Most residents in residential aged care facilities are incontinent. This study explored how conti... more Most residents in residential aged care facilities are incontinent. This study explored how continence care was provided in residential aged care facilities, and describes a subset of data about staffs' beliefs and experiences of the quality framework and the funding model on residents' continence care. Using grounded theory methodology, 18 residential aged care staff members were interviewed and 88 hours of field observations conducted in two facilities. Data were analysed using a combination of inductive and deductive analytic procedures. Staffs' beliefs and experiences about the requirements of the quality framework and the funding model fostered a climate of fear and risk adversity that had multiple unintended effects on residents' continence care, incentivising dependence on continence management, and equating effective continence care with effective pad use. There is a need to rethink the quality of continence care and its measurement in Australian residential aged care facilities.
: Support for patient self-management is an accepted role for health professionals. Little eviden... more : Support for patient self-management is an accepted role for health professionals. Little evidence exists on the appropriate basis for the role of health professionals in achieving optimum self-management outcomes. This study explores the perceptions of people with type 2 diabetes about their self-management strategies and how relationships with health professionals may support this.
Background: Life transitions are associated with high levels of stress affecting health behaviour... more Background: Life transitions are associated with high levels of stress affecting health behaviours among people with Type 1 diabetes. Transition to motherhood is a major transition with potential complications accelerated by pregnancy with risks of adverse childbirth outcomes and added anxiety and worries about pregnancy outcomes. Further, preparing and going through pregnancy requires vigilant attention to a diabetes management regimen and detailed planning of everyday activities with added stress on women. Psychological and social well-being during and after pregnancy are integral for good pregnancy outcomes for both mother and baby. The aim of this study is to establish the face and content validity of two novel measures assessing the well-being of women with type 1 diabetes in their transition to motherhood, 1) during pregnancy and 2) during the postnatal period. Methods: The approach to the development of the Pregnancy and Postnatal Well-being in T1DM Transition questionnaires was based on a four-stage pre-testing process; systematic overview of literature, items development, piloting testing of questionnaire and refinement of questionnaire. The questionnaire was reviewed at every stage by expert clinicians, researchers and representatives from consumer groups. The cognitive debriefing approach confirmed relevance of issues and identified additional items.
Iranian journal of nursing and midwifery research, 2014
All health professionals are responsible for facilitating empowerment among people with diabetes.... more All health professionals are responsible for facilitating empowerment among people with diabetes. However, research suggests that health professionals do not have the knowledge and skills to help people with diabetes become empowered. As a result, many Iranian people with diabetes do not become empowered. The aim of the study was to explore and understand how empowerment occurs in Iranian people with diabetes. Grounded theory using individual open in-depth interviews, field notes, and memos was used to collect data from 25 people with diabetes, their families, and health professionals. Strauss and Corbin's constant comparative analysis was used to analyze the data. Empowerment is a transitional, perceptual, and continuous process. The process for people with diabetes includes threatened identity when diabetes is diagnosed, reconstructing identity, and integrating diabetes into identity to become an empowered person with diabetes. The empowerment process was influenced by a combi...
Medical decision-making in oncology is a complicated process and to date there are few studies ex... more Medical decision-making in oncology is a complicated process and to date there are few studies examining how patients with cancer make choices with respect to different features of their care. It is also unknown whether patient choices vary by geographical location and how location could account for observed rural and metropolitan cancer differences. This paper describes an ongoing study that aims to (1) examine patient and healthcare-related factors that influence choices of patients with cancer; (2) measure and quantify preferences of patients with cancer towards cancer care using a discrete choice experiment (DCE) and (3) explore preference heterogeneity between metropolitan and rural locations. A DCE is being conducted to understand how patients with cancer choose between two clinical scenarios accounting for different patient and healthcare-related factors (and levels). Preliminary qualitative research was undertaken to guide the development of an appropriate DCE design includi...
