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Objectives: Cardiac rehabilitation (CR) provides evidence-based secondary prevention for people with heart disease (HD) (clients). Despite HD being the leading cause of mortality and morbidity, CR is under-utilised in Australia. This research investigated healthcare systems required to improve access to CR in rural and remote areas of North Queensland (NQ). Methods: A qualitatively dominant case study series to review management systems for CR in rural and remote areas of NQ was undertaken. Data collection was via semi-structured interviews in four tertiary hospitals and four rural or remote communities. An audit of discharge planning and CR referral, plus a review of community-based health services, was completed. An iterative and co-design process including consultation with healthcare staff and community members culminated in a systems-based model for improving access to CR in rural and remote areas. Results: Poorly organised CR systems, poor client/staff understanding of discharge planning and low referral rates for secondary prevention, resulted in the majority of clients not accessing secondary prevention, despite resources being available. Revised health systems and management processes were recommended for the proposed Heart: Road to health model, and given common chronic diseases risk factors it was recommended to be broadened into Chronic disease: Road to health. Conclusion: A Chronic disease: Road to health model could provide effective and efficient secondary prevention for people with chronic diseases in rural and remote areas. It is proposed that this approach could reduce gaps and duplication in current healthcare services and provide flexible, client-centred, holistic, culturally responsive services, and improve client outcomes. What is known about the topic? Cardiac rehabilitation is known to improve health outcomes and reduce hospitalisations, but referrals and attendance are low (30%). What does this paper add? A revised systems-based model for improved access to secondary prevention for people with heart and related chronic diseases in rural and remote areas of North Queensland is proposed: Chronic disease: Road to health. What are the implications for practitioners? A functional system from hospitalisation to local healthcare services has been designed to improve access to secondary prevention. Staff require support and education to improve skills, better manage care and improve job satisfaction. [ABSTRACT FROM AUTHOR]

This paper describes the cognitive interview phase of the development of two brief surveys, the Movement Behaviour Questionnaire-Baby (MBQ-B) and Movement Behaviour Questionnaire-Child (MBQ-C), which measure the duration of physical activity, screen time, and sleep of children aged 0–5 years. The aims were (1) review the format, content, and clarity of questionnaire items and response options, (2) understand how parents retrieve, encode, and formulate responses when asked about their child's movement behaviours, and (3) identify potential sources of response error and make appropriate modifications. Interviews with parents of children aged 0–5 years were conducted using concurrent think-aloud techniques and probing questions. Parents reviewed the MBQ-B and/or MBQ-C depending on the developmental stage of their child(ren). Twenty-nine interviews were conducted with 20 parents, over four iterative rounds. Participants recalled usual family routines and rules when estimating the duration/frequency of behaviours. To estimate active play, parents referred to the child's daily routine considering wake and bedtimes, naps, and mealtimes. Participants were influenced by the examples provided, being unable to interpret these as exemplars only. Decomposing general items into specific questions with examples was well received. Use of numeracy skills when estimating duration was evident. Interviews informed revisions to item wording, examples, and recall prompts, which will be taken forward into the MBQ-B and MBQ-C validation studies. Utilising cognitive interviewing can enhance confidence that questionnaire items are correctly interpreted and understood by participants. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to explore allied health professional (AHP) managers' implementation of the right to request part-time hours on return from maternity leave in Queensland Health (QH) hospitals. Methods: Qualitative data were collected via interviews with AHP managers from a cross-section of professions with variations in workforce size and gender composition. Interviews were audio recorded, transcribed and analysed thematically. Results: Twenty-one of a potential 40 AHP managers agreed to participate in the study (response rate 53%). The main finding was that the implementation of part-time work arrangements was being driven by regulation and work was being managed without complementary changes to established workplace practices or adequate organisational support. Conclusion: The use of regulatory instruments to implement part-time work in organisations without complementary work redesign, change management and organisational support suggests that there are significant barriers to this type of flexible working arrangement (FWA) becoming accepted workplace practice for AHPs in QH. A whole-of-organisation approach is needed to make FWA a reality. What is known about the topic?: Research has underlined the importance of implementation and management rather than simply the adoption of FWA policies. However, there have been few reports about AHP management of part-time hours on return from maternity leave. What does this paper add?: This paper provides information specifically about the management response to part-time work entitlements for AHP in QH. It indicates that managers are implementing part-time work because it is a regulatory requirement, but often without a substantive commitment to FWA complementary redesign of services or sufficient organisational support. What are the implications for practitioners?: Complementary work redesign measures and resources are needed to make workplaces genuinely flexible rather than just superficially consistent with regulatory requirements. [ABSTRACT FROM AUTHOR]

The aim of this study was to learn from trainees separating from the Queensland Rural Generalist Pathway (QRGP) the reasons and circumstances around their decision so as to improve the efficiency of the program and experience of trainees. Forty-one QRGP trainees who separated without achieving a Rural Generalist (RG) end point to training were interviewed regarding their reasons for separation and thoughts on improving the program. The mean period of time enrolled in the QRGP was 2.87 years. Broadly, the cohort divided into those separating for specialist training, those moving into non-RG general practice and those undecided. Separation for specialist training tended to occur during prevocational years and that to general practice later in the program before trainees had completed advanced skill training. Female trainees were over-represented among trainees separating without completing training. This cohort provided their opinions on the strengths of the QRGP and possible improvements. Understanding and addressing the reasons for early separation suggested several strategies to improve the efficiency of the QRGP in selecting and retaining trainees. Lessons learned included the value of employer-provided coordinated prevocational placements and training, potential benefits of guiding rural-interested medical graduates who ultimately enter other specialist training and the need for greater liaison with external Australian General Practice Training administration organisations to coordinate transition of trainees. There is a need to further address accessibility of advanced training for all trainees. What is known about the topic?: Policies to generate RG medicine programs are now present in most state jurisdictions and nationally in Australia, with reports of successes appearing. However, little information is available regarding non-completion of trainees selected. What does this paper add?: As programs grow in number and throughput, lessons learned from those choosing not to complete will inform the selection and management of trainees to improve the efficiency of these programs. This paper provides lessons learned by the QRGP regarding trainees not completing the program to inform the selection and management of trainees to make the program more efficient. What are the implications for practitioners?: RG programs may facilitate retention or efficient separation of trainees by addressing potential reasons for separation at relevant times in the program. [ABSTRACT FROM AUTHOR]

Language can shape and reinforce attitudes and stereotypes about living with dementia. This can happen through use of metaphors. However, common metaphors may not capture the complexity of experience of dementia from the perspective of the individual person or a family carer. This paper presents an alternative metaphor – that of a theatre production – based on the strategies used by carers to support people with dementia to live well in the community. We conducted face-to-face semi-structured interviews with 12 family members caring for someone with dementia in the community in Queensland, Australia. Our aim was to explore the strategies these carers used to provide support. Interview recordings were fully transcribed and thematically analysed. We identified positive care-giving strategies that described multiple roles that carers fulfilled as they felt increasingly responsible for day-to-day decision making. Family carers explained how they supported the person with dementia to remain a central character in their life and continued to support the person to be themselves. To achieve this, family carers embodied roles that we identified as similar to roles in a theatre production: director, stage manager, supporting cast, scriptwriter, and costume designer and wardrobe manager. Our metaphor of a theatre production offers a fresh perspective to explore the experience of informal care-giving in the context of dementia. [ABSTRACT FROM AUTHOR]

