Informing Better Health Care: Research snapshots from the School of Nursing and Midwifery 2013

Informing Better Health Care Research Snapshots

School of Nursing & Midwifery Flinders University

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Printing details Produced by the School of Nursing & Midwifery 2012

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Contents Introduction

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Writing the rulebook for mass gatherings

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Respecting spiritual and cultural values – but what are they?

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Cultural diversity and dementia care - the intervention model

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Changing clinical policy for improved care in mental health

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Social impacts on diabetes self-management

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Esophageal adenocarcinoma: one disease or two?

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Child health care among vulnerable groups

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Measuring resilience of Australian communities against disasters

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Consent in a moral void

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Improving quality in primary health care

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Building trust in the food industry

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Boundary-crossing between midwives and their clients

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Models of mediation to protect older persons from abuse

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Learning the language of disaster

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Professor Jeffrey Fuller

Introduction The School of Nursing & Midwifery at Flinders University is proud of its active and varied research profile. Our research strengths are optimised through focus on five research priorities: • Health care for the older person • Mental health • Primary health care • Population health • Educational scholarship Each team, led by a senior academic, provides a supportive and professional environment in which academic and research staff collaborate and higher degree students engage.

The School also hosts the Flinders University Disaster Research Centre, led by Professor Paul Arbon. The Centre’s vision is to enhance multidisciplinary research in the area of disaster at both national and international levels so as to translate research outcomes into practice based on evidence. In addition, the School hosts a node of the Centre for Research Excellence in Primary Health Care Microsystems with Professor Jeffery Fuller that is examining quality and safety systems in primary health care.

We are pleased to showcase, through this brochure, several exciting research projects which have and are being undertaken by staff in the School. The projects highlight the diversity of our research activity and its impact on health care through its capacity to inform policy, clinical practice, nurse and community education and health service delivery.

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Our researchers collaborate with industry, government and health care providers. We invite organisations to explore issues of mutual interest that may be investigated through research or addressed through professional consultancy.

We hope you enjoy learning about the research activities of the School and encourage you to contact us if you would like to know more about our research capabilities, or to explore opportunities for collaboration.

Associate Dean (Research) Professor Jeffrey Fuller

Dr Alison Hutton and Dr Steve Brown

1. Writing the rulebook for mass gatherings Project Title: Developing theory and predictive models for audience behaviour at mass gatherings Research Team: Dr Alison Hutton, Dr Steve Brown, Dr Lynette Cusack, Associate Professor Kathryn Zeitz Environmental and medical aspects in the area of mass gatherings is well developed, however there is limited theory on the psychosocial phenomenon of large scale public events. Therefore, the context and risk assessment of such events has been, up until now, incomplete. This research asks – why do people attend events and what are they going to do there? Are they going to drink, dance, ‘mosh’ etcetera? It maps the potential hazards implicated from these perspectives and allows for better mitigation of risk.

The School of Nursing & Midwifery’s Dr Alison Hutton is constructing the research in collaboration with another Flinders academic in the field of event design, Dr Steve Brown. The goal of this project is to determine how to ensure safety at mass gathering events attended by more than 10,000 people, based upon the understanding of crowd behaviour and relevant, strategic use of event design mechanisms.

It considers the impact of attendee’s motivations and actions in an attempt to deter health issues from arising, rather than focusing only on the outcome of issues occurring at events.

Where traditionally there may be tally of attendees who contracted disease at such events, the approach of this research could involve warnings and community education regarding washing of hands to avoid contracting gastro, for example. Or, with the schoolies festivals where a large gathering of young people are inclined to drinking, it is recommended that other young people be recruited to walk them home and avoid trouble.

Understanding the motivations and intentions of people to attend events allows parents, adolescents and the organisers of mass gatherings to mitigate some of the negative things that may otherwise arise. This is especially relevant as mass gatherings become larger and more frequent where cities seek to financially gain from the influx of large crowds. This work represents the science behind mass gatherings.

