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To understand the current evidence base regarding holistic nursing assessments performed by registered nurses in residential aged care homes in Australia, and identify the gaps in knowledge and potential areas for future research.
A scoping review informed by JBI guidelines and the PRISMA extension for Scoping Reviews.
The electronic databases Medline, EMBASE, CINAHL, Scopus and ProQuest Central were searched, alongside citation chaining and manual journal searches. Limits of English language and publication after the year 2000 were applied. Studies were screened against pre-defined eligibility criteria. Data were extracted and analysed using descriptive statistics and a narrative synthesis.
A total of 3987 studies were identified, of which 28 were categorised as comprehensive or multimodal assessment programmes, standalone assessment tools or assessment infrastructure papers. Key outcomes described included staff factors and resident emergency department transfers or hospitalisations. The key feature of existing nursing assessments across studies was education, which was generally associated with improved staff knowledge, confidence and efficiency. Apart from this, there was large heterogeneity among assessment interventions with inconsistent effects. Few studies focused on residents with dementia or palliative care needs.
There is currently no standardised, systematic approach to the holistic assessment of residents by registered nurses in Australia. This gap in assessment is especially evident for residents with dementia or palliative care needs.
This research highlights the need to develop standardised holistic nursing assessments to bridge this gap in practice.
No Patient or Public Contribution.
People experiencing severe and multiple disadvantage (SMD: homelessness, substance use and criminal offending) have multiple intersecting unmet health and social care needs and high mortality rates, often due to street-drug overdose. Pilot randomised controlled trials (RCTs) suggest an integrated, holistic, collaborative outreach intervention (Pharmacy Homeless Outreach Engagement Non-medical Independent Prescribing Rx (PHOENIx)) involving generalist-trained pharmacists, nurses or General Practitioners accompanied by staff from third sector homeless organisations may improve outcomes, including reducing overdose.
Multicentre, parallel group, prospective RCT with parallel economic and process evaluation. Set in six areas of Scotland, UK, 378 adults with SMD will be recruited and randomised (stratified by setting and previous non-fatal overdoses) to PHOENIx intervention in addition to usual care (UC) or UC. Aiming to meet participants weekly for 9–15 months, PHOENIx teams assess and address health and social care needs while referring onwards as necessary, co-ordinating care with wider health and third sector teams. During a person-centred consultation, in the participants’ choice of venue, and taking account of the participant’s priorities, the NHS clinician may prescribe, de-prescribe and treat, for example, wound care, and refer to other health services as necessary. The third sector worker may help with welfare benefit applications, social prescribing or advocacy, for example, securing stable housing. Pairings of clinicians and third sector workers support the same participants. The primary outcome is time to first fatal/non-fatal street-drug overdose at nine months. Secondary endpoints include health-related quality of life, healthcare use and criminal justice encounters. A health economic evaluation will assess cost per quality adjusted life year of PHOENIx relative to standard care. A parallel qualitative process evaluation will explore the perceptions and experiences of PHOENIx, by participants, stakeholders and PHOENIx staff.
The primary and other time-to-event secondary outcomes will be analysed by Cox proportional hazards regression.
IRAS number 345246, approved 23/10/2024 by North of Scotland Research Ethics Service. Results will be shared with participants, third sector homelessness organisations, health and social care partnerships, then peer-reviewed journals and conferences worldwide, from the first quarter of 2027.
ISRCTN12234059 registered on 20/2/2025 (ISRCTN).
To understand how staff who chose to live-in with residents in a level 3 dementia care unit perceived the experience, in particular, their perceptions of how residing on site affected resident well-being.
COVID-19 has been especially devastating in aged residential care (ARC) facilities. In March 2020, when the threat became realised in New Zealand, one residential dementia care facility implemented a unique response to the imminent threat of COVID-19. Eight staff members made the decision to live on site during the lockdown, ensuring residents’ risk of contracting the virus was significantly reduced as carers would not go outside of the facility.
