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Objective: This study explored the experiences, concerns and perceptions of hospital clinical staff returning to work after parental leave during the COVID-19 pandemic. Methods: An exploratory mixed-methods study was performed. Eligible staff employed at a large metropolitan tertiary health service in Melbourne, Australia, completed an ethics-approved anonymous online cross-sectional survey and/or participated in an interview between February and June 2021. Results: Ninety-six staff completed a survey and four participated in an interview. Staff reported both positive and negative aspects of being on parental leave during the COVID-19 pandemic including disappointment their leave had not gone as planned; feeling isolated from family and friends; wanting greater communication from their health service; appreciating the increased opportunities for them and their partner to be at home and bond with their baby; and concerns about returning to work such as limited knowledge of COVID-19 workplace policies and potentially infecting their baby and family. Conclusions: The COVID-19 pandemic had a unique impact on the parental leave and return to work experiences of hospital clinical staff. The findings suggest that staff would benefit from formal return to work policies and programs including regular contact with their manager while on parental leave and workplace reorientation on their return, especially during events such as a pandemic. What is known about the topic? Healthcare workers often experience additional challenges and stressors returning to work after parental leave compared to other workers. What does this paper add? The COVID-19 pandemic had a unique impact on the parental leave and return to work experiences of healthcare workers who reported positive and negative aspects including isolation, limited workplace communication and increased opportunities for bonding with their baby. What are the implications for practitioners? Appropriate organisational initiatives may alleviate staff distress and support their return to work and could include formal return to work programs, regular managerial contact and workplace reorientation. [ABSTRACT FROM AUTHOR]

Objective: HealthPathways (HPW) is an international web-based information portal that provides health practitioners with guidelines and referral pathways to specialists and services. The present study explored usage of HPW by general practitioners (GPs) in the Barwon region, south-west Victoria, and any benefits and barriers to its use. Methods: Approximately 421 GPs provide services in 86 clinics across the Barwon region, south-west Victoria and Barwon Health is the public health service providing acute, subacute, residential aged care and community health services to approximately 350 000 people. The present study was a mixed-methods analysis of all GPs in the region, who were invited to complete a survey in two waves (2014 and 2016) and participate in focus groups. Data were survey/questionnaire (fixed response and free text options, analysed with descriptive statistics and content analysis), and focus groups (interview and facilitated group discussion, analysed using the principles of thematic analysis). Results: Most GPs surveyed used HPW and usage increased over time from 2014 to 2016 (67% vs 77% respectively). Junior GPs used HPW more often than the more experienced practitioners. GPs reported that HPW was easy to access and navigate, improved their knowledge of local services, improved their confidence, changed their clinical management and saved them time. Main barriers to use of HPW were: GPs did not think to look at HPW, or simply did not know about it. Conclusions: HPW has the potential to improve patient management and health outcomes, and use of HPW is increasing over time. What is known about the topic?: Initiatives such as HPW are viewed positively by clinicians and have the potential to address challenges at the primary–secondary care interface, specifically, referral to secondary specialists. What does this paper add?: Proof of concept that the ongoing availability of localised HPW for common clinical conditions improves GP usage of HPW and has increased access to HPW as the first source of clinical information. Benefits and barriers to use have been identified. What are the implications for practitioners?: HPW improves knowledge of local services and provides GPs with easy access to referral pathways. [ABSTRACT FROM AUTHOR]

Aims and objectives: To develop a communication app to support nursing staff during the provision of standard care of patients from non‐English‐speaking backgrounds (NESBs), when an interpreter is not available. This paper reports on the user needs analysis phase that informed the development, content and functionality of the app. Background: In 2014 we developed CALD Assist, a communication app to support patient interactions with allied health clinicians when interpreters are not present. It includes 95 commonly used phrases professionally interpreted into 10 languages and grouped by discipline. This work expands upon our previous app to meet the needs of the nursing workforce. Design: Qualitative through focus groups, observations and interviews, with a quantitative component from observational data and staff surveys. Methods: Four focus groups with hospital staff, ten interviews with patients from NESBs and 85 observation sessions of everyday patient–staff interactions followed by staff surveys (n = 85) were held between January and June 2017. Results: Baseline data prior to app development revealed that staff confidence of the patients’ level of understanding and the success of the interaction were significantly greater for English‐speaking (ES) patients, than for non‐English‐speaking patients. A total of 143 phrases were identified and subdivided into 16 categories for inclusion in the new app. Conclusion: Staff participants highlighted that patients from NESBs are a challenging patient group to interact with. Patient and staff participants identified a range of areas where the nursing app could benefit, including pain management, mobility, hygiene and nutrition. Relevance to clinical practice: The proposed app can be used to reduce variances in practice and provide a timely and positive patient experience for patients from NESBs who are unable to communicate in English during hospital admissions. [ABSTRACT FROM AUTHOR]

