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Objectives: The objectives of this study were to examine the roles and needs of allied health professionals (AHPs) working in public healthcare settings in rural and regional Victoria, Australia in providing components of palliative care in their routine practice. Methods: A cross-sectional study was conducted between March and May 2023. Surveys were collected from AHPs working in public healthcare settings in the Loddon Mallee region of Victoria, Australia. Clinicians reported on the frequency of provision of care to patients with terminal illness, and their self-reported skill and confidence in providing interventions to patients with palliative care needs. Results: In total, 121 clinicians completed the survey. Almost every respondent reported they had provided care to patients with a terminal illness, with 41% of clinicians providing this care daily or weekly. The respondents were confident carrying out generalist interventions such as maintaining physical function but reported lower confidence in managing common symptoms of terminal illness such as loss of appetite, swallowing difficulties and changing communication needs. Two-thirds of respondents had not undertaken any training specific to palliative care, with many unaware of how to access palliative care-specific training. Conclusion: AHPs in rural and remote areas regularly provide care to patients with terminal illness. As the number of patients seen in non-specialist palliative care settings is likely to increase in rural and regional areas, the low self-reported confidence in providing common components of care, and the low uptake of palliative care-specific training must be addressed to ensure AHPs can provide high-quality care to people with terminal illness. What is known about the topic? Due to the increasing demand for palliative care services, this care is increasingly delivered by general non-specialist clinicians such as allied health professionals. What does this paper add? This study provides evidence for how often a surveyed population of allied health professionals in rural and regional Australia are providing care to people with a terminal illness, as well as their confidence, competence and learning needs. What are the implications for practitioners? High-quality care is needed at end-of-life, therefore rural and regional health services need to support allied health professionals to increase confidence and competence in providing palliative care. [ABSTRACT FROM AUTHOR]

Background: Opioid use disorder is a public health concern in Australia. Opioid agonist treatment (OAT) is effective at treating and minimising harm from opioid use disorder, yet is underused in Australia due to client barriers. Although these barriers have been reported, the barriers that are most important to clients is unclear. The aim of this paper was to determine the most important OAT barriers to Australian clients. Methods: A cross-sectional, self-completed survey was given to 204 opioid-dependent clients who attended needle and syringe sites in Australia. Participants were given 15 OAT barrier statements, which they answered using a 5-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree and 5 = strongly agree). The Likert scale data are presented using the count method and the mean Likert scores (for the whole sample and for subgroups). Results: The two methods determined that the four most important barriers to OAT were stigma, lack of support services, no flexibility and enjoy using opioids. Furthermore, those who used prescription opioids (compared with heroin) were female or non-binary (compared with male), were not currently using OAT (compared with current OAT), were younger (compared with older) and had high dependence scores (compared with low dependence scores) were impacted more by certain OAT barriers. Conclusions: Policies around improving support services, reducing stigma and increasing flexibility would be beneficial to reduce barriers to OAT in Australia. Second, certain groups were more vulnerable to OAT barriers, emphasising the importance to better tailor opioid treatment programs to these specific populations to increase treatment engagement. The aim of this paper was to determine the most important opioid agonist treatment barriers to Australian clients via a cross-sectional survey using a Likert scale. Results found that the most important barriers to opioid agonist treatment were stigma, lack of support services, no flexibility and enjoy using opioids. Furthermore, those who used prescriptions opioids were female or non-binary, were not currently using opioid agonist treatment, were younger and had high dependence scores were impacted more by certain treatment barriers. [ABSTRACT FROM AUTHOR]

Introduction Empathetic behaviour is regarded as a positive trait amongst healthcare professionals and has been attributed to increased patient compliance, greater patient satisfaction, and greater diagnostic accuracy and reduced rates of clinical errors. Despite this, past studies have shown that healthcare students fail to recognise the importance of empathetic behaviour in patient care and display significant empathy decline throughout their studies. In particular, paramedic students have typically displayed lower rates of empathy when compared to their healthcare counterparts. The objective of this study is to assess both the level of empathy and changes in empathy in undergraduate paramedic students over a 3-year period at a single tertiary institution. Method A cross sectional study employing a convenience sample of first, second and third year undergraduate paramedic students at Monash University from 2008-2010. Student empathy scores where measured with the Jefferson Scale of Empathy - Health Profession Student version (JSE-HPS); a validated, self-reporting questionnaire. Results 552 students were enrolled in the study, of which 69% were females and 83% were aged under 25. The mean overall JSE-HPS score for the cohort was 108.60 (SD=12.50). Female students displayed significantly higher empathy scores of 110.27 (SD=11.62) compared to males at 105.36 (SD=13.57). There was also a significant difference (p=0.03) noted between the 2008 JSE-HPS score 106.32 (SD=14.02), when compared to the 2009 cohort, 110.18 (SD=12.91). There was no significant difference found in mean JSE-HPS scores across differing age groups. Conclusion Results from this study suggest that paramedic students display lower empathy than those reported by fellow healthcare students within the literature. Additionally, this study provides further evidence that females are typically more empathetic than their male counterparts in the same profession. The fact that empathy levels did not decline significantly throughout the course as expected defies current literature and is worthy of future investigation. [ABSTRACT FROM AUTHOR]

Background: This paper aimed to describe the legal worries of Australian general practitioners (GPs) and nurses regarding end-of-life care provided in the aged care setting. Methods: An analysis of responses to the final, open-ended question of a cross-sectional online survey of GPs and nurses practising in aged care settings in Queensland, New South Wales and Victoria was undertaken. Results: Of the 162 GPs and 61 nurses who gave valid responses to the survey, 92% (151 GPs and 55 nurses) responded to the open-ended question. Participants identified concerns across all relevant areas of end-of-life law. The most common concerns were substitute decision-makers or family member(s) wanting to overrule an Advance Care Directive, requests for futile or non-beneficial treatment and conflict about end-of-life decision-making. Participants often also identified concerns about their lack of legal knowledge and their fear of law or risk related to both end-of-life care generally and providing medication that may hasten death. Conclusions: Australian GPs and nurses working in aged care have broad-ranging legal concerns about providing end-of-life care. Legal concerns and knowledge gaps identified here highlight priority areas for future training of the aged care workforce. The law supports good end-of-life clinical practice by facilitating health care that aligns with the values and goals of patients, including those residing in residential aged care facilities. GPs and nurses here reported broad-ranging legal concerns relevant to providing end-of-life care within aged care, including substitute decision makers/family members wanting to overrule Advance Care Directives, requests for futile or non-beneficial treatment and conflict about decision-making. Participants' concerns can inform end-of-life legal training for aged care GPs and nurses. [ABSTRACT FROM AUTHOR]

Objectives: Using Google online reviews, this study investigated why patients were satisfied or dissatisfied with their public dental clinic in Victoria, Australia. Methods: This mixed methods study gathered Google reviews published by users pre-March, 2021. The reviews were coded and subthemes and major themes were identified. The most common reasons why patients gave reviews were tabulated and stratified according to star rating, remoteness and accessibility index classification, and socio-economic status. Results: Of the 522 reviews included in this study, in 317 (60.7%) satisfaction was expressed. Compliments and complaints were documented. A total of 53 subthemes were identified. Major themes included Treatment, Staff, Communication and Professionalism, Patient Factors and Non-Clinical Reasons. From the reviews, more patients were satisfied with general unspecified treatment (n = 195; 14.7%) and dissatisfied with reception staff (n = 64; 4.8%). More reviews were generated by patients who visited clinics in major cities and lower socio-economic areas. Conclusion: This study found that most patients expressed satisfaction and identified reasons why patients were satisfied or dissatisfied. Consumer feedback, including compliments and complaints, is an integral aspect of monitoring and improving health service quality. It is important to continue seeking feedback and improve accordingly. What is known about the topic? Research has identified common factors for patient satisfaction or dissatisfaction with dental clinics including: facilities and location, waiting list time, cost, gentleness during procedures, communication, and staffing. What does this paper add? This study identified causes of patient satisfaction and dissatisfaction with Victorian public dental clinics. The focus is on the Victorian public dental system because almost half of the eligible population for public dental services are not utilising them. What are the implications for practitioners? Practitioners can use this study to self-reflect and improve the quality of health service delivery. [ABSTRACT FROM AUTHOR]