The redefining of human immunodeficiency virus (HIV) from an acute disease to a manageable chronic illness has reshaped the focus of care, emphasising clinical outcomes and sidelining the complex social barriers many people living with HIV (PLHIV) still face. This parallels changes in the location of HIV care in Australia, with many PLHIV seeking care from private general practitioners whose ability to address complex social issues is constrained by limitations of time and resources. In response, peer navigation has emerged as a model of care implemented by some HIV‐based community health organisations seeking to support PLHIV's biomedical and psychosocial needs. However, there is limited understanding of how peer navigation operates in community settings or of the way these programmes integrate with primary care. This paper is the first to explore peer navigation from the perspective of general practitioners (GPs), with experience in treating PLHIV, to understand the role they see for peer navigators (PNs) in supporting PLHIV. Semi‐structured in‐depth interviews were conducted with six GPs (11.5% of specialty HIV GPs in Queensland, Australia) to examine their views and experiences of peer navigation in the context of HIV care. GPs highlighted the complexities of care for PLHIV and the need for additional resources and supports for psychosocial care. GPs valued peer navigation as part of a patient support network and bridge to health and social care systems. PNs normalised HIV, alleviating fear and stigma, educating and translating clinical information for patients. However, a key challenge was the absence of direct communication pathways with PNs. Peer navigation has clear potential in supporting the care of PLHIV, to alleviate constraints in GP settings and expand HIV care beyond the clinic. [ABSTRACT FROM AUTHOR]

Objective: Allied health structures and leadership positions vary throughout Australia and New Zealand in their design and implementation. It is not clear which organisational factors support allied health leaders and professionals to enhance clinical outcomes. The aim of this project was to identify key organisational contexts and corresponding mechanisms that influenced effective outcomes for allied health professionals. Methods: A qualitative realist evaluation was chosen to describe key aspects of allied health organisational structures, identify positive outcomes and describe how context and processes are operationalised to influence outcomes for the allied health workforce and the populations they serve. Results: A purposive sample of nine allied health leaders, five executives and 49 allied health professionals were interviewed individually and in focus groups, representing nine Queensland Health services. Marked differences exist in the title and focus of senior allied health leaders' roles. The use of a qualitative realist evaluation methodology enabled identification of the mechanisms that work to achieve effective and efficient outcomes, within specific contexts. Conclusions: The initial middle range theory of allied health organisational structures in Queensland was supported and extended to better understand which contexts were important and which key mechanisms were activated to achieve effective outcomes. Executive allied health leadership roles enable allied health leaders to use their influence in organisational planning and decision-making to ensure allied health professionals deliver successful patient care services. Professional governance systems embed the management and support of the clinical workforce most efficiently within professional disciplines. With consistent data management systems, allied health professional staff can be integrated within clinical teams that provide high-quality care. Interprofessional learning opportunities can enhance collaborative teamwork and, when allied health professionals are supported to understand and use research, they can deliver positive patient and business outcomes for the health service. What is known about the topic?: A collective allied health organisational structure encourages engagement of allied health professionals within healthcare organisations. Organisational structures commonly include management and leadership strategies and service delivery models. Allied health leaders in Queensland work across a range of senior management levels to ensure adequate resources for sufficient suitably skilled professional staff to meet patient needs. What does this paper add?: Literature to date has described how allied health professionals operate within organisational structures. This paper examines key aspects of allied health management, governance and leadership, together with mechanisms that support allied health professionals to deliver effective clinical and business outcomes for their local community. What are the implications for practitioners?: Health service executives and allied health leaders should consider supporting executive allied health leadership roles to influence strategic planning and decision-making, as well as to deliver outcomes that are important to the health service. When allied health leaders implement integrated professional and operational governance systems, executives described allied health professionals as influential in supporting team-based models of care that add value to the business and improve outcomes for patients. When allied health leaders use consistent data management, executives reinforced the benefit of aligning activity data with financial costs to monitor, recognise and reimburse appropriate clinical interventions for patients. When allied health leaders support allied health workforce capability through educational and research opportunities, clinicians can use research to inform their clinical practice. [ABSTRACT FROM AUTHOR]

The peer workforce has increased significantly in recent years; however, structured development and support for the roles are lacking. This paper explores the role of executive and senior management understanding in the employment of peer roles. In‐depth, semi‐structured interviews and one focus group were conducted with 29 participants from a range of nongovernment and public mental health services within Queensland, Australia. Findings of this study suggest management exposure to and understanding of peer work are essential to the development of an effective peer workforce. Exposure and understanding of peer roles reportedly led to greater acceptance and commitment from management. This commitment inspired action in the form of; enhanced support including advocacy/championing, increased development of roles and influenced culture within the organization to be more accepting of peer work. There was a perception that developing an 'accepting' organizational culture supported the integrity and expansion of peer roles including designated 'peer management' positions. Development of peer management positions is suggested as an effective means of improving the impact of peer perspectives, advocating for peer work and providing ongoing and timely supervision. Recommendations include the need for training and information for management on the unique function, purpose and value of peer roles; and the development of networks, including mentoring opportunities, for organizations with limited experience to gain support and advice from those with greater experience developing peer roles. [ABSTRACT FROM AUTHOR]

With growing concerns about the efficacy and costs of intrusive child protection interventions and increasing recognition of citizen rights to participation in governance, jurisdictions are looking to collaborative alternatives that divert families from the courts and out‐of‐home care. In Queensland (Australia), "intervention with parental agreement" (IPA) is one such response. Under IPA, the statutory child protection authority can work collaboratively with families, without a court order, to respond to children assessed as "in need of protection." In this paper, we use procedural justice theory as a lens to explore how IPA policy is enacted in practice. Procedural justice relates to the quality of treatment a person receives and the fairness of the process than an authority uses during decision‐making (Tyler,). It is associated with voluntary cooperation and compliance; key practice concerns when working to address child maltreatment via parental agreement rather than court ordered intervention. We report on a qualitative study that utilized semistructured, in‐depth interviews to capture the perceptions of 30 practitioners regarding the factors that shape the extent to which they enact IPA policy in a procedurally fair manner. Strategies for enhancing procedurally just enactment of IPA policy in practice are discussed. [ABSTRACT FROM AUTHOR]

This qualitative descriptive study explored health consumers' preferences for receiving nutrition care in Australian primary care. The study was underpinned by a constructivist research paradigm. Semistructured telephone interviews were conducted with 25 health consumers (age 19–78 years; 19 female) from across Australia between May and August 2020. Content analysis, using an inductive approach revealed emergent themes. was used to reveal emergent themes. Five themes were identified in the data: (1) health consumers want to receive nutrition care from a qualified person; (2) nutrition care is viewed as important, and health consumers want to receive it in a format that meets their needs; (3) nutrition care should be low cost and available to everyone; (4) nutrition care services should be conveniently located; and (5) health consumers want nutrition care to be offered frequently, across their lifespan. Health consumers have a clear idea of how they would like to receive nutrition care in the primary care setting, but reported challenges to receiving this care within the current system. New models of service delivery are needed to meet the needs of health consumers. Diet-related chronic diseases are the leading cause of death and disability worldwide, and primary care provides an ideal setting to provide nutrition care to people at risk of chronic disease. This paper provides health consumer views on how the nutrition care model should be tailored to meet patient needs. The findings highlight the need for practice and healthcare system change to the current model of nutrition care in Australia to better meet the needs of patients. [ABSTRACT FROM AUTHOR]

Objective This paper contributes to the literature on relocation for specialist care by providing findings on specific issues impacting on rural farmers and property owners who have to travel to the metropolitan area for specialist care for a haematological malignancy. Design and setting This paper uses descriptive qualitative research based on 45 interviews with patients with haematology in Queensland. The interviews were audio-recorded, transcribed verbatim, coded and thematically analysed. Results In addition to issues of distance, farmers and rural property owners who have to relocate for specialist care must deal with problems associated with the lack of opportunity to take absence from the property because of the inescapable pressure of daily farm and property responsibilities and the high cost of, or lack of opportunity to, outsource daily maintenance. Further concerns include the cost of relocation in the context of continuing drought, serious problems sustaining the travel and time away required, and the lack of choice for some but to deal with treatment alone. Conclusion In recent years there has been considerable progress with regard to overcoming the distance barrier for rural and remote patients with cancer through innovative clinical models using technology and telemedicine. However, there has been limited uptake of such models for patients with haematology. The present findings indicate that from the perspective of rural farmers and property owners there are important reasons why the use of innovative strategies should be fostered and expanded. [ABSTRACT FROM AUTHOR]

