A theoretical framework for identifying sociocultural factors that influence nurses' compliance with early warning systems for acute clinical deterioration: A cross-sectional survey.

BACKGROUND: Systematic adoption of early warning systems in healthcare settings is dependent on the optimal and reliable application by the user. Psychosocial issues and hospital culture influence clinicians' patient safety behaviours. OBJECTIVE: (i) To examine the sociocultural factors that influence nurses' EWS compliance behaviours, using a theory driven behavioural model and (ii) to propose a conceptual model of sociocultural factors for EWS compliance behaviour. DESIGN: A cross-sectional survey. SETTING: Nurses employed in public hospitals across Queensland, Australia. PARTICIPANTS: Using convenience and snowball sampling techniques eligible nurses accessed a dedicated web site and survey containing closed and open-ended questions. 291 nurses from 60 hospitals completed the survey. METHODS: Quantitative data were analysed using ANOVA or t-tests to test differences in means. A series of path models based on the theory were conducted to develop a new model. Directed or theory driven content analysis informed qualitative data analysis. RESULTS: Nurses report high levels of previous compliance behaviour and strong intentions to continue complying in the future (M=4.7; SD 0.48). Individual compliance attitudes (ß 0.29, p<.05), perceived value of escalation (ß 0.24, p<.05) and perceived ease or difficulty complying with documentation (ß -0.31, p<.05) were statistically significant, predicting 24% of variation in compliance behaviour. Positive personal charting beliefs (ß 0.14, p<.05) and subjective norms both explain higher behavioural intent indirectly through personal attitudes. High ratings of peer charting beliefs indirectly explain attitudes through subjective norms (ß 0.20, p<.05). Perceptions of control over one's clinical actions (ß -0.24, p<.05) and early warning system training (ß -0.17, p<.05) directly contributed to fewer difficulties complying with documentation requirements. Prior difficulties when escalating care (ß -0.31, p<.05) directly influenced the perceived value of escalating. CONCLUSIONS: The developed theory-based conceptual model identified sociocultural variables that inform compliance behaviour (documenting and escalation protocols). The model highlights areas of clinical judgement, education, interprofessional trust, workplace norms and cultural factors that directly or indirectly influence nurses' intention to comply with EWS protocols. Extending our understanding of the sociocultural and system wide factors that hamper nurses' use of EWSs and professional accountability has the potential to improve the compliance behaviour of staff and subsequently enhance the safety climate attitudes of hospitals. TWEETABLE ABSTRACT: A newly developed model reports nurse's personal attitudes, peer influence, perceived difficulties encountered documenting and escalation beliefs all predict early warning system compliance behaviour.

Fur, Fin, and Feather: Management of Animal Interactions in Australian Residential Aged Care Facilities.

Animal-assisted interventions (AAI) have been occurring in Australian Residential Aged Care Facilities (RACF) for more than 40 years and may relieve loneliness and improve quality of life. The presence of animals in RACF poses an inherent risk to residents and the animals involved. Little is known about the policies and guidelines for including animals in the Australian RACF. We anticipated that most RACFs would have some policies, but they may lack the detail necessary to keep humans and animals safe. Using an adapted survey, we surveyed and interviewed a small but representative sample of Australian RACF managers. The results demonstrated that RACF did have animal policies; however, the content regarding the need for hand washing, infection prevention, and animal welfare was lacking. Including unregulated family pets in RACF was an unexpected additional risk factor identified during data analysis. There is a need for national guidelines tied to the national aged care policy, which includes training and educational resources for RACF and AAI providers.

Undergraduate Ethics Education in Paramedicine in Australia.

In Australia, paramedics are obliged to practice ethically. Graduates of baccalaureate degrees in paramedicine should therefore possess a common grounding in ethics to meet the professional capabilities expected of registered paramedics. However, there is a lack of clarity regarding ethics education for paramedicine students, including what is taught, how it is taught, and how it is assessed. This paper explores ethics education for paramedicine students in Australia, how it aligns with current professional expectations, and how it may be enhanced. Point-in-time data regarding ethics education was collected from websites of fifteen Australian universities offering undergraduate baccalaureate degrees in paramedicine. Data collection was supported by consultation with academics from several institutions. Content analysis was utilised to categorise and analyse data to explore similarities and differences in curricula. Similarities included approaches to learning and teaching and the use of case-based learning, with variability found across teaching staff profiles and content areas. Findings suggest it is time for collaboration to develop a model ethics curriculum for paramedicine students in Australia.

Research Ready Grant Program (RRGP) protocol: a model for collaborative multidisciplinary practice-research partnerships.

