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Accessible summary What is known on the subject? Mental health service users with medical co-morbidity frequently experience difficulties accessing and receiving appropriate treatment in emergency departments., Service users frequently experience fragmented care planning and coordinating between tertiary medical and primary care services., Little is known about mental health nurses' perspectives about how to address these problems., What this paper adds to existing knowledge? Emergency department clinicians' poor communication and negative attitudes have adverse effects on service users and the quality of care they receive., The findings contribute to the international evidence about mental health nurses' perspectives of service users feeling confused and frustrated in this situation, and improving coordination and continuity of care, facilitating transitions and increasing family and caregiver participation., Intervention studies are needed to evaluate if adoption of these measures leads to sustainable improvements in care planning and coordination, and how service users with medical co-morbidity are treated in emergency departments in particular., What are the implications for practice? Effective planning and coordination of care are essential to enable smooth transitions between tertiary medical (emergency departments in particular) and primary care services for service users with medical co-morbidity., Ongoing professional development education and support is needed for emergency department clinicians. There is also a need to develop an organized and systemic approach to improving service users' experience in emergency departments., Abstract Introduction Mental health service users with medical co-morbidity frequently experience difficulties accessing appropriate treatment in medical hospitals, and often there is poor collaboration within and between services. Little is known about mental health nurses' perspectives on how to address these problems. Aim To explore mental health nurses' perspectives of the experience of service users with medical co-morbidity in tertiary medical services, and to identify how to improve care planning and coordination for service users transitioning between tertiary medical and primary care services. Method Embedded within an experience-based co-design study, focus group discussions were conducted with 17 emergency department nurses and other clinicians, in Melbourne, Australia. Results Three main themes were abstracted from the data: feeling confused and frustrated, enhancing service users' transition and experience and involving families and caregivers. Participants perceived the service user experience to be characterized by fear, confusion and a sense of not being listened to. They highlighted that service users' transition and experience could be enhanced by facilitating transitions and improving coordination and continuity of care. They also emphasized the need to increase family and caregiver participation. Conclusion Our findings contribute to knowledge about improving the way service users are treated in emergency departments and improving care planning and coordination; in particular, facilitating transitions, improving coordination and continuity of care and increasing family and caregiver participation. [ABSTRACT FROM AUTHOR]

Background: The term 'life limiting conditions' refers to premature death following decline from chronic conditions, which is a common circumstance in which occupational therapists work with people at the end of life. The challenges for clinicians of working with these patients have long been recognised, and may have a significant impact on their professional self-care. This study aimed to evaluate a multidimensional workplace strategy to improve the professional self-care of occupational therapists working with people living with a life limiting condition., Methods: A pre and post mixed methods survey approach were utilised, with baseline data collection prior to the implementation of a multidimensional workplace strategy. The strategy included professional resilience education, targeted supervision prompts, changes to departmental culture and the promotion of self-care services across multiple organisational levels. Follow up data collection was undertaken after the strategy had been in place for 2 years. Quantitative data were analysed descriptively, while qualitative data were subjected to thematic analysis., Results: One hundred three occupational therapists responded (n = 55 pre, n = 48 post) across multiple service settings. Complex emotional responses and lived experiences were identified by participants working with patients with life limiting conditions, which were not influenced by the workplace strategy. Working with these patients was acknowledged to challenge the traditional focus of occupational therapy on rehabilitation and recovery. Participants were confident about their ability to access self-care support, and supervision emerged as a key medium. While the strategy increased the proportion of occupational therapists undertaking targeted training, around half identified ongoing unmet need around professional self-care with this patient group. Demographic factors (e.g. practice setting, years of experience) also had a significant impact on the experience and needs of participants., Conclusions: The multidimensional workplace strategy resulted in some improvements in professional self-care for occupational therapists, particularly around their use of supervision and awareness of available support resources. However, it did not impact upon their lived experience of working with people with life limiting conditions, and there remain significant gaps in our knowledge of support strategies for self-care of occupational therapist working with this patient group.

