Disruption and Improvisation: Experiences of Loneliness for People With Chronic Illness.

Chronic illness can disrupt many aspects of life, including identity, social relationships, and anticipated life trajectories. Despite significant scholarship on chronic illness, we know less about the ways in which chronic illness impacts feelings of loneliness and how people with chronic illness deal with loneliness. Drawing on concepts of biographical disruption and liminality and data from walking and photo-elicitation interviews with 14 people, we aimed to explore how people with chronic illness experience loneliness in their everyday lives. Tracing how past and present illness experiences are implicated in the lived experience of loneliness and the strategies people use to manage loneliness, our findings illustrated that being caught in a liminal state where participants struggled to maintain and adapt to a new normality in life with chronic illness was a central thread woven throughout their experience of loneliness. Although participants drew on their personal agency and adopted strategies to account for, manage, and limit disruptions from chronic illness and loneliness, they found that their strategies were not completely effective or satisfactory. Chronic illness and loneliness continue to be largely considered as an individual's problem, limiting opportunities for people with chronic illness who experience loneliness to seek support and social connection. Our research highlighted that chronic illness and loneliness need to be acknowledged as both a personal and collective problem, with multi-level responses that involve individuals, communities, and society.

COVID-19 infection and the broader impacts of the pandemic on healthcare workers.

The severe acute respiratory syndrome coronavirus (SARS-CoV-2) disease or COVID-19 pandemic is associated with more than 230 million cases and has challenged healthcare systems globally. Many healthcare workers (HCWs) have acquired the infection, often through their workplace, with a significant number dying. The epidemiology of COVID-19 infection in HCWs continues to be explored, with manifold exposure risks identified, leading to COVID-19 being recognised as an occupational disease for HCWs. The physical illness due to COVID-19 in HCWs is similar to the general population, with some HCWs experiencing a long-term illness, which may impact their ability to return to work. HCWs have also been affected by the immense workplace and psychosocial disruption caused by the pandemic. The impacts on the psychological well-being of HCWs globally have been profound, with high prevalence estimates for mental health symptoms, including emotional exhaustion. Globally, governments, healthcare organisations and employers have key responsibilities, including: to be better prepared for crises with comprehensive disaster response management plans, and to protect and preserve the health workforce from the physical and psychological impacts of the pandemic. While prioritising HCWs in vaccine rollouts globally has been critical, managing exposures and outbreaks occurring in healthcare settings remains challenging and continues to lead to substantial disruption to the health workforce. Safeguarding healthcare workforces during crises is critical as we move forward on the new path of 'COVID normal'.

The workplace and psychosocial experiences of Australian junior doctors during the COVID-19 pandemic.

BACKGROUND: Junior doctors experience high levels of psychological distress and emotional exhaustion. The current Coronavirus disease 2019 (COVID-19) pandemic has resulted in significant changes to healthcare globally, with quantitative studies demonstrating increased fatigue, depression and burnout in junior doctors. However, there has been limited qualitative research to examine junior doctors' experiences, challenges and beliefs regarding management of future crises. AIMS: To investigate the workplace and psychosocial experiences of Australian junior doctors working during the second wave of the COVID-19 pandemic. METHODS: Australian healthcare workers were invited to participate in a nationwide, voluntary, anonymous, single time point, online survey between 27 August and 23 October 2020. A qualitative descriptive study of responses to four free-text questions from 621 junior doctors was undertaken, with responses analysed using inductive content analysis. RESULTS: Participants were predominantly female (73.2%), aged 31-40 years (48.0%) and most frequently reported working in medical specialties (48.4%), emergency medicine (21.7%) or intensive care medicine (11.4%). Most (51.9%) participants had 0-5 years of clinical experience since medical graduation. Junior doctors described experiences related to four key themes: a hierarchical, difficult workplace culture; challenging working conditions; disrupted training and career trajectories; and broader psychosocial impacts. The COVID-19 pandemic exacerbated longstanding, workplace issues and stressors for junior doctors and highlighted the threat that crises pose to medical workforce retention. There is an urgent need for authentic, positive workplace cultural interventions to engage, validate and empower junior doctors. CONCLUSIONS: Challenging workplace cultures and conditions, which have worsened during the COVID-19 pandemic, are associated with poor psychological well-being in junior doctors. There exists a need for long-term, widespread improvements in workplace culture and working conditions to ensure junior doctors' well-being, facilitate workforce retention and enhance the safety and quality of patient care in Australia.

