Liz Thyer

Despite the presence of dual-qualified nurse-paramedics within the Australian health system, little is known about their professional identity. Given the predominantly profession-specific nature of health governance in Australia, it is important to understand how dual-qualified nurse-paramedics experience and construct their professional identity. A strong professional identity has been associated with improved outcomes for health workers, patients and health systems. Failure to recognise and meet the needs of this group may place their well-being at risk and compromise patient and system outcomes. The aim of this research was to explore the professional identity of dual-qualified nurse-paramedics. A Husserlian descriptive phenomenological approach was adopted, with data analysed using Colaizzi's method. Thirteen dual-qualified nurse-paramedics employed by jurisdictional ambulance services and/or emergency departments across Australia participated in online interviews. Participants reported feeling confused about their professional identity. Describing a constant ‘tug of war’ between being a nurse and a paramedic, they attributed this tension to governance structures that enforce strict professional boundaries. Interprofessional rivalry and a perceived lack of understanding of each other's professional roles further contributed to their identity confusion. Participants frequently described pressure to conform to the fixed expectations of one profession or the other, despite valuing both. Professional identity formation for individuals navigating both nursing and paramedicine is challenging. The siloed nature of existing governance structures, while not deliberately exclusionary, contributes to feelings of exclusion and a fragmented sense of identity. These dynamics filter down into organisations and workplace culture, creating a sustained lack of acknowledgement that leaves dual-qualified nurse-paramedics feeling invisible, disheartened and exhausted. In the context of contemporary health system challenges, this situation warrants careful consideration by health leaders and decision-makers.

Introduction: Recent data from the 2024 Australian Health Practitioner Regulation Agency (Ahpra) Occupational Therapy workforce survey indicated that the primary reason occupational therapists were considering leaving the profession was mental burnout. The second most commonly reported reason was a lack of professional satisfaction and feeling as though work was no longer fulfilling (Ahpra, 2024). The aim of this systematic review was to synthesise prevalence and incidence data of burnout among occupational therapists practising in Australia. Methods: This systematic review was registered via PROSPERO and conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines and Joanna Briggs Institute (JBI) manual for evidence synthesis. Six databases (CINAHL, Medline, Embase, Scopus, PsychINFO, and ERIC) were systematically searched from 1970 to present. Quality appraisal of the included studies was completed using the Joanna Briggs Institute Prevalence Critical Appraisal Tool. Consumer and Community Involvement: As this was a systematic review of previously published literature, no consumer or community involvement was required. Results: Only seven studies using two burnout measures, published between 1983 and 2025, met the inclusion criteria. Moderate burnout was reported in mean results across burnout measure subsets. The highest scoring sub‐category was exhaustion. Factors contributing to burnout were numerous, with the most common being high work and client loads, younger age, and working in roles not specific to occupational therapy. Conclusion: Moderate levels of burnout have been identified in Australian occupational therapists over the last five decades. Further research, such as longitudinal and larger scale studies, is required to gain a deeper understanding of burnout to assist in the development of protective strategies to prevent burnout and increase the career span of occupational therapists practising in Australia.

Objective: Describe Australian occupational therapy (OT) workforce distribution trends by total numbers, demographics, work type, and job roles across remoteness levels. Design: Exploratory spatial analysis of workforce distribution compared to total populations between 2013 and 2021. Setting: Australia. Participants: OTs participating in registration surveys (2013–2021) and Australians from the 2011, 2016, and 2021 National censuses. Main Outcome Measures: Proportion of occupational therapists, hours worked, First Nations inclusion, leadership roles, and practice areas across Modified Monash Model (MMM) levels of remoteness compared to populations. Results: Despite a 72% national workforce increase (over 10 000 OTs ) over nine‐years, metropolitan areas consistently retained a disproportionate share of workforce, hours worked, specialised practice areas, leadership roles, and First Nations identifying therapists. Regional centres showed the highest growth but would require similar growth for 4–15 years to equal metropolitan ratios, while workforce gaps will likely widen for other remoteness levels. Private sector hours increased substantially by 100‐h/10 000 population, while public sector hours increased by just 1‐h. However, private sector growth did not extend equitably to rural and remote places. Metropolitan, regional, and large rural towns outpaced all other remoteness levels in leadership growth suggesting a centralising tendency. At current rates, representative First Nations proportions will not be achieved. Equity against 2021 numbers requires redistribution of at least 1717 therapists, 278 formalised leadership positions, and increased specialised services to rural and remote places. At least 598 additional First Nations identifying therapists are needed nationally, of which 406 (68%) are needed in regional, rural, and remote places. Conclusion: Persistent maldistribution of the OT workforce across remoteness levels reflects structural inequities unlikely to resolve through organic growth. Current rural workforce strategies appear insufficient to address geographic and cultural disparities. Targeted investment in rural workforce development, including incentives and pipeline models are likely required to support equitable availability of OT services.