Introduction: Supervisors of occupational therapists play a key role facilitating reflective practice with their supervisees. Through reflective practice, supervisees can optimise their skills in professional reasoning and decision making. The aim of this study was to describe to what degree reflective practice is facilitated within occupational therapy supervision processes., Methods: A mixed methods study design was used, collecting data via online surveys and focus groups. Quantitative data were initially analysed using descriptive statistics. Qualitative and quantitative data were then thematically analysed to identify hindering and enabling mechanisms to reflective practice facilitation., Results: Eighteen supervisees and 17 supervising occupational therapists completed the surveys and 14 supervisors participated in a focus group. Half of the supervisees reported that reflective practice was facilitated through supervision only "rarely" or "sometimes." A hindering mechanism to reflective practice facilitation was the awareness of reflective practice models. Enabling mechanisms for reflective practice facilitation included understanding the benefits of reflective practice; recognising the attributes of a reflective practice practitioner; setting up an optimal supervision environment; and flexibly facilitating reflective practice., Conclusion: Findings suggest that reflective practice is not always regularly facilitated through supervision. This may limit opportunities for supervisees to optimise the development of their professional reasoning and clinical skills in the early stages of their careers., (© 2020 Occupational Therapy Australia.)

Background: Evidence shows that engaging consumers and clinicians in development of health services creates a more responsive, integrated service that better meets the needs of consumers and the community of practice it serves. Further, consumer and clinician participation in service development processes can boost confidence and motivation levels in organisational employees and help foster clinical accountability., Objective: To see where consumers' care experiences could be improved by better understanding where care coordination organisational systems needed improvement., Methods: Experienced based co-design informed an investigation of consumer and clinician experiences of a care coordination service and involved the sharing of those experiences across service employees in a series of iterative and feedback loops over eighteen months (July 2012-January 2014). Formal participants included care coordination clinicians (n = 13) and consumers. Data from formal participants were collected during September-December 2012, consisting of consumer video-recorded and clinician audio-recorded interviews. Interview transcriptions were analysed to identify service "touch points", being emotionally significant events related to key service aspects that connect or disconnect consumers and/or clinicians., Results: Results revealed that consumers highly valued the transdisciplinary skill base of the care coordination workforce, though service improvements were needed for transition support, quality discharge planning and conveying better understandings of care coordination activity both internally and externally., Conclusion: Incorporating consumer and clinician view-points about their experiences, including the production of a DVD, facilitated conversations across the entire service about care coordination provision and provided a catalyst for design improvement that may otherwise have been difficult to achieve. Some changes to the service were made such as improved client complaints processes, new roles for the care coordination service, and enlisting clinical staff to undertake motivational interviewing training to promote greater consumer self-management capacity. In this study, the user experience was given a platform within a larger healthcare workforce capability development project., Competing Interests: The authors have declared that no competing interests exist.

To use experience-based co-design to identify the key design requirements of a peer support model for critical care survivors; understand the use of the experience-based co-design method from clinician, patients, and family perspectives., Design: Using experience-based co-design, qualitative data about participants' preferences for a peer support model were generated via workshops. Participants' perspectives of experience-based co-design were evaluated with focus groups., Setting: University-affiliated hospital in Melbourne, Australia., Subjects: Snowball sampling was used to recruit clinicians from across the care spectrum (ICU-community); critical care survivors and nominated family members were recruited using convenience sampling., Measurements and Main Results: Consensus on a peer support model was reached through the experience-based co-design process, with the following key themes: 1) socialization and group cohesion; 2) management of potential risks; and 3) individualized needs of patients and families. Evaluation of participants' perspectives of the experience-based co-design method identified five key themes: 1) participation as a positive experience; 2) emotional engagement in the process; 3) learning from patients and family members; 4) feeling heard; and 5) practical challenges of experience-based co-design and readiness to participate., Conclusions: Experience-based co-design was a feasible approach to developing a peer support model for use with critical care survivors and was well received by participants. Future testing of the co-designed peer support model in a pilot randomized controlled trial will enhance understanding of peer support in critical care and the use of experience-based co-design as a design methodology., Competing Interests: Drs. Haines’s, Holdsworth’s, Cranwell’s, Skinner’s, Holton’s, Bates’s, Booth’s, Carmody’s, Searle’s, and Shackell’s institutions received funding from Society of Critical Care Medicine (SCCM) (THRIVE grant) and Western Health. Dr. Skinner’s institution also received funding from Canadian Institutes of Health Research, National Health and Medical Research Council (Australia), HCF Research Foundation (Australia), and Deakin University (Australia), and she received funding from Western Health and Melbourne Health. Dr. Iwashyna disclosed that he is a government employee (U.S. Department of Veterans Affairs). Dr. French’s institution received funding from SCCM. Dr. Maher’s institution received funding from Western Health. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright (c) 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)

