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In Australia, there are more than 46 000 children in out‐of‐home care (OOHC). Most of these children have been in OOHC for more than 2 years. Similarly, there are more than 407 000 children in the United States and over 80 800 in England who are 'looked after' with approximately one third of these children being in OOHC for more than 2 years. This paper concerns 'looked after' children's rights to contact with their birth parents. The United Nations Convention on the Rights of the Child (UNCRC) requires child protection systems to recognize the rights of children to maintain contact with their families except where this is not in the child's 'best interests'. In this paper, we report on a qualitative study conducted in Australia exploring legal and family support practitioners' perceptions of barriers to contact between children in OOHC and their birth parents. The thematic analysis identified four themes: These were as follows: a focus on systems driven responses; lack of cultural recognition and responsiveness; carers' disconnection from birth parents; and parents' exclusion. We discuss the implications of these findings for understanding and recognizing children's right to contact with birth parents. [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: Facilitators to implement shared cancer follow‐up care into clinical practice include mechanisms to allow the oncologist to continue overseeing the care of their patient, two‐way information sharing and clear follow‐up protocols for general practitioners (GPs). This paper aimed to evaluate patients, GPs and radiation oncologists (ROs) acceptance of a shared care intervention. Methods: Semi‐structured interviews were conducted pre‐ and post intervention with patients that were 3 years post radiotherapy treatment for breast, colorectal or prostate cancer, their RO, and their GP. Inductive and deductive thematical analysis was employed. Results: Thirty‐two participants were interviewed (19 patients, 9 GPs, and 4 ROs). Pre intervention, there was support for GPs to play a greater role in cancer follow‐up care, however, patients were concerned about the GPs cancer‐specific skills. Patients, GPs and ROs were concerned about increasing the GPs workload. Post intervention, participants were satisfied that the GPs had specific skills and that the impact on GP workload was comparable to writing a referral. However, GPs expressed concern about remuneration. GPs and ROs felt the model provided patient choice and were suitable for low‐risk, stable patients around 2–3 years post treatment. Patients emphasised that they trusted their RO to advise them on the most appropriate follow‐up model suited to their individual situation. The overall acceptance of shared care depended on successful health technology to connect the GP and RO. There were no differences in patient acceptance between rural, regional, and cancer types. ROs presented differences in acceptance for the different cancer types, with breast cancer strongly supported. Conclusion: Patients, GPs and ROs felt this shared cancer follow‐up model of care was acceptable, but only if the RO remained directly involved and the health technology worked. There is a need to review funding and advocate for health technology advances to support integration. Patient or Public Contribution: Patients treated with curative radiotherapy for breast, colorectal and prostate cancer, their RO and their GPs were actively involved in this study by giving their consent to be interviewed. [ABSTRACT FROM AUTHOR]

Background: Early childhood teachers (ECTs) play a significant role in equipping children with oral language and emergent literacy skills ahead of school entry. They are well positioned to play a vital role in ensuring preschool children receive a high‐quality preschool curriculum to prepare them for later literacy learning. Aims: The purpose of this study was to explore early career ECTs' views and confidence regarding their role in providing preschoolers with oral language and emergent literacy support and to examine their perceptions of their preservice preparation. Methods & Procedures: Nine Australian early career ECTs were recruited via purposive sampling for an in‐depth, semi‐structured interview. Data were analysed using an inductive thematic analysis approach. Outcomes & Results: Participants attached strong significance to their role in facilitating children's oral language growth and emergent literacy skills and reported a range of practices to support children's learning. However, they rarely referred to using established language facilitation strategies or using dialogic book reading prompts. Further, emergent literacy concepts such as phonological awareness and print awareness were not routinely described as features of participants' classroom activities. Participants did not consistently make a clear conceptual distinction between the constructs of oral language and emergent literacy and often used these terms interchangeably. Notably, participants indicated that they did not feel confident in their ability to identify preschool children who were not meeting developmental language milestones and reported that they felt poorly equipped to do so by their preservice training. Conclusions & Implications: ECTs' strong willingness to support preschool children's oral language and emergent literacy skills may be hindered by gaps in their knowledge; these may contribute to important and missed opportunities for identifying and supporting preschoolers' oral language and emergent literacy growth. What this paper adds: What is already known on this subject?: High‐quality learning experiences in preschool are important for maximising preschoolers' oral language and emergent literacy growth. Early childhood teachers can play an important role in facilitating this development and preparing children for later literacy learning. What this paper adds to existing knowledge?: The study findings provide insight into ECTs' perceptions of their role and support in developing children's oral language and emergent literacy skills. The results indicated ECTs did not feel confident with their knowledge of children's language milestones or identifying children with language difficulties. Participants reported that their preservice training left them underprepared in the area of oral language. What are the potential or actual clinical implications of this work?: ECTs demonstrated a strong willingness to support preschoolers' oral language and emergent literacy skills. However, their self‐reported knowledge gaps and low confidence may have implications for the early detection of children who are not reaching language developmental milestones in a timely way. [ABSTRACT FROM AUTHOR]

Objective: To explore the benefits and challenges of electronic prescribing (e‐prescribing) for general practitioners (GPs) and pharmacists in regional New South Wales (NSW). Methods: This qualitative study utilised semistructured interviews conducted virtually or in‐person between July and September 2021. Setting and Participants: General practitioners and pharmacists practising in Bathurst NSW. Main Outcomes: Self‐reported perceived and experienced benefits and challenges of e‐prescribing. Results: Two GPs and four pharmacists participated in the study. Reported benefits of e‐prescribing included improvement in the prescribing and dispensing process, patient adherence, and prescription safety and security. The increased convenience for the patients was appreciated particularly during the COVID‐19 pandemic. Challenges discussed were how the system was perceived to be unsafe and insecure, costs of messaging and updating general practice software, utilisation of new systems and patient awareness. Pharmacists reported the need for education to patients and staff to minimise the impact of inexperience with the novel technology on workflow efficacy. Conclusion: This study provided first insight and information on the perspectives of GPs and pharmacists 12 months after the implementation of e‐prescribing. Further nationwide studies are required to consolidate these findings; provide comparisons with the system's progress since conception; determine whether metropolitan and rural health care professionals share similar perspectives; and shed light on where additional government support may be required. [ABSTRACT FROM AUTHOR]

Background: Dysphagia affects over half of adults after stroke. Dysphagia rehabilitation aims to improve swallowing and reduce negative outcomes for these adults. However, significant variability exists in dysphagia rehabilitation. Research is needed to explore the underlying clinician‐specific and workplace factors that contribute to variability in dysphagia rehabilitation after stroke. Aim: To explore factors influencing speech pathology practice in dysphagia rehabilitation after stroke. Methods & Procedures: We used a phenomenological approach with an interpretivist perspective. Twenty speech pathologists working in dysphagia rehabilitation participated from different workplace settings around Australia. Five semi‐structured focus groups were conducted online. Data were inductively analysed using thematic analysis with a coding reliability method. Outcomes & Results: Four themes were discussed within focus groups: (1) relationship between experienced and less experienced clinicians: 'Following what other people have done', (2) need for collaborative learning: 'A safe space to share and train', (3) variation between settings impacts on continuity of care: 'There's a difference between community and acute', and (4) working effectively with multidisciplinary teams (MDT): 'An MDT which can listen to the voice of speech pathology'. Conclusions & Implications: Relationships between senior and junior speech pathologists, within speech pathology and MDT, and across inpatient and community settings influenced speech pathology practice. Flattened hierarchies in speech pathology, collaborative learning in workplaces, mutual respect within teams and connection across inpatient and community settings could improve the quality and consistency of dysphagia rehabilitation after stroke. WHAT THIS PAPER ADDS: What is already known on this subject: Dysphagia rehabilitation can improve swallowing after a stroke. However, dysphagia rehabilitation is characterised by variability in clinical practice. Clinician‐specific and workplace factors influence clinical practice and may contribute to variability in dysphagia rehabilitation. What this study adds: Professional relationships influence speech pathologists' clinical practice, including relationships between senior and junior clinicians, between inpatient and community settings and with peers and multidisciplinary teams. Workplace norms and hierarchies, poor continuity of care between settings and competing priorities from other disciplines can hinder dysphagia rehabilitation. However, collaborative learning, positive workplace cultures and respectful transdisciplinary care can improve the quality and consistency of clinical practice. What are the clinical implications of this work?: Flattening hierarchies in the workplace can foster a safe learning space. Further, questioning workplace norms and seeking out peer learning within and across settings can build clinical skills and confidence. Developing positive workplace cultures that support continuous development may be key for empowering speech pathologists to provide high‐quality and consistent dysphagia rehabilitation. [ABSTRACT FROM AUTHOR]

