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Not me! a qualitative, vignette-based study of nurses\u27 and physicians\u27 reactions to spiritual distress on neuro-oncological units
No full textPurpose: People with primary malignant brain tumors experience serious health-related suffering caused by limited prognosis and high symptom burden. Consequently, neuro-oncological healthcare workers can be affected emotionally in a negative way. The aim of this study was to analyze the attitudes and behavior of nurses and physicians when confronted with spiritual distress in these patients.
Methods: Neurospirit-DE is a qualitative vignette–based, multicenter, cross-sectional online survey that was conducted in Bavaria, Germany. Reflexive thematic analysis was used for data analysis.
Results: A total of 143 nurses and physicians working in neurological and neurosurgical wards in 46 hospitals participated in the survey. The participants questioned if the ability to provide spiritual care can be learned or is a natural skill. Spiritual care as a responsibility of the whole team was highlighted, and the staf refected on the appropriate way of involving spiritual care experts. The main limitations to spiritual care were a lack of time and not viewing spiritual engagement as part of the professional role. Some were able to personally benefit from spiritual conversations with patients, but many participants criticized the perceived emotional burden while expressing the imminent need for specific training and team refection.
Conclusions: Most neuro-oncological nurses and physicians perceive spiritual care as part of their duty and know how to alleviate the patient’s spiritual distress. Nonetheless, validation of spiritual assessment tools for neuro-oncology and standardized documentation of patients’ distress, shared interprofessional training, and refection on the professional and personal challenges faced when confronted with spiritual care in neuro-oncology require further improvement and training
Is clinician reported practice in Western Australian emergency departments aligned with direct discharge pathway protocols for minor self-limiting fractures? A multi-centre professional survey
No full textObjective
To determine ED clinician\u27s current management for five common minor self-limiting fractures (MSLF) and evaluate practice against evidence-informed direct discharge pathway (DD) protocols. Methods
A survey was provided to doctors, nurse practitioners and advanced scope physiotherapists working in seven metropolitan, public health EDs in Perth, Australia. The relative odds of ED location (e.g. which facility) and clinician level factors (e.g. country of initial training, years of ED experience, profession) on recommending care completely consistent with evidence informed direct discharge pathway protocols were estimated. Results
Two hundred sixty-two clinicians completed the survey. There was variability in practice across all sites, with most reported care assessed at 60%–76% consistency with individual elements of DD care provision. Highest consistency was seen in lower limb immobilisation and DVT prophylaxis. Lowest consistency was seen in weight bearing advice, pain management and (boxer\u27s) fracture reduction and immobilisation. There were very low levels of complete consistency, ranging from 9% (boxer\u27s fracture) to 25% (radial head fracture). Two factors were associated with increased odds of completely consistent care: (i) clinician experience working in ED, with greater duration of practice associated with increased odds ratios (OR range, 1.6–3.3); and (ii) profession, where advanced scope physiotherapy was associated with increased odds ratios (OR range, 3.2–25.0). Conclusions
Survey results suggested system wide variation in ED fracture management practice and target areas for service improvement. Avenues for service improvement could include hospital wide agreed management plans for specific fractures and support for less experienced clinicians
Prognostic implications and alterations in left atrial deformation following transcatheter aortic valve implantation
No full textAims: To evaluate the prognostic implications of the left atrial reservoir strain–defined diastolic dysfunction (LARS-DD) grade in patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) and to determine whether post-TAVI LARS was more closely associated with new-onset atrial fibrillation than pre-TAVI LARS.
Methods and results: Pre-TAVI LARS-DD was evaluated by speckle-tracking echocardiography and was assigned as Grade 0 to 1 (LARS ≥24%), Grade 2 (LARS 19–24%), and Grade 3 (LARS \u3c19%). Patients were followed up for the primary endpoint of all-cause mortality from the date of TAVI. For the secondary endpoint, patients with pre- and post-TAVI LARS measurements and no history of atrial fibrillation were evaluated for the occurrence of new-onset atrial fibrillation. A total of 601 patients [median age 81 (76–85) years, 53% males] were included. Overall, 169 patients (28%) were LARS-DD Grade 0/1, 96 patients (16%) were LARS-DD Grade 2, and 336 (56%) were LARS-DD Grade 3. Over a median follow-up of 40 (interquartile range 26–58) months, a total of 258 (43%) patients died. In a comprehensive multivariable Cox regression model, the LARSDD grade was independently associated with all-cause mortality [adjusted hazard ratio (HR) 1.28 per one-grade increase, 95% confidence interval (CI) 1.07–1.53, P = 0.007]. For the secondary endpoint of new-onset atrial fibrillation, a total of 285 patients were evaluated. Post-TAVI LARS (subdistributional HR 1.14 per 1% \u3c20%, 95% CI 1.05–1.23, P = 0.0009), but not pre-TAVI LARS (P = 0.93), was independently associated with new-onset atrial fibrillation.
