Search

Background: Interest in the role of employability in student-dietitian transitions is increasing. However, little is known about the cross-cultural transition-to-work experience of Australian-trained dietetic graduates of international backgrounds, as well as strategies to optimise work-readiness. The present study aimed to explore graduates' career narratives and identify employability capitals that enabled successful transitions to work., Methods: A qualitative interpretive approach was employed via a cultural lens. Eighteen participants from five Asian countries who had graduated from an Australian university within 3-15 years, with work experience in Australia or in their respective home countries, took part in in-depth interviews. Thematic analysis was performed, guided by the graduate capitals based approach., Results: Transition-to-work was dynamic and non-linear; four themes and 12 subthemes identified: (1) upon graduation, participants felt ambivalent about their decision to either stay in Australia or return home, influenced by graduate visa restrictions, and individual perceptions of their ability to mobilise cultural strengths to gain employment; (2) to get a foot in the door, participants demonstrated resilience, embraced uncertainty and utilised social networks to increase employment opportunities in Australia and their home countries; (3) regardless of which country they worked, graduates reported struggling with their cross-cultural identities in the workplace; and (4) eventually, these graduates appreciated their ethnic capital, thrived in their work and extended a helping hand to their junior cross-cultural dietitians., Conclusions: Initiatives facilitating connections to the host country and supporting cultural and ethnic capital development, along with ongoing research reviewing employability capital applications, will benefit cross-cultural dietetic graduates and the communities they potentially will serve., (© 2024 The Author(s). Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of British Dietetic Association.)

Background: Health informatics competencies, digital health education, and nursing students' perceptions of technology are critical to ensure a future digitally capable health care workforce., Purpose: To explore preregistration students' perceptions of digital health technology impact on their role as nurses., Methods: Using a qualitative exploratory approach, students from 2 Australian universities were purposively sampled. Data were collected through photo-elicitation from 3 focus groups and thematically analyzed. Photo-elicitation provided reference points to encourage more in-depth exploration., Results: Themes included fear of the unknown and who am I? Nursing in a digital world . Human interaction was fundamental to their nursing role and digital health technology could depersonalize care, creating tension around their reason for choosing a nursing career., Conclusions: Educators should prepare students to redefine their nursing identity by exploring how digital health technology augments their practice and critical thinking skills, while addressing fear of a perceived threat to the future of nursing., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: This paper aims to explore how an academic researcher and a practitioner experience scepticism for their qualitative research. Design/methodology/approach: The study applies Olt and Teman's new conceptual phenomenological polyethnography (2019) methodology, a hybrid of phenomenology and duoethnography. Findings: For the researcher-participants, the essence of living with scepticism means feeling a sense of injustice; struggling with the desire for simplicity and quantification; being in a circle of uneasiness; having a survival mechanism; and embracing healthy scepticism. They experience the essence differently and similarly in varied cultural contexts. Through duoethnographic conversations, they acknowledge that while there can be scepticism of their work, it is important to remain sceptical, persistent and curious by challenging traditional concepts. Theoretical and practical advances in artificial intelligence (AI) continue to highlight the need for clarifying qualitative researcher roles in academia and practice. Originality/value: This paper contributes to the debate of qualitative versus quantitative research. Its originality is in exploring scepticism as lived experience, from an academic and practitioner perspective and applying a phenomenological polyethnography approach that blends two different traditional research paradigms.

This paper draws on my experiences as a doctoral student undertaking a project to examine the professional adaptation of Asian immigrant teachers in Australia. Using a reflexive narrative approach, I examine how my position influenced my access to participants, the understanding of their contexts, and the nature of my relationship and interaction with the participants. The paper discusses the tensions that resulted from my insider-outsider positions and how they shaped my qualitative study's research process and outcomes. I conclude with recommendations for researchers to carefully consider the possible influence of their positionality in any research setting and its implications for informing future research.

Purpose: Poetic inquiry is an approach that promotes alternate perspectives about what research means and speaks to more diverse audiences than traditional forms of research. Across academia, there is increasing attention to decolonising research. This reflects a shift towards research methods that recognise, acknowledge and appreciate diverse ways of knowing, being and doing. The purpose of this paper is to explore the different ways in which poetic inquiry communicates parallax to further decolonise knowledge production and dissemination and centre First Nations' ways of knowing, being and doing. Design/methodology/approach: This manuscript presents two First Nations' perspectives on a methodological approach that is decolonial and aligns with Indigenous ways of knowing, being and doing. In trying to frame this diversity through Indigenous standpoint theory (Foley, 2003), the authors present two First Nation's women's autoethnographic perspectives through standpoint and poetics on the role of poetic inquiry and parallax in public pedagogy and decolonising research (Fredericks et al., 2019; Moreton-Robinson, 2000). Findings: The key to understanding poetic inquiry is parallax, the shift in an object, perspective or thinking that comes with a change in the observer's position or perspective. Challenging dominant research paradigms is essential for the continued evolution of research methodologies and to challenge the legacy that researchers have left in colonised countries. The poetic is often invisible/unrecognised in the broader Indigenist research agenda; however, it is a powerful tool in decolonial research in the way it disrupts core assumptions about and within research and can effectively engage with those paradoxes that decolonising research tends to uncover. Practical implications: Poetic inquiry is not readily accepted in academia; however, it is a medium that is well suited to communicating diverse ways of knowing and has a history of being embraced by First Nations peoples in Australia. Embracing poetic inquiry in qualitative research offers a unique approach to decolonising knowledge and making space for Indigenous ways of knowing, being and doing. Social implications: Poetic inquiry offers a unique approach to centring First Nations voices, perspectives and experiences to reduce hegemonic assumptions in qualitative research. Originality/value: Writing about poetic inquiry and decolonisation from a First Nations' perspective using poetry is a novel and nuanced approach to discussions around First Nations ways of knowing, being and doing.

This paper contributes to the 'future' methods literature by exploring the methodological potentials of material methods in qualitative research on young women's imagined futures. Existing research has demonstrated how producing knowledge about imagined futures remains a challenge, often leading to abstract or generic accounts of such futures. Arguing for a double focus on materiality as method and the materiality of methods, this paper extends material methods to innovatively study futures. By considering the narratives about imagined futures generated with and by 'future materials' brought by participants to an interview, the paper demonstrates that this approach is productive for gaining insights that go beyond generic accounts. That is, via the materiality of the objects, specific imagined futures become 'within reach' for participants, with the object serving as an anchor for these future narratives. Empirically the paper draws on data from a longitudinal qualitative study of young women's imagined futures in Australia.

When researching with or about families in home-based research, there are numerous unexpected ethical issues that can emerge, particularly in qualitative research. This paper is based on reflective accounts of four homed-based research projects, two in the UK and two Australia, which examined ethical dilemmas identified when engaged in home-based research with young children. Using a synergy of ecocultural theory and Foucauldian ideas of Heterotopia as theoretical conceptualisations, the authors employed reflective lenses to guide their approach, and examine dilemmas and complexities when conducting research in the home. We argue that, to address ethical dilemmas, researchers need to problematise and reflect upon the nature of respectful approaches and the ethical implications of their behaviours. We conclude that, although ethical codes are valuable when researching families at home, researchers should plan for and forefront their methodological approaches in ways that are family-centred, whilst also framed by practices that are ethical, respectful and reflective to the situated contexts of family's ecologies and heterotopias.

This special issue presents a collection of recent papers drawing on qualitative research in and about schooling in Australia and the ways in which gender-related issues in the broadest sense continue to shape people's educational experiences. These papers from the present are positioned in relation to the long histories of policy and research attention to gender equity in Australian education. We set the context for work in the present by scanning the past, noting the ambitions, the gaps and the failures of earlier policies, and drawing attention to the quality and volume of research that has previously been undertaken in this area. We explore the current policy vacuum regarding gender to consider some of the pressures and complexities that have led to the erasure or avoidance of gender-related issues. Each of the papers that form this special issue demonstrate—despite different methods, theoretical frameworks, settings and participant cohorts—how stereotypes and limitations circulate in everyday life in schools and beyond them, and how these impact on people. They each explore from a different starting point how gender injustices are perpetuated and produced, in often subtle and nuanced ways that require concerted effort to unpack. They simultaneously offer insights into the critical and creative ways that young people and those around them are reconfiguring gender and seeking more hopeful and more equitable educational experiences and outcomes. Collectively, the papers that form this special issue advocate for policies and practices that embrace the complexities of young people's lives and are oriented towards inclusive and equitable educational environments. [ABSTRACT FROM AUTHOR]

