Uncovering Complexities in Reducing Aggression, Conflict and Restrictive Practices in Acute Mental Healthcare Settings: An Overview of Reviews.

Aggression, conflict and restrictive practices present complexities in acute mental health services, as do implementing service changes to reduce them. Existing published literature needs to offer more high-level guidance on the effectiveness of these service changes and their associated implementation factors. As a result, an overview of systematic reviews was undertaken to identify (i) nonpharmacological interventions to reduce conflict, aggression and restrictive practices in acute mental health settings, and (ii) their effects across different clinical outcomes. A parallel re-extraction from primary studies was then utilised (iii) to identify factors influencing successful intervention implementation. Of 124 articles sourced from nine databases and registries, four reviews were retained for the final analysis, using the direction of effect and tabular and narrative summaries. These reviews included programmes or interventions focused on inpatient adolescent, adult and older adult populations. They reported on alternative containment strategies, risk assessments, Safewards, sensory rooms and equipment, Six Core Strategy-based interventions and staff training. The overview found that a combination of interventions intended to improve relationships and reduce interpersonal conflict may help reduce aggression, conflict and restrictive practices. At the same time, stand-alone staff training and sensory rooms and equipment may have mixed effects. The quality of the evidence linking these interventions to reductions in aggression, conflict and restrictive practices is limited. Successful implementation hinges on multiple factors: intervention characteristics, preparation and planning, evaluation and monitoring, outcome interpretation, stakeholder involvement/investment, staff-related factors and contextual factors. Any implementation initiative may benefit from using pragmatic and complexity-informed research methodologies, including integrating meaningful involvement with service users, peer workers and culturally diverse groups.

Workforce strategies to address children's mental health and behavioural needs in rural, regional and remote areas: A scoping review.

INTRODUCTION: Children living in rural, regional and remote locations experience challenges to receiving services for mental illness and challenging behaviours. Additionally, there is a lack of clarity about the workforce characteristics to address the needs of this population. OBJECTIVE: To scope the literature on the rural, regional and remote child mental health and behavioural workforce and identify barriers and enabling mechanisms to mental health service provision. DESIGN: A scoping review utilising the Joanna Briggs Institute methodology. A database search was undertaken using Medline, CINAHL, PsycINFO, ProQuest and Scopus to identify papers published 2010-2023. Research articles reporting data on mental health workforce characteristics for children aged under 12 years, in rural, regional or remote locations were reviewed for inclusion. FINDINGS: Seven hundred and fifty-four papers were imported into Covidence with 22 studies being retained. Retained studies confirmed that providing services to meet the needs of children's mental health is an international challenge. DISCUSSION: The thematic analysis of the review findings highlighted four workforce strategies to potentially mitigate some of these challenges. These were: (1) The use of telehealth for clinical services and workforce upskilling; (2) Role shifting where non mental health professionals assumed mental health workforce roles; (3) Service structure strategies, and (4) Indigenous and rural cultural factors. CONCLUSION: A range of potential strategies exists to better meet the needs of children with mental health and behavioural issues. Adapting these to specific community contexts through co-design and production may enhance their efficacy.

Promoting speaking-up behaviours among nurses working in the care for older people: A scoping review.

AIM: To explore interventions employed to foster speaking-up behaviours of registered nurses (RNs) working in the care of older people. DESIGN: Scoping review. METHODS: The updated Joann Briggs Institute scoping review methodological guidelines were followed. DATA SOURCES: CINAHL, PubMed, PsycINFO, and Scopus were searched. RESULTS: A total of 1691 titles and abstracts were screened, resulting in 11 articles that met the inclusion criteria. Analysis focused upon intervention types, methodologies, speaking up strategies, barriers and effectiveness. Education was the most used intervention. CONCLUSION: There is a lack of published research on successful interventions to promote speaking-up behaviours in the care of older people, particularly relating to poor care practices. Evidence of speaking-up interventions in the residential aged care setting is absent. This highlights the need to develop strategies to support the RN to lead and enable others to raise care concerns. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Developing strategies that enable staff, care recipients and their families to speak up about care concerns is a vital future area for nursing practice development. Nursing leadership of such strategies is central to improving the quality of care for older people, particularly those living in residential aged care. IMPACT: Older people receiving care should feel respected and be treated humanely. Evidence suggests this is often not the case. This review found a paucity of interventions to promote speaking-up about poor care practices among RNs working in the care of older people. Future research needs to address this, to empower RNs and improve the care afforded to older people. REPORTING METHOD: The PRISMA-ScR (Tricco et al., Annals of Internal Medicine, 169, 467-473, 2018) were adhered to throughout this scoping review. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution in this review.

