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Trauma Informed Care is an approach to the delivery of mental health care that requires sensitivity to the prevalence and effects of trauma in the lives of people accessing services. While TIC is increasingly emphasized in mental health policy and frameworks in Australia, people working in mental health settings have reportedly struggled to translate the values and principles into their everyday practice. This qualitative study used an experience‐based co‐design methodology to explore the potential for implementation of Trauma Informed Care into mental health services in Australia. The experiences of consumers, carers, clinicians, and managers were gathered. This paper presents the perspectives of clinicians (n = 64) and senior managers (n = 9) from across three Local Health Districts in New South Wales in Australia. All data were analysed thematically to address the research question: What is needed for Trauma Informed Mental Health Services in Australia? To be trauma‐informed, managers required: leadership at all levels, access to resource, relevant and accessible training, support for staff, resolution of wider systems issues, and clarification of the concept and actions of TIC. Clinicians identified that to be trauma‐informed they required services to: be aware of staff well‐being, support different ways of working, address workplace cultures and provide increased resources. The findings have implications for any service, team or individual seeking to implement TIC within mental health settings. [ABSTRACT FROM AUTHOR]

Aim To examine lesbian, gay, bisexual and transgender ( LGBT) people's attitudes to advance care planning ( ACP) options and alternative decision-making at the end of life. Method Three hundred and five LGBT people completed an online or paper-based questionnaire, comprising fixed-choice questions and open-ended questions. Results Most respondents, particularly those identifying as female or transgender, preferred a partner to be their alternative decision-maker at the end of life should the need arise. Fifty-two per cent of respondents had spoken to this person about their wishes. Regarding legal options enabling end-of-life decision-making, 29% had an enduring power of attorney, 18% an enduring guardian and 12% an advance care directive. Conclusion Despite the significance of ACP for promoting the rights of LGBT people at the end of life, the take-up of these options was nearly as low as for the general population. The potential for targeted strategies to increase the take-up of ACP is identified. [ABSTRACT FROM AUTHOR]

In this paper, midwives' experiences of working with vulnerable pregnant women who were subject to child protection orders in New South Wales, Australia, and faced the possible removal of their baby at birth, known as 'assumption of care', are described. A qualitative descriptive approach was used to explore the experiences of ten midwives who had been involved in some 91 episodes of assumption of care. In-depth interviews were undertaken and thematic analysis was used to analyse the data-set. Four themes were elicited that demonstrated how midwives worked with vulnerable women and Community Services during the antenatal period. These were labelled: Reporting - Taking the first step; The woman-midwife relationship remains a priority; Jumping through the 'community service' hoops; and Crunch time: The decision... sometimes justifiable sometimes not? Even though the three-way relationship between the woman-midwife-Community Services could be confrontational, it was essential that midwives worked in a positive way with Community Services to improve outcomes for the woman and her unborn child. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Messages Working effectively with Community Services is essential. Sharing information and developing multidisciplinary approaches and pathways will produce the best outcomes for vulnerable newborns and their mothers whilst at the same time supporting health and community workers to work in a cohesive manner to provide quality care., Midwives need to be supported to stay 'woman centred'. Keeping the woman engaged in the system will help ensure the health of the foetus (baby)., Further research is needed to explore the perspectives of all those involved in assumption of care. [ABSTRACT FROM AUTHOR]

Aim The hospital environment as a workplace has undergone rapid changes over the last 50 years. Despite this, there has been very little research exploring how dietitians working in hospitals perceive their workplace. Moreover, previous studies in this area have focused predominantly on examining the North American experience of dietitians. Only a handful of previous studies have investigated the experiences of Australian dietitians at different stages of their careers. Therefore this study, in part, addresses a gap in the extant literature by examining how New South Wales ( NSW) public-hospital dietitians perceive their workplace and its influence on their ability to function as healthcare professionals. Methods In 2011, 32 in-depth interviews were conducted with dietitians from 11 NSW public hospitals. Participants were selected from four career stages: new graduates, mid-career, specialists and managers. Data from the interviews were analysed through a grounded theory approach. Results Data analysis revealed that dietitians sought validation of their work experience from five sources within the workplace. In this paper, these five sources have been depicted as a conceptual model labelled the ' Five Sources of Value'. The five sources identified were: acquisition of knowledge; relationships with others; work culture; role clarity; and personal attributes. This study also found the relative importance of these values changed according to the career stage of the individual dietitian. Conclusions The retention and engagement of staff within a hospital environment is an ongoing issue for dietetic managers. The ' Five Sources of Value' identified through this study and their relative influence at different career stages may assist managers in developing workplace strategies that addresses the major areas of concern for many staff. As a result of the qualitative nature of this exploratory study, the generalisability of the findings are limited. To address this limitation, future research may follow a more quantitative approach. [ABSTRACT FROM AUTHOR]

