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Australia is undergoing major aged care reforms, changing from the previous service provider‐driven approach to consumer‐directed care principles. In residential aged care, this has resulted in a significant reduction in government funding in order to support reform initiatives in home and community‐based care. There has been limited research on the impact of structural aspects of the reforms such as the effect of changes in funding focus. Using a qualitative descriptive research methodology, this study explores the impact of the reforms on staff at various levels of operational responsibility in residential aged care. Issues identified by participants centered on the capacity to deliver care in three areas, the impact of funding reduction, challenges in meeting increasingly complex needs of residents and their families, and new requirements for care roles within current limitations. This paper provides an insight into how and why operational issues have informed the findings of the current Australian Royal Commission into Aged Care Quality and Safety. It identifies areas of support for the aged care workforce that are crucial in fulfilling consumer‐focused care delivery. [ABSTRACT FROM AUTHOR]

Because nurses are at the forefront of end-of-life care, it is imperative that nursing students are prepared for this role upon graduation. Research suggests that many nursing students are unprepared to deliver compassionate and quality end-of-life care. There have been many attempts to address this need; one emerging method is end-of-life care simulation. This paper explores the experiences of 18 undergraduate nursing students of end-of-life care simulation. Participants' stories were obtained via observation during end-of-life care simulation, audio-recorded post simulation debriefing, and semi-structured interviews. Using Clandinin and Connolly's three dimensions of Narrative Inquiry (temporality, spatiality, and sociality) participants' stories reflected convergence of time, place, and person. Findings revealed three distinct plotlines along a time continuum, specifically surrounding time of death: (i) 'The privilege of end-of-life care;' (ii) 'Witnessing death as surreal;' and (iii) 'The honor of providing after-death care.' Participants' narratives suggest that end-of-life care simulation is an important means of preparing students for clinical end-of-life care experiences. This has implications for nursing educators wishing to consider simulation in end-of-life care education. [ABSTRACT FROM AUTHOR]

Promoting young children's academic and developmental outcomes can no longer be achieved by the single efforts of one profession, but requires professionals to work together in inter-professional teams to understand the complexity of young children's lives. Collaboration in early childhood programs involves health professionals, educators, and other professionals sharing information, validating each other's roles, and providing input around which strategies promote positive outcomes for all children. There are, however, limited studies available within early childhood education on inter-disciplinary relationships between nurses and teachers. This paper helps to fill this void by exploring the relationship of an early childhood teacher and maternal and child health nurse working alongside one another in an Australian kindergarten. Through a narrative approach, a number of characteristics of the relationship were identified as key elements to a productive relationship. Findings are important for health professionals working with early childhood educators. By understanding the complexity within and between disciplines, professionals can work effectively to support young children and their families. [ABSTRACT FROM AUTHOR]

Providing care to methamphetamine‐related callout events in the prehospital environment is often complex and resource‐intensive, requiring staff to manage agitation and violence‐related side effects of methamphetamines. In Australia, emergency responders are increasingly required to attend events related to methamphetamines, even though reports suggest methamphetamine use across Australia has declined. The aim of the study was to explore Australian police and paramedic experiences attending methamphetamine‐related events. A qualitative descriptive phenomenology design was employed using semi‐structured interviews with employed police (10) and paramedics (8) from Australia. Data were analyzed using thematic analysis. Participants described the complexities associated with providing prehospital care to people affected by methamphetamines. Participants described associated domestic/family violence, increased levels of violence, challenges with communication, and responder emotional and psychological distress and physical injury. Violence associated with methamphetamine use is a critical factor in prehospital care. Workplace violence and family/domestic violence are important issues that require further research to ensure families and staff are well supported and have the services they need to continue responding to people affected by methamphetamine use. [ABSTRACT FROM AUTHOR]

