Practitioners In Australia Research Articles

Exploring Trismus Management in Australia: A Mixed Methods Evaluation of Surveys and Interviews With Health Professionals.

This study evaluates how health care professionals manage trismus in Australia and identifies facilitators and barriers experienced by clinicians in routine patient care. A mixed-methods approach was used to evaluate the experience of clinicians. Medical, nursing, and allied health practitioners in Australia were invited to participate if they had treated patients with trismus in the last 5 years. Participants completed an investigator-designed survey and were invited to participate in a semi-structured audio-recorded interview to explore practice in more depth. Quantitative data were analyzed using descriptive statistics and qualitative data were analyzed thematically using an inductive, data-driven approach. Fifty-six clinicians (38 speech pathologists, 9 physiotherapists, 7 medical doctors, 1 nurse, and 1 osteopath) completed the survey, 12 of which also participated in an interview. The most common assessment tool was a commercially available measurement tool (Therabite or Orastretch), the most common treatment approach was stacked tongue depressors, and the most common exercise regimen was a 30- s stretch 25 times per day. Common barriers to trismus management included the high cost of devices, lack of clinical experience, and lack of training opportunities outside their institution. Clinician-perceived facilitators were different modes of information provision and time to consider the exercise instructions and rationale. Several clinicians relied on telehealth to reach patients in remote locations and improve efficiency. A range of clinicians treat trismus arising from a variety of conditions. Training opportunities are critical for clinicians to develop and extend their skills in assessing and treating trismus. The morbidity associated with trismus, and the absence of a clinical guideline or consensus document warrants careful consideration as to the translation of evidence into the clinical context.

Defining the urology nurse practitioner in Australia and New Zealand: A Delphi study.

Nurse practitioners with roles in specialty environments face challenges including uncertain role expectations and achieve urology expertise with on-the-job training, mentoring, and independent study. This creates a wide variety of preparation and role descriptions. This study employed Delphi methodology to identify essential components of the urology nurse practitioner (NP) role in Australia and New Zealand, representing an inaugural description of the role. This Delphi study was completed in two rounds. Participants were a nonrandom panel of experts with experience as a full-time urology NP. A definition for the urology NP in Australia and New Zealand is proposed: "The urology nurse practitioner uses critical thinking, complex decision-making, clinical reasoning, advanced assessment skills and clinical expertise, offering acute and chronic care to individuals needing urologic health care, including office-based urology procedures as appropriate. This care is provided in an environment of autonomous practice, with a basis of graduate education and relevant specialty clinical experience, and this practice can extend across health care settings and serve as a model to the wider NP profession." Outpatient urology procedures were ranked highly and deemed integral to the Urology NP role. This may reflect the declining number of urologists and efforts to maintain urology access for local populations. Professional roles of the NP were given less weight by participants. The project offers a contemporary definition of the urology NP role that can be offered to educators and other stakeholders as the role continues to evolve in Australia and New Zealand.

The knowledge and skills needed for forensic social work in Australia: A Delphi study

Summary Forensic social work is the application of social work knowledge, skills, values and ethics within a legal and criminal justice context. Globally, social workers play an integral role in the criminal justice system but in many countries, including Australia, there is limited conception of the competencies needed for this specialist practice. Australia serves as an example of forensic social work regulated through a generalist social work competency framework, where specialist skills and knowledge are not distinctly outlined or assessed. The purpose of this study was to identify the knowledge and skills used by forensic social work practitioners in Australia. This study used a 3-round Delphi method with an expert panel of social workers working in forensic practice across Australia. It consisted of a 1-hour semi-structured individual interview followed by 2 rounds of online surveys. Findings Consensus was obtained for 30 skill and knowledge items for Australian forensic social work. The panel identified these competencies as specialist, meaning requiring further training beyond generalist proficiency. Of these, eight of the skill and knowledge items were seen as essential for graduates entering forensic social work. Applications The findings from this study contribute to an evidence-based model of forensic social work competency. In Australia, they can be used to consider potential gaps between current generalist mechanisms and specialist practice expectations. With further research, these findings can be used to inform professional standards for forensic social work in Australia and potentially internationally.