Thoughts of suicide or self-harm among Australian healthcare workers during the COVID-19 pandemic.

OBJECTIVE: To identify the prevalence and predictors of (a) thoughts of suicide or self-harm among healthcare workers during the COVID-19 pandemic and (b) help-seeking among those healthcare workers with thoughts of suicide or self-harm. METHOD: Analysis of data from the Australian COVID-19 Frontline Healthcare Workers Study, an online survey of healthcare workers conducted during the second wave of the COVID-19 pandemic in Australia. Outcomes of interest were thoughts of suicide or self-harm as measured through the Patient Health Questionnaire for depression and help-seeking behaviours. RESULTS: Overall, 819 (10.5%) of 7795 healthcare workers reported thoughts of suicide or self-harm over a 2-week period. Healthcare workers with these thoughts experienced higher rates of depression, anxiety, post-traumatic stress disorder and burnout than their peers. In multivariable models, the odds of suicide or self-harm thoughts were higher among workers who had friends or family infected with COVID-19 (odds ratio = 1.24, 95% confidence interval = [1.06, 1.47]), were living alone (odds ratio = 1.32, 95% confidence interval = [1.06, 1.64]), younger (⩽30 years cf. >50 years; odds ratio = 1.70, 95% confidence interval = 1.36-2.13), male (odds ratio = 1.81, 95% confidence interval = [1.49, 2.20]), had increased alcohol use (odds ratio = 1.58, 95% confidence interval = [1.35, 1.86]), poor physical health (odds ratio = 1.62, 95% confidence interval = [1.36, 1.92]), increased income worries (odds ratio = 1.81, 95% confidence interval = [1.54, 2.12]) or prior mental illness (odds ratio = 3.27, 95% confidence interval = [2.80, 3.82]). Having dependent children was protective (odds ratio = 0.75, 95% confidence interval = [0.61, 0.92]). Fewer than half (388/819) of the healthcare workers who reported thoughts of suicide or self-harm sought professional support. Healthcare workers with thoughts of suicide or self-harm were more likely to seek support if they were younger (⩽30 years cf. >50 years; odds ratio = 1.78, 95% confidence interval = [1.13, 2.82]) or had prior mental health concerns (odds ratio = 4.47, 95% confidence interval = [3.25, 6.14]). CONCLUSION: One in 10 Australian healthcare workers reported thoughts of suicide or self-harm during the pandemic, with certain groups being more vulnerable. Most healthcare workers with thoughts of suicide or self-harm did not seek professional help. Strong and sustained action to protect the safety of healthcare workers, and provide meaningful support, is urgently needed.

Differences in psychosocial distress among rural and metropolitan health care workers during the COVID-19 pandemic.