Background: Electronic prescription (e-prescription) was introduced in 2020 in Australia during the COVID-19 pandemic. This research aimed to explore general practitioners (GPs) and community pharmacists' experience with, and facilitators and barriers to, the use of e-prescription. Methods: This qualitative study used semi-structured interviews with GPs and pharmacists in Greater Sydney to explore their experience with e-prescription. Thematic analysis used descriptive and mixed inductive and deductive approaches. The Technology Acceptance Model (TAM) was used to further interpret and organise the themes. Results: Eleven GPs and nine pharmacists were interviewed. Thirteen themes were elicited, seven of which were categorised as benefits (facilitators) and six were challenges (barriers). Four facilitator themes (convenience for healthcare providers (HCPs) and patients, addressing issues with paper prescriptions, contactless nature reducing access barriers during COVID-19 lockdown, and enabling patients to manage multiple prescriptions) were mapped to the TAM construct of 'perceived usefulness'; and one facilitator (an easier process) and two barrier themes (lack of information during implementation, and technological issues) were mapped to the TAM construct of 'perceived ease of use'. Themes that fell outside these constructs were separately categorised: four barrier themes (reluctance of some patients and HCPs to change, patient expectations of 'instant prescription' and lost opportunities for best-practice care, HCPs' perceptions of inadequate governmental governance, and ongoing costs) were 'other issues with e-prescription', and two facilitator themes (providing training on the use of e-prescription for HCPs and patients, and making e-prescription more streamlined) were 'suggestions to improve'. Conclusion: There are many facilitators and barriers to the use of e-prescription. Our findings may inform the future promotion of e-prescription post-COVID-19 pandemic. Further research should focus on consumers' perspectives of e-prescription. It is inevitable that electronic prescriptions will one day supersede paper prescriptions, but there is resistance to their implementation at the practitioner and patient levels. This paper explored GPs and pharmacists' experience and views, and found that while e-prescription improves the quality of patient care, there are several challenges to its effective use. Findings may inform the future promotion of e-prescription, particularly post-COVID-19 pandemic, and guide future research in exploring consumer perspectives. [ABSTRACT FROM AUTHOR]

The analysis of exemplars of different quality is a potentially powerful tool in enabling students to understand assessment expectations and appreciate academic standards. Through a systematic review methodology, this paper synthesises exemplar-based research designs, exemplar implementation and the educational effects of exemplars. The review of 40 empirical exemplar-based studies indicated frequent use of post-intervention evaluation designs. The integrated use of exemplars and strategies such as rubrics, peer or self-assessment was a major pedagogic feature to enhance students' understanding of standards and aid their generation of internal feedback for self-monitoring. There was evidence suggesting that the combined use of exemplars with these strategies could advance students' academic performance and development of self-regulated learning. The review results set future directions for exemplar-based studies: quantitative research would benefit from controlled manipulation of variables to disentangle the effects of exemplars and those of other strategies; qualitative research could profitably use self-reflective diaries, think aloud protocols or classroom observations to develop deeper understandings of exemplar implementation. The key pedagogical implication recommends students' production of an assignment draft prior to exposure to exemplars so that they can compare their own work with exemplars and then make improvements independently of teachers.

This paper draws together critical learnings from diverse qualitative health research projects in Australia that sought to shift power and focus on the strengths and expertise of people with lived experience who are involved as co-researchers. These projects have included exploring and challenging identities, understanding experiences in treatment programs, critiquing and designing/re-designing services, and sharing experiences with the wider community in novel and innovative ways. Lived experiences included alcohol and other drug dependency, mental health, domestic, family or sexual violence, and living with HIV. This paper provides important learnings and actions about partnering with co-researchers with lived experience. In this paper we draw on a process of reflective discussions that occurred over six months with fortnightly online meetings between co-researchers, including co-authors with lived experience external to academia and university-based researchers, some of whom also have lived-experience that intersects with their research. From this, we distilled key learnings across seven themes: (1) the ethics of ethics, which highlights a need for constant reflection on the ethical issues in co-research; (2) recruiting co-researchers, which focuses on ensuring and integrating a diversity of voices; (3) creating safety for all, which must be a priority of engagement and support self-determination; (4) supporting different ways of partnering, which emphasises the need for diverse roles and ways to contribute on research teams; (5) capacity building and training, which requires ongoing evaluation of needs and tailored responses; (6) positioning, which highlights the need to transition from the idea of vulnerability to a strengths-based perspective of lived experience; and (7) power plays, reflecting the need to disrupt the dynamics and established hierarchies of privileging certain forms of knowledge and expertise. The paper includes recommendations for action against these seven themes. [ABSTRACT FROM AUTHOR]

This paper draws on my experiences as a doctoral student undertaking a project to examine the professional adaptation of Asian immigrant teachers in Australia. Using a reflexive narrative approach, I examine how my position influenced my access to participants, the understanding of their contexts, and the nature of my relationship and interaction with the participants. The paper discusses the tensions that resulted from my insider-outsider positions and how they shaped my qualitative study's research process and outcomes. I conclude with recommendations for researchers to carefully consider the possible influence of their positionality in any research setting and its implications for informing future research. [ABSTRACT FROM AUTHOR]

Actual accounts of the experiences of Aboriginal and Torres Strait Islander peoples since colonization remain largely misunderstood and misrepresented within Australian education systems and the broader social consciousness. Culturally sensitive practice and ethnic diversity are challenging topics to teach social work students when truth-telling is absent. Social workers need to develop an understanding of intergenerational trauma experienced by Aboriginal and Torres Strait Islander peoples, critically reflect on perpetuated stereotypes, and confront internalized beliefs about peoples of diverse ethnic and cultural identities in preparation to work respectfully with Indigenous communities. A course focused on building students' knowledge and skills for culturally responsive practice is described in this paper, along with suggestions for enhancing teaching and learning. The paper argues for the importance of truth-telling about Australia's continuing racism in social work education to create cultural safety for service users. [ABSTRACT FROM AUTHOR]

Background: Alcohol consumption presents a threat to the health and wellbeing of women. The alcohol industry often pushes back at global efforts to prioritise the prevention of alcohol harms to women. Qualitative researchers have investigated how younger and midlife women conceptualise their alcohol consumption, but there is very limited research relating to older women (those 60 years and over)., Methods: Using data collected from an online qualitative survey, this paper explored the factors that influence how older Australian women drinkers (n = 144. 60-88 years) conceptualised the role of alcohol in their lives. The study used a 'Big Q' reflexive approach to thematic analysis, drawing upon sociological theories of risk and symbolic interactionism to construct four themes from the data., Results: First, alcohol consumption was viewed by participants as an accepted and normalised social activity, that was part of Australian culture. Second, alcohol played a role for some participants as a way to cope with life changes (such as retirement), as well as managing stressful or challenging life circumstances (such as loneliness). Third, alcohol was part of the routines and rituals of everyday life for some women. For example, women discussed the consumption of wine with their evening meal as an important part of the structure of their day. Fourth, participants had clear personal expectancies about what it meant to be a 'responsible drinker'. They had clear narratives about personal control and moral obligation, which in some cases created a reduced perception of their own risk of alcohol-caused harm., Conclusions: This research provides a starting point for future public health research examining the factors that may shape older women's alcohol consumption beliefs and practices. Public health activities should consider the unique needs and potential vulnerabilities of older women drinkers, and how these may be potentially exploited by the alcohol industry., (© 2024. The Author(s).)

Objectives: Amidst the fulfilment of making a positive impact on patients' lives, cancer nurses also contend with high workloads, limited resources, and barriers to career advancement. Understanding the perceptions of cancer nurses is essential in addressing these challenges and fostering an environment that promotes both professional satisfaction and optimal patient care. Our aim was to explore Australian cancer nurses' experiences and perspectives of workforce challenges and their proposed solutions to address them., Methods: The Cancer Nurses Society Australia workforce cross-sectional survey was distributed online in 2022 through professional networks and social media. Free text responses to open-ended questions were analyzed using qualitative content analysis and inductive processes., Results: Responses from 601 cancer nurses highlight the intricate interplay between rewards and obstacles experienced by the profession and identify key areas for improvement. Positive and negative quotes highlight the passion of cancer nurses which were summarized into themes and subthemes: 1) Finding fulfilment while struggling against the tide. While feeling undervalued and facing workload pressures, burnout and limited opportunities for career progression, nurses express love for their jobs, finding it rewarding yet emotionally challenging. 2) Grassroots solutions versus organizational inertia. Proposed solutions included addressing nurse-to-patient ratios, proactive succession planning, more specific education, dedicated time for learning, and mentorship and career development programs. Perceived barriers to initiatives included lethargic management and resistance to change. Networking opportunities, appropriate remuneration, and interdisciplinary teamwork with an appreciation of individual expertise are desired., Conclusions: Our findings give a voice to the cancer nurses of Australia. Nurses identified a range of solutions to address workforce challenges., Implications for Nursing Practice: Addressing the systemic issues that contribute to high workload and impede nurses' well-being and their recognition, and promoting policies to support professional growth will increase satisfaction, enhance patient care outcomes, and contribute to a sustainable workforce., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Natalie Bradford reports financial support was provided by Cancer Nurses Society Australia. Deborah Kirk and Gemma McErlean report a relationship with Cancer Nurses Society Australia that includes: board membership. Authors are members of Cancer Nurses Society Australia. All authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: SMS text messages through mobile phones are a common means of interpersonal communication. SMS text message surveys are gaining traction in health care and research due to their feasibility and patient acceptability. However, challenges arise in implementing SMS text message surveys, especially when targeting marginalized populations, because of barriers to accessing phones and data as well as communication difficulties. In primary care, traditional surveys (paper-based and online) often face low response rates that are particularly pronounced among disadvantaged groups due to financial limitations, language barriers, and time constraints., Objective: This study aimed to investigate the potential of SMS text message-based patient recruitment and surveys within general practices situated in lower socioeconomic areas. This study was nested within the Reducing Alcohol-Harm in General Practice project that aimed to reduce alcohol-related harm through screening in Australian general practice., Methods: This study follows a 2-step SMS text message data collection process. An initial SMS text message with an online survey link was sent to patients, followed by subsequent surveys every 3 months for consenting participants. Interviews were conducted with the local primary health network organization staff, the participating practice staff, and the clinicians. The qualitative data were analyzed using constructs from the Consolidated Framework for Implementation Research., Results: Out of 6 general practices, 4 were able to send SMS text messages to their patients. The initial SMS text message was sent to 8333 patients and 702 responses (8.2%) were received, most of which were not from a low-income group. This low initial response was in contrast to the improved response rate to the ongoing 3-month SMS text message surveys (55/107, 51.4% at 3 months; 29/67, 43.3% at 6 months; and 44/102, 43.1% at 9 months). We interviewed 4 general practitioners, 4 nurses, and 4 administrative staff from 5 of the different practices. Qualitative data uncovered barriers to engaging marginalized groups including limited smartphone access, limited financial capacity (telephone, internet, and Wi-Fi credit), language barriers, literacy issues, mental health conditions, and physical limitations such as manual dexterity and vision issues. Practice managers and clinicians suggested strategies to overcome these barriers, including using paper-based surveys in trusted spaces, offering assistance during survey completion, and offering honoraria to support participation., Conclusions: While SMS text message surveys for primary care research may be useful for the broader population, additional efforts are required to ensure the representation and involvement of marginalized groups. More intensive methods such as in-person data collection may be more appropriate to capture the voice of low-income groups in primary care research., International Registered Report Identifier (irrid): RR2-10.3399/BJGPO.2021.0037., (©Elizabeth Sturgiss, Jenny Advocat, Christopher Barton, Emma N Walker, Suzanne Nielsen, Annemarie Wright, Tina Lam, Nilakshi Gunatillaka, Symrin Oad, Christopher Wood. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 05.09.2024.)

