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Objective/Aim: To examine the experiences of culturally safe mentoring programmes described by Aboriginal and Torres Strait Islander nurses and midwives in Australia. Design: A systematic scoping review. Data Sources: The following databases were accessed: CINAHL Plus with Full Text (EBSCO), EMCARE (Ovid), MEDLINE (Ovid), INFORMIT (Health Collection/Indigenous Collection) and SCOPUS. Support relating to key words and appropriate databases was provided by a university librarian. Review Methods: Search terms across databases were sourced from 1997–2021, identifying a total of 161 papers. Title/abstract searches were screened against the inclusion/exclusion criteria, resulting in 18 papers reaching full-text review. Of the 18 full-text papers reviewed, six were eligible for inclusion in the final review. Results/Findings: Culturally safe mentorship was a positive experience for Aboriginal and Torres Strait Islander nurses and midwives. Thematic discussion identified three key themes: Mentorship as a way forward, Culture in mentorship, and Cultural safety's role in mentorship. Discussion: Culturally safe mentoring has been a key recommendation in the nursing literature for over 20 years. There is limited knowledge on what constitutes an effective programme as mentoring programmes have not been empirically evaluated or reviewed. Conclusion: This review provides evidence that Cultural Safety and the exploration of culture impact culturally safe mentoring and can impact workforce cultural capability. Impact Statement: This review indicates that culturally safe mentoring has been a key recommendation in nursing literature for over 20 years. This review provides evidence that Cultural Safety and the exploration of culture impact culturally safe mentoring and can impact workforce cultural capability. However, there is limited knowledge of what constitutes an effective programme, as mentoring programmes have not been empirically evaluated or reviewed providing an opportunity for further research. Plain Language Summary: Little is known about Aboriginal and Torres Strait Islander nurses' and midwives' perspectives of culturally safe mentoring programmes in Australia. However, mentoring programme are seen as a key workforce retention strategy. This scoping review aims to explore and interpret Aboriginal and Torres Strait Islander nurses' and midwives' perspectives of culturally safe mentoring programmes in Australia. This review concludes that mentoring programmes require content in Cultural Safety and that programmes need to be empirically evaluated. [ABSTRACT FROM AUTHOR]

Background: Electronic prescription (e-prescription) was introduced in 2020 in Australia during the COVID-19 pandemic. This research aimed to explore general practitioners (GPs) and community pharmacists' experience with, and facilitators and barriers to, the use of e-prescription. Methods: This qualitative study used semi-structured interviews with GPs and pharmacists in Greater Sydney to explore their experience with e-prescription. Thematic analysis used descriptive and mixed inductive and deductive approaches. The Technology Acceptance Model (TAM) was used to further interpret and organise the themes. Results: Eleven GPs and nine pharmacists were interviewed. Thirteen themes were elicited, seven of which were categorised as benefits (facilitators) and six were challenges (barriers). Four facilitator themes (convenience for healthcare providers (HCPs) and patients, addressing issues with paper prescriptions, contactless nature reducing access barriers during COVID-19 lockdown, and enabling patients to manage multiple prescriptions) were mapped to the TAM construct of 'perceived usefulness'; and one facilitator (an easier process) and two barrier themes (lack of information during implementation, and technological issues) were mapped to the TAM construct of 'perceived ease of use'. Themes that fell outside these constructs were separately categorised: four barrier themes (reluctance of some patients and HCPs to change, patient expectations of 'instant prescription' and lost opportunities for best-practice care, HCPs' perceptions of inadequate governmental governance, and ongoing costs) were 'other issues with e-prescription', and two facilitator themes (providing training on the use of e-prescription for HCPs and patients, and making e-prescription more streamlined) were 'suggestions to improve'. Conclusion: There are many facilitators and barriers to the use of e-prescription. Our findings may inform the future promotion of e-prescription post-COVID-19 pandemic. Further research should focus on consumers' perspectives of e-prescription. It is inevitable that electronic prescriptions will one day supersede paper prescriptions, but there is resistance to their implementation at the practitioner and patient levels. This paper explored GPs and pharmacists' experience and views, and found that while e-prescription improves the quality of patient care, there are several challenges to its effective use. Findings may inform the future promotion of e-prescription, particularly post-COVID-19 pandemic, and guide future research in exploring consumer perspectives. [ABSTRACT FROM AUTHOR]

Objective: In Australia, there is little evidence exploring why higher degrees by research (HDRs) are undertaken by surgeons. This study aims to describe the attitudes and experiences of surgical trainees and surgeons towards HDRs. Methods: A 23-question cross-sectional survey of surgical trainees and consultant surgeons from three Australian public hospitals was undertaken between August and December 2022. Data were analysed according to stage of career and HDR status and assessed using chi-squared test, with P < 0.05 considered significant. Results: Out of 270 participants, 72 (27%) completed the survey including 30 (42%) trainees and 42 (58%) consultants. Overall, 43 (60%) participants had completed or were undertaking a HDR, which was similar between trainees (n = 18) and consultants (N = 25; P = 0.968). A HDR was associated with more publications (P < 0.5). Respondents with a HDR were more likely to have a salaried academic position (50%) than those without (15%). There was no significant difference in academic appointments based on HDR attainment (P = 0.192). For surgical trainees, 93% rated the strengthening of resumes as the primary driver, compared with only 60% of consultants. For consultants, academic career aspirations and research interests were ranked the highest at 64% equally. Lack of time and competing nature of surgical training were equally ranked among all as the key barriers to completing a HDR. Conclusions: These results provide insight into the academic pursuits of surgeons with an understanding of the role HDRs play, including the different drivers for Masters and Doctorates. This is important for supporting future surgeons who seek to pursue research. What is known about the topic? The value of research is well-recognised as a crucial part of the surgical training pathway. Despite this, minimal contemporary evidence exists which explores the impact of higher degrees by research (HDR) on academic career pathways in the Australian context. What does this paper add? Contemporary evidence was obtained to understand why Australian surgeons undertake HDRs and how their completion impacts the surgical career pathway. What are the implications for practitioners? By understanding the role of HDRs in the surgical landscape, practitioners can ensure beneficial support for future academic surgeons is in place. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the perceptions of the coronavirus disease 2019 (COVID-19) initiated workplace strategies implemented in radiation oncology departments across Australia. Methods: A multidisciplinary team from Princess Alexandra Hospital developed a survey to address the impact of the pandemic strategies on areas such as patient care, staff education, well-being, flexible working arrangements, and research. The survey was conducted from November 2020 to April 2021. Results: Out of 210 respondents from seven institutions, 45% reported burnout and 57% experienced work work-related stress. A significant majority of respondents were in favour of continued remote work (86%, 131/153). Radiation oncologists identified administrative or non-clinical work (92%, 34/37), telehealth clinics (32%, 12/37), or radiation therapy planning (22%, 8/37) as suitable for remote work. Additionally, 54% (21/39) of the radiation oncologists plan to use telehealth more frequently, with 67% (26/39) feeling more confident with the technology. The majority (81%, 171/210) of participants favoured continuation of hybrid in-person and virtual meetings. Virtual solutions were adopted for quality assurance activities (72%, 118/165) and 52% (60/116) indicated preference for ongoing utility of virtual platforms. However, 38% (79/210) of the respondents expressed concerns about the negative impact on junior staff training. Conclusion: These findings reveal a strong inclination towards technological advancements and remote work arrangements to enable flexible working conditions. Our study suggests the need for ongoing reforms, focusing on improving clinical service delivery efficiencies and enhancing job satisfaction among clinicians. What is known about the topic? During the coronavirus disease 2019 (COVID-19) pandemic there were significant adaptations required to the delivery of clinical care. What does this paper add? There is a strong preference for ongoing work from home arrangements, especially for administrative and non-clinical work. Most radiation oncologists feel more confident using telehealth and favour its ongoing use post-pandemic. Burnout and stress remain prevalent within the workforce. What are the implications for practitioners? There is a high demand among the radiation oncology workforce for adoption of technological advances to improve work satisfaction including remote access to enable flexible work arrangements. [ABSTRACT FROM AUTHOR]

