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In Australia, some non-Aboriginal social workers and academics have difficulty working in partnership with Aboriginal children, families, and communities because they do not know how to build authentic relationships and are fearful of doing so. This is particularly the case in Child Protection where children continue to be removed from Aboriginal families. Reciprocal and genuine relationships involve holding Aboriginal worldviews as equally valid as Euro-western ones. For non-Aboriginal social workers and academics, this means moving beyond a "helping" stance, and towards genuine openness to learn and understand the world, and their place in it, in new ways. This paper shows how two social work academics undertook building relationships with Traditional Custodians in our local area to establish a resource for students that foregrounds Aboriginal ways of knowing and learning by using the Tree of Life concept to embody Aboriginal experiences. The Aboriginal author focused on coming together respectfully to create a better-shared understanding on connecting to Country. For the non-Aboriginal author, a transformation occurred, gaining embodied understanding of her own belonging and connection to Country. The paper concludes with reflections useful to others embarking on this journey. IMPLICATIONS Cultivating an academic environment that prioritises forming authentic relationships with Traditional Custodians on Country is essential in order to be culturally responsive. A decolonising embodied concept, Tree of Life, invites social workers to take a journey of personal self-discovery, of belongingness, and cultural heritage. A simulation resource developed with Traditional Custodians can disrupt daily instances of colonisation and work toward social workers reflecting on practice to minimise further harm in working with Aboriginal communities. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: Comfort as a conceptual and lived experience is essential in psychiatric hospital contexts and for overall mental health wellbeing.Comfort is a valuable aspect when designing hospitals and built environments for psychiatric care. What the paper adds to existing knowledge: This article presents the results from a Design Anthropology study at four Psychiatric Units co‐located in a newly built regional hospital based on 126 ethnographic interviews with staff, within which 63 participants mentioned the importance of comfort in generating environments conducive to wellbeing.An in‐depth qualitative understanding of comforting practices, as emergent forms of everyday care. These may receive less attention within more established interventions from organisational models of care (e.g., Safewards) and might appear to be implicit gestures of courtesy. However, they contribute to meaningful encounters and contribute to individual and organisational wellbeing in psychiatric care. What are the implications for practice: This paper builds on comfort theories and demonstrates implications for practice through ethnographic examples. Comfort, often unnoticed until it is absent, needs to be maintained through continuous "small" but intentional acts of care. These constitute a finely tuned repertoire of everyday comforting practices of care at psychiatric contexts.Corridors and doors are presented as spaces where people have brief interactions that can contribute to everyday comforting experiences.Comfort is discussed in dialogue with existing literatures from psychiatric nursing, healthcare building design and design anthropology. Implicit and improvised practices of care that foster comforting environments have vital potential to support institutionally endorsed models of care (e.g., Safewards).The article proposes that design has a dual role for comforting environments in psychiatric care; (a) through the practice of architectural design and (b) through the practices of staff when creating everyday comforting interactions for wellbeing. Introduction: Creating a comforting environment is essential for delivering psychiatric care. While healthcare organisations explicitly implement care models and adapt the physical environment, attention to staff's implicit everyday practice is limited. Aim: Developing a design anthropology approach tailored specifically to the research site, we examine the social and physical environment to unpack how staff integrate both—implicit comforting interventions, and the explicit measures taken by the organisation—into their everyday practices of psychiatric care. Method: Design and sensory ethnography, using extended observations and "walking tours" were undertaken with 126 staff members. A thematic analysis was conducted on all visual and audio material. Results: Staff's everyday implicit care practices and situated design decisions provide a comforting environment for patients, visitors and staff. Discussion: Implicit practices combine with an explicit organisational model of care to achieve a comforting environment. The value of design anthropology to uncover these dynamics is emphasized. Comforting practice involving implicit gestures of courtesy, which are infrequently addressed within organisational models of care (e.g., Safewards), are foregrounded. Implications for practice: Explicit models of care have clear value in generating comfort; however, psychiatric hospital care also benefits from less visible modes of delivering comfort through everyday practices. By acknowledging both explicit and implicit modes of comfort, we can better understand how care models and psychiatric cultures of care are nurtured. Continuous "small" but intentional acts of care (e.g., brief interactions in corridors and at doors) constitute a finely tuned repertoire of everyday comforting practices. [ABSTRACT FROM AUTHOR]

Clinical engagement has supplemented clinical governance in healthcare to strengthen the contribution of medical professionals to the assessment of clinical outcomes for patients. Assessments of clinical engagement have, until now, been qualitative; this case study introduces the concept of quantitative assessment of clinical engagement by measuring the number of patients managed according to specialist society guidelines. Such an assessment engages all staff (medical, nursing, allied health and pharmacy) involved in patients receiving treatment according to such guidelines and provides an assessment of individual and organisational compliance with those guidelines. Clinical engagement is then quantified as the percentage of patients that have been documented to receive specialist society- or college-approved guideline-compliant treatment, relative to the total number who could receive such treatment, in any healthcare organisation. What is known about the topic?: Clinical engagement has emerged in recent years as a virtue to be encouraged in healthcare organisations because of its association with improved patient outcomes and employee satisfaction. Assessments have relied on repeated staff surveys in order to gauge engagement. What does this paper add?: This paper proposes a novel means of measuring clinical engagement in an organisational setting. The vision put forward is that adherence to clinical guidelines in an organisation measures clinician engagement across professional disciplines. What are the implications for practitioners?: The implications are that organisations will contribute to measuring the adherence of specialty groups of clinicians to guidelines that the clinicians select and use the data for individual and organisational accreditation. [ABSTRACT FROM AUTHOR]

