2011 Social Research Report

Transcription

UnitingCare Queensland Annual Research Report – 2011
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This report focuses predominately on research activity in Blue Care; the University of Queensland (UQ) / Blue Care
Research and Practice Development Centre; UnitingCare Community (formally Lifeline Community Care Queensland);
UnitingCare Health and Wesley Mission Brisbane.
Additional research reports are also published by the Wesley Research Institute, St Andrew’s Medical Institute and
The University of Queensland Blue Care Research/Practice Development Centre.
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UnitingCare Queensland – About us
2
UnitingCare Queensland Shared Values 3
Message from The Chair, Social Policy and Research
4
Message from Chief Executive Officer, UnitingCare Queensland
5
UnitingCare Queensland Research Committee
6
Research in UnitingCare Queensland and our strategic objectives
7
The research we have done
8
Completed research projects 2010/2011
9
Ongoing research projects 2010/2011 46
Index of completed research projects
79
Index of ongoing research projects
80
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About us
Who is UnitingCare Queensland?
UnitingCare Queensland is the health and community service provider of the Uniting Church and supports more than
14 000 people throughout Queensland every day of the year.
With over 15 000 staff and 8 500 volunteers in more than 400 geographic locations across Queensland, UnitingCare
Queensland is one of Australia’s largest non-profit health and community service providers, with annual revenue in
excess of one billion dollars.
UnitingCare Queensland also participates in the UnitingCare Australia network, contributing to social policy
development and advocacy at a national level.
Our mission
UnitingCare Queensland claims its place in the mission of God through its health and community services, research,
advocacy and community development.
As part of The Uniting Church, the mission of UnitingCare Queensland is to improve the health and
wellbeing of individuals, families and communities as we: Reach out to people in need; Speak out
for fairness and justice; Care with compassion, innovation and wisdom.
Blue Care, UnitingCare Community, UnitingCare Social Justice and UnitingCare Health are vital expressions of
this mission.
UnitingCare Queensland also works with Wesley Mission Brisbane to further the outreach of the Uniting Church
in Queensland.
page 2
Our Values: Compassion • Respect • Justice • Working Together • Leading through Learning
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UnitingCare Queensland Shared Values
Values are the principles, standards and qualities that characterise the way in which
we do our work.
UnitingCare Queensland believes the following values are fundamental to the work
we do and express the mission of God being present in people’s lives to offer hope,
healing and transformation.
Our values form the basis of our research agenda.
Compassion
Respect
Justice
Working together
Leading through learning
Through our understanding and empathy for others we bring holistic care,
hope and inspiration
We accept and honour diversity, uniqueness and the contribution
of others
We commit to focus on the needs of the people we serve and to work
for a fair, just and sustainable society
We value and appreciate the richness of individual contributions,
partnerships and teamwork
Our culture encourages innovation and supports learning
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Message from the Chair, Social Policy and Research
Research efforts at UnitingCare Queensland have continued to strengthen in the past
year. There has been a significant increase in the number of completed and ongoing
research projects in our service groups and a strengthening of the relationships between
service groups and our research institutes and University partners. Overall, this has
resulted in an increased capacity within UnitingCare Queensland to harness research
activities towards improving practice outcomes and contributing to policy debates.
An important landmark has been the establishment of the UnitingCare Community
Research, Analysis, Innovation and Development Unit headed up by Dr Sharon
Atkin, that will oversee the research agenda within that service group. This is
an important step and I would like to commend UnitingCare Community for the
commitment it has shown to research in setting up this unit. In Blue Care, a new
research approval group (RAG) was established to approve research before it is
submitted to the UnitingCare Human Research Ethics Committee (HREC). The Research Committee meetings
have provided the opportunity for our service groups to share their RAG policies to assist in selection criteria and
processes. Areas of interest included what research was not approved as well as what was, how to keep people
engaged when research is not approved and what facilitates and what hinders research activities by staff.
During the year the UnitingCare Queensland Research Committee established a sub-committee to assist in organising
our second research conference which is due to take place this year at The Wesley Hospital and the Wesley Research
Institute. This conference follows the successful inaugural conference in 2010 and promises to be bigger and better
than the first, very successful one. I would like to thank the sub-committee for their assistance with the planning and
also for their major contributions to this research report.
The Research Committee, together with the UnitingCare Human Research Ethics Committee (HREC) and the subcommittee have overseen the further development of research and research governance in UnitingCare Queensland
in the past year.
Some significant steps forward include the referral to the UnitingCare Queensland HREC of all research requiring ethics
approval for non-clinical research (clinical research is overseen by the UnitingCare Health Ethics Committee, and the
Research Institutes at The Wesley and St Andrew’s Hospitals maintain their own records of research activities). The
committee has also continued the development of research capacity by working with staff to identify practice issues that
require research input to establish alternative service models or to advocate for policy or practice changes.
Other work conducted by the Research Committee has included ongoing work to develop shared e-library resources
across UnitingCare Queensland and preparing submissions for funding for research both within the organisation,
and also together with other service providers. It has also conducted a workshop to understand the key concepts
introduced in the 2011 UnitingCare Queensland Strategic Plan. This is ongoing work, with another workshop
scheduled towards the end of the year.
This has been a busy and fruitful year for the UnitingCare Queensland Research Committee and I would like to thank
its members for their ongoing support and hard work.
I commend this report to you, as you will see it serves as a testament to the great progress we have made as an
organisation in our social research effort. I am sure that the research described here will provide information and
inspiration to help improve the wellbeing of the people we care for in the work that we do every day.
Jill Wilson
Chair, Social Policy and Research
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Message from the Chief Executive Officer,
UnitingCare Queensland
The past research year at UnitingCare Queensland has been a year of development
and growth not just at a project level but at an organisational capacity and capability
level. Our social research efforts have matured and the foundational frameworks
and processes are now well established which support a more coordinated and
sophisticated practice-based research approach across the organisation. These
developments are linked to a strong focus in the 2011 UnitingCare Queensland
Strategic Plan on research driving the ongoing development of outcome focussed
and person centred responses in our health and community services.
As you take a look through this research report, I am sure, that like me, you will
be impressed by the breadth and depth of our research effort across the group.
We are in a very fortunate position that the scale of our organisation provides us with such a rich seam of research
opportunities. The range of our services and the professionalism of our staff means that UnitingCare Queensland
can be involved in some very exciting client-based research projects. Across the organisation we have many highly
qualified and specialist practitioners with a passion for person-centred care and who are driven to finding better ways
to support the many thousands of people that we work with every day.
I would like to thank all of our staff who are involved in research across the group. I know that sometimes it might not
even feel like you are conducting research, but simply by investigating better ways to support and care for our clients
you are contributing to the research effort of the organisation.
I would particularly like to thank our Chair of Social Policy and Research, Professor Jill Wilson, for leading the research
agenda and to the members of the research committee and sub committee and the Human Research Ethics
Committee for their continued commitment and passion to seeking better outcomes for the people we serve.
I would also like to acknowledge the contribution and very positive working relationship we enjoy with our research
partners, The University of Queensland and our research institutes – the Wesley Research Institute, St Andrew’s
Medical Institute and The University of Queensland /Blue Care Research and Practice Development Centre.
Good quality practice-based research is fundamental to the work of UnitingCare Queensland and I look forward to
our continued commitment to research as we reach out, speak out and care for Queensland communities, every day
of the year.
Anne Cross
Chief Executive Officer, UnitingCare Queensland
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UnitingCare Queensland Research Committee
The UnitingCare Queensland Research Committee has been established by the CEO and Executive Leadership Team
to act as a monitoring and advisory body in relation to the conduct and implementation of research in UnitingCare
Queensland. Its primary focus is in community services.
The Research Committee’s membership includes a representative from each service area. The members for
2010 were:
Professor Jill Wilson, Chair, Social Policy and Research, UnitingCare Queensland
Anne Cross, CEO, UnitingCare Queensland
Dr Kathy Ellem, UnitingCare Queensland Postdoctoral Research Fellow
John Pini, Director, Individual and Personal Support, UnitingCare Community
Julie Aganoff, Director, Client Service Development, UnitingCare Community
Dr Sharon Atkin, State Manager Research, Analysis, Innovation and Development, UnitingCare Community
Linda Dawson, Director, Community Services, Blue Care
Richard Olley, Director, Residential Services, Blue Care
Brent Hodgkinson, Senior Care Advisor, (Development and Research) Blue Care
Colleen Geyer, Blue Care Director of Mission; Chair, UnitingCare Queensland Human Research Ethics Committee
Michelle Skinner, Director, Residential Services, Wesley Mission Brisbane
Associate Professor Deborah Parker, Director, University of Queensland/Blue Care Research and Practice
Development Centre
Richard Royle, Executive Director, UnitingCare Health
UnitingCare Queensland Human Research Ethics Committee
Colleen Geyer, Chairperson
Kathy Ellem, Academic, Disabilities representative
Dr Anthony Tuckett, Deputy Chairperson, Nursing Academic
Dr John North, Medical Practitioner
Dr Sally Bennett, Allied Health Academic
Neville Jolly, Community consumer
Glenys Webby, Allied Health Practitioner
Julie McStay, Legal representative
Lyndelle Gunton, Community consumer
Heather den Houting, Minister of Religion
Brent Hodgkinson, Research representative
Theresa McCormack, Legal representative
UnitingCare Queensland Research Conference sub-committee
Professor Jill Wilson, Chair, Social Policy and Research, UnitingCare Queensland
Dr Kathy Ellem, UnitingCare Queensland Postdoctoral Research Fellow
John Pini, Director, Individual and Personal Support, UnitingCare Community
Dr Sharon Atkin, State Manager Research, Analysis, Innovation & Development, UnitingCare Community
Brent Hodgkinson, Senior Care Advisor, (Development and Research) Blue Care
Dot King, Senior Communication Officer, UnitingCare Queensland
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Research in UnitingCare Queensland our strategic objectives
During the year UnitingCare Queensland undertook a major review of its strategic plan canvassing the changing
environment and inspired by a long term vision that focuses on our role in supporting our clients and patients to live
their lives as fully as possible – to be all that they can be. Our renewed core objectives focus on person-centred care
and our service models, on our capacity to attract and retain staff, volunteers and visiting medical practitioners and on
our partnerships within our sectors.
Our contribution to social policy and research is an important element of the new strategic plan and our core
objectives provide a common base for engagement in all service streams. Our updated mission statement states:
As part of the Uniting Church, the mission of UnitingCare Queensland is to improve the health and
wellbeing of individuals, families and communities as we: Reach out to people in need; Speak out
for fairness and justice; Care with compassion, innovation and wisdom.
This, together with our shared values of compassion, respect, justice, working together and leading through learning
are the principles for action that form the basis of our research agendas across UnitingCare Queensland.
The strategic plan emphasises the development of research capacity among practitioners and clinicians and the use
of research to:
•develop appropriate measures of person-centric outcomes and satisfaction with the services provided
•develop person-centric models of service delivery
•enhance client and patient engagement more broadly
•monitor a place-based trial to address disadvantage, building on the UnitingCare Queensland Disadvantage Scan
•promote social policy and advocacy in relation to our areas of service delivery.
This provides a broad framework for our research and social policy advocacy. Other research will be done that is
not directly indicated by the strategic plan. For example, considerations of workforce development support and
sustainability, or responding to issues that emerge from work within and across service streams. These agendas
together form the focus for research in 2012.
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The research we have done
Research reports have previously been published by UnitingCare Queensland in 2009 (for the years 2006, 2007
and 2008), and in 2010 (for the years 2009 and 2010). This report covers research completed and underway from
November 2010 - October 2011, and the core activities of the Research Committee over this period.
The following table summarises research that has been considered by the UnitingCare Queensland Human
Research Ethics Committee for the three research reports. A considerable amount of research has also been
conducted at The Wesley Research Institute and St Andrew’s Medical Institute and details of this work are available
at www.wesleyresearch.org.au and www.sami.org.au.
Period under review
Research projects completed
during the period of the report
Research projects ongoing at
conclusion of the period of the report
2008 Report (2006-2008)
23 (average of 7.3 per year)
40 (average of 10.3 per year)
2010 Report
(2009- October 2010)
30 (average of 15 per year)
44 (average of 22 per year)
2011 Report
(Nov 2010/Oct 2011)
31 per year
39 per year
The number of research projects conducted each year has continued to grow. This growth is linked to:
•thereorganisationandpromotionofresearchwithinservicegroups
•increasedcooperationbetweenresearchersexternaltoUnitingCareQueenslandandserviceteams
•theinjectionofmoreresourcestosupportresearch.
Comparing work that was ongoing in each research report, in 2011 69 per cent was undertaken by UnitingCare Queensland
staff, alone or in conjunction with University researchers; in 2010 the figure was 37 per cent and in 2008, 33 per cent. There
are also clear indications that the findings are increasingly being incorporated into practice in a range of services.
Informing our practice through research
This report summarises all of the research completed or current in 2011. Case studies on some of the research that
has been undertaken during the year are interspersed among the “completed” and “ongoing” research reports. These
case studies highlight the origins, research activities and outcomes for practice or for the research community.
The research undertaken in 2011 falls into three groupings:
•Advancingknowledgeforpracticetoachievesocialjusticeoutcomes
•Developingandsupportingourstaffandvolunteers
•Practiceapproachesforpeople-centricoutcomes
These groupings can be linked to the key research themes developed in 2009 and form a bridge to the key themes for
research currently being developed to align with the UnitingCare Queensland 2011 Strategic Plan.
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Completed projects
Advancing knowledge for practice to achieve social justice
outcomes
Pain rating scales for older people with severe dementia: Which is the
best for nurses to use?
Associate Professor Christine Neville, Kerry Neal, University of Queensland (UQ)/Blue Care Research and Practice
Development Centre
Purpose and research questions
The purpose of this study is to compare three pain rating scales and collect data for psychometric validation. The
overall aim of the study is to be able to recommend to nurses a validated and clinically useful methodology to assess
pain symptoms of older people with severe dementia.
Results, their use and policy/practice implications
Scales were tested on 102 residents most with moderate to severe cognitive impairment. Scales were completed
predominantly by registered nurses.
The Abbey Pain Scale (APS) demonstrated good reliability (0.82) and good agreement between the two assessors
(0.79). The Doloplus-2 demonstrated good reliability (0.81) and good agreement between the two assessors (0.68)
and the Checklist of Non-Verbal Pain Indicators (CNPI) demonstrated good reliability (0.79) and good agreement
between the two assessors (0.65). When staff were asked which scale they preferred they indicated that the Abbey
and Doloplus-2 were preferred over the CNPI.
The Abbey Pain Scale which is currently recommended by the Australian Pain Society for people with severe cognitive
impairment demonstrated good reliability and acceptability for use in Australian residential care settings.
Community links in dementia awareness
Judy Simpson, Kerrie Storey, Wendy Russell, Shashi van de Graff, Dr Helen Higgins, Blue Care
This project was aimed at raising awareness of dementia amongst the community and local businesses in the
Fraser Coast region by providing them with knowledge, education and skills for promoting positive interactions with
customers with dementia. It aimed to empower these people and their carers by raising community awareness in the
organisations and businesses that operate in their area and to equip business staff to identify incidents resulting from
memory loss e.g. taking possessions and inappropriate expenditure or withdrawal.
Two information packages were developed in consultation with carers of people with dementia and staff from other
non-government organisations – one for business owners and staff and the other for the carers of people with
dementia. These provide basic information about dementia and communication techniques and methods for handling
inappropriate actions. The information supplied assists business staff to formulate reasonable strategies for effective
interaction and reduces fear or judgement of people living with dementia.
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The information kits help provide vital support links between local business and community care providers and
provide a model for implementation across other communities within Australia to raise awareness and reduce stigma
for people living with dementia within their own communities.
The project has been launched to the community with 30 stakeholders attending the launch. Packs have been made
available to stakeholders including Blue Care, Maryborough Dementia and Memory Centre, Fraser Coast Regional
Council, Commonwealth Respite and Carelink Centres, Alzheimer’s Australia Qld, Endeavour Foundation and Local
Neighbourhood Centres.
The effectiveness of ExMI to reduce the incidence of urinary
incontinence in community dwelling adults
Suzanne Hindle, Christene Dennis, Maxine Olive, Susan Fee, Blue Care – Redcliffe Community; Tim Henwood – UQ/
Blue Care Research & Practice Development Centre; Brent Hodgkinson, Blue Care
An estimated 3.8 million Australians experience some degree of incontinence, with the prevalence of incontinence
increasing with age in both males and females. By 2051, it is projected that slightly more than one in four Australians
will be aged 65 years and older. Incontinence has a negative impact on an individual’s quality of life and incontinence
is considered a significant predictor for institutionalisation of older people.
Extracorporeal Magnetic Innervation (ExMI) involves the non-invasive application of a changing magnetic field to
control the depolarisation of nearby nerves and therefore muscle contractions. Before and after trials have displayed
the effectiveness of ExMI to reduce the incidence of urinary incontinence (UI) predominantly in female patients with
stress or urge UI. However, extended follow-up in some of these trials have shown a significant number of “cured” or
“improved” patients exhibiting a relapse back to urinary incontinence.
Two randomised controlled trials, showed either significant reductions in the number of incontinence episodes and
pad weights, and improvements in quality of life (QoL) scores compared with placebo treated patients, or found that
both treatment groups made significant improvements in UI symptoms but there were no differences between the
two treatment groups. Therefore the aim of this study was to perform a random controlled trial (RCT) to evaluate
the effectiveness of the Wave Brilliance™ ExMI chair to reduce incontinence symptoms in a community dwelling
population compared with standard practice.
In a single blind (participant) placebo RCT participants were adults >18 years with documented evidence of urinary
incontinence of type urge, stress or mixed of at least 6 months duration that had not yet received ExMI. The
intervention group received standard therapy plus Wave Brilliance™ ExMI chair 20 minutes twice per week for eight
weeks while the comparison group received standard therapy plus sham Wave Brilliance™ ExMI chair twice per week
for eight weeks.
Outcome measures for each of the treatment groups were collected prior to the trial and immediately after the trial at
eight weeks. Outcomes that were measured were:
•number of incontinent episodes per day (three day bladder diary)
•QoL (Kings Health Quality of Life Questionnaire)
•number of pads used per day
•Wave Brilliance Australia™ pre/post questionnaire
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Clients were considered to have been “cured” if they recorded no incontinent episodes per day and “improved” if they
displayed a 50 per cent reduction in the number of incontinent episodes per day.
Forty clients were enrolled in the trial (average age 73 years) who had been affected by incontinence for over seven
years on average. There were six dropouts, all in the control arm. Per protocol analysis showed no significant
differences between groups on any of the outcome measures. However, Intention to treat analysis showed a
significant difference between treatment groups favouring the intervention group in the number of clients who had a
50 per cent improvement in the number of hours between voids overnight (i.e. time between last void before retiring
and next void, p=0.03). The intervention group improved by almost two hours (1.9 hours) compared with the control
in the mean number of hours between overnight voids.
The Wave Brilliance™ chair may be beneficial to this client group in improving nocturnal enuresis episodes. However,
more research on a larger sample or on specific sub-populations of clients needs to be performed as no difference
was found for any other client outcomes between treatment arms.
Investigation of the useability and efficiency of the residential aged
care management software “Dashboard”
Brent Hodgkinson, Maureen Kennedy, Richard Olley, Blue Care
Dashboard has been implemented in Blue Care in an attempt to provide more complete and up to date productivity
data for care managers responsible for all residential aged care facilities in a cluster, and service managers
responsible for individual residential aged care facilities within a cluster. The aim of the Dashboard was to provide a
tool to assist care managers and service managers to ensure that their Key Performance Indicators (KPI) were being
met.
The aim of this investigation was to determine:
•whether care managers and service managers found the Dashboard easy to use and navigate
•whether care managers and service managers found the Dashboard a more efficient (i.e. timely) way of obtaining
Key Performance Indicators (KPIs) data.
The participants of this study were recruited from the pool of all Residential Care Managers (CM) and Service
Managers (SM) within each of the 10 Blue Care clusters (N>60 potential participants).
The intervention investigated in this study is the newly designed Blue Care RAC Dashboard. The Dashboard is an
online interface that draws data from Blue Care financial and Human Resources databases to a single point that
provides CM and SM the following information at a glance:
•Finance KPIs
•Care System KPIs
•Human Resources KPIs
The use of the dashboard to provide KPI data was compared with previous practice where KPI information was
obtained from numerous sources with varying refresh rates (daily, weekly or not available without special request).
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Twenty participants answered both the pre and the post intervention survey(s) - eighteen females, two males. With
a mean age 48.3 ± 7.7 years, three were care managers, 16 service managers and one a regional support team
member. Staff reported that they spent significantly less time accessing required KPI information using the Dashboard
compared with previous practice. Further, staff spent an average of five hours less time per week accessing KPI
information.
The results of the Dashboard useability survey showed that staff found the Dashboard superior to previous practice.
The overall impression of all respondents was rated as good to excellent (19/19), all respondents finding the software
useful (19/19) and all but one respondent (18/19) finding using the Dashboard better than previous practice. The one
respondent who responded “neutral” for whether they found the Dashboard better than previous practice was also
the oldest respondent in the survey (over 60 years).
Role of hydrotherapy in an aged care therapy service
Julie Yule, Manager, Sinnamon Village Therapy Centre, Wesley Mission Brisbane
This research project was undertaken by University of Queensland Social Science students in conjunction with the
physiotherapy staff at the Sinnamon Village Therapy Centre to explore the benefits of hydrotherapy in the healthy
ageing process. The project included the examination of existing anecdotal and research evidence of the positive
benefits for hydrotherapy clients, with associated improvements in their balance, flexibility, pain relief and their
strength/mobility (Batterham et al, 2011; Silva et al, 2008). The research aim was to “investigate the effectiveness
of hydrotherapy in regards to key outcome measures of physical improvement in addition to social interaction and
wellbeing” (Beasley et al, 2009). The project included the completion of questionnaires by clients attending the
hydrotherapy pool, the facilitation of focus groups with clients and treating physiotherapists and surveys of carers.
