Susan Slatyer

Introduction: Older adults who take on carer roles often face challenges in addressing their own health and wellbeing needs. As the care demands of their care recipient(s) increase, the needs of the care-partner may be overlooked.

Objective: This study aimed to implement and evaluate a novel co-designed multidisciplinary Carer Health and Wellbeing Service (CHWS) in Australia, targeting older care-partners (aged 50+ years) to prioritise their health and wellbeing needs.

Method: A mixed methods pre-post 6-month study design was employed. Assessments at CHWS commencement and discharge with consenting clients included: Carer Support Needs Assessment Tool (CSNAT); Preparedness for Caregiving Scale (PCS); Family Appraisal of Caregiving Questionnaire (FACQ); Quality of Life (EQ-5D-5L); and Health Economics Survey.

Results: From the 62 participants who have consented to date (86% conversion rate of CHWS clients), the majority were female (n=44; 71%). Key prioritised needs identified through the CSNAT included: 1) managing their relationships; 2) dealing with feelings and worries; and 3) having time for themselves. Preliminary post-data shows that 74% of CSNAT needs were met, 26% were ongoing, and none were unmet. Preparedness for caregiving improved from a pre-score of 2.1/4 to a post-score of 2.6/4. Quality of life scores also improved over the 6-month episode of care, particularly in areas related to pain/discomfort and anxiety/depression. Detailed pre- and post-data comparisons will be presented.

Conclusion: The health and wellbeing needs of older care-partners of older people significantly benefit from formalised support services such as the CHWS. Preliminary results support the effectiveness of the CHWS in enhancing care-partner outcomes and preparedness. The identified key priorities highlight the critical need for such services to support and sustain care-partners in their roles effectively.

The purpose of this study was to explore the experiences of informal caregivers receiving nurse telephone support for an older person discharged from hospital and how the nursing support influenced their experiences of caring.
A descriptive qualitative study.
Purposive sampling was used to recruit participants who cared for older adults from two states in Australia between April 2022 and March 2023 for one-on-one interviews 6 months (n = 28) and 12 months (n = 24) after patient discharge from hospital. Inductive directional content analysis was used to analyse the qualitative data.
Three themes were identified: (1) Caregiving elicited a complex mix of emotions; (2) nursing support improved caregivers' preparedness to care over time and (3) caregivers welcomed emotional and practical support as they took on new responsibilities. They reflected that nurse telephone support offered emotional and practical support, helping caregivers feel more confident and less stressed in the caregiving role.
The study highlighted the value of proactive nurse-led programs to support informal caregivers after patient discharge from hospital, improving their experience. Providing ongoing support after discharge via telephone communication can play a critical role in caregiver wellbeing and facilitate the sustainability of their caregiving responsibilities in the home.
Study design and conduct are reported in line with the consolidated criteria for reporting qualitative studies (COREQ) guidelines.
The research team includes a consumer investigator (H.L.) who has provided feedback and input at all stages of the research, including grant application, project design, data analysis and manuscript review.
Australian New Zealand Clinical Trials Registry identifier (ANZCTR): 12620000060943.

Older carers (≥50 years) of older people (≥65 years) are an important sub-group of carers performing valuable roles in providing informal care but often do not have the time or give priority to supporting their own health and wellbeing. Current services supporting older carers’ health and wellbeing are fragmented and inadequate. Through previous research and co-design activity by our team, an innovative multidisciplinary Carer Health and Wellbeing Service (CHWS) has been developed. The purpose of this protocol paper is to describe the rationale for the CHWS and the methods proposed to evaluate its effectiveness and implementation outcomes. The CHWS commenced in March 2024 at Peninsula Health, Melbourne, Australia. Older carers of older people can be referred from multiple sources, including self-referral. A pre-post mixed methods study design is being utilised. Initial assessments include the Carer Support Assessment Needs Tool (CSNAT) and carer prioritisation of their needs, which guides further assessment and interventions. Assessments will occur at Service intake and 6 months later. The primary effectiveness outcome is the Preparedness for Caregiving Scale, and primary implementation outcomes are reach and adoption. Interviews of carers, referrers and staff, and a cost-utility analysis will be undertaken. The target sample size is 137 carers undertaking assessment and intervention over the 15 months data collection. Generalised linear regression will be used to compare pre- and post-continuous outcome measures. Qualitative data will be thematically analysed. Results will inform future scaling up of this innovative approach to optimising health and wellbeing of older carers of older people.