Objective: This study gathered information from public hospital chief medical officers to better understand underlying mechanisms through which public reporting affects institutional behavioural change and decision making towards quality improvement. Methods: This qualitative study used thematic analysis of 17 semistructured, in-depth interviews among a peak group of medical directors representing 26 health services in Victoria, Australia. Results: The medical directors indicated a high level of in-principle support for public reporting of identifiable, individual clinician-level data. However, they also described varying conceptual understanding of what public reporting of performance data is. Overall, they considered public reporting of individual clinicians' performance data a means to improve health care quality, increase transparency and inform consumer healthcare decision making. Most identified caveats that would need to be met before such data should be publicly released, in particular the need to resolve issues around data quality and timeliness, context and interpretation and ethics. Acknowledgement of the public's right to access individual clinician-level data was at odds with some medical directors' belief that such reporting may diminish trust between clinicians and their employers, thus eroding rather than motivating quality improvement. Conclusions: Public reporting of identifiable individual healthcare clinicians' performance data is an issue that merits robust research and debate given the effects such reporting may have on doctors and on hospital quality and safety. What is known about the topic?: The public reporting of individual clinician-level data is a mechanism used in some countries, but not in Australia, for increasing health care transparency and quality. Clinician-level public reporting of doctors' performance attracts contention and debate in Australia. What does this paper add?: This paper informs debate around the public reporting of individual clinician-level performance data. Among a discrete cohort of senior hospital administrators in Victoria, Australia, there was strong in-principle support for such public reporting as a means to improve hospital quality and safety. What are the implications for practitioners?: Before public reporting of individual clinician performance data could occur in Australia, resolution of issues would be required relating to legality and ethics, data context and interpretation, data quality and timeliness. [ABSTRACT FROM AUTHOR]

Objectives: Gay, bisexual, and other men who have sex with men (gbMSM) are 131 times more likely to acquire HIV compared with other Canadian men. Pre‐Exposure Prophylaxis (PrEP) for HIV has the potential to reduce or eliminate disparities in HIV acquisition among key affected populations. This paper aims to discuss the feasibility and utility of a nurse‐led PrEP program administered by the Cool Aid Community Health Centre (CACHC) in Victoria, British Columbia as a public health PrEP program was initiated. Design, Sample and Measurements: A retrospective chart review of 124 gbMSM patients accessing PrEP at CACHC in 2018 collected information on patient demographics, STI testing results, and PrEP prescription pick‐ups at 3 time points. Results: Ninety‐nine (79.8%) patients have continued on PrEP, as defined as having picked up their second 90‐day PrEP prescription. Both older age and having an Sexually Transmitted Infection after PrEP enrolment were significantly associated with staying on PrEP; decreased risk perceptions contributed most to clinic‐level discontinuance. Very few patients who stayed on PrEP have transitioned to their own General Practitioner. Conclusions: Patients appear to recognize their risk and are continuing on PrEP to reduce their risk of HIV. As evidenced by ability to recruit and maintain patients, we conclude that nurse‐led PrEP at community health centres supports access and uptake of essential health services to optimize individual and population health. [ABSTRACT FROM AUTHOR]

The family-focused mental health intervention, 'Let's Talk About Children,' has positively influenced the lives of families affected by parental mental illness. This paper outlines the use of this brief, strengths-based intervention for parents with gambling and other co-occurring issues from the gamblers' support services sector. Over a six-month period, a training manual and accompanying resources were adapted for the gamblers' support services sector and a targeted training session developed. Nine problem gambling counsellors from three Victorian gambling support services trialled the Let's Talk About Children intervention over a four-month period. Qualitative data were gathered through focus groups, interviews, and practice enquiry groups to determine the impact of the Let's Talk About Children model for gambling support services. The results are presented as 'practice wisdoms and recommendations' reporting on the impact of the trial and to provide some guidance to support others in the implementation of a specific family-focused intervention. This paper reports on the first exploratory trial of Let's Talk About Children for the gambler's support services sector in Australia. [ABSTRACT FROM AUTHOR]

Issue addressed: Enhancing food skills and nutrition knowledge may help promote healthy eating among people who are food insecure. FoodMate® by SecondBite®, an 8‐week nutrition education and food hamper program, focuses on developing food skills and independence among Australians at risk of/experiencing food insecurity. This study aimed to explore participants' perceptions of and experiences with FoodMate® over a long‐term (up to 2 years) follow‐up. Methods: For evaluation purposes, SecondBite® previously collected data from participants prior to (T1) and following completion (T2) of FoodMate®. This paper reports results from semi‐structured telephone interviews conducted in a follow‐up study (2016/2017, T3) among 19 adults enrolled in FoodMate® programs delivered in Victoria and New South Wales within the previous two years. Data were analysed using inductive thematic analysis of responses to T3 open‐ended questions, and descriptive analysis of closed‐ended question responses (T1 vs T2 vs T3). Results: Major qualitative themes included program enjoyment; perceived positive long‐term program impact on participants' eating and related attitudes and skills; barriers to cooking; suggested program modifications; and impact on others. In descriptive quantitative analyses, participants' diet; confidence to cook using basic ingredients, follow simple recipes and try new foods; cooking and food‐related skills; social engagement and life satisfaction all improved between T1 and T3. Conclusions: Overall, FoodMate® was well‐received and associated with long‐term positive changes in a range of outcomes. Wider implementation among vulnerable groups should be considered. So what?: Future health promotion initiatives could adopt FoodMate® to increase food skills and knowledge among adults experiencing food insecurity. Summary: This study explored participants' perceptions of and experiences with FoodMate® by SecondBite®, a nutrition education program focused on developing food skills and independence among Australians at risk of/experiencing food insecurity. Long‐term positive changes in confidence, cooking and food‐related skills; social engagement; life satisfaction; and dietary intake were observed. [ABSTRACT FROM AUTHOR]

Background: This paper explores the experience of staff employed within forensic disability across Victoria in an attempt to better understand service needs in this field. The complex needs of individuals with disabilities involved in the criminal justice system or presenting with offence‐related behaviours suggest that there is a requirement to improve services directed towards forensic disability. Methods: Four semi‐structured group interviews, determined by geographical location, were completed with employees (n = 14) within the Australian Community Support Organisation, with an average of 5 years of forensic disability experience. Data were analysed based on thematic analysis. Results: Five themes were revealed. Three pre‐existing themes were emphasized that included client complexity; poor responses from external services; and funding, and two novel themes labelled as staff well‐being and responses to risk. Conclusions: Recommendations include multiagency collaboration, funding forensic disability services, development of best practice initiatives and advocacy. [ABSTRACT FROM AUTHOR]