Objective: There continue to be disparate health outcomes for people who are Aboriginal and Torres Strait Islander. The aim of the present study was to measure whether there were any differences in in-patient experiences between Aboriginal and Torres Strait Islander people and those without an Aboriginal or Torres Strait Islander background. Methods: Random samples of people were invited to complete a survey following admission at the hospitals at Peninsula Health, Victoria, Australia. This survey was based on the Victorian Patient Satisfaction Monitor. Open-ended questions were also asked to gauge perspectives on how the services could better meet needs of Aboriginal and Torres Strait Islander patients. Results: A total of 154 responses was obtained. There were differences between the two groups of participants in the following variables: respect of privacy, representation of culture, assistance with meals and access to a culturally specific worker if needed. This was reflected in thematic analysis, with three main themes identified: (1) interactions with staff; (2) the challenging environment; and (3) not just about me, but my family too. Conclusion: There were systemic differences in in-patient experiences. Healthcare services have a responsibility to make systemic changes to improve the health care of all Australians by understanding and reforming how services can be appropriately delivered. What is known about the topic?: There is a disparity in health outcomes between Aboriginal and Torres Strait Islander Australians and those who do not identify as Aboriginal and/or Torres Strait Islander. In addition, Aboriginal and Torres Strait Islanders have different interactions within healthcare services. Many rural health services have models that aim to deliver culturally appropriate services, but it is unknown whether the same challenges apply for this group of Australians within metropolitan health services. What does this paper add?: This paper identifies the structural supports that are required to help close the gap in health care provision inequality. Many of the key issues identified are not people but system based. Healthcare administrators should consider the factors identified and address these at a whole-of-service level. What are the implications for practitioners?: Many practitioners are aware of the challenges of providing culturally appropriate services. This research raises awareness of how traditional healthcare is not a one size fits all and flexibility is required to improve health outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Rationale, aims, and objectives: Whilst many dose omissions cause no patient harm, inappropriate dose omissions have been associated with increased length of hospital stay, risk of sepsis, and mortality. This study aimed to comprehensively describe the prevalence and nature of omitted doses overall and of high risk medication dose omissions in an organization using an electronic Medication Management System. Methods: A retrospective cross‐sectional study was undertaken in an Australian tertiary referral health service. All routinely documented electronic inpatient dose administration records from 1st July 2014 to 30th June 2015 were included. Period prevalence and characteristics of dose omissions overall and of high‐risk medication dose omissions were determined. Results: During the study period, 3.3 million inpatient doses were scheduled for administration, with doses endorsed as “not given” comprising 6.2% of all scheduled doses. Non‐valid dose omissions (medication not available or no justification documented) comprised 1.2% of scheduled doses. Patient refusal accounted for one third of all dose omissions, while for 12% no explanation was provided and 7% were endorsed “medication not available”. High‐risk medications accounted for 20% of all dose omissions. One in 20 antimicrobial doses scheduled were omitted, and of these, 17% were due to patient refusal. Conclusion: The period prevalence of dose omissions in this large study after electronic Medication Management System implementation is similar to that found when paper charts were used. Although most dose omissions appear appropriate, many orders were not given due to patient refusal or with no documented justification. Interventions to minimize unintentional dose omissions are indicated. [ABSTRACT FROM AUTHOR]

Background: Law purports to regulate end-of-life care but its role in decision-making by doctors is not clear. This paper, which is part of a three-year study into the role of law in medical practice at the end of life, investigates whether law affects doctors' decision-making. In particular, it considers whether the fact that the law differs across Australia's three largest states - New South Wales (NSW), Victoria and Queensland - leads to doctors making different decisions about withholding and withdrawing life-sustaining treatment from adults who lack capacity. Methods: A cross-sectional postal survey of the seven specialties most likely to be involved in end-of-life care in the acute setting was conducted between 18 July 2012 and 31 January 2013. The sample comprised all medical specialists in emergency medicine, geriatric medicine, intensive care, medical oncology, palliative medicine, renal medicine and respiratory medicine on the AMPCo Direct database in those three Australian states. The survey measured medical specialists' level of legal compliance, and reasons for their decisions, concerning the withholding or withdrawal of lifesustaining treatment. Multivariable logistic regression was used to examine predictors of legal compliance. Linear regression was used to examine associations between the decision about life-sustaining treatment and the relevance of factors involved in making these decisions, as well as state differences in these associations. Results: Response rate was 32% (867/2702). A majority of respondents in each state said that they would provide treatment in a hypothetical scenario, despite an advance directive refusing it: 72% in NSW and Queensland; 63% in Victoria. After applying differences in state law, 72% of Queensland doctors answered in accordance with local law, compared with 37% in Victoria and 28% in NSW (p < 0.001). Doctors reported broadly the same decision-making approach despite differences in local law. Conclusions: Law appears to play a limited role in medical decision-making at the end of life with doctors prioritising patient-related clinical and ethical considerations. Different legal frameworks in the three states examined did not lead to different decisions about providing treatment. More education is needed about law and its role in this area, particularly where law is inconsistent with traditional practice. [ABSTRACT FROM AUTHOR]

Aim: To evaluate pain prevalence and characteristics in children and adolescents with predominant dyskinetic and mixed (dyskinetic/spastic) cerebral palsy (CP) motor types.Method: Seventy-five participants with a diagnosis of CP and confirmed dyskinetic or mixed (dyskinetic/spastic) motor type took part in a multisite cross-sectional study. The primary outcome was carer-reported pain prevalence (preceding 2wks) measured using the Health Utilities Index-3. Secondary outcomes were chronicity, intensity, body locations, quality of life, and activity impact.Results: Mean participant age was 10 years 11 months (SD 4y 2mo, range 5-18y). There were 44 males and 31 females and 37 (49%) had predominant dyskinetic CP. Pain was prevalent in 85% and it was chronic in 77% of participants. Fifty-two per cent experienced moderate-to-high carer-reported pain intensity, which was significantly associated with predominant dyskinetic motor types (p=0.008). Pain occurred at multiple body locations (5 out of 21), with significantly increased numbers of locations at higher Gross Motor Function Classification System levels (p=0.02). Face, jaw, and temple pain was significantly associated with predominant dyskinetic motor types (p=0.005). Poorer carer proxy-reported quality of life was detected in those with chronic pain compared to those without (p=0.03); however, chronic pain did not affect quality of life for self-reporting participants.Interpretation: Pain was highly prevalent in children and adolescents with predominant dyskinetic and mixed (dyskinetic/spastic) motor types, highlighting a population in need of lifespan pain management.What This Paper Adds: Chronic pain prevalence in children and adolescents with predominant dyskinetic and mixed (dyskinetic/spastic) motor types is high. Pain occurs across multiple body locations in predominant dyskinetic and mixed (dyskinetic/spastic) motor types. Less recognized locations of pain include the face, jaw, and temple for predominant dyskinetic motor types. [ABSTRACT FROM AUTHOR]

Objective: To investigate the psychosocial effects of the COVID-19 pandemic on nurses and midwives working in acute care settings, specifically psychological distress, self-reported concerns, and perceived impact on their work and personal lives. Background: Little is known about the psychosocial impact of the pandemic on nurses and midwives in Australia, a country with a substantially lower number of COVID-19 cases and deaths than many others. Few studies investigating the prevalence of psychological distress among nurses during the pandemic have been conducted in more than one setting, especially in the Australian context. Study design and methods: Cross-sectional survey design (STROBE checklist). Nurses and midwives (n=1,611) at four metropolitan tertiary health services in Melbourne, Australia completed an anonymous online survey between 15 May and 31 August 2020, which assessed symptoms of depression, anxiety and stress (DASS-21); concerns related to COVID-19; and other effects of COVID-19. Space was provided for free-text comments. Results: Approximately one fifth of respondents reported moderate to extremely severe symptoms of depression, anxiety and stress. Fewer years of clinical experience were significantly associated with higher levels of psychological distress. More than half of the respondents were extremely/very concerned about passing COVID-19 on to family members and about their family's health, and almost half were concerned about caring for a patient who had confirmed or suspected COVID-19. Respondents reported that certain precautionary measures such as personal protective equipment (PPE) interfered with their ability to provide optimal patient care. Positive aspects of the pandemic were also reported including a sense of togetherness and cooperation among staff. Conclusion: The COVID-19 pandemic has had a considerable impact on the psychological wellbeing and work and personal lives of nurses and midwives working in acute care settings in Melbourne, Australia, particularly those with less clinical experience. Implications for nursing and health services research, policy and practice: Nurses and midwives, particularly those with less clinical experience, would benefit from additional, targeted wellbeing and support initiatives. For those with less experience, initiatives could include being partnered with more experienced colleagues and educators who can provide practical and emotional support and monitor their stress levels. What is already known about the topic? * Nurses and midwives have experienced more psychological distress than other healthcare workers during the COVID-19 pandemic. * Most studies about the psychosocial impact of the COVID-19 pandemic on nurses and midwives have been conducted in a single health service. * Few studies have concurrently investigated the experiences of nurses and midwives from different health services during the COVID-19 pandemic especially in the Australian context. What this paper adds * Despite the relatively low number of COVID-19 cases and deaths in Australia, the COVID-19 pandemic has had a considerable impact on the psychological wellbeing and work and personal lives of Australian nurses and midwives. * About one in five of the nurses and midwives surveyed reported moderate to extremely severe symptoms of depression, anxiety and stress during the first wave of the pandemic. * Nurses and midwives with fewer years of clinical experience experienced higher levels of psychological distress than those with more experience. [ABSTRACT FROM AUTHOR]

