Peter M. Sinclair

Recovery for people with lived experience (PLE) involves living a meaningful life within the community despite the limitations imposed by mental disorders. However, recovery can be hindered by factors beyond the symptoms themselves, including the stigmatising attitudes and behaviours of community members. Gaining a comprehensive understanding of these hindrances is essential for informing effective preventive strategies that can be implemented by caregivers and healthcare professionals. Despite its importance, limited research has explored the factors that impede recovery from a shared perspective of PLEs, caregivers, and nurses-highlighting a critical gap in the literature. This study explores PLEs, caregivers and registered nurses' sharing perspectives on factors hindering recovery in the collectivist society of Saudi Arabia. An exploratory descriptive qualitative methodology was employed using in-depth semi-structured interviews with 16 PLEs, 10 caregivers and eight registered nurses and inductive thematic analysis of the data. Society stigma, broken family bonding, unempathetic behaviours and toxic positivity were identified as factors hindering PLEs' recovery, leading them to adopt behaviours to protect their mental wellbeing. Regardless of the origins of stigma, resisting and protesting it may indicate that PLE overcame barriers to recovery. Future research should investigate the implementation of recovery-oriented language. Studies should explore the concept of toxic positivity among PLE and their caregivers. Global mental healthcare systems should establish and sustain a trauma-informed care to mitigate negative effects of factors gendering recovery. The consolidated criteria for reporting qualitative studies' 32-item checklist was followed in this study.

Background: Utilising point‐of‐care ultrasound for assessment and cannulation of vascular access in people receiving haemodialysis has shown positive clinical results. Nonetheless, there is variation in how renal health care professionals worldwide embrace this method, and there's a lack of research on the factors that promote or hinder its adoption.Objectives: To explore regional differences, and barriers and facilitators, to the use of point‐of‐care ultrasound for assessment and cannulation of vascular access in haemodialysis.Design: Exploratory descriptive cross‐sectional web‐based survey.Participants: Healthcare clinicians working in haemodialysis responsible for cannulation of arteriovenous fistula or grafts.Results: The survey was completed by 645 health care clinicians from 38 countries. 75% to 93% of respondents from Australia/New Zealand, Canada, Europe and United Kingdom/Ireland reported access to ultrasound, compared to 26% (n = 43/167) from the United States. United States respondent's reported lower levels of ultrasound training than other regions. Facilitators for using ultrasound were: the availability of ultrasound training (87%, n = 558), to reduce miscannulations (76%, n = 255/336) and to improve patient outcomes (73%, n = 246/336). Point‐of‐care ultrasound barriers were lack of access to ultrasound education (82%, n = 196/239), lack of ultrasound machines (33%, n = 212/645) or believing that ultrasound was someone else's role (38%, n = 29/86).Conclusions: This study revealed national and regional differences related to haemodialysis point‐of‐care ultrasound. Understanding the regions requiring more education and implementation of ultrasound and what motivates staff, or deters from using ultrasound, is crucial for effectiveness of future implementation and workplace change initiatives.

In 2019, the World Health Organization urged a global shift towards recovery‐focused practices in mental health care. In Western nations, this transition often prioritised individualism over collectivism. In contrast, collectivist societies prioritise recovery through community and social support. This study explored mental health recovery from the perspectives of consumers, carers and registered nurses in a mainly collectivist society (Saudi Arabia) using a qualitative exploratory descriptive design. Sixteen consumers, ten carers and eight registered nurses participated in online semi‐structured interviews. Inductive thematic analysis was employed to analyse English‐translated versions of the 34 interviews. Consolidated criteria for reporting qualitative studies 32‐item checklist were used. The study found that recovery was perceived as a process of transforming towards living a meaningful life of goals and values supported by trusted people who share moments of comfort and empowerment. A unique finding was the ‘bond of recovery’ a collectivist value that aid consumers' community integration in society. Saudi consumers' experiences of recovery were similar to consumers' movement narratives of recovery. Future research should establish a recovery‐focused educational program that incorporates our findings into a recovery‐oriented approach. This will facilitate providing a collaborative care between consumers, carers and nurses that centres around consumers' recovery goals and values.