Background: The Social Identity approach offers a unifying framework for understanding recovery from addiction as a process of identity change, associated with change in social network composition. This paper introduces Social Identity Mapping in Addiction Recovery (SIM-AR) — a visual method for capturing social group memberships, extended to integrate the substance use 'status' of group members as an indicator of group substance use norms. The aim here is to test theory-derived predictions focused on the relationship between changes in social identity and network composition reflected in groups' substance use norms in early recovery. Method: 155 therapeutic community (TC) residents in Victoria, Australia, completed the SIM-AR plus measures of substance-using and recovery identities and substance use shortly after admission, and 65% (N = 101) again 6 months later. Results: As predicted, substance use severity at follow up was associated with changes in both social identity and network composition. Furthermore, reduced strength of substance-using identity was associated with a decrease in the proportion of groups with heavy substance use norms, while increased strength of 'recovery' identity was associated with an increased proportion of non-using groups. Conclusion: SIM-AR proved useful in testing predictions about social identity and network changes in a residential treatment context. It captured key social identity constructs in recovery using a visual technique with value to both research and applied contexts. Findings highlight the clinical importance of assessing a person's group-based relationships in treatment and early recovery, especially the influence of social group norms in relation to substance use. [ABSTRACT FROM AUTHOR]

Copyright of Australian Social Work is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Nursing has a gendered and religious history where ideas of duty and servitude are present and shape its professional identity. The profession also promotes idealized notions of relationships with patients and of professional autonomy both of which are, in practice, highly constrained or even impossible. This paper draws on psychoanalytic concepts in order to reconsider nursing's professional identity. It does this by presenting an analysis of data from two focus group studies involving nurses in England and Australia held between 2010 and 2012. The studies gave rise to data where extremely negative talk about nursing work seemed to produce, or to be expressed with, a high degree of energy, and a particular kind of enjoyment. In our analysis, we focus on the nurses' apparent enjoyment derived from their expression of a position of powerlessness in which they describe themselves as 'slaves' or 'martyrs' in the health care system. We interpret this as jouissance and suggest that the positions of slave or martyr provide a possible response to what we argue is the impossibility of the nurse's role. We argue that a remnant of a quasi-religious ethic within the profession makes it acceptable for nurses to talk about self-sacrifice and powerlessness as part of their working subjectivity. We further argue that this analysis offers a new consideration of the issue of power and professional identity in nursing that goes beyond seeing nurses as simply overpowered by, or engaged in, a gendered power struggle with other professional groups. We suggest that powerlessness and victimhood hold particular attractions and advantages for nurses and are positions that are more available to nurses than to other occupational groups. This research shows how psychoanalytic theory can help produce new insights into the problems and complexity of nursing and extend existing study of the professions. [ABSTRACT FROM AUTHOR]

In Australia, there is no binding protocol that proscribes the processes by which the release of personal records of adults who grew up in care occurs. Individual agencies that hold the records - both government and non-government organizations - have their own policy and practice guidelines. While not specific to care-leavers, the existence of freedom of information and privacy legislation means that the subject of the records is entitled to access information about themselves, but this is not unproblematic. Drawing on qualitative in-depth interviews with a group of Australian care-leavers, this paper discusses their experiences of accessing personal records. Accessing these records was often highly significant to identity formation, but could produce both positive and negative effects. The negative aspects of the records were that, typically, at least in part, they were incomplete, insulting, incorrect and/or incomprehensible. Currently, the range of support provided to those accessing their records varies significantly across agencies. The findings of this research suggest the need for the greater provision of supported release and the implications for social work practice are discussed. [ABSTRACT FROM AUTHOR]

In this paper we examine the nature of loss in the context of environmental disasters. When the places people call home are irrevocably changed by disasters, people experience a profound sense of loss—loss that includes both tangible and intangible elements. Tangible aspects of loss include the loss of homes and infrastructure. Intangible losses are less evident but are associated with a loss of identity, of social cohesion, of belonging and community, and of health and wellbeing that are so integrally linked to one’s place. Social work academics across the world are developing environmental and ecological theories for practice that signal the need for social workers to be more engaged with the physical environment and the significance of place. Drawing on research conducted following the Black Saturday bushfires in Victoria, we highlight the nature of loss in the context of damaged “places”. IMPLICATIONS Social workers and others involved in disaster recovery need to be aware of both tangible and intangible losses and their impact on post-traumatic stress and growth. In the immediate postdisaster period, tangible losses such as homes and infrastructure are often the focus of disaster recovery efforts. Intangible losses of identity, community, and a sense of place and belonging may be of equal or greater significance than tangible losses for those affected by disasters. [ABSTRACT FROM AUTHOR]

We investigated nurses' experiences of hospital‐acquired pressure injury (PI) prevention in acute care services to better understand how PI prevention may be optimised. We used the Theoretical Domains Framework to systematically identify barriers and enablers to evidence‐based preventive practices as required by the International Guideline. This study was one element of a complex capacity building project on PI surveillance and prevention within the acute health service partners of Monash Partners Academic Health Science Centre, an accredited academic health partnership located in Melbourne, Australia. We adopted a qualitative descriptive design. We interviewed 32 nurses that provided care in intensive care units, general wards and COVID wards of four acute care services. Nurses were recruited from four large acute care services (three public, one private) located in Melbourne. Most of them worked with patients who were at high risk of hospital‐acquired PI on a daily basis. Interview transcripts were coded and analysed using thematic analysis guided by the Theoretical Domains Framework. The domains referred to most frequently by all participants included: Knowledge, Skills, Social/Professional Role and Identity, Beliefs about Capabilities, and Environmental Context and Resources. The key barriers discussed by nurses included gaps in nurses' knowledge and skills related to identification and staging of PI, heavy nursing workload and inadequate staffing levels, stigma and self‐blame related to PI identification, and exacerbating impacts of the COVID‐19 pandemic. Main facilitators discussed were training programmes, nursing audits and feedback, and teamwork. Participants suggested improvements including accessible and tailored training, visual reminders, and addressing heavy workloads and emotional barriers nurses face. Investing in tailored training initiatives to improve nurses' knowledge and organisational changes to address low level staffing and heavy workloads are urgently needed to support nurses in delivering optimal care and preventing hospital‐acquired PI. [ABSTRACT FROM AUTHOR]

The many Aboriginal and non Aboriginal social workers who work with Aboriginal communities to address health and socioeconomic disadvantage have a key role to play in reducing the continuing inequalities experienced by many Aboriginal clients in Australia. The need for more culturally-responsive practice is well recognised, as historic barriers to effective practice and relationships persist. This paper describes the views of Aboriginal people about the knowledge that social workers need to possess for effective work with Aboriginal clients, and the ways that this might be learned. Four focus groups with 30 urban Aboriginal community members identified three key areas of knowledge: Aboriginal history and its impact; cultural knowledge (including family and community structures); and the impact of social work interventions. Suggested methods for learning include building consultation and community connections, and field-education placements. The paper recommends that social work education prepares students for more effective practice with Aboriginal client groups by incorporating these content areas and methods into the core curricula. [ABSTRACT FROM AUTHOR]