Purpose - People with a history of depression are more likely to smoke and less likely to achieve abstinence from smoking long term. The purpose of this paper is to understand the factors associated with smoking and smoking cessation among patients with depression. Design/methodology/approach - This paper reports on smoking prevalence and cessation in a cohort of 789 primary care attendees with depressive symptoms (Centre for Epidemiologic Studies Depression Scale score of= 16) recruited from 30 randomly selected Primary Care Practices in Victoria, Australia in 2005. Findings - At baseline, 32 per cent of participants smoked. Smokers were more likely to be male, unmarried, receive government benefits, have difficulty managing on available income, have emphysema, a chronic illness, poor self-rated health, to have more severe depressive and anxiety symptoms, to be taking anti-depressants, to be hazardous drinkers, to report suicidal ideation and to have experienced childhood physical or sexual abuse. At 12 months, 20 participants reported quitting. Females and people with good or better self-rated health were significantly more likely to have quit, while people with a chronic illness or suicidal ideation were less likely to quit. Smoking cessation was not associated with increases in depression or anxiety symptoms. Only six participants remained quit over four years. Practical implications - Rates of smoking were high, and long-term cessation was low among primary care patients with depressive symptoms. Primary care physicians should provide additional monitoring and support to assist smokers with depression quit and remain quit. Originality/value - This is the first naturalistic study of smoking patterns among primary care attendees with depressive symptoms. [ABSTRACT FROM AUTHOR]

Objective: The aims of this paper were to report on the global psychosocial functioning of 5-year-old DHH children and examine the risk and protective factors that predict outcomes. Design: A cross-sectional analysis of data collected from a prospective, population-based longitudinal study. Study sample: Parents/caregivers of 356 children completed questionnaires on psychosocial development (CDI, SDQ), functional communication (PEACH) and demographic information. Children completed standardized assessments of non-verbal cognitive ability (WNV) and language (PLS-4). Results: On average, global psychosocial functioning was within the range of typically developing children; however, variability was high and 12% of children had scores that were more than 2 SDs below the norm. Non-verbal cognitive ability, presence of additional disabilities, language and functional communication significantly predicted outcomes. In contrast, type of hearing device, severity of hearing loss and age at intervention did not. Conclusion: The global psychosocial functioning of this cohort of 5-year-old DHH children fell within the range of typically developing children. The findings suggest that spoken language ability and functional communication skills are vital for healthy psychosocial development. [ABSTRACT FROM AUTHOR]

Background: Patients presenting with dental pain are common in general practice, despite dental infections being most appropriately managed with dental treatment to address the cause of the infection. Although antibiotics are not appropriate for the management of localised toothache without signs of systemic spread, general practitioners (GPs) often prescribe antibiotics and analgesics for the management of dental pain. The aim of this study was to explore GPs' perceptions and management of dental presentations in Australia. Methods: Twelve semi-structured interviews were conducted with GPs across Victoria, Australia, between October 2022 and January 2023. Data were thematically analysed. Results: The study found that dental pain was the most common presenting complaint for patients attending general practice with a dental problem. Five major themes were identified in this study: knowledge, beliefs about capabilities, emotion, environmental context and resources, and social influences/social professional role and identity. In terms of knowledge and capabilities, GPs would advise patients to seek dental care, as they are aware that antibiotics would not resolve the underlying issue. Challenges for GPs included limited training in oral and dental treatment, as well as emotions, such as patient anxiety and phobia resulting in patients seeking dental care through a GP rather than a dentist. Barriers due to the context, such as access to dental care, long waiting lists within the public dental system and cost, were some of the reasons patients present to general practice rather than a seeing a dentist. Furthermore, issues that influenced GPs' antibiotic prescribing included patients' expectations for antibiotics to treat their dental pain, as well as dentists advising their patients to attend their GP for antibiotics prior to dental treatment. Conclusions: This study identified factors that influenced GPs' management of patients with dental conditions. To address these issues, it is imperative to develop interventions addressing patients' knowledge around oral health, as well as providing improved access to dental care for these patients. Patients with dental pain often seek treatment from general practitioners (GPs), even though the problem often requires dental treatment rather than antibiotics and/or pain relief medications. This study looked at GPs' management of patients with dental problems, and identified barriers as to why patients would see a GP instead of a dentist. Understanding these reasons will help develop interventions to better educate patients in oral health, and provide better access to dental care to patients with oral conditions. [ABSTRACT FROM AUTHOR]

McKenna L, Boyle M, Brown T, Williams B, Molloy A, Lewis B, Molloy L. International Journal of Nursing Practice 2012; 18: 246-251 Levels of empathy in undergraduate nursing students Empathy and absence of prejudice and stigma are instrumental in facilitating effective nurse-patient relations. This study assessed empathy levels and regard for specific medical conditions in undergraduate nursing students. A cross-sectional study was undertaken using paper-based versions of the Jefferson Scale of Physician Empathy (JSPE) and Medical Condition Regard Scale (MCRS), along with a brief set of demographic questions. Participants reported good empathy levels on JSPE. Attitudes towards intellectual disability, chronic pain, acute mental illness and terminal illness rated well on MCRS. Attitudes towards substance abuse, however, were lower. There were no significant differences between age groups, gender or year level of study. Overall results of this study were positive. Nursing students demonstrated acceptable empathy levels. Attitudes towards patients who abuse substances highlight an area that needs both further exploration and addressing. Attitudes towards mental health diagnoses were particularly favourable given that these often attract stigma and negative attitudes. [ABSTRACT FROM AUTHOR]

Objective. This paper examines the quality and safety of the physical environment in Australian residential aged care facilities (RACFs). Design. Cross-sectional study. One assessor completed environmental audits to identify areas of the physical environment that needed to be addressed to improve the wellbeing and safety of residents. Setting. Nine RACFs participating in a broader falls prevention project were audited. RACFs were located in Queensland, Tasmania or Victoria and were chosen by convenience to represent high level, low level, dementia and psychogeriatric care, regional and metropolitan facilities, small and large facilities and a culturally specific facility. Main outcome measure. An environmental audit tool was adapted from a tool designed to foster older person friendly hospital environments. The tool consisted of 147 items. Results. Across all sites 450 items (34%) required action. This ranged from 21 to 44% across sites. The audit domains most commonly requiring action included signage, visual perception and lighting, and outdoor areas. Conclusions. Although not representative of all residential facilities in Australia, this audit process has identified common environmental problems across a diverse mix of residential care facilities. Results highlight the need for further investigation into the quality of physical environments, and interventions to improve physical environments in Australian RACFs. INSET: What is known about the topic?. [ABSTRACT FROM AUTHOR]

Mills J, Field J, Cant R. International Journal of Nursing Practice 2011; 17: 455-463 Factors affecting evidence translation for general practice nurses This paper explores the domains of influence affecting practice nurses' ability to find, evaluate and use clinical evidence. A cross-sectional survey of general practice nurses ( n = 590) in Victoria, Australia in 2008 provided data for a principal components analysis. The research replicates a study undertaken in the UK using the Developing Evidence-Based Practice Questionnaire. Five domains of influence on nurses' translation of evidence were identified: skills in finding/reviewing evidence; barriers to finding/reviewing evidence; knowledge from published sources; knowledge from other sources; and barriers or facilitators to change. Each domain was interpreted as underlying the relationship of nurses with evidence-based practice and was comparable to the original study's findings when subjected to factor analysis. Findings from this study show that the Developing Evidence-Based Practice Questionnaire-Au is a valid and useful instrument in determining the influences on practice nurses' ability to effect knowledge translation and conduct practice based on evidence. Given these findings, a new model is proposed that explains the influence of a number of domains on Australian general practice nurses' translation of knowledge into practice. [ABSTRACT FROM AUTHOR]

Parental incarceration has wide-ranging impacts on families. One key effect may be disruption to the care and legal custody of children, yet few studies have examined processes and outcomes relating to care planning for children of prisoners. This paper presents findings of interviews with 151 primary carer prisoners in two Australian states which aimed to address this research gap. The study examined care planning for children upon parental arrest, sentencing and imprisonment, stability of care arrangements and primary carer prisoners' involvement and satisfaction with care planning. Around one third of prisoners had discussions regarding children's care arrangements at arrest and imprisonment, although the issue was more commonly raised at sentencing. While there was much variation in the stability of care arrangements, children placed in out-of-home care experienced the most instability. A minority of prisoners reported being involved in care planning and decision-making for children upon imprisonment, and around one third rated care planning process poorly. Prisoners were more satisfied with care planning when there were fewer movements of children, where prisoners felt involved with decision-making, and when police officers, lawyers and corrections staff inquired about the welfare of their children. Implications for policy and future research are discussed. [ABSTRACT FROM AUTHOR]

Perinatal women are at risk of depression and/or suicidality. Suicide is the highest cause of indirect maternal deaths in the perinatal period. Midwives and maternal child health nurses ( MCHN), as key clinicians, need to be able to detect these mental health issues. Little is known about these clinicians' attitudes to suicide. In this paper, we report on the results of a cross-sectional study of midwives' and MCHN attitudes to suicide. A convenience sample of midwives ( n = 95) and MCHN ( n = 86) from south-eastern Victoria, Australia, was recruited into the study. Participants completed the Attitudes to Suicide Prevention Scale. The results showed that MCHN have more positive attitudes towards suicide prevention than midwives, and younger participants have more positive attitudes to suicide prevention compared to older participants. Midwives and MCHN could benefit from continuing professional education to build their knowledge and skills in assessing suicide risk for childbearing women and their families, increasing positive attitudes, improving detection, and mental health referrals. [ABSTRACT FROM AUTHOR]

