Caroline Bulsara

Background: Falls in hospital are a serious risk to older patients' recovery. Patient education programmes that provide falls prevention advice are recommended. Garnering the perspectives of older adults about implementing such programmes could improve how health professionals engage with hospital patients to educate them and increase patient enactment of falls prevention advice. Methods: Two forums, in two states of Australia, were conducted using a modified World Café methodology. Older consumers who had previous admissions to hospital shared their perspectives on three conversation topics: (i) delivery of a purpose‐designed patient falls prevention education programme called Safe Recovery; (ii) ward‐level support for programme delivery; and (iii) organisational‐level support for the programme. Table notes were combined and analysed using inductive content analysis. Results: Older consumers who could communicate in English from Western Australia (n = 17) and Victoria (n = 16) participated in the forums. Their perspectives appeared to concur that implementation of the Safe Recovery Programme for falls prevention on hospital wards requires staff attention to the right timing for patients, personalisation of the education and multiple modes of delivery to optimise programme exposure. Consumers advised that ward‐level support to remember and enact suitable strategies should be provided by staff, families, hospital volunteers and peers. They requested clear communication between staff that ensured they repeatedly and consistently reinforced patient participation and provided progress reports to patients on falls prevention. Organisations can support implementation by taking ownership for ensuring patients receive falls prevention education, endorse staff falls education training and allocate funding for programme sustainability. The group consensus was everyone can work together to prioritise falls prevention in hospitals. Conclusion: Older consumers expressed their enthusiasm to partner in planning how a patient falls prevention education programme is delivered on hospital wards. Consumer engagement can provide valuable stakeholder feedback about processes and resources required for delivery of patient falls prevention education, which may lead to successful delivery by hospitals. Patient or Public Contribution: The research team includes a consumer investigator (SP) who has provided feedback and input at all stages of the research, including project design, study procedures, data analysis and manuscript review. The education programme's original design and development was centred around patient and public involvement. The participants in this study who attended the world café forums were older people with lived experience of hospital admissions and caregivers of older people admitted to hospital.

Background: Falls in hospitals are associated with injuries, deaths and poor patient outcomes. Although clinical guidelines recommend educating hospital patients about how to prevent falls, not all hospitals systematically deliver evidence-based patient falls education. The primary aim of this study is to implement and evaluate the effectiveness of delivering a research-informed education program called the “Safe Recovery Program” with ward support on rates of falls and falls-related injuries in hospitals. The secondary aims include measuring changes in patient and staff knowledge and awareness about falls prevention and identifying barriers and facilitators to staff and patients taking action to reduce hospital falls. Methods: The trial will adhere to the Consolidated Standards of Reporting Trials guidelines. Twelve wards will be recruited from five Australian hospitals over a 65-week period. A stepped-wedge cluster randomised controlled trial design will be used with unidirectional crossover from control to experimental conditions together with randomisation of when each cluster makes the transition. The crossovers will occur at 12 timepoints, each five weeks apart. Alongside the trial, patients and staff on participating wards will be recruited for interviews and qualitative data analyses will be conducted to understand how to optimise implementation. The experimental condition involves usual care plus delivery of the Safe Recovery Program. For the Safe Recovery Program, supervised allied health assistants will deliver brief falls education programs to all suitable patients in designated wards, reinforced by all ward staff. Falls champions, who are registered nurses and allied health professionals, will provide Safe Recovery Program training for staff, using a train-the-trainer model. The ward staff will also be trained in how to support hospital patients to adopt safe behaviours. The primary outcome will be falls per 1000 patient bed days. The secondary outcomes will be: (i) injurious falls per 1000 patient bed days (ii) patient and staff changes in falls awareness, knowledge and motivation; and (iii) barriers and enablers to hospital staff engaging in behaviour change and program implementation. An economic evaluation will also be conducted to estimate the incremental cost effectiveness of implementing the Safe Recovery intervention. Ethics and Dissemination: Ethics approvals have been obtained from The Royal Melbourne Hospital Human Research Ethics Committee (HREC/113864/MH-2024). The findings will be disseminated through peer-reviewed journals, workshops and conferences. Consumer team investigators will guide the communication of findings to the target audiences, including older patients, hospital staff, healthcare managers and policy makers. Trial Registration Number: ACTRN12624001469505

