In some aspect of nursing since 1969. Between 1996 a nd 2013 Professor of Gerontic Nursing and then Interdisciplinary Aged CAre at La Trobe University. Emeritus since 2013.
Background The 2001 Australian census revealed that adults aged 65 years and over constituted 12.... more Background The 2001 Australian census revealed that adults aged 65 years and over constituted 12.6% of the population, up from 12.1% in 1996. It is projected that this figure will rise to 21% or 5.1 million Australians by 2031. In 1998, 6% (134 000) of adults in Australia aged 65 years and over were residing in nursing homes or hostels and this number is also expected to rise. As skin ages, there is a decreased turnover and replacement of epidermal skin cells, a thinning subcutaneous fat layer and a reduced production of protective oils. These changes can affect the normal functions of the skin such as its role as a barrier to irritants and pathogens, temperature and water regulation. Generally, placement in a long-term care facility indicates an inability of the older person to perform all of the activities of daily living such as skin care. Therefore, skin care management protocols should be available to reduce the likelihood of skin irritation and breakdown and ultimately promote comfort of the older person. Objectives The objective of this review was to determine the best available evidence for the effectiveness and safety of topical skin care regimens for older adults residing in longterm aged care facilities. The primary outcome was the incidence of adverse skin conditions with patient satisfaction considered as a secondary outcome. Search strategy A literature search was performed using the following databases:
International Journal of Evidence-based Healthcare, Mar 1, 2006
Background In Australia, around 59% of the general population uses prescription medication with t... more Background In Australia, around 59% of the general population uses prescription medication with this number increasing to about 86% in those aged 65 and over and 83% of the population over 85 using two or more medications simultaneously. A recent report suggests that between 2% and 3% of all hospital admissions in Australia may be medication related with older Australians at higher risk because of higher levels of medicine intake and increased likelihood of being admitted to hospital. The most common medication errors encountered in hospitals in Australia are prescription/medication ordering errors, dispensing, administration and medication recording errors. Contributing factors to these errors have largely not been reported in the hospital environment. In the community, inappropriate drugs, prescribing errors, administration errors, and inappropriate dose errors are most common. Objectives To present the best available evidence for strategies to prevent or reduce the incidence of medication errors associated with the prescribing, dispensing and administration of medicines in the older persons in the acute, subacute and residential care settings, with specific attention to persons aged 65 years and over. Search strategy Bibliographic databases PubMed, Embase, Current contents, The Cochrane Library and others were searched from 1986 to present along with existing health technology websites. The reference lists of included studies and reviews were searched for any additional literature. Selection criteria Systematic reviews, randomised controlled trials and other research methods such as non-randomised controlled trials, longitudinal studies, cohort or casecontrol studies, or descriptive studies that evaluate strategies to identify and manage medication incidents. Those people who are involved in the prescribing, dispensing or administering of medication to the older persons (aged 65 years and older) in the acute, subacute or residential care settings were included. Where these studies were limited, evidence available on the general patient population was used. Data collection and analysis Study design and quality were tabulated and relative risks, odds ratios, mean differences and associated 95% confidence intervals were calcu-Strategies to reduce medication errors 3
JBI database of systematic reviews and implementation reports, 2005
Background The 2001 Australian census revealed that adults aged 65 years and over constituted 12.... more Background The 2001 Australian census revealed that adults aged 65 years and over constituted 12.6% of the population, up from 12.1% in 1996. It is projected that this figure will rise to 21% or 5.1 million Australians by 2031. In 1998, 6% (134 000) of adults in Australia aged 65 years and over were residing in nursing homes or hostels and this number is also expected to rise. As skin ages, there is a decreased turnover and replacement of epidermal skin cells, a thinning subcutaneous fat layer and a reduced production of protective oils. These changes can affect the normal functions of the skin such as its role as a barrier to irritants and pathogens, temperature and water regulation. Generally, placement in a long-term care facility indicates an inability of the older person to perform all of the activities of daily living such as skin care. Therefore, skin care management protocols should be available to reduce the likelihood of skin irritation and breakdown and ultimately promote comfort of the older person. Objectives The objective of this review was to determine the best available evidence for the effectiveness and safety of topical skin care regimens for older adults residing in longterm aged care facilities. The primary outcome was the incidence of adverse skin conditions with patient satisfaction considered as a secondary outcome. Search strategy A literature search was performed using the following databases:
International Journal of Older People Nursing, Mar 1, 2007
Urinary tract infection: under treated and investigated: an examination of the nursing management... more Urinary tract infection: under treated and investigated: an examination of the nursing management of urinary tract infections in nursing home residents experiencing impaired cognition This research in nursing management of urinary tract infections in nursing home residents experiencing impaired cognition was informed through qualitative naturalistic enquiry. The findings suggest the response to this infective process lacks cohesive planning and the dearth of available evidence concerning the nursing management in this cohort has the potential to lead to detrimental health outcomes. The study exposes the complexities of issues which impact on satisfactory outcome.
