Current Grants & Tenders
The Division of Nursing & Midwifery’s research and tender activities focus on a number of real world issues. This work has in turn impacted upon Australian nursing practice and policy development in the following areas:
Aged Care:
Project Title: A program of research and education focussed on supporting the development of a model of clinical practice improvement (CPI) in relation to the sub-acute care of older people.
Investigators: Nay, R., Koch, B., Koch, S., Fetherstonhaugh, D., Bauer, M., Winbolt, M., O’Donnell, M., & McAuliffe, L.,
Funding: $250,000 from Bundoora Extended Care Centre (BECC).
CPI essentially uses interdisciplinary reference groups to establish practice priorities for research and indicators/outcomes that will be evaluated across a number of agencies. The practice priorities that have been identified include unmet need behaviours (specifically wandering, aggression and restlessness), falls, family/staff relationships, pain, medication management and staffing models. Practices and outcomes pertaining to these practice priorities are audited across several sites and then compared to determine which practices are associated with the best outcomes. CPI simultaneously considers specific characteristics of the practice being studied, the process steps involved, and the outcomes achieved. The results of the audit are then combined with the best available evidence from the international literature to develop an interdisciplinary guideline. The guideline is then implemented and the clinical practice is audited again. There is ongoing education with the staff and action research methods ensure a continuing interactive partnership so that the guideline can be continually improved and evaluated.
Project Title: Capacity building in clinical practice improvement (CPI) methodology and evidence-based practice for Thai nurses and other health personnel through an academic-practical clinical partnership.
Investigators: Nay, R & Lorga, T.
Funding: $43,450 from the Australia-Thailand Institute.
This project aims to transfer Australian expertise and experience in the areas of clinical practice improvement (CPI) and evidence-based aged care (EBAC) to Thailand. It will build capacity in the areas of CPI and EBAC among Thai nurses and other health personnel. The project will also develop a model of academic-practice collaboration to facilitate CPI and EBAC in Thai contexts and establish ongoing partnership with centres in Thailand.
Project Title: Improving hospital discharge preparation and support for families of patients with dementia.
Investigators: Bauer, M., Fitzgerald, L. & Koch, S.
Funding: $20,000 from the Alzheimer’s Australia Research Dementia Grants Program
The study aims to understand the family carer’s experience of the hospital discharge planning process for their family member with dementia. Using a qualitative research methodology, family carers will be interviewed in order to be informed about their experience of the preparation for and execution of the hospital discharge plan. The study will also seek to understand how well the discharge plan for a person with dementia met the needs of the family carer and what improvements could have been made to better assist them with the transition from hospital to residential, or home based care. The findings of this research will inform a review of hospital discharge practices for people with dementia and also act as a springboard for further research to improve the quality of hospital discharge for both family carers and people with dementia. The project will provide the basis for guidelines to assist staff and improve the experience for families.
Project Title: Collaborative caregiver-family relationships in the care of older hostel residents.
Investigators: Bauer, M. & Nay R.
Funding: $15,000 Windermere Foundation Special Grant
Participatory family care with the willing family is widely acknowledged to be important in the care of older people. This study extends a current project of clinical practice improvement (CPI) in family/staff relationships in sub-acute care to the ‘hostel’ setting. It aims to explicate the nature of staff-family collaboration in the care of older hostel (low care) residents. The data will be used to inform the development of a practical clinical guideline to enable care-giving staff to work better with the families of residents and moreover, pave the way for future research in this context.
Project: Improving the way in which families of residents and the care staff working in residential care experience their relationship in the context of resident care.
Investigators: Nay, R., Koch, B., Koch, S., Fetherstonhaugh, D., Bauer, M., Winbolt, M., O’Donnell, M., & McAuliffe, L.
Funding: $19,961 Australian Department of Health and Ageing
This project extends the family/staff relationship component of the clinical practice improvement (CPI) project in sub-acute care, to the residential care setting. This project aims to improve the way in which the families of residents and the care staff working in residential care, experience their relationship in the context of resident care. An evidence-based guideline will be developed to assist constructive family/staff relationships. This study will add to existing knowledge on translating evidence into everyday practice
Project Title: The effectiveness of in-home community nurse led interventions for the mental health of older persons: A systematic review.
