Research translation mentoring for emerging clinician researchers in rural and regional health settings: a qualitative study.

BACKGROUND: Building clinician and organisation-level research translation capacity and capability is fundamental for increasing the implementation of research into health practice and policy and improving health outcomes. Research translation capacity and capability building is particularly crucial in rural and regional settings to address complex problems impacting these socially and economically disadvantaged communities. Programs to build clinicians' research translation capability typically involve training and mentoring. Little is known about the features of and influences on mentorships in the context of training for emerging clinician-researchers working in rural and regional healthcare settings. Research translation mentorships were established as part of the Supporting Translation Research in Rural and Regional settings (STaRR) program developed and delivered in Victoria, Australia from 2020 to 2021. The study sought to address the following research questions: 1) What context-specific types of support do research translation mentors provide to emerging researchers?. 2) How does the mentoring element of a rural research translational training program influence research translation capacity and capability development in rural emerging researchers and mentors, if at all?. 3) How does the mentoring element of the program influence translation capacity and capability at the organisational and regional level, if at all? METHODS: We conducted a qualitative descriptive study. Interviews with individuals involved in the STaRR program took place approximately 12 months after the program and explored participants' experiences of the mentored training. Interviews were undertaken via telephone, audio-recorded, and transcribed. Data were analysed using a team-based five-stage framework approach. RESULTS: Participants included emerging researchers (n = 9), mentors (n = 5), and managers (n = 4), from five health services and two universities. We identified four themes in the interview data: (1) Mentors play an educative role; (2) Mentoring enhanced by a collaborative environment; (3) Organisational challenges can influence mentorships, and (4) Mentorships help develop research networks and collective research and translation capacity. CONCLUSIONS: Mentorships contributed to the development of research translation capabilities. The capabilities were developed through mentors' deepened understanding of the rural and regional healthcare contexts in which their emerging researchers worked, the broadening and strengthening of rural and regional research networks, and building and sharing research translation knowledge and skills.

Translating research into rural health practice: a qualitative study of perceived capability-building needs.

INTRODUCTION: The timely translation of research into practice and local policy is critical to improving healthcare delivery in rural and regional settings, and remains a concern for researchers, health professionals, health managers and policymakers alike. Successful and sustained research translation does not occur without concerted effort, support and strategies to build research translation capacity and capability. Research capacity comprises individual and organisational capabilities. This study is primarily focused on individual capabilities. Health professionals working in rural and regional settings, where research activity and infrastructure are generally less mature than that seen in metropolitan areas, need additional support and skills to build their capability to engage in translation-focused research. This study aimed to explore rural health research stakeholders' perspectives on capability-building needs for emerging researchers to enable the translation of research into health practice. METHODS: A qualitative description methodology was used to conduct three online focus groups to explore participants' understanding of research translation, and their perceptions of the supports that are needed to build capability for emerging health professional researchers to undertake translation-focused research. Emerging health professional researchers (emerging researchers hereafter) are health professionals who have little or no formal training or experience undertaking research. Data were analysed by a five-stage framework approach. RESULTS: Participants included emerging researchers (n=12), research mentors (n=3) and health managers (n=4) from six rural or regional organisations, including four health services, one university and one primary health network in Victoria, Australia. Participants' conceptualisation of research translation reflected previously documented definitions; that is, research grounded in health practice and characterised by adaptation of existing research evidence to local settings via implementation. Four key themes related to research translation support for rural and regional health researchers were identified: understanding the study and translation context is vital to enacting change; engaging with stakeholders identifies research and translation priorities and suitable approaches; mentor and managerial support assists navigation of research translation activities; and access to clinical and research networks promotes research translation partnerships and collaborations. Participants highlighted the need to identify and train appropriate research mentors and health leaders who can support translation-focused research at the emerging researcher level. The need for training that targets fundamental research translation skills, including systematic processes for engaging stakeholders and collaborative priority setting, and the processes to analyse both the research study and research translation contexts, were also identified as important. CONCLUSION: Given their understanding of the local community and health context, rural and regional health professionals are ideally placed to engage in translation-focused research; however, they require multiple types of research capability development through several levels of influence. This includes support and guidance to ensure their endeavours align with and leverage organisational and regional priorities for research translation. These findings can inform approaches to research capability building through training and resource provision, and organisational infrastructure development and capacity building, to support the rapid translation of research into clinical practice.

Delegation of patient related tasks to allied health assistants: a time motion study.