Aim This paper aims to identify and explore key obstacles preventing ward managers from effectively performing the human resource management (HRM) responsibilities required in their role. Background In the context of increasing costs and the decentralisation of responsibility to ward level, the relevance of the ward manager role within the 'black box' between human resource management and firm performance is becoming increasingly pertinent. Methods This paper presents an intensive case study including 37 interviews across all levels of a hospital where senior management attempted to shift to a high performance model of human resource management. Results The findings indicated that ward managers played a critical role in maintaining and improving employee performance, although they were restricted from effectively performing their responsibilities due to budget pressure and limited managerial skill development. Conclusions Our findings support the contention that hospitals would benefit from focusing on the critical role of the ward manager as the central locus of influence in high performance human resource management (HPHRM) systems. Implications for nursing management Investment into high performance human resource management is discouraged if the hospital cannot adequately enable ward managers who are responsible for implementation. Introduction of managerial skills training to potential and existing ward managers is critical. [ABSTRACT FROM AUTHOR]

The theme of mistrust in resettlement contexts is largely overlooked in refugee discourses. Through a qualitative inquiry of post-migration experiences of four women raising children alone in Brisbane, Australia, this paper outlines how the presence of mistrust could at times create difficult resettlement circumstances for these women, who then needed to negotiate additional obstacles in everyday life. The definition of social mistrust used here is a form of deliberate and ongoing suspicion about lone refugee women’s choices and lifestyles from other community members. Importantly, the women achieved a sense of well-being despite experiencing mistrust, both in inter-group and intra-group contexts, indicating that they conceptualised access to and benefits from social networks with different emphases on trust. Sociocultural narratives of mistrust, particularly gender-specific perspectives can enrich refugee discourses and challenge established notions of trust inherent to understandings of social networks in resettlement. The findings discussed in this paper contribute to debunking the ‘myth’ of homogeneity in relation to refugee groups and demonstrate the diversity of experiences among sub-groups of refugee women. The theme of mistrust, particularly among women, is an oft-neglected aspect and requires further attention. [ABSTRACT FROM PUBLISHER]

There has been much talk in sociological circles of bodies as 'projects' or 'choices,' but surprisingly little examination of how these projects and choices are experienced. Consumer culture has been described as heralding a new era in body-self relations, but few have explored the experience of body-self relations. Body-self relations emerged as central to understanding in this study of the experience of the body at different ages (20-30, 45-55 and 70+ years), demonstrating the utility of empirical investigations in this area. This paper describes an orientation to the body that was common to the sample of 20 young people (aged 20-30 years) interviewed as part of this study. This orientation informed their health-related behaviours such as diet and exercise, but some participants found it to be problematic. Their voices demonstrate that bodily 'choices' may actually be experienced as irrational and even psychopathological compulsions. This experiential perspective suggests that normality may be continuous with pathology, and that differences are of degree rather than kind. The findings have implications for the treatment and prevention of eating disorders and obesity. [ABSTRACT FROM AUTHOR]

In July 2006, “welfare-to-work” policies were introduced for single parents in Australia. These policies require most single parents with school-aged children to be employed or seeking employment of 15 to 25 hours per week in return for their income support payment. The changes represented a sharp increase in the obligations applying to single parents on income support. This paper is concerned with how the wellbeing of single mothers who are combining income support and paid employment is being influenced by these stepped-up activity requirements. The paper draws on data from semistructured interviews with 21 Brisbane single mothers. The analysis explores participants’ experiences in the new policy environment, utilising the theoretical framework of “relational autonomy”. Relational approaches to autonomy emphasise the importance of relations of dependency and interdependency to the development of autonomy and wellbeing in contrast with more individualistic approaches that privilege independence and self-sufficiency. Findings indicate that in their dealings with the welfare bureaucracy, participants experienced a lack of recognition of their identities as mothers, paid workers, and competent decision makers. These experiences have negative consequences for self-worth, relational autonomy, and ultimately the wellbeing of single parent families. [ABSTRACT FROM PUBLISHER]

Introduction: Collaboration, choice and power‐sharing are cornerstones of practice as occupational therapists support individuals to re‐establish an occupational identity and reintegrate into the community following stroke. Yet evidence of unmet client needs suggests client‐centred care is not optimal, and little is known of client perspectives of client‐centred practice. A deeper understanding of the client experience of therapeutic relationships during adjustment following stroke, will help facilitate client‐centred practice. This paper reports on a study exploring the research question: how do stroke survivors perceive their relationship with their health care team as they adjust to life following stroke? Methods: In this constructivist grounded theory study, in‐depth interviews were conducted with six adult stroke survivors from South‐East Queensland, Australia. Transcribed interviews were analysed using a constant comparative approach, identifying emerging concepts and patterns, to construct a theoretical understanding of the experience and meaning of adjustment and reintegration back into the community, with a specific focus on perceptions of therapeutic relationships and client‐centred practice. Results: Participant perspectives of client‐centred care during their rehabilitation following stroke were revealed and implications of this for their recovery identified. Themes of being understood; out of the driver's seat; knowing what's going on; and what I need when I need it emerged. Participants described not being: involved in decision making, provided with information, or receiving services aligned to their needs. Periods of frustration, loss of hope and fluctuating motivation were also common. Conclusion: Findings shed further light on previously reported health service and discharge experiences. The insight gained into individual experiences of client‐centred care following stroke suggest ways therapists can understand and address each client's adjustment experience and the impact this has on their needs, goal‐setting, motivation, and confidence. Client‐centred care must be grounded in client reality. [ABSTRACT FROM AUTHOR]

Aim: To describe for areas of improvement in the management of COPD and reduction in emergency department presentations in Queensland. Background: If current trends in the management of COPD do not change, the predicted 4.5 million Australians diagnosed with COPD by 2050 will place significant burdens on already over-utilised frontline ED services. Separately COPD is more costly per case than cardiovascular disease and is a more common presentation to Emergency Departments in any year than most types of cancer, road traffic accidents and heart disease. Study Design and Methods: This study used a qualitative thematic analysis methodology in which field convergent interviews were employed to generate data. Sixteen staff and nine patients across three major Southern Queensland Health acute care facilities participated in the study. The authors analysed interview data using qualitative thematic analysis. Results: This research has revealed several noteworthy concepts worthy of further exploration. Thematic analysis from both staff and patient interviews identified the following issues: 1. Nurse case management, 2. Integrated communication of patient assessment and history data, 3. Failure in COPD management, and 4. Knowledge utilisation among ED clinicians. Inherent among these key concepts is a primary goal of coordinated congruent COPD management that optimise a patient's functional status and quality of life, improving symptoms management, and avoiding recurrent exacerbations. Discussion: These insights into the experience of patients and hospital staff into the management of COPD provides valuable insight into current and desired practices that can help to minimise presentations to Emergency Departments. The findings of the research provide insights and future direction for improvements by addressing the inconsistency in disease management. The need for more accessible and consistent patient management and a more congruent centralised patient support framework was also identified. Conclusion: There is indication of support stemming from the voices of patients and hospital staff around the need for COPD case management to become the dominant method of care. Future research should consider the cost benefit and patient outcomes of the implementation of such a role and the avoidance of ED presentations. Implications for research, policy, and practice: The findings of this research imply a need to streamline the patient support and disease management discharged planning process by ensuring one health professional maintains ongoing education, support, and assessment to the patient. Future research needs to better ascertain the positive economic benefits to healthcare organisations by employing Case Managers for patients with COPD. What is already known about the topic? * Case management roles can be effective in reducing ED usage for adults with chronic illnesses. * The World Health Organization (WHO) has called for planned ongoing assessment, care and support coordinated by a proactive investment in real time solutions that address the increasing burden of this disease on the healthcare sector. * The WHO has endorsed targeted patient support strategies that coordinate care over time, addressing the physical and mental health needs of people with chronic illness. What this paper adds: * Findings from this research show that discharged planning support practices with Southern Queensland Healthcare Organisations require review and ongoing evaluation. * This may include, streamlining the patient support and disease management discharged planning; or designated case management or integration of systems to prevent ED presentations. * This research adds to the voices of patients and staff that confirm published research recommendations. [ABSTRACT FROM AUTHOR]

