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Introduction: People who inject drugs experience stigma across multiple settings, including when accessing health‐care services, however, comparatively little is known about experiences of stigma towards other groups of people who use illegal drugs. This paper examines experience of, and factors associated with, stigma among two samples of people who use illegal drugs when visiting both specialist alcohol and other drug (AOD) and general health‐care services. Methods: Australians who regularly (i.e., ≥monthly) inject drugs (n = 879; illicit drug reporting system [IDRS]) or use ecstasy and/or other illegal stimulants (n = 700; ecstasy and related drugs reporting system [EDRS]) were surveyed between April and July 2022 about past 6‐month experience of stigma in the above services. Multi‐variable regression analyses were performed to determine the socio‐demographic, drug use and health factors associated with stigma. Results: Experiences of stigma in general health‐care services were more common among IDRS (40%) than EDRS (24%; p < 0.001) participants, however, experiences were comparable in specialist AOD health‐care settings (22% and 20%, respectively; p = 0.687). Gender identity and experiencing high psychological distress were associated with experiencing stigma across both samples. Past‐year overdose was associated with experiencing stigma among the IDRS sample, while unstable housing and incomplete high school education were associated with experiencing stigma in the EDRS sample. Discussion and Conclusions: Experiences of stigma when accessing health‐care services are relatively common across different populations of people who use illegal drugs. Our findings highlight the multiple and intersecting dimensions of stigma and provide further support for recent calls for a universal precautions approach to stigma in health care. [ABSTRACT FROM AUTHOR]

Aims: This work aims to explore staff perceptions of (1) the effectiveness of organizational communication during the COVID‐19 pandemic and (2) the impact of organizational communication on staff well‐being and ability to progress their work and patient care. Background: Effective coordination and communication are essential in a pandemic management response. However, the effectiveness of communication strategies used during the COVID‐19 pandemic is not well understood. Design: An exploratory cross‐sectional research design was used. A 33‐item survey tool was created for the study. Methods: The study was conducted at a tertiary teaching hospital in Western Australia. Convenience sampling was used to recruit participants from nursing, medical, allied health services, administrative and clerical, and personal support services (N = 325). Data were collected between December 2020 and May 2021. Results: Overall, all occupational groups found working during the COVID‐19 pandemic stressful, and all groups wanted accessible and accurate communication from management and new policies, procedures, and protocols for future outbreaks. Conclusions: The use of occupational group‐relevant strategies and COVID‐19 protocols, as well as the on‐going use of email, face‐to‐face meetings with debrief sessions, are needed to improve communication and support staff to fulfil their roles. Summary statement: What is already known about the topic? Effective coordination and communication that is timely and two‐way in nature, is an essential part of a pandemic management response. What this paper adds? All occupational groups found working during the COVID‐19 pandemic stressful; all groups wanted accessible and accurate communication from management and new policies, procedures, and protocols for future outbreaks. The implications of this paper: Managing a pandemic situation in health care settings is challenging for all levels of staff including management and all occupational work groups.The use of occupational group‐relevant strategies and COVID‐19 protocols, as well as the on‐going use of email, face‐to‐face meetings with debrief sessions, are needed to improve communication and support staff to fulfil their roles. [ABSTRACT FROM AUTHOR]

Patients from racial/ethnic minority backgrounds can experience racism and race-based discrimination in the health system, enduring unfair and inferior treatment that negatively affects physical and mental health and well-being and may, in some cases, lead to premature and avoidable death. Racism within the health system also acts as a deterrent to health care access because individuals may choose to avoid healthcare settings for fear of repeated exposure to racism. Racism and its impacts in health are well documented and health care-related regulatory organisations and antidiscrimination commissions in Australia are the recipients of racism complaints that occur within the health system. However, the extent and nature of complaints of racism in healthcare settings (i.e. self-reported incidents of racism) and how they are managed by regulatory organisations and antidiscrimination commissions are not well understood. This paper provides a summary of existing approaches to complaints in the Australian health system related to healthcare regulatory organisations and antidiscrimination commissions. We offer recommendations for improvements to data collection and dissemination of racism complaints to better understand the nature and extent of racism and race-based discrimination in the health system, and thus inform changes to process and practices that will reduce the incidence of racism and improve health outcomes. [ABSTRACT FROM AUTHOR]

