Associate Professor Pamela Van Der Riet

Aim: This integrative review appraises the literature that explores the experiences of the adolescent diagnosed with cancer. Background: The cancer experience has an impact on the way the adolescent lives their life, their future hopes dreams and fears, their health and wellbeing. Healthcare professionals require an understanding of what the adolescent experiences after a diagnosis of cancer and during the treatment experience to be able to provide optimal age appropriate care. Methods: The review was conducted following Whittemore and Knafl's (2005) framework. A comprehensive search using the following four databases, CINAHL, MEDLINE, PyschINFO, Embase was undertaken for the period of 2005¿2016. Google scholar, healthcare policies and guidelines reference lists were also searched. Screening and appraisal of 911 articles resulted in 22 articles being included in this review. Findings: Three themes were identified: ¿Losing what I know - this is what makes me different¿, ¿Communication and information sharing - the need to know¿, and ¿The importance of friends, peers and relationships¿. Conclusion: This review reports that healthcare providers should be aware of the changing self-perceptions the adolescent experiences throughout the cancer journey. Accessing this information will enable healthcare providers to determine more appropriate care when these adolescents are feeling most vulnerable. The review identified there is limited information about the experience of the younger adolescent (11¿15 years) with cancer. Future research may benefit from focusing on the stage of development of the adolescent with cancer.

Background: Although, person centred care has for a long time been an important approach to nursing care, it is often not a reality in the clinical environment. The focus of health research has, until recently, been on the physical aspects of a persons¿ illness and this has influenced how care is delivered. There is a need to broaden the focus from the illness to the person who is ill. A holistic approach to the persons¿ social and cultural experience of their illness will aid health care professions to provide person centred care. This paper will make the argument that narrative inquiry is a well suited to health care research in general and nursing research in particular as it focuses its inquiry on the individual person's experience of their illness ¿ ¿what matters¿ from the person's point of view. Narrative inquiry explores the narrative from a temporal, social and spatial view. Conclusions: There is a need to find what is important from the patients¿ ¿point of view¿ to optimise care. Narrative Inquiry is a methodology often used in education and sociology. It is a gentle relational methodology that has the capability to uncover what is important to the person in their situation. The research findings are presented narratively, that is, informally and engagingly for the consumer of the research.

Clinical placements are specifically designed to facilitate authentic learning opportunities and are an integral component of undergraduate nursing programs. However, as academics and clinicians frequently point out, clinical placements are fraught with problems that are long-standing and multidimensional in nature. Collaborative placement models, grounded in a tripartite relationship between students, university staff and clinical partners, and designed to foster students¿ sense of belonging, have recently been implemented to address many of the challenges associated with clinical placements. In this study a qualitative descriptive design was undertaken with the aim of exploring 14 third year third year nursing students¿ perceptions of a collaborative clinical placement model undertaken in an Australian university. Students participated in audio recorded focus groups following their final clinical placement. Thematic analysis of the interview data resulted in identification of six main themes: Convenience and Camaraderie, Familiarity and Confidence, Welcomed and Wanted, Belongingness and Support, Employment, and The Need for Broader Clinical Experiences. The clinical collaborative model fostered a sense of familiarity for many of the participants and this led to belongingness, acceptance, confidence and meaningful learning experiences.

Background: A growing body of literature has identified a range of beneficial physiological and psychological outcomes from the regular practice of mindfulness meditation. For healthcare professionals, mindfulness meditation is claimed to reduce stress, anxiety and burnout, and enhance resilience. Objective: The objective of this integrative review was to critically appraise the literature that related to the effectiveness of mindfulness meditation programs for nurses and nursing students. Design: This review was conducted using Whittemore and Knafl's framework for integrated reviews. Data Sources: Using the terms mindfulness, mindfulness-based-stress reduction, Vipassana, nurses, and nurse education a comprehensive search of the following electronic databases was conducted: CINAHAL, Medline, PsycINFO, EMBASE. EMCARE, ERIC and SCOPUS. Review Methods: The initial search located 1703 articles. After screening and checking for eligibility 20 articles were critically appraised using the Critical Appraisal Skills Program checklist for qualitative papers and McMaster's Critical appraisal form for quantitative papers. The final number of papers included in the review was 16. Results: The results of this review identified that mindfulness meditation has a positive impact on nurses¿ and nursing students¿ stress, anxiety, depression, burnout, sense of well-being and empathy. However, the majority of the papers described small scale localised studies which limits generalisability. Conclusion: Contemporary healthcare is challenging and complex. This review indicated that mindfulness meditation is an effective strategy for preventing and managing the workplace stress and burnout, which so often plague nursing staff and students. Further studies with larger sample sizes using rigorous research methods would be useful in extending this work.