Some of Dr Hutton and Dr Brown’s research is to be included in a chapter for the World Health Organisation’s ‘rulebook’ on mass gatherings, Key Considerations for Mass Gathering Events, for use at events such as the Olympic Games, the Hajj pilgrimage to Mecca and the World Cup where understanding crowd behaviour is crucial to managing risk. The chapter considers the type and mood of a crowd, religious or political influences, the potential for violence and the effect of music, alcohol, seating and fencing at mass gatherings. This chapter involves collaboration with another School of Nursing & Midwifery academic Dr Lynette Cusack and Associate Professor Kathryn Zeitz from the School of Medicine.

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Anne Davies and Dr Ann Harrington

2. Respecting spiritual and cultural values – but what are they?

Project Title: The culture and spiritual life of older people in residential aged care Research Team: Dr Ann Harrington, Ms Anne Davies Increasing quality of care through a better understanding of spirituality and cultural diversity is at the core of this research.

Spirituality is found to be an important predictor of quality of life. The challenges of understanding spirituality in an older and increasingly diverse population is growing where spiritual interest is often pronounced in old age or in palliative care, where end of life is near. Further, Australia’s population of older people from non-English speaking backgrounds is expected to increase so that by 2026, one in four Australians aged 80 and over will be classified as such.

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Culture and spirituality are linked together within the Aged Care Accreditation Standard, ‘Cultural and Spiritual Life,’ as an expected outcome.

However, where culture is readily identifiable, spirituality is a ‘hidden’ area

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and not as accessible as the physical, psychological and emotional aspects of a person. In an aim to enhance health care related to this standard, School of Nursing & Midwifery researchers have partnered with Resthaven Incorporated to establish methods to measure what culture and spirituality mean to residents of Resthaven. This study addresses the question: What constitutes culture and spiritual life for a resident in a Residential Aged Care Facility in South Australia? In exploring spiritual need it distinguishes between religious tendency and other interpretations of spirituality.

Ambiguity around spirituality is also identified through nursing staff in the aged care sector who confirm that the documentation around this standard lacks clarity, raising questions as to whether this aspect of care is being delivered to residents. Therefore, in addition to addressing cultural difference as an important issue for improved health care, this research seeks to understand spirituality as it pertains to the individual.

The research in this area is underdeveloped, despite the fact that the Aged Care Accreditation standards and Palliative Care Australia identify the importance of cultural and spiritual care.

The project therefore fulfils a strong and increasing social need. It provides preliminary data for continuing research with interstate and international partners in the health care industry for a larger scale investigation. Findings from this research may inform patient experiences outside old age and palliative care where points of transformation occur, such as grief and loss

Dr Anita De Bellis and Dr Lily Xiao

3. Cultural diversity and dementia care - the intervention model Project Title: Improving support for caregivers of people with dementia from culturally and linguistically diverse backgrounds by strengthening community care services: a randomised controlled trial

with care services, while experiencing fewer burdens compared with those left to use a usual care format of caregiving support. This valuable research therefore supports personalised, culturally congruent caregiving support, and the potential for easy translation into similar service contexts.

Research Team: Dr Lily Xiao, Professor Brian Draper, Dr Anita De Bellis, Ms Helena Kyriazopoulos, Ms Cathy Zesers, Mr Tim Wallace

The School of Nursing & Midwifery’s Dr Lily Xiao and Dr Anita De Bellis have partnered with others in this research, including Alzheimer’s Australia, Carers SA, Carers Support, Chinese Welfare Services of SA Inc., Domiciliary Care SA, Greek Orthodox Community Care of SA Inc., Greek Welfare Centre, Healthfirst, Italian Benevolent Foundation SA Inc., Uniting Care Wesley, Vietnamese Community in Australia SA Chapter Inc. and Western Linkages.

Studies reveal that caregivers from a culturally and linguistically diverse background who care for people with dementia, also from a culturally and linguistically diverse background, are less likely to use care services and more likely to experience significantly higher care burden, compared with caregivers from mainstream culture.

This research is designed to test the hypothesis that caregivers in a personalised and coordinated support group will show an improved sense of competency, quality of life, satisfaction

A randomised controlled trial is being used to test this hypothesis where one hundred caregivers from a culturally and linguistically diverse background who care for persons with dementia, also from a culturally and linguistically diverse background, have been recruited to participate in the trial.

