD in adults who are in the pre-dialysis phase of this condition. Education that aims to increase the knowledge and understanding of the causes of CKD is an important component of the care. IMPLICATIONS FOR PRACTICE: Members of the multidisciplinary team should draw on their specific expertise to educate the patient about CKD. The nephrologist or a nurse practitioner should devise a management plan jointly with the patient and provide regular reviews.
Parker, D & Hodgkinson, B 2011, 'A comparison of palliative care outcome measures used to assess the quality of palliative care provided in long-term care facilities: a systematic review.', Palliat Med, vol. 25, no. 1, pp. 5-20.View/Download from: UTS OPUS or Publisher's site
Provision of palliative care in long-term care (LTC) facilities is important, but limited research has been undertaken to investigate the most appropriate outcome measure for use in this setting. In this systematic review we aimed to measure the psychometric properties (reliability/validity) and feasibility of palliative outcome measures used to assess the quality of palliative care provided in LTC. For identification of outcome measures we undertook systematic searches of electronic databases from 1 January 2000 to 12 September 2008. Included studies were assessed by two independent reviewers for methodological quality prior to inclusion in the review using an appraisal checklist developed for the review to evaluate validity, reliability and feasibility. Ten articles were included in the final review and these provided specific information on the psychometric properties of 10 outcome measures. Four of these measures reported data specifically for residents in LTC facilities, while the remaining six measures reported a sub-set of data for residents in LTC facilities. The Family Perceptions of Care Scale is considered by the authors as the most suitable outcome measure for use in LTC facilities. Of the remaining nine measures, a further two were also considered suitable for measuring the quality of palliative care in residential aged care facilities. These are the Quality of Dying in Long-term Care scale and the Toolkit Interview.
Froggatt, K, Hockley, J, Parker, D & Brazil, K 2011, 'A system lifeworld perspective on dying in long term care settings for older people: contested states in contested places.', Health and Place, vol. 17, no. 1, pp. 263-268.View/Download from: UTS OPUS or Publisher's site
In many Western countries, older people live and die in long-term institutional care settings. Habermas's concepts of lifeworld, system and communicative action are drawn upon to illuminate the experience of living and dying in this particular place. It is proposed that dying older adults, their family and care staff occupy different contested states and long term care settings are contested places, located in a wider system. This wider system, mediated through care homes, can colonise the life world experiences of dying individuals. The development of communicative space bridges the lifeworld and system and offers a way for the lifeworld of dying individuals, and those around them to be reintegrated into, and influence the wider system.
Tuckett, A, Hegney, D, Parker, D, Eley, RM & Dickie, R 2011, 'The top eight issues Queensland Australia's aged-care nurses and assistants-in-nursing worried about outside their workplace: a qualitative snapshot.', Int J Nurs Pract, vol. 17, no. 5, pp. 444-454.View/Download from: UTS OPUS or Publisher's site
The attainment of a work-life balance is an important issue for recruitment, retention and workforce planning. This paper aims to report on the free text data provided by the aged-care sector nurses around perceptions of important work-life issues. Data were written responses of aged-care nurses to the open-ended request at the end of a survey, which asked them to list up to five political/social/environmental issues concerning them outside of their work. For aged-care nurses, when asked to list political/social/environmental issues they were concerned about outside of work in late 2007, there emerged considered issues around work and life. Among the top eight themes there is an intriguing balance between the themes work, industrial relations, aged care/elder care and health-care services compared with the themes environment, water, societal values and housing. Qualitative insights into the political/social/environmental issues aged-care nurses are concerned about outside of your work suggest their desire for a labour/life or work/life harmony. Aged-care nurses place an equal importance on the nature of labour and the basics of life. The findings provide information for aged-care sector managers and workforce planners on areas in need of consideration to recruit and retain a workforce within aged care.
