AIM:To explore current evidence regarding the provision of palliative care for individuals with very severe to extreme behavioural and psychological symptoms of dementia (BPSD) in a hospital setting. DESIGN:Scoping review. REPORTING METHOD:The PRISMA-ScR reporting guideline. METHODS:The JBI guidelines for scoping reviews were followed. A data extraction form assisted in the identification of key findings via a process of content analysis. DATA SOURCES:Studies were obtained from bibliographic databases of PubMed, CINAHL, and PsycINFO. RESULTS:This review included six articles, and nine categories emerged from the findings. Symptom assessment and management, pain assessment challenges, atypical presentation of end-stage dementia, complex prescribing and treatment practices, principles of person-centred care, collaboration; training for health care professionals; emotional impact on staff; and family and caregivers. CONCLUSIONS:This scoping review highlighted a significant gap in the literature regarding palliative care for people living with very severe to extreme BPSD in hospital settings. This review highlighted key differences in the presentation of people with BPSD needing palliative care. There is a need for tailored models of care, specialised training and education for health professionals, families, and carers, and recognition of dementia as a terminal illness. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE:The results of this review provide valuable insights into the level of understanding about the unique palliative care needs for people experiencing very severe to extreme BPSD, making an important contribution to the planning and development of future models of care. IMPACT:Mapping the available literature highlights a paucity of research in palliative care for people with very severe to extreme BPSD in hospital settings. There is a need for rigorous research studies and models of care developed and informed by the evidence for this small population necessitating unique care needs. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.

Introduction: Worldwide in the population of older people, ethnic diversity is prevalent and therefore warrants culturally sensitive advanced care planning. This study aimed to explore advanced care planning documentation related to the cultural needs of residents of Chinese ethnicity in Australian aged care facilities. Methods: A retrospective review of advanced care plan documentation was undertaken among 31 older Chinese residents with life-limiting illnesses across two residential aged care facilities in New South Wales, Australia. Data were analyzed using descriptive statistics. Results: 90% of residents had advanced care planning documentation. The presence of the resident and their representative and medical care directives were well documented. Specific details on the provision of palliative care that considers the person’s cultural needs and preferences were limited. Discussion: Findings suggest the need for further research that explores an optimal way of embedding culture-specific information and the development of a culturally sensitive advanced care plan for people of Chinese ethnicity.

Objective: To identify the gaps in understanding the experience of older Chinese people receiving pallia-tive care in nursing homes. Design: A nine-step scoping review methodology was used to search for relevant literature. Methods: Sixteen databases were searched for relevant studies published in English from January 1990 to August 2019. The grey literature was searched for relevant theses pertaining to the topic. Results: A total of 18 studies from the United States ( n = 2), mainland China ( n = 1), Hong Kong ( n = 13), Taiwan ( n = 2) and one thesis from Hong Kong were included in the final analysis. The findings were categorised into four themes: (1) advance care planning preferences; (2) decision-making process related to palliative care; (3) palliative care experiences and barriers; and (4) practice to improve palliative care. Conclusions: Given the distinctive experiences of older Chinese residents in nursing homes when faced with death and dying, cultural beliefs strongly influenced their attitudes and behaviours in receiving end-of-life care. As Chinese immigrants have become a major ethnic group in western countries, there is benefit in recognising that older Chinese people living in nursing homes and needing palliative care will face specific challenges. Culturally appropriate interventions to address older Chinese people's exis-tential stress, grief related to loss, communication and dietary requirements, and other barriers should be developed and implemented. (c) 2021 Elsevier Ltd. All rights reserved.

This chapter will offer the reader an overview of roles post qualification, and the opportunities related to advanced practice. It will also provide the reader an overview of future challenges in career pathways for registered nurses.

It is estimated that people with dementia over 65 currently occupy 25% of acute hospital beds at any given time and generally have a longer length of stay and poorer outcomes than those who do not. (Alzheimer's Society 2009). Improving acute care was one of two key change areas in Scotland's first (Scottish Government 2010) and second national Dementia Strategies (Scottish Government 2013), to ensure that when admission to hospital is unavoidable for people with dementia, the care experience is safe, coordinated, dignified and person-centred. Acknowledging that the hospital setting can be a complex and potentially frightening environment, particularly when the person with dementia may be faced with physical illness or injury, the chapter will outline and explore four core approaches: understanding the illness, knowing the person, responding sensitively to individual needs and working in partnership with families/carers and integrated partners. Throughout the chapter, there will be good practice examples, reflective questions and opportunity to apply the learning within your own practice and setting.