The questionnaires were distributed to 69 clients, ranging from 55 to 84 years and seven carers. Focus groups were
also facilitated with 44 clients and three physiotherapists.
The outcome of the data analysis revealed the clients experienced “significant improvements in physical wellbeing,
in terms of pain relief, flexibility, strength/mobility and balance/confidence” (Beasley et al, 2009). The project also
discovered secondary benefits to clients of the social interaction and improvements in psychosocial wellbeing of
clients. There were also factors identified affecting clients’ participation in hydrotherapy, including transport issues,
access issues and referral procedures. Since the project was completed, Sinnamon Village Therapy Centre staff have
continued to work through and address some of these impacting factors, including access issues. The therapy centre
is currently expanding its physiotherapy services to include the use of hydrotherapy and/or other evidence-based
therapy modalities, such as Pilates and the use of gym equipment, to create a holistic healthy ageing model of service
delivery.
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Exploring associations and relationships between assisted conception
and breastfeeding outcomes
Associate Professor Margaret Barnes; Dr Anne Roiko; Rachel Reed; Kerry Willcocks and Cath Williams, The
Sunshine Coast Private Hospital
Funding
Queensland Nursing Council Experienced Researcher Grant of $25 000 for the joint research partnership between
The Sunshine Coast Private Hospital and University of the Sunshine Coast, 2007 to 2009
Baby Friendly Hospitals are required to consistently demonstrate that 75 per cent of women are exclusively
breastfeeding at discharge. During a Breast Friendly Hospitals Initiative (BFHI) assessment at The Sunshine Coast
Private Hospital, midwifery staff commented to the assessors: “If we did less IVF, our breastfeeding rates would be
significantly higher”. The lead assessor subsequently initiated a peri natal data check and found that the hospital
did indeed have a higher than state average for assisted conception and a higher than average number of mothers
going home with mixed feeding i.e. breastfeeding and artificial supplements. This sparked a partnership between
the hospital and The University of the Sunshine Coast, to explore associations and relationships between assisted
conception and breastfeeding outcomes, using a mixed methods study. Extensive literature reviews were undertaken
to look at the influence of assisted conception relating to mothers, babies, birth outcomes and psychosocial factors.
Component one involved logistical regression modelling which measured the nature and associations between
assisted conception and breastfeeding outcomes and key factors were adjusted using data from the Queensland
peri natal database. Component two was conducted at the same time and involved recruiting women for interviews
prior to birth and/or in the postnatal period and qualitative research looked at the stories of experiences from women
themselves.
Quantitative analysis from Queensland peri natal statistics 1996 to June 1997 found that there is a gap between those
who are breastfeeding at discharge depending on whether conception was assisted or natural. The research confirms
the midwife ‘feeling’ that there is more difficulty in establishing and maintaining lactation, despite the mothers’ own
desires to achieve breastfeeding success.
Women who have experienced assisted conception are more likely to be at risk of breastfeeding difficulties than
those who have conceived naturally so identifying this group may help them be better prepared. With the rising rate
of assisted conception the challenge for maternity facilities is to provide appropriate anticipatory support: protecting
breastfeeding while providing adequate nutrition for babies. The Sunshine Coast Private Hospital has responded with
changes in education, counselling and lactation management processes, as supporting breastfeeding is an important
health priority which has long term impacts for women, families and babies.
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Continuing effects: Factors contributing to the maintenance of physical
activity groups
Robert L. Hill, Professor Wendy Brown, School of Human Movement Studies, UQ
This study sought to determine the cause or causes of the remarkable continuation of two exercise groups several
years beyond the end of an intervention in Blue Care residential centres in the Brisbane area of Queensland. Focus
groups were conducted with residents of the Wondall centre in Manley West and the Nandeebie centre in Alexandra
Hills. Recordings of what the participants said during these focus groups were transcribed and the resulting data were
analysed for the purpose of finding common themes. A brief survey was also completed by participants. Tentative
conclusions about why these groups continued with exercise programs well beyond the conclusion of the intervention
are offered below.
In 2004, a team of researchers from the School of Human Movement Studies at the University of Queensland (UQ)
began a randomised controlled trial to compare the efficacy of 16-week home-based and group-based resistance
training programs on the functional status and health of older Australians who were residents of nine Blue Care
facilities. Outcomes were evaluated after 12 months in three settings: a group-based resistance training program
conducted in meeting rooms of residential villages and identified as ‘Come Have a Try’ (CHAT) groups, a home-based
resistance training program, and a group-based control group doing flexibility training and walking. The current study
interviewed participants who had been in CHAT groups.
Researchers in the United States noted in 1996 that studies of interventions to change health behaviours typically do
not provide compliance data beyond the conclusion of the intervention (Burton, German, Shapiro, and The Johns
Hopkins Medicare Preventive Services Demonstration Team, 1996), so little is known about their long-term effects.
By contrast, the Blue Care intervention conducted by Elizabeth Cyarto and others showed encouraging results in an
assessment done 44 weeks after the end of the intervention and resulted in exercise groups that have continued year
after year. Cyarto and colleagues published a report focussed on retention, adherence and compliance data from
their intervention (Cyarto, Brown, & Marshall, 2006). Their study compared results of 20 weeks of in-home resistance
training and resistance training in groups meeting in Blue Care facilities. The CHAT groups began with 81 members.
During a second, post-intervention phase, three CHAT groups were supervised for 24 weeks and then, during a
20-week on-going maintenance phase, participants were encouraged to continue with prescribed exercises, without
instructor support. By the end of the 64-week program, just over half, 41 persons, remained in the CHAT groups.
Of the 40 lost from the group-exercise program, one had died, one had left because they had become a caregiver,
four said they had lost interest, 8 left because of there were no more instructors, and 26 left for medical reasons.
Cyarto and colleagues found no significant differences in baseline characteristics between those who remained in the
program and those who withdrew (2006).
Nearly six years later, in 2010, two of the CHAT groups were continuing to meet regularly in Blue Care residential
centres for exercise using the techniques they had learned in 2004 and their participants agreed to participate in
focus-groups for the current study to explore their experiences during and after the intervention. Two additional focus
groups explored the reflections and situations of persons who had been in the CHAT groups but were no longer
members of the on-going exercise groups.
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Four focus groups were held in two of the residential centres to explore the views of (a) those continuing with the
group exercise program and (b) those still living in the centres who had been members of the original group but
were no longer participating. The principal author transcribed verbatim the recordings made of the four focus group
sessions and the transcripts were then coded in a two-step process using Nvivo 8 to pull together statements
of participants into about 30 and then, after reconsideration and refinement of headings and subheadings, 15
categories.
The Blue Care/UQ intervention led by Elizabeth Cyarto in 2004 accomplished significant short-term goals to the
benefit of many participants and left in the residential centres a DVD and a guidebook that was useful to two exercise
groups. More than 6 years later, two exercise groups have continued to benefit their participants, offering 20 or more
persons on-going physical exercise opportunities. Reasons for this remarkable continuation included the efforts
of volunteer leaders who stepped forward when professional leadership was concluded, group cohesion and peer
pressure, the availability of meeting spaces, participants’ knowledge that physical activity contributes to health and
participants’ desires to live independently and with the fullest functionality possible as long as possible.
The participants in the Manley West and Nandeebie centres have built a vibrant community spirit that shows itself in
banter and easy laughter when they get together. They express gratitude to Blue Care and to Cyarto and her helpers
for what they have been given. They also express, however, a sense of abandonment, lacking basic equipment such
as Therabands and, more significantly, outside, professional leadership.
The author of this research suggests that:
•a panel of Blue Care residents drawn from those who have stayed with the continuing groups be formed to advise
Blue Care on how best to plan and initiate a new group-exercise initiative
•this new program include competent exercise professionals to instruct, advise, and encourage group physical
activity at least one day a month in each residential centre.
•this new program be launched with full attention to marketing and promotion in order to attract as many new
participants as possible from among the residents of Blue Care centres.
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The research we do - a case study
Gut feeling led to world-first research
A gut feeling on the part of midwifery staff at The Sunshine Private Hospital that
there appeared to be a link between assisted conception and the likelihood
of mothers going home not exclusively breastfeeding their babies, led to a
piece of world-first research which has resulted in education, counselling and
lactation management processes being changed at the hospital.
“From our experience with hundreds of mothers and babies, it seemed to
us that IVF could go hand-in-hand with breastfeeding difficulties for many
mothers,” Cath Williams, Midwife-Lactation Consultant, The Sunshine Coast
Private Hospital, said.
This on-the-job observation was mentioned in passing during a Baby Friendly Hospital Initiative assessment in
2005 (“baby friendly hospitals” are required to demonstrate that 75 per cent of women are exclusively breastfeeding
at discharge).
“The midwifery staff commented to the assessors that the hospital would have an even better rate of mothers going
home exclusively breastfeeding if we didn’t have such a high proportion of mothers with assisted conception,”
Cath said.
The lead assessor was intrigued by this observation and decided to delve into the proposition further. A peri natal
data check was initiated and it was found that the hospital did indeed have a significantly higher than state average
for assisted conception and a higher than average rate of mothers going home with mixed feeding (breastfeeding
supplemented by bottle feeding).
“This finding led to the hospital partnering with Associate Professor Margaret Barnes at The University of the
Sunshine Coast to work together to explore associations and relationships between assisted conception and
breastfeeding outcomes,” Cath said.
“We successfully applied for a grant from the Queensland Nursing Council for the research partnership and an
extensive literature review was undertaken to look at the influence of assisted conception relating to mothers,
babies, birth outcomes and psychosocial factors,” she said.
Logistical regression modelling was undertaken to measure the association between conception and breastfeeding
using data from the Queensland peri natal database. In the meantime, a sample of pregnant women attending The
Sunshine Coast Private Hospital was interviewed before the birth of their child and six weeks after the birth.
“It turned out that the midwife’s gut feeling was backed up by science which was a wonderful affirmation of their
skill – it’s great to know that they were ahead of the science by some years,” Cath said.
“We now have an increased level of staff awareness and spend a lot more time with this group of mothers,
counselling, supporting and assisting them. In fact, this research has helped us in the care of all mothers when it
comes to breastfeeding their babies,” she said.
The Sunshine Coast Private Hospital was ranked number one in Australia in a 2011 national survey into
maternity experiences conducted by Medibank Private.
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Developing and supporting our staff and volunteers
Blue Care’s staff wellness project: Central Queensland and
Fraser Coast
Roxanne Machen, Blue Care, PhD student, Central Queensland University (CQU), Associate Professor Peter Raeburn
(CQU), Dr Thomas Cuddihy (QUT), Dr Helen Higgins (Blue Care).
Blue Care has initiated a workplace wellness pilot program covering the Central Queensland and Fraser Coast regions
of Queensland. The purpose of this project is to quantitatively evaluate the ability of a workplace wellness framework
to promote individual and organisational wellness and health culture change and effect change in organisational cost
productivity and retention measures across a geographically diverse health care setting. The Blue Care staff wellness
framework consists of a wellness focussed conceptual and process framework. Its implementation phase adopts
a socio-ecological approach to wellness promotion. The Blue Care staff wellness framework evaluation uses a pre/
post quasi experimental research design with a quantitative component measured through the use of the RE-AIM
framework (Glasgow & Linnan, 2008). The framework measures reach, efficacy, adoption, implementation, and
maintenance of the wellness program.
Reach: A total of 130 participants were initially recruited and registered at baseline, representing 11.8 per cent of the
total eligible population (N = 1098). Post intervention a total of 67 participants completed the program, representing
5.2 per cent of the total eligible population. The total number of eligible participants at follow-up was 72 (accounted for
by a 44.2 per cent turnover). A total of three participants declined to participate further in program measurements.
Efficacy: Participants showed a 26 per cent and 31 per cent increase in wellness and satisfaction scores respectively
measured by the wellness inventory. Health culture measures showed a significant improvement.
Adoption: Service level adoption as measured by individual participation revealed a geographic and demographic
dispersion of wellness program adoption. Ambassador level adoption was seen in 27 of the 29 eligible hubs
(93 per cent).
Implementation: Implementation was measured at the service level using activity summary and evaluation forms and
at ambassador level by evaluation forms.
The Blue Care Staff Wellness program is the first to measure both individual wellness and organisational health
culture as direct outcomes of a workplace wellness promotion research framework for an Australian health care
sector employee population. Overall, the results demonstrated the ability of the Blue Care Staff Wellness Program
pilot framework to affect positive change in individual wellness, wellness satisfaction and organisational health culture
amongst program participants, demonstrating these components as plausible measures within the workplace
wellness construct. The RE-AIM evaluation illuminated these improved health culture and wellness outcomes despite
identifying low participation rates, low representativeness, poor retention and modest implementation scores as
critical factors in the program dissemination. These outcomes suggest future efforts targeting workplace wellness
should consider the technology barriers and workplace logistics associated with such a workforce.
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What effect does the death of residents have on staff in residential
aged care facilities?
Rev Helen Dick, Blue Care
The aim of this exploratory study was to be an entry point into understanding more about the effect on staff of
resident deaths in residential aged care facilities (RACFs). The approach was guided by the following questions:
•are there common or recurring emotional, mental and spiritual issues for staff when a resident dies, if so what are they
•are there flow-on effects/consequences for the workplace, for staff, the organisation and/or residents
•are there common means by which staff find meaning in their work of caring for the “terminally aged”? (Fulton,
quoted by Sumaya-Smith, 1997, p449).
•are there existing formal and informal, internal and external, support mechanisms that staff have found to be helpful
when residents die
•do staff themselves perceive support needs which might need to be addressed.
It was intended that exploring these questions would provide direction for future research and provide information
which may help assess the need for further training and pastoral support strategies for staff in RACFs.
The most commonly reported effects, in the event of a “good death”, were some sadness but mostly relief for the
resident and satisfaction at having made a difference. The participants reported a strong sense of meaning in their
role. When pain and suffering were well controlled, sadness appeared to be transitory, with little evidence of ongoing
grief. However the data also revealed that the sense of meaning was significantly derailed in the event of a “bad” death
and in the presence of pain and suffering. In these circumstances participants reported more difficult emotions, such
as deeper sadness, anger and frustration and reported that they persisted longer. The data pointed to a possible link
between these adverse effects and workplace outcomes such as staff conflict and avoidance of residents in pain.
There are a number of possible areas for future research originating from the issues that have been identified and
discussed in this enquiry:
•replication of the study at multiple sites with different samples of RACF staff
•in-depth inquiries into the effects on staff of witnessing pain and suffering as well as death (perhaps in-depth
interviews throughout a year).
•ethnographic studies into staff behaviour in the presence of dying and death.
•investigations into the possibility of a link between employee attrition rates among RACF staff and frequent dealing
with death (exit interviews/surveys)
•investigation into the possible links between “religiosity” and the effects of resident deaths
•investigation of possible differences between gender and the effects of resident deaths.
In view of the fact that palliative care is likely to become an increasingly significant part of the work of aged care,
adequate training is an important aspect of supporting the sense of competence and meaning for staff.
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The data suggests that strengthening mentoring and support systems is particularly important for staff when they first
encounter resident death.
Consideration could be given to recruitment and training of appropriate volunteers to sit with the dying when family or
friends are not available. As funding levels are not sufficient for increased staffing it may be timely to consider the use
of volunteers to fill this role.
Fleet safety in the non-profit sector
Dr Sharon Newnam, Professor Myles McGregor-Lowndes, Associate Professor Jeremy Davey
The project aims to improve driver safety across UnitingCare Queensland by the use of training sessions and safety
messages.
The broad aims of the research are to:
•examine the factors influencing the safety of work-related drivers
•design and implement a multilevel fleet safety program incorporating all driving groups
•evaluate the effectiveness of the fleet safety program based on a reduction in crashes, costs, traffic infringements,
and improvement in self-report measures
•examine and map the particular statutory and common law requirements and potential liabilities applying to nonprofit organisations, their employees, members and volunteers in relation to vehicles
•devise a framework for formal risk management and legal compliance strategies.
An extensive review of the crash claims database was conducted to identify crash precipitating patterns. The
information obtained from this review has given insight into the factors contributing to crash involvement. For example,
the analysis found the majority of crashes were single vehicle crashes, which suggests that factors such as inattention
could have been a contributing factor.
Forty one interviews were conducted with pooled vehicle drivers, executives with salary sacrificed vehicles, truck
drivers, and volunteers. The major theme that emerged from the interviews was that fleet safety was not considered
a priority by senior level management and was not regularly discussed as a safety issue in meetings or when first
starting in their position.
Surveys were distributed to pooled vehicle drivers, executives with salary sacrificed vehicles, ministers within the
congregations and volunteers. Preliminary analysis found support for factors such as drivers’ perceptions of the safety
climate and their experience of workload contributed to unsafe driving behaviours. In turn, driving behaviours were
found to have a negative relationship with crash outcomes and loss of demerit points.
We developed an intervention designed to reduce speeding within a group of Ministers of the Uniting Church. This
intervention was a one-hour interactive participative education program followed by safety reminders at three and six
months. The results found that the intervention had a significant and positive effect on self-reported speeding, while
no significant change was reported in the control group (i.e., those who only completed pre and post intervention
surveys). Both the control and experimental groups reported a significant decrease in self-reported crashes over
the six month period. One year follow-up also found a significant decrease in crashes for both the experimental and
control groups.
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We have completed an intervention designed to improve speeding performance in the community oriented sample.
Seven service centres participated in the intervention with a final sample of seven service centre managers, 29
supervisors, and 142 drivers. The aim of the intervention was to increase the safety-related interactions between
supervisors and drivers over a three month period.
Monthly safety sessions were conducted with supervisors where context-specific safety messages which focussed
on specific aspects or situations in an individual’s driving day that may result in a driver exceeding the speed limit.
It was the role of the supervisor to engage with drivers on a regular basis to promote the safety message and
encourage them to drive safely. Fortnightly discussions were conducted with drivers to ascertain the number of safety
discussions they had been involved in with their supervisor over the past fortnight. Information relating to whether the
driver listened to the safety message and their attitudes and perceptions of safety were obtained in these discussions.
Subsequent to this, bi-weekly individual discussions were organised with supervisors (and managers) where they
were given feedback on the type and number of driving safety interactions they had with drivers in the past two
weeks. Very positive results were found for this intervention. The results found that overall driving behaviour was
improved in those workgroups.
Work life and vocational and educational training (VET): Increasing VET
participation amongst lower paid workers over the life cycle
Barbara Pocock, Deb Green, Catherine McMahon
The project examined ways in which ‘lower paid workers’ (for example workers who earn less than two thirds of
average weekly earnings) engage with Vocational Education and Training (VET), how VET is relevant or not to these
workers and how increased participation in VET can be enabled over the life course and in the context of changing
patterns of work, home and community life in Australia.
The study, funded by the National Centre for Vocational Education Research (NCVER) over three years from
January 2008 to December 2010, began with a literature review, an analysis of Australian Bureau of Statistics
(ABS), Household Income and Labour Dynamics in Australia (HILDA) survey and NCVER datasets, stakeholder
conversations and a discussion paper.
In 2009, 2691 Australian workers were surveyed as part of the Centre’s 2009 Australian Work and Life Index (AWALI)
and asked how work–life pressures influence the capacity and motivation of individuals across the income spectrum
to engage in education and training (including university and VET education). The report, Work–life issues and
participation in education and training by Dr Natalie Skinner was published by NCVER in late 2009. A discussion
paper Low paid workers, changing patterns of work and life, and participation in vocational education and
training: a discussion starter was published by NCVER in March 2009 on the issues emerging on what influences
people’s decisions to participate in vocational education and training.
In 2008–09 the Centre conducted focus groups and interviews with low-paid workers, VET students, managers
and VET educators in four states (South Australia, Victoria, Queensland and Western Australia) in the non-residential
aged care, retail and food processing industries. All focus groups and interviews with Blue Care personnel were
completed in 2009. Following the focus groups and interviews, a series of ‘strategic interviews’ were conducted with
24 participants drawn from senior personnel from government, industry skills councils, businesses and unions and
with academics, VET educators and equity, social inclusion and research experts.
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Two reports have been published by NCVER in June 2011. The qualitative report: Juggling work, home & learning:
a qualitative study, is divided into four sections. The first describes the context for the study, including the research
approach, the three industries in which the study is concentrated and some key aspects of low-paid work and the
context it creates for training and learning. The second section considers the drivers for VET—from the point of view
of employers, employees and VET students. The third section explores the barriers that inhibit VET participation in
low-paid occupations. The final section sets out a model of the systemic factors that shape VET outcomes in these
low-paid occupations in their work, home, community and educational contexts, and outlines the ‘push’ and ‘pull’
factors that help explain VET outcomes.
The project overview report Work, life and VET participation amongst lower-paid workers, published in June 2011 is
the culmination of the three-year research program and considered a wide range of quantitative data as well as the
experience and perspectives of employers, workers, students and vocational educators. The findings challenge any
easy assumptions that more VET will automatically enhance the position of lower paid workers, that all VET can be
assumed to be similar in positive effect for lower paid workers, or that lower paid workers share similar situations,
including their work/life circumstances.
Additional information on the project and the reports are available on the NCVER website: http://www.ncver.edu.au/
publications/2378.html
The use of mobile technology in community nursing: A pilot study
M. McLaughlin-Rolfe, R. Bell, M. Smith, C. Scott, J. Agotnes, Y. Hinwood, L. Hines, N. Hansen, B. Hodgkinson, Blue
Care Community Care Services
Funding
Non operating HACC capital funding of $5 000 and Operational Budget funding of $5 000
There is very little published research literature on the use of mobile technology in community nursing roles and the
literature that is available is in the form of discussion papers and media releases describing the advantages of the
tested systems. Generally, these reports describe advantages of mobile technology improving the effectiveness and
efficiency of community healthcare workers including:
•real time task updates (daily schedules online) and therefore no need to go to the office to collect
•reduced time in completion of assessment forms
•access to accurate data while in the field
•minimisation of manual data input
•standardising collection forms.