What are the attitudes and perceptions of general practitioners about the role of nurse practitioners in the community care setting: A scoping review

BackgroundThe Nurse Practitioner role in Australia is slowly expanding, with a well-established body of evidence supporting their introduction. Yet, there is a lack of consistent support from the medical profession for this role. Nurse Practitioners wishing to work in the community setting may, therefore, experience resistance from General Practitioners. ObjectiveTo identify and explore the attitudes and perceptions of Australian General Practitioners about Nurse Practitioners' community settings. To explore what is the view of GPs outside of Australia on this topic. MethodA scoping review of the Cochrane, MEDLINE, Psych INFO, and CINHAL databases was undertaken from 1995 to April 2023 and reported using PRISMA. Quality evaluation tools devised by Dixon-Woods et al. (2005) and previously used by Paterson et al. (2015) were used to evaluate the included studies. A narrative synthesis was then undertaken using the method described by Whittemore and Knafl (2005). FindingsThe scoping review identified 1623 potential publications. After a comparison of the title and abstract to the inclusion and exclusion criteria, 20 publications underwent an in-depth review, eight publications met the inclusion criteria for a full review. The review did not identify a publication from Australia. Elsewhere the attitudes of General Practitioners were influenced by the lack of definition of the Nurse Practitioner role, a lack of knowledge of the Nurse Practitioner skill level, fear of service duplication, deterioration in patient relationships, who had responsibility for the role and funding for the role. ConclusionThere is a lack of evidence in an Australian context to determine if General Practitioners in Australia have similar views to their international counterparts. Careful planning needs to be undertaken to overcome potential issues and to enable the Nurse Practitioner role to be effectively implemented in an Australian community setting.

Cross-Sectional Analysis of Australian Dental Practitioners’ Perceptions of Teledentistry

INTRODUCTION: There has been an increased use of teledentistry by dental practitioners in Australia as a response to the COVID-19 pandemic. Previous studies conducted analysing the opinions of dental practitioners were performed prior to the pandemic, and therefore it is important to determine if perceptions regarding teledentistry have changed following the outbreak. OBJECTIVES: The aim of this study was to determine the perceptions of oral healthcare professionals regarding teledentistry in a clinical setting. METHODS: The cross-sectional study involved an anonymous electronic questionnaire with a sample of 152 dental practitioners. The questionnaire contained 28 questions utilizing a 5-point Likert-scale to assess the perceptions of general dentists on teledentistry regarding diagnosis, accessibility, patient care, technology and finances. Chi-squared test and analysis of variance (ANOVA) were used to analyse the results and percentages of agreement and disagreement were calculated. RESULTS: The participants of the questionnaire believed that teledentistry was effective for consultations and in the diagnosis of simple cases. They indicated large benefits of teledentistry in improving access, delivering post-operative care, and triaging patients, and found it particularly useful during the COVID-19 pandemic. However, the participants felt that teledentistry was ineffective in diagnosing complex cases such as pathology. Concerns were also raised regarding the interventional capacity of teledentistry, the quality of the technology, data security and medicolegal issues. In general, participants preferred in-person care in comparison with teledentistry. They were neutral regarding finance. CONCLUSION: The study provided an insight into the perceptions of Australian dental practitioners regarding teledentistry post-COVID-19. Opinions have changed slightly, but there are large hurdles still to overcome before teledentistry is more widely accepted. Research should be continued to further improve teledentistry in the future.

Evaluation of community engagement for resilience outcomes: A pre-engagement approach

Recent disasters have placed enormous pressure on communities to be more resilient. Community resilience encompasses a range of structural, economic, and social dimensions that affect a community's ability to withstand change and disruption from disaster events. In recognition of the social processes that contribute to resilience, governments have increased investment in community engagement programs based on the assumption these programs of activity contribute to community resilience. While several studies identify the indicators of community resilience, few operationalize these indicators for community engagement in a way that can be used to establish baselines and evaluate change overtime. This paper addresses this gap. In-depth interviews with 16 community engagement practitioners in Australia investigated how community resilience in flood prone communities was conceptualized and how the outcomes from engaging communities for resilience building were identified. Findings from the study and the extant literature on resilience empirically informed the development of a four-step pre-engagement approach that extends current community engagement models and supports the measurement of engagement activities and aligned resilient outcomes. The pre-engagement approach can be adapted to diverse community contexts beyond flood emergencies and beyond Australian borders.

