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While consent forms part of the Health, Wellbeing and Relationships strand of the New South Wales (NSW) Personal Development, Health and Physical Education (PDHPE) curriculum in Australia, it is not consistently or effectively delivered within schools. The recent e-campaign, Teach Us Consent in NSW, drew attention to the alarmingly high rates of sexual assault experienced by young women during their school years or shortly after. The campaign called for mandatory, inclusive and comprehensive consent education in schools. This paper presents research from a case study of an elite, same-sex, Catholic boys' school in NSW, Australia, examining the types of knowledge and attitudes young men and their PDHPE teachers had about sexual consent and the types of consent pedagogies mobilised. Semi-structured, in-depth interviews were conducted with the five male PDHPE teachers, and a focus group was conducted with five Year 11 male students (aged 16–17). The findings highlight that while participants recognised the importance of sexual consent in intimate relationships, consent pedagogies were grounded in individualising discourses of risk, responsibility and care, which rearticulated hegemonic gender norms. Findings from this study contribute to discussions of how schools approach consent education, and the limitations presented by outsourcing relationships and sex education. [ABSTRACT FROM AUTHOR]

Individualized funding of disability support services has implications for people's choices about when to share their home. This paper examines how people with disabilities made choices about who to live with and the factors influencing these choices. This paper discusses data from interviews with 30 people with mostly intellectual disabilities using individualized support services, 21 interviews with family members, four interviews with service managers, and a focus group with five support workers. The data come from a large evaluation of individualized housing support programs in New South Wales, Australia. Only some people had the opportunity to choose whether to share and with whom. Their choices were constrained by the range of housing options and their limited experience of them, even when they had support to make choices about shared housing or living alone. In some cases, the choices reflected a conceptualization of people with disabilities as different to other citizens in their rights and expectations about their social arrangements. The results have implications for information sharing, housing stock, and the need to challenge the positioning of people with disabilities relative to other people regarding choices about where and with whom to live. Many people preferred not to live alone, so as to improve their economic and social circumstances, and their choice and control. The choices about shared housing that many people and their supporters made were constrained by their limited experience of housing options or their familiarity with the range of choices made by other people with disabilities. Being able to draw on the material, social, and information resources of family made a big difference to their housing choices. It raises questions for policy implementation about whether individualized support may lock some people into shared housing arrangements by failing to include housing costs in the individual package. [ABSTRACT FROM AUTHOR]

Take-home naloxone (THN) is provided to non-medically trained people to reverse potential opioid overdoses. There is an increasing range of effective intramuscular (IM) and intranasal (IN) naloxone devices and this paper explores the types preferred by people who use opioids, using consumer behaviour literature to interpret the findings. Data derive from two unconnected qualitative studies involving audio-recorded semi-structured interviews. Study 1 was conducted in the United States (n = 21 users of non-medical/illicit opioids). Study 2 was conducted in Australia (n = 42 users of non-medical/illicit or prescribed opioids). Most participants preferred IN naloxone. Preferences were based on the ease, speed, safety and comfort of each device and underpinned by accounts of overdose revivals as being very rushed and frightening situations. Preferences related to complex interactions between the naloxone device ('product'); the knowledge, skills, experience and attitudes of the lay responder ('consumer'), and when, where and how naloxone was to be used ('usage situation'). THN programs should offer choice of device when possible and nasal naloxone if resources permit. Asking people which devices they prefer and why and treating them as valued consumers of naloxone products can generate insights that improve future naloxone technology and increase THN uptake and usage. [ABSTRACT FROM AUTHOR]

Pet ownership provides a unique relationship that is beneficial to many aspects of the pet owner's life, including mental health and companionship. Mental health and social isolation are negatively impacted by homelessness, increasing the importance of the owner-pet bond during this time. However, this relationship is complicated by the need for pet owners to urgently find accommodation for themselves while still caring for their pets. This paper explores two firsthand narratives of the relationship between a person and their pets during a period of homelessness and subsequent search for accommodation. Both narratives highlight important aspects of the emotional bond between owner and pet: the concept of choosing pet over place; improved mental health and changed behaviours; and stressors or negative emotions of parental concern, separation anxiety and grief. These narratives emphasise the importance of supporting, expanding and creating new pet-friendly crisis and permanent accommodation options for pet owners experiencing homelessness. [ABSTRACT FROM AUTHOR]

This address was given as the final-day keynote of the Sixth International Drama in Education Research Institute (IDIERI) in Sydney, 2009. Using the Institute's title as his theme, O'Toole briefly surveys the growth of drama education research of the last two decades, and the changing landscape of practice and research. He then conducts an informal meta-analysis of the abstracts of all the papers submitted and accepted for the Institute. These are analysed in terms of what inferences can be made about the state of drama education research. Five analysis categories are investigated: the abstracts as phenomena; base-line data and research characteristics which the abstracts reveal; the learning content of the papers; the basic dimensions of drama education; and the methodologies used. There is some discussion of key gaps and omissions, based on a UK/Australian literature review of arts partnerships research. Finally, the paper raises, non-propositionally, the question of the identity of drama education research and researchers. Who are we and how are we perceived? [ABSTRACT FROM AUTHOR]

Children and young people in rural Australia experience disadvantage compared with metropolitan counterparts, with low educational attainment and disengagement from schooling being linked to poorer health outcomes. Schools are an existing contact point between individuals and health services. However, these health services are often overburdened and have limited scope to address broader social issues and teaching staff are focused on achieving curriculum outcomes. Embedding social workers within schools may provide an avenue for supporting students, yet social workers are rarely present in New South Wales public schools. This paper describes a study to determine teachers' understanding of the socioeconomic issues faced by school students, and the role of the social work profession in addressing such issues as part of the early stages of establishing a Social Work in Schools (SWiS) project. Eighteen semistructured interviews were undertaken with teachers across four rural Australian schools. Participants identified their awareness of potential risk factors that could lead to educational disengagement, reflected on their own limitations in dealing with these broader health presentations given their teaching focus, and provided insights into their understanding of the potential role of social workers. Rural and remote school children in Australia are at risk of reduced educational attainment and disengagement due to low socioeconomic status (SES), geographical location, parental education and employment, and family dysfunction. Social workers should advocate for the role they can play within rural school communities to assist in ameliorating the impact of socioeconomic factors on a student's capacity to engage in learning. Partnerships between schools and social work field education may facilitate the growth of social work in schools in New South Wales. [ABSTRACT FROM AUTHOR]