Spiritual care as an aspect of holistic or person‐centered care has been well documented. Studies on spirituality and spiritual care in nursing have taken place in various countries and contexts. Studies about spiritual care from the nurse perspective in the primary healthcare setting of Australian General Practice are not evident. Using an interpretive description study design, data about views on spirituality, spiritual care experiences, and descriptions about any spiritual care provided were collected from eight practice nurses. Four themes were drawn from the findings: the personal importance of spirituality and spiritual care to nurses and patients, spiritual care as an aspect of person‐centered care, spiritual care practices, and barriers and enablers to addressing spiritual needs. Participants identified that practice nurses require improved education about spirituality to adequately address spiritual needs as expressed by patients, as well as the tools to be able to provide spiritual care. They also identified that documentation templates used in general practice should include prompts to address spiritual and/or religious needs. [ABSTRACT FROM AUTHOR]

This study explored clinician perceptions of women's participation in decision‐making about antiemetic treatments during pregnancy, and the suitability of the five Choosing Wisely questions to increase women's involvement. The qualitative interpretive descriptive design used semi‐structured interviews to capture data. Participants were six obstetricians and six midwives experienced in providing care for pregnant women seeking support for nausea and vomiting at a single private, obstetrician‐led maternity health service in Australia. Thematic analysis revealed four themes that captured clinician perspectives about women's participation in decision‐making about antiemetic treatments: (i) information gathering; (ii) developing an understanding; (iii) using knowledge; and (iv) making decisions. Clinician attitudes and perspectives, as well as their self‐reported styles of communication and negotiation, influenced how they engaged with women during decision‐making. While unfamiliar with the five Choosing Wisely questions, almost all participants considered them potentially useful, but for other clinicians. Strategies to actively involve women in decision‐making about antiemetics were inconsistently used. The five Choosing Wisely questions may provide a useful tool for clinicians, but further research is needed to better understand women's perspectives and clinician‐related barriers to shared decision‐making. [ABSTRACT FROM AUTHOR]

Evaluation of new models of care requires consideration of the complexity inherent within health care programs and their sensitivity to local contextual factors as well as broader community, social and political influences. Evaluation frameworks that are flexible and responsive while maintaining research rigor are therefore required. Realistic evaluation was adopted as the methodology for the implementation and evaluation of an emergency department-based mental health nurse practitioner outpatient service in Sydney, Australia. The aim of realistic evaluation is to generate, test and refine theories of how programs work within a given context. This paper represents the final methodological step from the completed evaluation. A summary of quantitative and qualitative findings from the mixed-methods evaluation is presented, which is transformed into a set of overarching statements or 'middle range theories'. Middle range theory statements seek to explain the success of a program and provide transferable lessons for practitioners wishing to implement similar programs elsewhere. For example, the research team consider that early consultation with key local stakeholders and emergency department ownership of the project was pivotal to the implementation process. [ABSTRACT FROM AUTHOR]

The purpose of this study was to understand student nurses' perceptions and experiences of witnessing and responding to risks to patient safety during their integrated learning experiences. This qualitative study's two‐phased approach included individual semi‐structured interviews, followed by focus group discussions with students. Participants included 53 pre‐registration nursing students recruited from the first, second, and third years of study at two Australian universities. All had attended at least one clinical placement experience. Interpretive Description was used as a framework to guide the study. The findings highlight that students engage in specific and deliberate strategies when attempting to speak up. Students weigh up the risk to the patient and themselves. They use questioning techniques and their knowledge, experiences, and resources when speaking up. Students highlighted the need for caution and persistence while aiming to reduce the risk of reprisal. Exposing the challenges and successes students experience will provide educators, managers, and clinicians with the understanding necessary to better support both students and clinicians to achieve safe outcomes for patients as well a students. [ABSTRACT FROM AUTHOR]