The participants are randomly assigned to either an intervention group or a usual care format. The effects of the trial are measured at baseline, and after six and twelve months. Between-group and within-group comparisons are also explored and the anticipated outcomes include the following: −− Caregivers’ competence in their role will be improved after the intervention. −− Caregivers’ quality of life will be improved after the intervention. −− Care recipients’ behavioural disturbances will decrease after intervention. −− The use of dementia care services will increase after intervention. −− Caregivers’ satisfaction with care services and caregiver support will improve after intervention.

The next step in this research will involve implementing the evidence into practice in a wider community setting, and to test the outcomes.

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Dr Adam Gerace and Professor Eimear Muir-Cochrane

4. Changing clinical policy for improved care in mental health Project Title: An investigation into the role of the nurse in caring for patients at risk of absconding from psychiatric inpatient units Research Team: Professor Eimear Muir-Cochrane, Dr Adam Gerace, Dr Patricia Barkway Improving inpatient care in psychiatric units is at the core of this policy-changing work by our research team. The work is a result of three funding grants over five years and investigates issues around patient wellbeing involving absconding – patients leaving the ward/hospital without permission – and the locking of doors.

The research found that patients often abscond because they feel unsafe, where the locking of doors is exposed as a contributing factor, rather than a solution. It was also found that locking doors does not necessarily stop patients from leaving. The demonstrated potential for adverse outcomes resulting from this research, including harm to the

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patient and disruption to their treatment, supports the need for research and practice interventions in this area.

However, there has been limited research conducted in Australia until now.

Related research, also from the School of Nursing & Midwifery, found that the absconding rate across three acute inpatient units over one year was 13.3 per cent of patients admitted to those wards, indicating that absconding is a relatively common event and poses real implications for mental health professionals and patients. This research examines absconding episodes over several years and across multiple wards, examining patient perspectives on absconding and the nature of the ward environment and also includes contributions of carers and families. It is undertaken in partnership with the Department of Health, SA Mental Health Directorate and the Nurses’ Memorial Foundation with international partners including the City University of London and the Institute of Psychiatry (London).

The aims of this project are to: −− Determine rates of absconding and develop comprehensive profiles of absconding consumers, including sex, age, diagnosis, Aboriginal Torres Strait Islander/Culturally and Linguistically Diverse status, legal status, repeat absconding and previous seclusion or restraint episodes. −− Examine the role of the mental health nurse and other health professionals in the assessment and management of the risk of absconding within the ward environment. −− Examine the perceptions and experiences of mental health professionals, carers and consumers regarding absconding.

This work has informed hospital policy and procedures in developing interventions to address absconding and has changed clinical policy in South Australia, through the Department of Health, in regards to guidelines for people at risk from absconding.

Professor Jeffrey Fuller and Dr Julie Henderson

5. Social impacts on diabetes self-management Project Title: The impact of social networks on self-management of type 2 diabetes for people with mental illness Research Team: Dr Julie Henderson, Professor Jeffrey Fuller, Professor Debbie Kralik, Professor Paul Ward, Ms Mikaila Crotty, Ms Sue Gregory Effective diabetes self-management is essential for preventing complications of the disease which can severely impact the wellbeing of diabetes sufferers and lead to morbidity or institutional care. Addressing questions such as, ‘What do people need for self-management in their homes?’ helps to alleviate further complications of the disease such as the loss of limbs, which will in turn require extra support.

Effective self-management is therefore crucial to alleviating the pressure on an already overwhelmed health care system.

The School of Nursing & Midwifery’s Dr Julie Henderson and Professor Jeffrey Fuller have partnered with the Royal District Nursing Service to explore the social implications on type 2 diabetes self-management. The research specifies participants who are diabetes sufferers

with a mental illness, in an attempt highlight gaps in the current approach which places responsibility onto the person without consideration to their social context and the resources that they draw upon. The research therefore helps to inform how to better support the range of people with mental illness in managing type 2 diabetes.

Self-management can include support from peer relationships and can occur within broader support networks including professional support. The aims of the research are to determine: −− Who within the person’s social and professional networks supports selfmanagement of type 2 diabetes. −− How access to social, cultural and economic resources impact upon access to and use of social and professional networks.