Introduction: Voluntary assisted dying (VAD) is increasingly being legalised internationally. In Australia, all six states have now passed such laws, with Victoria being the first in 2019. However, early research in Victoria on the patient experience of seeking VAD shows that finding a connection to the VAD system is challenging. This study analyses the causes of this 'point of access' barrier. Methods: We conducted semi‐structured qualitative interviews with family caregivers and a person seeking VAD, with participants recruited via social media and patient interest groups. Data were thematically analysed. We also undertook documentary analysis (content and thematic) of publicly available reports from the oversight body, the Voluntary Assisted Dying Review Board. Results: We interviewed 32 family caregivers and one patient across 28 interviews and analysed six Board reports. Finding a point of access to the VAD system was reported as challenging in both interviews and reports. Four specific barriers to connecting with the system were identified: (1) not knowing VAD exists as a legal option; (2) not recognising a person is potentially eligible for VAD; (3) not knowing next steps or not being able to achieve them in practice; and (4) challenges with patients being required to raise the topic of VAD because doctors are legally prohibited from doing so. Conclusion: Legal, policy and practice changes are needed to facilitate patients being able to find a connection to the VAD system. The legal prohibition on doctors raising the topic of VAD should be repealed, and doctors and institutions who do not wish to be involved in VAD should be required to connect patients with appropriate contacts within the system. Community awareness initiatives are needed to enhance awareness of VAD, especially given it is relatively new in Victoria. Patient or Public Contribution: Families and a patient were the focus of this research and interviews with them about the experience of seeking VAD were the primary source of data analysed. This article includes their solutions to address the identified point of access barriers. Patient interest groups also supported the recruitment of participants. [ABSTRACT FROM AUTHOR]

Rationale: Mobile stroke units (MSUs) are increasingly being implemented to provide acute stroke care in the prehospital environment, but a comprehensive implementation evaluation has not been undertaken. Aim: To identify successes and challenges in the pre‐ and initial operations of the first Australian MSU service from an interdisciplinary perspective. Methods: Process evaluation of the Melbourne MSU with a mixed‐methods design. Purposive sampling targeted key stakeholder groups. Online surveys (administered June–September 2019) and semistructured interviews (October–November 2019) explored experiences. Directed content analysis (raters' agreement 85%) and thematic analysis results are presented using the Interactive Sociotechnical Analysis framework. Results: Participants representing executive/program operations, MSU clinicians and hospital‐based clinicians completed 135 surveys and 38 interviews. Results converged, with major themes addressing successes and challenges: stakeholders, vehicle, knowledge, training/education, communication, work processes and working relationships. Conclusions: Successes and challenges of establishing a new MSU service extend beyond technical, to include operational and social aspects across prehospital and hospital environments. [ABSTRACT FROM AUTHOR]

In Victoria, Australia, Maternal and Child Health nurses (MCHNs) play a key role in facilitating the timely identification of Postnatal Depression and Anxiety (PNDA). Understanding MCHNs' screening practices, and the factors which impact them, is central to ensuring that future screening policy agendas are evidence‐based and able to support MCHNs in carrying out this critical work. Yet, little is known about this subject. The purpose of this study was to gain an in‐depth understanding of MCHNs' screening practices, and the factors which impact them. Qualitative descriptive design with semi‐structured interviews were used. Participants were MCHNs who had been practicing for a minimum of 6 months and regularly saw new mothers. Purposeful sampling was used to facilitate diversity across participant characteristics. Twelve MCHNs were interviewed between March and May 2021. Thematic analysis was conducted to identify patterns across our data. Qualitative content analysis was then used to identify issues which were most emphasised by MCHNs. Two themes were identified. Theme one, 'variations in screening practices', pertained to MCHNs' various screening practices (i.e., who, when, how) and the factors which influence them. Theme two, 'systemic barriers hinder equitable screening', pertained to factors which hindered equitable screening practices. Results indicate that systemic barriers contribute to inconsistent and inequitable screening practices, with women from culturally and linguistically diverse backgrounds less likely to be screened in line with best practice. Our findings emphasise an urgent need for MCHNs to be allocated with the resources required to screen all women equally, regardless of their cultural background. [ABSTRACT FROM AUTHOR]

While there is a growing level of demand for accountability and documentation of services provided to students who are Deaf or Hard of Hearing (DHH), there is a paucity of evidence on the nature of such support; who (personnel), what (content), and how (delivery). This study describes Teacher of the Deaf (ToD) perspectives on current classroom student support practices across a range of contemporary service delivery models in Victoria, Australia. Maximum variation sampling was used to identify 10 Victorian ToDs; each completed a one-hour semi-structured interview, which focused on an interview topic guide associated with typical practice: pathways to teaching; role of the profession; professional development; role in the classroom; goal setting; professional identity; and one open-ended question regarding wishes for the future. Qualitative content analysis generated six categories from these interviews: scope of practice; content of teaching/support; goal setting; service delivery; communication; and accountability. Three recommendations to improve future service delivery for students who are DHH included: standardisation of goal setting/assessment tools; improved shared language between all student support personnel, students and parents; and implementation of agreed rubrics to determine frequency of service with consistent definitions of decision-making criteria for tiered service delivery. [ABSTRACT FROM AUTHOR]