In their own words: Mental health nurses' experiences of trauma-informed care in acute mental health settings or hospitals.

Trauma-informed care has emerged as a prominent strategy to eliminate coercive practices and improve experiences of care in mental health settings, with advocacy from international bodies for mental health reform. Despite this, there remains a significant gap in research understanding the integration of trauma-informed care in mental health nursing practice, particularly when applied to the acute mental health or hospital-based setting. The study aimed to explore the experiences of mental health nurses employed in acute hospital-based settings from a trauma-informed care perspective. The study design was qualitative, using a phenomenological approach to research. A total of 29 nurses employed in acute mental health or hospital-based environments participated. Three over-arching themes were uncovered: 'Embodied Awareness': highlighting mental health nursing emotional capabilities are deeply rooted in bodily awareness. 'Navigating Safety': signifying spatial elements of fear and how some mental health nurses' resort to coercive or restrictive practices for self-preservation. 'Caring Amidst Uncertainty': revealing the relational influences of security guards in mental health nursing. The study reveals a significant gap in trauma-informed care implementation when applied to the context of mental health nursing practice in this setting. Limited evidence on trauma-informed care for mental health nurses, coupled with inadequate workforce preparation and challenging work environments, hinder the effective integration of it. To genuinely embed TIC in acute mental health settings, the study emphasises the need for a thorough exploration of what this entails for mental health nurses.

More Than Just Movement: Exploring Embodied Group Synchrony During Seated Dance for Older Adults Living in Residential Aged Care Communities.

One in six people in Australia are aged over 65, with many older adults currently living in residential aged care communities (RACC). Fostering meaningful human connection through social activities, such as dance, is imperative to maintain or improve the quality of life in these settings. Drawing from an embodied cognition framework, this mixed-methods study explored synchrony during a seated dance program with 15 older adults living in a RACC. Qualitative video content analysis was used to code movement, language and music cooccurrences, resulting in five group synchrony labels. Hierarchical Cluster Analysis (HCA) was then employed to distil ten higher-order forms of embodied group synchrony. Using existing neurocognitive evidence, we detail the therapeutic and interpersonal implications of the most prominent forms of embodied group synchrony. These findings can be used to choreograph therapeutic forms of embodied group synchrony in dance programs with older adults.

Implementing intimate partner violence (IPV) screening within emergency departments - Barriers, challenges and enablers experienced by intimate partner violence practice change champions.

AIM: To identify the barriers, challenges, and enablers that clinical champions experience whilst implementing Intimate Partner Violence (IPV) screening within Emergency Departments (EDs). BACKGROUND: Champions support the introduction of IPV screening within EDs. This paper shares new knowledge about IPV practice change champions: barriers, challenges and enablers they experienced in their efforts. DESIGN: Between 2017-2019, semi structured qualitative interviews were conducted with 23 individuals who identified as champions, working to introduce routine IPV in two rural tertiary hospital Emergency Departments. An interpretive framework and process of constant comparison was used to thematically analyse data from transcribed interviews. RESULTS: Champions identified barriers, challenges, and enablers that they experienced. Enablers included: support for the work of champions; champion leadership and collegiality; and training for the champion role. Challenges and Barriers included: resistance to a change in the focus of practice; and workflow and workload. CONCLUSIONS AND IMPLICATIONS: Nurse champions can effectively support IPV practice change but face certain barriers, challenges and enablers. Nurse managers can use this information to support champions to undertake their role effectively in order to better meet the needs of individuals experiencing IPV.

Reproductive and sexual health effects of intimate partner violence: A longitudinal and intergenerational analysis.