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The relationship of parents and infants is ruptured at birth in the context of urgent issues such as congenital heart defects. The infants referred to in 10 semi-structured interviews had undergone cardiac surgery in a children's hospital in Australia and were participating in a new programme known as Heart Beads instigated by the cardiac ward nurses. Within the biomedical context infants are often alienated from their parents and treated as isolated bodies. The paper discusses the social implications of an ill or deformed child and the role of narrative in addressing social demands and the problems faced by parents in infant intensive care contexts. It is argued that theorising the infant within a relational framework allows agency to be attributed to the infant and parents while also recognising the importance of the intimate social world and interactional context that it is expressed within. The paper draws on Nick Crossley's relational sociology to highlight the importance of the relational embodiment that encompasses infants within a social world preceding them and enveloping them. The narrative is developed by parents in order to facilitate the social expression and integration of their child and thus plays a particularly social role in the context of infant surgery, rather than serving to adjust the individual to new circumstances. Exploring the role of narrative in this social relational sense is important for bringing the mother and the family back into the context and survival of the infant both physically and socially. [ABSTRACT FROM AUTHOR]

Infant well-being is intrinsically linked to maternal physical and emotional well-being. Internationally health services have implemented policies to identify women at risk of mental health problems and developed effective care pathways. The aim of this paper is to describe how perinatal and infant mental health clinicians perceive their role and the attachment-based interventions they use in their work. The study comes from a larger mixed methods study, which examined two specialist perinatal and infant mental health services in New South Wales (Australia). Two hundred and forty-four medical records were reviewed, and six perinatal and infant mental health clinicians participated in in-depth semi-structured interviews. Data were analysed by content and thematic analysis. One overarching theme, modelling a secure base and three supporting themes, enhancing reflective capacity, enhancing emotional regulation and enhancing empathy emerged from the analysis. These findings demonstrate how perinatal and infant mental health clinicians use attachment theory to inform practice by modelling "holding" and being a secure-base for women. They also provide a clearer understanding of perinatal mental health practice and can be used to inform educational programs for multidisciplinary mental health professionals particularly those working with women and infants. [ABSTRACT FROM AUTHOR]

With advances in medical technology, more people are surviving major trauma experiences. Those with a traumatic brain injury are one such group who may survive for several decades with significant health consequences including physical, cognitive, and psychosocial sequelae. Traumatic brain injury sufferers are typically young males with a premorbid history of risk taking. Consequently, the differential needs of female traumatic brain injury survivors are less likely to be acknowledged in the literature or by allied health workers. A large quantitative and qualitative study of people with traumatic brain injury was conducted in rural areas of New South Wales, Australia in 2004–2005. The qualitative component of the study included in-depth interviews with 11 women and 21 men. This paper focuses on the interviews with the 11 women who live in two rural areas of New South Wales. These data illustrate the psychosocial consequences of traumatic brain injury for women. They reveal that women are particularly vulnerable to isolation, disempowerment, and in extreme cases, abuse, and are less likely to have a carer. The need for gender to be a factor in ongoing social work and allied health treatment and support of traumatic brain injury sufferers and their carers is evident from this research. [ABSTRACT FROM PUBLISHER]

Purpose: Healthcare staff are on the frontline during disasters despite any personal adversity and vicarious trauma they may be experiencing. Wellness Warrior training is a post-disaster intervention developed in response to the 2019-2020 Australian bushfires to support staff in a rural hospital located on the South Coast of New South Wales, Australia. Method: This study explored the experiences and perspectives of 18 healthcare staff who were trained to provide emotional and peer support to their colleagues in the aftermath of a crisis. All the Wellness Warriors participated in semi-structured interviews between March and April 2020. Data were analysed using the reflexive thematic approach. Results: Healthcare staff reported developing interpersonal skills around deep listening and connecting with others which allowed for hearing the core of their colleagues' concerns. The training also helped staff to feel differently about work and restored their faith in healthcare leadership. Conclusion: Wellness Warrior training provided staff with knowledge and skills to support their colleagues in the aftermath of a natural disaster and later during the COVID-19 pandemic. As such, these findings suggest that peer support programs such as Wellness Warriors could be one way healthcare organisations can attempt to alleviate the psychological impact of natural disasters. [ABSTRACT FROM AUTHOR]

This paper illuminates two under-investigated, and often intersecting, frontline services accessed by unemployed people. It reports on the narratives of 32 Australian service providers working in emergency relief or employment services during 2012, including perceptions of clients' presenting issues and problems, and rationale for intervention. Workers tended to use reductionist and individualistic terms to describe complex client issues suggesting self-motivation and personal responsibility were key to gaining employment or alleviating poverty. Clients were often viewed as having the power to change their circumstances, while workers appeared unaware of their positional power and drew from dominant conservative discourse about welfarism and unemployment to fortify their compliance requirements. The findings are discussed in relation to service delivery and reform. [ABSTRACT FROM AUTHOR]

Globally, heart failure (HF) is one of the major health issues faced by many older people. It causes significant symptom burden that requires ongoing management. This paper reports on a descriptive–observational study undertaken to: (1) describe the prevalence of pain and analgesic prescription usage in hospitalized older HF patients; (2) determine the degree to which these patients are provided with a pain self-management strategy prior to discharge; and (3) determine if the patients' pain self-management strategy has been detailed in the discharge summary. A total of 122 older HF patients were included in this study. Results indicated that moderate to severe pain (Numeric Rating Scale score ≥4) is experienced by a substantial number of older people hospitalized with HF. There is little documented evidence that older people are provided with adequate analgesic prescriptions and the instructions required to effectively manage their pain on discharge to the community. [ABSTRACT FROM AUTHOR]

