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The authors respond to comments by Professor Eugene Carter concerning their paper "A Simultaneous Equation Approach to Financial Planning." They state that while matrix inversions are utilized in solving linear simultaneous equations, their own model utilizes nonlinearities that prevent the use of a straight-forward matrix inversion technique. They suggest their own model does a more effective job of portraying financial decision making than other models. They comment on the accuracy of projections for Sears-Roebuck and mention a discussion about if the U.S. Securities and Exchange Commission should permit or require projections in equity prospecti, considering the method for making financial projections is well-developed.

Objective: In this article we present a conceptual framework for enhancing effective healthcare communication in Australia and Aotearoa New Zealand., Methods: Through an iterative, deliberative dialogue approach, we, as experts from a variety of health professions and academic disciplines, worked together to identify core values and considerations for healthcare communication across numerous health professions and disciplines and within research, teaching, policy, and practice contexts., Results: The framework developed includes five core values at its centre: equitable, inclusive, evidence-based, collaborative, reflective. Around this are concentric circles showing key elements of collaborators, modality, context, and purpose. Each of these is explored., Conclusion: This work may support benchmarking for healthcare providers, researchers, policymakers, and educators across a breadth of professions to help improve communication in clinical practice. The framework will also help to identify areas across disciplines that are shared and potentially idiosyncratic for various professions to promote interprofessional recognition, education, and collaboration., Innovation: This framework is designed to start conversations, to form the foundation of a dialogue about the priorities and key considerations for developing teaching curricula, professional development, and research programs related to healthcare communication, providing a set of values specifically for the unique contexts of Australia and Aotearoa New Zealand. It can also be used to guide interdisciplinary healthcare professionals in advancing research, teaching, policy, and practice related to healthcare communication., Competing Interests: None., (© 2023 The Authors. Published by Elsevier B.V.)

Background: Workplace sense of belonging is an important contributor to health and wellbeing. It may be even more important for paramedics to buffer against distress inherent in the workplace. To date, however, there has been no research on paramedic workplace sense of belonging and wellbeing., Methods: Using network analysis, this study aimed to identify the dynamic relationships of workplace sense of belonging in paramedics with variables associated with wellbeing and ill-being-identity, coping self-efficacy and unhealthy coping. Participants were a convenience sample of 72 employed paramedics., Results: The results showed workplace sense of belonging linked to other variables through distress, distinguishable by the relationship with unhealthy coping for wellbeing and ill-being. The relationships between identity (perfectionism and sense of self) as well as the relationship between perfectionism and unhealthy coping were stronger for those with ill-being than observed for those with wellbeing., Conclusions: These results identified the mechanisms by which the paramedicine workplace can contribute to distress and unhealthy coping strategies, which can lead to mental illnesses. They also highlight contributions of individual components of sense of belonging highlighting potential targets for interventions to reduce the risk of psychological distress and unhealthy coping amongst paramedics in the workplace., Competing Interests: Conflict of interest We have no conflicts of interest to disclose., (Copyright © 2023. Published by Elsevier Ltd.)

Background: The combination of first-year placements, an increasing proportion of mental health callouts, and the high incidence of mental illness in health-professional tertiary students means standard curricula may not adequately prepare early-year paramedic students for mental health challenges., Methods: A retrospective online survey was used to explore the experiences of paramedic students who have completed Mental Health First Aid (MHFA) training within their undergraduate studies. The content-validated survey explored the relevance, appropriateness, and novelty of MHFA training, and invited participants to reflect on the course strengths and weaknesses., Results: The majority of 102 respondents, predominantly female first- and second-year paramedic students aged 18-24 years, agreed the content was relevant (86%) and appropriate (88%), with 73% agreeing they would recommend to other university students. Thematic analysis identified strengths of the course as perceived increases in mental health literacy and empowerment to act on mental health concerns. A weakness was students perceived the course did not prepare them adequately for clinical practice., Conclusion: The inclusion of MHFA early in paramedic curricula is appropriate and relevant, increasing mental health literacy and empowering students to recognise and act upon mental health concerns. Application of practical scenarios may further enhance student learning experiences., Competing Interests: Conflicts of interest All authors declare no conflicts of interest or external funding relating to this study., (Copyright © 2022 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.)