In Victoria, recent reforms to the child and family welfare system, through the introduction of the Children Youth and Families Act (2005), have significantly strengthened the principle of the 'best interests' of the child. Giving substance to the principle, this legislation defines a set of standards and a practice framework to guide its application. How this is to be applied is of particular interest to the Aboriginal child and family welfare sector, given that the principle of best interests has historically underpinned the removal of thousands of Aboriginal and Torres Strait Islander children from their families on the basis of their race (Bamblett, 2006). This paper presents the findings of a qualitative research study that aimed to identify an Aboriginal perspective on the best interests principle as it applies to Victorian Aboriginal children. In-depth interviews were conducted with six experienced Aboriginal child and family welfare practitioners. The outcomes of this study highlight the distinct cultural perspectives that inform Aboriginal child and family welfare practice and raise a number of concerns in regard to an ongoing ethnocentric application of the principle by mainstream service providers. Key findings of the study are discussed, including the importance of increasing understanding of Aboriginal child-rearing practices, recognising that there is a distinct Aboriginal understanding of what constitutes a best interests framework, and the implications of this for both Aboriginal and mainstream child and family welfare practice. The paper discusses these findings within the context of recent Victorian legislative reform, which promotes Aboriginal self-determination, and argues that more work is needed to ensure Aboriginal perspectives are incorporated into service provision to Aboriginal children and families if we are truly to meet the best interests of Aboriginal children. [ABSTRACT FROM AUTHOR]

The article presents information about the management of wild horses in Victoria. It presents results of a survey held in 2005, which shows different attitudes of people towards horse management. A two-step questionnaire was formed and sent to people, selected randomly from a directory. Few face-to-face interviews were also conducted. Seventy nine percent people did not consider horses as a pest animal, and rejected the idea of any environmental harm. Charts showing the result of the questionnaire are presented. Names of people who helped in the research are also mentioned.

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

Copyright of Australian Social Work is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Perinatal women are at risk of depression and/or suicidality. Suicide is the highest cause of indirect maternal deaths in the perinatal period. Midwives and maternal child health nurses ( MCHN), as key clinicians, need to be able to detect these mental health issues. Little is known about these clinicians' attitudes to suicide. In this paper, we report on the results of a cross-sectional study of midwives' and MCHN attitudes to suicide. A convenience sample of midwives ( n = 95) and MCHN ( n = 86) from south-eastern Victoria, Australia, was recruited into the study. Participants completed the Attitudes to Suicide Prevention Scale. The results showed that MCHN have more positive attitudes towards suicide prevention than midwives, and younger participants have more positive attitudes to suicide prevention compared to older participants. Midwives and MCHN could benefit from continuing professional education to build their knowledge and skills in assessing suicide risk for childbearing women and their families, increasing positive attitudes, improving detection, and mental health referrals. [ABSTRACT FROM AUTHOR]

Delay in diagnosis and difficulties in accessing appropriate health care services plague dementia care delivery in the community setting, potentiating the risk for misdiagnosis, inappropriate management, poor psychological adjustment and reduced coping capacity and ability to forward plan. We evaluated a clinical nurse consultant role with a speciality in dementia to provide person-centred pre-diagnosis support in the community. Clients, with a six-month history of cognitive and functional decline in the absence of delirium but no formal diagnosis of dementia, were recruited from a Home Care Nursing Service and an Aged Care Assessment Service located in the Western Suburbs of Melbourne, Victoria, Australia. The role of a clinical nurse consultant was highly regarded by clients and other health professionals. This paper discussing the CNC role and the outcomes of the role suggests it was successful in providing timely assistance and support for consumers and support for other health professionals. [ABSTRACT FROM AUTHOR]

In Australia, people experiencing personality disorder have featured little in policing studies and policy or mental health policy and legislation, and in the absence of specific guidance their behaviours represent an ongoing challenge for police. This paper presents police officers' accounts from a qualitative research project that explored police encounters with people experiencing mental illness. The officers singled out people with personality disorder and expressed frustration, anger, powerlessness and resignation with their referrals of this group to health services. Officers reported that emergency departments were reluctant to assess people with personality disorder and when they did assess them stated that the person did not meet criteria for admission to mental health services, or if admitted, they were quickly discharged. People with personality disorder were reported to take up considerable police resources. When police were told by mental health professionals that there was nothing they could do about people experiencing personality disorder, then the question from police was what was to be done with them. While pockets of collaborative practice exist between police and mental health services, much change is required to demonstrate that the needs of the person with personality disorder are being met. [ABSTRACT FROM AUTHOR]

Background Mental health recovery is a prominent topic of discussion in the global mental health settings. The concept of mental health recovery brought about a major shift in the traditional philosophical views of many mental health systems. Aim The purpose of this article is to outline the results of a qualitative study on mental health recovery, which involved mental health consumers, carers and mental health nurses from an Area Mental Health Service in Victoria, Australia. This paper is Part One of the results that explored the meaning of recovery. Methods The study used van Manen's hermeneutic phenomenology to analyse the data. Findings Themes suggested that the cohort had varying views on recovery that were similar and dissimilar. The similar views were categorised under two processes involving the self, an internal process and an external process. These two processes involved reclaiming various aspects of oneself, living life, cure or absence of symptoms and contribution to community. The dissimilar views involved returning to pre-illness state and recovery was impossible. Conclusion This study highlights the need for placing importance on the person's sense of self in the recovery process. [ABSTRACT FROM AUTHOR]

Over the past two decades in Australia, there has been significant change in the palliative care sector, the profile of the workforce and its educational requirements. This is reflective of worldwide developments, where educational aspects of palliative care have been integral to the development of service models. This paper describes a project undertaken by the Department of Health in Victoria Australia, to redirect its educational funding towards clinical scholarships to enable clinicians to undertake postgraduate academic studies. The aim of this project was to assess the impact of the Clinical Scholarship Program funding for recipients who undertook postgraduate studies in palliative care. As part of quality assurance, an online survey was distributed to Scholarship recipients across 2 cohorts spanning the years 2008-2010. Recipients were surveyed for the impact and outcomes of their participation in the program. Twenty one-year scholarships for each year (2008-2010), were available to medical, nursing, and allied health professionals currently working in Victoria's public palliative care service system, undertaking postgraduate study in approved courses. Analysis of the data indicated that of most significance was the benefit to the individual, in terms of the impact of study on their professional and personal life and the low rates of employment turnover. Participants also indicated their improved capacity to provide high-quality palliative care services. For the Department of Health this small investment has demonstrated great benefit; and for the palliative care sector it achieved a significant impact enabling an increase in educational opportunities to enhance capacity and capability of the workforce. [ABSTRACT FROM AUTHOR]