Some of the factors considered in mapping a person’s social networks included proximity to support services, hours spent, methods of contact and forms of assistance. For example, preliminary analysis shows that people with a spouse require less professional support, and that a spouse, pets and the RDNS are generally valued more highly towards the agenda of self-management than other professionals. This indicates that ongoing relationships in these areas may be necessary, based upon the motivation they provide for improved self-management.

In order to encourage independence and self-management through use of professional services, it was found that access to information and to funds plays a significant role for people with type 2 diabetes and a mental illness.

−− How different types of relationships are involved in different aspects of diabetes self-management. −− What network attributes are associated with professional-centred outcomes and patient-centred outcomes. −− How the existence of particular networks impact on the use of other health resources.

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Dr Paul Drew

6. Oesophageal adenocarcinoma: one disease or two?

Project Title: Oesophageal adenocarcinoma from patients with or without Barrett’s oesophagus: different gene expression and DNA methylation profiles, biomarkers for survival and response to treatment, and cancer biology?

Research Team: Dr Paul Drew, Dr Eric Smith, Dr Timothy Underwood, Dr Andrew Ruszkiewicz, Professor Glyn Jamieson Oesophageal adenocarcinoma is increasing in incidence more rapidly than any other common cancer in the western world, and continues to have a dismal prognosis. Dr Paul Drew is a scientist with the School of Nursing & Midwifery and together with national and international collaborators, he is investigating its development and progression.

Cancer research has typically focused on genetic defects such as mutations however the problem may not just

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be in the structure of the genes, but the mechanisms which regulate their switching on or off. This project focuses on DNA methylation, used by cells to ‘switch off’ genes for the medium to long term. Changes in DNA methylation are common and important in the biology of cancer, especially if protective genes are inappropriately switched off. Clinically, these changes have the potential to indicate critical points in the progression of cancer.

This cancer is thought to originate from pre-malignant change in the lining of the throat, known as Barrett’s oesophagus.

Generally Barrett’s is found adjoining the cancer, but in many patients (40 per cent in Adelaide) it is not detected, despite exhaustive searching. Patients with Barrett’s survive significantly longer. The accepted explanation is that both forms of the cancer arise from Barrett’s, but the cancer without Barrett’s oesophagus is at a later stage in which the cancer has overgrown the Barrett’s oesophagus.

However, Dr Drew and his team suggest that it is not that simple.

This research found that in Adelaide, the tumours in patients with Barrett’s were only slightly larger, but their behaviour was significantly more invasive and metastatic. Pilot studies found differences in DNA methylation, which in turn suggests differences in important molecular pathways between the two types of cancer. The team’s current research is trying to confirm these findings. They are analysing tissues from a large group of patients so that they can account for variables such as the stage and characteristics of the disease, and discover markers that will predict response to therapy and metastasis to lymph nodes.

This project has the potential to lead to new understandings of cancer biology, new prognostic molecular signatures, improved patient management, and possibly tailored therapies for this increasingly common cancer.

Dr Julian Grant

7. Child health care among vulnerable groups Project Title: Working with diversity in community child health care Research Team: Dr Julian Grant, Associate Professor Pauline Guerin Culturally safe healthcare, including respectful communication, is an essential component to reducing health inequities, especially for children and families who are ethnically and racially marginalised.

Children and families from Aboriginal and Torres Strait lslander backgrounds and from cultural and linguistically diverse backgrounds, including refugees, not only experience poorer health than AngloEuropean Australians, they are also often treated with discrimination that poses further challenges for them to be healthy and to access health services. This research collaboratively develops a model of critical cultural reflection with child health professionals who work with families from such marginalised communities in order to contribute to improving the health care outcomes for this vulnerable group of infants and children.

We know that what happens in the early years of a child’s life affects their long term health outcomes and their

ability to achieve educationally and economically. More specifically, refugee children who have also experienced traumas such as physical and mental deprivation, violence and displacement at critical developmental stages are likely to have a higher burden of mental health problems. Disadvantage which begins before birth and follows into infancy and early childhood is known to accumulate throughout life.