Serially controversial, Professor Rhonda Nay argues that instead of simply calling for more regis... more Serially controversial, Professor Rhonda Nay argues that instead of simply calling for more registered nurses in aged care, we should re-structure their scope of practice so they effectively become nurse practitioners, and in the process give personal care workers and enrolled nurses a much greater role in the system.
Background In Australia, around 59% of the general population uses prescription medication with t... more Background In Australia, around 59% of the general population uses prescription medication with this number increasing to about 86% in those aged 65 and over and 83% of the population over 85 using two or more medications simultaneously. A recent report suggests that between 2% and 3% of all hospital admissions in Australia may be medication related with older Australians at higher risk because of higher levels of medicine intake and increased likelihood of being admitted to hospital. The most common medication errors encountered in hospitals in Australia are prescription/medication ordering errors, dispensing, administration and medication recording errors. Contributing factors to these errors have largely not been reported in the hospital environment. In the community, inappropriate drugs, prescribing errors, administration errors, and inappropriate dose errors are most common. Objectives To present the best available evidence for strategies to prevent or reduce the incidence of medication errors associated with the prescribing, dispensing and administration of medicines in the older persons in the acute, subacute and residential care settings, with specific attention to persons aged 65 years and over. Search strategy Bibliographic databases PubMed, Embase, Current contents, The Cochrane Library and others were searched from 1986 to present along with existing health technology websites. The reference lists of included studies and reviews were searched for any additional literature. Selection criteria Systematic reviews, randomised controlled trials and other research methods such as non-randomised controlled trials, longitudinal studies, cohort or casecontrol studies, or descriptive studies that evaluate strategies to identify and manage medication incidents. Those people who are involved in the prescribing, dispensing or administering of medication to the older persons (aged 65 years and older) in the acute, subacute or residential care settings were included. Where these studies were limited, evidence available on the general patient population was used. Data collection and analysis Study design and quality were tabulated and relative risks, odds ratios, mean differences and associated 95% confidence intervals were calcu-Strategies to reduce medication errors 3
Nursing care of older people is informed by many different theoretical frameworks. This paper con... more Nursing care of older people is informed by many different theoretical frameworks. This paper contends that two such frameworks, the lifecourse theory and some aspects of Western medicine are cultural constructs that are often seen as normative therefore obscuring the power relations implicit in these constructions. The paper argues that nurses are implicated in reproducing these cultural constructions but more particularly, these constructions may have no meaning for non-English speaking older people. Finally, the paper suggests that nurses could benefit from a more localised, contextual view of ageing.
Background Modern healthcare philosophy espouses the virtues of holistic care and acknowledges th... more Background Modern healthcare philosophy espouses the virtues of holistic care and acknowledges that family involvement is appropriate and something to be encouraged due to the role it plays in physical and emotional healing. In the aged care sector, the involvement of families is a strong guarantee of a resident's wellbeing. The important role family plays in the support and care of the older adult in the residential aged care environment has been enshrined in the Australian Commonwealth Charter of Residents' Rights and Responsibilities and the Aged Care Standards of Practice. Despite wide acknowledgement of the importance of family involvement in the healthcare of the older adult, many barriers to the implementation of participatory family care have been identified in past research. For older adults in the healthcare environment to benefit from the involvement of their family members, healthcare professionals need an understanding of the issues surrounding family presence in the healthcare environment and the strategies to best support it. Objectives The objectives of the systematic review were to present the best available evidence on the strategies, practices and organisational characteristics that promote constructive staff-family relationships in the care of older adults in the healthcare setting. Specifically this review sought to investigate how staff and family members perceive their relationships with each other; staff characteristics that promote constructive relationships with the family; and interventions that support staff-family relationships. Search strategy A literature search was performed using the following databases for the
Indepth interviews were conducted with nineteen relatives of nursing home residents regarding the... more Indepth interviews were conducted with nineteen relatives of nursing home residents regarding their experience of nursing home entry. The study is interpretative and themes were identified from the data which assist understanding of this experience. In a previous paper I reported on the experiences from decision making to entry. This paper reports on the experiences after entry.
