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OBJECTIVE: First Nations Australians experience a higher burden and severity of Rheumatic Disease with poorer outcomes than the general population. Despite a widely acknowledged need to improve health outcomes, there has been minimal research assessing existing models of care from a First Nations perspective in Australia. The objective of this study was to describe First Nations experiences and barriers and enablers to accessing a hospital-based adult Rheumatology service in Sydney. METHODS: A qualitative study using semi-structured interviews was undertaken. Patients who self-identified as First Nations attending the Prince of Wales Hospital Rheumatology Clinic in 2021 were invited to participate. Interviews were conducted face-to-face or by telephone using culturally-appropriate Yarning methods with an Aboriginal Health Worker (AHW) at the request of participants. Thematic analysis was done in consultation with an Aboriginal Reference Group (ARG). RESULTS: Four categories, which encapsulated 11 themes were identified. Participants reported barriers to care such as logistics of the referral process, not feeling culturally safe because of uncomfortable clinic environments and health worker behaviours, inadequate cultural support and community perceptions of the specialty. Enabling factors included family member involvement, AHW support and telehealth consultation. CONCLUSION: The current model of care perpetuates access challenges for First Nations Australians within rheumatology. Barriers to care include the delayed referral process, limited cultural responsivity in the clinic environment and poor cross-cultural communication. There is a need for models of care that are co-designed with First Nations Peoples to address these barriers. PATIENT AND PUBLIC CONTRIBUTION: Participants were First Nations Australians with lived experience attending the rheumatology clinic. All interviewees were offered the opportunity to review their transcripts to ensure trustworthiness

BACKGROUND: Surgery can help patients with leg pain caused by sciatica recover faster, but by 12 months outcomes are similar to nonsurgical management. For many the decision to have surgery may require reflection, and patient decision aids are an evidence-based clinical tool that can help guide patients through this decision. OBJECTIVE: The aim of this study was to develop and refine a decision aid for patients with sciatica who are deciding whether to have surgery or 'wait and see' (i.e., try nonsurgical management first). DESIGN: Semistructured interviews with think-aloud user-testing protocol. PARTICIPANTS: Twenty clinicians and 20 patients with lived experience of low back pain or sciatica. OUTCOME MEASURES: Items from Technology Acceptance Model, Preparation for Decision Making Scale and Decision Quality Instrument for Herniated Disc 2.0 (knowledge instrument). METHODS: The prototype integrated relevant research with working group perspectives, decision aid standards and health literacy guidelines. The research team refined the prototype through seven rounds of user-testing, which involved discussing user-testing feedback and implementing changes before progressing to the next round. RESULTS: As a result of working group feedback, the decision aid was divided into sections: before, during and after a visit to the surgeon. Across all rounds of user-testing, clinicians rated the resource 5.9/7 (SD = 1.0) for perceived usefulness, and 6.0/7 for perceived ease of use (SD = 0.8). Patients reported the decision aid was easy to understand, on average correctly answering 3.4/5 knowledge questions (SD = 1.2) about surgery for sciatica. The grade reading score for the website was 9.0. Patients scored highly on preparation for decision-making (4.4/5, SD = 0.7), suggesting strong potential to empower patients. Interview feedback showed that patients and clinicians felt the decision aid would encourage question-asking and help patients reflect on personal values. CONCLUSION

BACKGROUND: StrokeLine is a stroke-specific helpline used by stroke survivors and their families in Australia to access professional support. There has been little research exploring stroke survivors' experiences of using helplines and their perceived impact on their stroke recovery. AIM: The aim of this study is to explore the reasons prompting stroke survivors to call StrokeLine and their experiences and to describe the perceived impact of calling StrokeLine on their recovery. METHODS: An exploratory descriptive qualitative study was undertaken using thematic analysis of data collected through semi-structured interviews of stroke survivors between December 2020 and May 2022. Participants were recruited using purposive sampling. Interviews were conducted via audio-recorded Zoom conference calling and transcribed verbatim for thematic analysis. RESULTS: A total of eight callers (four men and women women) participated, with the time since stroke ranging from 3.5 months to 5 years. Four major themes were identified, including 17 sub-themes. Key themes included (1) factors prompting use of StrokeLine; (2) experience of using StrokeLine; (3) perceived impact of using StrokeLine; and (4) conceptualising StrokeLine service provision. CONCLUSIONS: Participants perceived their experience of contacting StrokeLine as having a positive impact on their stroke recovery, leaving them feeling empowered and motivated to self-manage their condition. PATIENT OR PUBLIC CONTRIBUTION: Stroke survivors with lived experience influenced the conceptualisation of this study through conversations with consumers and the Stroke Foundation. Eight stroke survivors were involved as participants in the research study.

AIMS AND OBJECTIVES: To identify the reasons and/or risk factors for hospital admission and/or emergency department attendance for older (≥60 years) residents of long-term care facilities. BACKGROUND: Older adults' use of acute services is associated with significant financial and social costs. A global understanding of the reasons for the use of acute services may allow for early identification and intervention, avoid clinical deterioration, reduce the demand for health services and improve quality of life. DESIGN: Systematic review registered in PROSPERO (CRD42022326964) and reported following PRISMA guidelines. METHODS: The search strategy was developed in consultation with an academic librarian. The strategy used MeSH terms and relevant keywords. Articles published since 2017 in English were eligible for inclusion. CINAHL, MEDLINE, Scopus and Web of Science Core Collection were searched (11/08/22). Title, abstract, and full texts were screened against the inclusion/exclusion criteria; data extraction was performed two blinded reviewers. Quality of evidence was assessed using the NewCastle Ottawa Scale (NOS). RESULTS: Thirty-nine articles were eligible and included in this review; included research was assessed as high-quality with a low risk of bias. Hospital admission was reported as most likely to occur during the first year of residence in long-term care. Respiratory and cardiovascular diagnoses were frequently associated with acute services use. Frailty, hypotensive medications, falls and inadequate nutrition were associated with unplanned service use. CONCLUSIONS: Modifiable risks have been identified that may act as a trigger for assessment and be amenable to early intervention. Coordinated intervention may have significant individual, social and economic benefits. RELEVANCE TO CLINICAL PRACTICE: This review has identified several modifiable reasons for acute service use by older adults. Early and coordinated intervention may reduce the risk of hospital ad