Eley, R, Parker, D, Tuckett, A & Hegney, D 2010, 'Career breaks and intentions for retirement by Queensland's nurses--a sign of the times?', Collegian (Royal College of Nursing, Australia), vol. 17, no. 1, pp. 38-42.View/Download from: Publisher's site
OBJECTIVE: In order to support policy planning, nurses in Queensland were surveyed three times over a 7-year period. Results from the study offered the opportunity to explore changes in work practices with respect to career breaks and retirement intentions. DESIGN: A self-administered postal survey. SETTING: Nurse members of the Queensland Nurses Union residing in the State of Queensland. PARTICIPANTS: 3000 members of the Queensland Nurses' Union. MAIN OUTCOME MEASURES: An overview of nurses' work practices in relation to breaks in work and planned retirement. RESULTS: Response rates for 2001, 2004 and 2007 were 51%, 44.9% and 39.7%, respectively. Over the 7-year study period the number of nurses taking career breaks declined from 65% in 2001 to 54% in 2007. Of those nurses who reported taking breaks the number of breaks remained constant; however the average length of the breaks declined. Results reflected an ageing workforce. The expected time to remain in nursing increased dramatically for older nurses. Over 60% of 40-60-year-old nurses in 2007 expect to remain in nursing well into their mid-60s compared to 30% in the previous years. CONCLUSIONS: The dynamics of the nursing workforce have changed with nurses taking fewer and shorter breaks and expecting to work to a greater age. We speculate that these changes may be influenced by the economic climate.
Parker, D, Tuckett, A, Eley, R & Hegney, D 2010, 'Construct validity and reliability of the Practice Environment Scale of the Nursing Work Index for Queensland nurses.', International journal of nursing practice, vol. 16, no. 4, pp. 352-358.View/Download from: Publisher's site
This article reports on construct validity and reliability of 30 items of the Practice Environment Scale of the Nursing Work Index (PES-NWI). Australia, like other countries, is experiencing a shortage of nurses; a multifactor approach to retention of nurses is required. One significant factor that has received increasing attention in the last decade, particularly in the USA, is the nursing practice environment. The reliability of the 30 items of the PES-NWI was assessed by Cronbach's alpha and factor analysis was performed using principal component analysis. The PES-NWI was completed by nurses working in the aged-care, private and public sectors in Queensland, Australia. A total of 3000 surveys were distributed to a random sample of members of the Queensland Nurses Union. Of these, 1192 surveys were returned, a response rate of 40%. The PES-NWI was shown to be reliable demonstrating internal consistency with a Cronbach's alpha of the total scale of 0.948. The 30 items loaded onto five factors explaining 57.7% of the variance. The items across the factors differed slightly from those reported by the original author of the PES-NWI. This study indicates that the PES-NWI has construct validity and reliability in the Australian setting for nurses.
Hegney, D, Tuckett, A, Parker, D & Eley, RM 2010, 'Workplace violence: differences in perceptions of nursing work between those exposed and those not exposed: a cross-sector analysis.', International journal of nursing practice, vol. 16, no. 2, pp. 188-202.View/Download from: Publisher's site
Nurses are at high risk of incurring workplace violence during their working life. This paper reports the findings on a cross-sectional, descriptive, self-report, postal survey in 2007. A stratified random sample of 3000 of the 29 789 members of the Queensland Nurses Union employed in the public, private and aged care sectors resulted in 1192 responses (39.7%). This paper reports the differences: between those nurses who experienced workplace violence and those who did not; across employment sectors. The incidence of workplace violence is highest in public sector nursing. Patients/clients/residents were the major perpetrators of workplace violence and the existence of a workplace policy did not decrease levels of workplace violence. Nurses providing clinical care in the private and aged care sectors experienced more workplace violence than more senior nurses. Although workplace violence was associated with high work stress, teamwork and a supportive workplace mitigated workplace violence. The perception of workplace safety was inversely related to workplace violence. With the exception of public sector nursing, nurses reported an inverse relationship with workplace violence and morale.
This aim of this paper is to discuss the latest evidence in regard to palliative care in residential aged care with particular emphasis on three areas: (i) initiatives in providing palliative care; (ii) dementiaspecific initiatives in providing palliative care; and (iii) advance care planning. © 2010 Maney Publishing.