Objective: To identify and explore ED clinician perspectives on: (i) why patients with low back pain (LBP) present to the ED and are admitted into hospital from ED; (ii) barriers and enablers they face when providing care to patients with LBP; and (iii) strategies to improve the care of patients with LBP, and associated care processes, in the ED. Methods: We undertook a qualitative exploratory study with ED clinicians (medical officers, nurses and physiotherapists) at a tertiary‐level public hospital in New South Wales, Australia, using focus groups and individual interviews. We used thematic analysis to synthesise participant responses to answer the predefined research questions. Results: Twenty‐one clinicians participated (two individual interviews, 19 focus groups). Perceptions about better access to the ED and advanced care within ED were thought to drive presentations to the ED for LBP. Barriers and enablers to optimal patient care included patient‐, clinician‐ and service‐level factors. The main strategies to improve care included a department LBP pathway, modernised patient and clinician resources, better follow‐up options post‐discharge and improved communication between ED and primary care. Conclusion: We identified a range of targets to improve LBP management in ED. Clinicians perceived internal and external factors to the ED as influences of ED presentation and hospital admission. Clinicians also reported that patient‐, clinician‐ and service‐level barriers and enablers influenced patient management in ED. Strategies suggested by clinicians included improved follow‐up options, access to resources and an 'LBP pathway' to support decision making. [ABSTRACT FROM AUTHOR]

The landscape of mental health care and service delivery is changing, as is our understanding of the underlying causes for mental distress. It is now apparent that biogenic explanations have been overstated and instead experiences of trauma and adversity constitute the main contributor to people's experiences of mental health challenges. The shortcomings of treatments traditionally used in mental health care are also evident, and with a contemporary focus on person‐centred care, the utility of diagnostic labels has been called into question. Taking all this into consideration, this study sought to explore, what should be the future focus of mental health nursing? Three separate focus groups were conducted. One with a sample of senior clinical mental health nurses, one with a sample of consumer representatives and another with allied health professionals. The common theme across all three focus groups was the centrality of the therapeutic role of mental health nurses (MHNs). Consumers and allied health participants, in particular, advocated for a de‐emphasis on medications, psychiatric diagnoses, and custodial practices. The MHNs role in health promotion, working collaboratively with consumers, being hopeful, understanding the individual perspective, and appreciating the social determinants of mental health were all highlighted in framing the future focus of MHN practice. [ABSTRACT FROM AUTHOR]

Objective(s): To explore the attitudes of health‐care providers and the perceived barriers and facilitators regarding the use of cannabis‐containing medicines (CCMs) in older patients. Methods: Semi‐structured interviews with eleven health‐care providers in rural New South Wales (NSW). A thematic analysis was performed. Results: Themes and recommendations include attitudes towards CCMs for therapeutic purposes, their perceived uses, side effects, barriers to use and prescription (stigma, regulation, access and driving), difficulties encountered with the Special Access Scheme (SAS) and the need for ongoing research and education. An ecological framework demonstrated the complex interactions between patients and health‐care providers and their social, community and political environment. Conclusion: Providers' attitudes towards CCM use in older patients are generally positive; however, there is a need for further high‐quality evidence on efficacy and safety, alongside improved CCM education and training, to reduce barriers to their implementation. Barriers to prescription and access continue to evolve on personal, organisational and systemic levels. [ABSTRACT FROM AUTHOR]