Introduction: Occupational therapists recommending home modifications in Australia are often required by funding bodies to consider 'value' and 'value for money' (VFM); however, clear guidance on how to define and apply these concepts is not always provided. This paper reports on a qualitative study examining how the concepts of value and VFM are currently understood and operationalised by occupational therapists in Australian home modification practice, with the aim of positively contributing to both policy and practice in this area. Methods: The study utilised constructivist grounded theory to collect and analyse qualitative data from 20 occupational therapists who were currently working across Australia and had professional experience in home modifications. Findings: The grounded theory that was derived from the analysis highlights the unique position that occupational therapists occupy in home modification work as they strive to align the values of different stakeholders to create solutions that all consider to be valuable. In the absence of consistent frameworks or methods for determining value and VFM, evidence also emerged of occupational therapists using a range of individual approaches such as using formal and informal care as metrics, cheapest option approaches, and comparative costing. Conclusion: In addition to a clear need for consistent and transparent approaches to understanding and operationalising VFM in home modifications, there is also a need for further investigation into the value systems that underpin this work. A conceptualisation of occupational therapists as street‐level policy agents has proven useful here as it highlights the position occupational therapists occupy, enacting, making, and, at times, challenging policy in day‐to‐day practice as they work to align the values of the various stakeholders. [ABSTRACT FROM AUTHOR]

Child abuse and neglect is a complex problem that needs to be addressed through a multidisciplinary approach. Nurses internationally have frequent contact with children and are ideally placed to respond to children experiencing abuse and neglect. Nurses' roles can include reporting abuse to child protection services (CPS). This paper reports on one aspect of the findings of a qualitative study exploring Australian nurses' perceptions and experiences of keeping children safe from abuse. Specifically, this paper reports on the theme relating to nurses' experiences of communicating their concerns to CPS and the family when reporting abuse and neglect. This qualitative study was underpinned by social constructionism, with data collected through semi‐structured interviews with 21 nurses working with children in Australia. Key findings reported are: (1) being heard; (2) [feeling] disappointed, discouraged and disenfranchised; and (3) managing tensions between engagement and reporting. Nurses at times perceived that they were not taken seriously by CPS and felt powerless to enact change for children. Nurses subsequently had to decide how, and if, to discuss their report with families to mitigate negative reactions and maintain engagement. This study highlights the need for more effective multidisciplinary collaboration between nurses and CPS to promote change for children affected by abuse in Australia. 'This paper reports on... nurses' experiences of communicating their concerns to CPS and the family' Key Practitioner Messages: Nurses often perceived that they were not taken seriously by CPS and felt powerless to make a difference for children.Nurses experienced a tension between openly discussing their intention to report with families and minimising negative reactions such as disengagement and mistrust.This study highlights the need for greater collaboration between CPS and nurses to promote shared understanding and effective action to promote the wellbeing of children experiencing abuse and neglect. [ABSTRACT FROM AUTHOR]

Introduction: Current strategies to address shortages of rural doctors focus on developing a pipeline for rural generalist practice. Limited research has explored how doctors' professional journey engenders the skills required to practice rurally. Objective: This paper analyses how rural general practitioners' clinical pathway informs their scope of practice and future retention. Design: Qualitative thematic analysis using semi‐structured telephone interviews. Twenty‐one general practitioners appointed in their local health district of Murrumbidgee and Southern New South Wales, Australia, within the past 10 years. Participants comprised 10 Australian medical graduates (AMG) and 11 international medical graduates (IMG). Findings: AMGs and IMGs contrasted how their pathway into rural practice, and capacity to work rurally, informed their scope of practice. Australian medical graduates' familiarity with rural areas was consolidated through congruous experiences, including at rural clinical schools. Paradoxically, the fluency of their training limited the amount of unsupervised experience and confidence AMGs gained. Together with a focus on work‐life balance, this limited many to providing mainstream general practice, precluding extending their scope of practice. International medical graduates described disseminated experiences, often unsupervised in high‐volume contexts. However, a lack of professional opportunities prevented them from extending their scope of practice. Discussion: IMG and AMG motivation and pathway for working rurally differ. Respective cohorts have concerns regarding requisite skills and knowledge for rural practice, which incorporates opportunity and recognition. Entry points for training should be variable to allow consideration of life stage, prior skill development and extension of scope of practice. Conclusion: Doctors' scope of practice is informed by their pathways into rural practice. Australian medical graduates may not gain adequate competence during expedited training programs to confidently undertake extended clinical activities. International medical graduates, however lacked the opportunities and support, to utilise their expertise in rural practice. Complementarily utilising the expertise and commitment of both AMGs and IMGs may synergistically address workforce shortages. [ABSTRACT FROM AUTHOR]

Aim: Globally, type 2 diabetes care is often fragmented and still organised in a provider‐centred way, resulting in suboptimal care for many individuals. As healthcare systems seek to implement digital care innovations, it is timely to reassess stakeholders' priorities to guide the redesign of diabetes care. This study aimed to identify the needs and wishes of people with type 2 diabetes, and specialist and primary care teams regarding optimal diabetes care to explore how to better support people with diabetes in a metropolitan healthcare service in Australia. Methods: Our project was guided by a Participatory Design approach and this paper reports part of the first step, identification of needs. We conducted four focus groups and 16 interviews (November 2019–January 2020) with 17 adults with type 2 diabetes and seven specialist clinicians from a diabetes outpatient clinic in Brisbane, Australia, and seven primary care professionals from different clinics in Brisbane. Data were analysed using reflexive thematic analysis, building on the Capability, Opportunity, Motivation and Behaviour model. Results: People with diabetes expressed the wish to be equipped, supported and recognised for their efforts in a holistic way, receive personalised care at the right time and improved access to connected services. Healthcare professionals agreed and expressed their own burden regarding their challenging work. Overall, both groups desired holistic, personalised, supportive, proactive and coordinated care pathways. Conclusions: We conclude that there is an alignment of the perceived needs and wishes for improved diabetes care among key stakeholders, however, important gaps remain in the healthcare system. [ABSTRACT FROM AUTHOR]

New medicines can transform routines and priorities in clinical practice, but how do clinicians think and feel about these changes, and how does it affect their work? In Australia, the HIV prevention regimen pre‐exposure prophylaxis (PrEP) has been rapidly rolled out, transforming the sexual cultures and practices of users, but less attention has been given to the ways PrEP has reconfigured clinical practice. This paper draws on 28 qualitative semi‐structured interviews conducted between 2019 and 2020 with PrEP‐providing doctors and nurses in Australia to consider how they have affectively engaged with PrEP and put it into practice. Through a reflexive thematic analysis, we explore how clinicians adapted to PrEP, how the field of HIV prevention has been transformed, and how these developments have changed how clinicians approach patients. While the introduction of PrEP was initially received with uncertainty and shock, clinicians described PrEP as enjoyable to prescribe, and better aligned with the moral duties of sexual health consultations than existing HIV prevention strategies like condoms. Through approaching clinical work as an 'affective practice', we argue for attending not only to how new interventions change expectations and practices, but also how these changes are felt and valued by clinicians. [ABSTRACT FROM AUTHOR]

