Actions targeting the integration of peer workforces in mental health organisations: a mixed-methods systematic review.

BACKGROUND: Lived experience workforces are one of the fastest growing emerging disciplines in Australian mental health service settings. Individuals with lived and living experience of mental distress employed in mental health services, often referred to as peer or lived experience workers, are widely considered essential for mental health recovery and reform. Despite vast growth of this workforce, concerns remain over the widespread integration of peer workforces to align with recommended movement of healthcare services toward greater recovery-orientated and person-centered practices. Previous research has identified barriers for peer work integration including a lack of clear role definition, inadequate training, and poor supportive organisational culture. Stigma, discrimination and a lack of acceptance by colleagues are also common themes. This systematic review seeks to identify organisational actions to support integration of peer workforces for improved mental health service delivery. METHOD: A systematic search was conducted through online databases (n = 8) between January 1980 to November 2023. Additional data were sourced from conference proceedings, hand searching grey literature and scanning reference lists. Qualitative data was extracted and synthesised utilising narrative synthesis to identify key themes and findings reported adhere to PRISMA guidelines. The review protocol was registered with Prospero (CRD: 42,021,257,013). RESULTS: Four key actions were identified: education and training, organisational readiness, Structural adjustments, resourcing and support and, demonstrated commitment to peer integration and recovery practice. CONCLUSIONS: The study identifies actions for mental health service organisations and system leaders to adopt in support of integrating peer and lived experience workforces in service delivery.

Psychological pathway to emotional exhaustion among nurses and midwives who provide perinatal bereavement care in China: a path analysis.

BACKGROUND: A lack of confidence in perinatal bereavement care (PBC) and the psychological trauma experienced by nurses and midwives during bereavement care leads to their strong need for sufficient organisational support. The current study intended to test a hypothesised model of the specific impact paths among organisational support, confidence in PBC, secondary traumatic stress, and emotional exhaustion among nurses and midwives. METHODS: A descriptive, cross-sectional survey was conducted in sixteen maternity hospitals in Zhejiang Province, China, from August to October 2021. The sample (n = 779) consisted of obstetric nurses and midwives. A path analysis was used to test the relationships among study variables and assess model fit. RESULTS: Organisational support directly and positively predicted confidence in PBC and demonstrated a direct, negative, and significant association with secondary traumatic stress and emotional exhaustion. Confidence in PBC had a positive direct effect on secondary traumatic stress and a positive indirect effect on emotional exhaustion via secondary traumatic stress. Secondary traumatic stress exhibited a significant, direct effect on emotional exhaustion. CONCLUSIONS: This study shows that nurses' and midwives' confidence in PBC and mental health were leadingly influenced by organisational support in perinatal bereavement practice. It is worth noting that higher confidence in PBC may lead to more serious psychological trauma symptoms in nurses and midwives. Secondary traumatic stress plays an essential role in contributing to emotional exhaustion. The findings suggest that support from organisations and self-care interventions were required to improve confidence in PBC and reduce negative psychological outcomes among those providing PBC. The development of objective measures for assessing competence in PBC and organizational support are essential.

Conflict of interest policies at Australian medical schools.

BACKGROUND: Pharmaceutical industry exposure is widespread during medical training and may affect education and clinical decision-making. Medical faculties' conflict of interest (COI) policies help to limit this exposure and protect students against commercial influence. AIMS: Our aim was to investigate the prevalence, content and strength of COI policies at Australian medical schools and changes since a previous assessment conducted in 2009. METHODS: We identified policies by searching medical school and host university websites in January 2021, and contacted deans to identify any missed policies. We applied a modified version of a scorecard developed in previous studies to examine the content of COI policies. All data were coded in duplicate. COI policies were rated on a scale from 0 (no policy) to 2 (strong policy) across 11 items per medical school. Oversight mechanisms and sanctions were also assessed, and current policies were compared with the 2009 study. RESULTS: Of 155 potentially relevant policies, 153 were university-wide and two were specific to medical schools. No policies covered sales representatives, on-site sponsored education or free samples. Oversight of consultancies had improved substantially, with 76% of schools requiring preapproval. Disclosure policies, while usually present, were weak, with no public disclosure required. CONCLUSION: We found little indication that Australian medical students are protected from commercial influence on medical education, and there has been limited COI policy development within the past decade. More attention is needed to ensure the independence of medical education in Australia.

