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The study aimed to explore Indigenous narrative accounts of healthcare access within qualitative research papers, to better understand Indigenous views on culturally safe healthcare and health communication represented in that literature. A systematic literature review of peer-reviewed academic qualitative studies identified 65 papers containing Indigenous respondents' views on accessing healthcare. Analysis included all Indigenous voice (primary quotations) and author findings describing healthcare access across these studies. Healthcare communication, or 'talk', emerged as a key theme. Indigenous clients valued talk within healthcare interactions; it was essential to their experience of care, having the power to foster relationships of trust, strengthen engagement and produce positive outcomes. By mediating the power differentials between health professionals and Indigenous clients, talk could either reinforce powerlessness, through judgmental down-talk, medical jargon or withholding of talk, or empower patients with good talk, delivered on the client's level. Good talk is a critical ingredient to improving Indigenous accessibility and engagement with healthcare services, having the ability to minimise the power differentials between Indigenous clients and the healthcare system [ABSTRACT FROM AUTHOR]

Objective. The primary aim of the present study was to consider health care service quality from the patients' perspective, specifically through the patient's eyes. Method. A narrative analysis was performed on 300 patient stories. This rigorous analysis of patient stories is designed to identify and describe health care service quality through patients' eyes in an authentic and accurate, experiential manner. Results. The findings show that there are variant and complex ways that patients experience health care service quality. Conclusion. Patient stories offer an authentic view of the complex ways that patients experience health care service quality. Narrative analysis is a useful tool to identify and describe how patients experience health care service quality. Patients experience health care service quality in complex and varying ways. What is known about the topic? Patient satisfaction measures are increasingly used for benchmark and accreditation purposes. Measures of patient satisfaction are considered indicative measures of service quality and quality of care. However, the measurement of patient satisfaction and service quality is not an accurate reflection of what and how patients experience health care. What does this paper add? This paper takes a narrative approach and analyses 300 patient stories to demonstrate the essence of patients' evaluation of health care service quality. What are the implications for practitioners? Health care service quality is shown to be experienced in various ways. Identifying and describing these different ways of experiencing health care service quality provides practitioners with strategic insight into improving the quality of service they provide outside the realm of objective satisfactionmeasures. These findings also demonstrate the value in a third-party feedback system. [ABSTRACT FROM AUTHOR]

Objective. The Australian Dental Council is responsible for the assessment of overseas-qualified dentists seeking to practice dentistry in Australia. The aim of this paper is to reflect on the Council's assessment and examination process through the experiences and perceptions of overseas-qualified dentists in Australia. Methods. Qualitative methods were used. Life stories of 49 overseas-qualified dentists from 22 nationalities were analysed to discern significant themes and patterns. We focused on their overall as well as specific experiences of various stages of the examination. The analysis was consistent with a hermeneutic phenomenological approach to social scientific research. Results. Most participants referred to 'cost' of the examination process in terms of lost income, expenses and time. The examination itself was perceived as a tough assessment process. Some participants seemed to recognise the need for a strenuous assessment due to differences in patient management systems in Australia compared with their own country. Significantly, most of the participants stressed the importance of support structures for overseas-qualified dentists involved in or planning to undertake the examination. These considerations about the examination experience were brought together in two themes: (1) 'a tough stressful examination'; and (2) 'need for support.' Conclusion. This paper highlights the importance of support structures for overseas-qualified dentists. Appropriate support (improved information on the examination process, direction for preparation and training, further counselling advice) by recognised bodies may prevent potential exploitation of overseas-qualified dentists. Avenues that have been successful in providing necessary support, such as public sector schemes, offer policy options for limited recruitment of overseas-qualified dentists in Areas of Need locations. Such policies should also be in line with the local concerns and do not reduce opportunities for Australian-qualified dentists. [ABSTRACT FROM AUTHOR]

