Cardiopulmonary resuscitation and basic life support guidelines for people with disability: a scoping review.

PURPOSE: To explore literature, policies or procedures available to care providers on how to deliver CPR and BLS to people with a disability, for whom the current standard guidelines are not fit for purpose. MATERIAL AND METHODS: A scoping review was conducted using four databases, namely, CINHAL, PubMed, Scopus, Medline and Google Scholar. Keywords used included, disab*, wheelchairs, cardiopulmonary, resuscitation, "basic life support", life support care, and bystander CPR. 1119 papers were retrieved and 1043 were screened following removal of 76 for duplication. 18 full text articles were reviewed and 5 met the inclusion criteria. RESULTS: The five articles were from three counties and included one case study, three expert opinion papers and one intervention study. Four of the papers advocated in favour of improved CPR and BLS guidelines and three of the papers discussed techniques and ideas for supplementation of standard CPR and BLS. CONCLUSION: The scoping review has uncovered a paucity of evidence explaining delivery of CPR and BLS for people with disability and highlights the need for further research. In the absence of further evidence, it is reasonable for educators to provide ideas and discussion about supplementing CPR and BLS for people with disability to carers.

People with disability and wheelchair users are at a high risk for premature or preventable deaths.Improved first aid responses are proposed to be a mitigating factor for premature and preventable deaths.Improved first aid responses will afford people with disability and wheelchair users the same opportunities for care and rehabilitation as people without disability.Formal and informal carers do not currently have prescriptive guidelines to improve their knowledge on responding to emergency events for people with disabilities.Development of improved guidelines is recommended to reduce fear and anxiety for formal and informal carers whilst also increasing their confidence to respond to emergency situations.

Numeracy Teaching for Undergraduate Nursing Students: A Scoping Review.

BACKGROUND: Education providers teach numeracy to undergraduate nursing students using a diverse range of approaches. Proficiency in numeracy skills is critical for patient safety; however, alarmingly, the accuracy rate of calculations by both undergraduate nurses and RNs is reported to be low. METHOD: The literature search yielded 1,180 articles published between 1994 and 2022. The assessment of the studies was reported using the PRIMSA extension for Scoping Reviews. RESULTS: Thirty-nine articles were included in the review. A diverse range of approaches were used to teach numeracy including learning theory, methods of calculation, learning environment, and examination aids. CONCLUSION: This review highlights the plethora of approaches for teaching numeracy within undergraduate nursing education. Internationally, there were limited studies on the most effective teaching approaches; therefore, developing a robust evidence-based numeracy framework would be beneficial to guide non-nursing instructors in teaching undergraduate nurses. [J Nurs Educ. 2024;63(4):218-227.].

Emergency department Nurses' narratives of burnout: Changing roles and boundaries.

PURPOSE: Emergency department nurses work in rapidly changing environments, which can contribute to occupational stress. Emergency department nurses utilise diverse strategies to mediate the impact of stress on their daily lives. There is a paucity of qualitative research which explores emergency department nurses' experiences and perspectives of burnout. This study aimed to explore emergency department nurses' experiences of burnout. Further, the study considered how emergency nurses conceptualised burnout and the strategies they used to manage the professional and personal effects of burnout. PROCEDURES: The COREQ research guidelines were used throughout the study from the design stage through to dissemination. Narrative inquiry was used as the underpinning theoretical framework. The researcher met individually with eight emergency department nurses from NSW hospitals to undertake a face-to-face semi-structured interview. An inductive approach was used to establish major themes within the narrative. FINDINGS: Two major themes were established: experiencing conflicting emotions and trying to establish a personal sense of control. Emergency nurses felt passionate about their professional roles, yet encountered difficulties due to management structures, time constraints and a sense of underappreciation. The misalignment between their expectations and the reality of emergency department nursing, resulted in experiences of burnout such as dissatisfaction and frustrations at work. Consequently, these nurses adopted diverse strategies within both their professional and personal domains. PRINCIPAL CONCLUSIONS: The conclusions of this study are transferable to a variety of acute health services. Health service management have a role to promote a positive workplace culture for nurses, which advocates for home life balance. This will support nurses to construct clear boundaries between professional identity and their personal lives.

Indonesian nurses' awareness and application of reasonable adjustments when caring for people with intellectual disability and/or autism.

