Deirdre Fetherstonhaugh

Background: In Australian residential aged care, infection prevention and control (IPC) Lead nurses (IPC Leads) are a key part of the IPC program. IPC Leads are often the main IPC contacts and provide support to staff to improve IPC and resident outcomes. To enhance their competence and self-efficacy, IPC Leads need to engage in ongoing role development. Connecting with other IPC Leads, learning together, and sharing ideas and resources could also be beneficial. Communities of practice (CoPs) have been shown to improve self-efficacy and job satisfaction by fostering belonging, peer learning, and problem-solving. Drawing on social learning theory, CoPs encourage learning with and from one another to explore and iteratively develop practice. This study draws on the CoP literature and builds on our previous pilot of a CoP for IPC Leads in 1 state of Australia, which found promising impacts on confidence and practice change. Objective: This study will evaluate CoPs for IPC Leads working in Australian residential aged care. Primarily, the study will assess changes in IPC Leads’ self-efficacy. It will also explore job satisfaction and IPC practice improvement and assess the acceptability and feasibility of CoPs. Methods: We are conducting a before-and-after study using multimethods. We will recruit IPC Leads from across Australia to participate in the CoPs. The CoPs will be implemented over 12 months, with online sessions held monthly for 30 to 60 minutes each. Baseline and 12-month follow-up surveys of IPC Leads’ self-efficacy and job satisfaction and audits of IPC practice will be conducted. At the 12-month follow-up, surveys and interviews with IPC Leads will be used to assess the acceptability and feasibility of the CoPs and to explore case examples of IPC Leads facilitating practice change. Researcher notes and costing data collected will be used to further evaluate the feasibility and fidelity of the CoPs. Quantitative data will be summarized descriptively, and an ordinal mixed-effects model with a logit link will be used to assess change in self-efficacy. Interview data will be analyzed using an inductive approach, followed by a deductive approach, based on the Framework Method. Results: This project was funded in October 2024 and commenced in February 2025. As of April 30, 2026, 97 potential participants had registered their interest in participating, but no participants had been enrolled (ie, consented to participate). Recruitment of IPC Leads began in March 2026. The CoPs are expected to commence in June to July 2026. Data collection will commence in May 2026, and data analysis is expected to be completed by January 2028. Study results are expected to be published in 2028. Conclusions: The findings will create new research knowledge in the field of CoPs and knowledge translation in the aged care sector and inform the sustainability and potential for future scale-up of this collaborative social learning approach.

Background: Experience‐based co‐design (EBCD) seeks to bring together people with lived experience of healthcare with other interest holders to collaboratively generate creative solutions. Objective: A cluster randomised controlled trial is planned to assess the feasibility, acceptability and effectiveness of a co‐designed multicomponent intervention to improve communication in aged care services. Design: This paper describes a nested process evaluation design for the EBCD and implementation of the intervention with the aim of understanding the role of co‐design and other factors in achieving impact. Method: Primary data sources will include surveys, interviews, focus groups, field notes and observations of co‐design activities. Secondary sources will include data collected and materials produced by the researchers developing the intervention. Participants: Aged care recipients; family members and significant others; direct care workers; managers; and other healthcare professionals will be engaged as co‐designers of the intervention, and as research participants in the evaluation of its co‐design and implementation. Main Variables Studied: Evaluation findings will compare experiences of co‐design, within and across informant groups, with an explanatory theoretical model of change described in previous research employing EBCD. Additionally, the role of the co‐design and other contextual factors in the intervention's impact will be organised using the RE‐AIM (Reach, Efficacy, Adoption, Implementation and Maintenance) framework. Discussion: The involvement of people who use and deliver health services in the development of complex interventions is increasingly recommended as a means to improve impact and health outcomes. However, research evidence supporting the mechanisms of impact of co‐design and related approaches in healthcare is limited. Conclusion: Nested process evaluations of co‐design are needed to support the continued theoretical and methodological development and resourcing of co‐design in healthcare. Patient or Public Contribution: A lived experience advisory group (LEAG) of older people receiving aged care services and family or other informal supporters of those receiving aged care services has provided input to the evaluation design described in this manuscript, and a member of this group has co‐authored this article. LEAG members will continue to contribute to the conduct of the evaluation as well as the analysis and dissemination of the evaluation findings.