Despite more nurses working in Australian general practice, there has been limited investigation exploring ways that general practitioners and registered nurses work together to deliver clinical care. However, it has been postulated that the small business structure, common in Australian general practices, might influence collaboration between these two groups of health professionals. This paper presents one theme from a larger qualitative study. Eight general practitioners and fourteen registered nurses working in general practice participated in semistructured face-to-face interviews between February and May 2015. Naturalistic inquiry was adopted to elicit and explore the narrative accounts of participants about working together in general practice. An inductive process of thematic analysis was used to identify, analyse and report patterns and themes. Ancillary costs associated with the employment of registered nurses in general practice and the time registered nurses took to undertake procedural services were a concern for general practitioners. Registered nurses did not always work to their full scope of practice and many felt that their expertise was not appropriately remunerated. Findings suggested that fee for service-funding models can negatively influence collaboration between general practitioners and registered nurses working in general practice. [ABSTRACT FROM AUTHOR]

Chronic pain is a commonly reported problem in primary care, and is Australia's third most costly health problem. Despite advances in the understanding and treatment of pain, many people with chronic pain do not receive the best available care. This paper examines the health care experiences of people with chronic pain and focuses discussion on the impact that institutional and cultural factors can have on individual experience. Unstructured narrative interviews were conducted with a convenience sample of 20 people with chronic pain. Participants' experiences pointed to several factors that can affect the outcome of the health care they receive, including: the belief that all pain is due to identifiable injury or disease; a commitment to finding a diagnosis and cure; problematic patient-provider communication; and poor integration of health services. Comprehensively addressing these factors cannot be achieved by focusing interventions at the individual level. A multifaceted response, which includes public health and systemic initiatives, is required. [ABSTRACT FROM AUTHOR]

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The Australian Government Health Care Homes (HCH) model recently implemented in general practice targets people with chronic complex conditions. Identifying how general practitioners (GPs) and practice nurses (PNs) can work within this model is important given existing health workforce challenges. A narrative review and synthesis has been undertaken to develop a preliminary understanding of this, incorporating literature describing health workforce challenges, GP and PN functions, and team-based care; supplemented by interviews with key informants from within the primary healthcare system. Narrative synthesis principles guided literature analysis. Interview data were thematically analysed. A clear rationale for health workforce reform was ascertained and functions for the GP and PN under the HCH model were determined. The model was found to be an opportunity for an enhanced PN role in a team-based approach to care with the GP. Challenges to advancing thePNrole and team-based care were identified, including the medical dominance of the health system and the significant culture change required by general practices to fully implement the model. Enablers included strong nursing leadership and improved ongoing education for PNs to unlock their capacity. The HCH model is an opportunity to strengthen primary healthcare, provided concerted action is taken regarding these challenges and enablers. [ABSTRACT FROM AUTHOR]

Objectives. Culture and religion are important in advance care planning (ACP), yet it is not well understood how this is represented in ACP online resources. The aim of the present study was to identify the availability of Australian-based ACP websites and online informational booklets containing cultural and religious information. Methods. An environmental scanning framework was used with a Google search conducted from 30 June 2015 to 5 July 2015. Eligible Australian-based ACP websites and online informational booklets were reviewed by two analysts (APS & PM) for information pertaining to at least one culture or religion. Common characteristics were agreed upon and tabulated with narrative description. Results. Seven Australian-based ACP websites were identified with varying degrees of cultural and religious information. Seven Australian-based ACP informational booklets were identified addressing culture or religion, namely of Aboriginal and Torres Strait Islander (n = 5), Sikh (n = 1) and Italian (n = 1) communities. Twenty-one other online resources with cultural and religious information were identified, developed within the context of health and palliative care. Conclusions. There is no comprehensive Australian-based ACP website or informational booklet supporting ACP across several cultural and religious contexts. Considering Australia's multicultural and multifaith population, such a resource may be beneficial in increasing awareness and uptake of ACP. [ABSTRACT FROM AUTHOR]

