Australian nurses have used the nursing process since the 1980s as a way of systematically thinking about what to do for patients they provide care for. Over time expert clinical nurses and nurse scholars have described the basic process and the terms that name its components in a number of different ways. Yet the nursing process remains a dynamic, cyclic and ongoing process of problem solving in practice. The purpose of the nursing process is to identify a patient's health status and actual or potential health care problems/needs/strengths, to establish plans to meet the identified needs, and to deliver specific nursing interventions to meet those needs. The nurse's evaluation of care will lead to changes in the implementation of care, as the patient's needs change during their stay in hospital with improvement or deterioration in their health status. The nursing process not only focuses on ways to improve the patient's physical needs, but also on social, cultural, emotional and spiritual needs as well. Accordingly, the nursing process is: • cyclic and dynamic • goal directed and patient centred • interpersonal and collaborative • universally applicable • systematic. In this chapter, the patient may be an individual, a family or a group.

This case study describes a multi-organisation aged care emergency (ACE) service. The service was designed to enable point-of-care assessment and management for older people in residential aged care facilities (RACFs). Design of the ACE service involved consultation and engagement of multiple key stakeholders. The ACE service was implemented in a large geographical region of a single Medicare Local (ML) in New South Wales, Australia. The service was developed over several phases. A case control pilot evaluation of one emergency department (ED) and four RACFs revealed a 16% reduction in presentations to the ED as well as reductions in admission to the hospital following ED presentation. Following initial pilot work, the ACE service transitioned across another five EDs and 85 RACFs in the local health district. The service has now been implemented in a further 10 sites (six metropolitan and four rural EDs) across New South Wales. Ongoing evaluation of the implementation continues to show positive outcomes. The ACE service offers a model shown to reduce ED presentations and admissions from RACFs, and provide quality care with a focus on the needs of the older person.

'Objectives': To evaluate the impact of a nurse-led telephone support service to Residential Aged Care Facilities (RACFs) on a range of measures relating to the transfer of acutely unwell residents to the Emergency Department (ED) of a large tertiary referral hospital in New South Wales, Australia over a 9 month period. 'Methods': A pre- and post-intervention design determined the impact of the telephone service, associated clinical guidelines and education. Data from 4 intervention RACFs using the nurse-led telephone service were compared with 8 control RACFs. Data included the older patient's triage category, presenting problem(s), transfer rates from RACFs, ED admissions, and overall hospital length of stay. Interviews and focus groups with staff from RACFs and EDs were conducted to ascertain their experiences. 'Results': Reduced presentations of older people to the ED from the 4 pilot RACFs occurred. High levels of satisfaction among staff in RACFs were reported.

Contact with family and friends, in the form of visiting, is very important to the quality of the lives of rural nursing home residents. However, there has been little recent research that examines the frequency and determinants of visits to rural nursing homes and none in the rural Australian context. This study aimed to address this gap in the literature. A telephone survey with a close family member (N=257) of each participating resident in the rural New England area of New South Wales, Australia gathered data about 3,738 people who formed the potential social networks of these residents. This study found that the wider, potential, social networks of rural nursing home residents comprised approximately 17 people and involved a wide range of family and friends. However, their actual social networks consisted of approximately two females, daughters and friends, who had high-quality relationships with the resident and who visited at least once per month. In contrast to previous assertions that nursing home residents have robust support from their family and friends, the actual social networks of these residents have dwindled considerably over recent years, which may place them at risk of social isolation. This study has implications for nursing home policy and practice and recommendations for addressing the risk of social isolation that rural nursing home residents face are made.

The number of Chinese immigrants in Australia has increased significantly over the past two decades, and their ageing issues have gradually become the focus of concern. This study aims to fill the literature gap by investigating older Chinese immigrants' experiences and perceptions of growing older in rural Australia in order to gain an understanding of their health-related help-seeking behaviours in this context. This study is situated in a qualitative interpretive paradigm. It uses a transcultural perspective to inform a case study methodology, and it adopts the Theory of Planned Behaviour as an interpretive framework to guide the study. A combination of purposive sampling and snowball sampling strategies was used in recruitment, and six Chinese immigrants aged 60–85 years who resided in rural Australia were invited to participate in the study. Individual semi-structured, in-depth interviews were used to gather data, and thematic analysis was applied to analyse the interview data. This study found that the older Chinese immigrants were living in two cultures, and this forced them to reconstruct their cultural beliefs, especially in relation to filial expectations and maintaining harmony in the family. Further, because of a lack of English proficiency, they had greater difficulties dealing with ageing, especially in accessing health care services in rural Australia. These findings have implications for policy and practice related to migrant health care and rural community health practice.

Objective: This review of the literature was undertaken to assess the evidence regarding the social lives of the residents of rural Australian aged care facilities with a particular focus on the frequency of the visits that they receive. Design: A systematic review of the literature relevant to the social lives of residents of rural aged care facilities was conducted. Results: Social contact is important to the elderly and is particularly important to the frail elderly who reside in aged care facilities. However, there is evidence to suggest that the social networks of the elderly are contracting and that this contraction is particularly severe in rural areas. In addition, social contact, in the form of visiting, can be inhibited when an elderly person enters an aged care facility. While much of the literature asserts that the residents of aged care facilities have robust social lives, there is some evidence to suggest that, over the past two decades, these people have become increasingly at risk of becoming isolated from their social networks. Conclusions: Social isolation may have serious consequences for the quality of life of residents of rural aged care facilities and there is a dearth of recent research regarding the factors that determine the frequency of the visits that they receive.