Investigators: Lang, L., Annells, M. & Thompson, P.
Funding: $9,992.20 (2006) from La Trobe University Faculty of Health Sciences (Research Grant – Starter)
Effectively facilitating mental health for older persons living in the community is necessary; therefore, this systematic review reviewed evidence about the effectiveness on in-home community nurse lead interventions for older people with, or at risk of, mental health disorders to inform best practice nursing care with this focus. As the most relevant result, there is evidence to support applying validated screening and assessment tools for mental health disorders over relying on community nurses’ opinions, clinical judgment only or non-validated tools. There is a need for replication and multi-centre trials of reviewed pertinent studies.
Project Title: Search for the Silver Lining: Advancing best practice in leg ulcer management
Investigators: Gliddon, T., Lewin, G., Carville, K., Annells, M. & Santamaria, N.
Funding: $174,000 (2005 - 2007) from Angior Family Foundation
Aiming to improve care provided to community-dwelling older persons living with a leg ulcer, this project incorporates a wound management best practice education program, a qualitative study to identify barriers and enablers regarding the use of compression bandaging for venous leg ulcers, and implementation of a multi-site randomised controlled trial to compare two anti-microbial dressings for leg ulcer care use. This project will lead to the development of evidence and understandings that will inform multi-disciplinary leg ulcer management within and beyond primary health care. Professor Merilyn Annells is leading the qualitative study component of the project.
Project Title: Training, Innovation, Mentoring and Education (TIME) for Dementia
Investigators: Nay, R., Koch, S., Koch, B., Disler, P., Gibson, S., Crombie, A., Moore, L., Slater, D., Robinson, A. & Murray, M.
Funding: $1.97 million from the Australian Government Department of Health and Ageing
The Australian Centre for Evidence-Based Aged Care (ACEBAC), which is a research unit of the Division, and collaborators were awarded a $1.97 million tender as part of the Australian Government Dementia Training Study Centres Initiative. The Victorian and Tasmanian Dementia Training Study Centre will be headed by La Trobe University’s Australian Centre for Evidence Based Aged Care, in collaboration with Alzheimer’s Australia Tas, Alzheimer’s Australia Vic, Bayside Health, Bendigo Health, Bundoora Extended Care Centre, Monash University, the National Ageing Research Institute, the University of Melbourne and the University of Tasmania.
Known as Training, Innovation, Mentoring and Education (TIME) for Dementia, this virtual centre will provide a range of innovative and flexible dementia education packages suitable for General Practitioners, Nurses and Allied Health staff, as well as packages designed specifically for university students in these disciplines. In coming years the centre will also offer a series of conference and PhD scholarships. TIME will, offer incredible scope across metropolitan and regional Tasmania and Victoria with a unique interdisciplinary model and extensive coverage in both states the centre promises to be at the forefront of excellence in dementia care.
Project Title: Dementia Collaborative Research Centres
Investigators: Abbey, J., Nay, R., Koch, S., & Pemberton, G.
Funding: $2.2 million from the Australian Government Department of Health and Ageing.
The Dementia Collaborative Research Centres (DCRC) are an Australian Government initiative under the ‘Making Dementia a National Priority’ scheme. La Trobe University Division of Nursing and Midwifery’s Australian Centre for Evidence Based Aged Care is a collaborative partner in the DCRC headed by the Queensland University of Technology, lead by Professor Jennifer Abbey. ACEBAC’s research will focus on the identification and management of pain in older people with dementia across a range of care settings.
Project Title: Aged Care Clinical Placements – Best Practice Models
Investigators: Nay, R., Koch, S. & Koch, B.
Funding: $49,712 from Australian Government Department of Health and Ageing.
This project, which is funded by the Australian Government Department of Health & Ageing, will involve the development of best practice models for aged care clinical placements for undergraduate nursing students. The project will involve researching key elements of best practice related to undergraduate aged care clinical placements, as well as existing models of aged care clinical placement.
Project Title: La Trobe Online Clearinghouse of Aged Care Teaching Essentials – LOCATE
Investigators: Koch, B., Nay, R. & Koch, S.
Funding: $143,481 from Australian Government Department of Health and Ageing.