Empowerment concerning people with diabetes is well researched. However, few researchers specific... more Empowerment concerning people with diabetes is well researched. However, few researchers specifically focus on the barriers to and facilitators of empowerment in Iranian people with diabetes. Understanding the factors could help health professionals facilitate self-empowerment more effectively. This study aims to determine the barriers to and facilitators of empowerment in Iranian people with diabetes. A qualitative exploratory study was conducted using in-depth interviews to collect the data from 11 women and men in 2007. Themes were identified using constant comparative analysis method. Common barriers to empowerment were similar to other chronic diseases: prolonged stress, negative view about diabetes, ineffective health-care systems, poverty and illiteracy. Diabetes education, fear of diabetes' complications, self-efficacy and hope for a better future emerged as being crucial to empowerment. Facilitators specific to Iranians were: the power of religion and faith, the concept of the doctor as holy man, accepting diabetes as God's will, caring for the body because it was God's gift and support from families especially daughters. Empowerment was strongly influenced by cultural and religious beliefs in Iran and the power of faith emerged as an important facilitator of diabetes empowerment. The findings will help health professionals understand how Iranian people with diabetes view life and the factors that facilitate empowerment.
Complementary therapies in nursing & midwifery, 2001
A study investigated the use of aromatherapy hand and foot massage on 11 patients in a rural reha... more A study investigated the use of aromatherapy hand and foot massage on 11 patients in a rural rehabilitation setting. An education programme for nurses, carers and family members was developed and implemented. Clinical outcomes--pain, anxiety, joint flexibility and skin condition were evaluated using Likert scales completed before, and after, treatment at three time points and open questions to ascertain patients' feelings about the treatments. Each patient had three treatments, making a total of 33 massages. A significant reduction in pain and anxiety was apparent after all three treatments (p=0.05). Changes in skin condition (softer and more resilient) were highly significant (p=0.01). However, there was no significant change in joint flexibility (p<0.05). The main themes emerging from patients'comments were that aromatherapy massage facilitated communication, allowed emotional release and aided relaxation. Nine people undertook the education programme. They indicated th...
Objective: The RESCUE study examined the prevalence of patients at risk of a medical emergency in... more Objective: The RESCUE study examined the prevalence of patients at risk of a medical emergency in acute care settings by assessing the prevalence of cases where patients fulfil the hospital-specific criteria for MET activation. This article will detail the study methodology including the ethics applications and approvals process, organisational preparation, research staff training, tools for data collection, as well as barriers encountered during the conduct of the study. Design and Setting: A point prevalence design conducted at 10 hospitals, comprising of private and public, secondary and tertiary referral, ICU equipped, metropolitan and regional settings. Patients: All inpatients were eligible except intensive care and psychiatric patients. Measurement and main results: On a single day consenting inpatients in each hospital had a single set of vital signs obtained, their observation chart reviewed and followed up for MET activations, unplanned ICU admissions, cardiac arrests and 30 and 60 day mortality. Of 2199 eligible patients, 1688 (76.76%) were assessed, 175 (7.95%) refused consent and 336 (15.28%) were unavailable. Access to patients was refused in some wards despite ethics approval. Data collection required 2 student nurses approximately 14 min per patient assessment. Conclusion: In conducting a large multi-site point prevalence study, critical organisational processes were shown to influence the access to patients. This study demonstrated the impact of variation in Human Research Ethics Committee interpretations of protocols on consenting processes and the importance of communication and leadership at ward level to promote access to patients.
The Journal of Alternative and Complementary Medicine, 2009
The aim of this systematic review was to critically appraise published clinical trials designed t... more The aim of this systematic review was to critically appraise published clinical trials designed to assess the effect of Traditional Chinese Medicine (TCM) on the management of constipation. Databases searched included both English and non-English articles published in the Cochrane library, MEDLINE, CINAHL, AMED, EMBASE, China National Knowledge Infrastructure (CNKI), and the Chinese Electronic Periodical Services (CEPS). Studies reviewed included randomized controlled trials and controlled clinical trials. Methodological quality was assessed using the modified Jadad scale. One hundred and thirty-seven (137) studies met the inclusion criteria, of which 21 were high-quality trials (n = 2449). Eighteen (18) were Chinese herbal medicine (CHM) and 3 were acupuncture trials. The primary outcome measure was total effective rate. CHM was more effective than conventional medicines in eight trials. Of the 10 remaining CHM trials, 9 compared the study CHM with another CHM and the results were significant in 4 trials. The effective rate was significantly higher in the intervention group than in the placebo group in the last CHM study. One (1) of the three acupuncture trials compared acupuncture with a conventional medicine, one trial with Sennae folium, and one trial with deeper acupuncture on Tianshu (ST 25). The therapeutic effect in the treatment group was more effective than that in the control group in all three studies. TCM interventions appear to be useful to manage constipation. Significant positive results were found in 15 high-quality studies. However, only 21 of the 137 publications identified attained high Jadad scores. There was heterogeneity in diagnostic procedures and interventions among the studies. Outcome indicators were also different. Hence, the results should be interpreted cautiously.