Background: Mental health service users have high rates of medical co-morbidity but frequently experience problems accessing and transitioning between tertiary medical and primary care services. The aim of this study was to identify ways to improve service users' with medical co-morbidity care and experience during their transition between tertiary medical hospitals and primary care services., Method: Experience-based co-design (EBCD) qualitative study incorporating a focus group discussion. The study took place in a large tertiary medical service, incorporating three medical hospitals, and primary care services, in Melbourne, Australia. A purposive sample of service users and their caregivers and tertiary medical and primary care clinicians participated in the focus group discussion, in August 2014. A semi-structured interview guide was used to inform data collection. A thematic analysis of the data was undertaken., Results: Thirteen participants took part in the focus group interview, comprising 5 service users, 2 caregivers and 6 clinicians. Five themes were abstracted from the data, illustrating participants' perspectives about factors that facilitated (clinicians' expertise, engagement and accessibility enhancing transition) and presented as barriers (improving access pathways; enhancing communication and continuity of care; improving clinicians' attitudes; and increasing caregiver participation) to service users' progress through tertiary medical and primary care services. A sixth theme, enhancing service users' transition, incorporated three strategies to enhance their transition through tertiary medical and primary care services., Conclusion: EBCD is a useful approach to collaboratively develop strategies to improve service users' with medical co-morbidity and their caregivers' transition between tertiary medical and primary care services. A whole-of-service approach, incorporating policy development and implementation, change of practice philosophy, professional development education and support for clinicians, and acceptance of the need for caregiver participation, is required to improve service users' transition.

Medical comorbidity in people with long-term mental illness is common and often undetected; however, these consumers frequently experience problems accessing and receiving appropriate treatment in public health-care services. The aim of the present study was to understand the lived experience of mental health consumers with medical comorbidity and their carers transitioning through tertiary medical to primary care services. An interpretative, phenomenological analysis approach was used, and semistructured, video-recorded, qualitative interviews were used with 12 consumers and four primary caregivers. Four main themes and related subthemes were abstracted from the data, highlighting consumer's and carers' experience of transition through tertiary medical to primary care services: (i) accessing tertiary services is difficult and time consuming; (ii) contrasting experiences of clinician engagement and support; (iii) lack of continuity between tertiary medical and primary care services; and (iv) Mental Health Hospital Admission Reduction Programme (MH HARP) clinicians facilitating transition. Our findings have implications for organisational change, expanding the role of MH HARP clinicians (whose primary role is to provide consumers with intensive support and care coordination to prevent avoidable tertiary medical hospital use), and the employment of consumer and carer consultants in tertiary medical settings, especially emergency departments., (© 2016 The Authors International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd. on behalf of Australian College of Mental Health Nurses Inc.)

Background: The care coordination workforce includes a range of clinicians who manage care for patients with multiple chronic conditions both within and outside a hospital, in the community, or in a patient's home. These patients require a multi-skilled approach to support complex care and social support needs as they are typically high users of health, community, and social services. In Australia, workforce structures have not kept pace with this new and emerging workforce. The aim of the study was to develop, map, and analyse workforce functions of a care coordination team., Methods: Workflow modelling informed the development of an activity log that was used to collect workflow data in 2013 from care coordinators located within the care coordination service offered by a Local Health Network in Australia. The activity log comprised a detailed classification of care coordination functions based on two major categories - direct and indirect care. Direct care functions were grouped into eight domains. A descriptive quantitative investigation design was used for data analysis. The data was analysed using univariate descriptive statistics with results presented in tables and a figure., Results: Care coordinators spent more time (70.9%) on direct care than indirect care (29.1%). Domains of direct care that occupied the most time relative to the 38 direct care functions were 'Assessment' (14.1%), 'Documentation' (13.9%), 'Travel time' (6.3%), and 'Accepting/discussing referral' (5.7%). 'Administration' formed a large component of indirect care functions (14.8%), followed by 'Travel' (12.4%). Sub-analyses of direct care by domains revealed that a group of designated 'core care coordination functions' contributed to 40.6% of direct care functions., Conclusions: The modelling of care coordination functions and the descriptions of workflow activity support local development of care coordination capacity and workforce capability through extensive practice redesigns.