BACKGROUND: Little attention has been given to the process of implementing or evaluating a structured academic-clinician (university-health service) research capacity-building (RCB) model within healthcare settings. We have developed a model for collaborative multidisciplinary practice-research partnerships called the Research Ready Grant Program (RRGP). The RRGP is informed by Cooke's (BMC Fam Pract 6:44, 2005) RCB framework and principles. The aim of the study outlined in this protocol is to conduct a process and outcome evaluation of the programme. We will explore how the RRGP's structured mentor model contributes to RCB of clinician-led multidisciplinary research teams. We will identify key factors at the organization, team and individual levels that affect research capacity of health professionals working in one regional health service district. This protocol describes the RRGP design and outlines the methods we will employ to evaluate an RCB programme, the RRGP, delivered in a regional health service in Australia. METHODS: The study will adopt an exploratory concurrent mixed-methods approach designed to evaluate the process of implementing an RCB model across one regional hospital and health service. Both quantitative and qualitative data collection methods over a 12-month period will be implemented. Data triangulation will be applied to capture the complex issues associated with implementing collaborative multidisciplinary practice-research partnerships. DISCUSSION: The RRGP is an innovative RCB model for clinicians in their workplace. It is expected that the programme will facilitate a culture of collaborative multidisciplinary research and strengthen hospital-university partnerships.

Research capacity-building for clinicians: understanding how the research facilitator role fosters clinicians' engagement in the research process.

BACKGROUND: There is evidence reporting more positive outcomes from research capacity-building (RCB) programmes that include a research facilitator role. Further, it has been suggested that research facilitator roles can be a useful strategy in building the research capacity of healthcare clinicians. However, until now, little attention has been applied to identifying the characteristics of the research facilitator role and how this role contributes to clinicians' engagement with the research process. The aim of this present study is to explore the characteristics required of the research facilitator role in the educational workshop phase of an RCB programme. METHODS: This qualitative study employed an inductive approach and utilized face-to-face interviews to gather data from a purposely selected cohort. Professionally transcribed responses were thematically analysed. RESULTS: The role of the research facilitator emerged as comprising two main themes: (1) facilitating the research process and (2) engaging expert clinicians as novice researchers. Pragmatically, analysis of data led to the development of a table outlining the responsibilities, skills and attributes related to each theme. Conceptually, theme 1 encapsulates the research facilitators' skills and experience and their role as knowledge brokers and cocreators of knowledge. Theme 2 provides insight into the clinician-centric approach the research facilitators utilized to build and foster relationships and support the clinicians through their research journey. CONCLUSION: This study reports on the characteristics of the research facilitator role in one phase of an RCB programme in one regional health service district in Australia and explains how the role fosters clinicians' engagement with the research process. Findings from this study will inform the development of future RCB programmes, which is important considering that clinicians' increased engagement with the research process is vital for developing a sound evidence base to support decision-making in practice and leads to higher levels of skills and greater ability to perform useful research.

Mental Health Practitioners' Understanding of Speech Pathology in a Regional Australian Community.

(1) Background: This study aimed to determine the level of knowledge and the perceptions of speech pathology held by a sample of regional mental health practitioners and to explore factors that facilitate understanding of the roles of speech pathologists in mental health. While mental health is recognised as an area of practice by Speech Pathology Australia, the inclusion of speech pathologists in mental health teams is limited. (2) Methods: An anonymous online survey was created using previously validated surveys and author generated questions and distributed to mental health practitioners in Central Queensland, Australia. (3) Results: Mental health practitioners had difficulty identifying speech pathology involvement when presented with case scenarios. Accuracy was poor for language-based cases, ranging from 28.81% to 37.29%. Participants who reported having worked with a speech pathologist were more likely to demonstrate higher scores on the areas of practice questions, [r(53) = 0.301, p = 0.028], and the language scenarios [r(58) = 0.506, p < 0.001]. They were also more likely to agree to statements regarding the connection between speech pathology and mental health, r(59) = 0.527, p < 0.001. (4) Conclusions: As found in this study, contact with speech pathologists is a strong predictor of mental health providers' knowledge of the speech pathology profession. Thus, the challenge may be to increase this contact with mental health providers to promote inclusion of speech pathologists in the mental health domain.

Silencing by design: Lessons learned about child sexual abuse from a university sexual assault survey.

