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Effective health workforce preparation is critical to the health of those who stand to benefit from its services. Emerging dietitians can provide important insights on an evolving workforce that is well-placed to advance future global health. This study aimed to explore a national sample of dietetics graduates' experiences of, and challenges faced in, dietetics workforce preparation and preparedness in Australia. An interpretive description methodology guided this study whereby researchers interpreted the meanings that participants attributed to their experiences. Twenty dietitians (graduated within the last 2 years) were purposively sampled from across Australia and detailed insights were obtained through semi-structured interviews. A multi-analyst approach employing thematic and template analysis, enabled five themes to be identified across the data set. These included: (1) being held back; (2) chasing the prize; (3) valuing real learning; (4) easing the transition; and (5) encountering influencers. While graduates appreciated their preparation, they were not empowered or equipped to embrace opportunities in diverse and emerging areas of dietetics practice. Graduates were challenged by the competitive landscape of securing obvious job opportunities and by a lack of support in transitioning into the workforce. Practice exposures and encounters with influential dietitians were highly valued. Research on role-emerging dietetics placements along with enhanced support mechanisms for novice dietitians is urgently required to ensure appropriate alignment between future dietetics preparation and practice. Obtaining insights into health professional graduates' experiences of their education can be used to ensure that emerging health workforces are relevant and responsive to future market needs.

In their journey to becoming doctors, students engage with a range of teachers and trainers. Among these are simulated patients (SPs), who, through role-playing, assist students to develop their communication and physical examination skills, in contexts of formative and summative assessments. This paper explores the teaching and learning relationship between medical students and SPs, and considers how this might affect feedback and assessment. 14 SPs were interviewed on the subject of medical students' professional identity development in 2014. Data were examined using narrative analysis in conjunction with positioning theory to identify the positions that SPs assigned to themselves and to students. Narrative analysis yielded three interpretative positioning themes: "Occupational, familial and cultural" and "discursive and embodied" positioning. The interview process revealed that SPs adopt different positions intra-and interpersonally. SPs appear to hold dissonant perceptions of students in terms relating to their emerging professional identities, which may confound assessment and feedback. Training should include reflections on the SP/student relationship to uncover potential biases and positions, giving SPs the opportunity to reflect on and manage their individual and occupational selves.

Screening for domestic violence in healthcare settings increases detection. The emergency department (ED) is one setting where victims frequently attend with injuries and illnesses sustained from violence. However, screening rates remain suboptimal. There is little research about how formal screening occurs, or how less structured interactions are negotiated within the ED context. This article explores this important, but non-mandatory procedure within the context of clinician–patient interactions in Australia. A descriptive qualitative study was undertaken with 21 clinicians across seven EDs in Australia. Thematic analysis was undertaken by two researchers. Results indicate a lack of confidence around DV screening, and tensions in clinicians initiating conversation while managing their own emotional stressors. No participants expressed knowledge of formal screening processes in their workplaces. Successful DV screening programs must provide clinicians with the tools to minimize perceived discomfort in initiating and sustaining conversations while accepting patient preferences regarding disclosure. [ABSTRACT FROM AUTHOR]

Background: In Australia, women report higher rates of depressive symptoms than men. Research suggests that dietary patterns rich in fresh fruit and vegetables could protect against depressive symptoms. The Australian Dietary Guidelines suggest that consuming two servings of fruit and five serves of vegetables per day is optimal for overall health. However, this consumption level is often difficult for those experiencing depressive symptoms to achieve. Aims: This study aims to compare diet quality and depressive symptoms in Australian women over time using (I) two serves of fruit and five serves of vegetables per day (FV7), and (ii) two serves of fruit and three serves of vegetables per day (FV5). Materials and Methods: A secondary analysis was conducted using data from the Australian Longitudinal Study on Women's Health over 12 years at three time points 2006 (n = 9145, Mean age = 30.6, SD = 1.5), 2015 (n = 7186, Mean age = 39.7, SD = 1.5), and 2018 (n = 7121, Mean age = 42.4, SD = 1.5). Results: A linear mixed effects model found, after adjusting for covarying factors, a small significant inverse association between both FV7 (b = −.54, 95% CI = −.78, −.29) and FV5 (b = −.38, 95% CI = −.50, −.26) in depressive symptoms. Discussion: These findings suggest an association between fruit and vegetable consumption and decreased depressive symptoms. The small effect sizes indicate caution should be taken in interpreting these results. The findings also suggest that current Australian Dietary Guideline recommendations need not be prescriptive to two fruit and five vegetables for impact on depressive symptoms. Conclusions: Future research could evaluate reduced vegetable consumption (three serves per day) in identifying the protective threshold for depressive symptoms. [ABSTRACT FROM AUTHOR]