Despite the range of programs to develop culturally competent practice in health care, people from ethnically and racially marginalised backgrounds continue to experience health care that is discriminatory and culturally unsafe.

Programs which do exist have mostly developed outside contexts relevant to Australia or they are placed in particular contexts of care. While the majority of programs in Australia have been developed to enhance health care for people from lndigenous communities, only one program has been identified which involves families from other ethnically and racially marginalised backgrounds. In addition, the majority of programs have not been evaluated or based on research evidence.

This innovative research from the School of Nursing & Midwifery works with child health professionals and relevant families to deliver culturally safe practice and to explore race-based discrimination in practice, within an ‘early years’ context.

Uniquely, this research considers culturally safe approaches to care that value the life histories of ethnically and racially marginalised peoples. It will enhance the health experiences and health outcomes for ethnically and racially marginalised children across South Australia and will work towards a researched, sustainable model for critical cultural reflection for use across Australia. This a small project nested within a cluster of projects being undertaken by the research team, aimed at improving child health outcomes within families rendered vulnerable due to sociocultural health inequities.

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Professor Paul Arbon and Dr Lynette Cusack

8. Measuring resilience of Australian communities against disasters Project Title: Building community resilience to disasters Research Team: Professor Paul Arbon, Adjunct Professor Kristine Gebbie, Dr Lynette Cusack, Ms Sarah Verdonk The Flinders University Disaster Research Centre (DRC) is comprised of leading academics in the field of disaster research.

Professor Paul Arbon and Dr Lynette Cusack from the DRC are collaborating with the Torrens Resilience Institute on a project funded by the Commonwealth Government National Emergency Management Plan to develop a useful tool for measuring the resilience of Australian communities against disasters.

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The importance of strengthening local communities against disaster events by enabling them to determine how resilient they are against these adverse situations is critical. The Commonwealth National Strategy for Disaster Resilience notes that it is important to build upon our existing emergency planning arrangements. It also supports a focus

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on action-based resilience planning to strengthen local capacity and capability, with greater emphasis on community engagement and a better understanding of the diversity, needs, strengths and vulnerabilities within communities.

The Strategy emphasises that disaster resilience is not solely the domain of the emergency services but involves a wide range of organisations, groups and individuals.

The aim of this project is to clarify the concept of community disaster resilience, and develop a tool to measure the resilience of communities to all hazards.

The use of such tools will help identify the degree to which communities: −− Are able to gage and/or acknowledge threats and risks. −− Work with the emergency services and other agencies. −− Have a sense-of-community and social capital. −− Are willing to take collective responsibility to reduce the socioeconomic impact of disruptive events, emergencies and disasters.

The tool being developed to address these actions is called the Community Disaster Resilience Scorecard. The Scorecard contains four elements of community disaster resilience, supported by detailed assessments of each part, a guide outlining the process of using the Scorecard, a glossary of terms used in the Scorecard and a resource sheet to assist the Community Scorecard Working Group to find data sources to measure their areas of community resilience.

The Scorecard is being trialled with a number of communities across different Australian jurisdictions. These communities represent a mix of rural and metropolitan areas as well as those communities who have experienced a disaster, and those who have not.

Findings from this important research will help to strengthen our capacity to manage the ever-increasing occurrence of disaster, on the ground.

Associate Professor Sheryl de Lacey

9. Consent in a moral void Project Title: Consent in a moral void: moral, legal and community values in decisions about humans Research Team: Associate Professor Sheryl de Lacey, Professor Wendy Rogers, Professor Ngaire Naffine, Professor Annette Braunack-Mayer, Mrs Bernadette Richards, Mrs Angela Ballantyne This large, Australian Research Council funded project involves a collaboration between researchers in health ethics and law at Flinders University, Macquarie University and the University of Adelaide.

The project was led by our School of Nursing & Midwifery’s Associate Professor Sheryl de Lacey and investigated the views of the South Australian community in relation to issues of biological donation, particularly donation of frozen IVF embryos and organ donation. The findings will inform and help guide policy and practice in assisted reproduction and organ donation.