This was an exploratory study asking staff to compare their work scenario before and after the use of a mobile
technology, and to evaluate the usefulness of the mobile technology in their work scenario.
A total of two nursing teams took part in the study. They comprise one clinical nurse and the equivalent of four full
time equivalents of registered nurses (both full and part-time staff).
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Staff were randomly allocated to one of six devices:
•iPad 2 – tablet
•Dell Latitude 2120 netbook
•Motion Tablet CL900
•Motorola Xoom
•Dell Vostro V130
•Blackberry
Each participant attempted to incorporate the use of the provided device, however they deemed appropriate, in their
normal work day for a period of four weeks. At the end of the trial period for each device (four weeks) the participants
were asked to complete a useability survey. Staff were then randomly allocated to another of the six devices for a
further four weeks.
The outcomes tested were useability (how easy was it to use), functionality (did it offer all necessary functions) and
supportability (by Blue Care IT systems).
Within the first four week period it was apparent that two devices were superior on all three outcome measures: The
iPad2 and the Blackberry. Use of the Motion Tablet CL900 was discontinued within the first four weeks due to poor
outcomes for all three measures.
This pilot study has identified that the iPad2 and the Blackberry are presently the best mobile technology platforms
for Blue Care community nurses. Given the right platform, nursing staff are very quick to use the technology in
their practice.
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Palliative approach toolkit makes a ‘good death’ possible for
aged care residents
We all hope for a ‘good death’ for our loved ones and for most of us that means that
they end their lives in the most dignified and comfortable way possible. For those whose
parent, relative or friend ends their life in an aged care facility this hope is now more of
a reality than ever before, thanks to a palliative approach toolkit which aims to provide
quality care for residents of aged care facilities at the end of their life.
The toolkit is the culmination of a two-year, $1.4 million, comprehensive evidence-based
palliative approach research project led by Associate Professor Deborah Parker from
the University of Queensland/Blue Care Research and Practice Development Centre and funded by the Australian
Government’s Department of Health and Ageing under the Encouraging Better Practice in Aged Care (EBPAC) Program.
Researchers, health care providers and palliative care specialists from New South Wales, Queensland, Western Australia
and South Australia contributed to the project and nine residential aged care facilities were involved as demonstration
sites, including Blue Care’s Amaroo facility at Tweed Heads in New South Wales and Iona at Kenmore, Queensland.
“Significant research has already been done to identify the best ways to care for people who are approaching the
end of life in a residential aged care facility,” Deborah Parker said.
“We have consolidated that information into a step by step evidence-based model of palliative care, which will be
suitable for use in all Australian aged care facilities.”
For Sue Smith, a registered nurse who has worked at Blue Care’s Iona nursing centre for the past 14 years, the
toolkit provides a valuable means of ensuring that every detail is thought of ahead of time and that each patient
who is nearing the end of their life receives the best of care.
“It is very important to give people the opportunity of a good death and this toolkit gives structure to the way we
work with a person at the end of their life,” Sue said.
“The kit has everything you need to consider from which funeral director the person wants, to eye, mouth and skin
care; from whether the person wants to be transferred to a hospital when they are nearing the end, to symptom
and pain control - even their religious and cultural needs are considered,” she said
“It ensures that no small detail is forgotten, that everything is organised ahead of time and importantly, after death
occurs. This gives comfort not only to the person who is at the end of their life but also to their relatives and friends
who can see from the care plan that their loved one is being cared for well. It also helps them to be more prepared
for their loved one’s death.”
“Our nurses are very happy using the toolkit and we have found that it is a good teaching tool as well. Nurses new
to working in an aged care facility have a lot to take on board and the kit helps them make sense of it all, it reminds
them to do things and they can feel confident that they are doing what is required as they have checklists to tick off
tasks as they go,” she said.
For orders and more information please contact Karen Clifton at the University of Queensland/Blue Care Research
Practice and Development Centre: [email protected] or 07 3720 5302.
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Practice approaches for people centric outcomes
Development of a palliative approach in residential care outcome scale
Associate Professor Deborah Parker UQ/Blue Care Research and Practice Development Centre
Funding
National Health and Medical Research Council (NHMRC)
This project was designed to develop a palliative approach in residential care outcome scale. While Australia leads
the world with the first evidence based guidelines for a palliative approach in this setting, limited research has been
undertaken in measuring the extent to which these guidelines and other practice initiatives will impact on resident
and family outcomes. This is due in part to the difficulties of measuring outcomes in palliative care and particularly
the lack of evidence that measurement tools in palliative care measure what they are supposed to measure. Despite
these problems monitoring outcomes is important for the development of high quality care, particularly in new settings
where new models of care are being developed.
In 2009, in the first part of this research project, a Joanna Briggs systematic review identified two outcome measures
suitable for use in residential aged care. These were: The Family Perceptions of Care Scale (FPCS) and the Quality of
Dying in Long Term Care Scale (QOD-LTC). Neither of these scales had been tested in the Australian setting.
The 2010 phase of the project sought to test the validity of both these outcome measures and reports on a bereaved
carer survey conducted in 60 Australian residential aged care facilities (RACFs). Bereaved carers of residents who
died between July 2009 and December 2009 were invited to participate. A total of 582 invitations were sent to the
carers and a total of 108 surveys were returned a response rate of 18.6%. The survey included demographic data
on the residents and carers, 25 questions from the Family Perceptions of Care Scale (FPCS), 11 questions from the
Quality of Dying in Long Term Care Scale (QOD-LTC) and an open ended comment for other concerns.
The study validated the use of the FPCS and QOD-LTC with internal consistency of each of the outcome measures
providing a valid outcome measure for satisfaction with end-of-life care as rated by bereaved carers of people who
have died in residential aged care facilities.
A valid method of measuring the impact of how a palliative approach in residential care impacts on residents and
families is now available.
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Caring safely at home project: Development of a palliative
subcutaneous medication education program for carers
Associate Professor Liz Reymond, Professor Patsy Yates, Fiona Israel, Sue Healy and Dr Margaret Charles, Brisbane
South Palliative Care Collaborative (BSPCC)
Funding
Commonwealth Department of Health and Ageing (CDHA)
•to implement a standardised education and support package for lay caregivers living in urban, regional and rural settings
within Queensland and to evaluate that package across the domains of content, efficacy, safety and satisfaction
•to identify possible differences in outcomes for lay caregivers, in terms of confidence, safety, satisfaction, and stress
measures with the preparation and injection of subcutaneous medications across three different conditions:
» the caregiver prepares, labels and stores daily breakthrough medications for subsequent injection by the caregiver
registered nurse prepares and labels daily breakthrough medications for subsequent storage and injection
»a
by caregivers
»a
clinical trial pharmacist prepares and labels daily breakthrough medications for subsequent storage and
injection by caregivers.
Educational resources developed included:
•charts illustrating how to prepare and administer injections
•a practical demonstration kit to facilitate learning the skills of opening ampoules and injecting
•a colour-coded system for syringe labels, adapted from Australian and New Zealand Standard – User-applied labels
for use on syringes containing drugs used during anaesthesia (2), to reduce possible errors when choosing preprepared injections that were stored in the refrigerator
•a colour-coded fridge magnet that also aimed to reduce possible errors
•a medication administration diary that allowed types and numbers of medications used to be monitored
•a competency checklist to ensure lay carers understood the education
•A DVD focusing on injections and a medication booklet detailing various aspects of subcutaneous medication
management.
Overall, lay carers evaluated the package as being extremely beneficial in terms of supporting them to manage
subcutaneous medications. Having access to quality information was associated with a reduction in carer stress
and increased levels of carer confidence related to their role with subcutaneous injection administration. Additionally,
findings from the randomised controlled trial indicated that the package increased lay carers’ confidence in all aspects
of subcutaneous medication administration for symptom management, regardless of who prepared the injections.
The package enhances the capacity of lay carers to confidently and safely administer subcutaneous injections, thus
supporting palliative patients to remain at home while receiving timely and optimal symptom control. The findings from
this project have positive implications for lay carers, palliative patients and healthcare systems.
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Implementation of a comprehensive evidenced based palliative
approach in residential aged care
Associate Professor Deborah Parker, Dr Anthony Tuckett UQ/Blue Care Research and Practice Development Centre
The aim of this project was to implement and evaluate a comprehensive evidence based palliative approach in
residential aged care facilities (RACFs).
The objectives of the project were to:
•translate existing evidence based guidelines (palliative care and pain management) into policy and practice
(including documentation)
•provide education to all nursing and care staff at all levels working in the RACFs using existing training materials
•establish, train and support link nurses in each RACF
•promote the use of existing GP on-line training modules to support GPs in providing a palliative approach to
residents in their care
•implement the Brisbane South Palliative Care Collective (BSPCC) Residential Aged Care End-of-life Care Pathway
(RAC EoLCP) for residents requiring terminal care
•develop a palliative care case conferencing learning resource (DVD and hard copy) for residents and family
members, nursing staff and GPs
•develop from existing training modules a self-directed learning module for Link nurses
This project has developed and evaluated a comprehensive evidence based palliative approach in residential aged
care. Evaluation has indicated successful changes in clinical practice which has demonstrated improvements in
resident care, staff knowledge and family satisfaction.
All facilities engaged in the project have indicated that the key processes promoted in comprehensive evidenced
based palliative approach in residential aged care will continue and be embedded as part of routine care. A Palliative
Approach Toolkit developed as part of the project provides a step by step resource for implementing the evidenced
based model of care. Further details are available from www.uq.edu.au/bluecare
Music, therapy and dementia: A musical therapy program for spousal
caregivers of people with dementia
A/Prof Felicity Baker, Dr Nancy Pachana, UQ; Professor Denise Grocke, University of Melbourne
Funding
UQ Research Excellence Award $70 000
The purpose of this research was to develop and evaluate a home-based music program for caregivers of people with
dementia. By training home caregivers to use music strategically with their spouses, the project aimed to provide a
relaxing and enjoyable activity that would enhance the relationship between the caregiver spouse and the person with
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dementia. This would enable the caregiver to experience more meaningful shared moments of joy with their partners
and to enhance their experiences of being a caregiver.
Both the active music intervention and the music for relaxation were beneficial to all but one of the participant couples
in the evaluation study: music for relaxation had no effect on a spouse in mid to late stages of dementia. All other
participants with dementia were in early stages. Benefits were experienced during most music sessions for most
participants Data was collected for the training evaluation study with 40 people with dementia and their caregivers
living at home. Preliminary analysis of home training evaluation results and transcription of home conversation data
has been completed. In addition, a DVD-based caregiver training program on memory and communication support in
dementia is being prepared.
On the basis of data obtained from the evaluation phase, comprehensive revision of the educational DVD, with
separate versions developed for professional dementia care staff and caregivers in the home setting will be made.
It is planned to disseminate this worldwide and also in DVD form. Five national and four international conference
presentations on this project have been made. Information sessions have also been presented to dementia service
providers and carer support groups.
Defining and evaluating models of case management in Blue Care
Professor Jill Wilson (UQ), Linda Dawson and Jan Skinner (Blue Care)
Funding
Queensland Department of Communities and UnitingCare Queensland
This study was in two parts. The first, which took place in 2009, aimed to explore the uses and limitations of current
case management in two Blue Care services with different organisational arrangements for case management. The
results were used in a successful application to Home and Community Care (HACC) to trial a modified approach
to case management in two settings in 2010. The research had two main drivers. The first was recognition that
HACC workers were seeing an increasing number of complex situations where standard HACC responses were not
necessarily effective, and the second was that the identification and coordination of appropriate responses within and
outside standard HACC services for some clients seemed to require specific skills and knowledge across a broad
range of areas. An action-research method was used in both phases to ensure that staff opinions were included in the
research and that the emerging model would be sustainable in the contemporary HACC environment.
Phase one:
Across all sites, there were similar patterns that characterised the clients seen by case managers. They are
predominately (60-70 per cent) 65 plus with younger clients predominately 30 or older. There tend to be different
profiles of issues presented by these two age groups. Almost all referrals for Blue Care case management services
came from within Blue Care. All services had attempted to publicise this HACC service but other HACC services who
did not have HACC case management hours, had rarely taken up the offer.
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The points that were noted as making for effective case management were:
• timelines
•knowledge of options
•prepared to challenge the relevant systems
•good communication between the case manager and other service providers – working with the case manager
rather than ‘handing over’ to the case manager.
A high level of confidence in the case manager provides a strong platform for ongoing development of responsive
service models where staff are prepared to say that a client needs more than they can provide and to work with
the case manager to attempt to develop appropriate care responses. There was overall agreement that case
management should reflect a particular occupation, while some case management hours might usefully be used by
particular services, especially palliative care.
Phase two:
Two of the previously researched sites were selected to participate in the pilot project:
Site one, in a densely populated urban area, worked with service users covering a geographical area covered by
one Blue Care community care service. An existing worker was employed on the project. Eligibility criteria for case
management at site one was developed as:
either service users who are classified as ‘Low Function’ or ‘Medium Function’ (a score between 1-4 on the Ongoing
Need Identification (ONI) Priority Rating Tool, Decision Making Matrix),
or presenting with significant psychosocial or other issues. For example, this could include:
•people with a pattern of symptoms which contribute to episodes or an inability to function independently e.g. people
with dementia or mental health issues
•people with short term reduction in coping due to onset or exacerbation of a chronic medical condition
and one of the following:
•a demonstrated need for advocacy
•have a number of services involved in providing care
•the health or social circumstances make it a challenge for the client or carer to coordinate and navigate services
that are needed
•carers with a Carer Strain Index score above 8.
Site two, in a less populated yet growing regional location, a new case management position was established and
recruited to undertake the role which included all of one Blue Care community service area and parts of two other
areas. Eligibility criteria for case management at site two were more open than those at site one and included people
who were eligible for services funded by Home and Community Care and in need of support services in addition to
those otherwise available. The organisational approach taken at site two was justified because the service is located
in an area where the population is spread out over a large geographical area and there is a less well developed
service network.
Case management was provided to each client for a period of time ranging from one week to twelve months. The mean
length of time supporting clients was 12.5 weeks. The median length of time supporting clients was eight weeks.
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The largest number of referrals to case management, (46 per cent of referrals), originated from internal Blue Care
sources generally. The next largest referral source (21 per cent of referrals), originated from HACC services external to
Blue Care.
Issues affecting clients
People being referred to case management were experiencing:
•multiple and/or complex social issues e.g. financial, isolation, impaired decision making
•a significant change in circumstances that required increased support
•limited or vulnerable support systems
•difficulty accessing appropriate care or other resources.
Processes of intervention
There are many possible processes when supporting clients in the context of case management. The nine most
common processes used during the course of the project, from most frequent to less frequent, are listed below:
•information gathering and information provision
•assessment
•networking / liaising/ negotiating/ collaboration
•linking clients with existing services and community groups
•relationship building
•advocacy
•planning and practical support
•engagement with carers
•project work to address systemic issues.
Benefits of case management as reported by practitioners
The following outcomes were consistently identified as benefits of case management by referring practitioners and
case managers:
•reduction of carer stress
•improved sense of wellbeing for clients
•increased client functioning
•clients feel at peace with decisions made
•in receipt of adequate support
•reduced feelings of isolation
•working towards sustainable living and health situations
•more connected to services / community.
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The Ongoing Need Identification (ONI) rating
At entry to the service, case management clients’ ONI ratings ranged from one to nine, the mean being 3.4 and the
median being three. At exit, case management clients’ ratings ranged from three to nine, the mean being four and
the median being six. In 15 of the 21 cases initiated and closed during the research period, significant improvements
in ONI ratings took place and this was attributed to case management interventions. There were six cases where
the ONI ratings did not increase. Two of these were rated 9, the top of the scale, so could not improve ratingswise. However, these individuals did have greater connectivity with human services and the wider community which
stabilised their circumstances as a result of case management. In relation to the four other cases where the ONI
rating did not increase, their living situations were so complex the range of interventions initiated did not change the
overall ONI rating. However, in each case, better supports were established in response to the complex needs each
person had.
Proposed model
Case management is best seen as a program rather than a small number of service hours tacked on to other service
types. It is proposed that it has five elements:
•flexibility (in terms of time available, partnerships to meet client needs and developing resources around individuals
where necessary)
•active practice (a planned process of intake and assessment, planning, intervening and evaluation and closure)
•early referral (early intervention rather than referral when all else fails – a screening of all referrals for case
management is one approach here)
•outcome focussed (work with individuals to achieve nominated and emerging goals and the use of time limits)
•both individual and systemic work (addressing issues emerging across a number of clients)
Chronic disease self management (CDSM) project
Desleigh Hughes, Vicki Plummer, Glenys Webby, Dr Helen Higgins, Brent Hodgkinson, Blue Care
Funding
Department of Health and Ageing
Chronic diseases cannot be managed by the healthcare sector alone and require collaboration between nongovernment
and government sectors. In this context, self-management models are seen as a useful addition to other management
strategies. Blue Care gained funding to develop a pilot of CDSM models (Flinders, Stanford and motivational interviewing)
within metropolitan, regional and rural locations across South East Queensland. Phases of the pilot project included staff
training in CDSM models and the implementation and evaluation of these models with community dwelling clients. Staff
satisfaction with the training in CDSM models and with the implementation of CDSM into existing practice was measured
by a staff survey (Likert scale items and open-ended questions) and via focus groups. The ability of the CDSM models to
impact on client self efficacy (SE) to manage their disease was measured by comparing the differences in pre and post
total SE scale scores (Stanford SE for managing chronic disease 6-item scale).
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•Staff characteristics and outcomes (combined data [N=15]): Male 1 (7 per cent), Female 14 (93 per cent); Age ≥
41 years 11(74 per cent); 12 (80 per cent) overall impression good. 11 (74 per cent) were satisfied with the CDSM
training, 10 (67 per cent) thought CDSM assisted with the achievement of positive client outcomes, 12 (80 per cent)
thought that the implementation of CDSM compared with usual practice was about the same.
•Client characteristics and SE total score outcomes (pre-implementation combined data [N=129]): Male 46 (36 per
cent), female 83 (64 per cent). Geographic location - metropolitan 63 (49 per cent), regional 49 (38 per cent), rural
17 (13 per cent). Most common chronic disease: arthritis 54 (44 per cent).
•CDSM allocation - Stanford 56 (43 per cent), Flinders 41 (32 per cent) and motivational interviewing 32 (25 per
cent). There was a 16 per cent increase in total SE scores between pre and post-intervention and non-significant
between groups’ CDSM differences in total SE scores. Staff and client outcome comparisons between geographic
locations were non-significant across all variables.
Self management models were well received by clients and staff believed that the CDSM models assisted their clients to
better manage their chronic disease. The benefits of CDSM include keeping the clients focussed; encouraging clients to
take more responsibility for their conditions and clients receiving good adjunct care. These are all essential to optimising
client outcomes. To maximise benefits there needs to be sufficient follow-up to keep clients motivated and requires
more resources and referral pathways to facilitate self management. More staff education would help identify clients to
direct each model. In addition more liaison between providers and the education of GPs would assist in ensuring better
client outcomes.
Physical activity program for residents of an aged care facility by
physiotherapy students
Thomas Cordner, Dr Ruth Barker, James Cook University
As Australia’s population is ageing and the prevalence of chronic lifestyle diseases is increasing, there is greater
pressure on Australia’s health care system. Consequently, new cost effective health promotion strategies need to be
implemented to maintain a sustainable model of health service provision. The aim of this study was to investigate a
balance and mobility program for residents of two residential aged care facilities in which physiotherapy students were
utilised as participant supervisors. This model aimed to reduce the risk of falls while minimising cost. The objectives of
this study were to determine the effect of the program in terms of balance and mobility and participant satisfaction, as
well as gain insight into participants’ perceptions of the program.
A sequential, mixed method design was utilised. Phase one was the quantitative phase and involved measurement of
balance and mobility (Step Test, Functional Reach, Timed up and Go and Timed Ten Metre Walk) before and after the
balance and mobility program. A participant satisfaction survey was completed after the program had ceased. Phase
two was the qualitative phase and consisted of thematic analysis of in-depth interviews with four program participants.
Significant improvement across all balance and mobility measures and high levels of participant satisfaction were
found. Participants felt the program was enjoyable because it was ‘good for participants’, ‘good for students’,
‘provided personal attention’ and ‘contributed to a good lifestyle’.
The findings of this study indicate that balance and mobility programs that use physiotherapy students as participant
supervisors may be a viable and sustainable alternative to traditional health service models for residents of aged
care facilities.
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Eastside wellness: Community-based health promotion
Noela Sorenson, Sonia Kennett, Rosemary Vaughan, Dr Helen Higgins, Blue Care
Funding
The Port Authority
Client screening, referral to appropriate agencies and participation in health promotion activities are useful means
for promoting health, preventing diseases and delaying the progress of chronic disease pathology. Blue Care gained
three years of funding from the Port Authority to implement a nurse-led case-managed community based health
promotion project (one day per week) over three years that included health screening and participation in health
promotion activities with clinical support over a 12 month period. Program components are individualised to the
clients’ needs and also include group activities such as wellness seminars and participation in free recreational
activities such as Bocce, walking groups, Dance for Fitness, Tai Chi for arthritis, Lawn Bowls, nutritional shopping
challenges, Zumba and Yoga in collaboration with organisations such as the Stroke Foundation and other health care
providers (South East GP Alliance and Queensland Health). Program evaluation includes a participant satisfaction
survey with the overall program and with group activities such as the wellness seminars (open to the community)
and a quality of life survey conducted prior to enrolment in the program and again at six and 12 months during
participation in the wellness program.
Limited funding meant that only a small number of participants could be included in the first year of the program
(2009). Participant characteristics (N=6): Two male and 4 females with an age range of 51 – 70. All six rated their
overall impression of the program as excellent or good. Participants found the nutritional shopping challenge very
useful for reading and interpreting food labels. All 2009 wellness seminar attendees (n=36) thought that the seminar
was good to excellent.