The La Trobe Online Clearinghouse of Aged Care Teaching Essentials (LOCATE) web site was launched on 8 December 2006. LOCATE is a funded initiative of the Australian government. It provides a clearinghouse of primarily Australian aged care resources which are useful to students, teachers and clinicians from 2006 onwards.
The resources may be textbooks, reports, audio-visual resources, research reports, websites or more recent formats such as online audio streaming or podcasts. See http://www.latrobe.edu.au/locate/
Project Title: The development of a best practice mental health clinical pathway for community nursing care of veterans and war widow(er)s.
Investigators: Annells, M., Lang, L., Clark, E., Petrie, E., Robins, A. , Nunn, R. and Allen, J.
Funding: $124,783 from Department of Veterans’ Affairs (DVA)
From 2006, this project systematically developed, trialled and refined in rural and urban settings, a user-friendly evidence-based best practice Mental Health Clinical Pathway for generalist community nurses that from 2007 will be accessible via internet and other means for DVA funded community nursing care of veterans and war widow(er)s around Australia. The benefits to veterans and war widow(er)s will be the provision of holistic care focused on assessed mental health care needs.
Midwifery /Mother & Child Health
Project title: An alternative approach to early postnatal care: a pilot randomised controlled trial
Investigators: Dr Helen McLachlan, Division of Nursing and Midwifery with Dr Jane Yelland, Dr Della Forster, Ms Jo Rayner, Ms Lisa Gold, Assoc Prof Stephanie Brown (Mother and Child Health Research, La Trobe University) and Ms Tanya Farrell (The Royal Women’s Hospital).
Funding: La Trobe University Faculty Health Sciences Faculty Grant, $19,992
A decade of Victorian research has identified women’s low levels of satisfaction with the hospital stay following birth. A recent Victorian state-wide review found that there were a number of barriers to care provision including the busyness of postnatal wards, inadequate staffing numbers, and priority being given to other episodes of care. Whilst the length of the hospital stay has declined dramatically since the 1980’s in Australia, research evidence evaluating early discharge is limited. A pilot RCT will be used to evaluate alternative approaches to early postnatal care on women’s experiences of care, confidence, breastfeeding, depression and overall health status.
Project title: Caseload midwifery for women at low risk of medical complications: a randomised controlled trial.
Investigators: Dr Helen McLachlan, Dr Della Forster, Ms Mary-Anne Davey, Prof Judith Lumley, Ms Tanya Farrell, Prof Jeremy Oats, Ms Lisa Gold, Prof Ulla Waldenstrom., Prof Leah Albers.
Funding: NHMRC Project Grant, $583,125
Along with colleagues from Mother & Child Health Research and the Royal Women’s Hospital, Dr Helen McLachlan has received $583,000 for the first randomised controlled trial in Australia of caseload midwifery care for women at low risk of medical complications – and, she says, it is only the third such trial she is aware of in the world.
The trial will provide much needed information regarding the outcomes of caseload midwifery, including interventions in childbirth, safety, costs, women’s satisfaction with care and impact on the midwifery workforce.’
Project Title: "Building public health capacity for complex questions, complex settings, complex interventions"
Investigators: Prof Judith Lumley, Assoc Prof Stephanie Brown; Dr Rhonda Small; Dr Angela Taft; Dr Della Forster; Dr Helen McLachlan; Dr Lisa Amir; Dr Jane Yelland; Ms Lisa Gold; Ms Fiona Bruinsma; Ms Lyn Watson; Prof Jane Gunn; Prof Jeanne Daly; Prof Christine MacArthur; Dr Gail Gilchrist.
Funding: $2.3 million NH&MRC Capacity Building Grant in Population Health
Dr McLachlan is a team investigator on a NHMRC Capacity Building Grant which is led by Professor Judith Lumley of Mother and Child Health Research, La Trobe University. The grant will support continuing education and development for postdoctoral staff in their transition from completing a PhD to becoming independent researchers. The aim is to help them initiate their own research programs and secure competitive funding for research into a range of problems, from premature birth to partner violence.
Project Title: A review of postnatal in hospital care (PinC) in Victoria
Investigators: Della Forster, Judith Lumley, Jo Rayner, Jane Yelland, Mother and Child Health, with Dr. Helen McLachlan, Division of Nursing and Midwifery.
