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palacios-ceña d., losa-iglesias m.e., álvarez-lópez c., cachón-pérez m., reyes r.a.r., salvadores-fuentes p. & fernández-de-las-peñas c. (2011) Patients, intimate partners and family experiences of implantable cardioverter defibrillators: qualitative systematic review. Journal of Advanced Nursing 67(12), 2537-2550. Abstract Aim. This paper is a report of an interpretive review of qualitative research on how an implantable cardioverter defibrillator affects adult recipients and their significant others. Background. An implantable cardioverter defibrillator detects pathological cardiac rhythms and automatically converts the rhythm with electrical counter shocks. Data sources. A systematic literature search was conducted for qualitative research papers published between January 1999 and January 2009. PubMed, Medline, ISI Web of Knowledge and CINAHL databases were searched with the following key words: internal defibrillator, implantable defibrillator and qualitative research. Review Methods. Twenty-two papers were included. The Critical Appraisal Skills Programme and Prompts were used to appraise studies. Thematic analysis and synthesis approaches were used to interpret evidence. Findings. People with an implantable cardioverter defibrillator were found to experience physical, psychological and social changes. Shocks produce fear and anxiety, affecting relationships and sexual relations. The use of support groups and the use of the Internet are important in helping adjustment to an implantable cardioverter defibrillator. Women's responses to an implantable cardioverter defibrillator appear different than men's responses and include concerns about physical appearance and relationship issues. Postdischarge follow-up and educational programmes are still underdeveloped. Conclusion. Patients need additional education, support and follow-up care after hospital discharge. Patients and significant others benefit from collaboration between patient associations and healthcare professional societies. Future research is needed to identify the specific challenges that women recipients face. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to explore the features of sustainable antimicrobial stewardship (AMS) programs in Australian rural hospitals and develop recommendations on incorporating these features into rural hospitals' AMS programs. Methods: Lead AMS clinicians with knowledge of at least one AMS program sustained for >2 years in a health service in rural Australia were recruited to the study. A series of interviews was conducted and the transcripts analysed thematically using a framework method. Results: Fifteen participants from various professional disciplines were interviewed. Key features that positively affected the sustainability of AMS programs in rural hospitals included a hospital executive who provided strong governance and accountability, dedicated resources, passionate local champions, area-wide arrangements and adaptability to engage in new partnerships. Challenges to building AMS programs with these features were identified, particularly in engaging hospital executive to allocate AMS resources, managing the burn out of passionate champions and formalising network arrangements. Conclusions: Strategies to increase the sustainability of AMS programs in rural hospitals include using accreditation as a mechanism to drive direct resource allocation, explicit staffing recommendations for rural hospitals, greater support to develop formal network arrangements and a framework for integrated AMS programs across primary, aged and acute care. What is known about the topic?: AMS programs facilitate the responsible use of antimicrobials. Implementation challenges have been identified for rural hospitals, but the sustainability of AMS programs has not been explored. What does this paper add?: Factors that positively affected the sustainability of AMS programs in rural hospitals were a hospital executive that provided strong governance and accountability, dedicated resources, network or area-wide arrangements and adaptability. Challenges to building AMS programs with these features were identified. What are the implications for practitioners?: Recommended actions to boost the sustainability of AMS programs in rural hospitals are required. These include using accreditation as a mechanism to drive direct resource allocation, explicit staffing recommendations for rural hospitals, greater support to develop network arrangements and support to create integrated AMS programs across acute, aged and primary care. [ABSTRACT FROM AUTHOR]