Employees' experiences of a large-scale implementation in a public care setting: a novel mixed-method approach to content analysis.

BACKGROUND: Research for evidence-based interventions and strategies for implementation continues. Yet there is a continued shortage of qualified health care staff while stress and burnout are common. Health care professionals' individual perceptions towards change needs to be considered to succeed in organisational change. It is therefore relevant to investigate how implementation processes affect employees within the health care sector. Challenges to implementation are especially large in the field of disability care. The present study aims to investigate employees' experiences of an ongoing large-scale implementation, and what they perceived as important to succeed in a complex clinical setting. METHODS: Semi-structured focus group interviews were conducted with a self-selected sample of employees from a large and complex health care organisation responsible for public disability care in a centrally located Swedish region. A mixed-method approach adapted to content analysis was performed in a three-step process. In the first round, each unit of analysis was selected and then colour coded. In a second round, the coloured units were coded according to content analysis, and categories and concepts were compared and adjusted until the two researchers reached consensus. Finally, to further complement the content analysis, a quantitative analysis of the colour categories was made. RESULTS: In general, employees experienced the implementation as being insufficient, yet opinions of the process of implementation were mixed. Most positive experiences were found in relation to the outcomes that the new method had on work effectiveness and patient care. Closely related topics like time constraints, uncertainties concerning the method and the need for supportive functions reoccurred in several concepts suggesting a relationship between differing contextual factors, implementation activities and fidelity. Also evident in the results were the strain on organisational and social work environment and the importance of managers' active leadership. CONCLUSIONS: Implementation processes are experienced as challenging for employees. Key facilitators are available support functions, clear leadership and time that is sufficient and kept sacrosanct. Leaders need to communicate how and why employees may experience implementation processes differently. The impact that organisational change has on work environment should be considered.

Revolutionising health and social care: innovative solutions for a brighter tomorrow - a systematic review of the literature.

BACKGROUND: In an era marked by rapid technological advancements, changing demographics, and evolving healthcare needs, the landscape of health services has been undergoing a profound transformation. Innovation has emerged as a central force driving change in the healthcare sector, as stakeholders across the globe strive to enhance the quality, accessibility, and efficiency of healthcare services. OBJECTIVE: Within this dynamic context, this systematic literature review explored the barriers and driving forces behind successful health service innovation. METHODS: A comprehensive systematic literature review was conducted using the Griffith University Library search engine and databases that included PubMed, ProQuest, Web of Science, Scopus, and CINHAL. To achieve the study goal, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the associated PRISMA checklist guided the review and reporting method. RESULTS: Findings from this review identified a need for a universal definition of health innovation that encompasses the unique complexities and challenges within this context. In our comprehensive analysis of healthcare innovation, we have uncovered pivotal findings that underscore the indispensable nature of a well-structured framework. CONCLUSIONS: To succeed in fostering innovation within the health and social care sectors, it is imperative to establish an overarching organisational culture that meticulously addresses the following key components: team challenges; communication and collaboration; governance goals and authentic leadership, environmental engagement; and innovation endurance. Through systematic analysis of existing literature, this review offers a definition of health innovation, covering its conceptual foundations, determinants, and barriers, and provides a framework for creating an innovative culture.

Aligning organisational priorities and implementation science for cancer research.