OBJECTIVE: To examine the prevalence, pattern and predictors of sexual and reproductive adversity among Australian women who report intimate partner violence (IPV). METHODS: Repeat measure design employing two cohorts (born between the years of 1973-78 and 1989-95) from the National Australian Longitudinal Study on Women's Health. Logistic regression was employed to examine the effects of reported IPV exposure on sexual and reproductive outcomes. The analysis conducted throughout 2021-2022 investigated both longitudinal prevalence and outcomes, and the intergenerational differences between these cohorts. RESULTS: IPV exposure was associated with increased odds of experiencing a range of sexual and reproductive health outcomes, including STI, endometriosis, infertility, termination and miscarriage, which increased with greater exposure to IPV. Our longitudinal results suggest a dose-dependent effect of IPV on STI outcomes. Significant intergenerational trends were also identified in the nature of IPV exposure and dependent outcomes. Sexual orientation had a significant predictive value for IPV, with women who identified as bisexual significantly more likely to report IPV (OR = 2.91, 95% CI). CONCLUSION: Women who experience IPV are at significant risk of adverse sexual and reproductive outcomes. Healthcare professionals working with women who have diagnosed sexual and reproductive issues should inquire about IPV. Likewise, women who are exposed to IPV should undergo sexual and reproductive healthcare assessments, along with appropriate preventive measures, to assure sexual health. Future research should explore in greater detail the association between IPV and the sexual and reproductive outcomes among sexual minority women.

Trauma-informed care in acute mental health units through the lifeworld of mental health nurses: A phenomenological study.

Trauma-informed care has gained increasing popularity in mental health services over the past two decades. Mental health nurses remain one of the largest occupations employed in acute mental health settings and arguably have a critical role in supporting trauma-informed care in this environment. Despite this, there remains a limited understanding on how trauma-informed care is applied to the context of mental health nursing in the hospital environment. The aim of this study was to explore what it means for mental health nurses to provide trauma-informed care in the acute mental health setting. The study design was qualitative, using van Manen's (Researching lived experience: human science for an action sensitive pedagogy. State University of New York Press, 1990) approach to hermeneutic phenomenological inquiry. A total of 29 mental health nurses participated in this study. There were three overarching themes that emerged; these entail: embodied trauma-informed milieu, trauma-informed relationality and temporal dimensions of trauma-informed mental health nursing. The study found that for mental health nurses, there are elements of trauma-informed care that extend far beyond the routine application of the principles to nursing practice. For mental health nurses working in the acute setting, trauma-informed care may offer a restorative function in practice back to the core tenants of therapeutic interpersonal dynamics it was once based upon.

Process mining the trajectories for adolescent-to-mother violence from longitudinal police and health service data.

AIM: The aim was to discover longitudinal trajectories and patterns of events preceding adolescent-to-mother family violence in a geographic locale in Australia. DESIGN: This was a retrospective case series. METHODS: Routinely collected administrative data were sourced and linked from police and health service electronic records for adolescents born between 1994 and 2006 who had been issued a legal action for a family violence-related offence (n = 775). A time-stamped log of events from birth (where available) was created. Process mining was employed to discover dominant events and trajectories in the log from birth until adolescents' first recorded offence against their mother. RESULTS/FINDINGS: Most adolescents in the case series offended against mothers (63%, n = 486). Trajectory analysis confirmed dominant early childhood events were repeated exposure to parental intimate partner violence (P-IPV), parental drug and/or alcohol use and neglect. During early adolescence, pathways towards adolescent-to-mother violence involved other offending, drug and/or alcohol use and mental health service contact. CONCLUSION: The trajectories evidenced provide a complex picture of the emergence of adolescent-to-mother violence. From an early intervention perspective, it was found that many children and mothers were identifiable from police records in early childhood, at an average age of 35 months. Responses to adolescent family violence need to acknowledge the impact of childhood trauma and emerging mental health problems, along with strategies to mitigate the effect of P-IPV on mother-to-child relationships. IMPACT: This is the first large-scale study to specifically examine trajectories from birth for adolescents who engage in violence towards mothers. The findings have important implications for the design and delivery of early intervention childhood services and interagency collaboration in nursing and midwifery services. In early adolescence, contact with mental health services represents an opportunity for screening and support interventions. This is an important preventive timepoint for family violence, adolescent drug and alcohol use and other offences.

Parenting interventions targeting early parenting difficulty: A scoping review.

Parent and child wellbeing are reciprocal. Attentive, responsive parenting, is contingent on parental wellbeing. Insights into mechanisms of early parenting interventions that seek to improve parent and child outcomes are needed. This scoping review aimed to systematically map research reporting on parenting interventions for parents experiencing early parenting difficulty. A secondary aim was to synthesise existing research using a realist lens, to provide context, mechanism and outcome insights into elements of early parenting interventions. A systematic search was conducted across six databases within the publication period of 2010-2020, to identify evidence on interventions targeting early parenting difficulty. Using pre-determined inclusion criteria, fifteen studies were selected for review. Deductive reflexive thematic analysis identified three themes: conceptual disparities in early parenting difficulty, early parenting intervention diversity and an absence of theory to explain interventions or outcomes. Neither early parenting difficulty nor the theoretical basis for early parenting interventions were well defined. Identification of contexts, mechanisms and outcomes of early parenting interventions is a unique contribution of this study. These insights may be used to inform planning, implementation and evaluation activities to promote context-focused, early parenting interventions targeting a critical phase of child development.