In the context of a growing population of people experiencing mental illness worldwide, mental health nurses are a crucial workforce. Their recruitment and retention, however, is in decline. Drawing on qualitative data obtained from interviews with mental health nurses ( MHN) in Victoria, Australia, the paper employs a range of concepts from role theory to explore professional identity within mental health nursing. The data highlight three key issues in relation to the future recruitment and retention of MHN: (i) the ambiguity of the MHN role; (ii) the weak definition and lack of understanding of the scope of the MHN role by nursing students; and (iii) a lack of communication about MHN as a profession to a wider audience. These findings indicate three avenues through which recruitment and retention in mental health nursing could be improved: (i) public communication; (ii) training and educating of the next generation of MHN; and (iii) more accurately defining the role of the MHN. [ABSTRACT FROM AUTHOR]

Introduction. Australian medical speciality colleges have adapted and integrated the CanMEDS Physician Competency Framework into their training programs. The role as manager is one of the competencies and is presently thought to receive little attention during training. The objective of our study was to investigate the perceptions of Australian junior doctors regarding their management skills and their perceived need for management education. Methods. In November and December 2011, 1376 junior doctors from eight Victorian metropolitan health services were invited via email to participate in this study. Participating junior doctors received a questionnaire regarding their self- perceived management skills and knowledge and a medical management training needs assessment. Results. The response rate of one of the health centres was too low (6%) and therefore insufficient for credible conclusions to be drawn. Of the other health services, 194 (16%) out of 1213 junior doctors responded to the survey. Overall, the junior doctors rated their perceived competency on a 1-5 Likert scale as moderate (mean 3.45; s.d. 0.42). Of the 194 residents who responded, 71.3% (n = 139) reported a need for management training. Discussion. The junior doctors of Victoria, Australia perceived their knowledge on medical management as moderate. The results of this study showed that there is a perceived need among junior doctors for more management training. This need seems to confirm that management skills are thought to be valuable in medical practice. Our study also suggests that before the development of specific interventions, there is a need for a gap analysis between the perceived and actual management skills desired in medical residents. The attention paid to the role 'as manager' should therefore be embedded in training of all junior doctors. What is known about the topic? The CanMEDS 2005 Framework describes the seven key competencies physicians should possess to meet the needs of patients and society, and was developed by The Royal College of Physicians and Surgeons of Canada. One of these competencies is the role as manager. Published studies have shown that medical residents have a need for education in healthcare management in basic and postgraduate medical training. What does this paper add? In this study we discovered that junior doctors in Victorian metropolitan health services have a moderate perception of their competencies as managers. Previous management experience influenced the perceived competence in a positive way. What are the implications for practitioners? We believe that it is necessary that junior doctors continue to build on existing opportunities to develop their management skills. In order to achieve this, awareness of the importance of management competencies and the possibilities to obtain management experience must be raised among junior doctors. Furthermore, they need to be given the opportunity to obtain experience. [ABSTRACT FROM AUTHOR]

This paper establishes the value of a social work investigation of good practice with people on Community Treatment Orders in the context of social work's longstanding interest in the ethical challenges of working with involuntary clients. The emancipatory values of social work were used to guide this research, thereby ensuring the participation of consumers and their families or carers. Critical social work theory provided an important theoretical base. A mixed methods approach was undertaken, including a cluster analysis and case studies. Five principles of good social work practice emerged from the qualitative data: (a) use and develop direct practice skills; (b) take a human rights perspective; (c) focus on goals and desired outcomes; (d) aim for quality of service delivery; and, (e) enhance and enable the role of key stakeholders. These principles are briefly presented along with recommendations for practice and service development. [ABSTRACT FROM AUTHOR]

This paper describes the evaluation of the Transition Care Cognitive Assessment and Management Pilot (TC CAMP) at a residential care facility in Victoria, Australia. Transition care aims to provide a goal-oriented time-limited service to older people at the conclusion of an episode of hospital care. The TC CAMP was established to specifically meet the needs of people with cognitive impairment. The purpose of this study was to evaluate the implementation and effectiveness of the TC CAMP. The evaluation sought to explore the perceptions ofstaffandfamily carers, and outcomes for the person with dementia. Methods consisted of file audits, focus groups and individual interviews with nursing staff and carers. This evaluation found that it was possible to provide appropriate transition care to people with cognitive impair-ment who exhibited behavioural and psychological symptoms of dementia. The TC CAMP achieved length of stay and readmission rates that were comparable with transition care for cognitively intact people. The role of the Clinical Nurse Consultant was highly valued by staffand families involved in TC CAMP. The findings from TC CAMP suggest a suit-able environment, availability of trained and resourced nursing and clinical staff and clear roles and expectations for all stakeholders should be considered in implementation of this model of care. [ABSTRACT FROM AUTHOR]

Abstract Young people with complex support needs who live outside metropolitan areas face unique challenges. Issues such as poor educational and employment opportunities, homelessness, racism, problematic substance use, challenging behaviour, disability and mental illness can be magnified and lead to judgment and marginalisation in small communities such as those in rural and regional areas. As a result of poor resourcing of services in these areas, young people may be forced to transition from place to place, service to service as a way of coping with life challenges. This paper presents findings from interviews and focus groups with service providers who support such young people in regional and rural Queensland, New South Wales and Victoria in Australia. Service providers reported similar challenges to professionals working in urban areas, such as navigating inter-agency and inter-professional work and dealing with funding shortages. However, these issues were amplified by the need to work across broad geographical areas, to recruit and retain skilled workers and to respond to the many structural and resource inadequacies in smaller communities. While services aimed to be responsive to young people, the challenges of providing support in a non-metropolitan context could create a context in which young people either disengaged from services or poor response resulted in systemic escalation to crisis. The implications for policy and practice are explored. Highlights • Supports to young people with complex support needs in non-metropolitan areas in Australia are poorly resourced. • Non-metropolitan services work best when they are based on relationship-based practice and local community needs. • Interagency collaboration is essential when working across broad geographical areas. [ABSTRACT FROM AUTHOR]