Objective: To explore the experiences of older people receiving home care package (HCP) support following the introduction of consumer-directed care (CDC) by the Australian government on 1 July 2015. Methods: Thirty-one older people with existing HCP support from two service providers in regional New South Wales, Australia, participated in a face-to-face interview and/or a qualitative survey. Results: Analysis revealed the theme of Choices: Preferences, constraints, balancing and choosing. Participants described choosing to live at home with HCP support; however, they were constrained by poor communication and information about service changes and options, personal budgets and access to future care. HCP services remained largely unchanged during transition to CDC. Conclusion: Many aspects of the initial implementation of CDC were challenging for older people. Clear, relevant and timely communication and information about CDC and its consequences for consumers appear to be needed to enhance CDC.

Aims and objectives: To explore and present findings of qualitative studies exploring real-life experiences of people with transient ischaemic attack or minor stroke. Background: Transient ischaemic attack and minor stroke significantly increase the risk of stroke. Primarily, literature has examined healthcare pathways, patient outcomes and models of care through quantitative methodologies. Several studies have explored patient experiences using qualitative approaches. However, these findings have not been systematically collated or critically appraised to better understand the experiences of this population. Design: A literature review of the qualitative evidence. Method: A systematic literature search was conducted in CINAHL, MEDLINE, EMBASE and PsycINFO between January 2005¿October 2016 to identify qualitative studies that explored real-life experiences of people with transient ischaemic attack or minor stroke. The relevant EQUATOR guidelines were followed. Findings of relevant studies were critically appraised and collated using a thematic approach. Results: The search retrieved 709 articles. Twelve articles were included after critical review. Three themes emerged including recognition, awareness and action; the vulnerable self; and social and personal life change. Participants experienced ongoing vulnerability and change in their personal and social lives. Specifically, people believed that their condition did not reflect their physical appearance and led to their needs being unmet by health professionals. Conclusions: This is the first review of the literature to collate the thoughts, perspectives and experiences of people living with transient ischaemic attack or minor stroke. They reveal a complex, life-altering experience characterised by vulnerability, instability and change. Education that assists clinicians to connect with these experiences may alleviate the patient-reported disconnection with health professionals. Relevance to clinical practice: Physical and psychosocial dysfunctions were consistently reported to be overlooked or undetected by clinicians. Educating clinicians might enable them to better understand patient experiences, improve therapeutic interactions and meet the needs of this population.

Background: The incidence of cardiac arrest and cardiopulmonary resuscitation continues to increase worldwide largely due to greater awareness of the symptoms of cardiac events and increased attention to cardiopulmonary resuscitation training in the community. Globally, predicted survival rates after cardiopulmonary resuscitation have remained at 10% for decades and although patient outcome remains unpredictable, there is a positive trend in life expectancy. For a resuscitation attempt to be classed as successful, not only survival but also quality of life has to be evaluated. Aim: The aim of this review was to examine literature that explores the quality of life (QOL) for survivors' after CPR and the influence cognitive impairment, anxiety, depression and post-traumatic stress disorder (PTSD) has had on their QOL. Review methods: This review follows Whittemore and Knafl's framework for an integrative literature review. Electronic databases EBSCO, Ovid, PubMed and EMBASE were searched. After application of the inclusion and exclusion criteria, thirty-six papers published from January 2000 to June 2015 were included in this review. Results: These papers represent a broad spectrum of research evaluating quality of life for survivors of cardiopulmonary resuscitation. The heterogeneous research methods and vast number of different research tools make it challenging to compare the findings. The majority of papers concluded that quality of life for survivors of cardiac arrest and cardiopulmonary resuscitation was generally acceptable. However, studies also described survivors' experience of anxiety, depression, post-traumatic stress and cognitive dysfunction. Conclusion: A majority of papers reported an acceptable quality of life if the patient survived to hospital discharge. The heterogeneity in quantitative papers was noticeable and indicates a marked variance in patient outcomes. This review highlights the absence of specialized tools used to investigate survivors' experience of the event. Further exploration of the impact cardiopulmonary resuscitation has on the individual may improve ongoing rehabilitation and quality of life levels for survivors.