This paper presents selected findings from a research-based evaluation of a men's domestic violence intervention programme, which aims to assist men to develop alternative ways of relating to their partners, children and others. The qualitative component of this evaluation involved conducting interviews with 21 group participants after their completion of the course. These interviews investigated several issues, including participants' perceptions of their relationships with their children. The main theme underpinning all discussions of children was an expression of love, in that love for their children served as a motivation to stop using violence and to develop alternative ways of relating to all family members. The paper concludes by discussing the potential of men's relationships with their children as powerful contexts, or points of leverage, through which the impact of their violent behaviour can be realised and confronted. By realising the impact that violent behaviour can have on children's wellbeing and fathers' interpersonal relationships with them, it is argued that intervention programmes can support men to develop more appropriate ways of relating to their children, and thus safeguard children from potential long-term consequences of domestic abuse. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Messages Men attending domestic violence intervention programmes demonstrate a wide range of attitudes towards their partners and former partners, but unanimously report a desire to maintain meaningful relationships with their children., Men who have used violence in their family relationships can be challenged and motivated to change through realising the impact of their behaviour on their children's wellbeing and their father-child relationships. [ABSTRACT FROM AUTHOR]

Advance statements, advance directives, or psychiatric wills are a key component of a shift to mental healthcare that promotes autonomy and choice and aims to reduce restrictive and coercive care practices in mental health treatment settings. The use of advance statements has gained momentum to provide a means for individuals to detail clear preferences for mental health treatment. This paper uses a qualitative descriptive design to explore the experiences of clinicians (n = 15) implementing advance statements in the state of Victoria, Australia, a region that introduced advance statements as part of an overhaul of mental health legislation in 2014. The study, reported using the COREQ framework, found two key themes after analysis: experiences of advance statement training, with the availability and quality of training and training as a driver of change emerging as sub‐themes, and experiences of advance statements in practice, with participants providing narratives of the barriers and facilitators to successful advance statement implementation. We recommend that clinician and service user experiences of advance statement implementation are further explored to identify existing and emerging barriers to implementation of these tools, which are crucial to achieve autonomy and choice for individuals receiving mental healthcare. [ABSTRACT FROM AUTHOR]

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

Contemporary sociological work has emphasised that family is not static, but actively shaped by ideas of who and what makes family. Disclosure of an illness, including diagnosis of stigmatised infections such as HIV, hepatitis B virus and hepatitis C virus, can change the dynamics of family relationships. This paper draws on 61 qualitative semi‐structured interviews conducted between 2017 and 2019 with people in Australia with one or more of these blood‐borne viruses (BBVs) and their family members, to understand the experiences of serodiscordant (mixed viral status) families. Through a thematic analysis, we explore the family imaginaries that participants evoked when describing their disclosure practices in relation to (self‐defined) family members, revealing how some participants disclosed in ways that enabled them to shape their family, to maintain boundaries between self and family or to protect family from distress. Participants' accounts of disclosure to family revealed imaginaries of family as a precious web of connections to be nurtured or protected, but also as sites of ambivalent belonging and complex history. We conclude that BBV disclosure practices within families reveal important ideas about families that are imagined in response to the threat of loss, change and stigma. [ABSTRACT FROM AUTHOR]

There is currently limited information about the impact and experiences of a suicide attempt on the well‐being of a person providing care before, during, or after the attempt. Scant evidence available suggests that providing care has a profound impact on the support person or carers' own physical and psychological health; they may experience adverse health, financial, and functional outcomes, collectively described as 'caregiver burden'. This project sought to understand insights into the experience of providing care for someone who has previously attempted suicide. The larger study was designed in three phases consisting of an online survey, semi‐structured interviews, and a follow‐up survey. This paper reports the qualitative findings of the interviews which were thematically analysed. Two symbiotic themes emerged: the lived experience of caring and the impact of engagement and support from the healthcare system. The authors concluded that that the carer position is a multidimensional role involving informal agreements and situational or time‐based support. Further, awareness of this shifting relationship needs to be embedded in the provision of care by health professionals following a suicide attempt. Recommendations for enhanced health system response are proposed. [ABSTRACT FROM AUTHOR]

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

Objective: This paper reports findings from a study that sought to better understand the experiences of parents and their children with emergent mental health challenges following the parent's participation in a nurse-led therapeutic group. Design: This was an explorative qualitative study using semi-structured interviews which were then thematically analysed. Setting: Findings from this single-site study are drawn from regional Australia. Participants: Twenty parents and seven of their children aged between 13 and 24. Interventions: Family systems based therapeutic group intervention delivered to the parents of young people attending headspace. Main outcome measure: In line with qualitative research approaches, the participants lived experience was the outcome measure. Result: Three key themes were found in the data: (a) improved parent-child relationships, (b) understanding and being understood and (c) multi-generational perspectives. Conclusion: Regional and remote regions are challenged with comparatively fewer and less diverse services for youth mental health than in urban centres. Findings from this exploratory study highlight that young people can experience therapeutic gains where their parents are the recipients of the intervention. Recommendations from these findings include pursuing further research on the therapeutic gains of parental family system-based groups. [ABSTRACT FROM AUTHOR]

Nurses have an important role in preventing and responding to child abuse and neglect. This paper reports on nurses' perceptions of how organisational systems and hierarchies shaped their capacity to respond to child abuse and neglect. This is one of four key themes identified through an inductive analysis of data from a broader qualitative study that explored nurses' perceptions and experiences of keeping children safe. The study was guided by social constructionist theory, and data were collected through in‐depth interviews with nurses working with children in Australia (n = 21). Key findings showed that nurses experienced many challenges to responding to child abuse, including difficulties sharing information, fear of making mistakes and inflexible systems of care. This was underpinned by an organisational 'rule‐centred' culture of following policies at the expense of maintaining an explicit focus on children's needs. These findings demonstrate first the importance of creative and flexible thinking from individual professionals, so policies are enacted with a clear child focus. Second, they highlight the need for leadership to enact organisational and systemic cultural change that maintains a genuinely child‐centred approach. [ABSTRACT FROM AUTHOR]

Introduction: Indigenous women experience high rates of family violence‐related head injuries. At present, lived experience accounts from Indigenous women are absent, which results in incomplete understandings and inadequate responses that have detrimental impacts on them and their families. The aim of this study was to gain insight into Indigenous women's personal and family perspectives regarding violence‐related traumatic brain injury (TBI), including impacts on life, as well as decision‐making processes about healthcare access and engagement. Methods: Purposeful sampling was used to complete semi‐structured interviews with 18 Indigenous women living in regional and remote Australia who had experienced TBI from family violence. The data from these interviews were augmented by data from interviews and focus groups with 28 community members, including family members or carers of Indigenous women living with TBI from family violence. Results: Three themes were conceptualised based on the data and research aims: interweaving of the past and the present—ways women experience brain injury; factors that inform decision‐making to access healthcare; and managing everyday changes that result from TBI from family violence. Indigenous women described living with a range of symptoms following repeated head injuries including problems with memory, cognition and concentration. A range of strategies to manage long‐term symptoms of TBI were used by Indigenous women and when they did seek healthcare, Indigenous women were required to navigate a range of barriers. Conclusions: The findings identify a range of gaps in healthcare and housing supports for Indigenous women with TBI from violence, highlighting the significant investment needed to develop responsive and appropriate pathways of care in regional and remote areas. A range of suggestions are discussed including development of a specialised workforce who can provide apppropriate follow‐up support, co‐designed concussion clinics and educational resources. TBI must also be a key aspect of policy and practice for services working with Indigenous women who have experienced violence to ensure appropriate responses are provided. Public or Patient Contribution: Indigenous women shared their views and experiences of TBI from family violence as well as decision‐making about accessing healthcare and managing TBI symptoms. As such, study participants provided public contributions to the research. [ABSTRACT FROM AUTHOR]