Is Chinese Medicine Facing a Potential Workforce Crisis in Australia? Demographic Changes in the Profession over the Last Decade.

Background: As a prominent part of complementary and alternative medicine, Chinese Medicine (CM) has proved its strengths in treating a diverse range of acute and chronic medical conditions and is at present recognized in 196 countries and territories worldwide. In 2012, Australia regulated the CM profession under the National Regulation and Accreditation Scheme (NRAS) by legislation and reports quarterly demographic information about individual CM practitioners so to ensure public interest, although research examining the change of CM workforce in Australia has been scarce. Objective: This study aims to investigate the construction of the CM workforce in Australia and more importantly, evaluated its development in the last decade to capture the trajectory and trend in the present period and future potential changes. Methods: Data were sourced from the Australian Health Practitioner Regulation Agency (AHPRA) annual reports and the Chinese Medicine Board of Australia (CMBA) registration statistics from 2012 to 2023. A descriptive analysis was conducted with demographic variables, including profession, age, and gender, and chi-square tests and linear regression modeling were carried out to assess the variations between regions and across years. Results: The population of CM practitioners in 2022/2023 stagnated with slight decrease to 4,823, in contrast to the increase rate of 2.9% in the whole health care community. The number of young CM registrants (<35 y) shrank by 37.5% from 691 in 2012 to 432 in 2023. In comparison with other health care professions, CM comprises the smallest proportion of the population aged younger than 25 (0.2%) and the largest proportion aged older than 65 years (16.2%), advancing into an aging era. Conclusions: This study indicates a worrying potential decline in CM workforce in Australia, which is likely to be further exacerbated by the lack of new graduates and rise of median age among practitioners. Meanwhile, continued advancement in Western medicine technology and standards requires substantial efforts to increase both a better understanding of CM and demonstration of its efficacy. Furthermore, greater effort is needed to recruit and educate new young CM practitioners in Australia and to broaden the international training pipeline for a sustainable development of CM practice.

Maintaining Industry Currency and Upskilling for Low-Carbon Technologies in Small Business Construction Trades: Study of Plumbing Practitioners in Australia

Maintaining Industry Currency and Upskilling for Low-Carbon Technologies in Small Business Construction Trades: Study of Plumbing Practitioners in Australia

Youth theatre and the climate crisis in Australia: the role of ‘unmediatised liveness’ in performing recovery, resistance, and survival

ABSTRACT This paper presents the provocation that ‘unmediatised liveness', or experiences not filtered through digital technology, is vital to performances that promote recovery, resistance, and survival among young people in response to the climate crisis. Our provocation draws from interviews conducted with youth theatre and performance practitioners in Australia whose work addresses the climate crisis holistically across disaster preparedness, first response, disaster recovery, and climate activism. We argue that while mediatised interactions remain a critical element of contemporary youth culture and performance, unmediatised co-presence, artistic collaboration, community action, and activism are crucial in the high-stakes context of Australia’s climate crisis.

A comparison between veterinary small animal general practitioners and emergency practitioners in Australia. Part 1: demographic and work-related factors.