Migrants have higher levels of depression and anxiety than non-migrants. Pregnant migrant women are especially vulnerable to emotional distress due to their social circumstances, isolation from family and culture of origin, and aspects of the pregnancy itself. This study aims to report the process of planning an emotional-health group program for migrant women in an antenatal clinic and discusses potential reasons for its poor uptake. The program was developed with the aim to provide education, reduce symptoms of anxiety, depression and stress, and to improve the social resources and connectedness of the women. The paper describes the pathways taken in developing the program, including a literature review and needs assessment and collaborative planning discussions across different key health services, recruitment, and review. Possible reasons for failure to implement the program included staff factors, cultural barriers, mistrust of healthcare services, family opposition, and difficulties with transport. Strategies to address these practical implementation issues and improve the acceptability of such programs in this population are discussed. [ABSTRACT FROM PUBLISHER]

Background: Regular health screening provides opportunities for early detection and effective treatment of disease. There is underutilisation of health services by migrants from culturally and linguistically diverse backgrounds, particularly refugees in Australia. Aim: To explore the beliefs, understandings, and use of health and healthcare screening services among African refugee women living in Australia. Design/Method: Qualitative secondary analysis. Method: Oral narratives derived from two primary qualitative datasets of Sub-Saharan women in New South Wales, Australia, underwent secondary thematic analysis. Findings: Twenty-two of the forty-two women had refugee status on migrating to Australia. Thematic findings reflection of misinformation, low health literacy, and health screening as not a priority. Conclusions: There is an urgent need to develop innovative strategies to engage refugee migrant women in health screening by provision of culturally meaningful health information. Relevance to clinical practice: Including refugee women's suggestions for information to be provided by health services may improve attitudes towards screening and preventative health care. [ABSTRACT FROM AUTHOR]

Background Sexual health remains one of the most overlooked areas of life for people with intellectual disability. In recent years there has been an increasing expectation that this issue will be addressed by disability service providers. In this paper we examine the barriers to sexual health provision of people with intellectual disability as experienced by disability service providers and clinicians. Method This research uses a constructionist grounded theory approach. It was conducted in 2 phases using semistructured qualitative interviews to collect data from disability service managers and clinicians working with people with intellectual disability in New South Wales, Australia. Findings and Discussion Key themes within the interviews -- including funding shortages and a lack of policy guidelines -- were identified as significant administrative barriers to sexual health provision. Myths about the sexual health of people with intellectual disability, family attitudes, and lack of staff training were also identified as barriers. [ABSTRACT FROM AUTHOR]

Early childhood educators (ECEs) have an important role in promoting positive outcomes for children's language and literacy development. This paper reports the development of a new tool, The Interaction Communication and Literacy (ICL) Skills Audit, and pilots its reliability and validity. Intra- and inter-rater reliability was examined by three speech-language pathologists (SLPs). Five skill areas relating to ECE language and literacy practice were rated. The face and content validity of the ICL Skills Audit was examined by expert SLPs ( n = 8) and expert ECEs ( n = 4) via questionnaire. The overall intra-rater reliability for the ICL Skills Audit was excellent with percentage close agreement (PCA) of 91-94. Inter-rater agreement was PCA 68-80. Expert SLPs and ECEs agreed that the content was comprehensive and practical. Based on this preliminary study, the ICL Skills Audit appears to be a promising tool that can be used by SLPs and ECEs in collaboration to measure the skills of ECEs in the areas of language and literacy support. Future psychometric and outcome research on the revised ICL Skills Audit is warranted. [ABSTRACT FROM AUTHOR]

Australia is rapidly becoming home to an increasing number of Polynesians. While the Maori/Pacific Islander 'economic migrant' may appear fit and healthy, statistically the incidence of diabetes, hypertension and cardiovascular disease is extremely high. When this profile is coupled with family reunion migration of older relatives who are living longer, it represents an escalation of current and future outlay for Australian health services. Qualitative semi-structured interviews were conducted with 67 Polynesian migrants in regard to their perceptions of health and illness, and their experience of health services in Sydney and the Hunter region of New South Wales. Three key respondents, all Polynesian nurses practising in Australia, were also interviewed. The findings indicate a concentration of disadvantage concerning educational achievement, skill levels and health literacy that reinforce the process whereby social disadvantage impacts on health outcomes. This study also reveals a nexus of issues around cultural behaviours and poverty that contribute to the incidence of obesity-related illness and limit compliance with recommended preventative measures and treatments. This paper includes a discussion of the socio-political context of health delivery to Maori and Pacific Islander migrants and how the contraction of services under neoliberal 'belt tightening' undermines potential capacity to treat culturally and linguistically diverse (CALD) populations effectively. As Australian scholarship has traditionally concentrated on Melanesia, there is very little research on Polynesians who are one of our burgeoning migrant groups. This study therefore makes a timely contribution to redressing the lack of literature on Polynesian health, cultural practices and socio-economic positioning in this country. [ABSTRACT FROM AUTHOR]

Workforce shortages are forecast for speech-language pathology in Australia, and will have a more significant impact on rural and remote areas than on metropolitan areas. Allied health (AH) disciplines such as physiotherapy and occupational therapy address the problem of workforce shortages and growing clinical demand by employing allied health assistants (AHAs) to provide clinical and administrative support to AH professionals. Currently, speech-language pathologists (SLPs) don't work with discipline-specific allied health assistants in all states of Australia (e.g., New South Wales). This paper aims to provide insight into the perceptions of SLPs in one Australian state (NSW) regarding working with AHAs. Semi-structured interviews were conducted with eight rural SLPs. Qualitative analysis indicated that participants perceived they had deficits in skills and knowledge required to work with AHAs and identified further training needs. Participants perceived the SLP role to be misunderstood and were concerned about poor consultation regarding the introduction of AHAs into the profession. Ambivalence was evident in overall perceptions of working with AHAs, and tasks performed. While previous research identified benefits of working with AHAs, results from this study suggest that significant professional, economic, and organizational issues need addressing before such a change should be implemented in speech-language pathology. [ABSTRACT FROM AUTHOR]

Proportionately few problem gamblers seek formal help for gambling problems. However, research into gambling help-seeking behaviour is limited, especially qualitative studies capturing experiences of recovery. This paper conducted narrative analysis of in-depth interviews relating the help-seeking behaviour of 10 recovering problem gamblers. A common temporal sequence moved from self-help, professional and nonprofessional help, then returned to self-help, in a journey that emphasised the importance of their sharing of narratives. Key themes in the plot structures were: self-loathing and loss of identity; fear of failure, of the loss of the gambling experience, and of being judged; negotiation of control, being in control, and needing to be in control; changing based on insight, cognitive behavioural interventions, or integrative interventions; and finally, the shared narrative. The findings highlight the need for policy makers and practitioners to acknowledge the power of narrative and to open the door to a broader community awareness of problem gambling. [ABSTRACT FROM AUTHOR]