Aim: To explore families' experiences of their interactions in an Australian adult intensive care unit (ICU) to develop a grounded theory that can be used by critical care nurses to improve patient‐ and family‐centred care (PFCC). Background: Families in ICU play an important role in the patient's recovery and outcomes. However, families are at risk of significant psychological morbidity due to their experiences in ICU. Although many ICU patients can make their own decisions, a large proportion are unconscious or chemically sedated and unable to contribute to decisions about their care, leaving the decision‐making role to the family. Therefore, the families' psychosocial and emotional well‐being must be supported by implementing evidence‐based interventions that align with a PFCC approach. This study describes the findings of a grounded theory of family resilience in ICU, of which the core category is Regaining control. The focus of this paper is on the major category: Searching for meaning. Methods: We adopted a constructivist grounded theory method. Twenty‐five adult family members (n = 25) of 21 patients admitted unexpectedly to an ICU in metropolitan Australia were recruited. In‐depth interviews were used to collect the data, and the analytical processes of constructivist grounded theory underpinned the development of a core category and related subcategories. Results: When adult family members experience the unexpected admission of a relative to ICU, they move towards a state of being beyond emotional adversity and regaining control when facilitated to search for meaning in their situation. When families were able to make sense of their situation and find a purpose by contributing to their relative's recovery, it encouraged them to cope and be resilient. Conclusions: Our findings can be used to promote PFCC in ICU, which considers a collaborative approach to meet the patient's needs while providing emotional and psychosocial support to their families. [ABSTRACT FROM AUTHOR]

The potential of systems science concepts to inform approaches for addressing complex public health problems, such as obesity prevention, has been attracting significant attention over the last decade. Despite its recent popularity, there are very few studies examining the application of systems science concepts, termed systems thinking, in practice and whether (if at all) it influences the implementation of health promotion in real world settings and in what ways. Healthy Together Victoria (HTV) was based on a systems thinking approach to address obesity prevention alongside other chronic health problems and was implemented across 14 local government areas. This paper examines the experience of practitioners from one of those intervention sites. In-depth interviews with eight practitioners revealed that there was a rigidity with which they had experienced previous health promotion jobs relative to the flexibility and fluidity of HTV. While the health promotion literature does not indicate that health promotion should be overly prescriptive, the experience of these practitioners suggests it is being applied as such in real world settings. Within HTV, asking people to work with 'systems thinking', without giving a prescription about what systems thinking is, enabled practitioners to be 'practice entrepreneurs' by choosing from a variety of systems thinking methods (mapping, reflection) to engage actively in their positions. This highlights the importance of understanding how key concepts, both traditional planning approaches and systems science concepts, are interpreted and then implemented in real world settings. [ABSTRACT FROM AUTHOR]

Background: research in care home settings is often negatively focused, portraying life as sterile and devoid of meaningful experiences. Care homes have the potential to influence people's lives socially, physically and psychologically. It is important to understand what factors contribute to this.Objective: to conduct a systematic qualitative review of care home life and provide practical recommendations to enhance residents' quality of life.Methods: the following databases were searched: PsycINFO, Medline, Web of Science, EMBASE, Allied and Complementary Medicine Database and Cumulative Index to Nursing and Allied Health Literature. References from appropriate journals and individual articles were checked. Papers that fitted our selection criteria were selected. Two independent reviewers assessed methodological study quality. Thematic analysis and meta-ethnographic methods were adapted to synthesise findings.Results: thirty-one studies were identified. People in care homes voiced concerns about lack of autonomy and difficulty in forming appropriate relationships with others. Four key themes were identified: (i) acceptance and adaptation, (ii) connectedness with others, (iii) a homelike environment, (iv) caring practices.Conclusion: positive experiences in care homes can occur and are important for residents' quality of life. The review supports literature highlighting the need for relationship-centred approaches to care and emphasises the importance of understanding the resident's attitude towards living in care homes. [ABSTRACT FROM AUTHOR]

Home country re-entry from cross-cultural missionary work abroad may be associated with psychological distress. Re-entrants experience multiple losses including loss of identity which may be associated with personal/relational identity gaps and depersonalization/dehumanization. However, research suggests that some re-entrants are resilient with good mental health, while others are fragile with poor mental health. The aims of this paper are to explore the nature and frequency of re-entering missionaries' identity gaps and their depersonalization/dehumanization in resilient and fragile re-entrants. Fifteen re-entering adult Australian cross-cultural missionary workers from four interdenominational Australian mission organizations completed semi-structured interviews. Results were analysed using modified Consensual Qualitative Research methods. Links were established between personal/relational identity gaps, depersonalization/dehumanization and resilience on re-entry. Implications for re-entrants' care are discussed with suggestions for further research. [ABSTRACT FROM AUTHOR]