The aim of this paper is to study the effects of factors broadly captured under the rubric of parental social and cultural capital on child health. The setting was 11 disadvantaged communities in Victoria, Australia during the conduct and evaluation of Best Start, an early childhood initiative of the Victorian State Government. Questionnaires were sent to parents of 3-year-old children in 2004 and 2006. The principal dependent variable was parental global rating of their child's health. Social capital variables focussed, for example, on community support for parent's child rearing practices. Cultural capital variables focussed, for example, on parent's reading to their child. Socio-economic status and other potential confounding variables were also measured. Stepwise multivariable logistic regression was used. There were consistent independent effects for the cultural capital variables—‘Age started reading to the child’ and ‘Confident being a good parent’, and only one of a number of social capital variables—‘Community support for childrearing’ as well as for some other variables particularly that ‘Child had a chronic health/medical condition’. Dichotomizing parent's global ratings of their child's health differently had some effects on results. Cultural capital and, to a lesser extent, social capital variables were associated with parent's rating of the child's health. It is now timely to conduct and evaluate programs aimed at improving parents’ cultural capital. Better measures or inventories of parent's cultural capital will be essential for this. [ABSTRACT FROM AUTHOR]

Young people transitioning from state out-of-home care are arguably one of the most vulnerable and disadvantaged groups in society. Many have been found to experience significant health, social and educational deficits. Most western countries have now introduced specific policy and practice initiatives to improve the life chances of care leavers, but there have been varied conclusions about the efficacy of those programs. This paper argues that a community development support model based on a partnership between professional social welfare workers and local community networks is most likely to enhance opportunities for the social inclusion of care leavers. Particular reference is made to the leaving care and after care support program introduced by St Luke's Anglicare in the Australian rural city of Bendigo which has included key program initiatives around housing, employment and mentoring. Some conclusions are drawn based on the experiences of service users about 'what works' in leaving care programs. [ABSTRACT FROM AUTHOR]

Indigenous Australians are far more likely to suffer from chronic disease than are non Indigenous Australians. Taking a health promotion approach to address this inequity, prevention strategies that aim to improve nutrition, increase physical activity, and smoking cessation are indicated. In this paper, the authors outline results of a survey that investigated requirements for peer support and readiness-to-change behaviour for urbanised Indigenous people that focused on areas of nutrition, physical activity, and smoking behaviour. Results of this survey indicated that respondents were more ready to change behaviours that related to nutrition and physical activity but less ready to cease smoking. Peer support preferences were for face-to-face or group support for physical activity and smoking (rather than telephone or website), and assistance with food costs was the preferred strategy to improve nutrition. [ABSTRACT FROM AUTHOR]

The emphasis on a sexualised muscular body ideal in gay social and cultural settings has been described as facilitating body image dissatisfaction among gay men. Drawing on a concept of reflexive embodiment, this paper uses qualitative interviews to analyse gay men's embodiment practices in relation to discourses and norms that can be found across and beyond any coherent notion of 'gay subculture'. The findings reveal body image to be more complex than a limited focus on subculture or dissatisfaction can account for. In particular, gay men negotiate a gay pride discourse in which the muscular male body generates both social status and self-esteem, and deploy notions of everyday masculinity that imply rationality and control to resist gendered assumptions about gay men's body image relationships. [ABSTRACT FROM AUTHOR]

The importance of Psychiatric Consultation-Liaison Nursing (PCLN) in improving health outcomes for patients experiencing mental health problems has received some attention in the nursing literature. However, little effort has been made to evaluate the impact of this role. The study presented in this paper was conducted in order to assist in redressing this paucity. Focus groups were conducted with nurses (n = 17) employed at a large general hospital in Melbourne, Australia. The nurse participants were asked to discuss their views about utilizing the services of the specialist PCLN employed in this hospital. The responses of participants were overwhelmingly positive. The four main themes to emerge from the study were: helping staff, making contact, implementing strategies, and utilizing attributes. These findings are presented and discussed as a contribution to and extension of the existing literature. [ABSTRACT FROM AUTHOR]

Liveability is determined by characteristics of a place including walkability and access to natural environments. These two attributes can be quantified at a fine spatial scale providing insights into liveability. Most liveability studies focus on metropolitan areas, and we identified a research gap in regional liveability research. Using a case study on two towns in Indigo Shire in regional Victoria and focusing on older residents, we examined walkability and access to and attitudes about the natural environment. We found that opportunities for walking in regional towns can be limited, and that only a small number of older people walk regularly. Despite being largely surrounded by nature in regional towns, connection to nature and sense of community is sometimes lacking. In addition, measures of walkability and access to natural environments designed to be used in metropolitan environments do not translate well to regional areas. However, the data and insights gathered in this research helped build a context-specific understanding of liveability in each community and allowed us to provide useful recommendations to local government. While these recommendations are specific to the study area, the methodologies used, and insights gained are applicable to regional and rural towns in a wide range of contexts. [ABSTRACT FROM AUTHOR]

This paper explores the multi-level aspects of cultural competence from the perspectives of healthcare service providers in the community health context. Qualitative interviews were conducted with staff (n=14) from a community health service in Australia. Findings showed that most participants had an adequate understanding of cultural competence and viewed it as an important aspect of their work. In general, participants aimed to take a client-centred approach rather than trying to achieve cultural expertise. Difficulties with language, communication and organizational processes were identified as potential barriers to service provision. This study furthers the understanding of the challenges of culturally competent practice. [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]

Integrated coastal zone management (ICZM) involves multiple stakeholders operating through multiple processes and levels. This makes ICZM challenging. Trust is a critical ingredient for ensuring that the diverse understandings, perspectives and forms of knowledge about the coast are appropriately considered in decision-making. However, the number and diversity of stakeholders with an interest in the coast means that building and maintaining trust is challenging. Drawing on insights from 42 semi-structured interviews with stakeholders involved in coastal management in Victoria, Australia, this paper contributes to an improved understanding of the importance of trust in coastal zone management and what might be done to enhance it. In doing so, the importance of trust in coastal zone management is reinforced; stakeholders’ perspectives on who they trust to obtain advice from, and why, are unpacked; and the broader implications for coastal zone management are discussed. [ABSTRACT FROM PUBLISHER]