Aim: Competency‐based Education (CBE) has underpinned the education of dietitians in Australia since the first Competency Standards (CS) were published; however, little is known about how CBE has influenced dietetic practice. The aim of this paper is to explore how a CBE framework and the CS have influenced dietetic practice in Australia since 1990. Methods: A qualitative investigation explored concepts of dietetic practice. Data analysed were original interviews previously undertaken with recent graduate dietitians during 1991 (n = 26), 1998 (n = 23) and 2007 (n = 19) and seven guided discussions with dietitians and employers (n = 28) conducted in 2014 to identify themes. The DAA Competency Standards and Accreditation Manuals/Standards since 1990 were also analysed to triangulate the interview data and to investigate how the CS were interpreted. Results and Conclusions: Themes identified from interviews included: (i) communicating for better care, (ii) scientific enquiry for effective practice, (iii) critical thinking and evidence‐based practice and (iv) professionalism, which remained core to dietetic practice over time, but leadership, advocacy, business management and entrepreneurial skills have emerged more strongly as the scope of practice has diversified. The landscape in which dietitians' practice showed increasing complexity and clear boundaries separating professional roles were disappearing. The 2015 CS and the 2017 Accreditation Standards highlighted that competency remains a shifting construct and that professional behaviours change depending on economic and political reasons in the play of power. Accreditation policy and current standards have successfully maintained a standard of dietetic practice across a diverse country but have the potential to constrain innovation. [ABSTRACT FROM AUTHOR]

Abstract: In Australia and internationally, Peer Workers are increasingly being incorporated into the mental health workforce. Underpinning this trend is the conviction that the inclusion of workers with lived experience in overcoming mental health challenges is central to transforming service delivery. Given there are few identified Australian studies into the experiences of Peer Workers, this paper reports findings from qualitative interviews conducted in a Partners In Recovery programme in one regional area in Australia. The interviews formed part of a larger mixed‐method study evaluating Peer Worker roles in the programme. Thematic analysis of interview transcripts with Peer Workers and other staff employed in the programme (n = 22) was undertaken. Central to the five themes that emerged was the concept of lived experience expertise in overcoming mental health challenges. The themes were: (i) role variance, (ii) the challenges and opportunities for Peer Worker, (iii) the processes Peer Workers employed as they attempted to shape an identify and language, (iv) the inconsistencies and challenges of employing lived experience as a defining feature of the peer worker role, and (v) the nature of trust arising from lived experience relationships. From this study, it is evident that the Peer Worker role remains underdeveloped. The difficulties experienced by Peer Workers in establishing a homogenous identity and role is not unique. The process and lack of clarity around role identity revealed from the narratives, parallels the experiences of Mental Health Nursing. [ABSTRACT FROM AUTHOR]

Aim: To explore how undergraduate nursing students are assessed on nursing numeracy and medication calculations from the perspective of Australian nurse education leaders. Design: A qualitative study. Methods: Semi‐structured interviews were conducted with 17 nurse education leaders between November 2022 and January 2023. Braun and Clarke's six phases of thematic analysis were used to analyse the data. Results: Five key themes were identified: (i) high expectations to keep the public safe, (ii) diverse assessment formats, (iii) different ways of managing assessment integrity, (iv) assessment conditions incongruent to the clinical setting and (v) supporting struggling students. Conclusion: Nurse education leaders set high standards requiring students to achieve 100% in numeracy and medication calculation assessments, thus maintaining the reputation of nursing and patient safety. However, students struggled to meet this expectation. Diverse assessment formats were implemented, with some examination conditions contrary to clinical practice. Currently, there is no benchmark or independent point of registration examination in Australia, hence the problem is each university had a different standard to judge students' competence. Gaining insight into how these assessments are conducted provides an opportunity to work towards an evidence‐based model or benchmark for the assessment of numeracy. Implications for the Profession: Dosage errors in clinical practice threaten patient safety and the reputation of the nursing profession. The accuracy rate of calculations by undergraduate and registered nurses is deficient worldwide. This research highlights a major educational issue, that being the wide variation in how numeracy assessments are conducted with no clear pedagogical rationale for a standardised method. Such assessments would establish a national standard, contributing to quality assurance, the development of the nursing profession and improve patient safety. [ABSTRACT FROM AUTHOR]

Introduction: Globally, there is an increasing demand for quality medical rehabilitation services. This is the first article of a two‐part series showing the findings from the Rehabilitation Choices study in which the main aim was to understand the current landscape of decision‐making, enablers and barriers to access appropriate rehabilitation services in the Australian setting. In Part 1, these insights were sought from a healthcare professionals' perspective. Methods: This was an exploratory, qualitative study, using semi‐structured interviews with a discussion guide that was codesigned together with rehabilitation clinicians and rehabilitation researchers. Themes and sub‐themes were identified using an inductive approach. Results: We interviewed a heterogeneous group of 31 professionals who are involved in making referral decisions about rehabilitation or who design and deliver rehabilitation programs, including specialist rehabilitation physicians and other medical doctors across in‐patient, outpatient, and primary care settings, allied health professionals, rehabilitation service managers, nurses, multicultural health liaison officers and rehabilitation research scientists. Three key themes relevant to barriers and enablers to service access were identified from the data: defining rehabilitation; a lack of timely access to patient and rehabilitation service data; and patient diversity not expected by the system. Conclusions: Healthcare professionals who make decisions about rehabilitation referrals and services feel that it was necessary for them to keep up to date with information relating to rehabilitation services. There was some concern regarding what rehabilitation constituted and what services were available for different clinical indications. They also indicated that current systems did not consider diversity among patients' needs and goals. Their recommendations included the need for better communication pathways, improved referral systems and resources that could help provide best practice of rehabilitative care in the future. Patient or Public Contribution: Three study team members had a lived experience of rehabilitation as a patient or carer, and previous experience participating in qualitative research. They worked with the study team to codesign the recruitment strategy, participant‐facing communications, the interview discussion guide, and the approach to the conduct of activities with participants and in the interpretation and contextualization of findings and all were involved in writing this manuscript. [ABSTRACT FROM AUTHOR]

Background and Context: Involving people with lived experience of health conditions and the public (consumers) in health research is supported by policy, practice and research funding schemes. However, consumer involvement programmes in discovery‐based preclinical research settings are uncommon. Few formal evaluations of these programmes are reported in the literature. Objective: This study aimed to evaluate an established patient and public involvement programme operating in a major Australian Discovery‐Based Medical Research Institute (DBMRI) to inform programme development and the wider field. Design and Participants: A multimethods programme evaluation incorporating demographic, descriptive and qualitative data obtained through consumer/researcher co‐developed online surveys and semistructured virtual interviews. Programme participants (n = 111) were invited to complete an online survey seeking feedback on their experience of involvement, programme processes and perceived impacts. A purposive sample of 25 participants was interviewed. Descriptive data were analysed using explanatory statistics and qualitative data from surveys and interviews were thematically analysed. Results: This consumer involvement programme was found to be useful and meaningful for most participants, with specific examples of perceived added value. Consumers most commonly engaged with researchers to inform research development, prepare funding applications or strengthen lay communication of science. Genuine consumer–researcher interactions, relationship development and mutual respect were key elements in a positive experience for participants. Opportunities to 'give back', to learn and to ground research in lived experience were identified programme strengths and benefits. Developing researcher training in how to work with consumers, increasing the diversity of the consumer group membership and expanding the range of consumer activities were identified opportunities for improvement. Organisational support and adequate programme resourcing were identified as key enablers. Conclusion: Discovery‐based preclinical research is often viewed as being distant from clinical application; therefore, consumer involvement may be considered less relevant. However this study identified value in bringing a strong consumer voice to the discovery‐based research process through a coordinated, organisation‐wide approach with the potential for application in similar preclinical research settings. Patient or Public Contribution: Four consumer partners from the DBMRI Consumer Advisory Panel were actively engaged in developing this programme evaluation. Specifically, these consumer partners co‐developed and pilot‐tested surveys and interview guides, reviewed and commented on project data analysis and reporting and also contributed as co‐authors by editing the manuscript. [ABSTRACT FROM AUTHOR]

Aim This paper explores the experiences of older German Australians, with a focus on their support needs and preferences in later life. Methods Data were collected through qualitative semi-structured interviews. Data analysis incorporated a systematic concept matrix approach to content analysis. Results The findings of the study indicate that older German Australians have adapted well to the Australian way of life. Their high English language proficiency allowed them to source services without the barrier of language often reported in studies of older migrants. They did not show high interest in ethno-specific services. Conclusion Few studies have been conducted on older German Australians, and none focuses specifically on their experience of ageing in Australia. This study contributes to the body of knowledge on older migrants and, specifically, on those for whom language is not necessarily a major obstacle to obtaining aged care information or services. [ABSTRACT FROM AUTHOR]