BACKGROUND: Awareness and understanding of dementia remain limited in ethnically diverse populations in multicultural societies due to culturally inappropriate and inaccessible information. OBJECTIVE: To establish the impact, helpers and hinderers of an online multilingual dementia awareness initiative co-created with and for English, Arabic and Vietnamese speaking people. DESIGN: A case study using mixed methods to assess the impact and implementation of an information session on dementia knowledge. SETTING AND PARTICIPANTS: The study was conducted with English, Arabic and Vietnamese speaking individuals in Canterbury-Bankstown, Australia. INTERVENTION STUDIED: A dementia alliance co-created an online multilingual dementia information session, which was delivered synchronously in English, Arabic and Vietnamese by trained facilitators. MAIN OUTCOME MEASURES: In-session group discussions, quizzes and a postsession survey assessed the impact on dementia knowledge. A postimplementation focus group explored the factors that helped and hindered the initiative. RESULTS: The online dementia information session successfully supported participants understanding of dementia causes, impacts and care strategies. The initiative was hindered by competing priorities and limited accessibility to target audiences, while it was helped by the support of an established organisation and feedback mechanisms. DISCUSSION: Ongoing dementia education and awareness-raising campaigns that are culturally sensitive are needed in communities to promote dementia literacy and help-seeking. CONCLUSIONS: An online multilingual dementia information session can be an effective way to improve dementia literacy and advocate for change in multicultural communities. PATIENT OR PUBLIC CONTRIBUTION: English, Arabic and Vietnamese speaking members of the Canterbury Bankstown Dementia Alliance participated in the co-creation and evaluation of this initiative.

In 2019, the World Health Organization urged a global shift towards recovery-focused practices in mental health care. In Western nations, this transition often prioritised individualism over collectivism. In contrast, collectivist societies prioritise recovery through community and social support. This study explored mental health recovery from the perspectives of consumers, carers and registered nurses in a mainly collectivist society (Saudi Arabia) using a qualitative exploratory descriptive design. Sixteen consumers, ten carers and eight registered nurses participated in online semi-structured interviews. Inductive thematic analysis was employed to analyse English-translated versions of the 34 interviews. Consolidated criteria for reporting qualitative studies 32-item checklist were used. The study found that recovery was perceived as a process of transforming towards living a meaningful life of goals and values supported by trusted people who share moments of comfort and empowerment. A unique finding was the 'bond of recovery' a collectivist value that aid consumers' community integration in society. Saudi consumers' experiences of recovery were similar to consumers' movement narratives of recovery. Future research should establish a recovery-focused educational program that incorporates our findings into a recovery-oriented approach. This will facilitate providing a collaborative care between consumers, carers and nurses that centres around consumers' recovery goals and values.

AbstractBackgroundHistorically, researchers have been apt at conducting research on, rather than with, the people who are the focus of their efforts. Such approaches often fail to effectively support and benefit the populations they are intended to. This study aimed to explore the preferences of people with lived experience for engagement with research either as research participants within studies, or through active involvement in mental health research.MethodsData for this paper were collected in three separate lived experience agenda‐setting studies conducted over a 9‐year period from 2013 to 2022; two group discussions and an open‐ended online survey. Data were combined and thematic analysis undertaken.ResultsParticipants described the inclusion of lived experience as a critical ingredient and the highest level of knowledge and expertise in mental health research that should lead to knowledge generation and research agendas. Participants discussed the importance and value of research that enables sharing experiences and stories, expressed a need for flexibility in research methods for choice and agency, and support for greater active involvement of people with lived experience across all stages of research. Participants also spoke to the need for perspective and knowledge generated from people with lived experience to have equal power in research, making space for lived experience voices across multiple aspects of research, and greater respect and recognition of the value of lived experience.ConclusionLived experience in mental health research is coming of age, but dedicated, cocreated development is needed to get it right. People with lived experience increasingly understand the value their experiential knowl

AIMS: To examine the association between nursing unit safety culture, quality of care, missed care and nurse staffing levels, and inpatient falls using two data sources: incidence of falls and nurses' perceptions of fall frequency in their units. The study explores the association between the two sources of patient falls and identifies if nurses' perceptions of patient fall frequency reflect the actual patient falls recorded in the incident management system. BACKGROUND: Inpatient falls are associated with severe complications that result in extended hospitalisation and increased financial consequences for patients and healthcare services. DESIGN: A multi-source cross-sectional study guided by the STROBE guidelines. METHODS: A purposive sample of 33 nursing units (619 nurses) from five hospitals completed an online survey from August to November 2021. The survey measured safety culture, quality of care, missed care, nurse staffing levels and nurses' perceptions of patient fall frequency. In addition, secondary data on falls from participating units between 2018 and 2021 were also collected. Generalised linear models were fitted to examine the association between study variables. RESULTS: Nursing units with strong safety climate and working conditions and lower missed care were associated with lower rates of falls using both data sources. Nurses' perceptions of the frequency of falls in their units were reflective of the actual incidence rate of falls, but the association was not statistically significant. CONCLUSION: Nursing units with a strong safety climate and better collaborations between nurses and other professionals, including physicians and pharmacists, were associated with lower incidents of patient falls. RELEVANCE TO CLINICAL PRACTICE: This study provided evidence for healthcare services and hospital managers to minimise patient falls. PATIENT OR PUBLIC CONTRIBUTION: Patients who had experienced a fall, which was reported in the incident management system