AIM: This study aimed to understand Indonesian nurses' familiarity with the concept of reasonable adjustments, and the frequency of its application within their practice. BACKGROUND: People with intellectual disability and/or autism are exposed to significant barriers when accessing healthcare and have poorer health outcomes than those without developmental disabilities. Reasonable adjustments can improve accessibility and quality of healthcare for people with disabilities and involves adapting practices and environments to promote equitable healthcare. INTRODUCTION: There is a scarcity of literature focused on the application of reasonable adjustments in the Indonesian nursing context. A greater understanding of the application of reasonable adjustments in this context can help inform nursing curricula and policy. METHODS: A cross-sectional, descriptive survey -was undertaken and is reported in accordance with the Strengthening the Reporting of Evaluations and Non-randomised Designs. Following descriptive analysis, bivariate analyses were undertaken between key demographic, workplace, and self-reported capability variables, and familiarity and implementation of reasonable adjustments. RESULTS: The majority of respondents were not familiar with the concept of reasonable adjustments and self-reported sometimes applying it within their practice. Higher levels of educational and clinical exposure to intellectual disability and/or autism, and self-capability variables, were significantly associated with familiarity with reasonable adjustments and their application. CONCLUSIONS: An increase in nursing curricula focused on caring for people with intellectual disability and/or autism, including content focused on applying reasonable adjustments, is indicated. IMPLICATIONS FOR NURSING POLICY: Given that, internationally, people with intellectual disability and/or autism have disproportionately negative health outcomes and experiences, findings highlighting gaps in understanding and application of reasonable adjustments of Indonesian nurses have substantial implications for nursing policy and curriculum.

Barriers to communication with people with developmental disabilities: A reflexive thematic analysis.

People with Intellectual Disability and/or autism internationally experience some of the worst health outcomes of any population group. Registered nurses have been identified as having educational deficits in this domain, which include knowledge of adjustments to communication. This study aimed to explore perceived barriers to communication with people with Intellectual Disability and/or autism. A thematic analysis of data from an open-ended free-text survey question exploring barriers to communicating in a cross-sectional survey of 279 Australian registered nurses conducted in 2020 was undertaken. Six interrelated themes were identified. Increased educational content in undergraduate and postgraduate level nursing courses is indicated. The findings identify the benefit of educational design based on the foundation of understanding the diversity in thinking and information processing represented by the forms of neurodiversity in Intellectual Disability and Autism Spectrum Disorder.

A survey of Indonesian nurses' educational experiences and self-perceived capability to care for people with intellectual disability and/or autism spectrum disorder.

AIMS: To describe Indonesian nurses' educational experience regarding care for people with intellectual disability and/or autism and to explore if these educational experiences are associated with their self-perceived confidence, comfort, knowledge and preparedness to care for these cohorts. DESIGN: Cross-sectional descriptive survey. METHODS: A descriptive survey tool utilized in a study of Australian registered nurses was replicated and adapted for this study. Following descriptive analysis, chi-square analyses were undertaken to explore associations between educational experiences, and self-rated measures of confidence, comfort and knowledge to work with people with intellectual disability and/or autism. Although there was no end-user involvement in the design of the study, the concepts explored have all been raised by those with lived insights of intellectual disability and/or autism as being critical to their healthcare experiences. RESULTS: There were 544 complete responses, and 51.7% were not exposed to any educational or clinical content relevant to caring for people with intellectual disability and/or autism. Moderate to low levels of self-perceived confidence, comfort, knowledge and preparedness to address healthcare needs of these cohorts were reported. Significant associations were identified between educational and clinical experiences during undergraduate training, and higher levels of self-perceived confidence, comfort and knowledge. CONCLUSION: Mirroring international literature, the findings of this study highlight a large proportion of Indonesian nurses had little educational experience relevant to caring for people with intellectual disability and/or autism, and have relatively low levels of self-reported capability. IMPACT: This study highlights gaps in the educational experiences, and self-perceived confidence, comfort, knowledge and preparedness of Indonesian nurses regarding caring for people with intellectual disability and/or autism. Given that internationally, people with intellectual disability and/or autism have disproportionately negative health outcomes and experiences, these findings have substantial implications for nursing curriculum, policy and professional development.

Supporting the oral health of people with intellectual disability: A survey of disability staffs' knowledge, perceptions, disability service barriers, and training.