Hegney, D, Tuckett, A, Parker, D & Robert, E 2010, 'Access to and support for continuing professional education amongst Queensland nurses: 2004 and 2007.', Nurse education today, vol. 30, no. 2, pp. 142-149.View/Download from: Publisher's site
This paper reports on the findings of a prospective exploratory study related to nurses' self-reports of continuing professional education access and support. The data were gathered by two postal surveys undertaken in 2004 and 2007 each which sampled 3000 nurses of the 30,000 nurse members of the industrial body - Queensland Nurses' Union. The response rates were 44.9% and 39.7% for 2004 and 2007, respectively. Over 85% of the nurses reported they had access to continuing professional education activities. However, it is apparent that the majority of these activities are either partially or completely self-funded. Further, between 2004 and 2007 the amount of financial support provided by employers for continuing education and training activities has decreased significantly. While there were differences between 2004 and 2007, the major barrier to be able to attend continuing professional education were financial (could not afford the fee involved; could not afford to take unpaid leave to attend). Another major barrier in both 2004 and 2007 was having the time to undertake the activity. Analysis for differences between nurses in different geographical locations indicated that distance remains a major barrier for nurses in rural and remote areas. These quantitative findings were supported by the qualitative findings on nurses' work where 'education and training' was, overall, the fifth highest ranked issue requiring further attention.
Henwood, T, Eley, R, Parker, D, Tuckett, A & Hegney, D 2009, 'Regional differences among employed nurses: a Queensland study.', The Australian journal of rural health, vol. 17, no. 4, pp. 201-207.View/Download from: Publisher's site
OBJECTIVE: To ascertain differences in the working lives of geographically dispersed nurses. DESIGN: Cross-sectional. SETTING: Registered, enrolled and assistants-in-nursing members of the Queensland Nurses' Union employed in nursing in Queensland, Australia. PARTICIPANTS: A total of 3000 members of the Union, equally stratified by sector (public, private, aged care). Among them, 1192 responded and 1039 supplied postcodes matching the Australian Standard Geographical Classification. MAIN OUTCOME MEASURES: Statistically significant differences in working lives of nurses employed in different geographical locations. RESULTS: Nurses in outer regional/remote/very remote localities are more likely to be employed as permanent full-time staff and self-report higher levels of work stress. These levels could be explained by: lack of replacement staff for leave, longer working and on call hours and lack of support for new staff. Distance remains a major barrier to accessing continuing professional education. However, outer regional/remote/very remote nurses were more likely to be provided employer support for professional education. Inner regional nurses were more likely to work part time, would work more hours if offered and were more likely to have taken a break from nursing as a result of family commitments. CONCLUSION: The data confirm that current policies are not addressing the differences in the working lives of geographically dispersed nurses. Policies addressing orientation, mentoring and workloads should be implemented to address these issues.
Parker, D, Mills, S & Abbey, J 2008, 'Effectiveness of interventions that assist caregivers to support people with dementia living in the community: A systematic review', International Journal of Evidence-Based Healthcare, vol. 6, no. 2, pp. 137-172.View/Download from: Publisher's site
© 2008 The Authors Journal Compilation. © Blackwell Publishing Asia Pty Ltd. Objectives: The objective of this review was to assess the effectiveness of interventions that assist caregivers to provide support for people living with dementia in the community. Inclusion criteria: Types of participants: Adult caregivers who provide support for people with dementia living in the community (non-institutional care). Types of interventions: Interventions designed to support caregivers in their role such as skills training, education to assist in caring for a person living with dementia and support groups/programs. Interventions of formal approaches to care designed to support caregivers in their role, care planning, case management and specially designated members of the healthcare team - for example dementia nurse specialist or volunteers trained in caring for someone with dementia. Types of studies: This review considered any meta-analyses, systematic reviews, randomised control trials, quasi-experimental studies, cohort studies, case control studies and observational studies without control groups that addressed the effectiveness of interventions that assist caregivers to provide support for people living with dementia in the community. Search strategy: The search sought to identify published studies from 2000 to 2005 through the use of electronic databases. Only studies in English were considered for inclusion. The initial search was conducted of the databases, CINAHL, MEDLINE and PsychINFO using search strategies adapted from the Cochrane Dementia and Cognitive Improvement Group. A second more extensive search was then conducted using the appropriate Medical Subject Headings (MeSH) and keywords for other available databases. Finally, hand searching of reference lists of articles retrieved and of core dementia, geriatric and psycho geriatric journals was undertaken. Assessment of quality: Methodological quality of each of the articles was assessed by two independent...