BACKGROUND: While nurse-sensitive outcomes (NSOs) are well established in numerous health settings, to date there is no indicator suite of NSOs for inpatient mental health settings. AIM: To assess the relationship between nursing variables and patient outcomes in acute inpatient mental health settings to determine which outcomes can be used as indicators of the quality of nursing care. METHODS: Databases accessed were CINAHL, MEDLINE, PsycINFO and EMBASE, last searched in May 2022. The review followed the 2020 PRISMA checklist for systematic reviews. Papers published between 1995 and 2022, conducted in acute mental health care units were included. The quality of the studies was assessed using the Effective Public Health Practice Project Quality Assessment Tool. A meta-analysis was not possible because of the large number of variables and measurement inconsistencies. RESULTS: A total of 57 studies were reviewed. Studies were categorised according to whether they found a significant or non-significant relationship between nurse variables and patient outcomes. Seven outcomes-aggression, seclusion, restraint, absconding, pro-re-nata medications, special observations and self-harm-were identified. For each outcome, there were significant findings for several nurse variables indicating that all included outcomes could be used as NSOs. However, evidence for aggression, seclusion and restraint use as suitable NSOs was more robust than the evidence for self-harm, absconding, pro-re-nata medications and special observations. CONCLUSION: All the seven outcomes can all be used to develop an NSO indicator suite in mental health inpatient settings. More work is needed to establish high-quality studies to clearly demonstrate the relationship between these outcome measures and changes in nurse variables such as nurse staffing, skill mix, work environment, nurse education and nurse experience. PATIENT AND PUBLIC CONTRIBUTION: Patient or public contribution was not possible because o

The mental health consequences of pandemic isolation have been well documented extending from psychological conditions such as anxiety and depression to increased falls risk, medication errors and delirium. Whilst risk factors associated with isolation are known, there remains a gap in the guidance for healthcare staff on how to assess for these risks and develop effective management plans. Using a structured professional judgement (SPJ) approach and the author's recent experience providing consultation and leadership to clinical staff working with at-risk patients during the pandemic, an isolation risk assessment and management guideline was developed. SPJ is an evidenced-based analytical method used to understand and mitigate risk that was primarily developed for the assessment and management of aggression and violence. This paper discusses an evidenced-based process used to develop the guideline and the application of its use from the author's clinical experience.

Methamphetamines remain a public health problem due to the extensive burden of illicit drug use on society. Callout events in the pre-hospital environment related to methamphetamine use is increasing. In addition, there has been an increase in reported mental health side effects and breakdown in relationships and social networks. Descriptive phenomenology research design was undertaken and data analysed using thematic analysis. Semi-structured interviews were utilized to collect data exploring the experience of first responders attending callouts to people affected by methamphetamines in the pre-hospital environment. Interviews included paramedics (8) and police officers (10) from across Australia. Overall, participants reported responding to people affected by methamphetamines was complex in nature. Complexity was affected by extensive social circumstances, people presenting in states of crisis, lack of coordinated approach, and unsuitable care environments. The social impact of methamphetamine addiction is extensive. Staff working as first responders have an opportunity to help reduce the social impact and crises, referring people to follow-up care and drug and alcohol support services. Further research is needed to determine if a standardized approach, between first responders and EDs, should be developed to help streamlines services and improve how the individual services respond as a group to people affected by substances.

BACKGROUND: The 5-visual analogue scale Richards-Campbell Sleep Questionnaire subjective sleep measure is widely used in intensive care. A cut-off score indicative of good quality sleep has not been established and is required to guide the categorisation of individual patient and unit wide sleep quality. DESIGN AND METHODS: The aim was to determine the global Richards-Campbell Sleep Questionnaire cut-off score for good to very good sleep during an intensive care unit stay in non-ventilated patients. The study was a secondary (cohort) retrospective analysis of patient self-report data (n = 32) from an interventional study testing a sleep promotion bundle. The Standards for Reporting Diagnostic Accuracy studies statement were used to report the study. The study was conducted in two mixed adult 12 and 20-bed ICUs of a tertiary referral hospital in a metropolitan area. In the morning, eligible patients were administered the Richards-Campbell Sleep Questionnaire together with a 5-category item Likert scale in which patients rated their nocturnal sleep quality as 'very poor', 'poor', 'fair', 'good' and 'very good'. Receiver Operator Curve analysis was performed. RESULTS: Thirty-seven per cent (n = 32) of the total sample of 84 adult intensive care patients were females. The median age was 61.5 (51, 72) years. Self-reported median global Richards-Campbell Sleep Questionnaire score was 54.4 (30.1, 77.1) mm. A global score of ≥63.4 mm was the optimal cut-off for self-reported 'good sleep' (sensitivity: 87%, specificity: 81% and area under the curve: 0.896). CONCLUSIONS: Although the study requires replication in ventilated patients and other ICU settings, the cut-off score (63 mm) could be used to guide the categorisation of individual patient and unit wide sleep quality.

This paper emerged from discussions between the authors about our shared and different perspectives of climate change and its impact on the social, emotional, physical, spiritual and cultural wellbeing of Aboriginal Peoples and mental health services in a rural region, heavily impacted in recent years by bushfires and floods. Here we discuss, from the lead authors personal perspective as a Gamilaraay Woman, the experience of Solastalgia as a critical impact of climate change on wellbeing. Specifically, we discuss the relationship of a connection to country from a Gamilaraay, first person perspective through a series of diary entries from the lead author. Authors are researchers from different cultural backgrounds, connected through a medical research futures fund research project, to promote resilience within Aboriginal communities and the health services sector in the New England, North West region. The lead author has cultural connections to some of the communities we work with and our work is informed by these connections. While this paper was written to express an Aboriginal perspective on climate change and wellbeing, it reflects our shared perspectives of how disasters such as bushfires impact the wellbeing of Aboriginal peoples. We also explore the connection between the impact of localised, recurring natural disasters and the increasing demands on mental health services in regional and rural areas and discuss what this means with Aboriginal and non-Indigenous mental health nurses and researchers working in regional and rural areas where access to mental health services often poses considerable challenges. From our perspective, mental health research and nursing play an important role in walking alongside Aboriginal Peoples as we explore, respond and create resilience to the ever-present influence that climate change is having on our lives, communities, country and workplaces.