Background: Midwifery practice experience is an important component of education to develop an understanding of professional identity in midwifery students. The responsibility of supporting student development in the clinical setting is predominantly undertaken by clinical midwives. There is minimal literature relating to the professional identity development of midwifery students., Aim: To explore midwifery student experiences of the positive attributes of clinical midwives who supported the professional identity development of midwifery students in the clinical practice setting., Methods: An Appreciative Inquiry approach guided this study. The setting was a university in Sydney, Australia. Participants comprised thirteen students from a postgraduate midwifery course. Data were collected via individual interviews and analysed thematically. Students had two to six months of placement in the clinical setting., Findings: Data analysis identified three themes, Putting the woman at the centre of care; Supporting a woman-centred environment and Focusing on student success., Discussion: Findings from this study revealed that extended time spent with a midwife enabled the student to observe and reflect on the nuances of midwifery practice that are not overtly shared with students. Students were able to observe a midwife's tacit way of being. This paper reveals the positive attributes and behaviours of midwives whose practice the students want to emulate., Conclusions: Midwifery students' exposure to positive clinical midwife role models on clinical placement enables them to develop a greater understanding of professional identity., Competing Interests: Declaration of Competing Interest No conflict of interest has been declared by the authors., (Copyright © 2024. Published by Elsevier Ltd.)

Background: The World Health Organization recommends Midwifery Continuity of Care (MCoC) due to the consistent improvements in outcomes for mothers and babies. Surveys from the United Kingdom and Australia reported large numbers of midwives are unable to commit to the on call component required to provide MCoC across the continuum. To address this challenge a modified MCoC model called Midwifery Antenatal and Postnatal Services (MAPS) has been introduced. The aim of this study was to evaluate MAPS services in six sites across one State in Australia., Methods: A multi-site qualitative descriptive study was undertaken framed by the Quality Maternal Newborn Care (QMNC) Framework. The QMNC framework was used to develop focus group questions for data collection, and as a lens for analysing data. Data were collected via focus groups from midwives and women at six sites ranging from metropolitan to regional and rural settings and thematically analysed., Findings: Participants (n=80) included women (n=28), midwives (n=44) and MAPS managers (n=8). This paper reports the findings from the women and midwives, presented under three themes: Getting onto the program, Knowing the story and Building confidence by sharing information. Each theme had subthemes and the findings were aligned either positively or negatively with the QMNC framework., Conclusion: This study found the MAPS model aligns in positive ways with the QMNC quality care framework with some recommendations to improve quality care. Midwives want to provide continuity of care and MAPS is a useful model for providing continuity through the antenatal and postnatal periods., Competing Interests: Declaration of Competing Interest The second author, Kelley Lennon is the Midwifery Advisor in the Nursing and Midwifery Office, NSW Ministry of Health who have supported the implementation of MAPS models throughout the State and funded the evaluation., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Shared decision-making supports women's choices in pregnancy. Women with high body mass index (≥35 kg/m 2 ) experience a high rate of interventions in pregnancy, labour, and birth, providing an opportunity for clinicians to implement shared decision-making in practice. However, weight stigma may limit women's opportunities for shared decision-making., Aim: To understand how pregnant women with high body mass index perceive their involvement in antenatal decision-making, including whether weight stigma influences their experience., Methods: Women with high body mass index were recruited via purposive sampling from two sites in Melbourne, Australia. Semi-structured interviews were audio-recorded, transcribed, and analysed using reflexive thematic analysis., Findings: Ten pregnant women consented to participate. Three themes and six sub-themes were identified. These were: 1) Trusting the system, 2) Who takes the lead?, and 3) Defying disease., Discussion: Shared decision-making is limited for women with high body mass index in antenatal care, and weight stigma is experienced by women. Clinical practice recommendations relating to excess weight have the potential to further limit women's involvement in decision-making if adequate support is not provided to ensure women's understanding and involvement in care., Conclusion: Women's involvement in care is a central component of shared decision-making and it is currently limited for women with high body mass index. Transparency regarding the rationale for recommendations is required, and further work must be done to address the influence and impact of weight stigma on the care of women with high body mass index., Competing Interests: Conflict of Interest Linda Sweet has editorial duties with this journal. To reduce any real or perceived conflict of interest, she had no role in the processing or peer review of this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Young people who attend intensive alcohol and other drug (AoD) treatment commonly do so more than once. This paper aims to understand precipitators, enablers and barriers to young people's re-engagement in programs. Data come from a longitudinal qualitative study involving three waves of interviews with Australian young people recruited while attending intensive AoD programs (n = 38 at wave 1). We found that young people's ambitions for what they might achieve with a new stay and capacity to benefit from programs, evolved. Skills learnt in earlier stays or changed life circumstances often helped them achieve better outcomes subsequently. Ongoing contact with an AoD worker was the most important enabler to service re-engagement. Across the span of a year, we saw most young people in our study sample develop a stronger sense of wellbeing and control over substance use. While researchers tend to focus on evaluating outcomes associated with single stays at specific programs, young people think about their trajectories towards managing substance use and their lives as occurring more holistically, supported by engagements with a range of services. We argue that the notion of incremental treatment is useful in depicting the synergistic effects of service engagement over time., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Wearables hold potential to improve chronic disease self-management in conditions like cystic fibrosis (CF) through remote monitoring, early detection of illness and motivation. Little is known about the acceptability and sustainability of integrating wearables into routine care from the perspectives of people with CF (pwCF) and their treating clinicians., Methods: A cross-sectional qualitative study involving semi-structured interviews with adult pwCF and focus groups comprising members of a CF multidisciplinary team (MDT) were conducted at a specialist CF centre in Australia. A phenomenological orientation underpinned the study. Inductive thematic analysis was performed using the Framework method. The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist., Results: Nine pwCF and eight members of a CF MDT, representing six clinical disciplines, participated in the study. Eight themes were inductively generated from the data, of which four were identified from each group. PwCF valued wearables for providing real-time data to motivate healthy behaviours and support shared goal-setting with healthcare providers. Wearables did not influence adherence to CF-specific self-management practices and had some hardware limitations. Members of the CF MDT recognised potential benefits of remote monitoring and shared goal-setting, but advised caution regarding data accuracy, generating patient anxiety in certain personality traits, and lack of evidence supporting use in CF self-management., Conclusions: Perspectives on integrating wearables into CF care were cautiously optimistic, with emerging risks related to patient anxiety and lack of evidence moderating acceptance., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: The Stop Cancer PAIN Trial was a phase III pragmatic stepped wedge cluster randomised controlled trial which compared effectiveness of screening and guidelines with or without implementation strategies for improving pain in adults with cancer attending six Australian outpatient comprehensive cancer centres (n = 688). A system for pain screening was introduced before observation of a 'control' phase. Implementation strategies introduced in the 'intervention' phase included: (1) audit of adherence to guideline recommendations, with feedback to clinical teams; (2) health professional education via an email-administered 'spaced education' module; and (3) a patient education booklet and self-management resource. Selection of strategies was informed by the Capability, Opportunity and Motivation Behaviour (COM-B) Model (Michie et al., 2011) and evidence for each strategy's stand-alone effectiveness. A consultant physician at each centre supported the intervention as a 'clinical champion'. However, fidelity to the intervention was limited, and the Trial did not demonstrate effectiveness. This paper reports a sub-study of the Trial which aimed to identify factors inhibiting or enabling fidelity to inform future guideline implementation initiatives., Methods: The qualitative sub-study enabled in-depth exploration of factors from the perspectives of personnel at each centre. Clinical champions, clinicians and clinic receptionists were invited to participate in semi-structured interviews. Analysis used a framework method and a largely deductive approach based on the COM-B Model., Results: Twenty-four people participated, including 15 physicians, 8 nurses and 1 clinic receptionist. Coding against the COM-B Model identified 'capability' to be the most influential component, with 'opportunity' and 'motivation' playing largely subsidiary roles. Findings suggest that fidelity could have been improved by: considering the readiness for change of each clinical setting; better articulating the intervention's value proposition; defining clinician roles and responsibilities, addressing perceptions that pain care falls beyond oncology clinicians' scopes of practice; integrating the intervention within existing systems and processes; promoting patient-clinician partnerships; investing in clinical champions among senior nursing and junior medical personnel, supported by medical leaders; and planning for slow incremental change rather than rapid uptake., Conclusions: Future guideline implementation interventions may require a 'meta-implementation' approach based on complex systems theory to successfully integrate multiple strategies., Trial Registration: Registry: Australian New Zealand Clinical Trials Registry; number: ACTRN 12615000064505; data: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspxid=367236&isReview=true ., (© 2024. The Author(s).)

