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Inpatient parent-infant psychiatric units (PIUs) are considered "gold standard" for treating maternal mental illness, with well-documented positive outcomes for mothers. However, little research addresses outcomes for infants in these units, who often face significant developmental and socio-emotional adversity. This pilot study aimed to evaluate the characteristics and progress of an Australian PIU population, focusing on the impact of PIU admission on infant outcomes. Over 3 months, 31 consecutively admitted mother-infant pairs (dyads) were assessed through interviews, observations, and standardized measures to evaluate maternal and infant characteristics and progress from admission to discharge. Maternal well-being and the mother-infant relationship improved. Infants exhibited high levels of physical (29%) and developmental concerns (80.6%). 22.6% receiving an Axis I infant mental health diagnosis. Infant socio-emotional responsiveness improved significantly, as measured by the modified Alarm-Distress Baby Scale, indicating a positive impact of PIU admission. The small sample size and reliance on clinician-observed measures limit the generalizability of the findings. PIU infants are particularly vulnerable, and PIU admission may ameliorate socio-emotional responsiveness. Further research with larger samples and extended follow-up is needed to determine the most effective intervention strategies during and after PIU admission to maximize benefits for these infants., (© 2024 Michigan Association for Infant Mental Health.)

Mobile phones are an essential means for remaining connected, yet many acute inpatient mental health units restrict consumer access to their mobile phones due to safety concerns. The ubiquitous nature of mobile phones makes this approach seemingly incongruent with contemporary mental health practice. One Local Health District in Australia evaluated the implementation of a process that provided mental health consumers access to their mobile phones while in hospital. This study used a mixed methods design to explore the views of consumers and nurses, both before and after implementation. Participants were asked about their perceptions of the importance of mobile phone access to people in acute units, and their views about any perceived (pre) and actual (post) issues, challenges or benefits associated with the change in practice. Survey responses showed significant differences across group on all measures, with consumers more likely to rate the importance and frequency of mobile phone use higher, while also significantly more likely to rate potential issues lower. Issues associated with consumer phone access were rated lower in the post surveys. Descriptive content analysis of qualitative data identified differences in the level of concern between staff and consumers about consumers having access to their phone before implementation. Views about the therapeutic benefits and level of concern also changed post implementation. The need to have a clear process for implementation and governance was identified by both groups. The findings support consumers having access to their phone during admissions to acute mental health units.

Background: Improving palliative care for inpatients is urgently needed. Data from patient-reported experience measures (PREM) can assist in identifying areas for focused improvement. This study aimed to describe patient reported experience of care in inpatients with palliative care needs, to inform a baseline understanding of care experience and identify key areas for improvement., Methods: Cross-sectional study design where inpatients with palliative care needs were invited to complete 'consideRATE,' a patient reported experience measure of care, over six months in 2022. Inpatients with palliative care needs receiving care on an oncology, general medicine/renal and general medicine/respiratory ward (n = 3) at an Australian metropolitan hospital were screened for eligibility. Carers could provide proxy responses where inpatients were unable to participate. Descriptive statistics were used to analyse quantitative ratings, whilst free text responses were analysed using integrated thematic analysis., Results: One-hundred and twenty participants (108 patients and 12 carers) completed consideRATE. The questions with the highest number of 'very good' responses were attention to symptoms, attention to feelings and attention to what matters most; the questions with the lowest number of 'very good' responses was attention to patients' affairs, what to expect, and the environment of care. Almost half (n = 57, 48%) indicated that attention to patients' affairs 'did not apply' to their inpatient stay. Analysis of 532 free text responses across 8 questions highlighted the importance of feeling supported, feeling informed, feeling heard and navigating the clinical environment., Conclusion: Enabling inpatients with palliative care needs to provide feedback about their experience of care is one method of ensuring improvements matter to patients. Supporting clinical teams to understand and use these data to make tailored improvements is the next step in this multi-phase research., (© 2024. The Author(s).)

We aimed to compare disclosure of social risks according to self-report on an iPad versus face-to-face questions from a health professional and to explore carers' experiences of screening. This two-arm, parallel group, randomized trial was conducted from January 19, 2021, to December 17, 2021, in a public hospital pediatric ward serving a disadvantaged area of an Australian capital city. Carers of children aged ≤ 5 years admitted to the Children's Ward were eligible. The primary outcome was disclosure of social risks. The screener included nine items on food security, household utilities, transport, employment, personal and neighborhood safety, social support, housing and homelessness. Disclosure of social risks was similar between the self-completion (n = 193) and assisted-completion (n = 193) groups for all 9 items, ranging 4.1% higher for worrying about money for food (95% CI - 11.4, 3.1%) among the assisted-completion group, to 5.7% (-1.6, 13.0%) higher for unemployment among the self-completion group. In qualitative interviews, participants were positive about screening for social risks in the hospital ward setting and the majority indicated a preference for self-completion.  Conclusion: Differences in the disclosure of social risks according to self- versus assisted-completion were small, suggesting that either method could be used. Most carers expressed a preference for self- completion, which is therefore recommended as the ideal mode for such data collection for Australian pediatric inpatient settings.  Trial registration: Australia New Zealand Clinical Trial Registry ( www.anzctry.org.au ; #ACTRN12620001326987; date of registration 8 December 2020). What is Known: • Most evidence on screening of social risks in pediatric inpatient settings is from the USA. • Little is known about disclosure of social risks in countries with universal health care and social welfare. What is New: • Disclosure of social risks was similar for electronic compared with face-to-face screening. • Carers preferred electronic completion over face-to-face completion., (© 2024. The Author(s).)

Hospitalisation is designed to protect patients from harm; however, patients have been reported to take their own lives during hospital admissions. While a significant healthcare concern, few studies have analysed inpatient suicides in general and psychiatric hospital units. Understanding these deaths is important for informing future prevention initiatives. Here we investigate a national sample (n = 367) of inpatient suicides in general (24%, n = 87) and psychiatric (76%, n = 278) hospital units. Patient characteristics, suicide location, timing, and suicide methods were assessed and compared. Patients who died from suicide were mostly male and admitted into psychiatric units. General hospital patients were less likely to have a known history of mental illness or previous self-harm and were often admitted for mental illness-related presentations. Suicides frequently occurred outside of the hospital by hanging. Patients in psychiatric units were more likely to be on approved leave at their death, and general patients were more likely to have absconded. These results indicate the need to identify risk factors relevant to each setting and address broader system-level factors. Removing obvious ligature points, preventing absconding, and assessing patients before episodes of leave, could contribute to preventing inpatient suicides., Competing Interests: Declaration of Competing Interest This study was conducted as part of a PhD project, and the Universities Supplementary Funding grant for Higher Degree research students funded access to the NCIS database. All authors declare that they have no conflicts of interest., (Copyright © 2023. Published by Elsevier B.V.)

The rates of mental health hospitalisations in Australia are rising. This paper presents the findings of a study undertaken in a regional mental health unit. The aim of the study was to obtain user perspectives to inform the redesign of the unit, which provides inpatient mental health services to rural and regional adults. A qualitative descriptive study with data collected via focus groups and in-depth interviews was undertaken with 38 participants, including current inpatients, carers and 27 staff members of a single regional inpatient mental health unit. The 25-bed mental health inpatient unit accommodates adults from 18+ years of age. The mental health unit sits within a referral hospital precinct and is associated with community-based mental health services within a large regional and rural Australian public health service. The analysis of interviews and focus groups with patients, carers and mental health professionals revealed three major themes congruent with the literature These were: Firstly, Theme 1: Rooms should be designed to promote physical security. Next, Theme 2: Purposeful planning to support interactions between users and systems will promote relational security. And finally, Theme 3: Optimizing service integrity should promote procedural security. Based on the themes arising from the study, a list of recommendations was produced to inform the design of a new build for a regional mental health unit. In particular, all users of the space should expect that the built environment will promote their physical security and psychological safety and accommodate a wide range of diversity and acuity. The aesthetics should align with the promotion of recovery in the context of person-centred and trauma-informed models of care. Designers should plan to alleviate boredom and accommodate meaningful wayfinding. Mental health nurses should have spaces that support their work without compromising their relational security with consumers. Building designers should optimize therapeutic environments to facilitate dignified intensive and stabilizing treatments and eliminate vicarious stigma associated with caring for people with mental illness. This study provides valuable insights from a community of users who have experienced receiving and delivering mental health care within a regional and rural mental health unit., (© 2022 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.)