OBJECTIVE: The Australian COVID-19 Frontline Healthcare Workers study examined the prevalence and severity of mental health symptoms during the second wave of the COVID-19 pandemic. This substudy examined the differences in psychological well-being between rural and metropolitan health care workers (HCWs). DESIGN: A nationwide survey conducted between August and October 2020. SETTING AND PARTICIPANTS: Australian HCWs were recruited through multiple strategies. MAIN OUTCOME MEASURES: Demographics, mental health outcomes (anxiety, depression, post-traumatic stress disorder [PTSD] and burnout). RESULTS: Complete responses were included from 7846 participants, with 1473 (18.8%) in regional or remote ('rural') areas and 81.2% in metropolitan areas. Rural participants were older, more likely to work in allied health, nursing or in health administration, and had worked longer in their profession than metropolitan participants. Levels of resilience were similar (p = 0.132), but there was significantly higher prevalence of pre-COVID-19 pandemic mental illness in the rural workforce (p < 0.001). There were high levels of current mental health issues: moderate-severe PTSD (rural 38.0%; metropolitan 41.0% p = 0.031); high depersonalisation (rural 18.1%; metropolitan 20.7% p = 0.047); and high emotional exhaustion (rural 46.5%; metropolitan 43.3% p = 0.002). Among rural participants, mental health symptoms were associated with younger age, worry about being blamed if they contracted COVID-19, fear of transmitting COVID-19 to their family, experiencing worsening relationships and working in primary care or allied health. CONCLUSION: Despite having low COVID-19 case numbers in rural Australian health services compared with metropolitan counterparts over the course of 2020, there were widespread mental health impacts on the workforce. Rural health services need specific and flexible training, education, work policies and practices that support psychological well-being now in preparedness for ongoing or future crises.

Mental health illness in chronic respiratory disease is associated with worse respiratory health and low engagement with non-pharmacological psychological interventions.

Patients with chronic respiratory disease commonly experience comorbid mental illness. This study aimed to explore associations between mental illness and respiratory health, as well as determine access to and uptake of mental health treatment. Mental health conditions were highly prevalent, long-standing and associated with worse respiratory outcomes. Active treatment with psychotropic drugs was common; however, acceptance of non-pharmacological interventions was poor. Further research is required to understand co-existing mental illness management in chronic respiratory disease.

Fall prevention programs for culturally and linguistically diverse groups: program provider perspectives.

Objectives: Older people from culturally and linguistically diverse (CALD) backgrounds are one of the fastest growing and rapidly ageing population segments in Australia. This qualitative study aims to explore the experiences, needs and challenges that individual program providers encountered in implementing and delivering a fall prevention program for CALD groups and meeting the linguistic, cultural and contextual needs of the program participants.Design: Semi-structured in-depth interviews were conducted with a convenience sample of 24 program providers implementing, delivering or supporting fall prevention programs including Stepping On for CALD groups. Interview transcripts were analysed using thematic analysis.Results: Two major themes emerged: (1) extra layers of complexity are needed in program planning, delivery, recruitment and enabling participation of older people from CALD background and (2) program leaders 'going the extra mile' influences success of the program. Complexity included accommodating the linguistic and sociocultural needs in planning the programs, knowing and using the 'right way' to reach and deliver the program to CALD groups and understanding the nuances of facilitating program participation. While it was important to ensure the acceptability and accessibility of the program for the older people from diverse CALD communities, it was the drive and determination of the program leader and their striving for cultural relevance that made the program possible. Sustainability and wider implementation requires unique support and additional resources.Conclusion: These findings can be used by program providers, policy-makers and health researchers to improve the capacity of fall prevention programs to better respond to the growing diversity in needs and preferences among older populations in Australia and internationally.

'When you are on your own, everything is your responsibility': Experiences of audiologists and audiometrists working in rural Australia.

OBJECTIVE: To investigate the experiences of audiologists and audiometrists working in regional and remote areas of Australia. DESIGN: A qualitative design, using telephone and videoconference semi-structured interviews and thematic analysis. SETTING: Regional and remote locations across Australia PARTICIPANTS: 5 audiologists and 2 audiometrists, 6 female and one male. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Insights into the experiences of audiologists and audiometrists working in rural Australia. RESULTS: Core themes that emerged from analysis were (a) professional isolation and increased scope of practice, (b) the importance of social and professional networks, (c) variable access to professional support, (d) challenges in the recruitment and retention of clinicians, and (e) tensions between service provision and profitability. CONCLUSION: This study provides valuable insights into both the rewarding and challenging aspects of working as an audiologist or audiometrist in regional and remote areas. This study emphasised the need to address these challenges in order to attract more audiological professionals to work and stay in regional and remote areas of Australia.

