A systematic review of effective local, community or peer-delivered interventions to improve well-being and employment in regional, rural and remote areas of Australia.

OBJECTIVE: To systematically review evaluated local, community or peer-delivered well-being and employment interventions delivered within regional, rural and remote Australia. DESIGN: Searches within nine databases retrieved peer-reviewed and grey literature from an initial pool of 3186 papers published between 2012 and 2022. PRISMA guidelines were adhered to, and the Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the well-being or employment (or both) articles. FINDINGS: A total of 19 items met the inclusion criteria, which included two quantitative, 12 qualitative and five mixed-methods evaluations. Intervention cohorts included Indigenous Australians, youth, older people, workers and the general community. The average methodological rating was 83%. The overall level of evidence for the interventions was low due to mostly descriptive studies. DISCUSSION: Interventions that appeared effective in improving well-being tended to focus on addressing social connectedness and self-determination. Unexpected employment outcomes were evident across many of the studies, which highlighted the reciprocity between well-being and employment. CONCLUSION: This review highlights promising interventions for improving well-being by focusing on social connectedness and self-determination. Further empirical evidence is encouraged to explore the reciprocal relationship between well-being and employment, emphasising the significance of social connectedness and self-determination in this context.

Cognitive mental workload of emergency nursing: A scoping review.

AIM: Emergency nurses work in an environment of high cognitive mental workload. Excessive cognitive mental workload may result in patient harm and nurses' burnout. Therefore, it is necessary to understand nurses' subjective experience of cognitive workload. This scoping review aimed to curate literature about the subjective experience of cognitive mental workload reported by nurses and psychometric measures of the phenomenon. DESIGN: The scoping review was conducted in accordance with JBI methodology and reported using PRISMA extension for scoping review checklist. METHODS: A priori protocol was created with Peer Review of Electronic Search Strategies checklist and registered in the OSF registry. Databases including PubMed, CINAHL, ProQuest, Scopus, Science Direct, Web of Science and Google Scholar were searched. Published reports were reviewed against the eligibility criteria by performing Title and Abstract screening, followed by Full-text screening. The initial search yielded 1373 studies. Of these, 57 studies met the criteria for inclusion in this study. RESULTS: The search revealed five general measures of cognitive mental workload and their variations. Only one customised measure specifically for medical-surgical nurses was found in the study. Identified measures were collated and categorised into a framework for conceptual clarity. NASA Task Load Index and its variations were the most popular subjective measure of cognitive mental workload in nursing. However, no measure or self-report scale customised for emergency nurses was identified. PATIENT OR PUBLIC CONTRIBUTION: The findings of this scoping review can inform future research into the cognitive mental workload of nurses. The findings have implications for workplace health and safety for nurses and patients.

Risk factors for violence in an emergency department: Nurses' perspectives.

OBJECTIVE: Work-related violence remains a significant problem in healthcare settings, including EDs. Violence risk assessment tools have been developed to improve risk mitigation in this setting; however, incorporation of these tools into standard hospital processes remains scarce. This research aimed to explore nurses' perspectives on the Bröset Violence Checklist used in routine violence risk assessment and their recommendations for additional items. METHODS: Thirty nursing staff who used the Bröset Violence Checklist (BVC) as standard practice for 5 years participated in two focus groups where 23 violence risk factors were presented. Using multiple methods, participants were asked to select and elaborate from a pre-determined list what they considered most useful in violence risk assessment in respect to descriptors and terminology. RESULTS: Quantitative data showed most risk factors presented to the group were considered to be predictive of violence. Ten were regarded as associated with risk, and overt behaviours received the highest votes. The terms 'shouting and demanding' was preferred over 'boisterous', and 'cognitive impairment' over 'confusion'. Patient clinical characteristics and staff perceptions of harm, inability to observe subtle behaviour, imposed restrictions and interventions and environmental conditions and impact were also important considerations. CONCLUSIONS: We recommend that violence risk assessment include: history of violence, cognitive impairment, psychotic symptoms, drug and alcohol influence, shouting and demanding, verbal abuse/hostility, impulsivity, agitation, irritability and imposed restrictions and interventions. These violence risk factors fit within the four categories of historical, clinical, behavioural and situational.