A qualitative descriptive inquiry.
Seven staff who chose to live-in, and the facility manager, participated in semi-structured, face-to-face interviews at the ARC. Audio-recorded interviews were transcribed verbatim and analysed using a thematic analysis approach. COREQ guidelines were adhered to in the reporting of this study.
An overarching motif which emerged from the findings was the articulation of an ‘all in this together’ attitude which fostered feelings of camaraderie and collaboration which enhanced the experience for staff individually, and as a group. Themes identified were as follows: (a) A ‘safe’ but challenging choice, (b) Benefits for the staff and (c) Positive outcomes for the residents.
This crisis inadvertently brought about an enhanced ‘dementia-friendly’, person-centred communal environment.
This study identified themes that deepen our understanding of caring for vulnerable populations during a pandemic and beyond. Given the success of this ‘live-in’ innovation, consideration must be given to applying these findings more generally when planning care models for best outcomes for residents receiving rest home level dementia care. How we care for people in disaster situations reflects the heart of the caring workforce, but such innovation may be extended to usual care where indicated.
The aim of this study was to develop a conceptual understanding of the role of caring for older adults with combined vision and hearing impairment (DSI).
Dual sensory impairment (DSI) impacts both listening and speechreading communication, function and social participation, meaning that older adults often require support and care to ‘age in place’ successfully. Family carers play a key role in supporting older adults with DSI to maintain social and physical health.
This qualitative study uses Charmaz's constructivist grounded theory (GT) methodology. Data were collected between 2017 and 2019 and analysed using constructivist GT methods. Lengthy interviews with eight family carers of older adults living with DSI explored personal histories of DSI, relationships with families, social networks and health care professionals.
This study demonstrates that caring in this context is predominantly social and ‘invisible’. To reduce the social effort of their family member with DSI and to maintain their own self-identity, family carers adopted a ‘conscious caring’ approach. This is conceptualised as an approach to caring that supports family carers to access resources embedded in their social networks by bridging the gap between the dyad and their broader, more diverse social networks.
This study identifies that a reduction in both close and broader social networks limits personal, social and psychosocial resources and impacts the capacity of the dyad to renegotiate their roles, create and maintain their individual and shared social networks and successfully transition to living with DSI.
There is a gap in the literature regarding the impact of sensory impairments on complex communication, health and social care needs of older adults and the role that family carers play. Registered nurses require complex communication skills to support older persons with DSI during health and social care interactions. A better understanding of DSI itself, as well as understanding the key role family carers play in integrating care for their family member, is crucial to delivering person-centred care.
This study addresses a growing social gerontological issue and identifies the role that family carers play in integrating health and social care for their family member with DSI. Better professional recognition of DSI and increased visibility of the challenges of living with DSI could help address barriers to effective communication between service providers, formal care support staff and those with DSI. Integrating family carers into care teams is critical to improving health and social care experiences for both caregiver and care receiver.
This study did not include patient or public involvement in its design, conduct, or reporting.
To canvas the contemporary contextual forces within the Australian residential aged care sector and argue for new research and innovation. There is a pressing need to provide systematised, high-quality and person-centred care to our ageing populations, especially for those who rely on residential care. This paper advances a warrant for establishing a new systematic framework for assessment and management that serves as a foundation for effective person-centred care delivery.
Position paper.
This paper promulgates the current dialogue among key stakeholders of quality residential aged care in Australia, including clinicians, regulatory agencies, researchers and consumers. A desktop review gathered relevant literature spanning research, standards and guidelines regarding current and future challenges in aged care in Australia.
This position paper explores the issues of improving the quality and safety of residential aged care in Australia, including the lingering impact of COVID-19 and incoming reforms. It calls for nurse-led research and innovation to deliver tools to address these challenges.
The paper proposes an appropriate holistic, evidence-based nursing framework to optimise the quality and safety of residential aged care in Australia.
This study did not include patient or public involvement in its design, conduct, or reporting.
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