Comparative optimism about infection and recovery from COVID-19; Implications for adherence with lockdown advice.

BACKGROUND: Comparative optimism, the belief that negative events are more likely to happen to others rather than to oneself, is well established in health risk research. It is unknown, however, whether comparative optimism also permeates people's health expectations and potentially behaviour during the COVID-19 pandemic. OBJECTIVES: Data were collected through an international survey (N = 6485) exploring people's thoughts and psychosocial behaviours relating to COVID-19. This paper reports UK data on comparative optimism. In particular, we examine the belief that negative events surrounding risk and recovery from COVID-19 are perceived as more likely to happen to others rather than to oneself. METHODS: Using online snowball sampling through social media, anonymous UK survey data were collected from N = 645 adults during weeks 5-8 of the UK COVID-19 lockdown. The sample was normally distributed in terms of age and reflected the UK ethnic and disability profile. FINDINGS: Respondents demonstrated comparative optimism where they believed that as compared to others of the same age and gender, they were unlikely to experience a range of controllable (eg accidentally infect/ be infected) and uncontrollable (eg need hospitalization/ intensive care treatment if infected) COVID-19-related risks in the short term (P < .001). They were comparatively pessimistic (ie thinking they were more at risk than others for developing COVID-19-related infection or symptoms) when thinking about the next year. DISCUSSION: This is one of the first ever studies to report compelling comparative biases in UK adults' thinking about COVID-19.

Assisting clients experiencing family violence: Clinician and client survey responses in a child and family health service.

AIMS AND OBJECTIVES: To determine the baseline levels of training, knowledge and confidence working in the area of family violence in staff at a public child and maternal health service in Melbourne, Australia, as well as perceived staff barriers to working effectively in this area. This study also aimed to explore the client perception of existing screening practices. BACKGROUND: Family violence is a global concern with pregnancy and the postnatal period times of particularly high risk. Child and maternal health services are well placed to screen for violence, yet clinician and client perceptions of screening remain poorly characterised. DESIGN: Thirty-five staff and 15 mothers participated in this cross-sectional, mixed-method study, via an online survey. Strengthening the Reporting of Observational studies in Epidemiology (STROBE) cross-sectional guidelines were used. RESULTS: The majority of staff screened clients for family violence, at least some of the time, with over 50% often or always screening. However, only half of staff respondents indicated that they believed they knew how to screen appropriately. Screening occurred most often over the phone or at the first service visit. The most commonly reported barriers to screening were suspected perpetrators being present during consultations and language barriers. Most clients reported being screened for physical violence and safety in the home with few being asking about financial and sexual abuse, or psychological violence and coercive control. Clients who disclosed violence reported being well supported. CONCLUSION: While some baseline staff knowledge and skills have been identified, further support for clinicians is needed to ensure best practice and improve services and outcomes, particularly in regard to screening for different types of violence across the spectrum. RELEVANCE TO CLINICAL PRACTICE: This study helps to inform clinical screening practices in maternal health services through an exploration of facilitators and barriers in the screening process.

Relatives' strategies in subacute brain injury rehabilitation: The warrior, the observer and the hesitant.