Background: Clinical documentation is a fundamental component of patient care. The transition from paper based to electronic medical records/electronic health records has highlighted a number of issues associated with documentation practices including duplication. Developing new ways to document the care provided to patients and in turn, persuading clinicians to accept a change, must be supported by evidence that a change is required. In Australia, there has been a limited number of studies exploring the clinical documentation practices and beliefs of clinicians. Objective: To gain an in-depth understanding of clinician documentation practices. Method: A qualitative design using semi-structured interviews with clinicians (allied health professionals, doctors (physicians) and nurses) working in a tertiary-level hospital in South-East Queensland, Australia. Results: Several themes emerged from the data: environmental factors, including departmental policy and systemic issues, and personal factors, including verification, clinical reasoning and experience influencing documentation practices. Conclusion: Our study identified that the documentation practices of clinicians are complex, being driven by both environmental and systemic factors and personal factors. This in turn leads to duplication and some redundancy. The documentation burden of duplication could be reduced by changes in policy, supported by multidisciplinary documentation procedures and electronic systems aligned with clinician workflows, while retaining some flexible documentation practices. The documentation practices of individuals, when considered from the perspective of enhancing quality care, are considered legitimate and therefore will continue to form part of the health (medical) record regardless of the format. [ABSTRACT FROM AUTHOR]

The aim of the present case study is to illustrate the outcomes of a dedicated allied health (AH) research position within a large Queensland regional and rural health service. The secondary aim of the case study is to describe the enabling and hindering mechanisms to the success of the role. Semistructured interviews were conducted with the Executive Director of Allied Health and the current AH research fellow incumbent within the health service. A focus group was also undertaken with six stakeholders (e.g. clinicians, team leaders) who had engaged with the research position. Outcomes of the AH research fellow included clinical and service improvements, enhanced research culture and staff up-skilling, development of research infrastructure and the formation of strategic research collaborations. Despite being a sole position in a geographically expansive health service with constrained resources, key enabling mechanisms to the success of the role were identified, including strong advocacy and regular communication with the Executive. In conclusion, the case study highlights the potential value of an AH research position in building research capacity within a large non-metropolitan health service. Factors to facilitate ongoing success could include additional research and administrative funding, as well as increased use of technology and team-based research. What is known about the topic?: Dedicated research positions embedded within health care settings are a well cited strategy to increase research capacity building of allied health professionals (AHPs). However the majority of these positions are within metropolitan health settings and unique challenges exist for these roles in regional and rural areas. Few studies have described the impact of dedicated AH research positions within regional health centres or the factors which facilitate or hinder their role. What does this paper add?: Dedicated research positions within a non-metropolitan Australian health service may have a positive impact on AH clinical services, research culture, staff upskilling, research infrastructure and research collaborations. Key enabling mechanisms to support the role may include advocacy from higher level management, strong networks and communication channels. Additional research and administrative funding, the use of technology and team based research may enhance sustainability of such roles. What are the implications for practitioners?: AH research positions have potential value in building research capacity within a large non-metropolitan health service. Health managers and researchers should be aware of the unique challenges to these roles and consider mechanisms that may best enhance and sustain outcomes of the positions including: the development of infrastructure (i.e. technology, website of resources), networks, and communication strategies (i.e. regular meetings with leadership and promotion internally). [ABSTRACT FROM AUTHOR]

This paper presents the findings of a study that interviewed Aboriginal nurses to explore their experiences of the whiteness of nursing. Despite concerted efforts to improve the health of Aboriginal Australians, it still remains equivalent to third world countries. One strategy identified to address this is to increase the participation rates of Aboriginal registered nurses within the Australian healthcare workforce. Presently Aboriginal nurses account for only a small percentage of the nursing workforce. While there has been research into the recruitment and retention strategies dedicated to improving the numbers of Aboriginal registered nurses, this paper focus on the experiences of Aboriginal registered nurses within Australia's mainstream healthcare system, where they are exposed and subjected on a daily basis to the 'whiteness of nursing.' [ABSTRACT FROM AUTHOR]

Introduction and Aims: Stroke survivors with aphasia (impaired language/communication) have poor outcomes and gaps in the clinical implementation of best practice contribute to this. Little is known, however, about speech pathologist perspectives on the touchpoints (key moments shaping experiences) in the clinical care pathway that have the greatest impact on service delivery nor how this varies by geographical location. We explored the experiences of speech pathologists who provide aphasia services to establish priorities for improvement and design. Methods and Analysis: This is the initial experience gathering and priority identification stage of an experience‐based co‐design (EBCD) project. Speech pathologists were recruited from 21 geographically diverse Hospital and Health Services in Queensland, Australia. Speech pathologists working in acute, rehabilitation and community services shared positive and negative experiences of delivering aphasia care in interviews and focus groups. Experiential data were analysed using qualitative thematic analysis to determine touchpoints. Priorities for service design were identified using an adapted nominal group technique. Results: Speech pathologists (n = 62) participated in 16 focus groups and nine interviews and shared 132 experiences of delivering aphasia care. Providing care in teams with poor awareness of the impacts of aphasia was identified as a key challenge, as poor patient‐provider communication was perceived to increase risk of adverse outcomes for patients. Speech pathologists identified areas for improvement related to their own professional needs (e.g., greater access to clinical supervision); collaborative health care (e.g., better coordination and interdisciplinary care to increase therapy time); and the service context and environment (e.g., psychological services able to support diverse communication needs). Conclusions: Speech pathologist delivery of aphasia services could be improved through increased access to clinical supervision, opportunities for peer debriefing and interdisciplinary care. Priorities for service design varied by geographical location and included: education to support care transitions (remote areas), improved referral pathways and service linkage (regional areas) and dedicated aphasia staffing (metropolitan areas). Patient or Public Contribution: A consumer advisory committee comprising people with aphasia (n = 3, authors K.M., K.D. and B.A.), their significant others (n = 2, authors J.D. and P.M.), and a Cultural Capability Officer (author G.B.) guided this research. The team: (1) reviewed participant information; (2) co‐designed surveys and workshop resources; (3) copresented research outcomes and contributed to publications. Research questions and study design (e.g., analysis methods and assessment measures) were developed by the research team (authors L.A., V.J.P., D.A.C. and S.J.W.). [ABSTRACT FROM AUTHOR]

The aim of this study was to explore and document the enablers and barriers of chiropractic care colocation in general practice at a large-scale private primary care centre in Australia. This study focused on the perceptions of healthcare professionals regarding this integration. The research setting was a large integrated primary care centre located in an outer metro, low-socioeconomic area in the City of Moreton Bay, Queensland, Australia. Participant inclusion criteria included general medical practitioners, practice nurses, and medical managers who self-reported interactions with the physically collocated and integrated chiropractic practice. Data was collected from 22 participants using face-to-face, qualitative, semi-structured interviews with an average duration of 32 min. The data collected included perceptions of chiropractic treatment, enablers to patient referral pathways, and views of the integrated chiropractic care model. A reflexive thematic analysis was conducted on the data set. All participants reported that this was their first exposure to the colocation of a chiropractor within a general medical practice. Four key enablers of chiropractic care integration were identified: (1) the practitioner [chiropractor], (2) the organisation [general practice], (3) consumer flow, and (4) the environment [shared spaces and tenant ecosystem]. The chiropractic integration enhanced knowledge sharing and interprofessional trust among healthcare providers. The formal reporting of patient outcomes and understanding of the chiropractor's scope of practice further enabled referrals to the service. Shared administrative and business processes, including patient records, booking systems, and clinical meetings, facilitated relationship development between the chiropractor and referring health providers. Colocation as part of a larger primary care centre created proximity and convenience for health providers in terms of interprofessional communication, and for patients, in terms of access to chiropractic services. Existing governance structures supported communication, professional education, and shared values related to the delivery of patient-centred care. Identified barriers included limited public funding for chiropractic services resulting in reduced access for patients of low-socioeconomic status. Additionally, scepticism or negativity towards the discipline of chiropractic care was identified as an initial barrier to refer patients. In most cases, this view towards the chiropractor was overcome by regular patient reporting of positive treatment outcomes to their GP, the delivery of education sessions by the chiropractor for the health providers, and the development of interprofessional trust between the chiropractor and referring health providers. This study provides preliminary evidence and a conceptual framework of factors influencing the successful integration of chiropractic care within an Australian large primary care centre. The data collected indicated that integration of chiropractic care into a primary care centre serving a low-socioeconomic region can be achieved with a high degree of health provider satisfaction. [ABSTRACT FROM AUTHOR]