Funding: Funded by The William Buckland Foundation Grant 2003/4 ($65,078); and Telstra Foundation Community Development Fund Grant 2004 ($100,000) ($165,078)
A decade of Victorian research has found low levels of satisfaction with the hospital stay following birth. Little is known about how hospital postnatal services are organised, what guides the provision of care and how maternity units approach maternal health issues, including breastfeeding support and early responses to postnatal depression.
PinC (Postnatal in-hospital Care: a review) was conducted in 2004 with two major stages of data collection – a survey of all public maternity hospitals and interviews with key informants. Sixty-six hospitals participated in the survey, a response ratio of 96%. Over forty interviews were conducted with managers, midwives and medical practitioners working in a range of large and small, rural and metropolitan maternity hospitals across Victoria.
Overall, care providers were enthusiastic about postnatal care, and committed to ensuring this care was of high quality. However, there was a strong sense that the provision of early postnatal care is considered a lower priority compared to other episodes of maternity care. A final report of the PinC Review findings was launched in May 2005 in conjunction with a seminar on early postnatal care.
Project Title: The feasibility and development of a patient preference package of postnatal care
Investigators: Dr. Helen McLachlan Division of Nursing and Midwifery, with Jane Yelland, Della Forster, Jo Rayner, Stephanie Brown and Lisa Gold, Mother and Child Health Research, La Trobe University
Funding: ($34,517) Funded by La Trobe Faculty of Health Sciences Grant 2006 & Mother and Child Health Research Grant 2006 ($9,517 & $25,000)
In 2006 a feasibility study explored women’s views of alternative packages of early postnatal care and examined managerial and organisational support for a reorganisation of early postnatal care. The proposed package options presented to women included alternatives to the current standard length of stay in hospital together with home or community-based care arrangements. It is anticipated that such approaches will provide women with flexibility and choice in how they receive care following birth and may lead to improvements in women’s experiences of postnatal care and in maternal health outcomes including breastfeeding.
The findings of the feasibility study will inform new options for postnatal care which will be piloted in 2007 prior to evaluation within a randomised controlled trial.Project Title: Peer support for breastfeeding – feasibility study ($34,884)
Investigators: Della Forster, Mary-Ann Davey, Judith Lumley and Lisa Amir in collaboration with Dr. Helen McLachlan, Division of Nursing and Midwifery, La Trobe University and Lisa Gold, School of Public Health, La Trobe University
Funding: Funded by La Trobe Faculty of Health Science Faculty Grant 2006, MCHR grant 2006. ($9,884 & $25,000)
Breastfeeding has health benefits for both mother and baby and exclusive breastfeeding is recommended for the first six months of life, followed by continued breastfeeding (along with other food) into the second year of life. Women often stop breastfeeding sooner than they would like because of inadequate support. Low income women in particular are less likely to continue to breastfeed and less likely to seek support. Many strategies aimed at increasing the duration of breastfeeding have failed. Trials in Canada and the Philippines have achieved increased duration of breastfeeding by providing women with support from a peer who has herself successfully breastfed. Before introducing such a program in Australia, it is important to explore local women’s views about using peer supporters, and women's views about acting as peer supporters. We are conducting a feasibility study to explore the idea that telephone peer support in the early postnatal period might increase breastfeeding duration.
Project Title: A state-wide review of postnatal care in private hospitals in Victoria (PinC Private)
Investigators: Della Forster, Jo Rayner, and Jane Yelland, Mother and Child Health Research, with Dr. Helen McLachlan, Division of Nursing and Midwifery, La Trobe University
Funding: La Trobe Faculty of Health Science Faculty Grant 2006, MCHR Grant 2006 ($9,930 & $25,000)
A decade of Victorian research has identified women’s low levels of satisfaction with the hospital stay following birth. A recent Victorian state-wide review of postnatal care in public hospitals (PinC) found that there were a number of barriers to care provision including the busyness of postnatal wards, inadequate staffing numbers, and priority being given to other episodes of care. The review involved a survey of all public maternity facilities in Victoria and interviews with key informants from selected hospitals.