Introduction: Physical injury is a leading cause of death and disability among children worldwide and the largest cause of paediatric hospital admission. Parents of critically injured children are at increased risk of developing mental and emotional distress in the aftermath of child injury. In the Australian context, there is limited evidence on parent experiences of child injury and hospitalisation, and minimal understanding of their support needs. The aim of this investigation was to explore parents' experiences of having a critically injured child during the acute hospitalisation phase of injury, and to determine their support needs during this time.Methods: This multi-centre study forms part of a larger longitudinal mixed methods study investigating the experiences, unmet needs and well-being of parents of critically injured children over the two-year period following injury. This paper describes parents' experiences of having a child 0-13 years hospitalised with critical injury in one of four Australian paediatric hospitals. Semi-structured interviews were conducted with forty parents and transcribed verbatim. The data were managed using NVIVO 10 software and thematically analysed.Findings: Forty parents (26 mothers and 14 fathers) of 30 children (14 girls and 16 boys aged 1-13 years) from three Australian States participated. The majority of children were Australian born. Three main themes with sub-themes were identified: navigating the crisis of child injury; coming to terms with the complexity of child injury; and finding ways to meet the family's needs.Conclusions: There is a need for targeted psychological care provision for parents of critically injured children in the acute hospital phase, including psychological first aid and addressing parental blame attribution. Parents and children would benefit from the implementation of anticipatory guidance frameworks informed by a family-centred social ecological approach to prepare them for the trauma journey and for discharge. This approach could inform care delivery throughout the child injury recovery trajectory. The development and implementation of a major trauma family support coordinator in paediatric trauma centres would make a tangible difference to the care of critically injured children and their families. [ABSTRACT FROM AUTHOR]

Background: Adolescents and young people are the population at greatest risk of injury and therefore injury-related mortality and morbidity. Inquiry into the injury trajectory of young people is needed to identify this group's specific needs for healthcare. This paper reports the integration of quantitative and qualitative findings from a sequential explanatory mixed methods study examining young people aged 16-24 years' experience and trajectory of traumatic physical injury in the initial six months. The aim of integration was to address the question: In what ways are injured young peoples' experiences and self-management during the initial six months of the injury trajectory impacted by their injury, family support, and provision of healthcare?Methods: Key findings from epidemiological datasets on young person injuries from hospital and coronial databases (Phase 1) were combined with key findings from qualitative interviews with 12 injured young people and 10 family members (Phase 2).Results: The integration of findings from Phase 1 and Phase 2 resulted in three new findings; [1] (Alfred Health, 2014). A young person's perception of the severity of their injury, as well as the amount of time spent in hospital, impacts substantially on the way in which they experience injury, and this is managed differently between genders; [2] (Newnam et al., 2014). Admission to an Intensive care unit, including the intensity and duration of care, is the primary influence on how a family will provide support to the young person in the inpatient period; and [3] (Lyons et al., 2010). Young people's perception and understanding of their recovery from injury is in contrast with how healthcare systems are structured to provide rehabilitation and recovery care.Conclusion: The injury trajectory and recovery process of young people in the six months following injury have been have conceptualised. These trajectories of recovery can inform the development of anticipatory guidance frameworks for clinicians and guide the provision of and planning for clinical services for injured young people. [ABSTRACT FROM AUTHOR]

