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Item Open Access Cultural bias in kidney care and transplantation: review and recommendations to improve kidney care for Aboriginal and Torres Strait Islander people(Wiley, 2023) Hughes, J.T.; Owen, K.J.; Kelly, J.; Cundale, K.; Majoni, S.W.; D'Antoine, M.; McDonald, S.P.Inequities persist for Aboriginal and Torres Strait Islander people accessing health services in Australia, as evidenced by kidney health outcomes and the consistently lower rate of access to kidney transplantation experienced by Aboriginal and Torres Strait Islander people.1 The Australian Government has endeavoured to address this persisting inequity in access to kidney transplantation by establishing the National Indigenous Kidney Transplantation Taskforce (NIKTT), and tasking them to evaluate cultural bias interventions in Australia, with a focus on kidney services. The NIKTT’s objective was to develop recommendations for best practice care and support that would enable health services to provide more culturally safe care for Aboriginal and Torres Strait Islander people. In this article, we highlight the main findings and recommendations from the Cultural bias Indigenous kidney care and kidney transplantation report. 2 We reflect on the resulting recommendations and highlight key elements that the NIKTT anticipates could substantially improve the cultural safety of kidney care for Aboriginal and Torres Strait Islander people across Australia.Item Open Access Shifting Power to Improve First Nation Peoples’ Access and Outcomes in Kidney Care(Elsevier BV, 2021) Hughes, J.T.; Owen, K.J.; McDonald, S.P.Item Metadata only Transdisciplinary Research In Frailty: Knowledge Translation To Inform New Models of Care(Frailty and Sarcopenia Congress, 2017) Archibald, M.; Kitson, A.; Frewin, D.; Visvanathan, R.Transforming care for frail older adults requires more than rigorous research. While preventing, identifying and managing frailty are critical to reducing the personal and health systems impact of frailty worldwide, collaborative approaches to research and research application that reflect stakeholder perspectives and priorities are necessary to create meaningful solutions to frailty-related challenges. In South Australia, a new Centre for Research Excellence in Frailty was recently launched with funding from the National Health and Medical Research Council of Australia. Comprised of a national team with international partnerships and expertise spanning geriatric medicine, nursing, general practice, health economics, pharmacy and rehabilitation medicine, the team is working across traditional disciplinary silos to achieve system level improvements. Drawing from this exemplar, we discuss how a co-design approach to knowledge translation underpins this transdisciplinary research, and how successfully restructuring health services to meet the physical, emotional and social needs of older adults hinges upon such collaboration.Item Open Access Greater nurse density correlates to higher level of population ageing globally, but is more prominent in developed countries(Public Library of Science (PLoS), 2023) You, W.; Donnelly, F.; Mannocci, A.Background Representing over 50% of the healthcare workforce, nurses provide care to people at all ages. This study advances, at a population level, that high levels of nursing services, measured by nurse density may significantly promote population ageing measured by the percentage of a population over 65 years of age (65yo%). Methods Population level data was examined to explore the correlation between nurse density and 65yo%. The confounding impacts on ageing such as the effects of economic affluence, physician density, fertility rate, obesity and urban advantages were also considered. Scatter plots, bivariate correlation, partial correlation and multiple linear regression analyses were performed for examining the correlations. Results Nurse density correlated to 65yo%; this relationship was independent of other influences such as fertility rate, economic affluence, obesity prevalence, physician density and urban advantages. Second to fertility rate, nursing density had the greatest influence on 65yo%. The predicting and confounding variables explain 74.4% of the total 65yo% variance. The universal correlations identified in country groupings suggest that low nurse density may be a significant global concern. Conclusions While nurse density might contribute significantly to 65yo% globally, the effect was more prominent in developed countries. Ironically, countries with higher nurse densities and therefore greater levels of 65yo%, were countries with an increased need for more nursing staff. To highlight the profound implications for the role the nursing profession plays especially at a time of global nursing shortage, further study into the effects of long-run elasticity of nurse