Objective: This systematic review aimed to critically appraise published clinical trials designed... more Objective: This systematic review aimed to critically appraise published clinical trials designed to assess the effect of Tai Chi on psychosocial well-being. Data Sources: Databases searched included MEDLINE, CINAHL, EMBASE, HEALT, PsycINFO, CISCOM, the Cochrane Central Register of Controlled Trials of the Cochrane Library, and dissertations and conference proceedings from inception to August 2008. Review Methods: Methodological quality was assessed using a modified Jadad scale. A total of 15 studies met the inclusion criteria (i.e. English publications of randomized controlled trials with Tai Chi as an intervention and psychological well-being as an outcome measure), of which eight were high quality trials. The psychosocial outcomes measured included anxiety (eight studies), depression (eight studies), mood (four studies), stress (two studies), general mental health three studies), anger, positive and negative effect, self-esteem, life satisfaction, social interaction and self-rated health (one study each). Results: Tai Chi intervention was found to have a significant effect in 13 studies, especially in the management of depression and anxiety. Although the results seemed to suggest Tai Chi is effective, they should be interpreted cautiously as the quality of the trials varied substantially. Furthermore, significant findings were shown in only six high quality studies. Moreover, significant between group differences after Tai Chi intervention was demonstrated in only one high quality study (the other three significant results were observed in non-high quality studies). Two high quality studies in fact found no significant Tai Chi effects. Conclusion: It is still premature to make any conclusive remarks on the effect of Tai Chi on psychosocial well-being.
7 9 ( 2 0 0 8 ) S 1 -S 1 2 7 S121 any benefits arising from facilitating peer-to-peer interaction... more 7 9 ( 2 0 0 8 ) S 1 -S 1 2 7 S121 any benefits arising from facilitating peer-to-peer interaction in this way. The pilot study shows that people with diabetes have great enthusiasm for the potential of social networking and sharing information and experiences in an OVC that is relevant to NZ.
: Support for patient self-management is an accepted role for health professionals. Little eviden... more : Support for patient self-management is an accepted role for health professionals. Little evidence exists on the appropriate basis for the role of health professionals in achieving optimum self-management outcomes. This study explores the perceptions of people with type 2 diabetes about their self-management strategies and how relationships with health professionals may support this.
Diabetes in ageing communities imposes a substantial personal and public health burden by virtue ... more Diabetes in ageing communities imposes a substantial personal and public health burden by virtue of its high prevalence, its capacity to cause disabling vascular complications, the emergence of new non-vascular complications, and the effects of frailty. In this Review, we examine the current state of knowledge about diabetes in older people (aged ≥75 years) and discuss how recognition of the effect of frailty and disability is beginning to lead to new management approaches. A multidimensional and multidisciplinary assessment process is essential to obtain information on medical, psychosocial, and functional capabilities, and also on how impairments of these functions could limit activities. Major aims of diabetes care include maintenance of independence, functional status, and quality of life by reduction of symptom and medicine burden, and active identification of risks. Linking of therapeutic targets to individual functional status is mandatory and very tight glucose control is often not necessary. Hypoglycaemia remains an important avoidable iatrogenic event. Quality diabetes care in older people remains an important challenge for health professionals.