Patient empowerment has been linked to physical health outcomes and recovery; however, its relationship with mental health remains insufficiently explored, particularly in oncology populations, as most prior research has focused on non-oncology patients. Given the growing number of individuals diagnosed with cancer, this gap warrants investigation. This study examined the associations between overall patient empowerment and key indicators of mental functioning in oncology patients undergoing treatment, and aimed to develop a Polish adaptation of the Patient Empowerment Scale (PES). The analyzed indicators- coping strategies, health locus of control, quality of life, anxiety, depression, and post-traumatic growth- correspond to the intrapersonal, interactional, and behavioral components of psychological empowerment as conceptualized by Zimmerman. The sample comprised 120 patients (65 women, 55 men; aged 30-83). Measures included the PES, MINI-MAC, MHLC, EORTC QLQ-C30, HADS-M, and PTGI. Empowerment was significantly associated with all examined psychological indicators. The findings enhance understanding of psychosocial functioning in cancer patients and support the development of empowerment-based psychological interventions. The study also resulted in the development of PES-PL, a Polish adaptation of the Patient Empowerment Scale.

Background/Objectives: Pain is a common symptom for hospitalised older adults. Pain is not always adequately assessed, which can lead to inadequate pain management and adverse patient outcomes. Thus, new technology-driven pain assessment tools have been developed; however, little is known about patients’ and families’ experiences of nurses using them in acute care. This study aimed to explore the perspectives of older adult inpatients and their families’ regarding nurses’ use of the digital technology-driven pain assessment application PainChek^® Universal. Methods: A survey was undertaken as part of a stakeholder evaluation of a randomised control trial exploring the effectiveness of nurse-led volunteer support and technology-driven pain assessment in improving the outcomes of hospitalised older adults. The PainChek^® Universal application was implemented on two medical wards of an acute private hospital in Western Australia as part of a larger single-centre, prospective, non-blinded, cluster-randomised control trial. This stakeholder evaluation invited older adult inpatients and their family members to participate in a survey about nurses’ use of the PainChek^® Universal application for pain assessment. Results: A total of 96 inpatients and 27 family members completed the survey. Thirteen patients and nine family members provided additional feedback. Over 90% of patients and family members agreed that the use of the PainChek^® Universal application was a positive addition to pain assessments, rendered no concerns, and helped nurses complete pain assessments. A total of 84% of patients and 87% of family members felt PainChek^® Universal provided a more accurate pain assessment. Survey feedback related to PainChek^® Universal application use, integration of technology, and need for further education. Conclusions: The findings suggest that older adults and their families recognised the benefits of nurses using a digital application for pain assessments. Technology integration in healthcare must be accompanied by patient and family education.

The Australian Journal of General Practice (AJGP) aims to provide relevant, evidence-based, clearly articulated information to Australian general practitioners (GPs) to assist them in providing the highest quality patient care

Breast density reporting is recommended; however, guidance for general practitioners (GPs) is limited. This study investigates GPs' beliefs, attitudes, and practices within the only state-run Breast Screen program in Australia that has been notifying women if they have dense breasts for over a decade. A mixed-methods study was undertaken from four multi-GP practices. Qualitative interviews from GPs and de-identified data from a randomized sample of 692 women who attended screening mammography (2019-2022) were collated. Descriptive statistics, binomial regression for quantitative data, and both deductive and inductive analyses of qualitative data are reported. Interviews highlighted inconsistencies in practice regarding risk assessment and appropriateness of referrals for supplemental imaging. Three themes were identified: the professional role and responsibility, handling uncertainty and patients and the system. Quantitative data reported 31 percent of those with dense breasts were referred for supplemental ultrasound. Adjusting for age, family history, hormone replacement therapy, and socioeconomic status, only higher socioeconomic status was associated with a 1.35 times greater likelihood of ultrasound referral. This study emphasizes the complexities and uncertainty GPs face when consulting women with dense breasts and who and when to refer for supplemental imaging. Results inform optimum care pathways from a primary care perspective for those with increased breast density.

