The aim of this study is to determine the accuracy, feasibility and acceptability of the surprise question (SQ) in combination with a clinical prediction tool (Supportive and Palliative Care Indicator Tool (SPICT)) in identifying residents who have palliative care needs in residential aged care facilities (RACFs) in Australia. A prospective cohort study in two RACFs containing both high-level care (including dementia) and low-level care beds. Directors of Nursing screened 187 residents at risk of dying by 12 months using first the SQ, and if positive, then the SPICT. At 12-months follow-up, deaths, hospitalisations, use of palliative care services, end-of-life care and clinical indicators were recorded. The SQ had a sensitivity of 70%, a specificity of 69.6%, a positive predictive value of 40.6% and a negative predictive value of 88.7% for death. All residents identified by the SQ had at least two general indicators of deterioration, while 98.8% had at least one disease-specific indicator on the SPICT. The SPICT marginally increased the ability to identify residents in need of proactive end-of-life planning. A combination of the SQ and the SPICT is effective in predicting palliative care needs in residents of aged care facilities, and may trigger timely care planning.

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ObjectiveTo measure the quality of interaction between the Public Health Nursing Sister (PHNS) and the Public Health Midwife (PHM) during supervision. Methods This was a cross-sectional study, using triangulation of data obtained from structured observations and audio tape records of supervisor-supervisee interactions and written records of all supervision activities. Twenty four PHNS participated in the study. This study was undertaken in the district of Kalutara. Results Supervisors spent less time on supervising client care issues than on supervising facility level issues and interacting with clients. The weakest skills among the PHNS were 'seeking client input' and 'discussing the next visit' and the strongest skills were 'giving feedback', 'discussing/interpreting data' and 'developing rapport'. Skills of supervision increased with the service duration of the PHNS but none were able to achieve the cut-off mark for satisfactory overall quality of interaction. Conclusions This study indicates that the overall quality of interaction between the PHNS and the PHM during supervision was poor. PHNS lacked skills in prioritisation of supervision activities and time management. They also lacked other necessary skills that ensure a higher quality of PHNS-PHM interaction.