staffing level on population ageing may be needed. For instance, what percentage of nursing staff increase would be required to meet every 1% increase of an ageing population.Item Open Access Issues and complexities in safety culture assessment in healthcare(Frontiers Media SA, 2023) Ellis, L.A.; Falkland, E.; Hibbert, P.; Wiig, S.; Ree, E.; Schultz, T.J.; Pirone, C.; Braithwaite, J.The concept of safety culture in healthcare-a culture that enables staff and patients to be free from harm-is characterized by complexity, multifacetedness, and indefinability. Over the years, disparate and unclear definitions have resulted in a proliferation of measurement tools, with lack of consensus on how safety culture can be best measured and improved. A growing challenge is also achieving sufficient response rates, due to "survey fatigue," with the need for survey optimisation never being more acute. In this paper, we discuss key challenges and complexities in safety culture assessment relating to definition, tools, dimensionality and response rates. The aim is to prompt critical reflection on these issues and point to possible solutions and areas for future research.Item Open Access Effectiveness of virtual reality interventions to reduce pre-operative anxiety in adult surgical patients in the pre-operative period: Systematic review and meta-analysis(Australian College of Perioperative Nurses, 2023) Mbewe, A.M.; Smith, Z.Aims: To synthesise and evaluate the effectiveness of virtual reality (VR) interventions compared to standard care to reduce pre-operative anxiety in adult surgical patients during the pre-operative period. Design: Systematic review of effectiveness and meta-analysis. Data sources: MEDLINE, EMBASE, JBI EBP, PUBMED, CINAHL, SCOPUS, PsycINFO, Cochrane Library, EMCARE, World Health Organisation, WEB OF SCIENCE, Grey Literature, National Institute of Health & Care Excellence were searched with limits between 2010 to 2022. Review methods: The review followed the Joanna Briggs Institute (JBI) methodology for systematic reviews of effectiveness and the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA 2020) guidelines. Two independent reviewers conducted the selection, critical analysis, data extraction and critical appraisal using the JBI Critical Appraisal Checklist for Randomised Controlled Trials. Data was synthesised through meta-analysis using random effect model in RevMan 5 software (version 5.4.1) and narrative syntheses. Results: This analysis included data from five studies with a combined total of 466 adults. The meta-analysis of the included studies suggested positive outcomes (SMD = -0.18 [-0.37, 0.00]) of VR interventions compared to standard care in managing anxiety in pre-operative adult patients. The pooled results showed statistically significant difference (p-value <0.001; I2 =69%) with no substantial heterogeneity in effects among the included studies. The null hypothesis was thus rejected and it was concluded that, on average, the VR intervention does decrease anxiety in the universe of populations comparable to those in the analysis. Similarly, all the independent studies also indicated that VR interventions were favorable in the reduction of preoperative anxiety in adult surgical patients, though the statistical significance was not overwhelming. Conclusion: The primary evidence on the effectiveness of VR interventions to manage pre-operative anxiety, though limited, is increasing and substantiates the need for more rigorous research to optimise its application in adults.Item Open Access Understanding consumer perceptions of frailty screening to inform knowledge translation and health service improvements(Oxford University Press (OUP), 2021) Archibald, M.M.; Lawless, M.T.; Ambagtsheer, R.C.; Kitson, A.L.BACKGROUND AND OBJECTIVES: despite growing support for the clinical application of frailty, including regular frailty screening for older adults, little is known about how older adults perceive frailty screening. The purpose of this study was to examine older adults' perspectives on frailty screening to inform knowledge translation and service improvements for older adults with frailty. RESEARCH DESIGN: interpretive descriptive qualitative design. PARTICIPANTS: a total of 39 non-frail (18%), pre-frail (33%) and frail or very frail (49%) South Australian older adults aged 62-99 years, sampled from community, assisted living and residential aged care settings. METHODS: seven focus groups were conducted and analysed by two independent investigators using inductive thematic analysis. RESULTS: three themes were identified. First, older adults question the necessity and logic of an objective frailty measure. Second, older adults believe any efforts at frailty screening need to culminate in an action. Third, older adults emphasise that frailty screening needs to be conducted sensitively given negative perceptions