Purpose: Physical activity is an important component of treatment for people living with mental illness, and exercise practitioners are well placed to deliver these interventions. In response to the COVID-19 pandemic and associated lock-down regulations, exercise professionals have rapidly adapted to the online delivery of services to continue care for their clients. To date, the research surrounding the delivery of exercise sessions via telehealth for this population has been scarce. Therefore, this study aims to explore how exercise professionals working in mental health have adapted to telehealth, the barriers and facilitators they have experienced and the implications for the future. Design/methodology/approach: A qualitative study using semi-structure interviews was conducted. Interviews were audio recorded, transcribed and analysed using reflexive thematic analysis. Findings: Nine exercise physiologists working in mental health settings in Australia participated in the interviews. Two main themes were explored. The first related to the implementation of telehealth and was divided into four sub-themes: service delivery, accessibility and suitability, technology barriers and facilitators, adaptations to exercise prescription. The second theme related to attitudes and was categorised into two sub-themes: attitudes towards telehealth and future recommendations. Practical implications: Telehealth appears to be a feasible and well accepted platform to deliver exercise sessions for people with mental illness, and this study provides guidance for clinicians including service and training recommendations. Originality/value: To the best of the authors’ knowledge, this is the first study to examine the experiences of exercise physiologists working in mental health and using telehealth.

BACKGROUND: An integral part of clinical practice is decision-making. Yet there is widespread acceptance that there is evidence of cognitive bias within clinical practice among nurses and physicians. However, how cognitive bias among emergency nurses and physicians' decision-making influences patient outcomes remains unclear. AIM: The aim of this review was to systematically synthesise research exploring the emergency nurses' and physicians' cognitive bias in decision-making and its influence on patient outcomes. METHODS: This scoping review was guided by the PRISMA Extension for Scoping Reviews. The databases searched included CINAHL, MEDLINE, Web of Science and PubMed. No date limits were applied. The Patterns, Advances, Gaps, Evidence for practice and Research recommendation (PAGER) framework was used to guide the discussion. RESULTS: The review included 18 articles, consisting of 10 primary studies (nine quantitative and one qualitative) and eight literature reviews. Of the 18 articles, nine investigated physicians, five articles examined nurses, and four both physicians and nurses with sample sizes ranging from 13 to 3547. Six primary studies were cross-sectional and five used hypothetical scenarios, and one real-world assessment. Three were experimental studies. Twenty-nine cognitive biases were identified with Implicit bias (n = 12) most frequently explored, followed by outcome bias (n = 4). Results were inconclusive regarding the influence of biases on treatment decisions and patient outcomes. Four key themes were identified; (i) cognitive biases among emergency clinicians; (ii) measurement of cognitive bias; (iii) influence of cognitive bias on clinical decision-making; and (iv) association between emergency clinicians' cognitive bias and patient outcomes. CONCLUSIONS: This review identified that cognitive biases were present among emergency nurses and physicians during clinical decision-making, but it remains unclear how cognitive bias influences patient o

The COVID-19 pandemic led to significant adaptations to healthcare. Provision of mental healthcare in a changing environment presented healthcare workers with unique challenges and demands, including changes in workload and expectations. To inform current and future healthcare service responses, and adaptations, the current review aimed to collate and examine the impact of the pandemic on mental healthcare workers (MHWs). We conducted a rapid systematic review to examine the overall impact of the COVID-19 pandemic on MHWs. Searches were conducted in Ovid Medline and PsycInfo and restricted to articles published from 2020. Inclusion criteria specified articles written in English, published in peer-reviewed journals, and that examined any outcome of the impact of COVID-19 on MHWs; 55 articles fulfilled these criteria. Outcomes were categorized into 'work-related outcomes' and 'personal outcomes'. Mental healthcare workers worldwide experienced a range of work-related and personal adversities during the pandemic. Key work-related outcomes included increased workload, changed roles, burnout, decreased job satisfaction, telehealth challenges, difficulties with work-life balance, altered job performance, vicarious trauma and increased workplace violence. Personal outcomes included decreased well-being, increased psychological distress and psychosocial difficulties. These outcomes differed between inpatient, outpatient and remote settings. The COVID-19 pandemic significantly altered the delivery of mental healthcare and MHWs experienced both work-related and personal adversities during the COVID-19 pandemic. With the continuation of changes introduced to healthcare in the initial stages of the pandemic, it will be important to maintain efforts to monitor negative outcomes and ensure supports for MHWs, going forward.

AIMS: To examine registered nurses' attitudes about end-of-life care and explore the barriers and facilitators that influence the provision of high-quality end-of-life care. DESIGN: A sequential explanatory mixed methods research design was used. METHODS: An online cross-sectional survey was distributed to 1293 registered nurses working in five different hospitals in the Kingdom of Saudi Arabia. The Frommelt Attitudes Towards Care of the Dying Scale was used to assess nurses' attitudes towards end-of-life care. Following the survey, a subset of registered nurses were interviewed using individual semi-structured interviews. RESULTS: Four hundred and thirty-one registered nurses completed the online survey, and 16 of them participated in individual interviews. Although nurses reported positive attitudes towards caring for dying patients and their families in most items, they identified negative attitudes towards talking with patients about death, their relationship with patients' families and controlling their emotions. The individual interview data identified the barriers and facilitators that registered nurses experience when providing end-of-life care. Barriers included a lack of communication skills and family and cultural and religious resistance to end-of-life care. The facilitators included gaining support from colleagues and patients' families. CONCLUSION: This study has identified that while registered nurses hold generally favourable attitudes towards end-of-life care, they have negative attitudes towards talking with patients and families about death and managing their emotional feelings. RELEVANCE TO CLINICAL PRACTICE: Education providers and leaders in healthcare settings should consider developing programmes for undergraduate nurses and nurses in clinical practice to raise awareness about the concept of death in a cross-section of cultures. Nurses' attitudes towards dying patients will be enhanced with culture-specific knowledge which will also enhance c