Healthcare staff are in a unique position of understanding client experiences, physiological impacts of client behaviour, the local healthcare system and the physical environment in which the services operate. Their perspectives may provide insights into the feasibility and effectiveness of existing models of diabetes care and suggestions for improvements to models of care (MoC). The objective of this qualitative study was to explore the experiences of healthcare staff delivering care for people with diabetes at the request of an existing healthcare service. Semi‐structured interviews were conducted with 21 healthcare staff from three community health centres in one region of Victoria, Australia, in 2018. Interviews were audio‐recorded and transcribed verbatim. Data were subject to qualitative content analysis and, subsequently, emerging themes were classified at individual, relationship, community and societal levels of the social–ecological model (SEM). Perceived barriers of access to health services using the current MoC included a lack of public transport, low socioeconomic status, job insecurity (resulting in an inability to take time away from work) and inflexible appointment times, all of which negatively impact diabetes management. Perceived enablers included having a co‐located, multidisciplinary team, a holistic approach to diabetes management and motivation resulting from improvement in diabetes‐related health outcomes. The findings indicate that there is potential to improve the service in this region by adopting a more integrated, team‐focused and accessible MoC. [ABSTRACT FROM AUTHOR]

Objectives: Though several studies have focused on risk factors associated with excess weight gain, little is known about the extent to which socio-cultural beliefs about body sizes may contribute to risk of excess weight gain, especially in non-Western migrant communities. Drawing on socio-cultural and attribution theories, this study mainly explored socio-cultural beliefs about an ideal body size among Australian residents who were born in sub-Saharan Africa (SSA). Implications of body size beliefs for risk of excess weight gain after immigration have also been discussed. Design: Employing a qualitative design, 24 in-depth interviews were conducted with Australian residents who were born in SSA. Thematic content analysis was undertaken to ensure that participants' experiences and views were clearly captured. Results: According to the participants, a moderately large body size is idealised in the SSA community and post-migration weight gain is commonly regarded as evidence of well-being. While desirability of a moderately large body size was noted by some participants, others were concerned about health risks (e.g. high blood pressure) associated with excess weight gain. Moreover, body size ideals seemed to be different for men and women in the SSA community and these ideals were mainly promoted by family and friends. Participants reported that women with very slim (skinny) body sizes are often regarded as persons suffering from health problems, whereas those with 'plumpy' body types are often considered beautiful. Participants also noted that men are expected to look well-built and muscular while those with big bellies are often seen as financially rich. Conclusions: Participants' interpretation of post-migration weight gain as evidence of well-being calls for urgent intervention as risk of excess weight gain appear to be high in this immigrant group. [ABSTRACT FROM AUTHOR]

Background: Thriving has emerged as a contemporary and health-promoting concept for older people living in nursing homes; however, there has been limited research to explore how nursing home staff identify thriving in their everyday practice. The aim of this study was to explore how staff recognize expressions of thriving among persons living in nursing homes. Methods: Semi-structured interviews were conducted with 14 nurses working at a nursing home in Victoria, Australia. The interviews were audio-recorded, transcribed and analyzed using qualitative content analysis. Results: The analysis resulted in six sub-categories and three main categories. Expressions of thriving were recognized in relation to how staff understood thriving, observed thriving and sensed thriving. Staff described comparing and contrasting clinical assessment indicators with their own personal and professional understandings of thriving, as well as their overall sense of the individual person within the wider situational and environmental context. Conclusions: Our results illuminate how staff recognize everyday expressions of thriving for people living in nursing homes and emphasizes the importance of utilizing person-centred care principles in clinical assessments. These findings have practical implications with regards to how thriving is identified and assessed in long-term care, and could be used to inform and guide staff education, person-centred care strategies, and organizational policies to better support and promote thriving in nursing homes. [ABSTRACT FROM AUTHOR]

Sustainability is a desired outcome of implementation. Understanding how organizations support new practices after implementation is important for sustainability. Let's Talk about Children (hereby referred to as 'Let's Talk'), a family‐focused intervention with parents with a mental illness, improves family, parent, and child outcomes. Little is understood about how organizations support sustained practice. The study aimed to (i) understand the implementation process that occurred in eight adult mental health services during a previous randomized controlled trial; (ii) establish their continued capacity to embed Let's Talk; and (iii) explore links between organizational capacity and sustained delivery by practitioners. This mixed method study used a questionnaire and individual interviews to collect data on the implementation process and current organizational capacity to support Let's Talk 12months after the randomized controlled trial. Links between organizational capacity and the adult mental health services with practitioners' continuing to use Let's Talk in the past 12 months were explored. Services with higher current organizational capacity scores had practitioners currently delivering Let's Talk. These services had all made changes to their organizational structures to support Let's Talk practice. All services experienced significant changes during and after implementation, influencing sustainability of Let's Talk. Addressing organizational capacity appears to be important to enable sustainability of Let's Talk implementation endeavours. Real‐world settings are constantly changing systems requiring ongoing tracking and adjustments to understand and support sustainability. Internal service development staff appear to support the shaping of organizational capacity to support Let's Talk; however, broader organizational support is needed for change within a complex system. [ABSTRACT FROM AUTHOR]

