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The Optimising older People’s Transition from acute care Into residential aged care through Multidisciplinary Assessment and Liaison (OPTIMAL) trial is a multisite hybrid type II stepped wedge randomised controlled trial with an embedded process evaluation that aims to evaluate the effectiveness of implementing a bundle of evidence-based interventions to provide systematic support to older adults being discharged from hospital to residential aged care (RAC) homes for the first time. The trial is based on evidence from models of care used internationally to improve the quality of care transitions and addresses a need to provide evidence of transferability and effectiveness of these models in the Australian context. The embedded process evaluation will assess the acceptability, appropriateness, feasibility, adoption and fidelity of the OPTIMAL intervention, as well as the mechanisms of impact.
The OPTIMAL trial will be implemented across the three metropolitan local health networks (LHNs) in South Australia. The process evaluation will be conducted in parallel with the main trial and is theoretically informed by the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) implementation framework, which theorises that the implementation success of OPTIMAL is determined by the facilitation of the intervention with the intended recipients in their inner and outer contextual setting. The process evaluation will employ a mixed methods approach. Qualitative and quantitative data will be collected through baseline context mapping of LHNs, interviews with key LHN and RAC stakeholders, online survey of clinical teams, fortnightly check-in forms, and activity logs and field notes maintained by the nurse facilitator in each LHN. Data will be mapped and reported based on the i-PARIHS framework.
Ethical approval for the OPTIMAL trial was obtained from the Southern Adelaide Clinical Human Research Ethics Committee (approval 2023/HRE00111), and the relevant governance approvals were obtained for each participating LHN. Ethical approval includes a waiver of the requirement for consent for routinely collected patient data. Study findings will be disseminated via journal publications, presentations at conferences, stakeholder discussions, consumer forums and advocacy to key decision makers to support knowledge translation.
Australia New Zealand Clinical Trial Registry, ACTRN12624001008516, registered 20 August 2024.
To discuss reflexivity for conducting hermeneutic phenomenology and to present the hermeneutic phenomenological circle.
Discussion paper.
We employed data on the lived experience of loneliness of older adults in residential care homes during the COVID-19 pandemic to demonstrate the reflexivity required for hermeneutic phenomenology. We showcased a reflective process grounded in Heidegger's notions of Being and temporality to uncover the context of meaningfulness and its temporal influence on being.
We proposed a hermeneutic phenomenological circle encompassing four relations passing between Being, the interpreter and being. The circle was successfully applied to demonstrate the reflexivity required to conduct hermeneutic phenomenology.
Engaging in reflexivity requires the researcher to develop knowledge about the philosophy of hermeneutic phenomenology. The hermeneutic phenomenological circle facilitates researchers in anchoring their reflections in Being and temporality.
The hermeneutic phenomenological circle serves as a useful tool for researchers/health professionals to learn hermeneutic phenomenology and to facilitate researchers/health professionals at all career stages to engage in reflexivity.
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