Search

Background: Early identification and intervention for hearing loss is important for supporting language development. Despite this, parents are required to overcome barriers to access hearing assessments for their children. Aims: To identify the enablers and barriers to accessing hearing assessments for Australian children identified by their parents, and to compare between metropolitan, regional and rural areas. Methods & Procedures: This sequential, explanatory mixed‐methods study was undertaken online and included participants in metropolitan, regional and rural area of Queensland, New South Wales, Victoria, South Australia, Western Australia and the Northern Territory. A total of 56 participants participated in the surveys, and 10 participated in semi‐structured interviews. Outcomes & Results: Participants in metropolitan areas were more likely to have services in their area; however, access to hearing assessment was related more to individual circumstances (including health literacy skills) rather than geographical location. Many participants experienced long wait times, reduced flexibility, and a lack of audiologists experienced in working with children. Conclusions & Implications: Barriers to hearing assessments (which assist with early identification and intervention for hearing loss) should be addressed so that children have access to clear auditory information to assist with their speech and language development. WHAT THIS PAPER ADDS: What is already known on the subject: Poor audiological input can lead to poor speech, language and literacy outcomes for children. What this paper adds to the existing knowledge: Although previous research indicates that people in regional and remote locations experience difficulty accessing health services within a reasonable timeframe, in this study barriers were experienced regardless of geographical location, and were dependent on individual circumstances. Many parents are unaware of the impact of hearing on speech and language. What are the potential or actual clinical implications of this work?: Further research might examine how health literacy affects access to hearing assessment. Parents shared several potential solutions to these access barriers which should be considered by service providers. [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]

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]

Background: Formative online multiple‐choice tests are ubiquitous in higher education and potentially powerful learning tools. However, commonly used feedback approaches in online multiple‐choice tests can discourage meaningful engagement and enable strategies, such as trial‐and‐error, that circumvent intended learning outcomes. These strategies will not prepare graduates as self‐regulated learners, nor for the complexities of contemporary work settings. Objectives: To investigate whether providing only a score after formative online multiple‐choice test attempts (score‐only feedback) increases the likelihood of students to engage in self‐regulated learning compared with more directive feedback. Measurable outcomes included deeper learning, collaboration, information seeking, and satisfaction. Methods: Data in this mixed methods study were collected from nursing students through surveys, test results, focus groups, and student discussion board contributions. A quasi‐experimental design was used for quantitative data, and qualitative data were analysed thematically against domains of self‐regulated learning. Results and Conclusions: Students receiving score‐only feedback were more cognitively engaged with the content, collaborated constructively, and sought out richer sources of information. However, it was also associated with lower satisfaction. In this study, minimal feedback created states of uncertainty, which resulted in the activation of self‐regulatory actions. Implications for Practice: Providing overly directive feedback for formative online multiple‐choice tests is conducive to surface‐level learning strategies. By minimising feedback and allowing for extended states of uncertainty, students are more likely to regulate their learning through self‐assessment and problem‐solving strategies, all of which are required by graduates to meet the challenges of real‐world work settings. Lay Description: What is already known about this topic: Formative online multiple‐choice tests are widely used in higher education.Feedback is a critical element in the design of effective online multiple‐choice tests.Formative feedback should promote self‐regulated learning.Feedback types used in multiple‐choice tests facilitate strategies not conducive to self‐regulation. What this paper adds: Online multiple‐choice test feedback can influence how students self‐regulate their learning.Less feedback can result in greater self‐evaluation and performance in summative assessment.Less feedback can encourage richer help‐seeking strategies (collaboration and information seeking).However, less feedback can result in student dissatisfaction. Implications for practice and/or policy: Judicious use of feedback is required in the design of online multiple‐choice tests.Educators should consider providing less feedback to promote learner self‐regulation.Satisfaction with online multiple‐choice tests does not necessarily equate to greater learning. [ABSTRACT FROM AUTHOR]