Background: Adverse perinatal health outcomes are notably high among African-born women living in Australia. This problem is partly attributed to their lower engagement in maternity care services as compared to Australian-born women. Various barriers might limit African-born women's access to and use of services; however, these barriers are not well documented. Therefore, this review aimed to synthesise current qualitative evidence on barriers and facilitators of access to maternity care for African-born women living in Australia., Methods: The search was conducted in MEDLINE, CINAHL, Embase, PsychInfo, and Maternity and Infant Care databases on 16 April 2023. All articles retrieved were meticulously screened for eligibility by two independent reviewers with any disagreements resolved through discussion. The quality of the included articles was evaluated using the Mixed Methods Appraisal Tool. Studies were screened in Covidence and analysed in NVivo. The findings were organised and presented using Levesque's framework of healthcare access., Results: Out of 558 identified papers, 11 studies comprising a total of 472 participants met the eligibility criteria. The review highlighted provider-side barriers such as shortage of information, unmet cultural needs, long waiting times, low engagement of women in care, discrimination, and lack of continuity of care. User-side barriers identified include communication issues, difficulty navigating the health system, and lack of trustful relationships with healthcare providers. In contrast, the review pinpointed provider-side facilitators including positive staff attitudes, service availability, and the proximity of facilities to residential homes, while user-side facilitators such as cultural assimilation and feeling valued by healthcare providers were noted., Conclusions: This review identified barriers and facilitators of access to maternity care for African-born women living in Australia. Empirical evidence that would inform potential changes to policy and practice to address African-born women's unique health needs was highlighted. Designing and implementing a culturally safe service delivery model could remove the identified access barriers and improve African-born women's engagement in maternity care. Moreover, reinforcing factors associated with positive healthcare experiences is essential for improving maternity care access for this priority population., Systematic Review Registration: PROSPERO CRD42023405458., (© 2024. Crown.)

Aim: This qualitative study aims to explore the perspectives of nursing students regarding the application and integration of generative Artificial Intelligence (AI) tools in their studies., Background: With the increasing prevalence of generative AI tools in academic settings, there is a growing interest in their use among students for learning and assessments., Design: Employing a qualitative descriptive design, this study used semi-structured interviews with nursing students to capture the nuanced insights of the participants., Methods: Semi-structured interviews were digitally recorded and then transcribed verbatim. The research team reviewed all the data independently and then convened to discuss and reach a consensus on the identified themes., Results: This study was conducted within the discipline of nursing at a regional Australian university. Thirteen nursing students, from both first and second year of the programme, were interviewed as part of this study. Six distinct themes emerged from the data analysis, including the educational impact of AI tools, equitable learning environment, ethical considerations of AI use, technology integration, safe and practical utility and generational differences., Conclusions: This initial exploration sheds light on the diverse perspectives of nursing students concerning the incorporation of generative AI tools in their education. It underscores the potential for both positive contributions and challenges associated with the integration of generative AI in nursing education and practice., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Objectives: Siblings are an important yet often forgotten part of the paediatric intensive care unit (PICU) family experience. Commonly, siblings are supported through the experience by their parents; however, very little is known about parental experiences of providing this support. This study aims to explore parental experiences of supporting sibling inclusion in PICU., Research Methodology/design: This study utilised a qualitative descriptive approach to conduct semi-structured interviews with 6 parents of 5 children with congenital heart disease who had spent time in PICU. Data were analysed using reflexive thematic analysis., Setting: Australian PICUs., Findings: Parental considerations and experiences for sibling inclusion were identified across three key phases: Pre-inclusion, The PICU visit, and Post-inclusion. Prior to including siblings in PICU, parents considered various ways of sharing information with siblings, and weighed up the risks and benefits of bringing siblings into PICU. Parents also recounted a number of challenges and facilitators to a positive sibling experience in PICU, including supportive staff and fun activities. Finally, parents, identified that siblings require ongoing support after their inclusion in PICU and made suggestions for ongoing availability of information and supportive resources., Conclusions: This study has illuminated key parental experiences when supporting sibling inclusion in PICU before, during and after their visit. By understanding these parental experiences, PICU staff can work with and support parents where needed, helping to achieve a positive sibling inclusion experience., Implications for Clinical Practice: Parents need ongoing support to explain the PICU to siblings of critically ill children and may benefit from specific visual resources to aid communication. In addition, PICUs should aim to ensure the physical layout is supportive of sibling needs, with dedicated spaces for siblings to play and take time out during their experience., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: There is a lack of understanding regarding the impact of telehealth on clinical delivery and the feasibility of sustained implementation by health services. The COVID-19 pandemic provided an ideal opportunity to identify factors related to the implementation of telehealth. This study assessed factors that influenced telehealth implementation during COVID-19 in the Western region of Victoria, Australia, from the perspectives of practice managers and general practitioners (GPs)., Methods: Employing a qualitative approach, we conducted semi-structured interviews with 14 GPs and 11 practice managers across metropolitan and rural settings in the Western region of Victoria, Australia. Interviews were conducted between December 2021 to June 2022, which included periods during and beyond the peak of the COVID-19 pandemic. Themes were synthesised using the Consolidated Framework for Implementation Research, which comprised five domains: innovation, inner setting, outer setting, individuals and implementation process. An additional domain related to billing and finances was added., Results: The innovation domain revealed that telehealth was identified by both stakeholder groups as a critical tool for improving healthcare access for vulnerable patients. GPs highlighted the role of telehealth in follow-up care and the need for extended telephone consultation services. For the implementation process, both stakeholder groups identified a shift in attitudes among GPs from reluctance to acceptance of telehealth. In terms of outer setting, constant changes in regulations posed challenges to administrative staff. Practice managers faced difficulties in acquiring information on changes, but those with robust professional networks were well supported. Initial loss of incentive funding and government-imposed billing methods posed hurdles for clinics. Both stakeholder groups highlighted the need for education around videoconference and a standardised telehealth platform., Conclusion: Evolving telehealth regulations during the emergence of COVID-19 posed financial, operational and administrative challenges to primary care clinics. To ensure sustainability, policymakers should improve stakeholder communication, set interoperability standards, and ensure sustainable funding for telehealth., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: This paper explores the mental health and wellbeing outcomes of a massed community choir program in Australia. Methods: This study employed a mixed methods approach. Data were collected via a survey of choir participants (N = 305), four qualitative interviews and focus groups with facilitators and participants (N = 22), and two workshops with organising staff (N = 5). Questions were derived from a co-designed program logic, and data were triangulated and analysed thematically. Results: Participants reported feeling a sense of connectedness (psychological), but also experiencing connection (social) with their fellow singers. Psychological outcomes included the sensations of affect, arousal, and affirmation. Social outcomes included experiencing belonging, inclusion, and sharing. These positive psycho- social experiences promoted positive mental health and wellbeing outcomes in the large group of participating singers. Conclusions: This paper addresses gaps in our understanding about the mental health and wellbeing outcomes fostered by community choirs at scale. [ABSTRACT FROM AUTHOR]