BACKGROUND:Providing quality palliative care in residential aged care facilities (RACFs) (aged care homes) is a high priority for ageing populations worldwide. Older people admitted to these facilities have palliative care needs. Nursing assistants (however termed) are the least qualified staff and provide most of the direct care. They have an important role at the frontline of care spending more time with residents than any other care provider but have been found to lack the necessary knowledge and skills to provide palliative care. The level of competence of this workforce to provide palliative care requires evaluation using a valid and reliable instrument designed for nursing assistants' level of education and the responsibilities and practices of their role.METHOD:The overall study purpose was to develop and test an instrument capable of evaluating the knowledge, skills and attitudes of nursing assistants within a palliative approach in RACFs. Development consisted of a four-phase mixed-methods sequential design. In this paper, the results and key findings following psychometric testing of the instrument in Phase 4 is reported using data collected from a random sample of 17 RACFs and 348 nursing assistants in the Greater Sydney region. Study hypotheses were tested to confirm discriminative validity and establish the utility of the instrument in both research and training assessment.RESULTS:Individual item properties were analysed for difficulty, discrimination and item-total correlations. Discriminative and structural validity, and internal consistency and test-retest reliability were demonstrated. Three separate questionnaires comprising 40 items were finalised: The Palliative Approach for Nursing Assistants (PANA)_Knowledge Questionnaire (17 items), the PANA_Skills Questionnaire (13 items) and the PANA_Attitudes Questionnaire (10 items).CONCLUSIONS:This study provides preliminary evidence for the validity and reliability of three new questionnaires that demonstrate sensitivity for nursing assistants' level of education and required knowledge, skills and attitudes for providing a palliative approach. Implications for practice include the development of palliative care competencies through structured education and training across this workforce, and ongoing professional development opportunities for nursing assistants, especially for those with the longest tenure.

Nursing assistants are the largest aged care workforce providing direct care to older people in residential aged care facilities (RACF) in Australia and internationally. A palliative approach is a large component of this direct care that necessitates nursing assistants possess requisite knowledge, skills and attitudes. While training needs have been identified to enhance their practices, preservice education is variable, educational interventions have been adhoc and professional development found to be inadequate to the demands of the workplace. In addition, evaluation of nursing assistants' knowledge, skills and attitudes has lacked an instrument specifically tailored to nursing assistants' level of education and role responsibilities when providing a palliative approach. This paper reports on Phase 3 of a research study to develop such an instrument capable of assessing nursing assistants' knowledge of, skills in, and attitudes within a palliative approach. This phase assesses the usability and performance capabilities of the new instrument on a purposive sample of nursing assistants in two RACFs using the survey method. Results showed that the instrument was able to discriminate between groups of nursing assistants based on experience in role. Usability results indicated that the instrument is user friendly and time efficient.

Background People with intellectual disability often have few friends and experience social exclusion. Recognising this gap, supported social groups with the aim of inclusion and interdependence were created by a supported employment provider. Methods Interviews were undertaken with 10 adults with intellectual disability exploring their lived experiences of a supported social group. Data were analysed using descriptive phenomenology. Results Two themes emerged (i) supported engagement fosters wellbeing , and (ii) developing social belonging and connectedness . Participants not only acknowledged the support that they needed to participate, but also that the social group had changed their lives in many ways. Conclusions Adults with intellectual disability want to socialise, have friends and be part of their community. For this to be achieved, they recognise the need to seek some form of support. With appropriate and targeted support, adults with intellectual disability can move from social exclusion towards supported inclusion and experience richer lives.

The percentages of blood spots in eggs from White Leghorn and Barred Rock pullets, and of meat spots in eggs from Barred Rock pullets, were determined monthly from November to August About 23,000 e...