Occupational stressors are commonly encountered in small animal veterinary practice and have been associated with burnout. The working context of veterinarians differs by specialty, and this can potentially lead to variable exposures to risk factors for burnout. The aim of this study was to explore differences in demographic and working conditions of veterinary general practitioners (GPs) and emergency practitioners (EPs) to compare exposure to different potential stressors. An anonymous, online survey was administered to veterinary GPs and EPs practicing in metropolitan regions of Australia. In total, 320 participant responses were analyzed (n = 237, 74.2% GPs and n = 83, 25.9% EPs). Significant differences (P < 0.05) in the demographics and work-related exposures were found between the two groups. GPs were found to be older than EPs with a greater number of years of experience in their field (P < 0.001). Most veterinary GPs worked only day shifts (207/236, 87.7%); where EPs worked a greater variety of shift patterns, with "only day shifts" being the least common shift pattern (P < 0.001). Most GPs worked a set and predictable roster pattern (195/236, 83.6%), while most EPs did not (51/83, 61.5%). EPs worked more weekends and public holidays (P < 0.001). The EP group performed more hours of work each week but worked less overtime. The main contributing factors for overtime were scheduling factors for GPs and staffing issues for EPs. EPs were commonly not able to take meal-breaks and GPs' meal-breaks were commonly interrupted by work. EPs were more frequently exposed to patient death, euthanasia (including for financial reasons), emotionally distressed clients and delivering negative news (P < 0.001). Both groups indicated that most work environments were collegiate and supportive, and a minority reported toxic colleagues (11.8%) or management teams (26.9%). Just under one-half of respondents reported having witnessed or experienced workplace bullying. Of our respondent group, 52.0% (166/319) were not satisfied with their remuneration. Desire to leave their principal area of practice was prevalent among this survey group (192/319, 60.2%) with approximately one-third considering leaving the veterinary profession. We discuss the implications of these workplace factors, including mitigation strategies.

A comparison between veterinary small animal general practitioners and emergency practitioners in Australia. Part 2: client-related, work-related, and personal burnout.

Burnout is reported to be common among veterinarians. However, there is limited research investigating the relationship between specific types of veterinary practice and burnout. A previous study found significant differences in work exposures between veterinary general practitioners (GPs) and emergency practitioners (EPs). The primary aim of this study was to investigate whether Australian veterinary EPs suffer from a higher level of burnout compared to veterinary GPs. The secondary aim of this study was to explore if the previously reported differences between GP and EP groups were positively associated with burnout. An anonymous, online survey incorporating the Copenhagen Burnout Inventory (CBI) was administered to veterinary GPs and EPs practicing in metropolitan regions of Australia. In total, 320 responses were analysed (n = 237, 74.2% GPs and n = 83, 25.9% EPs). Both groups suffered from moderate levels of burnout, but there were no significant differences in the severity of CBI burnout scores between the two groups. From the multivariable analysis four investigated factors were found to be significantly associated (p < 0.05) with the work-related CBI subscale: frequency of finishing work on time; adequate staffing; work satisfaction and seriously considering leaving their principal area of practice. Five factors were significantly associated (p < 0.05) with the client-related CBI subscale: position in practice; frequency of client adherence; work satisfaction; frequency of interacting with emotionally distressed clients and seriously considering leaving their principal area of practice. Four factors were significantly associated (p < 0.05) with the personal burnout CBI subscale: gender; seriously considering leaving their principal area of practice; frequency of interacting with emotionally distressed clients and the workplace environment. The total burnout score was also significantly associated (p < 0.05) with four factors: position in practice, workplace environment, appropriate staffing in the past week and client adherence. Future studies should focus on investigating effective strategies to mitigate these risk factors for both GPs and EPs, to reduce career attrition.

The Making of a Health Profession: How Chinese Medicine Became a Nationally Registered Allied Health Profession in Australia

Abstract In 2012, traditional Chinese medicine (TCM) practitioners in Australia became nationally-registered allied health professionals in three categories: acupuncturist, Chinese herbal medicine practitioner, and Chinese herbal medicine dispenser. Australia was the first Western country to introduce national registration for Chinese medicine, followed by Portugal and, recently, New Zealand. The practice of TCM in Australia can be traced back to the beginning of Chinese immigration to Australia during the Victorian Gold Rush which began in the 1850s. The process which led to national registration commenced in the early 1970s with the establishment of the first acupuncture courses. Decades of gradual development of courses from unaccredited part-time diplomas to accredited bachelor degrees, and the development, by the profession, of national consensus on educational standards were essential elements in the process which led to registration. Professional associations, such as the Australian Acupuncture and Chinese Medicine Association Ltd. (AACMA), also developed a framework of professional self-regulation, including Codes of Ethics, Codes of Conduct, ongoing professional development requirements and Infection Control Guidelines, and provided leadership in the development of the profession. After decades of tribalism and division within the TCM profession, the National Academic Standards Committee brought almost all stakeholders together to reach a consensus on the Australian Guidelines for Traditional Chinese Medicine Education which were published by AACMA in 2001. Professional associations also collaborated on joint submissions to the government in support of registration, which was introduced first in the state of Victoria in 2000, and subsequently became national in 2012. Despite national registration, some barriers still remain, and professional associations continue to lobby the federal government for inclusion in Medicare, chronic disease management scheme, and Veterans Affairs.