BACKGROUND: The challenge of implementing evidence into routine clinical practice is well recognised and implementation science offers theories, models and frameworks to promote investigation into delivery of evidence-based care. Embedding implementation researchers into health systems is a novel approach to ensuring research is situated in day-to-day practice dilemmas. To optimise the value of embedded implementation researchers and resources, the aim of this study was to investigate stakeholders' views on opportunities for implementation science research in a cancer setting that holds potential to impact on care. The research objectives were to: 1) Establish stakeholder and theory informed organisation-level implementation science priorities and 2) Identify and prioritise a test case pilot implementation research project. METHODS: We undertook a qualitative study using semi-structured interviews. Participants held either a formal leadership role, were research active or a consumer advocate and affiliated with either a specialist cancer hospital or a cancer alliance of ten hospitals. Interview data were summarised and shared with participants prior to undertaking both thematic analysis, to identify priority areas for implementation research, and content analysis, to identify potential pilot implementation research projects. The selected pilot Implementation research project was prioritised using a synthesis of an organisational and implementation prioritisation framework - the organisational priority setting framework and APEASE framework. RESULTS: Thirty-one people participated between August 2022 and February 2023. Four themes were identified: 1) Integration of services to address organisational priorities e.g., tackling fragmented services; 2) Application of digital health interventions e.g., identifying the potential benefits of digital health interventions; 3) Identification of potential for implementation research, including deimplementation i.e., discontinuing ineffective or low value care and; 4) Focusing on direct patient engagement e.g., wider consumer awareness of the challenges in delivering cancer care. Six potential pilot implementation research projects were identified and the EMBED project, to support clinicians to refer appropriate patients with cancer for genetic testing, was selected using the synthesised prioritisation framework. CONCLUSIONS: Using a theory informed and structured approach the alignment between strategic organisational priorities and implementation research priorities can be identified. As a result, the implementation research focus can be placed on activities with the highest potential impact.

Responding to health literacy of refugees in Australian primary health care settings: a qualitative study of barriers and potential solutions.

BACKGROUND: Organisational health literacy is a promising area of research that enables a focus on how systems and services can be designed in ways that are responsive to populations with varying states and levels of health literacy, knowledge, and practices, including African refugees. The challenge is how organisations and professionals do this in practice, and research in this area is in its early stages. This qualitative study examined barriers to implementing health literacy responsive care practices in primary health care settings in Australia. It also offered suggestions to potentially address the barriers to improving organisational health literacy. METHODS: Refugees (n = 19), primary health care professionals (n = 14), and other key stakeholders (n = 19) were recruited through convenience and snowball strategies from three states in Australia: New South Wales, Victoria, and Queensland. All but one participant was interviewed face-to-face via Zoom. Semi-structured interview guides were used to guide the conversations. Transcriptions from audio recordings were analysed using directed content analysis. RESULTS: Thirteen themes were extracted from the data. Themes were organised into the following categories: structural and systemic, organisational context, individual professional level, individual patient level, and socio-community level. Major structural and system-level factors affecting organisational health literacy included rigid systems and structures and limited time. Key organisation-level factors included inflexible organisational processes and policies, institutionalised othering, discrimination and racism, and lack of interpreters. Individual professional factors were poor communication with patients and cultural knowledge gaps. Linguistic issues and service mistrust were key individual patient-level factors. Socio-community factors included limited community engagement. Participants identified potential solutions to help services navigate out of the barriers and improve their response to health literacy. CONCLUSION: The findings suggest that mainstream services and organisations could improve timely and appropriate health care access and utilisation for refugees through strategies such as designing services and health literacy programs with refugee communities, promoting health literacy champions in the workforce, integrating health literacy and culturally responsive care plans and strategies into organisational priorities.

Cost of implementing CAR-T activity and managing CAR-T patients: an exploratory study.