The role of champions in leading domestic violence and abuse practice improvement in health care: A scoping review.

AIM: To describe and synthesize evidence for champions of domestic violence practice improvement in health care and highlight implications for leadership and nurse management. BACKGROUND: Globally, health care leaders have been tasked with improving service responses to domestic violence. Evidencing the role of champions, and how managers may harness champions in improving responses to domestic violence, is an important factor in successfully leading change in this field. EVALUATION: A scoping review was conducted using four electronic databases (Proquest, PubMed, Medline and PsycINFO). KEY ISSUES: Eleven studies were included. Champion characteristics, roles, and factors influencing their impact were distilled. Barriers to the success of champions were identified as were four aspects of the champion role: mentor and expert advice; communication and engagement; strategic advocacy, coordination and project leadership; personal and emotional support. CONCLUSIONS: The review highlighted that champions involved in domestic violence project implementation have unique aspect to their role, along with characteristics reported in the broader champion literature. As an emerging field, there is evidence that domestic violence champions play an important role in mentoring and supporting health care workers to effectively change their practice. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers and leaders need to understand the champion construct and the roles that champions enact to generate domestic violence and abuse system and practice change. Further research is required to provide guidance.

Pressure injuries and skin tone diversity in undergraduate nurse education: Qualitative perspectives from a mixed methods study.

AIMS: To, firstly, explore student and academic nurse perceptions of classroom content about the assessment and identification of pressure injuries across skin tone diversity and, secondly, to describe the impact of classroom content on student nurse understanding of pressure injury in people with dark skin tones. DESIGN: Qualitative case study employing focus groups and semi-structured interviews. METHODS: Five higher education institutions in the United Kingdom were purposively chosen. At each of the five-case sites, one focus group with student nurses and one semi-structured interview with a nurse academic were conducted between May 2018 and April 2019. The participants' narratives were transcribed verbatim and analysed via thematic analysis. RESULTS: Classroom learning was predominately framed through a white lens with white normativity being strongly reinforced through teaching and learning activities. This reinforcement of white normativity was evidenced through two main themes: (i) dominance of whiteness in the teaching and learning of pressure injuries in undergraduate nurse education and (ii) the impact and implications for student nurses of whiteness as the norm in pressure injury teaching. CONCLUSION: Nurses responsible for the design and delivery of teaching and learning experiences for nursing students need to ensure meaningful teaching and learning experiences. This learning should assist future nurses to interrogate their complicity in a system of white dominance. IMPACT: Nurse education delivered today influences and shapes nurses of the future. Nurses are the cornerstone of healthcare and play a significant role in the delivery of equitable healthcare. Nurse academics have a duty of care to inform and highlight health inequities in nursing and ultimately to enhance equity in care.

An aged life has less value: A qualitative analysis of moral disengagement and care failures evident in Royal Commission oral testimony.

AIMS AND OBJECTIVES: To identify common themes about care failures in residential aged care as described from the perspectives of older people and their families in transcripts from hearings and submission to the Australian Royal Commission. These failures are explored through the lens of moral disengagement. BACKGROUND: Previous inquiries into care failures have highlighted widespread harm from inhumane care, caused by staff carelessness, indifference and callousness. In health care, limited consideration has been given to the moral engagement or disengagement of staff and the relationship of moral engagement with care failures. METHOD: Qualitative latent content analysis of 22 transcripts from the Royal Commission between March 2020-August 2020. Methods are reported using the SRQR. RESULTS: This paper presents one theme, Dehumanisation of the care process: An aged life has less value, from a larger study. Care failures relating to morally disengaged staff were found to be widespread and influenced by the environments created by organisations. CONCLUSION: This study highlights the need for further research to identify indicators of moral disengagement among staff and explore strategies to reduce or prevent moral disengagement within organisations trusted with providing care to older people. RELEVANCE TO CLINICAL PRACTICE: Caregiving is necessarily associated with, and shaped by, moral dimensions. The erosion or disengagement of these moral dimensions among care staff reveals important aspects of residential aged care's lived experience. Studying dynamics within aged care facilities can provide a useful analytic lens for illuminating ways that residents and their family or those close to them, experience or are impacted by moral dimensions and behaviours.