Objective: In 2018 the Australian Commission on Quality and Safety in Health Care released a new consumer driven Australian Hospital Patient Experience Question set. The objective was to explore the acceptability, adoption, appropriateness, feasibility, fidelity, penetration, resources and sustainability of implementing the AHPEQS, and to review which questions correlated with overall rating of care. Methods: Thirty-six Australian private hospitals participated in the AHPEQS implementation over an 18-month period. Results: Responses were analysed for 86 180 patient experience surveys. Positive patient experiences (Question 12) correlated most highly with Question 2 (My individual needs were met; correlation coefficient (CC) 0.45, P < 0.001), Question 4 (I felt cared for; CC 0.45, P < 0.001) and Question 9 (When I was in the hospital, I felt confident in the safety of my treatment and care; CC 0.44, P < 0.001). Day procedure patients rated their experience higher than overnight patients. Uptake was rapid across the 36 hospitals, with minimal resources and demonstrable acceptability, adoption, appropriateness, feasibility, fidelity, penetration and sustainability. Conclusion: Utilising a consumer-driven survey highlighting treatment and care, assisted in enhancing staff engagement and continuous improvement in patient experience in acute, day procedure and rehabilitation hospitals. What is known about the topic?: Patient experience in hospital is associated with healthcare quality, safety and outcomes. What does this paper add?: From a consumer perspective, feeling cared for, having needs met and confidence in the safety of care, correlated with a positive patient experience. What are the implications for practitioners?: Investing staff time and health service resources into a consumer-driven patient experience survey tool, which highlighted treatment and care, assisted in enhancing staff engagement and continuous improvement in patient experience in acute, day procedure and rehabilitation hospitals. [ABSTRACT FROM AUTHOR]

Drawing on findings from a study of two social generations of gender and sexuality diverse Australians, this paper offers a critical analysis of expectations and experiences of inclusive health care for LGBTQ+ youth. Data were collected by means of individual and focus group interviews with people from two different social generations who grew up in regional or urban Australia: those born in the 1970s (n = 50) and those born in the 1990s (n = 71). Data were analysed inductively to develop insights into what inclusive health care meant, and what this revealed about the potential for fostering belonging in healthcare settings. Findings raise critical questions about how inclusiveness of care might best be understood in encounters between gender and sexual minorities and health professionals. In particular, forms of 'inclusivity labour' were observed across the social generations, both in terms of the work involved in seeking to locate supportive services, and in assessing the performance of clinicians in healthcare settings, with implications for the continued engagement of LGBTQ+ young people with essential forms of care. Mobilising contemporary forms of inclusivity labour, including attention to the affective dimensions of healthcare engagement, has the potential to promote both better health and more meaningful experiences of belonging for gender and sexual minorities. [ABSTRACT FROM AUTHOR]

This paper reports the impact of a major life event–death–on the physical, psychological and social well-being of the deceased’s close friends. We utilised data from a large longitudinal survey covering a period of 14 years (2002–2015) consisting a cohort of 26,515 individuals in Australia, of whom 9,586 had experienced the death of at least one close friend. This longitudinal cohort dataset comprises responses to the SF-36 (health related quality of life measure) and allowed for analysis of the short and longer-term impacts of bereavement. In order to manage the heterogeneity of the socio-demographics of respondents who did/not experience a death event, we use a new and robust approach known as the Entropy Balancing method to construct a set of weights applied to the bereaved group and the control group (the group that did not experience death). This approach enables us to match the two groups so that the distribution of socio-demographic variables between the two groups are balanced. These variables included gender, age, marital status, ethnicity, personality traits, religion, relative socio-economic disadvantage, economic resources, and education and occupation and where they resided. The data show, for the first time, a range of negative and enduring consequences experienced by people following the death of a close friend. Significant adverse physical and psychological well-being, poorer mental health and social functioning occur up to four years following bereavement. Bereaved females experienced a sharper fall in vitality, suffered greater deterioration in mental health, impaired emotional and social functioning than the male counterparts up to four years after the death. The data show that the level of social connectedness plays an important role in bereavement outcomes. Specifically, we found that less socially active respondents experienced a longer deterioration in physical and psychological health. Finally, we found evidence that the death of a close friend lowered the respondent’s satisfaction with their health. Since death of friends is a universal phenomenon, we conclude the paper by reflecting on the need to recognise the death of a close friend as a substantial experience, and to offer support and services to address this disenfranchised grief. Recognising bereaved friends as a group experiencing adverse outcomes can be used internationally to prompt health and psychological services to assist this specific group, noting that there may be substantial longevity to the negative sequelae of the death of a friend. Facilitating bereaved people’s support networks may be a fruitful approach to minimising these negative outcomes. [ABSTRACT FROM AUTHOR]