BACKGROUND: University students have been recognized as particularly being vulnerable to sexual victimization. PURPOSE: With little research to date, and acknowledgement for the need of a better understanding of sexual violence, our study analysed the CQUniversity Sexual Assault Survey's qualitative responses. An open-ended qualitative question allowed students to provide information anonymously. METHODS: A total of 109 participants contributed responses with 17 respondents commenting on the fact that the survey omitted to ask about child sexual abuse prior to the cut-off age of 12 years. RESULTS: University students revealed unexpected disclosures of prepubescent child sexual abuse victimization and ongoing sexual victimization into adulthood. Furthermore, students' comments indicated negative impacts including distress, mental health and substance use problems, distrust, and interpersonal difficulties. Strong feelings about 'silencing' prepubescent child sexual abuse in university surveys were expressed with a request that questions about child sexual abuse prior to the age of 12 years be included. CONCLUSION: Our study found that child sexual abuse victimization is important to students. Recommendations indicate the need for future research about sexual violence among university students without age restrictions to gain a better understanding about the impact of trauma including revictimization experiences.

What is my child telling me? Reducing stress, increasing competence and improving psychological well-being in parents of children with a developmental disability.

High levels of stress in parents of children with a developmental disability have been extensively documented. These heightened stress levels seem independent of diagnosis and are better explained by the level of challenging behavior of the children. Furthermore, the relationship between stress level and difficult behavior appears reciprocal. The negative impact of stress on parents' skill development, response to difficult behavior, sense of competence, well-being and the child's developmental outcomes have also been thoroughly detailed. The Parent Child Relationally Informed - Early Intervention (PCRI-EI) aims to expand the response repertoires of parents to help address the challenges of parenting a child with a developmental disability, including through reducing parental stress. The current study presents a quasi-experimental assessment of the efficacy of PCRI-EI in reducing stress levels and increasing sense of competency and psychological well-being in a sample of 22 parents of children with a variety of disabilities presenting to a community early childhood development service. Statistically and clinically significant changes in overall stress levels (Parenting Stress Index), psychological well-being (K6) and sense of competence (PSOC) were observed across time.

The guidelines and policies that influence the conduct of Animal-Assisted Activities in Residential Aged-Care Facilities: A systematic integrative review.

INTRODUCTION: For some time, Residential Aged Care Facilities (RACF) have incorporated animals into their environment to relieve loneliness and isolation for aged-care residents. However, research examining this practice is not as developed. This paper aims to identify the policies and practices influencing the conduct of Animal-Assisted Activities (AAA) in RACF focusing on the Australian context. METHODS: Peer-reviewed and gray literature were searched using an array of databases including CINAHL; Embase; Medline; Pubmed; Scopus and Web of Science; Google Scholar; PROSPERO, Proquest Dissertations; Theses Global; Animal Studies Repository; Medicine and Health Science Commons; Open Gray and a targeted Google search for relevant Australian Guidelines. Database searches had no time limits. Nine documents published between 1990 and 2018 were identified, appraised and subsequently included in the analysis. RESULTS: Facilities have not developed or implemented core policies; instead, there appears to be a reliance on AAA providers ensuring resident safety. Animal welfare is also identified as an emerging area, warranting further action and policy development. CONCLUSION: The requirement for effective AAA policies for RACF staff continues to be an area of need. Over the last 30 years, the development of policies guiding the provision of animal activities within RACFs has been inconsistent in both content and application, including the implementation of basic hygiene policies. If the international situation is indicative, further work is needed in Australia to develop and enforce infection control, risk management and animal welfare policies in RACF and AAA organizations. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration # CRD42020150440.

Community awareness of speech pathology: A regional perspective.

OBJECTIVE: Speech pathology has a history of low public awareness and in the absence of current research it is unclear if community awareness has changed in recent years. This study sought to explore a regional community's awareness of speech pathology as the impetus for considering future directions pertaining to awareness and understanding of the scope of practice of this profession. DESIGN: An anonymous online survey was created using questions from previously validated surveys on this topic, and then distributed via snowball sampling using social media. SETTING: Data are from residents of the Central Queensland community in Australia. PARTICIPANTS: Two hundred and seven adults who live in Central Queensland completed the survey. MAIN OUTCOME MEASURES: Comparisons were drawn between the responses from this survey to those from earlier studies. RESULTS: The majority of respondents had heard of speech pathology mostly due to personal contact, but they indicated that they did not know 'a lot' about speech pathology. Knowledgeable individuals had higher levels of education and were better able to identify speech pathologists' scope of practice. Personal contact with a speech pathologist also significantly contributed to self-rated knowledge and accurate identification of scope of practice of speech pathologists. CONCLUSION: While regional Central Queensland community members have heard of speech pathology, their self-reported knowledge of the profession continues to be low. In order to optimise service access and consumer outcomes it is recommended that the profession aims to improve community awareness of speech pathology.