Aim. This systematic review aimed to determine the best available evidence regarding the effectiv... more Aim. This systematic review aimed to determine the best available evidence regarding the effectiveness of nursing interventions in minimising the complications associated with administering medication via enteral tubes in adults. Background. Giving enteral medication is a fairly common nursing intervention entailing several skills: verifying tube position, preparing medication, flushing the tube and assessing for potential complications. If not carried out effectively harmful consequences may result leading to increased morbidity and even mortality. Until now, what was considered to be best practice in this area was unknown. Design. Systematic review. Methods. CINAHL, MEDLINE, The Cochrane Library, Current Contents/All Editions, EMBASE, Australasian Medical Index and PsychINFO databases were searched up to September 2005. Reference lists of included studies were appraised. Two reviewers independently assessed study eligibility for inclusion. There were no comparable randomised-controlled trials; data were presented in a narrative summary. Results. Identified evidence included using 30 ml of water for irrigation when giving medication or flushing small-diameter nasoenteral tubes may reduce tube occlusion. Using liquid medication should be considered as there may be less tube occlusions than with solid forms in nasoenteral tubes and silicone percutaneous endoscopic gastrostomy tubes. In addition, nurses may need to consider the sorbitol content of some liquid medications, for example elixirs, as diarrhoea has been attributed to the sorbitol content of the elixir, not the drug itself. Conclusion. The evidence was limited. There was a lack of high-quality research on many important issues relating to giving enteral medication. Relevance to clinical practice. Nurses have the primary responsibility for giving medication through enteral tubes and need knowledge of the best available evidence. Some of the nursing considerations and interventions relating to this skill have been researched in the clinical area and have implications for practice. There is a need for further studies to strengthen these findings.
ABSTRACT The literature suggests that food service largely has become identified as a non-nursing... more ABSTRACT The literature suggests that food service largely has become identified as a non-nursing duty and as a task that should be completed as quickly as possible. This conflicts with the evidence that social interaction at mealtimes has the potential to promote well being. Using observational and interview techniques, the social and functional context of meal service in 10 nursing homes was examined in this study. The findings from the observation of and interviews with staff are reported in this article. Three broad themes describing the cultural practices of nursing home staff during mealtimes are identified as follows: maintaining personal identity, assisting individuals to eat, and maintaining interaction. Alongside residents' general outward acquiescence to the service, nurses did not see problems and deficiencies with the service observed by the researchers or reported by the residents. Recommendations to improve mealtime service in nursing homes have been put forward in an effort to enlighten staff.
Summary The lived experience of relocating to a nursing home is explored from the perspective of ... more Summary The lived experience of relocating to a nursing home is explored from the perspective of 19 residents of Australian nursing homes. The interpretative research methodology is informed by hermeneutic phenomenology. In‐depth interviews were conducted with 19 nursing home residents living in nursing homes in NSW. Interviews were audiotaped, transcribed and analysed to identify emergent themes. The themes are described and interpreted to provide an understanding of the relocation experience.