Early parenting residential units provide a child and family health support and education service for parents experiencing parenting difficulties. An ongoing concern of nursing staff and management is whether the parenting knowledge and skills gained are translated into sustainable parenting practices after discharge. This paper explores the response to a post discharge telephone interview about parents' experience of nursing care during their residential stay and their parenting experience since discharge. A descriptive qualitative approach identified four themes in the parents' responses: greater confidence, greater knowledge about their babies, changing expectations of parenting and their infants, and sustainability of parenting skills. [ABSTRACT FROM AUTHOR]

Education is state-run in Australia, and within each of the eight states and territories there are both government and independent schooling systems. This paper details the position of gay, lesbian, bisexual, transgender, intersex and queer (GLBTIQ) students within Australian education policy documents nationally, focusing on the three largest states and educational sectors in Australia. Survey data are used to report on the schooling experiences of over 3000 Australian GLBTIQ young people aged 14–21 years. Data from interviews with key policy informants identify both the obstacles to implementing policies, and how such obstacles have been overcome. Much official policy sees sexuality education as promoting inclusive, protective and affirming messages around GLBTIQ students. There exist significant correlations between policy and a variety of well-being and psycho-social outcomes for GLBTIQ students, including lowered incidence of homophobic abuse and suicide, and the creation of supportive school environments. Ideal policy visions are outlined, along with practical recommendations of relevance to a variety of stakeholders. [ABSTRACT FROM PUBLISHER]

This paper reports on an evaluation of an educational initiative that seeks to improve the diabetes health outcomes of a vulnerable group, Indigenous Australians residing in remote and rural New South Wales. In this context seven Aboriginal Health Workers (AHWs) and ten registered nurses (RNs) undertook an accredited Australian Diabetes Educators Association (ADEA) course. The aims of this study were to identify the beliefs, attitudes and experiences of this group concerning specialist diabetes training, strategies already used by managers and those that could be used to help consolidate the diabetes expertise of AHWs and RNs. The fi ndings indicate specialist diabetes training and constructive support is required if AHWs and RNs are to develop from a novice to an expert. We concluded that the ADEA diabetes course is highly relevant to the needs of Indigenous Australians an [ABSTRACT FROM AUTHOR]

This paper reports on one of the key findings from a recent descriptive phenomenological study on lived experience of 10 new graduate nurses (NGNs) in an intensive care unit (ICU) in a major acute care hospital. Interpersonal relationships experienced by NGNs in ICU give rise to diverse thoughts, perceptions and feelings that may have significant impact on their professional development, job satisfaction and retention. The researcher conducted in-depth, semi-structured audiotaped interviews to collect the data. Interaction with others as key theme and related subthemes: interaction with patients; interaction with other members of the ICU team; who is approachable; and feedback emerged. The NGNs' perception of their ability to interact with others, as part of their professional development, is influenced by both (i) how they see themselves and (ii) how they perceive that others see them. [ABSTRACT FROM AUTHOR]

This paper explores how the structuring of places and time influence Aboriginal and Torres Strait Islander patient and carer experiences of health services. Face-to-face in-depth interviews were conducted with urban Aboriginal and Torres Strait Islander people with diabetes, chronic heart failure or chronic obstructive pulmonary disease as well as family carers (N = 19). Content analysis was undertaken. Participants report that each element of the time spent in Aboriginal Medical Services is seen as more valuable and worthwhile than in mainstream health services, from social and health sharing experiences in the waiting room to health care in clinical places; and that users feel they can rely on sufficient time and respectful care in their clinical consultation. Purposeful design of both physical and temporal aspects of health services is called for. We suggest re-introducing opportunities for spatiotemporal design in health care that have been limited by the segmented 'person as illness' design features of Australia's current mainstream health system. [ABSTRACT FROM AUTHOR]

The transition process from student to Registered Nurse has been recognised as an important yet challenging time for newly graduated nurses. Knowledge about this experience from the nurse's perspective, particularly in a rural setting, is limited. This paper reports the findings of a qualitative study of the experiences of newly graduated nurses working in a rural acute care facility in New South Wales. The study examined, from the perspective of the new nurse, the orientation and support which can help to facilitate the transition from student to registered nurse. Four themes emerged which were being supported, being challenged, reflections on being a new graduate, and reflections on a rural new graduate program. These findings contribute to what is know about the transition of new graduates in a rural facility and have implications for program improvements, specifically within the rural acute care environment. The findings are also relevant to students considering rural employment on graduation and for the recruitment and retention of New Graduate Registered Nurses in rural areas. [ABSTRACT FROM AUTHOR]

This paper discusses the findings of a research study that used semi-structured interviews to explore the views of primary school principals on inclusive education in New South Wales, Australia. Content analysis of the transcript data indicates that principals' attitudes towards inclusive education and their success in engineering inclusive practices within their school are significantly affected by their own conception of what 'inclusion' means, as well as the characteristics of the school community, and the attitudes and capacity of staff. In what follows, we present two parallel conversations that arose from the interview data to illustrate the main conceptual divisions existing between our participants' conceptions of inclusion. First, we discuss the act of 'being inclusive,' which was perceived mainly as an issue of culture and pedagogy. Second, we consider the mechanics of 'including,' which reflected a more instrumentalist position based on perceptions of individual student deficit, the level of support they may require and the amount of funding they can attract. [ABSTRACT FROM AUTHOR]

The concept and definition of pastoral care in aged care remains ambiguous. This paper reports on the defining characteristics and meaning of pastoral care from the perspective of older recipients, their family members and pastoral care workers. Using a qualitative descriptive approach semistructured in-depth interviews were conducted with 18 pastoral care workers and 11 older people. Transcribed data were analysed using NVivo software and coded for emerging themes. The defining characteristics of pastoral care that emerged from analysis of transcribed interviews were: a trusting relationship, spiritual support, emotional support and practical support. Findings also portray the role of the pastoral care worker as spiritual guide, confidante, and emotional and practical supporter acting within a trusting relationship. Future studies should confirm these results by exploring the perceptions of experts in the field of pastoral care. [ABSTRACT FROM AUTHOR]