The Link Between Domestic Violence and Abuse and Animal Cruelty in the Intimate Relationships of People of Diverse Genders and/or Sexualities: A Binational Study.

Over the past three decades, a growing body of research has focused on experiences of domestic violence and abuse (DVA) among people of diverse genders and/or sexualities. Missing, however, has been a focus on what is known as "the link" between DVA and animal cruelty with regard to people of diverse genders and/or sexualities. The present article reports on a study of 503 people living in either Australia or the United Kingdom, who reported on both their intimate human relationships and their relationships with animals, including relationships that were abusive. In terms of "the link," a fifth of respondents who had experienced violence or abuse also reported that animal cruelty had been perpetuated by the violent or abusive partner. Statistical interactions were found between having witnessed animal cruelty perpetrated by a partner, gender and sexuality, and both psychological distress and social connectedness. Female participants who had witnessed animal cruelty reported greater psychological distress and lower levels of social support, and both lesbian and bisexual participants who had witnessed animal cruelty reported lower levels of social support. The article concludes by considering the implications of these findings for future research and service provision.

Developing a sociocultural framework of compliance: an exploration of factors related to the use of early warning systems among acute care clinicians.

BACKGROUND: Early warning systems (EWS) are most effective when clinicians monitor patients' vital signs and comply with the recommended escalation of care protocols once deterioration is recognised. OBJECTIVES: To explore sociocultural factors influencing acute care clinicians' compliance with an early warning system commonly used in Queensland public hospitals in Australia. METHODS: This interpretative qualitative study utilised inductive thematic analysis to analyse data collected from semi-structured interviews conducted with 30 acute care clinicians from Queensland, Australia. RESULTS: This study identified that individuals and teams approached compliance with EWS in the context of 1) the use of EWS for patient monitoring; and 2) the use of EWS for the escalation of patient care. Individual and team compliance with monitoring and escalation processes is facilitated by intra and inter-professional factors such as acceptance and support, clear instruction, inter-disciplinary collaboration and good communication. Noncompliance with EWS can be attributed to intra and inter-professional hierarchy and poor communication. CONCLUSIONS: The overarching organisational context including the hospital's embedded quality improvement and administrative protocols (training, resources and staffing) impact hospital-wide culture and influence clinicians' and teams' compliance or non-compliance with early warning system's monitoring and escalation processes. Successful adoption of EWS relies on effective and meaningful interactions among multidisciplinary staff.

People of Diverse Genders and/or Sexualities Caring For and Protecting Animal Companions in the Context of Domestic Violence.

This article reports on a thematic analysis of open-ended questions about how humans respond to violence directed toward animals in the context of violent human relationships, derived from an Australian-U.K. survey of people of diverse genders and/or sexualities. From the 137 responses, three major themes were identified: (a) animals are an important source of support, (b) humans actively protect animal companions, and (c) witnessing animal abuse can trigger leaving violent relationships. The findings offer unique insights for practitioners into the help-seeking needs of people of diverse genders and/or sexualities who live with animal companions in the context of domestic violence.

Double Jeopardy: Insurance, Animal Harm, and Domestic Violence.

Although the role of companion animals within the dynamic of domestic violence (DV) is increasingly recognized, the overlap of animal harm and insurance discrimination for victims/survivors of DV has not been considered. Prompted by a case study presented in a National Link Coalition LINK-Letter, this research note examines "Pet Insurance" policies available in Australia and whether nonaccidental injury caused by an intimate partner would be covered. We discuss the implications of exclusion criteria for victims/survivors of DV, shelters providing places for animals within a DV dynamic, and, more broadly, for cross- or mandatory-reporting (of animal harm) initiatives.

Needle Fixation Profile: An Exploratory Assessment of Applicability in the Australian Context.

BACKGROUND: Needle fixation has the potential to undermine harm-reduction efforts and may affect up to one-quarter of all injecting drug users (IDUs). Being largely ignored in the extant literature, the majority of research on this phenomenon has been carried out exclusively in Cardiff, Wales. OBJECTIVES: The current exploratory study examined the applicability of needle fixation in a population of Australian IDUs to determine whether Australian IDUs were familiar with the behaviors and secondary gains that have been found to be associated with needle fixation and are assessed by the needle fixation profile (NEFPRO). METHODS: A mixed-method design utilizing semi-structured interviews and questionnaire data was employed. RESULTS: Australian IDUs were aware of or had experience with the behaviors and secondary gains that have been found to be associated with needle fixation. A number of other behaviors and secondary gains associated with injecting were discussed by participants during the semi-structured interviews. CONCLUSIONS/IMPORTANCE: This study offers preliminary support for the use of NEFPRO as a clinical and research tool within Australia. To ensure that all avenues toward harm reduction are being explored, it would be fruitful to engage in further research concerning the cross-cultural representations of needle fixation specifically as well as the general influence of needle fixation in perpetuating injecting drug use.