Objectives: This study explored the familiarity, perceptions and confidence of Australian radiology clinicians involved in reading screening mammograms, regarding artificial intelligence (AI) applications in breast cancer detection. Methods: Sixty-five radiologists, breast physicians and radiology trainees participated in an online survey that consisted of 23 multiple choice questions asking about their experience and familiarity with AI products. Furthermore, the survey asked about their confidence in using AI outputs and their preference for AI modes applied in a breast screening context. Participants' responses to questions were compared using Pearson's χ 2 test. Bonferroni-adjusted significance tests were used for pairwise comparisons. Results: Fifty-five percent of respondents had experience with AI in their workplaces, with automatic density measurement powered by machine learning being the most familiar AI product (69.4%). The top AI outputs with the highest ranks of perceived confidence were 'Displaying suspicious areas on mammograms with the percentage of cancer possibility' (67.8%) and 'Automatic mammogram classification (normal, benign, cancer, uncertain)' (64.6%). Radiology and breast physicians preferred using AI as second-reader mode (75.4% saying 'somewhat happy' to 'extremely happy') over triage (47.7%), pre-screening and first-reader modes (both with 26.2%) (P < 0.001). Conclusion: The majority of screen readers expressed increased confidence in utilising AI for highlighting suspicious areas on mammograms and for automatically classifying mammograms. They considered AI as an optimal second-reader mode being the most ideal use in a screening program. The findings provide valuable insights into the familiarities and expectations of radiologists and breast clinicians for the AI products that can enhance the effectiveness of the breast cancer screening programs, benefitting both healthcare professionals and patients alike. What is known about the topic? Artificial intelligence (AI) holds promise in providing computer-aided detection in health care, however, current research suggests that standalone AI applications in clinical practice fall short of matching the accuracy of a single radiologist. What does this paper add? The study showed a significant preference among clinicians for using AI as a supplementary tool, serving as a second-reader. Such an integrated approach, where AI aids in flagging suspicious areas on mammograms or offers automatic classification, reflects the ideal cooperation between breast screening readers and AI systems. What are the implications for practitioners? These insights shed light on clinicians' familiarity with and expectations of AI tools that can boost the effectiveness of breast screening programs. [ABSTRACT FROM AUTHOR]

Aims: This work aims to explore staff perceptions of (1) the effectiveness of organizational communication during the COVID‐19 pandemic and (2) the impact of organizational communication on staff well‐being and ability to progress their work and patient care. Background: Effective coordination and communication are essential in a pandemic management response. However, the effectiveness of communication strategies used during the COVID‐19 pandemic is not well understood. Design: An exploratory cross‐sectional research design was used. A 33‐item survey tool was created for the study. Methods: The study was conducted at a tertiary teaching hospital in Western Australia. Convenience sampling was used to recruit participants from nursing, medical, allied health services, administrative and clerical, and personal support services (N = 325). Data were collected between December 2020 and May 2021. Results: Overall, all occupational groups found working during the COVID‐19 pandemic stressful, and all groups wanted accessible and accurate communication from management and new policies, procedures, and protocols for future outbreaks. Conclusions: The use of occupational group‐relevant strategies and COVID‐19 protocols, as well as the on‐going use of email, face‐to‐face meetings with debrief sessions, are needed to improve communication and support staff to fulfil their roles. Summary statement: What is already known about the topic? Effective coordination and communication that is timely and two‐way in nature, is an essential part of a pandemic management response. What this paper adds? All occupational groups found working during the COVID‐19 pandemic stressful; all groups wanted accessible and accurate communication from management and new policies, procedures, and protocols for future outbreaks. The implications of this paper: Managing a pandemic situation in health care settings is challenging for all levels of staff including management and all occupational work groups.The use of occupational group‐relevant strategies and COVID‐19 protocols, as well as the on‐going use of email, face‐to‐face meetings with debrief sessions, are needed to improve communication and support staff to fulfil their roles. [ABSTRACT FROM AUTHOR]

Australian research indicates that post-parental care transitions are rarely planned and primarily occur following a crisis for a primary carer. This paper examines disability staff perceptions of transitions for people with intellectual disability and their ageing carers in rural South Australia. A focus group interview model was used, with a semi-structured interview guide initiating group discussions. A thematic analysis methodological approach was selected to analyse the data. This paper reports on the theme of Service Delivery, which has three sub-themes of Availability; Distance; and Individual Access. The key findings are presented and supported by the use of exemplar quotes. This research indicates a poor intersection of general and specialist services is inhibiting post-parental transitional care for rural people. Simply allocating money to the individual does not resolve the issues, and the interface between different services needs to be better considered at government level. [ABSTRACT FROM AUTHOR]

Aim: To explore the satisfaction and experiences of women and staff with the BSOTS in an Australian hospital. Design: Cross‐sectional descriptive survey. Methods: Surveys were distributed to women and staff between February and May 2022. Survey questions reflected satisfaction with triage and provision of care under the BSOTS system (for women) and confidence in using the BSOTS system and its impact on triage‐related care (for staff). Survey data were summarized using descriptive statistics, and qualitative responses were analysed using content analysis. Results: There were 50 women and 40 staff (midwives and doctors) survey respondents. Most women were satisfied with triage wait times, the verbal information they received and the time it took for them to receive care. Nearly all midwife participants indicated they had high knowledge and confidence in using the BSOTS. Most staff indicated that the BSOTS supported the accurate assessment of women and had benefits for women, staff and the hospital. Conclusion: The findings showed that women and staff were satisfied with receiving and providing care in a maternity triage setting under the BSOTS system. Implications for the Profession and/or Patient Care: Implementing standardized maternity triage approaches such as the BSOTS in health settings delivering care to pregnant women is recommended for improving flow of care and perceptions of care quality by women. Impact: Quality of maternity triage processes is likely to impact the satisfaction of women attending services and the staff providing care. The BSOTS was shown to improve maternity triage processes and was associated with satisfaction of women and staff. Maternity settings can benefit from implementing triage approaches such as the BSOTS as it standardizes and justifies the care provided to women. This is likely to result in satisfaction of women and staff engaged in maternity triage and improve the birth outcomes of women and babies. Reporting Method: The reporting of this paper has followed SQUIRE guidelines. Patient or Public Contribution: Women engaged with maternity services were participants in the study but did not contribute to the design, conduct or publication of the study. [ABSTRACT FROM AUTHOR]

Introduction: Telepractice service delivery of allied health interventions to people with disability can potentially reduce access barriers and improve service equity. However, questions remain regarding telepractice functionality for people with disability. This study addressed questions related to how allied health clinicians and managers perceive telepractice as functioning in the provision of therapy services to people with disability. Methods: Thirteen interviews of allied health clinicians and managers from across Australia were conducted between 21 November and 22 February via MS teams. Qualitative methodology and critical realist theoretical paradigm underpin the study. Data analysis was completed using a reflective thematic analysis method and five themes were generated and described utilising an analytic metaphor. Results: The study themes were described in relation to a shopping for shoes analytic metaphor and the five themes included (1) a shoe for every foot, (2) planned purchases, (3) shoe on the other foot, (4) you need both shoes and (5) help choosing their shoes. In summary, the function of telepractice fits differently for each individual, similar to pairs of shoes. Conclusions: Telepractice has its own strengths and weaknesses and isn't a direct substitute for in‐person sessions, much like left and right shoes are similar but not the same. The results support participant perceptions that telepractice functions best as an adjunct to in‐person sessions through a flexible hybrid delivery model in the provision of therapy services to people with a disability. A strategy for improving perceived usefulness may involve positioning telepractice as unique with strengths and weaknesses, not replacing in‐person care. Patient or Public Contribution: The paper forms part of a larger codesign process which included customer and carer participants throughout the design and planning of the project, inclusion of a peer researcher, and the selection of the analytic metaphor including in the findings of this article production. [ABSTRACT FROM AUTHOR]

Introduction: Older carers or 'care partners' of older people experiencing care needs often provide essential support, at times while neglecting their own health and well‐being. This is an increasingly frequent scenario due to both demographic changes and policy shifts towards ageing in place. Multiple community stakeholders within the care and support ecosystem hold valuable expertise about the needs of older care partners, and the programme and policy responses that may better support their health and well‐being. The aim of this study was to identify the perspectives of stakeholders obtained through the codesign phase of a multicomponent research project investigating new models of care and support for older care partners suitable for the Australian context. Methods: Principles of codesign were used to engage a purposeful sample of older care partners, health professionals, researchers, policy makers and health service administrators. Participants took part in a series of three codesign workshops conducted remotely via video conferencing. The workshops were supported with briefing material and generated consensus‐based summaries, arriving at a preferred service model. Findings: This paper reports the research design and structure of the codesign panels, the range of findings identified as important to support the health and well‐being of older carers of older people, and the resulting service model principles. The codesigned and preferred model of care is currently being prepared for implementation and evaluation in Australia. Public Contribution: This study was conducted using codesign methodology, whereby stakeholders including older care partners and others involved in supporting older carers, were integrally involved with design, development, results and conclusions. [ABSTRACT FROM AUTHOR]