Aims and objectives: The aim of the study was to enhance understanding about dignified care from older peoples' and their carers' perspectives. The information will contribute to the development of a tool to measure older peoples' dignity during hospitalisation. Background: Older people are a vulnerable cohort at risk of loss of dignity during acute hospitalisation arising from environmental, behavioural and patient factors. It is not clear how older people and their relatives define dignified care in acute care settings. Design: An interpretative descriptive method was used. Methods: A purposive sample of older people (at least 65 years) who had been hospitalised in acute care and subsequently transferred to sub‐acute care, and their relatives, were invited to participate. The study was undertaken in one sub‐acute ward in a regional healthcare organisation in Victoria, Australia. Individual interviews were audio‐recorded then transcribed. Data were analysed using thematic content analysis. The COREQ checklist was used to document reporting of the study. Results: Individual interviews were conducted: 24 patients and 12 relatives. Three main themes were identified: "Involve me in decisions about my care and treatment," "Keep me safe when I am vulnerable" and "Treat me as an individual and with respect." Older people want to be involved in decisions about their care and treatment and to receive adequate, suitable information. They feel vulnerable during hospitalisation and want to feel safe when speaking up about concerns. Individual acknowledgement is an important aspect of dignity. Conclusions: Older people and their relatives identified specific elements of care that uphold or threaten dignity during acute hospitalisation. Nurses play a major role in upholding dignity for older people in hospital. Relevance to clinical practice: Clinicians may benefit from systematic dignity‐related training. Specific strategies to enhance older persons' dignity, including communication skills training and continence management need to be developed, implemented and evaluated. [ABSTRACT FROM AUTHOR]

People with severe mental illness have significantly reduced life expectancy and higher risk of cardiovascular diseases than the general population. There is a critical need for quality physical health care to improve consumers' health outcomes. There is minimal knowledge, however, on the impact of mental health nurse practitioner candidate (NPC) practices on consumers' health outcomes. The aim of this proof‐of‐concept study was to describe the impacts of NPC practices on the quality of physical healthcare provision and physical health outcomes (cardiovascular and cardiometabolic) of consumers in community mental health service settings. Using a mixed methods design, quantitative data were collected for 12 months prior to (Period 1), and 12 months during (Period 2), the candidacy period. Qualitative interviews were conducted with a purposive sample of n = 10 consumers to explore their perspectives on physical healthcare provision by the NPCs. During the 12‐month candidacy period, the number of metabolic monitoring assessments rose from n = 55 in Period 1 to n = 146 in Period 2 (P < 0.01, χ2 = 41.20). Advanced practices provided by NPCs included taking an extensive holistic history and clinical examination, ordering diagnostic pathology, and clinical simulation of physical health medication prescription (under medical supervision). Analysis of consumer interviews resulted in two themes: (i) positive and helpful NPC health care and (ii) improvements in physical and mental health. The findings add new knowledge on specialist mental health nurse practitioner candidate roles and demonstrate the benefits these roles can have in reducing the significant morbidity and mortality of mental health consumers. [ABSTRACT FROM AUTHOR]

Aims and objectives: The proposed study aimed to answer the following question: What communication issues do nurses find challenging when caring for people with life‐limiting illness? Background: Evidence suggests that attitudes, skills and knowledge about how nurses communicate effectively with patients and their families could be improved. However, the literature predominantly focuses on nurses working in oncology and the medical profession. Design: A qualitative descriptive design was used. Methods: Focus groups were conducted with 39 nurses from three wards within a regional healthcare organisation in Victoria, Australia. Data were analysed using thematic content analysis. The COREQ checklist was used to document reporting of the study. Results: In their view, nurses have the potential to develop a strong bond with patients and their families. Three key themes were identified: (a) feeling unskilled to have difficult conversations with patients who have life‐limiting illness; (b) interacting with family members adds complexity to care of patients who have life‐limiting illness; and (c) organisational factors impede nurses' capacity to have meaningful conversations with patients and their families. Conclusions: Caring for individuals with life‐limiting illness is complex and often occurs in an emotionally charged environment. However, nurses report being hampered by time restraints and lack of information about the patient's condition and goals of care. Limitations in conversation structure and a comprehensive range of core communication skills affect their ability to confidently engage in conversations, particularly when they are responding to prognostic questions. Relevance to clinical practice: Whilst nurses are responsible for performing technical skills, they can maximise care by developing a trusting relationship with patients and their relatives. Increased acuity limits the time nurses have to talk with patients. In addition, they lack confidence to deal with difficult questions. Specific training may increase nurses' confidence and efficiency when communicating with patients and their families. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore the perspectives of caregivers regarding the information and support they received following diagnosis of their child’s hearing loss. Design: A mixed methods explanatory sequential design was conducted. Study sample: A total of 445 caregivers of children completed a written survey, and five parents participated in qualitative in-depth interviews. Results: The most common sources of information for caregivers were discussion with an audiologist, written information, and discussion with a medical professional. Approximately 85% of caregivers reported they were satisfied with the personal/emotional support and information received from service providers. Additional comments from 91 caregivers indicated that 11% experienced a breakdown in information transfer with health professionals. Interviews conducted with five parents from three families revealed two themes which described the diagnostic period as a difficult and emotional experience for parents: (1) support and information provided during diagnosis: what happens first? and (2) accessing early intervention services following a diagnosis of hearing loss: navigating the maze. Conclusions: The findings of this study give insight into the perspectives of caregivers who have a child diagnosed with hearing loss. The importance of providing timely information and personal/emotional support to caregivers cannot be underestimated. [ABSTRACT FROM AUTHOR]