Introduction: People living with advanced cancer want to continue participating in their valued occupations amid cancer progression. However, increasing dependence and bodily deterioration challenge a person's ability to do so, thus requiring adaptation to how they engage in their occupations. Theoretical frameworks on the process of occupational adaptation often do not address the implications of progressive functional decline. Methods: A longitudinal phenomenological design was used to understand the lived experience of occupational engagement for working‐aged adults living with advanced cancer. A semi‐structured interview series explored participants' experience of occupational engagement and how this changed over time. Data were analysed thematically and mapped against the Model of Human Occupation (MOHO). Findings: Eight adults (40–64 years old) participated in 33 interviews over 19 months. Three themes were constructed from the data: ongoing adaptation through doing, the significance of volition in adaptation, and everyday life is contingent on my environment. Study findings demonstrate that the process of adaptation occurs through occupational engagement, is motivated by volition, and is affected by the environment. Volition and the environment play a more central role in occupational adaptation than occupational competency for the advanced cancer cohort. Conclusion: Study findings further MOHO's theoretical conceptualisation of occupational adaptation by identifying the centrality of volition and the environment in the process of adaptation. For people living with advanced cancer, disease progression results in unremitting functional decline, thus rendering competency an unstable and untenable construct. Rather, this paper argues that occupational adaptation is facilitated by volition (i.e., the motivation behind the doing) and the environment, thus fostering a sense of identity and meaning at the end of life. Occupational therapists' awareness of the significance of volition and the environment can thus foster continued occupational engagement and meaning at the end of life for people living with advanced cancer. [ABSTRACT FROM AUTHOR]

Many Australians are requiring mental health care, including families, leading to long wait times in order to access support. Walk‐in therapy reduces barriers to mental health support services by providing support at the time that families seek help. This paper presents a proof‐of‐concept study investigating the acceptability and short‐term effectiveness of an online walk‐in family therapy service, Walk‐in Together (WIT). Part 1 of the paper describes the experiences of 44 family members from 22 families who presented to a public family therapy clinic for a virtual walk‐in family therapy session. The session was conducted by a team of three experienced family therapists. Family members' experiences were sought pre‐session, post‐session, and at 6 weeks follow‐up via survey and interview. Part 2 of the paper explores therapist perceptions (n = 7) of the WIT approach, through thematic analysis of semi‐structured interview data. Post‐session feedback showed 85% of family members found WIT to be helpful and 50% were optimistic about their future as a family after their WIT session. Six weeks post‐session it was revealed that WIT supported planning for families in equipping them to move forward with 88% of family members reporting that they knew what to do after the session. All therapists uniformly experienced the model as offering a timely and beneficial service, suitable for diverse presentations and constellations of families. These preliminary results suggest the significant utility of this WIT intervention as a well‐received and helpful service for families, who valued the easy access and rapid therapeutic response afforded by the online, walk‐in delivery model. This proof‐of‐concept paper suggests the potential for further development and growth of WIT, as well as other mental health support services using a walk‐in, telehealth model to meet the rising demand for therapeutic support for families in distress. [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]

The life expectancy of persons with intellectual disability is increasing, and this is often occurring concurrently with the aging of their long‐term parental carers. Research in both Australia and around the world indicates that proactive post‐parental care planning is not widely implemented, and transitions primarily happen suddenly following a personal crisis for the primary caregiver. Little focus in Australia has been placed on identifying the barriers that inhibit post‐parental care planning in rural areas, specifically in the context of the newly implemented National Disability Insurance Scheme. This paper examines the factors that limit disability services and their staff in supporting successful post‐parental care planning for individuals with intellectual disability and their aging carers in rural South Australia. Small focus groups were conducted with three groups of rural disability support workers using online technologies to assist with the participants' geographic disparity. A semi‐structured interview guide was developed prior to commencement and was used to initiate discussions on key points. A thematic analysis methodological approach was used for data analysis. There were three themes identified through the analysis; Recruitment; Provision of Care; and Retention. The key findings relating to these themes are presented and supported with exemplar quotes. This research proposes three recommendations for policy or practice change: developing a national advertising campaign for new disability staff that positively emphasizes the high‐level skillset need for proactive planning; supporting rural disability providers to collaborate to establish shared teams of staff with expertise in post‐parental care planning; and, using incentive payments to retain staff with these invaluable skillsets in the disability sector. [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: The purpose of this paper is to report on enablers and barriers during the first 2 years of the health systems integration project that included the implementation of a health navigator role. The project aims to improve health outcomes for children and young people residing in out of home care in rural Australia with a health navigator co‐located between child protection practitioners and community health services clinicians. Setting: Rural Northwest Victoria. Participants: Sunraysia Community Health Services and the Department of Health and Human Services. Design: The qualitative design of the project evaluation involved semi‐structured interviews and documentary evidence analysis. Analyses of interviews and documentary data demonstrate the challenging nature of siloed service delivery in rural Australia, particularly during a time that comprised multiple interruptions due to COVID‐19. Results: A limited synergy between organisational priorities and reporting systems hindered project progress. The lack of a shared definition of 'health' challenged the effective collaboration between health clinicians and child protection practitioners and the role of the health navigator. The health navigator raising health awareness through project involvement, training and sector‐wide stakeholder engagement resulted in a slow but steady process of increased prioritisation of health care, increased health literacy among the child protection workforce, and broadening participation of area‐based stakeholders, but did not translate to increased access to health plans for children. Conclusion: Integrating health systems across multiple sites with support of a health navigator revealed difficulties, particularly during COVID‐19. The first phase of the project demonstrated the value of shared governance and partnerships as an imperative foundation for fundamental change. Relationships strengthened throughout the project, leading to a better understanding of area‐based strengths, which in turn supports improved pathways to health care for children and young people in OOHC within rural communities and driving the subsequent phases of the 10‐year project. [ABSTRACT FROM AUTHOR]