National and international guidelines recommend opportunistic screening for chronic kidney disease to allow for early detection and management. Despite these guidelines, screening for chronic kidney disease in general practice settings is often suboptimal. This paper reports the results of a study that evaluated: (a) the effect of an asynchronous web-based e-learning module on general practice nurses’ knowledge about chronic kidney disease risk factors and screening practices; and (b) general practice nurses’ perceived satisfaction with the e-learning module. Changes in chronic kidney disease knowledge were assessed using a pre-test and post-test evaluative design, and satisfaction scores were measured on completion of the module. Participants’ baseline knowledge scores were poor, with mean pre-test scores of 3.77 (s.d. 1.66) out of 10. Post-test scores revealed a significant improvement (mean difference 1.81, (95% CI: 1.53 – 2.09), P < 0.01); however, overall final scores remained inadequate. Participants highly rated their satisfaction with the design of the module. Our results suggest that an asynchronous web-based e-learning module can improve general practice nurses’ knowledge about chronic kidney disease risk factors and screening practice. Efforts are required to increase practice nurses’ access to educational opportunities designed to improve knowledge in this area with the aim of increasing opportunistic screening for chronic kidney disease in the general practice setting.

Background: The burden of Chronic Kidney Disease (CKD) on the Australian health system is growing. Efforts to reverse this trend have not been successful. This paper evaluates the effectiveness of a targeted asynchronous web based e‐learning module on general practice nurses’ behavioural intentions in relation to opportunistic screening practices for people at risk of CKD.Design: Double blinded pre‐post interventional randomised control design.Methods: Participants were nurses working in general practice settings in Australia. Participants were randomised to a knowledge based active control or targeted behavioural based intervention which were delivered using asynchronous e‐learning modules. The intervention was designed to influence the behavioural constructs of the theory of planned behaviour (TPB): attitude, subjective norm and perceived behavioural control (PBC).Results: Of the 420 participants, we analysed the primary and secondary outcomes for 212 (50.47%) who had complete follow up data. There were no significant differences (p 0.424, [d] 0.04) in behavioural intention between the intervention and control groups at follow‐up, when controlling for baseline values. However, regression models assessing the relationship between the change in the TPB constructs and behavioural intention at follow‐up for all participants, regardless of study arm, demonstrated a significant change in intention to initiate a kidney health check. Although these changes could not be attributed to the effect of the intervention. Attitude (r2 = 0.3525, p 0.0004) and PBC (r2 = 0.3510, p 0.0005) models accounted for approximately 35% of the explained variance in behavioural intentions and social norm (r2 = 0.3297, p 0.0171) accounted for approximately 33% of the variance. When all TPB constructs were included in the model, 37% of the variance in intention was explained.Conclusion: A targeted behavioural online intervention was no more effective than a knowledge based online program to improve primary health care nurses’ intention to initiate a kidney health check in people at risk of chronic kidney disease.Relevance to clinical practice: Collaborative efforts are required by all staff working in general practice to develop models of care to improve screening practices for chronic kidney disease. Future research should focus on interventions that improve collaboration between health care professionals in the primary care setting and public health campaigns to increase awareness of risks of CKD and the importance of screening in the primary care setting.

Aim: Opportunistic screening in general practice (GP) is a cost‐effective and viable approach to the early identification of chronic kidney disease (CKD). This study sought to identify the barriers and facilitators to CKD screening practices of GP nurses working in a regional area of New South Wales, Australia.Methods: An eight‐item elicitation questionnaire informed by the Theory of Planned Behaviour was administered to a convenience sample of 26 GP nurses.Results: Participants identified that the advantages of CKD screening were its early detection and treatment, the reduction of disease burden, and the opportunity to increase awareness and provide disease prevention education. These positive attitudinal beliefs were offset by negative beliefs about the impost of opportunistic screening on nursing time, particularly when there were other competing clinical priorities. Participants reported that practice doctors were wary of the financial costs associated with additional non‐claimable services and believed that unfunded services, regardless of patient benefit, were difficult to justify in a private business environment. Screening was enabled in GP settings with existing screening protocols or initiatives, and when patients presented with known risk factors. Barriers to screening were more frequently described and illustrated a strong focus on financial aspects of GP. Without reimbursement through the Medicare Benefits Scheme, screening was not considered an economical use of nursing time. Other competing and billable clinical services took precedence.Conclusion: The findings of this study can be used to inform the development and evaluation of interventions that target opportunistic CKD screening in the GP setting.

: E‐learning involves the transfer of skills and knowledge via technology so that learners can access meaningful and authentic educational materials. While learner engagement is important, in the context of healthcare education, pedagogy must not be sacrificed for edu‐tainment style instructional design. Consequently, health professional educators need to be competent in the use of current web‐based educational technologies so that learners are able to access relevant and engaging e‐learning materials without restriction. The increasing popularity of asynchronous e‐learning programs developed for use outside of formal education institutions has made this need more relevant. In these contexts, educators must balance design and functionality to deliver relevant, cost‐effective, sustainable, and accessible programs that overcome scheduling and geographic barriers for learners.This paper presents 10 guiding design principles and their application in the development of an e‐learning program for general practice nurses focused on behavior change. Consideration of these principles will assist educators to develop high quality, pedagogically sound, engaging, and interactive e‐learning resources.