Background: Historically, researchers have been apt at conducting research on, rather than with, the people who are the focus of their efforts. Such approaches often fail to effectively support and benefit the populations they are intended to. This study aimed to explore the preferences of people with lived experience for engagement with research either as research participants within studies, or through active involvement in mental health research. Methods: Data for this paper were collected in three separate lived experience agenda‐setting studies conducted over a 9‐year period from 2013 to 2022; two group discussions and an open‐ended online survey. Data were combined and thematic analysis undertaken. Results: Participants described the inclusion of lived experience as a critical ingredient and the highest level of knowledge and expertise in mental health research that should lead to knowledge generation and research agendas. Participants discussed the importance and value of research that enables sharing experiences and stories, expressed a need for flexibility in research methods for choice and agency, and support for greater active involvement of people with lived experience across all stages of research. Participants also spoke to the need for perspective and knowledge generated from people with lived experience to have equal power in research, making space for lived experience voices across multiple aspects of research, and greater respect and recognition of the value of lived experience. Conclusion: Lived experience in mental health research is coming of age, but dedicated, cocreated development is needed to get it right. People with lived experience increasingly understand the value their experiential knowledge brings to the mental health research effort, and describe a wide range of ways that researchers can support them to be research participants, and to get actively involved. Power‐sharing, respect and recognition of lived experience as central to effective mental health research are the keys to 'keeping it real'. Patient or Public Contribution: People with lived experience of mental health problems or distress either personally, and/or as carers, family and kinship group members, were involved in the coideation and codesign of this research. All authors identify as people with lived experience. [ABSTRACT FROM AUTHOR]

Aim: To explore undergraduate nursing and midwifery student perspectives of using digital patient systems on clinical placements. Design: This was an interpretative qualitative design study. Methods: Undergraduate nursing and midwifery students in a large Australian metropolitan university were invited to participate in two focus groups from April to June 2019. Twenty (20) students participated and data on their perspective of using digital systems on placement were collected. Thematic analysis using NVivo 12 software was undertaken. Findings: Students identified benefits and challenges when moving between paper records and digital systems. Whilst paper reporting was more efficient for some processes, the students recognised the advantages of digital technology, such as enabling greater confidentiality and consolidation of patient data in one place. However, they also reported difficulty with student access and the size of the portal digital workstation at the bedside. Generally, the lack of preparation and access was considered frustrating and mitigated some of the benefits described when using digital systems. Conclusions: Nursing and midwifery students prefer to be prepared for both paper and digital record keeping. Whilst students identify the benefits of digital platforms, not having direct access mitigates the benefits of these systems. Students identified the use of simulation and interactive modules prior to commencement of clinical practice to enable them to feel more confident with using the systems in patient care. Impact: Health care students require direct access to digital health platforms whilst on clinical placement to facilitate their learning. Higher Education Institutions (HEIs) are in a unique position to work with health care providers to better prepare health care professionals, including nurses and midwives, to work with digital health care systems. Further research is needed to develop the educational preparation for nurses, midwives, and other health care professionals to work with digital systems in practice. [ABSTRACT FROM AUTHOR]

Background: Electronic medical record (EMR) systems provide timely access to clinical information and have been shown to improve medication safety. However, EMRs can also create opportunities for error, including system-related errors or errors that were unlikely or not possible with the use of paper medication charts. This study aimed to determine the detection and mitigation strategies adopted by a health district in Australia to target system-related errors and to explore stakeholder views on strategies needed to curb future system-related errors from emerging., Methods: A qualitative descriptive study design was used comprising semi-structured interviews. Data were collected from three hospitals within a health district in Sydney, Australia, between September 2020 and May 2021. Interviews were conducted with EMR users and other key stakeholders (e.g. clinical informatics team members). Participants were asked to reflect on how system-related errors changed over time, and to describe approaches taken by their organisation to detect and mitigate these errors. Thematic analysis was conducted iteratively using a general inductive approach, where codes were assigned as themes emerged from the data., Results: Interviews were conducted with 25 stakeholders. Participants reported that most system-related errors were detected by front-line clinicians. Following error detection, clinicians either reported system-related errors directly to the clinical informatics team or submitted reports to the incident information management system. System-related errors were also reported to be detected via reports run within the EMR, or during organisational processes such as incident investigations or system enhancement projects. EMR redesign was the main approach described by participants for mitigating system-related errors, however other strategies, like regular user education and minimising the use of hybrid systems, were also reported., Conclusions: Initial detection of system-related errors relies heavily on front-line clinicians, however other organisational strategies that are proactive and layered can improve the systemic detection, investigation, and management of errors. Together with EMR design changes, complementary error mitigation strategies, including targeted staff education, can support safe EMR use and development., (© 2024. The Author(s).)

Background: The process of tailored implementation is ill-defined and under-explored. The ItFits-toolkit was developed and subsequently tested as a self-guided online platform to facilitate implementation of tailored strategies for internet-based cognitive behavioural therapy (iCBT) services. In ImpleMentAll, ItFits-toolkit had a small but positive effect on the primary outcome of iCBT normalisation. This paper investigates, from a qualitative perspective, how implementation teams developed and undertook tailored implementation using the toolkit within the trial., Methods: Implementation teams in thirteen sites from nine countries (Europe and Australia) used the ItFits-toolkit for six months minimum, consistent with the trial protocol. A qualitative process evaluation was conducted. Descriptive data regarding goals, barriers, strategies, and implementation plans collected within the toolkit informed qualitative data collection in real time. Qualitative data included remote longitudinal interviews (n = 55) with implementation team members (n = 30) and observations of support calls (n = 19) with study sites. Qualitative data were analysed thematically, using a team-based approach., Results: Implementation teams developed and executed tailored implementation projects across all steps in the toolkit process. Working in a structured way but with room for flexibility, decisions were shaped by team members' ideas and goals, iterative stakeholder engagement, internal and external influences, and the context of the ImpleMentAll project. Although teams reported some positive impacts of their projects, 'time', both for undertaking the work, and for seeing project impacts, was described as a key factor in decisions about implementation strategies and assessments of success., Conclusion: This study responds directly to McHugh et al.'s (2022) call for empirical description of what implementation tailoring looks like in action, in service settings. Self-guided facilitation of tailored implementation enables implementers in service settings to undertake tailoring within their organisations. Implementation tailoring takes considerable time and involves detailed work but can be supported through the provision of implementation science informed guidance and materials, iterative and ongoing stakeholder engagement, and working reflectively in response to external influencing factors. Directions for advancement of tailored implementation are suggested., (© 2024. The Author(s).)

Aim: This study aimed to explore nursing and midwifery clinical educators' preparation practices related to in situ simulation-based education, at a tertiary health service in Australia., Background: Simulation-based education is routinely used in healthcare education and training. A key mechanism to optimise simulation-based education is learner preparation. While diverse pre-simulation preparation approaches are described in the literature, these are predominantly focused on activities that are undertaken in either university and/or skills centre contexts. In contrast, the learner preparation practices for simulation-based education that is delivered insitu in healthcare facilities by clinical nurse and midwifery educators are underexplored., Design: This study used an exploratory qualitative design., Methods: Participants were recruited using purposive sampling from a potential study group of thirty. Twelve individuals from the nursing and midwifery education group met selection criteria and agreed to participate in the study. Each individual participated in a semi-structured interview. Interview data were then transcribed and analysed using qualitative descriptive methods., Results: Data analysis resulted in the development of four themes related to the preparation of participants for insitu simulation-based education sessions. Each theme informs the choices of clinical nurse/midwifery educators' preparation practices: 1) responsivity to workplace and clinical priorities; 2) clinical educator objectives; 3) preparedness for learning and clinical practice; and 4) evolving educational expertise., Conclusion: This study explored the preparation practices of nurse and midwifery clinical educators engaged in the delivery of insitu simulation-based education. Findings indicate a depth of experiences and a willingness to share practice insights, suggesting that insitu simulation-based education is an integral part of the in service repertoire and a key component of departmental education strategies, designed to support practice and hone skills required to deliver quality patient care., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Over the past decade, the adoption of virtual wards has surged. Virtual wards aim to prevent unnecessary hospital admissions, expedite home discharge, and enhance patient satisfaction, which are particularly beneficial for the older adult population who faces risks associated with hospitalization. Consequently, substantial investments are being made in virtual rehabilitation wards (VRWs), despite evidence of varying levels of success in their implementation. However, the facilitators and barriers experienced by virtual ward staff for the rapid implementation of these innovative care models remain poorly understood., Objective: This paper presents insights from hospital staff working on an Australian VRW in response to the growing demand for programs aimed at preventing hospital admissions. We explore staff's perspectives on the facilitators and barriers of the VRW, shedding light on service setup and delivery., Methods: Qualitative interviews were conducted with 21 VRW staff using the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework. The analysis of data was performed using framework analysis and the 7 domains of the NASSS framework., Results: The results were mapped onto the 7 domains of the NASSS framework. (1) Condition: Managing certain conditions, especially those involving comorbidities and sociocultural factors, can be challenging. (2) Technology: The VRW demonstrated suitability for technologically engaged patients without cognitive impairment, offering advantages in clinical decision-making through remote monitoring and video calls. However, interoperability issues and equipment malfunctions caused staff frustration, highlighting the importance of promptly addressing technical challenges. (3) Value proposition: The VRW empowered patients to choose their care location, extending access to care for rural communities and enabling home-based treatment for older adults. (4) Adopters and (5) organizations: Despite these benefits, the cultural shift from in-person to remote treatment introduced uncertainties in workflows, professional responsibilities, resource allocation, and intake processes. (6) Wider system and (7) embedding: As the service continues to develop to address gaps in hospital capacity, it is imperative to prioritize ongoing adaptation. This includes refining the process of smoothly transferring patients back to the hospital, addressing technical aspects, ensuring seamless continuity of care, and thoughtfully considering how the burden of care may shift to patients and their families., Conclusions: In this qualitative study exploring health care staff's experience of an innovative VRW, we identified several drivers and challenges to implementation and acceptability. The findings have implications for future services considering implementing VRWs for older adults in terms of service setup and delivery. Future work will focus on assessing patient and carer experiences of the VRW., (© Leanne Greene, Miia Rahja, Kate Laver, Vun Vun Wong, Chris Leung, Maria Crotty. Originally published in JMIR Aging (https://aging.jmir.org).)

