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Introduction: Patient safety has been an undervalued component of quality healthcare but is a challenging area of research. Ultrasound is the most common imaging modality in the world. Research on patient safety in ultrasound is generally focused on bioeffects and safe operation of ultrasound equipment. However, other safety issues exist in practice that warrant consideration. This paper forms the first part of a PhD study exploring patient safety in medical diagnostic ultrasound, beyond the notion of bioeffects. The ultimate aim of the study is to inform the final phase of the research study which will consider the next steps in improving the quality and safety of healthcare experienced by patients. Methods: A qualitative study using semi-structured, one-on-one interviews. A thematic analysis categorised data into codes and generated final themes. Results: A heterogeneous mix of 31 sonographers, who reflected the profile of the profession in Australia, were interviewed between September 2019 and January 2020. Seven themes emerged from the analysis. These were bioeffects, physical safety, workload, reporting, professionalism, intimate examinations and infection control. Conclusion: This study presents a comprehensive analysis of sonographers' perceptions of patient safety in ultrasound imaging, not previously available in the literature. Consistent with the literature, patient safety in ultrasound tends to be viewed in technical terms through the potential for bioeffects of tissue damage or physical harm to the patient. However, other patient safety issues have emerged, and while not as well recognised, have the potential to negatively impact on patient safety. [ABSTRACT FROM AUTHOR]

Background: Despite emerging evidence of validity and reliability, speech and language therapists' (SLT) uptake of telehealth has been limited and barriers remain to the effective and confident use of this service model. The COVID‐19 pandemic has caused significant disruption to essential health services, including speech and language therapy assessment and intervention, meaning that telehealth must now be considered as part of the suite of service delivery options for all clinicians. Aims: To explore the perceived barriers and facilitators of telehealth among community paediatric SLTs before and after their use of a telehealth platform with an embedded standardised assessment tool. Methods & Procedures: Mixed‐methods questionnaires were developed for this study and completed by SLTs before and after the 3‐month trial of the telehealth platform. A total of 38 SLTs completed the pre‐trial questionnaire and training in the use of telehealth platform (Coviu), including instruction in using a standardised, norm referenced language test as an integrated tool within the Coviu platform. A total of 27 SLTs went on to use the telehealth platform, and 25 of these completed the post‐trial questionnaire on which subsequent qualitative and quantitative analysis was completed. Outcomes & Results: Prior to using the platform, perceived barriers included technology issues, limited clinician experience and concerns around parent acceptance of the service. Potential facilitators included access to appropriate platforms, tools and resources as well as increased clinician confidence with telehealth. Following the trial, barriers to telehealth use continued to include technology barriers, particularly internet stability, and client issues, including suitability for telehealth services. Facilitators for future telehealth use included access to appropriate platforms for telehealth, stable and appropriate internet connectivity, and more extensive telehealth resources for both assessment and intervention for this mode of service delivery. Conclusions & Implications: This study provides insights into the perceptions of the barriers and facilitating factors for telehealth use among community‐based SLTs. This information will be useful in developing strategies to promote uptake and effective and confident use of telehealth as a mode of service delivery beyond the pandemic. What this paper adds: What is already known on the subject: Research about telehealth has shown that it is a reliable and valid way of delivering speech pathology services, yet many clinicians have been wary of its use and uptake of telehealth prior to COVID‐19 had been limited. We wanted to know what SLTs thought about using telehealth before and after participating in a 3‐month trial of a telehealth platform with an embedded formal language assessment. What this study adds to existing knowledge: This study indicates that technology issues including internet stability are a barrier to effective telehealth services, but that appropriate telehealth platforms, resources and experience are facilitators of uptake and successful use of telehealth. What are the potential or actual clinical implications of this work?: This information will be useful in developing strategies to promote uptake and effective and confident use of telehealth as a mode of service delivery for children during and beyond the pandemic, including those isolated by geographical or transport barriers. [ABSTRACT FROM AUTHOR]