BACKGROUND: People with intellectual disabilities experience poorer oral health outcomes, which can negatively impact their quality of life. Disability support staff who support peoplewith an intellectual disability have the potential to assist with oral hygiene. However, there is limited understanding of the current practices of disability support staff around oral health, particularly in Australia. OBJECTIVE: To describe disability support staff knowledge about oral health, explore their practice perceptions when supporting people with intellectual disabilities around oral health and their experiences of oral health training. METHODS: A national cross-sectional survey was undertaken with 156 disability support staff across Australia. Recruitment was via publicly available websites of disability services and social media. RESULTS: Disability staff were generally knowledgeable about appropriate oral hygiene practices and risks to oral health. They were less knowledgeable about the links between poor oral health and chronic diseases (<40%) and the importance of oral care for individuals who are fed enterally. Most participants (>80%) felt oral health was an important part of their care and were interested in further oral health training. Staff in semi-assisted living felt they had more time for oral health tasks compared to home-based living and residential facilities (p = 0.007). Lack of oral health training programs was the main barrier cited (44%), with only a quarter receiving any training in this area. CONCLUSIONS: Disability support staff are receptive to promoting oral health. More training around oral health and intellectual disability is needed for this workforce to support them in undertaking this role.

Filling the Gaps: Evaluation of an Online Continuing Professional Development Program for Australian Registered Nurses to Build Capacity to Care for People With Developmental Disability.

BACKGROUND: People with autism spectrum disorder and/or intellectual disability have some of the worst health outcomes of any population group. Internationally, it has been identified that RNs are not adequately prepared to provide care to these groups through mainstream health care services. METHOD: A cross-sectional online evaluation survey of participants who completed learning to build the capacity of RNs to care for people with autism spectrum disorder and/or intellectual disability was conducted. RESULTS: The learning site was found to be easily accessible and engaging, and it facilitated knowledge construction. A statistically significant increase in self-reported comfort, confidence, and preparedness compared with the sample of RNs in a national survey conducted before the site launch was identified. CONCLUSION: This online continuing professional development program facilitated RNs' perceived comfort, confidence, and preparedness to care for people with autism spectrum disorder and/or intellectual disability. Findings suggest the merit of high-quality online continuing professional development programs to fill this educational gap. [J Contin Educ Nurs. 2023;54(12):554-560.].

Becoming a non-resident father: Marginalised through distress, disadvantage and disempowerment.

ISSUE ADDRESSED: Becoming a non-resident father through divorce is stressful and this often results in compromised mental health and well-being. Non-resident fathers' mental well-being has been measured at very low levels which may require clinical treatment, especially when correlated with child access and family court issues. A United Nations report highlighted how non-resident fathers may be marginalised, but to date, limited literature considers the lives of non-resident fathers from their own perspective and reflecting their own voice and it has been claimed that as fathers are often absent from parenting research, this absence, they are not heard. The aim of this paper was to identify how non-resident fathers' interactions with legal and welfare services and ex-partners may result in their marginalisation and affect their mental health. METHODS: In-depth interviews with open-ended questions were conducted with 19 non-resident fathers, both long term, newly divorced or in the divorce process, so as to capture a long range view of their experiences. Thematic Analysis was used for data analysis and the generation of the themes. RESULTS: Three themes emerged from the data: (1) Becoming a non-resident father with two sub themes; (2) Being in a state of distress, with three sub-themes and (3) Managing distress and seeking help, with two sub-themes. Participants reported a lack of agency, lack of power in decision making and a lack of social and financial resources all contributing to the deterioration in their self-reported experiences of mental health. This impact was highlighted by the number of participants who undertook counselling or psychological assistance to deal with their perceived marginalisation, feeling of invisibility and disempowerment. CONCLUSIONS: The implications of marginalisation for non-resident fathers' mental health, as outlined by the participants, are discussed regarding the impact of becoming a non-resident father, legal aspects, welfare service experiences and relationship with ex-partner. The chronic stress experienced by non-resident fathers who often find themselves in a situation which is difficult to resolve without major compromises to their desired outcomes must be recognised. SO WHAT: One means of achieving better mental health for non-resident fathers is to address the impact of marginalisation and lack of agency and that court processes are resolved swiftly with a view to increasing non-resident father's agency in post-divorce decision making.

Nurse education leaders' perspectives on the teaching of numeracy to undergraduate nursing students: A qualitative research study.