BACKGROUND: Relative involvement is crucial in rehabilitation when patients are incapable of being involved due to cognitive and functional dysfunction. However, studies have shown that this is complex because of differing understandings of the meaning of involvement as well as diverse needs to be involved. AIMS AND OBJECTIVES: To explore the experience of the rehabilitation process from the perspectives of relatives of patients with a traumatic brain injury. The aim of the study was, through a theoretical-empirical analysis, to identify relatives' strategies and practices in the rehabilitation process as evidenced in meetings with providers. DESIGN: A longitudinal study with a qualitative approach, drawing on the theory of Pierre Bourdieu. METHODS: Data were generated using participant observation and semi-structured interviews. Participants were eleven relatives of patients with a severe traumatic brain injury, followed through in-patient rehabilitation varying from 9-12 weeks. Analysis was undertaken using both an inductive and deductive approach. FINDINGS: Drawing on Bourdieu's concept of strategy, three relative positions were identified, the warrior, the observer and the hesitant. These positions illustrate how different relative positions and their related dispositions influence the strategies used by relatives of patients with a severe traumatic brain injury evidenced in how they act, participate and relate to both the patient and the providers during the course of rehabilitation. CONCLUSIONS: Acknowledging the relatives' positions during the rehabilitation process enables better understanding and support of the relatives in the rehabilitation process to meet their (and thus the patients') diverse needs. RELEVANCE TO CLINICAL PRACTICE: The findings have practical implications in informing how clinicians meet, interact, communicate and involve relatives of adult patients' with traumatic brain injury in decision-making during rehabilitation.

Controlled, Constrained, or Flexible? How Self-Management Goals Are Shaped By Patient-Provider Interactions.

A person-centered approach to goal-setting, involving collaboration between patients and health professionals, is advocated in policy to support self-management. However, this is difficult to achieve in practice, reducing the potential effectiveness of self-management support. Drawing on observations of consultations between patients and health professionals, we examined how goal-setting is shaped in patient-provider interactions. Analysis revealed three distinct interactional styles. In controlled interactions, health professionals determine patients' goals based on biomedical reference points and present these goals as something patients should do. In constrained interactions, patients are invited to present goals, yet health professionals' language and questions orientate goals toward biomedical issues. In flexible interactions, patients and professionals both contribute to goal-setting, as health professionals use less directive language, create openings, and allow patients to decide on their goals. Findings suggest that interactional style of health professionals could be the focus of interventions when aiming to increase the effectiveness of goal-setting.

The impact of inpatient education on self-management for patients with acute coronary syndrome and type 2 diabetes mellitus: a cross-sectional study in China.

This study examined the impact of inpatient education on diabetes knowledge, acute coronary syndrome (ACS) symptom management and diabetes self-management on discharge for patients with ACS and type 2 diabetes mellitus (T2DM). A cross-sectional survey and patient health record review of 160 patients was conducted in a major hospital in Shanghai. Patient education received was measured using a visual analogue scale. The survey included valid and reliable measures of diabetes knowledge, self-efficacy, attitudes to ACS and clinical outcomes. Inpatient education contributed to improvements in fasting blood glucose on discharge (P < 0.05). ACS symptom management [Chinese language version of the ACS response index (C-ACSRI) scores] and self-management of T2DM [Chinese version of diabetes management self-efficacy scale (C-DMSES) scores] on discharge differed for the limited education group and sufficient education group (P < 0.001). Based on the multiple regression analyses, increasing scores for the C-ASCRI and C-DMSES could be explained by higher scores for perceived health education. Education relating to ACS and T2DM delivered during an acute admission was associated with improved scores in ACS symptom management and T2DM self-management, preparing some patients to manage both conditions on discharge.

Making fall prevention routine in primary care practice: perspectives of allied health professionals.