The study explores the following: −− Community views about the status of human embryos and human bodies on death. −− The acceptable range of uses of them. −− Views about who should make the decision for donation.

This innovative project has illuminated the views of ordinary people with a range of age, gender, education, socio-economic status and residence (metropolitan, rural and remote) who were recruited in a population survey. The findings show that women and men had different views about what an embryo is, how it should be used and who should decide, where men were more likely to consider embryos to be biological cells rather than humans or potential humans.

The majority of participants thought that embryos should be used rather than discarded. However the community held different views about how they should be used with many favouring their use in research but others favouring their use in reproduction. Whether an embryo was perceived as being human or biological cells influenced how community members thought it should be used.

Finally, the survey sought community views about organ donation after brain death and found that two thirds of the community thought organs should be donated, while one quarter thought bodies should be left whole. Three quarters of the community thought that the person themselves should decide whether to be an organ donor and that if their family had a different view, that the person’s wishes should be respected, even if this upset the family.

The survey also asked the community about the timing of organ recovery when a patient donates organs after cardiac death. The study found that 45 per cent of the community selected a timeframe that meant the organs could be transplanted, while 34 per cent selected a timeframe that meant that the organs could not be transplanted.

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L-R front row: Dr Shelley Wilkinson, Professor Claire Jackson, Caroline Nicholson and Dr Tina Janamian Back row: Professor James Dunbar, Associate Professor Julie Johnson and Professor Jeffrey Fuller

10. Improving quality in primary health care Project Title: Building quality, governance, performance and sustainability in primary health care through the clinical microsystem approach Research Team: Professor Claire Jackson, Professor James Dunbar, Professor Jeffrey Fuller, Associate Professor Julie Johnson, Professor Paul Batalden, Caroline Nicholson, Dr Shelley Wilkinson This is a program of work to address quality and safety gaps in the general practice system in Australia through supporting good evaluation and care management practices by primary health care providers. The research will be of particular benefit to the management of chronic disease and to caring for an aging population, where follow through of a care regime requires a team based approach with the patient and carers.

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The research is examining a multimillion dollar team-based Australian Primary Care Collaboratives approach (Plan, Do, Study, Act), over a national spread of 20 general practices. The Collaboratives approach is focused on the

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roles and responsibilities of participating practitioners as a team, as well as the use of processes to ensure the provision of effective, high quality and safe care.

The aim of the project is to generate better clinical outcomes through the exploration of case studies that will identify the processes which lead to high level service performance, according to accredited standards.

Best practice regimes of care such as including evidence-informed checkups in a patient’s schedule, involve much more than the GP and include an effective IT system and extended roles for practice nurses and practice managers.

How central is the nurse in the team and for what functions? What do we need to support the development of the nurse in a team based approach?

This research program is therefore twofold. It explores the extent to which this collaborative team approach leads to a better system of management and better outcomes in chronic disease management, and it identifies the characteristics of high performing practices. It is anticipated that practice leadership, high level team functioning and good use of IT management systems

will be instrumental in determining whether appropriate care is provided that leads to improved clinical outcomes.

The program involves the expertise of the School of Nursing & Midwifery’s Professor Jeffrey Fuller and it forms one of the Centres of Research Excellence of the Australian Primary Health Care Research Institute. The Centre is a collaboration between Flinders University’s School of Nursing & Midwifery and Greater Green Triangle University Department of Rural Health, University of Queensland and University of New South Wales. There is a range of partners involved including the Australia Primary Health Collaborative Program, the Australian Practice Nurses Association, the Royal Australian College of General Practice, the Australian Practice Managers Association and the Australian Commission on Quality and Safety in Health Care.

Dr Julie Henderson

11. Building trust in the food industry Project Title: Trust makers, breakers and brokers: building trust in the Australian food system Research Team: Professor John Coveney, Professor Paul Ward, Dr Julie Henderson, Dr Samantha Meyer, Professor Anthony Elliott, Dr Trevor Webb, Professor Martin Caraher, Professor Michael Calnan, Dr Annabelle Wilson Trust is a key ingredient in the food industry and this Australian Research Council funded research explores how to build it and maintain it in the face of a food scare. How do media and public relations representatives build or destroy trust among consumers, and how does the issue of trust impact upon food industry regulation? The project aims to develop models of trust repair and maintenance in order to potentially preempt relevant policy.