BACKGROUND: Chimeric antigen receptor T cells (CAR-T) represent an innovation but raise issues for healthcare payers because of the uncertainty on impact at market launch, high cost and important organisational impact. The literature has focused on their assessment, appraisal and market access solutions. No evidence on the costs sustained to implement CAR-T is available and a few studies reported the cost of the CAR-T clinical pathway, including the activities that are remunerated through inpatient or outpatient fee-for-service/episode. This paper aims at filling the information gap, assessing the cost of implementing CAR-T activity and the full cost of managing the CAR-T clinical pathway. METHODS: Cost analysis relied on the Activity Based Costing approach, which was applied to two Italian healthcare organisations, both CAR-T Centres authorized by the regional governments with a minimum of 20 patients treated with the first two CAR-T therapies launched on the market. RESULTS: The cost of implementing CAR-T was estimated at €1.31 million (calculated for one of the organizations with complete data). Most of these costs (77%) were generated by quality assurance activity. The mean cost per patient entering the CAR-T pathway (59 and 27) and surviving at follow-up (21 and 5) ranges from €48K to €57K and from €96K to €106K, respectively. Fees for hospitalization and infusion of gene therapy accounts for more than 70% of these costs. The actual hospitalisation cost varies greatly across patients and is in general lower than the fee-for-episode paid by the region to the hospital. CONCLUSIONS: Despite its limitations (exploratory nature; the time spent by staff on activities which are not remunerated through fees was estimated through interviews with the CAR-T coordinators; cost items are not fully comparable), this research highlighted the relevant organisational and economic impact of CAR-T and provided important insights for policy makers and healthcare managers: the necessity to invest resources in CAR-T implementation; the need for assessing activities which are not remunerated through fees for service / episode; the opportunity to shift from fee-for-episode / service to bundled payments for CAR-T clinical pathway.

A collaboratively produced model of service design for children and young people with common mental health problems.

BACKGROUND: Little is known about the effectiveness of, and implementation complexities associated with, service delivery models for children and young people (CYP) experiencing 'common' mental health problems such as anxiety, depression, behavioural difficulties and self-harm. This paper outlines how a model for high-quality service design for this population group was developed by identifying available services, their effectiveness, cost-effectiveness and acceptability, and the barriers and enablers to access. METHODS: Sequential, mixed-methods design, combining evidence syntheses (scoping and integrative reviews of the international literature) with primary research (a collective case study in England and Wales). Data from these two elements were collaboratively synthesised in a subsequent model-building phase. RESULTS: The scoping review yielded a service model typology. The integrative review found effectiveness evidence only for four models: collaborative care (the only service model to also have cost-effectiveness evidence), outreach approaches, brief intervention services and an organisational framework called 'Availability, Responsiveness and Continuity'. No service model seemed more acceptable than others. Three case study themes were identified: pathways to support; service engagement; and learning and understanding. The model-building phase identified rapid access, learning self-care skills, individualised support, clear information, compassionate and competent staff and aftercare planning as core characteristics of high-quality services. These characteristics were underpinned by four organisational qualities: values that respect confidentiality; engagement and involvement; collaborative relationships; and a learning culture. CONCLUSIONS: A consistent organisational evidence-base for service design and delivery in CYP's mental health spanning many years appears to have had little impact on service provision in England and Wales. Rather than impose - often inflexible and untested - specific local or national models or frameworks, those commissioning, designing and delivering mental health services for CYP should (re)focus on already known, fundamental components necessary for high-quality services. These fundamental components have been integrated into a collaboratively produced general model of service design for CYP with common mental health problems. While this general model is primarily focused on British service provision, it is broad enough to have utility for international audiences.

Conflict and antagonism within global psychiatry: A discourse analysis of organisational responses to the UN reports on rights-based approaches in mental health.