This paper addresses an aspect of bereavement which has received scant attention: the various meanings of the dead body for the bereaved person and the practical implications of these for social workers in the field of grief and loss. The discussion is embedded within a consideration of the role of social work in the field. The practice context is discussed and the literature of attachment in bereavement and conceptualisations of the dead body briefly reviewed. The core of the paper derives from a series of interviews with relatives of people whose bodies underwent autopsy-based coronial investigations involving the retention of whole organs in Queensland, Australia. A number of emergent themes are identified regarding the resonance of identity and the ways it is contained, asserted and incorporated into the life and grief of the bereaved. Conflicts and concurrences between the perspectives of interviewees and dominant medico-legal perspectives are also considered. The paper concludes by discussing the role of social work in bringing the perspectives of the bereaved person to the fore. It suggests the profession, by virtue of its familiarity with the Ambiguous and Contradictory, is well placed to develop practical understandings of death and bereavement and to enhance the various governmental systems in which they are enacted. [ABSTRACT FROM PUBLISHER]

Objective: To explore rural residents' experiences of access to maternity care with consideration of the policy context. Design: This paper describes findings from focus groups with parents which formed part of case study data from a larger study. Setting: Four north Queensland rural towns. Participants: Thirty-three parents living in one of the four rural towns. Main outcome measures: Identifying prevalent themes in case studies regarding rural parents' expectations and experiences in accessing maternity care. Results: Parents desired a local, safe and consistent maternity service. Removing or downgrading rural services introduced new barriers to care for rural residents: (i) increased financial costs; (ii) family issues; and (iii) safety concerns. Conclusions: Although concerns about rural residents' health status and health care access have received significant policy attention for over a decade, many of the problems which prompted these policy initiatives remain today. Current policy approaches should be re-evaluated in order to improve rural Australians' access to vital health services such as maternity care. [ABSTRACT FROM AUTHOR]

Background: Physiotherapy private practitioners represent a growing proportion of Australia's primary care workforce; however, they face significant barriers in integrating seamlessly within interprofessional teams. Historically, the landscape of primary care in Australia has been one where many physiotherapists work in monoprofessional private practice facilities at dispersed locations, potentially limiting collaborative and coordinated care. The aim of this study was to investigate strategies recommended by physiotherapists to promote effective interprofessional collaborative practice (IPCP) within the Australian private practice setting. Methods: Using interpretive description as the guiding methodological framework, semi-structured interviews were conducted with 28 physiotherapists in 10 private practice sites in Queensland, Australia. Results: Data analysis produced three themes that characterised physiotherapy private practitioners' recommendations to improve IPCP: (a) the need for improved funding and compensation, particularly addressing the limitations of the Medicare Chronic Disease Management program; (b) the development of integrated and secure digital communication systems to facilitate better information exchange; and (c) prioritising professional development and training to enhance collaboration. Conclusions: This research lays the groundwork for informed policy making to advance person-centred care and support the integration of services in the Australian healthcare system. The findings from this study indicate that promoting effective IPCP in physiotherapy private practice requires a comprehensive strategy that addresses systemic funding and compensation issues, enhances digital communication systems and optimises interprofessional education and training. Physiotherapists working in primary care are becoming increasingly important members of interprofessional healthcare teams. This research outlines key strategies from the perspective of Queensland physiotherapy private practitioners, including reforming funding structures, leveraging digital communication and improving education and training initiatives, to promote effective interprofessional collaborative practice. The insights from this study underscore the broader complexities within Australia's healthcare system and emphasise the need for strategic changes to achieve collaboration in ensuring optimal patient care. [ABSTRACT FROM AUTHOR]

Population health data, collected worldwide in an effort to monitor mortality and morbidity of mothers and babies, namely, perinatal data, are mandated at a federal level within Australia. The data are used to monitor patterns in midwifery, obstetric and neonatal practice, health outcomes, used for research purposes, funding allocation and education. Accuracy in perinatal data is most often reported via quantitative validation studies of perinatal data collections both internationally and in Australia. These studies report varying levels of accuracy and suggest researchers need to be more aware of the quality of data they use. This article presents findings regarding issues of concern identified by midwives relating to their perceptions of how technology affects the accuracy of perinatal data records. Perinatal data records are perceived to be more complete when completed electronically. However, issues regarding system functionality, the inconsistent use of terminology, lack of data standards and the absence of clear, written records contribute to midwives’ perceptions of the negative influence of technology on the quality of perinatal data. [ABSTRACT FROM AUTHOR]

Objective: To date, there is limited research to inform an understanding of cancer patients' choice as to location of treatment. This paper makes a contribution by providing findings on a group of regional, rural and remote cancer patients, namely those diagnosed with a haematological malignancy, who have to relocate for specialist care in Queensland, Australia. Methods: Adescriptive qualitative method was used based on 45 in-depth interviews with haematology patients living in Queensland who were supported by the Leukaemia Foundation of Queensland. Results: Four key factors were found to affect the decision making of patients who prefer to travel to metropolitan hospitals for specialist haematology treatments, namely access to own doctor, bonds and familiarity with metropolitan staff, desire for 'quality' specialist care and a distrust of local clinical care and, for some, the absence of usual barriers to visiting the metropolitan area. Conclusions: There are a group of patients who have experiences that lead them to distrust non-metropolitan hospitals and motivate them to travel long distances to attend specialist treating centres for 'quality' care. The literature affirms the concerns of this group. It is the hope and expectation in publishing this article that these patients' concerns will be taken into consideration in the development of health services and policy so that eventually all regional, rural and remote patients will be provided with equitable choice with regard to the location of accessing specialist care. [ABSTRACT FROM AUTHOR]

Purpose: This paper examines the findings from an exit interview with a cardiometabolic health nurse (CHN) following a 26‐week trial. Design and Methods: The CHN participated in a semi‐structured exit interview following completion of the 26‐week trial. Applied thematic analysis was used to identify themes contained in the resultant transcript. Findings: Contrary to the literature, the CHN did not consider additional training necessary to undertake the role. The CHN felt additional information regarding the research implications of the trial and greater organizational support would contribute to better consumer and health service outcomes. Practice Implications: While personally rewarding, more can be done to help the CHN role reach its potential. [ABSTRACT FROM AUTHOR]

As part of the findings of a study on culturally and linguistically diverse older people relocating to a nursing home, this paper contributes to our understanding of how older people draw on their cultural history to explain their decisions to relocate. Family reciprocity was identified by most participants as central to their decisions, regardless of their specific cultural origins. Using the grounded theory methodology, data were collected through progressive, semi-structured, repeated, in-person, individual interviews with 20 residents of four nursing homes in the northern suburbs of Melbourne, Australia. Culturally and linguistically diverse (CALD) older people, regardless of specific cultural origin, make relocation decisions based on the importance and meaning of reciprocity within families. Understanding their decisions as reflecting a culturally valued reciprocity offered a sense of cultural continuity to the relocation and was comforting to the older adults involved in the study. This study also suggests that culturally and linguistically diverse older people are much more active participants in the decision to relocate to a nursing home than is commonly recognised. The four nursing homes in the northern suburbs of Melbourne and the 20 participants studied constitute only a small proportion of all culturally and linguistically diverse older nursing home residents in Australia. Therefore, the findings may not be pertinent to other culturally and linguistically diverse elderly. Nonetheless, this study makes an important contribution to future discussions regarding cultural diversity in the nursing home relocation of culturally and linguistically diverse older Australians. The study findings provide some insight into the conditions and contexts that impact nursing home relocation. [ABSTRACT FROM AUTHOR]