The 2010 cohort included 13 participants with the 2009 program expanded to include:
•referral to multidisciplinary care providers
•increases in the number of health promotion displays (20)
•increases in the number of quick health checks (164) in community settings
•Tai Chi for arthritis (individual or group sessions [gold coin donation] with up to 50 attendees per session).
•428 participants were involved in 2010 Eastside Wellness activities.
2011 saw an increase in the breadth of the project with:
•referral to multidisciplinary care providers continuing
•continued high numbers of health promotion displays
•further increase in the number of quick health checks (263) in community settings
•a total of 165 participants for Tai Chi for arthritis (individual or group sessions [gold coin donation]).
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The success of this project has led to the development of a self funded chronic disease healthy living program the aim
of which is to:
•develop or enhance formal and informal linkages between existing community services
•improve individual health outcomes via the provision of health educational opportunities and skill building, referral
advice and peer and clinical support as appropriate to the individual’s needs.
•improve individual social support networks via the provision of group activities over a period of 12 months.
Creating champions for skin integrity: Encouraging best practice in
residential aged care
Professor Helen Edwards, Dr Kathleen Finlayson, Michelle Gibb, Christina Parker, Robert Jenson, School of Nursing
and Midwifery, Queensland University of Technology (QUT); Professor Mary Courtney, Faculty of Health, QUT;
Professor Anne Chang, Professor, Nursing Research, Mater Health Services and QUT; Professor Glenn Gardner,
Centre for Clinical Nursing, RBH and QUT; Kathleen Finlayson
The incidence of skin tears, pressure ulcers and chronic leg or foot ulcers increases with age and is a serious issue
in residential aged care facilities (RACFs). This project focussed on promoting healthy skin through the application
of evidence to prevention, assessment and management of wounds. The aim of this project was to utilise evidence
based strategies to preserve skin integrity and increase implementation of evidence based wound management
through implementation of the Champions for Skin Integrity (CSI) model of practice. To achieve these aims the
project initially obtained contextual data on how the participating RACFs assessed, managed and prevented wounds
(specifically venous leg ulcers, arterial leg ulcers, diabetic foot ulcers, pressure ulcers and skin tears) by quantifying
the prevalence of these wound types and undertaking clinical audits, surveys and interviews to assess resident and
staff attitudes and knowledge regarding wound management in RACFs.
The project team developed, implemented and evaluated an evidence-based model of practice (the Champions for
Skin Integrity model) to promote transference of evidence-based guidelines into practice. As part of the CSI model,
a package of resources - the RACF Wound Management Education and Self-evaluation resource package – was
developed, trialled and evaluated.
The CSI model
This project utilised evidence based strategies to promote the transfer of evidence into practice through
implementation of the Champions for Skin Integrity model of wound management. Central to the model were
strategies drawn from systematic reviews of the effectiveness of guideline dissemination and implementation
strategies. The CSI model involved:
•multifaceted interventions, which are reported to be more likely to be effective than single strategy interventions
•educational materials and easy access to information
•evidence provided in a form that can be easily used in practical situations
•hands-on skill development sessions
•audit and feedback cycles including modification of resources according to feedback consumer-directed
interventions
•clinical decision making support systems and documentary aid or reminder systems
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•a supportive environment with local champions and management and resource support. In the CSI model, teams
of ‘champions’ were identified to become key points of contact for staff and the project team.
Following a six month implementation phase, evaluation via surveys, clinical audit and interviews found significantly
decreased prevalence and severity of wounds in residents, improved staff skills and knowledge of evidence based
wound management, increased staff confidence with wound management, increased implementation of evidence
based wound management and prevention strategies and increased staff awareness of their roles in evidence based
wound care at all levels. A resource kit on evidence based wound management was developed and could be made
available to all Residential Aged Care Facilities. Undertaking this project demonstrated to us the importance of clinical
leadership and of keeping resources brief, simple and easily accessible.
There are a large number of evidence based guidelines addressing various aspects of wound management and/or
different types of wounds. As the literature reports, skin tears, pressure ulcers and chronic leg ulcers are the most
frequent wounds found in residential aged care settings. Clinical practice guidelines and international consensus
documents were supported by a range of other guidelines including wound bed preparation and evidence on
strategies for prevention of wounds. The existence of a large body of evidence in the literature created a challenge to
translate the evidence into education and practice for the multi-disciplinary and diverse skills profile of staff in RACFs.
To address this issue the project team developed a suite of guidelines summaries which provided a simple summary
of evidence based guidelines from multiple documents in a two-three page document for each topic. All education
and resources for the project were then based on these summary documents.
Evaluation of outcomes from the project found the implementation of the Champions for Skin Integrity model of care
resulted in:
•improved implementation and documentation of evidence based practices for prevention, assessment and
management of wounds
•significantly decreased prevalence and severity of wounds in residents
•improved staff confidence and knowledge of evidence based wound management
•increased awareness of residents, family, carers and RACF staff of evidence based wound management and
prevention strategies
•a resource kit on the CSI model and evidence based wound management was developed and could be made
available to all Residential Aged Care Facilities.
In addition, project activities demonstrated:
•wounds are a major health issue for residents in aged care settings
•involvement of all levels of staff, residents and family in education and decision making promoted greater uptake of
evidence based practice and continuity of care
•clinical leadership and management support was crucial for successful practice changes
•the importance of keeping resources brief, simple and easily accessible
Issues that were found difficult to address within the scope of the project were:
•the breadth of the topic – multiple strategies and changes in practice were required to address evidence based
management and prevention of all common wound types. Facilities were encouraged to focus on a priority area in
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their RACF (identified from the surveys and audit at the beginning of the project) e.g. skin tears, and concentrate on
practice changes in this area
•role definitions for staff – perceptions and understanding of roles in implementing wound management and
prevention activities varied across facilities and were not always clearly defined
•it was a challenge for staff, and in particular visiting Link Clinicians, to find time to attend meetings to review
progress and plan future strategies.
The project was successful in achieving increased implementation of evidence based wound management,
assessment and prevention strategies; decreased prevalence and severity of wounds in residents and development of
a resource kit on the CSI model and evidence based wound management for RACFs.
Recommendations include:
•wounds should be recognised as a major health issue for residents in aged care settings and be monitored regularly
•the CSI model or a similar strategic approach should be implemented in RACFs to facilitate the uptake of evidence
based wound management and prevention
•the resource kit on evidence based wound management should be made available to all Residential Aged Care
Facilities and interested parties
•resources to facilitate evidence based practice should be brief, simple and easily accessible
•there are a number of easily implemented evidence based strategies (e.g. moisturising skin twice per day, padding
equipment, daily ankle and calf muscle exercises, regular position changes) which can be undertaken by staff,
carers, residents and/or family members to prevent common wounds such as skin tears and pressure ulcers
•all members of RACF communities (i.e. residents, family, carers, staff, surrounding community link clinicians) should
receive information on evidence based wound management and prevention strategies and be aware of who their
local wound expert contacts are within the facility.
The impact of an exercise program among semi-dependent older adults
accessing day respite care
Dr Tim Henwood, Daniel de Souza, UQ/Blue Care Research and Practice Development Centre
Alicia Wooding, Jacqui McLean and Brendan McNamara, Blue Care
The aim of the present research was to investigate the benefits of a moderate-intensity resistance and weight-bearing
program that could be delivered safely and effectively in a day care respite centre on functional ability in a group of
semi-dependant older adults.
Burremah Respite Day Care in Blue Care’s Southern Cluster had been running a low intensity, seated exercise
program that showed some promise of improving functional capacity for clients. Keen to research the value of the
program they approached Dr Tim Henwood of the UQ/Blue Care Research and Practice Development Centre.
Following extensive research of other programs appropriate for this age group among adults with a similar level of
function, Dr Henwood changed the Burremah program slightly to maximise the benefits without having to introduce
specialist staff. Therefore, the intervention program for the study incorporated the centres pre-existing low-intensity
program with five new moderate-intensity weight-bearing activities designed to improve functional ability and balance
in a group of semi-dependent adults accessing a community day respite centre.
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Training sessions lasting approximately one hour were delivered initially by an accredited exercise physiologist, then
later by centre staff. This was an important transition for the program given one of the study aims was to ensure the
program could be delivered by centre staff without the supervision of an exercise specialist. Pre-existing exercises
acted as a warm up and cool down, and participants complete three sets of 10 repetitions of the new exercise. For
the new exercise participants started with no resistance but to ensure training was progressive, weights (dumbbells)
were increased when individuals could successfully complete the set repetitions.
Twenty three adults (three males and twenty females, 77.1 +/- 8.7 years) participated in the study. Thirteen were
recruited directly from the Blue Care Burremah Respite Centre and ten from the associated Senior Citizens
community. Inclusion criteria were being age over 60 years of age, who were independent living but with some level
of dependency needs and that could attend 16 sessions during a maximum period of 20 weeks. Participants were
excluded if they had significant advanced and/or unstable cardiovascular, terminal or cognitive illness or if they were
using medication with a known contraindication to moderate intensity exercise. Participants undertook a battery of
functional performance measures before and after the intervention. These were a grip strength (left and right hand),
FICSIT4 balance (standing, semi-tandem, tandem and single leg stance), a 6m habitual and fast walk, 3m timed up
and go (TUG) and 30 second chair stands test.
Six participants dropped out of the study, though none suggested the program was the reason for leaving. At
baseline, the group took on average 5.9 ± 3.7 medications and had 5.6 ± 2.2 co-morbidities. Participants had a BMI
of 30.4 ± 7.2 m/kg2 putting them within the range for obesity and had a walking speed of 0.8 ± 0.2 m/s, indicating
they were at risk of institutionalisation and falls. Post-intervention left and right grip strength increased 19.88 ± 8.03
per cent (p ≤ .080) and 11.01 ± 6.01 per cent (p = .033), respectively. All other physical performance measures
increased significantly (p ≤ .002), except the 6m habitual walk which only approached significance (p = .061).
The study demonstrates that moderate-intensity weight-bearing exercise, designed to improve capacity in activities of
daily living, can have significant physical benefits for older adults with dependent care needs, even if undertaken once
per week. This has important implications for respite centre exercise delivery and client prolonged functional capacity.
Importantly, these programmes can be safely and effectively delivered in respite centres or similar, away from the
research environment, at minimal cost but with significant client benefit.
The findings have important implications for prolonged independence among this age group. This study supports
the use of moderate-intensity exercise among very old semi-dependant adults. In addition to gains in strength and
functional ability, the present research was able to demonstrate that group training can be safely delivered to an at risk
population. The present research also identified lower-body strength, balance and agility differences in similar aged
adults which could be a defining precursor to the level of independence in the very old.
Moderate intensity weight bearing exercise has important implications for low functioning adults, with programs such
as employed here offering prolonged independence to a vulnerable portion of the population which may translate to a
reduced falls and all cause mortality risk.
To ensure the program is available for all adults accessing Blue Care respite services, program training is being rolled
out across the state. Centre based trainings are approximately four hours long and offer staff a thorough overview
of the Blue Care Exercise Program and include education about exercise training for older adult, warning signs and
other considerations. Also included is training about assessment and consent considerations. This is complemented
by a manual and DVD of the program. The manual can be viewed on the Blue Care Exercise Program intranet site
(http://intranet/CareServices/CentreRespite/BlueCareExerciseProgram/default.asp), along with the other program
support documents.
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End of life care pathway in residential aged care facilities and
community care for clients living with dementia and other clients who
palliate within our services
Sandra Larkin, End of Life Care Pathway Project Officer, Wesley Mission Brisbane
Funding
Local Palliative Care Grants Program, round five
Older people now have a longer life expectancy as they live with chronic degenerative diseases (including dementia
and malignancy) and are entering residential aged care (RAC) much later in life. Wesley Mission Brisbane’s (WMB)
thirteen RACs along with all other Australian RACs are caring for older people who often require a palliative approach
or end of life care within a few weeks or months of entry. Almost one third of people who are admitted to a high care
residential aged care facility will die within six months and 61 per cent will die within a year. Four out of five residents’
deaths are from a non cancer diagnosis and 69 per cent of those, four out of five are due to dementia. The purpose of
this study is too provide an education program, building on the End of Life Care Pathway program, for carers of older
people who focus on dementia care and palliation, with the overall aim of enhancing care for people living with or
without dementia who receive services from the beginning of the relationship until the time of death.
WMB RAC Bethesda Caring Centre participated in a research study (2007- 2009) with Brisbane South Palliative
Care Collaborative (BSPCC) along with 5 other Brisbane RACs to trial the use of the RAC End of Life Care Pathway
(EoLCP). The results of this study overwhelming demonstrated that when clients are placed onto the RAC EoLCP
(once it has been determined that they have entered the terminal phase) they are less likely to be transferred to
hospital for end of life care and the outcomes for them and their families are significantly improved. Therefore, it was
WMB’s goal to implement the utilisation of the RAC EoLCP in all its RACs. The majority of residents who palliate
have dementia and/ or cognitive impairment. Aged Care in the community incorporates the provision of a palliative
approach and end of life care. WMB has extended the provision of end of life care for their community clients in
Queensland by adapting the RAC EoLCP for use in the home setting. This supports elderly people to stay at home for
as long as possible as most people say they want to die at home.
WMB was able to achieve these goals by running the project from March 2010 to June 2011. The project was based
upon the “Palliation in Dementia Care” course run by Queensland Dementia Training Study Centre/ Queensland
University of Technology, the BSPCC project and the “Guidelines for a Palliative Approach in Residential Aged Care”.
The project activities and outcomes align with Palliative Care Australia’s consensus statement that “assisting people to
not only live well but to die well too, free from pain, in the place of their choice, with the people they wish to be present
and above all, with dignity” and the Australian Standards for providing quality palliative care for all Australians.
A major component of the project was to up skill senior clinicians to be the experts in a palliative approach to care.
WMB now has a palliation advisor to continue to implement and support the use of EoLCP and ensure the best
possible end of life care in all our aged care services.
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An exploration of long term planning with parental carers for people
with disabilities
Dr Andrea Petriwskyj, UQ/ Blue Care Research and Practice Development Centre, UQ; J Franz, B Adkins, G Bitner,
R Hannaford, Queensland University of Technology and D O’Toole, Kyabra Community Association
Funding
This research was funded by a $12 000 University of Queensland new staff start-up grant
Long term planning is important to facilitate independence and participation and enable effective care and support for
both people with a disability, as well as their parental carers in the longer-term. However, these choices are impacted
by recognition of, and planning for, the future needs of both parties. This is a complex issue which can be challenging
for these families, for whom planning is often centred mainly or solely on the individual with a disability. Many families
also face challenges accessing support and accommodation resources.
This study explored the issue of future planning for care and independence from the perspective of parental carers who
are currently engaged in exploring independent living options, as well as staff of planning programs. A series of semistructured interviews was conducted. Respondents included both parental carers aged 50 or over and undertaking
future planning, and staff of long-term planning programs in Queensland. Interviews addressed a range of issues relating
to experiences with long term planning and planning programs from the perspective of parental carers. Interviews were
transcribed and the data analysed with the assistance of qualitative data management program NVivo.
Results revealed a broad range of experiences of planning which were related to family circumstances and
relationships with services and service providers. Data also highlighted the complex ties between the caring
relationship and future planning for both parents and children. A range of challenges to the planning process were
identified.
The findings have implications for both long term planning programs and other disability services. These address the
ways the interface between services and families can facilitate or hinder future plans. The findings also highlight the
interdependency of plans for people with a disability and their parental carers and point to the importance of support
for carers’ future needs as part of the planning process.
Gold Coast Social Connections Project – Stage 2
Christine Collins, Wesley Mission Brisbane
Funding
The Gold Coast Primary Care Partnership Council Connecting Healthcare in Communities and Chronic Disease
funding; Gold Coast Public Health Unit, Queensland Health; Communities for Children Northern Gold Coast,
UnitingCare Community and Wesley Mission Brisbane
Stage two of the Social Connections Project drew on research identifying the benefits of social connection to our
health and wellbeing, along with data highlighting local perceptions of social connection levels. The project was
informed by a partnership of government and non-government organisations from the Gold Coast health and
community services sectors and developed a small grants program in conjunction with place based community
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capacity building. Community meetings in three Gold Coast communities aimed to support locally identified strategies
to build social connection and a small grants program was delivered to grassroots groups in order to facilitate local
activities to build social connectedness. The project had a number of desired outcomes including the supporting of
local communities to build and enhance social connections.
The Social Connections project utilised an action research approach whereby the project was continually modified
according to feedback and consultation. This enabled the project to be community driven and for developmental work
with stakeholders to be undertaken. It also supported the inclusion of groups that may not otherwise be involved in
small grants programs or may experience barriers in accessing social connection activities.
The project focussed on the involvement of grassroots groups as a way of engaging with local community members
and providing seed funding and support to these groups in order to build sustainability of social connection activities.
The premise of involving grassroots groups was related to an understanding that naturally occurring social networks
especially protect and enhance health and wellbeing and that the groups’ flexibility and on-the-ground knowledge
of their local areas would enhance efficacy. In its initial stages the project provided opportunity for those involved
to discuss their perceptions of social connection levels and suggested ways to improve this. Project workers also
discussed attributes of socially connected communities in order to raise awareness.
Grassroots group leaders provided qualitative feedback on their experiences of facilitating their group and provided
ratings of their perception of improved social connection across a number of levels which were reported in an external
evaluation of the project.
Findings suggest that capacity building with grassroots groups is likely to provide long term benefit for the
communities of the Gold Coast, and built skills, confidence and connections for participating groups.
The project worker has provided presentations on project learning to a wide range of community and health sector
workers and community development students. The advisory group for the project continues to meet regularly to
explore opportunities to expand capacity building activities to other Gold Coast communities, especially in those
where local community leadership has not yet naturally occurred. It is also overseeing the development of a Social
Connections DVD and kit to provide to groups working in the community as well as local community development
and health promotion workers.
While the time limited nature of the project did not build in follow-up interviews with groups funded through the
project, a number have advised that they have successfully linked in with local initiatives, groups and services. These
include Gold Coast City Council community development, physical activity, gardening, leasing and multicultural
strategies; Seniors Week activities; the process of incorporation for some groups, linking in with service sector
networks; accessing additional funding sources; developing local strategies by working with each other and
continuing their activities and expanding their membership.
The Social Connections Project Stage 2 built awareness of the importance of grassroots groups in building social
connection in the community. A shift from service delivery to stakeholders, to working alongside or with groups to
support them developmentally, is an important message gained from the project. This supports empowering local
community members and groups including those who are often excluded from grants processes and the social
service sector.
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Blue Care falls prevention benchmarking program
Andrea McIntyre, Blue Care; Dr Tim Henwood, UQ Blue Care Research and Practice Development Centre; Glenys
Webby, Blue Care
Funding
The present investigation was an internally supported benchmarking exercise. Blue Care community services have
approved support to a project coordinator one day per week.
Among older Australians it has been reported that between 30 and 50 per cent fall each year, of which up to half are
multiple fallers. Fear of falling and decreased balance confidence are known precursors to social withdrawal among
older adults and reduce community and family interactions and quality of life. There is an abundance of literature
outlining falls prevention best practice within the community setting.
Falls prevention has been highlighted as a key area for development both internationally and within Australia. Blue
Care routinely run best practice falls prevention interventions however, across the organisation, objective comparisons
of these programs had not been available due to the variations in clinical outcome measures being used. This project
is a quality improvement activity that aims to evaluate and compare existing falls prevention programs offered by a
number of Blue Care Allied Health Services using a validated set of outcome measures.
Prior to the benchmarking process a review of outcome measures was undertaken. This informed a core set
of outcome measures to be used across the centres involved and their programs. Project design and outcome
measures were agreed on between the project team and the clinical program leaders of the participating centres.
Four Blue Care centres that were running falls prevention programs, delivered a minimum of once a week for
eight weeks, agreed to participate. Outcome measures were Balance Outcome Measure for Elder Rehabilitation
(BOOMER) – consisting of timed up and go, functional reach, step test and static balance test; timed six metre
walk; activity-specific balance confidence scale (ABC) and falls history. Pre and post intervention assessments were
conducted at each of the centres by clinical leaders. Data were then entered and analysed by the project coordinator
using SPSS statistical analysis software. These data were then collated with program specific objective information
and a benchmarking report prepared. Objective data included program details, client recruitment and retention
issues, outcome measure feedback and staff training.
Outcomes suggest a strong and consistent commitment to provide clients with the best health care possible.
However, results also indicate all programs require further development to ensure they meet Blue Care’s falls
prevention and management program criteria. In addition, further work is required to ensure programs achieve best
practice standards and expected outcomes. The project identified strengths within the services as well as issues
that require addressing and outlined recommendations at both an organisational and service level. It also proposed
a working group be developed to progress and implement the recommendations. The outcomes of this project will
inform best practice in program implementation and review, thereby improving quality of client care service delivery.
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Evaluation of the 1-2-3 Magic emotion coaching parenting program
Pauline King and Janelle Middleton, UnitingCare Community
Funding
The costs of delivering the parent program and collecting the data were funded by UnitingCare Community (formerly
Families Plus Division of Lifeline Community Care Queensland). Pauline King, the principal researcher, was a paid
employee of the organisation but also used the data to complete a dissertation submitted in partial fulfilment of the
requirements for the degree of Doctor of Psychology.
Research has demonstrated that early interventions targeting parenting practices have resulted in reductions in
child psychopathology symptoms. Parental engagement in the process of developing or increasing functional and
consistent parenting practices is therefore considered of vital importance. When families are experiencing adverse
circumstances such as early involvement with child protection agencies, accommodation issues, or the threat of
breakdown to a foster placement, caregivers may be disinclined to commit to attendance at long duration programs.
Therefore, brief, easy-to-understand parenting interventions may serve an important purpose. 1-2-3 Magic is a three
session parenting program designed for parents of children aged two to 12 years to assist them to better manage
their children’s emotional and behavioural difficulties in the context of parenting. This evaluation sought to determine if
1-2-3 Magic is an appropriate treatment response for this population.