BACKGROUND: Allied health assistants (AHAs) are support staff who complete patient and non-patient related tasks under the delegation of an allied health professional. Delegating patient related tasks to AHAs can benefit patients and allied health professionals. However, it is unclear whether the AHA workforce is utilised optimally in the provision of patient care. The purpose of this study was to determine the proportion of time AHAs spend on patient related tasks during their working day and any differences across level of AHA experience, clinical setting, and profession delegating the task. METHODS: A time motion study was conducted using a self-report, task predominance work sampling method. AHAs were recruited from four publicly-funded health organisations in Victoria, Australia. AHAs worked with dietitians, occupational therapists, physiotherapists, podiatrists, social workers, speech pathologists, psychologists, and exercise physiologists. The primary outcome was quantity of time spent by AHAs on individual task-categories. Tasks were grouped into two main categories: patient or non-patient related activities. Data were collected from July 2020 to May 2021 using an activity capture proforma specifically designed for this study. Logistic mixed-models were used to investigate the extent to which level of experience, setting, and delegating profession were associated with time spent on patient related tasks. RESULTS: Data from 51 AHAs showed that AHAs spent more time on patient related tasks (293 min/day, 64%) than non-patient related tasks (167 min/day, 36%). Time spent in community settings had lower odds of being delegated to patient related tasks than time in the acute hospital setting (OR 0.44, 95%CI 0.28 to 0.69, P < 0.001). Time delegated by exercise physiologists and dietitians was more likely to involve patient related tasks than time delegated by physiotherapists (exercise physiology: OR 3.77, 95% 1.90 to 7.70, P < 0.001; dietetics: OR 2.60, 95%CI 1.40 to 1.90, P = 0.003). Time delegated by other professions (e.g. podiatry, psychology) had lower odds of involving patient related tasks than physiotherapy (OR 0.37, 95%CI 0.16 to 0.85, P = 0.02). CONCLUSION: AHAs may be underutilised in community settings, and by podiatrists and psychologists. These areas may be targeted to understand appropriateness of task delegation to optimise AHAs' role in providing patient care.

Research training incorporating education and mentoring for rural and regional allied health professionals: An evaluation study.

INTRODUCTION AND OBJECTIVE: Building rural health workforce research capacity is critical to addressing rural health inequalities. Research training is a mainstay research capacity building strategy. This paper describes the delivery and evaluation of a research training program for rural and regional allied health professions (AHPs). DESIGN: A mentored research training program was delivered to AHPs employed public health services in rural and regional Victoria, Australia. The program was evaluated using the Evidence-Based Practice Knowledge Attitudes and Practice (EBP-KAP) tool at baseline and 3 months post-training. Semi-structured interviews undertaken at 3 and 16 months post-training explored participants' perspectives of the training, their development and application of EBP and research skills. Survey data were analysed descriptively, and interview data were analysed using a framework approach. FINDINGS: Thirty-four individuals from 14 organisations attended the first workshop and 31 attended the second. Thirty-one participants completed the survey at baseline and nine at 3 months post-training. Sixteen interviews were undertaken with 11 participants, five participating at both time points. Participants had positive EBP attitudes at both time points. Overall, participants' knowledge and incorporation of EBP into their practice, and retrieval of evidence was unchanged 3 months post-training. Themes identified in the interview data were as follows: (1) individual research capacity enhanced through supported practice, (2) organisational factors influence individuals' progression of research and (3) individual contributions towards research capacity within the organisation. CONCLUSION: A mentored rural research training program promoted the application of EBP skills at the individual level and contributed to organisational research capacity.

Student dignity during work-integrated learning: a qualitative study exploring student and supervisors' perspectives.

While University students increasingly participate in work-integrated learning (WIL), their dignity is often violated during WIL. The current literature is limited in so far as it typically focuses on student perspectives within healthcare contexts and does not use the concept of 'dignity'. Instead, this study explored student and supervisor perspectives on student dignity during WIL across healthcare and non-healthcare disciplines. Research questions included: What are: (1) types of student dignity experiences and patterns by groups; (2) factors contributing to experiences; (3) consequences of experiences? Sixty-five semi-structured interviews were conducted using narrative interviewing techniques with 30 supervisors and 46 students from healthcare (medicine, nursing and counselling) and non-healthcare (business, law and education) disciplines. Data were analyzed using framework analysis. Nine common narrative types were identified within 344 stories: verbal abuse, right for learning opportunities, care, inclusion, reasonable expectations, right for appropriate feedback, equality, trust, and right to be informed. Factors contributing to dignity experiences and consequences were often at the individual level (e.g. student/supervisor characteristics). We found some salient differences in perceptions of experiences between students and supervisors, but few differences between healthcare and non-healthcare disciplines. This study extends WIL research based on student perspectives in healthcare, and provides practice and further research guidance to enhance student dignity during WIL.