Consumer trust in food system actors is foundational for ensuring consumer confidence in food safety. As food labelling is a direct communication between consumers and food system actors, it may influence consumer perceptions of actor trustworthiness. This study explores the judgements formed about the trustworthiness of the food system and its actors through labelling, and the expectations these judgements are based on. In-depth, semi-structured interviews with 24 Australian consumers were conducted. Theoretical sampling focussed on shopping location, dietary requirements, rurality, gender, age and educational background. The methodological approach used (adaptive theory) enabled emerging data to be examined through the lens of a set of guiding theoretical concepts, and theory reconsidered in light of emerging data. Food labelling acted as a surrogate for personal interaction with industry and government for participants. Judgements about the trustworthiness of these actors and the broader food system were formed through interaction with food labelling and were based on expectations of both competence and goodwill. Interaction with labelling primarily reduced trust in actors within the food system, undermining trust in the system as a whole. Labelling has a role as an access point to the food system. Access points are points of vulnerability for systems, where trust can be developed, reinforced or broken down. For the participants in this study, in general labelling demonstrates food system actors lack goodwill and violate their fiduciary responsibility. This paper provides crucial insights for industry and policy actors to use this access point to build, rather than undermine, trust in food systems. [ABSTRACT FROM AUTHOR]

Falls are common events with serious consequences for older people. With an ageing population and increasing health-care costs, information and communication technologies (ICT) will have a potential role in future health-care delivery. However, research on technology acceptance in health care for older people is limited and its application to falls prevention is unknown. The aims of this study were to explore and describe the perceptions of community-dwelling Australian and Irish older people about their current use of technology, and the potential use of technology for falls prevention. Qualitative data were collected from three focus groups conducted in and around Limerick in Ireland, and three in the Sydney area, Australia. A total of 35 older people participated. Data were analysed using thematic analysis. Four themes emerged from the data: (a) perceptions of vulnerability to falls, (b) preferences for exercise interventions, (c) participation in and ownership of technology, and (d) perceptions about applications of technology for falls prevention. As the use of technology is an instrumental activity of daily living, health professionals need to assess the capacity of older people to adopt these technologies, and provide falls prevention interventions to accommodate the technology skills of older people. Some participants were reluctant to embrace technology and barriers to the effective use of technology to assist in preventing falls may conflict with future health service trends. [ABSTRACT FROM AUTHOR]

The population of Australia is ageing, with women being the primary beneficiaries of this increase in longevity. Increasingly older individuals are being diagnosed with different chronic illnesses such as peripheral arterial disease (PAD) which causes blockages of the blood vessels in the legs resulting in pain, non-healing ulcers, immobility and the potential amputation of the threatened limb. PAD has been traditionally thought to affect men more than women. Resultingly, women have been under-represented in clinical trials of PAD and under-diagnosed in the health-care setting. However, it has recently been acknowledged that women are indeed more likely to suffer from PAD than men due to increased presence of disease and survival advantage. As such, very little is known about women's understanding of and the meaning they create of their experiences of PAD. Therefore, how older women with PAD experience the ageing process is the focus of this qualitative research project. Interviews were conducted with 11 women from Sydney, Australia aged over 65 years who had been diagnosed with PAD. The interviews were analysed using an inductive thematic analysis. Three manifest themes were constructed: independence and control, active and involved, and the acceptance of ageing. These findings emphasised the idea that despite the presence of a chronic illness and increased age, remaining independent and engaged with life was vital to these women's wellbeing. Their subjective experiences of ageing reflect the fact that by adapting to the physical, mental and social changes that come with growing older, the focus does not need to be on loss and decline but rather can be about the continuation of life that can be both positive and meaningful. [ABSTRACT FROM AUTHOR]

This article is based upon the findings of a five-year prospective longitudinal study of relocation disputes in Australia, involving interviews with 80 parents and 33 children in 70 families. In the five years following the relocation dispute, much changed for some of these families. A few mothers left without their children; several mothers returned to the original location; some fathers followed. There were also changes in some custody arrangements. The mothers who moved were not surprisingly satisfied with the outcome; however, even mothers who were not allowed to move mostly showed greater improvements in stress levels and mental health than fathers over the five year period, even if the fathers successfully opposed the move. Several mothers adapted to staying if they could see the benefit to their children. All children who moved adapted to the new location and made new friends; however, those who had close relationships with their father found it very hard to be a long distance from him. Drawing upon these interviews, it is argued that decision making in relocation cases must be resolutely child-centered. It cannot be based upon adults’ rights. Children usually benefit from a continuing relationship with a nonresident parent who wants to be involved in their lives. In the adjudication of relocation disputes, careful attention is needed to how close and how developmentally important the child’s relationship is with their nonresident parent. Consideration must also be given to whether the nonresident parent can move to the preferred location of the primary caregiver. [ABSTRACT FROM AUTHOR]