Background Hospital facilities that can support the well-being of sick children and their families by providing an environment outside of the paediatric ward can be beneficial to health outcomes. Access to a garden environment that allows young patients and their family to engage with natural and built features has been shown to relieve stress, provide opportunities for educational activities, improve socialisation amongst children and adults and so create a more calming and supportive environment to help the healing process. Aim To explore experiences of family members of sick children who have participated in formal and informal activities in a child-centred environment called a ¿Fairy Garden¿ (FG) within a hospital in northern Thailand. Method Narrative inquiry situated within qualitative research was selected as a methodology to capture the holistic notion of the participant's experience. Eight family members (seven parents and one grandparent) were interviewed in four focus groups. Interviews were carried out over a 5-week period in June 2013. Findings Findings show that the Fairy Garden (FG) offers a therapeutic modality of healing that improves the quality of life for sick children and includes storylines of happiness and relaxation, cooperation from the children, social interaction and learning. For family members the FG provided opportunities to relax with their sick child, watch as their child played in the garden and explored the variety of natural and built features and encouraged their child to eat. The FG allowed contacts to occur amongst family members of sick children, share information, prepare meals and spend time sitting and walking around the garden while waiting while their child received treatment. Conclusion Through family members stories we were able to capture numerous storylines of the FG creating a space for children and families that counter balances the clinical environment of hospital as an alien place and results in an improved hospital experience for sick children and their families.

Background: Survival following cardiac arrest and subsequent cardiopulmonary resuscitation (CPR) is increasing worldwide, mainly due to greater awareness of the symptoms of cardiac events and an increased attention to CPR training. Although patient outcomes remain unpredictable and quantitative studies suggest that the overall quality of life (QOL) is acceptable, it is valuable to synthesise qualitative studies exploring these phenomena in depth, providing a deeper knowledge of survivors' experiences and QOL. Aims: To critically appraise and synthesise the qualitative literature on survivors' experiences of a cardiac arrest and CPR with the aim of identifying common themes that can inform clinical pathways and thereby improve survivor outcomes and QOL. Methods: A systematic review and meta-synthesis of the qualitative literature, using Thomas and Harden's framework, and confined to peer-reviewed papers published from 2000 to 2015, which were identified through database searches of EBSCO, OVID and ProQuest. Results: The search produced 204 papers, and of these, seven relevant papers were identified for review. Data extraction included setting, participants, research design, data collection, analysis and themes. Five qualitative themes were identified and were the subject of this meta-synthesis: multitude of contrasting feelings; disruption in the continuum of time; new reality and psychological challenges; changed body with new limitations; and confrontation with death. Conclusion: This review provides insights into the experiences of survivors' QOL after CPR. Increased knowledge can improve person-centred care in the immediate and forthcoming care after the event, both in terms of planning for discharge and in the future care of people who survive a cardiac arrest.

This paper reports phase one, conducted from March to June 2015, of a two-phase, qualitative descriptive study designed to explore the perceptions and experiences of older people before and after the introduction of consumer directed care (CDC) to home care packages (HCP) in Australia. Eligible consumers with a local HCP provider were mailed information about the study. Data collection occurred before the introduction of CDC and included face-To-face, in-depth interviews, summaries of interviews, field notes and reflective journaling. Semi-structured questions and 'emotional touchpoints' relating to home care were used to guide the interview conversation. Line-by-line data analysis, where significant statements were highlighted and clustered to reveal emergent themes, was used. Five older people, aged 81 to 91 years, participated in the study. The four emergent themes were: seeking quality and reciprocity in carer relationships; patchworking services; the waiting game; and technology with utility. Continuity of carers was central to the development of a trusting relationship and perceptions of care quality among older consumers. Care coordinators and workers should play a key role in ensuring older people receive timely information about CDC and their rights and responsibilities. Participants' use of contemporary technologies suggests opportunities to improve engagement of HCP clients in CDC.