A rights perspective proposes supported decision-making as an alternative to substitute decision-making. However, evidence about supported decision-making practice is limited. Our aim was to build evidence about building the capacity of decision supporters. Eighteen parents of people with intellectual disabilities were trained in decision support using the La Trobe Support for Decision-making Practice Framework. Data from repeated semi-structured interviews and mentoring sessions were used to capture parental reflections on the value of training. The training acted as a catalyst for parent self-reflection and the Framework prompted them to adopt a more deliberative approach to supporting decision-making. Some parents perceived increased confidence of their adult offspring in expressing preferences resulting from their own changed approach. This study demonstrates the efficacy of this Framework and evidence-based training in building the capacity of parental decision supporters to be consistent with the rights paradigm. The La Trobe Support for Decision-making Practice Framework is an evidence-based approach to decision support practice with an accompanying set of free online resources which can be used by individual practitioners or programs to inform their practice and build the capacity of supporters. Parents of adults with intellectual disabilities value training in the La Trobe Support for Decision-making Practice Framework, which they consider helps to develop their decision support skills and self-reflection. Parents also value individual mentoring following training to assist them to apply the principles of the practice framework to the everyday support for decision-making they provide to their adult son or daughter. Training in support practice should be accompanied by individual mentoring or other strategies to assist parents of adults with intellectual disabilities to discuss and solve the difficult issues they confront in providing decision support more aligned to the rights paradigm. [ABSTRACT FROM AUTHOR]

Clinical practice guidelines for dementia recommend the provision of rehabilitative or reablement interventions that support functioning. This project sought to develop an assessment guide, centring on goal attainment scaling (GAS), for practitioners to measure attainment of meaningful outcomes for people living with dementia participating in reablement programs. To assist in guide development, two focus groups (people impacted by dementia [n = 10]) explored priority reablement goals. Two further focus groups (allied health practitioners [n = 11]) explored understanding and experience using GAS, opinions on what goals would be realistic, and how an assessment guide could best support practice. The key focus group themes that emerged and which underpinned guide development were: 'what is possible'; 'who sets the goals'; 'practitioner perspectives on using GAS'. Leisure was a key goal priority for people impacted by dementia, and echoed by practitioners. The assessment guide is structured around three steps: choosing goals (using focus group derived Reablement Goal Lists); defining goals (using a new Dementia-specific SMART Framework); scoring goals (using GAS-Light). Providing a structured approach to evaluation of reablement programs for people living with dementia could lead to more consistent service provision, improved outcomes and opportunities for benchmarking. Dementia is a leading cause of disability in older people. Rehabilitative interventions such as reablement are recommended to support functioning in people living with dementia, but there is currently no consistent method of selecting and evaluating attainment of meaningful outcomes. This study describes the reablement goals identified by people impacted by dementia as being most important, along with allied health practitioner views on goal-setting and the use of Goal Attainment Scaling (GAS). Study findings were used to develop a structured assessment guide employing three steps: choosing reablement goals; defining those goals using a new dementia-specific SMART Framework; and scoring goals using GAS-Light. A consistent approach to goal selection and evaluation of attainment for people impacted by dementia participating in reablement programs may lead to more effective rehabilitative interventions in this group. [ABSTRACT FROM AUTHOR]

Background: The impetus for this research came from a group of 11 Clinical Nurse Consultants (CNCs) within a health service in NSW, Australia, who wanted to investigate the CNC role from multiple stakeholder perspectives. With support from academic researchers, the CNCs designed and implemented the study. Objectives: The aim of this research project was to investigate the role of the CNC from the multiple perspectives of CNCs and other stakeholders who work with CNCs in the Health District. Design: This was a co-operative inquiry that utilised qualitative descriptive research approach. Methods: Co-operative inquiry methods enabled 11 CNCs to work as co-researchers and to conduct the investigation. The co-researchers implemented a qualitative descriptive design for the research and used interviews (7) and focus groups (16) with CNC stakeholders (n = 103) to gather sufficient data to investigate the role of the CNC in the organisation. Thematic analysis was undertaken to obtain the results. Findings: The CNC role is invaluable to all stakeholders and it was seen as the "glue" which holds teams together. Stakeholder expectations of the CNC role were multiple and generally agreed. Five themes derived from the data are reported as "clinical leadership as core", "making a direct difference to patient care", "service development as an outcome", "role breadth or narrowness and boundaries", and "career development". There was clear appreciation of the work that CNCs do in their roles, and the part that the CNC role plays in achieving quality health outcomes. Conclusion: The role of the CNC is complex and the CNCs themselves often negotiate these complexities to ensure beneficial outcomes for the patient and organisation. For the wider audience this study has given further insights into the role of these nurses and the perspectives of those with whom they work. [ABSTRACT FROM AUTHOR]

Fathers in families raising children with disabilities are under-researched. Fathers' perspectives can be better accommodated in childhood disability services that operate on a family-centred paradigm if their perspectives are understood. This study aimed to investigate the perspectives of fathers on caring and family life, work, and health. A mixed-methods design with an online questionnaire included open-ended questions and three instruments: Depression Anxiety Stress Scales (DASS); Health Promoting Activities Scale (HPAS-M); Fathers of Children with Developmental Challenges (FCDC) Scale. Fathers (n = 33) reported high depressive (58%), anxiety (37%), and stress symptoms (61%). Fathers reported low participation in health-promoting activity with less than weekly: planning health activities (58%); solo physical activity (26%); social activity (3%); time relaxing (16%). Sixty-four percent worked full-time, although work was reported to be challenged by family responsibilities. Fathers described directly caring for their children although service interactions were low and delegated to mothers. Fathers in this study reported stress, mental health issues, and low participation in healthy activity. Fathers experienced challenges related to career progression and job choices due to family responsibilities. Providing individualised and responsive support to fathers of a child with a disability would better support the family unit. Fathers of children with a disability in this study experienced high mental health symptoms. Fathers were involved with their child's care at home but had low service interactions suggesting that service providers need to discover new ways to better engage fathers. Fathers experienced challenges to participation in paid work secondary to care responsibilities for their child with a disability and resulting needs of their family. Services that better support fathers are important to promote better health and wellbeing and support families. [ABSTRACT FROM AUTHOR]