Throughout my nursing career from new graduate to experienced clinician, nurse educator, and finally nurse leader, my passion for the profession has rarely waned. It has been one of my long-standing beliefs that nurses are privileged to be entrusted with the care of individuals who are often at their most vulnerable. However, that privilege comes with enormous responsibility. We must be clinically competent, technologically savvy, emotionally connected, and physically able. © 2006 Mosby, Inc. All rights reserved.
Parker, D, Grbich, C, Brown, M, Maddocks, I, Willis, E & Roe, P 2005, 'A palliative approach or specialist palliative care? What happens in aged care facilities for residents with a noncancer diagnosis?', Journal of palliative care, vol. 21, no. 2, pp. 80-87.
This article presents results of the second stage of a research project which explored the palliative care needs of 69 residents with a noncancer diagnosis in South Australia. Extensive data were collected prospectively from case notes, and resident and staff interviews over a 10-week period. Residents were suffering multiple conditions and were highly dependent for activities of daily living. Most residents' care was consistent with a palliative approach, with only three residents in the study referred to a specialist palliative care service. However, for some residents, pain and symptom management were not always adequate, and referral to a specialist palliative care service would have been appropriate. This research indicates that, with additional education, it could be possible to extend the principles and philosophy of palliative care by adopting a palliative care approach within aged care facilities.
Grbich, C, Maddocks, I, Parker, D, Brown, M, Willis, E, Hofmeyer, A & Piller, N 2005, 'Palliative care in aged care facilities for residents with a non-cancer disease: Results of a survey of aged care facilities in South Australia', Australasian Journal on Ageing, vol. 24, no. 2, pp. 108-113.View/Download from: Publisher's site
Objectives: This study reports the results of a cross-sectional study of residential aged care facilities in South Australia which sought to quantify the extent of specialist palliative care involvement in residential aged care facilities as well as identifying the current need for palliative care. Method: A questionnaire was completed by 51 Directors of Care from 51 of 90 facilities targeted, representing a response rate of 57% and representing 20% of the total number of South Australian licensed beds. Facilities responding were representative of residential aged care facilities in South Australia for location, type of funding and level of care. Results: Thirty facilities (59%) used specialist palliative care services during 2001 with the average number of residents consulted being four. There were 627 deaths recorded in the 2785 licensed beds, a death rate of 23%. The majority of these deaths were from non-cancer diseases (83%) and up to two-thirds of all deaths occurred away from low care facilities, usually in an acute care setting. Main reasons for transfer away from the facility were; an acute care episode requiring other expertise, rapid deterioration of the resident, care needs beyond the facility, or the general practitioner or family requested a transfer. Care Directors estimated that 7% of their current residents would be considered palliative and the majority of these had non-cancer diseases (78%). Conclusion: These findings indicate that palliative care is an important aspect of care in residential aged care facilities for clients with a non-cancer diagnosis.