Most staff genuinely want to provide psychosocial care but argue that too much documentation, not... more Most staff genuinely want to provide psychosocial care but argue that too much documentation, not enough staff and no time prevents them from doing anything but the basics. While we think of care as a set of tasks to be done and we assume care of the physical body is the number one priority, there will not be time. Think differently about how we do tasks so that the tasks are simply tools used to assist us in meeting the real priority - improving quality of life for older people - and time ceases to be a limitation. Using the best available evidence to inform clinical care, environmental design and use and interactions with other staff, clients and families will reduce inconsistency and improve outcomes. (non-author abstract)
Background The 2001 Australian census revealed that adults aged 65 years and over constituted 12.... more Background The 2001 Australian census revealed that adults aged 65 years and over constituted 12.6% of the population, up from 12.1% in 1996. It is projected that this figure will rise to 21% or 5.1 million Australians by 2031. In 1998, 6% (134 000) of adults in Australia aged 65 years and over were residing in nursing homes or hostels and this number is also expected to rise. As skin ages, there is a decreased turnover and replacement of epidermal skin cells, a thinning subcutaneous fat layer and a reduced production of protective oils. These changes can affect the normal functions of the skin such as its role as a barrier to irritants and pathogens, temperature and water regulation. Generally, placement in a long-term care facility indicates an inability of the older person to perform all of the activities of daily living such as skin care. Therefore, skin care management protocols should be available to reduce the likelihood of skin irritation and breakdown and ultimately promote comfort of the older person. Objectives The objective of this review was to determine the best available evidence for the effectiveness and safety of topical skin care regimens for older adults residing in longterm aged care facilities. The primary outcome was the incidence of adverse skin conditions with patient satisfaction considered as a secondary outcome. Search strategy A literature search was performed using the following databases:
International Journal of Evidence-based Healthcare, Mar 1, 2006
Background In Australia, around 59% of the general population uses prescription medication with t... more Background In Australia, around 59% of the general population uses prescription medication with this number increasing to about 86% in those aged 65 and over and 83% of the population over 85 using two or more medications simultaneously. A recent report suggests that between 2% and 3% of all hospital admissions in Australia may be medication related with older Australians at higher risk because of higher levels of medicine intake and increased likelihood of being admitted to hospital. The most common medication errors encountered in hospitals in Australia are prescription/medication ordering errors, dispensing, administration and medication recording errors. Contributing factors to these errors have largely not been reported in the hospital environment. In the community, inappropriate drugs, prescribing errors, administration errors, and inappropriate dose errors are most common. Objectives To present the best available evidence for strategies to prevent or reduce the incidence of medication errors associated with the prescribing, dispensing and administration of medicines in the older persons in the acute, subacute and residential care settings, with specific attention to persons aged 65 years and over. Search strategy Bibliographic databases PubMed, Embase, Current contents, The Cochrane Library and others were searched from 1986 to present along with existing health technology websites. The reference lists of included studies and reviews were searched for any additional literature. Selection criteria Systematic reviews, randomised controlled trials and other research methods such as non-randomised controlled trials, longitudinal studies, cohort or casecontrol studies, or descriptive studies that evaluate strategies to identify and manage medication incidents. Those people who are involved in the prescribing, dispensing or administering of medication to the older persons (aged 65 years and older) in the acute, subacute or residential care settings were included. Where these studies were limited, evidence available on the general patient population was used. Data collection and analysis Study design and quality were tabulated and relative risks, odds ratios, mean differences and associated 95% confidence intervals were calcu-Strategies to reduce medication errors 3
JBI database of systematic reviews and implementation reports, 2005
Background The 2001 Australian census revealed that adults aged 65 years and over constituted 12.... more Background The 2001 Australian census revealed that adults aged 65 years and over constituted 12.6% of the population, up from 12.1% in 1996. It is projected that this figure will rise to 21% or 5.1 million Australians by 2031. In 1998, 6% (134 000) of adults in Australia aged 65 years and over were residing in nursing homes or hostels and this number is also expected to rise. As skin ages, there is a decreased turnover and replacement of epidermal skin cells, a thinning subcutaneous fat layer and a reduced production of protective oils. These changes can affect the normal functions of the skin such as its role as a barrier to irritants and pathogens, temperature and water regulation. Generally, placement in a long-term care facility indicates an inability of the older person to perform all of the activities of daily living such as skin care. Therefore, skin care management protocols should be available to reduce the likelihood of skin irritation and breakdown and ultimately promote comfort of the older person. Objectives The objective of this review was to determine the best available evidence for the effectiveness and safety of topical skin care regimens for older adults residing in longterm aged care facilities. The primary outcome was the incidence of adverse skin conditions with patient satisfaction considered as a secondary outcome. Search strategy A literature search was performed using the following databases:
International Journal of Older People Nursing, Mar 1, 2007
Urinary tract infection: under treated and investigated: an examination of the nursing management... more Urinary tract infection: under treated and investigated: an examination of the nursing management of urinary tract infections in nursing home residents experiencing impaired cognition This research in nursing management of urinary tract infections in nursing home residents experiencing impaired cognition was informed through qualitative naturalistic enquiry. The findings suggest the response to this infective process lacks cohesive planning and the dearth of available evidence concerning the nursing management in this cohort has the potential to lead to detrimental health outcomes. The study exposes the complexities of issues which impact on satisfactory outcome.