Conclusion: An increased LARS-DD grade was independently associated with long-term post-TAVI survival in patients with severe AS. Post-TAVI LARS was closely related to the occurrence of new-onset atrial fibrillation
\u27This is the greatest thing a man can do\u27: Vocational journeys of recently ordained Catholic priests in Australia
No full textIn many Western countries, the Catholic Church (like several others) is currently suffering a vocations crisis. Australia is no exception. Each year, dioceses see more priests retire, die, or leave the priesthood than new ones are ordained. For this reason, it is becoming increasingly mission-critical for dioceses to understand better the vocational journeys of those men who do become priests. These are also, of course, groups of considerable sociological interest: what motivates them to do (and become) something so countercultural? This article presents the main findings from a qualitative research project exploring the vocational journeys of recently ordained (i.e., within the past ten years at the time of the study) priests in the Archdiocese of Sydney, New South Wales
Exploring the Experiences of a South Asian Client and Facilitators of Men\u27s Behaviour Change Programs in Western Australia
Get PDFThis study explores the experiences of male perpetrators of Intimate Partner Violence (IPV) attending men’s behaviour change programs in Western Australia from the perspective of program facilitators and a South Asian client. Informed by social and contextual constructionism with Interpretative Phenomenological Analysis (IPA), this study examines the experience of 10 mixed culture facilitators who worked with South Asian intimate partner violence perpetrators in men’s behaviour change programs and one South Asian client of an intervention. The participants’ experiences were contextualised through a semi-structured interview. The facilitators’ findings revealed that South Asian clients demonstrated patriarchal beliefs with a victim-blaming tendency and supported socially constructed gender roles and hierarchy. The facilitators also found that the South Asian clients had limited recognition of their intimate partner violence. They also identified a lack of cultural elements in the existing interventions. In comparison, the client participant perceived himself as patriarchy-oriented and ingrained with socially constructed gender roles and hierarchy. Despite challenges with the program, he believed the intervention positively affected him. The client also suggested that his facilitators’ influential attributes benefited the change in his behaviour and attitudes towards women. This study suggests that the men’s behaviour change programs contribute to shifting the attitudes of South Asian clients. The study’s findings also foster an understanding of the characteristics of collectivist and patriarchally oriented South Asian clients of men’s behaviour change programs to best meet their needs. This research recommends a two-pronged approach of compulsory individual counselling and group intervention for clients as well as enhanced training and support for the facilitators
Pre-implementation context and implementation approach for a nursing and midwifery clinician researcher career pathway: A qualitative study
No full textAim: To describe the pre-implementation context and implementation approach, for aclinician researcher career pathway.
Background: Clinician researchers across all health disciplines are emerging to radically influence practice change and improve patient outcomes. Yet, to date, there are limited clinician researcher career pathways embedded in clinical practice for nurses and midwives.
Methods: A qualitative descriptive design was used.
Data Sources: Data were collected from four online focus groups and four interviews of health consumers, nursing and midwifery clinicians, and nursing unit managers(N = 20) between July 2022 and September 2023.
Results: Thematic and content analysis identified themes/categories relating to: Research in health professionals\u27 roles and nursing and midwifery, and Research activity and culture (context); with implementation approaches within coherence, cognitive participation, collective action and reflexive monitoring (Normalization Process Theory).Conclusions: The Pathway was perceived to meet organizational objectives with the potential to create significant cultural change in nursing and midwifery. Backfilling of protected research time was essential. Implications for the Profession and/or Patient Care: The Pathway was seen as an instrument to empower staff, foster staff retention and extend research opportunities to every nurse and midwife, while improving patient experiences and outcomes.
Impact: Clinicians, consumers and managers fully supported the implementation of clinician researchers with this Pathway. The Pathway could engage all clinicians in evidence-based practice with a clinician researcher leader, effect practice change with colleagues and enhance patient outcomes.