Physiotherapists report using a range of psychosocial strategies in their practice, yet, barriers to implementation include lack of time, limited knowledge, and minimal training. This research aimed to establish what training physiotherapists have had with regards to psychosocial strategies, why they think they would benefit from more training, what training they want, and delivery preferences. Content analysis of answers to four open‐ended, online survey questions collected from Australian physiotherapists (N = 208) was conducted. Physiotherapists reported having minimal training specific to psychosocial strategies. Physiotherapists reported wanting training in assessment and management of psychosocial issues, and practical application of specific psychosocial strategies. Didactic and interactive training delivered by experts who understand the psychosocial needs of their patients, and the constraints of physiotherapy practice was preferred. These findings suggest that training in psychosocial strategies at the undergraduate level and continued professional development are necessary. Specifically, training in the assessment and management of psychosocial factors, and in referral processes is warranted, and should be applicable and appropriate for rehabilitation settings. Training should be both didactic and interactive as outlined in the proposed framework. [ABSTRACT FROM AUTHOR]

First‐time parents' groups are offered to new parents in Australia to support their transition to parenthood. Not all parents avail of the service, some cease attendance, and fathers are under‐represented. In the present descriptive, qualitative study, we examined first‐time mothers' perspectives on the barriers to parental participation in the groups. Semi‐structured interviews were conducted with a sample of eight first‐time mothers in a regional city in Victoria, Australia. Interviews revealed groups were perceived as sites strongly reinforcing traditional social norms of parenting. From this central theme, six gendered subthemes emerged as barriers to attendance. Barriers to mothers included non‐normative mothering narratives, such as experiencing stillbirth or having a disabled child, perceived dissonance in parenting ethos, and group size. Barriers to fathers, as perceived by mothers, included groups as female spaces, dads as a minority, and female gatekeeping. A multi‐faceted approach is required to change the common perception that groups are for mothers only. Groups need to be more inclusive of different parenting experiences and philosophies. Segregated groups might better address the needs of both parents. Further research is required to capture fathers' perspectives. [ABSTRACT FROM AUTHOR]

Abstract: Adverse events in health care significantly impact health professionals who become the second victims of medical error. The aim of the present study was to understand the effects of adverse events in health care on nurses in acute health‐care settings in an Australian context. In this qualitative, descriptive study, we used purposeful sampling and recruited 10 acute care nurses. Interviews were conducted from 2011 to 2012 and were recorded, transcribed, and returned to participants to verify their accuracy. Data were categorized and analyzed to determine four emergent themes and subthemes. The four themes were: rescuing patients, effects on nurses, professional responsibility, and needs of nurses. Our analysis indicated that nurses need organizational responses to adverse events, including the provision of information and collegial support after adverse events occur. This will minimize the psychological trauma associated with these events for second victims and support effective communication and collegial working relationships. [ABSTRACT FROM AUTHOR]

Abstract: An observational study was conducted to examine the use of sun protective hats, clothing, and sunglasses of people attending an outdoor entertainment event in an area of high‐to‐extreme ultraviolet radiation in New South Wales, Australia. Armidale is unique, as it is a highly‐elevated area, almost 1000 m above sea level, and temperatures are often mild with very high‐to‐extreme levels of ultraviolet radiation. Four trained data collectors observed attendees as they entered the event, and recorded their use of sun protective hats, clothing, and sunglasses. While more than half of the attendees wore sun protective hats, only 14% wore sun protective clothing. Broad‐brimmed hats were considered sun protective, while sun protective clothing was defined by shirts with at least three‐quarter‐length sleeves. Females were more likely to wear both a sun protective hat and clothing than males, and children were less protected than adults. Legislative changes are required to ensure that organizers of outdoor events have a legal responsibility to provide a safe environment for attendees, including strategies to help reduce ultraviolet radiation exposure. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify Australian medical students' complementary medicine information needs. Thirty medical students from 10 medical education faculties across Australian universities were recruited. Data were generated using in-depth semi-structured interviews and constructivist grounded theory method was used to analyze and construct data. Students sought complementary medicine information from a range of inadequate sources, such as pharmacological texts, Internet searches, peer-reviewed medical journals, and drug databases. The students identified that many complementary medicine resources may not be regarded as objective, reliable, differentiated, or comprehensive, leaving much that medical education needs to address. Most students sought succinct, easily accessible, evidence-based information to inform safe and appropriate clinical decisions about complementary medicines. A number of preferred resources were identified that can be recommended and actively promoted to medical students. Therefore, specific, evidence-based complementary medicine databases and secondary resources should be subscribed and recommended to medical schools and students, to assist meeting professional responsibilities regarding complementary medicines. These findings may help inform the development of appropriate medical information resources regarding complementary medicines. [ABSTRACT FROM AUTHOR]