AIM: The aim of this study was to explore the perspectives of nurse education leaders of Australian undergraduate nursing degrees on the teaching of nursing numeracy and how the Australian Nursing & Midwifery Accreditation Standards influence curriculum development. BACKGROUND: Nurses' numeracy skills are reportedly deficient worldwide, posing a significant threat to patient safety. This is an issue for the education of undergraduate nurses and thus for the nursing profession. The international literature reveals a heterogeneous blend of learning approaches, but it is unclear which approaches are best suited to improve the numerical calculation ability of nurses. In the Australian context, there are no accreditation standards referring to numeracy, therefore, it is important to discover how nurse education leaders' design and implement the teaching of numeracy. DESIGN: A qualitative approach using thematic analysis was employed. The setting was Australian universities that delivered an accredited undergraduate nursing degree leading to nursing registration. METHODS: Purposive sampling was used to recruit 17 nurse education leaders of Australian undergraduate nursing degrees. Individual, semi-structured virtual interviews were conducted between November 2022 and January 2023. Interview data were analysed using Braun and Clarke's (2006) six phases of thematic analysis. FINDINGS: Five themes emerged from the analysis: (i) indistinct accreditation standards, (ii) teaching basic maths for clinical applications, (iii) a range of bespoke teaching approaches (iv) we're nurses, not numeracy educators and (v) assumptions about an unprepared cohort. CONCLUSION: The leaders of undergraduate nursing degrees assumed that nursing students would have proficiency in numeracy skills on entering university. However, this was not the case, hence numeracy was an essential skill that needed to be taught to the undergraduate nursing students. Lack of direction from the accreditation council led to the existence of various curricula and an array of approaches to teaching numeracy and medication calculations, which challenged nursing academics who did not consider themselves numeracy educators. This study makes a novel contribution to knowledge, teaching and practice in undergraduate nursing numeracy curricula.

Barriers and Enablers to Nurses' Engagement With Continuing Professional Development: A Survey.

BACKGROUND: Continuing professional development (CPD) is perceived as a pivotal component of building and maintaining nursing skill and capacity. Exploring motivators for CPD engagement can aid program adaptation and improvement. The goal of this study was to survey the barriers, enablers, and changes of Australian RNs' engagement with CPD in general during the coronavirus disease 2019 (COVID-19) pandemic. An additional goal was to understand factors influencing the interest of participants to engage with programs focused on care for people with intellectual disability and/or autism. METHOD: This study was a cross-sectional exploratory survey. RESULTS: Most of the sample had engaged with CPD in the previous 12 months, and the most reported topics were related to COVID-19. Sixty percent of nurses saw a change in volume of CPD. Younger nurses, with fewer years of experience, and practicing in major cities, were significantly more likely to report less CPD. CONCLUSION: It is pivotal that the design and promotion of CPD curricula consider the motivators and barriers for nurses' engagement with them. [J Contin Educ Nurs. 2023;54(9):405-412.].

Cardiopulmonary resuscitation and basic life support for people with atypical chest shapes and wheelchair users: Toward supplemented education and emergency management plans.

This article explores current practice issues in basic life support (BLS) and cardiopulmonary resuscitation (CPR) delivery for people with disability and poses recommendations for development of education and training where specialist nurses and other health professionals can facilitate BLS and CPR techniques catering for people with atypical chest shapes wheelchair users and people at high risk of choking. People with a disability are at higher risk of premature and unexpected death. At present there is a significant gap in knowledge about how to deliver optimal BLS or CPR to people with atypical chest shapes wheelchair users and people at high risk of choking. This leave carers to augment guidelines during emergency situations. Introduction of supplemented BLS and CPR together with development of emergency care plans for people with disability could reduce the number of people with disability dying premature or preventable deaths.

A scoping review of registered nurses' delegating care and support to unlicenced care and support workers.