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.

BACKGROUND In Australian residential aged care, infection prevention and control (IPC) lead nurses are a key part of the IPC program. IPC Leads are often the main IPC contact and provide support to staff to improve IPC and resident outcomes. To enhance their competence and self-efficacy, IPC Leads need to engage in ongoing role development. Connecting with others IPC Leads, learning together and sharing ideas and resources could also be beneficial. Communities of practice (CoPs) have been shown to improve self-efficacy and job satisfaction by fostering belonging, peer learning and problem-solving. Drawing on social learning theory, CoPs encourage learning with and from one another to explore and iteratively develop practice. This study draws on the CoP literature and builds on our previous pilot of a CoP for IPC lead nurses in one state of Australia, which found promising impacts on confidence and practice change. OBJECTIVE This study will evaluate CoPs for IPC Leads working in Australian residential aged care. Primarily the study will assess for change in IPC Leads’ self-efficacy. It will also explore job satisfaction, IPC practice improvement and assess the acceptability and feasibility of CoPs. METHODS A before-and-after study design using multi-methods. We will recruit IPC Leads from across Australia to participate in the CoPs. The CoPs will be implemented over 12 months, with online sessions held monthly for 30-60 minutes each. Baseline and 12-month follow-up surveys of IPC Leads’ self-efficacy and job satisfaction, and audits of IPC practice will be conducted. At 12-months follow-up, surveys and interviews with IPC Leads will be assess acceptability and feasibility of the CoPs and explore case examples of IPC Leads facilitating practice change. Researcher notes and costings data collected will be used to further evaluate the feasibility and fidelity of the CoPs. RESULTS This project was funded in October 2024 and commenced in February 2025. Recruitment of IPC Leads began in March 2026. The CoPs are expected to commence in June-July 2026. Data collection will commence in June 2026 and is expected to be completed by January 2028. CONCLUSIONS Findings will create new research knowledge in the field of CoPs and knowledge translation in the aged care sector and will inform the sustainability and potential for future scale-up of this collaborative social learning approach. CLINICALTRIAL Not applicable

Background and Objectives: Communication changes in older adults affect independence, social participation, and quality of life. In aged care settings, timely identification of communication support needs and preferences is essential to upholding older people’s rights and ensuring person-centered care, yet communication is not routinely assessed. This scoping review systematically identifies and describes instruments that measure communication support needs and preferences in older adults. Research Design and Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, we searched PubMed, PsycINFO, CINAHL, and Embase alongside gray literature. Titles, abstracts, and full texts were screened against eligibility criteria using Covidence. Data on instrument context, content, and administration were extracted and synthesized using content analysis and the World Health Organization International Classification of Functioning, Disability and Health framework. Results: 26 publications describing 29 instruments were included. Instruments were typically condition-specific (e.g., dementia) or impairment-specific (e.g., hearing loss). Communication preferences and personal factors, such as cultural and linguistic background, were rarely considered, and only one instrument assessed both needs and preferences. While self-report instruments were often intended for completion by the older adult, only one offered a communication-accessible version (e.g., easy read text, larger font, visual aids). Discussion and Implications: No existing instrument adequately measures communication support needs and preferences for use in aged care settings. A condition-agnostic instrument is needed that adopts a holistic, biopsychosocial perspective; accounts for the aged care environment; incorporates multiple perspectives; and is communication-accessible. Developing such a measure is a foundational step toward accurate, consistent, and timely identification of the communication needs of older adults in aged care.

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.

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.