This paper presents findings from the evaluation of an Australian trial of self‐managed home aged care. The self‐management model was codesigned by advocacy organisation COTA Australia, consumers and service providers. The primary aim of the evaluation was to examine whether self‐management improved consumers' perceptions of their choice, control, and wellbeing. The secondary aim was to examine whether provider prior experience with self‐managed packages significantly influenced consumers' perceptions of choice, control and wellbeing, thereby confounded trial effects. A pre‐test post‐test quasi‐experimental design and mixed‐methods design were used to collect data over nine months in 2018–2019. The pre‐trial methods and findings have been published. The post‐trial evaluation replicated the pre‐trial data collection method of an online survey (n = 60) and semi‐structured telephone interviews with consumers (n = 9), family carers (n = 13), and consumers and carers jointly (n = 2), totalling 24 interviews. Semi‐structured telephone interviews were also conducted with CEOs and senior managers from each of the seven providers (n = 14). Three providers had prior experience supporting self‐management. Parametric and non‐parametric tests examined the statistical data. Qualitative data were analysed thematically and framed according to self‐determination principles and ecological systems theory. Both datasets demonstrated that consumers reported greater choice and control at post‐trial than pre‐trial. This finding was not affected by providers' prior experience with self‐management; therefore, it was not a confounding factor. Participants reported improved wellbeing in interviews, however this was not reinforced statistically. Key desirable features of self‐management included greater autonomy and control over spending, recruiting support staff and paying lower administration fees. There was no evidence of increased risks or fraud. The research limitations included a small sample size, convenience sampling with providers recruiting interview participants, no control group and differences in trial implementation. The findings support the expansion of self‐management opportunities and more comprehensive evaluations that use mixed methods. [ABSTRACT FROM AUTHOR]

Introduction/Objective: The objective of the study was to develop an understanding of the perceptions of people with Parkinson's disease and clinical academics on the implementation of a regional interdisciplinary model of care. Methods: A qualitative descriptive study was undertaken. A PD interdisciplinary clinic was conducted in an Australian regional location. As a novel variation, in this clinic, 4 clinical academics consulted simultaneously offering a long, 3-h appointment. Following the clinic, we conducted 2 focus groups with all clinical academics and 6 semi-structured interviews with people with PD and carers. Data were analyzed using Elo & Kyngäs' inductive content analysis approach. Results: An overarching main category namely, "interdisciplinary care proved valuable to regional people with PD and clinical academics," and 3 generic-categories including "identifying interdisciplinary care as a viable option in regional locations," "current care provision is disempowering and burdensome," and "regional residing people with PD and their carers seek locally accessible healthcare with PD skilled clinicians" were identified. Conclusion: Our findings suggest the implementation of interdisciplinary care to regional healthcare systems is valued by clinical academics and people with PD and carers. Further research is required to establish how interdisciplinary care can be implemented in regional Australia and its effects on practice changes, patient outcomes, and quality of life. [ABSTRACT FROM AUTHOR]

Aim: To develop and psychometrically test the Australian Midwifery Workplace Culture instrument. Background: Workplace culture is critical within midwifery settings. Culture determines not only the well‐being and continued retention of maternity staff and managers but it also affects the quality and ultimate safety of the care they provide to women, infants and families. Several studies have identified cultural problems within maternity services. Relatively few instruments take account of the unique aspects of these workplaces and the relationship between midwives and women. Design Three‐stage instrument development involved item generation (based on the Culture of Care Barometer), expert content validation and a pilot test. Methods: During 2016, 38 midwifery experts reviewed the initial items, and 322 midwives then pilot‐tested the draft instrument. We used exploratory factor analysis to identify key domains and to refine the instrument. Results: The refined instrument contained 22 items in three distinct domains: relationship with managers, empowerment and collegiality. Conclusion: The instrument can contribute to understanding important dimensions of the culture in maternity workplaces and thus to examining problematic attitudes and practices. The instrument requires further development and testing with larger and more diverse samples of midwives and validation in specific midwifery settings and models of care. SUMMARY STATEMENT: What is already known about this topic? Previous research reports problems in the organizational culture in maternity services, increasing the stress on midwives and potentially affecting the care they provide to women and infants.Negative workplace culture may contribute to attrition in maternity workforce.There are few measures that specifically address midwifery workplace culture. What this paper adds? This paper presents a new instrument designed to measure dimensions of midwifery workplace culture, detailing item generation and pilot testing.Analysis identified three domains that demonstrated good psychometric properties: relationship with management; empowerment and autonomy; collegiality and relationship with peers. Implications of this paper: The exploratory factor analysis suggests the utility of this instrument for assessing workplace culture in midwifery settings.The study recommends further testing of this instrument and validation in diverse midwifery workplaces, including large and small hospitals, community services and rural and remote areas. [ABSTRACT FROM AUTHOR]