Aims: To explore Australian healthcare providers' perspectives on factors that influence disclosure and domestic violence screening through the lens of Heise's (1998) integrated ecological framework. Design: This paper reports the findings that were part of a sequential mixed methods study with survey data informing interview questions. Participants for interviews were recruited after expressing an interest after completing surveys, as well as via snowball sampling. Methods: Semi‐structured interviews were undertaken in 2017 with 12 practicing healthcare providers delivering care to women in the perinatal period in Greater Western Sydney, NSW, Australia. Data were analysed using Braun and Clarke's (2006) six‐step thematic approach. Findings The findings were framed within Heise's integrated ecological framework under four main themes. The main themes were 'Ontogenic: Factors preventing women from disclosing'; 'Microsystem: Factors preventing healthcare providers from asking'; 'Exosystem: Organizational structures not conducive to screening'; and 'Macrosystem: Cultural attitudes and socioeconomic influences affecting screening'. Conclusion: Organizational policies are needed for better systems of reminding healthcare providers to enquire for domestic and family violence and mandating this within their practices. Mandatory domestic and family violence education and training that is suitable for the time constraints and learning needs of the healthcare provider is recommended for all healthcare providers caring for perinatal women. Further research is needed in addressing culturally specific barriers for healthcare providers to enquire about domestic and family violence in a culturally appropriate way. Public and Patient Engagement and Involvement in Research (PPEI): No Patient or Public Contribution was embedded into the research reported in this paper as this research was specifically exploring healthcare providers' perspectives on domestic violence screening within their own practice experience. [ABSTRACT FROM AUTHOR]

Aims: The primary aim of the review was to provide an overall assessment of residential parenting services in Australia, by describing the characteristics of infants and parents using residential parenting services, their prior service use and reasons for admission, referral pathways for access and parenting and infant outcomes. The secondary aims were to explore parent and staff perception of the programmes. Design: An integrative literature review. Methods: A systematic and comprehensive search of health and social sciences databases was conducted for studies related to residential parenting services (published between 1st January 1990–31st December 2019). Six hundred and eleven peer‐reviewed papers were identified, after which 301 duplicates were removed and an additional 256 papers excluded after titles/abstracts were read. Of the remaining 54 abstracts/papers, a further 14 were omitted as not relevant. Forty papers were independently reviewed by four authors. ENTREQ and MOOSE checklists were applied. Results: Thirty studies were quantitative, nine were qualitative, and one was mixed methods. All studies originated from in Australia. Women and babies admitted to residential parenting services were found more likely to be: older, Australian born, from higher socio‐economic groups, and first‐time mothers, and having labour and birth interventions and a history of mental health disorders. The babies were more likely to be twins, male and admitted with sleep disorders and dysregulated behaviour. Studies reporting postintervention outcomes demonstrated improvements to maternal mental health, breastfeeding, parenting confidence and sleep quality, and infant sleeping and behaviour. [ABSTRACT FROM AUTHOR]

Background: Online knowledge translation (KT) approaches are becoming increasingly prevalent within healthcare due to their accessibility and facilitation of international support networks. Online platforms enable timely and far‐reaching dissemination of current evidence and best‐practice recommendations. Although there is potential to improve the uptake of rehabilitation guidelines, it is essential to consider the acceptability of online approaches to healthcare professionals to ensure their successful integration within everyday clinical settings. Aims: To establish the prospective acceptability of a theoretically informed online intervention for speech pathologists, Aphasia Nexus: Connecting Evidence to Practice, that aims to facilitate the implementation of aphasia best practice. Methods & Procedures: A mixed‐methods multinational electronic survey based on the Theoretical Framework of Acceptability (TFA) completed by aphasia researchers and clinicians. Outcomes & Results: A total of 43 participants completed the survey with 91% (n = 39) indicating that they would use Aphasia Nexus. Understanding the intervention and how it works (intervention coherence as per the TFA) was the key factor influencing the likelihood of integration within everyday clinical practice. Participants identified potential areas where the intervention could influence service change and also recommended further design and content changes to improve the intervention. Conclusions & Implications: Aphasia Nexus is an acceptable platform for further feasibility testing in the form of a pilot trial within an Australian‐based health service. The study progresses the theory of TFA as it was a valuable framework facilitating the identification of prominent factors influencing acceptability. The study also informs further intervention refinements in preparation for the next stage of research. WHAT THIS PAPER ADDS: What is already known on the subject: Online strategies have the potential to enhance KT and promote the uptake of rehabilitation guidelines. An online intervention, however, can only be effective if implemented well. For this reason, it is essential to establish the acceptability of online interventions to the intended recipients and therefore increase the likelihood of successful implementation. What this paper adds to existing knowledge: This study used a theoretically based framework to establish the acceptability of an online implementation intervention, Aphasia Nexus, to multinational aphasia clinicians and researchers. It demonstrated the value in identifying the prominent factors influencing acceptability to inform further intervention refinements and warrant continuing research. What are the potential or actual clinical implications of this work?: Speech pathologists should use online platforms to drive the implementation of best practice on an international scale. It is important for clinicians to have an in‐depth understanding of online interventions and how they work to enhance their successful uptake into routine clinical practice. Aphasia Nexus is an acceptable online platform for implementing best practice in aphasia. [ABSTRACT FROM AUTHOR]

Objective: The coronavirus disease 2019 (COVID-19) pandemic precipitated a major shift in the use of telehealth in Australia. The changes highlighted gaps in our knowledge regarding the efficacy of, and clinician attitudes to, the use of telehealth. The current study expands and deepens the available evidence as a result of being collected in unique circumstances that removed one of the major barriers (lack of Medicare rebates) and also one major enablers (willingness) of telehealth uptake. Methods: Using a semi-structured interview, we invited clinicians (N = 39) to share their perspectives, attitudes and experiences of using telehealth. Topics covered included perceptions of the strengths and challenges of telehealth, and how experience of using telehealth during the COVID-19 pandemic had influenced clinicians' views and intentions regarding their future practice. Participants included clinicians from five disciplines across public and private practice: paediatrics, neurology, immunology, rural general practice, and orthopaedics. Results: We found three key dimensions for consideration when assessing the suitability of telehealth for ongoing practice: the attributes of the patient population, the attributes of the clinical context and environment, and the risks and benefits of a telehealth approach. These findings map to the existing literature and allow us to infer that the experiences of clinicians who previously would have chosen telehealth did not differ significantly from those of our 'pandemic-conscripted' clinicians. Conclusions: Our findings map clearly to the existing literature and allow us to infer that the experiences of the clinicians who have chosen telehealth (and are already represented in the literature) did not differ significantly from those trying out telehealth under the unique circumstances of the removal of the Medicare Benefits Scheme barrier and external pressure that over-rides the 'willingness' enabling factor in uptake decisions. What is known about the topic? Clinician and patient experiences of telehealth use have already been documented in contexts where both clinician and patient have opted-in to that process. What does this paper add? The paper adds data on clinician experience across a range of specialities, from a context (pandemic public-heath measures) where the choice element was reduced for both patient and clinician. What are the implications for practitioners? The data speak to the generalisability of existing evidence, but also provide practical considerations in planning for the inclusion of telehealth for specialist health services in the Australian context. [ABSTRACT FROM AUTHOR]

Aim: This paper provides the main accomplishments of the Royal North Shore Hospital (RNSH) Pharmacy Department's COVID‐19 Pandemic Response Plan and key recommendations for other departments developing a remote model of care. Methods: The overall objective was to preserve the active workforce by minimising staff‐to‐staff and staff‐to‐patient contact. The response plan involved splitting the department into teams, implementing a remote ward‐based clinical pharmacy service, staff upskilling and optimising the physical environment. Results: In April 2020, 1240 clinical tasks were completed remotely compared with 1254 tasks completed on site. In May 2020, 1700 tasks were completed offsite, compared with 1544 tasks onsite. The percentage of pharmacists rating themselves 5 out of 5 (very confident) in communicating over the phone increased from 34.8% prior to remote service delivery, to 60% after completion of the service. Counselling patients over the phone increased from 17.4% to 40% while providing remote clinical service increased from 26.1% to 80%. Discussion: The paper provides key recommendations for other sites wanting to implement a remote model of care. There are details of recommendations for communication, adequate skill mix, upskilling, education, training, staff resilience, role expansion and administration. Conclusion: The formation of a team hospital pharmacy department COVID‐19 Pandemic Response Plan has provided assurance that a complete pharmacy service could continue in the event of reduced staffing. Intense, thoughtful, collaborative work was required in a short period of time to design an appropriate physical environment, create a remote working model of care, and to train and educate members of staff. [ABSTRACT FROM AUTHOR]

Purpose: Since 2018, Australian paramedics have been regulated under the National Registration and Accreditation Scheme (NRAS) for health practitioners. Established professions have been regulated in Australia for some time, so there is limited knowledge of their entry to regulation. However, as paramedicine has not been previously centrally regulated, this provides a unique case study to explore the transition to regulated practice. Design/methodology/approach: Australian paramedics undertook two surveys: pre- and post-introduction of registration. The first survey was in the month leading up to the commencement of registration (N = 419), and the second survey took place 31 months after registration (N = 407). This paper presents the results of statistical analyses of the post-registration survey including comparisons to the pre-registration survey. Findings: Although support for regulation has increased over time, there remains strong dissent consistent with 2018 levels. After 31 months of regulation, respondents reported increasing knowledge of the scheme and greater ease of navigation. The impacts of regulation are more nuanced and less polarised than in the first survey. Identity is again canvassed, and results suggest a shift from employment status and qualifications as key elements of identity to a community of practice and registration. Originality/value: Paramedics' experiences and understanding of the rationale for registration are developing. Further support is needed to assist with the emerging professional identity and behaviours. Regulation is one of many occupational factors influencing professional identity and professionalism. Exploring the experience of regulation potentially assists regulators in better supporting practitioners and helps better understand professional evolution. [ABSTRACT FROM AUTHOR]