Patient perspectives and experiences of sexual health conversations and cardiovascular disease: A qualitative study.

AIM: This study aimed to explore the experiences of individuals discussing sexual well-being with healthcare professions within the context of their cardiac illness to determine their sexual health information needs. BACKGROUND: Cardiovascular disease is the leading cause of morbidity and mortality worldwide and known to have a detrimental impact on sexual health. Despite sexual health being recognised as a fundamental component of well-being, it may be a neglected aspect of care within the context of cardiovascular disease. DESIGN: A qualitative exploratory study conducted in accordance with COREQ guidelines. METHODS: We conducted semi-structured interviews with participants (n = 13) aged between 30-77 years who had been diagnosed with a cardiovascular disease. Data were transcribed and subject to thematic analysis. RESULTS/FINDINGS: Analysis revealed two major themes-Sexual healthcare information and expectations: I expect them to tell me and Experiences of sexual adversity: it's really scary. Although participants expected and welcomed information in relation to their illness and sexual health, this was rarely received. Subsequently, when some participants experienced sexual adversity including erectile dysfunction, they felt anxious and distressed which impacted their intimated relationships. It was often when participants sought information associated with adversity that information was provided and this was primarily in relation to medication associated with assisting dysfunction. CONCLUSION: Individuals who have cardiovascular disease may require sexual health care. Nurses are well placed to provide information and education associated with cardiovascular disease and associated sexual well-being to promote positive outcomes for individuals and minimise distress around sexual adversity. RELEVANCE TO CLINICAL PRACTICE: Findings highlight the importance of providing clear and accurate information about sexual well-being and function to patients experiencing cardiovascular disease. Provision of information should be considered an essential and routine aspect of care with patients being afforded opportunities to discuss concerns associated with their sexual well-being.

Evidencing diversity: development of a structured tool for investigating teaching of pressure injury on people with darker skin tones.

BACKGROUND: Dismantling structural racism challenges nurses to consider the extent to which issues of inclusion, diversity and race are operationalised in day-to-day professional practice. This includes nurse education. To be truly effective, any examination of teaching content in nurse education needs to be investigated through document analysis plus observation in the classroom. However, tools to ensure consistency between these methods of collecting data are limited. AIM: To design a structured tool for collecting data by analysing teaching materials and observing teaching on pressure injuries and people with darker skin tones. DISCUSSION: This novel approach of using a single tool provides a unique opportunity to explore teaching materials and what is actually taught in the classroom. The data collected can assist with comparative analysis, enabling an in-depth view of curriculum content. CONCLUSION: The nuanced and subtle data gathered using the complementarity of analysis between teaching materials and teaching observations in the exemplar tool presented created a unique data set for examination. IMPLICATIONS FOR PRACTICE: This tool has broad applications for nurse researchers, particularly for examining topics that are often perceived to be sensitive, such as race and skin tone. It can be used for in-depth scrutiny of classroom teaching, to develop and influence curriculum content and team discussions, and in larger studies exploring nurse education content.

"Can mental health nurses working in acute mental health units really be trauma-informed?" An integrative review of the literature.

WHAT IS KNOWN ON THE SUBJECT?: The lifetime prevalence of trauma for consumers of mental health services is high. Both nurses and consumers of mental health services experience trauma and re-traumatization in mental health units. TIC is a model of care or approach increasingly used in mental health units to guide nursing actions to minimize trauma and re-traumatization for those working and accessing mental health services. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Overall, there is poor quality of studies exploring TIC in acute mental health units from the perspective of the MHN. Acute mental health units have competing organizational demands that can often be a source of conflict for nurses providing TIC. To be trauma-informed, a critical examination of the dynamic and unique system-related processes in mental health units is required. TIC literature reveals that nurses are seeking to develop the basic skills expected to be gained in earlier preparatory education to respond therapeutically to consumers. Not all MHNs agree that TIC is necessarily a new or useful model to inform their practice. Trauma and re-traumatization experienced by MHNs can be a source of conflict for TIC in the mental health unit environment. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The broader environmental and organizational demands placed on nurses can create professional and moral conflict for providing TIC. TIC should acknowledge trauma and re-traumatization experienced by MHNs in the acute mental health units. ABSTRACT: INTRODUCTION: Trauma-informed care (TIC) is an approach that mental health inpatient units are increasingly adopting, with mental health nurses (MHNs) being the largest occupational group working this area. AIM: To critically examine the literature on TIC in mental health inpatient units from a MHN perspective. METHODS: Primary studies examining TIC in mental health inpatient units from a MHN perspective were examined in CINAHL, Medline and PsycINFO database including the reference lists of primary sources. A total of n = 10 studies met the inclusion criteria with four themes identified. DISCUSSION: There is a paucity of quality research available on TIC to guide MHNs employed in mental health inpatient units. The review has highlighted that MHN practice is influenced by the medical model ideology and competing organizational demands that can at least partially negate the effective provision of TIC. IMPLICATIONS FOR PRACTICE: For purposeful application of TIC, the parallel and often unconscious organizational processes that exist for MHNs working in mental health units must too be examined. RELEVANCE STATEMENT: The review invites an opportunity for important reflections by MHNs employed in mental health units. TIC may help restore MHN practice to the interpersonal tenants the profession is best distinguished by.