BACKGROUND: Health literacy interventions and research outcomes are not routinely or systematically implemented within healthcare systems. Co-creation with stakeholders is a potential vehicle through which to accelerate and scale up the implementation of innovation from research. METHODS: This narrative case study describes an example of the application of a co-creation approach to improve health literacy in an Australian public health system that provides hospital and community health services to one million people from socioeconomically and culturally diverse backgrounds. We provide a detailed overview of the value co-creation stages and strategies used to build a practical and sustainable working relationship between a University-based academic research group and the local health district focussed on improving health literacy. RESULTS: Insights from our experience over a 5-year period informed the development of a revised model of co-creation. The model incorporates a practical focus on the structural enablers of co-creation, including the development of a Community of Practice, co-created strategic direction and shared management systems. The model also includes a spectrum of partnership modalities (spanning relationship-building, partnering and co-creating), acknowledging the evolving nature of research partnerships and reinforcing the flexibility and commitment required to achieve meaningful co-creation in research. Four key facilitators of health literacy co-creation are identified: (i) local champions, (ii) co-generated resources, (iii) evolving capability and understanding and (iv) increasing trust and partnership synergy. CONCLUSION: Our case study and co-creation model provide insights into mechanisms to create effective and collaborative ways of working in health literacy which may be transferable to other health fields in Australia and beyond. PATIENT AND PUBLIC CONTRIBUTION: Our co-creation approach brought together a community of practice of consumers

AIM: This study aimed to explore what constitutes brilliant aged care. BACKGROUND: Although many aged care services do not offer the care that older people and carers need and want, some perform better. Rather than focus on problems with aged care, this study examined brilliant aged care-practices that exceeded expectation. DESIGN: The methodology for this study was informed by grounded theory, underpinned by constructionism to socially construct meaning. METHODS: This study invited nominations for a Brilliant Award via a survey, and interviews with the nominees via web conference. After receiving survey responses from 10 nominators, interviews were conducted with 12 nominees. Data were analysed using reflexive thematic analysis and documented according to COREQ guidelines to optimise rigour and transparency. RESULTS: According to participants, brilliant aged care involved being relationally attuned to older people, a deep understanding of the older person, recognition of aged care as more than a job, innovative practices and permission to reprioritise. CONCLUSIONS: This study suggests that, in aged care, brilliance happens. It emphasises the importance of meaningful connections and relationships in aged care, where thoughtful acts acknowledge an older person's value and humanity as well as creativity and innovation. RELEVANCE TO CLINICAL PRACTICE: For those who manage and deliver aged care, the findings suggest that small practice changes can make a positive difference to older people. Brilliant aged care can involve acts of empathy; enthusiasm for aged care; innovative practices, even those that are small scale; and reprioritising workplace tasks to spend time with older people. For policymakers, this study highlights the need to recognise and raise the profile of the pockets of brilliance within the aged care sector. This might be achieved via awards and other initiatives that serve to celebrate and learn from brilliance in its myriad forms. PATIENT OR PUBLIC CON

PURPOSE: Busyness as a construct within modern healthcare is complex and multidimensional. To date, few studies have sought to explore how busyness influences family-centred care. This study explored the influence of busyness on the delivery of family-centred care for nurses and parents. DESIGN AND METHOD: Ethnography was selected as the research design. The study site was a metropolitan tertiary hospital inpatient paediatric unit in Sydney, Australia. Semi-structured interview and non-participant observation techniques were used for data collection. Ten paediatric nurses and 10 parents were interviewed and 40 h of non-participant observations were undertaken. The COREQ was used to report the study. RESULTS: The findings are presented as three key themes: (i) 'Supporting family-centred care' in which participants detail beliefs about the nurse-parent relationships and how despite busyness nurses sought out moments to engage with parents; (ii) 'Being present at the bedside' identified the challenges in optimising safety and how parents adapted their way of being and interacting on the unit; and (iii) 'The emotional cost of busyness' and how this influenced nurse-parent interactions, care delivery and family-centred care. CONCLUSIONS: The ethnography has given shape to social understandings of busyness, the complexities of paediatric nursing and family-centred care. The culture of care changed in moments of busyness and transformed parent and nursing roles, expectations and collaborative care that at time generated internal emotional conflict and tension. PRACTICE IMPLICATIONS: Given the increasing work demands across health systems, new agile ways of working need to ensure maintenance of a family-centred approach. Strategies need to be developed during periods of busyness to better support collaborative connections and the well-being of paediatric nurses and parents. At an organisational level, fostering a positive workplace culture that shares a vision for family-ce

AIM: To explore how the Cognitive Continuum Theory has been used in qualitative nursing research and to what extent it has been integrated in the research process using the Qualitative Network for Theory Use and Methodology (QUANTUM). BACKGROUND: Theory, research and nursing are intrinsically linked, as are decision-making and nursing practice. With increasing pressure on nurses to improve patient outcomes, systematic knowledge regarding decision-making is critical and urgent. DESIGN: A meta-aggregative systematic review. METHODS: DATABASES: CINAHL, Medline, PsycINFO, Embase and PubMed were searched from inception until May 2022 for peer-reviewed research published in English. Seven studies were included and assessed for methodological quality using the Joanna Briggs Institute checklist for qualitative research. A meta-aggregative synthesis was conducted using Joanna Briggs methodology. The QUANTUM typology was used to evaluate the visibility of the Cognitive Continuum Theory in the research process. RESULTS: The review identified five synthesised findings, namely: 1. the decision-making capacity of the individual nurse, 2. nurses' level of experience, 3. availability of decision support tools, 4. the availability of resources and 5. access to senior staff and peers. Only two of seven studies rigorously applied the theory. The included studies were mainly descriptive-exploratory in nature. CONCLUSION: The transferability of the Cognitive Continuum Theory was demonstrated; however, evolution or critique was absent. A gap in the provision of a patient-centric approach to decision-making was identified. Education, support and research is needed to assist decision-making. A new Person-Centred Nursing Model of the Cognitive Continuum Theory has been proposed to guide future research in clinical decision-making. RELEVANCE TO CLINICAL PRACTICE: Nurses make numerous decisions every day that directly impact patient care, therefore development and testing of new theories, mod

The COVID-19 outbreak led to widespread disruption and stress to people's lives. Concern about the escalation of domestic violence (DV) rates and related mental health issues soon emerged following the implementation of strategies aimed at curbing the spread of the virus. This perspective paper presents an overview of the issues, argues for greater recognition of the link between DV against women and serious emotional distress, and the need for greater awareness and knowledge about DV among mental health professionals. While we acknowledge that men also experience DV, their rates are much lower than for women and in this paper our focus is on women.