Objectives: To examine nurses' and midwives' preferences for the characteristics of their jobs.Methods: A discrete choice experiment of 990 nurses and midwives administered as part of a survey of nurses and midwives in Victoria, Australia.Results: Autonomy, working hours, and processes to deal with violence and bullying were valued most highly. Nurses and midwives would be willing to forgo 19% and 16% of their annual income for adequate autonomy and adequate processes to deal with violence and bullying, compared to poor autonomy and poor processes for violence and bullying.They would need to be paid an additional 24% to increase their working hours by 10% ($73 per hour). Job characteristics that were less important were shift work, nurse to patient ratios, and public or private sector work.Conclusions: Policies to improve retention and job satisfaction of nurses and midwives should initially focus on autonomy, processes to deal with violence and bully [ABSTRACT FROM AUTHOR]

This article reports the findings of a study about the work of Aboriginal hospital liaison officers (AHLOs) and hospital social workers in Victoria. Guided by an Aboriginal Critical Reference Group, in-depth interviews were held with nine AHLOs, 10 social workers, and three Aboriginal health policy and program informants. Telephone focus groups held with study participants confirmed an analysis of the narratives of good practice and themes identified by participants. Focusing on the strengths of collaborative work, six key principles for good practice were defined. These principles relate to nonbiomedical knowledge and skills that non-Aboriginal social workers and AHLOs require to work well with Aboriginal patients. Implications for training and further research are discussed. IMPLICATIONS Similar elements of shared good practice between AHLOs and social workers were identified across a range of hospital types in Victoria suggesting that this is an important area of social work practice to understand and develop. The relationship and practice between AHLOs and social workers were previously underexplored, and the strengths and challenges of their working together practice have the potential to positively impact the hospital stay and health outcomes of Aboriginal patients. This study calls for opportunities to further strengthen and facilitate the ongoing, dynamic, and positive relationships between hospital social workers and AHLOs. Working together, they contribute to the creation of cultural safety and care for Aborignal patients and their families. [ABSTRACT FROM AUTHOR]

Tram drivers operate a master controller to control the acceleration and braking of the tram. Operation should ensure passenger comfort and safety through smooth tram motion and the avoidance of jerkiness that may cause passengers to fall in the carriage. This work investigates current driver practices and strategies for tram driving in normal operations through interviews and the capacity of a new haptic master controller to support drivers in achieving smooth and safe tram journeys. A haptic feedback algorithm based on viscosity was implemented on the master controller to provide drivers with feedback on the rate at which they were accelerating and braking the tram. This aspect was tested in a virtual tram within a simulated inner city virtual reality environment. Results indicate that the haptic master controller and coupled viscosity feedback algorithm did not increase smoothness of driving during the simulated experiences. Despite this, the drivers indicated a preference for the provision of further haptic information to support driving tasks and the overall journey safety and smoothness. Practitioner Summary: This research comprises two studies. The first investigates strategies currently used by drivers to operate a tram smoothly in order to elicit design requirements for a haptic tram master controller. The second study evaluates the impact of a novel haptic master controller on journey smoothness within a virtual environment. [ABSTRACT FROM AUTHOR]

Background. Investigations into 'inappropriate' use of emergency health services are limited by the lack of definition of what constitutes a health emergency. Position papers from Australian and international sources emphasise the patient's right to access emergency healthcare, and the responsibility of emergency health care workers to provide treatment to all patients. However, discordance between the two perspectives remain, with literature labelling patient use of emergency health services as 'inappropriate'. Objective. To define a 'health emergency' and compare patient and health professionals perspectives. Method. A sample of 600 emergency department (ED) patients were surveyed about a recent health experience and asked to rate their perceived urgency. This rating was compared to their triage score allocated at the hospital ED. Results. No significant relationship was found between the two ratings of urgency (P = 0.51). Conclusions. Differing definitions of a 'health emergency' may explain patient help-seeking behaviour when accessing emergency health resources including hospital ED and ambulance services. A new definition of health emergency that encapsulates the health professional and patient perspectives is proposed. An agreed definition of when emergency health resources should be used has the potential to improve emergency health services demand and patient flow issues, and optimize emergency health resource allocation. [ABSTRACT FROM AUTHOR]

Healthcare staff are in a unique position of understanding client experiences, physiological impacts of client behaviour, the local healthcare system and the physical environment in which the services operate. Their perspectives may provide insights into the feasibility and effectiveness of existing models of diabetes care and suggestions for improvements to models of care (MoC). The objective of this qualitative study was to explore the experiences of healthcare staff delivering care for people with diabetes at the request of an existing healthcare service. Semi‐structured interviews were conducted with 21 healthcare staff from three community health centres in one region of Victoria, Australia, in 2018. Interviews were audio‐recorded and transcribed verbatim. Data were subject to qualitative content analysis and, subsequently, emerging themes were classified at individual, relationship, community and societal levels of the social–ecological model (SEM). Perceived barriers of access to health services using the current MoC included a lack of public transport, low socioeconomic status, job insecurity (resulting in an inability to take time away from work) and inflexible appointment times, all of which negatively impact diabetes management. Perceived enablers included having a co‐located, multidisciplinary team, a holistic approach to diabetes management and motivation resulting from improvement in diabetes‐related health outcomes. The findings indicate that there is potential to improve the service in this region by adopting a more integrated, team‐focused and accessible MoC. [ABSTRACT FROM AUTHOR]

Communication disability, including aphasia, is prevalent in the stroke population and impacts service delivery. This study explored the experiences of the multidisciplinary stroke team in delivering healthcare to patients with aphasia. A phenomenological approach was used to understand the experiences of delivering healthcare services in the presence of aphasia. Healthcare professionals (n = 16) were recruited across acute and subacute stroke care, with a range of discipline backgrounds and experience. Participants took part in focus groups and data were analysed using an inductive thematic approach. Five themes were evident: 1) aphasia is time consuming, 2) health professionals do not know how to help, 3) health professionals limit conversations with patients with aphasia, 4) health professionals want to know how to help, and 5) health professionals feel good after successful communication. Aphasia disrupts usual care. Health professionals want to help but are working in a non-optimal environment where communication and patient-centred care are not adequately resourced. A video abstract is available in . Current hospital systems and ward culture make it difficult to offer patient-centred care to patients with aphasia. Health professionals want to help patients with aphasia but are working in an environment where patient-provider communication is not adequately resourced. As a result, health professionals dread, limit or avoid talking with patients with aphasia. Health professionals need support which may include ongoing education and on-the-job training, and a change in ward culture including key performance indicators focusing on patient-provider communication. [ABSTRACT FROM AUTHOR]