Between 2017 and 2020, the UN Special Rapporteur (SR) Dainius Puras published three reports that called for significant changes to organisation, funding and service provision in mental health care in ways that emphasise inclusive, rights-oriented, democratic and sustainable community health services. This article aims to examine formal organisational responses to the UN mental health reports and consider the underlying arguments that either support or delegitimise the SR stance on the need for a paradigmatic shift towards a human rights-based approach to mental health. By combining several different search strategies to identify organisational responses across the web, a total of 13 organisational responses were included in the analysis. Given the political nature of the responses, concepts from discourse theory were used to analyse the responses. The analysis showed how the responses articulated two binary positions and contesting articulations of good mental health care, which formed a backdrop for rejecting the SR reports in defence of psychiatry. The discussion elucidates how the responses tend to resemble previous ways in which critique has been dealt with mainly by 'biological psychiatry', but that the counter-critical nature of the medical and psychiatric organisational responses remains in contrast to the broader reception within the UN community.

"We forgot about the donkeys!" An institutional analysis of the shift in animal welfare from direct implementation towards advocacy-based programming.

Shifts from direct implementation to advocacy-based programming have been documented across many non-governmental organisation (NGO) sectors, including animal welfare. Semi-structured interviews with 32 staff from different positions within animal welfare NGOs explored recent programming changes. Maintaining a balance between direct implementation and advocacy-based activities emerged as a strong theme. The findings suggest that risks are associated with both the direct implementation status quo and transitioning to an advocacy-based focus. Risks of the former include treating symptoms rather than root causes of welfare problems. Organisational change can be disruptive and necessitates realignment of core competences, in turn influencing NGO mission. Identified risks of transition include loss of individuals whose values fail to align with new programming directions, increased upwards accountability requirements for accessing institutional donors and difficulties when phasing out direct implementation approaches. Whilst having to be dynamic, NGOs need to evaluate the risks associated with programming decisions, considering their vision, mission and staff identity in order to ensure that welfare programming is as effective as possible.

Interpersonal helping in the workplace: social expectation predicts anticipated guilt and intention to help a coworker.

Promoting interpersonal helping among coworkers is an important aim for any organisation that cares about employee well-being. Drawing on guilt aversion hypothesis, this research focuses on the power of social expectations in promoting prosocial behaviour among employees and investigates the role of anticipated guilt for failing to meet coworkers' expectations. In two preregistered studies, the effect of beneficiary expectation on benefactors' anticipated guilt and intention to help was investigated. In Study 1, Japanese participants (n = 284) recalled a situation when they helped a coworker spontaneously, and evaluated perceived beneficiary expectation to receive help, as well as anticipated guilt for not helping. Beneficiary expectation positively predicted anticipated guilt, and the effect was stronger when the beneficiary was a same-status colleague, and when interpersonal helping frequency in the organisation was low. Study 2 (n = 499) employed vignettes and manipulated beneficiary expectation. A mediational model revealed that beneficiary expectation leads to more anticipated guilt for not helping, which, in turn, increases employees' intention to help. Together, these studies show that employees are sensitive to their coworkers' expectations, and guilt-averse; therefore, interpersonal helping among employees may be promoted by establishing legitimate expectations of prosociality in the workplace.

English Premier League and English Football League academy managers' experiences of how psychosocial skills and characteristics are identified and developed in youth academy soccer players.

Psychological skills and characteristics (PSCs) are vital for player development, yet there is a lack of agreement on which are important and how they should be identified and developed in academy players, creating barriers to implementation into curricula. The key stakeholder with considerable insight into PSC development is the academy manager (AM). The aims of this study were (a) explore AMs' experiences of PSC identification and development, (b) identify challenges AMs feel affect development of PSCs. Nine AMs (i.e. Category 1; n = 3, Category 2; n = 3 and Category 3; n = 3) comprising an average coaching experience of 20.4 ± 7.4 years and time in the role of 5.2 years ±3.2 years participated in semi-structured interviews. Reflexive thematic analysis generated themes identified ideal PSC outcomes that AMs felt were important. AMs identified current practices within academies alongside challenges: transitions, need to upskill coaches, access to additional support from external partners and National Governing Bodies. There was consensus that PSCs are key drivers of progression and that embedding them into the pathway was critical to facilitating development. Academies should think carefully about design, implementation and evaluation of programmes to support player PSC development for success during and after soccer careers.