Reporting Method: This study adheres to relevant EQUATOR guidelines using the COREG checklist. Patient or Public Contribution: Health consumers involved in this research as participants, did not contribute to the design or conduct of the study, analysis or interpretation of the data, or in the preparation of the manuscript
National Sorry Day
No full textEvery May 26 in Australia, National Sorry Day reminds the colonist-descended people of the nation to remember the mistreatment of Aboriginal and Torres Strait Islander people. Why? During the 20th century, Indigenous children were forcibly removed from their families to be “assimilated” into white Australian culture. They are known as the “Stolen Generations.” It took several Australian government administrations coming and going before an apology was officially offered to the Indigenous Australians, but it finally was made official, and actions are still being undertaken to this day to repair the damage caused by tearing native families apart
Long COVID in a highly vaccinated but largely unexposed Australian population following the 2022 SARS-CoV-2 Omicron wave: A cross-sectional survey
No full textObjective: To estimate the prevalence of long COVID among Western Australian adults, a highly vaccinated population whose first major exposure to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was during the 2022 Omicron wave, and to assess its impact on health service use and return to work or study.
Study design: Follow-up survey (completed online or by telephone).
Setting, participants: Adult Western Australians surveyed 90 days after positive SARS-CoV-2 test results (polymerase chain reaction or rapid antigen testing) during 16 July – 3 August 2022 who had consented to follow-up contact for research purposes.
Main outcome measures: Proportion of respondents with long COVID (ie, reporting new or ongoing symptoms or health problems, 90 days after positive SARS-CoV-2 test result); proportion with long COVID who sought health care for long COVID-related symptoms two to three months after infection; proportion who reported not fully returning to previous work or study because of long COVID-related symptoms.
Results: Of the 70 876 adults with reported SARS-CoV- 2 infections, 24 024 consented to contact (33.9%); after exclusions, 22 744 people were invited to complete the survey, of whom 11 697 (51.4%) provided complete responses. Our case definition for long COVID was satisfied by 2130 respondents (18.2%). The risk of long COVID was greater for women (v men: adjusted risk ratio [aRR], 1.5; 95% confidence interval [CI], 1.4–1.6) and for people aged 50–69 years (v 18–29 years: aRR, 1.6; 95% CI, 1.4–1.9) or with pre-existing health conditions (aRR, 1.5; 95% CI, 1.4–1.7), as well as for people who had received two or fewer COVID–19 vaccine doses (v four or more: aRR, 1.4; 95% CI, 1.2–1.8) or three doses (aRR, 1.3; 95% CI, 1.1–1.5). The symptoms most frequently reported by people with long COVID were fatigue (1504, 70.6%) and concentration difficulties (1267, 59.5%). In the month preceding the survey, 814 people had consulted general practitioners (38.2%) and 34 reported being hospitalised (1.6%) with long COVID. Of 1779 respondents with long COVID who had worked or studied before the infection, 318 reported reducing or discontinuing this activity (17.8%).
Conclusion: Ninety days after infection with the Omicron SARS- CoV- 2 variant, 18.2% of survey respondents reported symptoms consistent with long COVID, of whom 38.7% (7.1% of all survey respondents) sought health care for related health concerns two to three months after the acute infection
Lateropulsion resolution and outcomes up to one year post-stroke: A prospective, longitudinal cohort study
No full textBackground: Post-stroke lateropulsion is prevalent and associated with poor rehabilitation outcomes; however, data regarding long-term function associated with lateropulsion are lacking.
Objectives: This study aimed to explore lateropulsion resolution and associations between lateropulsion, functional outcomes, and fall occurrence up to 12 months post-stroke.
Methods: Participants for this prospective, longitudinal cohort study were recruited from a Stroke Rehabilitation Unit (SRU). Assessments were conducted at SRU admission, at discharge, and at three, six, nine, and twelve months post-stroke. Outcomes included the Four-Point Pusher Score (4PPS), Functional Independence Measure (FIM), and fall occurrence. Longitudinal outcomes were modeled using generalized linear mixed-effects models.
Results: The final analyses included data from 144 participants. Eighty-two participants (56.9) had lateropulsion (4PPS ≥ 1) on admission. Odds of resolved lateropulsion (4PPS = 0) increased longitudinally from discharge for people who participated in rehabilitation physiotherapy (OR: 9.7, 28.1, 43.1, 81.3: \u3c0.001 at three, six, nine, and twelve months respectively). The greatest FIM improvement among participants in all 4PPS categories occurred during the SRU inpatient phase. The probability of falls post-discharge was greatest among participants with 4PPS = 1 at three months, when compared with 4PPS = 0 (p= 0.022).
Conclusions: This study showed that lateropulsion can continue to resolve up to one year poststroke. Earlier lateropulsion resolution was associated with ongoing rehabilitation physiotherapy participation. Long-term functional gains were maintained among people discharged home, whereas functional status deteriorated after six months among those in residential care. Study findings will allow rehabilitation and service providers to better plan for and accommodate the long-term rehabilitation and care needs of people with post-stroke lateropulsion