Background: Refugee mothers have fled from their homeland to escape persecutions with their children only to find other threats to their well-being in the new country. Building on previous research, it is known that being a new immigrant is challenging and requires adaptation. The adaptation process, known as acculturation, may not be successful leading to psychological distress. It is also known that a generation gap can occur when children acculturate faster than their parents. What was lacking was understanding about the experiences of single refugee mothers. Methods: Interpretative phenomenological study was undertaken to explore the lived experiences of eight Burundian refugee single mothers in Australia. Data were collected by in-depth interviews. Each interviews were transcribed and analyzed using thematic analysis. Results: Findings revealed three themes. First theme 'Traditional mothering practices of Burundian culture' illustrated mothering strategies as practiced prior to their arrival in Australia including mothering with sufficient social support, strong position of parents, and regular use of physical disciplining. Second theme 'Challenges identified after arrival to new country' revealed that mothers felt their children acculturated faster than themselves which led to intergenerational gap. This has also led participants to live in a continuous dilemma, experiencing inner conflicts and struggles associated with their mothering practices, especially when mothers had arrived with a lack of knowledge relating to acceptable mothering practices in a new culture. Final theme, 'Reforming family life in Australia' highlighted the decisions made by single refugee mothers which is to embrace both new and original cultures, leading to successful acculturation. However, lack of appropriate knowledge of acceptable mothering practices led to involvement of legal authorities who threatening to remove children from the mother's care. This has led mothers feeling change of power from 'mother to child, 'to child to mother', raises concerns for family wellbeing. Conclusions: A need for parenting information when entering a new country including education about any legal obligations for parents such as a Child Protection Act will assist successful acculturation. As nurses are likely to encounter refugee single mothers, they are well placed to provide support and education to new refugee single mothers. [ABSTRACT FROM AUTHOR]

Purpose:Family members often assume the role of driver for individuals who are not driving post-acquired brain injury (ABI). Given that return to driving can be unpredictable and uncertain, the impact of driving disruption on family members may vary at different stages post-injury. This study aims to understand the needs and experiences of family members over time during driving disruption following an ABI. Method:A qualitative prospective longitudinal research design was used with semi-structured interviews at recruitment to study, 3 and 6 months later. Results:Fourteen family members completed 41 interviews. The longitudinal data revealed four phases of driving disruption: (1) Wait and see, (2) Holding onto a quick fix, (3) No way out, and (4) Resolution and adjustment. The phases described a process of building tension and a need for support and resolution over time. Conclusions:Holding onto a quick fix is a pivotal phase whereby supports, such as engagement in realistic goal setting, are essential to facilitate family members’ resolution of driving disruption issues. Family members who see no way out might not actively seek help and these points to a need for long-term and regular follow-ups. Future research can explore ways to support family members at these key times.Implications for rehabilitationHealth professionals need to facilitate the process of fostering hope in family members to set realistic expectations of return to driving and the duration of driving disruption.It is necessary to follow-up with family members even years after ABI as the issue of driving disruption could escalate to be a crisis and family members might not actively seek help.Health professionals can consider both practical support for facilitating transport and emotional support when addressing the issue of driving disruption with family members. [ABSTRACT FROM PUBLISHER]