Background: In the Australian state of Victoria, specialist doctors are central to the operation of voluntary assisted dying (VAD). However, a broad range of clinicians may be involved in the care of patients requesting or using VAD. Aims: To describe levels of support for and willingness to be involved in VAD and consider factors associated with clinician support for the VAD legislation and physicians' willingness to provide VAD in practice. Methods: A multisite, cross‐sectional survey of clinicians in seven Victorian hospitals. All clinicians were invited to complete an online survey measuring demographic characteristics, awareness of and support for the VAD legislation, willingness to participate in VAD related activities and reasons for willingness or unwillingness to participate in VAD. Results: Of 5690 who opened the survey, 5159 (90.1%) were included in the final sample and 73% (n = 3768) supported the VAD legislation. The strongest predictor of support for the VAD legislation was clinical role. Forty percent (n = 238) of medical specialists indicated they would be willing to participate in either the VAD consulting or coordinating role. Doctors did not differ in willingness between high impact (44%) and low impact specialty (41%); however, doctors specialising in palliative care or geriatric medicine were significantly less willing to participate (27%). Conclusion: Approximately 73% of surveyed staff supported Victoria's VAD legislation. However, only a minority of medical specialists reported willingness to participate in VAD, suggesting potential access issues for patients requesting VAD in accordance with the legal requirements in Victoria. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) presents with physical, emotional and social difficulties that affect quality of life. Multimodal management includes both pharmacological and non-pharmacological strategies, and pulmonary rehabilitation (PR) plays an important role. Recent research has suggested that manual therapies may improve perceptions of dyspnea for people with COPD. Methods: Focus group interviews were conducted as part of a mixed methods study to assess the feasibility of implementing a manual therapy technique—muscle energy technique (MET)—as an adjunct to PR for people with moderate to severe COPD. Focus group interviews were conducted to examine trial participants views of the intervention and the trial design. A thematic analysis was undertaken to explore the data. Results: Twelve participants with moderate to severe COPD participated in three focus groups. Participants were motivated to participate in the trial to be proactive about their health. They perceived MET to be a gentle, comfortable form of stretching that allowed them to 'breathe easier' and prepared them for PR. A small number of participants reported mild muscular discomfort during MET, but this was short-lasting and was not bothersome. Participants enjoyed the one-on-one contact with researchers and learned more about their breathing while performing spirometric testing. Most participants wanted longer and more frequent MET sessions, and some requested 'homework' stretching exercises. Conclusions: The findings of this study show that a manual therapy intervention was received well by participants in a clinical trial setting. A small number of participants reported mild musculoskeletal discomfort in relation to the MET treatment. Participant preferences for additional and longer treatment sessions should be carefully considered against available resources in future clinical trials. Trial registration: ANZCTR, ACTRN12618000801213. Registered 11 May 2018 - Retrospectively registered. http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374643&isReview=true [ABSTRACT FROM AUTHOR]

The Spiritual Health Association2 has developed two frameworks for use by spiritual care management across health services in Victoria (Australia), namely, the "Spiritual Care Minimum Data Set Framework" (SHV, 2015) and second, the "Spiritual Care in Victorian Health Services: Towards Best Practice Framework" (SHV, 2016a), hereafter referred to as "the frameworks." For the first time, the frameworks have provided a consistent way of collecting data in Victoria, and of benchmarking spiritual care services in several areas including governance, credentialing, and quality improvement processes. The evaluation was conducted by surveying 36 spiritual care managers/ co-ordinators in Victorian hospitals. The results were used to report to chief executive officers in Victorian health services. The results of the evaluation showed that the frameworks were effective tools for auditing, benchmarking, and improving quality in spiritual care departments within health services in the State of Victoria, Australia. These frameworks were found to support spiritual care departments in undertaking continuous improvement initiatives in their local health services. The results have informed the development of future frameworks and guidelines for the spiritual care sector. [ABSTRACT FROM AUTHOR]

During the debates about the legalization of Voluntary Assisted Dying (VAD) in Victoria, Australia, the presence of anti-VAD health professionals in the medical community and reported high rates of conscientious objection (CO) to VAD suggested access may be limited. Most empirical research on CO has been conducted in the sexual and reproductive health context. However, given the fundamental differences in the nature of such procedures and the legislation governing it, these findings may not be directly transferable to VAD. Accordingly, we sought to understand how CO operates in the context of VAD. Prior to the implementation of the VAD legislation in June 2019, we conducted semi-structured interviews with seventeen health professionals with a self-declared CO to VAD, to explore what motivated their CO. Participants identified multiple motivations, which can be broadly categorized as: concerns for oneself; concerns for patients; concerns about the current Victorian legislation; and concerns for the medical profession. Participants' moral commitments included personal, professional, and political commitments. In some cases, one's CO was specific to Victoria's current legislation rather than VAD more broadly. Our findings suggest CO motivations extend beyond those traditionally cited and suggest a need to better understand and manage CO in the healthcare context. [ABSTRACT FROM AUTHOR]

Care staff in residential aged care facilities (nursing homes) in Australia are obligated, under the Australian National Framework for Action on Dementia 2015–2019, to support residents to exercise choice and make decisions. Research indicates, however, that care staff are often given little guidance regarding which residents' decisions should be supported or how to make decisions on their behalf. This lack of guidance can result in a denial of residents' rights and inconsistent treatment by staff, placing residents' wellbeing at risk. Through providing an analysis of the responses of staff at RACFs in Victoria and Queensland to two case scenarios, this study seeks to provide some understanding of the difficulties staff face in supporting residents' self-determination and their own need for greater organisational support. [ABSTRACT FROM AUTHOR]

The impact of Australian disability policy reform, known as the National Disability Insurance Scheme, on the capacity of rural health and human service organizations to facilitate higher education has been poorly investigated. This study explored how health professionals perceive the impact of the National Disability Insurance Scheme on nursing and allied health work-integrated learning (WIL) in rural host organizations during the scheme's implementation in Victoria, Australia. Data collected from 20 health professionals across rural Victoria were thematically analyzed and mapped onto WIL dimensions. This process revealed themes relating to shifts in WIL purpose, context, nature and responsibilities. The findings suggest the National Disability Insurance Scheme may have limited rural organizational capacity to host students undertaking WIL, and in turn, contributed to a decline in rural health education during the implementation phase. Thus, WIL partners may need to pay greater attention to the policy framework surrounding rural WIL opportunities. [ABSTRACT FROM AUTHOR]