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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]

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]

This paper reports on a study which explored the views and attitudes of family members towards the sexual expression of residents with dementia in residential aged care facilities in two states in Australia. Recruitment was challenging and only seven family members agreed to an interview on this topic. Data were analysed using a constant comparative method. Family were generally supportive of residents’ rights to sexual expression, but only some types of behaviours were approved of. There was an acknowledgement that responding to residents’ sexuality was difficult for staff and many families believed that they should be kept informed of their relative’s sexual behaviours and moreover be involved in decision making about it. Findings suggest the need for family education and a larger study to better understand the views and motivations of family carers and how these might impact on the sexual expression of the older person with dementia living in residential aged care. [ABSTRACT FROM PUBLISHER]

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]

Aim: This study aimed to explore patient barriers to accessing services, current technology ownership/use and digital device preferences for accessing health information/health service delivery. Additionally, it aimed to explore the Theoretical Domains Framework and the acceptability of future eHealth solutions in bariatric surgery. Methods: This mixed‐method study (survey and semi‐structured interviews) was conducted in a bariatric surgery service in an Australian public hospital. Quantitative data were analysed descriptively, and the qualitative data were deductively and inductively analysed. Results: This study included 117 participants (n = 102 surveyed and n = 15 interviewed). Most participants were aged ≥51 years (n = 70, 60%), and two‐thirds were female (n = 76, 65%). One in three participants reported barriers to accessing services (n = 38, 37%), including parking, travel time, and taking time off work. Most participants preferred to receive or access additional health information via email (n = 84, 82%) and were willing to engage with health professionals via email (n = 92, 90%), text messages (n = 87, 85%), and telephone (n = 85, 83%). Deductive analysis of interviews generated three themes: 'Knowledge', 'Social influence' and 'Behavioural regulation, goals and environmental resources'. The inductive analysis generated one theme: 'Seeing a place for eHealth in service delivery'. Conclusion: This study's findings can potentially influence the development of future eHealth solutions. Text message, email, and online approaches may be suitable for delivering further information and resources to patients, particularly regarding diet and physical activity. Online health communities are being used by patients for social support and may be worth further investigation. In addition, developing a bariatric surgery mobile application may be beneficial. [ABSTRACT FROM AUTHOR]

The article reports that identifying leadership for clinical governance in rural and remote primary health care services. Topics include the clinical governance being a system for improving the quality and safety of health care, the importance of clinical governance in primary care and the contribution of leadership to implementation of clinical governance have been established, and the role of leaders in implementation has multifaceted and continues to evolve and expand.

Background: Collaboration between dental practitioners and non-dental primary care providers has the potential to improve oral health care for people in rural and remote communities, where access to oral health services is limited. However, there is limited research on collaboration between these professional disciplines. The purpose of this paper was to explore the relationships between dental practitioners and non-dental primary care providers from rural and remote areas of Queensland and to identify strategies that could improve collaboration between these disciplines from the perspective of dental participants. Methods: Semi-structured interviews were conducted between 2013 and 2015 with visiting, local and regional dental practitioners (n = 12) who had provided dental services to patients from eight rural and remote Queensland communities that did not have a resident dentist. Participants were purposely recruited through a snow ball sampling technique. Interview data were analysed using thematic analysis with the assistance of QSR Nvivo v.10. Results: Four major themes emerged from the data: (1) Communication between dental practitioners and rural primary care providers; (2) Relationships between dental and primary care providers; (3) Maintenance of professional dualism; (4) Strategies to improve interprofessional relationships (with subthemes: face to face meetings; utilisation of technology; oral health training for primary care providers; and having a community based oral health contact person). Participants observed that there was a lack of communication between the dental providers who saw patients from these rural communities and the primary care providers who worked in each community. This was attributed to poor communication, the high turnover of staff and the siloed behaviours of some practitioners. Visiting dental practitioners were likely to have stronger professional relationships with hospital nursing, administrative and allied health care staff who were often long term residents of the community. Conclusions: The findings suggest that there was little relationship between the dental personnel and primary care providers. Interprofessional collaboration between dental care providers and non-dental rural primary care providers in the rural and remote communities sampled could be improved by having regular face to face meetings between practitioners from across the health disciplines, providing oral health education to primary care providers, establishing and maintaining effective communication and referral pathways, and exploring a greater role for tele-dentistry. [ABSTRACT FROM AUTHOR]

