Aim
We aimed to implement a systematic nurse–caregiver conversation, examining fidelity, dose and reach of implementation; how implementation strategies worked; and feasibility and mechanisms of the practice change.
Background
Appropriate hospital care for people living with dementia may draw upon: information from the patient and family caregiver about the patient's perspective, preferences and usual support needs; nursing expertise; and opportunities the nurse has to share information with the care team. Within this context, planned nurse–caregiver communication merits further investigation.
Methods
In Phase I, we established the ward staff's knowledge of dementia and Alzheimer's disease, prepared seven nurse change leaders, finalised the planned practice change and developed implementation plans. In Phase II, we prepared the ward staff during education sessions and leaders supported implementation. In Phase III, evaluations were informed by interviews with change leaders, follow‐up measures of staff knowledge and a nurse focus group. Qualitative data were thematically analysed. Statistical analyses compared nurses' knowledge over time.
Results
Planned practice change included nurses providing information packs to caregivers, then engaging in, and documenting, a systematic conversation. From 32 caregivers, 15 received information packs, five conversations were initiated, and one was completed. Knowledge of dementia and Alzheimer's disease improved significantly in change leaders (n = 7) and other nurses (n = 17). Three change leaders were interviewed, and six other nurses contributed focus group data. These leaders reported feeling motivated and suitably prepared. Both nurses and leaders recognised potential benefits from the planned conversation but viewed it as too time‐consuming to be feasible.
Conclusions
The communication initiative and implementation strategies require further tailoring to the clinical setting. A caregiver communication tool may be a helpful adjunct to the conversation. Implementation may be enhanced by more robust stakeholder engagement, change leader inclusion in the reference group and an overarching supportive framework within which change leaders can operate more effectively.
Implications for Practice
Nurse‐caregiver communication in this context requires inititatives tailored to the clinical setting with input from all stakeholders.
Diffusion of pro-environmental behaviors (PEBs) is known to be influenced by the perceived social status of those behaviors, but little is known about what gives PEBs social status. A sample of Australian residents ( N = 601) were asked to rate the social status of 16 PEBs and report their self and public environmental identities. Environmental identities accounted for 18% to 19% of the variance in social status ratings. Efficiency behaviors were perceived as conveying the greatest social status, and activism behaviors the least. Visibility, cost, and effort also predicted perceived social status. Short-answer responses indicated the social status ratings of PEBs were also dependent on the perceived environmental motivations for performing those behaviors. Understanding which PEBs are seen as high status provides insight into PEBs that may be easiest to promote and sheds light on the broader social structures that influence social status perceptions.
Recent research has shown that many Australians see pro-environmental behaviour as desirable, and identify as being green. However when compared to other countries, Australians score poorly on pro-environmental behaviour measures, engaging mostly in tokenistic pro-environmental actions, and demonstrate low levels of concern for the environment. In this article we examine this tension through exploring the meaning of the term sustainability to Australian participants who self-identify as pro-environmental. Twentysix interviews were conducted and analysed using Causal Layered Analysis. Through the examination of participants' environmental discourse and practices, some of the deeper sociopsychological processes influencing pro-environmental behaviour are revealed. While participants aspired to be green, their actions were bound by cultural traditions and worldviews that perpetuate environmental degradation. Participants struggled to define the term sustainability and held self-enhancing motives for adopting what they identify as a proenvironmental identity. These findings highlight the influence of collective cultural constructs in shaping how pro-environmental behaviours are understood and enacted.
The actions of others, and what others approve of, can be a powerful tool for promoting proenvironmental behavior. A potential barrier to the utility of social norms, however, are cognitive biases in how people perceive themselves and others, including the better‐than‐average effect. This effect describes the tendency for people to think they are exceptional, especially when compared with their peers. To investigate the role of the better‐than‐average effect in proenvironmental behavior, we administered questions as part of a larger online survey of 5,219 nationally representative Australians. Participants were asked to report whether they engaged in a list of 21 proenvironmental behaviors, and then asked to estimate how their engagement compared with that of the average Australian. Over half of our participants self‐enhanced; they overestimated their engagement in proenvironmental behaviors relative to others. Self‐enhancement was related to reduced perceptions of personal harm from climate change, more favorable assessments of coping ability, less guilt, and lower moral and ethical duty to take action to prevent climate change. These relationships held when participants skeptical about anthropogenic climate change were removed from analyses. We discuss the implications of the findings for the use of social norms in promoting proenvironmental behavior.
1The aim of the present study was explore perceptions of group-based walking and gather 2 suggestions to inform the development of a group-based walking intervention among older 3 adults in retirement villages. Twenty-four physically inactive residents (16 female, 8 male; 4 age range: 69-88) and 4 managers from four retirement villages were interviewed. Inductive 5 thematic analysis revealed 6 broad themes: lack of motivation, values versus constraints, fears 6 and confidence, need for structure, creating a sense of belonging, and the physical 7 environment as a double-edged sword. Proposed intervention strategies included using trained 8 walk leaders, using small groups, planning for flexibility, setting attainable goals, creating a 9 routine, creating opportunities for sharing experiences, and planning a variety of walks.
Community gardens have been associated with a number of positive outcomes, including community and individual well-being. We used selfdetermination theory as a framework to interpret the social-psychological characteristics of community gardens that may determine their role in sustaining need satisfaction and well-being. Semistructured face-to-face interviews were conducted with 5 experienced community gardeners and 10 aspiring community gardeners. Data were analyzed via a framework approach to thematic analysis. Findings support the proposition that satisfaction of community-level needs may be the precursor to communities and individuals experiencing well-being, via experiences of participating in community gardens. Findings have implications for how community-based interventions could be optimized via targeted integration of theories of motivation and perspectives of well-being.
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