Because nurses are at the forefront of end-of-life care, it is imperative that nursing students are prepared for this role upon graduation. Research suggests that many nursing students are unprepared to deliver compassionate and quality end-of-life care. There have been many attempts to address this need; one emerging method is end-of-life care simulation. This paper explores the experiences of 18 undergraduate nursing students of end-of-life care simulation. Participants' stories were obtained via observation during end-of-life care simulation, audio-recorded post simulation debriefing, and semi-structured interviews. Using Clandinin and Connolly's three dimensions of Narrative Inquiry (temporality, spatiality, and sociality) participants' stories reflected convergence of time, place, and person. Findings revealed three distinct plotlines along a time continuum, specifically surrounding time of death: (i) "The privilege of end-of-life care;" (ii) "Witnessing death as surreal;" and (iii) "The honor of providing after-death care." Participants' narratives suggest that end-of-life care simulation is an important means of preparing students for clinical end-of-life care experiences. This has implications for nursing educators wishing to consider simulation in end-of-life care education.

A transient ischemic attack (TIA) significantly increases a person's risk of ischemic stroke. However, little is known about the experiences of these people or what influences their decision to access care. This article explores the stories of three people who experienced a TIA. All participants were interviewed after receiving a diagnosis of TIA by a specialist neurologist. By utilizing a framework of narrative inquiry, several storylines were revealed across temporal, social, and geographical landscapes. The main storylines include: bodily disruption, time stasis, altered temporal perceptions, the roles of others, and help-seeking behavior. The primary author also reflects upon his own origin and explores how this inquiry has influenced his perceptions, career, and nursing practice. This inquiry may assist healthcare workers to gain insight into the experiences of people with TIA and suggests how involvement of significant others is beneficial when educating people at risk of TIA.

Decreasing the numbers of adverse health events experienced by people from culturally diverse backgrounds rests, in part, on the ability of education providers to provide quality learning experiences that support nursing students in developing cultural competence, an essential professional attribute. This paper reports on the implementation and evaluation of an immersive 3D cultural empathy simulation. The Satisfaction with Cultural Simulation Experience Scale used in this study was adapted and validated as the first stage of this study. Exploratory factor analysis and confirmatory factor analysis were undertaken to investigate the psychometric properties of the scale using two randomly-split sub-samples. Cronbach's Alpha was used to examine internal consistency reliability. Descriptive statistics were used for analysis of mean satisfaction scores and qualitative comments to open-ended questions were analysed and coded. A purposive sample (n = 497) of second of nursing students participated in the study. The overall Cronbach's alpha for the scale was 0.95 and each subscale demonstrated high internal consistency: 0.92; 0.92; 0.72 respectively. The mean satisfaction score was 4.64 (SD 0.51) out of a maximum of 5 indicating a high level of participant satisfaction with the simulation. Three factors emerged from qualitative analysis: "Becoming culturally competent", "Learning from the debrief" and "Reflecting on practice". The cultural simulation was highly regarded by students. Psychometric testing of the Satisfaction with Cultural Simulation Experience Scale demonstrated that it is a reliable instrument. However, there is room for improvement and further testing in other contexts is therefore recommended.