Patient falls in hospital may lead to physical, psychological, social and financial impacts. Understanding patients' perceptions of their fall risk will help to direct fall prevention strategies and understand patient behaviours. The aim of this study was to explore the perceptions and experiences that influence a patient's understanding of their fall risk in regional Australian hospitals. Semi-structured, individual interviews were conducted in wards across three Australian hospitals. Participants were aged 40 years and over, able to communicate in English and were mobile prior to hospital admission. Participants were excluded from the study if they returned a Standardised Mini-Mental State Examination (SMMSE) score of less than 18 when assessed by the researcher. A total of 18 participants with an average age of 69.8 years (SD ± 12.7, range 41 to 84 years) from three regional Victorian hospitals were interviewed for this study. Data were analysed using a reflexive thematic analysis identifying three major themes; (1) Environment (extrinsic) (2) Individual (intrinsic), and (3) Outcomes, as well as eight minor themes. Participants recognised the hazardous nature of a hospital and their personal responsibilities in staying safe. Falls education needs to be consistently delivered, with the focus on empowering the patient to help them adjust to changes in their clinical condition, whether temporary or permanent.

Objective: The objective of this study is to explore both the negative and positive lived experiences of cancer survivors during specialist inpatient rehabilitation programmes., Methods: This phenomenological study explored the negative and positive perspectives of cancer survivors with residual disability, during their inpatient rehabilitation. Semi-structured interviews conducted with 22 inpatients on admission and discharge were analysed using the protocols of Interpretative Phenomenological Analysis., Results: Experiences of inpatient cancer rehabilitation were not independent of the whole cancer trajectory. Rather, for these inpatients, processing and ruminating upon challenges to self from the moment of cancer diagnosis and throughout treatments indicated that more emotional and psychosocial support may be useful throughout cancer rehabilitation and the whole cancer trajectory., Conclusion: Understanding the concurrent sources of psychological distress and growth in these cancer survivors as they recover from life changing events provides a unique consumer evaluation of an inpatient cancer rehabilitation service and the overall cancer experience. This study has implications for developing insight into the impact that the cancer trajectory has on the individual and reinforces the importance of a holistic approach to rehabilitation that includes a supported mind, body and spirit appreciation of healing., (© 2022 John Wiley & Sons Ltd.)

Over recent decades, the shift to recovery-oriented practice has been central to mental health policy. Despite this emphasis, mental health services can struggle to meet this expectation. This study explores the knowledge and attitudes in relation to the recovery-oriented practice of clinical staff working at an Australian acute inpatient mental health unit. The Recovery Knowledge Inventory (RKI) is a widely used self-report tool that assesses mental health professionals' knowledge and attitudes towards recovery; higher scores indicate higher levels of recovery knowledge and attitudes. Seventy-four staff members (44 nursing staff and 30 medical staff) completed the RKI via an online survey. The study has been reported according to the STROBE checklist for cross-sectional studies. The relationships between the RKI scores and a range of variables were considered using inferential statistics, including multivariate regression. Medical staff had higher mean RKI scores than nursing staff, although this did not meet the predefined threshold for a clinically significant difference. More years of mental health experience were associated with increased mean RKI scores for medical staff. This Australian inpatient staff cohort demonstrated higher mean RKI scores than have been observed in recent international studies of mental health professions. However, the recovery knowledge and attitude levels were disappointingly similar to those shown in earlier Australian research completed over a decade ago. Efforts are needed to further enhance the recovery knowledge of clinicians working in mental health inpatient units., (© 2022 John Wiley & Sons Australia, Ltd.)

Background: In inpatient psychiatric units, seclusion (isolation in a locked room) is recommended only as a last resort for serious aggression or agitation. In response to an increase in seclusion during 2015, an 8-bed child and adolescent inpatient unit implemented a suite of multidisciplinary interventions. This study examines changes in seclusion rates following intervention implementation and assesses whether specific patient factors were associated with seclusion rates before and after interventions., Method: Multi-modal interventions, comprised of patient treatment plans, intake and handover meetings, staff supervision and debriefing sessions, were implemented from January 2016. We compared quarterly seclusion rates (episodes per 1000 patient days) across a thirteen-year period, from July 2008 to June 2021. Change in seclusion rates following intervention was evaluated using a segmented regression analysis. We examined whether patient factors were associated with seclusion rates, and whether the duration of seclusion episodes differed before and after interventions., Results: There was a 100% reduction in seclusion rates in the 6 months following intervention implementation, from 28.4 episodes per 1000 patient days in July-September 2015, to 4.7 episodes in January-March 2016, reaching 0.0 episodes by April-June 2016. This reduction was maintained until April-June 2021. Most patients with seclusion events before and after intervention implementation had a neurodevelopmental disorder diagnosis and a minority of patients accounted for most seclusion events. There was a 65% reduction in the average duration of seclusion episodes following interventions, however this was not statistically significant., Limitations: Due to a crisis in staff morale, interventions were implemented simultaneously, preventing an understanding of whether a single intervention accounted for change. While not addressed in the current study, assessing perceptions of staff, children and parents following intervention implementation may have elucidated barriers and facilitators to change., Conclusions: Multidisciplinary, patient-centered interventions may be effective for long-term reduction of seclusion rates in inpatient psychiatric units. These findings highlight patient factors associated with seclusion reduction which should be considered when implementing interventions., (Copyright © 2022. Published by Elsevier B.V.)

Background: Nutrition and mealtime interventions can improve nutritional intake amongst hospital inpatients; however, patient-reported experience is rarely considered in their development and evaluation. The present study aimed to measure patient-reported food and mealtime experience to evaluate and inform continuous quality improvement of hospital nutrition care., Methods: A cross-sectional survey with inpatients in seven acute care and rehabilitation wards was conducted. A 27-item validated questionnaire measured five domains of patient experience: food choices, organisational barriers, feeling hungry, physical barriers to eating and food quality. Responses were summarised descriptively and compared between settings (acute versus rehabilitation), patient demographics (age, gender) and time in hospital., Results: Responses from 143 participants (mean age 67 years, 57% male, 28% rehabilitation, median 6 days into hospitalisation) showed that 10% or fewer respondents reported difficulties with food choices, feeling hungry or food quality. The most common difficulties were opening packets (36%), insufficient menu information provided (29%), being interrupted by staff when eating (28%), being disturbed when eating (27%), being in an uncomfortable position when eating (24%) and difficulty reaching food (21%). There were no significant differences in domain patterns by sex, age group or time in hospital. Organisational barriers were reported less frequently amongst rehabilitation participants compared to acute care (P = 0.01)., Conclusions: This survey highlights areas of positive patient-reported experience with nutrition care and suggests that local improvement efforts should focus on physical assistance needs and organisational barriers, especially in acute care wards. The questionnaire may be useful for informing and evaluating systematic nutrition care improvements., (© 2021 The British Dietetic Association Ltd.)