Introduction: Osteoporosis remains unrecognised and untreated in patients with fragility fractures, which leads to higher mortality rate, increasing social and economic burden related to subsequent fractures. However, the presence of a coordinated and centralised care pathway for fragility fractures is lacking. The purpose of this paper is to explore the perspectives of health professionals regarding the current management for distal radius fragility fractures, how the care pathway can be optimised for patients with distal radius fragility fractures, and where occupational therapists can contribute. Methods: This paper uses a phenomenological qualitative methodology with selective and purposeful sampling, consisting of health professionals from an Australian Health Service (N = 20). Online surveys (N = 18) and semi-structured interviews (N = 16) were conducted. Content analysis was applied, followed by thematic analysis to identify emerging themes. Results: Eighteen health professionals participated in the presurvey of which 16 were interviewed. The identified themes presented the gaps in the knowledge and awareness of fragility fractures and osteoporosis, as well as a lack of coordination in the system, especially the referral process. Discussion: These findings are consistent with previous studies which also highlight the importance of communication, coordination, collaboration, cooperation, responsibility, and a population approach in achieving integrated care. This study contributes to the global call for a centralised and coordinated care pathway for fragility fractures. The study explores personal experiences of health professionals who expressed interest in fragility fractures management. Exploring patients' perspectives on their journey of fragility fractures management provides opportunity for future research. [ABSTRACT FROM AUTHOR]

Background: Bridging the research–practice gap in autism communication services is an identified priority for improving services. Limited research has investigated the views of practitioners regarding this research–practice gap. Investigation of the barriers experienced and facilitators used in clinical practice may assist to identify scalable and sustainable strategies to increase use of evidence‐based practices (EBPs) in the delivery of communication services to children with autism. Aims: To elucidate how Australian speech pathologists engage with external evidence and how communication outcomes are measured to demonstrate the effectiveness of service provision to children with autism. Methods & Procedures: A total of 15 Australian speech pathologists, with experience ranging from less than 1 to more than 16 years, participated in three focus groups. Data from focus groups were analysed using reflexive thematic analysis within an interpretive phenomenological paradigm. Outcomes & Results: Seven themes were identified. Participants reported on the diversity of individuals with autism, their experiences of resource constraints, seeking collegial advice and accessing a diverse range of evidence sources, the role of clinical expertise in translating evidence to practice, the barriers experienced in outcome measurement and use of stakeholders to facilitate data collection to demonstrate outcomes. Conclusions & Implications: Individual practitioner skill and beliefs are facilitators to translating research to practice. Interventions to improve clinician use of EBP should address the skill and belief barriers, aiming to increase a clinician's EBP self‐efficacy and increasing their expectation that investing in EBP activities will result in improved services for children with autism. Modelling and reflective practice are two strategies that may have an application as interventions to improve EBP use in clinical practice. What this paper adds: What is already known on the subject: Constrained resources, especially lack of time, is a barrier to routine uptake of best available evidence in clinical services for children with autism. What this paper adds to existing knowledge: In this study, the perception that speech pathologists lacked time to engage in EBP activities was linked with the speech pathologist's research skill and their beliefs about the benefits of engaging in EBP. Speech Pathologists reported using a range of information sources, as "evidence" but also reported feeling uneasy when using evidence of disputable, or unknown quality. Accessibility and relevance to their individual client were highly prioritised in selecting evidence. Clinical expertise was an essential skill for research translation. What are the potential or actual clinical implications of this work?: Interventions which target professional beliefs and research translation capability are requisite for motivating speech pathologists to improve their use of EBP.Modelling of EBP use, individual reflective practice and collegial active listening to facilitate reflective practice, might be useful strategies which target beliefs and capability of individual speech pathologists; thereby changing their EBP use. [ABSTRACT FROM AUTHOR]

As the COVID-19 pandemic in Australia reaches its peak, medical radiation practitioners (MRPs) are at capacity both physically and emotionally. High workloads and stress impact the mental wellbeing of MRPs, with suppression of feelings and emotions resulting in experiences of compassion fatigue. From a MRP workforce perspective, the long-term cost of the pandemic has yet to be realised. MRPs need to be supported to prevent unintended health consequences. Robust management interventions will be required to support the MRP workforce to manage and hopefully mitigate compassion fatigue transitioning out of the pandemic. What is known about the topic? COVID-19 has highlighted the pressures on the healthcare system and subsequent effects on the healthcare workforce. Relatively little is known about this topic in relationship to the psychological wellbeing of medical radiation practitioners. What does this paper add? This paper recognises some of the effects of the impact of COVID-19 and contributes to literature on wellbeing Human Resource Management in the allied health sector. What are the implications for practitioners? Identification of various management interventions required to actively support medical radiation practitioners to manage and address compassion fatigue transitioning out of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic catapulted Telehealth to the forefront of Emergency Medicine (EM) as an alternative way of assessing and managing patients. This challenged the traditional idea that EM can only be practised within brick‐and‐mortar EDs. Many Emergency Physicians may find the idea of practising Telehealth in Emergency Medicine (TEM) confronting, particularly in the absence of training and clear practice guidelines. The purpose of the present paper is to describe the current use of TEM in Australasia, and outline the advantages and barriers in adopting this practice domain. [ABSTRACT FROM AUTHOR]

Background: Many studies have explored the effect of electronic medication management systems (EMMS) on doctors' and nurses' work, but few have focused specifically on pharmacists' work. Aim: This study examined how implementation of a commercial EMMS affected the work of pharmacists in an Australian paediatric hospital. In particular, the study investigated whether any pharmacy tasks changed or were eliminated, or whether new tasks emerged following EMMS introduction. Methods: Two rounds of semistructured interviews with pharmacists, one 4 months and the other 1 year after EMMS implementation, were conducted. In total, 17 pharmacists were interviewed, comprising inpatient, outpatient and oncology pharmacists, as well as pharmacy managers. Results: EMMS implementation eliminated a small number of tasks, changed some tasks and created many new work tasks for pharmacists. These new tasks included helping doctors and nurses to use the EMMS, duplicated data entry and the review of additional information. Pharmacists held the view that their workload had increased and that additional pharmacists were necessary to cope with the new work requirements associated with the EMMS. Some problems were perceived to be the result of implementation of a US‐designed EMMS that did not fully support Australian pharmacy workflows. Conclusion: Implementation of an EMMS in a paediatric hospital affected pharmacists' work in a variety of ways, predominately by introducing new tasks. Anticipating how workflows will change with EMMS implementation is challenging. Undertaking regular reviews of workflow and planning for an increased burden on pharmacy staff is likely to improve the transition from paper to electronic medication management. [ABSTRACT FROM AUTHOR]

Introduction: A lack of patient safety research hampers capacity to improve safety in healthcare. Ultrasound is often considered 'safe' as it does not use ionising radiation, a simplistic view of patient safety. Understanding sonographers' actions towards patient safety is crucial; however, self-reported measures cannot always predict behaviour. This study is part of a PhD exploring patient safety in medical diagnostic ultrasound. The aim of this paper is to explore sonographers' responses to the patient safety concerns identified in Part one of this study. The ultimate aim of the study is to inform the final phase of the doctoral 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. The Theory of Planned Behaviour (TPB) explained how sonographers respond to perceived patient safety risks in practice. Results: Thirty-one sonographers were interviewed. Based on the seven themes identified in Part one of the study, results showed that incongruences exist between identifying patient safety risks and the actions taken in practice to manage these risks. Conclusion: The TPB showed that behavioural, normative and control beliefs impact sonographers' responses to perceived patient safety risks in practice and can lead to risk avoidance. Lack of regulation in ultrasound creates a challenge in dealing with Fitness to Practice issues. Collective actions are required to support sonographers in taking appropriate actions to enhance patient safety from multiple stakeholders including accreditation bodies, regulatory authorities, educational institutions and employers. [ABSTRACT FROM AUTHOR]