Introduction: Worldwide, stroke is the principal cause of adult disability and second leading cause of death. Traditional and complementary therapies such as yoga, tai chi, massage and herbal therapies are widely used to treat a variety of illnesses in developing countries and recent research has shown that they may be of some benefit in stroke rehabilitation. Methods: A quasi-experimental controlled before-and-after study that recruited 40 stroke patients from Thung Bo Paen rehabilitation centre (treatment group) and Lampang hospital (control group), located in Northern Thailand. Measures included activities of daily living (ADLs), involving Barthel Index scores, and pain, emotion and sleep scores. Results: There was a statistically significant difference between the changes in Barthel Index scores in patients from the two treatment locations, where patients from Thung Bo Paen showed greater improvement compared to patients from Lampang hospital (. p=. 0.020). However, there were no significant differences between the changes in pain scores (. p=. 0.492), emotion scores (. p=. 0.671) or sleep scores (. p=. 0.197) in patients from the two treatment locations. Conclusions: Patients receiving traditional Thai therapies had significant improvements in ADLs at 3 months compared to conventional treatments. Future research on the use of traditional Thai therapies for stroke recovery should be conducted using a RCT, to avoid biases such as the differences in baseline measures, and should also contain an evaluation of cost, because if both approaches are shown to be equivalent, the next issue to be addressed is which approach is more cost effective.

Aims and objectives: To determine the effect of immersive 3D cultural simulation on nursing students' empathy towards culturally and linguistically diverse patients. Background: Accelerated globalisation has seen a significant increase in cultural diversity in most regions of the world over the past forty years. Clinical encounters that do not acknowledge cultural factors contribute to adverse patient outcomes and health care inequities for culturally and linguistically diverse people. Cultural empathy is an antecedent to cultural competence. Thus, appropriate educational strategies are needed to enhance nursing students' cultural empathy and the capacity to deliver culturally competent care. Design: A one-group pretest, post-test design was used for this study. The simulation exposed students to an unfolding scene in a hospital ward of a developing county. Methods: A convenience sample of second-year undergraduate nursing students (n = 460) from a semi-metropolitan university in Australia were recruited for the study. Characteristics of the sample were summarised using descriptive statistics. T-tests were performed to analyse the differences between pre- and post simulation empathy scores using an eight item modified version of the Kiersma-Chen Empathy Scale. Results: Students' empathy towards culturally and linguistically diverse patients significantly improved after exposure to the 3D simulation experience. The mean scores for the Perspective Taking and Valuing Affective Empathy subscales also increased significantly postsimulation. Conclusions: The immersive 3D simulation had a positive impact on nursing students' empathy levels in regards to culturally and linguistically diverse groups. Research with other cohorts and in other contexts is required to further explore the impact of this educational approach. Relevance to clinical practice: Immersive cultural simulation experiences offer opportunities to enhance the cultural empathy of nursing students. This may in turn have a positive impact on their cultural competence and consequently the quality of care they provide to culturally and linguistically diverse patients.

Background: Simulation is an evolving pedagogical approach to teaching in many undergraduate nursing curricula, however, there is little published literature on end of life care simulation as an effective means of teaching nursing students about end of life care. Literature review aims: To examine available literature on end of life care simulation. Review methods: An extensive literature search on end of life care simulation in the undergraduate nursing curriculum was conducted in CINAHL, Mosby's Index, Cochrane Database, Scopus, Eric via Proquest, and Medline. 6 research articles and 10 descriptive articles published between 2009 and 2013 that met the selection criteria are included in the review. Findings: Findings of these 16 articles are reported under 4 main themes: 1) Increased knowledge of end of life care through 'experiential learning'; 2) Impact of family presence on student learning; 3) the Debriefing imperative, and 4) Methodological issues raised from studies. Conclusion: The findings of the studies reviewed support end of life care simulation as a strong and viable pedagogical approach to learning for its positive effects on knowledge acquisition, communication skills, self-confidence, student satisfaction and level of engagement in learning. However, the important factors including psychological safety of students and the costs involved require careful consideration. Research on the use of simulation in nursing is still in its infancy, further research using various research designs is required to adequately explore the issues surrounding end of life care simulation. © 2013.

