To co-design and pilot test a best practice model of continence care and knowledge translation resources for Australian residential aged care, a mixed methods study was undertaken. The study had four stages: (1) a scoping review of literature;(2) a survey, interviews and co-design workshops with residential aged care stakeholders; (3) the co-design of a draft model and knowledge translation resources; and (4) a pilot trial of an education program and qualitative interviews with residents. The pilot trial involved a convenience sample of 22 staff (registered and enrolled nurses and personal care assistants) from two Australian residential aged care homes. Staff completed one pre-and two post-education surveys, and 13 aged care residents were interviewed about their views about continence care. Pilot test data revealed post-education improvements in staff knowledge for eight of the ten questions, and 100% agreement on the feasibility, appropriateness and acceptability of the model and education program. Of the 22 participants, 63% rated the education as 'very helpful' in applying the model to practice and 37% rated it as 'somewhat helpful'. There was no statistically significant difference between the results of any of the three assessment surveys. A content analysis of resident interviews validated the importance of evidence-based, safe, clinically-informed, person-centred continence care that optimises a resident's functional abilities and responds to their individual needs, choices and dignity. The Continence Foundation of Australia has used these findings to design Continence SMART Care (CSC), which represents best practice continence care, meets the Aged Care Quality Standards, and aligns with current reform strategies for the aged care sector. Further research is required to determine the impact on practice and resident outcomes, and its relevance for use in other settings or countries.

There is increasing interest in harnessing aged care residents’ perspectives to drive quality improvement in aged care homes. We conducted a systematic review of qualitative evidence including literature examining residents’ descriptions of “quality of care” in aged care homes, using database searches and screening records according to eligibility criteria. Three independent reviewers conducted quality assessment of forty-six eligible articles and performed thematic synthesis of articles’ findings. We distinguish nine key themes describing factors influencing quality care: staffing levels, staff attitude, continuity, routine, environment, decision-making and choice, dignity of risk, activities, and culture and spirituality. While many themes were consistent across studies, residents’ prioritization of them varied. Aged care home residents have differing conceptions of quality care as well as heterogeneous and dynamic needs and preferences. Care providers are best able to facilitate quality care when intentional efforts are made to recognize this and tailor delivery of services the individual residents.

Background: As places of both residence and work, what constitutes "good quality care" in residential aged care requires consideration of staffs' perspectives.Objective: A meta-synthesis of the qualitative literature was conducted exploring residential aged care staff perspectives on "quality of care." Methods: Six electronic databases were searched for articles that met the screening inclusion criteria. This meta-synthesis was informed by the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, and included studies were critically appraised using JBI SUMARI. Two independent reviewers conducted thematic network mapping and analysis of included articles, with oversight from three additional reviewers.Results: Forty-seven articles were included, with findings summarised into four organising themes and nine basic themes. The four organising themes about quality care from staff perspectives include direct care, professional values and competence, the care environment and organisational/regulatory factors. Conclusion:Staff describe a wide range of factors that they perceived to influence the quality of care. Some may feel motivated to leave employment in aged care, due to organisational pressures that make staff unable to uphold what they perceive as an acceptable standard of care. There is tension between professional values and organisation/regulatory factors-regulation should be enacted at a level that supports good practice and staff's moral integrity.Relevance to clinical practice: This review found that while person-centred care is now well established as the benchmark of quality care in residential aged care homes, achieving it in reality remains challenged by limitations on staff members' time, resources and sometimes their competencies and the regularity of their employment. K E Y W O R D Smeta-synthesis, nursing practice, qualitative research, quality care, residential care | 3125 GARRATT eT Al.

Background A rapidly aging population, a shifting disease burden and the ongoing threat of infectious disease outbreaks pose major concerns for Vietnam’s health care system. Health disparities are evident in many parts of the country, especially in rural areas, and the population faces inequitable access to patient-centered health care. Vietnam must therefore explore and implement advanced solutions to the provision of patient-centered care, with a view to reducing pressures on the health care system simultaneously. The use of digital health technologies (DHTs) may be one of these solutions. Objective This study aimed to identify the application of DHTs to support the provision of patient-centered care in low- and middle-income countries in the Asia-Pacific region (APR) and to draw lessons for Vietnam. Methods A scoping review was undertaken. Systematic searches of 7 databases were conducted in January 2022 to identify publications on DHTs and patient-centered care in the APR. Thematic analysis was conducted, and DHTs were classified using the National Institute for Health and Care Excellence evidence standards framework for DHTs (tiers A, B, and C). Reporting was in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Results Of the 264 publications identified, 45 (17%) met the inclusion criteria. The majority of the DHTs were classified as tier C (15/33, 45%), followed by tier B (14/33, 42%) and tier A (4/33, 12%). At an individual level, DHTs increased accessibility of health care and health-related information, supported individuals in self-management, and led to improvements in clinical and quality-of-life outcomes. At a systems level, DHTs supported patient-centered outcomes by increasing efficiency, reducing strain on health care resources, and supporting patient-centered clinical practice. The most frequently reported enablers for the use of DHTs for patient-centered care included alignment of DHTs with users’ individual needs, ease of use, availability of direct support from health care professionals, provision of technical support as well as user education and training, appropriate governance of privacy and security, and cross-sectorial collaboration. Common barriers included low user literacy and digital literacy, limited user access to DHT infrastructure, and a lack of policies and protocols to guide the implementation and use of DHTs. Conclusions The use of DHTs is a viable option to increase equitable access to quality, patient-centered care across Vietnam and simultaneously reduce pressures on the health care system. Vietnam can take advantage of the lessons learned by other low- and middle-income countries in the APR when developing a national road map to digital health transformation. Recommendations that Vietnamese policy makers may consider include emphasizing stakeholder engagement, strengthening digital literacy, supporting the improvement of DHT infrastructure, increasing cross-sectorial collaboration, strengthening governance of cybersecurity, and leading the way in DHT uptake.

Primary carers play an important role in supporting the Australian Government’s policy of ‘ageing in place’ or encouraging people to receive care in their own homes or communities rather than in institutions. Supporting carers in their role is therefore an important aspect of the policy’s success. Despite numerous programs in place, this study finds that among carers of older Australians, a relatively high proportion (39%) cite unmet needs in their carer role, including a need for financial support, physical assistance, emotional support, improvement in carer health and more respite care. Concerningly, unmet support needs were shown to be strongly associated with markers of poor carer well-being, including an almost 2-fold increase in odds of poor carer satisfaction (odds ratio (OR) 1.77, 95% confidence interval (CI) 1.24–2.51), a 4- to 5-fold increase in the odds of changes to physical and emotional well-being (OR 5.29, 95% CI 3.83–7.31), deterioration in financial situation (OR 4.60, 95% CI 3.26–6.48) and strained carer–recipient relationship (OR 3.79, 95% CI 2.39–6.01).