Enhancing new graduate nurses and midwives person-centredness through clinical supervision during COVID-19; evaluation of a non-randomized intervention study.

AIM: The aim of the study was to evaluate a person-centred model of clinical supervision to enhance person-centredness. DESIGN: Experimental, quantitative. METHODS: One hundred and three New Graduates were supported to reflect through a person-centred lens (July-December 2020). Evaluation was undertaken at 6 months using: the Manchester Clinical Supervision Scale-26 (effectiveness of supervision) and the Person-centred Practice Inventory (measures attributes of the nurse/midwife, the care environment and person-centred processes). Due to participation difficulties, scores were calculated by attendance rates using descriptive and inferential statistics. RESULTS: Regular attendees scored higher on the supervision's effectiveness; however, this did not reach efficacy. 'Finding time' to attend contributed to low scores. Supervision scored well on its supportive function when attended. Many New Graduates perceived a decline in their care environment. Attendance aside, New Graduates averaged an increased in their person-centred attributes and processes. Greater participation was found in those who scored higher at baseline on their person-centred attributes and processes, and this higher scoring continued at 6 months than those who attended less. CONCLUSION: New Graduates who perceive themselves as person-centred and reflective at baseline are more likely to attend a person-centred clinical supervision and score higher at 6 months than those who attended less often. New Graduates found support within supervision during challenging times. IMPLICATIONS FOR PRACTICE FOR PROFESSIONAL AND/OR PATIENT CARE: For successful implementation of Person-centred Clinical Supervision, New Graduates need support to attend, as attendance supports them to begin seeing value in the process. IMPACT: This intervention kept person-centred practice at the forefront of New Graduates reflection, in a time of extreme change. The research has implications for nursing and midwifery management with the imperative to deliver person-centred care and create the person-centred cultures for staff to feel supported and empowered. REPORTING METHOD: Transparent Evaluation of Non-randomized Designs (TREND). PATIENT OF PUBLIC CONTRIBUTION: No patient or public contribution. CONTRIBUTION TO WIDER COMMUNITY: New Graduates grow their person-centredness over their transitioning year; however, this can be enhanced with regular clinical supervision underpinned by person-centred theory. Clinical supervisors can provide support to New Graduates when the environment is challenged.

The sound of silence? Listening to localisation at the World Humanitarian Summit.

Based on research with key stakeholders, this paper draws on theories of organisational and political listening to analyse the critical emergence of 'localisation' during the 2016 World Humanitarian Summit. The central focus is the two-year pre-summit consultation process, engaging 23,000-plus people, mainly from the Global South, and organised specifically to bring different views and experiences to the task of reforming the global humanitarian agenda. This research explores 'voice and listening' during the consultations, investigating how these were framed by, and have framed, power differentials within the humanitarian system. The consultations were a unique event, evoking optimism among participants that change might be possible. However, the space to speak, and the listening that occurred, struggled to breach the political sphere. The 'Grand Bargain', some interviewees claim, amounted to a re-silencing. Notably, the localisation debate happened when a largely coherent message from the Global South and allies emerged, making unmet but heard claims on powerful actors.

Protocol for a scoping review to map health outcomes in individuals with inducible laryngeal obstruction.