Background: Middle ear disease (otitis media) is endemic among Aboriginal and Torres Strait Islander children in Australia and represents an important cause of hearing loss. The disease is the result of a mix of biological, environmental and host risk factors that interact in complex, non-linear ways along a dynamic continuum. As such, it is generally recognised that a holistic, systems approach is required to reverse the high rates of otitis media in Aboriginal and Torres Strait Islander children. The objective of this paper is to examine the alignment between efforts designed to address otitis media in Aboriginal and Torres Strait Islander children in Queensland, Australia and core concepts of systems thinking. This paper’s overall purpose is to identify which combination of activities, and at which level, hold the potential to facilitate systems changes to better support ear health among Aboriginal and Torres Strait Islander children. Methods: We began with a review of documents identified in consultation with stakeholders and an online search. In addition, key informants were invited to participate in an online survey and a face-to-face or phone interview. Qualitative interviews using a semi-structured interview guide were used to explore survey responses in more depth. We also undertook interviews at the community level to elicit a diverse range of views. Ideas, statements or activities reported in the documents and interviews as being performed under the Intervention Level Framework were identified using qualitative thematic and content analysis. A quantitative descriptive analysis was also undertaken, whereby data was extracted into an Excel spreadsheet and coded under the relevant strategic directions and performance indicators of the Framework. Subsequently, we coded activities against the five-level intervention framework developed by Malhi and colleagues, that is: 1) paradigm; 2) goals; 3) system structure; 4) feedback and delays; and 5) structural elements. Results: Overall, twenty documents were reviewed. We examined surveys and interviews with six key informants. Twenty-four individual and 3 group interviews were conducted across central and community level informants. One hundred and four items were coded from the 20 documents and 156 items from interview data. For both data sets, the majority of activities were coded at the structural elements level. The results suggested three key areas where further work is needed to drive sustained improvements: 1) build the governance structures needed for paradigm shift to achieve a multi-sectoral approach; 2) develop shared system level goals; 3) develop system-wide feedback processes. Conclusions: Sustained progress in improving ear health within Aboriginal and Torres Strait Islander children requires a holistic, system-wide approach. To advance such work, governance structures for multi-sectoral collaboration including the development of joint goals and monitoring and feedback are required. Intervening at these higher leverage points could have a profound effect on persistent public health issues. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper was to use current stroke care guidelines to identify and discuss current stroke care challenges in rural Australian health care and potential solutions for delivery of evidence‐based practice. Design and setting: A review of national guidelines since 2002 for organised stroke care was undertaken to determine best practice for delivering primary stroke care. We then employed a narrative literature review strategy looking at relevant articles, based on keywords, outlining current stroke service availability in Australia, highlighting the challenges of implementing evidence‐based stroke care in rural areas in Australia based on the current guidelines. Results: Delivery of evidence‐based stroke care in rural Australia is fraught with challenges. Although national best‐practice guidelines for stroke care are well established, the recommendations made in these guidelines do not always reflect the resource availability in rural Australia. Redesigning processes and utilising available resources, such as telemedicine or local clinical pathways, can achieve an evidence‐based standard; however, ultimately better resourcing of these areas is required. Conclusion: Evidence‐based stroke care, aligned with current national standards is the key to providing adequate stroke services in rural Australia. Improved health service resourcing and better utilisation of currently available resources are options for achieving elements of evidence‐based stroke care. Implications for public health: Availability of adequate services for stroke patients directly impacts public health as it determines health outcomes for these patients. Indirect implications for public health include the effects on health professionals and the general public. [ABSTRACT FROM AUTHOR]

