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Introduction and aims Treatment of opioid dependence through opioid replacement therapy is widely recognised as effective. Nonetheless, while there has been a community-based program in the state of Victoria for over two decades, consumer experiences have received little attention. This study aimed to describe the experiences of opioid replacement therapy consumers living in rural and regional areas of the state. Design and methods A qualitative design employed an interpretative phenomenological approach. Sixteen consumers were interviewed. Thematic analysis was conducted by the researchers to examine the phenomena of consumers' experiences and findings were verified by a stakeholder group. Results Findings centred on themes of consumers' experience of becoming recipients; consumer perceptions of pharmacists and pharmacy settings and psychosocial impacts on consumers. A majority of participants believed opioid replacement therapy brought increased normality to their life, however systemic and psychosocial barriers impacted on well-being. The pharmacy setting itself as a public dosing space commonly provoked feelings of stigma and discrimination among consumers. Other barriers prominently reported were restrictions on number of takeaways, cost of dispensing and lack of access to medical practitioners and allied supports. Discussion and conclusions There were psychosocial impacts on opioid replacement therapy consumers relating to financial and social burdens, stigma and discrimination. Access to medical care and a choice of pharmacy appeared to be restricted in rural regions. The findings suggest a need to address, in particular, the financial and dispensing point burdens experienced by consumers to facilitate program retention.

To review the literature regarding the value and consumer focus of research on opioid replacement therapy (ORT) programs, relevant to the Australian rural context and community pharmacy. We conducted a narrative review of literature published between 1995 and 2015, searching EBSCOhost, PubMed and Google Scholar. Three authors collaborated to screen and synthesise studies. Effectiveness, cost affordability, diversion and retention benefits were reported from pharmacological or prescribers’ or dispensers’ standpoint. Research was fragmented and evaluated contributions of these individual types of stakeholders with less discussion of consumers, or consumers’ everyday experiences of ORT. No studies took into account consumers’ psychosocial aspects or power discourses. We found ORT as a beneficial treatment for opioid dependence is well researched, although overall Australian program evaluation was lacking. A gap within ORT literature should be addressed by making consumer experiences central in designs for future research and for program evaluation.

The implementation of action learning workshops in three nursing homes in rural Victoria, Australia has been critical in the re-visioning of how care can be enhanced for residents. The workshops were designed with the intent of improving quality of care for residents by providing health care staff with opportunities to learn together and effect cultural change. Valuing what was accomplished well in these nursing homes was the starting point. The project was funded by a Commonwealth Government Rural Education Grant and was based on ‘My Home Life’ a popular programme that promotes quality of life and delivers positive change in care homes for older people across the United Kingdom. This paper provides an account of the project including key components of the action learning workshops and subsequent evaluation of the programme conducted in Australia. The lessons learnt throughout this project have provided the impetus to continue using appreciative inquiry and action learning to involve participants in reflecting on their practice, valuing what they do well while identifying areas that require change. Working together in a safe and respectful space provides participants with opportunity to harness their own collective wisdom and as the health professionals in this project experienced, also learn valuable skills that support progressive action that makes a difference to older people’s lives.

A study exploring older people's participation in their care in acute hospital settings reveals both consumers' and nurses' views of participation. Using a critical ethnographic design, data were collected through participant observation and interviews from consumers in acute care settings who were over 70 years old and nurses who were caring from them. Thematic analysis identified that older people equated participation with being independent. Importantly, consumers highlighted the complexity of the notion of participation when describing situations where they were unable to participate in their own care. The difficulties in communicating with health professionals and an inability to administer their own medications in inpatient settings were identified as barriers to participation. Understanding what consumers believe participation means provides a starting point for developing meaningful partnerships between health professionals and people receiving care.

Background: Nurses worldwide are expected to take a leading role in caring for older people. Considerable literature dedicated to the range and application of assessment skills used by nurses vary. There is limited knowledge of registered nurses' (RNs) views of their assessment of older adults.Aim: The aim of this project was to explore RNs current perceptions of nursing assessment, and the core skills they identified as necessary.Design: A qualitative descriptive design study was conducted in three inpatient units in one regional hospital in Victoria.Method: Date were collected through participant observation of RNs (n = 13) followed by 1:1 semi-structured interviews. Data were analysed thematically.Conclusion: This research has illuminated that an ill-defined repertoire of skills was used by RNs when assessing older persons. Skills identified appeared to be based on years of personal-professional experience. Differences were noted between the descriptions nurses gave and what was observed during interac...

The purpose of this study was to determine the impact of stroke on survivors of the condition and to identify their physical and psychosocial needs in rural and regional settings. Data were collected via focus group interviews with stroke survivors, carers and key informants. Data were managed using NUD*IST and analysed using a content analysis method identifying major themes related to the impact of living in the community after having a stroke. It was found that stroke survivors suffered severe physical and emotional effects. The findings also identified the vulnerability of this group and a lack of organised, on-going psychosocial and rehabilitative support. Recommendations are made to enhance the current management of stroke after the acute and subacute phases.