Alcohol and other drug (AOD) nurse practitioners have an advanced scope of practice that allows them to diagnose, prescribe pharmacological treatments for alcohol and other substance use disorders, and monitor physical and mental health. The Behaviour Change Wheel (BCW) is used to understand barriers and facilitators to implementation by applying three conditions of behaviour change (capability, opportunity, and motivation—the COM‐B framework). The aim of this paper is to describe the current AOD nurse practitioner workforce, and to explore barriers and facilitators to AOD nurse practitioner uptake in Australia. A mixed method approach was used in this study: a survey to determine the current state of the AOD nurse practitioner workforce (n = 41) and qualitative interviews with 14 participants to determine barriers to endorsement and ongoing work as a nurse practitioner. Interview transcripts were analysed using thematic analysis and mapped to the COM‐B framework. The AOD nurse practitioner is a highly specialized provider of holistic care to people who use alcohol and other drugs, with AOD nurse practitioners performing advanced roles such as prescribing and medication management. However, there are several barriers to the further uptake of AOD nurse practitioners in Australia, including varied organizational support, a lack of support for the higher study required to become a nurse practitioner and a lack of available positions. Arguably, nurse practitioners are key to addressing prescriber shortages inherent in AOD treatment settings. In addition, they are equipped to provide true holistic care. We recommend that barriers are addressed to expand the AOD nurse practitioner workforce in Australia. [ABSTRACT FROM AUTHOR]

Background: Social media is increasingly used by young people, including those with communication disability. To date, though, little is known about how speech–language therapists (SLTs) support the social media use of young people with communication disability. Aims: To explore what services SLTs provide to facilitate the social media use of young people with communication disability, including what these services look like, and the factors that impact SLTs' professional practices. Methods & Procedures: A sequential mixed methods approach was employed including an online survey and in‐depth semi‐structured interviews. Participants were qualified practising SLTs in Australia with a caseload that included clients aged 12–16 years. Quantitative data were analysed with SPSS. A thematic analysis of qualitative data was conducted with NVivo. Outcomes & Results: Survey responses from 61 SLTs were analysed. Interviews were conducted with 16 participants. Survey data indicated that SLTs do not systematically assess or treat young people's use of social media as part of their professional practice. Interview data revealed that where SLTs do support young people's use of social media, they transfer knowledge and practices typically used in offline contexts to underpin their work supporting clients' use of social media. In terms of factors that affect SLTs' practices, three major themes were identified: client/family factors, SLT factors, and societal factors. Conclusions & Implications: While young people with communication disability may desire digital participation in social media spaces, SLTs' current professional practices do not routinely address this need. Professional practice guidelines would support SLTs' practices in this area. Future research should seek the opinions of young people with communication disability regarding their use of social media, and the role of SLTs in facilitating this. WHAT THIS PAPER ADDS: What is already known on the subject: Young people with communication disability use social media, but digital inequality means that they may not do so to the same extent as their typically developing peers. Services targeting a young person's social media use is within the SLT scope of practice. Whether or not SLTs routinely address the social media use of young people with communication disability as part of their professional practice is unknown. What this study adds to existing knowledge: This study found that SLTs in Australia do not systematically provide professional services targeting young people's use of social media. When services do address a young person's use of social media, knowledge and practices typically used by SLTs in offline contexts are adapted to support their work targeting online social media contexts. What are the potential or actual clinical implications of this work?: This study indicates that SLTs should consider a range of factors when deciding whether to address a young person's social media use. Adapting existing offline professional practices to online environments could support SLTs' work in providing services targeting social media use. Professional practice guidelines would support SLTs' work facilitating the social media use of young people with communication disability. [ABSTRACT FROM AUTHOR]