of the term frailty and the potential adverse effects of frailty labelling. DISCUSSION AND IMPLICATIONS: previous screening experiences and underlying beliefs about the nature of frailty as inevitable shaped openness to, and acceptance of, frailty screening. Findings correspond with previous research illuminating the lack of public awareness of frailty and the nascent stage of frailty screening implementation. Incorporating consumer perspectives, along with perspectives of other stakeholder groups when considering implementing frailty screening, is likely to impact uptake and optimise suitability-important considerations in person-centred care provision.Item Open Access Older adults' understandings and perspectives on frailty in community and residential aged care: an interpretive description(BMJ Journals, 2020) Archibald, M.; Lawless, M.; Ambagtsheer, R.C.; Kitson, A.OBJECTIVES: Despite growing interest in frailty as a significant public health challenge, comparatively little is known about how older adults perceive and experience frailty, limiting the effectiveness of strategies to improve frailty management and prevention. The objective of this study was to understand how older people, including frail older persons in residential aged care, perceive and understand frailty through an interpretive-descriptive qualitative study. SETTING: Aged care facility, community-based university for older persons and an aged care auxiliary care group in a large metropolitan centre in South Australia. PARTICIPANTS: 39 non-frail, prefrail, frail and very frail South Australian older adults. METHODS: Seven focus groups were conducted. Participants completed one of two frailty instruments depending on setting and indicated whether they self-identified as frail. Data were analysed inductively and thematically by two independent investigators. RESULTS: Frailty was described according to three schemas of (1) the old and frail: a static state near the end of life; (2) frailty at any age: a disability model; and (3) frailty as a loss of independence: control, actions and identity. In addition, a theme was identifying linking mindset, cognition and emotion to frailty. The term frailty was viewed negatively and was often implicated with personal choice. There was little correlation between frailty assessments and whether participants self-identified as frail. CONCLUSIONS: Aside from a disability model, views of frailty as unmodifiable permeated older persons' diverse perspectives on frailty and are likely to impact health behaviours. To our knowledge, this is among the largest qualitative studies examining consumer perceptions of frailty and contributes a clinically relevant schema linking age, prevention and modifiability from a consumer perspective.Item Open Access Online platforms for prescription and supply of hormonal contraception in Australia: a mapping review(CSIRO Publishing, 2023) Stevenson, T.B.; Rumbold, A.; Callander, E.; Buckingham, P.; Assifi, A.; Mazza, D.; Grzeskowiak, L.E.; Hocking, J.Online platforms have emerged as a convenient way for individuals to access contraception. However, the extent to which such services exist in Australia and how they operate is currently unknown. We aimed to identify Australian online contraception platforms and evaluate the services they provide to determine the degree to which they may facilitate equitable access to contraception. We conducted an internet search to identify online contraception platforms operating in Australia. Data were extracted from each of the platforms relating to operating policies, services provided and associated payment processes, as well as prescribing and screening processes for assessing user suitability. As of July 2022, eight online contraception platforms operating within Australia were identified. All platforms offered oral contraception, with two also offering the vaginal ring, and one emergency oral contraception. None of the platforms provided access to long-acting reversible contraception. Significant variability existed in product and membership costs across platforms, with only one platform providing access to subsidised medicines. Five platforms restricted services to those already using oral contraception. Overall, online questionnaires were deemed to be adequately screening for important contraindications to using oral contraception. While online contraception platforms may be a valuable option for some individuals who face access barriers and are willing to pay out-of-pocket for to have their contraception sent straight to their home, they do not necessarily ensure that individuals can access their contraceptive method of choice or address recognised financial and structural barriers to contraceptive care.Item Open Access Instruments Measuring Self-Care and Self-Management of Chronic Conditions by Community-Dwelling Older Adults: A Scoping Review(SAGE Publications, 