Background: Although exclusive breastfeeding is recommended for the first six months of life, research suggests that breastfeeding initiation rates and duration among Indigenous communities differ from this recommendation. Qualitative studies point to a variety of factors influencing infant feeding decisions; however, there has been no collective review of this literature published to date. Therefore, the objective of this scoping review was to identify and summarize the qualitative literature regarding Indigenous infant feeding experiences within Canada, the United States, Australia, and Aotearoa., Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses- Scoping Reviews and the Joanna Briggs Institute Guidelines, in October 2020, Medline, Embase, CINAHL, PsycINFO, and Scopus were searched for relevant papers focusing on Indigenous infant feeding experiences. Screening and full-text review was completed by two independent reviewers. A grey literature search was also conducted using country-specific Google searches and targeted website searching. The protocol is registered with the Open Science Framework and published in BMJ Open., Results: Forty-six papers from the five databases and grey literature searches were included in the final review and extraction. There were 18 papers from Canada, 11 papers in the US, 9 studies in Australia and 8 studies conducted in Aotearoa. We identified the following themes describing infant feeding experiences through qualitative analysis: colonization, culture and traditionality, social perceptions, family, professional influences, environment, cultural safety, survivance, establishing breastfeeding, autonomy, infant feeding knowledge, and milk substitutes, with family and culture having the most influence on infant feeding experiences based on frequency of themes., Conclusions: This review highlights key influencers of Indigenous caregivers' infant feeding experiences, which are often situated within complex social and environmental contexts with the role of family and culture as essential in supporting caregivers. There is a need for long-term follow-up studies that partner with communities to support sustainable policy and program changes that support infant and maternal health., (© 2024. The Author(s).)

Aim: This study aims to elicit graduate entry nursing students' views on factors that enable and constrain their learning engagement., Background: Learning engagement has been associated with student retention/attrition and the achievement of learning confidence and success. While all students are subject to challenges that affect their learning engagement, those experienced by international students who are learning in a foreign and unfamiliar context are of particular concern to academics. An understanding of international graduate entry nursing students' perspectives on factors that enable and constrain their engagement can inform development of learning and teaching strategies that are more responsive to the needs of this group of students and can support their learning achievement., Design: A qualitative descriptive design conducted in one Australian multi campus university School of Nursing. Participants included first and second-year international students enrolled in a graduate entry Master of Nursing course., Methods: Data, including demographic information, was collected via a theoretically informed online survey consisting of a Likert scale and open- ended questions. This study reports participant responses to open ended questions included in the survey. A thematic analysis was used to interpret findings., Findings: Analysis identified participants' perspectives on factors that influenced their learning engagement in four theme areas: 1) Availability of study support resources, 2) Opportunities for social interaction, 3) Opportunities to build a sense of belonging, and 4) Constraints on development of a sense of engagement. Opportunities for social engagement emerged as a dominant finding across all themes., Conclusion: This research, which focused on international students' perspectives on learning engagement, contributed to existing knowledge on student engagement in higher education graduate entry nursing courses. Opportunities for social interaction within and beyond formal course learning experiences were valued by students and identified as key to their learning engagement. These findings have implications for academics and student support services who together, can influence the context of students learning to better meet their engagement needs., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Accessible summary: What Is Known on the Subject?: Service user involvement in mental health nursing education is beneficial in terms of attitudinal change to reduce stigma, clinical skill development and enhancing understandings of recovery‐oriented practice.Service users as experts by experience have not been embedded within pre‐registration nursing programs. Consequently, they remain limited in number, ad hoc and frequently tokenistic.Nurse academics responsible for the design and delivery of pre‐registration mental health nursing curricula have a potentially important role in facilitating expert by experience involvement in mental health nursing education. What this Paper Adds to Existing Knowledge: Nurse academics teaching mental health nursing have generally favourable views about the importance of expert by experience involvement.Nurse academics experience significant barriers in supporting the implementation of academic positions for experts by experience, particularly in obtaining funding.The experts by experience could contribute to mental health nursing education does not appear to be clearly understood by nurse academics. What Are the Implications for Practice?: Mental health services aspire to adopt a recovery‐oriented approach to practice. Involving experts by experience in mental health nursing education can facilitate increased understanding and appreciation of recovery‐oriented practice.Nurse academics could play an important role in supporting the implementation of experts by experience positions in nursing academia. To do so, they require an understanding of the benefits of EBE involvement in academia and the barriers that can be encountered when attempting to facilitate the implementation of such positions.Experts by experience contribute unique expertise, essential to the development of quality mental health services. Conveying this expertise through the educating the future nursing workforce in mental health is essential. Introduction: Involving service users in mental health nursing education is ad hoc and minimal, despite growing evidence of its benefits. Insights and experiences of nurse academics teaching mental health to pre‐registration students have been underrepresented in the research to date. Aim: To seek insights and experiences of nurse academics involved in designing and delivering pre‐registration mental health nursing education in Australian universities regarding involving service users in mental health nursing education. Methods: A descriptive qualitative study involving 19 nurse academics from 13 Australian universities, involved in pre‐registration mental health nursing education. Data were analysed thematically. Results: Participants reported minimal service user involvement. Most sought an increase and identified barriers. Data analysis resulted in five identified themes: (1) value‐rich, (2) resource‐poor, (3) imperfect processes, (4) 'part, but not all' and (5) unrecognised worth. Conclusions: Increasing meaningful involvement of service‐users in mental health nursing education requires support and investment from multiple stakeholders. Nurse academics are crucial stakeholders in understanding the unique expertise service users bring. Implications for Practice: Service users being central to all aspects of mental health services requires their active participation in the education of health professionals. Nurse academics have an important role in realising this goal. [ABSTRACT FROM AUTHOR]

Accessible Summary: What Is Known on the Subject?: Dual diagnosis is one of the leading causes of disability globally.Consumers with dual diagnosis have complex needs and are at risk of relapse of their psychiatric symptoms.Mental health nurses require essential skills, including empathy, to manage consumers with dual diagnosis.No studies have explored mental health nurses' empathy towards consumers with dual diagnosis. What Does the Paper Add to Existing Knowledge?: Developing empathy towards consumers with dual diagnosis is complex.Mental health nurses' unemotional empathy experiences with consumers with dual diagnosis are related to their lack of ability to connect to their consumers' choices and feelings.Negative attitudes towards consumers with dual diagnosis contributed to nurses' poor empathy experiences.The unemotional responses of mental health nurses can be caused by factors such as novelty, insufficient information, and neutral evaluation of a consumer's situation. What Are the Implications for Practice?: The study results benefit researchers, teachers, clinicians, and administrators when designing, developing, and delivering empathy training packages for mental health nurses.Improving the empathy of mental health nurses towards consumers with dual diagnosis should be a top priority for healthcare leaders and educators.A core curriculum containing holistic awareness of the biopsychosocial components of dual diagnosis makes it easier for mental health nurses to understand and develop empathy towards consumers with dual diagnosis.Future studies must address the relationship between attitude, stress, burnout, compassion fatigue and empathy among mental health nurses in relation to consumers with dual diagnosis. Introduction: There is a lack of evidence regarding mental health nurses' empathy towards consumers with dual diagnosis. Aims: This qualitative study aimed to describe mental health nurses' empathy towards consumers with dual diagnosis in Australian mental health settings. Method: Through purposeful sampling, interviews were conducted with 17 mental health nurses who have experience in caring for consumers with dual diagnosis. Thematic analysis, as an inductive approach was used, to generate codes and themes from participant data. To report on this qualitative study, we adhered to the ENTREQ guidelines. Results: Four themes emerged: challenges to develop empathy with consumers, lack of conducive attitude of nurses towards consumers, appraising consumers' emotions accurately and holistically responding to the appraised emotions. The findings indicated that developing empathy towards consumers with dual diagnosis is a complex task. Discussion: Mental health nurses may struggle to empathize with consumers when encountering confrontational situations. Interventional studies are required to address the relationship between mental health nurses' attitudes, stress, burnout, compassion fatigue and empathy in relation to consumers with dual diagnosis. Implications for Practice: Understanding why mental health nurses emotional experiences differ about a similar challenging situation experienced by their consumers is vital. Further research on strategies to address empathy issues among mental health nurses could enhance nursing practice and consumer care. [ABSTRACT FROM AUTHOR]