Objectives: The importance of engaging junior doctors in quality improvement (QI) initiatives is well recognised. Junior doctors bring fresh perspectives and engage closely with patients, consumers, families and the healthcare team. They are well positioned to recognise inefficiencies in the system that may compromise safe, timely and effective care. To promote QI participation by our junior doctors our organisation created a specific role; the Improvement House Medical Officer (IHMO). The objective of this study is to describe and evaluate the IHMO rotation at the Royal Melbourne Hospital, a large tertiary hospital in Australia. Methods: A mixed-methods study was performed that involved a survey of previous IHMOs since 2011, including a review of the major QI projects undertaken by IHMOs. Results: Twenty-seven out of 40 IHMOs completed the survey. Doctors were attracted to the rotation to make an impact on the working conditions of junior doctors (selected by 20 respondents, 74%) and improve the quality of health care experienced by patients (18, 67%). Most respondents strongly agreed or agreed (22, 82%) that they used the skills gained in the rotation in their ongoing work. More than 40 QI projects have been led or co-led by IHMOs since 2011. Challenges of the role included the short timeframe of the rotation and the perceived slow pace of institutional change. Respondents found engaging other junior doctors with QI and understanding the hospital's organisational structure to be barriers. Conclusions: The full engagement of junior doctors in QI upholds a healthcare culture that celebrates innovation and promotes patient safety. The IHMO rotation offers an immersive, experiential and impactful way to do so. What is known about the topic? The importance of engaging junior doctors in quality improvement initiatives is well recognised. What does this paper add? Introduces and evaluates the Improvement House Medical Officer position at a large tertiary hospital. What are the implications for practitioners? Other health services may be inspired to implement quality improvement programs for the benefit of their health service, patients and junior doctors. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: ●Expert by Experience participation in mental health services is embedded in mental health policy in many countries. The negative attitudes of nurses and other health professionals to consumer participation poses a significant obstacle to this policy goal.●Involving mental health Experts by Experience in the education of nursing students demonstrates positive attitudinal change. What the paper adds to existing knowledge: ●The paper presents perspectives from Experts by Experience about the unique knowledge and expertise they derive from their lived experience of mental distress and mental health service use. As a result, they can make a unique and essential contribution to mental health nursing education. They utilize this knowledge to create an interactive learning environment and encourage critical thinking.●The international focus of this research enriches understandings about how Experts by Experience might be perceived in a broader range of countries. What are the implications for practice: ●Mental health policy articulates the importance of service user involvement in all aspects of mental health service delivery. This goal will not be fully achieved without nurses having positive attitudes towards experts by experience as colleagues.●Positive attitudes are more likely to develop when nurses understand and value the contribution experts by experience bring by virtue of their unique knowledge and expertise. This paper provides some important insights to achieving this end. Introduction: Embedding lived experience in mental health nursing education is increasing, with research findings suggesting the impact is positive. To date, research has primarily targeted the perspectives of nursing students and academics from the health professions. Aim: To enhance understanding of the unique knowledge and expertise experts by experience contribute to mental health nursing education. Methods: Qualitative exploratory research methods were employed. In‐depth individual interviews were conducted with experts by experience who delivered a coproduced learning module to nursing students in Europe and Australia. Results: Participants described their unique and essential contribution to mental health nursing education under four main themes: critical thinking, beyond textbooks; interactive and open communication; understanding personal recovery; and mental health is health. Conclusions: These findings present an understanding of the unique knowledge and expertise Experts by Experience contribute to mental health education not previously addressed in the literature. Appreciating and respecting this, unique contribute is necessary as Expert by Experience contributions continue to develop. Implications for Practice: Mental health services purport to value service user involvement. Identifying and respecting and valuing the unique contribution they bring to services is essential. Without this understanding, tokenistic involvement may become a major barrier. [ABSTRACT FROM AUTHOR]

Although health services in Australia have an aim to provide inclusive care for their patients/clients, this study highlights how barriers to care can lie at the centre of patient-provider interactions. Racial microaggression is a subtle form of racism that can occur in health settings, leading to further exclusion for First Nations Australians, immigrants and refugees. This paper is guided by Derrida's approach to deconstructionism by unpacking how language is used by health professionals – as holders of organisational power – and how they construct 'truths' or discourses about clients that historically have been marginalised by health services and system. Data comprise 21 interviews with staff from two rural health services. It identified three racial microaggressions were used to justify the challenges of providing care to people from First Nations, immigrant and refugee backgrounds: (1) Participants problematised culture(s) of service users; (2) participants implied cultural superiority in their conceptualisation of 'other' cultures; and (3) participants shared stories of inactions, discomfort and relegating of responsibility. The findings identified these discourses as forms of racial microaggression that can potentially lead to further exclusion of people seeking services and support. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to describe nurses' and midwives' experiences following the first phase of the implementation of an electronic medical record (EMR) system at a large public health service in metropolitan Melbourne, Australia. Methods: Four focus groups were held 8–10 months after implementation of the EMR. Transcripts were analysed using thematic analysis. Results: Of 39 participants, 25 were nurses (64%), 12 were midwives (31%) and two did not provide this information. The mean (±s.d.) duration of clinical experience was 15.6 ± 12.2 years (range 2–40 years). Three main themes were identified: (1) effects on workflow: although some participants reported that EMR facilitated easier access to real-time patient data, others indicated that workflow was disrupted by the EMR being slow and difficult to navigate, system outages and lack of interoperability between the EMR and other systems; (2) effects on patient care and communication: some participants reported that the EMR improved their communication with patients and reduced medication errors, whereas others reported a negative effect on patient care and communication; and (3) negative effects of the EMR on nurses' and midwives' personal well-being, including frustration, stress and exhaustion. These experiences were often reported in the context of cognitive workload due to having to use multiple systems simultaneously or extra work associated with EMR outages. Conclusion: Nurses' and midwives' experiences of the EMR were complex and mixed. Nurses and midwives require significant training and ongoing technical support in the first 12 months after implementation of an EMR system. Including nurses and midwives in the design and refinement of the EMR will ensure that the EMR aligns with their workflow. What is known about the topic?: Studies reporting nurses' and midwives' experiences of using EMR are scarce and mostly based in countries where whole-of-service implementations are carried out, funded by governments. What does this paper add?: Nurses and midwives perceive benefits of using an EMR relatively soon after implementation in terms of their workflow and patient care. However, in the first year after EMR implementation, nurses and midwives experience some negative effects on workflow, patient care and their own well-being. The effects on clinical workflow are further compounded by EMR downtime (scheduled and unscheduled) and hybrid systems that require users to access other technology systems alongside the EMR. What are the implications for practitioners?: In countries like Australia, whole-of-service, simultaneous implementation of EMR systems using best-available server technology may not be possible due to funding constraints. In these circumstances, nurses and midwives may initially experience increased workload and frustration. Ongoing training and technical support should be provided to nurses and midwives for several months following implementation. Including nurses and midwives in the design of the EMR will result in better alignment with their specific workflow, thus maximising benefits of EMR implementation. [ABSTRACT FROM AUTHOR]

Introduction: Systemic barriers impacting smoking cessation in pregnant women may include nicotine replacement therapy (NRT) access and training. Aim: Assess general practitioner (GP) and obstetrician's agreement with system-based changes to improve the management of smoking in pregnancy; compare group responses. Methods: National cross-sectional survey with two samples: (1) online survey emailed to a random sample of 500 GPs from Royal Australian College of General Practitioners (RACGP); (2) paper survey posted to 5571 GPs and obstetricians from Royal Australia and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Percentages agreeing that specified changes would improve the management of smoking in pregnancy were calculated. Pairwise comparisons used Kruskal–Wallis tests (RACGP/RANZCOG GPs/obstetricians). Results: N = 378 participated. Response rates 8.4% (N = 42; online survey) and 6% (N = 335; paper survey), respectively. Total percentages agreeing with system-based changes: 79% training, 64% oral NRT subsidy, 62% Medicare item for smoking cessation, 54% improved access to NRT patches. Within RANZCOG, more GPs (73.1%) agreed that oral NRT should be subsidised (P = 0.001) than obstetricians (53.7%). Conclusion: GPs and obstetricians agreed that system changes would improve their management of smoking in pregnancy. Oral NRT subsidy was the only pairwise group difference. Subsequently, oral NRT has been subsidised; in time, this may influence prescribing and quit rates. [ABSTRACT FROM AUTHOR]

The article emphasizes the need to consider the potential harm of testing and interventions. It presents two papers that challenge the traditional view that testing and interventions are always helpful. It is reported that the first paper shows that early aggressive intravenous hydration in patients with mild acute pancreatitis causes increased fluid overload while the second paper shows that prophylactic fluid bolus given during intubation of critically ill adults did not prevent hypotension.

