2013 grant recipient
Janice Taylor’s early physiotherapy career was varied, interspersed with overseas travel during which she worked as a physiotherapist in London and Scotland. On her return to Australia, Janice was interested in working with older people so completed a part-time Masters in Gerontology at La Trobe University. In 2006 she obtained a Certificate IV in Training and Assessment and applied what she learnt to practice, clinical supervision and managerial roles in community based rehabilitation and residential aged care.
In 2009, Janice was awarded a Primary Health Care Research, Evaluation and Development Fellowship. Janice completed her PhD in 2014, entitled 'A Collaborative and Integrated Approach to Resident Mobility.' This program of exploratory qualitative research pointed to the need for improvements in residential aged care staff’s provision of mobility care; staff needed to not only ensure safety, but also to optimise residents’ mobility and apply person-centred approaches during mobility care. The research suggested that collaborative approaches to learning, and culture change would be required to gain and sustain mobility care improvements—didactic training models are less successful in securing staff behaviour change than interactive models and facility cultures based on relationships are more likely to support practice change.
Research areas and findings
Janice’s PRF grant was awarded in 2013 to test the feasibility of a complex mobility care improvement intervention. The project was entitled 'Evaluating a physiotherapist-led training program to improve residents’ mobility care in nursing homes: A feasibility study.' Physiotherapists, Professor Terry Haines and Associate Professor Anna Barker, and a dementia care consultant, Dr Heather Hill collaborated on the project. The study was conducted in a 90-bed residential aged care facility in Melbourne over eight months. The team tested an adaptive and flexible approach to adult learning that included individual and collective reflective practice. This was innovative as other interventions employing reflective practice for residential aged care staff had not been reported in the literature. It aimed to improve mobility care by improving staff’s interaction and communication with residents as well as staff’s ability to promote residents’ independence during transfers on and off chairs and wheelchairs. Initial training sessions were followed by mobility care huddles or small staff gatherings. All aspects of the intervention were focused on experiential and interactive learning and the key element of reflection.
Achievements with grant money
The PRF study showed the intervention to be feasible; it was practical and well accepted by staff and management. Janice and her team recruited over one-third of direct care workers and ambulatory residents. Outcome measures demonstrated the potential for significant improvements in staff behaviour change. During 2014, Janice presented on the study at an international dementia conference and at the Australian Association of Gerontology National Conference. A paper reporting the study has been published in Geriatric Nursing.
Research impact on physiotherapy
This PRF funded study highlighted the value of transference of the tacit knowledge held by skilled physiotherapists to residential aged care staff. It demonstrated an innovative and feasible means for such knowledge transfer. Key elements of the intervention were management support and external facilitators who were flexible and who could call upon a range of adult learning strategies. Facilitators understood the notion of situation awareness—being present and able to adapt to circumstances—and had well-developed communication skills, commonly associated with person- and relationship-centred care, essential to the development of trust and rapport with staff and residents.
Important areas for development in physiotherapy
This study suggests that for physiotherapists to support and advance quality mobility care in the complex environment of residential aged care, they need knowledge and skills in a range of collaborative modes of training as well as in mobility optimisation, safe manual handling and person-centred care. Janice believes more physiotherapists should be willing and able to act collaboratively as change agents with organisations to improve the quality of mobility care.