2023) Lawless, M.T.; Tieu, M.; Chan, R.J.; Hendriks, J.M.; Kitson, A.Given the high prevalence of chronic conditions and multimorbidity in older adults, there is a need to better conceptualize and measure self-care and self-management to promote a person-centered approach. This scoping review aimed to identify and map instruments measuring self-care and self-management of chronic conditions by older adults. We searched six electronic databases, charted data from the studies and tools and reported the results in accordance with the PRISMA-ScR guidelines. A total of 107 articles (103 studies) containing 40 tools were included in the review. There was substantial variation in the tools in terms of their aims and scope, structure, theoretical foundations, how they were developed, and the settings in which they have been used. The quantity of tools demonstrates the importance of assessing self-care and self-management. Consideration of the purpose, scope, and theoretical foundation should guide decisions about tools suitable for use in research and clinical practice.Item Metadata only Survival Benefit of Deceased Donor Kidney Transplantation for Aboriginal and Torres Strait Islander Australians(Lippincott Williams & Wilkins, 2022) Bateman, S.; Owen, K.; Lester, R.; Pearson, O.; McDonald, S.; Jesudason, S.; Clayton, P.; 29th International Congress of the Transplantation Society (TTS) (10 Sep 2022 - 14 Sep 2022 : Buenos Aires)Item Metadata only Improving Aboriginal people's kidney care journeys - Kanggawodli hostel dialysis(Health Services Research Association of Australia and New Zealand (HSRAANZ), 2022) Owen, K.; Sinclair, N.; Kelly, J.; Arnold-Chamney, M.; Bateman, S.; Graham, A.; O'Donnell, K.; 12th Health Services Research Conference (HSR) (30 Nov 2022 - 2 Dec 2022 : Sydney, Australia)Item Metadata only Cardiovascular Nursing and Climate Change: A Call to Action From the CSANZ Cardiovascular Nursing Council(Elsevier BV, 2023) Inglis, S.C.; Ferguson, C.; Eddington, R.; McDonagh, J.; Aldridge, C.J.; Bardsley, K.; Candelaria, D.; Chen, Y.Y.; Clark, R.A.; Halcomb, E.; Hendriks, J.M.; Hickman, L.D.; Wynne, R.This Call to Action aims to provide key considerations for cardiovascular nursing, related to climate and environmental impacts. Strategies to optimise nursing preparation, immediate response and adaptation to climate emergencies are crucial to ensure those at greatest risk, including First Nations peoples, are protected from potentially avoidable harm. Professionals who manage climate consequences must also understand the impact of their care on the root cause of the problem.Item Open Access Impact of a prospective feedback loop on care review activities in older patients at the end of life. A stepped-wedge randomised trial(Springer Science and Business Media LLC, 2022) Brown, C.; Lee, X.J.; Farrington, A.; Shield, C.; Carter, H.E.; McPhail, S.M.; Cardona, M.; Hillman, K.; Callaway, L.; Willmott, L.; White, B.P.; Harvey, G.; Graves, N.; Barnett, A.G.BACKGROUND: Hospitalisation rates for older people are increasing, with end-of-life care becoming a more medicalised experience. Innovative approaches are warranted to support early identification of the end-of-life phase, communicate prognosis, provide care consistent with people's preferences, and improve the use of healthcare resources. The Intervention for Appropriate Care and Treatment (InterACT) trial aimed to increase appropriate care and treatment decisions for older people at the end of life, through implementation of a prospective feedback loop. This paper reports on the care review outcomes. METHODS: A stepped-wedge randomised controlled trial was conducted in three large acute hospitals in Queensland, Australia between May 2020 and June 2021. The trial identified older people nearing the end of life using two validated tools for detecting deterioration and short-term death. Admitting clinical teams were provided with details of patients identified as at-risk with the goal of increasing awareness that end of life was approaching to facilitate appropriate patient centred care and avoid non-beneficial treatment. We examined the time between when the patient was identified as 'at-risk' and three outcomes: clinician-led care review discussions, review of care directive measures and palliative care referrals. These were considered useful indicators of appropriate care at the end of life. RESULTS: In two hospitals there was a reduction in the review of care directive measures during the intervention compared with usual care at 21 days (reduced probability of - 0.08; 95% CI: - 0.12 to - 0.04 and - 0.14; 95% CI: - 0.21 to - 0.06). In one hospital there was a large reduction in clinician-led care review discussions at 21 days during the intervention (reduced probability of - 0.20; 95% CI: - 0.28 to - 0.13). There was little change in palliative care referrals in any hospital, with