To investigate determinants of willingness to adopt telerehabilitation, willingness of technology use, core affect regarding using telerehabilitation, and digital competencies in rehabilitation professionals in Austria and Germany before and during the COVID-19 pandemic. A cross-sectional paper-based and online survey was conducted before and during COVID-19, respectively, with three cohorts of rehabilitation professionals. Outcomes were the willingness to adopt telerehabilitation evaluated using the extended Unified Theory of Acceptance and Use of Technology; willingness of technology use using the short scale for assessing the willingness of technology use; digital competencies and core affect using the Digital Competence Framework and semantic differential, respectively. Multivariate ordinal regression analysis was performed to determine predictors. Included were 603 rehabilitation professionals. Analysis revealed differences between Austria and Germany and before and during the pandemic for most outcomes. German residency, the pandemic, and a higher educational level were most important predictors of higher willingness to adopt telerehabilitation, willingness of technology use, digital competencies, and positive core affect. The pandemic increased most aspects of willingness to adopt telerehabilitation, willingness of technology use, digital competencies, and positive core affect. Results confirm that rehabilitation professionals with higher degrees are more prone to adopt innovations in healthcare.Registration: German Clinical Trials Register (DRKS00021464) The willingness to adopt telerehabilitation is associated with external factors increasing the need for alternative rehabilitation delivery, such as COVID-19, and with financial facilitators, such as reimbursement. As the willingness to adopt telerehabilitation is higher among speech and language therapists and dietitians, efforts are necessary to enhance its use in physiotherapists and occupational therapists. As a higher willingness to adopt telerehabilitation was observed in younger rehabilitation professionals and those with higher education, increasing the importance of telerehabilitation in education curricula and further knowledge transfer into practice for those already working in the field seems necessary. [ABSTRACT FROM AUTHOR]

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 review aims to identify healthcare providers' (HCPs) experiences with issues related to the quality use of medicines among culturally and linguistically diverse (CALD) patients, the underlying factors, and the enablers of and barriers to providing culturally safe care to promote quality use of medicines. The searched databases were Scopus, Web of Science, Academic search complete, CINHAL-Plus, Google Scholar and PubMed/Medline. The initial search returned 643 articles, of which 14 papers were included. HCPs reported that CALD patients were more likely to face challenges in accessing treatment and sufficient information about treatment. According to the theoretical domains framework, determinants such as social influences due to cultural and religious factors, lack of appropriate resources about health information and cultural needs, lack of physical and psychological capabilities such as lack of knowledge and skills, and lack of motivation could impede HCPs' abilities to provide culturally safe care. Future interventions should deploy multilevel interventions, such as education, training, and organisation structural reforms. [ABSTRACT FROM AUTHOR]

Objectives: Hospital in the Home models are rapidly expanding in response to increasing bed pressures. This study examined patient and multidisciplinary health professional perceptions of a new geriatric evaluation and management and rehabilitation hospital in the home service in Australia. The service was unique, as adults of all ages with a variety of rehabilitation or geriatric evaluation and management needs were within scope. Methods: A qualitative descriptive approach was used with a consumer co-researcher and a consumer advisor being integral to decision-making. Patient feedback was collected via a paper-based patient satisfaction survey between August 2020 and February 2022. Additionally, interviews with current and past staff were conducted from July to November 2021. Reflexive thematic analysis was conducted for qualitative data and descriptive statistics used for quantitative data. Results: Patient surveys were analysed (n = 199, 42.2% response rate) with 60.8% of participants aged 75 years or over and 26.6% speaking a language other than English. High satisfaction was expressed. Feelings of comfort, familiarity, convenience, and reassurance were voiced. A person-centred approach enhanced involvement in care. Challenges included carer burden and clear communication. Sixteen staff (33% response rate) were interviewed. In general, staff said the service was inclusive and responsive, and the home environment beneficial, particularly for patients from culturally diverse backgrounds. A strong hospital partnership and comprehensive multidisciplinary approach were vital. Challenges included fragmentation due to part-time roles and combining with a pre-existing acute hospital in the home service. Conclusions: This qualitative exploration of staff and patients' perceptions of a geriatrician-led, multidisciplinary geriatric evaluation and management and rehabilitation hospital in the home service demonstrated that it was person-centred and optimised patients' control and ownership of care. The inclusive service parameters ensured responsiveness to diverse needs whilst allowing earlier return home from hospital, both of which are vital for quality patient care. [ABSTRACT FROM AUTHOR]

This paper considers the role of academic training programs in the integration of family therapy and infant mental health (IMH) curricula. It takes the form of a conversation between senior academic staff of the Bouverie Centre in Australia and the special issue editors. Robyn Elliott and Colleen Cousins are family therapists, trauma specialists, and academics at the Bouverie Centre, La Trobe University. Robyn supervises the development and delivery of the Master of Clinical Family Therapy, accredited by the Australian Association of Family Therapy. Colleen is a psychologist and family therapist and coordinates the Graduate Certificate of Family Therapy program. They are in dialogue here with the special issue co‐editors, Jessica Opie and Jennifer McIntosh. We consider the degree to which current family therapy training holds the infant in mind, and approaches to deepening the future training nexus between IMH and family therapy. [ABSTRACT FROM AUTHOR]

Translation of evidence into practice in healthcare is challenging, particularly with new innovations. Indocyanine Green (ICG) lymphography is a novel innovation where the superficial lymphatics are imaged to provide information about lymphoedema diagnosis and to guide individualised therapy for a person's long‐term chronic management of lymphoedema, supporting care across the continuum to the community setting. Despite the unique information ICG lymphography provides, the technology itself is complex and highly specialised and currently has limited adoption in clinical practice. This paper sought to determine the barriers and enablers to establishing an ICG lymphography clinic within an outpatient lymphoedema service by exploring staff perceptions and experiences. An interpretive descriptive design was used with semi‐structured interviews of key staff participants from a quaternary public hospital six months after ICG lymphography clinic establishment. An interview guide was developed, underpinned by the Consolidated Framework for Implementation Research (CFIR), to guide the inquiry. Interview data were transcribed, inductively coded and analysed to identify themes. All eligible management, clinical and ancillary staff were included (N = 8). Four key themes were identified from the data as essential to implementation success. These were support is critical for implementation; beliefs about the technology; practicalities are achievable; and sustainability for ongoing success. Themes were found to be interrelated and centred around support from staff and the organisation as a critical process facilitator. The study demonstrated an ICG lymphography clinic can be successfully established as part of an outpatient lymphoedema service. Key enablers related to positive staff attitudes and beliefs about ICG lymphography and its application. Future implementation sites may consider that although the complexity of this innovation creates process challenges, the use of an implementation framework can assist in identifying determinants of success for effective implementation to practice. [ABSTRACT FROM AUTHOR]

Objectives: This pilot study aimed to explore the perceived benefits of a new children's sensory garden in a healthcare centre in south-eastern Melbourne that provides specialised care, support and guidance to parents. Methods: A mixed-method research design was employed in this study comprising a combination of quantitative (surveys) and qualitative (interviews) data collection methods. A total of 19 staff and 36 parents completed surveys relating to their experiences in the new garden. Results: The staff members and parents surveyed were found to use the new children's garden on a regular basis and suggested that the new garden provided them with an opportunity to escape and feel calmer and had positively impacted on their interactions with their child. Interviews were also undertaken with four staff members who indicated that they believe the new garden is affording them perceived personal wellbeing benefits and that the activities in the new garden led to better perceived outcomes for families. Conclusion: The perceived benefits reported provide support for the development of sensory gardens at other similar healthcare facilities. What is known about the topic? The restorative benefits of gardens and other natural features are well known. What does this paper add? Pilot study findings as to whether there are any perceived benefits of accessing a children's sensory garden in a healthcare setting. What are the implications for practitioners? The inclusion of children's gardens could be considered at healthcare facilities to promote wellbeing of staff, patients and visitors. [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]

Background: The COVID-19 pandemic has had widespread impacts on the community and has demanded a rapid response from the aged care sector. System changes for infection control have been required including the use of personal protective equipment, lockdowns, visitor restrictions and changes to activities within aged care facilities. Even prior to COVID-19, the high physical and emotional demands of aged care work were recognised. Objective: This study sought to understand aged care workers' experiences of the COVID-19 pandemic. Methods: Using a pragmatic paradigm qualitative data about work experiences during COVID-19 was collected from people employed in different aged care organisations in a range of aged care roles and settings from multiple Australian states. Data was collected using focus groups and interviews conducted online between August-October 2020. Inductive thematic analysis was used to identify key themes in the data. results: Participants included 15 people working across a range of aged care roles including clinical, care and management staff and across both residential and community settings. Five themes were identified which characterised aged care workers thoughts about their jobs during the pandemic. These included intensified procedures and emotional demands, feeling undervalued and detached from the frontline, exposure of existing system deficiencies, recognising teamwork and increased confidence in technology. conclusion: Reflecting on aged care workers' experiences of COVID-19 highlights the need to better support workers and acknowledge their important role in caring for older Australians. This includes at an organisational level by providing supportive environments and access to online resources as well as at the community and policy level by recognising aged care workers as frontline workers. The COVID-19 pandemic has also highlighted existing systemic issues in the aged care sector that need to be addressed for the provision of quality aged care in Australia during the COVID-19 pandemic and into the future. What is already known about the topic? * While the COVID-19 pandemic is affecting the global community, it is disproportionately impacting the aged care sector with higher rates of severe illness and death and wide-ranging system changes to prevent and control the spread of the virus. * Prior to COVID-19, aged care work was associated with high job demands and lack of access to resources to support aged care workers in their role. * Survey data on the Australian RACF workforce found workers felt prepared for the pandemic with a wide range of measures to control the spread of COVID-19 but they faced several challenges associated with their additional roles and restrictions. What this paper adds * This paper provides qualitative and descriptive insights into the challenges experienced by the Australian aged care workforce during COVID-19 including increased workloads and intensified emotional demands of their roles while at the same time feeling undervalued by the wider community. * This study has highlighted the need to better support and acknowledge aged care workers in the community through their portrayal in the media and within their organisations by facilitating supportive team environments and providing access to online resources and training. * This paper discusses existing systemic issues that have been highlighted by COVID-19 and the Royal Commission into Aged Care Quality and Safety and need to be addressed for the wellbeing of workers and the provision of quality aged care. [ABSTRACT FROM AUTHOR]