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Objective: This evaluation considered the potential of We‐Yarn, a suicide prevention gatekeeper training workshop, to contribute to Aboriginal suicide prevention in rural New South Wales. Design: A mixed methods approach included surveys, in‐depth interviews and workshop observations. Setting: Aboriginal suicide prevention training in rural New South Wales, Australia. Participants: Attendees at We‐Yarn training. Intervention: We‐Yarn provided culturally safe suicide prevention skills training for Aboriginal people and for those who work with Aboriginal communities and persons in rural New South Wales. Training workshops were delivered across multiple locations for 6 hours in one day. Workshops were facilitated by two facilitators with lived and professional experience; one Aboriginal and one non‐Aboriginal facilitator. We‐Yarn content was developed by staff from the Centre for Rural and Remote Mental Health, and in consultation with Aboriginal Elders and representatives of Aboriginal Medical Services to ensure relevance and cultural appropriateness. Main outcome measures: Pre and post‐workshop surveys captured capacity and participants' confidence in identifying and responding to a person at risk of suicide. Interviews explored participants' experiences of workshops, implementation of learning, and attitudes regarding social and emotional wellbeing and suicide. Observations detailed the workshop environment, participants' engagement, and participants' responses to facilitators and content. Results: We‐Yarn was considered culturally appropriate. Participants responded to facilitators' lived experiences. Participants reported significant improvements in understanding the links between cultural strengths, social and emotional wellbeing and suicide prevention. However, health professionals with existing knowledge wanted a stronger focus on clinical training. Conclusion: We‐Yarn promoted discussion of suicide prevention within a holistic health framework, building on participants' pre‐existing knowledge about social and emotional wellbeing. Importantly, skilful facilitators with lived experience were vital to the success of the workshops. Consideration should be given to attracting people with low suicide prevention knowledge to the workshops, developing tailored workshops for health professionals and ensuring prolonged engagement with communities. Multifaceted and long term responses in addition to this type of training are important. [ABSTRACT FROM AUTHOR]

Rationale and aim: Working with assistants has the potential to be an economically and professionally sustainable solution to workforce shortages in speech‐language pathology. However, there is some resistance to the workforce redesign, and factors that determine how assistants are utilised are not well understood. The aim of this study was to understand the perceptions that engender professional resistance and identify factors that may lessen such resistance. Method: Semi‐structured interviews were conducted with 20 speech‐language pathologists (SLPs) to learn about perceptions towards implementing assistants into the profession. Findings and discussion: While assistants were seen as augmenting existing capacity, findings demonstrated ambivalence towards their utilisation, with tension between perceived benefits and risks of SLPs utilising assistants. Sharing workload and reducing administrative duties in favour of increasing clinical output was an important positive perception. However, this perception was moderated by the concern that the introduction of assistants would result in a decrease in consumer focus, which was seen as being at odds with the strongly held values of the profession. Findings provide insight into professional acceptance of this vocationally trained group and highlight discrepancies between perceptions and actualities, both of which may influence how assistants are utilised. They suggest that implementation of a workforce redesign involving assistants may result in paradoxical perceptions among SLPs. Understanding the way SLPs think about working with assistants and how this workforce redesign may be realised will impact on how SLPs view their role and their relationships with co‐workers. This understanding will also be useful in a wider sense for organisations seeking to introduce assistants, by allowing enhanced understanding of likely areas of resistance, as well as highlighting possible strategies that may be useful to address such issues. [ABSTRACT FROM AUTHOR]

Police have historically been responsible for transporting people during a mental health crisis in Australia. A major change to the New South Wales ( NSW) Mental Health Act ( MHA) in 2007 expanded the range of coercive transportation agencies to include NSW Ambulance (paramedics) and NSW Health (mental health nurses). Anecdotal reports, however, describe a lack of clarity around how these changes should be implemented in practice. This research aims to explore this lack of clarity through qualitative analysis of interviews with people with the lived experience of involuntary transport under the MHA. Sixteen interviews were conducted; most ( n = 14) interviews in northern NSW regions: six with people who had been transported (consumers), four with carers, and six with service providers (two police, one paramedic, and three mental health nurses). For consumers and carers, the police response was often perceived as too intense, particularly if the person was not violent. Carers were often conflicted by having to call for emergency intervention. Service providers were frustrated by a lack of a coordinated interagency response, resourcing issues, delays at emergency departments, and lack of adequate training. A central theme across all groups was the importance of communication styles. As one participant (consumer) said: 'Everybody needs a lesson in kindness'. All groups agreed that high-risk situations necessitate police involvement. However, invocation of the MHA during a high-risk situation is fraught with stress and difficulties, leaving little room for empathetic communications. Effective and diverse, evidence-based, early intervention strategies - both consensual and non-consensual - are necessary to reduce the requirement for police involvement in mental health transports. [ABSTRACT FROM AUTHOR]