Background: Mood and anxiety disorders, and problems with self-harm are significant and serious issues that are common in young people in the Criminal Justice System. Aims: To examine whether interventions relevant to young offenders with mood or anxiety disorders, or problems with self-harm are effective. Method: Systematic review and meta-analysis of data from randomized controlled trials relevant to young offenders experiencing these problems. Results: An exhaustive search of the worldwide literature (published and unpublished) yielded 10 studies suitable for inclusion in this review. Meta-analysis of data from three studies (with a total population of 171 individuals) revealed that group-based Cognitive Behaviour Therapy (CBT) may help to reduce symptoms of depression in young offenders. Conclusions: These preliminary findings suggest that group-based CBT may be useful for young offenders with such mental health problems, but larger high quality RCTs are now needed to bolster the evidence-base. (Contains 4 tables and 3 figures.)

Depression is a chronic and complex condition experienced by over 300 million people worldwide. While research on the impact of nutrition on chronic physical illness is well documented, there is growing interest in the role of dietary patterns for those experiencing symptoms of depression. This study aims to examine the association of diet quality (Dietary Questionnaire for Epidemiological Studies version 2) and depressive symptoms (Centre for Epidemiological Studies for Depression short form) of young Australian women over 6 years at two time points, 2003 (n 9081, Mean age = 27·6) and 2009 (n 8199, Mean age = 33·7) using secondary data from the Australian Longitudinal Study on Women's Health. A linear mixed-effects model found a small and significant inverse association of diet quality on depressive symptoms (β = −0·03, 95 % CI (−0·04, −0·02)) after adjusting for covarying factors such as BMI, social functioning, alcohol and smoking status. These findings suggest that the continuation of a healthy dietary pattern may be protective of depressive symptoms. Caution should be applied in interpreting these findings due to the small effect sizes. More longitudinal studies are needed to assess temporal relationships between dietary quality and depression. [ABSTRACT FROM AUTHOR]

Paediatric organ donation rates in Australia do not match the demand for paediatric organ transplants. Paediatric donations require parents to consent to donate the organs of their child, yet little research exists on how paediatric donation is understood outside of the medical world. Drawing from social representation theory, we examined how paediatric donation was portrayed by the media, the primary source of information about organ donation. Fifty‐nine newspaper articles, across eight Australian newspapers, were subjected to thematic analysis. Common themes coalesced around the paediatric donation decision, what the decision means for parents, and the experiences of paediatric transplant recipients and their families. Donation and transplantation were portrayed either as a contradiction, where a child was required to die in order for a child to live, or as mutually beneficial, where donation was a positive outcome of a tragic death. Interpreted within a dialogical framework, we suggest that notions of contradiction and mutual benefit are generated by the underlying thema life/death, and shaped in tandem by the paediatric context. The roles of themata, emotional anchoring, and objectification are discussed. Importantly, this study highlights the need to investigate the interplay between emotional contradiction, mutual dependence, and parental decision‐making about paediatric organ donation. [ABSTRACT FROM AUTHOR]