Forensic mental health nurses (FMHN) provide care to address the needs of people who have mental illnesses across a range of diverse settings. The Clinical Reasoning Cycle (CRC) has been identified as a potential framework to assist FMHNs; however, adaptations were required to reflect the unique nature of the clinical setting. This study aimed to explore adaptations made to determine suitability prior to implementation in practice. Nominal Group Technique was used to explore suggested adaptations determined from a previous study and reach a consensus on the changes. Fourteen senior nurses from a state-wide Forensic mental Health (FMH) service participated. A consensus was reached for two proposed changes. Data were analysed using thematic analysis. Three main themes were interpreted from the data; FMH adaptations are warranted, the focus of the CRC, and who owns the cycle? Nurses in this study considered the need to include offence and risk issues due to the impact these factors have on the therapeutic relationship and cognitive bias; however, they also identified the need to focus on recovery-oriented care while engaging in clinical reasoning. Nurses in this study also expressed some reluctance for nursing to 'own' the model, due to concern that ownership may cause division among the team or result in inconsistency in care. However, some participant's suggested the CRC with adaptations assisted FMH nurses to articulate their specialist skills and knowledge to others and highlight the nursing contribution to care. Further work is needed to finalize adaptations with a focus on engaging the consumer carer workforce and interdisciplinary team.

BACKGROUND: Nurses comprise the largest portion of the healthcare workforce worldwide. However, nurse representation in the leadership of clinical research and research funding is largely unknown. The Australasian Nursing and Midwifery Clinical Trials Network was established to provide a coordinated network, focussed on building research capacity in nursing and midwifery. To support this work, this scoping review of nurse-led randomised controlled trials was conducted to summarise research activity, as well as highlight future research directions, gaps and resources. Midwife-led trials will be reported elsewhere. AIM: To quantify number, type and quality of nurse-led randomised controlled trials registered between 2000-2021. DESIGN: A scoping review of RCTs. DATA SOURCES: Medline, Emcare and Scopus were searched from 2000 to August 2021. ANZCTR, NHMRC, MRFF and HRC (NZ) registries were searched from inception to July 2021. REVIEW METHODS: This review was informed by the JBI scoping review framework using the PRISMA-ScR. RESULTS: Our search yielded 188 nurse-led publications and 279 registered randomised controlled trials. Multiple trials had the same nurse leaders. There were more registrations than publications. Publications were predominantly of high methodological quality; however, there was a reliance on active controls and blinding was low. Trial registrations indicate that universities and hospital/healthcare organisations were the major sources of funding, while publications indicate that Governments and the National Health and Medical Research Council were the main funding bodies. CONCLUSION: A small number of high-quality, large-scale, nationally funded randomised controlled trials were identified, with a larger number of locally funded small trials. There was a disparity between the number of registered trials and those published. Additional infrastructure, funding and career frameworks are needed to enable nurses to design, conduct and publish clinical tr

AIMS AND OBJECTIVES: To evaluate acceptability, efficiency, and quality of a new digital care management system in a residential aged care home (RACH). BACKGROUND: Improving care quality and efficiency in RACH, while simultaneously upgrading data management, is a priority for communities and governments. DESIGN: Participatory action research with mixed methods data collection was employed to evaluate a digital care management system implemented at a 169-bed RACH. This paper reports qualitative findings of the 2-year evaluation. METHODS: Qualitative data were collected using focus groups with residents, visitors, nurses, managers, care workers, and consultants; resident/visitor and staff hallway interviews and responses to open-ended questions in online staff surveys. Data were analysed thematically under the four predetermined study objectives. Reporting adhered to COREQ guidelines. RESULTS: 325 data captures from 88 participants, over seven data sources were coded. Findings indicate that the system was acceptable to both residents and staff due to perceptions of time-saving and improved quality of care. Increased efficiency was perceived through timeliness as well as reduced time spent retrieving and documenting information. Quality of care was improved through care scheduling individualised to resident needs, with reminders to avoid missed care. Relatives were reassured and activities were scheduled to loved one's preferences. The co-design implementation process was successful through commitment to quality from leadership teams and prioritising the focus on the holistic needs of the residents. CONCLUSION: A strong emphasis on co-design with care staff in developing and implementing the digital care system contributed to a system that supported nursing and care work, facilitated reporting and documentation, and improved resident care and well-being including identification of missed care. RELEVANCE TO CLINICAL PRACTICE: Nurses, carers, administrators, and advocate

INTRODUCTION: Following 2016 legislation permitting limited access to cannabis for research and medicinal purposes, the number of randomized clinical trials (RCTs) investigating the effectiveness of medicinal cannabis (MC) on symptom burden relief in cancer contexts has increased in Australia. This study aimed to understand the perceptions, hopes and concerns of people with advanced cancer regarding the future availability and regulation of MC in Australia. METHODS: This qualitative study draws on semistructured interviews conducted between February 2019 and October 2020 in Brisbane, Australia, as part of an MC RCT substudy. Interviews were undertaken on 48 patients with advanced cancer in palliative care eligible to participate in an MC trial (n = 26 participated in an RCT; n = 2 participated in a pilot study; n = 20 declined). Interviews included a discussion of patients' decision-making regarding trial participation, concerns about MC and perceptions of future availability, including cost. Transcribed interviews were analysed inductively and abductively, informed by constructivist thematic analysis conventions. RESULTS: Overall, participants supported making MC legally accessible as a prescription-only medication. Fear of financial toxicity, however, compromised this pathway. Steep posttrial costs of accessing MC prompted several people to decline trial participation, and others to predict-if found effective-that many would either access MC through alternative pathways or reduce their prescribed dosage to enable affordable access. CONCLUSIONS: These findings suggest that-despite a relatively robust universal healthcare system-Australians are potentially vulnerable to and fearful of financial toxicity. Prevalent in the United States, financial toxicity occurs when disadvantaged cancer patients access necessary but expensive medications with lasting consequences: bankruptcy, ongoing anxiety and cancer worry. Interview transcripts indicate that financial fears-and t