Objective. Nursing directors in mental health services hold important leadership positions that include responsibility for the nursing workforce. The comprehensive or generalist approach to undergraduate nursing education consistently poses significant recruitment problems. Specialisation in mental health within Bachelor of Nursing programs has been suggested as a potential solution. This paper presents the views and opinions of mental health nursing directors regarding undergraduate specialisation. Methods. A qualitative exploratory study was undertaken. Thirteen nursing directors from Queensland Mental Health Services participated in an in-depth telephone interview. The data were analysed thematically. Results. Nursing directors were very supportive of specialisation in mental health at the undergraduate level. Thematic analysis revealed four main themes: perceived advantages of the specialist stream; knowledge and experience; increased recruitment; and commitment. Conclusions. Nursing directors are important stakeholders in educational preparation for practice in mental health settings. The research participants described many potential benefits to undergraduate specialisation. Their voice provides an important contribution to this issue. [ABSTRACT FROM AUTHOR]

Dementia is one of the major causes of disability and dependence amongst older people and previous research has highlighted how the well-being of people with dementia is inherently connected to the quality of their relationships with their informal carers. In turn, these carers can experience significant levels of emotional stress and physical burden from the demands of caring for a family member with dementia, yet their uptake of formal services tends to be lower than in other conditions related to ageing. This paper is based on a qualitative study undertaken in the Australian state of Queensland and explores issues of access to and use of formal services in dementia care from the perspective of the informal family carers. It identifies three critical points at which changes in policy and practice in the formal care system could improve the capability of informal carers to continue to care for their family member with dementia: when symptoms first become apparent and a diagnosis is sought; when the condition of the person with dementia changes resulting in a change to their support needs; and when the burden of informal care being experienced by the carer is so great that some form of transition appears to be immanent in the care arrangement [ABSTRACT FROM AUTHOR]

Sexual issues are common for consumers of mental health services and have many adverse consequences for quality of life as well as impacting negatively on the mental illness itself. Nurses in mental health settings are well placed to assess for the presence of and provide interventions for sexual concerns. To date, little research has been undertaken to explore nurses' attitudes and whether sexual issues would be accepted as part of their care. This paper presents findings from the third stage of a qualitative, exploratory research study with mental health nurses working in an Australian mental health service. The findings from the first two stages suggested that the participants had tended to avoid discussion of sexual issues, but a brief education intervention had produced a greater willingness to address sexual issues as part of care. The aim of the third stage was to determine the degree to which changes in practice had continued over time. Two main themes that emerged from this data were: (i) holism, from rhetoric to reality; and (ii) part of what I do. Addressing sexual issues became part of practice, a change sustained 2 years following the intervention, because participants recognized its importance for holistic nursing care. [ABSTRACT FROM AUTHOR]

Our understanding of the qualities and value of clinical supervision is based on uniprofessional clinical education models. There is little research regarding the role and qualities needed in the supervisor role for supporting interprofessional placements. This paper reports the views and perceptions of medical and allied heath students and supervisors on the characteristics of clinical supervision in an interprofessional, international context. A qualitative case study was used involving semi-structured interviews of eight health professional students and four clinical supervisors before and after an interprofessional, international clinical placement. Our findings suggest that supervision from educators whose profession differs from that of the students can be a beneficial and rewarding experience leading to the use of alternative learning strategies. Although all participants valued interprofessional supervision, there was agreement that profession-specific supervision was required throughout the placement. Further research is required to understand this view as interprofessional education aims to prepare graduates for collaborative practice where they may work in teams supervised by staff whose profession may differ from their own. [ABSTRACT FROM AUTHOR]

This paper presents a sub-set of findings from the first interview (T1) of an Australian longitudinal study that documents the living donor's experience with renal transplant. There has been limited Australian research on this topic to date. A qualitative methodological approach was used, involving open-ended interviews with prospective living kidney donors (n = 20) from the Renal Transplantation Unit at the Princess Alexandra Hospital in Brisbane, Queensland, Australia. The interviews were analysed using qualitative research methods of coding and thematic analysis. A significant majority of participants reported that the decision to become a living kidney donor was a positive, easy and spontaneous decision. It was driven by their natural instincts and they offered to be a donor at the earlier opportunity, rather than waiting to be asked. The offer was based on their desire to relieve the recipient's suffering and possible death associated with dialysis and kidney failure. While concerns associated with the medical operation for donation (nephrectomy) were a consideration, this was significantly overshadowed by their desire to improve the recipient's quality of life and avoid their possible death. In the face of such suffering and death, the donation of a kidney was considered ‘no big deal’. Such findings can be used to inform the assessment process for live donor screening. [ABSTRACT FROM PUBLISHER]

Sexuality is an integral component of every individual's identity. The literature offers limited information about the sexuality and sexual identity of women with spinal cord injury (SCI), beyond the physiological and neurological aspects. The qualitative study described in this paper aimed to explore the experiences and perceptions of a small sample of adult women with SCI regarding their sexuality post-injury. Semi-structured interviews were conducted with four women, which were audio-taped and then transcribed. Thematic analysis was adopted for analyzing the narrative data. Themes that were identified include: factors facilitating positive sexual adjustment, barriers to sexuality post-injury and lack of sexual education in the rehabilitation process. Women with SCI echoed the need to be recognized as sexual beings, despite disability. Health professionals must be willing to discuss issues of a sexual nature and need an understanding of how illness or disability may impact on sexuality, in order to adequately assist individuals with physical disabilities address sexual and intimacy issues. [ABSTRACT FROM AUTHOR]

ABSTRACT Over the past two decades, child protection authorities internationally have begun to implement models of family participation in child protection decision-making. Debate exists about the extent to which these models promote family involvement in decision-making. While a significant body of research on family and professional experience and perceptions of models of family participation in decision-making has emerged, there has been little observational research of these approaches. In this paper, we report on observational data from 11 family group meetings (FGMs) in a child protection context in Queensland, Australia. Under Queensland child protection law, these meetings are referred to as an inclusive process for child protection decision-making and planning. We draw on observational data to analyse how family inclusion in child protection decision-making is facilitated, or limited, by the FGM process. We consider tensions in the realization of a participatory ethos in child protection services systems and discuss what practitioners can practically do to enhance family participation in child protection decision-making. [ABSTRACT FROM AUTHOR]

ABSTRACT Concern about the decision-making abilities of practitioners in child protection has led to the development and implementation of increasingly structured assessment tools, many based on forms of risk assessment. The positive and negative effects of such tools on practice have been widely researched and debated. This paper presents the findings from ethnographic research about the use of a particular set of decision-making tools that provide insights into how tools might affect the professional development of practitioners. The overall finding that the use of decision-making tools may impair professional development draws attention to the importance of the process of implementation, in particular how tools are regarded within an organization in relation to practitioner expertise. [ABSTRACT FROM AUTHOR]

A key component of the 2011 Australian National Health Reform, via the Access and Equity Policy, is to improve access to quality health services for all Australians including CALD communities. Awareness has been raised that certain CALD communities in Australia experience limited access to health care and services, resulting in poor health outcomes. To address this issue, the Community Navigator Model was developed and implemented in four CALD communities in Logan, Queensland, through a partnership between government and non-government organisations. The model draws on local natural leaders selected by community members who then act as a conduit between the community and health service providers. Nine 'navigators' were selected from communities with low service access including the Sudanese, Burmese, Afghan and Pacific Islander communities. The navigators were trained and employed at one of two local non-government organisations. The navigators' role included assessing client needs, facilitating health promotion, supporting community members to access health services, supporting general practitioners (GPs) to use interpreters and making referrals to health services. This paper explores the 'lived experience' of the navigators using a phenomenological approach. The findings revealed three common themes, namely: (1) commitment to an altruistic attitude of servility allowing limitless community access to their services; (2) becoming knowledge brokers, with a focus on the social determinants of health; and (3) 'walking the walk' to build capacity and achieving health outcomes for the community. These themes revealed the extent to which the role of CALD community navigators has the potential to make a difference to health equity in these communities, thus contributing to the Australian National Health Reform. [ABSTRACT FROM AUTHOR]