Serially controversial, Professor Rhonda Nay argues that instead of simply calling for more regis... more Serially controversial, Professor Rhonda Nay argues that instead of simply calling for more registered nurses in aged care, we should re-structure their scope of practice so they effectively become nurse practitioners, and in the process give personal care workers and enrolled nurses a much greater role in the system.
Background In Australia, around 59% of the general population uses prescription medication with t... more Background In Australia, around 59% of the general population uses prescription medication with this number increasing to about 86% in those aged 65 and over and 83% of the population over 85 using two or more medications simultaneously. A recent report suggests that between 2% and 3% of all hospital admissions in Australia may be medication related with older Australians at higher risk because of higher levels of medicine intake and increased likelihood of being admitted to hospital. The most common medication errors encountered in hospitals in Australia are prescription/medication ordering errors, dispensing, administration and medication recording errors. Contributing factors to these errors have largely not been reported in the hospital environment. In the community, inappropriate drugs, prescribing errors, administration errors, and inappropriate dose errors are most common. Objectives To present the best available evidence for strategies to prevent or reduce the incidence of medication errors associated with the prescribing, dispensing and administration of medicines in the older persons in the acute, subacute and residential care settings, with specific attention to persons aged 65 years and over. Search strategy Bibliographic databases PubMed, Embase, Current contents, The Cochrane Library and others were searched from 1986 to present along with existing health technology websites. The reference lists of included studies and reviews were searched for any additional literature. Selection criteria Systematic reviews, randomised controlled trials and other research methods such as non-randomised controlled trials, longitudinal studies, cohort or casecontrol studies, or descriptive studies that evaluate strategies to identify and manage medication incidents. Those people who are involved in the prescribing, dispensing or administering of medication to the older persons (aged 65 years and older) in the acute, subacute or residential care settings were included. Where these studies were limited, evidence available on the general patient population was used. Data collection and analysis Study design and quality were tabulated and relative risks, odds ratios, mean differences and associated 95% confidence intervals were calcu-Strategies to reduce medication errors 3
Nursing care of older people is informed by many different theoretical frameworks. This paper con... more Nursing care of older people is informed by many different theoretical frameworks. This paper contends that two such frameworks, the lifecourse theory and some aspects of Western medicine are cultural constructs that are often seen as normative therefore obscuring the power relations implicit in these constructions. The paper argues that nurses are implicated in reproducing these cultural constructions but more particularly, these constructions may have no meaning for non-English speaking older people. Finally, the paper suggests that nurses could benefit from a more localised, contextual view of ageing.
Background Modern healthcare philosophy espouses the virtues of holistic care and acknowledges th... more Background Modern healthcare philosophy espouses the virtues of holistic care and acknowledges that family involvement is appropriate and something to be encouraged due to the role it plays in physical and emotional healing. In the aged care sector, the involvement of families is a strong guarantee of a resident's wellbeing. The important role family plays in the support and care of the older adult in the residential aged care environment has been enshrined in the Australian Commonwealth Charter of Residents' Rights and Responsibilities and the Aged Care Standards of Practice. Despite wide acknowledgement of the importance of family involvement in the healthcare of the older adult, many barriers to the implementation of participatory family care have been identified in past research. For older adults in the healthcare environment to benefit from the involvement of their family members, healthcare professionals need an understanding of the issues surrounding family presence in the healthcare environment and the strategies to best support it. Objectives The objectives of the systematic review were to present the best available evidence on the strategies, practices and organisational characteristics that promote constructive staff-family relationships in the care of older adults in the healthcare setting. Specifically this review sought to investigate how staff and family members perceive their relationships with each other; staff characteristics that promote constructive relationships with the family; and interventions that support staff-family relationships. Search strategy A literature search was performed using the following databases for the
Indepth interviews were conducted with nineteen relatives of nursing home residents regarding the... more Indepth interviews were conducted with nineteen relatives of nursing home residents regarding their experience of nursing home entry. The study is interpretative and themes were identified from the data which assist understanding of this experience. In a previous paper I reported on the experiences from decision making to entry. This paper reports on the experiences after entry.