Aim: This phenomenological study explored the lived experience of paramedics attending to individuals experiencing a mental health crisis in the community. Background: In recent years, paramedicine has evolved significantly, becoming a distinct discipline within the health sector with transformed roles and practices. Simultaneously, mental healthcare has transitioned for most consumers to community-based models of care. However, limited services have led individuals to rely on emergency departments and ambulance services as their primary, albeit last resort, during a crisis. Consequently, paramedics have become crucial providers of unscheduled mental healthcare, offering assessment and support to individuals experiencing a mental health crisis. Method: This study utilised descriptive phenomenology, following the tradition of Husserl, to capture detailed descriptions of the phenomenon under study. Eighteen Australian paramedics employed by a Jurisdictional Ambulance Services took part in the study. Unstructured recorded interviews were conducted with each participant, ranging from 25 to 95 min. Data analysis was carried out using Colaizzi's seven-step method. Results: The study revealed four central themes experienced by paramedics: (a) the clinical interaction; (b) the barriers to accessing care for mental health consumers in a one-size-fits-all system; (c) It's just all a little bit grey – paramedic education and training in mental health presentations; and (d) the paramedic, the clinician and the person. Structural and non-structural barriers, including personal, professional and organisational factors influenced care delivery. Limited specialised services and referral networks further complicate optimal care delivery. Conclusion: The study highlights paramedics’ challenges in caring for individuals experiencing a mental health crisis. Participants noted their limitations due to inadequate education, training and on-site support, leading to frustration with a system focused on episodic rather than holistic care. Additionally, limited access to specialised services and referral networks complicated their efforts to provide optimal care.

Effective partnerships between universities and industry facilitate health-profession students’ learning and work readiness. However, developing sustainable industry engagement in academic curricula remains challenging. This study utilised Social Exchange Theory (SET) to explore the benefits of and barriers to industry engagement within health-profession preparation programs. A realist evaluation framework was used to consider factors that impacted experiences and outcomes for academics and clinicians who engaged in the development and delivery of curriculum for a new health professional preparation program in speech pathology. A sequential mixed-methods design was adopted to explore factors influencing clinicians’ motivation to engage with the university, using an online survey (n = 18) and focus group (n = 5). Clinicians rated “personal development” and contributing to the “future workforce” as the highest personal benefits. “Sharing knowledge” was the highest team benefit, and “staff satisfaction” was the highest employer benefit. Time and workload were perceived barriers. Academics (n = 2) and clinicians (n = 3) who collaborated in learning and teaching experiences also participated in a post-engagement focus group. Three Context Mechanism Outcome configurations were shown to facilitate engagement outcomes: engagement as opportunity, partnership, and work readiness. In accordance with SET, the nature of exchange processes and professional relationships contributed to positive engagement outcomes for clinicians, academics, and enhanced health-profession education.

Background: The need to belong is a fundamental human desire that provides the basis for relationships and community; it provides a sense of security that enables growth and development. This sense of belonging is pivotal to new University students, indeed, without it, students are at greater risk of failing or withdrawing from their studies. Yet developing a sense of belonging within a new cohort is complex and multi-faceted and further complicated by a sudden shift away from in-person to online learning. Using the situated-learning framework, our study explores first year clinical health students’ sense of belonging in the context of the rapid transition to online learning because of the COVID-19 pandemic. Methods: We utilised a current mixed-method approach including a survey incorporating previously validated tools, demographic and open-ended qualitative questions. Data was also gathered from three focus groups: two dedicated student groups and one academic focus group. Qualitative data was subjected to thematic analysis whilst descriptive statistics were used to describe the quantitative data. Results: 179 first year students complete the survey and four students, and five academics were involved in the focus groups. All participants were from clinical health science courses at an Australian university. Our qualitative results indicated a global theme of: Navigating belonging during the COVID-19 crisis: a shared responsibility; with four organising themes describing (1) dimensions of belonging, (2) individual experiences and challenges, (3) reconceptualising teaching and learning, and (4) relationships are central to belonging. Conclusion: While the rapid transition to online learning did not greatly impact knowledge acquisition of first-year students in this cohort, the lack of sense of belonging highlights the need for further research into development of this essential aspect of learning in the online domain. Although contextualised in the COVID-19 pandemic, it became clear that the findings will remain relevant beyond the current situation, as a student’s need to belong will always be present in the face of challenges or change.