This paper reports an Australian project designed to simultaneously explore and capacity build professional practice when working at the intersection of parental mental health and/or problematic substance use and domestic violence (DV). Data from this paper are derived from two main sources: observations and ethnographic notes obtained during 28 Community of Practice (CoP) meetings and semi‐structured interviews with 28 CoP participants. Participants were front‐line workers from a range of government and non‐government organizations providing services to families experiencing DV across three Australian states who participated in The STACY Project: Safe and Together Addressing ComplexitY. Thematic analysis was employed to examine the research questions: How do professionals and organizations understand and respond to families experiencing DV, parental mental health difficulties and problematic substance use issues? How did practitioners report participation in the STACY Project reorienting professional practice with families experiencing DV, parental mental health difficulties, and substance misuse issues? This paper reports workers' exploration of practice implications. The research found that 'domestic violence blind' practice has become entrenched at the intersections of child protection, substance misuse and mental health problems, but a shared framework could bring practitioners from diverse sectors together to generate new ways of working with these complex problems. [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]

Background: Communicating about medications across transitions of care is important in older patients who frequently move between health care settings. While there is increasing interest in understanding patient communication across transitions of care, little is known about older patients' involvement in formal and informal modes of communication regarding managing medications. Objective: The aim of this paper was to explore how older patients participated in managing their medications across transitions of care through formal and informal modes of communication. Methods: The study was conducted across two metropolitan hospitals: an acute hospital and a geriatric rehabilitation hospital in metropolitan Melbourne, Australia. A focused ethnographic design was used involving semi‐structured interviews (n = 50), observations (203 h) and individual interviews or focus groups (n = 25). Following thematic analysis, data were analysed using Fairclough's Critical Discourse Analysis. Results: Data analysis revealed two major discursive practices, which comprised of an interplay between formal and informal communication and environmental influences on formal and informal communication. Self‐created patient notes were used by older patients to initiate informal discussion with health professionals about medication decisions, which challenged traditional unequal power relations between health professionals and patients. Formal prompts on electronic medication administration records facilitated the continuous information discourse about patients' medications across transitions of care and encouraged health professionals to seek out older patients' preferences through informal bedside interactions. Environmental influences on communication comprised health professionals' physical movements across private and public spaces in the ward, their distance from older patients at the bedside and utilization of the computer systems during patient encounters. Conclusion: Older patients' self‐created medication notes enabled them to take on a more active role in formal and informal medication communication across transitions of care. Older patients and family members did not have continuous access to information about medication changes during their hospital stay and systems often failed to address older patients' key concerns about their medications, which hindered their active involvement in formal and informal communication. Patient or Public Contribution: Older adults, family members and health professionals volunteered to be interviewed and observed. [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]

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]

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

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]

The majority of children and young people removed from the care of their parents by the state of Victoria, Australia, reside in foster or kinship care. These children have experienced a broad range of adverse conditions and are up to 4 times more likely to experience problems with mental health than their mainstream peers. This paper draws on the perspectives of foster and kinship carers, describing the disconnection between their role as mental health advocates and their interest in early intervention in a field which is dominated by crisis and the historic marginalisation of foster and kinship carers. Thirty‐one foster and kinship carers across greater metropolitan Melbourne, Australia, contributed to this study through interviews and focus groups. Participants demonstrated a practical understanding of mental health and an ability to identify a range of conditions that have an adverse impact on the mental health of children and young people in their care. The paper concludes that there is a lack of systemic support and even a range of barriers that affect the capacity of foster and kinship carers to promote the mental health and well‐being of the children and young people in their care. [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]

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]