Objective and importance of study: Considerable evidence suggests that adverse social determinants of health (SDH), such as poor education, unemployment, food and housing insecurity, interpersonal violence, inadequate social support and poverty, are key determinants of health and wellbeing. This prospective cohort study piloted a screening tool to collect individual SDH data in a South Australian hospital inpatient population. We explored participants' attitudes to SDH screening in brief follow-up interviews., Methods: This mixed-methods study used an SDH screening tool to collect individual-level SDH data from inpatients living in a highly disadvantaged socio-economic area. Participants had a primary diagnosis of chronic obstructive pulmonary disease (COPD), heart failure (HF) or diabetes mellitus. Follow-up interviews were completed post discharge via telephone. Descriptive statistics were employed to examine the prevalence and type of adverse SDH reported by the sample. Thematic analysis was applied to explore participants' attitudes to the screening., Results: The sample population (N = 37) reported a substantial burden of a range of adverse SDH (mean 4.7 adverse SDH experienced per participant, standard deviation 2.8). Participants involved in follow-up interviews (n = 8) believed screening might enhance communication between healthcare providers and patients and assist in identifying underlying social problems., Conclusion: A screening tool for SDH was successfully used to collect individual-level data in a hospital setting. An array of adverse SDH was common in the sample population. Participants believed screening for SDH may potentially benefit doctors and patients. A larger study is required to more robustly characterise the adverse SDH affecting individuals in this population and to explore how the healthcare system might effectively intervene., Competing Interests: MB has received research grants (paid to his institution) from Gilead Sciences and honoraria from Gilead Sciences and ViiV Healthcare for participation in HIV advisory boards and the preparation and delivery of educational presentations.

Background: Sorting tests detect cognitive decline in older adults who have a neurodegenerative disorder, such as Alzheimer's and Parkinson's disease. Although equally effective at detecting impairment as other cognitive screens (e.g. Mini-Mental State Examination (MMSE)), sorting tests are not commonly used in this context. This study examines the QuickSort, which is a new brief sorting test that is designed to screen older adults for cognitive impairment., Design: Observational cohort study., Setting: General community and inpatients, Australia., Participants: Older (≥60 years) community-dwelling adults (n = 187) and inpatients referred for neuropsychological assessment (n = 78). A normative subsample (n = 115), screened for cognitive and psychological disorders, was formed from the community sample., Measurements: Participants were administered the QuickSort, MMSE, Frontal Assessment Battery (FAB), and Depression Anxiety and Stress Scale-21. The QuickSort requires people to sort nine stimuli by color, shape, and number, and to explain the basis for their correct sorts. Sorting (range = 0-12), Explanation (range = 0-6), and Total (range = 0-18) scores were calculated for the QuickSort., Results: The Cognitively Healthy subsample completed the QuickSort within 2 minutes, 50% had errorless performance, and 95% had Total scores of 10 or greater. The likelihood of community-dwelling older adults and inpatients (n = 260) being impaired on either the MMSE or FAB, or both, increased by a factor of 3.75 for QuickSort Total scores of less than 10 and reduced by a factor of 0.23 for scores of 10 or greater., Conclusion: The QuickSort provides a quick, reliable, and valid alternative to lengthier cognitive screens (e.g., MMSE and FAB) when screening older adults for cognitive impairment. The QuickSort performance of an older adult can be compared with a cognitively healthy normative sample and used to estimate the likelihood they will be impaired on either the MMSE or FAB, or both. Clinicians can also use evidence-based modeling to customize the QuickSort for their setting., (© 2020 The American Geriatrics Society.)

Empowering patients to participate in nutrition care during hospitalisation may improve their dietary intakes and associated outcomes. This study tested the acceptability and feasibility of a technology-based intervention to engage hospital patients in nutrition care at a tertiary teaching hospital in Australia. The hospital used an electronic foodservice system (EFS), by which patients ordered meals via bedside computers. Adults at nutritional risk received the nutrition technology (NUTRI-TEC) intervention, involving nutrition assessment, education on nutrition requirements and training on using the EFS to enter food intakes and monitor nutrition goals. Acceptability was assessed using patient satisfaction and engagement surveys. Feasibility was assessed by evaluating the intervention delivery/fidelity and patient recruitment/retention. Patients' dietary intakes were observed daily to indicate the intervention's effects and assess the accuracy of the patient-recorded intakes. Descriptive and inferential statistics were used to analyse the data. Of the 71 patients recruited, 49 completed the study (55% male; median (IQR) age 71 (65-78) years; length of stay 10 (7-14) days). Patient satisfaction with NUTRI-TEC was high. Intervention delivery and fidelity targets were met but recruitment (≥50%) and retention (≥75%) targets were not; only 31% of patients agreed to participate and 69% completed the study (mostly due to unexpected/early discharge). Patient- and researcher-recorded dietary intakes correlated strongly, indicating patients can record food intakes accurately using technology. This study highlights the important role technology is likely to play in facilitating patient engagement and improving care during hospitalisation.

Objectives: Our aim was to (1) describe the clinical characteristics and symptoms of people diagnosed with dementia at the time of admission to inpatient palliative care; and (2) compare the nature and severity of these palliative care-related problems to patients with other chronic diseases., Design: Descriptive study using assessment data on point of care outcomes (January 1, 2013, to December 31, 2018)., Setting: A total of 129 inpatient palliative care services participating in the Australian Palliative Care Outcomes Collaboration., Participants: A total of 29,971 patients with a primary diagnosis of dementia (n = 1,872), lung cancer (n = 19,499), cardiovascular disease (CVD, n = 5,079), stroke (n = 2,659), or motor neuron disease (MND, n = 862)., Measurements: This study reported the data collected at the time of admission to inpatient palliative care services including patients' self-rated levels of distress from seven common physical symptoms, clinician-rated symptom severity, functional dependency, and performance status. Other data analyzed included number of admissions, length of inpatient stay, and palliative care phases., Results: At the time of admission to inpatient palliative care services, relative to patients with lung cancer, CVD, and MND, people with dementia presented with lower levels of distress from most symptoms (odds ratios [ORs] range from .15 to .80; P < .05 for all) but higher levels of functional impairment (ORs range from 3.02 to 8.62; P < .001 for all), and they needed more assistance with basic activities of daily living (ORs range from 3.83 to 12.24; P < .001 for all). The trends were mostly the opposite direction when compared with stroke patients. Patients with dementia tended to receive inpatient palliative care later than those with lung cancer and MND., Conclusion: The unique pattern of palliative care problems experienced by people with dementia, as well as the skills of the relevant health services, need to be considered when deciding on the best location of care for each individual. Access to appropriately trained palliative care clinicians is important for people with high levels of physical or psychological concerns, irrespective of the care setting or diagnosis. J Am Geriatr Soc 68:1825-1833, 2020., (© 2020 The American Geriatrics Society.)

Problem: Adolescent inpatient units have been studied regarding their effectiveness, yet little is known about the experiences of young people who are admitted and their caregivers. It is important to address this gap to understand adolescent inpatient models of care and therapeutic outcomes to maximize the benefit. Our aim was to explore adolescent and caregivers' experiences of an inpatient model of care (MoC) and perceived helpfulness., Methods: A longitudinal prospective qualitative design was utilized. Semistructured interviews were conducted with 16 adolescents and 12 caregivers at T1 (admission), T2 (discharge), and T3 (6 months postdischarge). Data were analysed first thematically and then using trajectory analysis. Themes from the three time-points are presented from the combined perspectives of adolescents and caregivers., Findings: Experiences described followed a recovery narrative consisting of three key phases which included, "waiting for help" (T1), "help arrived" (T2), and having "returned to regular life" (T3). The overarching trajectory theme was a "winding road to recovery.", Conclusion: Findings provide insights into the lived experiences from adolescents who have had an inpatient stay and their caregivers of an adolescent-specific inpatient MoC. These findings can help conceptualize quality adolescent models of care for young people and their families., (© 2020 Wiley Periodicals, Inc.)