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Objective. This paper reports on a project to examine the expectations of senior nurses regarding graduate roles of registered and enrolled nurses educated in Victoria, Australia. Methods. Participants completed an online survey to indicate whether predetermined competencies were in the roles of graduate enrolled or registered nurses or not in the role of either nurse. Chi-squared analysis was used to identify differences between participant groups. Results. Participants expressed variations in role expectations for the different level of graduate nurse. Although basic nursing care was undertaken by both graduate enrolled and registered nurses, no specific role was identified for enrolled nurses. Differences were found in the opinions of senior nurses over the roles of graduate nurses, demonstrating considerable variation in expectations. Management, education and research roles were not identified as the role of either nurse on graduation. Differences were found in the expectations of the different senior nurse groups regarding the roles of the enrolled nurse, particularly in the new skills taught in the enrolled nurse diploma program. Conclusions. Confusion exists regarding the roles of both types of nurse on graduation. Further research across Australia is required to clarify the roles of the different level of nurse in different practice contexts. [ABSTRACT FROM AUTHOR]

Purpose: Human papillomavirus (HPV)-associated oropharyngeal cancer (OPC) commonly affects people of working age, yet there is limited data regarding the return-to-work experience in this cohort. This study aimed to investigate the proportion of survivors currently working after completion of radiation therapy and to explore potential facilitators and barriers to working after treatment.Methods: A cross-sectional, single-institutional study was undertaken at the Peter MacCallum Cancer Centre, a comprehensive cancer center in Melbourne, Victoria, Australia. Eligible participants were 18 to 65 years old at diagnosis, were employed at or within the 3 months before diagnosis, and had completed curative treatment for HPV-associated OPC ≥4 months before enrollment. Participants completed a paper-based survey to assess baseline demographics, employment status, and quality of life (QOL; Functional Assessment of Cancer Therapy Head and Neck). Open-ended questions explored factors affecting return to work. Associations between current employment status and various disease, treatment, and demographic variables and with QOL were examined. Free-text items were analyzed by summarizing content analysis.Results: Of 93 participants approached, 68 responded (73.1%). Mean age was 54.1 years (range, 39-64 years), and 89.7% were male. Most participants (67.6%) had stage II disease and were treated with chemoradiation (85.3%). Mean time after treatment was 2.6 years (range, 0.3-9.1 years). Fifty-eight of 68 participants (85.3%) were working at enrollment; median time to return to work was 6.0 months (interquartile range, 4-10 months); 45 (77.6%) were in the same role and 35 (60.3%) worked the same number of hours. Ten participants were not working, 3 had retired, 5 reported persistent and significant treatment toxicity preventing employment. Survivors currently working reported higher physical, functional, and global QOL scores. Access to leave and support from treating doctors were facilitators for return to work, whereas fatigue was frequently reported as a barrier to returning to work.Conclusion: With time, the majority of participants with HPV-associated OPC will return to work after radiation therapy. Attention to symptom management and support from the workplace may enable more successful return to work. [ABSTRACT FROM AUTHOR]

Purpose: Schools have long been perceived as an ideal setting to support the healthy eating behaviours of children. The aim of the study was to examine the views of Australian primary school parents regarding school food and nutrition, including education, practices and policy. Design/methodology/approach: An online survey was conducted among 787 parents in March 2021, which included closed and open-ended questions. Findings: The results indicated the inconsistent implementation of policies and/or varying practices among different schools. Parents' views were slightly associated with some demographic and personal measures including their SES levels, education, age, the main language spoken at home and universalism values. Parents viewed healthy food provision through canteens, policies and informing parents, fruit and vegetable breaks and kitchen and garden programs as the main contributors to the promotion of healthy eating. They believed unhealthy options in canteens, school fairs, events and birthdays are the major contributors to the formation of unhealthy eating habits among children at schools. Results revealed the efforts to establish health promoting school food environments in Australian primary schools; however, inconsistencies and discrepancies among schools should be addressed to ensure equity among all children. Practical implications: The findings may provide directions for policymakers and school managers and can inform future reforms and initiatives in Australian primary schools and elsewhere. Originality/value: This is the first study that has examined Australian parents' views of school food policy, practices and environments using a mixed-methods design. [ABSTRACT FROM AUTHOR]

Background: Variations exist internationally in the types and numbers of nurses registered to practice. Whilst the United Kingdom has phased out second level nurses, countries such as Australia, New Zealand, Singapore and the United States have maintained a two level system. In Australia, the two levels of nurse authorised to practice are the registered nurse whom complete an undergraduate nursing degree, and enrolled nurse (EN) whom complete either a certificate or diploma programme. Recent changes to educational preparation and resulting scope of practice for ENs have resulted in increased confusion between roles and expectations of the different levels. Aim: This paper reports on findings of a study aimed at identifying differences in educational preparation of the different levels of nurse in Australia. Method: Course coordinators from nine organisations offering pre-registration nursing programmes completed self-reporting questionnaires designed to obtain information on types and lengths of courses, and details of curricula including course objectives, teaching and assessment methods and content areas. Results: Comparative analysis of survey responses identified similarities and differences between registered and EN programmes. Common areas included teaching and assessment methods, core theoretical units and general nursing skills. The diploma and degree programmes appear aligned in most theory and clinical skills. The main difference identified existed between skills taught in the two EN programmes. Conclusions: Findings further add to confusion regarding registered and ENs in Australia. Further research is required to determine expectations of employers and other major stakeholders with regard to the differences. [ABSTRACT FROM AUTHOR]

Introduction The health of Indigenous Australians is worse than that of other Australians. Most of the determinants of health are preventable and the poor health outcomes are inequitable. The Australian Government recently pledged to close that health gap. One possible way is to improve the priority setting process to ensure transparency and the use of evidence such as epidemiology, equity and economic evaluation. The purpose of this research was to elicit the perceptions of Indigenous and non-Indigenous decision-makers on several issues related to priority setting in Indigenous-specific health care services. Specifically, we aimed to: 1. identify the criteria used to set priorities in Indigenous-specific health care services; 2. determine the level of uptake of economic evaluation evidence by decision-makers and how to improve its uptake; and 3. identify how the priority setting process can be improved from the perspective of decisionmakers. Methods We used a paper survey instrument, adapted from Mitton and colleagues' work, and a faceto- face interview approach to elicit decision-makers' perceptions in Indigenous-specific health care in Victoria, Australia. We used mixed methods to analyse data from the survey. Responses were summarised using descriptive statistics and content analysis. Results were reported as numbers and percentages. Results The size of the health burden; sustainability and acceptability of interventions; historical trends/patterns; and efficiency are key criteria for making choices in Indigenous health in Victoria. There is a need for an explicit priority setting approach, which is systematic, and is able to use available data/evidence, such as economic evaluation evidence. The involvement of Indigenous Australians in the process would potentially make the process acceptable. Conclusions An economic approach to priority setting is a potentially acceptable and useful tool for Aboriginal Community Controlled Health Services (ACCHS). It has the ability to use evidence and ensure due process at the same time. The use of evidence can ensure that health outcomes for Indigenous peoples can be maximised - hence, increase the potential for 'closing the gap' between Indigenous and other Australians. [ABSTRACT FROM AUTHOR]

Aims To investigate the extent to which emotional labour and emotional intelligence are associated with well-being and job-stress among a group of Australian community nurses. The moderating role of emotional intelligence was evaluated as a key factor in the rescue of healthcare workers from job-stress, thus increasing job retention. Background Although emotional labour has been broadly investigated in the literature, the contribution of emotional labour and emotional intelligence to the well-being and experience of job-stress in a community nursing setting requires further exploration. Design This study used a cross-sectional quantitative research design with data collected from Australian community nurses. Methods Australian community nurses ( n = 312) reported on their perceived emotional labour, emotional intelligence and their levels of well-being and job-stress using a paper and pencil survey in 2010. Results/Findings Results from structural equation modelling support the hypothesis that both emotional labour and emotional intelligence have significant effects on nurses' well-being and perceived job-stress. Emotional intelligence plays a moderating role in the experience of job-stress. Conclusion These findings provide additional evidence for the important effects that emotional labour and emotional intelligence can have on well-being and job-stress among community nurses. The potential benefits of emotional intelligence in the nurses' emotional work have been explored. [ABSTRACT FROM AUTHOR]