Sri Lankan Tamil refugees are among the largest group of refugees to resettle in Australia in the last decade. The aim of this study is to characterise the narratives of health-seeking among unwell Sri Lankan Tamil refugees in Melbourne, Victoria, Australia. Drawing on a qualitative, phenomenological perspective, we conducted in-depth interviews in Tamil and English with 12 participants who identified as being unwell for 6 months or more. Findings revealed three narratives of health-seeking: the search for the 'good life' that was lost or never experienced, seeking help from familiar channels in an unfamiliar context, and the desire for financial and occupational independence. These three narratives are undergirded by the metanarrative of a hope-filled recovery. These narratives of Tamil refugees' lived experience provide new insights into clinical care and health service delivery. [ABSTRACT FROM AUTHOR]

Over 750 000 refugees have resettled in Australia since 1945. Despite complex health needs related to prior traumatic experiences and the challenges of resettlement in a foreign country, refugees experience poor access to primary care. Health and settlement service providers describe numerous cultural, communication, financial and health literacy barriers. This study aimed to investigate the acceptability of general practitioner (GP) services and understand what aspects of acceptability are relevant for Afghan refugees in south-eastern Melbourne. Semi-structured interviews were conducted with two Afghan community leaders and 16 Dari- or English-speaking Afghan refugees who accessed GP services. Two distinct narratives emerged - those of recently arrived refugees and established refugees (living in Australia for 3 years or longer). Transecting these narratives, participants indicated the importance of: (1) a preference for detailed clinical assessments, diagnostic investigations and the provision of prescriptions at the first consultation; (2) 'refugee-friendly' staff; and (3) integrated, 'one-stop-shop' GP clinic features. The value of acceptable personal characteristics evolved over time - GP acceptability was less a consideration for recently arrived, compared with more, established refugees. The findings reinforce the importance of tailoring healthcare delivery to the evolving needs and healthcare expectations of newly arrived and established refugees respectively. [ABSTRACT FROM AUTHOR]

Objective. This is a report of a qualitative health research study examining how nurse practitioners construct and implement their roles. Methods. In-depth interviews and a focus group discussion were conducted to obtain narrative data from nurse practitioners from a variety of clinical backgrounds. Data were analysed utilising the principles of grounded theory. Subjects. Seven nurse practitioners participated in face-to-face interviews and six participated in a focus group discussion. Results. The central process of 'developing legitimacy and credibility' is achieved through the processes of: 'developing Clinical Practice Guidelines', 'collaborating with the multidisciplinary team', 'communicating', and 'transitioning to practice'. Conclusion. Policy makers and those responsible for operationalising nurse practitioner roles need to support the central process of developing legitimacy and credibility vital for successful implementation. First, this involves enabling a supportive and informed process of Clinical Practice Guideline development. Second, key inter-disciplinary relationships need to be identified to facilitate collaboration and sources of mentorship for nurse practitioners. Finally, an identified period of transition will facilitate identification, development and implementation of the above processes. [ABSTRACT FROM AUTHOR]

Objective. The purpose of this study was to investigate the characteristics of the Residential Aged Care Coronial Communiqué that have promoted previously reported professional practice change, and to explore the circumstances of these changes. Methods. This was an exploratory, qualitative study for which data was collected through semi-structured interview of 15 subscribers to the Residential Aged Care Coronial Communiqué. Results. The Residential Aged Care Coronial Communiqué was reported to promote self-reported practice change though the inclusion of case studies, by being associated with the Coroner, and by providing evidence to justify change. The combination of existing concerns about risk and staff awareness, in conjunction with reading the Residential Aged Care Coronial Communiqué was also reported to promote practice change, as was having the support of senior staff and the authority to implement change. Conclusions. The combination of narrative case studies in the context of an educational publication associated with the Coroner's Office has been reported to provided evidence and incentive to promote professional practice change in an aged care setting. However the relative influence of the Residential Aged Care Coronial Communiqué, and other background circumstance and facilitating factors on practice change cannot be determined from this study. [ABSTRACT FROM AUTHOR]