Objective: Patients admitted to mental health services may exhibit behaviours of concern (BOCs) such as aggression, self-harm, absconding and sexual harm. BOCs can lead to restrictive interventions, which have adverse effects on patients, carers and staff. This paper aims to explore the nature and outcome of BOCs within an adult inpatient mental health setting., Methods: A retrospective audit was conducted at a metropolitan inpatient service between 1 August 2016 and 31 July 2017. The frequency, nature and outcomes of BOC episodes were described and thematic analysis was used to summarise BOC antecedents., Results: A BOC was documented for 179 (18.2%) patients who also showed high rates of drug abuse, homelessness and longer admission. Most self-harm and sexual harm events occurred outside of normal business hours. Medications and verbal de-escalation were commonly used interventions. Episodes of deliberate self-harm were likely to result in patient and staff injury or mechanical restraint, whereas aggression was associated with seclusion. Mental state, care engagement, physiological stress and situational stressor were identified as BOC antecedents., Conclusion: Multiple forms of BOCs were experienced with mental state, physical and interpersonal contributors identified. Improving multidisciplinary input into early assessment and treatment of BOC causes is needed to improve safety.

Objective: Induction of labor (IOL) typically involves cervical priming in an inpatient setting. Outpatient cervical priming may be a safe and cost-effective alternative. However, little is known about women's preference and the impact of outpatient cervical priming on their healthcare experience. The objective was to compare women's healthcare experiences following IOL using a balloon catheter and going home, versus prostaglandin (PG) and remaining an inpatient., Study Design: A randomized controlled trial was undertaken across eight Australian maternity hospitals. Between September 2015 and October 2018, 695 women with uncomplicated term singleton pregnancies were randomized. Of these, 215 and 233 women in the balloon-outpatient and PG-inpatient groups, respectively, received the allocated intervention. The PG group received Dinoprostone gel or controlled-release tape. The balloon group had a double-balloon catheter inserted and went home. Experiential and quality-of-life outcomes were measured via written questionnaire after birth. The primary outcome was a composite neonatal measure. Women's healthcare experience, health-state (EQ-5D-3 L) and pain scores are reported here., Results: Questionnaire data were available for 366 (81.7 %) women enrolled who received their treatment allocation. More women in the balloon-outpatient group reported they would choose IOL next pregnancy (49.2 % vs 38.4 %; p = 0.037) and desire the same method (72.4 % vs 61.1 %; p = 0.022). The balloon-outpatient group experienced higher pain scores at the start of IOL (median (IQR) 3(2-5) vs 2(1-4); p = 0.002) but lower scores at time of rupture of membranes (3(1-5) vs 4(2-6); p = 0.007). The EQ-5D-3 L health-utility index did not differ significantly between the groups (0.77 vs 0.78; p = 0.899)., Conclusions: Women report similar healthcare experiences following balloon-outpatient compared to PG-impatient IOL, but are more likely to desire the same method next pregnancy if IOL is required. If both options are available, then differences in experience should be shared with women, alongside differences in clinical outcomes as part of their decision-making process., Competing Interests: Declaration of Competing Interest The authors report no conflict of interests., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: The incidence of young stroke is increasing worldwide. However, young adults are inadequately supported in their recovery by a system of stroke care in which the older patient is the majority consumer. Purpose: To examine the unmet needs of younger stroke survivors in inpatient and outpatient healthcare settings and identify opportunities for improved service delivery. Materials and Methods: In-depth semi-structured interviews were undertaken with 19 participants aged 18-55 at the time of their first-ever stroke and inductively analysed using a rigorous qualitative descriptive approach. Results: Many unmet care needs were identified within three emergent themes: inadequately addressed psycho-emotional and cognitive needs after young stroke; isolation from lack of information and structured support; and failure to deliver age-relevant patient-centred care. These themes were further divided into sub-themes and the sub-themes were named in a manner to signpost the way forward for young stroke care. Conclusions: This study provides new insights into the experience of inpatient and outpatient stroke care by younger stroke survivors and outlines possible improvements for clinical practice. Future research should evaluate the effect of targeted strategies to support younger adults after stroke.Implications for rehabilitationPost-stroke rehabilitation might be improved by providing more support for the non-physical effects of stroke (e.g., psycho-emotional support, cognitive rehabilitation).Younger stroke survivors may also benefit from a long-term community care plan and longer-term rehabilitation.Patient-centered rehabilitation and education about self-management interventions appear to be important areas for further development.Future research is required to evaluate the effect of targeted strategies to support younger stroke survivors, as well as identify the needs of younger adults with post-stroke communication impairment.

Objective: To investigate the association of goal attainment scaling outcomes with change in the Func-tional Independence Measure, and the association between the perceived importance, difficulty and degree of achievement of individual goals in general inpatient rehabilitation., Design: Prospective cohort study., Participants: A total of 208 participants admitted to inpatient rehabilitation in a metropolitan tertiary referral hospital in Melbourne, Australia., Methods: Participants determined the nature of the goals and their importance, and therapists determined the difficulty of the goals. The associations were investigated using median regression and random effect ordinal regression., Results: An increase of each point in the goal attainment scaling score was associated with an adjusted median increase of 0.34 points (95% confidence interval (CI): 0.18-0.5, p < 0.001) in Functional Independence Measure change. More important goals of similar difficulty (very important vs a little important: adjusted common odds ratio (cOR) = 1.97, 95% CI: 1.01-3.83, p = 0.045) and less difficult goals of similar importance (moderately difficult vs a little difficult cOR = 0.59, 95% CI: 0.04-0.87, p = 0.007; very difficult vs a little difficult cOR = 0.59, 95% CI 0.37-0.94, p = 0.027) were better achieved., Conclusion: Rehabilitation progress measured using the goal attainment scaling method is associated with changes in functional outcomes. For goals with similar difficulty, those with higher importance were better achieved, while for goals with similar importance, less difficult goals were better achieved.

Objective: Scant research explores health professionals' experiences of providing inpatient cancer rehabilitation services, either from the negative or positive perspectives., Method: This report explores the lived experiences of 14 multidisciplinary health professionals providing cancer rehabilitation services within an inpatient setting. Their interpretations provide a distinctive evaluation of an inpatient, cancer rehabilitation service, both negative and positive, and the impacts of their experiences on them and their patients. Data from semi-structured focus groups and interviews were analysed using Interpretative Phenomenological Analysis (IPA: Psychology and Health, 11, 1996, 261-271) to produce thematic results., Results: Health professionals' focus groups and interviews produced one superordinate theme: Therapeutic community. Subordinate themes were Healing and Hope, Limited by the System, Moral Integrity and Growth, with further subthemes; Invalidation, Moral dilemmas, Gratitude and Humility. Positive views of the specialist service were tempered with issues associated with finite resources and staff feeling unsupported in their person-centred approach. Although rehabilitation was the primary focus of the unit, metastatic cancer may behave unpredictably; symptom recurrences meant that a dialogue of accepting palliative care and dying as a phase of life was also an important factor raised by some patients and families in our setting. Referral to palliative specialists for this dialogue was incorporated in the context of the rehabilitation care provided., Conclusion: Study participants provided a unique window, encompassing both negative and positive perspectives, to understanding their deep commitment to quality of care, despite resource limitations. Professionals in this inpatient team worked to provide optimal multidisciplinary services relevant to each individual's need to move towards strength and independence., (© 2019 John Wiley & Sons Ltd.)