Aim: This paper explored the relationship between maternal controlling feeding behaviours and child eating and weight in preschool-aged children. Methods: Ninety mothers of 2- to 5-year-old children (M = 3.48, SD = 0.84, 54.4% males) completed self-report measures assessing maternal controlling feeding behaviours, child eating patterns and weight. Results: Univariate analyses indicated that child food neophobia was associated with authoritarian feeding ( r= 0.29), pressure to eat ( r= 0.28) and restriction ( r= 0.34). Child food pickiness was associated with authoritarian feeding ( r= 0.35). No association was found between maternal feeding strategies and child weight. Multivariate regression analyses indicated that authoritarian feeding, restriction and pressure to eat were significantly associated with the variance in child food neophobia (adjusted R2= 12.6%) and pickiness (adjusted R2= 12.0%). Conclusions: The findings suggest that maternal control in feeding is associated with undesirable eating patterns in preschool-aged children. Interventions targeting reduction in maternal controlling feeding may promote desirable eating patterns in preschool-aged children. [ABSTRACT FROM AUTHOR]

Background: Typically a large amount of information is collected during healthcare research and this information needs to be organised in a way that will make it manageable and to facilitate clear reporting. The Chiropractic Observation and Analysis STudy (COAST) was a cross sectional observational study that described the clinical practices of chiropractors in Victoria, Australia. To code chiropractic encounters COAST used the International Classification of Primary Care (ICPC-2) with the PLUS general practice clinical terminology to code chiropractic encounters. This paper describes the process by which a chiropractic-profession specific terminology was developed for use in research by expanding the current ICPC-2 PLUS system. Methods: The coder referred to the ICPC-2 PLUS system when coding chiropractor recorded encounter details (reasons for encounter, diagnoses/problems and processes of care). The coder used rules and conventions supplied by the Family Medicine Research Unit at the University of Sydney, the developers of the PLUS system. New chiropractic specific terms and codes were created when a relevant term was not available in ICPC-2 PLUS. Results: Information was collected from 52 chiropractors who documented 4,464 chiropractor-patient encounters. During the study, 6,225 reasons for encounter and 6,491 diagnoses/problems were documented, coded and analysed; 169 new chiropractic specific terms were added to the ICPC-2 PLUS terminology list. Most new terms were allocated to diagnoses/problems, with reasons for encounter generally well covered in the original ICPC 2 PLUS terminology: 3,074 of the 6,491 (47%) diagnoses/problems and 274 of the 6,225 (4%) reasons for encounter recorded during encounters were coded to a new term. Twenty nine new terms (17%) represented chiropractic processes of care. Conclusion: While existing ICPC-2 PLUS terminology could not fully represent chiropractic practice, adding terms specific to chiropractic enabled coding of a large number of chiropractic encounters at the desired level. Further, the new system attempted to record the diversity among chiropractic encounters while enabling generalisation for reporting where required. COAST is ongoing, and as such, any further encounters received from chiropractors will enable addition and refinement of ICPC-2 PLUS (Chiro). More research is needed into the diagnosis/problem descriptions used by chiropractors. [ABSTRACT FROM AUTHOR]

The aim of this research was to determine the current knowledge of uniform police at one 24-hour police station regarding people with communication disabilities, in order to implement effective communication strategies, and award the Communication Access Symbol. Twenty-nine frontline uniform police from one police station responded to a paper-based survey that probed the frequency of their interactions with people with a communication disability and their knowledge of communication strategies. Quantitative data were analysed using descriptive statistics and qualitative data were analysed thematically. Results indicated that although the majority of respondents were experienced police who frequently faced difficulties in interactions, they had limited communication strategies and had received little or no training in using visual supports. The results from the survey informed the communication strategies that speech language pathologists will employ to address the barriers police face in initial interactions with community members with communication disabilities. [ABSTRACT FROM AUTHOR]

Background: While previous research on fast food access and purchasing has not found evidence of an association, these studies have had methodological problems including aggregation error, lack of specificity between the exposures and outcomes, and lack of adjustment for potential confounding. In this paper we attempt to address these methodological problems using data from the Victorian Lifestyle and Neighbourhood Environments Study (VicLANES) - a cross-sectional multilevel study conducted within metropolitan Melbourne, Australia in 2003. Methods: The VicLANES data used in this analysis included 2547 participants from 49 census collector districts in metropolitan Melbourne, Australia. The outcome of interest was the total frequency of fast food purchased for consumption at home within the previous month (never, monthly and weekly) from five major fast food chains (Red Rooster, McDonalds, Kentucky Fried Chicken, Hungry Jacks and Pizza Hut). Three measures of fast food access were created: density and variety, defined as the number of fast food restaurants and the number of different fast food chains within 3 kilometres of road network distance respectively, and proximity defined as the road network distance to the closest fast food restaurant. Multilevel multinomial models were used to estimate the associations between fast food restaurant access and purchasing with never purchased as the reference category. Models were adjusted for confounders including determinants of demand (attitudes and tastes that influence food purchasing decisions) as well as individual and area socio-economic characteristics. Results: Purchasing fast food on a monthly basis was related to the variety of fast food restaurants (odds ratio 1.13; 95% confidence interval 1.02 - 1.25) after adjusting for individual and area characteristics. Density and proximity were not found to be significant predictors of fast food purchasing after adjustment for individual socio-economic predictors. Conclusion: Although we found an independent association between fast food purchasing and access to a wider variety of fast food restaurant, density and proximity were not significant predictors. The methods used in our study are an advance on previous analyses. [ABSTRACT FROM AUTHOR]

Introduction: Access to after‐hours care (AHC) is an important aspect of general practice service provision. Objective: To establish the prevalence and associations of early‐career GPs' provision of AHC. Design: An analysis of data from the New alumni Experiences of Training and independent Unsupervised Practice (NEXT‐UP) cross‐sectional questionnaire‐based study. Participants were early‐career GPs (6‐month to 2‐year post‐Fellowship) following the completion of GP vocational training in NSW, the ACT, Victoria or Tasmania. The outcome factor was 'current provision of after‐hours care'. Associations of the outcome were established using multivariable logistic regression. Findings: Three hundred and fifty‐four early‐career GPs participated (response rate 28%). Of these, 322 had responses available for analysis of currently performing AHC. Of these observations, 128 (40%) reported current provision of AHC (55% of rural participants and 32% of urban participants). On multivariable analysis, participants who provided any AHC during training were more likely to be providing AHC (odds ratio (OR) 5.51, [95% confidence interval (CI) 2.80–10.80], p < 0.001). Current rural location and in‐training rural experience were strongly associated with currently providing AHC in univariable but not multivariable analysis. Discussion: Early‐career GPs who provided AHC during training, compared with those who did not, were more than five times more likely to provide after‐hours care in their first 2 years after gaining Fellowship, suggesting participation in AHC during training may have a role in preparing registrars to provide AHC as independent practitioners. Conclusion: These findings may inform future GP vocational training policy and practice concerning registrars' provision of AHC during training. [ABSTRACT FROM AUTHOR]

Background: Chiropractors use a variety of therapeutic interventions in clinical practice. How the selection of interventions differs across musculoskeletal regions or with different patient and provider characteristics is currently unclear. This study aimed to describe how frequently different interventions are used for patients presenting for chiropractic care, and patient and provider characteristics associated with intervention selection. Methods: Data were obtained from the Chiropractic Observation and Analysis STudy (COAST) and Ontario (O-COAST) studies: practice-based, cross-sectional studies in Victoria, Australia (2010–2012) and Ontario, Canada (2014–2015). Chiropractors recorded data on patient diagnosis and intervention selection from up to 100 consecutive patient visits. The frequency of interventions selected overall and for each diagnostic category (e.g., different musculoskeletal regions) were descriptively analysed. Univariable multi-level logistic regression (provider and patient as grouping factors), stratified by diagnostic category, was used to assess the association between patient/provider variables and intervention selection. Results: Ninety-four chiropractors, representative of chiropractors in Victoria and Ontario for age, sex, and years in practice, participated. Data were collected on 7,966 patient visits (6419 unique patients), including 10,731 individual diagnoses (mean age: 43.7 (SD: 20.7), 57.8% female). Differences in patient characteristics and intervention selection were observed between chiropractors practicing in Australia and Canada. Overall, manipulation was the most common intervention, selected in 63% (95%CI:62–63) of encounters. However, for musculoskeletal conditions presenting in the extremities only, soft tissue therapies were more commonly used (65%, 95%CI:62–68). Manipulation was less likely to be performed if the patient was female (OR:0.74, 95%CI:0.65–0.84), older (OR:0.79, 95%CI:0.77–0.82), presenting for an initial visit (OR:0.73, 95%CI:0.56–0.95) or new complaint (OR:0.82, 95%CI:0.71–0.95), had one or more comorbidities (OR:0.63, 95%CI:0.54–0.72), or was underweight (OR:0.47, 95%CI:0.35–0.63), or obese (OR:0.69, 95%CI:0.58–0.81). Chiropractors with more than five years clinical experience were less likely to provide advice/education (OR:0.37, 95%CI:0.16–0.87) and exercises (OR:0.17, 95%CI:0.06–0.44). Conclusion: In more than 10,000 diagnostic encounters, manipulation was the most common therapeutic intervention for spine-related problems, whereas soft tissue therapies were more common for extremity problems. Different patient and provider characteristics were associated with intervention selection. These data may be used to support further research on appropriate selection of interventions for common musculoskeletal complaints. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to assess student nurses’ knowledge of and attitudes towards pressure injury prevention evidence-based guidelines. Background Pressure injuries are a substantial problem in many healthcare settings causing major harm to patients, and generating major economic costs for health service providers. Nurses have a crucial role in the prevention of pressure injuries across all health care settings. Design A multi-centered, cross-sectional study was conducted using a paper-based questionnaire with undergraduate nursing students enrolled in seven universities with campuses across five Australian states (Queensland, New South Wales, Western Australia, Victoria and Tasmania). Methods Data were collected from nursing students using two validated instruments (Pressure Ulcer Knowledge Assessment Instrument and Attitude Toward Pressure Ulcer Prevention Instrument), to measure students’ pressure injury prevention knowledge and attitudes. Results Students reported relatively low pressure injury prevention knowledge scores (51%), and high attitude scores (78%). Critical issues in this study were nursing students’ lack of knowledge about preventative strategies to reduce the amount and duration of pressure/shear, and lower confidence in their capability to prevent pressure injury. Level of education and exposure to working in a greater number of different clinical units were significantly related to pressure injury prevention knowledge and attitude scores. Conclusion The study findings highlight the need to implement a comprehensive approach to increasing Australian nursing students’ pressure injury prevention and management knowledge, as well as ensuring that these students have adequate experiences in clinical units, with a high focus on pressure injury prevention to raise their personal capability. [ABSTRACT FROM AUTHOR]