Grbich, C, Maddocks, I, Parker, D, Brown, M, Willis, E, Piller, N & Hofmeyer, A 2005, 'Identification of patients with noncancer diseases for palliative care services.', Palliative & supportive care, vol. 3, no. 1, pp. 5-14.View/Download from: Publisher's site
OBJECTIVE: To identify criteria for measuring the eligibility of patients with end-stage noncancer diseases for palliative care services in Australian residential aged care facilities. METHODS: No validated set if guidelines were available so five instruments were used: an adaptation of the American National Hospice Association Guidelines; a recent adaptation of the Karnofsky Performance Scale; the Modified Barthel Index; the Abbey Pain Score for assessment of people who are nonverbal and a Verbal Descriptor Scale, also for pain measurement. In addition, nutritional status and the presence of other problematic symptoms and their severity were also sought. RESULTS: The adapted American National Hospice Association Guidelines provided an initial indicative framework and the other instruments were useful in providing confirmatory data for service eligibility and delivery.
Brown, M, Grbich, C, Maddocks, I, Parker, D, Connellan, PR & Willis, E 2005, 'Documenting end of life decisions in residential aged care facilities in South Australia.', Australian and New Zealand journal of public health, vol. 29, no. 1, pp. 85-90.View/Download from: Publisher's site
OBJECTIVE: This research examined the provision of palliative care for residents with a non-cancer diagnosis including the use of advance directives and advance care planning as part of palliative care policies in residential aged care facilities in South Australia. There are no guidelines for recording residents' wishes if they are no longer competent. METHODS: Stage 1 involved a survey of 90 randomly selected aged care facilities. Stage 2 involved case studies of 69 residents, appropriate for palliative care, from 17 facilities and interviews with 15 directors of care. RESULTS: Most residential aged care facilities used forms to record residents' wishes about end of life care, but there was little consistency. Some had no palliative care policy and few facilities required a formal advance directive. Not all residents had formally appointed a proxy. CONCLUSIONS: Residential aged care facilities should be required to develop and implement a palliative care policy acknowledging the Accreditation Standards and State legislation and including a simple tool for advance care planning. Case conferencing could assist in discussing and documenting the resident's wishes. Public education is essential to increase community and professional awareness in order to promote empowerment for the increasing number of older people who will die in residential aged care facilities.
Abbey, J, Piller, N, De Bellis, A, Esterman, A, Parker, D, Giles, L & Lowcay, B 2004, 'The Abbey pain scale: a 1-minute numerical indicator for people with end-stage dementia.', International journal of palliative nursing, vol. 10, no. 1, pp. 6-13.View/Download from: Publisher's site
The need for a specialized clinical regimen for patients with dementia who require palliative care has only recently been recognized. Structured approaches to palliative care are not well developed. The recognition and treatment of pain is an important part of this management risk. However, pain is consistently underdiagnosed and undertreated in this population. A factor contributing to this has been a lack of appropriate tools to help recognize and document pain. This study sought to develop and validate an easy-to-use pain scale for use in residential aged care homes. The tool was developed with residents with end- or late-stage dementia who were unable to articulate their needs, identified by the registered nurses who knew them. Results showed that following pain-relief intervention the average pain score recorded using the scale fell by more than half. A paired Student's t-test showed the reduction to be highly significant (P<0.001). Validity and internal reliability, assessed by calculating Gamma and Cronbach's alpha, were found to be satisfactory. Qualitative evidence gathered from users of the scale indicated that it was considered a useful clinical device that could be completed within one minute. Further analysis of the use of the scale in clinical settings, testing of inter-rater reliability and examination of the limitations found in this study will commence early in 2004.
Grbich, C, Parker, D & Maddocks, I 2001, 'The emotions and coping strategies of caregivers of family members with a terminal cancer.', Journal of palliative care, vol. 17, no. 1, pp. 30-36.
This study documents the emotional experiences and coping strategies of a group of caregivers as they move from the diagnosis of a close family member with terminal cancer through the stages of caring and post bereavement. Supportive evidence, matching that of previous literature, was gathered regarding the impact of such care, but additional findings counter the notion of "burden" by revealing that strong positive emotions were experienced by these caregivers regarding the opportunity given to them to express their love through care. By contrast and post bereavement, however, intense grief was reported. There appeared to be a complete lack of emotional support throughout from health professionals, particularly in the bereavement phase when need is very apparent.