BACKGROUND: Inducible laryngeal obstruction causes narrowing of the laryngeal aperture in response to external triggers. Outcomes are measured in inducible laryngeal obstruction to monitor changes in health status over time. METHODS: This study is a scoping review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. The review will be guided by the following research question: 'What health outcomes are measured in studies including people with inducible laryngeal obstruction?' The research question was validated using the Population-Concept-Context framework according to the methodology for Joanna Briggs Institution Scoping Reviews. Relevant peer-reviewed studies and grey literature conducted over the last 40 years will be identified from electronic databases including AMED, CINAHL, Embase, EMCARE, MEDLINE, OVID, PubMed and PsycINFO. The search strings 'inducible laryngeal obstruction', 'ILO', 'vocal cord dysfunction', 'VCD', 'paradoxical vocal fold motion', 'PVFM', 'outcome', 'measure', 'measurement instrument', 'assessment', 'scale', 'questionnaire' will be combined using Boolean logic. An independent reviewer will conduct title screening; two independent reviewers will conduct abstract and full article screening, followed by data extraction by two reviewers. Analyses will be conducted appropriate to the findings. DISCUSSION: The review will document evidence of health outcomes measured in inducible laryngeal obstruction, identifying measurement characteristics and potential utility. Collating studies may identify gaps in coverage, the need for novel tools, and for standardisation for clinical and research purposes. WHAT THIS PAPER ADDS: What is already known on the subject Inducible laryngeal obstruction causes narrowing of the laryngeal aperture in response to external triggers. Outcomes are measured in inducible laryngeal obstruction to monitor changes in health status over time. Currently, there are no standardised outcome measures for measuring the effects of interventions in inducible laryngeal obstruction (ILO). What this paper adds to existing knowledge Assessment of health can be measured in a variety of ways. Physiological, radiological and biochemical measurements of impairment are more common historically but there are a lot of outcomes of other factors now including subjective measures of functional status and health-related quality of life, with data collected directly from patients. This study will allow us to scope the literature to see the health outcomes being measured in ILO to attempt to standardise and develop future health outcomes. What are the potential or actual clinical implications of this work? The review will document evidence of health outcomes measured in inducible laryngeal obstruction, identifying measurement characteristics and potential utility. Collating studies may identify gaps in coverage, the need for novel tools and for standardisation for clinical and research purposes.

It's not special treatment That's part of the Treaty of Waitangi! Organisational barriers to enhancing the Aged Residential Care environment for older Maori and Whanau in New Zealand.

BACKGROUND: New Zealand's older Indigenous Maori people experience poorer health and reduced access to healthcare than their older non-Maori counterparts. Organisational factors (such as leadership or workforce) may influence the attitudes and perceptions of older Maori and their family (whanau) to use aged residential care services. Currently, there is a paucity of research surrounding the organisational barriers that impact the experiences of older Maori people who seek care in aged residential care (ARC) services. METHODS: This study used a Kaupapa Maori qualitative research approach that legitimises Maori knowledge and critiques structures that subjugate Maori autonomy and control over their wellbeing. Interviews regarding their experiences of care were carried out with older Maori (n = 30) and whanau (family) members (n = 18) who had used, or declined to use an aged residential care facility. Narrative data were analysed inductively for themes that illustrated organisational barriers. RESULTS: The key organisational theme was 'Culturally safe care', within which there were three barriers: 'Acceptability and Adequacy of Facility', 'Interface Between Aged Residential Care and Whanau Models of Care', and 'Workforce'. Collectively, these barriers emphasise the importance of an organisational approach to improving the quality of care delivered to older Maori and whanau in ARC. CONCLUSION: Fostering a collective culture of equity within ARC provider services and equipping healthcare leaders and staff with the skills and knowledge to deliver culturally safe care is critical to addressing organisational barriers to ARC.

Unpacking participation in healthcare governance: Lessons from two local health councils in Brazil and Spain.

This paper describes and compares the integration of cross-sector actors' participation into the governance of two local health councils, one located in Salvador de Bahia (Brazil) and the other in the Canary Islands (Spain). Based on the cross-national comparative research conducted as part of a doctoral thesis, a qualitative design based on secondary data analysis was proposed on the three stages of the organisational integration process of participation. We used information from individual semi-structured interviews (n = 70), situational observation, focus groups, literature review, and field notes to understand participatory processes of networking between multiple cross-sector actors and to show how such processes might be associated with innovative practices. For these innovations to be successfully implemented, stakeholders need to acquire adequate competencies in cross-sector collaboration, enabling them to learn about new organisational practices and to adapt the network of actors to the often unpredictable influences of contextual factors.