Background: The involvement of speech and language therapists (SLTs) within paediatric palliative care (PPC) settings has been recognized within the extant literature. However, there is little understanding of SLT's specific roles and practices when working with this vulnerable cohort of children and their families. As part of a larger body of work to develop consensus‐based recommendations for SLTs working in PPC, it is important to investigate demographic and caseload characteristics. Aims: This exploratory study aimed to gather previously undocumented international demographic data pertaining to SLT service provision, caseload and training in PPC. Additionally, it sought to ascertain the current treatment and assessment approaches of SLTs, and if variations exist in beliefs and practices. Methods & Procedures: An anonymous cross‐sectional survey was designed and reported according to the Checklist for Reporting Results of Internet E‐Surveys (CHERRIES). The online survey consisted of 40 items spanning four domains: (1) demographic information, (2) caseload information, (3) service provision and (4) training and education. SLTs from Australia, Canada, New Zealand, the UK, Ireland and the United States were recruited using a purposive snowball sampling approach. Descriptive analysis of closed‐ended survey responses and content analysis of open‐ended responses are presented. Outcomes & Results: A total of 52 respondents completed the survey. SLTs worked in a variety of PPC settings, with patients of varying age and disease groups. Over 50% of participants reported working in PPC for ≤ 4 years. Genetic disorders (34%), oncology (27%) and neurological conditions (21%) made up a significant portion of respondents' caseloads. Reported treatments and assessment approaches used by SLTs are not unique to a PPC population. Barriers and enablers for practice were identified. A portion of participants did not feel trained and prepared to assess (19.2%) or treat (15.4%) PPC clients. Conclusions & Implications: This study confirms that SLTs internationally have a role in the management of communication and swallowing impairments in a PPC context. However, whether current training and resources adequately support SLTs in this role remains questionable. This paper helps to provide SLTs, administrators, professional associations and tertiary institutions with foundational data to help inform workforce planning, advocacy efforts and training priorities. What this paper addsWhat is already known on the subjectThe published multidisciplinary literature has identified that SLTs have a role in PPC. However, there has been no targeted research investigating the professional characteristics of clinicians in this context, nor any detailed information regarding associated clinician beliefs or management approaches.What this paper adds to existing knowledgeThis study is a snapshot of attributes, practice patterns and beliefs of SLTs who work with a PPC population. It highlights SLT perspectives of education and training, as well as meta‐perceptions of themselves within the multidisciplinary team.What are the potential or actual clinical implications of this work?Data presented in this paper will help to enable SLTs, organizations and associations to augment service provision and determine future professional development priorities within the field of PPC. [ABSTRACT FROM AUTHOR]

Young people with severe and complex depression experience substantial social connectedness difficulties. The aim of this qualitative study was to evaluate the role of social connectedness in a novel group therapy (Relate) for youth living with severe and complex depression from clinicians' perspectives. Semi-structured interviews were conducted with 11 clinicians practicing at Orygen's Youth Mood Clinic in Melbourne. Eight of the 11 clinicians were female, with the sample aged 30–42 years (M = 34 years, SD = 3.6 years) and having an average 4.5 years clinical experience at Orygen. Four key themes were identified by codebook thematic analysis. The first theme pertained to clients' difficulties with social engagement, which impacted their attendance of Relate, but were addressed by the intervention. In the second theme, clinicians identified Relate as providing a safe space. In the third theme, clinicians identified opportunities for positive relational experiences. In the fourth theme, clinicians observed social and clinical improvements in Relate clients, but marked recovery did not always occur after attending. Findings provide initial support for the continuation of Relate. Recommendations for future iterations of Relate include refining the intake criteria for referring clients to Relate and potentially lengthening the program's duration. What is already known about this topic: Group interpersonal therapy is an effective intervention for depression and interpersonal functioning in young people. Few studies have evaluated treatments for young people with severe and complex depression and high suicide risk. Few studies have evaluated group programs within early intervention services. What this paper adds: A relationally-focussed group therapy could improve social connectedness and interpersonal functioning for youth living with severe and complex depression. The Relate group emphasises a safe environment for sharing and social risk-taking, providing opportunities for positive relational experiences with similar others which might be particularly useful for youth with complex social difficulties. Identified issues with engagement suggest clients could benefit from an explicit rationale for how their participation in the group benefits their depression treatment. [ABSTRACT FROM AUTHOR]

Introduction: Although various studies have examined availability, access barriers and patient experiences of rural health services for the ageing population, no synthesis of this literature exists in Australia. Objective: The objective of this study was to examine the current literature surrounding rural service provision and to evaluate the barriers to access for older individuals and to recognise gaps in the literature. Design: A systematic scoping review of peer‐reviewed literature from three online databases (PUBMED, SCOPUS and Web of Science). Findings: Thirty‐two papers were included in analysis. The most prominent types of health service discussed were residential aged care (n = 12) and community health care (n = 10). More studies explored the perspectives of health personnel than the service end users. Qualitative synthesis revealed three themes associated with health service and rural ageing: access to services, health workforce experiences and end user experiences. Discussion: Access to health services for the elderly population is a complex issue. Promoting positive experiences for both health providers and patients is critical to assisting in healthy ageing for people living in rural and remote areas. This requires intervention on a social and institutional level. Key research gaps in the literature include the effectiveness of an integrated approach to institutional interventions, utilisation of preventative measures such as screening programs for cancer and greater identification of the health needs and perceptions among culturally diverse elderly residents. These studies are critical to promote appropriate and patient‐centred care for elderly populations in rural and remote areas. Conclusion: The review highlights the need to address availability, retention and service innovations across health services to improve access to care and health outcomes of rural elderly residents. [ABSTRACT FROM AUTHOR]

Objectives: The study investigated how senior residential aged care staff perceived the purpose, function, impact and challenges of implementing a new role in their organisation for an unregistered care worker with a Bachelor of Dementia Care: the Dementia Care Support Worker. The role was piloted over two years in an Australian organisation with three aged care facilities to examine its potential to address gaps in service provision for people with dementia. Background: The residential aged care workforce is under pressure to care for residents with increasingly complex health conditions and where most care is provided by care workers. Presently no formal leadership role exists for care workers with specialised dementia knowledge in the aged care setting. Study design and methods: A qualitative descriptive approach was taken to explore senior staff members' perceptions of the role at two time points. Twenty-three semi-structured interviews held in July-August 2017 (n = 12), soon after role commencement, and in February-March 2019 (n = 11) were thematically analysed. Results: Three themes reflected senior staff members' expectations of the role: enhancing staff and management knowledge about dementia and dementia care practices; facilitating changes to improve care for residents living with dementia; and educating and supporting residents' families. Eighteen months later, participants felt the role was helping meet the need for improved care of residents with dementia, and staff understanding of dementia. They suggested communication and support structures to improve role effectiveness. Discussion: Staff were receptive to the establishment of the Dementia Care Support Worker role and felt it resulted in improvement in dementia care. Success was contingent on strong organisational support and resourcing. Conclusion: Improving dementia knowledge of care staff is an essential first step in driving care quality improvements. The Dementia Care Support Worker role for care workers has the potential to address knowledge needs and support improved care practices. Implications for research, policy, and practice: This research models how a new role might be configured for unregistered care workers with specialist dementia knowledge. Further research is needed to explore the establishment of such a role more widely in other organisations, to investigate whether it could provide a new career development pathway for care workers and improve the skills and capacity of the aged care workforce. Substantial policy changes would also be required to support role viability, such as around increased salary. Research which examines the impact of such roles on care outcomes would complement the findings. What is already known about the topic? • While dementia is common in residential aged care, knowledge of dementia is typically low among the care staff. • Consequently, care staff are not equipped to meet the complex needs of residents with dementia and their families. • New roles for unregistered care workers with specialised dementia knowledge have been proposed, but not tested. What this paper adds • This research models how a new role might be configured for care workers with specialist dementia knowledge. • Aged care facility leaders support a role for care workers with formal specialist dementia knowledge and skills, and perceive the role helps improve the quality of resident care and develop stakeholders' dementia knowledge. • Appropriate communication and support structures are required for the effective establishment of the role. [ABSTRACT FROM AUTHOR]