Most residents in residential aged care facilities are incontinent. This study explored how conti... more Most residents in residential aged care facilities are incontinent. This study explored how continence care was provided in residential aged care facilities, and describes a subset of data about staffs&amp;amp;amp;amp;amp;amp;#39; beliefs and experiences of the quality framework and the funding model on residents&amp;amp;amp;amp;amp;amp;#39; continence care. Using grounded theory methodology, 18 residential aged care staff members were interviewed and 88 hours of field observations conducted in two facilities. Data were analysed using a combination of inductive and deductive analytic procedures. Staffs&amp;amp;amp;amp;amp;amp;#39; beliefs and experiences about the requirements of the quality framework and the funding model fostered a climate of fear and risk adversity that had multiple unintended effects on residents&amp;amp;amp;amp;amp;amp;#39; continence care, incentivising dependence on continence management, and equating effective continence care with effective pad use. There is a need to rethink the quality of continence care and its measurement in Australian residential aged care facilities.
: Support for patient self-management is an accepted role for health professionals. Little eviden... more : Support for patient self-management is an accepted role for health professionals. Little evidence exists on the appropriate basis for the role of health professionals in achieving optimum self-management outcomes. This study explores the perceptions of people with type 2 diabetes about their self-management strategies and how relationships with health professionals may support this.
Background: Life transitions are associated with high levels of stress affecting health behaviour... more Background: Life transitions are associated with high levels of stress affecting health behaviours among people with Type 1 diabetes. Transition to motherhood is a major transition with potential complications accelerated by pregnancy with risks of adverse childbirth outcomes and added anxiety and worries about pregnancy outcomes. Further, preparing and going through pregnancy requires vigilant attention to a diabetes management regimen and detailed planning of everyday activities with added stress on women. Psychological and social well-being during and after pregnancy are integral for good pregnancy outcomes for both mother and baby. The aim of this study is to establish the face and content validity of two novel measures assessing the well-being of women with type 1 diabetes in their transition to motherhood, 1) during pregnancy and 2) during the postnatal period. Methods: The approach to the development of the Pregnancy and Postnatal Well-being in T1DM Transition questionnaires was based on a four-stage pre-testing process; systematic overview of literature, items development, piloting testing of questionnaire and refinement of questionnaire. The questionnaire was reviewed at every stage by expert clinicians, researchers and representatives from consumer groups. The cognitive debriefing approach confirmed relevance of issues and identified additional items.
Iranian journal of nursing and midwifery research, 2014
All health professionals are responsible for facilitating empowerment among people with diabetes.... more All health professionals are responsible for facilitating empowerment among people with diabetes. However, research suggests that health professionals do not have the knowledge and skills to help people with diabetes become empowered. As a result, many Iranian people with diabetes do not become empowered. The aim of the study was to explore and understand how empowerment occurs in Iranian people with diabetes. Grounded theory using individual open in-depth interviews, field notes, and memos was used to collect data from 25 people with diabetes, their families, and health professionals. Strauss and Corbin's constant comparative analysis was used to analyze the data. Empowerment is a transitional, perceptual, and continuous process. The process for people with diabetes includes threatened identity when diabetes is diagnosed, reconstructing identity, and integrating diabetes into identity to become an empowered person with diabetes. The empowerment process was influenced by a combi...
Medical decision-making in oncology is a complicated process and to date there are few studies ex... more Medical decision-making in oncology is a complicated process and to date there are few studies examining how patients with cancer make choices with respect to different features of their care. It is also unknown whether patient choices vary by geographical location and how location could account for observed rural and metropolitan cancer differences. This paper describes an ongoing study that aims to (1) examine patient and healthcare-related factors that influence choices of patients with cancer; (2) measure and quantify preferences of patients with cancer towards cancer care using a discrete choice experiment (DCE) and (3) explore preference heterogeneity between metropolitan and rural locations. A DCE is being conducted to understand how patients with cancer choose between two clinical scenarios accounting for different patient and healthcare-related factors (and levels). Preliminary qualitative research was undertaken to guide the development of an appropriate DCE design includi...