Background: Effective digital social capital interventions have great potential to establish trusted social pathways to access supportive services and to enable talking about issues contributing to distress. Aim: This review explores the digital social capital interventions used in individuals with social skills deficits, and the best social health outcomes achieved. Method: Four databases (PubMed, CINAHL, PsychINFO, and Web of Science) were used with no time limitation, and 33 papers were included. Results: A diverse range of digital social programs was used for social capital improvement based on individuals' characteristics (e.g. age range and illnesses). Programs ranged from digitally-enhanced self-help or self-guided treatment (to enhance the self-efficacy of individuals), to group treatments and/or web-based caregiver support services. They comprised mobile social apps, video blogging, video-communication system/video-conferencing, and online social communication, to more advanced techniques such as virtual reality. All of these modalities were shown to be beneficial for improving the social health of individuals. Interventions targeted two aspects of social capital: (1) cognitive social capital, focusing on enhancing trust and control, self-efficacy on life. Some examples were cognitive behavioural therapy, and increasing the received and more importantly perceived social support. (2) structural social capital, focusing on individuals' relationships with family/carers, friends, peers to other connections at the macro level, such as health care providers and their community as a whole. The two interconnected aspects of social capital play a role in decreasing fears of being judged by others, general fears in social interactions and interpersonal problems. Conclusion: Guided digital social support interventions result in open and flexible access to various resources through supportive social networks, for patients and their family members/carers. [ABSTRACT FROM AUTHOR]

Aim: Dietetics educators represent a small but influential workforce group that has experienced significant change in recent years. The workforce development challenges faced by this group have been largely unexplored. The present study aimed to explore the experiences of, and challenges faced by, academic dietetics educators in preparing dietitians for the workforce. Methods: The approach taken in the present study was informed by qualitative description. Fifteen dietetics educators employed by 13 universities across Australia were purposively sampled. In‐depth, semi‐structured interviews conducted via telephone (n = 12) or face‐to‐face (n = 3) were digitally recorded then transcribed verbatim. Data were managed with NVivo and inductively analysed using open coding. Codes were condensed into themes through an iterative process involving multiple researchers. Results: The overarching theme of 'aiming for a moving target' was underpinned by the themes of: (i) striving for betterment; (ii) bridging dissonance and (iii) distressing impossibilities. Interviewees described how they were driven to enhance the preparation of dietitians but acknowledged disparity between what graduates are being prepared for and what they need to be prepared for. Heightened expectations of others, professional constraints and a lack of collegiality among the profession were among the challenges that manifested in a sense of frustration, concern and isolation. Conclusions: Dietetics educators are motivated to shape and enhance the future profession. However, they face numerous challenges in their efforts to prepare graduates who are well‐equipped for increasingly diverse dietetics practice. Strong leadership, academic collaboration and greater engagement of the broader workforce are required for the benefit of the entire profession. [ABSTRACT FROM AUTHOR]

This interview-based study uses phenomenology as a theoretical framework and thematic analysis to challenge existing explanatory frameworks of shared decision-making, in an exploration of women's experiences and perceptions of shared decision-making for adjuvant treatment in breast cancer. Three themes emerged are as follows: (1) women's desire to participate in shared decision-making, (2) the degree to which shared decision-making is perceived to be shared and (3) to what extent are women empowered within shared decision-making. Studying breast cancer patients' subjective experiences of adjuvant treatment decision-making provides a broader perspective on patient participatory role preferences and doctor–patient power dynamics within shared decision-making for breast cancer. [ABSTRACT FROM AUTHOR]

Shared decision making (SDM) is acknowledged as the gold standard of healthcare communication, particularly relevant to preference-sensitive care such as breast cancer treatment. However, research on patients' experiences shows a misalignment between clinicians' goals and the rhetoric regarding patients' empowerment during SDM for this treatment. This warrants detailed examination on the conversational dynamics of SDM, and this study aims to identify interactional features and social practices through which SDM is achieved. Fifteen audio recordings from adjuvant treatment breast cancer consultations were examined using the methodology of conversation analysis (CA), and recurrent patterns relevant for understanding SDM were identified. Boundary markers, rhetorical questioning and epistemic markers discouraged a shared orientation to patient participation, reinforcing perceived imbalanced doctor-patient power relations. Cues for SDM such as multi-turn utterances and spaces for transition were presented but not recognised by patients, resulting in sub-optimal two-way discussions about decision making. The findings also reveal that interactional practices were deployed that theoretically should have enabled patients to contribute to SDM. However, in reality these did not result in extended sequences of reciprocated contributions from practitioner and service user. SDM did not happen with the ease implied by current models, and the resultant interactions bore more similarity to expert-led, rather than collaborative, decision making. [ABSTRACT FROM AUTHOR]