Communicating nursing care during the patient's total hospital stay is a difficult task to achieve within the context of high patient turnover, a lack of overlap time between shifts, and time constraints. Clear and accurate communication is pivotal to delivering high quality care and should be the gold standard in any clinical setting. Handover is a commonly used communication medium that requires review and critique. This study was conducted in five acute care settings at a major teaching hospital. Using a grounded theory approach, it explored the use of three types of handover techniques (verbal in the office, tape-recorded, and bedside handovers). Data were obtained from semi-structured interviews with nurses and participant field observations. Textual data were managed using NUD-IST. Transcripts were critically reviewed and major themes identified from the three types of handovers that illustrated their strengths and weaknesses. The findings of this study revealed that handover is more than just a forum for communicating patient care. It is also used as a place where nurses can debrief, clarify information and update knowledge. Overall, each type of handover had particular strengths and limitations; however, no one type of handover was appraised as being more effective. Achieving the multiple goals of handover presents researchers and clinicians with a challenging task. It is necessary to explore more creative ways of conducting the handover of patient care, so that an important aspect of nursing practice does not get classified as just another ritual.

Background This research explores family members’ experience of the end-of-life care (EoLC) that their loved one received at Ballarat Health Services (BHS). Participants’ were asked to describe the EoLC their relative received, including information given about the dying process by health care professionals (HCP). Aim The intent of the research was to explore the meaning of end of life care for family members. It is anticipated this research will inform the End-of-Life framework for BHS, in Victoria Australia. Methods A qualitative interpretative design was adopted and data was collected via semi-structured open-ended individual interviews. Interviews were audio recorded, transcribed and analysed to identify common themes. Results Thirteen participants shared their thoughts and memories of the death of their loved one and five key themes emerged: Communication Preparation for death Follow up after death The care experience The dying experience. Discussion Health care professionals are positioned to play an integral role in supporting the person who is dying and also their family during EoLC. This care is a vital focus for HCP in the last days and hours of the person dying and their family. It is essential that HCPs in all settings are equipped to provide the highest possible standard of EoLC. Conclusion This research will inform the EoL framework being developed to integrate the elements of: Advance Care Planning, a tool to help HCPs identify patients who are dying, medical goals of care documentation, a Care of the Dying Management Plan and a range of other supporting tools and documents.

Background Primary care professionals have a major role to play in access towards palliative care. Our hypothesis is that interprofessional teamwork within Multiprofessional Primary Health Care Centres (MPHCs) may contribute to early identification (EI) of patients at the end of life, in order to proceed to the multidimensional assessment (MA) of their needs. EI and MA are not enough and must be combined with an interprofessional training to anticipatory care planning (ACP) in order to increase referral to palliative care services. Aim To determine if the use of simple identification tools by a primary care team, coupled with an interprofessional training (based on simulation) can improve access to specialist palliative care for patients at the end of life. Methods Our mixed-methods research includes: a qualitative study in MPHCs and in patients, the development of a simulation-based training, and the evaluation of the whole intervention in a cluster randomised controlled trial. Results Improvement is expected regarding 1/access to specialist palliative care, 2/respect for the priorities of patients, and 3/unplanned admissions in the last weeks of life. Discussion Process evaluation will have to consider the influence of different regional contexts or economical models, and the extent of collaboration between primary and secondary care services. Conclusion Implementing ACP within interprofessional primary care might play a prominent role in accessing palliative care. A well-conducted assessment shall nevertheless precede any wider dissemination.

This paper will examine and discuss some of the strengths and weaknesses of conceiving nursing as a form of praxis, encompassing within this, the idea that in order to conceive nursing as a form of praxis, reflection has to be considered a key component. It will be argued that praxis can (and should) become a practical process and that, when applied to one's own nursing practice, changes, reshapes and allows one to discover new meanings (or, draws out the meanings which were always there). Clearly there are many different forms, understandings and applications of the term praxis and this paper will examine some of the tensions and the nexus that exist. These claims will be supported by using personal-professional journal extracts as a catalyst, showing that there is potential for closing the theory-practice gap through more in-depth reflection, and that this examination using reflective techniques will demonstrate that nurses, by using this process develop their own implicit personal nursing theories. Using one's colleagues as a critical resource allows what might be described as ongoing reflection to occur, where critical friends in both theoretical and practice worlds act as a dialectical catalyst for growth and change, moving toward closing the theory-practice gap.

Reflective inquiry in nursing practice or 'revealing images' Nurses live and work in complex practice worlds; worlds of shrinking resources and expanding needs. Reflection through journaling offers unique opportunities to gain insight into practice. What might we learn from one's journal? A reflective journal can be a source of interplay between the self as written and the self as other. Likewise, the journal may act to situate ourselves in practice, while at the same time enabling us to illuminate how and in what ways our understandings have become distorted. The extent to which one's journal is educative depends upon the manner in which one chooses to use it as a transformative tool, a tool that might well be described as a process of healing and enlightenment. In order to illustrate the reflexive nature of journaling, this paper is presented as a play reading, where a conversation about practice stories between the different aspects of the nurse's self is depicted. In adopting a play reading, an alternative pedagogical tool is used to illustrate different methodologies exemplifying the emergence of how and in what ways we develop and reconstruct our understanding in nursing.