average probability differences at 21 days of - 0.01, 0.02 and 0.04. DISCUSSION: The results are disappointing as an intervention designed to improve care of hospitalised older people appeared to have the opposite effect on care review outcomes. The reasons for this may be a combination of the intervention design and health system challenges due to the pandemic that highlight the complexity of providing more appropriate care at the end of life. TRIAL REGISTRATION: Australia New Zealand Clinical Trial Registry, ACTRN12619000675123 (registered 6 May 2019).Item Open Access Patient journey mapping to investigate quality and cultural safety in burn care for Aboriginal and Torres Strait Islander children and families - development, application and implications.(Springer Science and Business Media LLC, 2022) Fraser, S.; Mackean, T.; Grant, J.; Hunter, K.; Ryder, C.; Kelly, J.; Holland, A.J.A.; Griffin, B.; Clapham, K.; Teague, W.J.; Darton, A.; Ivers, R.Q.Background Quality and safety in Australian healthcare is inequitably distributed, highlighted by gaps in the provision of quality care for Aboriginal and Torres Strait Islander children. Burns have potential for long-term adverse outcomes, and quality care, including culturally safe care, is critical to recovery. This study aimed to develop and apply an Aboriginal Patient Journey Mapping (APJM) tool to investigate the quality of healthcare systems for burn care with Aboriginal and Torres Strait Islander children. Study design Interface research methodology, using biomedical and cultural evidence, informed the modification of an existing APJM tool. The tool was then applied to the journey of one family accessing a paediatric tertiary burn care site. Data were collected through yarning with the family, case note review and clinician interviews. Data were analysed using Emden's core story and thematic analysis methods. Reflexivity informed consideration of the implications of the APJM tool, including its effectiveness and efficiency in eliciting information about quality and cultural safety. Results Through application of a modified APJM tool, gaps in quality care for Aboriginal and Torres Strait Islander children and families were identified at the individual, service and system levels. Engagement in innovative methodology incorporating more than biomedical standards of care, uncovered critical information about the experiences of culturally safe care in complex patient journeys. Conclusion Based on our application of the tool, APJM can identify and evaluate specific aspects of culturally safe care as experienced by Aboriginal and Torres Strait Islander peoples and be used for quality improvement.Item Metadata only Resetting the relationship: decolonizing peer review of First Nations’ kidney health research(Elsevier Inc, 2022) Hughes, J.T.; Kelly, J.; Cormick, A.; Coates, P.T.; O'Donnell, K.M.Kerr et al. interpret the perspectives of First Nations People striving for kidney health within the United States, Canada, Aotearoa (New Zealand), and Australia. The urgency for First Nations Peoples' perspectives and leadership in kidney health care, research, quality reporting, and publishing was confirmed. Advancing this internationally is within scope of high-impact journals, such as Kidney International. Tracking Sovereignty is a proposed framework supporting First Nation Peoples' representation and leadership within journal submission and publication processes.Item Metadata only Once we knew it, we couldn't unknow it, nor would we want to, realisations of renal nurses working in Indigenous kidney care(Renal Society of Australasia, 2022) Arnold-Chamney, M.; Rix, L.; tyrell, K.; Kelly, J.; Renal Society of Australasia Annual Conference (RSA) (16 Jun 2022 - 18 Jun 2022 : Darwin)Item Open Access Reporting and conducting patient journey mapping research in healthcare: A scoping review(Wiley, 2023) Davies, E.L.; Bulto, L.N.; Walsh, A.; Pollock, D.; Langton, V.M.; Laing, R.E.; Graham, A.; Arnold-Chamney, M.; Kelly, J.AIM: To identify how patient journey mapping is being undertaken and reported. DESIGN: A scoping review of the literature was undertaken using JBI guidance. DATA SOURCES: Databases were searched in July 2021 (16th-21st), including Ovid's Medline, Embase, Emcare and PsycINFO; Scopus; Web of Science Core Collection, the Directory of Open Access Journals; Informit and; ProQuest Dissertations and Theses Global. REVIEW METHODS: Eligible articles included peer-reviewed literature documenting journey mapping methodologies and studies conducted in healthcare services. Reviewers used Covidence to screen titles and abstracts of located sources, and to screen full-text articles. A table was used to extract data and synthesize results. RESULTS: Eighty-one articles were included. An acceleration of patient journey mapping research was observed, with 76.5% (n = 62) of articles published since 