Aims: To map the pathway and service provision for pregnant women whose newborns require admission into the surgical neonatal intensive care unit at or soon after birth, and to examine the nature of continuity of care (COC) provided and the facilitators and barriers to woman‐ and family‐centred care from the perspective of women/parents and health professionals. Background: Limited research exists on current service and care pathways for families whose babies are diagnosed with congenital abnormality requiring surgery. Design: A mixed method sequential design adhering to EQUATOR guidelines for Good Reporting of a Mixed Methods Study. Methods: Data collection methods included: (1) a workshop with health professionals (n = 15), (2) retrospective maternal record review (n = 20), prospective maternal record review (17), (3) interviews with pregnant women given a prenatal diagnosis of congenital anomaly (n = 17) and (4) interviews with key health professionals (n = 7). Results/Findings: Participants perceived care delivered by state‐based services as problematic prior to admission into the high‐risk midwifery COC model. Once admitted to the high‐risk maternity team women described care 'like a breath of fresh air' with a 'contrast in support', where they felt supported in their decisions. Conclusion: This study highlights provision of COC, in particular relational continuity between health providers and women as essential to achieve optimal outcomes. Relevance to Clinical Practice: Provision of individualised COC offers an opportunity for perinatal services to reduce the negative consequences of pregnancy‐related stress associated with diagnosis of foetal anomaly. Patient or Public Contribution: No patient or public was involved in the design, analysis, preparation or writing of this review. [ABSTRACT FROM AUTHOR]

Background: Paramedic practice is diversifying to accommodate evolving global health trends, including community paramedicine models and growing expertise in palliative and end-of-life care. However, despite palliative care specific clinical practice guidelines and existing training, paramedics still lack the skills, confidence and clinical support to provide this type of care. Aim: To elicit paramedics', palliative care doctors and nurses', general practitioners', residential aged care nurses' and bereaved families and carers' experiences, perspectives, and attitudes on the role, barriers and enablers of paramedics delivering palliative and end-of-life care in community-based settings. Design: A qualitative study employing reflexive thematic analysis of data collected from semi-structured online interviews was utilised. Setting/participants: A purposive sample of 50 stakeholders from all Australian jurisdictions participated. Results: Five themes were identified: positioning the paramedic (a dichotomy between the life saver and community responder); creating an identity (the trusted clinician in a crisis), fear and threat (feeling afraid of caring for the dying), permission to care (seeking consent to take a palliative approach) and the harsh reality (navigating the role in a limiting and siloed environment). Conclusion: Paramedics were perceived to have a revered public identity, shaped by their ability to fix a crisis. However, paramedics and other health professionals also expressed fear and vulnerability when taking a palliative approach to care. Paramedics may require consent to move beyond a culture of curative care, yet all participant groups recognised their important adjunct role to support community-based palliative care. [ABSTRACT FROM AUTHOR]