INTRODUCTION: To extend research on positive aspects of health care, this article focusses on health care for children who tube-feed-this is because knowledge about tube-feeding for children is limited and fragmented. This is achieved by consulting with clinicians and carers who supported children who tube-feed to clarify their understandings of and experiences with brilliant feeding care. METHODS: Nine clinicians and nine carers who supported children who tube-fed were interviewed. The interview transcripts were analysed thematically. RESULTS: Findings highlighted several features of brilliant feeding care-namely: practices that go above and beyond; attentiveness; empowerment; being 'on the same page'; hopefulness and normalcy. CONCLUSIONS: These findings show that seemingly trivial or small acts of care can make a significant meaningful difference to carers of children who tube-feed. Such accounts elucidate brilliant care as grounded in feasible, everyday actions, within clinicians' reach. The implications associated with these findings are threefold. First, the findings highlight the need for clinicians to listen, be attuned and committed to the well-being of children who tube-feed and their carers, share decision-making, source resources, and instil hope. Second, the findings suggest that carers should seek out and acknowledge clinicians who listen, involve them in decision-making processes, and continue to source the resources required to optimize child and carer well-being. Third, the findings point to the need for research to clarify the models of care that foster brilliant feeding care, and the conditions required to introduce and sustain these models. PATIENT OR PUBLIC CONTRIBUTION: All of the carers and clinicians who contributed to this study were invited to participate in a workshop to discuss, critique, and sense-check the findings. Three carers and one clinician accepted this invitation. Collectively, they indicated that the findings resonated with the

BACKGROUND: Chronic lung disease is a common and complex condition. Pulmonary rehabilitation programmes-either hospital-based or in the community are recommended in evidence-based clinical practice guidelines. AIM: To explore the experience of older people with chronic lung disease involved in a peer support community-based exercise maintenance programme. DESIGN AND METHOD: Participants were a part of the Lungs in Action programme run in a local community leisure centre through Lung Foundation Australia. All the programme participants (n = 25) were invited by an independent person through email and/or letter to participate in the study and provided with a participant information and consent form. Participants who returned consent forms were scheduled for group interviews. Participants were recruited over a 2-week period between 30 August and 13 September 2022. We conducted qualitative group interviews using a semi-structured interview guide to explore the experiences of older people living with chronic lung disease. Data were analysed using reflexive thematic analysis. RESULTS: A total of 14 participants (eight female and six male) aged between 64 and 86 years were interviewed. Three themes emerged from the data: motivation, authentic social engagement, and sustainable achievement. Motivation stemmed from the participants' perceived health benefits, and from the trainers' motivation and encouragement. Participants discussed how sharing experiences created an environment of trust and understanding, fun and friendship. Social engagement and creating authentic relationships were key aspects raised by participants. Feeling more confident in themselves and being able to accomplish physical tasks, making activities of daily living more manageable featured highly in participants' responses. DISCUSSION AND CONCLUSION: Community-based peer support exercise groups enable environments for people with chronic lung disease to maintain physical fitness, and to connect with others

Individuals with dementia and their informal caregivers face significant challenges to their psychosocial well-being, necessitating immediate attention. In spite of the prevalence of this problem, there is limited data regarding the factors that influence the dyadic psychosocial well-being and potential actor-partner influencing mechanisms. Therefore, this review was conducted to synthesise the factors associated with the psychosocial well-being of people with dementia and their informal caregivers. MEDLINE via EBSCOhost, CINAHL, PsycINFO, Embase and Scopus were systematically searched to identify relevant studies. Quantitative, qualitative or mixed-method studies examining the factors influencing dyadic psychosocial well-being outcomes were included. The quality of included studies was assessed using Joanna Briggs Institute Critical Appraisal checklists. A narrative synthesis approach was employed for data analysis. A total of 3217 records were yield, out of which 26 studies were included in the analysis. Quality of life emerged as the most extensively investigated dyadic psychosocial well-being outcome, followed by depression. The interrelation between the quality of life for people with dementia and caregivers was observed, where individual members' quality of life was influenced by their own, partner and dyadic factors. However, there is a dearth of research exploring the mechanisms through which one member's factors exert influence on both their own and partner's quality of life within the dyad. This gap also exists for other psychosocial well-being outcomes, such as depression and anxiety. Further research is warranted to elucidate the underlying mechanisms through which dyadic members influence their own and their partner's psychosocial well-being.

Forensic mental health nursing is a specialty area of practice requiring specific knowledge and skills to work collaboratively with consumers. The Clinical Reasoning Cycle has been recognised as a potential framework to support nursing practice; however, it has been identified that adaptations are required to enhance utility in a forensic mental health services. The aim of this study was to explore and finalise a version of the cycle for forensic mental health nursing practice. Focus groups and interviews were used to explore adaptations with staff from a state-wide forensic service and forensic mental health nursing academics. Data were thematically analysed. Four main themes were interpreted: (1) allegiance to the Nursing Process, (2) moving the cycle from page to practice, (3) working as a team, or not, and (4) implementation will be a marathon and not a sprint. While nursing academics were more in favour of updating the Nursing Process to ensure contemporary practice is captured, staff from the service were supportive of the adapted cycle but emphasised the need to ensure collaboration with the consumer and their supporters. The adapted cycle was seen to articulate the contribution of forensic mental health nursing care, and support for a nursing-specific cycle was embraced by other disciplines, despite some hesitation from nurses. Prior to implementation there is a need to ensure the merits of the cycle are clearly articulated, along with a range of resources and specific contextual information to ensure the cycle can be successfully applied to enhance nursing practice and consumer care.

High staff turnover is common within the Australian public mental health workforce, contributing to workforce shortages and ultimately impacting the ability to provide stable efficient, effective, and ongoing optimal care to the community. In this study, we aimed to (a) establish the most pertinent factors associated with increased turnover intention in the public mental health workforce in Australia, and (b) establish whether such factors differ between metropolitan and rural services. We used a cross-sectional, correlational design using an online survey method. In total, 235 mental health service staff of various disciplines and levels, from four public hospitals in Victoria, Australia participated in the study. We used three feed-forward multiple regression analyses to assess the study aims. We found that job satisfaction, occupational burnout, and understaffing may be the most pertinent factors to consider regarding turnover intention. Job satisfaction and occupational burnout were factors endorsed across the entire sample, as well as specifically within both the metropolitan and rural services, while understaffing was a pertinent factor regarding turnover intention across the entire sample and for rural services, but not metropolitan services. Our findings regarding the pertinence of job satisfaction, occupational burnout, and understaffing in turnover intention provide key information that may be used to inform interventional targets aimed at reducing attrition from the public mental health workforce in Australia.

