Leading wellness in healthcare: A qualitative study of leadership practices for wellness in hospital settings.

Ways of dealing with workplace stress and enhancing healthcare workers wellness are sought globally. The aim of this study was to explore healthcare leaders' practice in relation to the implementation of a workplace wellness program called SEED in the context of multiple crises (bushfires and COVID-19) affecting a local health district in New South Wales, Australia. Practice theory informed interviews (n = 23), focus groups (n = 2) and co-analysis reflexive discussions (n = 2) that were conducted with thirteen leaders and twenty healthcare workers. A pragmatic approach to program implementation for healthcare workers' wellness explored the process and actions that resulted from leadership practice in an inductive thematic analysis. Preliminary themes were presented in the co-analysis sessions to ensure the lived experiences of the SEED program were reflected and co-interpretation of the data was included in the analysis. Three key themes were identified. 1) Leading change-implementing a wellness program required leaders to try something new and be determined to make change happen. 2) Permission for wellness-implicit and explicit permission from leaders to engage in wellness activities during worktime was required. 3) Role-modelling wellness-leaders viewed SEED as a way to demonstrate leadership in supporting and caring for healthcare workers. SEED provided a platform for leaders who participated to demonstrate their leadership practices in supporting wellness activities. Leadership practices are critical to the implementation of healthcare wellness programs. The implementation of SEED at a time of unprecedented crisis gave leaders and healthcare workers opportunities to experience something new including leadership that was courageous, responsive and authentic. The study highlighted the need for workplace wellness programs to intentionally include leaders rather than only expect them to implement them. The practices documented in this study provide guidance to others developing, implementing and researching workplace wellness programs.

"I Wasn't Gonna Quit, but by Hook or by Crook I was Gonna Find a Way Through for the Kids": A Narrative Inquiry, of Mothers and Practitioners, Exploring the Help-seeking of Mothers' Experiencing Child to Parent Violence.

Purpose: Child to parent violence is a significant concern that has been researched over the last sixty years. However, little is known about the help-seeking pathways of parents experiencing child to parent violence (CPV). Barriers and enablers to disclosing CPV have been explored, and responses to address CPV have been nominally researched. The mapping of a disclosure to a choice of where to get help has not occurred. This study seeks to map help-seeking pathways of mothers and considers these pathways in regards to the relations within families and sociomaterial conditions. Method: This narrative inquiry utilizes response-based practice and Barad's concept 'intra-action' to examine interviews with mothers (n = 11) who experience CPV, and practitioners (n = 19) who work with families experiencing CPV. Results: Five help-seeking pathways of mothers are found in this study. Three themes evident across the pathways are explored including: (1) help-seeking within pre-existing relationships; (2) mothers' feelings of fear, shame and judgement entangled with help-seeking; and (3) conditions which enable and hinder help-seeking from family. Conclusions: This study finds sociomaterial conditions such as single motherhood and judgement limit help-seeking possibilities. Further, this study finds help-seeking occurs within pre-existing relationships along with the entanglement of CPV with other issues such as intimate partner violence (IPV) and homelessness. This study demonstrates the benefits of employing a response-based approach alongside 'intra-action' within a research and practice context.

A Systematic Review of Child to Parent Violence Interventions.

Objective: To identify, appraise and synthesize research on the interventions used in child to parent violence. Method: A systematic literature review was conducted using the electronic databases of PsycINFO, Scopus, Web of Science and CINAHL Full Text. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, three authors conducted the screening process which was implemented in two stages including screening the title and abstract, followed by screening the full text. Papers were assessed for quality using the Mixed Methods Assessment Tool. The search identified 727 studies which met the inclusion criteria, deduplication resulted in 525 number for review, with 8 articles included in the review. Results: This review identifies six themes from the six unique interventions included to address the research questions: How do practitioners effectively support families experiencing child-to-parent violence? The six themes are: Conceptualising the violence; Assessment of needs and risks; Intervention types and settings; Program techniques and components of interventions; Intervention outcomes and effectiveness; and Research design and methods. Three narratives were iteratively developed from these themes which highlight the main findings of the review: importance of the practitioner and their skills; conceptual clarity of CPV; and CPV interventions. Conclusions: The findings from this systematic review identifies the need for further research into child to parent violence including what makes interventions effective, what needs and outcomes the interventions are addressing, and the implications of classifications of this violence.

A Narrative Inquiry into the Practices of Healthcare Workers' Wellness Program: The SEED Experience in New South Wales, Australia.

The 2019-2020 Australian bushfires followed by the COVID-19 pandemic brought the significant mental health implications of working in healthcare to the fore. The importance of appropriate support services to ensure the resilience and recovery of healthcare workers has been highlighted. In response to healthcare staff experiences during the bushfires, the SEED Wellness Program was created in 2020 in the Illawarra Shoalhaven Local Health District in New South Wales, Australia. SEED used a participant-led design to engage healthcare staff in workplace-based restorative activities. Guided by practice theory, this study aimed to identify and describe SEED wellness practices that supported healthcare staff. Thirty-three healthcare workers participated in focus groups or individual interviews between June 2021 and March 2022. The analysis involved inductive thematic individual and collective exploration of SEED practices, including co-analysis with participants. Eight core practices that supported participants' wellbeing were identified, including responsive and compassionate leading, engaging staff at every stage of the recovery process, creating a sense of connection with others, and collective caring. The study found that workplace wellness initiatives are optimised when they are place-based and grounded in local knowledge, needs, and resources incorporating a collective and supportive team approach. Moreover, to ensure engagement in, and sustainability of these initiatives, both bottom-up and top-down commitment is required.