Objectives: Despite high levels of mental ill‐health amongst young people (aged 15–30), this group demonstrates low help‐seeking and high drop‐out from mental health services (MHS). Whilst shared decision‐making can assist people in receiving appropriate and effective health care, young people frequently report that they do not feel involved in treatment decisions. The current study focused on co‐design of a clinical education and participant information programme for the Brain and Mind Centre Youth Model of Care. This model, which articulates a youth‐focused form of highly personalised and measurement‐based care, is designed to promote shared decision‐making between young people and clinical service providers. Methods: We conducted workshops with 24 young people (16–31; MAge = 21.5) who had accessed mental health services. Participants were asked what advice they would give to young people entering services, before giving advice on existing materials. Workshops were conducted and transcripts were coded using thematic analysis by two lived experience researchers and a clinical researcher. Results: Young people found it empowering to be educated on transdiagnostic models of mental illness, namely clinical staging, which gives them a better understanding of why certain treatments may be inappropriate and ineffective, and thus reduce self‐blame. Similarly, young people had limited knowledge of links between mental health and other life domains and found it helpful to be educated on multidisciplinary treatment options. Measurement‐based care was seen as an important method of improving shared decision‐making between young people and health professionals; however, to facilitate shared decision‐making, young people also wanted better information on their rights in care and more support to share their expertise in their own needs, values and treatment preferences. Conclusions: These findings will inform the delivery of the further development and implementation of a youth‐specific clinical education and participant information programme for the BMC Youth Model. Patient or Public Contribution: Workshops were facilitated by researchers with lived expertise in mental ill‐health (A.H. and/or C.G.) and a clinical researcher (who has expertise as an academic and a clinical psychologist). A.H. and C.G. were also involved in conceptualisation, analysis, interpretation, review and editing of this paper. [ABSTRACT FROM AUTHOR]

Objective: Along with other Australian health professionals, occupational therapy students need to understand Aboriginal and Torres Strait Islander culture and health issues to develop their capacity to work effectively with this community and meet accreditation standards. The study aimed to explore the learning experiences of occupational therapy students during a module focused on Aboriginal and Torres Strait Islander peoples' health issues and approaches. Methods: A qualitative descriptive method was used. Individual interviews were audiotaped, transcribed and analysed thematically following the module. Participants were asked about their prior experience with Aboriginal and Torres Strait Islander peoples, feelings about undertaking the module, difficulties and highlights of the module, and how the module contributed to their learning. Results: In all, 18 students participated in interviews. Interview themes were (1) student context of learning about Aboriginal and Torres Strait Islander peoples' heath and culture, (2) experiencing the module with others and (3) student learning gains following the module. Conclusion: Students developed in their self-awareness and understanding of Aboriginal and Torres Strait Islander peoples' issues of relevance to occupational therapy. Further research is needed to evaluate educational activities with occupational therapy and other health professional students across Australia, and ongoing culturally responsiveness training for health professionals (post-registration). What is known about the topic? Health professional students need to develop their knowledge and skills in working with Aboriginal and Torres Strait Islander peoples to be culturally responsive and meet their health needs effectively. What does this paper add? This study is the first to describe the responses of occupational therapy students to a module on Aboriginal and Torres Strait Islander health and wellbeing. Students were challenged about any biases that could affect their capacity to be culturally responsive. What are the implications for practitioners? Both practitioners and students need to be culturally responsive to provide culturally safe services to Aboriginal and Torres Strait Islander peoples. [ABSTRACT FROM AUTHOR]

This paper contributes to the 'future' methods literature by exploring the methodological potentials of material methods in qualitative research on young women's imagined futures. Existing research has demonstrated how producing knowledge about imagined futures remains a challenge, often leading to abstract or generic accounts of such futures. Arguing for a double focus on materiality as method and the materiality of methods, this paper extends material methods to innovatively study futures. By considering the narratives about imagined futures generated with and by 'future materials' brought by participants to an interview, the paper demonstrates that this approach is productive for gaining insights that go beyond generic accounts. That is, via the materiality of the objects, specific imagined futures become 'within reach' for participants, with the object serving as an anchor for these future narratives. Empirically the paper draws on data from a longitudinal qualitative study of young women's imagined futures in Australia. [ABSTRACT FROM AUTHOR]

Introduction: Women play a significant role in the management of their own healthcare and that of others, however women diagnosed with mental illness and physical health concerns experience significant health inequalities as compared to people living without mental health concerns., Methods: In this paper, we reflect on the experiences of 20 cis women diagnosed with mental and physical health concerns who agreed to be a part of this research. This qualitative study is part of the larger Healthtalk Australia research project which was not gender specific. Female participants shared many experiences of mental and physical healthcare in interviews with researchers that pointed to the need for a gendered approach to addressing health inequalities. Consequently, we iteratively consolidated transcripts of interviews with participants into thematic categories facilitated by NVIVO 12., Results: We identified two broad themes and a set of subthemes: in the doctor's office - experience of labelling; negotiating medications; and interactions with physical and mental health, and outside the doctor's office - responses to trauma, financial concerns, and reliance on participant's internal resources to get healthcare needs met., Discussion: We conclude that participants in this study undertook significant work to manage their own healthcare needs, despite being challenged by clinicians and systems that failed to see them as whole people with expertise regarding their own health., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Zirnsak, Elwyn, McLoughlan, Le Couteur, Green, Hill, Roberts and Maylea.)

Background: Competent clinical reasoning forms the foundation for effective and efficient clinical swallowing examination (CSE) and consequent dysphagia management decisions. While the nature of initial CSEs has been evaluated, it remains unclear how new information gathered by speech–language therapists (SLTs) throughout a patient's acute‐care journey is integrated into their initial clinical reasoning and management processes and used to review and revise initial management recommendations. Aims: To understand how SLTs' clinical reasoning and decision‐making regarding dysphagia assessment and management evolve as patients transition through acute hospital care from referral to discharge. Methods & Procedures: A longitudinal, qualitative approach was employed to gather information from two SLTs who managed six patients at a metropolitan acute‐care hospital. A retrospective 'think‐aloud' protocol was utilized to prompt SLTs regarding their clinical reasoning and decision‐making processes during initial and subsequent CSEs and patient interactions. Three types of concept maps were created based on these interviews: a descriptive concept map, a reasoning map and a hypothesis map. All concept maps were evaluated regarding their overall structure, facts gathered, types of reasoning engaged in (inductive versus deductive), types of hypotheses generated, and the diagnosis and management recommendations made following initial CSE and during subsequent dysphagia management. Outcomes & Results: Initial CSEs involved a rich process of fact‐gathering, that was predominantly led by inductive reasoning (hypothesis generation) and some application of deductive reasoning (hypothesis testing), with the primary aims of determining the presence of dysphagia and identifying the safest diet and fluid recommendations. During follow‐up assessments, SLTs engaged in increasingly more deductive testing of initial hypotheses, including fact‐gathering aimed at determining the tolerance of current diet and fluid recommendations or the suitability for diet and/or fluid upgrade and less inductive reasoning. Consistent with this aim, SLTs' hypotheses were focused primarily on airway protection and medical status during the follow‐up phase. Overall, both initial and follow‐up swallowing assessments were targeted primarily at identifying suitable management recommendations, and less so on identifying and formulating diagnoses. None of the patients presented with adverse respiratory and/or swallowing outcomes during admission and following discharge from speech pathology. Conclusions & Implications: Swallowing assessment and management across the acute‐care journey was observed as a high‐quality, patient‐centred process characterized by iterative cycles of inductive and deductive reasoning. This approach appears to maximize efficiency without compromising the quality of care. The outcomes of this research encourage further investigation and translation to tertiary and post‐professional education contexts as a clear understanding of the processes involved in reaching diagnoses and management recommendations can inform career‐long refinement of clinical skills. WHAT THIS PAPER ADDS: What is already known on the subject: SLTs' clinical reasoning processes during initial CSE employ iterative cycles of inductive and deductive reasoning, reflecting a patient‐centred assessment process. To date it is unknown how SLTs engage in clinical reasoning during follow‐up assessments of swallowing function, how they assess the appropriateness of initial management recommendations and how this relates to patient outcomes. What this paper adds to the existing knowledge: Our longitudinal evaluation of clinical reasoning and decision‐making patterns related to swallowing management in acute care demonstrated that SLTs tailored their processes to each patient's presentation. There was an emphasis on monitoring the suitability of the initial management recommendations and the potential for upgrade of diet or compensatory swallowing strategies. The iterative cycles of inductive and deductive reasoning reflect efficient decision‐making processes that maintain high‐quality clinical care within the acute environment. What are the potential or actual clinical implications of this work?: Employing efficient and high‐quality clinical reasoning is a hallmark of good dysphagia practice in maximizing positive patient outcomes. Developing approaches to understanding and making explicit clinical reasoning processes of experienced clinicians may assist SLTs of all developmental stages to provide high standards of care. [ABSTRACT FROM AUTHOR]

Objective: This paper explores Australian military families' use of social media and digital communication to maintain and strengthen parent–child relationships during military deployments. Background: The physical and emotional well‐being of children and partners of military serving members is affected by service. Maintaining positive family relationships between military members and their children during periods of absence (including deployment) is important for parental relationships as well as the well‐being of the child. Method: A qualitative meta‐analysis is used to collate data from two previous studies of Australian Defence Force (ADF) families with children, in order to generate a new data set from which novel insights were drawn. Results: Families show a preference for social media and digital communication methods, and digital technologies affordances and practicalities are well suited for Defence families with children. There are a range of benefits; digital technologies are used to strengthen relationships between children and their deployed parent. The study highlights a range of challenges for deployed parents as well as points to the work required from the at‐home parent in facilitating these connections. Conclusion: Maintaining positive family relationships between military members and their children during times of absences is important for both relationships. This paper explores how ADF families use social and digital communication during military absences and outlines the role these technologies play as a medium for strengthening familial relationship. Implications. The findings of this paper highlight the importance of digital and social communication technologies for supporting families during absences. This has implications for the ADF, who might look to reduce members' access to such communication for security concerns. Reduced family well‐being may also have impacts on retention, a key issue for military organizations. Accordingly, the findings of this paper may be used to inform decisions about restricting internet and social media access for deployed military members. [ABSTRACT FROM AUTHOR]