Background: Nursing assistants are the largest aged care workforce providing care to older people in residential aged care facilities. Although studies have focused on their training and development needs when providing a palliative approach, a valid and reliable instrument to evaluate their knowledge, skills and attitudes is required.Aims: To examine what instruments have been used to evaluate nursing assistants' knowledge of, skills in and attitudes towards a palliative approach in residential aged care facilities, critically evaluate development processes, and discuss the strengths and limitations of existing instruments for this population.Methods: CINAHL, the Cochrane Library, ERIC, MEDLINE, PubMed, Scopus and Web of Science were searched using key words. Selected articles were published in English in the period 2004-2014 and included instruments which evaluated nursing assistants and a palliative approach.Results: Ten studies using seven instruments met the inclusion criteria. One of these instruments measured nursing assistants' level of comfort in providing end-of-life care. The six remaining instruments measured palliative care knowledge, palliative care practice, self-efficacy, knowledge and attitudes towards people with advanced dementia, beliefs and attitudes to death, dying, palliative and interdisciplinary care across the aged care workforce.Conclusion: Seven instruments have been used to evaluate nursing assistants' knowledge, skills and attitudes in a palliative approach. Instrument design and recommended psychometric processes for development limit specificity and usefulness of these instruments for nursing assistants' scope of practice. Adhering to recommended psychometric processes will increase the validity and reliability of an instrument tailored to this population and a palliative approach. (C) 2015 Elsevier Ltd. All rights reserved.

Aims and objectivesTo promote simulation as a learning strategy to support undergraduate nursing students with disabilities.BackgroundSupporting undergraduate nursing students with disabilities has gained further momentum because of amendments to the Disability Discrimination Act in 2009. Providers of higher education must now ensure proactive steps to prevent discrimination against students with a disability are implemented to assist in course progression. Simulation allows for the impact of a student's disability to be assessed and informs the determination of reasonable adjustments to be implemented. Further suitable adjustments can then be determined in a safe environment and evaluated prior to scheduled placement. Auditing in this manner, offers a risk management strategy for all while maintaining the academic integrity of the program.DesignDiscursive.MethodsLow, medium and high fidelity simulation activities critically analysed and their application to support undergraduate nursing students with disabilities assessed.ResultsWith advancing technology and new pedagogical approaches simulation as a learning strategy can play a significant role. In this role, simulation supports undergraduate nursing students with disabilities to meet course requirements, while offering higher education providers an important risk management strategy.ConclusionThe discussion recommends simulation is used to inform the determination of reasonable adjustments for undergraduate nursing students with disabilities as an effective, contemporary curriculum practice. Adoption of simulation, in this way, will meet three imperatives: comply with current legislative requirements, embrace advances in learning technologies and embed one of the six principles of inclusive curriculum. Achieving these imperatives is likely to increase accessibility for all students and offer students with a disability a supportive learning experience.Relevance to clinical practiceProvides capacity to systematically assess, monitor, evaluate and support students with a disability. The students' reasonable adjustments can be determined prior to attending clinical practice to minimise risks and ensure the safety of all.

Background Agitation is recognised by aged care literature as the most common behavioural problem in residential aged care facilities. Complementary therapies are advocated by some as a solution to reduce the effect of agitation in older people and are becoming increasingly incorporating into nursing care. Complementary therapies in nursing management, is endorsed by the Australian Nurses and Midwifery Board for nurse initiation. Objectives The review objective was to discover which types of Complementary therapies are being implemented in RACFs for agitation management and which of these therapies where effective in reducing agitation. Inclusion criteria Types of participants Participants were people over the age of 65 years living permanently in a residential aged care facility and experiencing agitation, regardless of cognitive ability, gender or ethnicity and existing co‐morbidities. Types of intervention(s)/phenomena of interest The types of complementary therapy interventions explored in this systematic review were Aromatherapy, Exercise, Massage, Music Therapy and Therapeutic Touch Types of studies The systematic review considered randomised controlled trials of complementary therapy interventions that could be initiated by a nurse Types of outcomes Outcomes measured were the frequency and/or severity of verbal, non‐physical aggressive and physical aggressive agitation among the participants. Search strategy A comprehensive search strategy was developed for eleven electronic databases with dates ranging from January 2000 to September 2010. Searches included unpublished studies and the reference lists from identified papers. Only English language papers were considered due to a lack of interpreter facilities. Methodological quality An adapted version of the Joanna Briggs Institute quality appraisal checklist was used to assess the methodological quality of studies. Appraisal was performed separately by two independent reviewers with any disagreement between appraisers settled by a third appraiser. Data collection Data was extracted using the standardised Joanna Briggs Institute Data Extraction Tool. Data synthesis Measurement tools reported different subcategories of agitated behaviours making data comparison difficult. A variety of complementary interventions made the comparing of this data inappropriate. Extracted data was unable to be synthesised in meta analysis, a narrative analysis of results was therefore more appropriate. Results The ten included randomised controlled trials reported all interventions effective in reducing non‐physical and verbal agitation. Two interventions, aromatherapy and music therapy, showed significant effect in reducing physical aggressive agitation. Conclusions The results of this systematic review support the growing evidence that Complementary Therapies are effective in agitation management of older people in Residential Aged Care Facilities. Nurse initiation of complementary therapies will see timely and expedient management of agitation for older people. Therapies can be implemented with relative ease and low cost to the facility.