Background: Research on end of life care education suggests that undergraduate nursing students are largely unprepared to provide end of life care to dying patients and their families. Although there have been attempts to address the issue of lack of preparedness, little is known on how to improve this. Literature Review Aims: To examine how end of life care education has been delivered to undergraduate nursing students and to critically discuss the research on modes of delivery and teaching strategies. Review Methods: An extensive literature search on end of life care education in the undergraduate nursing curriculum was conducted in CINAHL, Mosby's Index, Cochrane Database, Scopus, Eric via Proquest, and Medline. 18 research papers published between 1984 and 2012 that met the selection criteria are included in the review. Findings: Findings of these 18 articles are reported under two main themes: Modes of End of Life Education Delivery and End of Life Care Education Initiatives. Conclusion: This review highlights issues with end of life care education and suggests that end of life care simulation is an innovative strategy that may help to prepare undergraduate nursing students to provide quality end of life care. © 2013.

For the past 4 years, undergraduate students from the Faculty of Health, University of Newcastle, Newcastle, Australia, have undertaken a two week cultural study tour in Thailand, being exposed to a broad range of cultural interactions, health settings in rural and remote areas, and health-treatment approaches, including traditional and complementary therapies. Student evaluations and reflections were collected after the 2010 and 2011 study tours. This paper reports on findings following thematic analysis of the data, which identified central themes, including connectivity to others, "awakenings", "embodiment", and looking to the future. Findings included a recognition by students of a growth in awareness and change in perspective, which they felt would impact on their future approach in caring for patients from culturally- and linguistically-diverse backgrounds. We conclude that the study tour provided an effective way of sensitizing students to cultural differences and promoting cross-cultural awareness.

Aims and objectives: To report on the stories of registered nurses and nurse administrators in a Thai hospital that recently constructed a healing haven environment called a 'Fairy Garden' to support the formal and informal activities of sick children. Background: While there has been some research into healing environments in health for adults, there has been no qualitative research into healing environments such as natural gardens for children. Design: Narrative inquiry was selected to capture the holistic notion of the participant's experience. Clandinin's narrative inquiry framework involving three dimensions sociality, space and temporality was used to analyse the data. Methods: Eight nurses (including two head nurses, three ward nurses and three nurse administrators) were interviewed in three separate focus groups between November 2011-June 2012. Results: Findings included storylines/threads of happiness, relaxation and calmness, imagination, spirituality and cooperation in reporting observed responses of sick children to the 'Fairy Garden'. Importantly, play was seen as a distractor from the children's pain and illness, with the children's ward no longer viewed as simply a clinical hospital site. Rather the opportunities that were afforded to children to interact with the 'Fairy Garden' environment expanded their hospital experience to include play, social interaction and educational activities. Conclusion: The Nurses' stories capture numerous storylines and threads in which the 'Fairy Garden' becomes an environment beyond the constraints of the hospital ward. Storylines indicate increased acceptance and adherence to treatment as the 'Fairy Garden' opens up alternatives for children, especially those children long term in the hospital. Children exhibit behaviours that suggest the 'Fairy Garden' supports psycho-social and physical benefits that improve their hospital stay and provide potential for improved clinical outcomes. Relevance to clinical practice: Designed hospital environments need to consider the addition of natural and activity spaces to support sick children and their families. Reports from nurses caring for children indicate benefits of the natural environment outside the clinical area.

Aims and objectives: To explore the perceptions of nurses regarding the provision and nonprovision of medical nutrition and hydration during the end stage of life when death is imminent in the acute care setting. Background: When people are dying, they often experience a loss of appetite and desire for drinking which are natural processes at this time. The cessation of eating and drinking challenges both family members and clinical staff. This article builds on previous studies that describe the perceptions of medical doctors and palliative care nurses regarding medical nutrition and hydration during the end stage of life when death is imminent. Design: Qualitative descriptive design. Methods: This study included three focus group meetings with ten nurses in an acute care setting in medical, oncology and haematology units. An interview schedule was used to guide the discussions. Results: The main theme to emerge from this study was 'finding a comfort space/ambiguous spaces of unrest' that included four subthemes: (1) limited involvement in decision-making, (2) comfort vs. discomfort, (3) uncertainty and (4) the comfort of withdrawing treatment. Finding a comfort space captures the challenges nurses faced when speaking about the concerns of patients and family. In this space, there were ambiguities that created unease and unrest: a reluctance to talk about death; a reluctance to engage with the patient and the family. Conclusions: Acute care nurses need to be more cognisant of the palliative approach to care and become more engaged with decision-making during the end stage of life when death is imminent. Relevance to clinical practice: Nurses in acute care settings need to be involved in decision-making and advocate for patients and family during the dying phase. Nurses in acute care need better understanding about the palliative approach to care and nutrition and hydration for people who are dying. © 2013 John Wiley & Sons Ltd.