Enigmatic fossil plants with three-dimensional, arborescent-growth architecture from the earliest Carboniferous of New Brunswick, Canada.

The evolution of arborescence in Devonian plants, followed by their architectural radiation in the Carboniferous, is a transition fundamental to Earth-system processes and ecological development. However, this evolutionary transition in trees is based on preserved trunks, of which only a few known specimens possess crowns. We describe Mississippian-aged (Tournaisian) trees with a unique three-dimensional crown morphology from New Brunswick, Canada. The trees were preserved by earthquake-induced, catastrophic burial of lake-margin vegetation. The tree architecture consists of an unbranched, 16-cm-diameter trunk with compound leaves arranged in spirals of ∼13 and compressed into ∼14 cm of vertical trunk length. Compound leaves in the upper ∼0.75 m of the trunk measure >1.75 m in length and preserve alternately arranged secondary laterals beginning at 0.5 m from the trunk; the area below the trunk bears only persistent leaf bases. The principal specimen lacks either apical or basal sections, although an apex is preserved in another. Apically, the leaves become less relaxed toward horizontal and are borne straight at an acute angle at the crown. The compact leaf organization and leaf length created a crown volume of >20-30 m3. This growth strategy likely maximized light interception and reduced resource competition from groundcover. From their growth morphology, canopy size, and volume, we propose that these fossils represent the earliest evidence of arborescent subcanopy-tiering. Moreover, although systematically unresolved, this specimen shows that Early Carboniferous vegetation was more complex than realized, signaling that it was a time of experimental, possibly transitional and varied, growth architectures.

Exploring the role of medical imaging assistants in Australian medical imaging departments: A mixed-methods study.

INTRODUCTION: Allied health assistants are support staff who assist medical imaging professionals in their clinical and non-clinical role. Assistants can improve efficiency of medical imaging services; however, little is known about the specific tasks they perform. METHOD: A two-phase explanatory, sequential mixed-methods study design comprising a time motion survey and qualitative interviews was conducted across three health services in Victoria, Australia. Participants were medical imaging assistants supporting medical imaging professionals. Participants recorded tasks completed on a time motion proforma across two working days. Time spent on tasks was categorised into patient related and non-patient related tasks. Semi-structured interviews were conducted to explore assistants' perspectives about tasks, their roles and any responsibilities. Time motion data was descriptively analysed. Qualitative data were audiotaped, transcribed verbatim and analysed using the framework analysis method. Quantitative and qualitative findings were integrated using data triangulation. RESULTS: Four medical imaging assistants participated, providing 4170 min of time motion data and 138 min of interview data. Integration of time motion and interview data revealed the medical imaging assistant role is predominantly non-patient facing; autonomous and critical to workflow; diverse and requires flexibility; has the potential to expand into a more patient-facing role. CONCLUSIONS: Medical imaging assistants make significant contributions to workflow management. Their role is predominantly non-patient facing but there appear opportunities for the clinical role to expand. Realizing these opportunities will require careful consideration of the challenges and benefits of extending their scope of practice.

Allied health assistants' perspectives of their role in healthcare settings: A qualitative study.

Allied health assistants (AHAs) are important members of the health workforce and key to meeting population health needs. Previous studies exploring the role and utility of AHAs from multiple stakeholder perspectives suggest AHAs remain poorly utilised in many healthcare settings. This qualitative study explores the experiences and perspectives of AHAs working in healthcare settings to determine the contextual factors influencing their role, and mechanisms to maximise their utility. We conducted semi-structured interviews using purposive sampling with 21 AHAs, from one regional and three metropolitan health services in Australia, between February and July 2021. We used a team-based framework approach to analyse the data. Four major themes were identified: 1) AHAs' interpersonal relationships, 2), clarity and recognition of AHA roles and role boundaries, 3) AHAs accessing education and professional development, and 4) the professional identity of the AHA workforce. Underpinning each of these themes were relationships between AHAs and other healthcare professionals, their patients, health services, and the wider AHA workforce. This study may inform initiatives to optimise the utility of AHAs and increase their role in, and impact on, patient care. Such initiatives include the development and implementation of guidelines and competencies to enhance the clarity of AHAs' scope of practice, the establishment of standardised educational pathways for AHAs, and increased engagement with the AHA workforce to make decisions about their scope of practice. These initiatives may precede strategies to advance the AHA career structure.