Background: Online cancer support group discussions enable patients to share their illness experience with others. The sharing of technical and emotional support information and the ability to ask for advice are some of the primary discussions shared online. People with bowel cancer can also use these forums to support each other by sharing information based on personal experiences. This type of support provides newly diagnosed patients with advice about several topics, including exercise from those who have been there. Information gathered from online discussion boards may complement the advice received by health professionals.Objective: This study aimed to explore the nature of information related to exercise and physical activity exchanged online for cancer survivors.Methods: A public open access bowel cancer discussion board was searched for threads containing information related to physical activity or exercise. Keywords such as exercise, physical activity, moving, walking, lifting, weights training, and resistance were used to search for threads (online conversations) related to exercise or physical activity. Only threads initiated by bowel cancer patients or survivors were included. From more than 6000 posts, the inclusion criteria yielded 75 threads for analysis. Inductive thematic analysis was conducted across all included threads.Results: Analysis yielded 3 main themes: level of exercise competence, beneficial dimensions of exercise, and faith in the knowledge. Level of exercise competence illustrated the varying definitions of exercise that members of the forum discussed in the forum. Beneficial dimensions of exercise revealed that forum members shared both the spiritual benefits associated with exercise as well as the physical benefits or goodness that they feel exercise or physical activity provides them. Faith in the knowledge of exercise demonstrated that forum members were aware of the general benefits of exercise but felt disappointed that it did not keep the cancer at bay. However, members also had faith that exercise would keep them healthy after diagnosis and treatment.Conclusions: The analysis revealed that people with bowel cancer discuss exercise and physical activity online and that they view exercise as having a mostly positive influence on their cancer journey. However, personal definitions of exercise became a source of conflict within the group. People with bowel cancer seeking information about exercise may benefit from participating in online support groups as it appears that there are many similar others willing to share their personal experiences with exercise. In addition, health care professionals responsible for caring for people with bowel cancer may use these findings to discuss exercise with their patients while being mindful of how they may view exercise. [ABSTRACT FROM AUTHOR]

The article reviews the film "The Sessions" starring John Hawkes and Helen Hunt, directed by Ben Lewin.

ObjectiveConsumer involvement is when patients (their families, friends, and caregivers) work with researchers on research projects. While health services are expected to support consumer-researcher collaborations, conducive environments still need to be developed, with limited research into how Australian health services support this practice. This study explores current consumer involvement in research activity and staff perceptions at an Australian tertiary hospital and health service.MethodsResearch-active employees at a health service were invited to participate in an online cross-sectional survey. It assessed experience with and confidence in involving consumers in research, the perceived value of consumer involvement, and considerations related to challenges, facilitators, and solutions to enhance consumer involvement in health service research.ResultsAmong 83 respondents, including medical, nursing, and allied health professionals, 54 completed the survey. Approximately half had experience with involving consumers in research. Over 80% recognised that involving consumers enhanced research relevance. Identified barriers included challenges in finding (46.6%) and compensating (59.3%) consumers, as well as deficiencies in researcher skills, knowledge (32.2%), and time constraints (39%). Facilitators comprised access to experienced researchers and educational opportunities. Moreover, 87% advocated for increased support to involve consumers within health services, with the appointment of a designated consumer involvement officer deemed the most beneficial solution by 92.5% of respondents.ConclusionsWhile individual barriers inhibit consumer involvement in research, more prominent institutional factors such as financial and technical support may determine successful and meaningful collaborations. As health services evolve towards co-design models in research, the outcomes of this study will guide initiatives aimed at enhancing consumer involvement in the research process within Australian health services.