BACKGROUND: While there is strong evidence that fall prevention interventions can prevent falls in people aged 65 and over, translating evidence into routine practice is challenging. Research regarding how allied health professionals (AHPs) respond to this challenge is limited. As part of the Integrated Solutions for Sustainable Fall Prevention (iSOLVE) project, this study aimed to explore how AHPs were making fall prevention practice routine in primary care and the factors that influenced their fall prevention practice. METHODS: In-depth qualitative interviews were conducted with fifteen AHPs who had attended evidence-based workshops associated with the iSOLVE project. AHPs had backgrounds in physiotherapy, occupational therapy, exercise physiology and podiatry. Interviews explored how fall prevention was being incorporated into routine practice and the factors that influenced routinisation, including the project workshops. Thematic analysis was used to analyse the data. RESULTS: We found fall prevention was valued in practice and recognised as complex. AHPs worked through challenges relating to clients (multi-morbidity, complex living situations, client motivation), challenges working alongside other health professionals (understanding respective roles/overlapping roles, sense of competition, communication) and challenges associated with funding systems perceived as complicated and constantly changing. Despite these challenges, AHPs were adopting strategies for integrating fall prevention routinely. The iSOLVE workshops were perceived as important in supporting existing practice and in providing strategies to enhance practice. CONCLUSIONS: Policy makers, program managers, educators and AHPs can adopt strategies identified in this research for routinising fall prevention such as being alert that falls are common, asking every client about falls, having processes for assessing clients for fall risk, and having structured and evidence-based programs to work with clients on fall prevention. Adapting and streamlining funding systems are also important for facilitating fall prevention work.

Learning from consumers: An eDelphi study of Australian mental health consumers' priorities for recovery-oriented curricula.

BACKGROUND/AIM: Mental health reform in Australia emphasises recovery, partnership working and prioritises consumers' needs over professionals'. Occupational therapy students must develop capabilities for working in this way. Learning from consumers' lived experience of mental illness and recovery is considered critical to developing such capabilities and aligns with occupational therapy programme accreditation for consumer involvement in designing, delivering and evaluating curricula. No definitive capability standards exist to inform curricula and little is known about Australian mental health consumers' preferred modes of involvement in health professional education. This study sought to identify consumers' priorities for curricula, and ways in which they would like to participate in entry-level student education. METHODS: An eDelphi study utilising the Policy Delphi approach was employed. Consensus by 70% of participants was set as the standard for item inclusion. The first round asked open questions about participants' priorities for recovery-oriented curricula, their experiences with mental health workers and asked participants to identify their preferred methods of participating in education. Items generated were rated in subsequent rounds until consensus was reached in round three. RESULTS: Twenty-eight participants completed round one, 18 completed round two and 14 completed round three. Five core values and 171 curriculum priorities, forming 12 capability domains, reached consensus. Each capability domain comprised knowledge and understanding; skills and abilities; and behaviours and actions. Ten ways of participating in mental health curricula in entry-level occupational therapy programmes were identified, with an emphasis on active participation in design, delivery and review of curricula. CONCLUSION: These findings highlight important capabilities from consumers' perspectives, suggesting key content for curricula. Active roles in designing, delivering and evaluating curricula were preferred, providing some guidance for educators seeking to involve consumers. Further research is required to refine these priorities, and to evaluate acceptability, feasibility and efficacy of varying modes of consumer involvement.

Social networks and expertise development for Australian breast radiologists.

BACKGROUND: In this study, we explore the nexus between social networks and expertise development of Australian breast radiologists. Background literature has shown that a lack of appropriate social networks and interaction among certain professional group(s) may be an obstacle for knowledge acquisition, information flow and expertise sharing. To date there have not been any systematic studies investigating how social networks and expertise development are interconnected and whether this leads to improved performance for breast radiologists. METHODS: This study explores the value of social networks in building expertise alongside with other constructs of performance for the Australian radiology workforce using semi-structured in-depth interviews with 17 breast radiologists. RESULTS: The findings from this study emphasise the influences of knowledge transfer and learning through social networks and interactions as well as knowledge acquisition and development through experience and feedback. The results also show that accessibility to learning resources and a variety of timely feedback on performance through the information and communication technologies (ICT) is likely to facilitate improved performance and build social support. CONCLUSIONS: We argue that radiologists' and, in particular, breast radiologists' work performance, needs to be explored not only through individual numerical characteristics but also by analysing the social context and peer support networks in which they operate and we identify multidisciplinary care as a core entity of social learning.