Errors-in-variables (EIV) regression is widely used in econometric models. The statistical analysis becomes challenging when the regression function is discontinuous and the distribution of measurement error is unknown. In the literature, most existing jump regression methods either assume that there is no measurement error involved or require that jumps are explicitly detected before the regression function can be estimated. In some applications, however, the ultimate goal is to estimate the regression function and to preserve the jumps in the process of estimation. In this paper, we are concerned with reconstructing jump regression curve from data that involve measurement error. We propose a direct jump-preserving method that does not explicitly detect jumps. The challenge of restoring jump structure masked by measurement error is handled by local clustering. Theoretical analysis shows that the proposed curve estimator is statistically consistent. A numerical comparison with an existing jump regression method highlights its jump-preserving property. Finally, we demonstrate our method by an application to a health tax policy study in Australia. [ABSTRACT FROM AUTHOR]

Background: Home visiting programs are implemented in high income countries to improve outcomes for families with young children. Significant resources are invested in such programs and high quality evaluations are important. In the context of research trials, implementation quality is often poorly reported and, when reported, is variable. This paper presents the quality of implementation of the right@home program, a sustained nurse home visiting intervention trialled in Australia, and delivered in a ‘real world’ context through usual child and family health services. right@home is structured around the core Maternal Early Childhood Sustained Home-visiting (MECSH) program, which is a salutogenic, child focused prevention model. Method: At each visit right@home practitioners completed a checklist detailing the client unique identifier, date of contact and activities undertaken. These checklists were collated to provide data on intervention dose, retention to program completion at child age 2 years, and visit content, which were compared with the program schedule. Quality of family-provider relationship was measured using the Session Rating Scale. Exploratory factor analysis was conducted to identify clusters of activities and allow qualitative assessment of concordance between program aims and program delivery. Results: Of 363 intervention families offered the program, 352 (97·0%) commenced the program and 304 (87·3%) completed the program to child age 2 years. 253 of 352 (71·9%) families who commenced the program received more than 75 percent of scheduled visits including at least one antenatal visit. Families rated the participant-practitioner relationship highly (mean 39.4/40). The factor analysis identified six antenatal and six postnatal components which were concordant with the program aims. Conclusions: The right@home program was delivered with higher adherence to program dose, schedule and content, and retention than usually reported in other home visiting research. Program compliance may have resulted from program design (visit schedule, dose, content and delivery flexibility) that was consistent with family aims. [ABSTRACT FROM AUTHOR]

Background: Rural Australian populations experience an increased burden of ischaemic heart disease (IHD) compared to their metropolitan counterparts, similar to other developed countries, globally. Policy and other efforts need to address and acknowledge these differences in order to reduce inequalities in health burden. This paper examines rural health policy makers’ perceptions and use of evidence in efforts to reduce the burden of IHD in rural areas. Methods: Policy makers and government advisors (n = 21) who worked with, or advised on, rural health policy at local, state and federal government levels, with specific focus on the state of Victoria (n = 9) were identified from publicly available documents and subsequent snowball sample. Semi-structured qualitative interviews were conducted in regards to the use of evidence in policy to prevent IHD and thematic analysis undertaken applying two theoretical perspectives: context-based evidence-based policy making and the conceptual framework for understanding rural and remote health. Results: The rural context, particularly low resourcing, was seen as limiting potential for evidence based policy at local government (LG) level. Lower levels of political pressure and education were seen as constraints to evidence-based policy in rural communities. Participants described the potential for policy to have a greater impact on reducing heart disease in rural areas though they felt under-resourced and out of touch with the scientific evidence. Scientific studies were less valued than local anecdote to prioritise specific policy. At all levels (local, state and federal) low self-efficacy in interpreting evidence and perceived lack of relevance inhibited development of evidence informed policy. Conclusion: The rural context constrains the use of scientific evidence in policy making for the prevention of heart disease in rural areas in Australia with multiple factors influencing the capacity for evidenced based health policy. This is similar to findings at the international scale and is for consideration across other developed countries that experience inequalities in IHD disease burden between rural and urban populations. [ABSTRACT FROM AUTHOR]