Ninety-eight caregivers (48 foster carers and 46 biological parents) attended the parenting program and agreed
to participate in the study. Caregivers completed questionnaires assessing parent emotion socialisation practices
(emotion coaching vs. emotion dismissing parenting style), parent emotional competence, parent psychosocial
adjustment and childrearing attitudes that have the potential for child abuse and parent-reported child emotional and
behavioural difficulties. Assessment data were collected at three time points, each nine weeks apart.
At post-intervention, both foster carers and biological parents reported significant improvements across all parentreported child and adult outcomes. This study provides support for the effectiveness of the 1-2-3 Magic emotion
coaching parenting program to assist caregivers increase their emotion-coaching and decrease their emotion
dismissing parenting behaviours, to improve the regulation of their own emotions, to develop more functional
childrearing attitudes, to improve their psychosocial adjustment and to improve parent-reported child behaviours.
This study lays an effective foundation for future development and evaluation of this intervention. It also provides
a platform to consider/evaluate the appropriate treatment response provided to clients where child behavioural
problems and/or parenting concerns are the presenting issue.
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Elder Abuse: Effectiveness and outcomes of an awareness campaign
Dominica Sparkes and Les Jackson, UnitingCare Community Elder Abuse Prevention Unit
The UnitingCare Community Elder Abuse Prevention Unit (EAPU) undertook an exploratory analysis of an elder abuse
awareness campaign that was based on a literature review of previous awareness campaigns.
The EAPU is funded to provide a state-wide Helpline to anyone who experiences, witnesses or suspects abuse of
an older person. Elder Abuse is a subject that is not readily discussed in the community which makes it difficult to
promote. Three phases of research were conducted:
•Identify a target audience, message and medium
•Design and undertake the campaign and collect the data
•Analyse the data and make recommendations.
The EAPU campaign used multimedia strategies to reach the target audience determined as the family and friends
of the abused older person. A campaign message of “Is It Happening to Someone You Know” was developed to
target this audience. World Elder Abuse Awareness Day (WEAAD) in June 2010 was selected as the focal point of the
campaign period to make use of any media interest generated by WEAAD. Other services were actively encouraged
to participate with their own promotions around that date. The Department of Communities was approached and
subsequently delivered a poster campaign (Act as 1 against Elder Abuse) promoting the EAPU Helpline number.
UnitingCare Community’s Communications and Fundraising area were instrumental in having material produced and
distributed for radio, television, newspapers, internet and Twitter as well as through public libraries and at several
EAPU supported community events. The EAPU Helpline was used to collect data on the caller’s relationship to the
abused older person and where they found the EAPU Helpline number.
Descriptive statistical analyses showed that there was an increase in overall elder abuse notifications to the EAPU
Helpline as well as the predicted increase in notifications from the family and friends target group. Callers reported
that they found the EAPU Helpline number from a variety of media with family and friends increasingly sourcing the
contact details from the internet and from promotional material put out during the campaign period.
Promotional activities are an important part of service delivery. They help to increase awareness of the issue in the
community and where people can seek assistance. Knowing who to target and what media work best are crucial to this
cause and are also critical in getting the most out of limited funding. Recommendations from this study include further
research into notifiers reporting motivations, and the impact that awareness campaigns have on target audiences.
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Walk in My Shoes program, Logan City Services
Fiona Ware, Program Coordinator, Wesley Mission Brisbane
The ‘Walk in My Shoes’ program was developed in response to an increasing trend of bullying in schools. ‘The Walk
in My Shoes’ program developed a film which was launched in 2007 which was presented to various conferences
including the 2007 Queensland Youth Conference, the 2008 Autism Queensland conference on bullying, the 2008
National Connections Conference in Canberra and the 2008 Youth Pathways National Conference in Melbourne.
The film evoked a strong response and it was suggested by a number of viewers that support material would
complement the film. Subsequently, the coordinator, along with three teachers and a psychologist/guidance officer
developed a resource workbook and facilitator’s guide to support the viewing of the film.
An initial evaluation was undertaken to determine how best to support the film. A forum was then held between
five local high schools, teachers and year eight students. This forum provided an opportunity for participants to
showcase their work, sing the soundtrack they wrote, perform their choreographed dancing, host the day, prepare
the lunch, support the year eight students and celebrate their success. The Coordinator was also able to trial the new
resources.
One of the outcomes of the program has been the provision of a TAFE qualification of ‘Certificate in Skills for the
Future’ for 20 participants who had left mainstream education. It has also given these participants transferable
employability skills and a link to further study.
In May and June of 2009 the pilot ‘Walk In My Shoes’ professional development workshops and mini forums were
conducted with approximately 30 form teachers, guidance officers and support staff and 220 year eight students from
Nerang State High School in Queensland. An ‘action research’ model was used, which included workshops, mini
forums, focus groups for teachers and students, feedback sheets, tape recording of sessions, letters for film students
from year eight students and teachers.
To monitor the overall success and development of the program, a series of project outcomes were established.
Feedback from schools after the workshops indicated that the workshop assisted them to create a bridge for
communication by students having confidence to report incidences of concern, to discuss problems more readily
and openly and to develop more friendships. Evaluation of the program was conducted by a research assistant
recommended by Professor Bruce Burton Director, Acting against Bullying, Chair in Applied Theatre, Faculty of
Education, Griffith University.
Evidence to measure the success of this program was collected in the form of surveys and feedback sheets, ongoing
interviews with teachers and students and extensive observations. Four ‘key themes’ for the success of the rollout
in schools became evident throughout the workshops. These themes were ‘environment’, ‘approach’, ‘positive
reinforcement’, and ‘staff presence’. These themes have been adapted and consolidated since the pilot to be
part of the national rollout of ‘Walk in My Shoes’ across Australia. The full report is available on the website:
www.walkinmyshoes.com.au
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17/11/2011 2:53:19 PM
The cost effectiveness of a no-rinse bed bath regime on skin integrity in
residents of a Blue Care facility
Carol Thompson, May Clarkson, Jan Kennedy, Brent Hodgkinson, Blue Care
Purpose and research questions:
The aim of this research is to determine the cost effectiveness of a bed bath product compared with soap and water
wash to:
•maintain or improve skin integrity in residents of an aged care unit
•reduce the variability of use of other skin care products that many not be cost effective in order to improve resident
quality of life with regards to skin irritation, tears and overall skin integrity
•educate staff on skin care
•reduce wastage and reduce water consumption and costs of care
This was trialled through the use of no-rise bed bath products. Research has identified these products to be beneficial
in the prevention of skin tears, pressure sores and dryness. Two identical wards were enlisted to act as a control
and experimental group with the control group carrying out their usual care practices (soap and water), and the
experimental group altering their bathing regime to incorporate the use of no rinse bed bath products. Both groups
collected skin integrity and linen count information over a period of one year.
The results showed that for the outcomes of skin integrity, the waterless bed bath system was as effective as soap
and water with a significant improvement in incidence of bruising (possibly due to less manual handling of the client to
perform the cleansing activities). Assuming then that the outcomes are similar between the two treatment groups the
costing exercise is underway to determine which of the two is less costly to perform.
Identification of resources to support palliative care for people from
culturally and linguistically diverse communities
Associate Professor Deborah Parker UQ/Blue Care Research and Practice Development Centre; Professor Philip
Davies, Claire Brolan, Gillian Davies, Patricia Whipple
Funding
Department of Health & Ageing $80 000
The aim of this project was to gather information on the resources available in Australia which support palliative and
end of life care for people from culturally and linguistically diverse communities, to critically assess the evaluation
undergone by these resources and to determine the appropriateness and suitability for reprinting and general
distribution.
A total of 47 resources were identified, 15 for health professionals and 32 for patient/carers. None of these resources
had undergone evaluation. A final report has been published and presented to the Department of Health and Ageing.
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Easy as 1-2-3- Magic
Many parenting programs give parents and carers strategies to modify
behaviour but there are few that also focus on the emotions of the
child in the context of parenting. The 1-2-3-Magic emotion coaching
parenting program is an exception – the program consists of easyto-understand parenting interventions that help parents and carers
of children aged two to 12 years to better manage their children’s
behaviour and to help them with their emotional difficulties.
This brief, easy-to-understand program was recognised by UnitingCare Community as having great potential as a
useful approach for families who might be experiencing adverse circumstances such as early involvement with child
protection agencies, having accommodation issues or experiencing the threat of breakdown to a foster placement.
Janelle Middleton, of UnitingCare Community’s Research, Analysis, Innovation & Development Team, said that the
potential of this type of program seemed very promising.
“Intuitively we could see that a parenting program which addresses emotions as well as behaviour could be very
useful, as we know that many mental health issues have their beginnings in childhood,” she said.
“This program was also suitable for parents who might be experiencing difficulties and unable to commit to a long
duration program – 1-2-3- Magic only lasts for three sessions and yet appears to achieve worthwhile results.”
Parent and Child Interaction Therapist, Cheryl McMahon, was involved in helping to facilitate some of the groups
that were used in the research and is now a great champion for this program.
“The research has backed up our instincts that this is a really useful course for parents and foster parents - whether
they are people who have come to the attention of the Department of Communities (Child Safety Services), a
kinship or foster carer who wants to brush up their parenting skills or families who just want a bit of help to manage
their children’s behaviour,” Cheryl said.
“With this program we can explain how the brain develops in simple to understand terms, and give parents and
carers strategies to help their children to label, track and manage their own emotions, as well as giving them
strategies for behaviour management,” she said.
“It is wonderful to see the parents and carers return for the third session feeling much more confident and amazed how
well their children have grasped the concepts. In a small way we help parents and children to relate to one another.”
The research validates the experience of Cheryl and her UnitingCare Community colleagues. At post-intervention,
both foster carers and biological parents reported significant improvements across all parent-reported child and
adult outcomes. This study provides support for the effectiveness of the 1-2-3-Magic emotion coaching parenting
program, to assist caregivers increase their emotion coaching and decrease their emotion dismissing parenting
behaviours, to improve the regulation of their own emotions, to develop more functional childrearing attitudes, to
improve their psychosocial adjustment and to improve parent-reported child behaviours.
For further information about 1-2-3-Magic emotion coaching parenting program please contact Cheryl McMahon
on 07 3624 2437.
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Ongoing projects
Advancing knowledge for practice to achieve social justice
outcomes
Managing older people’s money: assisted and substitute decision
making in residential aged care
Dr Cheryl Tilse, Professor Jill Wilson, UQ; Professor Linda Rosenman, Dr David Morrison and Dr Anne-Louise
McCawley, Victoria University
Funding
Australian Research Council Linkage Grant with Blue Care, Tri Care and the Office of the Adult Guardian as partners
For older people, decision making about financial matters is contentious because of competing interests in their
assets and concerns about risk, misuse and abuse. In residential care settings, older people risk being characterised
as dependent and vulnerable, especially in relation to decisions about financial assets. This study aims to identify the
factors that facilitate and constrain resident involvement in decision making about their financial assets.
Case studies of four aged care facilities explored how staff interpreted the legislative and policy requirements
for assisted and substitute decision making and the factors that facilitated and constrained residents’ inclusion
in decisions about their finances. The observed practices reveal considerable variation in the ways that current
legislation is understood and implemented, that there are limited resources for residents in this area and that policies
and procedures prioritise managing risk and protecting assets rather than promoting assisted decision making.
The implementation of assisted decision making requires resources and support and this area of care is underdeveloped. The resource constraints affect opportunities to include older people in decision making as is required in
the Charter of Residents’ Rights and Responsibilities (1997). The challenge is to develop a range of practices around
assisted and substitute decision making that reflect the diverse needs and interests of older people which fluctuate
over time.
Data collection and feedback sessions with industry partners are completed and analysis of all phases is in progress.
Predictors of complicated grief and health outcomes in family
caregivers of people with dementia
Patricia Shuter, Professor Helen Edwards, Dr Sandy Sacre, Professor Elizabeth Beattie, Queensland University of
Technology (QUT)
The purpose of this research is to determine the influence of key factors experienced by family caregivers (spouses
and adult children) of people with severe dementia on their health outcomes and on the development of complicated
grief following the death of their relative with dementia. The findings will be used to identify areas and indicators where
interventions would be likely to improve outcomes for the caregivers.
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The specific questions are:
•what are the most significant issues central to the role of family caregivers of relatives with severe dementia?
•what are the most significant issues central to experiencing the death of their relative with dementia?
•what are the most important factors that influence the way the caregivers cope following the death of their relative?
Measurement of depression in a geriatric population
Genevieve Cavanagh, Dr Andrea Quinn, University of Southern Queensland (USQ)
The purpose of this study is to assess the use of the Cornell scale for depression in dementia (CSDD), the Yesavage
geriatric depression scale (YGDS, 15-item), and the Hayes and Lohse non verbal depression scale, in geriatric
institutions and to recommend the most effective scale to meet institutions’ requirements for diagnostic efficiency.
The study intends to identify the most effective scale to be used as a depression screening tool.
Food services in residential aged care: Financial, personnel and service
delivery factors
Dr Olivia Wright, Professor Jill Wilson, Associate Professor Elizabeth Ward, Professor Sandra Capra and R. Haddow, UQ
Funding
Australian Research Council (ARC) Linkage – partners Blue Care and Tri Care
The overall aim of the research is to understand and identify the factors that affect food intake and nutritional status
for residents in aged care facilities. More specifically the project aims to construct a multidimensional view of food
intake and nutrition including:
•levels of nutrition and malnutrition risk
•the amount of food wastage
•resident foodservice satisfaction and resident characteristics
•the amount of eating assistance required
•foodservice personnel and foodservice system characteristics, including special diets
•financial systems and budgetary constraints or barriers to implementing effective food services
At this stage data has been analysed for three facilities with two more facilities to be completed. Results to date
indicate that 60 per cent of residents who participated in the study (n=62) were well nourished, 69 per cent received
high to minimal assistance with eating meals, 45 per cent were dysphagic and the median number of medications
per day was 11. The research will assist in identifying the best way of meeting the nutritional needs of residents.
Additionally, the research is highlighting the important role families play in relation to residents, especially around meal
times and the research will assist in identifying issues for residential staff to take into account when working with
family members, as well as residents.
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The results will inform existing aged care accreditation standards and may assist in the development of foodservice
management practice guidelines to improve Australia’s training of aged care foodservice personnel and managers.
The use of nutritional supplements versus common foodstuffs to ensure
nutritional benefits in residents of aged care facilities
Stuart Donohoe, Rachel Denning, Brent Hodgkinson, Blue Care
Currently, some aged care facilities are routinely using high quantities of commercial supplements and others are
using low quantities, choosing instead to use natural products such as cream, high fat milk, cheese and butter. The
difference in the levels of nutrition provided between these two practices has not been calculated previously. The cost
implications based on the use of, for example, Sustagen Hospital Formula as a supplement versus a combination of
full cream milk and skim milk powder are significant. Sustagen costs, on average, three times as much as the milk
equivalents whilst providing a similar level of nutrition. The key aim, therefore, is to discover whether the use of natural
products are as effective in providing the required levels of nutrition measured by maintenance or improvements
in body weight (and body mass index), as the use of commercial supplements en masse in the production and
preparation of residents’ meals.
The research aims to demonstrate whether the use of natural foodstuffs as supplements, in the production and
preparation of residents’ meals, is more, less or similarly effective in providing adequate nutrition than the provision of
a similarly balanced diet using commercial food supplements. The results will inform dietary practice within the Blue
Care organisation to ensure maximum nutritional benefit without compromise to taste and palatability.
Understanding vulnerability: on being a resident with heart failure
Dr Anthony Tuckett UQ/Blue Care Research and Practice Development Centre; Brent Hodgkinson, Blue Care; Mary
Boyde, UQ; Robyn Peters, Princess Alexandra Hospital, Brisbane.
The aim of this research is to understand the experience of old age vulnerability in persons with Heart Failure (HF)
who are residents in a residential aged care facility.
Typical research questions to be answered will include, but not be restricted to:
•what are the ‘universal needs’ of the HF resident?
•what is the ‘expectation’ or ‘outcome’ as perceived by the HF resident?
•what do HF residents ‘strive for’ or ‘try to avoid’?
•what makes ‘old age worth living’ as an HF resident?
•what constitutes ‘good’ and ‘bad’ outcomes for HF residents in care?
The research will enable the development of a clinical practice framework for old age vulnerability for persons with
Heart Failure that promotes resident focussed end-of-life care in residential aged care.
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Wound management research in aged care
Collaborative research (see below)
Funding
$28 million granted by Minister for Innovation, Industry, Science and Research to the Co-operative Research Centre
(CRC) for Wound Management Innovation – Blue Care is a partner in research with the major partner being the
Queensland University of Technology
The Wound Management Innovation (WMI) collaborative research centre (CRC) has a vision to improve wound healing
and quality-of-life for people with wounds and provide cost-effective wound care that lessens the burden on the
health system.
The WMI CRC aims to employ around sixty equivalent full time researchers over the course of the program and has a
total budget (cash and in-kind) of just over $100 million for the next eight years provided by the Australian Government
and the participants.
The WMI CRC functions through three programs: Program one - Enabling technologies, program two - Tools and
therapies and program three - Clinical application. Blue Care is an industry partner in program three.
Participants in the WMI CRC are:
•Queensland University of Technology
•Australian Wound Management Association
•Blue Care
•Curtin University
•Ego Pharmaceuticals
•Flinders University
•Gallipoli Medical Research
•Foundation Queensland
•Queensland Health
•Royal District Nursing Service-South Australia
•Royal District Nursing Service
•Wesley Hyperbaric
•Silver Chain Nursing Association
•Smith & Nephew
•South Australia Health
•Southern Cross University
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•Tissue Therapies
•University of South Australia
•University of Western Australia
•University of Queensland (Queensland Facility for Advanced Bioinformatics)
•Victoria Health
•WoundsWest
•Women’s and Children’s Health Research Institute
Blue Care’s participation in this CRC provides an opportunity to participate in innovative, cutting-edge research into
wound care with the potential to provide better outcomes for clients and residents. Blue Care’s participation also
provides opportunities for staff education, national and international recognition in published research and facilitates
our ability to work in partnership with recognised and well-respected care organisations, universities and government
from across Australia. Outcomes will include improved clinical interventions and treatments and the development of
national best practice.
The inaugural national conference provided an opportunity for participants from across the three programs to share
their research project’s aims and progress to date. It also provided an opportunity to increase understanding between
clinicians and scientists. Blue Care is currently participating in two projects - Leg ulcer risk assessment and The rural
and remote wound education program.
Evaluation of measure of generativity and ego integrity in older adults
Dean Vuksanovic, Professor Murray Dyck, Dr Heather Green, Griffith University
Funding
Part of a PhD project
The aim of this study is to evaluate a brief 11 item measure of older people’s sense of generativity and ego integrity. These
two constructs form the last two stages of adult psychosocial development as per Erikson’s (1963) theory of development.
Despite Erikson’s stages of development being the most widely known theory of lifespan development, there are
only a few available and tested measures involving the concepts of generativity and ego integrity and none are
suitable for specific populations such as palliative care patients. In order to address this issue, a new 11 item measure
was created from existing measures of generativity and ego integrity. Evaluation of this brief measure among older
people is essential before it can be used in other upcoming research projects that will evaluate the efficacy of several
interventions for palliative care patients.
The primary research outcome will be the evaluation and validation of a brief measure of the last two stages of human
psychosocial development as per Erikson’s (1963) theory of development. Consequently, this measure will be able to
be used in determining the efficacy and impact of a variety of interventions and programs for older people including
people with advanced illnesses.
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Elder abuse prevalence study
Dr Sharon Atkin, Margaret McDiarmid, Research, Analysis, Innovation and Development Unit, UnitingCare
Community; Les Jackson, Elder Abuse Prevention Unit, UnitingCare Community
Funding
UnitingCare Community’s Research, Analysis, Innovation and Development Unit - research human resources valued
at $40 000; UnitingCare Community - $10 000 to cover other costs associated with the research; Drummond Street
Services, Victoria - in kind resources $10 000; Blue Care - in kind resources of $10 000.
Elder abuse is recognised worldwide as a growing social problem, however, there has been limited Australian
research on this topic. There is a need for Australian prevalence research so that future responses to elder abuse are
based on knowledge obtained in an Australian context. Of particular importance is understanding the size of the elder
abuse problem, who is being abused, the types of abuse and neglect being experienced by older victims, and related
to this, the community’s actual ability to recognise abuse when it is happening.
Methodological inconsistencies, problems with defining elder abuse, as well as differing ideological perspectives have
caused a wide divergence in findings on prevalence and types of abuse among international researchers. Australian
research on prevalence is extremely rare and also suffers from the same limitations found in the international studies.
The use of existing elder abuse or family violence prevalence research, therefore, is not considered a viable option for
informing Australia’s elder abuse response.
UnitingCare Community in partnership with BlueCare and Drummond Street Services, Victoria is in the process of
preparing for the survey stage of an elder abuse prevalence study. Survey participants will include staff and clients
from UnitingCare Community, Drummond Street Services and Blue Care populations.
Other participants will be drawn from the general community. There has already been a large amount of interest in the
proposed project, leading to media articles/ interviews both in print and radio. This exposure has resulted in contacts
from the general community to UnitingCare Community’s Elder Abuse Prevention Unit in regard to participating in the
survey. Therefore, it is expected that a proportion of general community participants will be recruited through these
communication processes.
It is anticipated that surveys will be available for participants in the latter months of 2011 with initial data analysis
occurring in the early months of 2012. The project plan is for analyses and results to be finalised by March 2012. This
elder abuse prevalence research project is not intended to be a definitive study of prevalence in Australia. The intent
is to demonstrate the necessity for a broader nationwide study by undertaking a pilot project that clarifies the nature
of elder abuse and indicates the possible prevalence.
The outcomes of the study have the potential to inform the capacity of decision makers and service providers
to develop more effective policies; inform resource allocation and the strategic targeting of government funding
initiatives; enhance existing service responses and assist in identifying service gaps; underpin prevention strategies
and provide an elder abuse prevalence rate, and measure the level of awareness in the community which will provide
a baseline to measure the success of elder abuse initiatives through follow-up surveys.