Empowerment concerning people with diabetes is well researched. However, few researchers specific... more Empowerment concerning people with diabetes is well researched. However, few researchers specifically focus on the barriers to and facilitators of empowerment in Iranian people with diabetes. Understanding the factors could help health professionals facilitate self-empowerment more effectively. This study aims to determine the barriers to and facilitators of empowerment in Iranian people with diabetes. A qualitative exploratory study was conducted using in-depth interviews to collect the data from 11 women and men in 2007. Themes were identified using constant comparative analysis method. Common barriers to empowerment were similar to other chronic diseases: prolonged stress, negative view about diabetes, ineffective health-care systems, poverty and illiteracy. Diabetes education, fear of diabetes&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; complications, self-efficacy and hope for a better future emerged as being crucial to empowerment. Facilitators specific to Iranians were: the power of religion and faith, the concept of the doctor as holy man, accepting diabetes as God&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s will, caring for the body because it was God&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s gift and support from families especially daughters. Empowerment was strongly influenced by cultural and religious beliefs in Iran and the power of faith emerged as an important facilitator of diabetes empowerment. The findings will help health professionals understand how Iranian people with diabetes view life and the factors that facilitate empowerment.
Complementary therapies in nursing & midwifery, 2001
A study investigated the use of aromatherapy hand and foot massage on 11 patients in a rural reha... more A study investigated the use of aromatherapy hand and foot massage on 11 patients in a rural rehabilitation setting. An education programme for nurses, carers and family members was developed and implemented. Clinical outcomes--pain, anxiety, joint flexibility and skin condition were evaluated using Likert scales completed before, and after, treatment at three time points and open questions to ascertain patients' feelings about the treatments. Each patient had three treatments, making a total of 33 massages. A significant reduction in pain and anxiety was apparent after all three treatments (p=0.05). Changes in skin condition (softer and more resilient) were highly significant (p=0.01). However, there was no significant change in joint flexibility (p<0.05). The main themes emerging from patients'comments were that aromatherapy massage facilitated communication, allowed emotional release and aided relaxation. Nine people undertook the education programme. They indicated th...
Objective: The RESCUE study examined the prevalence of patients at risk of a medical emergency in... more Objective: The RESCUE study examined the prevalence of patients at risk of a medical emergency in acute care settings by assessing the prevalence of cases where patients fulfil the hospital-specific criteria for MET activation. This article will detail the study methodology including the ethics applications and approvals process, organisational preparation, research staff training, tools for data collection, as well as barriers encountered during the conduct of the study. Design and Setting: A point prevalence design conducted at 10 hospitals, comprising of private and public, secondary and tertiary referral, ICU equipped, metropolitan and regional settings. Patients: All inpatients were eligible except intensive care and psychiatric patients. Measurement and main results: On a single day consenting inpatients in each hospital had a single set of vital signs obtained, their observation chart reviewed and followed up for MET activations, unplanned ICU admissions, cardiac arrests and 30 and 60 day mortality. Of 2199 eligible patients, 1688 (76.76%) were assessed, 175 (7.95%) refused consent and 336 (15.28%) were unavailable. Access to patients was refused in some wards despite ethics approval. Data collection required 2 student nurses approximately 14 min per patient assessment. Conclusion: In conducting a large multi-site point prevalence study, critical organisational processes were shown to influence the access to patients. This study demonstrated the impact of variation in Human Research Ethics Committee interpretations of protocols on consenting processes and the importance of communication and leadership at ward level to promote access to patients.