Introduction: Domestic violence (DV) is a major cause of morbidity worldwide. The ED is a location recommended for opportunistic screening. However, screening within EDs remains irregular., Objective: To examine intrinsic and extrinsic barriers to routine screening in Australian EDs, while describing actions taken after identification of DV., Methods: Emergency clinicians at nine public hospitals participated in an anonymous online survey. Factor analysis was performed to identify principal components around attitudes and beliefs towards screening., Results: In total, 496 emergency clinicians participated. Universal screening was uncommon; less than 2% of respondents reported screening all adults or all women. Although willing, nearly half (45%) reported not knowing how to screen. High patient load and no single rooms were 'very or severely limiting' for 88% of respondents, respectively, while 24/7 social work and interpreter services, and online/written DV protocols were top enablers. Factor analysis identified four distinct intrinsic belief components: (1) screening is not futile and could be done in ED, (2) screening will not cause harm, (3) there is a duty to screen and (4) I am willing to screen., Conclusion: This study describes a culture of Queensland ED clinicians that believe DV screening in ED is important and interventions are effective. Most ED clinicians are willing to screen. In this setting, availability of social work and interpreter services are important mitigating resources. Clinician education focusing on duty to screen, coupled with a built-in screening tool, and e-links to a local management protocol may improve the uptake of screening and subsequently increase detection., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Depression is a chronic and complex condition experienced by over 300 million people worldwide. While research on the impact of nutrition on chronic physical illness is well documented, there is growing interest in the role of dietary patterns for those experiencing symptoms of depression. This study aims to examine the association of diet quality (Dietary Questionnaire for Epidemiological Studies version 2) and depressive symptoms (Centre for Epidemiological Studies for Depression short form) of young Australian women over 6 years at two time points, 2003 ( n 9081, Mean age = 27·6) and 2009 ( n 8199, Mean age = 33·7) using secondary data from the Australian Longitudinal Study on Women's Health. A linear mixed-effects model found a small and significant inverse association of diet quality on depressive symptoms ( β = -0·03, 95 % CI (-0·04, -0·02)) after adjusting for covarying factors such as BMI, social functioning, alcohol and smoking status. These findings suggest that the continuation of a healthy dietary pattern may be protective of depressive symptoms. Caution should be applied in interpreting these findings due to the small effect sizes. More longitudinal studies are needed to assess temporal relationships between dietary quality and depression.

Rationale. Many cancer patients and survivors do not meet nutritional and physical activity guidelines, thus healthier eating and greater levels of physical activity could have considerable benefits for these individuals. While research has investigated cancer survivors' perspective on their challenges in meeting the nutrition and physical guidelines, little research has examined how health professionals may assist their patients meet these guidelines. Cancer nurses are ideally placed to promote healthy behaviours to their patients, especially if access to dieticians or dietary resources is limited. However, little is known about cancer nurses' healthy eating promotion practices to their patients. The primary aim of this study was to examine current healthy eating promotion practices, beliefs and barriers of cancer nurses in Australia and New Zealand. A secondary aim was to gain insight into whether these practices, beliefs and barriers were influenced by the nurses' hospital or years of work experience. Patients and Methods. An online questionnaire was used to obtain data. Sub-group cancer nurse comparisons were performed on hospital location (metropolitan vs regional and rural) and years of experience (<25 or ≥25 years) using ANOVA and chi square analysis for continuous and categorical data respectively. Results. A total of 123 Australasian cancer nurses responded to the survey. Cancer nurses believed they were often the major provider of nutritional advice to their cancer patients (32.5%), a value marginally less than dieticians (35.9%) but substantially higher than oncologists (3.3%). The majority promoted healthy eating prior (62.6%), during (74.8%) and post treatment (64.2%). Most cancer nurses felt that healthy eating had positive effects on the cancer patients' quality of life (85.4%), weight management (82.9%), mental health (80.5%), activities of daily living (79.7%) and risk of other chronic diseases (79.7%), although only 75.5% agreed or strongly agreed that this is due to a strong evidence base. Lack of time (25.8%), adequate support structures (17.3%) nutrition expertise (12.2%) were cited by the cancer nurses as the most common barriers to promoting healthy eating to their patients. Comparisons based on their hospital location and years of experience, revealed very few significant differences, indicating that cancer nurses' healthy eating promotion practices, beliefs and barriers were largely unaffected by hospital location or years of experience. Conclusion. Australasian cancer nurses have favourable attitudes towards promoting healthy eating to their cancer patients across multiple treatment stages and believe that healthy eating has many benefits for their patients. Unfortunately, several barriers to healthy eating promotion were reported. If these barriers can be overcome, nurses may be able to work more effectively with dieticians to improve the outcomes for cancer patients.