Sexual minority young people use licit and illicit substances at disproportionate levels. However, little is known about the perceptions of substance use among members of LGBT communities. This paper reports the results of a content analysis of 45 semi-structured interviews about substance use in LGBT communities with sexual minority young people (n = 31) and community stakeholders (n = 14). Results indicated both sexual minority youth and community stakeholders perceived the use and acceptance of substances to be higher in LGBT communities compared to the general population. Participants identified a range of characteristics potentially leading to higher levels of substance use including peer pressure, high exposure to substance use, and the high concentrations of licensed venues in LGBT communities. Marginalisation, discrimination and mental health were also perceived as important reasons for these disparities. Community stakeholders identified a range of potential interventions including legislation to address discrimination and substance use, increased services and activities, advertising in commercial LGBT venues and social media, and reinvigorating community cohesion. [ABSTRACT FROM AUTHOR]

This paper estimates the cost-effectiveness of a 20% price discount on healthy food and beverages with and without consumer nutrition education, as trialled in remote Northern Australia. Changes in actual store sales, from the pre-discount baseline period, were analysed for population impact on consumption of fruit and vegetables, water and artificially sweetened soft drinks, in addition with total dietary weight (grams), energy (Mega Joules), and sodium (milligrams). Disability Adjusted Life Years (DALYs), arising from changes in dietary risk factor prevalence in the population, were estimated as the primary health outcome in a multi health-state Markov model. The costs of the strategies were sourced from paid invoices and time estimates of staff providing store-based discount promotion and consumer education. The incremental cost-effectiveness ratio adopted a partial societal perspective, (including health and retail sector costs), as cost per DALY averted and was presented in 2011 Australian dollars. The price discount, helped address a gap in food price equity for residents of remote communities. However, the discount strategy, with or without consumer education led to a net loss of population health –36 95%CI (-47,-25) or -21(-28, -15) DALYs respectively, at increased cost to the retail and health sectors, of AUD860000 95%CI (710000, 1million) or AUD500000 (410000, 590000). The strategies trialled were thereby categorised as dominated by current practice while acknowledging considerable uncertainty surrounding the health outcome estimates. The 20% discount on limited targeted products appeared to need to be considered in conjunction with other marketing strategies to support healthy food choices, if remote Australian Indigenous population health is to be improved. [ABSTRACT FROM AUTHOR]

This paper estimates the influence of inadequate access to healthcare services on the rate of Emergency Room (ER) hospital visits in Australia. We take micro-data on different types of healthcare shortfalls from the 2012 Australian Survey of Disability, Aging and Carers, and employ Propensity Score Matching (PSM) techniques to identify their effects on ER visits. We find that shortfalls in access to various medical services increases ER visits for individuals with mental and physical conditions by about the same degree. Conversely, inadequate community care services significantly predict ER visits for individuals with physical conditions, but not for persons with mental conditions. The lack of predictive power for inadequate community care for persons with mental health problems is surprising, as “acopia” is thought to be a significant driver of crises that require emergency treatment. We discuss some of the mechanisms that may underpin this finding and address the policy implications of our results. Lastly a number of robustness checks and diagnostics tests are presented which confirm that our modelling assumptions are not violated and that our results are insensitive to the choice of matching algorithms. [ABSTRACT FROM AUTHOR]

General practice has an important role within the Australian healthcare system to provide access to care and effective management of chronic health conditions. However, people with serious mental illness experience challenges associated with service access. The current paper seeks to examine drivers of access to general practice for people with common and serious mental disorders, compared with people who access care for type II diabetes, a common physical health problem managed in general practice. The Bettering the Evaluation and Care of Health (BEACH) programme provides the most comprehensive and objective measurement of general practitioner activity in Australia. Using BEACH data, this study compared general practice encounters for depression, anxiety, bipolar disorder, schizophrenia, and type II diabetes during a 10-year period between 2006 and 2016. Analysis revealed more frequent encounters for depression compared to anxiety, and a higher representation of women in encounters for bipolar disorder compared to men. The relationship between number of encounters and patient age was strongly associated with the life course and mortality characteristics associated with each disorder. The findings highlight specific challenges associated with access to primary care for people with serious mental illness, and suggest areas of focus to improve the ability of these patients to access and navigate the health system. [ABSTRACT FROM AUTHOR]