Workplace Leadership Development Practices: An Environmental Scan

Effective workplace leadership development programs are considered critical to organizational adaptive capacity and sustainability. The purpose of this exploratory study is to conduct an environmental scan of contemporary practices and approaches to leadership and management development programs in Australian workplaces. An online survey was distributed to a sample of Australian human resource professionals given the field’s strong practitioner orientation. The survey sample includes members of the Australian Human Resources Institute (AHRI), the professional body for human resource professionals and practitioners in Australia. The findings indicate a substantial majority of the current practice is not informed by evidence-based theory or practice. The most commonly used model is 70:20:10, which lacks a coherent evidence base and has been widely criticized for that reason. The findings point to the frequent application of bespoke leadership frameworks and significant theory–practice gaps. While organizations cite “ensuring delivery of business results”, as the main driver for instigating leadership development programs, with support from top management being crucial to the effectiveness and success of leadership development programs/interventions, evaluation and measurement of impact and return on investment remains problematic. Based on these insights, we present a future research agenda for monitoring and evaluating leadership development programs that will build a stronger theoretical foundation to inform evidence-based practice.

Behaviour support provision in Australia: A cross‐sectional survey of practitioners developing behaviour intervention plans

AbstractThere is currently a limited understanding of the characteristics of the workforce of behaviour support practitioners in Australia. A better understanding will help future considerations of training requirements, professional credentialling and associated professional regulation. A cross‐sectional online survey captured the demographic and work‐related characteristics of those who develop behaviour intervention plans for people with disability in Australia. The sample (n = 423) was primarily female (78 per cent), aged 26–45 years (57 per cent) and held a graduate (39 per cent) or postgraduate (53 per cent) degree. The largest single professional group was psychologists (28 per cent). The most common duration of experience was 1 year. Approximately half of the respondents were allied health practitioners either registered with the Australian Health Practitioner Regulation Agency or a member of the National Alliance of Self‐Regulating Health Professionals. The majority of practitioners had registered with the National Disability Insurance Scheme to provide behaviour support services (85 per cent). Both clients and services were concentrated in metropolitan regions, raising concerns regarding equity of access to behaviour support in remote communities, and among Aboriginal and Torres Strait Islanders. Given the vulnerability of many people with disabilities in receipt of behaviour support, ongoing policy and procedure work is needed to ensure professional credentialling and regulation of the workforce.

Need for Recovery among Site-Based Construction Practitioners in Australia: A Latent Class Analysis and Multinomial Logistic Regression

Need for Recovery among Site-Based Construction Practitioners in Australia: A Latent Class Analysis and Multinomial Logistic Regression

The permitting process for marine and coastal restoration: A barrier to achieving global restoration targets?

AbstractTo meet global restoration targets, action is needed at a large scale, and at a high level of ambition. Coastal and marine restoration may be hindered by an array of factors, including governance: in particular, the cost and time associated with obtaining permits. We interviewed a small group of restoration practitioners in Australia to further explore this permitting issue. Our study revealed a deeper problem, with the legal permitting process driving outcomes. Some proponents are turning away from the sites with the highest restoration potential, and instead choosing sites based on the ease of obtaining permits. We also found that the permitting process is only one part of the problem, and progress is also being hampered by onerous post‐approval conditions, including ongoing liability for restorative interventions. Finally, the permitting process stifles innovation and creativity as outcomes are locked‐in at the permit stage. We conclude by highlighting the urgent need to reform legal permitting processes for restoration, as current practice may put the achievement of global restoration targets at risk. It is anticipated that these findings will be of interest to restoration practitioners navigating this space, as well as policymakers.