Background: Research suggests that rates of mental illness are similar in rural and urban Australia, although there are significant workforce shortages in rural regions along with higher rates of chronic disease and obesity and lower levels of socioeconomic status. However, there are variations across rural Australia and limited local data on mental health prevalence, risk, service use and protective factors. This study describes the prevalence of self-reported mental health problems of psychological distress and depression, in a rural region in Australia and aims to identify the factors associated with these problems. Methods: The Crossroads II study was a large-scale cross-sectional study undertaken in the Goulburn Valley region of Victoria, Australia in 2016–18. Data were collected from randomly selected households across four rural and regional towns and then screening clinics from individuals from these households. The main outcome measures were self-reported mental health problems of psychological distress assessed by the Kessler 10 and depression assessed by Patient Health Questionnaire-9. Unadjusted odd ratios and 95% confidence intervals of factors associated with the two mental health problems were calculated using simple logistic regression with multiple logistic regression using hierarchical modelling to adjust for the potential confounders. Results: Of the 741 adult participants (55.6% females), 67.4% were aged ≥ 55 years. Based on the questionnaires, 16.2% and 13.6% had threshold-level psychological distress and depression, respectively. Of those with threshold-level K-10 scores, 19.0% and 10.5% had seen a psychologist or a psychiatrist respectively while 24.2% and 9.5% of those experiencing depression had seen a psychologist or a psychiatrist, respectively in the past year. Factors such as being unmarried, current smoker, obesity, were significantly associated with a higher prevalence of mental health problems whereas physical activity, and community participation reduced the risk of mental health problems. Compared to rural towns, the regional town had higher risk of depression which was non-significant after adjusting for community participation and health conditions. Conclusions: The high prevalence of psychological distress and depression in this rural population was consistent with other rural studies. Personal and lifestyle factors were more relevant to mental health problems than degree of rurality in Victoria. Targeted lifestyle interventions could assist in reducing mental illness risk and preventing further distress. [ABSTRACT FROM AUTHOR]

Objective: To determine whether primary school children's weight status and dietary behaviours vary by remoteness as defined by the Australian Modified Monash Model (MMM). Design: A cross-sectional study design was used to conduct secondary analysis of baseline data from primary school students participating in a community-based childhood obesity trial. Logistic mixed models estimated associations between remoteness, measured weight status and self-reported dietary intake. Setting: Twelve regional and rural Local Government Areas in North-East Victoria, Australia. Participants: Data were collected from 2456 grade 4 (approximately 9–10 years) and grade 6 (approximately 11–12 years) students. Results: The final sample included students living in regional centres (17·4 %), large rural towns (25·6 %), medium rural towns (15·1 %) and small rural towns (41·9 %). Weight status did not vary by remoteness. Compared to children in regional centres, those in small rural towns were more likely to meet fruit consumption guidelines (OR: 1·75, 95 % CI (1·24, 2·47)) and had higher odds of consuming fewer takeaway meals (OR: 1·37, 95 % CI (1·08, 1·74)) and unhealthy snacks (OR = 1·58, 95 % CI (1·15, 2·16)). Conclusions: Living further from regional centres was associated with some healthier self-reported dietary behaviours. This study improves understanding of how dietary behaviours may differ across remoteness levels and highlights that public health initiatives may need to take into account heterogeneity across communities. [ABSTRACT FROM AUTHOR]

Objective: To pilot the Pharmacist Community Apgar Questionnaire (PharmCAQ) and evaluate its usability and capacity to develop a greater understanding of the unique factors that impact the rural recruitment and retention of pharmacists. Design: Cross‐sectional design involving face‐to‐face, telephone or video conferencing interviews. Setting: Twelve rural communities across Tasmania and Western Victoria, Australia. Participants: Participants (n = 24) included pharmacists, a Director of Clinical Services, pharmacy practice managers and senior pharmacy assistants. Main Outcome Measures: Interviews enabled the completion of the PharmCAQ, which assigns quantitative values to 50 key factors to ascertain a community's strengths and challenges associated with recruitment and retention and their relative importance to the pharmacist workforce. Results: The cumulative PharmCAQ scores indicated the tool was sensitive enough to differentiate high‐ and low‐performing communities. Overall, the highest‐rated factors considered most vital to pharmacist recruitment and retention were the reputation of the pharmacy, the ability of the pharmacist to be independent and autonomous, the loyalty of the community to the pharmacy, the level and stability of monetary compensation and the breadth of tasks available to a pharmacist. Conclusions: This study identified the strengths and challenges of participating communities and provided an insight into the shared factors to consider in recruiting and retaining pharmacists. Further, each community has unique strengths that can further be promoted in recruitment, flagging where limited resources are best used to address site specific challenges. This is more likely to ensure the matching of the right candidate with the right community. [ABSTRACT FROM AUTHOR]

Background: An important service system for rural parents experiencing complex trauma is primary health care. Aim: To investigate workforce knowledge, attitudes and practices, and barriers and enablers to trauma‐informed care in rural primary health care. Material & Methods: This study used a descriptive, cross‐sectional design. It involved an on‐line survey conducted in 2021 in rural Victoria, Australia. Participants were the primary health care workforce. The main outcome measures were study‐developed and included, a 21‐item Knowledge, Attitudes and Practices tool, a 16‐item Barriers and Enablers to Trauma‐Informed Care Implementation tool, and three open‐ended questions. Results: The 63 respondents were from community health (n = 40, 63%) and child and family services (n = 23, 37%). Many (n = 43, 78%) reported undertaking trauma‐informed care training at some point in their career; with 32% (n = 20) during higher education. Respondents self‐rated their knowledge, attitudes and practices positively. Perceived enablers were mainly positioned within the service (e.g. workforce motivation and organisational supports) and perceived barriers were largely external structural factors (e.g. availability of universal referral pathways, therapeutic‐specific services). Open‐ended comments were grouped into four themes: (1) Recognition and understanding; (2) Access factors; (3) Multidisciplinary and collaborative approaches; and (4) Strengths‐based and outcome‐focused approaches. Discussion & Conclusion: Primary health care is an important driver of population health and well‐being and critical in rural contexts. Our findings suggest this sector needs a rural trauma‐informed care implementation strategy to address structural barriers. This also requires policy and system development. Long‐term investment in the rural workforce and primary care service settings is essential to integrate trauma‐informed care. [ABSTRACT FROM AUTHOR]

Background: Preventable harms during hospitalization pose a major challenge for health systems globally. Nurse‐led strategies provide comprehensive harm prevention to keep the most vulnerable patients safe in hospital, but gaps in care are common. Nursing roles and activities to prevent harm to patients during acute hospitalization are poorly understood. Aim: The aim of this study was to identify nurses' perceived enablers and barriers to the implementation of comprehensive harm prevention for older people admitted to an acute hospital setting. Design: Anonymous, online, cross‐sectional survey. Methods: The adapted Influences on Patient Safety Behaviours Questionnaire (IPSBQ) was used to collect data from nurses working on five general medicine wards across three hospitals of a single tertiary health service in Australia in 2019. Participants also rated their perceptions of overall quality of care, missed care and awareness of strategies for an eight‐factor framework for comprehensive harm prevention. The STROBE reporting checklist was used. Results: Ward response rates between 35% and 58% resulted in 132 complete questionnaires for analyses. High mean scores for behavioural regulation (3.28), beliefs about capabilities (2.96) and environmental context and resources (2.73) indicated these domains were perceived by nurses as enablers. Low mean scores for the domains of intentions (1.65), beliefs about consequences (1.69), optimism (1.72) and professional role and identity (1.85) indicated these were barriers to comprehensive harm prevention by nurses. High perceived quality of care (scored 9–10/10) (p =.024), and awareness of strategies for the eight‐factor framework (p =.019) were significant enablers of comprehensive harm prevention. Conclusion: Targeted evidence‐based strategies that include education, persuasion, incentivization, coercion and modelling would be most useful for promoting comprehensive harm prevention by nurses. However, to be most effective the harm prevention strategy may need to be tailored for each ward. [ABSTRACT FROM AUTHOR]