Can teaching veterinary and animal-science students about animal welfare affect their attitude toward animals and human-related empathy?

Attitudes toward animals are important in influencing how animals are treated. Few studies have investigated attitudes toward animals in veterinary or animal-science students, and no studies have compared attitudes to animals before and after a course teaching animal welfare and ethics. In this study, students enrolled in veterinary (first-year) or animal-science (first- and third-year) programs completed a questionnaire on attitudes toward different categories of animals before and after the course. Higher attitude scores suggest a person more concerned about how an animal is treated. Normally distributed data were compared using parametric statistics, and non-normally distributed data were compared using non-parametric tests, with significance p < .05. Attitudes toward pets (45.5-47.6) were higher than those toward pests (34.2-38.4) or profit animals (30.3-32.1). Attitude scores increased from before to after the course in the veterinary cohort on the Pest (36.9 vs. 38.4, respectively, n = 27, p < .05) and Profit (30.3 vs. 32.1, respectively, n = 28, p < .05) subscales, but not in the animal-science cohorts. Attitude scores in all categories were higher for women than for men. Currently having an animal was associated with higher pet scores (46.8 vs. 43.8, ns = 120 and 13, respectively, p < .05), and having an animal as a child was associated with higher profit scores (31.0 vs. 26.6, ns = 129 and 8, respectively, p < .05). Students electing to work with livestock had lower scores on the Pest and Profit subscales, and students wanting to work with wildlife had significantly higher scores on the Pest and Profit subscales. This study demonstrates attitudinal changes after an animal-welfare course, with significant increases in veterinary but not animal-science students.

Willingness to pay: Australian consumers and "on the farm" welfare.

The success of welfare legislation for nonhuman animals rests upon primary producer compliance that, in turn, is affected by public willingness to pay (WTP) for such initiatives. Although the topic of the welfare of animals on farms (and relevant legislation) is becoming increasingly important to the Australian public, there remain relatively few recent assessments of the variables that may affect WTP and, therefore, support initiatives aimed at improving the welfare of animals living on farms. This study surveyed 1,224 community members in Queensland, Australia. The study assessed respondents' self-rated knowledge of, and concern regarding, farm animal welfare. In addition, the survey asked respondents how much more they would be prepared to pay for animal-based products to ensure that they came from a source where the Five Freedoms were met. Although self-rated knowledge and level of concern were found to affect WTP, the study found only concern for farm animal welfare actually predicted consumer behavior. Further analyses showed a potential confound between knowledge levels and locality. This article discusses the implications of this for future initiatives to increase WTP.

Full of sound and fury, signifying something: the impact of autonomic arousal on EGM gambling.

An experiment was conducted to observe the influence of autonomic arousal on subsequent gambling behavior. Thirty-seven male and 32 female regular Electronic Gaming Machine (EGM) players were recruited through newspaper advertisements. Participants were randomly assigned to either: (1) a control condition, or (2) an experimental condition that introduced a loud white-noise event (80 db) at fixed 120 s intervals throughout the 5-min EGM gambling session. Galvanic Skin Response (GSR) measurements showed that the manipulation was successful in elevating autonomic arousal. The results showed differences in behavioral response to the manipulation based on prior experience with gambling problems. Persons with many gambling problems had lower average bet-sizes in the white-noise condition compared to the control, while those with few or no problems had higher average bet-sizes. The results suggest that arousal may provide different signals to gamblers with few versus many problems. Gamblers with many problems may interpret their arousal as a sign that they will soon lose money, while gamblers with few or no problems may associate feelings of arousal exclusively with winning.

Community demographics and the propensity to report animal cruelty.

The last decade has seen an increased awareness concerning links between violence to nonhuman animals and violence to humans. This has resulted in a number of cross-reporting initiatives between family service providers and animal welfare organizations. The success of these initiatives rests on individuals being willing to report such violence. Thus, there is a need to determine which variables influence an individual's willingness to report deliberate animal cruelty and abuse. The aim of this study was to examine demographic and attitudinal variables to ascertain their impact on propensity to report deliberate animal harm. A telephone questionnaire resulted in 1,208 valid responses from members of the general community. Results showed a number of variables that affected the propensity to report: gender, occupation, and acknowledgment of the link between family violence and deliberate animal harm. This article discusses these variables and their implications.