Introduction: Employment of occupational therapists in generic roles in public mental health services (PMHSs) constrains capacity to undertake discipline‐specific activity meaning consumers may be unable to access valuable occupational therapy assessments and interventions that could promote recovery. Establishing a dedicated occupational therapy clinic has been identified as one way of improving care provided and outcomes for organisations, therapists, and consumers. To inform such developments, this paper reports evaluation of feasibility, acceptability, and sustainability of a pilot clinic established within a PMHS. Methods: An observational evaluation was used combining quantitative and qualitative data collected from service documents, clinic records, and in semi‐structured interviews with 42 stakeholders. Quantitative data were used to describe referrals and flow through the clinic. Framework analysis of qualitative data examined the process and outcomes of referrals and enabled understanding of acceptability, perceived impact and areas for improvement. Results: Substantial ground work, particularly stakeholder engagement, and redistribution of resources enabled establishment and successful operation of an assessment clinic for 12 months. Assessments were completed for 68% of the 100 accepted referrals, with the remainder in process or unable to be completed. Stakeholders agreed that the clinic enabled clinicians' timely access to specialist assessment, improving care for consumers. Occupational therapists valued the opportunity to deploy and develop discipline‐specific skills and when there was some impact on work flow of occupational therapists' 'home teams', team managers judged the investment worthwhile. Strong leadership by the discipline lead and support from team managers who enabled allocation of occupational therapists to the clinic were critical to success. Conclusion: An occupational therapy assessment clinic can be established and operate successfully within a public mental health setting. Redistribution of resources supported increased efficiency and consumer access to specialist interventions that support their recovery. [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]

This paper draws from interviews with 45 mothers and 52 children who participated in an action research project to develop activities to support women and children in the aftermath of domestic violence. A thematic analysis was used to analyse the data and explore the question: In what ways does the perpetrator of abuse remain present in the lives of women and children following separation? The paper invites workers to recognize the distortions created by domestic violence that may need to be identified and addressed in the aftermath of violence. The ways in which past trauma, erosion of self‐esteem and the undermining of the mother–child relationship continues to create a shadow across the present relationship are identified. The continued presence of the perpetrator of abuse through child contact arrangements and ongoing harassment is also highlighted. The ‘absent presence’ of the abusive partner is posited as a concept to assist workers with a framework through which to understand problems in the mother–child relationship which emerge when living with and separating from a violent partner. The paper has implications for social workers orientating practice to focus on perpetrator accountability and support strengthening the mother–child relationship. [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: This paper explores how food regulators respond to food incidents and the barriers and enablers associated with doing so. Methods: Twenty‐six semi‐structured interviews lasting between 30 and 60 minutes were undertaken with Australian food regulators. Regulators worked across food policy development, implementation, enforcement and standards setting. These interviews ascertained food regulators' views on food safety and responses to real and hypothetical food incidents. Data were analysed using thematic analysis. Results: Food regulators reported that working together with other food regulators is an important part of effective food regulation and response to food incidents. Strategies for working together included clarifying expectations and developing formal documents such as a memorandum of understanding. However, challenges in working together were reported, including different risk thresholds, different political agendas and a lack of clarity on regulators' roles. Conclusions: A focus on partnerships and good communication between food regulators is likely to facilitate effective management of food incidents, and maximise the chances that food incidents do not lead to increased consumer morbidity and mortality as a result of a poor response to a food incident. [ABSTRACT FROM AUTHOR]

Promoting young children's academic and developmental outcomes can no longer be achieved by the single efforts of one profession, but requires professionals to work together in inter-professional teams to understand the complexity of young children's lives. Collaboration in early childhood programs involves health professionals, educators, and other professionals sharing information, validating each other's roles, and providing input around which strategies promote positive outcomes for all children. There are, however, limited studies available within early childhood education on inter-disciplinary relationships between nurses and teachers. This paper helps to fill this void by exploring the relationship of an early childhood teacher and maternal and child health nurse working alongside one another in an Australian kindergarten. Through a narrative approach, a number of characteristics of the relationship were identified as key elements to a productive relationship. Findings are important for health professionals working with early childhood educators. By understanding the complexity within and between disciplines, professionals can work effectively to support young children and their families. [ABSTRACT FROM AUTHOR]

This paper is about older people with learning disabilities who live in the country in Australia. We talked to both individuals and their carers to find out what things helped them they got older, and what things made it harder. These people said that they were well supported by the local community and particularly their doctors. However, many people in this project also reported problems about living in the country such as limited choices and being forced to make decisions they did not like. Access to support services in rural areas is known to be problematic both in Australia, and in other countries around the world, but the majority of research on the population of people ageing with learning disability has so far focussed on metropolitan residents. The authors report about select aspects of the lived experience of older adults with learning disability resident in rural locations in two states of Australia. This pilot project examined data drawn from 34 semi-structured interviews conducted with 17 older adults and 17 carers. Responses were analysed for thematic areas. It was observed that the capacity of certain rural areas to support meaningful choice-making was limited due to constraints of access to key services, including community-based aged care, generic and specialist health services, and both supported disability and aged-care residential options. Responses indicated that those living in both small- and medium-sized congregate care settings (such as group homes and residential aged-care facilities) had more limited choices and only partial (if any) control over their living situation. An understanding of the needs of older adults with learning disability resident in rural areas is important to ensure that both aged-care and disability support structures are built on individuals' needs. [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]