Aims and objectives This paper examines the use of structured Palliative Care Case Conferences in long-term care. The issues families bring to the Palliative Care Case Conference, their level of distress prior to the conference, the extent to which these issues are addressed by staff and family satisfaction with this process are described. Background In most developed countries, up to 30% of older people die in long-term care. A palliative approach generally refers to the resident and family as the 'unit of care'. Interventions, which include family in palliative care, are required in this setting. Design Descriptive and thematic results from the intervention arm of a pre-post, sequential mixed method study. Methods Examination of documents of 32 resident/family dyads participating in a Palliative Care Case Conference, and interviews with the residents' family postintervention. Results Main concerns raised by family members prior to a Palliative Care Case Conference were physical and medical needs, pain, end-of-life care planning and nutrition and hydration. Families rated a high level of concern, 7.5 on a 10-point rating scale, prior to the Palliative Care Case Conference. A formalised Palliative Care Case Conference process ensured issues relating to end-of-life care planning, pastoral care, pain and comfort and physical and medical needs were well documented by staff. Issues relating to care processes and the family role in care were less well documented. All families, interviewed postintervention, recommended Palliative Care Case Conferences; and over 90% of families felt their issues were addressed to their satisfaction. Families also reported an increased understanding of the resident's current and future care. Conclusions The Palliative Care Case Conference in long-term care provides an important platform for family to voice concerns. Palliative Care Case Conference documentation indicates that staff are attending to these issues, although more reference to concerns relating to care processes and the family role could be made. Implications for practice Increased communication between staff and family, in the form of a Palliative Care Case Conference, may reduce stress, anxiety and unwanted hospitalisations during the palliative phase. [ABSTRACT FROM AUTHOR]

Background Understanding decision-making about health service provision is increasingly important in an environment of increasing demand and constrained resources. Multiple factors are likely to influence decisions about which services will be provided, yet workforce is the most noted factor in the rural physiotherapy literature. This paper draws together results obtained from exploration of service level decision-making (SLDM) to propose 'conceptual' models of rural physiotherapy SLDM. Method A prioritized qualitative approach enabled exploration of participant perspectives about rural physiotherapy decision-making. Stakeholder perspectives were obtained through surveys and in-depth interviews. Interviews were transcribed verbatim and reviewed by participants. Participant confidentiality was maintained by coding both participants and sites. A system theory-case study heuristic provided a framework for exploration across sites within the investigation area: a large area of one Australian state with a mix of regional, rural and remote communities. Results Thirty-nine surveys were received from participants in 11 communities. Nineteen in-depth interviews were conducted with physiotherapists and key decision-makers. Results reveal the complexity of factors influencing rural physiotherapy service provision and the value of a systems approach when exploring decision-making about rural physiotherapy service provision. Six key features were identified that formed the rural physiotherapy SLDM system: capacity and capability; contextual influences; layered decision-making; access issues; value and beliefs; and tensions and conflict. Conclusions Rural physiotherapy SLDM is not a one-dimensional process but results from the complex interaction of clusters of systems issues. Decision-making about physiotherapy service provision is influenced by both internal and external factors. Similarities in influencing factors and the iterative nature of decision-making emerged, which enabled linking physiotherapy SLDM with clinical decision-making and placing both within the broader healthcare context. The conceptual models provide a way of thinking about decisions informing rural physiotherapy service provision. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background In Australia, Aboriginal children experience significantly poorer health outcomes compared with non-Aboriginal children. Health policies aimed at improving Aboriginal health outcomes include interventions in the early childhood period. There is a need for government health services to work in partnership with Aboriginal people and other services to achieve the highest level of health possible for Aboriginal children, who often require a range of services to meet complex needs. Aim This paper describes the views of service providers on how paediatric outreach services work in partnership with other services, Aboriginal families and the community and how those partnerships could be improved to maximize health outcomes for children. Methods In-depth, semi-structured interviews and focus groups were conducted with managers and service providers over a 6-week period in 2010. The views and suggestions of participants were documented and a thematic analysis was undertaken. Results and Discussion Analysis of two focus groups with seven service providers and five individual interviews with service managers resulted in the identification of four themes: (i) using informal and formal ways of working; (ii) cultivating effective relationships; (iii) demonstrating cultural sensitivity; and (iv) forging strong leadership. Use of formal and informal approaches facilitated effective relationships between service providers and Aboriginal families and communities. Partnerships with the community were founded on a culturally appropriate model of care that recognized a holistic approach to health and wellness. Leadership emerged as an essential component of effective partnerships, cultivating the ethos of the workplace and creating an environment where collaboration is supported. Conclusion Culturally appropriate child health services, which utilize effective relationships and employ a range of informal and formal collaboration with other services and community members, are well positioned to implement health policy and improve access to services for Aboriginal children with better health outcomes as a result. [ABSTRACT FROM AUTHOR]

Little empirical research has been conducted in Australia on what constitutes as effective practice with interpreters in child protection matters. This study aimed to address this gap. Qualitative interviews were conducted with 29 non–English‐speaking background (NESB) client families and 17 child protection caseworkers (as part of a larger study). Four examples of good practice (e.g. accurate translation) and 14 examples of ineffective practice emerged. The examples of poor practice were consequently grouped as issues with: (i) interpreters (e.g. inaccurate translation); (ii) caseworkers (e.g. insufficient time); (iii) NESB families (e.g. refusing to use an interpreter); and (iv) resources (e.g. insufficient face‐to‐face interpreters). As expected, the results largely replicate the (scant) national and international literature, indicating that features of good practice, and barriers to them, are similar across multicultural countries. This paper does however argue that training for interpreters dealing in such sensitive matters and training for caseworkers on working effectively with interpreters seem to be at the heart of good practice. This study is significant because it draws on the richness of data that qualitative methods offer to identify the full range of relevant variables and provide empirical support for principles of good practice. [ABSTRACT FROM AUTHOR]

An international nurse shortage, tightening fiscal constraints, and increased service demands have seen health systems increasingly turn to employing assistants in nursing ( AIN) as a cost-effective means to meet demand. This paper describes social positioning from the perspective of 11 AIN who were employed to work in specialist mental health settings in a metropolitan health service in Sydney. Data was collected by means of semistructured interviews. Interview questions encouraged AIN to explore their experience with reference to positioning within the service, role perception, role development, staff relationship, and role satisfaction. Thematic analysis was utilized to generate themes and explore meaning within the data. The following themes emerged: role definition and clarity; socialization and adaptation; and enhancing education. Analysis suggests that whilst AIN were integrated into mainstream service, the scope of activities or role remains geographically variable and inconsistent. Encouragingly, as AIN became familiar with their work environments and teams, they considered themselves to be of value and were able to play a meaningful role. A desire for learning and a need for continuing education also emerged as a primary theme. Findings from the data suggest that AIN in the mental health setting remain a novel and, to some extent, poorly utilized resource. [ABSTRACT FROM AUTHOR]

Aim Evaluation or assessment of competence is an important step to ensure the safety and efficacy of health professionals, including dietitians. Most competency-based assessment studies are focused on valid and reliable methods of assessment for the preparation of entry-level dietitians, few papers have explored student dietitians' perceptions of these evaluations. The present study aimed to explore the perceptions of recent graduates from accredited nutrition and dietetics training programs in Australia. It also aimed to establish the relevance of competency-based assessment to adequately prepare them for entry-level work roles. Methods A purposive sample of newly graduated dietitians with a range of assessment experiences and varied employment areas was recruited. A qualitative approach, using in-depth interviews with 13 graduates, was undertaken. Graduates were asked to reflect upon their competency-based assessment experiences as a student. Data were thematically analysed by multiple authors. Results Four themes emerged from the data analysis: (i) transparency and consistency are critical elements of work-based competency assessment; (ii) students are willing to take greater responsibility in the assessment process; (iii) work-based competency assessment prepares students for employment; and (iv) the relationship between students and their assessors impacts student experience and assessment performance. Conclusions Understanding this unique perspective of students can improve evaluation of future health professionals and assist in validating competency-based assessment approaches. [ABSTRACT FROM AUTHOR]