Background The need to belong is a fundamental human desire that provides the basis for relationships and community; it provides a sense of security that enables growth and development. This sense of belonging is pivotal to new University students, indeed, without it, students are at greater risk of failing or withdrawing from their studies. Yet developing a sense of belonging within a new cohort is complex and multi-faceted and further complicated by a sudden shift from face-to-face to online learning. Our study explores first year clinical health students’ sense of belonging in the context of the rapid transition to online learning because of the COVID-19 pandemic. Methods We utilised a current mixed-method approach including a survey incorporating previously validated tools, demographic and open-ended qualitative questions. Data was also gathered from three focus groups: two dedicated student groups and one academic focus group. Qualitative data was subjected to thematic analysis whilst descriptive statistics were used to describe the quantitative data. Results 179 first year students complete the survey and four students, and five academics were involved in the focus groups. All participants were from clinical health science courses at an Australian university. Our qualitative results indicated a global theme of: Navigating belonging during the COVID-19 crisis: a shared responsibility; with four organising themes describing (1) dimensions of belonging, (2) individual experiences and challenges, (3) reconceptualising teaching and learning, and (4) relationships are central to belonging. Conclusion While the rapid transition to online learning did not greatly impact knowledge acquisition of first-year students in this cohort, the lack of sense of belonging highlights the need for further research into development of this essential aspect of learning in the online domain. Although contextualised in the COVID-19 pandemic, it became clear that the findings will remain relevant beyond the current situation, as a student’s need to belong will always be present in the face of challenges or change.

Community paramedicine (CP) has extended the role of paramedics and the main goal is to provide non-emergency care, which reduces the visits to emergency departments. The aim of this study was to describe the Finnish CP and examine the factors that were involved in CNPs’ decision-making processes. The study was based on data from 450 consecutive CP patient records from three hospital districts. A more detailed analysis was carried out on 339 cases in patients’ homes and elderly care homes, and the data analysis included multivariate logistic regression to examine the impact of variables on the CNPs’ decisions. These patients’ most common health issues were general weakness (15.9%) and fever (10.6%), and over half (58.7%) could remain at home after the CP visit. There were five independent factors associated with the CNPs’ decisions of the patient’s care continuum: the hospital district, if the patient could walk, whether the troponin test was performed, a physician was consulted, and the nature of the task. CP units played a valuable role in non-emergency care. Understanding the factors associated with CNP decision-making can increase the safety and effectiveness of reducing hospital visits, by providing patient care at home, or in elderly care facilities.

The emergence of augmented reality (AR) and mixed reality (MR) modalities has increased the potential of simulation in paramedicine education. The integration of AR/MR into education programmes should be underpinned by sound learning design; however, little is known about their effective use. The purpose of this scoping review was to identify the application and integration of AR/MR within paramedicine education. The review searched MEDLINE, EMBASE, PsychInfo, CINAHL and ERIC up to February 2020 to identify peer-reviewed articles describing the application or integration of any AR/virtual reality (VR) in the context of paramedicine education. The search yielded 11 records for qualitative synthesis from 170 unique records. The quality assessment showed diversity, from good to very poor quality papers. Categories of AR/MR were identified: computer-based avatar worlds, headset-based VR and screen-projection immersive spaces. An application was diverse, with triage and management of mass casualty featuring prominently. One paper described cost-effectiveness, and none discussed issues associated with volume or frequency of exposure required to achieve sustained outcomes. This review identified a small and heterogeneous evidence base describing AR/MR in paramedicine education. Limited, weak evidence demonstrates outcomes of equal to or better than traditional simulation when using AR/VR in paramedicine education.