Social distancing restrictions are undoubtedly important for controlling the spread of COVID‐19 however, they are also adversely impacting population health and health service access. It is important that priority populations with a disability which may already have adverse health, access to health services, and autonomy and participation compared to those without disability, are able to receive preventative health and social care during periods of restriction. The impact of social distancing restrictions on people with disability is not uniform nor well‐understood. Research has been cross‐sectional and considered data gathered during social distancing restrictions, or longitudinal, considering data gathered during a pre‐pandemic baseline. This longitudinal study investigated the impact of lifting social distancing restrictions on priority domains for people with disability including autonomy and participation, access to health services, health issues and quality of life. People with spinal cord injury in Victoria, Australia (n = 71) completed a survey towards the end of social‐distancing restrictions (T1) and 6‐months post social distancing restrictions (T2). Non‐parametric tests for significant differences confirmed that 6‐months post‐lifting social distancing restrictions participants experienced a significant increase in health conditions, a significant decrease in the number of inaccessible health services, and a significantly lower level of limitations across participation and autonomy, outdoor autonomy and work and education domains. QOL improved 6‐months post lifting restrictions, however not to a significant level. The adverse health experienced by people with spinal cord injury after lifting restrictions may in part result from limited health service access and reduced participation during the time of restrictions. Clear definitions of what constitutes as essential care may ensure that eligible and required care remains received during lockdown or instances when service provision is compromised. Health and social care providers should be equipped with the knowledge of priority populations so that their support can be targeted to those most in need. [ABSTRACT FROM AUTHOR]

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

Introduction: Family violence (FV) is one of the most urgent health issues of our generation. While nurses play a vital role in identifying and supporting victim/survivors of violence, little is known about nursing readiness to respond across clinical areas. Objective: This study aimed to compare and contrast the knowledge, confidence, clinical skills, and perceived barriers of nurses across three clinical areas of a tertiary trauma hospital in Melbourne, Australia, in responding to FV. Method: A prospective, mixed methods design was used. The nursing staff at a large trauma hospital were approached to participate. Participants completed a brief online survey to quantify clinician-reported knowledge, clinical skills, and barriers to managing FV. Results: Two hundred and forty-two nursing staff electronically completed a brief survey to capture self-reported confidence, knowledge, clinical skills, and barriers to working effectively in the area. The descriptive analysis reflected service-wide deficits in knowledge, confidence, and self-reported clinical skills, irrespective of the work area. Deficits were identified on a background of limited structured training for FV among this cohort. Significantly higher rates of FV confidence and knowledge were identified among emergency department nurses relative to acute and subacute clinical counterparts. Conclusion: Nurse respondents overall reported low rates of confidence, knowledge, and clinical skills in responding to disclosures of FV. Findings reinforce the need for imbedded training programs to support frontline responses. [ABSTRACT FROM AUTHOR]

Objective: The rates of family violence within some rural communities are higher than that of metropolitan areas. The extent to which these rural communities know about and access family violence support services is not well understood. Local health services often play a role in providing information and support for community members at risk of, or experiencing family violence. For a rural community in Victoria, the study aimed to: (a) determine community members' knowledge of family violence services, (b) explore community members' help seeking behaviour for family violence, (c) identify perceived barriers and enabling factors to accessing family violence services and (d) explore community members' expectations of, and preferences for, family violence support provided by local health services. Design: A cross‐sectional, anonymous, mixed‐methods online survey. Setting A rural community in Victoria's Western District, Australia. Participants: Ninety‐nine residents, over 18 years of age. Results: The majority of respondents had been exposed to family violence. There were varying knowledge levels of family violence support services as well as a number of barriers identified that directly impacted community members seeking help. There were clear expectations about the role of the local health service in family violence identification and response. Conclusion: There are particular challenges for rural communities in providing support for family violence. Valuable insights can be gained from local communities about their knowledge of services and help seeking behaviours. Evidence generated by this study will inform future strategic planning for family violence services and the local health service. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the perceptions and beliefs of rural high school teachers about student suicide completion in their school and their perceived self‐efficacy in identification of suicidality in students (suicidal ideation, plans and behaviours). Design: A cross‐sectional survey methodology. Setting: Gippsland and the Loddon Mallee regions of Victoria, Australia. Participants: Rural high school teachers. Outcome Measure: A survey that aimed to obtain participants' perceptions and self‐reports about students who had died by suicide in their school within the last 5 years, their perceived self‐efficacy in identifying suicidal students and barriers to helping students at risk. Results: Two hundred and seventy‐seven rural high school teachers participated and 86% reported that a student from their school had died by suicide within the last 5 years. Sixty‐five per cent believed that more than one student had died by suicide and 70% perceived they were currently aware of students experiencing suicidality in their class. Receiving professional development about suicide and obtaining help from mental health clinicians predicted perceived self‐efficacy in identification of suicidality in students. Participants perceived the barriers to help students at risk included insufficient numbers of school‐based mental health professionals and community mental health services. Conclusions: Many rural high school teachers perceive they are at the front line of the youth suicide crisis due to unmet service need in youth mental ill health. Increased access to effective services immediately after teachers become aware of suicidality may assist in reducing youth suicide in rural areas. [ABSTRACT FROM AUTHOR]

Unlawful assisted dying practices have been reported in Australia for decades. Voluntary assisted dying (VAD) is now lawful in Victoria and Western Australia in limited circumstances and will soon be lawful in a further four Australian States. This article examines nine cases involving unlawful assisted dying practices in Victoria in the 12 months prior to the commencement of the Voluntary Assisted Dying Act 2017 (Vic) in 2019. It explores whether, if that Act had been in operation at the relevant time, these patients would have been eligible to request VAD, having regard to their decision-making capacity and their disease, illness or medical condition. Many of these patients would not have been eligible to request VAD had the legislation been operational, primarily because they lacked decision-making capacity. As VAD is lawful only in a narrow set of circumstances, unlawful assisted deaths may continue to occur in those States where voluntary assisted dying is legal. [ABSTRACT FROM AUTHOR]

Fathers in families raising children with disabilities are under-researched. Fathers' perspectives can be better accommodated in childhood disability services that operate on a family-centred paradigm if their perspectives are understood. This study aimed to investigate the perspectives of fathers on caring and family life, work, and health. A mixed-methods design with an online questionnaire included open-ended questions and three instruments: Depression Anxiety Stress Scales (DASS); Health Promoting Activities Scale (HPAS-M); Fathers of Children with Developmental Challenges (FCDC) Scale. Fathers (n = 33) reported high depressive (58%), anxiety (37%), and stress symptoms (61%). Fathers reported low participation in health-promoting activity with less than weekly: planning health activities (58%); solo physical activity (26%); social activity (3%); time relaxing (16%). Sixty-four percent worked full-time, although work was reported to be challenged by family responsibilities. Fathers described directly caring for their children although service interactions were low and delegated to mothers. Fathers in this study reported stress, mental health issues, and low participation in healthy activity. Fathers experienced challenges related to career progression and job choices due to family responsibilities. Providing individualised and responsive support to fathers of a child with a disability would better support the family unit. Fathers of children with a disability in this study experienced high mental health symptoms. Fathers were involved with their child's care at home but had low service interactions suggesting that service providers need to discover new ways to better engage fathers. Fathers experienced challenges to participation in paid work secondary to care responsibilities for their child with a disability and resulting needs of their family. Services that better support fathers are important to promote better health and wellbeing and support families. [ABSTRACT FROM AUTHOR]

Objective There is little evidence that useful electronic data could be collected at Australian small rural emergency services. If in future their funding model changed to the Activity- Based Funding model, then they would need to collect and submit more data. We determine whether it is possible to collect episode-level data at six small rural emergency services and quantify the accuracy of eight fields. Design A prospective cross-sectional study. Setting South-West Victoria, Australia. Participants Six small rural emergency services. Intervention We collected and audited episode-level emergency data from participating services between 1 February 2011 and 31 January 2012. A random sample of these data were audited monthly. Research assistants located at each service supported data entry and audited data accuracy for four hours per week. Main outcome measures Rates for data completeness, accuracy and total accuracy were calculated using audit data. Results Episode-level data were collected for 20 224 presentations across six facilities. The audit dataset consisted of 8.5% (1504/17 627) of presentations from five facilities. For all fields audited, the accuracy of entered data was high (>93%).Triage category was deemed appropriate for 95.9% (95% confidence interval ( CI): 94.9-96.9%) of the patient records reviewed. Some procedures were missing (28.7%, 95% CI: 27.2-30.3%). No significant improvement in data accuracy over 12 months was observed. Conclusion All six services collected useful episode-level data for 12-months with four hours per week of assistance. Data entry accuracy was high for all fields audited, and data entry completeness was low for procedures. [ABSTRACT FROM AUTHOR]