Emergency department staff experiences of the Bröset Violence Checklist.

AIM: Work-related violence is a significant problem in healthcare settings and emergency departments are one of the highest at-risk locations. There have been significant challenges in identifying successful risk-mitigation strategies to reduce the incidence and impact of work-related violence in this setting. This research explores the perspectives of clinical staff who routinely use violence risk assessment to provide recommendations for improvements. DESIGN: This qualitative research used interviews of staff who routinely use of the Bröset Violence Checklist in an emergency department. The study was conducted in April 2022. METHOD: Interview transcripts were subjected to Thematic Analysis to explore participants' clinical experiences and judgements about the utility of the Bröset Violence Checklist. RESULTS: Eleven staff participated in semi-structured interviews. Participants described themes about the benefits of routine violence risk assessment and the influence of the subjective opinion of the scorer with respect to the emergency department patient cohort. Four categories of violence risk factors were identified: historical, clinical, behavioural and situational. Situational risks were considered important for tailoring the tool for context-specificity. Limitations of the BVC were identified, with recommendations for context-specific indicators. CONCLUSION: Routine violence risk assessment using the Bröset Violence Checklist was deemed useful for emergency departments, however, it has limitations. IMPACT: This study's findings offer potential solutions to reduce violence affecting front-line workers and practical processes that organizations can apply to increase staff safety. IMPLICATIONS: The findings produced recommendations for future research and development to enhance utility of the Bröset Violence Checklist. REPORTING METHOD: EQUATOR guidelines were adhered to and COREQ was used. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution was involved in this study.

A Systematic Literature Review of the Career Choice of Helping Professionals Who Have Experienced Cumulative Harm as a Result of Adverse Childhood Experiences.

The pervasive effects of cumulative harm resulting from adverse childhood experiences influence all aspects of an individual's life course. Research highlights a relationship between early trauma and career choice; however, there is a dearth of research pertaining specifically to cumulative harm and the influence on career choice in the helping professions. A systematic literature review was conducted to explore the associations of cumulative harm and childhood trauma on career decision making in people in the helping professions. A search was conducted across databases between February 1990 and February 2019 relevant to searches combining three areas of interest: (a) "childhood trauma," (b) "career choice," and (c) "helping professionals." Database searches and further manual searches yielded a total of 208 articles, and 28 studies satisfied all inclusion criteria. Only studies that were peer-reviewed and published between February 1990 and February 2019 were included. The evidence from the review indicated that family of origin dysfunction, parentification, individual characteristics, and traits developed through adversity, and experiential motivations were associated with the career choice in the helping professions. Further research is required to explore different professional cohorts and the utility of life themes as both a source of data for research and reflexive practice in helping professionals.

Indicators for effective visiting primary care services: A case study.

OBJECTIVE: The objective of this study was to assess the clinical utility of a model of seven principles for effective visiting primary care services and to determine how it could be conceptualised as a tool for evaluation. SETTING: The research was undertaken in the context of visiting primary care services with an agency, Outback Futures, selected as a case study. PARTICIPANTS: Three executive staff with Outback Futures participated in the research. DESIGN: The case study design involved data collection by four group interviews conducted between July and November 2021. The interview data were analysed using thematic analysis. RESULTS: This case study is additional evidence for the clinical utility of the model of seven principles. The results reinforce the importance of a community-focussed approach to assess the impact of visiting service organisations on rural and remote communities. A comprehensive approach to evaluation is required to justify the investments made and safeguard the health and well-being of rural and remote residents. A self-assessment protocol has been established from the model for use by visiting services. Furthermore, three themes were drawn from the data: relationship is fundamental, the importance of co-design, and being effective as a visiting service is challenging. CONCLUSION: The model is appropriate for the case study organisation, and has clinical utility and implications for other visiting services. A self-assessment protocol has been developed. Future research should apply the model and protocol self-assessment tool in an effort to construct a consistent and credible approach to evaluation of visiting primary care services.