Background: The majority of women experience pain during labour and childbirth, however not all women experience it in the same way. In order to develop a more complete understanding of labour pain, this study aimed to examine women's experiences within the perspective of modern pain science. A more complete understanding of this phenomenon can then guide the development of interventions to enhance women's experiences and potentially reduce their need for pharmacological intervention.Methods: A qualitative study was conducted using phenomenology as the theoretical framework. Data were collected from 21 nulliparous women, birthing at one of two large maternity services, through face-to-face interviews and written questionnaires. Data were analysed using an Interpretative Phenomenological Analysis approach.Results: The data from this study suggest that a determining factor of a woman's experience of pain during labour is the meaning she ascribes to it. When women interpret the pain as productive and purposeful, it is associated with positive cognitions and emotions, and they are more likely to feel they can cope. Alternatively, when women interpret the pain as threatening, it is associated with negative cognitions and emotions and they tend to feel they need help from external methods of pain control. The social environment seems particularly important in shaping a woman's pain experience by influencing her interpretation of the context of the pain, and in doing so can change its meaning. The context and social environment are dynamic and can also change throughout labour.Conclusion: A determining factor in a woman's experience of pain during labour is its perceived meaning which can then influence how the woman responds to the pain. The meaning of the pain is shaped by the social environment and other contextual factors within which it is experienced. Focussed promotion of labour pain as a productive and purposeful pain and efforts to empower women to utilise their inner capacity to cope, as well as careful attention to women's cognitions and the social environment around them may improve women's experiences of labour pain and decrease their need for pain interventions. [ABSTRACT FROM AUTHOR]

Purpose: Communication of a mental health diagnosis can be a difficult process and is a poorly understood area of service provision. The aim of this qualitative study was to examine clinicians' perceptions of barriers and helpful strategies to discussing information about a mental health condition.Method: Qualitative interviews with 19 Australian clinicians (general practitioners, mental health nurses, psychiatrists, and psychologists) working in several settings (community, hospital inpatient, outpatient, accident and emergency) and locations (urban, suburban and rural) were conducted and analysed thematically.Results: After theme saturation was reached, four primary themes relating to barriers and facilitators to communication at the time of diagnosis were identified in the data. Outside a recognised lack of focus on this area in training, themes included (1) engagement and timing of conversations; (2) stigma and its reduction; (3) perceived and desired knowledge for diagnostic information; and (4) working with distress. The synthesis of themes is demonstrated in a flowchart of suggestions for communicating news of mental health diagnosis that tracks the patient journey in receiving information from initial engagement to follow-up.Conclusions: Talking with an individual about a mental health diagnosis is a non-linear, complex and changeable situation. However, health professionals report using specific strategies to aid this communication process, to meet the specific individual's needs. Strategies such as tailoring to the person's situation, utilising collaborative practice, effective coordination, and addressing stigma may be useful to inform clinician training and support whilst diagnosis remains a key feature of the mental health system in Australia. [ABSTRACT FROM AUTHOR]

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Aim The aim of this study was to explore and compare the experiences of nurses in Australia and the UK as they moved from clinical practice into higher education institutions. Background When nurse education moved from hospitals into higher education institutions, the roles and career pathways of nurse educators changed. Design The design method used in this study was qualitative interview study. Methods Semi-structured interviews were undertaken with 14 nurse educators, seven in Australia and seven in the UK, in 2011-2012. Thematic analysis of the transcripts was undertaken and triangulated with automated content and thematic analysis by Leximancer© software. Findings Nurse academics in Australia and the UK voiced similar enthusiasms and concerns. These coalesced around four emergent themes: adapting to change, external pressures, teaching and progress up the academic ladder. The Leximancer© analysis for both sites ranked 'research' as the primary theme, linked with 'time', 'University' and 'nursing' on both sites. Respondents were aware of the importance of research to career progression in universities, but most prioritized their teaching and clinical commitments for the sake of their organizations. Most respondents were supported in their doctoral studies, but the absence of postdoctoral research teams, mentors and role models was striking. Conclusion Additional support is needed to ensure that nurse academics are able to pursue research beyond doctoral level. [ABSTRACT FROM AUTHOR]