Objective: This scoping review will identify and map the literature on interventions to address impostor phenomenon., Introduction: Impostor phenomenon, also known as impostor syndrome, describes intense feelings of fraudulence and chronic self-doubt. The phenomenon has been associated with a range of psychological issues and has been linked to negative career outcomes. While research on the prevalence of impostor phenomenon and its associated comorbidities has been reported for over 40 years, there is a paucity of studies that describe interventions to address this phenomenon., Inclusion Criteria: The review will consider any English-language study that describes or evaluates interventions to mitigate impostor phenomenon. Quantitative and qualitative studies will be sourced from published literature, gray literature, and the references of retrieved articles. Studies will not be limited by participant or setting. Authors of primary studies will be contacted to identify additional sources or for clarifications, where required. Conference abstracts, editorials, and opinion papers will be excluded., Methods: Databases to be searched will include APA PsycNet, MEDLINE, Scopus, and Web of Science. All databases will be searched from inception till the present. Retrieved citations will be independently reviewed by the reviewers, and relevant studies will be extracted using a data extraction form developed for this review. The results will be presented in tabular format and accompanied by a narrative summary. The review will be conducted in accordance with the JBI guidelines for scoping reviews., Details of This Review Available at: Open Science Framework osf.io/w7xg6., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 JBI.)

Mental Health First Aid (MHFA) training exists to improve supportive behaviours towards peers, increase mental health literacy, and reduce stigma. Community sport clubs have potential to successfully deliver mental health programs. This study investigated the effectiveness of online MHFA training undertaken by members of the rugby community and evaluated the feasibility and usefulness of the online delivery mode and users' engagement with it. A mixed-methods approach was used to provide depth of understanding through qualitative analysis, combined with quantitative outcomes. Online surveys examining participants' knowledge and perceptions were administered pre- and post-MHFA training. Significant improvements ( p < 0.05) across all assessed domains were observed post- compared to pre-MHFA training. A large effect size was identified in relation to advice giving and sign and symptom identification. A moderate effect size pre- to post-improvement was identified for users' perceptions of therapy's effectiveness, the ability of people with severe mental health conditions to recover, and benefit of a healthcare professional. Participants endorsed the MHFA program to improve mental health literacy, advance non-technical skills, and improve confidence. MHFA training can increase the awareness and knowledge of mental health issues in key individuals in community sport clubs and enable them to aid people with mental health concerns. Online MHFA training is associated with improved mental health literacy and may be a suitable and economically sustainable model for community sport.

Objective: Infant or child death is reported as being the most distressing type of case paramedics attend. Student paramedics also identify supporting bereaved families as an area associated with low confidence. This study evaluated the CARES skills framework (Connect to emotion, Attention training, Reflective listening, Empathy, Support help seeking) as a peer support model to encourage student paramedics to talk about grief and death related to infants and children., Method: A convenience sample of first-year paramedic students (target n = 154) was recruited from a single Australian regional university. A modified nominal group technique method was used following a student debriefing session designed to identify problems, generate solutions, and make decisions regarding the efficacy of the CARES skills framework., Results: Of 154 eligible participants, 141 participated (92% response rate). Peer social support normalized students' emotions related to death and dying. Although naming emotions was challenging, students reported that the CARES model facilitated a safe environment to talk about death and dying. Students reported feeling heard and connected to their peers during the exercise and an enhanced sense of belonging after the exercise., Conclusions: Findings contribute to evidence that suggests the CARES model is a useful mechanism to enhance peer social support in paramedic students.