Objectives:
This scoping review aims to examine the current literature on using extended reality (XR) technologies to teach communication skills in nursing education.

Design:
This scoping review was conducted using the Joanna Briggs Institute (JBI) method.

Data sources:
Searches were conducted in five electronic databases: CINAHL Ultimate, Cochrane Library, ERIC, PsycINFO, and PubMed, in February 2024.

Review methods:
The research procedure was assessed using the PRISMA-ScR checklist.

Results:
The analysis generated four overarching categories that described key characteristics of the integration of XR technologies: program overview, pedagogical approaches, evaluation, and nursing students’ experiences.

Conclusion:
This review underscored the effectiveness of XR technologies, particularly VR, as the predominant tool for enhancing communication skills in nursing education. It identifies gaps in the diversity of communication scenarios covered and recommends expending future research to include diverse clinical settings and scenarios. Furthermore, this review highlights a paucity of research utilizing mixed reality (MR) technology for communication training. The insights gained from this review are instrumental in directing further research into MR-based simulations for communication skills training across various nursing contexts.

Informal caregivers who provide home-based care frequently experience stress and burden that adversely affect their health-related quality of life (HRQOL).
To evaluate the efficacy of the Further Enabling Care at Home (FECH+) program for the HRQOL of caregivers of older adults discharged home from the hospital.
This multicenter, parallel, 2-group randomized clinical trial, with blinded baseline and outcome measurements, was conducted at 3 hospitals in 2 states in Australia. Recruitment took place between August 2020 and July 2022, and follow-up was performed for 12 months after hospital discharge. Participants were dyads of caregivers and patients. Eligible caregivers were aged 18 years or older who provided informal home-based care at least weekly for a patient aged 70 years or older. Caregivers were enrolled when their patient was discharged from the hospital. Dyads were randomly assigned to either the intervention or control group. Data analysis followed an intention-to-treat approach.
Caregivers in the intervention group received the FECH+ program, structured nurse support of 6 telephone calls over 6 months after the patient's discharge plus usual discharge care. Caregivers in the control group received usual care alone.
Primary outcome was caregivers' HRQOL 6 months after discharge, which was measured using the Assessment of Quality of Life 8-Dimension (AQOL-8D). Secondary outcomes were caregivers' HRQOL 12 months after discharge as well as preparedness to care (measured using the Preparedness for Caregiving Scale), self-efficacy (measured using the Caregiver Inventory), and levels of strain and distress (measured using the Family Appraisal of Caregiving Questionnaire) at 6 and 12 months after discharge. Baseline and outcome measurements were administered by telephone at 3, 6, and 12 months after discharge.
A total of 547 dyads (caregivers: 405 females [74.0%], mean [SD] age, 64.50 [12.82] years; patients: 296 females [54.1%], mean [SD] age, 83.16 [7.04] years for the intervention group and 83.45 [7.20] years for the control group) were included in the intention-to-treat analysis. There was no significant difference in caregivers' HRQOL between the 2 groups at the primary time point of 6 months (difference in AQOL-8D score, 0.01; 95% CI, -0.02 to 0.03; P = .62) after hospital discharge.
In this randomized clinical trial, the FECH+ program-a nurse telephone support intervention for caregivers of older adults after hospital discharge-did not significantly improve caregivers' HRQOL at 6 months after discharge compared with usual care. Additional examination is warranted into improving caregivers' HRQOL at the time of their patient's hospital discharge.
Australian New Zealand Clinical Trials Registry Identifier: ACTRN12620000060943.

Background
Appropriate management of pain remains a challenging issue. Surfacing nurses’ inherent assumptions about pain may lead to better pain management. This study developed and evaluated new audio-visual (AV) simulations for nursing students showcasing patient characteristics that may influence pain assessment.