Background Social support is essential for physical and mental health and well-being. Evidence indicates that social and peer support is particularly important and beneficial for the well-being of those who care for children with chronic illness or disability in improving personal well-being and influencing parent-child play opportunities and child behaviour and development positively. MyTime is a government-funded Australia-wide facilitated peer support group program for carers of children with special needs. Aim The aim was to investigate the barriers and promoters of participation in this peer support group program. Method A qualitative approach was adopted where semi-structured telephone interviews were conducted with 20 group members, four group facilitators and three play helpers. Interviews were recorded and transcribed. Inductive thematic analysis of the transcripts was conducted. Results Most group members described gaining significant social support from group participation. Good group facilitation, the availability of play helpers, access to disability-related information and expertise, and the mutual exchange of support between members emerged as the most important promoters of group participation. Barriers included insufficient funding to run the program throughout the year, too much diversity in group members' socio-economic position and severity of their children's disability. Conclusion The facilitated peer support group program described in this paper appears to confer significant benefits to carers of children with disabilities and may be a model for other nations to consider in their strategies to improve services for carers of children with special needs. [ABSTRACT FROM AUTHOR]

Context: In vitro fertilisation (IVF) is now a common assisted reproductive technology (ART) procedure globally, with 8 million children alive today having been conceived utilising IVF. For many patients, IVF is a difficult experience with many discontinuing treatment because of emotional, relationship and financial stress, or intolerable physical side effects of hormone treatments. Design and Participants: A qualitative study, in which 31 professionals and 25 patients from the ART sector in Australia were interviewed. The interviews were analysed using codebook thematic analysis. Results: Our data indicates there are 'silences' within the therapeutic relationship of IVF, which may limit the capacity for patients to prepare emotionally, financially, or medically for the procedure, and may contribute to psychological distress and dissatisfaction with care. These 'silences' include what the patient 'is not told' by their clinician or 'does not hear' and what the patient feels they 'cannot say'. Discussion: Drawing upon the work of Jay Katz, Charis Thompson, and Miles Little on 'silences' and performance in clinical practice, we argue that although IVF is a complex and multifaceted procedure that is often conducted in a commercial setting, the clinical and therapeutic relationship between doctor and patient remains pivotal to the experiences of patients. The 'silences' within this relationship may impact negatively on decision‐making, and on the delivery and experience of care. Conclusions: Careful attention to the realities of IVF treatment in the clinic room (and awareness of the performances that hide them) should allow for more present and compassionate care. Such care may leave patients more satisfied with their experience and their choices, regardless of treatment outcomes. Patient or Public Contribution: This article draws on interviews with patients who had undergone or were currently undergoing IVF, as well as a range of representatives from the ART community (including reproductive medicine specialists, general practitioners, fertility nurses, counsellors, administrators in ART businesses and embryologists). [ABSTRACT FROM AUTHOR]

Changes to the educational preparation of the nursing workforce in mental health continue to have profound effects on the availability of sufficient numbers of skilled graduates willing to work in this field. The longevity of the problem has focused attention on possible solutions. Introducing a major stream in mental health nursing in undergraduate Bachelor of Nursing programmes was proposed and supported as a potentially beneficial strategy, adopted by some Australian universities. Despite the promise invested in this strategy, systematic evaluations to determine the effectiveness or otherwise of this approach were not initiated. A qualitative exploratory study was undertaken with Australian universities, which had implemented the major stream, regarding their experiences and observed outcomes. In-depth interviews were conducted with a mental health nurse academic from each university. The barriers to the effectiveness of the major in mental health nursing are the specific focus of this paper. Thematic data analysis revealed three main barriers: clinical placements, lack of support from other academics, and integrated curricula. These barriers substantially limited the effectiveness of this strategy - in some instances, leading to the programme's termination - and must be assertively addressed to maximize the potential of the major in mental health nursing. [ABSTRACT FROM AUTHOR]

Introduction: A growing body of research has examined the physical, psychological, social and financial impacts of living kidney donation. However, little is known about the unique experiences or additional burdens faced by living donors from regional or remote locations. Objective: To explore the experiences of living kidney donors who live outside metropolitan centres and to determine how support services could be orientated to better meet their unique needs. Design/Setting/Participants: Seventeen living kidney donors participated in semistructured telephone interviews. Qualitative data were analysed using thematic analysis. Findings: Eight themes were identified: (1) donor's emotional well‐being is influenced by the recipient's outcome, (2) varied levels of access to medical support and other important services in rural areas, (3) travel takes a toll on time, finances and well‐being, (4) varied level of financial impact, (5) medical, emotional and social challenges, (6) both lay and health professional support is valued, (7) varied levels of knowledge and experiences accessing information and (8) a worthwhile experience overall. Conclusion: Despite many challenges, and travel adding to the complexity, rural living kidney donors generally consider it to be a worthwhile experience. The provision of additional emotional, practical and educational support would be welcomed by this group. [ABSTRACT FROM AUTHOR]

Objective: To understand the barriers and enablers to participation in family‐assisted therapy for older people in Transition Care. Methods: A qualitative study, underpinned by interpretive description, was conducted at two public health services in Melbourne, Australia. Participants included patients in Transition Care, or their family members, who either participated in or chose not to participate in a family‐assisted therapy trial. Semi‐structured interviews were conducted, transcribed verbatim and analysed thematically. Results: Forty‐four participants were interviewed (17 patients and 27 family members). The unifying theme was to let families decide about participation in family‐assisted therapy. The unifying theme was illustrated by three subthemes. The first, what is possible for the family now, described practical considerations including geography, paid and unpaid work structure and commitments and the presence of fit and willing social networks. The second, what is important to the family now, recognised the role of family priorities in deciding. Physical rehabilitation and extra therapy were of high importance to some families. For others, emotional support or searching for a residential aged care bed were more important at the time. Finally, how the family functions described the complexity of relationships and family history that impacted the decision to participate. Conclusions: The decision to participate in family‐assisted therapy is complex and is best made by patients and their families. Clinicians offering family‐assisted therapy are encouraged to avoid assuming what will or will not work for families and instead, to let families decide. [ABSTRACT FROM AUTHOR]

Aims: Diet‐related chronic disease contributes significantly to the global burden of disease. Dietitians are best placed to address this disease burden, yet graduate dietitians may struggle to find employment. This study aimed to explore dietetics graduates' experiences of employment and employability, up to 6‐month post‐degree completion. Methods: Secondary data analysis of in‐depth qualitative interview data and longitudinal audio‐diaries was undertaken. An interpretivist approach was employed whereby knowledge was viewed as subjective and multiple realities exist. A total of five entrance interviews, 31 audio‐diaries and three exit interviews, from nine graduates were included in the analysis. This comprised 12 h of longitudinal audio data. Thematic analysis was undertaken using a framework analysis method. Results: Four key themes were identified: (1) The tumultuous process of applying for jobs demonstrated that graduates struggled with repeated rejections. (2) The uncertain journey to employment indicated that job‐seeking was a limbo stage marked by uncertainty. (3) Feeling the pressure showed that graduates experienced pressure from multiple sources. (4) Enhancing employability explained that graduates were not prepared for available employment opportunities, but utilised resources to increase their employability. Conclusion: Diverse placement experiences may better prepare graduates for available employment opportunities. To enhance employability, it may be beneficial to assist students to develop job‐seeking skills, and to engage in networking and volunteering experiences during their education. [ABSTRACT FROM AUTHOR]

