Current research activities
Nurses clinical decision making process in the administration of PRN psychotropic medications: a prospective study
Grants received
Nursing Innovations Scholarship received from the Nurses and Midwifery, NSW Health Department ($10,000)
Progress to date
Data collection for the study has been completed with 100 episodes of PRN administration recorded. Analysis is underway.
Background
A recent retrospective chart audit of all admissions over a 2-month period across 4 sites in the former South Eastern Sydney Area Health Service (n=422) yielded data to support previous studies (Stein-Parbury, et al, 2005). The results of the audit demonstrated that: 79.1% of all admissions received at least one PRN medication. There were no statistically significant differences across sites, or for clinical diagnosis. Nursing staff initiated the majority of PRNs (57.9%), although there was no indication of who initiated the PRN in 30.2% of the charts. The reason for administering was stated 62.1% of the time; and, an outcome was documented 50.9% of the time. The most frequent reason for administering a psychotropic PRN was stated as patient agitation, but inadequate documentation means that the reason is unknown in 38.9% of the time. More alarming was evidence that indicated that inappropriate medications were administered, for example, benztropine given for agitation.
Aims
This study aims to explore in more detail the factors that nurses consider when making a decision to administer a PRN medication. Such an investigation will reveal what non-pharmacological, therapeutic measures were attempted prior to the administration. In addition it will reveal the outcome that nurses are hoping to achieve when administering a PRN medication. The authors of previous studies postulate that a prospective study will provide answers to these questions (see, for example Usher et al 2001). More importantly, the study is designed to develop a best practice model, improve documentation, identify and rectify knowledge deficits, and generally increase nurses' awareness of alternatives to PRN use.
Chronic illness care for older people in the Emergency Department
This study is being undertaken in collaboration between UTS and UCLA and is funded by an internal research grant from the University of Technology, Sydney for $25,000. Team members are as follows:
UTS Faculty of Nursing, Midwifery and Health project team
Associate Professor Robyn Gallagher
Associate Professor Margaret Fry
Professor Lynn Chenoweth
Professor Lin Perry
Professor Jane Stein-Parbury
University of California Los Angeles School of Nursing Project Team
Professor Linda Phillips
Adjunct Professor Mary Cadogan
Associate Professor Jan Mentes
Assistant Professor Lynn Woods
People aged over 65 years with a chronic illness are major consumers of health services because the incidence of disability and chronic disease increases with age. These characteristics are the strongest predictors of hospital admission via the emergency department (ED) and the ED forms an important component of the network of care. EDs are currently challenged to provide care for these patients due to the growth in the number of older people, the complexity of assessment and care required and because ED processes are more compatible with transiting trauma and primary care patients. To enable improved understanding of the needs and expectations of older people, their families and ED nursing staff development this project will investigate these issues using a mixed methods design comprised of three phases.
Phase 1.
Service use patterns of older people with chronic illness (cardiovascular, respiratory, diabetes, neuroprogessive) will be retrospectively examined using routinely collected, de-identified data extracted from the St George Hospital ED dataset for the year 2010. Sociodemographic and chronic illness clinical characteristics will be examined against the outcomes of hospital admission, discharge home, transition to other care facilities, return ED visit or readmission within 30 days.
Phase 2.
Patient and family expectations and experiences in relation to ED will be collected during home interviews within 1 month of the patient’s discharge either from the ED or hospital. Twenty five patients aged over 60 years with and family members aged over 18 years will be recruited. The younger age of 60 years has been selected as people with chronic illness experience illness consequences at a younger age than the general population.
Phase 3.
ED nursing staff expectations and experiences of interacting with older people with chronic illness and their families will be collected using focus group interviews. Three focus groups will be conducted.
Data from the three sources will be analysed separately and then comparisons will be made between nursing staff, patient and family perspectives to determine areas of shared understanding, mismatches and gaps. The Wagner Chronic Illness Model will be used as the framework for this final analysis. The knowledge gained will provide the foundation for tailoring of care in the ED for the older person’s needs, educational interventions to promote self-management of chronic illness for older people and education programs for ED staff.
Person-centred environment and care for residents with dementia: a cost effective way of improving quality of life and quality of care (PerCEN)
Funding: National Health and Medical Research Council, Dementia Research Grants Program (2009- 2012). A$ 1,461,759.
Project team
Professor Lynn Chenoweth (UTS)
Ian Forbes (UTS)
Professor Madeleine King (University of Sydney)
Professor Jane Stein-Parbury (UTS)
Professor Marian Haas (UTS)
Professor Richard Fleming (University of Wollongong)
Associate Professor Yun-Hee Jeon (University of Sydney)
Professor Henry Brodaty (University of New South Wales)
Summary
Improving the quality of life (QOL) and quality of care for persons with dementia are important areas of Australian health research. A growing body of evidence shows that QOL in dementia can be improved by relatively simple and inexpensive modifications to nursing care practices and the physical environment. Most studies in these areas are observational, few have utilized a randomized control group design, and none has included economic evaluation. This study will address these deficiencies. This is the first time that a randomized controlled trial of Person-Centred Care (PCC) and Person-Centred Environment Design (PCD) will be undertaken. The study will be conducted in 40 residential aged care services in New South Wales, to determine the efficacy and cost effectiveness of implementing PCC and PCD separately, and in combination, in improving resident quality of life and quality of care.
