Amanda Johnson

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.

This discussion paper proposes four new nursing leadership roles to address planetary health challenges. Nurses are essential in reducing healthcare's greenhouse emissions. The Planetary Health Education Framework (PHEF) supports integrating planetary health concepts into sustainable healthcare practice. Nurse educators with planetary health expertise should teach the PHEF, while nurse climate advocates promote it to health professionals, with nurse-led planetary health researchers undertaking climate-change research and Planetary Health Nurse Practitioners practicing sustainable healthcare. Discussion paper. A PICO framework was used to identify relevant articles: In nursing (P) should new roles be introduced (I) compared to no new roles (C) to understand climate change impacts on both nursing and planetary health (O). Barriers to sustainable healthcare include denial, group-think, and ignorance. National and International organisation enablers highlight the importance of climate change in nurse education. The Australian College of Nursing recommends government funding for nurse-led planetary health research. Educators should focus on curricula development, nurse climate advocates on education and policy, researchers on supporting planetary health research, and PHNPs on climate justice, environmental protection, and emissions reduction.

Background: There is a growing momentum around the world to foster greater opportunities for the involvement of mental health service users in their care and treatment planning. In‐principle support for this aim is widespread across mental healthcare professionals. Yet, progress in mental health services towards this objective has lagged in practice.Objectives: We conducted a systematic review of quantitative, qualitative and mixed‐method research on interventions to improve opportunities for the involvement of mental healthcare service users in treatment planning, to understand the current research evidence and the barriers to implementation.Methods: Seven databases were searched and 5137 articles were screened. Articles were included if they reported on an intervention for adult service users, were published between 2008 and October 2023 and were in English. Evidence in the 140 included articles was synthesised according to the JBI guidance on Mixed Methods Systematic Reviews.Results: Research in this field remains exploratory in nature, with a wide range of interventions investigated to date but little experimental replication. Overarching barriers to shared and supported decision‐making in mental health treatment planning were (1) Organisational (resource limitations, culture barriers, risk management priorities and structure); (2) Process (lack of knowledge, time constraints, health‐related concerns, problems completing and using plans); and (3) Relationship barriers (fear and distrust for both service users and clinicians).Conclusions: On the basis of the barriers identified, recommendations are made to enable the implementation of new policies and programs, the designing of new tools and for clinicians seeking to practice shared and supported decision‐making in the healthcare they offer.Patient or Public Contribution: This systematic review has been guided at all stages by a researcher with experience of mental health service use, who does not wish to be identified at this point in time. The findings may inform organisations, researchers and practitioners on implementing supported decision‐making, for the greater involvement of people with mental ill health in their healthcare.

To conduct an integrative literature review to reveal any evidence supportive of the integration of traditional therapies for First Nations peoples in Australia within a western healthcare model, and to identify which, if any, of these therapies have been linked to better health outcomes and culturally safe and appropriate care for First Nations peoples. If so, are there indications by First Nations peoples in Australia that these have been effective in providing culturally safe care or the decolonisation of western healthcare practices. Integrative literature review of peer-reviewed literature. Online databases searched included CINAHL, Medline, Scopus, ScienceDirect InformitHealth, and ProQuest. Databases were searched for papers with full text available and published in English with no date parameter set. The PRISMA guidelines were used during the literature review and the literature was critiqued using the Critical Appraisal Skills tool. Seven articles met the inclusion criteria and were included in the review. Four articles selected were qualitative, two used a mixed method design, and one used a quantitative method. Six themes arose: (i) bush medicine, (ii) traditional healers, (iii) traditional healing practices, (iv) bush tucker, (v) spiritual healing, and (vi) therapies that connected to cultures such as yarning and storytelling. There is limited literature discussing the use of traditional therapies in Western healthcare settings. A need exists to include traditional therapies within a Western healthcare system. Creating a culturally safer and appropriate healthcare experience for First Nations people in Australia and will contribute to advancement in the decolonisation of current healthcare models.

Aims and objectives: To conduct an integrative review of the literature to understand how the incorporation of traditional therapies affect First Nations people's utilisation of palliative care services.Background: First Nations peoples face many barriers related to accessing and utilising specialised health services such as palliative care. Whilst culturally appropriate care has been shown to improve these outcomes, there is little evidence regarding how this may be achieved.Design: Integrative review.Methods: A systematic search was conducted using electronic databases CINAHL, Joanna Briggs, Medline, Scopus, ScienceDirect InformitHealth and ProQuest between the years of 20052021 databases were searched for papers with full text available and published in English. Papers were included if they were primary‐based research and focused on the topics of the use of traditional therapies in a palliative care context by First Nations persons. The Critical Appraisal Skills Programme principles were used to assess the methodological quality of the selected articles.Results: Seven studies met the inclusion criteria and were included in the review. The review included six qualitative studies and one quantitative study. From these studies, five themes were identified in the literature: supporting a holistic approach, developing culturally appropriate care, conflict within a Western medical model, regulatory issues, and geographical barriers.Conclusion: There is a dearth of current literature available discussing the utilization of traditional therapies in palliative care. From the literature analysed, the benefits of including traditional therapies are overall positive, however, there are barriers including conflict with the Western model of medicine and regulation. More research is required in the provision of traditional therapies in palliative care.Relevance to Clinical Practice: The incorporation of traditional medicines within a palliative care setting could help nurses provide holistic and culturally appropriate care, especially in rural and remote areas where they make up the majority of the healthcare force.

This article reports on the development of a new transition service in Norfolk; ‘Preparing for Adult Life’ (PfAL), led by Adult Services (ASSD). It identifies the strategies that were used to develop effective partnership working across Children’s Services, Education and Health, including how shared understanding and learning from one another is being incorporated to manage risk and support for personalisation as part of promoting a transitional approach to safeguarding for individuals as they approach the transition to adulthood. Using the literature, we examine why improved multi-agency working and understanding of roles and responsibilities is important as part of safety planning, particularly during transition to adulthood, and the benefits of an ASSD led strengths-based approach for the young person. The primary focus of this work is based on the principles of Making Safeguarding Personal to the young person; allowing opportunity to make unwise decisions, with consideration of the Mental Capacity Act 2005, and considering a risk assessed approach with the aim of achieving better outcomes for young people.

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. 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. 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). 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.

Aims and objectives: This article presents the generation of a model of care encompassing “function” and “affect” based on findings from a 2011 research project aimed at improving care delivery for people with advanced dementia. Objectives were to provide comprehensive and sustainable care, honouring and respecting the person.Background: Dementia is a debilitating, progressive, and terminal disease with a trajectory ranging from approximately 3 to 16 years, yet attention to end‐of‐life care, promoting comfort, alleviating suffering, and maximizing quality of life is frequently overlooked for people living in the advanced stages of the disease.Methods: The research project from which the model was drawn used a three‐phase mixed methods approach at three residential aged care facilities (nursing homes) providing high care in New South Wales, Australia. Thematic analysis was elicited from focus group discussions with staff, family members, and carers of residents.Findings: Themes describe distinct dimensions of a model of care: “function” (dedication, designation, and deliberation) and “affect” (the personal outcomes revealed in relaxation, stimulation, and transformation).Conclusion: Reframing nursing practice from task and disease orientation to person centred and relationship focused is essential in meeting the complete needs of people with advanced dementia. This transformational model of care may be useful in adapting to other end‐of‐life care settings.

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.