Latest Australian research

Bindley K, Lewis J, DiGiacomo M.

Abstract: Caring for someone with a life-limiting illness is associated with complex psychosocial sequelae; amplified for carers experiencing structural vulnerability. Workers across sectors of health and social care provide support for vulnerably positioned carers, yet exploration of the impacts of this work has predominantly focused on health professionals directly engaged with death and dying. This qualitative study explored ways in which palliative care and welfare workers experience work with current and bereaved carers of people with life-limiting illness, in a region associated with socioeconomic disadvantage. Work in this landscape involved: (1) navigation of evocative content, (2) encountering limits of grief literacy, (3) negotiating effects of policy constraints, (4) meaning-making for system survival, and (5) varied utilization of resources and strategies. Findings indicate the need for cross-sectoral recognition of consequences of this work, reflected through initiatives to cultivate grief literacy, acknowledgement of harmful consequences of policy, and structural approaches to workforce well-being.

Meyer C, Golenko X, Sinclair R, Lowthian J.

Abstract: Respite and permanent transition to residential aged care are processes that are designed to support preferences and needs of people living with dementia and their carers as the disease progresses. These services are highly variable in acceptability, accessibility, and availability for the caregiving dyad, often not reflecting a person-centred, co-ordinated and cohesive approach. This study aimed to use a two-phase realist synthesis to explore how respite and permanent transition models of care work in different contexts, through different mechanisms to produce varying outcomes.Phase 1 explored preliminary theories and assumptions of the respite care journey, including (a) identification of systematic reviews and innovative programs, and (b) semi-structured interviews sessions with key stakeholders. Phase 2 involved an iterative scoping review to identify and map the available evidence, with a synthesis designed to unpack underlying program theories of why, for whom and in what circumstances respite/transition models of care works.Phase 1(a) identified ten citations from 126 systematic review abstracts. Fourteen residential care managers participated in a contextual scan - Phase 1(b). Phase 2 expanded this knowledge, identifying a further 13 studies. Three program theories, at the macro, meso and micro level, were elucidated: (1) system-level evidence-based integration, through collaboration and co-ordination; (2) inclusive, quality care, with supportive environmental design; and (3) trust, autonomy, and meaning-making.A novel realist synthesis approach was used to explore respite and permanent transition models of care beyond 'what works'. Importantly, findings at the macro, meso and micro level context, suggest nuance, with a shared decision-making approach, is needed to optimise the ever-changing dementia care journey.

Roche N, Darzins S, Oakman J, Stuckey R.

Abstract: Workers employed in clinical healthcare settings often encounter dying and death of patients as a part of their role. This scoping review aimed to explore the physical and psychosocial OHS impacts on health workers exposed to death within their occupational role and their inherent coping strategies. Six electronic databases PsycINFO (Ovid), Medline (Ovid), AMED (EBSCO), CINAHL (EBSCO), and Proquest Social Sciences were searched for peer reviewed research articles published between March 1971 and April 2022. PRISMA-ScR guidelines were followed. Three authors independently assessed articles for inclusion. Fifty-three studies with focus settings in hospitals, hospice, general practice and residential care were identified. Five main themes were developed and organized using and ergonomic systems approach: Cultural Environment, Workplace, Job Demands, Impacts and Coping. The findings demonstrate that caring for dying patients, the dead and their families in clinical settings impacts workers emotionally, physically, behaviorally and spiritually.

Bloomer MJ, Brooks LA, Coventry A, Ranse K, Rowe J, Thomas S.

Background: The death of a child can have a profound impact on critical care nurses, shaping their professional practice and personal lives in diverse, enduring ways. Whilst end-of-life care is recognised as a core component of critical care nursing practice and a research priority, evidence about nurses’ experiences after death in neonatal and paediatric intensive care is poorly understood.

Research question: What is the experience of the nurse after death of a patient in neonatal and/or paediatric intensive care?

Method: Following registration with Open Science Framework, an integrative review of the empirical literature was undertaken. A combination of keywords, synonyms, and Medical Subject Headings was used across the Cumulative Index Nursing and Allied Health Literature (CINAHL) Complete, Medline, APA PsycInfo, Scopus, and Embase databases. Records were independently assessed against inclusion and exclusion criteria. All included papers were assessed for quality. Narrative synthesis was used to analyse and present the findings.

Findings: From 13,018 records screened, 32 papers reporting primary research, representing more than 1850 nurses from 15 countries, were included. Three themes were identified: (i) postmortem care; (ii) caring for bereaved families; and (iii) nurses’ emotional response, which includes support for nurses. Nurses simultaneously cared for the deceased child and family, honouring the child and child–family relationship. Nurses were expected to provide immediate grief and bereavement support to families. In response to their own emotions and grief, nurses described a range of strategies and supports to aid coping.

Conclusion: Recognising neonatal and paediatric critical care nurses' experience after death is key to comprehensively understanding the professional and personal impacts, including the shared grief of a young life lost. Enabling nurses to acknowledge and reflect upon their experiences of death and seek their preferred supports is critically important. Thus, ensuring organisational and system processes similarly align with nurses’ preferences is key.

Dharmagunawardene D, Kularatna S, Halahakone U, Purtell L, Bonner A, Healy HG, et al.

Introduction: Kidney failure can be managed either conservatively or via kidney replacement therapy. Kidney supportive care combines the expertise of nephrology with palliative care in a multidisciplinary team with a focus on improving quality of life.

Objective: To identify and appraise evidence-based health system kidney supportive care interventions DESIGN: Systematic review (PROSPERO Registration - CRD42022333650).

Participants: Adults with chronic kidney failure.

Measurements: Six databases were searched, using terms "palliative care" and "chronic kidney disease" for publications between January 2010 and March 2024. The Cochrane "Effective Practice and Organisation of Care" and "Clinical Practice Guidelines for Quality Palliative Care" domains informed data extraction.

Results: Of the 60 studies included, one-third were randomised controlled trials. The most common "Effective Practice and Organisation of Care" domain described was care delivery (58/60). End-of-life care (33/60), and physical aspects of care (19/60), were commonly described "Clinical Practice Guidelines for Quality Palliative Care" domains. Multidisciplinary shared care was highlighted in 26 studies. Least described domains were cultural (0/60) and ethical aspects (3/60). Almost 2/3 (39/60) of studies compared the outcomes of kidney supportive care interventions, and the most common outcome assessed was advance care planning (18/39). Key findings reported integrated palliative care reduced hospital admissions and costs, facilitated better patient-clinician communication, and improved symptom management. Gaps were identified in cultural and ethical/legal aspects of care.

Conclusions: The studies highlighted the effectiveness of kidney-supportive care interventions in improving patient outcomes, especially in end-of-life care and symptom management. However, significant existing gaps identified necessitate further research.