To enhance the understanding of the skills and attitudes of mental health nurses working in the Australian Mental Health Nurse Incentive Program. The Mental Health Nurse Incentive Program places qualified mental health nurses alongside community-based general practitioners, private psychiatric practices and other appropriate organisations to provide clients with mental health conditions with a more integrated treatment plan. An exploratory, qualitative approach was undertaken, given the paucity of relevant research in this area. Exploratory individual interviews were conducted with ten mental health nurses working in this scheme. Data analysis was organised and managed using QSR NVivo qualitative analysis software. Respondents identified specific skills and attitudes required for practice under the Mental Health Nurse Incentive Program. Eight areas of skill and attitude were identified as essential for mental health nurses working in this field. This study highlights that many of these skills and attitudes are specific to the setting where mental health nurses are working. Mental health nurses working under this programme have a role to play in the dissemination of knowledge about their practice. More needs to be done by governments and other institutions to ensure that general practitioners and other health professionals understand the role played by mental health nurses in the provision of care. The extent to which the Mental Health Nurse Incentive Program becomes a sustainable strategy to promote quality and accessible mental health care will depend to some degree on the capacity to identify the skills and attitudes necessary for practice. The findings presented in this paper provide a significant contribution to articulating the essential characteristics required for this area of practice. [ABSTRACT FROM AUTHOR]

Aims and objectives: This paper reports a study aimed at exploring the nursing practices associated with the administration of pro re nata (PRN) postoperative analgesia to children, and at gaining a preliminary understanding of the decisions that nurses make about this important intervention. Background: Nurses are responsible for assessing and administering the appropriate medication at the appropriate time to the child in pain. There was scant published research about the administration of postoperative PRN analgesia to children, or about the decision-making processes inherent in this aspect of clinical nursing care. Design: A sequential mixed methods explanatory study with two data collection phases -- quantitative followed by qualitative -- was conducted. Results: Nurses used multiple strategies to ascertain children's need for postoperative PRN analgesia, including reference to pain assessment tools, focussing on the behavioural cues of children, involving parents and children, and drawing upon personal and professional backgrounds and experience. Evaluation of the effectiveness of PRN postoperative analgesia was poorly communicated. Conclusions: Decision-making associated with the selection and administration of appropriate analgesia to children is complex. In-service education should be developed and offered to nurses working with children postoperatively to ensure the appropriate use of PRN pain relief. Relevance to clinical practice: Documentation surrounding this task is poor and needs to be addressed as a matter of urgency to ensure quality patient outcomes. [ABSTRACT FROM AUTHOR]

Men who were sexually abused in childhood are overrepresented in mental health and other clinical populations. There is heterogeneity in outcomes for such men and a substantial number develop coping strategies that minimise negative consequences of abuse. However, little research has been undertaken with abused men to understand the nature of their coping. This paper reports on one arm of a major study of mental health outcomes for Australian men who are survivors of childhood sexual abuse and presents findings from thematic analysis of qualitative interviews with thirty-nine men, exploring how their coping mechanisms have developed and the nature of the advice for coping they would give to professionals or other survivors. The study found that coping strategies developed adaptively through the life course but clustered into two types: those that are concerned with forms of suppression and denial, which are associated with negative mental health outcomes, and those that involve reframing the abuse, which tend to be associated with more positive outcomes. Implications of the study for practice are consistent with the advice suggested by the men themselves, that they were helped by consistent relationships with others who could provide practical support and inspire hope. [ABSTRACT FROM PUBLISHER]

The incidence of falls and fall-related injuries in older age is predicted to increase concomitantly with global population ageing, representing a serious challenge to health care systems. In spite of the availability of policy and practice guidelines for the prevention of falls and fall-related injuries, a considerable gap remains between best practice and current health service delivery. This paper describes the method and results of the implementation and evaluation of a state-wide workforce enhancement strategy to promote the uptake of evidence-based falls prevention activities for older people. The project was undertaken in Queensland, Australia in 2008 across the community, acute and residential aged care sectors. Six Falls Safety Officers (FSOs) were appointed to implement a 1-year pilot of strategies aimed at enhancing workforce capacity to deliver a coordinated approach to falls prevention across the care continuum. The project was independently evaluated for process, impact and outcome. Both quantitative and qualitative data were extracted from records maintained by the FSOs for the evaluation and additional data were obtained from interviews with key stakeholders. Considerable progress was achieved towards the project's objectives, including the wide dissemination of information and resources, as well as the establishment of working groups to continue falls prevention planning and implementation. Barriers and facilitators to the project's implementation were identified. The formal evaluation provides evidence for the development of a cross-continuum service delivery model for implementing coordinated state-wide falls prevention strategies for the prevention of falls in older people. [ABSTRACT FROM AUTHOR]

Problem: Nurses are fundamental in presenting information to their patients to ensure understanding of information, and health directions enabling improved health outcomes. Limited research exists exploring how nurses assess patient's health literacy in Australia. Aim: To explore Australian nurses' perceptions of patients' health literacy and how nurses assess health literacy to provide patient education. Design: A qualitative study underpinned by phenomenology. Methods: Registered Nurses (N = 19) across five Queensland hospitals participated in semi‐structured interviews which explored nurses' assessment of patient's health literacy level and their practices of delivering education. The transcripts were analysed using an inductive process with interpretative analysis. Results: Four themes were identified: how we assess patient health literacy; challenges with health literacy assessment; consumer focused assessment; and building assessment strategies. Participants relied on cues from the patient to identify when information has not been understood. Participants felt that online training programs in the workplace would assist in education for assessment techniques; identification of patients with low health literacy; and how to best communicate with patients that have low health literacy. Conclusion: Formal health literacy assessments should be introduced to hospitals in Australia, but training is required to enable the nurse, the confidence and ability for health literacy assessment. Tailored education based on health literacy assessment would enhance the patient's understanding and improve discharge planning, which may reduce health service costs and readmissions. Reporting method: The Consolidated criteria for reporting qualitative research (COREQ) guidelines for qualitative research were followed. Patient or public contribution: Registered Nurses (N = 19) participated in qualitative interviews, providing data for analysis. Relevance to clinical practice: This study shows that nurses are already conducting informal assessments, simply by using observation and looking for cues. More education for nurses about health literacy and how to tailor their discussions with patients will improve communication. [ABSTRACT FROM AUTHOR]

Aims: To explore healthcare professionals' perceptions of the feasibility and acceptability of family engagement in early mobilisation for adult critically ill patients. Background: Early mobilisation is beneficial to minimise intensive care unit acquired‐weakness in critically ill patients and family engagement can help with meeting early mobilisation goals, but it is not widely practiced. Understanding healthcare professionals' perceptions of feasibility and acceptability of family engagement in early mobilisation of adult critically ill patients is required to inform future implementation strategies to promote early mobilisation. Design: A descriptive qualitative study. Methods: Face‐to‐face, individual, semi‐structured interviews were conducted between August 2021 and March 2022 with healthcare professionals working in two intensive care units in Australia. The interviews were analysed using the inductive content analysis, and descriptive statistics were used to summarise participant characteristics. The COREQ checklist was followed when reporting this study. Results: Eleven ICU nurses, five physiotherapists and four physicians participated in the interviews. Three main categories were identified: (i) healthcare professionals' readiness, (ii) mediators of engagement and (iii) foundations for successful implementation. Most participants demonstrated a positive attitude towards an implementation of family engagement in early mobilisation for adult critically ill patients; however, capability and capacity of healthcare professionals, family members' willingness, availability and readiness and the care context were considered factors that could influence the successful implementation. Conclusion: From the perspectives of healthcare professionals, family engagement in early mobilisation is feasible and acceptable to enact but implementation is influenced by contextual factors including, healthcare professionals' capability and capacity and family members' willingness, availability and readiness. Collaborative teamwork and preparing family members and healthcare professionals are needed to support this practice. Relevance to Clinical Practice: The findings provide important information to further identify potential strategies of family engagement in early mobilisation and to help and mitigate factors that impede implementation. [ABSTRACT FROM AUTHOR]