'He's out of control, I'm out of control, it's just - I've got to do something': a narrative inquiry of child to parent violence.

Families globally experience child to parent violence (CPV). Stories of CPV have been considered at an individual and collective level to ascertain themes in parents' accounts to identify enabling and restraining factors for CPV. However, understanding the societal narratives, defined as discourses, which have a multi-directional and entangled relationship with individual recounts of CPV have yet to be investigated. This research utilizes Narrative Inquiry with participatory approaches to explicate the societal narratives within mothers' recounts of CPV. This analysis, guided by the interactional and discursive view of violence, and response-based practice, identifies societal narratives which set the conditions for what is possible and impossible in relation to CPV. The analysis contributes to understanding the attitudes of minimization and concealment of violence within parents' accounts of CPV. The mothers' recounts were constrained and made possible by the 'good' mother narrative and narratives of adolescence and gender. This research examines the intra-actions mothers' recounts have with the societal narratives, and the performance of their roles as (en)actors of the subject positions 'mother' and 'child'. Implications for practice and research include: consideration to practitioner's views of power and subject positions in a parent and child relationship when working with CPV; and practitioners to be critical of essentialism and gender in working with CPV. This study posits a practical demonstration for using the response-based practice approach in research; and a way of viewing stories which can be incorporated in working with families experiencing CPV.

The SEED Wellness Model: A Workplace Approach to Address Wellbeing Needs of Healthcare Staff During Crisis and Beyond.

Workplace wellness has gained new meaning and significance in the healthcare workforce in the face of the COVID-19 pandemic. Healthcare workers across the world have carried the burden of responding to the public health crisis by having to work under new pressures and constantly changing environments, take on additional shifts, risk their own health and lives, and cope with the ongoing psychological and emotional strain. The purpose of this paper is to articulate a workplace wellness model applied across hospitals in the Illawarra Shoalhaven Local Health District, a regional area in New South Wales, Australia. The description of the development, components, and lessons learned from the SEED Wellness Model illustrates one possible solution about how to provide better care for the staff thus not only preventing staff burnout and turnover, but also creating lasting organizational benefits. The detailed model description can assist in developing a larger and more rigorous evidence-base to improve staff wellness in healthcare settings, both within Australia and internationally.

The impact of interventions to reduce risk and incidence of intimate partner violence and sexual violence in conflict and post-conflict states and other humanitarian crises in low and middle income countries: a systematic review.

Sexual violence and intimate partner violence are exacerbated by armed conflict and other humanitarian crises. This narrative systematic review of evidence for interventions to reduce risk and incidence of sexual and intimate partner violence in conflict, post-conflict and other humanitarian crises, updates and expands our review published in 2013. A search of ten bibliographic databases for publications from January 2011 to May 2020 used database specific key words for sexual/intimate partner violence and conflict/humanitarian crisis. The 18 papers, describing 16 studies were undertaken in conflict/post-conflict settings in 12 countries. Six intervention types were reported: i) personnel; ii) community mobilisation; iii) social norms; iv) economic empowerment; v) empowerment; and vi) survivor responses, with the most common being economic empowerment (n = 7) and gendered social norms interventions (n = 6). Combined interventions were reported in nine papers. Four studies identified non-significant reductions in incidence of sexual/ intimate partner violence, showing an evident positive trend; all four evaluated gendered social norms or economic empowerment singly or in combination. Evidence for improved mental health outcomes was found for some economic empowerment, social norms and survivor interventions. Some evidence of reduced risk of sexual violence and intimate partner violence was identified for all intervention types. Qualitative studies suggest that experiences of social connection are important for women who participate in programming to address sexual and intimate partner violence. Interventions with multiple strategies appear to hold merit. Achieving and demonstrating reduced sexual and intimate partner violence remains challenging in this context. Future research should continue to explore how social norms interventions can be most effectively delivered, including the impact of including mixed and same sex groups. Work is needed with local partners to ensure programs are contextually adapted.

Leading the way: changing the focus from teaching to learning in large subjects with limited budgets.

To lead positive change in the teaching practice of teams that service large numbers of diverse students from multiple degree programs provides many challenges. The primary aim of this study was to provide a clear framework on which to plan the process of change that can be utilized by academic departments sector wide. Barriers to change were reduced by adapting and utilizing Kotter's principals of change specifically by creating a sense of urgency and defining a clear goal designed to address the problem. Changing attitudes involved training staff in new teaching and learning approaches and strategies, and creating a collaborative, supportive team-based teaching environment within which the planned changes could be implemented and evaluated. As a result senior academics are now directly involved in delivering sections of the face-to-face teaching in the new environment. Through promoting positive change we enabled deeper student engagement with the theoretical concepts delivered in lectures as evidenced by favorable student evaluations, feedback, and improved final exam results. A collaborative team-based approach that recognizes the importance of distributed leadership combined with a clearly articulated change management process were central to enabling academics to design, try, and evaluate the new teaching and learning practices. Our study demonstrates that a concerted focus on "change management" enabled teaching team members to adopt a major shift in the teaching and learning approach that resulted in measurable improvements in student learning.