Men in the gay liberation generation are approaching or entering older age. Being at the forefront of gay rights movements since the 1970s and 1980s, this generation has experienced dramatic changes in gay life. The present study aimed to provide a greater understanding of this generation by examining some of the ways these men perceive their changing lives. Participants included 439 Australian gay-identified men aged 50 years and older who completed an online survey of their health and wellbeing. These men gave unrestricted open-ended responses to a question on how life had changed for them as a gay man since being aged in their twenties. Responses were analysed qualitatively using a thematic analysis approach to identify main themes. Participants expressed many positive changes to their lives, including greater public- and self-acceptance of their sexuality, greater confidence and self-esteem, and more freedom for same-sex relationships. However, some men expressed a loss of gay community compared to their younger years and a perception that the younger generation under-appreciated the struggles they had endured. Age- and HIV-related stigma from within the gay community, as well as a loss of sexual attractiveness, also emerged as concerns for some participants. These findings may assist researchers, health professionals and aged care services to further understand the needs and experiences of this older generation of gay men. [ABSTRACT FROM AUTHOR]

Introduction: There is limited research into the role of occupational therapy in discharge planning in palliative care. This study aimed to explore patients' and caregivers' perceptions of occupational therapy in the context of discharge home from an inpatient palliative care setting. Method: Semi-structured interviews were conducted with patients and caregivers following discharge home from inpatient palliative care. Participants were selected using purposive sampling and data was thematically analysed. Results: Five caregivers and three patients were interviewed. Three main themes emerged: (1) shared roles in discharge planning; (2) perceived benefits of occupational therapy; and (3) adapting to discharge home. Patients and caregivers viewed occupational therapy as the practical help needed to achieve discharge. They had difficulty differentiating between professional roles and perceived the discharge process as a shared responsibility between themselves and the clinicians. Adapting to discharge home involved coping with the uncertain and unexpected, where limited understanding of professional roles meant participants did not know who to seek assistance from. Conclusion: Occupational therapy was viewed as the practical help needed for discharge home from a palliative care setting. Clinicians need to take primary responsibility for understanding each other's roles and providing information on who can assist after discharge. [ABSTRACT FROM AUTHOR]

Objective:The aim of this study was to better understand how young women in their early 20s transition and adjust to motherhood in the first year postpartum, compared to teenage mothers.Background:A body of research suggests that teen mothers have unique challenges and experiences adjusting to motherhood. However, less research has focussed on mothers in their early 20s, who have increasingly become a minority in Western countries, and are supposedly adjusting to motherhood in a new developmental period characterised by self-focussed identity exploration and individual freedom.Method:Using a semi-structured interview format, 12 Australian women (mean age 20.5 years; mean baby age 6.5 months) were interviewed, and verbatim transcriptions analysed with thematic analysis.Results:Two broad themes identified wereChange within the selfandInvolvement of others.Some of the early 20s women reported more difficulties with identity adjustment compared to that of teen women, and this appeared primarily related to women’s background and circumstance. Social support was important for all women, while experiences of stigma were common and negatively impacted on women’s adjustment to motherhood.Conclusions:The extent to which first-time mothers in their early 20s experience conflict between responsibilities of motherhood and self-focussed identity exploration appeared to be largely dependent on background and prior circumstances, suggesting that emerging adulthood norms do not consistently apply to these women. [ABSTRACT FROM PUBLISHER]

Primary objective: To understand how the spouses of individuals with severe TBI experience the process of supporting their partners with decision-making. Design: This study adopted a constructivist grounded theory approach, with data consisting of in-depth interviews conducted with spouses over a 12-month period. Data were analysed through an iterative process of open and focused coding, identification of emergent categories and exploration of relationships between categories. Participants: Participants were four spouses of individuals with severe TBI (with moderate-severe disability). Spouses had shared committed relationships (marriage or domestic partnerships) for at least 4 years at initial interview. Three spouses were in relationships that had commenced following injury. Main outcome and results: Two main themes emerged from the data. The first identified the saliency of the relational space in which decision-making took place. The second revealed the complex nature of decision-making within the spousal relationship. Conclusions: Spouses experience decision-making as a complex multi-stage process under-pinned by a number of relational factors. Increased understanding of this process can guide health professionals in their provision of support for couples in exploring decision-making participation after injury. [ABSTRACT FROM AUTHOR]