Aim. This systematic review aimed to determine the best available evidence regarding the effectiv... more Aim. This systematic review aimed to determine the best available evidence regarding the effectiveness of nursing interventions in minimising the complications associated with administering medication via enteral tubes in adults. Background. Giving enteral medication is a fairly common nursing intervention entailing several skills: verifying tube position, preparing medication, flushing the tube and assessing for potential complications. If not carried out effectively harmful consequences may result leading to increased morbidity and even mortality. Until now, what was considered to be best practice in this area was unknown. Design. Systematic review. Methods. CINAHL, MEDLINE, The Cochrane Library, Current Contents/All Editions, EMBASE, Australasian Medical Index and PsychINFO databases were searched up to September 2005. Reference lists of included studies were appraised. Two reviewers independently assessed study eligibility for inclusion. There were no comparable randomised-controlled trials; data were presented in a narrative summary. Results. Identified evidence included using 30 ml of water for irrigation when giving medication or flushing small-diameter nasoenteral tubes may reduce tube occlusion. Using liquid medication should be considered as there may be less tube occlusions than with solid forms in nasoenteral tubes and silicone percutaneous endoscopic gastrostomy tubes. In addition, nurses may need to consider the sorbitol content of some liquid medications, for example elixirs, as diarrhoea has been attributed to the sorbitol content of the elixir, not the drug itself. Conclusion. The evidence was limited. There was a lack of high-quality research on many important issues relating to giving enteral medication. Relevance to clinical practice. Nurses have the primary responsibility for giving medication through enteral tubes and need knowledge of the best available evidence. Some of the nursing considerations and interventions relating to this skill have been researched in the clinical area and have implications for practice. There is a need for further studies to strengthen these findings.
ABSTRACT The literature suggests that food service largely has become identified as a non-nursing... more ABSTRACT The literature suggests that food service largely has become identified as a non-nursing duty and as a task that should be completed as quickly as possible. This conflicts with the evidence that social interaction at mealtimes has the potential to promote well being. Using observational and interview techniques, the social and functional context of meal service in 10 nursing homes was examined in this study. The findings from the observation of and interviews with staff are reported in this article. Three broad themes describing the cultural practices of nursing home staff during mealtimes are identified as follows: maintaining personal identity, assisting individuals to eat, and maintaining interaction. Alongside residents' general outward acquiescence to the service, nurses did not see problems and deficiencies with the service observed by the researchers or reported by the residents. Recommendations to improve mealtime service in nursing homes have been put forward in an effort to enlighten staff.
Summary The lived experience of relocating to a nursing home is explored from the perspective of ... more Summary The lived experience of relocating to a nursing home is explored from the perspective of 19 residents of Australian nursing homes. The interpretative research methodology is informed by hermeneutic phenomenology. In‐depth interviews were conducted with 19 nursing home residents living in nursing homes in NSW. Interviews were audiotaped, transcribed and analysed to identify emergent themes. The themes are described and interpreted to provide an understanding of the relocation experience.
Most staff genuinely want to provide psychosocial care but argue that too much documentation, not... more Most staff genuinely want to provide psychosocial care but argue that too much documentation, not enough staff and no time prevents them from doing anything but the basics. While we think of care as a set of tasks to be done and we assume care of the physical body is the number one priority, there will not be time. Think differently about how we do tasks so that the tasks are simply tools used to assist us in meeting the real priority - improving quality of life for older people - and time ceases to be a limitation. Using the best available evidence to inform clinical care, environmental design and use and interactions with other staff, clients and families will reduce inconsistency and improve outcomes. (non-author abstract)
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Papers by Rhonda Nay