Jo-Anne Rayner

Aim: To explore the experiences and perspectives of clinical facilitators supervising first‐year nursing students in nursing homes. Design: The qualitative clinical facilitator interview component of a two‐stage sequential mixed methods study exploring the impact of student nurses' clinical placements in nursing homes on career choices. Methods: Clinical facilitators from three nursing schools that offered a Bachelor of Nursing in 2023 participated in semi‐structured interviews. All interviews were audio recorded and transcribed. Data were analysed thematically. Results: Ten experienced clinical facilitators participated in an interview. All but one were female. All had worked casually for more than one nursing school for an average of 12 years, had experience in acute specialist nursing settings but only three had worked as registered nurses in a nursing home. While clinical facilitators felt nursing homes were an appropriate venue for first‐year nursing students, there were caveats to this endorsement, which the three themes generated illustrate: (1) the clinical placement setting, (2) the supervision, and (3) the students. Clinical facilitators felt their role was to advocate, educate, and support students in this environment because students are often unprepared for, overwhelmed by, and have limited opportunities to apply their learning. Conclusion: In line with the literature, these findings highlight the pivotal role of clinical facilitators in the learning experience of student nurses on clinical placement in nursing homes. Pre‐placement contact and being available daily allay student anxiety and increase learning opportunities. However, challenges associated with nursing homes as the first placement remain, including the readiness of nursing homes to facilitate students, the competence of the staff supervising students, and students' preparedness for the setting. Implications for Practice: These findings should encourage nursing schools to review the provision of ongoing education to clinical facilitators as their knowledge and experience, like that of nurse academics who teach theoretical content to students, are pivotal to student learning. Casual status should not be a determinant of access to ongoing professional education. If nursing schools cannot ensure the quality of supervision to first‐year students on clinical placement in nursing homes, they should reconsider these settings for the first clinical placement. Adverse experiences in nursing homes, including inadequate clinical facilitation with an inexperienced registered nurse and exposure to poor clinical practices during the first clinical placement, are likely to impact students' consideration of gerontological nursing as a career. Public Contribution: No public contribution. All the participants of this study were Australian registered nurses employed as clinical facilitators by participating schools of nursing.

Aim: Exploration of factors associated with clinical placements in nursing homes for first‐year nursing students which may impact their career choices. Design: This paper reports on Stage I of a larger study which comprised a 2‐stage sequential mixed‐methods design. Methods: Stage I was a national survey conducted as a telephone interview with nurse academics involved in arranging clinical placements for first‐year student nurses; and Stage II which included: interviews with student nurses before and after their first clinical placement in a nursing home, and interviews with clinical supervisors. The Stage I national survey was conducted as a telephone interview and was audio recorded. Transcripts of the interviews were analysed using descriptive statistics, content analysis, and reflexive thematic analysis. Results: All Australian nursing schools that offered a Bachelor of Nursing in 2023 were invited to participate. Twenty‐nine (81%) participated. The first clinical placement for most (79%) Australian student nurses is in a nursing home. Four themes were identified from the data analysis: (1) clinical placements are increasingly organised by centralised teams (48%); (2) the supervision model and the clinical supervisor are determined by placement agreements where students can be supervised by someone ill equipped for the role; (3) the purpose of this first‐year clinical placement is difficult to articulate, other than to practise fundamental skills; and (4) nursing homes can provide positive learning experiences for student nurses, if they are prepared for the setting and supervised appropriately. Conclusion: While many of these findings have been documented for decades, clinical placements in nursing homes may provide student nurses with valuable experiences. Schools of nursing need to better prepare students for clinical placements in nursing homes (especially if it is their first clinical placement) and ensure they are appropriately supervised. If not, graduate nurses will not consider aged care nursing as a career option. Implications for Practice: These findings should encourage nursing schools to reconsider their curriculum design, especially the timing of clinical placements in nursing homes, and their employment of clinical supervisors. The Australian Nursing and Midwifery Accreditation Council (ANMAC) should mandate a care of older persons subject in all undergraduate nursing curricula to be undertaken before students undertake a clinical placement in a nursing home. Public Contribution: There was no public contribution to this research. All participants were nurse academics from participating Australian schools of nursing.

Introduction: Providing high-quality care in nursing homes requires a skilled and knowledgeable workforce. The Australian nursing home workforce is made up predominantly of personal care workers who are unprepared educationally to provide care to older people with complex care needs. We describe the design, development, and implementation of two education packages for Australian personal care workers to improve their knowledge and confidence in providing optimal care to older people.Methods—pedagogy and education development: The first package was developed following original research, which explored the need for education focusing on recognising and reporting resident deterioration, the preferred way of delivering this education, and barriers to education. Time and costs were identified as barriers, indicating that short, modular education for care workers was required. Using a train-the-trainer model, this education (10 h of delivery) comprises eight modules designed to be delivered individually or over two days by a registered nurse. The second education package was commissioned work following the interim findings from the Australian Royal Commission into Aged Care Quality and Safety and focused on three identified areas of need: dementia care, a palliative approach to care, and oral and dental care. Also modular, the second package has a learner-centric approach for the multidisciplinary aged care team and is freely available online.Results: User acceptability testing found the first package to be of high quality, easy to deliver, and the content can be adapted to meet individuals’ different learning styles, knowledge needs, and time availability. User acceptability testing of the second education package was undertaken in the development phase. This package has an international reach and continues to provide a popular single, easily accessible site for personal care worker education, who comprise 60% of users.Conclusion: While research suggests that personal care workers prefer face-to-face interactive education and training, the COVID-19 pandemic has changed the education landscape, and care workers are also embracing online learning. These education packages meet the needs of the personal care workforce, providing choice and flexibility: interactive learning in the context of care delivery or freely available online learning that can be undertaken in personal time.