Less is known about the experiences of older adults (65+ years of age) with co-occurring mental health and alcohol and other drug use disorders (dual diagnosis) than is known about the experiences of their younger counterparts. This exploratory qualitative study sought to interview individuals receiving case management from an inner Melbourne community mental health service to determine their experiences of living with dual diagnosis and explore their interactions with mental health and addiction treatment, and general medical services alike. Six older adults with a dual mental health and substance disorder agreed to participate in a semi-structured interview process and provided their perspectives about living with complex mental illness and alcohol and other drug use. Several key themes emerged throughout the interview process, mirroring the notion of dual diagnosis being a complex phenomenon involving a number of interrelated factors: these include medical complexity, poor service engagement and long-term use of alcohol and other drugs. Interviews also demonstrate the challenges inherent in providing care to this cohort, with the participants frequently describing their experiences with services as being fraught with difficulty. The increased understanding of the perspectives of older adults with dual diagnosis provides the foundation for further research into this population in addition to influencing future nursing care provided to this cohort. [ABSTRACT FROM AUTHOR]

Objective: Patient-centred communication (PCC) is an essential skill for effective healthcare provision and is accepted as a core competency in medicine and allied health. In audiology, recent studies have shown that audiologists rarely display PCC in adult hearing interactions. This highlights a need to investigate how PCC is taught and learnt in audiology. There is a paucity of studies on PCC in audiology education. The aim of this study is to examine educator perceptions of teaching PCC, including barriers and facilitators, in Australian graduate audiology programmes. Design: Semi-structured interviews were conducted with audiology educators responsible for communication training. Interview transcripts were analysed using qualitative content analysis. Study sample: Nine participants, including programme coordinators and key teaching staff from all six Australian audiology programmes participated in the study. Results: PCC education was found to be influenced by four emerging themes: professional culture and values, contextual factors, knowledge and understanding of PCC and individual factors. Conclusions: These results provide an insight into the competing agendas involved in implementing PCC education in both the university and clinical component of audiology programmes. The findings can play a role in refining and building the evidence-base for teaching and facilitating patient-centred audiological care in future audiologists. [ABSTRACT FROM AUTHOR]

Background Within the context of growing concerns about a potential oversupply of occupational therapist, this research examines when, where and how long new graduates take to gain employment and identifies influences upon the health and university systems. Method A mixed method research design, using an online survey was adopted to investigate the topic. Two consecutive cohorts of graduates from a single university program were invited to participate. Results Seventy-five (58%) responses were received, with 63 (84%) currently employed in an occupational therapy role. Of the 12 (16%) not employed, only 3 (4%) described themselves as actively seeking employment in an occupational therapy role. A wide spread of employment settings and scope of practice areas was reported. Conclusion Findings suggest that occupational therapy graduates are gaining employment in a range of settings and practice areas, relatively quickly. This research adds evidence to the conversation around graduate employment within a region of Australia. The Australian population, health system and university changes are possible factors influencing employment. The research reveals the difficulties in understanding the current situation with limitations in data collected, varied terminology and an ever changing job seeking environment. The research provides a starting point for the occupational therapy profession to further understand the directions the profession is taking. University programs may also benefit by using the research to tailor course content to assist graduates in gaining employment or to present students with the prospects of new employment opportunities. [ABSTRACT FROM AUTHOR]

Background: Stroke telemedicine can reduce healthcare inequities by increasing access to specialists. Successful telemedicine networks require specialists adapting clinical practice to provide remote consultations. Variation in experiences of specialists between different countries is unknown. To support future implementation, we compared perceptions of Australian and United Kingdom specialists providing remote acute stroke consultations.Methods: Specialist participants were identified using purposive sampling from two new services: Australia's Victorian Stroke Telemedicine Program (n = 6; 2010-13) and the United Kingdom's Cumbria and Lancashire telestroke network (n = 5; 2010-2012). Semi-structured interviews were conducted pre- and post-implementation, recorded and transcribed verbatim. Deductive thematic and content analysis (NVivo) was undertaken by two independent coders using Normalisation Process Theory to explore integration of telemedicine into practice. Agreement between coders was M = 91%, SD = 9 and weighted average κ = 0.70.Results: Cross-cultural similarities and differences were found. In both countries, specialists described old and new consulting practices, the purpose and value of telemedicine systems, and concerns regarding confidence in the assessment and diagnostic skills of unknown colleagues requesting telemedicine support. Australian specialists discussed how remote consultations impacted on usual roles and suggested future improvements, while United Kingdom specialists discussed system governance, policy and procedures.Conclusion: Australian and United Kingdom specialists reported telemedicine required changes in work practice and development of new skills. Both groups described potential for improvements in stroke telemedicine systems with Australian specialists more focused on role change and the United Kingdom on system governance issues. Future research should examine if cross-cultural variation reflects different models of care and extends to other networks. [ABSTRACT FROM AUTHOR]