Background While legitimate practice tools have been the subject of debate within the profession, little attention has been paid to psychological frames of reference ( PFs OR). Hence, this article explores the ways psychological theories and therapies shape occupation-based practice in mental health settings. Methodology Narrative inquiry methods and thematic analysis were used to explore the career stories of nine occupational therapists who had worked in mental health practice for more than five years. Findings Respondents found it difficult to hold onto their occupational focus in the psychology-dominated world of mental health practice. The main themes to emerge were (i) tension between occupation and psychology; (ii) overwhelming pressures to adopt PFs OR; (iii) resistance to PFs OR; and (iv) using PFs OR to enhance professional repertoires. Findings pointed to the need to ensure PFs OR include occupational considerations for occupation-based practice in mental health. Conclusion A occupation-based perspective means balancing PFs OR with occupation-based considerations, so service-user issues are holistically addressed. There is a need to critically review occupational therapists' use of PFs OR lest their most visible practical actions appear psychologically based rather than occupation based. [ABSTRACT FROM AUTHOR]

Background: Patients with amyotrophic lateral sclerosis (ALS) face numerous decisions for symptom management and quality of life. Models of decision making in chronic disease and cancer care are insufficient for the complex and changing needs of patients with ALS. Objective: The aim was to examine the question: how can decision making that is both effective and patient‐centred be enacted in ALS multidisciplinary care? Setting and participants: Fifty‐four respondents (32 health professionals, 14 patients and eight carers) from two specialized ALS multidisciplinary clinics participated in semi‐structured interviews. Interviews were transcribed, coded and analysed thematically. Results: Comparison of stakeholder perspectives revealed six key themes of ALS decision making. These were the decision‐making process; patient‐centred focus; timing and planning; information sources; engagement with specialized ALS services; and access to non‐specialized services. A model, embedded in the specialized ALS multidisciplinary clinic, was derived to guide patient decision making. The model is cyclic, with four stages: ‘Participant Engagement’; ‘Option Information’; ‘Option Deliberation’; and ‘Decision Implementation’. Discussion: Effective and patient‐centred decision making is enhanced by the structure of the specialized ALS clinic, which promotes patients' symptom management and quality of life goals. However, patient and carer engagement in ALS decision making is tested by the dynamic nature of ALS, and patient and family distress. Our model optimizes patient‐centred decision making, by incorporating patients' cyclic decision‐making patterns and facilitating carer inclusion in decision processes. Conclusions: The model captures the complexities of patient‐centred decision making in ALS. The framework can assist patients and carers, health professionals, researchers and policymakers in this challenging disease environment. [ABSTRACT FROM AUTHOR]

Background/aim Occupational therapists working in brain injury rehabilitation are required to use the skill of advocacy to ensure that people with a brain injury have the right to engage in their chosen occupations. However, no studies were found exploring the use of advocacy by occupational therapists working in brain injury rehabilitation. To investigate how occupational therapists working in brain injury rehabilitation defined and implemented the skill of advocacy when working with clients. Method Interpretative phenomenological analysis was used to guide planning, data collection and analysis. Thirteen occupational therapists from six NSW metropolitan, regional and rural brain injury rehabilitation units participated in semi-structured interviews. All interviews were transcribed and member-checked prior to in-depth idiographic, inductive and interrogative analysis of each transcript. Findings Participants identified the key elements of advocacy as the representation and education of clients and significant others. They indicated that all brain injury rehabilitation workers used advocacy when working with their clients, but were unable to identify unique ways that occupational therapists used advocacy when compared with other brain injury rehabilitation staff. However, they all felt that occupational therapists were well suited to advocate for clients in brain injury rehabilitation settings. Conclusion Although participants had difficulty identifying unique ways in which occupational therapists used advocacy in brain injury rehabilitation settings, they all agreed that advocacy was an important skill for occupational therapists to develop and implement. [ABSTRACT FROM AUTHOR]