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The impact of relinquishing care of a child with a disability
Dr Kathy Ellem, Nicole Harvison, Professor Jill Wilson, UQ; Carmen Bonner, UnitingCare Community
This study involves interviewing family members who have previously relinquished caring responsibilities for their child
with a severe disability. The research will address the following questions:
•how do family members perceive the impact of the process of relinquishment on their child with a disability at the
time of transition and into adulthood?
•how do family members perceive the impact of the process of relinquishment on themselves at the time of transition
and when the child becomes an adult?
•what are family members’ perceptions of how child protection and disability service systems respond prior, during
and after the process of relinquishment?
•what are the implications of these findings for policy and practice in child protection and disability service systems?
Relinquishment in this study refers to families giving up the caring role of their child with a disability with no definite
plans to bring the child home. The child with a disability is often placed in an out-of-home respite facility until
permanent accommodation can be arranged for them. Relinquishment is instigated by families and initially leads to
an unstable situation for the child who has been relinquished as out-of-home accommodation has not been planned
for the child. It is not only important to understand the complex factors surrounding the decisions and the process
for out-of-home care but the implications and perceptions involved in these processes. This study will explore these
factors and will identify the resources available to families following relinquishment of their child.
The findings of this study will assist service providers in identifying the issues and concerns of families who have
relinquished care of their child with a disability and will provide useful information to the Shared Care and Family
Support Service to improve their own practice and the relevant policy environment.
Supporting care-leavers with mild and borderline intellectual disability:
Practitioners’ and policy makers’ accounts of needs, issues and
challenges
Dr Kathy Ellem, Professor Jill Wilson, Professor Robert Bland, Sarah MacDonald, School of Social Work and Human
Services, University of Queensland; Dr Marie Knox, Centre for Disability Studies, University of New South Wales
The aims of this research study are:
•to explore practitioners’ perspectives on the support needs, service issues and challenges for care-leavers with a
mild/borderline intellectual disability
•to explore policymakers’ perspectives on the support needs, policy issues and challenges for care-leavers with a
mild/borderline intellectual disability.
The study is the beginning of a program of research on service responses to care-leavers with a mild/borderline
intellectual disability in Queensland.
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We are interested in finding out what leads to helpful and unhelpful outcomes for young people with mild/borderline
intellectual disability who are or have been Wards of the State as children and who have experienced one or more of
the following:
•child protection interventions – as parents of children at risk
•mental health disorders
•contact with the criminal justice system – as offenders.
This group has been under-researched in the literature. However, they frequently access many community services
who struggle to provide appropriate responses.
Many people with mild to borderline intellectual disabilities in our society are not afforded the same opportunities as
the general population to a fulfilling quality life. Compared to the general population, they are more likely to experience
housing stress and homelessness, unemployment and poverty, poor physical and mental health and abuse and
exploitation. A survey of the views of 221 young people in residential care in Queensland (including 169 young people
in the care of the Department of Communities, Child Safety) found that one in four participants had a disability, with
intellectual disability being one of the most common reported disabilities. When a person with an intellectual disability
has been in the protective care of the State as a child, life difficulties are compounded by the effects of a history of
child maltreatment; a lack of ongoing familial or carer support and an early and abrupt transition into adulthood. Careleavers with mild to borderline intellectual disabilities can traverse a difficult path through multiple service systems,
often entering, exiting and returning to the same service providers. These agencies often only provide responses to
some of the issues and the unchallenged expectation that care-leavers with mild to borderline intellectual disability will
slot into existing service arrangements results in significant costs to the individuals involved, their local communities
and government.
The research will assist in understanding how service responses create helpful and unhelpful outcomes for careleavers with intellectual disability. Many young people with intellectual disability traverse multiple service systems.
There is a need to understand the ways in which such systems interact and how they can improve frontline practice
and outcomes for this group.
This study will be the beginning of a much larger research program that explores the needs of young people with
mild and borderline intellectual disabilities who are or have been children in care. Subsequent research will inform
the development of a service model, incorporating these young people’s experiences and the views of those who
assist them. The research program will contribute to more effective program and policy responses within mainstream
services for these people.
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The acceptability of the Aged Care Channel as a method of distance
education for care workers in residential aged care facilities
Brent Hodgkinson, Richard Olley, Blue Care; Anthony Tuckett, UQ/Blue Care Research and Practice
Development Centre
Funding
Aged Care Channel subscription to all facilities including set up and hardware provided through a grant from the
Department of Health and Ageing of $95 000.
In order to provide optimal care to residents of aged care facilities, ongoing professional development is essential to:
•orient new staff
•maintain skills and knowledge of existing staff
•inform staff of new advancements in care.
Due to time constraints, cost and/or distance many staff in rural and remote regions of Queensland do not have ready
or regular access to ongoing professional development. The Aged Care Channel (ACC) is a training and education
television channel specifically designed to deliver facilitated or self directed learning packages in aged care topics to
staff in Residential Aged Care Facilities (RACF).
In November 2010 the Department of Health and Ageing (DoHA) provided a grant to Blue Care to cover the cost of
hardware installation and a one year membership to the ACC in 13 rural RACF. The cost of accessing the ACC is not
inconsiderable. Recent quotes from the ACC suggest that to continue subscription in the 13 sites beyond funding
from the DoHA grant would cost approximately $3 600 per site per year ($46 800 per year), with new sites costing
$4 000 per site in set up fees alone. Therefore, the aim of this project is to determine the usability and acceptability of
the ACC by staff in these RACF in order to assist decision makers to decide whether to continue the ACC subscription
(and indeed have the service installed in other Blue Care RACF), after the DoHA grant expires in December 2011.
Recommendations will be made to Blue Care decision-makers about the future subscription status for the ACC based
on usability and acceptability data, as described by the end-users in the RACF.
Evaluation of the use of Client Directed Outcome Informed Measures
within UnitingCare Community
Janelle Middleton, Dr Sharon Atkin, UnitingCare Community Research, Analysis, Innovation and Development Unit
Funding
The collection of data for this project has been via the course of normal service delivery, and/or utilising the resources
of the Research, Analysis, Innovation and Development (RAID) Unit of UnitingCare Community. The evaluation is being
undertaken within the RAID Unit.
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It is commonly assumed that the delivery of evidenced based psychological interventions by experienced mental
health professionals is the key to best practice. However, evidence based practice often fails to achieve its aim of
improving practice. It would seem that this approach is not the answer, with no one approach showing superiority
over another. Nor does it seem that the level of experience of the counsellor holds the answer. Two factors that do
seem to be of importance are the client, and the client-therapist relationship.
UnitingCare Community had committed to the use of Outcome Informed Client Directed Measures to capture
client feedback, and in parts of the organisation, commenced using the Outcome Rating Scale (ORS: Miller and
Duncan, 2000) and the Session Rating Scale (SRS: Miller, Duncan, and Johnson (2000). There is evidence to
suggest that Client Informed Outcome Measures (CDOI) for example, using the ORS and SRS, provide a continuous
feedback system that improves outcomes. After a period of time utilising these measures Uniting Care Community
is undertaking an evaluation of how useful these measures have been to UnitingCare Community clients and
counsellors, not only in counselling sessions but also in counsellor supervision.
Quantitative and qualitative research is currently being conducted to determine not only the effectiveness of the tools
but also to establish the attitudes of staff towards using, and the benefits of, the measures. The evaluation is also
examining the implementation process.
Analyses are currently being undertaken. The evaluation is likely to influence the use of CDOI measures within
UnitingCare Community. The data reviewed to date suggests that it may provide useful information not only about the
use of the measures but also about client service delivery, counsellor supervision, and future roll out/implementation
of similar projects within the organisation.
Community development and collaboration: Lessons learned from three
projects in UnitingCare Queensland and UnitingCare Community
Margaret McDiarmid, UnitingCare Community Research, Analysis, Innovation and Development Unit
While there are examples of endeavours in Australia to integrate service responses rather than working in service silos,
there has been limited exploration of how collaboration occurs, what makes it work or not work and what benefits,
if any, accrue from it. The aim of this project is to examine three current community development projects – two
projects from UnitingCare Community and one from UnitingCare Queensland – and the approaches to collaboration
being practiced in these projects.
The projects discussed are the Social Inclusion project in its preliminary stage of development in the Wide Bay
Burnett region; the Family Law Pathways project which has been in operation and development for two years on the
Sunshine Coast and the Community for Children project which has been operating for six years and is situated in the
northern Gold Coast corridor. The social and policy contexts and values and aims of each project are being explored
along with an analysis of how each of the projects approaches collaboration and project development and delivery in
the community.
This is currently a work in progress. The purpose of this exploration is to draw out some principles to inform future
collaborative projects involving UnitingCare Community and to consider some of the key factors in the projects and
from research which have been identified as supporting collaborative practice.
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Memory and communication training in dementia to enhance the
transition from home to residential care
Professor Helen Chenery, Professor Michael Humphreys, Associate Professor Nancy Pachana, Associate Professor
Gerard Byrne, Professor Cynthia Gallois, Dr David Copland, Dr Anthony Angwin Baker, UQ
Funding
National Health and Medical Research Council (NHMRC)
The project aims to develop and evaluate a communicative and cognitive training program for caregivers of people
with dementia, both at home and in residential aged care facilities (RACF). By training home caregivers and RACF
staff in techniques that support communication and memory, the project aims to maximise functional skills in people
with dementia and facilitate the transition from home to residential care.
In May 2009 the production of a DVD-based cognitive-communicative training program for RACF staff and home
caregivers was completed. The training materials comprise:
•MESSAGE communication strategies (30 min DVD)
•RECAPS memory strategies (20 min DVD)
•accompanying booklet, posters and reminder cards
In June 2009 the implementation of research into the effectiveness of this training in the first of our four nominated
Blue Care residential facilities was begun. Training sessions for care staff were conducted in three of these, with the
fourth serving as a control facility (where training will be provided later). Baseline and three-month follow up measures
with care staff and residents with dementia have now been completed in two facilities. Baseline measures have also
been conducted in the remaining two facilities.
Interim results from care staff who have received the MESSAGE and RECAPS training show a significant increase in
staff knowledge of memory and communication support strategies from baseline to immediately post-training.
In addition, staff evaluations of the training indicate that 71 per cent have found it very useful, 91 per cent would
recommend it to a colleague, 95 per cent indicated that it would not be hard to implement the training strategies in
every day life and 68 per cent considered that they had learnt a lot from the training.
On the basis of data obtained from the evaluation phase, comprehensive revision of our educational DVD on memory
and communication support was made with separate versions developed for professional dementia care staff and
caregivers in the home setting. Planned dissemination will be worldwide, via YouTube, and also in DVD form.
The research has also been implemented with caregivers and people with dementia living at home. Recruitment in
the community setting has involved site visits to 22 Blue Care Community Services and the distribution of approved
information leaflets by community service personnel. Forty people with dementia living at home and their caregivers
have been recruited through Blue Care so far.
The audio-recorded conversation samples between participants with dementia and their caregivers (in residential
facilities or at home) have been transcribed and analysis commenced. The results of the evaluation of the training
with RACF care staff have been reported in the International Journal of Nursing Studies. Further analysis of the RACF
conversation data using Leximancer text analytics and SALT (Systematic Analysis of Language Transcripts) software,
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and preliminary work for two journal papers on communication between care staff and residents with dementia
have been completed. Five national and four international conference presentations have been made on this project.
Information sessions have also been presented to dementia service providers and carer support groups.
Approval from NHMRC has been gained to extend the life of the grant for one year (to 30 June 2012), to
accommodate changes to the project implementation. This extended timeframe allows for completion of the revised
DVD-based education programs for professional and home caregivers and for comprehensive analysis of the
transcribed conversations which are proving to be a rich and informative source of data.
Reduction of carer burden and falls in people with dementia by using
simple strategies for coping with individual mobility problems
Dr Jennifer C Nitz, Kylie Dunn UQ; Dr Tim Henwood UQ/Blue Care Research and Practice Development Centre
The purpose of this study is to provide care staff with knowledge and strategies for assisting people with dementia
and mobility difficulties thereby reducing stress and anxiety for the carers. This will be done by producing an
education booklet backed up with training and conducting an evaluation of the education and training booklet. The
study will evaluate training content translation to practice with residents by care staff. The second aspect of the study
is to look at the impact of carer training on fall rate in the residents with dementia, using the fall data base in the facility
where the study is being undertaken.
There are currently no resources that provide care staff with simple strategies for coping with and understanding
the behavioural problems encountered at various times when caring for people with dementia and variable mobility
impairments such as transfers, mobilising, bed mobility, bathing and feeding. The concept of combining in one place
(a booklet), information on why various behaviours are demonstrated and strategies for managing these behaviours
on an individual basis, in an easy to understand way, is novel. An example of the sort of information that would be
included is: People with dementia cannot understand conceptual words such as backwards and sideways so when
you are assisting with mobility and the person with dementia is being seated into a chair, asking them to step back
until they feel the chair behind their legs before sitting, invariably gets a step forwards response much to the frustration
of the carer and the person concerned. The booklet will provide suggested strategies to overcome such problems
and explain why the person with dementia can’t understand the instruction.
Utilisation of the information in the booklet could reduce stress experienced by care staff when communication
between the carer and the person with dementia breaks down. Ultimately it is hoped that improvements in these
aspects of care would improve care quality of life, leading to less “burnout”, sick days and staff turnover. The study
will evaluate the effect of the education and training booklet with regard to the change in the perceived burden of
care for care staff that might be attributable to using the reference booklet as reflected in lower stress, anxiety and
depression, as well as improved self-perceived health status; the perceived usefulness and acceptance of the booklet
by staff and any change in fall incidence by residents with dementia in participating facilities.
Confirmation of the usefulness of this training and the skills it will provide carers could be used to guide best practice
for carers of people with dementia, thereby enhancing quality of care. Its usefulness has the potential to be expanded
to all health professionals engaged in the care of people with dementia, as well as family carers within the community.
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The cost effectiveness of a nurse-led pain clinic
Linda Taylor, Liddy Harding, Julie Elliot, Bernadette Lee, Rachael Viney, Susan Ripley, Robyn Hume, Brent
Hodgkinson, Blue Care
Given the current climate in healthcare where demand for services outweighs the available resources it is imperative
that solutions be investigated that may be cost effective and allow for the provision of services where none were
available before. Anecdotal evidence suggests that the availability of chronic pain services provided by allied health
practitioners is limited and that another model, where provision of these services is provided by an alternative clinician
group i.e. registered nurses (RNs) would be beneficial for clients suffering with chronic pain.
The aim of this research is to compare the cost-effectiveness of a nurse led pain clinic with a pain clinic run by an
external physiotherapy provider. It is intended to also compare both of these clinics against outcomes of residents in a
facility not currently running a pain clinic (standard care).
Cost effectiveness will be expressed in terms of:
•the cost of external provider charges and nurse salary weighed against changes in Aged Care Funding Instrument
(ACFI) funding
•effectiveness of the service to change client pain scores
This study aims to determine whether a nurse led pain clinic in Blue Care Residential Aged Care facilities will be a cost
effective alternative to using an external provider to deliver these same services. If the RN led clinic is cost effective,
this will be an especially useful model in facilities where an external provider is not available.
If the RN led clinic is cost-effective then clients living in Blue Care Residential Aged Care Facilities will have greater
access to chronic pain relief services. Providing a chronic pain service to clients may change individuals’ ACFI
designation for complex health care procedures resulting in increased ACFI funding.
The effectiveness of services and support for parents of children with a
behavioural disorder diagnosis in a regional context
Jeff Jones; Professor Lena Robinson, Central Queensland University
This investigation aims to examine services available to, and most frequently accessed by, parents of children with
a diagnosed behavioural disorder (such as Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder,
Conduct Disorder) in the Toowoomba region. Focus groups will be facilitated with the objective of identifying key
areas in which existing support and access to such networks/programs for these parents can be improved, including
identification of perceived barriers that may prevent service access by these parents. The specific issues faced by
the families will be explored and ways in which parents can further resource themselves on how to respond to and
support their child/ren will be discussed. The research aims to gain a greater understanding of specific issues faced
by the child and family in this target group which will enable keys to improving existing community networks and
support programs.
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The participation of parents in this study will provide key data towards identifying strengths and gaps in existing
networks for children with a behavioural disorder in Toowoomba. It is anticipated that this project will contribute
towards the knowledge base and future directions for service providers in the community and parents of a child with
a behavioural disorder. It could also help facilitate the streamlining of available services, while creating and increasing
awareness of what specific support services are available in the community for these families.
Managing swallowing difficulty in residents in aged care facilities
Dr Lisa Nissen, Dr Julia Cichero, Dr Anthea Jones, UQ; Dr Anthony Tuckett and Associate Professor Deborah Parker
UQ/Blue Care Research and Practice Development Centre
This study aims to evaluate the effect of residents who have difficulty swallowing medications on the ability of
Registered Nurses, Endorsed Enrolled Nurses and Enrolled Nurses to carry out their day-to-day work. It involves a
survey of staff working in Blue Care residential aged care facilities and a time and motion study of medication delivery.
Mental healthcare: towards an understanding of registered nurses’
most important caring behaviours: an e-Cohort sub-study
Associate Professor Christine Neville, Dr Anthony G Tuckett, UQ/Blue Care Research and Practice
Development Centre
The caring Assessment Instrument (CARE-Q) specifically identifies the nursing caring behaviours that are perceived
as important in making clients/patients feel cared for. The aim of this replication study is to determine which registered
nurse caring behaviours are perceived by mental health nurses, who are part of the Nurses and Midwives e-Cohort
Study, as being most or least important in making a client/patient feel cared for.
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Seeking to understand impacts of relinquishing care of a
child with a disability
For a parent who has reached the point when they are unable to care for their
child with a disability, and the only course of action they have is to relinquish that
care, the decision can be extremely traumatic. Often the very services that exist
to assist parents in this position are unable to provide the necessary support to
help them through this overwhelming situation, and seem unsuccessful in helping
them to plan for the future of the relationship between the parent and their child.
This gap in service delivery has been recognised by the Shared Care and
Family Support Service (SCAFS) and now research is being conducted through
UnitingCare Community, led by Dr Kathy Ellem, UnitingCare Queensland
Postdoctoral Research Fellow, to assess the short-term and long-term impacts on
parents and other family members of the process of relinquishment of their child.
“We are planning to talk to parents and family members who have been through this process in the past to hear
their stories and find out what factors led up to their decision, what issues they confronted when they relinquished
care of their child, what issues their child has to cope with and how the process could have been different – what
would have been helpful or better handled,” Kathy Ellem said.
Although the study is in its early days, the research has already identified a number of issues that can be faced by
both the parents and the children involved in a situation where a child with a disability is relinquished. For example,
one mother wasn’t advised that if circumstances allowed, she would be able to retain guardianship over her child
which would have meant that she could have been involved in some decision making about his future.
“Instead, because the child protection services were involved, she was treated in the same way as a parent who
had harmed or neglected their child would be, with little say about his future care,” Kathy said.
“The child was moved from his school to one in another town which was highly traumatic, especially given the other
changes that he had recently faced and given the fact that his particular disability made change very distressing
for him.”
“But by talking with the families in this way, we not only hope to be able to understand the complex factors
surrounding the decisions and the process for out-of-home care but also the implications and perceptions involved
in these processes.
“We would hope that our findings will contribute to the development of more appropriate responses, better practice
and help influence policy.
“One of the outcomes we hope for is to create a guide for practitioners which could identify possible issues that
parents relinquishing their child might face and how the practitioner can assist with these,” she said.
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Closing the Gap in employment and health: Blue Care’s Indigenous
employment strategy
Norelle Watson, David Conlon, Donna Corrie, Trish Noel-Borg, Blue Care
Blue Care is committed to providing long term career pathways for Aboriginal and Torres Strait Islander peoples by
providing employment opportunities, training and career development and provision of a work environment in which
all workers are treated with respect. In 2002 Blue Care launched its Indigenous Employment Strategy with the aim of
proactively recruiting, training and retaining Aboriginal and Torres Strait Islander staff. In 2004 Blue Care commenced
the development of an Indigenous Care Strategy which committed the organisation to developing culturally
appropriate care services to Aboriginal and Torres Strait Islander peoples.
Program components of this integrated and coordinated approach to Closing the Gap include:
•facilitating equitable employment opportunities for Aboriginal and Torres Strait Islander people
•changing the culture from within
•modelling appropriate behaviour which is reinforced through policy
•developing, implementing, monitoring and evaluating Indigenous staff management practices
•working in partnership with Indigenous communities.
Blue Care’s Indigenous employment program has reached the present employment target of 2.5 per cent of Blue
Care’s total workforce being Aboriginal and Torres Strait Islander, with the aim of increasing this representation to
3.1 per cent by 2013 – the equivalent proportion of the Aboriginal and Torres Strait Islander population to the total
population of South-East Queensland. Blue Care currently employs more than 130 Indigenous staff in diverse areas of
care, including nursing, allied health, respite care, disability support and personal care.
Attitudes towards ageing and death: Impacts on job satisfaction and
psychological wellbeing of nurses working in aged care
Sharon Mackenzie RN, Doctoral Candidate Clinical Psychology; Associate Professor Shirley Morrissey,
Griffith University and Dr Elizabeth Conlon, Behavioural Basis of Health Research Centre
Aged care is a demanding career path as nurses face the difficult task of reconciling emotional, physical and systemic
demands into a framework where they can attend to daily tasks with a sense of meaning and purpose. Currently,
more than half of the aged care nursing workforce is over the age of 45 years and these nurses report high levels of
workplace dissatisfaction.
This research project aims to explore issues associated with workplace stress and dissatisfaction of aged care nurses
and to develop an intervention for this cohort. The first research stage will investigate the attitude of nurses towards
ageing, fear of death, levels of job satisfaction and psychological wellbeing. Stage two of the project aims to develop,
implement and evaluate a psychosocial intervention for nursing staff specifically directed towards attitudes to ageing,
death anxiety, personal growth and strategies for self-care.