Dual diagnosis has been identified as a significant challenge to mental health services, resulting in higher rates of psychiatric relapse and greater illness severity. Much research explores dual diagnosis in the adult mental health cohort, however little research attention has been paid to older adults with dual diagnosis. Far from being a trivial issue, preliminary studies have shown that dual diagnosis in older adults is under diagnosed and poorly identified by clinicians with few specific treatment options available. In addition, studies of the ageing baby boomer cohort demonstrate a potential for dual diagnosis presentations to increase in the coming years. This article explores the experiences of a clinical team providing care to older adults with dual diagnosis in Melbourne, Australia, through a semi-structured interview process. The participants described a number of systemic barriers to providing care to the older adults with dual diagnosis presenting to the mental health service, in addition to feeling poorly prepared and expressing a degree of clinical helplessness. Additionally, the participants described service improvement, which included a strong dual diagnosis culture in the leadership team of the mental health service and role modelling dual diagnosis competent practice among clinicians. [ABSTRACT FROM PUBLISHER]

The aim of this study is to explore local health and wellbeing plans and priorities by Victorian local governments (LGs), specifically to: (1) analyse how LG priority areas are described in comparison to the State-level plan; (2) identify differences between regional and metropolitan health priorities; and (3) identify differences between LGs with high and low socioeconomic status. Content analysis of 79 LG health and wellbeing plans was undertaken. Differences in health and wellbeing priorities between LGs were examined using the t-test for two proportions. In total, 20% of the plans did not specify actions to address health priorities. One in three (34%) did not specify how evaluation will be done. Alcohol and other drugs, gambling and housing were prioritised more by metropolitan LGs, whereas disease prevention was prioritised more in regional LGs. There was no significant difference in health and wellbeing priorities of LGs with high and low socioeconomic status except for gambling. State-level health and wellbeing plans should be sensitive to differences in priorities of LGs. There is a need for local plans to commit to specific actions and evaluation. This analysis provides basis for more community-reflective, State-level planning and calls for more emphasis on identifying actions and evaluation in local level planning. [ABSTRACT FROM AUTHOR]

Purpose: There is a lack of clarity regarding nursing roles and strategies in providing culturally meaningful end-of-life care to elderly immigrants admitted to Australian hospitals. This article redresses this ambiguity. Method: A qualitative exploratory descriptive approach was used. Data were obtained by conducting in-depth interviews with a purposeful sample of 22 registered nurses, recruited from four health services. Interview transcripts were analyzed using content and thematic analysis strategies. Results: Despite feeling underprepared for their role, participants fostered culturally meaningful care by “doing the ground work,” “facilitating families,” “fostering trust,” and “allaying fear.” Discussion and Conclusion: The Australian nursing profession has a significant role to play in leading policy, education, practice, and consumer engagement initiatives aimed at ensuring a culturally responsive approach to end-of-life care for Australia’s aging immigrant population. Implications for Practice: Enabling elderly immigrants to experience a “good death” at the end of their lives requires highly nuanced and culturally informed nursing care. [ABSTRACT FROM AUTHOR]

Purpose:While research has begun to explore the management of aphasia across the continuum of care, to date there is little in-depth, context specific knowledge relating to the speech pathology aphasia management pathway. This research aimed to provide an in-depth understanding of the current aphasia management pathway in the acute hospital setting, from the perspective of speech pathologists. Method:Underpinned by a social constructivist paradigm, the researchers implemented an interpretive phenomenological method when conducting in-depth interviews with 14 Australian speech pathologists working in the acute hospital setting. Interview transcripts and interviewer field notes were subjected to a qualitative content analysis. Results:Analysis identified a single guiding construct and five main categories to describe the management of aphasia in the acute hospital setting. The guiding construct,First contact with the profession,informed the entire management pathway. Five additional main categories were identified:Referral processes;Screening and assessment;Therapeutic intervention;Educational and affective counselling; andAdvocacy. Conclusions:Findings suggest significant diversity in the pathways of care for people with aphasia and their families in the acute hospital setting. Additional support mechanisms are required in order to support speech pathologists to minimise the evidence-practice gap.Implications for RehabilitationSignificant diversity exists in the current aphasia management pathway for people with acute post-stroke aphasia and their families in the acute hospital setting.Mechanisms that support speech pathologists to minimise the evidence-practice gap, and consequently reduce their sense of professional dissonance, are required. [ABSTRACT FROM AUTHOR]

Aims and objectives The aim of this study is to report on a key finding of a larger study investigating the 'gaps' in patient care that registered nurses encounter during the course of their practice. A key finding of this larger study was that 'cutting corners' was a gap discerned by nurses. Background 'Cutting corners' has been characterised as a 'violation' and threat to patient safety, although there is a paucity of research on this issue. Design Naturalistic inquiry using a qualitative exploratory descriptive approach. Methods Data were collected from a purposeful sample of 71 registered nurses from emergency department, critical care, perioperative, rehabilitation and transitional care and neurosciences settings in Australia and analysed using content and thematic analysis strategies. Results Cutting corners was a common practice that encompassed (1) the partial or complete omission of patient care, (2) delays in providing care and (3) the failure to do things correctly. Corners were cut in patient assessment, essential nursing care, the care of central venous catheters and medication administration. The practice of cutting corners was perceived as contributing to preventable adverse events. Conclusions The study found that cutting corners created gaps that contributed to unfinished nursing care and preventable adverse events. The findings of the study raise the possibility that cutting corners is a salient but underinvestigated characteristic of nursing practice. Further research and inquiry are needed to deepen understanding of cutting corners and its impact on patient safety. Relevance to clinical practice Identifying the nature and implications of cutting corners when providing nursing care is an important contributing factor to improving patient safety and quality care. [ABSTRACT FROM AUTHOR]