Objective: Objective: The aim of this project was to understand aged care service providers’ (ACSP) experiences of providing care during the COVID‐19 travel restriction period. Setting: Setting: Aged care facilities and community‐based settings within the Kimberly region of Western Australia. Participants: Participants: A total of 16 participants from 11 ACSPs took part in the project. Design: Design: A convergent mixed‐method design was employed for this project. A Project Advisory Committee (PAC) helped to inform the direction and robustness of this project. An online survey and semistructured interviews were used to collect quantitative and qualitative data. Results: Results: The key themes that emerged from this project included ‘ rapid changes to services,’ ‘importance of community ’ and ‘ long-term impact on the older people.’ These themes were impacted by barriers (access to services, resourcing, and equipment, staffing shortages and burnout, and government mandates, reporting and funding) and ameliorated by enablers (adapting existing services, supply of equipment and resources, staff training and support and changes to strategies and planning procedures). Conclusion: Conclusion: This project was informed by the PAC to ensure real‐world implications were considered. In health emergencies, additional resources such as improved infrastructure and telehealth, providing cultural safety training, avoiding a ‘one fits all approach’ for ACSP, and funding for staff retention could be considered.

Promoting adolescent wellbeing continues to challenge families, community groups, and schools, so ways to complement existing health programs should be sought. This paper aimed to synthesise four sequential, mixed-methods studies, resulting in a novel framework to impact adolescent wellbeing. Studies were conducted in Perth, Western Australia between 2020 and 2023, involving a quantitative systematic review and meta-analysis, qualitative analysis of focus groups with adolescent outdoor adventure education participants and key informant interviews with outdoor adventure education teachers, and mixed-method analysis of an electronic Delphi study with a panel of international experts in adolescence, wellbeing, and outdoor adventure education. The studies comprising this synthesis were conducted to provide an evidence base for adventure education practitioners to impact the wellbeing of their adolescent participants. The findings of these studies have resulted in the development of the Wellbeing in Outdoor Adventure Education Model (WOAEM), a new model that aims to provide outdoor adventure education practitioners with a practical application of the PERMA (positive emotions, engagement, relationships, meaning, and accomplishment) multidimensional framework of wellbeing. This practical application is specifically designed to guide program structure in a way that can positively impact the wellbeing of adolescents. Implications and recommendations for future research are discussed.

It is estimated that 6% to 12% of Australian emergency department (ED) presentations are due to musculoskeletal (MSK) conditions. In response, primary contact physiotherapy roles have developed in many Australian EDs. A further innovation is a diversion pathway for people with MSK conditions to move from the ED to a primary contact physiotherapy outpatient clinic. To explore the perceptions of people with MSK conditions and hospital staff on diverting patients from the emergency department (ED) to receive care from primary contact physiotherapists in the outpatient setting. A qualitative descriptive study with thematic analysis. Fourteen patient and 18 staff participants with experience of the diversion pathway were interviewed. There were four main themes combining staff and patient participant perspectives. The three combined themes were: (i) appropriateness of physiotherapists diverting patients from ED; (ii) communication; and (iii) impact of diverting patients from the ED. The unique staff theme was "staff perceptions of the diversion pathway." All patients felt diversion from the ED to see a physiotherapist in the outpatient clinic was appropriate, even if this was not their initial expectation of receiving care in the ED. Staff also perceived the diversion process as safe and valued addition to the ED. Both patient and staff participants described positive communication experiences from the physiotherapists in the diversion pathway. Several staff participants suggested improvements to the diversion pathway. Patient and staff participants perceived the diversion pathway as a safe, appropriate and effective addition to the public general hospital ED processes.

Background: It is estimated that 6% to 12% of Australian emergency department (ED) presentations are due to musculoskeletal (MSK) conditions. In response, primary contact physiotherapy roles have developed in many Australian EDs. A further innovation is a diversion pathway for people with MSK conditions to move from the ED to a primary contact physiotherapy outpatient clinic.Objective: To explore the perceptions of people with MSK conditions and hospital staff on diverting patients from the emergency department (ED) to receive care from primary contact physiotherapists in the outpatient setting. Methods: A qualitative descriptive study with thematic analysis. Results: Fourteen patient and 18 staff participants with experience of the diversion pathway were interviewed. There were four main themes combining staff and patient participant perspectives. The three combined themes were: (i) appropriateness of physiotherapists diverting patients from ED; (ii) communication; and (iii) impact of diverting patients from the ED. The unique staff theme was ‘staff perceptions of the diversion pathway’.All patients felt diversion from the ED to see a physiotherapist in the outpatient clinic was appropriate, even if this was not their initial expectation of receiving care in the ED. Staff also perceived the diversion process as safe and valued addition to the ED. Both patient and staff participants described positive communication experiences from the physiotherapists in the diversion pathway. Several staff participants suggested improvements to the diversion pathway.Conclusion: Patient and staff participants perceived the diversion pathway as a safe, appropriate and effective addition to the public general hospital ED processes.