Aim: The aim of this study was to identify patient preferences for involvement in medication management during hospitalization., Design: A qualitative descriptive study., Methods: This is a study of 20 inpatients in two medical and two surgical wards at an academic health science centre in Melbourne, Australia. Semi-structured interviews were recorded and analysed using content analysis., Findings: Three themes were identified: (a) 'understanding the medication' established large variation in participants' understanding of their pre-admission medication and current medication; (b) 'ownership of medication administration' showed that few patients had considered an alternative to their current regimen; only some were interested in taking more control; and (c) 'supporting discharge from hospital' showed that most patients desired written medication instructions to be explained by a health professional. Family involvement was important for many., Conclusion: There was significant diversity of opinion from participants about their involvement in medication management in hospital. Patient preferences for inclusion need to be identified on admission where appropriate. Education about roles and responsibilities of medication management is required for health professionals, patients and families to increase inclusion and engagement across the health continuum and support transition to discharge., Impact Statement: Little is known about patient preferences for participation in medication administration and hospital discharge planning. Individual patient understanding of and interest in participation in medication administration varies. In accordance with individual patient preferences, patients need to be included more effectively and consistently in their own medication management when in hospital., (© 2019 John Wiley & Sons Ltd.)

Background: Evidence suggests that single-room inpatient wards are associated with better patient outcomes than open-room wards but little is known about the impact on adverse events, patient satisfaction, and clinician experiences., Methods/purpose: We evaluated the impact of a new inpatient single-room orthopaedic ward on patient and clinician outcomes using a medical record audit; patient, nurse, and medical doctor surveys; and nonparticipant observations in a tertiary hospital in Sydney, Australia., Results: The audit (1,569 patients; 819 open-room ward and 750 new single-room ward) revealed unchanged adverse event rates and fewer emergency calls after the move to a single-room ward. Survey responses from nurses, medical doctors, and patients were positive. Observations suggested that clinicians devised solutions to potential threats to patient safety., Conclusion: The single-room ward design did not negatively impact on patient and clinician outcomes and was preferred by them. Clinicians organized their work to ensure patient safety.

Objectives: We aimed to report substance use across a five-year period in individuals admitted to an acute mental health unit, utilizing data from a routine clinical measure, diagnoses, and findings related to gender, ethnicity and the implementation of a new dual-diagnosis policy., Methods: Data was extracted from the electronic records of 2118 individuals who had consecutive admissions to the acute inpatient unit. Analysis focused on demographic and diagnosis variables and the drug and alcohol question in the Health of the Nations Outcome Scale., Results: Some 57.6% of the sample was in the at-risk drug and alcohol category. Male and indigenous inpatients were most at risk. More than 50% of patients with schizophrenia, anxiety and personality disorders were deemed at-risk. Following implementation of the dual-diagnosis policy, recorded primary and secondary substance use disorder (SUD) diagnoses significantly increased., Conclusions: The study replicated previous findings of a high proportion of patients with co-morbid drug and alcohol use. In this sample it seems likely that the dual-diagnosis policy and related activities increased the rate of SUD diagnoses recorded, although it is likely to still be under-reported.

Introduction: Improving mental healthcare for adolescents is a global policy priority. Despite demands for community-based services, many adolescents require more intensive interventions, such as an inpatient admission. This is typically at a point of crisis, often accompanied by intense emotional dysregulation, impairment of coping function and impulsivity. However, limited evidence exists on how best to support this group while they are in inpatient care, aside from pharmacological treatments which have a limited role in adolescents. Little is known about the models of care (MoC) offered in inpatient units, whether adolescents perceive these as helpful and the perspectives of caregivers and clinicians. Here, we describe a protocol which aims to explore and evaluate an inpatient MoC., Methods and Analysis: We designed a longitudinal, mixed-methods, case study. The population consists of adolescents, caregivers and clinicians at a single inpatient unit in Melbourne, Australia. Standardised outcome measures, including semi- structured interviews, will be administered to adolescents at three time-points, T1 (admission), T2 (discharge) and T3 (6 months post discharge). Caregivers will also be interviewed at T1, T2 and T3. Clinicians will be interviewed once. The measures include: Life Problems Inventory, Quick Inventory of Depressive Symptomatology, Kessler Psychological Distress Scale and the Youth Self-Report. Health of the Nation Outcome Scales for Children and Adolescents will be collected at T1 and T2. Quantitative analysis will include descriptive statistics and paired t-tests summarising adolescents admitted to the unit, clinical characteristics and longitudinal data on symptomatology. Qualitative data will be analysed using both thematic and trajectory analysis. Data collection began in May 2017 and will cease with T3 interviews by October 2018. ETHICS AND DISSEMINATION., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Clinically operated community-based residential rehabilitation units (Community Rehabilitation Units) are resource intensive services supporting a small proportion of the people with severe and persisting mental illness who experience difficulties living in the community. Most consumers who engage with these services will be diagnosed with schizophrenia or a related disorder. This review seeks to: generate a typology of service models, describe the characteristics of the consumers accessing these services, and synthesise available evidence about consumers' service experiences and outcomes., Method: A systematic review was undertaken to identify studies describing Community Rehabilitation Units in Australia, consumer characteristics, and evidence about consumer experiences and outcomes. Search strings were applied to multiple databases; additional records were identified through snowballing. Records presenting unique empirical research were subject to quality appraisal., Results: The typology defined two service types, Community-Based Residential Care (C-BRC), which emerged in the context of de-institutionalisation, and the more recent Transitional Residential Rehabilitation (TRR) approach. Key differentiating features were the focus on transitional care and 'recovery' under TRR. Schizophrenia spectrum disorders were the most common primary diagnosis under both service types. TRR consumers were more likely to be male, referred from community settings, and less likely to be subject to involuntary treatment. Regarding outcomes, the limited quantitative evidence (4 records, 2 poor quality) indicated C-BRC was successful in supporting the majority of consumers transferred from long-term inpatient care to remain out of hospital. All qualitative research conducted in C-BRC settings was assessed to be of poor quality (3 records). No methodologically sound quantitative evidence on the outcomes of TRR was identified. Qualitative research undertaken in these settings was of mixed quality (9 records), and the four records exploring consumer perspectives identified them as valuing the service provided., Conclusions: While there is qualitative evidence to suggest consumers value the support provided by Community Rehabilitation Units, there is an absence of methodologically sound quantitative research about the consumer outcomes achieved by these services. Given the ongoing and increasing investment in these facilities within the Australian context, there is an urgent need for high-quality research examining their efficiency and effectiveness., Trial Registration: PROSPERO ( CRD42018097326 ).

Background: Health literacy describes the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health. Suboptimal health literacy is common and is believed to impact up to 60% of Australians. Co-design is a participatory approach to the development of interventions that brings together to staff and patients to design local solutions to local problems. The aim of this study is to describe a staff and patient co-design process that will lead to the development of health literacy interventions in response to identified health literacy needs of hospital patients., Methods: A mixed methods, two-step sequential explanatory design. Step 1: hospitalised patients surveyed and data analysed using hierarchical cluster analysis to establish health literacy profiles. Step 2: clusters presented as vignettes to patients and clinicians to co-design interventions to address needs., Results: Eight health literacy clusters were identified from surveys. Seven patients attended two patient workshops and 23 staff attended two staff workshops. Three key themes were identified: organisational, provider-patient, and patient self-care. Within these, five sub-themes emerged: "Good quality communication during hospital stay", "Social support for health", "A good discharge", "Care across the continuum" and "Accessing quality information when home". Fifteen potential interventions were produced, including changes to message design and delivery, staff training in assessing for understanding, social support to improve understanding, improving communication consistency across the care continuum, and strategic dissemination of web-based resources., Conclusion: This study identified fifteen strategies to address health literacy needs of a hospital population. Implementation and evaluation will identify sets of strategies that have the maximum patient, clinician and organisational benefit. This approach allows for the development of locally-driven, contextually-appropriate interventions to address health literacy needs.