Parker, D, Grbich, C & Maddocks, I 2001, 'Financial issues in caring for someone with terminal cancer at home', Australian Journal of Primary Health, vol. 7, no. 2, pp. 37-42.
For the majority of patients with terminal cancer their preferred place of death is at home. Many factors determine this choice, in particular the availability of a carer, the patient's physical condition and adequate services. A factor often underestimated is the financial impact of caring for someone at home. This paper examines the financial concerns of carers of terminally ill cancer patients and whether current Australian health care policy is able to address thes concerns. Two main categories of cost were identified, those related to the patients physical care needs and those impacted on carer lifestyle. The current government allowances to assist carers in these costs are limited by carers either being unaware that the benefits existed or by the strict qualifying criteria that restricts access to those who care for the terminally ill.
Cadd, A, Keatinge, D, Henssen, M, O'Brien, L, Parker, D, Rohr, Y, Schneider, J & Thompson, J 2000, 'Assessment and documentation of bowel care management in palliative care: incorporating patient preferences into the care regimen.', Journal of clinical nursing, vol. 9, no. 2, pp. 228-235.View/Download from: Publisher's site
Nurses in a palliative care unit (PCU) recognized that there were several inconsistencies relating to assessment and documentation of patient preferences in bowel care management. Although bowel care is recognized as of key importance to the wellbeing of palliative care patients, there is little evidence in current literature about accommodation of patient preferences in bowel care management. A questionnaire was developed to assess whether patient preferences were elicited on admission to the PCU, were documented, and were included in the bowel care regimen. Data were collected from 100 patients in two PCUs in Australia. The findings suggested that little was assessed or documented about bowel care management on admission except functional or pharmacological information. According to patients in the study, their preferences were seldom incorporated into the bowel care regimen. Lack of documentation of bowel care preferences was also found following an audit of patient notes. Techniques for eliciting information, awareness of alternative or complementary methods of bowel care and better documentation procedures are all recommended for inclusion in nursing practice in the palliative care setting.
Parker, D, Maddocks, I & Stern, LM 1999, 'The role of palliative care in advanced muscular dystrophy and spinal muscular atrophy.', Journal of paediatrics and child health, vol. 35, no. 3, pp. 245-250.View/Download from: Publisher's site
OBJECTIVE: This study examines the potential role for palliative care services in the care of individuals with muscular dystrophy and spinal muscular atrophy, and the support of their families. METHODOLOGY: Semistructured interviews were conducted in South Australia with nine bereaved and four current family members of individuals with muscular dystrophy or spinal muscular atrophy. Issues explored during interview included: (i) the family perceptions of the difficulties in caring; (ii) the psychological and physical resources which were available to assist them; and (iii) family recall of the management of the terminal phase of the illness. RESULTS: Significant issues identified included: (i) a lack of coordination of care and access to skilled, competent carers; (ii) a lack of support for siblings; (iii) inadequate bereavement care; and (iv) limited discussion of options of ventilatory support and advance directives. CONCLUSIONS: The terminal care for individuals with muscular dystrophy and spinal muscular atrophy and their families requires improvement. Although many individuals with these conditions will die following an acute event, palliative care services may be appropriate for those who require a period of terminal care at home.
Maddocks, I, Somogyi, A, Abbott, F, Hayball, P & Parker, D 1996, 'Attenuation of morphine-induced delirium in palliative care by substitution with infusion of oxycodone.', Journal of pain and symptom management, vol. 12, no. 3, pp. 182-189.View/Download from: Publisher's site
We have observed among patients of the Southern Community Hospice Programme that up to 25% experience acute delirium when treated with morphine and improve when the opioid is changed to oxycodone or fentanyl. This study aimed to confirm by a prospective trial that oxycodone produces less delirium than morphine in such patients. Oxycodone was administered by a continuous subcutaneous infusion, as this allowed more flexible and reliable dosing, and patients were monitored for any adverse reactions to the drug. Thirteen patients completed the study. Statistically significant improvements in mental state and nausea and vomiting occurred following a change from morphine to oxycodone. Pain scores improved but did not reach a level of statistical significance. The phenotype status of the patients was tested to establish their capacity to metabolize oxycodone. One patient who did not achieve adequate pain control proved to be a poor metabolizer. These results show that oxycodone administered by the subcutaneous route can provide effective analgesia without significant side effects in patients with morphine-induced delirium. This treatment allows patients to remain more comfortable and lucid in their final days. A small proportion of patients who do not metabolize oxycodone effectively may not receive this benefit.