Health funding provisions supported by governments are pivotal for families accessing independent speech-language pathology services in Australia. Little is known of the facilitators and barriers that exist for accessing public funding for speech-language pathology services through independent providers. This study aimed to investigate and describe the perceptions of speech-language pathologists in accessing public funding models (PFMs) for children and young persons with communication and swallowing needs within Australian independent practice. Semi-structured qualitative interviews were conducted with twenty independent speech-language pathologists who had experience of PFMs in Australia. Digitally recorded interviews were transcribed verbatim and subjected to thematic analysis. Data analysis revealed five superordinate and eighteen subordinate themes. The five superordinate themes were: (a) accessibility in securing funding provisions; (b) time as a commodity; (c) incongruence between funding provisions and speech-language pathology evidence; (d) trust as a multifaceted quality; and (e) consequences of PFMs. This original and timely research offers perceptive descriptions of the multifaceted facilitators and barriers for families seeking to access public funding for independent speech-language pathology services in Australia. Research findings illuminate challenges for the speech-language pathology profession. Accessibility to funding was identified as a major issue. Research findings suggest that current funding provisions do not align with the dosage required for evidence-based speech-language pathology management. Further, this research has highlighted the need for funding to be equitable, acceptable to stakeholders, and for services to be delivered in an efficient and sustainable manner. Future research is recommended to understand which Australian PFMs: (a) facilitate consumer access to speech-language pathology services; (b) enrich consumer experiences; and (c) align with scientific evidence to promote optimal outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Internationally, the adoption of technology into residential aged care settings has been slow and fraught with multiple challenges for residents, staff and service providers. The aim of this study was to evaluate the acceptability, efficiency, and quality of health information system implementation into aged care. Methods: Three‐stage, mixed‐methods participatory action research, concurrent with the natural experiment of a co‐designed health information system implementation into a 169‐bed aged care home in Australia. Data were collected pre‐, during, and post implementation between 2019 and 2021. Qualitative data included focus groups, interviews, and observations. Quantitative data included work observations, pedometers, record audits, incident reports and staff and resident surveys. There were 162 participants composed of 65 aged care residents, 90 staff, and 7 managers/consultants. Results: Improved work efficiency included reduced staff time searching for information (6%); reduced nurse time on documentation (20.4% to 6.4%), and 25% less steps. Documentation improvement included resident assessments (68% to 96%); resident‐focused goals (56% to 88%) and evaluations (31% to 88%). The staff reported being better equipped to manage the 'delicacies of dignity'. Conclusion: Implementation of a health information system into a residential aged care facility was associated with improved resident‐focused care and staff efficiency. Clinical relevance: Technology can support nurses and care staff to spend more time with residents in residential aged care homes, improve the quality of resident care, and assist meeting regulatory reporting requirements. Flexible and tailored co‐design strategies can enhance both effectiveness and success of technology implementation into residential aged care. [ABSTRACT FROM AUTHOR]

Aim: To investigate the strategies used by nurse leaders to facilitate fundamental care delivery in their clinical area. Design: An interpretative qualitative design study reported in line with the Consolidated Criteria for Reporting Qualitative Research (COREQ). Methods: Twenty‐four self‐identified nurse leaders from across Australia were interviewed between November 2020 and April 2021 to discuss their strategies for facilitating fundamental care. Data was analysed using inductive thematic analysis. Results: Nurse leaders' experience of facilitating fundamental care produced two major themes, delivery of fundamental care (comprising three sub‐themes: valuing fundamental care, understanding and developing staff capacity and supportive relationships), and monitoring of fundamental care (including three sub‐themes: visibility in the clinical area, embedding fundamental care in the practice setting and specific direct actions). Conclusion: Facilitating fundamental care delivery is complex. This study highlighted the importance of nurse leaders' individual characteristics, and nurse leaders' ability to establish and maintain relationships alongside the role of informal and formal monitoring of fundamental care delivery. Impact Findings from this study build on existing research into fundamental care and contribute to our understanding of the role, characteristics and actions of nurse leaders to facilitate fundamental care. The results demonstrate the complexity and intricacy of nursing leadership to facilitate fundamental care, and that a dynamic 'thinking and linking' approach is required. The results show individualized practice which may create challenges for new nurse leaders seeking guidance, and for monitoring nurse leader activity. Further research is advocated to explore insights and tools to optimize nurse leaders' endeavours in facilitating fundamental care. Patient or Public Contribution: This study was designed using insights generated from patient and public involvement in nursing leadership and fundamental care. [ABSTRACT FROM AUTHOR]