'Virtually daily grief'-understanding distress inhealth practitioners involved ina regulatory complaints process: a qualitative study inAustralia.

Protection of the public is the paramount aim for health practitioner regulation, yet there has been growing concern globally on the association between regulatory complaints processes and practitioner mental health and wellbeing. The objective was to understand the experience, particularly distress, of health practitioners involved in a regulatory complaints process to identify potential strategies to minimise future risk of distress. Semi-structured qualitative interviews were conducted with health practitioners in Australia who had recently been through a regulatory complaints process, together with a retrospective analysis of documentation relating to all identified cases of self-harm or suicide of health practitioners who were involved in such a process over 4 years. Data from interviews and the serious incident analysis found there were elements of the regulatory complaints process contributing to practitioner distress. These included poor communication, extended time to close the investigation, and the management of health-related concerns. The study found external personal circumstances and pre-existing conditions could put the practitioner at greater risk of distress. There were found to be key moments in the process-triggers-where the practitioner was at particular risk of severe distress. Strong support networks, both personal and professional, were found to be protective against distress. Through process improvements and, where appropriate, additional support for practitioners, we hope to further minimise the risk of practitioner distress and harm when involved in a regulatory complaints process. The findings also point to the need for improved partnerships between regulators and key stakeholders, such as legal defence organisations, indemnity providers, employers, and those with lived experience of complaints processes. Together they can improve the support for practitioners facing a complaint and address the stigma, shame, and fear associated with regulatory complaints processes. This project provides further evidence that a more compassionate approach to regulation has the potential to be better for all parties and, ultimately, the wider healthcare system.

Use of thromboprophylaxis guidelines and risk stratification tools in atrial fibrillation: A survey of general practitioners in Australia

Use of thromboprophylaxis guidelines and risk stratification tools in atrial fibrillation: A survey of general practitioners in Australia

Care, choice, complexities: The circulations of hormone therapy in early menopause

Navigating whether to prescribe hormone replacement therapy (HRT) requires that health practitioners approach a woman’s individual life circumstances, and early menopause (EM) as a particularly intricate experience and condition. Drawing on qualitative interviews with 16 practitioners in Australia, this article examines the modalities of care that emerge in the nexus of EM and HRT. Early menopause emerges in participants’ narratives as far from a ‘unitary’ medical condition, but rather one that reaches across other embodied changes for women which may be moderated by HRT. Thus, different modes of care and tensions surface, and we suggest that these constitute an oscillation between ‘caring for’ and ‘caring with’ in medical practice. This oscillation combines experimentation with and adjustment of HRT, while contending with responsibility, risk and choice, and shared, knowledgeable care. Our goal is not to neatly split ‘caring for’ from ‘caring with’. Rather, we discuss how ambiguities of care circulate through a complex diagnosis and its treatment options. We argue that care, in this context, manifests as potentiality and as a set of flexible practices that at times cannot be fully disentangled from issues of choice and control, and HRT itself.

Disruptive docs: teaching hybrid documentary filmmaking in Australia

ABSTRACT As a documentary educator and practitioner in Australia, ‘truth’ is an area of concern for both my students and I in undertaking the risky capturing and the representation of the lives of others. Documentaries are deceptively difficult to make, especially for the novice, and most especially when considering hybrid non-fiction genre forms. The questions my students pose often centre on how much can they blend reality in the ‘post truth’ moment, and what are the practical and ethical challenges of doing so? This paper urges teachers and makers alike to refer to established documentarians who investigate at truthful depictions that often transcend the didactic recitation of facts. Citing the examples of Conjuring the Rolling Thunder Revue: A Bob Dylan Story (directed by Martin Scorsese, 2019) and The Rehearsal (created by and starring Nathan Fielder, 2022), I present a pragmatic discussion as to how disruptive non-fiction form a pure triadic relationship between participants, audiences, and filmmakers, which necessarily involves the overlap of ethics and creativity. I refer to a recent student hybrid documentary film Bustard Head (directed by Lucy Lakshman, 2021) as an example outcome of this pedagogically oriented approach.