Spiritual care is an important component of holistic care. In Australia competency statements relating to nursing practice emphasise the need to provide care that addresses the spiritual as well as other aspects of being. However, many nurses feel they are poorly prepared to provide spiritual care. This is attributed largely to lack a of spiritual care education provided in undergraduate nursing programmes. A few higher education providers have responded to this lack of spiritual care education by incorporating specific content related to this area into their undergraduate nursing programme. Minimal international studies have investigated the impact of spiritual care education on undergraduate nursing students and no Australian studies were identified. This review explores spiritual care education in undergraduate nursing programmes and identifies the need for an Australian study.

Review Questions/Objectives: The following question guides the systematic review: What is the efficacy of complementary therapies in the symptom management of agitation in older people living in a RACF? This systematic review aims to identify the efficacy of complementary therapy interventions in reducing the frequency and severity of agitated behaviour among older people in RACF. Specific questions to be addressed include: What type of complementary therapies are been implemented for the symptom management of agitation in older people residing in a RACF? Which complementary therapies are identified as being effective in reducing the frequency and severity of agitation in older people in a RACF? Inclusion Criteria: Types of Participants: Older people living in RACFs will be included regardless of cognitive ability, gender or ethnicity and existing co-morbities. Trials of RCTs investigating symptom management of agitation in older people over the age of sixty five will be examined. Trials undertaken in settings other than RACFs will be excluded. Types of Interventions: The types of interventions to be explored in this review are complementary therapies include: aromatherapy exercise massage music therapy therapeutic touch These interventions are of interest as they are non invasive, have minimal interactions with current medications and require minimal time, resources and training by nurses. Types of Outcome Measures: The outcome measures to be explored include severity and frequency of agitated behaviours. Outcomes will be measured with a variety of standardised and non standardised measurement tools using observation, with long term and short term measures. Measures will review the findings of frequency and severity of agitation.

The need for improved communication around end-of-life issues has been identified in cancer care. However, caregivers assisting those with dementia have been given scant attention. This study investigated the application of a new dementia information booklet for family caregivers, accessing those that were both community-based and linked to a residential aged-care facility through the distribution of 672 information booklets. This occurred via 14 dementia advisory services and 48 residential aged-care facilities throughout New South Wales, Australia. A total of 233 carers (33%) completed the booklet questionnaire evaluation. The descriptive statistics indicated that most carers found the booklet useful and thought that the booklet should be freely available to them. Almost half of the carers said that they wanted to receive the information at the time of, or soon after, the diagnosis of dementia. Only a small group of respondents considered the information to be confronting. The reported anxiety was thought to be part of a larger issue of dementia education and dealing with loss and not specifically related to the booklet itself.

AIM:Agitation is a common symptom of dementia which becomes exacerbated in the advanced stages of the disease. The negative effects of this symptom are numerous and often result in institutionalisation. Given it is the registered nurse, with the cooperation of the enrolled nurse/ assistant in nursing, who provide the majority of face-to-face care in residential aged care facilities, there is a clear need to identify effective management strategies for agitated behaviours which nursing staff can easily access and implement.This review identifies the best available evidence regarding the efficacy of nurse implemented non-pharmacological strategies for the symptom management of agitation in persons with advanced dementia living in residential aged care facilities METHOD: A systematic literature search of MEDLINE, CINAHL, PsycINFO, Cochrane Library, SCOPUS, EMBASE, and AgeLine databases was undertaken. Additionally, the reference lists of relevant papers were examined for additional trials.This review considered any English language randomised trial that investigated strategies implemented by a nurse for the symptom management of agitation in persons with advanced dementia living in residential aged care facilities. Outcomes measured included frequency and severity of agitation.RESULTS:Seven trials were included in this review. Five of the seven strategies investigated were shown to be effective in the symptom management of agitation when compared to alternate strategies. Effective strategies include: behavioural therapy, balancing arousal states, therapeutic touch, multi-sensory stimulation and person-centred bathing.CONCLUSIONS:The heterogeneity of the included trials made it difficult to draw definitive conclusion. However, the results of this systematic review reveal that some non-pharmacological strategies are effective when implemented by a nurse for the symptom management of agitation in pesons with advanced dementia living in residential aged care facilities. Despite this finding, there is currently insufficient evidence to develop practice guidelines.