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]

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]

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]

Objectives In Australasia, emergency registrars usually gain experience 'running' an ED overnight - without supervision. This paper describes the introduction of FACEM-supervised daytime 'registrar in charge' ( RIC) shifts into a tertiary adult ED over a 6 month period. Methods Each registrar was allocated at least one RIC shift during their 13 week ED term. Structured questionnaires gathered data regarding the educational impact of the shifts, any adverse effects on departmental function, changes to work practices, and perceptions of teaching and learning. Data were analysed using thematic analysis. Results During the study period, 16 senior ED registrars were rostered for 26 RIC shifts. Questionnaires were completed by 16/16 registrars and 13/16 emergency physicians. The RIC shifts were viewed positively by the emergency registrars - 93% reported useful feedback, felt that the shifts provided a good insight into their workplace behaviour, and that they should be rolled out across other departments. FACEMs were also positive in their evaluation, and reported little negative impact on departmental function. Major themes identified by both registrars and emergency physicians included communication skills, knowledge and experience, delegation, professionalism and organisational skills. Additional themes that were more prominent in FACEM responses included multitasking, dealing with interruptions, managing patient flow and being aware of the whole department. Conclusions RIC shifts are a feasible and acceptable method to teach running the floor in the ED. Further study should assess impact on patient outcomes. [ABSTRACT FROM AUTHOR]

Background and Purpose A profession's values guide daily practice and professional behaviours. They clarify what professionalism means to a profession, by providing insight into the values that members of the profession aim to uphold and profess. There has been limited research into the values of the Australian physiotherapy profession, and as such, the values that guide practice and constitute professionalism are not explicit. This study aimed to make a preliminary identification of the values of the profession, by exploring the shared professional values of 14 Australian physiotherapists. Methods This study was guided by a qualitative approach and constructivist paradigm. Purposive sampling was employed to identify physiotherapists who could contribute rich information to the study. Semi-structured interviews were conducted and analysed using an inductive data analysis method. Results The emerging professional values formed three main themes. The first theme, 'the patient and the patient-therapist partnership', incorporated values such as having patient trust and working collaboratively with patients. The theme labelled 'physiotherapy knowledge, skills and practice' included the values of having an evidence base and respecting professional boundaries. The last theme, 'altruistic values', was inclusive of values such as honesty, empathy and caring. The values that emerged went beyond philanthropic values, to values that guided every day practice, professional relationships and the responsibilities of being a professional. Conclusion The results contribute to research orientated towards identifying the values of the profession and in doing so, clarifying what professionalism means to the Australian physiotherapy profession. Differences between the values identified by the American Physical Therapy Association and the study reported in this paper highlight the importance of identifying the values of the profession within the Australian context. In terms of practice implications, physiotherapists may be prompted to reflect on their values and how these values align with those of their patients. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT The moral importance of the 'intention-foresight' distinction has long been a matter of philosophical controversy, particularly in the context of end-of-life care. Previous empirical research in Australia has suggested that general physicians and surgeons may use analgesic or sedative infusions with ambiguous intentions, their actions sometimes approximating 'slow euthanasia'. In this paper, we report findings from a qualitative study of 18 Australian palliative care medical specialists, using in-depth interviews to address the use of sedation at the end of life. The majority of subjects were agnostic or atheistic. In contrast to their colleagues in acute medical practice, these Australian palliative care specialists were almost unanimously committed to distinguishing their actions from euthanasia. This commitment appeared to arise principally from the need to maintain a clear professional role, and not obviously from an ideological opposition to euthanasia. While some respondents acknowledged that there are difficult cases that require considered reflection upon one's intention, and where there may be some 'mental gymnastics,' the nearly unanimous view was that it is important, even in these difficult cases, to cultivate an intention that focuses exclusively on the relief of symptoms. We present four narratives of 'terminal' sedation - cases where sedation was administered in significant doses just before death, and may well have hastened death. Considerable ambiguities of intention were evident in some instances, but the discussion around these clearly exceptional cases illustrates the importance of intention to palliative care specialists in maintaining their professional roles. [ABSTRACT FROM AUTHOR]