Introduction: In 2011 Bond University was looking for innovative ways to meet the professional standards and guidelines in Aboriginal and Torres Strait Islander health in its Bachelor of Medicine, Bachelor of Surgery (MBBS) curriculum. In 2012 Bond piloted a compulsory cultural immersion program for all first year students, which is now a usual part of the MBBS program., Methods: Three phases were included - establishing an Indigenous health group, determining the Aboriginal and Torres Strait Islander educational content based on the professional standards and developing nine educational sessions and resources - as well as significant administrative processes. The cultural immersion was piloted in 2012 with 92 first year medical students. Following refinements it was repeated in 2013 with 95 students and in 2014 with 94 students. A comprehensive evaluation process was undertaken that included a paper-based evaluation form using a five-point Likert scale, as well as a confidential talking circle evaluation. The response rate was 95.4% (n=271, pooled cohort). Data were entered separately into SPSS and annual reports were written to the Faculty. Descriptive statistics are reported alongside themed qualitative data., Results: The three combined student evaluation results were extremely positive. Students (n=271) strongly agreed that the workshop was well organised (M=4.3), that the facilitators contributed very positively to their experience (M=4.3), and that they were very satisfied overall with the activity (M=4.2). They agreed that the eight overall objectives had been well met (M=3.9-4.3). The nine sessions were highly evaluated with mean ratings of between 3.9 and 4.8. The 'best thing' about the immersion identified by more than half of the students was overwhelmingly (n=140) the Storytelling session, followed by bonding with the cohort, the Torres Strait Islander session and learning more about culture. The item identified as needing most improvement was the food (n=87), followed by the accommodation (n=65)., Conclusions: The use of immersion in the early part of a cultural awareness program for medical students provides an extremely valuable platform from which to launch more detailed information about the history of Aboriginal and Torres Strait Islander Australia and its impact on the current health status of Aboriginal and Torres Strait Islander Australians. Doing this in a safe, supportive cross-cultural environment with highly skilled facilitators is essential. Key to success is strong leadership, commitment and support from Faculty level, a structured educational program and educating all staff and students about its importance throughout the journey.

Background: On their journey to "becoming" doctors, medical students encounter a range of health professionals who contribute to their socialisation into clinical practice. Amongst these individuals are registered nurses (RNs) in clinical practice who are often employed by medical schools as clinical tutors. These RNs will encounter medical students on campus and later in the clinical setting., Aims: This qualitative study explored RNs' perceptions of their contribution to medical students' developing professional identities in order to provide a greater understanding of this process and ultimately inform future curriculum., Methods: This qualitative study took place in 2012 at one Australian medical school as part of a broader study exploring medical students' professional identity development from the perspectives of their teachers and trainers. Eight of the nine RNs involved in teaching procedural skills were interviewed. Recorded interviews were transcribed verbatim. Data were analysed inductively by the research team., Results: Two major themes emerged: RNs as change agents and RNs as facilitators of medical students' transition to the clinical environment. RNs as change agents related to their role modelling good practice, being patient-centred, and by emphasising factors contributing to good teamwork such as recognising and respecting individual professional roles. They facilitated students' transition to the clinical environment often through personal narratives, by offering advice on how to behave and work with members of the healthcare team, and by being a point of contact in the hospital., Conclusion: Based on their descriptions of how they role modelled good practice and how they facilitated students' transition to clinical practice, we believe that RN clinical tutors do have the experience and expertise in clinical practice and a professional approach to patients to contribute to medical students' developing professional identities as future doctors.