Background: Health service providers should understand and attend to the health literacy needs of their population in view of the known association between low health literacy and poorer health outcomes. This study aimed to determine the health literacy profile of patients treated at a large private hospital in Melbourne, Australia, and any associations between this profile and socio-economic position, health behaviours, health status and use of hospital services., Methods: A mailed survey was sent to 9173 people aged ≥18 years with a hospital admission between February and October 2014. It included the Health Literacy Questionnaire (HLQ), a multidimensional tool comprising nine independent scales, and socio-demographic and clinical questions. For both respondents and non-respondents, we also extracted residential postcode and admission and follow up details from the Patient Administrative Services database. Differences in demographic, socio-economic and hospital use patterns between respondents and non-respondents were analysed using descriptive statistics. Regression-tests were used to identify differences in health literacy between socio-economic subgroups, with the magnitude of these differences determined using Cohen's d effect sizes., Results: There were 3121 respondents (response rate: 35% excluding 154 returned invitations), the majority born in Australia (74.6%) and living in areas of high socio-economic advantage. Respondents were slightly older than non-respondents (mean (SD) age 65.6 (17.0) versus 60.6 (20.8) years) and included proportionately less females (51.9 versus 59.1%) but were similar with regard to other socio-demographic factors and health service use. Participants who did not speak English at home, reported lower scores across several HLQ scales, including those that measure health provider support and engagement. Those who smoked and reported low physical activity had lower scores for actively managing their health. No relationship was seen between HLQ scale scores and use of hospital services., Conclusions: Based upon the health literacy profile of a large cohort of patients attending a large private hospital, we found no relationship between HLQ scale scores and use of hospital services. However we did identify significant health literacy needs particularly among patients whose primary language at home was not English and patients needing assistance completing the survey. Identifying ways of addressing these needs may improve patient outcomes.

Objectives: Older inpatients compromised by illness and cognitive decline may be stripped of physical and cultural identifiers, making them vulnerable to erosion of dignity. This study explored the experiences of patients, carers and clinical staff in response to a simple intervention that could enhance the dignity of care for older inpatients., Methods: All patients in a rehabilitation ward were encouraged to have a photograph of themselves next to their bed. Of those who participated, focus groups were recruited for patients, family members and staff to explore their reflections. Discussions were transcribed and analyzed using a deductive approach to capture evolving themes relating to patient care., Results: All groups reported that the photograph provided "connection" and means of communication between patients and staff. Staff spoke positively of gaining additional insights into patients' lives. Benefits included enrichment of inter-personal relationships between patients and staff, between staff and families and between patients themselves., Conclusions: A bedside photograph improved connections between staff, patients and carers, promoting patients' dignity of identity., Clinical Implications: Displaying a bedside photograph as a visual reminder of the patient in the pre‑illness state helps preservation of an individual's dignity, a core concept in patient‑centered care.

Background: The discrepancy between the number of admissions and the allocation of hospital beds means that many patients admitted to hospital can be placed in units or wards other than that which specialise in the patient's primary health issue (home-ward). These patients are called 'outlier' patients. Risk factors and health system outcomes of hospital care for 'outlier' patients diagnosed with dementia and/or delirium are unknown. Therefore, the aim of this research was to examine patient journeys of people with dementia and/or delirium diagnoses, to identify risk factors for 'inlier' or 'outlier' status and patient or health system outcomes (consequences) of this status., Methods: A retrospective, descriptive study compared patients who had dementia and/or delirium according to the proportion of time spent on the home ward i.e. 'inliers' or 'outliers'. Data from the patient journey database at Flinders Medical Centre (FMC), a public hospital in South Australia from 2007 and 2014 were extracted and analysed. The analysis was carried out on the patient journeys of people with a dementia and/or delirium diagnosis., Results: When 6367 inpatient journeys with dementia and/or delirium within FMC were examined, the Emergency Department (ED) Length of Stay (LOS) after being admitted as inpatient was prolonged for 'outlier' patients compared to 'inlier' patients (OR: 1.068, 95% CI: 1.057-1.079, p = 0.000). However, the inpatient LOS for'outlier' patients was only marginally shorter than that of the 'inlier' patients (OR: 0.998, 95% CI: 0.998-0.998, p = 0.000). The chances of dying within 48 h of admission increased for 'outlier' patients (OR: 1.973, 95% CI: 1.158-3.359, p = 0.012) and their Charlson co-morbidity Index was higher (OR: 1.059, 95% CI: 1.021-1.10, p = 0.002). Completion of discharge summaries within 2 days post-discharge for 'outlier' patients was compromised (OR: 1.754, 95% CI: 1.492-2.061, p = 0.000).Additionally, 'outlier' patients were more likely to be discharged to another hospital for other care types not offered at FMC (OR: 1.931, 95% CI: 1.559-2.391, p = 0.000)., Conclusion: An examination of the patient journeys at FMC has determined that the health system outcomes for patients with dementia and/or delirium who are admitted outside of their home-ward are affected by in-hospital location despite the homogenous nature of the study population.

Review Question/objective: The objective of this systematic review is to identify and synthesize available qualitative evidence to understand the in-hospital communication experiences of Aboriginal and Torres Strait Islander adults, their family members and hospital staff, and the factors that impact on these experiences.Specifically, the review questions are as follows.

Peer support has long been recognised as an essential component of a supportive network for people facing adversity. In particular, burn survivor peer support is a valuable and credible resource available to those rehabilitating from a severe burn. The aim of this study was to explore burn survivors' experiences of providing and receiving inpatient peer support to develop an in-depth understanding of the influence during the rehabilitation journey. In 2011, twenty-one burn survivors were recruited from four severe burn units across Australia. A qualitative phenomenological methodology was used to construct themes depicting survivors' experiences. Participants were selected through purposeful sampling, and data collected through in-depth individual semi-structured interviews. Data were analysed using Colaizzi's phenomenological method of data analysis. Central to burn rehabilitation was the notion of peer support having a significant impact on burn survivors' psychosocial rehabilitation. The emergent theme 'Burn Survivor Peer Support' identified five cluster themes: (1) Encouragement, inspiration and hope (2) Reassurance (3) The Importance of Timing (4) The Same Skin (5) Appropriate Matching. These findings demonstrate that peer support assists with fostering reassurance, hope and motivation in burn rehabilitation. A national network based on a clinician led inpatient burn survivor peer support programme could provide burn survivors across Australia, and in particular remote access locations, with the benefits of peer support necessary to endure the rehabilitation journey., (Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.)

3An involuntary treatment order (ITO) allows a person to be treated for a mental illness without consent under some circumstances. While the treatment and assessment of mental illness are essentially clinical decisions, involuntary mental health admissions are governed by a framework of legal principles, safeguards and procedures. The underlying philosophy of these laws is based on therapeutic jurisprudence. This approach focuses on the importance of the legal process as a social force and suggests that this can either protect or empower people. The legal processes can however adversely impact upon people's states of mind. This study reports on 25 qualitative interviews with involuntary inpatients of a major teaching hospital. The interviews were analysed thematically using a general inductive approach. The analysis focused on the patients' general experience of being placed under an ITO and their understanding of the ITO process. Generally, those who described the experience of an ITO in more positive terms, also experienced the ITO as a positive right. In addition to providing them with the treatment needed, they also felt that the ITO gave them protection and guidance. Conversely, those who experienced being placed under an ITO in more negative or mixed ways, described feeling powerless in the process, as they felt that the ITO took away their rights. By and large the ITO process was experienced as arbitrary when patients did not understand the reasons for their admission. In addition, these patients had limited or no information about their involuntary treatment order and they did not know what was expected of them to have the ITO revoked. Most importantly, they did not feel that there were any meaningful legal protections in place. These experiences highlight the importance of the legal processes and how these can be used as clinical tools., (Copyright © 2015. Published by Elsevier Ltd.)