Mental health can affect young people’s sense of wellbeing and life satisfaction, their ability to participate in employment and education, and their onward opportunities in life. This paper offers a rare opportunity to longitudinally examine mental health in a population-representative study of children aged 4–5 years to 14–15 years. Using data from the Longitudinal Study of Australian Children (LSAC), this study examined maternally-reported child mental health over a 10 year period, in order to understand their initial mental health status early in life and its change over time, as measured by the Strengths and Difficulties Questionnaire. Longitudinal models were fitted from ages 4–5 to 14–15 years. Results showed that child sex, maternal mental health, socio-economic status (family income, maternal education, neighbourhood disadvantage), maternal hostility, and child temperament (persistence, sociability, reactivity) are all independent contributors to child mental health at age 4. These effects largely persist over time, with the effects of maternal mental health increasing slightly over time. Persistence of these effects suggests the need for early intervention and supports. The independent contribution of these factors to child mental health suggests that multi-faceted approaches to child and maternal mental health are needed. [ABSTRACT FROM AUTHOR]

In recent years policy makers and social scientists have devoted considerable attention to wellbeing, a concept that refers to people’s capacity to live healthy, creative and fulfilling lives. Two conceptual approaches dominate wellbeing research. The objective approach examines the objective components of a good life. The subjective approach examines people’s subjective evaluations of their lives. In the objective approach how subjective wellbeing relates to objective wellbeing is not a relevant research question. The subjective approach does investigate how objective wellbeing relates to subjective wellbeing, but has focused primarily on one objective wellbeing indicator, income, rather than the comprehensive indicator set implied by the objective approach. This paper attempts to contribute by examining relationships between a comprehensive set of objective wellbeing measures and subjective wellbeing, and by linking wellbeing research to inequality research by also investigating how subjective and objective wellbeing relate to class, gender, age and ethnicity. We use three waves of a representative state-level household panel study from Queensland, Australia, undertaken from 2008 to 2010, to investigate how objective measures of wellbeing are socially distributed by gender, class, age, and ethnicity. We also examine relationships between objective wellbeing and overall life satisfaction, providing one of the first longitudinal analyses linking objective wellbeing with subjective evaluations. Objective aspects of wellbeing are unequally distributed by gender, age, class and ethnicity and are strongly associated with life satisfaction. Moreover, associations between gender, ethnicity, class and life satisfaction persist after controlling for objective wellbeing, suggesting that mechanisms in addition to objective wellbeing link structural dimensions of inequality to life satisfaction. [ABSTRACT FROM AUTHOR]

Objective This paper analyses an organisational development project that aimed to change the organisational culture and improve people management systems and processes. The questions addressed were: was the change process a success; how was success defined; and what were the barriers to its progress? Methods We examined the process of change over a 3-year period. The organisational development intervention is described and analysed. Qualitative methods, including document review, in-depth interviews and focus groups, participant observation, newsletters and diary entries were used to gather the data. A variant of competing values was used to analyse the data. Results We sought to build trust with all managers and encouraged reflection by conducting feedback sessions, presentations, workshops and one-on-one and group discussions. A cross-site action group was established to encourage organisation-wide participation in the project. However, it was clear that stakeholders had different understandings and perceptions of the problems facing the organisation. The project faltered when a leadership development intervention was organised. Conclusions The existence of at least four different organisational 'worlds' and identities, according to different professional groupings with different goals, languages and values, was evident. The relationship between the researcher and subjects was key in terms of whether the researcher is seen as an 'expert' or as a 'facilitator'. In bringing about change, we need to work with the Chief Executive Officer in empowering others. Hence, the researchers need to engage in continual dialogue across boundaries and within groups as well as at individual levels to provide support for organisational change. [ABSTRACT FROM AUTHOR]