Background: Built and social environments are associated with physical activity. Global Positioning Systems (GPS) and accelerometer data can capture how people move through their environments and provide promising tools to better understand associations between environmental characteristics and physical activity. The purpose of this study is to examine the associations between GPS-derived exposure to built environment and gentrification characteristics and accelerometer-measured physical activity in a sample of adults across four cities. Methods: We used wave 1 data from the Interventions, Research, and Action in Cities Team, a cohort of adults living in the Canadian cities of Victoria, Vancouver, Saskatoon, and Montreal. A subsample of participants wore a SenseDoc device for 10 days during May 2017–January 2019 to record GPS and accelerometry data. Two physical activity outcomes were derived from SenseDoc data: time spent in light, moderate, and vigorous physical activity; and time spent in moderate or vigorous physical activity. Using corresponding GPS coordinates, we summarized physical activity outcomes by dissemination area—a Canadian census geography that represents areas where 400 to 700 people live- and joined to built (active living space, proximity to amenities, and urban compactness) and gentrification measures. We examined the associations between environmental measures and physical activity outcomes using multi-level negative binomial regression models that were stratified by city and adjusted for covariates (weekday/weekend), home dissemination area, precipitation, temperature) and participant-level characteristics obtained from a survey (age, gender, income, race). Results: We found that adults spent more time being physically active near their homes, and in environments that were more walkable and near parks and less time in urban compact areas, regardless of where participants lived. Our analysis also highlighted how proximity to different amenities was linked to physical activity across different cities. Conclusions: Our study provides insights into how built environment and gentrification characteristics are associated with the amount of time adults spend being physically active in four Canadian cities. These findings enhance our understanding of the influence that environments have on physical activity over time and space, and can support policies to increase physical activity. [ABSTRACT FROM AUTHOR]

Background: Cystic fibrosis (CF) primarily affects the lung, however, gastrointestinal disorders and symptoms, including dysbiosis, also impact on morbidity and quality of life. There is interest in strategies to modulate the gastrointestinal microbiota, including probiotics, although the evidence remains inadequate to guide practice, and information on use is limited. The present study aimed to characterise probiotic use, beliefs and experiences of adults with CF. Methods: A cross‐sectional questionnaire study was conducted in adults with CF (n = 205) and a general population Control group (n = 158), recruited from Victoria, Australia. Participants were classified as probiotic 'Ever Users' or 'Never Users'. Outcomes included self‐reported probiotic use and factors associated with probiotic use, which were analysed using logistic regression analysis. Open‐ended questionnaire responses were thematically analysed. Results: In total, 70% of adults with CF had ever used probiotics (supplements and/or foods), comparable to Controls (80%) (p = 0.03). Key reasons for CF probiotic use were gastrointestinal‐ and antibiotic‐related (75%). Most CF Ever Users (73%) did not discuss probiotic use with CF clinicians and 33% were uncertain if probiotics had been helpful. Female gender (odds ratio [OR] = 2.82; 95% confidence interval [CI] = 1.36–5.87; p = 0.005), university‐level education (OR = 2.73; 95% CI = 1.24–6.01; p = 0.01) and bloating on antibiotics (OR = 2.14; 95% CI = 1.04–4.40; p = 0.04) were independently associated with probiotic use in CF; as was female gender in Controls (OR = 2.84; 95% CI = 1.20–6.71; p = 0.02). Conclusions: Probiotics were used by adults with CF for gastrointestinal‐ and antibiotic‐related reasons often without informing clinicians and despite uncertainty about perceived helpfulness. Further research investigating gastrointestinal outcomes of probiotics will inform practice recommendations guiding their use in CF and other chronic diseases. Key points: Probiotics are used by many adults with cystic fibrosis (CF) for gastrointestinal‐ and antibiotic‐related reasons.Most CF probiotic users did not discuss probiotic use with healthcare professionals.Female gender, university‐level education and bloating when on on antibiotics were associated with probiotic use in CF.Gastrointestinal symptoms are important to consider for adults with CF, including as patient‐important outcome measures in research. [ABSTRACT FROM AUTHOR]

Aim: To assess the prevalence of modifiable health‐risk behaviours among Indigenous Australian adults with diabetes attending a regional Victorian Indigenous primary‐care clinic. Design: A cross‐sectional observational single‐site study. Methods: As part of a multi‐study project we administered the Smoking, Nutrition, Alcohol consumption, Physical activity and Emotional wellbeing (SNAPE) survey tool during the study baseline visit to methodically capture health‐related behavioural data in the nurse‐led integrated Diabetes Education and Eye Screening (iDEES) project in a regional Indigenous primary healthcare setting between January 2018 and March 2020. This descriptive SNAPE study helps address the lack of health behaviour data for Indigenous people with diabetes. Results: Of 172 eligible adults, 135 (79%) were recruited to the iDEES study, 50 (37%) male. All participated in at least one survey. Median (range) age was 56 (46–67) years; 130 (96%) had Type 2 diabetes of median [IQR] duration 6 (2–12) years. All 135 provided smoking data; 88 (65%) completed all surveys. Forty‐nine (36%) and 29 (22%) were current or former smokers, respectively; 5 (6%) met vegetable intake guidelines, 22 (25%) met fruit intake guidelines; 38 [43%] drank alcohol in the past year. On average, participants walked for ≥10 min at a time 4 days/week and sat for an average of 8 h on weekdays; 35 (40%) had minimal‐mild, and 30 (34%) had moderate‐severe depressive symptoms. Conclusion: Suboptimal modifiable health‐risk behaviours and depressive symptoms are common in Indigenous Australian adults with diabetes. Impact: Orderly assessment and reporting of health‐risk behaviours using a single multi‐component survey instrument (SNAPE tool) during a nurse‐led diabetes education clinical visit is feasible and efficient. Such data may facilitate personalised interventions and improve diabetes management at both individual and health service levels. [ABSTRACT FROM AUTHOR]

Background: The Coronavirus disease 2019 (COVID‐19) pandemic has had a major impact on healthcare services with many changes to telehealth care delivery. More information is needed about the patient perspective of telehealth in hospital services and the potential costs and benefits for patients. Aim: To measure patients' evaluation of telehealth, preferences for telehealth versus in‐person appointments, and potential cost savings by patient characteristics. Methods: A cross‐sectional online survey (including patient and appointment characteristics, telehealth evaluation, preferences for care and costs) of adult patients using video telehealth in four metropolitan tertiary hospital services in Melbourne, Victoria. Results: A total of 1045 patients (median age 44 years; interquartile range 29–59) participated with an overall response rate of 9.2%. For 98.7% patients, telehealth was convenient, 96.4% stated that it saved time, 95.9% found telehealth acceptable to receive care and 97.0% found that telehealth improved their access to care. Most (62.6%) preferred in‐person consultations, although 86.9% agreed that telehealth was equivalent to an in‐person consultation. Those in regional and rural areas were less likely to prefer in‐person consultations. Patients attending for medical reasons were less likely to prefer in‐person consultation compared with patients with surgical reasons. Patient preference to telehealth was independent of level of education, appointment type, self‐rated health status and socio economic status. Patients saved an average of A$120.9 (standard deviation A$93.0) per appointment, with greater cost savings for patients from low and middle socio economic areas and regional or rural areas. Conclusion: Telehealth video consultations were largely evaluated positively with most patients considering the service to be as good as in‐person. Understanding patient preference is critical to consider when implementing telehealth as mainstream across hospital health services. [ABSTRACT FROM AUTHOR]

In 2020 Coronavirus disease (COVID-19) was identified in Australia. During the pandemic, as essential workers, hospital-based social workers have been on the frontline. This cross-sectional study examines the resilience of social workers during the COVID-19 pandemic, how the pandemic impacted on social work and lessons learnt. Hospital social workers working in three states, namely Victoria, Queensland, and New South Wales were invited to participate in an online web-based survey, providing non-identifiable demographic details and information a) relating to their proximity to COVID-19, b) their degree of resilience (CD-RISC-2), c) professional quality of life, d) perceived social support, e) physical health, f) professional and personal growth during the pandemic, and g) impacts of COVID-19 on their practice. Basic descriptive statistics were computed for variables of interest. Within group, comparisons were made using paired t-tests or one-way ANOVAs for continuous variables as appropriate to investigate possible interstate differences. Regression analyses were conducted to determine which factors contribute to resilience. Social workers, during the pandemic, whether working under the constraints of lockdown or not, demonstrated high levels of resilience. These levels were similar across the three states, unaffected by the degree of infection in the community, indicating that as a group, social workers have high innate levels of resilience. This study provides an in-depth understanding of the impact of COVID-19 on hospital social workers, the long-term impact of the pandemic on social work practice, and potentially useful lessons learnt for the future. [ABSTRACT FROM AUTHOR]