Objective: To evaluate the proportion of patients hospitalised with acute coronary syndrome (ACS) in Australia and New Zealand who received optimal inpatient preventive care and to identify factors associated with preventive care., Methods: All patients hospitalised bi-nationally with ACS were identified between 14-27 May 2012. Optimal in-hospital preventive care was defined as having received lifestyle advice, referral to rehabilitation, and prescription of secondary prevention pharmacotherapies. Multilevel multivariable logistic regression was used to determine factors associated with receipt of optimal preventive care., Results: For the 2299 ACS survivors, mean (SD) age was 69 (13) years, 46% were referred to rehabilitation, 65% were discharged on sufficient preventive medications, and 27% received optimal preventive care. Diagnosis of ST elevation myocardial infarction (OR: 2.64 [95% CI: 1.88-3.71]; p<0.001) and non-ST elevation myocardial infarction (OR: 1.99 [95% CI: 1.52-2.61]; p<0.001) compared with a diagnosis of unstable angina, having a percutaneous coronary intervention (PCI) (OR: 4.71 [95% CI: 3.67-6.11]; p<0.001) or coronary bypass (OR: 2.10 [95% CI: 1.21-3.60]; p=0.011) during the admission or history of hypertension (OR:1.36 [95% CI: 1.06-1.75]; p=0.017) were associated with greater exposure to preventive care. Age over 70 years (OR:0.53 [95% CI: 0.35-0.79]; p=0.002) or admission to a private hospital (OR:0.59 [95% CI: 0.42-0.84]; p=0.003) were associated with lower exposure to preventive care., Conclusions: Only one-quarter of ACS patients received optimal secondary prevention in-hospital. Patients with UA, who did not have PCI, were over 70 years or were admitted to a private hospital, were less likely to receive optimal care., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Aim: To examine the feedback given by nurse educators and clinicians on the quality of communication skills of nurses in interactions with simulated patients., Background: The quality of communication in interactions between nurses and patients has a major influence on patient outcomes. To support the development of effective nursing communication in clinical practice, a good understanding of what constitutes effective communication is helpful., Design: An exploratory design was used involving individual interviews, focus groups and written notes from participants and field notes from researchers to investigate perspectives on nurse-patient communication., Methods: Focus groups and individual interviews were held between August 2010-September 2011 with a purposive sample of 15 nurse educators and clinicians who observed videos of interactions between nurses and simulated patients. These participants were asked to give oral feedback on the quality and content of these interactions. Verbatim transcriptions were undertaken of all data collected. All written notes and field notes were also transcribed. Thematic analysis of the data was undertaken., Findings: Four major themes related to nurse-patient communication were derived from the educators' and clinicians' feedback: approach to patients and patient care, manner towards patients, techniques used for interacting with patients and generic aspects of communication., Conclusion: This study has added to previous research by contributing grounded evidence from a group of nurse educators and clinicians on the aspects of communication that are relevant for effective nurse-patient interactions in clinical practice., (© 2013 John Wiley & Sons Ltd.)

Whooping cough or pertussis is a major cause of morbidity and mortality for adults and children around the world. There has been a rise in pertussis-related deaths in the elderly; pertussis vaccination is not currently routinely recommended in adults, excepting new parents and other adults household members including grandparents and care-givers of young children. Currently, there is lack of clear vaccine recommendations after the age of 50 years. Given the increase in adult pertussis, adult vaccine recommendations are a policy consideration. The study surveyed a convenience sample of patients previously recruited in a case control study designed to examine the burden of influenza with and without AMI in adults aged ≥ 40 years. Our findings showed that only 9.6% had received the pertussis vaccination within the past five years and 79.4% of participants had no knowledge of the pertussis adult booster vaccine, and 30.7% of participants who had regular contact with children under the age of two years in the past 12 months. The results showed that even though there is general acceptance of prevention by vaccines, there is low awareness about pertussis vaccination. This lack of knowledge presents a barrier against pertussis vaccination thus it is imperative that any future adult immunisation policy recommendations around pertussis vaccine include awareness programs in the target population., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The end of life is a highly emotive and critical period in the life course and families often play a central role during this time. Despite significant sociological work on dying as a relational experience, there has been little exploration of the significance of contemporary family structures and relations. In this article, drawing on the accounts of twenty hospice in-patients, we explore how the end of life (in this case within an in-patient unit) is mediated by family dynamics and expectations. Participants' accounts reveal a range of interpersonal experiences, including: pressures and strains on families and patients; differentiation in family responses to and involvement in the dying process; and tensions between individual and family preferences/desires. We argue that family dynamics strongly influence individual experiences near death and that the focus on individual preferences and the management of disease in palliative care contexts must be augmented with sophisticated and nuanced understandings of the family context. We suggest that sociological conceptual explanations of shifts in social and family life, such as individualisation and ontological security, may also help us better understand the ways families approach and respond to the dying process., (© 2012 The Authors. Sociology of Health & Illness © 2012 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.)

This research used a collaborative approach to gain a comprehensive, quantitative understanding of the breadth and depth of the social work role in health care. Data was collected from individual interviews with all employed hospital social workers (N = 120) across five Melbourne, Australia health networks about their most recently completed case. This data was coded using a revised version of the Karls and Wandrei (1994) Person-in-Environment (PIE) tool to retrospectively analyze the reasons for social work involvement over the course of the case. The findings demonstrate that the hospital social work role is multidimensional across a number of domains but centers predominantly on assisting clients and their significant others with issues of altered social roles and functioning; particularly in relation to role responsibility, dependency, and managing associated role-change losses. The findings of this study will assist hospital social workers, managers, and academics to better describe and effectively undertake this complex work. These findings will also assist in the development of professional training and education to up-skill social workers who operate within this complex setting.

Objective: To compare prevalence of problems with body weight, eating and exercise (past or present) of female psychiatric inpatients with routine care, gynaecological and obstetric female outpatients, and eating disorder inpatients., Method: One thousand and thirty-eight females aged 18-55 years from routine care (n=99), gynaecological (n=263) and obstetric (n=271) outpatient clinics, and eating disorder (n=223) and general psychiatric units (n=182) participated. Participants self-reported past or current problems with weight, eating and exercise using a short survey. A sub-sample of women completed the Eating and Exercise Examination (EEE) which includes the Quality of Life for Eating Disorders (QOL ED)., Results: The prevalence of self-reported problems controlling weight (52%), disordered eating and eating disorders (43%) for the psychiatric patients was significantly greater than for the routine care and gynaecological and obstetrics outpatients. The psychiatric group had a significantly higher mean body mass index (BMI) of 27.3 kg/m(2) (standard deviation (SD)=6.7) and prevalence of self-reported obesity (28%) than the other groups., Conclusion: Treatment of women with psychiatric problems should include assessment and concurrent attention to body weight, eating disorder and exercise problems in association with appropriate medical, psychiatric, psychological and medication treatment of their presenting disorder.

Purpose: Inpatient psychiatric units are dynamic in nature, potentially creating a different treatment experience for each person, which may be difficult to quantify. Among the goals of this multi-centre service evaluation project was an assessment of shift-to-shift changes in unit-level events and their impact on the social-emotional environment., Methods: Over 1 year, various nurse-completed logs were used within the 11 participating Australian psychiatric units (n = 5,546 admissions) to record patient- and unit-level events per shift, including ratings of the overall social-emotional climate using a novel shift climate ratings (SCR) scale (n = 8,176 shifts). These were combined with admission-level patient characteristics to investigate shift climate profiles and correlates., Results: Occupancy rates averaged 88% and two-thirds of admissions were involuntary. The psychometric performance of the SCR scale was considered to be satisfactory (e.g., high internal consistency, unidimensional factor structure, and evidence of discriminant and predictive validity). A series of hierarchical regressions revealed considerable variation in SCR total scores, with poorer climates being significantly associated with: day/afternoon shifts; higher occupancy levels; higher proportions of experienced staff, and male, older, or involuntary patients; higher rates of less serious aggressive incidents; reporting of additional staffing demands; and unit location in a stand-alone psychiatric hospital., Conclusions: The day-to-day social-emotional climate can have important consequences for patient engagement and recovery. Improved understanding of the role played by unit, staff and patient characteristics, together with routine monitoring, should facilitate the development and evaluation of targeted interventions to reduce adverse incidents and improve the overall social-emotional climate.