BACKGROUND People experiencing homelessness also experience poorer health and frequently attend acute care settings when primary health care would be better equipped to meet their needs Existing scholarship identifies a complex mix of individual and structural level factors affecting primary health care engagement driving this pattern of health services utilisation We build on this existing knowledge by bringing the spatio temporal configurations of primary health care into focus Specifically we interrogate how space and time inflect situated practices and relations of care METHODS This study took an ethnographic approach and was conducted 2021 2022 at an inclusive health and wellness centre the Centre in Southeast Queensland Australia The data consists of 46 interviews with 48 people with lived experience of homelessness including participants who use the services offered at the Centre n 26 and participants who do not n 19 We also interviewed 20 clinical and non clinical service providers affiliated with the Centre and observed how service delivery took place Interviews and observations were complemented by visual data including participant produced photography All data were analysed employing a narrative framework RESULTS We present three interrelated themes demonstrating how space and time affect care that is staying safe feeling welcome and being seen Staying safe captures the perceptions and practices around safety which sit in tension with making service users feel welcome Feeling welcome attends to the sense of being invited to use services free of judgment Being seen depicts capacities to see a health care provider as well as being understood in one s lived experience CONCLUSION Spatio temporal configurations such as attendance policies consultation modalities and time allocated to care encounters afford differential opportunities to nurture reciprocal relations We conclude that flexible service configurations can leverage a relational model of care PATIENT

Sleep quality and sleep duration are important for children's physical and mental health. Mental health diagnoses and sleep disturbances may be interlinked. We sought to identify the methods used to assess sleep in paediatric community-based mental health programmes. A systematic review was conducted using an a priori protocol to ascertain the sleep assessment methods used in paediatric community-based mental health programmes. Children for this review were defined as any person under the age of 19. Cochrane Library, CINAHL, Web of Science, ProQuest, APA PsycInfo, and PubMed databases were searched from January 2021 to March 2022. Of the 320 records screened, 314 records were excluded. Six studies were included for analysis. A variety of validated and non-validated sleep instruments were used to measure sleep quality and a range of sleep disturbances in community health programmes for children. There were a limited number of studies associated with sleep assessment in paediatric community-based settings suggesting this is an area of research that may be understudied. Sleep questionnaires were predominately completed by parents or guardians. Further research is required to establish the most effective method for screening sleep behaviour in paediatric community mental health programmes to understand the impact of sleep in the recovery of children and adolescents with mental health disorders.

This perspective paper presents a discussion around the issues of sexual violence (SV) in rural and remote areas and the associated discourses of shame. The authors propose that shame of SV adds additional trauma to survivors, further impacting survivors' mental health which may be exacerbated in rural areas. Shame is a complex emotion that can result in increased feelings of guilt, humiliation, and embarrassment. Shame has been identified as an underlying risk factor and a mechanism for post-assault mental health problems. We propose it can be particularly pronounced for women subjected to sexual assault in rural or remote areas. This paper will explore the link between SV and shame, explain how shame attached to SV may be used as an informal social control mechanism for women, particularly in rural and remote areas, and discuss the role of health practitioners, particularly mental health nurses, who play a key role in supporting people impacted by SV. SV is an insidious social phenomenon that can have profound consequences for individuals, families, and communities. Addressing shame and stigma is a crucial component of supporting survivors of SV in rural and remote areas. There is a need for targeted community-led interventions and responsive support services to address the complex and multifaceted issues contributing to SV in rural and remote communities.

The aim of this study was to investigate coping styles, posttraumatic stress, and mental health symptoms among a sample of community members affected by 2019-20 Australian bushfires. Using a convenience sampling approach, an online survey was used to assess a range of coping strategies, posttraumatic stress and symptoms of depression, anxiety, and stress among the affected community members of Black Summer bushfires. The results revealed that study participants reported moderate symptoms of depression and stress, and severe levels of anxiety. Additionally, participants reported use of both approach and avoidance coping strategies following the bushfire event as well as experiencing symptoms of posttraumatic stress, such as having intrusive thoughts and symptoms of avoidance and hyperarousal. Despite the durability of many individuals, others remain affected by the event and there is evidence there may be longer term mental health consequences of the bushfires for some people. Given these findings, it is imperative that mental health services be readily available for people in the bushfire-affected areas. Mental health nurses have an important role to play in supporting individuals affected by disasters. Awareness of the short- and long-term impacts of disasters on the mental health of people is paramount for mental health nurses.

Alcohol and other drugs (AOD) use is a significant public health issue and is associated with high mortality and morbidity rates. Despite this, people who use drugs are often reluctant to seek care due to the lack of trauma-informed treatment and harm reduction treatment options, as well as experiences of stigma and discrimination in health services. Arguably, AOD education that is co-produced with people who use alcohol and drugs can enhance future health professionals' ability to practice in ways that support the needs of this population. This paper reports on a qualitative co-evaluation of a co-produced undergraduate nursing AOD subject. The AOD subject was co-planned, co-designed, co-delivered, and co-evaluated with experts by experience, who have a lived experience of substance dependence and work as advocates and peer workers. Following the delivery of the subject in 2021 and 2022, focus groups were undertaken with 12 nursing students. Focus group data indicate that the co-produced subject supported participants to understand and appreciate how stigma impacts on nursing care and how to recognize and undertake 'good' nursing care that was oriented to the needs of service users. Student participants noted that being co-taught by people who use drugs was particularly powerful for shifting their nursing perspectives on AOD use and nursing care and took learning beyond what could be understood from a book. Findings indicate that co-produced AOD education can shift nursing students' perceptions of AOD use by providing access to tacit knowledge and embodied equitable and collaborative relationships with people who use drugs.