AIM: To scope the international literature about registered nurses delegated models of care to unlicenced workers, identify gaps and reflect upon how the evidence relates to nursing in multiple contexts. DESIGN: Scoping review of the peer reviewed literature from the year 2000 onwards, using the PRISMA-ScR checklist. METHODS: The study searched the following databases in February 2022: CINAHL, Medline, ProQuest, and SCOPUS, and included keywords, Boolean operators and subject headings relevant to registered nurses delegating the provision of care to unlicenced workers. RESULTS: A total of 49 articles met the eligibility criteria for this study, and relevant data were extractedThree models of delegation were highlighted within the literature: direct, indirect and a mixture of both. The data highlighted that direct delegation mainly occurred in acute contexts, with delegation decreasing with increasing patient acuity and/or complexity but the threshold of when this would occur was not clear. There was one intervention study that measured patient outcomes which could aid in the determination of what is effective delegation. For studies that did report on it (n = 6), there were few examples of better patient outcomes in cases where care was delegated from registered nurses to unlicenced workers. CONCLUSIONS: The scoping review highlighted heterogeneity in practice areas and methods of delegation practice. A key gap in literature is the absence of studies focusing on patient outcomes, with a clear baseline to measure and identify effective delegation practices. Additionally, the legal and logistical implications presented in both direct and indirect delegation practices is not evident in the literature. IMPLICATIONS FOR THE PROFESSION: Decisions related to delegation are often made at the service level and prescribed to those who work within the service, suggesting that models of indirect delegation are in fact not delegation at all, rather a re-distribution of nurses' work. RELEVANCE TO CLINICAL PRACTICE: Delegation is a vital component of the scope of practice of registered nurses. This review has highlighted unique differences in delegation by practice context, where the proliferation of unlicensed workers in certain contexts places a vastly different professional and legal burden on the registered nurse.

The Experience of Facilitating Inclusive Research Advisory Groups With Parents and People With Intellectual Disability and/or Autism Spectrum Disorder.

There is little nursing research about process issues in conducting inclusive project advisory groups of people with autism and/or intellectual disability or those who are parents/carers of this cohort. Through a descriptive qualitative design, this article aims to analyze the processes, challenges, and solutions when facilitating these groups for a nursing project in Australia. Reflexive thematic analysis was utilized to analyze field notes and meeting minutes. Results highlight the need for a defined, robust communication process between researchers and advisory groups, skilled facilitators, and careful planning of when in the life of the project the groups can contribute meaningfully. This project offers a proposed framework for the valuable contribution of lived experiences from research advisory groups.

Analysis of an Australian death database of people with intellectual disability living out of the family home: Place of death and associated variables.

This study reports on a five-year data set about the deaths of 599 individuals in New South Wales Australia, who at the time of their death were living in out-of-home care. Analysis aimed to: i) gain a clearer understanding of place of death for people with intellectual disability; and ii) identify and analyse associated variables to investigate how well they predict place of death for this population. Hospital admissions, polypharmacy and living situation were the strongest standalone predictors of place of death. A hospital death was more likely if the target population were subject to polypharmacy, lived in a group home, had a moderate intellectual disability or had GORD. Death, and place of death, is an issue requiring individual consideration. This study has identified some of the variables that need attention when supporting people with intellectual disability to have a good death.

From mainstream employment to mainstream retirement: A randomised controlled trial of a transition to retirement intervention for adults with intellectual disability.

BACKGROUND: We evaluated a transition to retirement intervention that adapted strategies used to support employment of people with intellectual disability in mainstream workplaces. The intervention facilitated their independent participation in mainstream community groups and volunteering. METHODS: We randomised 29 older Australians who currently/previously worked in mainstream employment into an intervention group or wait-list control group. Hours of independent participation in target activities were collected before and after the 13-week initial intervention/waiting period, and at 52 weeks for intervention participants. RESULTS: Six of the 12 intervention participants selected an activity and increased hours of independent participation following 13 weeks in the Keeping Active (KA) program and eight were independently accessing their selected activity at 52-week follow-up. None of the 19 wait-list participants increased their independent participation after 13 weeks. CONCLUSIONS: The intervention was effective and highlighted the need to account for factors such as participant choice in evaluation of individualised programs.

Psychosocial-behavioural interventions for school-aged children with intellectual disabilities: A systematic review of randomised control trials.

BACKGROUND: Evidence-based interventions are essential for school-aged children with intellectual disabilities to facilitate development and promote future independence. METHODS: Using a PRISMA approach, systematic screening of five databases was undertaken. Original randomised controlled studies with psychosocial-behavioural interventions were included where participants were school aged (5-18 yrs) with documented intellectual disability. Study methodology was assessed using the Cochrane RoB 2 tool. RESULTS: Two thousand three hundred and three records were screened with 27 studies included. Studies mainly included primary school participants with mild intellectual disabilities. Most interventions focused on intellectual skills (e.g., memory, attention, literacy and mathematics) followed by adaptive skills (e.g., daily living, communication, social and education/vocation) and some focused on a combination of these. CONCLUSION: This review highlights the gap in evidence-base for social, communication and education/vocation interventions with school-aged children with moderate and severe intellectual disability. Future RCTs that bridge this knowledge gap across ages and ability are required for best practice.