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It is proposed that the intervention will result in improved job satisfaction, an increased acceptance of death and
ageing and improved psychological wellbeing for the participants. Ultimately it will result in carers who have a greater
sense of purpose and improved personal wellbeing which is more likely to provide an improved level of service to the
elderly individuals in their care. The delivery of eight educational sessions to nurses who have volunteered from stage
one has been completed. All feedback has been positive and outcome data is currently being collated for the second
stage of the project.
In the first stage of the study 121 aged care nurses completed a questionnaire that investigated the attitudes of nurses
towards ageing, fear of death, levels of job satisfaction and psychological wellbeing. Nurses reporting less fear of
death also reported more positive attitudes to working in aged care. Higher job satisfaction was associated with few
mental health problems, a sense of control at work, resilience and positive attitudes to ageing. At post intervention, a
significant increase was found in reports of collegiality among the participating nurses. Qualitatively, the participants
reported reduced death anxiety, personal growth and improved psychological wellbeing. Ultimately, carers appeared
to have a greater sense of purpose and improved personal wellbeing. This may lead to an improved level of service to
the elderly individuals in care.
Let’s talk about change: Middle managers in aged care; challenges,
career pathways and adjustments to change
Ellen Meissner, Professor Jill Wilson, Professor Victor Callan, UQ
Funding
PhD Scholarship
The aim of this research study is to investigate the current demands and challenges middle managers in the aged care
service sector are facing, including their perception of ongoing change and the extent to which this perception is influenced
by employee identification. A model is tested on how identification (e.g. as a professional, or as a manager) and other critical
factors such as organisational climate, influence middle managers’ adjustment with organisational change.
The research questions central to the study are:
•what are the contemporary demands and challenges middle managers are facing in the aged care sector?
•how do they respond to these challenges?
•what are the salient reference groups in terms of identity (e.g. work unit, profession) and how do they influence
employee perception of ongoing change?
•which are the key factors influencing their personal adjustment to change? (e.g. organisational climate, role clarity).
The emergent complexity and tensions in the professional service setting create sets of behavioural and managerial
challenges that are imperfectly understood. In response to changes in the environment, aged care providers have
reorganised, restructured and implemented new ‘business-like’ management approaches. Evaluations of change
efforts have mainly focussed on structural changes, management processes and the implementation of quality
improvement rather than impacts on organisational culture, changing roles and the perceptions of employees. The
impact on professionals has not been studied sufficiently. This study is particularly interested in the impact of the
changes on organisational roles and identities of middle managers. By shedding light on how managers perceive
ongoing changes and adjust to them, the study will provide support to personal and professional development.
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Conceptually, the research will add to our understanding of the role of professional identity in assisting managers
to make sense of ongoing changes within the organisational environment as well as their work environment. At an
applied level, the research will provide knowledge on how to enhance the ability of middle managers to adjust to
ongoing changes with particular focus on relevant factors within the aged care service sector. The research will
provide insights into how to provide a supportive environment, improve the role transition of middle managers and
ultimately improve employee satisfaction and retention.
By gathering an understanding of the characteristics of this particular group of employees across the sector, the
development of a much needed leadership and management quality framework with consideration of the diversity of
the sector can be initiated.
Enhancing students as evolving professionals and collaborative
members of the healthcare team – an inter-professional community –
integrated collaborative learning approach in a residential aged care
Dr Annetta Tsang, Sandra Goetz, Libby Dann, Dr Kitty Chow, Associate Professor Stephanie Fox-Young, UQ
The purpose of this study was to develop students as evolving professionals and collaborative members of the
healthcare team using an inter-professional community-integrated collaborative learning approach in a residential
aged care.
Particular issues that were addressed were:
•enhancing professional socialisation and professional development of oral health and nursing students
•developing inter-professional understanding and improve reflective communication and team skills
•improving oral health students’ understanding of the aged care environment
•determining resident/carer perceptions on inter-professional student placements
•enhancing interest in the aged care sector and inspiring students to consider contributing to the aged care sector
post graduation.
Results from the study are still being analysed but trends noted from the data after initial analysis suggest that:
•inter professional learning is useful for nursing and oral health students in the aged care setting and contributed
to increased knowledge/skills as well as enhanced professional development, in particular inter professional
understanding, communication and team skills
•oral health students’ understanding of the aged-care setting and geriatric care was enhanced
•nursing students’ understanding of oral health needs for the elderly and basic skills for risk assessment and oral
hygiene provision were enhanced
•collaborative learning and team skills building were facilitated by the introductory workshops organised especially for
this purpose, in particular the collaborative team skills workshop using art therapy and reflection.
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Limiting factors / areas to address in future iterations include: duration of placement (one semester may have been
too little time to rotate students through); the importance of a coordinator at the residential facilities to optimise patient
availability, consent and interaction opportunities; day sheet of available patients be made available to supervising
staff; medical charts to be made available to oral health students to facilitate risk assessment for oral diseases;
timing of sessions may be better in the morning if possible and greater involvement of carers to facilitate knowledge
exchange and education.
Has an injection of aged care curriculum content and support changed
undergraduate nurse perceptions of gerontological nursing?
Associate Professor Christine Neville, UQ/Blue Care Research and Practice Development Centre; Ms Kerry Neale, UQ
Funding
The University of Queensland $11 947
The aim of this project is to determine if there has been a change in the perceptions of undergraduate nurses
towards nursing older people in light of the extra resourcing and attention that has been given to this area of nursing
education.
In recognition of the worldwide trend for an ageing population and what this will mean for Australia, various levels of
government and the non-government sector, practicing nurses and nurse academics have been working together to
prepare future nurses for the impact of this very significant demographic change on the health care system.
Success of the collaborative work had two obstacles to overcome:
•existing educational preparation of nurses did not provide the level of knowledge and skills that practitioners needed
•many undergraduate nurses do not find work with older people an attractive career option causing recruitment and
retention difficulties in the field.
Over the past few years, two main strategies to address these issues have been implemented, firstly, a number of
projects focussing on the extent of aged care content in the nursing curricula across Australian universities have been
undertaken to understand and strengthen the ability of universities to more effectively teach aged care. Secondly,
specific government and non-government scholarship programs have been offered to encourage undergraduate
nursing students to pursue a career in aged care.
While past research conducted in Australia on undergraduate nursing student perceptions and experiences of aged
care is sparse and what does exist varies in consistency, depth and sophistication, they are unified by a common
absence – that of a meaningful nationwide approach. The proposed project will be a national survey and will also
take advantage of being able to evaluate the recent high level national activity regarding aged care in undergraduate
nursing curricula.
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Elder abuse – what do you know about it?
Although elder abuse is recognised world wide as a growing problem, ask
the average Australian what they know about the subject and nine times
out of ten the reply will be “very little” – we know it exists but we don’t
know how widespread it is or what exactly it entails. Well we are not alone.
Researchers from UnitingCare Community have identified the need for
research to discover the incidence of elder abuse in Australia and also
what types of abuse are being experienced by older people and where
they live, so that future responses to this problem can be tailored to meet actual needs.
In partnership with another UnitingCare Queensland service group, Blue Care, and Drummond Street Services,
Victoria, members of the UnitingCare Community Research Unit led by the Unit’s Manager, Dr Sharon Atkin, are in
the process of preparing for the survey stage of an elder abuse prevalence study.
Les Jackson, Coordinator of the UnitingCare Community Elder Abuse Prevention Unit, says that this survey will
help develop parameters for a major study of the elder abuse problem and will also enable researchers to gain a
snapshot of how much and where elder abuse exists and what types of abuse are happening.
“As this isn’t a randomised study it won’t be statistically significant but it will provide a good profile of what is out
there which we can use as a benchmark for later similar surveys,” Les said.
“At the moment everything the Elder Abuse Prevention Unit does is based on incomplete information. We get lots
of calls to our Help Line about financial abuse but we really don’t know if that is the predominant type of abuse or
whether it is the easiest to identify. It is quite possible that there are a lot of other types of abuse out there which
are far more prevalent than we have realised such as emotional or controlling behaviour, social isolation, physical
abuse and other types of abuse that we receive fewer calls about.”
“Also, we don’t know exactly who the perpetrators of abuse are – we hear a lot about sons and daughters abusing
their parents but we also get calls where other people are the abusers. For example, recently we heard from a
lady in her 80’s who had returned to care for a former partner when he became ill - she had left him years before
because of his difficult behaviour. Even though he was gravely ill he again managed to make her life a misery- he
even tried to throttle her twice.”
“It is possible that the survey might give us information that indicates that there are many older people who are perpetrators
as well as being the victims of abuse, as was the case in this instance. Once we have a good picture of what is out
there it will be much easier to target a campaign to raise awareness and hopefully decrease abuse.”
“We will also be able to improve the training we give to hospital, residential aged care staff and other providers on
how to recognise if abuse is taking place,” he said
There has already been a large amount of interest in the proposed project, leading to media articles/ interviews
both in print and radio. This exposure has resulted in contacts from the general community to UnitingCare
Community’s Elder Abuse Prevention Unit in regard to participating in the survey. Survey participants will also
include staff and clients from UnitingCare Community, Drummond Street Services and BlueCare populations.
Other participants will be drawn from the general community.
For more information call the Elder Abuse Help Line on 1300 651 192.
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Care coordination: Linking chronic diseases services on the
Darling Downs
Donna Hart, Vicki Plummer, Blue Care
Funding
Queensland Strategy for Chronic Disease 2005 – 2015
The Queensland Government’s Strategy for Chronic Disease 2005 - 2015 identified the need to balance acute
hospital care with a stronger focus on prevention and early management of chronic disease. In 2010, the Toowoomba
and Darling Downs Primary Health Care Partnership Council gained funding from the Queensland Strategy for
Chronic Disease 2005 – 2015 to develop the Linking Chronic Disease Services program. The partnership included
Queensland Health, the local divisions of general practice (GP Connections and RHealth) and Blue Care as the
community care service.
The focus of the program was to decrease avoidable hospital admissions for patients with Type II Diabetes, chronic
heart failure or chronic obstructive pulmonary disease and to improve their quality of life. Care governance structures
included a program manager and an administration officer (employed by Queensland Health) who were responsible
for the strategic management and administration of the program. A care coordinator (employed by Blue Care, the GP
practice or Queensland Health) was assigned to all program participants and served as the central point of contact
for all service providers and was responsible for the comprehensive assessment of the patient and their care planning
in consultation with the patient’s GP. Two service coordinators (employed by RHealth and GP Connections) were
responsible for capacity building such as providing formal training in care coordination and joint care planning visits
with clients and GPs.
Integrated and coordinated care delivery processes included the use of:
•internet-based online tools e.g. auto populating care plans and the ongoing needs identification (ONI)
•a care plan designed to enable access to Medicare subsidised allied health visits
•an online directory of participating service providers
•a patient-held record designed to aid communication between service providers.
Since program commencement in July 2009 Blue Care Toowoomba has provided care coordination for 40 clients.
Lessons learned include:
•more effective and efficient care planning in the client’s home via the use of an interactive web based program
•a streamlined electronic referral system
•reduced duplication of information
•staff access to electronic client progress and status information decreases the need for phone calls to other care
providers seeking this information.
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One of the advantages of these processes was that the care coordinator could be informed if their patient presented
to an emergency department, thus enabling continuity of care in treatment and discharge planning. Integrated and
coordinated approaches to preventing and/or managing common risk factors for chronic diseases in concert with
secondary prevention will provide a more efficient and targeted use of health resources across the health continuum.
Partnership models such as Linking Chronic Disease Services Program are system enablers that facilitate the
prevention and management of chronic disease and better support consumers as their health care needs change.
The care coordinator’s position and the use of information technology were seen as key components to providing
linked continuity of care. This project is currently under evaluation and a report is expected by June 2012.
Queensland Health is continuing the program and Blue Care is hopeful of being involved with it going forward.
The feasibility of telehealth for the provision of allied health services in
rural and remote areas
Glenys Webby, Brent Hodgkinson, Dr Helen Higgins, Trevor Russell, Deborah Theodoros, Blue Care
The objective of this telehealth rehabilitation project is to test the feasibility of providing allied health telehealth services
from a regional centre base into a rural community using the eHAB™ telehealth system.
The aims of the study are to assess:
• the feasibility of using eHAB™ telehealth for allied health interventions in a rural area
• the differences, if any, in the feasibility of delivering eHAB™ telehealth allied health consultations between service
delivery environments (residential and community)
• the level of client satisfaction with use of eHAB™ telehealth to address their allied health needs
• staff (allied health professional and allied health assistant/personal carer) satisfaction with the use of eHAB™
telehealth for allied health consultations
• the cost of providing an allied health assessment using the eHAB™ telehealth service compared with providing an
in-home assessment.
Pulmonary rehabilitation or self-management for chronic obstructive
pulmonary disease (COPD): which is the best approach?
Professor Bill Vincenzino, Dr Angela Chang, Dr Terry Haines, Professor Claire Jackson, Dr Ian Yang, Dr Jennifer Nitz,
Mrs Nancy Chow; Dr Allison Mandrusiak
Funding
MBF Foundation Grant
The purpose of this project is to compare the clinical effectiveness of chronic disease self management, multi-factorial
pulmonary rehabilitation and usual care in improving disease specific health related quality of life amongst people with
COPD and to compare the economic efficiency (cost utility) of these interventions. A secondary aim is to investigate
the effect of geographical location (metropolitan centre versus smaller regional centre) on project outcomes.
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The intervention programs and testing are complete, including the testing that occurred three months postintervention and the surveys which were distributed via mail at six, nine and 12 months post-intervention. Data
analysis is currently being undertaken, along with preparation of journal manuscripts and conference presentations.
Evaluation of a Blue Care dementia café within a dementia specific
respite service
Ruth MacKinnon, Nerida Jones, Debra Gibbons, Cathy Thomas, Dr Helen Higgins, Brent Hodgkinson, Blue Care
This project was initiated by Blue Care staff at the dementia specific Cooper’s Plains Respite Centre who identified a
need for more support systems to improve the quality of life for their clients who were attending the respite centre and
to supply the clients informal carers. The purpose of a Dementia Café is to promote the social inclusion of people with
dementia and their carers by offering education and support and informal advice and consultation by professionals in
a relaxed manner.
The aim of the project is to evaluate the informal carers’ satisfaction with the café and the staff perceptions regarding
the usefulness of this initiative to improve the social inclusion of people with dementia and their informal carers. The
dementia café was completed in August 2011 and data collection is ongoing.
The development of an appropriate model of pastoral care for those in
the dementia journey – being responsive to the ongoing emotional and
spiritual needs, including grief
Dianne Crowther, Blue Care
The purpose of this research, within the paradigm of practical theology, is to present a relevant model of pastoral
care to enhance the quality of life of people with dementia and their family caregivers. The research uses theological
insights and social scientific research into the emotional and spiritual needs of people with dementia and their carers,
including the grief of the dementia journey. It also aims to analyse the current understanding and practice of the local
Christian community in relation to pastoral care for people with dementia and caregivers, in order to facilitate the
enhancement of that practice within the church and in the church’s service to the broader community.
The approach involves interpretative phenomenology, where individual experiences and perceptions of the emotional
and spiritual needs of caregivers in the local area are being sought, described and interpreted. Further qualitative
research will involve focus groups of local ministers of Christian churches, with the aim of discovering current attitudes
and practice in pastoral care in the churches, to people with dementia and their caregivers.
The purpose of the qualitative research is to understand deeply the lived experience of family caregivers who care for
a person with dementia, and gaps in the care practice, with a view to proposing a model of appropriate pastoral care
throughout the care giving journey.
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Qualitative research is in progress, with the first round of interviews of six caregivers having been completed.
Analysis of the data is underway, and case studies are being developed. Emerging themes suggest that intense
stress, emotional isolation, anticipatory grief, anger and sadness are common for caregivers. While participants have
acknowledged the value of practical and social support, a common theme has been the need for someone who can
listen with empathy.
This research has significant implications for community care providers such as Blue Care, which seek to offer
holistic care.
Humour Intervention Project (HIP) - every moment counts
L. Eggins, C. Crystal, D. Redley, Wesley Mission Brisbane
Funding
The Australian Department of Health and Ageing funded the HIP from the 2010 Dementia Community Support grants
– round three.
Limited literature exists which describes, examines or validates the use and benefits of humour through arts based
programs for people living with dementia. The Humour Intervention Project (HIP) based on the pioneering Elderflowers
program, initiated by Hearts & Minds ™ in Scotland in 2001 offers a unique approach to dementia care through a
combination of applied theatre practices; physical comedy, music, song, dance, movement, games, characterisation,
puppetry and sensory engagement. This program of playful engagement offers clients permission to play. Wesley
Mission Brisbane in partnership with the Humour Foundation developed the Elderflower concept for suitability within
the Australian culture.
The concept of making every moment count is drawn from the idea that all people respond to their circumstances by
evaluating their perceptions from their accumulated feelings over the course of time. This builds good or bad ideas
about their current situation and therefore impacts how they interact within their environment. Through activities which
enable self expression, self esteem is supported and within that positive, trustworthy environment people’s memories,
imagination, ideas and creativity find meaning and respect.
Information was offered to staff and families before, during and after the intervention, including pre and post surveys
regarding their knowledge about the concept and any participant’s responses and reminiscence regarding the
sessions. Session plans and evaluation documents were used to review the effectiveness of the session itself and
client notes identified individual participation and responsiveness to the session. Staff also reported through diary
entries and reflective discussions with the practitioners.
A model of practice principles was developed which offers guidelines to expand the possibilities of the work and
promote a change in the culture in activities / practice offered in dementia care in the aged care sector. Questions
regarding staff attitudes, Australian concepts of clown-work, boundaries in arts based practice and the impact on
individual behavioural changes were also discussed and the need for the pilot to be evaluated in residential aged care
settings was concluded.
Currently a partnership with Griffith University is being fostered to investigate the concept within dementia specific
residential aged care facilities.
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The HIP seeks to change the culture which drives the choices of lifestyle activities for people living with dementia in
aged care services. A move away from entertainment and poor quality activities “programs” to empowering, personcentred participation projects which add meaning and personal happiness to people’s lives is a more appropriate and
economical investment.
The Watermemories Swim Club for people with dementia
Christine Neville, Tim Henwood, Karen Clifton, Elizabeth Beattie, UQ/Blue Care Research Practice Development Centre
Funding
Department of Health and Ageing, Dementia Community Support Grants Program, $55 000.
Anecdotal reports indicate that swimming stimulates people with dementia physically, psychologically and socially.
This has been evidenced with an increase in verbal responses, singing, clapping, smiling, less agitation and generally
being more aware. Some people have even remembered how to swim while others use floatation aids.
This project aims to try something different - rekindle positive memories of swimming in people with dementia who
enjoyed swimming throughout their lives and get them involved in active swimming again. The program is supported
by an evidenced-based aquatic exercise program and members are being monitored for any changes in aspects
of quality of life such as sleep, appetite, pain, falls, behavioural and psychological symptoms of dementia (BPSD),
depression and their overall sense of wellbeing.
Members attend the swimming club twice a week for 45 minutes. Thirty minutes is spent doing the exercise program
delivered by a trained instructor and 15 minutes of free time. Each session has a maximum of eight participants and
is attended by residential aged care facility (RACF) staff and adult swimming volunteers. Psychosocial and physical
assessments are being completed before, during and after the 12 week project. Focus groups will be held with a
number of stakeholders to determine the experience of participation.
The first outcome has been the development of a dementia specific, evidenced-based, aquatic exercise program. This
valuable resource will ensure that the benefits will be maximized with tailored exercises for strength, agility, flexibility,
balance, relaxation and stress reduction. The second outcome anticipated will be improved quality of life for the
person with dementia. It is well known that exercise has a positive influence on sleep, pain, falls, BPSD, depression
and appetite (e.g. good appetite  less weight loss  better skin integrity  faster wound healing). The third
outcome will be identification of barriers and facilitators to setting up a swimming club for people with dementia.
If aspects of quality of life and clinical problems surrounding BPSD, sleep, pain, falls, depression and anxiety are
lessened it means that staff will have more time to devote to other issues and less use of medications and restraints.
For family carers is would lessen their burden at home and they can use the time for respite. There are wide ranging
benefits for the person with dementia, RACF staff and family carers. Other agencies may want to replicate or make
local adaptations for this activity. The swimming club can be added to an activity program, it makes use of resources
that are available in most communities.
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Interpreting the signs – medical interpreting for Deaf Indigenous
Australians
Keri Gilbert and Elizabeth Temple National Auslan Interpreter Booking Service (NABS), Wesley Mission Brisbane
Funding
The Federal Department of Families Housing Community Services and Indigenous Affairs funds the NABS
interpreting service.
NABS began providing sign language interpreting access to medical services to Deaf Indigenous consumers in the
urban and remote centres of the Northern Territory in 2006. The new service provided an alternative to the historical
delivery of services to Indigenous Deaf people. It required acceptance by Indigenous clients, their health services and
medical professionals as well as the adaptation of interpreting practices to recognise Indigenous cultural, linguistic and
social differences.
Auslan (Australian Sign Language) is the language of the Australian Deaf community however it is not widely used
in the Indigenous community but there are a multitude of languages and associated signs/gestures. There is no
identifiable Indigenous Deaf community although the incidence of hearing loss is extraordinarily high. A person’s
Aboriginality is recognised though not their bi-culturalism i.e. Aboriginal-Deaf. This is the context in which NABS is
developing interpreting services to assist to improve the health outcomes of Indigenous people.