The objectives of the research are to describe the cultural activities offered in residential drug and alcohol rehabilitation for Aboriginal Australian men, along with client perceptions of the benefits associated with these cultural activities. Participants were 101 Australian Aboriginal male clients attending five residential drug and alcohol rehabilitation services in New South Wales. Participants completed a semi-structured interview and questionnaires that included the Growth and Empowerment Measure, the Aboriginal Cultural Engagement Survey, Clinical Global Impressions, and two questionnaires regarding cultural engagement while in treatment. Service users indicated that the most beneficial cultural activities offered within services were traditional art/craft, culturally-focused talks/meetings, and being on the land. Hierarchical multiple regression analysis indicated that cultural engagement in everyday life significantly predicted empowerment but not other measures of mental ill-health. The opinions of service users are presented, and recommendations are made regarding ways to enhance the effectiveness of cultural activities within drug and alcohol rehabilitation programs. [ABSTRACT FROM AUTHOR]

A qualitative study was conducted in rural New South Wales, Australia, to understand the barriers to help-seeking among young rural men with emergent mental health problems. Participants who had real life experiences of these problems within their families were interviewed. Themes emerged from the data which explained some barriers to early intervention. Despite these barriers, families had developed skills in helping and in providing early mental health help to their sons. The findings of this study showed that a substantial burden on the emotional and social integrity of the family, combined with diminished psychological well-being, caused some parents to question how long they could cope before they reached 'the end of their strings'. This downward spiralling trajectory of mental health and well-being for both the young men and their families has implications for clinical practice. Current models of mental health service delivery do not adequately capture the early help-seeking dynamics of young rural men and their families. A more flexible approach is needed to identify and help the family and the young men, without the pre-requisite for a formal medical diagnosis. Future research should involve health and well-being solution focused service delivery. [ABSTRACT FROM AUTHOR]

Accountability for the use of limited health resources requires quality information for ongoing monitoring of program effectiveness. We outline the challenges involved in the monitoring and evaluation of a large-scale community nurse home visiting program. Efforts to establish and maintain rigorous assessment were impaired by interrelated difficulties, impacting on the quality of information collected. The consequences and outcomes of these challenges are discussed. Recommendations to facilitate the monitoring and evaluation of community-based programs are made. Successful program monitoring and evaluation, guided by these recommendations, will support the ongoing review of program activities and evidence-based decision making to inform current operation and future planning. [ABSTRACT FROM AUTHOR]

Objectives: Though several studies have focused on risk factors associated with excess weight gain, little is known about the extent to which socio-cultural beliefs about body sizes may contribute to risk of excess weight gain, especially in non-Western migrant communities. Drawing on socio-cultural and attribution theories, this study mainly explored socio-cultural beliefs about an ideal body size among Australian residents who were born in sub-Saharan Africa (SSA). Implications of body size beliefs for risk of excess weight gain after immigration have also been discussed. Design: Employing a qualitative design, 24 in-depth interviews were conducted with Australian residents who were born in SSA. Thematic content analysis was undertaken to ensure that participants' experiences and views were clearly captured. Results: According to the participants, a moderately large body size is idealised in the SSA community and post-migration weight gain is commonly regarded as evidence of well-being. While desirability of a moderately large body size was noted by some participants, others were concerned about health risks (e.g. high blood pressure) associated with excess weight gain. Moreover, body size ideals seemed to be different for men and women in the SSA community and these ideals were mainly promoted by family and friends. Participants reported that women with very slim (skinny) body sizes are often regarded as persons suffering from health problems, whereas those with 'plumpy' body types are often considered beautiful. Participants also noted that men are expected to look well-built and muscular while those with big bellies are often seen as financially rich. Conclusions: Participants' interpretation of post-migration weight gain as evidence of well-being calls for urgent intervention as risk of excess weight gain appear to be high in this immigrant group. [ABSTRACT FROM AUTHOR]

Prisons are complex environments where there is a high risk of transmission of blood borne viruses, including hepatitis C (HCV). Providing trustworthy information in such settings can be challenging. This article presents the findings from a qualitative study examining interpersonal trust between people in prison and other individuals from whom they access information regarding HCV (health professionals, custodial officers, and peers). In-depth semi-structured interviews were conducted across 12 prisons in New South Wales, Australia, with 30 participants that had a history of injecting drug use. Questions addressed topics including awareness of HCV and harm reduction information sources. Data analysis was guided by two frameworks examining the affective and cognitive determinants of trust and the domains of fidelity, competence, honesty, confidentiality, and global trust. In general, health professionals were seen as trustworthy, while custodial officers were seen as untrustworthy. In contrast, the trustworthiness of peers was dependent on the individuals and the context. Peers were trusted if they had previous experience with HCV or were considered an 'elder' of their group, whereas others were not trusted due to a perceived lack of competence or fidelity. Information about HCV must come through trusted sources such as health professionals, selected peers, and, typically, not custodial officers. Affective and cognitive determinants of trust, as well as the domains of fidelity, competence, honesty, confidentiality, and global trust, are evident and should be leveraged to develop harm reduction interventions that will be trusted and adopted by people in prison. [ABSTRACT FROM AUTHOR]

Many nursing contexts have introduced bedside handover, where the person in care participates in the transfer of clinical information, with benefits for person, carers, and clinicians. This type of handover has been implemented across a number of mental health settings, but there is limited evidence regarding implementation approaches or of practice change. This study reports the development and evaluation of a co-produced education and support package. To evaluate changes in nurses' practice regarding bedside (person-side) handover following implementation of a structured education and support package. Multi-method design incorporating nurse surveys and chart audit. The survey and audit were conducted in 2019–2020 on two inpatient mental health units in a metropolitan health service immediately prior to, and 6 months after, implementation, with 70 survey responses and 52 files audited. Non-parametric tests assessed change, and text comments were reported. Significant improvements were observed in nurses' reports of confidence, the ability to maintain privacy, identified benefits for the person and in information transfer. In contrast, the chart audit identified no change in documentation of this practice. The implementation of a co-produced education and support package demonstrated positive practice change in engaging people receiving care in handover. This approach to handover provides increased opportunity for nurses to work in partnership with people receiving mental healthcare, facilitating collaborative person-centred care and shared decision making. [ABSTRACT FROM AUTHOR]