Aim: To explore how compassion is received by patients in a hospital setting and how compassion is expressed by health professionals in a hospital setting. Background: Compassion is important to health professionals and patients. Perceived deficits in compassion in healthcare have led increasing concerns about the quality of care for patients. To better understand compassionate practice in a hospital setting we used narrative inquiry to explore the expression of compassion by health professionals and the experience of receiving compassion by patients. Design: Narrative Inquiry. Reported in line with Consolidated Criteria for Reporting Qualitative Research (COREQ). Methods: Qualitative interviews were conducted with 24 patients and health professionals in Australia. Data were collected between August 2018 and August 2019. Narrative analysis processes were used to develop a thematic framework. Results: Compassionate practice is presented as an overarching theme and comprises of three themes: (1) Amalgamation of various knowledges and skills (2) Delivery of meaningful actions which alleviate suffering and (3) Meeting individual needs and prevention of further preventable suffering. The expression of compassion by health professionals involved the fusion of many skills and knowledges. Patients received compassion through the actions of the health professional which alleviated their suffering. Conclusion: Compassionate practice is both important, and complex. Presence, skilled and purposeful action and the alleviation of suffering are essential to the expression and receipt of compassion in the hospital setting. Impact: Findings from this study contribute to the growing body of literature on compassionate practice in health settings, specifically in how it is expressed and received in a hospital setting. The complexity of compassion is explained for health professionals. Compassion was shown to be embedded in the caring moments between health professionals and patients. This paper explains the different elements that comprise compassion which can guide health professional practice. The importance of seemingly small acts has a big impact on patients, families and health professionals. There is a need for greater stakeholder value and recognition of this aspect of practice. [ABSTRACT FROM AUTHOR]

Prevention of chronic diseases happens within systems of action across whole communities. In local communities, organisations play important roles that influence health, but many are in non-health sectors where health or 'prevention' is not their main remit. In this paper, we explore how organisations in communities perceive their role as part of a local system of chronic disease prevention. We use interview data from 'Prevention Tracker', an investigation undertaken with Australian communities that aimed to describe how local prevention systems are organised. Four communities participated – one regional, one remote, and two urban. In each, local advisory groups identified key informants for semi-structured interviews (n = 80). We applied the Ottawa Charter for Health Promotion as a sensitising framework to categorise responses; and undertook inductive thematic analysis to generate deeper insights into organisations' orientation to prevention. While some respondents clearly recognised and articulated linkages between their organisation's activities and prevention, sometimes drawing from health promotion principles to do so, many did not and were prompted by the interview to consider their contributions. A proportion explicitly distanced themselves from prevention despite their work directly addressing the social determinants that underscore health. For some, this distancing reflects a tactical decision to reduce competition and promote partnership between organisations, and to engage clients. This study demonstrates that diverse organisations make contributions to prevention – often outside of 'core business' – whether or not the organisations themselves realise, relate to and/or self-identify as playing this role. [ABSTRACT FROM AUTHOR]

Online platforms can support health and educational professionals in their daily work; however, it is challenging to keep online platforms sustainable. This paper aims to indicate the most important factors of platform sustainability from the perspective of professionals involved in online platforms. Further, it aims to understand how these factors operate. A mixed methods study was carried out among professionals from Europe, Australia, the USA and Canada. In the first phase, the importance of 54 factors from the literature was assessed with a questionnaire among 17 professionals. The relative importance of the factors and the consensus regarding this importance were calculated using median scores and interquartile deviations. In total, 19 factors were selected representing general characteristics, characteristics related to the platform, communication, visitor and context. In the second phase, insight was gained regarding the experiences with those factors through 12 individual Skype interviews. The most frequently mentioned important factors of platform sustainability were (i) having sufficient time, resources and expertise, (ii) user friendliness and (iii) creating a sense of belonging. Platforms should use a planned approach to address a combination of factors directly from platform development. Gaining long-term resources is challenging and should be considered from the start of a project by building partnerships. To promote user friendliness, platforms should be simple, have a clear set-up and provide high-quality tools. Finally, establishing a sense of belonging could be supported by branding and face-to-face networking activities. For all aspects, involving visitors and stakeholders is essential. [ABSTRACT FROM AUTHOR]

Purpose: Telehealth is rapidly becoming an essential part of speech-language pathologists' core business, and yet the experiences and opinions of community-based therapists in using telehealth remain relatively unknown. This paper describes a recent study in which speech-language pathologists were provided with access to a formal language assessment within a telehealth platform and asked to provide feedback about their experiences. Method: Twenty-seven speech-language pathologists in paediatric practice were recruited via callouts on social media, community contacts and professional networks. The participants were provided access to a telehealth platform with a built-in formal language assessment and asked to use the assessment with their own caseload as clinically indicated and provide feedback after each assessment. Questionnaire data was collected via an online survey system and contained questions about each assessment including the most enjoyable and most difficult aspects of the assessment and their overall experience of the platform. Result: More than 100 assessments were completed during the 3-month trial, with clinicians reporting that on most occasions, video and audio quality was adequate or more than adequate, and that interactions with their child clients were effective. Qualitative data indicated that technical difficulties were a drawback to the assessments, but that ease of use of the assessment, the added functionality of using the assessment within the telehealth platform and factors including general benefits of telehealth, particularly that of being able to continue to provide services when face-to-face work was not possible were seen as positive elements. Conclusion: This study adds clinicians' voices to the research into telehealth, indicating that the assessment within the telehealth platform was generally easy to use, and provided an unexpected depth of insight and connection for clinicians and their clients. Future research may consider the voices of other stakeholders in telehealth interactions, including parents and child clients. [ABSTRACT FROM AUTHOR]

Objective: The need for more Remote Area Nurses in the Northern Territory is clear. This paper investigates the perspectives of Remote Area Nurse workforce issues among multiple stakeholders. The aim is to identify how Remote Area Nurse staffing issues are perceived by clinic managers, Remote Area Nurses themselves, Aboriginal colleagues and community members in seven remote communities in the Northern Territory. Design: This is a qualitative study that uses interviews and focus groups to identify key messages of local stakeholders about Remote Area Nurse workforce issues. A content analysis was used for data analysis. Setting: Seven diverse remote Aboriginal communities in the Northern Territory with government‐run health clinics were visited. Participants: Non‐random sampling techniques were used to target staff at the clinics at the time of field work. Staff and community members, who agreed to participate, were interviewed either individually or in groups. Interviews were conducted with 5 Managers, 29 Remote Area Nurses, 12 Aboriginal staff (some clinics did not have Aboriginal staff) and 56 community residents. Twelve focus groups were conducted with community members. Results: Content analysis revealed that participants thought having the "right" nurse was more important than having more nurses. Participants highlighted the need for Remote Area Nurses to have advanced clinical and cultural skills. While managers and, to a lesser extent, Remote Area Nurses prioritised clinical skills, Aboriginal staff and community residents prioritised cultural skills. Conclusions: Participants identified the importance of clinical and cultural skills and reiterated that getting the "right" Remote Area Nurse was more important than simply recruiting more nurses. Thus, retention strategies need to be more targeted and cultural skills prioritised in recruitment. [ABSTRACT FROM AUTHOR]

Background: Cultural competency is often promoted as a strategy to address health inequities; however, there is little evidence linking cultural competency with improved patient outcomes. This article describes the characteristics of recent educational interventions designed to improve cultural competency in healthcare workers for First Nations peoples of Australia, New Zealand, Canada and the USA. Methods: In total, 13 electronic databases and 14 websites for the period from January 2015 to May 2021 were searched. Information on the characteristics and methodological quality of included studies was extracted using standardised assessment tools. Results: Thirteen published evaluations were identified; 10 for Australian Aboriginal and Torres Strait Islander peoples. The main positive outcomes reported were improvements in health professionals' attitudes and knowledge, and improved confidence in working with First Nations patients. The methodological quality of evaluations and the reporting of methodological criteria were moderate. Conclusions: Cultural competency education programs can improve knowledge, attitudes and confidence of healthcare workers to improve the health of First Nations peoples. Providing culturally safe health care should be routine practice, particularly in places where there are concentrations of First Nations peoples, yet there is relatively little research in this area. There remains limited evidence of the effectiveness of cultural education programs alone on community or patient outcomes. Cultural competency is often promoted as a strategy to address health inequities, although evidence linking cultural competency to patient outcomes is scarce. We conducted a narrative review of the recent literature on cultural education programs and found 13 published evaluations, mainly reporting improvements in health professionals' attitudes and knowledge, and improved confidence in working with First Nations patients. Although cultural education has a positive short-term impact, none of the studies included measured improved patient health outcomes. [ABSTRACT FROM AUTHOR]