The Journal of Alternative and Complementary Medicine, 2009
The aim of this systematic review was to critically appraise published clinical trials designed t... more The aim of this systematic review was to critically appraise published clinical trials designed to assess the effect of Traditional Chinese Medicine (TCM) on the management of constipation. Databases searched included both English and non-English articles published in the Cochrane library, MEDLINE, CINAHL, AMED, EMBASE, China National Knowledge Infrastructure (CNKI), and the Chinese Electronic Periodical Services (CEPS). Studies reviewed included randomized controlled trials and controlled clinical trials. Methodological quality was assessed using the modified Jadad scale. One hundred and thirty-seven (137) studies met the inclusion criteria, of which 21 were high-quality trials (n = 2449). Eighteen (18) were Chinese herbal medicine (CHM) and 3 were acupuncture trials. The primary outcome measure was total effective rate. CHM was more effective than conventional medicines in eight trials. Of the 10 remaining CHM trials, 9 compared the study CHM with another CHM and the results were significant in 4 trials. The effective rate was significantly higher in the intervention group than in the placebo group in the last CHM study. One (1) of the three acupuncture trials compared acupuncture with a conventional medicine, one trial with Sennae folium, and one trial with deeper acupuncture on Tianshu (ST 25). The therapeutic effect in the treatment group was more effective than that in the control group in all three studies. TCM interventions appear to be useful to manage constipation. Significant positive results were found in 15 high-quality studies. However, only 21 of the 137 publications identified attained high Jadad scores. There was heterogeneity in diagnostic procedures and interventions among the studies. Outcome indicators were also different. Hence, the results should be interpreted cautiously.
Objective: This systematic review aimed to critically appraise published clinical trials designed... more Objective: This systematic review aimed to critically appraise published clinical trials designed to assess the effect of Tai Chi on psychosocial well-being. Data Sources: Databases searched included MEDLINE, CINAHL, EMBASE, HEALT, PsycINFO, CISCOM, the Cochrane Central Register of Controlled Trials of the Cochrane Library, and dissertations and conference proceedings from inception to August 2008. Review Methods: Methodological quality was assessed using a modified Jadad scale. A total of 15 studies met the inclusion criteria (i.e. English publications of randomized controlled trials with Tai Chi as an intervention and psychological well-being as an outcome measure), of which eight were high quality trials. The psychosocial outcomes measured included anxiety (eight studies), depression (eight studies), mood (four studies), stress (two studies), general mental health three studies), anger, positive and negative effect, self-esteem, life satisfaction, social interaction and self-rated health (one study each). Results: Tai Chi intervention was found to have a significant effect in 13 studies, especially in the management of depression and anxiety. Although the results seemed to suggest Tai Chi is effective, they should be interpreted cautiously as the quality of the trials varied substantially. Furthermore, significant findings were shown in only six high quality studies. Moreover, significant between group differences after Tai Chi intervention was demonstrated in only one high quality study (the other three significant results were observed in non-high quality studies). Two high quality studies in fact found no significant Tai Chi effects. Conclusion: It is still premature to make any conclusive remarks on the effect of Tai Chi on psychosocial well-being.
7 9 ( 2 0 0 8 ) S 1 -S 1 2 7 S121 any benefits arising from facilitating peer-to-peer interaction... more 7 9 ( 2 0 0 8 ) S 1 -S 1 2 7 S121 any benefits arising from facilitating peer-to-peer interaction in this way. The pilot study shows that people with diabetes have great enthusiasm for the potential of social networking and sharing information and experiences in an OVC that is relevant to NZ.
: Support for patient self-management is an accepted role for health professionals. Little eviden... more : Support for patient self-management is an accepted role for health professionals. Little evidence exists on the appropriate basis for the role of health professionals in achieving optimum self-management outcomes. This study explores the perceptions of people with type 2 diabetes about their self-management strategies and how relationships with health professionals may support this.
Diabetes in ageing communities imposes a substantial personal and public health burden by virtue ... more Diabetes in ageing communities imposes a substantial personal and public health burden by virtue of its high prevalence, its capacity to cause disabling vascular complications, the emergence of new non-vascular complications, and the effects of frailty. In this Review, we examine the current state of knowledge about diabetes in older people (aged ≥75 years) and discuss how recognition of the effect of frailty and disability is beginning to lead to new management approaches. A multidimensional and multidisciplinary assessment process is essential to obtain information on medical, psychosocial, and functional capabilities, and also on how impairments of these functions could limit activities. Major aims of diabetes care include maintenance of independence, functional status, and quality of life by reduction of symptom and medicine burden, and active identification of risks. Linking of therapeutic targets to individual functional status is mandatory and very tight glucose control is often not necessary. Hypoglycaemia remains an important avoidable iatrogenic event. Quality diabetes care in older people remains an important challenge for health professionals.
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Papers by Trisha Dunning