Factors related to motivation, organisational climate and work engagement within the practice environment of nurse practitioners in the Netherlands.

AIM: To explore motivation, organisational climate, work engagement and related factors within the practice environment of nurse practitioners. BACKGROUND: Motivation in the workplace, organisational climate and work engagement are important to motivate nurse practitioners and prevent early exit. However, little is known about related factors. DESIGN: A cross-sectional design using a digital survey with multiple-choice and open-ended questions. Data were collected from 1 November 2019 to 30 March 2020. METHODS: The survey contained demographic and job-related data, instruments on motivation in the workplace, organisational climate and work engagement. Three open-ended questions were added to invite respondents to tell about their next career step, (dis)satisfaction with salary and additional comments. Quantitative data were not normally distributed (Kolmogorov-Smirnov test). Kruskal Wallis tests and Mann-Whitney U tests were used to test the relationship between independent and dependent variables. Answers on the open-ended questions were coded and categorised in themes. The STROBE checklist was followed. RESULTS: In total 586 questionnaires were completed. The majority of the respondents were female (85%), and their mean age was 47 years (range 26-66 years). Aged 45 or over, more work experience, working in nursing homes, experiencing more autonomy, collaboration with other nurse practitioners, a firmly anchored position, satisfaction with salary and developmental opportunities contributed positively to the practice environment. Answers on the open-ended questions supported the quantitative results. CONCLUSIONS: Work motivation, organisational climate and work engagement are positively related to a large variety of personal and work-related factors. Therefore, policymakers and professional organisations should be aware of the impact of these influencing factors to enhance an inspiring work environment. RELEVANCE TO CLINICAL PRACTICE: Awareness of factors that influence nurse practitioners' practice environment can be used as a tool to screen and improve the present work environment.

Implementing a ward-level intervention to improve nursing handover communication with a focus on bedside handover-A qualitative study.

AIM: To improve the effectiveness of nursing clinical handover through a qualitative, tailored communication intervention. DESIGN: A multisite before and after intervention using qualitative ethnography combined with discourse analysis of nursing handover interactions. METHODS: We implemented a tailored ward-based intervention to redesign nursing handover practice with co-constructed recommendations for organisational and cultural change on seven wards across three affiliated metropolitan hospitals between February 2020 and November 2022. The intervention was informed by pre-implementation interviews and focus groups with nursing, medical and allied health staff and patients (n = 151) and observed and/or audio-recorded handover events (n = 233). Post-intervention we conducted interviews and focus groups (n = 79) and observed and/or audio-recorded handover events (n = 129) to qualitatively evaluate impact. RESULTS: Our translational approach resulted in substantial changes post-intervention. Nurses conducted more shift-to-shift handovers at the bedside, with greater patient interaction and better structured and more comprehensive information transfer, supported by revised handover documentation. Redesigned group handovers were focused and efficient, communicating critical patient information. CONCLUSION: Contextualised training combined with changes to ward-level systemic factors impeding communication results in improved nursing handovers. Practice change requires strong executive leadership and project governance, combined with effective ward-level leadership, collaboration and mentoring. The speed and degree of change post-intervention demonstrates the power of interdisciplinary collaborative research between hospital executive, ward leadership and communication specialists. RELEVANCE TO CLINICAL PRACTICE: Nurses are more likely to conduct efficient group handovers and informative, patient-centred bedside handovers in line with policy when they understand the value of handover and have practical strategies to support communication. Communication training should be combined with broader ward-level changes to handover practice tailored to the ward context. A multilevel approach results in more effective practice change. REPORTING METHOD: We adhered to the COREQ guidelines. PATIENT OR PUBLIC CONTRIBUTION: We interviewed patients on study wards pre and post intervention.