The mad cow disease of the 1990s has positioned UK researchers as excellent partners in this collaborating project, where the City University London and Kent University have joined with

researchers from the disciplines of Public Health, Food Standards Australia and New Zealand and the School of Nursing & Midwifery’s Dr Julie Henderson to tackle the task, where the Department of Health SA is also an industry partner. In addition to food scares, trust in food has also been jeopardised by the importing of food into Australia.

the benefits of new food technologies and expert advice on healthier eating habits. The approach to this research is three phase – a cross-country comparison of reporting of food trust; an exploration of organisational mechanisms and strategies; the contribution of food industry experts to develop models of trust building, maintenance and repair.

The outcomes of the study will seek to inform Australian food regulation with appropriate strategies to address the following:

The need for models of trust maintenance and rebuilding is born out of an earlier Flinders Australian Research Council funded research project which found that Australian consumers exhibit trust which is characterised by dependence upon food systems, rather than active reflection about the safety of food supply. It was found that a majority of participants in this study took the safety of the Australian food supply for granted. It is expected that the findings from the current study will be easily transferable to other consumer based offerings such as traditional medicine as well as pharmaceutical medicine, pet foods and other products.

−− Why and how food-related organisations develop, maintain and rebuild consumer trust in response to food scares. −− The role of the media, consumer organisations and public relations department in developing and maintaining trust during food scares. −− Trust in food systems in an era of intensive globalisation. −− Models of trust building, trust maintenance and trust repair.

The significance for the study is based upon the need for trust in food supply if consumers are to recognise and accept

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Associate Professor Pauline Glover

12. Boundary-crossing between midwives and their clients Project Title: Development of a conceptual model for the continuity of care for midwifery students Research Team: Associate Professor Pauline Glover, Dr Linda Sweet Midwifery students are able to follow women throughout their pregnancy, birthing and post-natal care. This model is known as continuity of care. The midwifery student forms a relationship with the woman and their families and often act as an advocate for the woman during her pregnancy and the birth. Defining boundaries around this relationship, from professional to personal, is therefore often difficult to achieve, and ending the association can pose even greater challenges.

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This research aims to identify a model of care which allows the student to establish personal boundaries around the process. It involves developing a package for teachers, students and clinicians which will contain guidelines which prepare the student in this context;

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advise on support for the student while they learn; provide guidance in critical reflection; and provide guidance in terminating the relationship in order to retain professional boundaries. This project provides national strategic leadership in its capacity to facilitate the development and sharing of knowledge and practice for this mandated Work Integrated Learning (WIL) activity.

The project involves: −− Collecting data from the 25 universities which have a midwifery course accredited with the Nursing and Midwifery Board of Australia. The Midwifery Course Coordinators will be asked to provide details of their Continuity of Care instructions to both students and clinical venues that include the before, during and after activities. These will then be collated to provide a national perspective. −− Survey of 50 Registered Midwives who supervise midwifery students during the Continuity of Care WIL experiences. −− Survey 50 newly graduated midwives and 50 current students.

The research builds on former work where participants identified powerful learning through their continuity of care experiences and the development of their conceptual, procedural and dispositional knowledge. The research identified that there were a range of considerations for how these types of knowledge might be maximised before, during and after the continuity of care experience. The learning from the continuity of care is student led, student controlled, and student directed and therefore has the potential to develop the agency of the student.

The current project will have the potential for national impact on all midwifery education programs across Australia.

Dr Lana Zannettino

13. Models of mediation to protect older persons from abuse Project Title: Preventing the financial abuse of older people by a family member: designing and evaluating older-person centred models of family mediation Research Team: Associate Professor Dale Bagshaw, Dr Lana Zannettino, Dr Sarah Wendt, Dr Valerie Adams This project explores the design and evaluation of types of intervention models that will prevent and mitigate the financial abuse of older persons by their family members. Elder abuse has been a hidden phenomenon impacting the lives of vulnerable adults and research and policy development in this field is approximately 30 years behind child abuse and domestic violence. The most prevalent type of abuse towards older persons reported by persons over 65 years of age is of a financial nature.