One third of Victorian births occur in the private sector. In 2006 we undertook a review of hospital postnatal care in the private sector using a similar methodology to PinC public. A postal questionnaire was sent to all private hospitals providing maternity services and indepth interviews were conducted with care providers at randomly selected participating hospitals. It is anticipated that the findings will highlight successes, gaps and concerns in service provision as well as provide important information to plan, implement and evaluate interventions to improve in-hospital postnatal care.
Research in Supportive Care (RISC)
Project Title: Evaluation of RPC in community palliative care services
Investigators: Street, A., Blackford, J.
Funding source: Department of Health and Ageing Respecting patient choices (2005-6) $15,000
The Respecting Patient Choices (RPC) program was trialled in two community palliative care services. It was apparent that it was not possible to separate the normal process of an end of life care discussion from an advance care planning discussion leading to more formal procedures that staff identified as RPC-related, including documentation. Nor was it possible to identify end-of-life outcomes for clients that were specifically a result of the RPC Program. The client group had complex care needs and reduced care options that had to be met in the home. Orientation and education needed to be tailored to acknowledge the end of life care expertise of staff. Likewise, the electronic documentation systems did not make the Advance Care Planning process visible in the client record, unlike the paper-based systems used in other services.
Project Title: Advanced care planning: State of the Science Review
Investigators: Street, A., Ottmann, G.
Funding source: Department of Health & Ageing (2006) $57,553.
A comprehensive State of the Science literature review was undertaken of advance care planning models. The aim of the project was to contribute to the international evidence base of advance care planning and inform the development of an advance care planning palliative care model. Databases of Medline, Proquest, CINAHL, and Google Scholar were searched (1989 through 2006) employing the following search terms: Advance Care Planning, Advance Directives, Advanced Directives, and End-of-Life Decisions. A total of 346 studies met established inclusion criteria. Three reviewers independently evaluated and ranked the articles. A total of 85 articles were retained. Studies were ranked according to their strength of evidence. A widely used four letter taxonomy (A-D) was employed and expanded to include qualitative studies. C and D-level evidence was excluded from the review. The results indicated that an effective form of ACP requires an ongoing values-directed discussion involving health professionals, clients, and family; a transformation of systemic processes to support ACP across a range of institutional settings; adequate funding and support to normalise ACP into clinical practice and culture; the targeted involvement of specific cultural communities and the wider public; and excellent education and applied research to guide this process. There were significant knowledge gaps identified with future research needing to focus on the transferability and sustainability of successful models, as well as the information needs associated with particular illness trajectories.
Project Title: Development of advance care planning community specialist palliative care model
Investigators: Street, A., Blackford, J.
Funding source: Department of Health & Ageing (2007-2010) $292,654
The aim of this study is to develop an advance care planning (ACP) health services model for specialist palliative care services. This model needs to be accessible, transferable, sustainable, capacity building, cost-effective and ready for national implementation. The project consists of three stages. Stage 1 involves the use the State of the Science review and expert opinion to identify, refine and develop a set of tools and processes that will constitute the proposed model. This model will be sent to national and international experts for review and incorporation into an implementation manual. At Stage 2 (2008) using the implementation manual the refined model will be implemented into four Victorian palliative care services providing complex or intermediate care in metropolitan and rural settings. These services will have previously been involved in advance care planning and will provide feedback and further refinement of the model. The final stage will be to conduct a national comparison study to evaluate the efficacy of the ACP palliative care model in selected palliative care services.
Project title: Improving access, quality and cost effectiveness of the Respecting Patient Choices education program
Investigators: Street, A., Love, A., Blackford, J.
Funding Source: Department of Health & Ageing 2006-7 $142,989.00
The Respecting Patient Choices (RPC) program of Advance Care Planning was instigated to ensure patients have choices in their care at end of life. The program has been introduced in a variety of health services in Victoria as well as trialled nationally. The program trains health professionals to assist patients and families develop advance care plans for end of life care. The existing RPC education program consists of a two day workshop based around the introduction of necessary content concerning advance care planning as well as experiential learning in the form of role-plays. Funding has been provided to design an e-learning education and training component to improve access and facilitate greater national uptake, to reduce training costs and to meet specific learning needs. In Stage 1 of the project an on-line e-learning package was developed that delivers the knowledge- and attitude-related content, tailored to the specific needs of individual learners. In Stage 2 an evaluation of the package will be undertaken using health professionals, web design and content experts.