Background: There is a clear need for food and nutrition research to lead to pragmatic and sustainable solutions to the ongoing problems in residential aged care, particularly within foodservices. The present study aimed to identify systemic challenges for residential aged care homes in Australia to participate in quality food and nutrition research, using a complexity science lens. Methods: Qualitative data from three studies in residential aged care were gathered, which included 28 participants across 21 aged care homes. Qualitative data consisted of in‐depth interviews, field notes and email communications with aged care staff. Thematic analysis was undertaken using both inductive and deductive approaches. Results: Four themes were identified: (1) complex staffing issues deter or impede participation in research; (2) external pressure on the aged care system leads to research not being a priority; (3) funding issues are variable and pose a barrier for some aged care homes; and (4) research processes and requirements can lead to biased samples. Conclusions: Several challenges to undertaking quality empirical research in residential aged care in Australia were identified. Research needs to be part of usual business, similar to hospitals, and operate independently of staffing and funding issues. Issues within foodservices are system issues and there is a need for quality empirical research to determine solutions. Key points: There is a need for research to lead to pragmatic and sustainable solutions to the ongoing food and nutrition problems in residential aged care.Several challenges to participating in food and nutrition research were identified, including complex staffing issues, external pressure on the aged care system, funding issues and research processes.Research needs to be part of usual business and operate independently of staffing and funding issues. [ABSTRACT FROM AUTHOR]

Introduction: Family carers play a crucial role in dementia care. As the condition progresses, people with dementia become increasingly dependent on their carers for all areas of daily living. The risk of carer burnout is significant. One of the more stressful events for family carers is when hospital admission is required for the person they care for. Living in regional Australia adds complexity to the experience. Hospital and health services in regional Australia could use a greater understanding of the issues associated with hospital care to inform patient and carer management, improve outcomes for this population and support the goal of 'ageing in place'. Objective: To explore the experience of carers of people with dementia in regional Australia when hospital care or treatment was required for the person they provide care for. Design: Six family carers living in regional Australia participated in this interpretative phenological study. Individual, semistructured interviews were held and transcribed verbatim shortly after. Data analysis occurred via three key processes: reading and highlighting, coding and grouping, which yielded the major themes and subthemes of the study. Findings: Three major themes and nine subthemes emerged from data analysis. The major themes were: (i) support and supply of specialist care; (ii) travel needs and negotiations; and (iii) empathy and experience make a difference. Discussion: Findings from this study highlight aspects of care that healthcare providers can address to improve outcomes for patients with dementia and their carers. Carers need opportunities to seek clarification and provide input on care plans. Good communication, involvement and relationship building between healthcare staff and carers are vital to achieving optimal patient outcomes. Staff training supporting understanding of appropriate dementia care is essential for improved patient and carer outcomes. Conclusion: Factors related to regional location, including lack of specialist care and support, compound carers' challenges. Healthcare provider education on dementia care and dementia‐friendly processes in hospitals will support optimal patient and carers outcomes. [ABSTRACT FROM AUTHOR]

Background: The implementation of digital healthcare systems in hospitals globally and in Australia has led to the introduction of the informatics pharmacist as a career in the healthcare system. However, informatics pharmacists are not yet part of routine clinical services in Australia, so their perspective and roles are not well understood. Aim: To explore pharmacists' and other health professionals' perspectives of the roles of informatics pharmacists within interprofessional teams in Australian health care. Method: This study used semi‐structured interviews with experts in pharmacy and/or informatics. They were recruited using convenience sampling and snowballing. The interviews were audio‐recorded and transcribed and analysed using inductive thematic techniques to identify major themes. Ethical approval was received from the local institutional Human Research Ethics Committee (Approval No: 2020000069). Results: The process of inductive thematic analysis was used to analyse the interview transcriptions of 11 participants. Six themes were identified: (1) a promising future for the informatics pharmacists, (2) education, (3) specific skills, (4) scope of informatics role, (5) impacts, and (6) barriers. Participants described the career of informatics pharmacists as an emerging specialty in today's healthcare systems. The roles of informatics pharmacists in Australian health care are described together with the skills and knowledge required for these roles. Conclusion: A key role of informatics pharmacists is to facilitate the appropriate use of digital systems to prevent medication errors and improve patients' safety. While international experience has shown the potential scope for an informatics pharmacist, this research shows the use of informatics pharmacists in Australia is in its infancy. [ABSTRACT FROM AUTHOR]

Background: Poor diet is implicated in multiple chronic diseases. Although doctors may be well placed to facilitate nutrition care, nutrition remains a low priority in medical education internationally. Consensus is required on nutrition competencies as a benchmark for education with a regulatory framework to ensure implementation. The aim of this qualitative study was to explore work roles, attitudes, barriers and enablers in the delivery of nutrition care among a cohort of Australian and UK doctors. Method: Semi‐structured interviews were conducted with primary care doctors/general practitioners (n = 14) and medical specialists (n = 8) based in Australia and the United Kingdom to explore work roles, attitudes, barriers and enablers in the delivery of nutrition care. Results: Framework analysis identified five key themes: (1) knowledge and skills in nutrition to support medical nutrition care, (2) the delivery of nutrition education, (3) multidisciplinary and interdisciplinary care, (4) systemic barriers and facilitators to care and (5) the need for a paradigm shift. Participants acknowledged nutrition as an important component of medical care but recognised they are currently ill‐equipped to support such care, identifying limitations to the systems supporting integrated care. Participants identified that nutrition sits within both a health promotion and medical/treatment model, but they currently work only within the latter. Conclusion: Participants highlighted a lack of knowledge and training regarding nutrition, without which change is not possible. Efforts to improve the nutrition capacity of the medical workforce must be matched by increased investments in primary prevention, including nutrition – a paradigm shift from the medical model. Key points: This qualitative study explores work roles, attitudes, barriers and enablers in the delivery of nutrition care among a cohort of Australian and UK doctors.Doctors acknowledge nutrition as an important component of nutrition care but are ill‐equipped to support such care, identifying limitations to the systems that might support integrated care.Efforts to build the nutrition capacity of the medical workforce must be matched by increased investments in primary prevention, including nutrition – a paradigm shift away from a traditional medical (treatment) model. [ABSTRACT FROM AUTHOR]

Aim: We aimed to explore current approaches to assessing professionalism in dietetics education in Australia and New Zealand, and asked the questions what is working well and what needs to improve? Method: We employed a qualitative interpretive approach and conducted interviews with academic and practitioner (workplace‐based) educators (total sample n = 78) with a key stake in dietetics education across Australia and New Zealand. Data were analysed using team‐based, framework analysis. Results: Our findings suggest significant shifts in dietetics education in the area of professionalism assessment. Professionalism assessment is embedded in formal curricula of dietetics programs and is occurring in university and placement settings. In particular, advances have been demonstrated in those programs assessing professionalism as part of the programmatic assessment. Progress has been enabled by philosophical and curricula shifts; clearer articulation and shared understandings of professionalism standards; enhanced learner agency and reduced power distance; early identification and intervention of professionalism lapses; and increased confidence and capabilities of educators. Conclusions: These findings suggest there have been considerable advances in professionalism assessment in recent years with shifts in practice in approaching professionalism through a more interpretivist lens, holistically and more student‐centred. Professionalism assessment in dietetics education is a shared responsibility and requires further development and transformation to more fully embed and strengthen curricula approaches across programs. Further work should investigate strategies to build safer learning cultures and capacity for professionalism conversations and in strengthening approaches to remediation. [ABSTRACT FROM AUTHOR]

Objective: Expansion of opportunities for ophthalmology training beyond the 'big smoke' is anticipated to support the future distribution of ophthalmologists in regional, rural and remote areas of Australia. However, little is known about what enables supervision outside of metropolitan tertiary hospital settings that would contribute to positive training experiences for specialist medical trainees and encourage them to leave the 'big smoke' once qualified. The aim of this study was therefore to explore the perceived enablers of ophthalmology trainee supervision in regional, rural and remote health settings across Australia. Setting: Australia. Participants: Ophthalmologists working in regional, rural or remote health settings with experience and/or interest in supervising ophthalmology trainees (n = 16). Design: Qualitative design involving semistructured interviews. Results: Seven key enablers of ophthalmology trainee supervision in regional, rural and remote health settings were identified: adequate physical infrastructure, resources and funding to host a trainee; availability of online curriculum and teaching resources so as to ensure equity of training opportunities; pre‐established training posts, driven by supervision 'champions'; a critical mass of ophthalmologists to help share the supervisory load; relationships and support between training posts, the training network and the Specialist Medical College; alignment of trainee competence and attitude with the needs of the training setting; and the recognition of reciprocal benefits for supervisors through supporting trainees, including workforce support and renewal. Conclusion: With training experiences beyond the 'big smoke' anticipated to influence future ophthalmology workforce distribution, implementation of enablers of trainee supervision should occur in regional, rural and remote health settings wherever possible. [ABSTRACT FROM AUTHOR]