Importance of attachment to place in growing a sustainable Australian Rural Health Workforce: A rapid review.

INTRODUCTION: Personal, community, and environmental factors can influence the attraction and retention of regional, rural, and remote health workers. However, the concept of place attachment needs further attention as a factor affecting the sustainability of the rural health workforce. OBJECTIVE: The purpose of this rapid review was to explore the influence of a sense of place in attracting and retaining health professionals in rural and remote areas. DESIGN: A systematic rapid review was conducted based on an empirical model using four dimensions: place dependence, place identity, social bonding and nature bonding. English-language publications between 2011 and 2021 were sought from academic databases, including studies relevant to Australian health professionals. FINDINGS: A total of 348 articles were screened and 52 included in the review. Place attachment factors varied across disciplines and included (a) intrinsic place-based personal factors; (b) learning experiences enhancing self-efficacy and rural health work interest; (c) relational, social and community integration; and (d) connection to place with lifestyle aspirations. DISCUSSION: This rapid review provides insight into the role of relational connections in building a health workforce and suggests that community factors are important in building attachment through social bonding and place identity. Results indicate that future health workforce research should focus on career decision-making and psychological appraisals including place attachment. CONCLUSION: An attachment to place might develop through placement experiences or from a strong rural upbringing. The importance of the relational interactions within a work community and the broader community is seen as an important factor in attracting, recruiting, and sustaining a rural health workforce.

Revised model for evaluating visiting health care services in rural and remote settings.

OBJECTIVE: Visiting health care services were developed to improve access to essential health care in rural and remote areas. Evaluating these services requires a robust framework. The objective of this study was to assess the confirmability and credibility of a model of 7 principles for effective visiting health care services. SETTING: Three iterative online survey rounds administered between July and December 2020. PARTICIPANTS: A heterogeneous panel of 13 experts in rural and remote health care participated, including managers of health care services, senior clinical staff in rural and remote regions and research academics specialising in rural infrastructure. DESIGN: The model was appraised using the Delphi method involving iterative online survey rounds to facilitate anonymous and structured discussion between panel members. RESULTS: Findings indicate consensus between panel members and support for a revised model. The revised model includes 4 modifications: (a) proposal of a new principle titled Feasibility, (b) restructure of 2 existing principles, (c) refined shape of the model to more accurately reflect the nature of service delivery and (d) detailed definitions of each principle. CONCLUSION: This study presents a credible, revised version of the model of 7 principles for effective visiting services. This will enhance the quality of the health workforce across geographically large countries, like Australia, enabling organisations to more effectively and consistently evaluate the impact of their service on rural and remote communities.

A multidimensional, person-centred perspective on teacher engagement: Evidence from Canadian and Australian teachers.

BACKGROUND: Hitherto, little work has examined the proposition that teachers may simultaneously invest varying degrees of their energetic resources in the teaching and learning environment. AIMS: Drawing on a multidimensional, person-centred perspective, the study aimed to identify profiles of teacher engagement, reflecting distinct configurations of teachers' energetic investments, and their generalizability across Canadian and Australian teachers. Additionally, we examined teachers' self-efficacy beliefs as predictors of engagement profile membership and the cross-country generalizability of these relations. We also examined emotional exhaustion (EE) and job satisfaction (JS) as outcomes of profile membership in Canadian and Australian teachers, respectively. SAMPLES: The samples comprised 586 Canadian and 595 Australian teachers. METHODS: Data on teachers' multidimensional engagement and teacher self-efficacy were collected in both the Canadian and Australian samples. Additionally, data on Canadian teachers' burnout and Australian teachers' job satisfaction were collected. RESULTS: Latent profile analyses revealed three engagement profiles, representing distinct configurations of teachers' multidimensional energetic investments, which were found to mostly generalize. Additionally, self-efficacy beliefs were found to predict the likelihood of engagement profile membership equally in Canadian and Australian teachers, and EE in Canadian teachers and JS in Australian teachers were found to differ significantly across the profiles. CONCLUSIONS: The results of the study constitute among the first evidence that teachers may be differentially engaged in the teaching environment with respect to their distinct energetic investments, and such differential profiles of engagement have differential implications for well-being-related outcomes and can be predicted by their teaching capability beliefs.