2015. Diverse mapping approaches were identified. Reporting of studies was inconsistent and largely non-adherent with relevant, established reporting guidelines. CONCLUSION: Patient journey mapping is a relatively novel approach for understanding patient experiences and is increasingly being adopted. There is variation in process details reported. Considerations for improving reporting standards are provided. IMPACT: Patient journey mapping is a rapidly growing approach for better understanding how people enter, experience and exit health services. This type of methodology has significant potential to inform new, patient centred models of care and facilitate clinicians, patients and health professionals to better understand gaps and strategies in health services. The synthesised results of this review alert researchers to options available for journey mapping research and provide preliminary guidance for elevating reporting quality.Item Metadata only The role of scoping reviews in reducing research waste(Elsevier, 2022) Khalil, H.; Peters, M.D.J.; McInerney, P.A.; Godfrey, C.M.; Alexander, L.; Evans, C.; Pieper, D.; Moraes, E.B.; Tricco, A.C.; Munn, Z.; Pollock, D.Objectives
Scoping reviews and evidence map methodologies are increasingly being used by researchers. The objective of this article is to examine how scoping reviews can reduce research waste.Study design and setting
This article summarizes the key issues facing the research community regarding research waste and how scoping reviews can make an important contribution to the reduction of research waste in both primary and secondary research.Results
The problem of research waste is an enduring challenge for global health, leading to a waste of human and financial resources and producing research outputs that do not provide answers to the most pressing research questions. Research waste occurs within primary research but also in secondary research such as evidence syntheses. The focus of scoping reviews on characterizing the nature of existing evidence on a topic and including all types of evidence, potentially reduces research waste in five ways: (1) identifying key research gaps on a topic, (2) determining appropriate outcome measures, (3) mapping existing methodological approaches, (4) developing a consistent understanding of terms and concepts used in existing evidence, and (5) ensuring scoping reviews do not exacerbate the issue of research waste.Conclusion
To ensure that scoping reviews do not themselves end up contributing to research waste, it is important to register the scoping review and to ensure that international reporting standards and methodological guidance are followed.Item Open Access Fit for purpose. Co-production of complex behavioural interventions. A practical guide and exemplar of co-producing a telehealth-delivered exercise intervention for people with stroke(Springer Nature, 2022) Ramage, E.R.; Burke, M.; Galloway, M.; Graham, I.D.; Janssen, H.; Marsden, D.L.; Patterson, A.J.; Pollack, M.; Said, C.M.; Lynch, E.A.; English, C.Background: Careful development of interventions using principles of co-production is now recognized as an important step for clinical trial development, but practical guidance on how to do this in practice is lacking. This paper aims (1) provide practical guidance for researchers to co-produce interventions ready for clinical trial by describing the 4-stage process we followed, the challenges experienced and practical tips for researchers wanting to co-produce an intervention for a clinical trial; (2) describe, as an exemplar, the development of our intervention package. Method: We used an Integrated Knowledge Translation (IKT) approach to co-produce a telehealth-delivered exercise program for people with stroke. The 4-stage process comprised of (1) a start-up planning phase with the co-production team. (2) Content development with knowledge user informants. (3) Design of an intervention protocol. (4) Protocol refnement. Results and refections: The four stages of intervention development involved an 11-member co-production team and 32 knowledge user informants. Challenges faced included balancing conficting demands of diferent knowledge user informant groups, achieving shared power and collaborative decision making, and optimising knowledge user input. Components incorporated into the telehealth-delivered exercise program through working with knowledge user informants included: increased training for intervention therapists; increased options to tailor the intervention to participant’s needs and preferences; and re-naming of the program. Key practical tips include ways to minimise the power diferential between researchers and consumers, and ensure adequate preparation of the co-production team. Conclusion: Careful planning and a structured process can facilitate co-production of complex interventions ready for clinical trial.