Introduction: Secondary prevention is essential in reducing recurrence of diabetes‐related foot disease (DFD) but is frequently poorly implemented in clinical practice. Objective: To explore the perceptions of people with diabetes‐related foot disease (DFD) on their self‐perceived knowledge in managing DFD, facilitators and barriers influencing their DFD care, and ideas and preferences for a secondary prevention program. Design: Sixteen people with a history of DFD from Queensland and Victoria, Australia, underwent semi‐structured interviews. Interviews were audio‐recorded over telephone and transcribed and analysed following a thematic framework. Participants were asked about their experiences and perceptions relating to DFD and factors influencing the care they receive for DFD relevant to the development of a secondary prevention program for DFD. Findings and discussion: Participants had high self‐perceived knowledge in managing DFD, especially in implementing healthy lifestyle changes and conducting daily foot checks and foot care, though most received support from family members acting as carers. However, issues with access and adherence to offloading footwear, and a lack of clear education received on footwear and other aspects of DFD care were perceived as major barriers. Improved patient education, provided in a consistent manner by proactive clinicians was perceived as an essential part of secondary prevention. Telehealth was perceived positively through facilitating faster care and considered a good adjunct to standard care. Health and technological literacy were considered potentially major barriers to the effectiveness of remote care. Conclusion: People with DFD require improved access to offloading footwear and education about secondary prevention, which could be provided by telehealth with adequate support. [ABSTRACT FROM AUTHOR]

Objectives: To identify community pharmacists' perceptions of their role, knowledge and confidence in relation to bowel cancer and breast cancer screening health promotion. Methods: This was a mixed-methods study with community pharmacists and key informants in the Metro South Health (MSH) region of Brisbane, Queensland, Australia. In Part 1, quantitative data was collected from community pharmacists via an electronic survey. In Part 2, qualitative data was collected from community pharmacists and key informants via in-depth interviews. This paper reports the findings of community pharmacists' perceptions of their role, knowledge and confidence to promote bowel cancer and breast cancer screening in community pharmacies. Results: A total of 27 community pharmacists (13 males, 14 females) completed the survey. Most (71%) either 'agreed' or 'strongly agreed' discussing health advice, such as cancer screening, with their consumers was valuable and integral to their broader role. An average of 60% described their confidence as 'average' or 'good' when discussing bowel and breast cancer screening and prevention with consumers. In eight knowledge questions about bowel and breast cancer and cancer screening, an average of 82% of community pharmacists responded with correct answers (range 52% to 100%). Community pharmacists were consistently more confident and knowledgeable about bowel cancer services than breast cancer services. Five (5) community pharmacists participated in in-depth interviews. The interview findings supported the quantitative findings. Most community pharmacists described their confidence to promote bowel cancer and breast cancer screening as moderate, and consistently reflected they felt more knowledgeable and confident about bowel cancer topics than breast cancer topics. Conclusions: Overall, this research supports the feasibility of promoting bowel cancer screening in community pharmacies. It suggests further training is warranted for community pharmacists to increase their knowledge of breast cancer and their confidence in promoting breast cancer referral and screening services. It highlights the important role community pharmacists have in increasing engagement in the national bowel cancer and breast cancer screening programs, and in potentially decreasing the mortality rates of these cancers. [ABSTRACT FROM AUTHOR]

Objective: The primary aim is to explore rural clinicians' self‐reported knowledge, skills and attitudes in the decision‐making process for requesting aeromedical retrieval of patients with suspected appendicitis. A secondary aim is to understand the supports and barriers of rural clinicians experience in this clinical scenario. Setting: Clinician interviews conducted face‐to‐face in three rural hospitals in Central Queensland. Participants: Rural doctors and nurses. Design: A five‐part qualitative content analysis. Results: The majority of 44 participants identified the strong and effective teamwork. The decision to request aeromedical retrieval was a shared, joint process and identified a supportive collegial culture which supported the asking of questions and not expecting to have all the answers. Perceived barriers were lack of receiving clinicians understanding of transfer agreements, and data connectivity. Clinician pessimism was identified for perceived patient outcomes. Discussion Effective teamwork can nurture trust and collaboration across multiple health service roles. High job satisfaction may counter the physical isolation in some rural environments. Fragmentation of care is the unintended consequence of interhospital transfer and may impact rural clinicians' perception of patients' outcomes and hinder receiving clinicians' understanding of rural service limitations. Conclusion: Future work in the area of linked electronic medical records could remove a barrier for rural clinicians and improve their reflective practice by challenging their perception of definitive patient outcomes. Increased awareness by receiving clinicians of the limitation of rural services, may minimize communication barriers and thereby, improve timely patient care transfers. [ABSTRACT FROM AUTHOR]

Remote-living and Indigenous Australians can experience menstrual health and hygiene challenges. The topic is not often openly discussed as it is considered private 'women's business'. We were invited into a remote Indigenous town and community to discuss the lived experience of menstruation with female students as well as clinical, educational and community workers. Our yarning circles and interviews collated 16 barriers in four clusters: structural living situation; knowledge, culture and behavior; discomfort and public life; and finances. Targeted efforts by relevant organizations, including schools and government agencies, were identified by participants to better support menstrual health and hygiene without associated pain, ranging moods and a sense of shame. [ABSTRACT FROM AUTHOR]

This article aims to problematize individualistic strategies developed in western institutions to address violence against women and suggests more collective responses that engage refugee men. The data comes from a qualitative research project in Southeast Queensland, Australia. Thirty-one interviews with frontline workers from domestic violence and refugee settlement organizations reveal dissenting voices that challenge the hegemony of dominant groups who either advocate gender equality or overemphasize cultural differences. These dissenting voices suggest new knowledge being mobilized by refugees and associated communities, presenting opportunities for nongovernmental organizations and community groups to find ways to align across their differences toward a common goal. [ABSTRACT FROM AUTHOR]

Background: Occupational therapist‐led environmental assessment and modification (EAM) is effective in reducing falls for populations at high risk. Two regional and rural public health services in Queensland devised an implementation strategy to embed best practice occupational therapist‐led EAM. Methods: A qualitative study was conducted to compare the determinants of implementation success across the different health services, using the COM‐B model of behaviour change. Six semi‐structured interviews were completed with occupational therapists involved at each site, following 12 months of implementation. Interview data were triangulated with minutes from three combined site steering committee meetings, eight local steering committee meetings, and field notes. Thematic analysis was completed to compare barriers and facilitators to best practice uptake of EAM and differences in outcomes between the two sites. Results: Both sites commenced implementation with similar states of capability and motivation. After 12 months, one site considered that practice change had been embedded as noted in steering committee minutes and comments; however, the other site observed limited progress. According to the COM‐B analysis, opportunity (the factors that lie outside the individual's control) had a significant influence on how both sites were able to respond to the practice change and navigate some of the unexpected challenges that emerged, including the COVID‐19 pandemic. Existing team structure, multiple responsibilities of key stakeholders, differences in access to resources, and lack of connection between complementary services meant that COVID‐19 disruptions were only a catalyst for unveiling other systemic issues. Conclusion: This study highlights the power of external factors on influencing behaviour change for best practice implementation. Learnings from the study will provide deeper understanding of completing implementation projects in regional and rural contexts and support the future implementation of EAM in occupational therapy clinical settings. [ABSTRACT FROM AUTHOR]