Poor hand hygiene is a major contributor to hospital acquired infection. In this study, a comparison of the related attitudes of psychiatric and non-psychiatric nurses was made using a cross-sectional survey design. N = 79 nurses who work in psychiatric or non-psychiatric hospital wards completed questionnaires regarding intended compliance with hand-washing protocols and potential cognitive predictors of compliance. Perceived ease of compliance and behavioural norms, and working in a non-psychiatric ward, predicted superlative intended compliance. Working in psychiatry did not in itself predict outgroup membership suggesting that psychiatric ward-related factors, rather than psychiatric nurse-related factors are most relevant in determining between-group differences. Consideration of factors unique to psychiatry wards during service design could improve compliance. [ABSTRACT FROM AUTHOR]

New approaches are needed to assist residential aged care (RAC) staff increase their skills and confidence in identifying when residents are nearing the dying phase and managing symptoms. One new evidence-based approach to improve palliative and end-of-life care in RAC is outreach Specialist Palliative Care Needs Rounds (monthly triage and risk stratification meetings – hereafter Needs Rounds); as yet untried in rural settings which may face unique enablers or challenges. Needs Rounds were introduced into two RAC facilities in the rural Snowy Monaro region of New South Wales, Australia. This study explored staff and general practitioners'(GPs') experiences and perceptions of palliative and end-of-life care in rural RAC, and staff confidence and capability in providing such care, prior to, and after the introduction of Needs Rounds. A mixed-methods, pre- and post-intervention approach was taken, utilizing a Likert-scale written questionnaire and face-to-face semi-structured interviews. Between March and November 2018, 61 questionnaires were completed by 48 RAC staff (33 pre-, 28 post-intervention); eight staff and three GPs were interviewed. Despite system and site-specific barriers, staff self-reported that Needs Rounds increased their capability in providing end-of-life care (p = 0.04; 95% CI 0.20–7.66), and improved staff: (1) awareness of end of life, reflective practice, and critical thinking; (2) end-of-life decision making and planning; and (3) pain management. Needs Rounds are acceptable and feasible in rural RAC. Palliative and end-of-life care for residents may be improved through education, collaboration, communication, and planning. Further studies should explore running Needs Rounds via telehealth and/or utilizing a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Clear links have been established between low health literacy (HL) levels and poor health outcomes. One means of improvement may be found in the rapidly growing paid home care workforce, whose direct and frequent contact with aged/disabled care recipients positions them to provide HL support. This study examines Australian homecare worker (HCW) experiences in HL when providing assistance to their care recipients. A self-reported cross-sectional survey collected data from 75 HCWs. They reported concerns about their clients' HL, yet were cautious about providing support in this area. HL levels of the HCWs themselves were unconvincing, and the majority requested targeted education and training. Further research is needed into HL levels of both HCWs and care recipients, client demographics, the types of HL support being requested of HCWs, a more detailed scoping of the HCW role, and the curriculum and pedagogies which may comprise a HL education and training program for HCWs. [ABSTRACT FROM AUTHOR]

Objectives: The New South Wales personal injury compensation schemes have produced evidence‐based practice (EBP) treatment guidelines for the management of functional disability following musculoskeletal injury. Psychologists' adherence with these guidelines is suboptimal, therefore the aim of this study was to elicit recommendations from field experts to overcome barriers to adherence and determine feasibility of their application by psychologists working within these schemes. Methods: A mixed methods design was used, consisting of a focus group and individual interviews (n = 8) of field experts followed by an online survey of psychologists (n = 150). The qualitative data were imported into QSR NVivo software and analysed using thematic analysis. The survey data were analysed using descriptive statistics in SPSS, and the narrative data were subjected to content analysis. Results: Five recommendations were made by experts and endorsed by majority of surveyed psychologists; however, some practical issues impacting application were identified. The recommendations included: mandatory training and continuing professional development; use of independent consultants for expert advice; completion of outcome measures prior to the first session and again in the eighth and final sessions; completion of the treatment plan in‐session with the injured person. From the narrative comments of surveyed psychologists two key reasons for not endorsing the recommendations emerged: time and cost burden of compliance; and a perceived low efficacy for enhancing clinical practice. Conclusion: Overall, the recommendations proposed by field experts to increase adherence with EBP treatment guidelines were endorsed by the wider community of psychologists working under State Insurance Regulatory Authority insurance schemes. [ABSTRACT FROM AUTHOR]

Introduction: Opioid dependence is a complex health condition often requiring long-term treatment. The main objectives of treatment are to reduce dependence and the associated morbidity and mortality. Opioid replacement therapy (ORT) is an effective pharmacological therapy for opioid dependence. The aims of this research were to explore barriers and enablers to ORT in rural areas of Australia. Design and Methods: A qualitative study design incorporating semi-structured interviews was used to explore views of people in ORT. Interviews were analysed for emergent themes and issues. Results: Barriers to ORT were restrictiveness, stigma, the medication and structure of the program. Enablers were structure of the program, access to takeaway doses, effect on drug use and the medication. Discussion: To improve access and retention in ORT programs action is needed to facilitate programs meeting the needs of rural people, including reducing cost of medication, addressing the restrictiveness of programs and effect on employment opportunities, and stigma associated with drug use and addiction in communities. Conclusions: Barriers and enablers to ORT programs exist in the rural areas studied. Geographical distance, inability to gain and maintain social connections including employment, and lack of community education addressing stigma are significant barriers to ORT in these areas. [ABSTRACT FROM AUTHOR]

Background: Registered nurses in a rural context are expected to support undergraduate students during clinical placement, however, they may experience challenges that are unique to the rural context. Aim: To describe the registered nurses' experience of mentoring undergraduate nursing students on clinical placements in a rural context. Design: Qualitative descriptive study. Method: Data were collected from nine participants at two rural hospitals in Australia. Individual semi-structured interviews were conducted and content analysis was used to analyse data. Findings: Four categories emerged from the data: 'The challenges of mentoring', 'Supporting students and facilitating learning', 'Supporting registered nurses who mentor undergraduate nursing students' and 'The rewards of mentoring'. Conclusion: The experience of the rural registered nurse mentor is affected by limited staffing and skill mix, the generalist nature of their work, time constraints and lack of information about students. They need flexible strategies, improved communication and information about students attending clinical placements. [ABSTRACT FROM AUTHOR]