To explore the decision-making processes and experiences of acute and rehabilitation clinicians, regarding referral and acceptance of patients to rehabilitation after stroke. Multi-site rapid ethnography, involving observation of multidisciplinary case conferences, interviews with acute stroke and rehabilitation clinicians, and review of key documents within five (5) acute stroke units (ASUs) in Queensland, Australia. A cyclical, inductive content analysis was performed. Seven key themes were identified, revealing the complex nature of post-stroke rehabilitation referral and acceptance decision making. Although the majority of clinicians felt that all patients could benefit from rehabilitation, they acknowledged this could not always be the case. Rehabilitation potential and goals were considered by clinicians, but decision making was impacted by ASU context and team processes, rehabilitation service availability and access procedures, and the relationships between the acute and rehabilitation clinicians. Patients and families were not actively involved in the decision-making processes. Post-stroke rehabilitation decision making in Queensland, Australia involves complex processes and compromise. Decisions are not based solely on patients' rehabilitation needs, and patients and families are not actively involved in the decision-making process. Mechanisms are required to streamline access procedures, and improve shared decision making with patients. Referral decision making for post-stroke rehabilitation is complex and not always based solely on patients' needs. Clear and straightforward access procedures and positive relationships between acute and rehabilitation clinicians have a positive impact on referral decision making. Stroke services should review their processes to ensure shared decision making is facilitated when patients require access to rehabilitation. [ABSTRACT FROM AUTHOR]

Australian and international findings report pharmacy staff are motivated to expand and undertake new roles in public health and expressed a strong interest in providing oral healthcare services to the community. We sought to describe consumer experiences within primary oral healthcare, and views about pharmacy staff roles and boundaries in providing oral health services as perceived by a sample of consumers living within metropolitan Australia. Sampling occurred purposively to enable diverse perspectives on the topic. Socioeconomic status, as defined by the Socio‐Economic Index for Areas, was used as the primary criteria to stratify focus group recruitment. Thematic, in‐depth analysis of focus group discussions was carried out. In all, 34 participants took part in six focus groups, held in metropolitan settings in Queensland, Australia. Findings show that consumers supported pharmacy staff performing non‐invasive oral health services including providing oral health education and advice, reviewing medications and recommending evidence‐based medications. As services became more invasive (i.e., oral screening and fluoride application), questions and concerns were raised around the appropriateness of the community pharmacy setting and the level of training of pharmacy staff to provide these services. This study identifies the need to support greater integration of oral healthcare roles by community pharmacy staff. Future innovative and collaborative research involving additional stakeholder groups are necessary to explore, develop and test the feasibility and effectiveness of pharmacy‐led oral healthcare models. [ABSTRACT FROM AUTHOR]

Objectives: Managing oral health after the treatment for head and neck cancer requires meticulous daily oral hygiene practices and regular professional dental care; however, the individual factors and health system structures required to achieve oral health are often not well considered. This study aimed to explore how oral health was understood and managed after head and neck cancer treatment and identify factors that influenced oral health behaviours and dental service utilization. Methods: A qualitative, inductive approach was used for data collection and analysis. Sampling of participants was purposive, using a maximum variation approach, and data were analysed using thematic analysis. Participants were recruited from the maxillofacial clinic at a tertiary facility in Brisbane, Queensland, Australia. Results: Twenty‐one participants took part in the study. Findings described individual and structural factors that influenced the management of oral health post‐treatment. Individual determinants of oral health behaviours included a cognitive shift towards lifelong oral health; management of unexpected barriers; and management of competing priorities. Structural factors included availability, accessibility of services, and continuity of care. The ability to fund oral health emerged as a salient theme that influenced both individual and structural factors. Conclusions: Strong self‐efficacy and financial and spousal support enhanced the management of oral health, whereas difficulty managing competing issues post‐treatment, such as psychological and financial stress, limited participants' capacity to prioritize and manage oral health. Policy initiatives are needed to address the structural barriers caused by a lack of timely access to general and preventive dental care post‐treatment. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to explore the nature of parental involvement in the intervention of children with hearing loss, as experienced by parents. Design: A qualitative descriptive methodology was adopted to conduct semi-structured in-depth interviews with a purposive sample of parents who have a child with hearing loss. Study sample: Seventeen parents of 11 children aged 6-9 years participated in this study. Results: The overarching theme of parents taking the central role was identified using thematic analysis. This overarching theme connected five themes which described the nature of parental involvement: (1) parents work behind the scenes; (2) parents act as ‘case managers’; (3) parents always have their child’s language development in mind; (4) parents’ role extends to advocacy for all children with hearing loss; and (5) parents serve a number of roles, but at the end of the day, they are parents. Conclusions: The results indicate that parental involvement in the intervention of children with hearing loss is multifaceted in nature and incorporates a broad range of behaviours and practices. These findings have important implications for the provision of family-centred practices. [ABSTRACT FROM AUTHOR]