Miller, RS, Peterson, GM, Abbott, F, Maddocks, I, Parker, D & McLean, S 1995, 'Plasma concentrations of fentanyl with subcutaneous infusion in palliative care patients.', British journal of clinical pharmacology, vol. 40, no. 6, pp. 553-556.
1. Plasma concentrations of fentanyl were measured by g.c. in 20 patients (median age: 75 years and range: 54-86 years; eight females) in palliative care receiving the drug by continuous s.c. infusion (median rate: 1200 micrograms day-1 and range: 100-5000 micrograms day-1). 2. The infusion rate was significantly related to the duration of therapy (Spearman rho = 0.56, P < 0.05). The total steady-state plasma concentrations of fentanyl ranged between 0.1 and 9 ng ml-1, with a median of 1 ng ml-1. The unbound fraction of fentanyl in the plasma ranged from 17.8 to 44.4%, with a median value of 33.6%. Infusion rates and both total and unbound plasma concentrations of fentanyl were correlated (Spearman rho = 0.92, P < 0.05 in each case). Even with standardization for dosage, there was an eightfold variation in total plasma concentrations and 3.5-fold variation in unbound plasma concentrations of fentanyl. 3. There is considerable inter-patient variability in the pharmacokinetics of fentanyl with s.c. infusion in the palliative care setting, which necessitates careful titration of dosage according to individual clinical response.
Parker, D 2012, 'Ageing, dementia and palliative care' in O'Connor, M & Aranda, S (eds), Palliative Care Nursing, Ausmed, Australia, pp. 309-329.
Parker, D 2011, 'The development and implementation of evidence-based palliative care guidelines for residential care: Lessons for other countries' in Merryn, G & Christine, I (eds), Living with Ageing and Dying: Palliative and End of Life Care for Older People, Oxford University Press, UK, pp. 226-236.View/Download from: UTS OPUS
Palliative and End of Life Care for Older People Merryn Gott, Christine Ingleton ...
care of older people is that, in the past and in other societies less modern than
our own, communities have cared for their elderly better than we currently do.
Parker, D & Froggatt, K 2011, 'Palliative care for older people' in Tolson, D, Booth, J & Schofield, I (eds), Evidence Informed Nursing with Older People, Wiley-Blackwell, United Kindgom, pp. 84-100.View/Download from: UTS OPUS
Froggatt, K & Parker, D 2009, 'Care homes and long-term care for people with dementia' in Supportive Care for the Person with Dementia, Oxford University Press, UK, pp. 181-188.View/Download from: Publisher's site
A significant proportion of people living with dementia will live and stay in long-term care settings. Consequently, care homes have an important role to play in the provision of supportive care for people with dementia. This chapter initially describes the care home context, as this shapes the experiences of living and dying for people with dementia residing in care homes. It draws on two recent studies, both considering the provision of palliative care for people who are living and dying in care homes: one from the UK (Froggatt) and one from Australia (Parker). From this empirical research it identifies two key challenges that face care homes as they support people with dementia living in such settings: how do we, on the one hand, create a culture of openness to people's experiences of living and dying alongside, on the other hand, maintaining people's identities? These both require attention in the care home setting if person-centred supportive care is to be provided throughout a person's life until their death.
Xu, X & Parker, D 2018, 'Long-term breakfast cereals consumption and heart diseases for older Australians.', Australian Association of Gerontology, Melbourne.
DiGiacomo, M, Lewis, J, Parker, D, Chang, S, Koirala, B & Phillips, J 2018, 'Healthy Ageing, Yet Unmet Need in Australian War Widows: A Sequential Mixed Methods Study', International Council of Women's Health Issues Congress, Hong Kong.