Background: In the midst of changing environmental conditions and increasing populations aged over 65 years, how best to provide nursing care that promotes mental health and wellbeing within residential aged care facilities is an important concern. Aim/Objective: To explore the perceptions of temperature control, thermal comfort and nursing care in a small group of older Australians. Design: Descriptive, qualitative study using thematic analysis. Methods: Individual semi-structured interviews were conducted with a group of older Australians living within an aged care facility. Interviews were taped, transcribed and then analysed using thematic analysis. Results: Five adults participated. Themes emerging included: (1) balancing nursing care and resident autonomy; (2) the importance of mobility to cope with temperature; and (3) r⁠eliance on habitual behaviour to cope with temperature. The importance of experiencing a sense of choice and ability to self-regulate personal environment arose as a substantial concern. Conclusions: The attention of older residents to personal issues related to thermal comfort linked to physical and mental health emphasise the importance of concerns regarding mobility, nursing care and autonomy. For older age residents the interplay between thermal comfort and behaviour adaptation is influenced by nurses and their control of the residential environment. [ABSTRACT FROM AUTHOR]

This article outlines client and service data from an early psychosis service in New South Wales (NSW), Australia, and presents a client and service profile, with a focus on the psychiatric, psychosocial, and physical health profile of young people with early psychosis. Implications for practice are discussed. Client and service data were captured through a range of processes and comprise a number of different datasets, specifically client demographical information and service data as routinely collected (N = 601), psychosocial data collected through a file audit (N = 33), and client physical health data maintained by the physical health nurse (N = 39). The service researcher extracted all data from each of the databases and analyzed the data descriptively for client and service profile information. The client profile data indicate early psychosis clients present with a range of psychiatric, psychosocial, and physical health vulnerabilities. The data presented support the need for mental health care to be provided in conjunction with primary health care, vocational and employment support, exercise and dietary interventions, and support with substance use. Furthermore, this article highlights the importance of family inclusive practice and trauma-informed care in early psychosis services. The findings support calls for services to be integrated and young people to be responded to holistically through the integration of psychological, psychosocial, and physical health care. [ABSTRACT FROM AUTHOR]

Background: Low health literacy is associated with adverse health outcomes and raises healthcare costs. General practitioners (GPs) are the first point of access to health care services and play a key role in building patients' health literacy level. This study aimed to explore: (1) GPs' understanding of health literacy, (2) their perceived challenges to addressing health literacy, and (3) the strategies they used to support patients with health literacy difficulties. Method: This qualitative study was conducted in South Western Sydney, New South Wales, Australia. Semi-structured interviews were audio-recorded and transcribed verbatim. Interview data were analyzed using the Framework method, a matrix-based approach to thematic analysis. Results: Eighteen participants took part in the study. Four key themes were identified: (1) identifying patients with health literacy difficulties; (2) perceived consequences of low health literacy; (3) being sensitive to developing health literacy skills; and (4) strategies used to build health literacy. Intuitive skills were used to identify the patient's health literacy skills through recurring encounters with patients over time. A range of communication techniques were used to build health literacy. The value of a long-term relationship with patients and support from relatives were reported (Please eliminate this comma and the one right before this) to be important in helping patients build their health literacy skills. Conclusions: A number of challenges in health literacy exist in general practice. General practitioners can play a role in overcoming these challenges by placing an increased focus on health literacy, including self-education on this topic, identification of patients with low health literacy skills and helping build patients' level of health literacy. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore the perspectives of caregivers regarding the information and support they received following diagnosis of their child’s hearing loss. Design: A mixed methods explanatory sequential design was conducted. Study sample: A total of 445 caregivers of children completed a written survey, and five parents participated in qualitative in-depth interviews. Results: The most common sources of information for caregivers were discussion with an audiologist, written information, and discussion with a medical professional. Approximately 85% of caregivers reported they were satisfied with the personal/emotional support and information received from service providers. Additional comments from 91 caregivers indicated that 11% experienced a breakdown in information transfer with health professionals. Interviews conducted with five parents from three families revealed two themes which described the diagnostic period as a difficult and emotional experience for parents: (1) support and information provided during diagnosis: what happens first? and (2) accessing early intervention services following a diagnosis of hearing loss: navigating the maze. Conclusions: The findings of this study give insight into the perspectives of caregivers who have a child diagnosed with hearing loss. The importance of providing timely information and personal/emotional support to caregivers cannot be underestimated. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to explore the nature of parental involvement in the intervention of children with hearing loss, as experienced by parents. Design: A qualitative descriptive methodology was adopted to conduct semi-structured in-depth interviews with a purposive sample of parents who have a child with hearing loss. Study sample: Seventeen parents of 11 children aged 6-9 years participated in this study. Results: The overarching theme of parents taking the central role was identified using thematic analysis. This overarching theme connected five themes which described the nature of parental involvement: (1) parents work behind the scenes; (2) parents act as ‘case managers’; (3) parents always have their child’s language development in mind; (4) parents’ role extends to advocacy for all children with hearing loss; and (5) parents serve a number of roles, but at the end of the day, they are parents. Conclusions: The results indicate that parental involvement in the intervention of children with hearing loss is multifaceted in nature and incorporates a broad range of behaviours and practices. These findings have important implications for the provision of family-centred practices. [ABSTRACT FROM AUTHOR]

Semi-structured interviews were used to explore identity development for nine adoptees (aged 9-23 years) who were adopted by their foster carers in New South Wales, Australia. Adoptions were open, with court-ordered face-to-face contact with birth families. Findings suggest that participants had healthy adoptive identities, with coherent and meaningful narratives about their life histories. Adoption provided a sense of security and belonging. Openness provided information to build a self-narrative and encouraged discussion of adoption issues within adoptive families. Adoptive parents were critical in helping children understand their adoption and facilitating direct contact with birth families, thus laying foundations for positive identity development. [ABSTRACT FROM AUTHOR]