Resolving Dimensionality Problems With WHOQOL-BREF Item Responses.

The World Health Organization Quality of Life Scale (WHOQOL-BREF) is predicated on a multidimensional perspective on quality of life (QOL); yet studies are unclear about the latent structure underlying responses. This article reports on a study conducted to investigate the structure of WHOQOL-BREF scores. Competing latent structures of the data were examined in a general population sample. In addition, the complete factorial invariance of the retained model was investigated across gender. We also investigated latent mean differences in the QOL dimensions over age as well as age by gender interactions effects. Based on responses to the WHOQOL-BREF, support was found for a bifactor exploratory structural equation modeling representation of the data. This measurement structure accounts for construct-relevant multidimensionality in item responses due to the presence of general and specific factors underlying the data and the fallibility of indictors as pure reflections of only the single constructs they are purported to measure. Furthermore, support was found for measurement and structural invariance across gender. Finally, evidence was obtained for a curvilinear relationship of age with QOL, characterized by a midlife nadir. Taken together, the results of the study yield important validation data for the WHOQOL-BREF and tentatively resolve the dimensionality issues in the measurement of QOL using this instrument.

A Thematic Analysis of Career Adaptability in Retirees Who Return to Work.

Retirement can no longer be conceptualized as disengagement, as the end of a person's career, as it is in the life-span, life-space theory. Increasingly, retirees are returning to work, in paid, and unpaid positions, in a part-time or full-time capacity, as an act of re-engagement. Vocational psychology theories are yet to adequately conceptualize the phenomenon of retirees' re-engagement in work. The research reported in this paper is the first attempt to understand re-engagement through the theoretical lens of career construction theory (CCT) and its central construct, career adaptability. The study involved intensive interviews with 22 retirees between the ages of 56 and 78 years (M = 68.24), who had retired no less than 1 year prior to the study. Participants were engaged in a discussion about their reasons for returning to the world of work. Thematic analysis of interview transcripts extracted evidence of the four career adaptability resources: concern, control, curiosity, and confidence. In addition, the influence of family and making a contribution were discerned as important themes. These findings are the first evidence that the CCT and career adaptability provide a new conceptual lens to theorize and conduct research into the phenomenon of retirement.

The mediating roles of coping and adjustment in the relationship between personality and academic achievement.

BACKGROUND: Existing literature has documented relationships between personality traits and academic achievement as well as some of the mechanisms underlying these links. However, the pathways by which personality traits are associated with achievement during stressful educational circumstances require further investigation. AIMS: This study examined a model of the roles of conscientiousness and neuroticism in achievement during the typically stressful university transition, with a focus on coping strategies and academic adjustment to university as mediators in the putative chain of events linking the dispositional traits with achievement. SAMPLE: The sample comprised 498 first-year students attending a metropolitan university in Australia. METHODS: A multiwave design was used with measures of the personality traits administered at the beginning of the semester, measures of coping administered 4 weeks thereafter, and data on academic adjustment collected mid-semester. Students' GPA data were retrieved at the end of the semester. RESULTS: In structural equations analyses, conscientiousness was associated with greater primary control engagement coping and lesser narrow disengagement coping, whereas the opposite was found for neuroticism. Furthermore, conscientiousness and neuroticism were indirectly associated with academic adjustment via the coping strategies, and the personality factors were also indirectly associated with achievement via the coping strategies and academic adjustment linked serially in three-path mediated sequences. CONCLUSIONS: The findings of this study replicate existing data concerning the direct and indirect relationships of personality with coping and adjustment, and extend these data by elucidating the pathways through which conscientiousness and neuroticism are linked with achievement during a typically stressful educational event.