Project Title: Caring Communities project Improving consumer and health professional access to comprehensive, accessible, user-friendly, evidence-based online palliative care information
Investigators: Street, A. F., Woodruff, R., Annells, M.
Funding source: Department of Health & Ageing (2003-6) $180,161
This project aimed to address the first goal of the palliative care strategy which is to improve community and professional awareness and understanding, and professional commitment to, the role of palliative care practices in supporting the care needs of people who are dying and their families of care. In Victoria at the commencement of the project there was no co-ordinated approach to the organisation and dissemination of palliative care information and educational material. Palliative Care Victoria (PCV) had some excellent leaflets that were available on the PCV website. However PCV and government reports identified the need for better link consumer access to information and the development of a website that provides fact sheets and links to other information for health professionals, particularly GPs and community nurses in urban and rural contexts. Likewise current information did not provide information for those who are deaf and have sight or communication difficulties. This project addressed this goal by enhancing the existing website so that it provided comprehensive, accessible, user-friendly, evidence-based information for consumers and health professionals with enhanced features for some people with disabilities. A strategy to ensure the sustainability of the website was established and evaluated.
Project Title: National Continence Management Strategy Consultation, consensus and commitment to guidelines for inclusion of Continence into undergraduate nursing curricula
Investigators: Patterson, J., St John, W., Thorogood, C. & Watt, E.
Funding source: Department of Health & Ageing (2005-6) $93,734
The main aim of the project was to produce a final version of the guidelines (developed in a previous project) for Inclusion of Continence into Undergraduate Nursing and Midwifery Curricula’. These guidelines recommended: (1) how to adopt/adapt (usage) of guidelines into curricula, (2) how to overcome potential barriers to their usage (3) the development and compilation of a suite of teaching resources to assist the usage. A series of focus groups across Australia with key people considered able to influence content for undergraduate and midwifery curricula were undertaken. Analysis of the data from the focus groups identified two major barriers to the usage of the guidelines. Firstly, the need for workforce development across the health care sector, and secondly, the need for a targeted continence awareness strategy. There was consensus among participants in the focus groups that many health professionals across the health care and university sectors were not aware of incontinence as a major health care issue and many were still subscribing to the myths surrounding incontinence. The experience of the participants suggests that many ‘decision makers’ in academic and health settings do not value continence, and do not see incontinence as ‘an issue of importance’. There was overall support for the guideline content, with some minor additions and deletions. The suggested changes and recommendations have been carefully considered and where appropriate the draft guidelines have been modified.
Other Research
Project Title: Expanding organisational capacity: a model for strengthening rural nursing undergraduate clinical experience
Investigators: Kenny, M., Beadle, B., Callaghan, A., Kevin, Nankervis, K.
Funding: Department of Human Services - $48,900
Current figures suggest that over 70% of university students are in paid employment, primarily in the hospitality and retail sectors. Over the last few years, there has been increasing interest in innovative ‘paid nursing student fellowship’ type models where undergraduate nursing students are explicitly employed in health settings in a student nurse capacity. Whilst there is little documented about the Australian experience, internationally, student nurse employment models, designed as collaborative endeavours between universities and industry, have reported significant benefits, both in terms of graduate skill and knowledge, and organisation recruitment and retention. This mixed method study funded as part of the Prepare Nurses for the Future initiative aims to explore the concept of paid nursing student employment and provide recommendations on the potential of models for the rural context.
Project Title: Strengthening Mature Age Students Access into Undergraduate Nursing Education
Investigators: Kenny, M. McLennan, J., & Lang, L.
Funding: Department of Human Services - $48,141
To be responsive to current and future workforce projections there is a need to fully understand how the profession can better strengthen access to pre registration nursing education for the mature age student. Presently little is known about what attracts mature age students to nursing, nor is there information regarding their background and trajectory, their methods of entry into the profession, why they choose nursing, and factors that made access to nursing education easier or more difficult. This collaborative study between La Trobe University and Central Gippsland Institute Of TAFE aims to establish current statistics on the prevalence of mature age students in pre-registration nursing courses, to identify current university requirements for mature age entry into pre registration nursing education, to explore areas for standardisation of credit processes for mature age students and overall to provide knowledge that will assist in the development of supportive information for individuals seeking access to nursing as a career choice