Background Despite awareness of the health inequalities experienced by people with intellectual disability, their health status remains poor. Inequalities in health outcomes are manifest in higher morbidity and rates of premature death. Contributing factors include the barriers encountered in accessing and receiving highquality health care. Aims This paper outlines health inequalities experienced by people with intellectual disability and focuses on the opportunities medical education provides to address these. Strategies to ensure that health professional education is inclusive of and relevant to people with disabilities are highlighted. Conclusions The barriers experienced by people with intellectual disabilities to the receipt of high-quality health care include the attitudes, knowledge and skills of doctors. Improving medical education to ensure doctors are better equipped is one strategy to address these barriers. Improving health enhances quality of life, enables engagement and optimizes opportunities to participate in and contribute to the social and economic life of communities. [ABSTRACT FROM AUTHOR]

Aim To illuminate ways that avoidant leadership can be enacted in contemporary clinical settings. Background Avoidance is identified in relation to laissez-faire leadership and passive avoidant leadership. However, the nature and characteristics of avoidance and how it can be enacted in a clinical environment are not detailed. Methods This paper applied secondary analysis to data from two qualitative studies. Results We have identified three forms of avoidant leader response: placating avoidance, where leaders affirmed concerns but abstained from action; equivocal avoidance, where leaders were ambivalent in their response; and hostile avoidance, where the failure of leaders to address concerns escalated hostility towards the complainant. Conclusions Through secondary analysis of two existing sets of data, we have shed new light on avoidant leaderships and how it can be enacted in contemporary clinical settings. Further work needs to be undertaken to better understand this leadership style. Implications for nursing management We recommend that organizations ensure that all nurse leaders are aware of how best to respond to concerns of wrongdoing and that mechanisms are created to ensure timely feedback is provided about the actions taken. [ABSTRACT FROM AUTHOR]

Nurse practitioners were introduced into Australia in 1990 to improve access to health care in isolated communities where medical doctors are scarce. The slow uptake of nurse practitioners in these areas has largely been the result of legislation not affording them access to provider numbers through the Medicare Australia Act 1973. This has denied nurse practitioners the opportunity to become primary care providers because they cannot prescribe medications and order diagnostic tests at rebated costs. Recently this Act changed, making provision for nurse practitioners. Ironically the enactment of the new legislation still prevents nurse practitioners from practicing effectively. This paper describes the discursive practices in legislation, driven by traditional power brokers, which perpetuate the traditional role of nurses as care givers and fails to support the evolution of nurse practitioners as care providers. These continued practices effectively prevent nurse practitioners from working to their potential, despite government reassurance under recent health care reform in Australia. [ABSTRACT FROM AUTHOR]

With the arrival of another wave of “boat people” to Australian waters in late 2009, issues of human rights of asylum seekers and refugees once again became a major feature of the political landscape. Claims of “queue jumping” were made, particularly by some sections of the media, and they may seem populist, but they are also ironic, given the protracted efforts on the part of the federal government to stymie any orderly appeals process, largely through resort to “privative clauses”. Such clauses demonstrate the many ways in which human rights of those seeking asylum in far-off lands and are potential future immigrants, who often lack much-touted needed papers, yet who are for the most part genuine refugees, are subject to the slings and arrows of political fortune (and misfortune). Approaching the courts if treated unfairly or seeking a further decision as to your fate would seem one of the fundamental premises of human rights. Yet privative clauses—or attempts to ouster the jurisdiction of the courts and to insulate decisions from appeal—have become an increasingly frequent feature of the Australian migration legislation. With a seemingly watertight federal constitutional power set in stone since 1901, to deal with migration and aliens, and without the tempered contemporary update of a federal Bill of Rights, the Australian federal government has been able to narrow the grounds of judicial review in those contexts. We argue that the concerted efforts to deny such fundamental rights of appeal to those most in need of the full armoury of the protection of the law in a modern, affluent democracy, constitutes both a breach of their human rights and a breach of core constitutional principles such as separation of powers. Those principles may not be formally articulated in the text of the Australian Constitution, but in our view they are implicit in the constitutional arrangements, and hence we can conclude with the arguments of former Justice of the High Court of Australia, Michael Kirby, who asked—to whom does sovereignty truly belong? [ABSTRACT FROM AUTHOR]