More questions are posed than answered: Auslan interpreters, more often than not, need to work as part of a
multi disciplinary team. To what extent does this impact on interpreter training and ethics? How does the Western
interpreting role need to alter to be sensitive to Indigenous cultural differences? What is the role of the traditional
communicator used by many deaf clients? Considering the limited use of Auslan by Indigenous people and the
proliferation of other signs/ gestures, is Auslan the most appropriate language for interpreting? Does low education
attainment combined with the high incidence of hearing loss suggest that Auslan interpreting in schools could
enhance learning outcomes and facilitate preventative health measures and better communication in medical
situations? Considering the Indigenous Deaf are not considered a distinct entity, how does NABS increase its
relevance and thus collaborative effort with other peak bodies?
Evaluation of the On Track Diabetes program: An automated, webbased intervention aimed to improve type-2 diabetes self-management
and dysphoria
Mandy Cassimatis, Wesley Research Institute; Professor David Kavanagh, Professor Andrew Hills, Professor Paul
Scuffham, A/Professor Judith Bauer, A/Professor Anthony Smith Queensland University of Technology
Funding
Wesley Research Institute - $20 000
The purpose of this research is to evaluate the effectiveness of an online Type 2 diabetes (T2D) self-management and
dysphoria intervention, with a view to improving the clinical and emotional prognosis of people living with T2D.
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This study aims to:
•evaluate the effectiveness of the OnTrack Diabetes program, which is an automated online Type 2 diabetes and
dysphoria intervention, in improving clinical, emotional, behavioural and psychological outcomes
•evaluate acceptability, uptake, usability and utility of the OnTrack Diabetes program for people with Type 2 diabetes
•examine the cost-effectiveness of program implementation.
This study represents the first Australia-wide implementation and evaluation trial of an online Type 2 diabetes and
dysphoria support program of its kind.
The program aims to address the urgent need for intervention of two of Australia’s top National Health Priority Areas,
Type 2 diabetes and depression/ anxiety. Wide-spread sub-optimum Type 2 diabetes self-management and the
need for emotional support for people with diabetes has been emphasised in the literature. However, there is a lack
of adequate regular, ongoing, long-term follow-up and support due to limitations in Australian health care system
resources, particularly in rural and regional areas. An easily accessible, cost-effective and regularly available form
of support with substantial outreach, is needed. By encouraging self-awareness of, and support for, managing the
effects of dysphoria and Type 2 diabetes on wellbeing, this research aims to improve the quality of life and health
outcomes of Australians living with Type 2 diabetes, including those in rural and regional areas.
To date, no known web-based intervention targeting sub-optimum Type 2 diabetes self-management and dysphoria,
has been trialled in Australia. In response to the empirically well-established need for support, this study will evaluate
an automated, web-based program, OnTrack Diabetes, which aims to improve clinical, behavioural, psychological
and emotional outcomes for people with Type 2 diabetes. Initially, semi-structured, qualitative interviews were
conducted with people with Type 2 diabetes and General Practitioners to inform understanding of enablers and
barriers to effective Type 2 diabetes self-management, emotional challenges/ day-to-day stressors experienced, and
suggestions for online program inclusions. The development of content for the OnTrack Diabetes program is based on
the results.
The role of allied health in the management of complex conditions in
a multi-disciplinary comprehensive primary care setting (the CHARMS
study)
Professor Geoffrey Mitchell, Dr Michele Foster, Dr Hugh Senior, Dr Ian Williams, UQ
In Australia, health expenditure attributable to chronic diseases was 22 per cent of the annual health expenditure
in 2000-1 and chronic disease is the primary reason for 36 per cent of all general practitioner consultations. The
magnitude of this problem will increase rapidly as the population ages.
A multidisciplinary approach to the management of chronic illness is increasingly accepted as best practice. However,
there are difficulties for the delivery of care from the allied health professional perspective. The limited number of visits
per year for each patient can compromise care delivery on the one hand or generate alternative service pathways that
are not necessarily cost effective or equitable.
This project aims to conduct a comprehensive examination of the role and impact of allied health professionals in
the care of chronic conditions in a primary health care setting in Brisbane. As it is not feasible, given the available
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resources, to examine all chronic illnesses, the project focuses on patients with a diagnosis of at least one of the
following ‘index’ conditions:
•Osteoarthritis
•Diabetes Mellitus Type 1 and 2
•Urinary incontinence
The common thread for these three index conditions is the major role that allied health professionals play in their
management. Collectively they require management from a broad spectrum of allied health professionals thus
enabling the project to make broad findings about allied health services in the primary care setting.
The objectives of this project are to:
•describe the journey of patients with a chronic illness who have received care from allied health professionals
•describe the role of allied health professionals in providing care for patients with a chronic illness as part of a
multidisciplinary team in influencing patient outcomes; patient referral, assessment, case conferences and care
planning; implementation of care plans; influencing patient access to other health services in the private, public and
non-government sectors; influencing team dynamics and individual clinical practice of the health care team and
preventative care
•identify the policy settings enabling allied health professionals to have influence on patient outcomes
•identify the promoters and barriers to care of patients with a chronic illness from allied health professionals on the
multidisciplinary team.
This project has potential to directly influence patient care and outcomes by providing a greater understanding of
the role of allied health professionals. Findings could also influence funding allowances for individuals and enhance
recognition of the ability of allied health professionals to effectively manage chronic illness. In the broader context the
project has potential to inform developing policies for primary healthcare in Australia.
Blue Care assistive technology demonstration project
Emily Needham, Lisa Guiver, Brent Hodgkinson, Katy McCrea, Dianna Campbell, Blue Care
Funding
Home and Community Care $376 000
Australia’s elderly population is expected to quadruple by 2050. By this time it is predicted ninety one per cent of
this demographic will remain living in the community, bringing with it the associated economic burden of providing
increased community services. Internationally, many governments have identified the issue of an ageing population
and have adopted assistive technology as one answer to help in supporting the elderly to remain in their own home
for as long as possible. Assistive technology can be described as any item, piece of equipment, product or system
that is used to increase, maintain or improve the functional capabilities and independence of people.
This research is a demonstration project to assess the impact of assistive technology on the service delivery
and quality of life for clients of Blue Care Community Services in the Sunshine Coast area. A number of assistive
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technology devices such as: falls detectors, movement detectors, sensor lights, medication dispensers and a watch
to prompt regular nutrition and hydration, will be trialled to promote independence in the home.
Training tools will be developed and training delivered to participating staff (note only one device will be trialled in a
client’s home at a time).
Outcomes will be collected to establish the impact of using these tools and devices on the quality of life for carers and
clients. The impact on community services needs will also be analysed.
The goal is to see 163 clients across the duration of the trial and staff involvement in the project will include the regular
health professional and personal care staff that support the clients with care, for the duration of the placement of the
assistive technology.
Evaluation of the project will include:
•client and carer satisfaction post intervention
•collating the staff views via a focus group post trial
•usefulness of assistive technology to support clients via a Blue Care staff survey developed for the project post
intervention
•Blue Care form: Assessment of Quality of Life pre and post intervention
•time and cost comparisons will be made against usual service delivery models for allied health services.
Outcomes could include Blue Care clients being able to remain in their own home longer in the future with
increased quality of life for both clients and carers and a greater understanding of the possibilities offered by
assistive technology.
An evaluation of UnitingCare Community’s Lifeline Psychological First
Aid training and implementation
Dr Sharon Atkin and Samina Shah, UnitingCare Community Research, Analysis, Innovation and Development Unit
Funding
$10 000 from the Lifeline flood appeal funds
Psychological First Aid (PFA) is an evidence informed approach to assist individuals in the immediate aftermath of
a disaster. PFA is designed to reduce the initial distress caused by traumatic events and to foster short and long
term adaptive coping and is now internationally recognised as the recommended intervention to assist people
in the immediate aftermath of a disaster. International research has identified a need for further evaluation of the
effectiveness of PFA as applied in specific field settings. A review of the literature has concluded there has been
limited study in this area due to the unplanned nature of disaster events.
The proposed research project on PFA will investigate the effectiveness of UnitingCare Community’s Lifeline PFA
training program delivered in three Queensland regions following the 2011 summer flood events.
The primary intent of the proposed research project is to provide a further evidence base to support the continued
delivery of UnitingCare Community’s Lifeline PFA programs and identify any service gaps and areas of improvement.
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Consistent with UnitingCare Community’s strategic plan and research agenda, it aims to validate UnitingCare
Community is delivering high quality client centric services through continuous improvement processes that are
responsive to clients feedback and insights.
The methodology will include a survey of Lifeline PFA field workers and individuals who received PFA services as part
of UnitingCare Community’s Lifeline Community Recovery response. The research will focus on the Queensland
communities of Ipswich, Toowoomba and Central Queensland
The proposed research project is an opportunity to contribute much needed research for what is a topical and
important area of interest.
Specifically the proposed research will:
•evaluate the effectiveness of UnitingCare Community’s Psychological First Aid training to enhance existing post
disaster service responses to the community and identify any service gaps
•provide an evidence base to support the continued use of UnitingCare Community’s Psychological First Aid training
as a best practice model following disasters and traumatic events
•contribute to the international and local evidence base of PFA to inform future disaster recovery planning
•enhance existing post disaster service responses to the community through evaluation of organisational responses
and survivor satisfaction
•provide potential opportunities for partnerships and policy development
•inform resource allocation and the strategic targeting of funding initiatives.
Evaluation of the Eastside nurse-led chronic disease healthy
living program
Sonia Kennett, Wendy Porter, Brent Hodgkinson, Blue Care
Australian health care planners are becoming increasingly concerned about the morbidity and mortality associated
with chronic disease particularly among Australian’s ageing population. The features inherent in successful chronic
disease prevention and management include continuity of care and coordinated and comprehensive care. Recent
research suggests that chronic disease management should incorporate the assessment of clinical and social
parameters as well as an emphasis on patient self-management.
Recent frameworks in health promotion advocate a socio-ecological approach that places the individual in the context
of their environment.
Key strategies for success include:
•building linkages between health care programme management and community networks
•the provision of an individual assessment and referral mechanism
•the provision of individualised education and information in conjunction with other interventions to achieve
behavioural and environmental change
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•the provision of skill development opportunities to help increase individual independence and the capacity to make
healthy choices
•the provision of peer support opportunities via group activities
•the provision of long-term follow-up and frequent clinician contact (face-to-face and telephone follow-up).
The Eastside Chronic Disease Healthy Living Program (ECDHLP) is a community based nurse-led health promotion
programme that will be implemented with individuals aged 65 and over who live within Blue Care’s Eastside region.
The overall aim of the project is to improve the quality of life of enrolled participants who live in this community. The
case-managed nurse-led programme will include comprehensive health related assessments, early intervention
and referral to appropriate services over a 12 month period from entry into the programme. Individual follow-up and
reassessment will occur throughout the programme.
Research participants will be clients of Blue Care Eastside Community Care who:
•have been diagnosed with a chronic illness
•are motivated to participate in the Healthy Living Program activities
•are cognitively able and can read and write in English.
The ECDHLP represents a new health promotion model for Blue Care where the focus is on screening, referral as
appropriate and early intervention in the chronic disease management of community-dwelling older Australians living
in the Eastside region. The programme is underpinned by an empowerment model where participants will participate
in the decision-making about their health. There is a programme emphasis on the contribution of the participants
in the planning and development of their own health care. Programme elements include providing opportunities for
building the participants’ knowledge and skills to address their own health, group education sessions, as well as
frequent clinician follow-up over the 12 month enrolment in the ECDHLP.
The evaluation findings of the ECDHLP will be used to improve content and practices within Blue Care which will
enhance the effectiveness of such services in this and similar settings. Potential benefits to ECDHLP participants
include access to a comprehensive health promotion service designed to address chronic disease management.
Participation in such a programme is likely to provide health related enhanced quality of life outcomes.
The Eastside Chronic Disease Health Living Programme aims:
•to develop or enhance formal and informal linkages between existing community services
•to improve individual health outcomes via the provision of health educational opportunities and skill building, referral
advice, and peer and clinical support as appropriate to the individual’s needs
•to improve individual social support networks via the provision of group activities over a period of 12 months.
Indicators of change in perceived health related quality of life plus follow-up information as available will be used to
form an assessment of the success of the processes for improved programme and participant outcomes. If sufficient
data is available, participant outcomes may be explored in relation to other variables, contextual variables and
participant characteristics (gender, age, financial circumstances). This may identify those older Australians who are in
most need of this type of service.
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Evaluation of the Nintendo Wii in an aged care and disability service
Dr Suzanne Kuys, The Prince Charles Hospital, Dr Tim Henwood, UQ/Blue Care Research and Practice
Development Centre
In many of its respite centres, Blue Care has purchased a Nintendo gaming unit. However, research explaining the
Wii’s use and benefits is sparse. This is of particular concern given the widespread and varied use of this unit among
functionally challenged older adults that access day respite care. The aim of the project is to explore the views of
respite centre staff on, and feasibility of, the development of a proposed research submission to investigate the
effectiveness of a physical activity program using Wii in improving psychosocial and physical wellbeing in older adults.
The key research questions that will be addressed by this research are:
•how is Nintendo Wii currently being implemented in a day respite setting
•what are the barriers and enablers of implementing Nintendo Wii in a day respite setting
Findings from this study will inform the development of a proposed research submission investigating the
effectiveness of a physical activity program using Wii in improving psychosocial and physical wellbeing in older adults.
In addition, outcomes will inform best practice implementation and use of Wii as a proactive tool in Blue Care’s day
respite centres.
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Inspirational work put to the test after severe
weather events
Living through the severe weather events of 2010/2011 was a frightening
and difficult time for the many thousands of people in Queensland
affected by the floods and Cyclone Yasi. In the aftermath of the disasters
UnitingCare Community, through its Lifeline Community Recovery
service, deployed more than 230 community recovery counsellors, all
trained in Psychological First Aid (PFA), in more than 60 sites across the
state, to provide support to individuals whose lives had been shattered.
The work that the staff and volunteers did was truly inspirational and there
were many stories of grateful recipients but not content just to enjoy the
accolades and the pats on the back, and in keeping with UnitingCare
Queensland shared value of Leading through learning, UnitingCare
Community has taken the opportunity to conduct research into the
PFA support given during the natural disasters in order to find out what
improvements could be made for future deployments.
Richard Johnson, Regional Director for Central Queensland and State
Community Recovery Executive Officer, UnitingCare Community, said
that this year’s disasters have presented a unique opportunity to evaluate
the effectiveness of the organisation’s PFA programs and the PFA training
program that it conducts, and to identify any gaps that exist.
“We have wanted to do some research on this for some considerable time and this has now been made possible
through cash donations after the disasters which have given us the necessary funds to do the research and
learn from these life shattering events. I’m pleased to say that something good has come out of a bad situation,”
Richard said.
“The research will include feedback from those we supported in the communities of Ipswich, Toowoomba and Central
Queensland and from our staff and volunteers who were involved in the community recovery effort,” he said.
“We want learn lessons from our experiences so we can better prepare our PFA counselling teams to support
people in distress following future disasters,” Richard said.
“This is a golden opportunity to target and refine our training resources by finding out first hand how the people
involved in the events experienced the support that was provided through the PFA framework. The research will
engage both the people directly affected by the disasters and our own community recovery counsellors.”
”We have also had a lot of things flagged anecdotally and this is an opportunity to test some of these theories.
For example, we have heard from some people that they really appreciated and benefitted from being contacted
again a few weeks after the actual event. We made 650 follow up calls after the recent disasters and it will be very
interesting to find out if this is something that definitely helped and if so, whether we should try and get this type of
action written into the state community recovery plan,” he said.
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Index of projects
Completed projects
Advancing knowledge for practice to achieve social justice outcomes
Pain rating scales for older people with severe dementia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Community links in dementia awareness
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
The Effectiveness of ExMI to reduce the incidence of urinary incontinence
. . . . . . . . . . . . . . . . . . . . 10
Investigation of the useability and efficiency of “Dashboard” software . . . . . . . . . . . . . . . . . . . . . . . 11
Role of hydrotherapy in an aged care therapy service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Exploring associations between assisted conception and breastfeeding . . . . . . . . . . . . . . . . . . . . . . 13
Continuing effects: Factors contributing to maintenance of physical activity groups . . . . . . . . . . . . . . . . 14
Blue Care’s staff wellness project . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Effect of death of residents on staff in residential aged care facilities . . . . . . . . . . . . . . . . . . . . . . . . 18
Fleet safety in the non-profit sector . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Increasing vocational and educational training participation amongst lower paid workers . . . . . . . . . . . . . 20
Use of mobile technology in community nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Development of a palliative approach in residential care outcome scale . . . . . . . . . . . . . . . . . . . . . . 24
Development of a palliative subcutaneous medication education program for carers . . . . . . . . . . . . . . . . 25
Implementation of a comprehensive evidenced based palliative approach . . . . . . . . . . . . . . . . . . . . . 26
Music, therapy and dementia: A musical therapy program for spousal caregivers of people with dementia . . . . 26
Defining and evaluating models of case management in Blue Care . . . . . . . . . . . . . . . . . . . . . . . . . 27
Chronic disease self management project . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Physical activity program for residents of an aged care facility by physiotherapy students . . . . . . . . . . . . . 31
Eastside wellness: Community-based health promotion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Creating champions for skin integrity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Impact of an exercise program among semi-dependent older adults at day respite care . . . . . . . . . . . . . . 35
End of life pathway in RACF and community care for clients living with dementia . . . . . . . . . . . . . . . . . . 37
Exploration of long term planning with parental care leavers for people with disabilities. . . . . . . . . . . . . . . 38
Gold Coast Social Connections project – Stage 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Blue Care falls prevention benchmarking program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Evaluation of the 1-2-3-Magic emotion coaching program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Elder Abuse: Effectiveness and outcomes of an awareness campaign . . . . . . . . . . . . . . . . . . . . . . . 42
Walk in My Shoes program, Logan City Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
The cost effectiveness of a no-rinse bed bath regime on skin integrity . . . . . . . . . . . . . . . . . . . . . . . 44
Resources to support palliative care in culturally and linguistically diverse communities . . . . . . . . . . . . . . 44
page 79
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Ongoing projects
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Advancing knowledge for practice to achieve social justice outcomes
Managing older people’s money: assisted and substitute decision making in residential aged care . . . . . . . . 46
Predictors of complicated grief and health outcomes in family caregivers of people with dementia . . . . . . . . . 46
Measurement of depression in a geriatric population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Food services in residential aged care: Financial, personnel and service delivery factors . . . . . . . . . . . . . . 47
Use of nutritional supplements versus common foodstuffs to ensure nutritional benefits in residents . . . . . . . . 48
Understanding vulnerability: on being a resident with heart failure . . . . . . . . . . . . . . . . . . . . . . . . . 48
Wound management research in aged care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Evaluation of measure of generativity and ego integrity in older adults . . . . . . . . . . . . . . . . . . . . . . . 50
Elder abuse prevalence study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
The impact of relinquishing care of a child with a disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Supporting care-leavers with mild and borderline intellectual disability . . . . . . . . . . . . . . . . . . . . . . . 52
The acceptability of the Aged Care Channel as a means of distance education for care workers . . . . . . . . . . 54
Evaluation of the use of Client Directed Outcome Informed Measures . . . . . . . . . . . . . . . . . . . . . . . 54
Community development and collaboration: Lessons learnt from three projects . . . . . . . . . . . . . . . . . . 55
Memory and communication training in dementia to enhance transition from home to residential care . . . . . . . 56
Reduction of carer burden and falls in people with dementia by using simple strategies . . . . . . . . . . . . . . 57
The cost effectiveness of a nurse-led pain clinic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
The effectiveness of services and support for parents of children with a behavioural disorder diagnosis . . . . . . 58
Managing swallowing difficulty in residents in aged care facilities . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Mental healthcare: towards an understanding of registered nurses’ most important caring behaviours . . . . . . . 59
Closing the Gap in employment and health: Blue Care’s Indigenous employment strategy . . . . . . . . . . . . . 61
Attitudes towards ageing and death: Impacts on job satisfaction and psychological wellbeing of nurses . . . . . . 61
Let’s talk about change: Middle managers in aged care; challenges, career pathways and adjustments . . . . . . 62
Enhancing students as evolving professionals and collaborative members of the healthcare team . . . . . . . . . 63
Has an injection of aged care curriculum content and support changed undergraduate nurse perceptions . . . . 64
Care coordination: Linking chronic diseases services on the Darling Downs . . . . . . . . . . . . . . . . . . . . 66
The feasibility of telehealth for the provision of allied health services in rural and remote areas . . . . . . . . . . . 67
Pulmonary rehabilitation or self management for chronic obstructive pulmonary disease: The best approach . . . 67
Evaluation of a Blue Care dementia café within a dementia specific respite service . . . . . . . . . . . . . . . . . 68
The development of an appropriate model of pastoral care for those in the dementia journey . . . . . . . . . . . 68
Humour intervention project – every moment counts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
The Watermemories Swim Club for people with dementia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Interpreting the signs – medical interpreting for Deaf Indigenous Australians . . . . . . . . . . . . . . . . . . . . 71
Evaluation of the On Track Diabetes program: An automated web-based intervention . . . . . . . . . . . . . . . 71
The role of allied health in the management of complex conditions (the CHARMS study) . . . . . . . . . . . . . . 72
Blue Care assistive technology demonstration project . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
An evaluation of UnitingCare Community’s Lifeline Psychological First Aid training and implementation . . . . . . 74
Evaluation of the Eastside nurse-led chronic disease healthy living program . . . . . . . . . . . . . . . . . . . . 75
Evaluation of the Nintendo Wii in an aged care disability service . . . . . . . . . . . . . . . . . . . . . . . . . . 77
page 80
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Reach out Speak out Care Reach out Spea
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UnitingCare Queensland would like to
acknowledge the generosity of the many
funders, research partners and staff across
the organisation that initiate, support and
implement our research projects.
These people make it possible to continue to
improve the wellbeing of all who we serve.
17/11/2011 2:53:39 PM
Level 5, 193 North Quay, Brisbane Queensland 4000
GPO Box 45, Brisbane Queensland 4001
Telephone 07 3025 2000
Facsimile 07 3025 2099
www.ucareqld.com.au
17/11/2011 2:53:39 PM

2011 Social Research Report

Transcription

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