Aims To understand the barriers and enablers to fertility-awareness education in general practice. Background Most women along with their primary care practitioners - general practitioners and practice nurses - believe that women should be educated about fertility-awareness when first reporting trouble conceiving. To date, no in-depth study has examined the enablers and challenges of this type of education in general practice. Design A descriptive exploratory qualitative study using deductive content analysis. Methods General practitioners ( N = 11) and practice nurses ( N = 20) were recruited from general practices in three socioculturally diverse areas in Victoria, Australia. Data were collected through semistructured interviews based on the 12 domains of a theoretical behaviour change framework from April-August 2012. The participants' responses were organized into themes that fall under the framework domains. Findings The biggest barriers to fertility-awareness education in general practice were short consultations and time constraints faced by general practitioners together with a lack of patient educational materials and remuneration to support its delivery. The biggest enablers were a greater use of nurses trained in fertility-awareness in a collaborative team care arrangement with general practitioners. Conclusion This study has identified several important barriers and enablers to fertility-awareness education in general practice. Translation into practice of our findings is imperative as the first step in establishing a primary care model in fertility-awareness. This would fill an important gap in the primary care of infertile women and build capacity in general practice to reduce infertility through women's enhanced fertility knowledge. [ABSTRACT FROM AUTHOR]

Background: Death anxiety is a known phenomenon in older people of culturally and linguistically diverse backgrounds (CALD) hospitalised for end-of-life (EOL) care. Little is known about how nurses assuage death anxiety in this population. Aims: To investigate strategies used by nurses to assuage death anxiety and facilitate a good death in older CALD Australians hospitalised for EOL care. Methods: Advanced as a qualitative descriptive inquiry, a purposeful sample of 22 nurses was recruited from four Victorian healthcare services. Interviews were transcribed verbatim and analysed using thematic analysis processes. Findings: Nurses used three key strategies: recognising death anxiety; delineating its dimensions; and initiating conventional nursingcaring behaviours to help contain it. Contrary to expectations, cultural similarities rather than differences were found in the strategies used. Conclusions: Nursing strategies for recognising, delineating, and managing death anxiety in older CALD people hospitalised at the EOL is an important component of quality EOL care. [ABSTRACT FROM AUTHOR]

Aims and objectives. To examine carers' views on patient self-care in chronic heart failure (CHF). Background. Self-care, a key strategy in the long-term management of CHF, can be complex and difficult to master. Carers play a key role in supporting patients in self-care, yet their views on it are rarely sought. Design. A qualitative approach was adopted with a purposeful sample of carers of patients with CHF residing in Australia. Methods. Carers who identified themselves as providing informal care to a person diagnosed with chronic heart failure were interviewed about their views on patient self-care. Data were collected by face-to-face interviews with a semi-structured interview guide. Qualitative content analysis of the interviews was undertaken by two nurses and one psychologist. Results. Four key themes were identified pertaining to CHF patient self-care: hindrance to engagement; roles and relationships; social support and community engagement and competency. Most carers viewed patients' fatigue and inactivity, mood and coping, and memory loss as major challenges to engagement in self-care. They viewed emotional support and encouragement, independence and organised routines as important aspects of their relationship with the patient and as facilitators of self-care, but also required for themselves support from their families, communities and healthcare professionals. They also viewed patient and carer experience and knowledge as being essential to successful self-care. Conclusion. Carers viewed self-care as an important issue for patients with CHF and indicated that they could play an enhanced role with the provision of better support and knowledge from their families, communities and health care professionals. Relevance to clinical practice. Carers are closely involved in supporting patients in CHF self-care, even though their views are rarely considered in the organisation and delivery of heart failure management programmes. Therefore, their important contribution should be acknowledged and supported in contemporary heart failure health services. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aim of this study was to investigate the experiences of relatives who had a family member in an aged care facility subsequently transferred to an emergency department. Background. The provision of timely and relevant patient information is vital for assessment and management of older patients presenting to the emergency department from aged care facilities. Older people are commonly accompanied by relatives who are an important resource for emergency department staff, providing medical information and assisting with treatment decisions. Investigating the experiences of relatives may provide key information to enable improvements in the delivery of emergency department care. Design. This study used a descriptive qualitative design. Methods. Semi-structured interviews were undertaken with 24 relatives of residents who were transferred from an aged care facility to an emergency department in Victoria, Australia in the previous three years. Inductive content analysis was used to analyse the transcripts. Results. Relatives reflected on four main themes following their emergency department visit: The need for clear communication; The role of relatives in emergency department care; How older people are perceived in the health care system and an Ability to provide specialised care. Conclusions. Many people link their emergency department experience to the quality of communication with emergency department staff, and participants in this study felt satisfied with their visit when they were included in discussions about treatment, and their role was recognised by staff members. In contrast, participants were dissatisfied with the care provided to their family member when staff members failed to communicate with them, or recognise their role in the care of the family member. Relevance to clinical practice. The findings of this study emphasise the importance of effective communication between emergency department staff and family members, in relation to treatment and end-of-life care. [ABSTRACT FROM AUTHOR]