Limited research has directly sought the input of parents involved in the child protection system during pregnancy and with their infants. As the focus of these policies and practices, parents have a unique and important insight not available to others, so it is vital to obtain their input. As part of a larger Australian study, qualitative interviews were undertaken with 13 parents asking about their views and experiences. Parents predominantly became involved with child protection services during pregnancy through a prenatal report. Parents who previously had their newborn removed from their care described it as sudden and unexpected, leaving them distressed and unsupported post‐removal, with a growing list of requirements for them to see their baby or for restoration to be considered. Domestic violence was a particular issue of concern for some mothers who expressed distress that their partners, perpetrators of violence, were allowed access to their infant with fewer requirements than for them. Improvements recommended by the parents included greater communication and preparation for the removal, better recognition of improvements in their situations and increased supports to be provided to parents both pre‐ and post‐removal. Parental experiences provide an important guide to improving child protection practice with these families. [ABSTRACT FROM AUTHOR]

Background: Previous studies have highlighted the unmet nutritional and supportive care needs of patients with head and neck cancer (HNC) and their carers from diagnosis and throughout the treatment and survivorship period. The aim of this study was to bring patients, carers and healthcare professionals together to co‐design a framework to improve access to nutrition information and support for patients and carers with HNC from diagnosis and throughout the treatment and survivorship period. Methods: Using experience‐based co‐design (EBCD), semistructured individual interviews were conducted with patients, carers and healthcare professionals to understand their experiences in accessing information and support outside of the hospital environment. Feedback events and co‐design workshops were held to prioritise areas for service improvement. Results: Participants (10 patients, 7 carers and 15 healthcare professionals) highlighted the importance of having consistent information and support recommendations from the multidisciplinary team. The two key areas for improvement identified through group and workshop events were linking reputable HNC resources to a HNC portal on the hospital website and the development of a series of short podcasts and video blogs with fact sheets attached presented by members of the multidisciplinary team, patients and carers at four time points spanning pretreatment and throughout the survivorship period. Conclusions: Using EBCD has enabled the co‐design of a framework for resource development with patients, carers and healthcare professionals to improve access to information and resources to support nutrition intake and supportive care needs for patients with HNC with their carers. Development and implementation of resources and evaluation of outcomes is ongoing. Key point: Using experience‐based co‐design has enabled the co‐design of a framework for resource development to improve access to nutrition care information and support for patients with head and neck cancer and their carers. [ABSTRACT FROM AUTHOR]

Aims: Hospital food service operations have been affected by the COVID‐19 pandemic, particularly resulting in increased waste. The aim of this research was to explore the impact of the COVID‐19 pandemic on hospital food services, particularly on food waste and the completion of food waste audits. Methods: A qualitative interview research design was used. Semi‐structured interviews were completed and recorded via Zoom, focusing on the barriers and enablers towards the completion of hospital food waste audits. Twenty‐one participants were interviewed from 12 hospitals. No questions were related to the COVID‐19 pandemic and its impact on hospital food services, however this issue frequently emerged during interviews. Data were coded following inductive thematic analysis. Results: Five themes were generated from the interviews related to COVID‐19 and hospital food services; impacts on practice, labour, change, technology and post‐pandemic expectations. Participants reported COVID‐19 negatively affected food service operations. Changes included increased food waste, contact restrictions, and labour shortages. Nonetheless, hospitals embraced the challenge and created new positions, trialled different food waste data collection methods, and utilised technology to support food service operations around COVID‐19 restrictions. Conclusions: Despite the impact COVID‐19 had on hospital food services, including their ability to audit food waste and increased food waste generation, the response from food services has demonstrated their adaptability to change. Sustainable healthcare, including the aggregate measuring and reduction of food waste in hospital food services, is an essential transition post‐pandemic, and may be facilitated through the operational changes forced by COVID‐19. [ABSTRACT FROM AUTHOR]

Individuals with depressive symptoms often experience changes in physical activity and lifestyle factors. Despite the benefits of exercise, mental health clinicians often do not refer for or prescribe exercise as part of traditionally accepted models of care for consumers with depression and anxiety. The aims were to investigate: (i) mental health clinicians' understanding of the relationship between exercise and mental health, (ii) if and how exercise is used by mental health clinicians in treatment for depression and anxiety, and (iii) the barriers to prescription of exercise. A descriptive qualitative method was used, and data were collected via individual semi‐structured interviews. Ten mental health clinicians with varying backgrounds participated in this study. The data driven inductive analysis of participants views identified three themes: (i) knowing and not knowing, (ii) consumer comorbidities – the risk and benefit dilemma, and (iii) protecting vulnerable consumers. Enhancing clinicians' knowledge of the beneficial role of exercise in treatment for consumers' experiencing depression and anxiety is an important step. Mental health services can support integration of exercise by implementing policies and training for staff to support exercise prescription, and the role and referral of exercise and physical activity specialists, as part of routine care to improve clinical outcomes for consumers. Additional considerations should be given to fiscal support to access exercise as an adjunct therapy. [ABSTRACT FROM AUTHOR]

Introduction: The Specialist Training Program (STP) is a commonwealth funding initiative to support specialist medical training positions in regional, rural and remote areas, and in private settings. The program helps to improve the skills and distribution of the specialist medical workforce by providing trainees experience of a broader range of healthcare settings. Objective: To examine the benefits and challenges of ophthalmology training delivered by the STP in regional, rural, remote, and/or private settings across Australia. Design: Qualitative design involving semi‐structured in‐depth interviews with thirty‐two participants experienced in the delivery of ophthalmology training at STP posts including ophthalmology trainees (n = 8), STP supervisors and clinical tutors (n = 16), and other stakeholders (n = 8). Findings: Training delivered at STP posts was reportedly beneficial for ophthalmology trainees, their supervisors and the broader community given it enabled exposure to regional, rural, remote and private settings, access to unique learning opportunities, provided workforce support and renewal, and affordable ophthalmic care. However, all participants also reported challenges including difficulties achieving work/life balance, unmet training expectations, a lack of professional support, and financial and administrative burden. Malalignment between trainee preferences for STP posts, low STP literacy and limited regional, rural and remote training experiences were also seen as missed opportunities to foster future rural ophthalmic workforce development. Discussion: The STP improves access to ophthalmic care in underserved populations while enabling valuable rural and/or private practice exposure for medical specialist trainees and workforce support for supervising ophthalmologists. Conclusion: Efforts are needed to improve the quality of training experiences provided at STP posts and post sustainability. Although research is needed to investigate the longer‐term benefits of the STP to rural and/or private workforce recruitment and retention, RANZCO should develop further regional, rural and remote STP posts to help realise future rural practice intention amongst ophthalmology trainees. [ABSTRACT FROM AUTHOR]

Settler colonisation continues to cause much damage across the globe. It has particularly impacted negatively on Indigenous peoples' health and wellbeing causing great inequity. Health professional education is a critical vehicle to assist in addressing this; however, non‐Indigenous educators often feel unprepared and lack skill in this regard. In this qualitative study, 20 non‐Indigenous nursing, physiotherapy and occupational therapy educators in Australia were interviewed about their experiences and perspectives of teaching Indigenous health. Findings from the inductive thematic analysis suggest educators require skill development to: identify their discomfort in teaching cultural safety; contextualise the sources of this discomfort and; reflect on how this understanding can improve their teaching. Additionally, educators require professional training to become practitioners of cultural humility and to be facilitators and colearners (rather than experts) of the Aboriginal‐led curriculum. Of relevance to this is educator training in how to decentre non‐Indigenous needs and perspectives. Educators can also renew their teaching practices by understanding what a dominant settler paradigm is, identifying if this is problematically present in their teaching and knowing how to remedy this. Crucial to improved cultural safety teaching is institutional support, which includes Indigenous leadership, institutional commitment, relevant policies, and well‐designed professional development. [ABSTRACT FROM AUTHOR]