Rationale: Due to their frailty, older people living in nursing homes are at risk of harm if the care provided is not evidence‐based and high quality. The performance measures routinely collected to measure quality care in public sector nursing homes in Victoria, Australia, are currently acute care focused and collected ‘after the fact’, so there is a need for predictive performance measures that identify circumstances that reflect poor‐quality care that will cause harm to residents.Aims and Objectives: To evaluate the readiness of public sector nursing homes in Victoria, Australia to introduce predictive performance measures in aged care.Methods: A qualitative descriptive design was used to evaluate the introduction of eight predictive performance measures in six geographically diverse public sector nursing homes in Victoria, Australia. After implementing the performance measures interviews with staff were undertaken which were used to create 18 most significant change stories. The stories were workshopped by key stakeholders, to detect subtle changes in nursing home staff behaviours and clinical practice.Results: In the workshop, using the most significant change methodology six themes from the stories, each with sub‐themes were identified which reflect the preparedness of nursing homes for the introduction of predictive performance measures, revealing ‘gaps’ in aged care practice, and the need for improvements. These included staff‐identified strategies, changes in practice, gaps in aged care practice, areas for improvement, and the need for improvement plans, which prompted changes in staff behaviours and better care for residents.Conclusions: The study highlights the value and adaptability of using the most significant change methodology to evaluate complex interventions. This method enriches analysis by emphasising individual experiences, and the dynamics of organisational change. It highlighted subtle changes in aged care practice that would have been difficult to measure including staff behaviour, organisational culture, and the role of leadership in improving care quality for residents.

Objectives: To explore the experiences of older people living in Australian residential aged care facilities (RACFs) and families of older people living in RACFs, regarding the process of Resident of the Day (ROD; sometimes referred to as a resident review) and their knowledge of how these assessments inform care planning.Methods: Semi‐structured interviews were used to engage residents and families in conversations about their experiences and knowledge of the assessment associated with ROD and subsequent care planning. A reflexive thematic analysis was used to generate findings.Results: Twenty‐six interviews were conducted in four RACFs across Victoria, diverse in terms of geographic location and provider type. Those residents who had some awareness of the ROD described the process only in superficial terms. Connections between ROD and care planning were unable to be made by most residents. Family members had a greater level of awareness of the ROD, although they were unable to describe the process or purpose and did not connect it to care planning.Conclusions: Despite being undertaken in all Victorian RACFs, residents and families have little or no knowledge of the ROD process, purpose or what happens to the information collected.

Context: Providing high-quality care to older people living in long-term care homes requires consideration of their cultural backgrounds and spiritual beliefs. Objective: To ascertain the views of key informants from Australian culturally and linguistically diverse (CALD), Aboriginal and Torres Strait Islander (ATSI), and spiritual care organisations about providing high-quality cultural and spiritual care in long-term care homes. Method: Semi-structured interviews were undertaken with seven representatives of these Australian organisations. Interview transcripts were thematically analysed. Findings: The importance of cultural and spiritual care to older people living in long-term care was acknowledged. However, it was noted that this care for older people from diverse CALD, ATSI, and spiritual backgrounds was often absent due to staff ignorance, lack of awareness, and assumptions. Staff need further education to provide culturally and spiritually appropriate care; long-term care homes need to incorporate an organizational approach to providing culturally and spirituality appropriate care; and staff should be encouraged to consult experts in cultural and spiritual care when the care they provide is insufficient. Cultural and spiritual care champions may be an appropriate way of disseminating knowledge and establishing a culturally and spiritually aware workforce. Limitations: The small number of existing Australian cultural and spiritual care organisations, and the smaller number of representatives within these organisations who have experience with older people living in long-term care homes, limited the number of eligible participants. Implications for practice Long-term care homes must invest in comprehensive education to better equip staff to provide high-quality cultural and spiritual care to older people. Education should assist staff in identifying the range of life areas to which culture and spiritual care have relevance and how to apply appropriate knowledge. Staff should be aware of the available guidelines about culturally and spiritually informed care; and recognise when to consult experts. Workplace champions can provide and encourage an ethos where culture and spirituality are considered in everyday care.

Objective: This paper reports on the design and implementation of an interactive online education package for the diverse Australian residential aged care workforce, in response to the findings of the Royal Commission into Aged Care Quality and Safety. A decade of reports has consistently highlighted the need for an educated workforce to care for the increasingly frail older people with complex care needs living in residential aged care. Cost, availability and timing of education have been identified as barriers to uptake of education for this workforce.Methods: A heutagogical approach was used to design an evidence‐based, modular, online education package for nurses, care workers and allied health practitioners working in the residential aged care sector. The subject matter was developed by experts and the education divided into modules. A key challenge was to design a package that was inclusive of the diversity of educational needs in this workforce. The package does not provide assessments on completion of the modules, relying solely on the motivation of the individual learner.Results: This online education package provides choice and self‐determination for users in their learning journey. Collaborating with experts to develop an online education program that is learner‐driven, challenges the conventions of education. Users can navigate the package at their pace; choose the modules they have identified as knowledge gaps or are of interest; and complete the education in their own time.Conclusion: As expected, most users are care workers and nurses and the five modules of the Dementia program are the most popular.