Background: Mid ‐ to late ‐ stage dementia is often characterized by behavioural and psychological symptoms, including, but not limited to physical and verbal aggression. Introduction: Although there is a considerable research about the prevalence, aetiology, and management of behavioural and psychological symptoms of dementia, there is limited research about the experience of caring for people with such symptoms in long ‐ term aged care facilities. Aim: The aims of the study were to describe: (i) nurses' experiences of caring for people with behavioural and psychological symptoms of dementia in long ‐ term aged care facilities, and (ii) strategies nurses used to deal with these symptoms. Methods: A qualitative exploratory and descriptive design, involving focus group interviews with 30 nurses from three long ‐ term aged care units in Australia. The transcripts were analysed using inductive content analysis. Results: The findings revealed five interrelated themes: (i) working under difficult conditions, (ii) behavioural and psychological symptoms of dementia: an everyday encounter, (iii) making sense of behavioural and psychological symptoms of dementia, (iv) attempting to manage behavioural and psychological symptoms of dementia, and (v) feeling undervalued. Conclusion: This study highlighted the difficult conditions under which nurses worked and the complexity of caring for individuals who have behavioural and psychological symptoms of dementia. Implications for nursing and health policy: Organizational efforts to enhance the quality of care for individuals with behavioural and psychological symptoms of dementia in long ‐ term aged care facilities should extend beyond staff education to heed nurses' concerns about organizational barriers to interpersonal care. [ABSTRACT FROM AUTHOR]

Background: Patient participation in medication management during hospitalization is thought to reduce medication errors and, following discharge, improve adherence and therapeutic use of medications. There is, however, limited understanding of how patients participate in their medication management while hospitalized. Objective: To explore patient participation in the context of medication management during a hospital admission for a cardiac surgical intervention of patients with cardiovascular disease. Design: Single institution, case study design. The unit of analysis was a cardiothoracic ward of a major metropolitan, tertiary referral hospital in Melbourne, Australia. Multiple methods of data collection were used including pre‐admission and pre‐discharge patient interviews (n = 98), naturalistic observations (n = 48) and focus group interviews (n = 2). Results: All patients had changes made to their pre‐operative cardiovascular medications as a consequence of surgery. More patients were able to list and state the purpose and side‐effects of their cardiovascular medications at pre‐admission than prior to discharge from hospital. There was very little evidence that nurses used opportunities such as medication administration times to engage patients in medication management during hospital admission. Discussion and Conclusions: Failure to engage patients in medication management and provide opportunities for patients to learn about changes to their medications has implications for the quality and safety of care patients receive in hospital and when managing their medications once discharged. To increase the opportunity for patients to participate in medication management, a fundamental shift in the way nurses currently provide care is required. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore nurses' reactions to new novel technology for acute health care. Background Past failures of technology developers to deliver products that meet nurses' needs have led to resistance and reluctance in the technology adoption process. Thus, involving nurses in a collaborative process from early conceptualisation serves to inform design reflective upon current clinical practice, facilitating the cementing of 'vision' and expectations of the technology. Design An exploratory descriptive design to capture nurses' immediate impressions. Methods Four focus groups (52 nurses from medical and surgical wards at two hospitals in Australia; one private and one public). Results Nursing reactions towards the new technology illustrated a variance in barrier and enabler comments across multiple domains of the Theoretical Domains Framework. Most challenging for nurses were the perceived threat to their clinical skill, and the potential capability of the novel technology to capture their clinical workflow. Enabling reactions included visions that this could help integrate care between departments; help management and support of nursing processes; and coordinating their patients care between clinicians. Nurses' reactions differed across hospital sites, influenced by their experiences of using technology. For example, Site 1 nurses reported wide variability in their distribution of barrier and enabling comments and nurses at Site 2, where technology was prevalent, reported mostly positive responses. Conclusion This early involvement offered nursing input and facilitated understanding of the potential capabilities of novel technology to support nursing work, particularly the characteristics seen as potentially beneficial (enabling technology) and those conflicting (barrier technology) with the delivery of both safe and effective patient care. Relevance to clinical practice Collaborative involvement of nurses from the early conceptualisation of technology development brings benefits that increase the likelihood of successful use of a tool intended to support the delivery of safe and efficient patient care. [ABSTRACT FROM AUTHOR]

Cancer‐related fatigue (CRF) can be a devastating consequence of cancer and cancer treatments, negatively impacting 50%–90% of cancer patients regardless of age, sex or diagnosis. Limited evidence and research exist to inform effective patient‐centred interventions. To target symptom management, there must first be a broader understanding of the symptoms and the lived experience of the persons experiencing CRF and those caring for them, from a supportive as well as a healthcare perspective. This study set out to consider whether components of the language used or descriptors reported by patients, family members, and/or healthcare professionals may provide new insights for potential targets for intervention development. Descriptors from 84 responses (n = 84) from cancer survivors, family members and healthcare professionals were analysed for content. The descriptors reiterate the physical, emotional and functional consequences of CRF, but also reflect two new potential targets for intervention to mitigate the impacts of CRF: uncertainty and sense‐of‐self. [ABSTRACT FROM AUTHOR]