Despite threats to wellbeing inherent in paramedicine, little is known about how paramedics cope. This study explored the breadth of healthy and unhealthy coping strategies used by paramedics and student paramedics. A convenience sample of 198 paramedics and student paramedics completed an online survey. Wellbeing was measured using WHO-5 and coping using the Coping Index. Primary outcomes were summarised using descriptive statistics. Most of the sample had wellbeing (68%); student paramedics had significantly better wellbeing than paramedics. There was no significant difference between paramedics and student paramedics on healthy or unhealthy coping. Participants with ill-being had significantly fewer healthy and more unhealthy coping strategies than those with wellbeing, and relatively few used professional support (28%). Internationally, few studies have reported coping strategies in paramedics. This study expands our understanding of healthy and unhealthy coping strategies used by paramedics and student paramedics. The results support research that shows paramedic work affects wellbeing, however not that paramedics are at greater risk of unhealthy coping than students or the general population. The results have implications for both the prevention of overwhelming distress in the workplace and the need to increase the use of professional support to prevent unhealthy coping, including suicidality., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2022 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.)

Exposure to repeated trauma is an inherent component of paramedicine. Additionally, paramedics are exposed to threats that can undermine healthy workplaces, social connectedness, and health behaviour, predisposing them to overwhelming distress and unhealthy coping, including suicidality and psychiatric disorders. This scoping review aimed to identify how paramedics cope. PubMed, PsycINFO and CINAHL were searched between January 1, 2010, to April 21, 2021. Studies were included if they used any research design to identify specific coping strategies used by paramedics. Three studies met the inclusion criteria-two qualitative and one cross-sectional survey design. There was a high risk of bias across all studies. Studies were conducted in Israel, Poland, and the UK, primarily with males. Two studies only identified healthy coping strategies-self-soothing and social and professional support. Unhealthy strategies identified in the third study were limited to negative self-talk and alcohol use, with no mention of other harmful behaviours, social withdrawal, or suicidality. There is limited research describing how paramedics cope, and in particular, how female paramedics cope. Further research exploring the breadth of coping strategies used by paramedics is needed to understand the impact of the work paramedics undertake on coping and inform prevention and support activities., (Copyright © 2021 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.)

Work integrated learning (WIL) in the ambulance setting is an essential part of the paramedic curriculum. However, qualified ambulance personnel are reported to experience higher suicide rates and mental stress disorders due to high pressure work environments, and there is growing concern for the wellbeing of students entering this setting. The aim of this integrative review was to explore how studies have reported paramedic students' experience of stress whilst undertaking WIL. Five studies met the inclusion criteria and were evaluated for quality according to validated tools from the Critical Appraisal Skills Program, then ranked on the level of evidence used. Data was summarised in a comprehensive research paper matrix, and findings were categorised into levels and sources of stress. Levels of stress were measured by the percentage of paramedic students who developed post-traumatic stress disorder. The primary sources of stress were experiencing death and fear of making clinical mistakes. Students also identified emotional expression as a negative attribute. Future research should prioritise identifying the levels and sources of stress students face in each year of their academic program when undertaking WIL to provide a direction for preparatory activities that may mitigate the negative effects of stress., (Copyright © 2021 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.)

There is growing concern for the health and wellbeing of paramedic students who are required to undertake work integrated learning (WIL) in the ambulance setting to become a registered paramedic. Paramedic culture, barriers to help seeking, and difficulty in accessing peer support is limiting their ability to express emotions and cope with workplace stress. This study aimed to examine whether participation in a peer social support group, using the CARES skills framework, changed paramedic students' emotional expression and emotion-focused coping. A convenience sample of seventy-eight participants were recruited from a paramedic program at a single regional university in Australia. Due to small participant numbers third year students were assigned to the intervention group (n = 44) and second year students were assigned to the control group (n = 34). The intervention group received training on how to undertake a peer social support group using the skills embedded in the CARES framework and were encouraged to meet every two weeks over a twelve-week period. All participants completed online surveys consisting of the DASS-21 stress subscale, General Help Seeking Questionnaire, Emotional Approach Coping Scale, Emotional Expressivity Scale and Multidimensional Scale of Perceived Social Support in week 1 and in week 12. Findings suggest that peer social support participation significantly increased emotional expression and emotion-focused coping when compared to the control group. Furthermore, this intervention significantly reduced participants' reliance upon help seeking without a significant increase in external social support. This is the first known study to investigate the role of peer social support amongst paramedic students, and the findings provide new information on how to help individuals cope with the stressors of working in the ambulance setting. Future studies should investigate whether the positive effects of peer social support are consistent over time and focus on minimising sampling issues., (Copyright © 2021 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.)