Chronic low back pain is a leading cause of disability worldwide. A clinical model for its cause is lacking. Defining a cause based clinical model and a framework of understanding back pain in terms of peripheral structural and central functional pain is essential for optimal management. We describe the results of the largest published audit of 41 chronic low back pain patients, receiving outpatient sublingual ketamine therapy for defined central functional pain along with conventional peripheral structural pain management. Our clinical model assigns Movement Dysfunction as the primary cause for low back pain symptoms and restores it with Movement Therapy focused rehabilitation which is also defined. Patients were derived from a tertiary single neurosurgical specialist practice in Brisbane Australia over a three year period. Severe pain and disability measurements more than halved and only 13% of patients ceased ketamine prematurely due to predominantly non-sinister side effects common to all pharmaceutical therapies. All other surveyed metrics of utility were highly favourable in this challenging cohort of chronic back pain patients biased to poor outcomes. Outpatient ketamine maintains high efficacy and safety used in conjunction with a unique clinical model that describes chronic low back pain. This paper builds on our previous publications that describe the disease of movement dysfunction as an integral factor to the development of a cause based clinical model for the condition of chronic low back pain symptoms. Our clinical application of this model, applying the necessary dual approach of controlling symptoms arising from peripheral structural pain and central functional pain in conjunction with elimination of root causation has shown favourable outcomes in patients with high levels of pain and disability based on their tertiary referral origin and high Oswestry Disability Scores. Removing chronic low back pain from its position as one of the world's leading causes of pain and disability is more likely if the rehabilitation industry can replicate and test treatment algorithms based around established clinical models of disease which is the important subject of this paper. [ABSTRACT FROM AUTHOR]

This paper develops knowledge of the logistics of moving house amongst older people living in insecure housing. These people typically do not move once and settle into a new house, but face ongoing moves driven by factors including housing affordability, tenure conditions and eviction. The paper identifies four domains of experience faced by people undergoing cumulative, involuntary residential moves: the material (process of relocating oneself and possessions), economic (costs of moving house), embodied (physical experience) and affective (how relocation is experienced and felt). The logistics of relocation are examined through the experiences of single older women living in insecure housing in the greater Sydney region of Australia. The accounts of these women foreground the costs and challenges of insecure housing that are a consequence of relocation. Conceptually this work contributes to understandings of mobility-based disadvantage in older age through drawing out the ways that the logistics of moving house – of relocating oneself and possessions – contribute in distinct ways to mobility-based disadvantage through risks to identity and senses of home. Empirically it addresses gaps in gerontological and housing scholarship through developing knowledge of the logistics and experiences of ongoing, involuntary residential moves. [ABSTRACT FROM AUTHOR]

Background: The implementation science literature acknowledges a need for engagement of key stakeholders when designing, delivering and evaluating implementation work. To date, the literature reports minimal or focused stakeholder engagement, where stakeholders are engaged in either barrier identification and/or barrier prioritisation. This paper begins to answer calls from the literature for the development of tools and guidance to support comprehensive stakeholder engagement in implementation research and practice. The paper describes the systematic development of the Implementation‐STakeholder Engagement Model (I‐STEM) in the context of an international, large‐scale empirical implementation study (ImpleMentAll) aimed at evaluating the effectiveness of a tailored implementation toolkit. The I‐STEM is a sensitising tool that defines key considerations and activities for undertaking stakeholder engagement activities across an implementation process. Methods: In‐depth, semistructured interviews and observations were conducted with implementers who were tailoring implementation strategies to integrate and embed internet‐based cognitive behavioural therapy (iCBT) services in 12 routine mental health care organisations in nine countries in Europe and Australia. The analytical process was informed by principles of first‐ and third‐generation Grounded Theory, including constant comparative method. Results: We conducted 55 interviews and observed 19 implementation‐related activities (e.g., team meetings and technical support calls). The final outcome of our analysis is expressed in an initial version of the I‐STEM, consisting of five interrelated concepts: engagement objectives, stakeholder mapping, engagement approaches, engagement qualities and engagement outcomes. Engagement objectives are goals that implementers plan to achieve by working with stakeholders in the implementation process. Stakeholder mapping involves identifying a range of organisations, groups or people who may be instrumental in achieving the engagement objectives. Engagement approaches define the type of work that is undertaken with stakeholders to achieve the engagement objectives. Engagement qualities define the logistics of the engagement approach. Lastly, every engagement activity may result in a range of engagement outcomes. Conclusion: The I‐STEM represents potential avenues for substantial stakeholder engagement activity across key phases of an implementation process. It provides a conceptual model for the planning, delivery, evaluation and reporting of stakeholder engagement activities. The I‐STEM is nonprescriptive and highlights the importance of a flexible, iterative approach to stakeholder engagement. It is developmental and will require application and validation across a range of implementation activities. Patient or Public Contribution: Patient contribution to ImpleMentAll trial was facilitated by GAMIAN‐Europe at all stages—from grant development to dissemination. GAMIAN‐Europe brings together a wide variety of patient representation organisations (local, regional and national) from almost all European countries. GAMIAN‐Europe was involved in pilot testing the ItFits‐toolkit and provided their views on the various aspects, including stakeholder engagement. Patients were also represented in the external advisory board providing support and advice on the design, conduct and interpretation of the wider project, including the development of the ItFits‐toolkit. Trial registration: ClinicalTrials.gov NCT03652883. Retrospectively registered on 29 August 2018. [ABSTRACT FROM AUTHOR]

Research has consistently established the positive impact of sharing books with young children. Evidence suggests several important factors when evaluating book sharing with young children, including the quality of educator practice = and the nature of groupings, as well as the frequency and duration of book sharing sessions and access to books. Other evidence suggests book sharing may be particularly important for children from low ses backgrounds attending early learning settings. This paper reports on a larger study which investigated the factors and relationships influencing the use of children's literature to support principles of diversity in kindergarten rooms of long day care centres. A mixed methods approach was adopted and a convergent design was employed to synthesise the qualitative and quantitative data and interpret significant relationships and their meanings. The quality of educator practice was measured through the Systematic Assessment of Book Reading (SABR) and Children's engagement in book sharing was assessed using the Children's Orientation to Book Reading Rating Scale. Detailed analysis of 148 video recorded book sharing sessions produced statistical representations of the frequency and duration of book sharing across the contexts and the nature of involvement of the children in the study. Twenty four educators and 110 children from four long day care centres in Western Australia participated. Data were collected through semi-structured interviews, video-based observations, field notes, document analysis and a book audit. The results showed that while the children in this study had a range of book sharing experiences, few of these were frequent or of high quality. Of great concern is the finding that the children in this study most likely to be considered at risk of educational disadvantage were those with the least exposure to book sharing in general, and, even less so, to high quality book sharing, raising concerns about equitable outcomes for them. [ABSTRACT FROM AUTHOR]

In Australia, there are more than 46 000 children in out‐of‐home care (OOHC). Most of these children have been in OOHC for more than 2 years. Similarly, there are more than 407 000 children in the United States and over 80 800 in England who are 'looked after' with approximately one third of these children being in OOHC for more than 2 years. This paper concerns 'looked after' children's rights to contact with their birth parents. The United Nations Convention on the Rights of the Child (UNCRC) requires child protection systems to recognize the rights of children to maintain contact with their families except where this is not in the child's 'best interests'. In this paper, we report on a qualitative study conducted in Australia exploring legal and family support practitioners' perceptions of barriers to contact between children in OOHC and their birth parents. The thematic analysis identified four themes: These were as follows: a focus on systems driven responses; lack of cultural recognition and responsiveness; carers' disconnection from birth parents; and parents' exclusion. We discuss the implications of these findings for understanding and recognizing children's right to contact with birth parents. [ABSTRACT FROM AUTHOR]

Suicide has a devasting and far-reaching effect on our communities. In developed countries, most people who die by suicide are male. Understanding men's mental health and what they experience in a suicidal state is key to preventing future attempts. Our paper explores how a group of 37 men in Australia describe the leadup to their suicidality. Underpinned by interpretive phenomenological analysis, interview transcripts were examined for phrases that the investigative team subjectively identified as profound. Our approach considered language and expression that evoke reactions to the sometimes contradictory nature of suicide. The process enabled our team to identify the emotions, rationales, and motivations for and against suicide that give rise to and arise during suicidal states. One man's source of strength may be another's cause of anguish, so any single, one-size-fits-all pathway to suicide prevention is unlikely to succeed, signaling the need for a tailored approach to suicide prevention. [ABSTRACT FROM AUTHOR]