Methods
Descriptive pre/post intervention study informed by the STROBE framework. Participants were drawn from two Australian universities. Three AV simulations were codesigned by clinicians, educators, and health consumers. Data included: demographics, previous experiences of pain assessment; compassion scale, feasibility, and relevance of AV simulations. Quantile regression and content analyses were applied.

Results
Full data sets of 491 participants (314 from Curtin University and 177 from Queensland University of Technology) were analyzed. Cohorts were equivalent except for age, country of birth, and stage within the program of study. Participants found the AV simulations easy to understand, relevant to practice, and beneficial in prompting reflection on patients’ responses to pain and nurses’ critical thinking. Compassion scores increased significantly following the intervention.

Conclusions
AV simulations triggered participants’ reflection on factors that can influence pain assessment and were considered valuable learning experiences.

This article aims to critically analyse current literature that explores nurses’ perspectives concerning the use of chemical restraints amongst people with dementia—regarding behavioral and psychological symptoms of dementia (BPSD)—to consolidate existing knowledge on this phenomenon and generate a foundation for further research. This literature review followed the 12-step approach by Kable et al. A total of 17 articles published between 2012 and 2022 were included following critical appraisal. A total of 2,806 participants, primarily consisting of nurses of various levels (44%) were included amongst the 17 included articles. Five themes emerged from the analysis of the findings: (a) nurses’ perceptions of BPSD, (b) perceived effectiveness and safety of chemical restraints, (c) influence of the practice environment, (d) perceptions of non-pharmacological approaches (NPA)s, and (e) barriers to using NPAs. Explicit and implicit pressures to prescribe and utilize chemical restraints exerted by nurses and families promote the use of chemical restraints, amplified by barriers to using alternative approaches. A tentative conceptual model was proposed to explain these emergent concepts and relationships between the themes.

Introduction
Older carers or ‘care partners’ of older people experiencing care needs often provide essential support, at times while neglecting their own health and well-being. This is an increasingly frequent scenario due to both demographic changes and policy shifts towards ageing in place. Multiple community stakeholders within the care and support ecosystem hold valuable expertise about the needs of older care partners, and the programme and policy responses that may better support their health and well-being. The aim of this study was to identify the perspectives of stakeholders obtained through the codesign phase of a multicomponent research project investigating new models of care and support for older care partners suitable for the Australian context.

Methods
Principles of codesign were used to engage a purposeful sample of older care partners, health professionals, researchers, policy makers and health service administrators. Participants took part in a series of three codesign workshops conducted remotely via video conferencing. The workshops were supported with briefing material and generated consensus-based summaries, arriving at a preferred service model.

Findings
This paper reports the research design and structure of the codesign panels, the range of findings identified as important to support the health and well-being of older carers of older people, and the resulting service model principles. The codesigned and preferred model of care is currently being prepared for implementation and evaluation in Australia.

Public Contribution
This study was conducted using codesign methodology, whereby stakeholders including older care partners and others involved in supporting older carers, were integrally involved with design, development, results and conclusions.

Background

Older women have higher levels of frailty resulting in disability and reduced quality of life. Presentation to an Emergency Department (ED) is an opportunity to address frailty and provide tailored interventions to promote function. An ED allied health team integrated frailty assessment and interventions into care through a ‘Frailty Intervention Team’ (FIT) program.

Methods

A prospective study informed by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework to evaluate the FIT program tailored to female older adults. The purpose of this project was to evaluate the FIT program over a three-month period and use the findings to further develop the intervention.

Results

Over three-months, 192 older females (>70 years) were identified with mild frailty and discharged directly home. Ninety percent were offered the FIT program with 83.3 % accepting all recommended frailty management strategies. Ninety percent of patients were satisfied with the FIT program, however staff and patient barriers to provision of frailty services were identified.

Conclusions

The FIT program was largely adopted by staff and accepted by older female patients with mild frailty in the ED. However, program effectiveness was limited by gaps in communication about frailty in the ED and implementation of frailty management strategies after discharge.