Aims
- Determine the effect of providing person-centred care (PCC) on the quality of life (QOL) of aged care residents with dementia;
- Determine the effect of modifying the physical dementia care environment (person-centred environment design (PCD) on the QOL of aged care residents with dementia;
- Determine the combined effect of PCC and PCD on resident QOL;
- Determine the effect of PCC on quality of care for aged care residents with dementia
- Determine the effect of PCD on quality of care
- Determine the combined effect of PCC and PCD on quality of care
- Determine the costs of PCD and PCC, and undertake an economic evaluation.
Publications
Smith, R., Fleming, R., Chenoweth, L., Jeon, Y-H., Stein-Parbury, J., & Brodaty, H. (in press). Validation of an environmental audit tool in both purpose-built and non-purpose-built dementia settings. Australasian journal of ageing.
Chenoweth, L., King, M., Luscombe, G., Forbes, I., Jeon, Y-H., Stein-Parbury, J., Brodaty, H., Fleming, R. & Haas, M. (2010). Study Protocol of a Randomised Controlled Group Trial of Client and Care Outcomes in the Residential Dementia Care Setting. Worldviews on Evidence-Based Nursing. published online : 13 OCT 2010, DOI: 10.1111/j.1741-6787.2010.00204.x
First level construction of the person-centred iHome
Funded by Dementia Collaborative Research Centre, Prince of Wales Hospital (2012-2013), A$39,014
Project team
Professor Lynn Chenoweth (UTS)
Associate Professor Yun-Hee Jeon (University of Sydney)
Dr. Victor Vickland (University of New South Wales)
Professor Henry Brodaty (University of New South Wales)
Professor Jane Stein-Parbury (UTS), Dr. Patsy Kenny (UTS)
Aims
- Establish a database of primary research data from previous studies conducted by the research team and publicly available secondary data to determine the key assumptions of person-centred (PCC) and non-person-centred residential aged care (non-PCC) facility (RACF) models
- Analyse the available datasets to construct activity-based frameworks of virtual non-PCC – standard and PCC-standard RACFs (iHome)
Summary
This project represents the First Level construction of a ‘virtual model’ of a person-centred RACF in which we use primary and secondary data from previous studies conducted by the research team to build activity-based model frameworks, with reference to the PCC theoretical constructs.
Person Centred Care (PCC) has proven to be an effective model for RACFs, one which supports the health and well-being of dementia care residents and staff. However, current understanding of the organisational systems and work force requirements necessary to implement and sustain PCC in diverse and complex RACF settings remains theoretical. Building the iHome model from primary and secondary data, with reference to the PCC constructs and Expert Advisory Committee expertise, will help to translate PCC theory into practice. We will establish the key assumptions and activity-based framework of the iHome for two small sized RACFs (dementia-specific and mixed), each with twenty residents with dementia and ten nurses and care staff.
Caregiver coaching program for families living with dementia
Funded by Dementia Collaborative Research Centre, Prince of Wales Hospital (2011-2013), A$40,000
Project team
Professor Lynn Chenoweth (University of Technology Sydney)
Associate Professor Yun-Hee Jeon (University of Sydney)
Associate Professor Victoria Traynor (University of Wollongong)
Ms Matilda Freeman (Prince of Wales Hospital, Community Aged Care Services)
Ms Vicki Weeden (Rehabilitation and Aged Services, Calvary Health Care)
Ms Cathy Farrington (Sutherland Hospital, Southcare aged care community service)
Professor Jane Stein-Parbury (University of Technology Sydney)
Aims
- Pilot an evidence-based community nurse caregiver coaching program that promotes self-efficacy for caregiving and an improved caregiving relationship with family caregivers of persons with dementia.
- Evaluate the feasibility and effectiveness of the caregiver coaching program for caregivers and community nurses
Summary
A train-the-trainer caregiver support program will be piloted with community aged care nurses and consenting family caregivers of persons with mild to moderate dementia living at home, and compared with controls receiving usual community care services, using a pre/post-test and 3 month follow-up evaluation design. The evidence-based coaching program teaches community nurses how to coach family caregivers in developing self-efficacy for caregiving and in developing a positive caregiving relationship with their family member. The caregiver coaching program will be evaluated by assessing outcomes for caregivers compared with controls: changes in the caregiving relationship, self-efficacy for caregiving, goal achievement, health, well-being and coping. The feasibility of the coaching program will be evaluated by asking caregivers and community nurses to discuss their dis/satisfaction with the program such as assistance in setting and achieving caregiving goals, and to make recommendations on how the program content, focus and procedures can be improved/adjusted for continued use in community services and in wider applications.