LARSEN A-C. Nursing Inquiry 2012; 19: 334-344 Trappings of technology: casting palliative care nursing as legal relations Community palliative care nurses in Perth have joined the throng of healthcare workers relying on personal digital assistants (PDAs) to store, access and send client information in 'real time'. This paper is guided by Heidegger's approach to technologies and Habermas' insights into the role of law in administering social welfare programs to reveal how new ethical and legal understandings regarding patient information add to nursing's professional responsibilities. This qualitative research interprets data from interviews with twenty community palliative care nurses about clients' legal rights to informational privacy and confidentiality. It explores nurses' views of their nursing responsibilities regarding clients' legal rights, liability issues, bureaucratic monitoring and enforcement procedures. It concludes that nurses and clients are construed as legal subjects entrenched in legal relations that have magnified since these nurses began using PDAs in 2005/2006. [ABSTRACT FROM AUTHOR]

Background People with intellectual disability ( ID) experience health inequity compared with the general population, a key contributing factor being disparities in social determinants of health. The enactment of the United Nations Convention on the Rights of Persons with Disabilities ( CRPD) provides a platform for the progression and promotion of health and other interconnected rights to address barriers to the highest attainable standard of health for this populace. Rights can be brought to life through advocacy efforts. This paper explores the meaning, perceptions and experiences of advocacy by family members and paid support workers of adults with ID and locates the findings within a health and human rights discourse. Methods As part of a larger randomised controlled trial, 113 parents and 84 support workers of adults with ID completed a telephone interview that included open-ended questions about their understanding and experiences of advocacy. Thematic analysis was used to identify relevant themes. Results Five key themes were identified. The first underscored how advocacy to 'speak up' for the person with ID is integral to both parent and support worker roles. The second and third themes considered the contexts for advocacy efforts. Access to quality health care was a core concern, along with advocacy across other areas and sectors to address the person's wider psychosocial needs. The remaining themes highlighted the many dimensions to advocacy, including differences between parent and support worker views, with parental advocacy being an expression of 'caring' and support workers motivated by a 'duty of care' to protect the individual's 'rights'. Conclusion Parent and support worker advocacy provides one means to address the social determinants of health and fulfilment of health rights of and for people with ID. Policy and practice in the context of governmental obligation under the CRPD should support advocacy and make health rights the reality not rhetoric for this group of men and women. [ABSTRACT FROM AUTHOR]

Everyday conversations among non-Indigenous Australians are a significant site in which racism towards Indigenous Australians is reproduced and maintained. This study explores the possibilities of everyday antiracism by asking how people negotiate racist discourses in interpersonal contexts. Twelve first year psychology students (10 female, 2 male, aged 18-50) who had completed a compulsory Indigenous studies course were recruited as participants. Semi-structured interviews were thematically analysed for the constraints and facilitators for responding to racism in everyday contexts. As constraints against speaking up, participants offered 'social expectations to fit in', 'fear of provoking aggression and conflict', assessments of 'the type of relationship', whether they 'could make a difference' and the 'type of racism'. As a facilitator for speaking up, participants reported they were confident in challenging erroneous statements when they felt well informed and authoritative about the facts. The research suggests that everyday antiracism requires a preparedness to deal with possible discomfort and 'bad feeling' which participants reported avoiding. The paper concludes with suggestions for stimulating critical thinking and intergroup dialogue in relation to everyday antiracism. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Almost half the Australian population, aged 16-85 years, are affected by mental illness at some point in their life, and general practice plays a key role in providing effective mental health care. This paper presents the findings from a study that explored how people living with mental illness are supported in Australian general practice. A descriptive, exploratory study was conducted using semistructured interviews to gather data. The role of mental health nurses in the care and support of people with mental illness emerged from the data. This was explored further and resulted in two key themes: dimensions of time and dimensions of space. Findings from this study present key similarities and differences in the role of mental health nurses, as compared to general practitioners, in relation to dimensions of time and space. Dimensions of time and space are important considerations for general practices when planning to introduce a mental health nurse into their interprofessional team. [ABSTRACT FROM AUTHOR]