Aim: A standardised tool was needed to measure a generalist dietitian's confidence about working with clients experiencing psychological issues in order to effectively evaluate mental health ‐ related professional development activities. The aim of this study was to develop, pilot and validate a robust instrument that measures a generalist dietitian's professional confidence for working with clients experiencing psychological issues. Methods: The Dietetic Confidence Scale (DCS) was developed. Two cross ‐ sectional samples of practicing dietitians (n = 185; 458) from various settings and locations were recruited. Study 1: principal components analysis (PCA) helped refine scale items and derive a model, which was then validated using confirmatory factor analysis (CFA, Study 2). Cronbach's alpha estimated scale reliability. Correlations assessed associations between factors. Results: Study 1: A 13 ‐ item, two ‐ factor solution accounted for 69.1% of the total variance. Total Cronbach's α = 0.92. Dietetic confidence was associated with: (i) Confidence using the Nutrition Care Process and (ii) Confidence Advocating for Self care and Client care. Study 2: The CFA supported the proposed scale and model. A Good Fit Index of 0.95 indicated a strong fit. Item ‐ factor correlations ranged from r = 0.50 to 0.91. The final scale showed good reliability (α = 0.93). Conclusions: This is the first self ‐ efficacy scale for dietetic practitioners subjected to PCA and CFA using two independent samples. The DCS is a psychometrically robust instrument with strong internal consistency. It can be used to measure dietetic confidence about working with clients experiencing psychological issues and to highlight areas where additional support or training may be needed. Further validity and reliability testing is needed to enhance scale generalisability and use. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to explore the perceived influences on food and meal choices of Queensland paramedics during shift work. Methods: A qualitative study using individual semi ‐ structured telephone interviews was conducted on a purposive sample of 15 paramedics working on a rotating shift roster in Queensland. Interviews explored the perceived influences on their food choices while working shifts. Interviews were audio recorded, transcribed verbatim and content analysed manually using open ‐ coding inductive thematic analysis. Results: A conceptual model was developed that illustrated four major themes of influences on food choices that emerged from the data analysis. These themes were physiological influences, psychosocial influences, the physical environment and the organisational environment. Of significant influence on the participants' food choice unique to the nature of their shift work was the meal break structure and being ambulance based for the majority of their shift. Conclusions: The specific influences affecting the food choice of paramedics are created by the environmental influences in which they work and result in extended periods of not eating or ‘opportunistic eating’. This has implications for their ability to make ‘healthy food choices’. Further investigation into strategies to enable paramedics to improve food choice within the context of the unpredictable nature of their workload and their work environment is warranted. [ABSTRACT FROM AUTHOR]

Aims To assess the medication knowledge of emergency department nurses and determine the factors affecting their nurse-initiated medication practices. Background Nurse-initiated medications is a vital practice for all nurses in emergency departments which improves pain assessment, provides safe pain management and reduces time-to-analgesia and other meaningful treatments. Design Mixed methods. Between September 2014-January 2015, data were collected by questionnaire assessing medication knowledge and face-to-face interviews determining factors affecting practice. Results Nurse-initiated medications frequency of the Registered Nurses ranged from 0-36 times per week dependent on employed hours and emergency department area worked. Medication knowledge was consistent among nurses, but there was an overall deficit in nurses' knowledge of mechanism of action. Four major themes were identified from the 24 interviews: patient-centred care, caution and safety as principles of practice; continuing support and education; improvement of practice over time. All nurses regard the practice positively and to be extremely beneficial to patients. Although apprehensive at the start of their nurse-initiated medications practice, confidence improved with exposure and experience. Nurses sought additional information from colleagues and the available evidence-based resources. Conclusion Medication knowledge is not the sole determinant of nurse-initiated medications practice. The practice is motivated by multiple factors such as patients' needs, safety and nurses' confidence. [ABSTRACT FROM AUTHOR]