Female genital mutilation/cutting (FGM/C) is a harmful cultural practice with significant health consequences for affected women and girls. Due to migration and human mobility, an increasing number of women with FGM/C are presenting to healthcare facilities of western countries (including Australia) where the practice is non-prevalent. Despite this increase in presentation, the experiences of primary healthcare providers in Australia engaging and caring for women/girls with FGM/C are yet to be explored. The aim of this research was to report on the Australian primary healthcare providers' experiences of caring for women living with FGM/C. A qualitative interpretative phenomenological approach was utilised and convenience sampling was used to recruit 19 participants. Australian primary healthcare providers were engaged in face-to-face or telephone interviews, which were transcribed verbatim and thematically analysed. Three major themes emerged, which were: exploring knowledge of FGM/C and training needs, understanding participants' experience of caring for women living with FGM/C, and mapping the best practice in working with women. The study shows that primary healthcare professionals had basic knowledge of FGM/C with little or no experience with the management, support, and care of affected women in Australia. This impacted their attitude and confidence to promote, protect, and restore the target population's overall FGM/C-related health and wellbeing issues. Hence, this study highlights the importance of primary healthcare practitioners being skilled and well-equipped with information and knowledge to care for girls and women living with FGM/C in Australia. [ABSTRACT FROM AUTHOR]

This research aimed to explore the needs, potential roles and implementation of Bilingual Community Navigators (BCNs) in providing navigation support for patients in general practice settings in Australia. A total of 19 participants (general practitioners, practice managers, practice nurses and receptionists) from five general practices in Sydney where most of the patients spoke a language other than English were interviewed about their views on needs, potential roles and implementation of BCNs in general practice settings. Data were collected between August 2019 and July 2020. The interview transcripts were inductively analysed for themes. Themes emerged across four broad categories: patients' barriers to access health and social care services; potential roles of BCNs; recruitment, training, and employment of BCNs and considerations and anticipated barriers to BCNs' role. Many barriers both at the patient and at the service provider levels in accessing healthcare and social care services were consistent with the Levesque et al. access framework including lack of understanding of the health system, language and cultural barriers, hesitancy to approach general practice and problems navigating services. Participants believed that BCNs would be able to help overcome these barriers through health education, support in booking appointments, arranging transport, providing language and cultural support and improving communication with the health services. Conditions for effective implementation of BCNs in practice included proper training of the navigators to ensure patient confidentiality and addressing organisational/system barriers such as lack of a funding mechanism, a clear role definition of BCNs and acceptance of BCNs by patients. BCNs potential role in facilitating access to appropriate care by culturally and linguistically diverse (CALD) patients in general practice warrants further evaluation in the context of the Australian healthcare system. [ABSTRACT FROM AUTHOR]

Children are at heightened risk of maltreatment during community wide crises. The Parenting Skill Development and Education (PSDE) Service is a 6‐week telehealth intervention designed and implemented during the COVID‐19 pandemic to support families with young children in Australia at risk of child maltreatment. This study aimed to conduct a formative review of the PSDE service to (a) describe families accessing the PSDE during the pandemic, (b) determine parent and referrers' satisfaction of the service and (c) explore clinicians' experiences of service delivery. A mixed‐method study design incorporating the analysis of routinely collected data, and qualitative interviews with clinicians was conducted. Participants were 11 families displaying child maltreatment risk and 11 clinicians. Parents accessing the service were experiencing considerable risk factors for child maltreatment. The service was deemed acceptable by parents and referrers; however, several challenges in telehealth delivery were documented including parent engagement, technology difficulties and assessing child safety. Our findings highlighted the importance of ensuring adequate support and monitoring of families where there is child maltreatment risk during the COVID‐19 pandemic. In addition, these findings highlight the acceptability of telehealth services to support families at risk of child maltreatment for families, clinicians, and referrers. [ABSTRACT FROM AUTHOR]

The article presents a study which examined the effectiveness of the telehealth palliative care Needs Rounds in a rural residential aged care (RAC) facility in New South Wales (NSW). The Needs Rounds is part of a specialist palliative care needs rounds (SPCNR) led by in-reach specialist palliative care nurse practitioners. Also cited is the use of the Standards for Reporting Implementation Studies (StaRI) guidelines in the research.