Background: Multi attribute utility (MAU) instruments are used to include the health related quality of life (HRQoL) in economic evaluations of health programs. Comparative studies suggest different MAU instruments measure related but different constructs. The objective of this paper is to describe the methods employed to achieve content validity in the descriptive system of the Assessment of Quality of Life (AQoL)-6D, MAU instrument., Methods: The AQoL program introduced the use of psychometric methods in the construction of health related MAU instruments. To develop the AQoL-6D we selected 112 items from previous research, focus groups and expert judgment and administered them to 316 members of the public and 302 hospital patients. The search for content validity across a broad spectrum of health states required both formative and reflective modelling. We employed Exploratory Factor Analysis and Structural Equation Modelling (SEM) to meet these dual requirements., Results and Discussion: The resulting instrument employs 20 items in a multi-tier descriptive system. Latent dimension variables achieve sensitive descriptions of 6 dimensions which, in turn, combine to form a single latent QoL variable. Diagnostic statistics from the SEM analysis are exceptionally good and confirm the hypothesised structure of the model., Conclusions: The AQoL-6D descriptive system has good psychometric properties. They imply that the instrument has achieved construct validity and provides a sensitive description of HRQoL. This means that it may be used with confidence for measuring health related quality of life and that it is a suitable basis for modelling utilities for inclusion in the economic evaluation of health programs.

Objective: To reflect upon the implementation of sensory-based approaches within the environment of a psychiatric inpatient unit., Method: A literature review on sensory modulation within psychiatric inpatient care, including seclusion and restraint reduction initiatives, was conducted. A variety of sensory-based principles were planned, developed and implemented over a 3-year period. Preliminary data regarding sensory room use and acute arousal ratings within the high-dependency area were analysed., Results: Preliminary sensory room data showed a significant reduction in patient distress levels, as per consumer and clinician ratings, and that the majority of sensory room sessions were conducted by nursing staff. A significant reduction was also found for acute arousal ratings, pre to post, for the HDU engagement program. Several issues were uncovered throughout implementation of the sensory-based strategies., Conclusions: Findings indicate the importance of cultural change, compared with simply an environmental change, giving all staff and consumers the confidence to utilise a variety of sensory-based methods during times of need. Further Australian research is required to explore the positive contribution sensory modulation can potentially make across the spectrum of psychiatric settings.

Purpose: The aim of the research was to investigate swearing and verbal aggression in Australian inpatient settings, including incidence, gender, patient motivation, and nursing interventions., Design and Methods: A mixed methods approach utilizing the Overt Aggression Scale and a survey of 107 nurses' perceptions of their experience of swearing was used., Findings: High levels of swearing and verbal aggression were found, with differing patterns for male and female patients. Nurses subjected to swearing experienced high levels of distress, especially females. All nurses appeared to use a limited range of interventions to deal with patient aggression., Practical Implications: In order to provide optimal care for patients, there is a clear need to improve nurses' ability to predict and prevent aggression., (© 2011 Wiley Periodicals, Inc.)

Objective: This study was to investigate factors influencing the length of stay and predictors for the risk of readmission at an acute psychiatric inpatient unit., Method: Two comparative studies were embedded in a retrospective cross-sectional clinical file audit. A randomly selected 226 episodes of admissions including 178 patients during a twelve-month period were reviewed. A total of 286 variables were collected and analysed. A case control study was employed in the study of length of stay. A retrospective cohort study was used to investigate the predictors for the risk of readmission., Results: Logistic regression analyses showed that 10 variables were associated with length of stay. Seclusion during the index admission, accommodation problems and living in an area lacking community services predicted longer stay. During the follow-up period 82 patients (46%) were readmitted. Cox regression analyses showed 9 variables were related to the risk of readmission. Six of these variables increased the risk of readmission, including history of previous frequent admission, risk to others at the time of the index admission and alcohol intoxication. More active and assertive treatment in the community post-discharge decreased the risk of readmission., Conclusions: Length of stay is multifactorially determined. Behavioural manifestations of illness and lack of social support structures predicted prolonged length of stay. Good clinical practice did not necessarily translate to a shorter length of stay. Therefore, length of stay is predictable, but not readily modifiable within the clinical domain. Good clinical practice within the community following discharge likely reduces the risk of readmission. Quality of inpatient care does not influence the risk of readmission, which therefore raises a question about the validity of using the rate of readmission as an outcome measure of psychiatric inpatient care.

A qualitative study was conducted in Australia to explore women's preferences for inpatient or outpatient settings for cervical priming for induction of labour. The concept of therapeutic landscapes was used to explore the different aspects of the home and hospital that make them therapeutic to women. The therapeutic value of the home and hospital landscapes was defined by their ability to provide women with 'comfort' and 'safety', and women were found to draw on a range of contextual factors to negotiate between the comfort of home and the perceived safety of the hospital. The study provides important information for health professionals to enable them to enhance women's wellbeing should they be offered the choice of inpatient or outpatient priming., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Purpose: The aim of this article is to present findings from an Australian study that explored road trauma survivors' perceptions of spirituality and of a hospital-based pastoral care service throughout their inpatient rehabilitation. All participants had experienced severe orthopaedic injury., Method: A mixed-method research design was used. The survey method elicited demographic, pastoral care contact and hospitalisation data. It included the Posttraumatic Growth Inventory (PTGI; Tedeschi and Calhoun 1996) and an adapted World Health Organisation Pastoral Intervention (WHO 2002) coding schema (Constitution of the World Health Organisation, basic documents, supplement. 45 ed.). An interview method was used to elicit information about participants' prior and current experiences of faith and spirituality, expectations, and experiences of the pastoral care service, and perceptions of the role of pastoral care in their rehabilitation., Results: A thematic analysis of both quantitative and qualitative data identified nine core themes of supportive pastoral care. Pastoral care was seen as a valued and supportive intervention. Participants who completed the PTGI reported at least some degree of posttraumatic growth., Conclusions: Further research is recommended to examine the role and efficacy of pastoral care that is integral to road trauma recovery support.

Objective: To describe the outcomes and clinical experience of a 12-week pilot study of routine distress screening of newly admitted patients to an acute haematology and oncology ward., Design, Patients and Setting: Bedside measurement of psychological distress, and collection of demographic and clinical data for 115 newly admitted patients in an acute haematology and oncology ward of The Alfred hospital in Melbourne between 5 June and 25 August 2006., Main Outcome Measures: Psychosocial distress as measured by the Distress Thermometer and Problem Checklist, and 18-item Brief Symptom Inventory; rate of referral to psychology and social work services in the 12 weeks before and 12 weeks during the pilot study; ward staff feedback on the benefits and challenges associated with routine distress screening., Results: 51% of patients were identified as being significantly distressed, of whom 47% had not received psychosocial support before screening. A significantly higher number of emotional and physical problems were reported by significantly distressed patients. Referrals to psychology and social work services during the pilot study increased, highlighting that screening directed more patients into care. Staff were generally positive about the ability of routine screening to help them care for their patients, and most agreed that some form of routine screening should continue., Conclusion: The use of routine distress screening by inpatient cancer services can significantly improve their capacity to offer psychosocial care.