Falls amongst older people is a global public health concern. Whilst falling is not a typical feature of ageing, older people are more likely to fall. Fall injuries amongst older people are a leading cause of death and disability. Many older people do not do regular exercise so that they lose muscle tone, strength, and flexibility which affect balance and predispose them to falls. The management of falls in residential care settings is a major concern with strategies for prevention and monitoring a focus in this setting. Yoga and tai chi have shown potential to improve balance and prevent falls in older adults. They also have potential to improve pain and quality of life. The aim of this study was to determine the feasibility of conducting a three-arm randomised controlled trial (RCT) with frail older people in a residential care setting to test the hypothesis that a 14-week modified tai chi or yoga programme is more effective than usual care activity in improving balance function, quality of life, pain experience and in reducing number of falls. There were no statistically significant differences between the three groups in the occurrence of falls. Yoga demonstrated a slight decrease in fall incidence; quality of life improved for the tai chi group. Only the yoga group experienced a reduction in average pain scores though not statistically significant. The findings of the study suggest it is possible to safely implement modified yoga and tai chi in a residential care setting and evaluate this using RCT design. They show positive changes to balance, pain and quality of life and a high level of interest through attendance amongst the older participants. The results support offering tai chi and yoga to older people who are frail and dependent with physical and cognitive limitations.

This review discusses palliative care and end-of-life models of care for Aboriginal people in the Australian state New South Wales, and considers Aboriginal palliative care needs by reflecting on recent literature and lessons derived from Aboriginal consultation. Aboriginal people in Australia account for a very small proportion of the population, have poorer health outcomes and their culture demonstrates a clear resistance to accessing mainstream health services which are viewed as powerful, isolating and not relevant to their culture, way of life, family and belief systems. Aboriginal people regard their land as spiritual and their culture dictates that an Aboriginal person needs to know their origins, emphasising the value placed on kin and also demonstrating a strong desire to remain within their own country. Currently Aboriginal people tend to not access palliative care services in mainstream facilities; and there is very little data on Aboriginal admissions to palliative care centres. Over the last two decades only two models of palliative care focusing on and developed in Aboriginal communities have been implemented. The seminal contribution to Aboriginal Palliative Care was in the form of a resource kit developed to support palliative care providers to examine their practice for cultural appropriateness for Aboriginal and Torres Strait Islanders. The 'living model' coming from this project is adaptive and flexible, enabling implementation in different Aboriginal country as a participative process with community input. The Australian government's National Indigenous Palliative Care Needs Study similarly indicated that Australian empirical research on Aboriginal palliative care service provision is in its infancy, and comprehensive data on the rates of Aboriginal access to palliative care services did not exist. What literature does exist is drawn together in an argument for the development and need for culturally specific Aboriginal palliative care models, which are culturally appropriate, locally accessible and delivered in collaboration and partnership with Aboriginal controlled health services. This is essential because Aboriginal people are a minority cultural group who are disconnected from mainstream health service delivery, and have a sense of cultural isolation when accessing mainstream services. It is preferable that palliative care is delivered in a collaboration between Aboriginal Controlled Health Service and mainstream palliative care services to ensure a dignified end of life for the Aboriginal person. These collaborations and partnerships are fundamental to ensure that a critical mass of Aboriginal clinicians are trained and experienced in end of life care and palliation. Developing palliative care programs within Aboriginal communities and training Aboriginal Health Workers, promoted and developed in partnership with the Aboriginal community, are important strategies to enhance palliative care service provision. Further partnerships should be championed in this collaborative process, acknowledging a need for palliative care models that fit with Aboriginal peoples' community values, beliefs, cultural/ spiritual rituals, heritage and place.