An exploration of women's sexual and reproductive health following traumatic brain injury.

AIMS AND OBJECTIVES: To develop a gendered understanding of sexual and reproductive health for Australian women following traumatic brain injury. BACKGROUND: The intersection of socialised normative expectations of sexuality and sexual health, and being a woman with a disability, can lead to inequity and a misconception that a woman with a disability is asexual. DESIGN: An equal weighting concurrent mixed methods design. METHODS: Twenty women participated in conversational interviews and 49 women completed an online survey. Equal priority was given to both qualitative and quantitative data which were collected concurrently. A separate analysis of data was performed and was later merged. This paper follows the Good Reporting of a Mixed Methods Study guidelines for reporting mixed methods research. RESULTS: Women reported changes in menstruation, reproduction, and sexual activity. Results identified that following traumatic brain injury, routine reproductive, and sexual health screening were neglected. Women revealed a personal reticence to discuss sexual health in a holistic sense and appeared more comfortable discussing reproductive health rather than sex for pleasure. Additionally, they perceived there was a reticence by clinicians to discuss sexual health as part of their rehabilitation. CONCLUSIONS: Shifting the focus to be on women's health through periodic comprehensive health assessments is essential to the delivery of holistic health care. These results can inform the provision of sexual health, sexual safety, and sexual assertiveness education and training for women and girls within a rehabilitation framework and would be a way of addressing what women in this study identified as an unmet need. RELEVANCE TO CLINICAL PRACTICE: Reproductive and sexual health are important elements of routine comprehensive health screening for women. Nurses are well positioned to begin discussions regarding sexual agency, sexual, and reproductive health to ensure person-centred care.

Cardio-pulmonary-resuscitation for people who use a wheelchair and/or have an atypical chest shape: an educational intervention.

PURPOSE: To determine the impact of the addition of information specific to people with atypical chest shapes and/or in a wheelchair during mandatory CPR classes on staff confidence to respond to emergency scenarios with these populations. MATERIALS AND METHODS: A pre-test post-test intervention study was conducted with staff from one of the largest disability organisations in Tasmania, Australia. Supplemented CPR and BLS classes were presented to participants. A purpose-designed questionnaire was completed pre, post, and six-months post after the training. RESULTS: A significant rise in confidence post-training was demonstrated, and this was retained at the six-month time point. Time spent in the disability sector before the supplemented training or attendance at previous standard CPR classes did not have a significant effect on confidence levels before the supplemented training. CONCLUSIONS: Confidence is closely linked to willingness to act during emergency situations. Improved confidence may therefore result in improved willingness to act for people with disability, atypical chest shapes, and wheelchair users, thus improving health outcomes for these populations and providing this cohort with access to more equitable healthcare.IMPLICATIONS FOR REHABILITATIONGuidelines for undertaking CPR and BLS on people with atypical chest shapes and/or in a wheelchair are not currently available.Including information specific to people with atypical chest shapes and/or in a wheelchair during mandatory CPR classes increases staff confidence to respond to such situations.Supplementary disability-specific information can be successfully incorporated into existing CPR and BLS training.

Qualitative Insights from A Novel Staff-Led Oral Health Champions Program Within a Residential Service For People With Intellectual and Developmental Disability.

The oral health of people with intellectual and developmental disability is poorer than that of the general community. Any solution for people with intellectual and developmental disability living in residential services needs to include disability support workers (DSWs). Previous studies have used either didactic or train-the-trainer approaches to enhance DSW knowledge and skills. Taking a different approach, a novel program used DSWs as embedded oral health champions. This model provided educational opportunities for DSWs to learn about good oral health and then share with peers and provide benefits to people with intellectual and developmental disability that they support. Interviews with a sample of these champions were conducted and analysed using content analysis. Findings suggest that DSWs are capable of affecting change with the right type and depth of training, management and organisational support. A DSW-led champions model has merit, however requires ongoing expert support to help maintain and sustain benefits over time.