The challenges and opportunities for provision of, and access to, reliable chronic cardiovascular health care for Indigenous people were addressed by expert speakers from New Zealand and Australia. It is well recognised that cardiovascular disease is a life-long concern, requiring reliable follow-up, early transition of clinical research into practice and ongoing support of patients. The clinical outcomes and long-term prognosis of individuals with cardiovascular disease are critically dependent upon the quality and availability of follow-up and chronic care facilities. This paper summarises the principal issues identified by the expert speakers for the provision of chronic cardiovascular health care to Indigenous peoples in Australia and New Zealand; identifies common challenges and describes important initiatives which the Cardiac Society of Australia and New Zealand (CSANZ), in partnership with health care professionals, communities and governments, can undertake in order to achieve the goals of uniform and equitable health care for chronic cardiovascular disease in all the Indigenous peoples, relevant to the needs of these peoples, in New Zealand and Australia. The issues addressed by the meeting include: [(1)] Determination of appropriate models for effective delivery of cardiovascular health care. [(2)] Who should deliver cardiovascular health care and what are the workforce requirements. [(3)] What support systems and infrastructure are required. [(4)] How can primary care and secondary specialist services be effectively integrated. [Copyright &y& Elsevier]

Across the globe, people are not equitably included or respected by health services. This results in some people being 'hardly reached' and having less access to safe and appropriate care. While some health services have adopted specific agendas to increase inclusion, these services can struggle to implement such strategies because the underlying reasons for exclusion have not been addressed. This calls for preparation prior to implementation of inclusion approaches that deconstructs discourses and practices of exclusion. This paper presents a pre-inclusion framework that seeks to deconstruct exclusion in health services. Authors developed this framework from action research in four 'mainstream' regional health services in southeast Australia over five years. Research identified dominant discourses of exclusion among staff in these services. The study also identified common experiences of residents hardly reached by these services. Following, a range of change activities were undertaken within these services to deconstruct exclusion. Researchers also kept journals, reflected on their impact, and identified lessons learned from trying to deconstruct exclusion. Triangulating these analyses, researchers developed an interdisciplinary framework that weaves together Foucauldian theory on power/discourse with continuous quality improvement processes to embed cultural humility and voices of the hardly reached in health care. The framework outlines five foundational concepts (power as productive, deconstruction, use of continuous quality improvement processes, cultural humility and voices of service users), followed by six principles (a journey, expect resistance, whole of service approach, make visible the reasons for change, we are all cultural beings and people centred care) and six actions undertaken within health services (commitment, assessment of exclusion, action plans, structural change, reflective discussions and engagement). Until such approaches to deconstruct exclusion are implemented, inclusive agendas are likely to be ineffective. • Before inclusion can be achieved, reasons for exclusion must be challenged. • Pre-inclusion readies a health service for engagement with those hardly reached. • This framework weaves Foucault, cultural humility, those hardly reached and CQI. • The framework aims to rupture power relations to privilege discourses of service users. • Health practitioners learn about their privilege and actions of exclusion. [ABSTRACT FROM AUTHOR]

Pen pals: correspondence as a method for data generation in qualitative research The study aimed to understand the impact of chronic illness on the lives of midlife women and explore and share the ways in which women adapt to and/or tolerate chronic illness in their lives. In 1998, 80 women participated in a study in which data were generated by corresponding with the researcher. Guided by feminist principles of collaboration, reciprocity and disclosure, we created rich stories about what it is like to live with a chronic illness. In this paper we will discuss the first phase of this inquiry which utilized correspondence between the researcher and the women. The issues posed by the use of correspondence as an innovative data generation process will be analysed. Correspondence, at first glance, may appear to be a rather impersonal communication medium. However, we are committed to this method of data generation and believe we have unlocked the doors to a viable qualitative research process. The literature to guide this process is scarce so we are keen to share work in progress. We will describe the preparation phase in setting up the study; discuss some practical issues, share some of the researcher’s experiences in generating narratives from dialogues and hear from the women themselves what they consider to be significant about this research process. [ABSTRACT FROM AUTHOR]