Embedding skin tone diversity into undergraduate nurse education: Through the lens of pressure injury.

OBJECTIVE: To explore health disparity in on-campus undergraduate nurse education through the analysis of teaching and teaching material exploring pressure injuries. BACKGROUND: As a discipline, nursing espouses ideologies of inclusion, equity and valuing diversity. However, little is known about how these ideologies translate into clinical care. Pressure injury prevention is a routine aspect of nursing care; yet, there is evidence of inequity in relation to clinical care and patient assessment, as people with darker skin tones have a higher prevalence of severe pressure injuries before detection of damage occurs. Despite limited literature being available surrounding the topic of pressure injuries and skin tone diversity, it remains the responsibility of nurse educators to address contemporary issues and health disparity within the nursing curriculum. DESIGN: A multiple method collective case study. The STROBE checklist was followed in reporting this study. METHODS: Documentary and observational data of lectures regarding pressure injuries were collected during 2017 and 2018 from five Higher Education Institutes in England delivering approved nursing undergraduate programmes. RESULTS: Documentary analysis confirmed all Higher Education Institutes overwhelmingly directed teaching and learning activities about pressure injury towards people with Caucasian skin tones. Observation of teaching indicated all teaching sessions only contained brief, separate and superficial information on people with pressure injuries and darker skin tones. There was no discursive language or awareness of colour or colour blindness. CONCLUSION: Radical critique of all teaching and learning activities needs to occur, to help explore, improve and meaningfully and authentically include diversity and inclusivity in nurse education, and in particular, how people across the skin tone spectrum are included and represented in teaching and learning activities. RELEVANCE TO CLINICAL PRACTICE: Critical examination of current teaching practice is crucial to address disparity and ensure care for people with darker skin tones is optimised. Nurse educators have a responsibility to educate for the care needs of all, as the quality of nurse education has a direct impact on care delivery and health disparity. This paper highlights the importance of addressing skin tone diversity and offers the opportunity for reflective practice, not just in formal education, but in clinical settings by preceptors and senior staff.

The impact of caregiving on the health status of regional carers in Australia: Findings from a mixed-method study.

While it is known that informal carers provide the majority of caregiving in Australia, there remains limited understanding of the challenges that regional carers face in their caring role and the impact of the caregiving role on carer well-being. OBJECTIVE: The aim of this study was to better understand the health status of caregivers as the person they care for was entering the National Disability Support Scheme. DESIGN: This is a mixed-methods study. SETTING: The study was undertaken in regional New South Wales, Australia. PARTICIPANTS: Seventy-five carers were enrolled into the study. All lived in regional New South Wales. MAIN OUTCOME MEASURE: The World Health Organization Well-being Index was used for quantitative data collection, and semi-structured interviews were undertaken for the collection of qualitative data. RESULT: Quantitative data indicated that carers from Aboriginal or Torres Strait Islander backgrounds and those from low socio-economic status had significantly lower scores on the well-being index. Two key qualitative categories were evident describing carer's journey to resilience by (a) adjusting to reality predominantly through cognitive reframing strategies and (b) carers accessing external supports. CONCLUSION: The health status of regional carers who are predominantly women is experiencing low levels of well-being. While many of these carers have initiated successful coping responses to the challenges of caring, there is an urgent need to increase the supports available to this population. As the recent National Disability Support Scheme is embedded, it is of importance to monitor if there are improvements in the health status of carers over time.