Durepos, PM, Kaasalainen, S, Tamara, S, Ploeg, J, Parker, D, Brazil, K & Papaioannou, A 2017, 'ASSESSING FAMILY CARE CONFERENCES IN LONG-TERM CARE: LESSONS LEARNED FROM CONTENT ANALYSIS', Innovation in Aging, Oxford University Press, pp. 254-255.View/Download from: UTS OPUS or Publisher's site
End-of-life (EOL) communication in long-term care (LTC) is often inadequate and delayed, leaving residents dying with unknown preferences or goals of care. Poor communication with staff contributes to families feeling unprepared, distressed and unsatisfied negatively effecting bereavement. Family Care Conferences (FCC) aim to increase structured, systematic communication around goals and plans for EOL.
FCCs were implemented as part of the 'Strengthening a Palliative Approach to Care' (SPA-LTC) project in four LTC sites in Ontario, Canada. The purpose of this sub-study is to evaluate: a) content, b) processes, and c) interdisciplinary engagement using mixed methods. Twenty-four FCCs were held for residents with a Palliative Performance Scale of 40% (nearing death) considered appropriate by staff. Data was collected from FCC forms (i.e., Family Questionnaires, Conference Summaries) and electronic charts. Through directed-analysis, data was analyzed using the Canadian Hospice Palliative Care Association's 'Square of Care' model which includes eight domains of care: Disease Management, Physical, Psychological, Social, Practical, Spiritual, EOL, and Loss/Bereavement.
Findings showed on average each FCC documented 66% of domains with physical and EOL care domains being used the most, and content about loss/bereavement documented the least. Use of FCC hard copy forms had benefits over standard electronic charts including: higher proportion of goals, timely completion, category for end-of-life care and accessibility. FCCs were attended by an average of three disciplines prompting holistic content although Personal Support Workers (PSW) and physicians attended minimally. Implications to optimize FCCs include tailoring use of FCCs forms, prompting bereavement discussion, furthering engagement of PSWs and physicians.
Neville, C, Mittelman, MS, Beattie, E, Scott, T, Hobday, J & Parker, D 2013, 'SUPPORTING CARERS OF PEOPLE WITH DEMENTIA: AN INNOVATIVE LEARNING PLATFORM FOR HEALTH WORKERS', GERONTOLOGIST, OXFORD UNIV PRESS INC, pp. 72-72.
Parker, D 2012, 'Psychometric Properties of the Family Perceptions of Care Scale in Australian Long-Term Care Settings', JOURNAL OF PALLIATIVE CARE, CENTRE RECHERCHE INSTITUT UNIV GERIATRIE MONTREAL, pp. 213-213.
Parker, D, van der Steen, J & Clifton, K 2012, 'Bereaved Carer Satisfaction with Palliative Dementia Care: Comparisons between Long-Term Care (LTC) in Australia and the Netherlands', JOURNAL OF PALLIATIVE CARE, CENTRE RECHERCHE INSTITUT UNIV GERIATRIE MONTREAL, pp. 228-228.
Brazil, K, Froggatt, K, Parker, D & Teno, J 2006, 'Palliative care for older people in long-term care settings: an international comparison of challenges and solutions', JOURNAL OF PALLIATIVE CARE, CENTER BIOETHICS CLIN RES INST MONTREAL, pp. 197-197.
Grbich, C, Maddocks, I, Parker, D, Piller, N, Brown, M, Willis, E & Connellan, P 2003, 'What do we Mean by Palliative Care in Residential Aged Care Facilities', AUSTRALASIAN JOURNAL ON AGEING, WILEY-BLACKWELL, pp. 19-20.
Grbich, C, Maddox, I & Parker, D 2000, 'The emotions and coping strategies of caregivers of family members with a terminal cancer.', PSYCHO-ONCOLOGY, JOHN WILEY & SONS LTD, pp. S60-S60.