Our aging population along with the increasing numbers of older persons being cared for in the community and their increasing wealth means that this type of abuse is likely to increase.

Older persons are less likely to report financial abuse because it occurs within a relationship of trust. Many older persons are not aware that they are victims of financial abuse and interestingly, much of this abuse is unintentional. The School of Nursing & Midwifery’s Dr Zannettino and team have undertaken a national survey of Chief Executive Officers and service providers in human services organisations, as well as older persons and family members. More than 80 per cent of service providers reported that the main risk factor for financial elder abuse is a family member with a strong sense of entitlement to the older person’s property or assets. Other risk factors reported included an older person with diminished capacity (81.1 per cent); and an older person being dependent on a family member for care (80.6 per cent). Over one-third of older people and family members surveyed reported being concerned about the older person’s property, finance or assets.

This research develops, trials, and evaluates new, innovative and specialised models of family mediation as a prevention and early intervention strategy.

It focuses on strengthening family relationships, preventing financial abuse, centralising the best interests of older people (with and without capacity), and including their voices in decisions that affect them. It addresses conflict and poor communication, and educates the older person as to the dynamics and meaning of such abuse. This approach therefore aims to reduce the incidence and severity of financial abuse within a framework that promotes social sustainability and family cohesion. The outcomes of the project will have a direct and positive impact on policy and practice in the social and economic care of older people.

The research is a collaboration between the School of Nursing & Midwifery and researchers from UniSA. It is Australian Research Council funded and its project partners include Alzheimers Australia (SA), Department for Communities and Social Inclusion, Guardianship Board, SA Health Office for the Aging, Office of the Public Advocate, Relationships Australia (SA and Vic), with assistance from the Aged Rights Advocacy Service and Braes Mediation Solutions, who each contributed to the development of the models.

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Associate Professor Lidia Mayner

14. Learning the language of disaster Project Title: The need for consensus for disaster terminology Research Team: Associate Professor Lidia Mayner and Professor Paul Arbon Strategic research in the field of disaster nursing is underway, led by the School of Nursing & Midwifery’s Associate Professor Lidia Mayner, through the Flinders University Research Program for Disaster Nursing (FURPDN). This work will enable nurses who respond to extreme events to have access to a glossary of terms specific to the field of disaster nursing.

The glossary on disaster nursing is almost completed and will be distributed for comments and suggestions and then for consensus by the International Council of Nurses (ICN) board members and the wider nursing community.

To attain international consensus is complex, however a list of terms has been established for the glossary where the terms have been identified through text analysis software.

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The need for a consensus arises in response to the confusion over varying definitions of relevant words, such as ‘disaster’, where for example one term may carry over 40 different definitions.

This complexity of definitions hinders research efforts since such terms have a different meaning for different people.

While nurses responding to extreme events would have experience in public health, emergency or critical care, they may not necessarily have experience in disaster nursing. Therefore, the glossary sets out the first step from which nurses around the world can begin to practice from an evidence-based forum. This will also provide the foundation from which research can be established and research findings compared more easily across different studies and different disasters.

The ICN accredited the FURPDN as an International Classification for Nursing Practice (ICNP) centre late in 2010. The ICNP is one of the programs encompassed in the e Health activity within the Professional Practice Pillar of the ICN. The inaugural Director of the Centre is Associate Professor Lidia Mayner. At the time this was the only ICNP centre in Australia and today it

is still the only ICNP Disaster Nursing Centre in the world. The centre is housed within the Flinders University Disaster Research Centre, directed by Professor Paul Arbon. The main goal of the FURPDN is to provide a harmonised glossary on disaster nursing that lays the foundation for a global framework for nursing practice built on evidence based practice in the area of disaster nursing.

Flinders University School of Nursing & Midwifery

inspiring achievement

Contact:

CRICOS No: 00114A

6512

Ms Pam Smith Research Manager Email: Pam.Smith@Flinders.edu.au P: +61 8 8201 5350 F: +61 8 8276 1602