Background/aim Growth in the number of occupational therapy programmes in Australia has resulted in a critical shortage of academics. When experienced clinicians are recruited into academia, they may find the transition process difficult. The study aimed to explore clinicians' perspectives of what happens when they transition into academia. Method A constructivist grounded theory approach was used in this qualitative research project. Recruitment was conducted using purposive and theoretical sampling from occupational therapy programmes in Australia. Interview transcripts were analysed using constant comparative method through a process of open, axial, selective and theoretical coding. Results Sixteen participants engaged in semi-structured in-depth interviews. The theory of transition into academia included a process of 'weighing up the commitment' to academia and the core category of 'a good fit for me'. The transition was characterised by the taxing nature of the work, the need to learn multiple aspects of a new role, the different values and beliefs in an academic environment and the amount of time it took to achieve success. Participants underwent a shift in identity to adjust to the academic environment and eventually reached a point where they were able to judge if academia suited them. Conclusion Australian universities have long-standing cultural practices which differ considerably from clinical settings. Transitioning from a clinical to an academic occupational therapy role requires complex adjustments to values, beliefs and identity. The process involved consideration by the new academics of their 'fit' for academia, and how committed they were to stay. [ABSTRACT FROM AUTHOR]

Background: Exploring the concept of living successfully with aphasia challenges researchers and clinicians to identify positive rather than negative adaptive processes and factors that may inform clinical interventions and other community-based services for people with aphasia. Previous research on this topic has focused on the perspectives of individuals with aphasia, and identified a number of core components of living successfully with aphasia, including doing things, meaningful relationships, striving for a positive way of living, and communication. As service providers, speech-language pathologists may also contribute valuable insights regarding components of living successfully with aphasia and factors influencing individuals' abilities to achieve this goal. Aims: This research aimed to explore speech-language pathologists' perspectives about the meaning of living successfully with aphasia, and factors they perceive to influence individuals' abilities to live successfully with aphasia. Methods & Procedures: Twenty-five speech-language pathologists from around Australia participated in semi-structured in-depth interviews on the topic of living successfully with aphasia. All interviews were transcribed verbatim and analysed using interpretative phenomenological analysis to identify themes of relevance. Outcomes & Results: Through the analysis of speech-language pathologist participant transcripts, the following themes emerged as components of living successfully with aphasia: participation and community engagement; communication; meaningful relationships; autonomy or independence; acceptance and embracement of aphasia; self-esteem; happiness; and purpose or meaningfulness. A wide variety of factors were perceived to influence individuals' abilities to live successfully with aphasia. These included support, acceptance, and understanding; personal factors; and speech-language pathology services. Conclusions & Implications: Further research is required to extend findings by investigating how speech-language pathologists address identified themes in clinical practice. To improve service provision, continued reflection by speech-language pathologists on how services provided align with client's values and priorities is a necessity. A commitment by speech-language pathologists to work in partnership with people with aphasia and their families and friends to achieve successful living with aphasia is one way to translate this research into practice. [ABSTRACT FROM AUTHOR]

In recent years, due to economic development and globalization, there is a dramatic increase of international students, mainly from Asian countries, coming to Australia and attending various courses, such as language courses, professional training and university degree. Not only do they contribute in substantial financial income, but also bring a diversity of cultures into this country. International students have become an important population group in Australia. However , due to geographic and cultural transition, some students do have difficulties in adapting to the unfamiliar educational system and the cultural discourse of teaching and learning. Qualitative research method is used in this research to explore in-depth thoughts and feelings of Asian students. The data were drawn from interviews conducted at an Australian university. Thematic analysis was conducted with the use of NVivo (version 8). The final findings indicate that although Asian students certainly encounter some difficulties in their academic experiences, most of them can adopt effective coping strategies to deal with the problems. [ABSTRACT FROM AUTHOR]