Emergency department nurses are challenged to provide safe, quality care to older people; however, nurses' perceptions of their role and experiences are seldom investigated. This focus-group study investigated emergency department nurses' perceptions and experiences of caring for older people, using four focus groups of nurses with a minimum three months' experience in the emergency department and a demographic survey. Data were thematically analyzed. Two themes emerged. The first was the clash of expectations between nurses and family/carers related to safety and quality of nursing care. Older people were perceived to be vulnerable in the emergency department, and nurses were frustrated that competing priorities decreased their ability to ensure them safe and quality care. Nurses felt family/carers were disappointed with care provided, and might not empathize with or understand their predicament. The second theme concerned nurses' perception that family/carers could provide a safety net for the older person in the emergency department in times of high workload. Nurses need support to care for older people in the emergency department to ensure safe and optimal care, and a shared understanding of care provision between nurses and family needs development. [ABSTRACT FROM AUTHOR]

Recovery approaches to health care now feature in the mental health policies of many Western countries. There are, however, continuing challenges to the operationalization of these approaches. This study aimed to identify the nature of these challenges for a public mental health service organization located in a major urban center in southeastern Australia, where Recovery-oriented services have been implemented; and to develop recommendations to address these challenges. These aims were achieved by asking mental health consumers about their experiences of the implementation of Recovery-oriented services. Research participants described an uncertainty in health professionals and consumers alike about how to practice within a Recovery model, with many health professionals taking a 'hands off' approach in the name of Recovery, rather than working in partnership with consumers and other stakeholders, including the community managed organizations. Solutions to these challenges included more targeted, practice-focused education for consumers and health professionals, with this education provided by consumer representatives. Insights derived from this research add to the growing body of evidence related to the implementation of Recovery-oriented services in Western countries. [ABSTRACT FROM AUTHOR]

Emergency department mental health triage is a complex clinical task for which the evidence base is minimal. Research in the past decade has consistently identified issues associated with the accuracy and consistency of mental health triage assessment. In this study, we investigated the predictive validity of the clinical descriptors in the Victorian Emergency Department Mental Health Triage Tool. Using a naturalistic, retrospective study design, an audit of the emergency department triage database was undertaken on 12 months of continuous data for all mental health presentations ( n = 1718). The main outcome measure was urgency categorization. The study findings indicate that triage nurses can accurately identify the urgency of mental health presentations using defined clinical criteria. A significant finding was that patients with acute psychotic symptoms were more likely to be triaged as high urgency (code 2); however, the Australasian Triage Scale, in use in all Australian and many international emergency departments, provides no mental health-specific descriptors in high-urgency categories (1 and 2). [ABSTRACT FROM AUTHOR]

Abstract: To facilitate expansion of privately‐practicing nurse practitioners in community and primary care settings, a legislative amendment in 2010 made privately‐practicing nurse practitioners eligible to provide services subsidised through the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme. To evaluate their practice activities, a national survey of privately‐practicing nurse practitioners in Australia was conducted, and data analysed using descriptive statistics and thematic analysis (n = 73). As part of their role, 96% (n = 70) participants reported undertaking direct patient care, 95% (n = 69) patient education and health promotion, 95% (n = 69) prescribed medications, 92% (n = 67) referred patients for diagnostic investigations, and 88% (n = 64) reported making a diagnosis. Over 50% of participants saw up to 15 patients daily, and 80% (n = 58) treated the same patients on a regular basis. Of the participants, 59% (n = 43) perceived that they worked to their full scope of practice. The mainstay of privately‐practicing nurse practitioner services is provision of direct patient care in community and primary healthcare settings, suggesting they have emerging potential in addressing the ever‐increasing demand for healthcare in Australia. [ABSTRACT FROM AUTHOR]