Adaptation of the technology readiness levels for impact assessment in implementation sciences: The TRL-IS checklist.

Background: Intervention development is a critical process in implementation research. There are key stages involved in the process to design, pilot, demonstrate and release a technology or an intervention. The Technology Readiness Level (TRL) is a globally accepted instrument for assessing the maturity of research development. However, the original levels do not fit all, and some adjustments are required for its applicability in implementation sciences. Aims: This study aimed to gather the prior knowledge base on TRL in public and population health research; to develop a standard definition of readiness, and to adapt and validate the TRL to an implementation science context (TRL-IS). Materials and methods: A Mixed methods approach has been followed in this study. A scoping review using the PRISMA extension (PRISMA-ScR) informed a nominal expert panel for developing a standard definition of readiness and to modify the TRL following an ontoterminology approach. Then the maturity of six practical case study examples were rated by ten researchers using the modified TRL to estimate inter-rater reliability, and a group of experts provided final content and face validity and feasibility.This mixed methods study included 1) a scoping review to examine the current literature and develop a knowledge base, identify knowledge gaps and to clarify concepts; 2) the development of a standard definition of 'Readiness' and related terms; and 3) adaptation of the TRL to implementation science and development of a checklist to rate the maturity of applications.A standard definition of readiness and related terms was produced by the core team, and an international nominal group (n = 30) was conducted to discuss and validate the definition and terms, and the location of 'Readiness' in the initiation and early development phases of implementation.Following feedback from the nominal group, the development of the TRL-IS was finalised and a TRL-IS rating checklist was developed to rate the maturity of applications. The TRL-IS checklist was tested using six cases based on real world studies on implementation research.The inter-rater reliability of the TRL-IS was evaluated by ten raters and finally six raters evaluated the content and face validity, and feasibility, of the TRL-IS checklist using the System Usability Scale (SUS). Results: Few papers (n = 11) utilised the TRL to evaluate the readiness of readiness of health and social science implementation research. The main changes in the adaption of the TRL-IS included the removal of laboratory testing, limiting the use of "operational" environment and a clearer distinction between level 6 (pilot in a relevant environment) and 7 (demonstration in the real world prior to release). The adapted version was considered relevant by the expert panel. The TRL-IS checklist showed evidence of good inter-rater reliability (ICC = 0.90 with 95 % confident interval = 0.74-0.98, p < .001) and provides a consistent metric. Conclusions: In spite of recommendations made by national and international research funding agencies, few health and social science implementation studies include the TRL as part of their evaluation protocol. The TRL-IS offers a high degree of conceptual clarity between scientific maturity phases or readiness levels, and good reliability among raters of varying experience. This study highlights that adoption of the TRL-IS framework in implementation sciences will bolster the scientific robustness and comparability of research maturity in this domain.

Social issues, crisis, and care coordination: First responders experience responding to people affected by methamphetamines.

Methamphetamines remain a public health problem due to the extensive burden of illicit drug use on society. Callout events in the pre-hospital environment related to methamphetamine use is increasing. In addition, there has been an increase in reported mental health side effects and breakdown in relationships and social networks. Descriptive phenomenology research design was undertaken and data analysed using thematic analysis. Semi-structured interviews were utilized to collect data exploring the experience of first responders attending callouts to people affected by methamphetamines in the pre-hospital environment. Interviews included paramedics (8) and police officers (10) from across Australia. Overall, participants reported responding to people affected by methamphetamines was complex in nature. Complexity was affected by extensive social circumstances, people presenting in states of crisis, lack of coordinated approach, and unsuitable care environments. The social impact of methamphetamine addiction is extensive. Staff working as first responders have an opportunity to help reduce the social impact and crises, referring people to follow-up care and drug and alcohol support services. Further research is needed to determine if a standardized approach, between first responders and EDs, should be developed to help streamlines services and improve how the individual services respond as a group to people affected by substances.

De-problematising Aboriginal young peoples' health and well-being through their voice: An Indigenous scoping review.

BACKGROUND: The continued use of a deficit discourse when researching Aboriginal and Torres Strait Islander Peoples of Australia is problematic. Understanding and challenging the researchers position and the power of the words they use is important. It will ensure we do not persist in framing Aboriginal and Torres Strait Islander People as a problem to be solved. DESIGN: Indigenist review of the evidence of Aboriginal young people's health and well-being. METHODS: This review was conducted using an Indigenist approach to identify texts which amplified the voices of Aboriginal young people of Australia and presents a narrative summary of their accounts. This review is reported in line with the PRISMA-ScR reporting guidelines. RESULTS: Culture and connection are critical components of Aboriginal young people's health and well-being. Aboriginal young people describe feeling of powerlessness to influence health and well-being of their community, and they understood the risks they and their communities faced. Young people identified the importance of connection to culture, community and Elders as crucial to their social and emotional well-being. CONCLUSION: By harnessing an Indigenous analysis, we were able to reveal a strong counter narrative of strength and resilience within their historical, social, and political contexts through the storied accounts of Aboriginal young people. RELEVANCE TO CLINICAL PRACTICE: Most of the currently available evidence about Aboriginal health and well-being is immersed in deficit discourse. Literature reviews being the foundation of research and informing nursing practice, we call for a purposeful shift towards the adoption of an Indigenist strength-based approach which emphasises the strength and resilience of Aboriginal young people.

Community perspectives on delivering trauma-aware and culturally safe perinatal care for Aboriginal and Torres Strait Islander parents.

BACKGROUND: Since colonisation, Aboriginal and Torres Strait Islander peoples have experienced violence, loss of land, ongoing discrimination and increased exposure to traumatic events. These include adverse childhood experiences which can lead to complex trauma, and are associated with increased incidence of high-risk pregnancies, birth complications and emergence of post-traumatic symptoms during the perinatal period, potentially impacting parenting and leading to intergenerational trauma. The perinatal period offers unique opportunities for processing experiences of trauma and healing yet can also be a time when parents experience complex trauma-related distress. Therefore, it is essential that trauma-aware culturally safe perinatal care is accessible to Aboriginal and Torres Strait Islander parents. AIM: This study aimed to understand community perspectives of what 'trauma-aware culturally safe perinatal care' would look like for Aboriginal and Torres Strait Islander parents. METHODS: Data were collected during a workshop held with predominantly Aboriginal and Torres Strait Islander key stakeholders to co-design strategies to foster trauma-aware culturally safe perinatal care. Data were thematically analysed. FINDINGS: Four overarching themes represent proposed goals for trauma-aware culturally safe care: Authentic partnerships that are nurtured and invested in to provide the foundations of care; a skilled workforce educated in trauma awareness; empowering and compassionate care for building trust; and safe and accessible environments to facilitate parent engagement. CONCLUSIONS: Provision of trauma-aware culturally safe care achieving these goals is likely to enable parents experiencing complex trauma to access appropriate support and care to foster healing in the critical perinatal period.

Key features of a trauma-informed public health emergency approach: A rapid review.

COVID-19 is a major threat to public safety, and emergency public health measures to protect lives (e.g., lockdown, social distancing) have caused widespread disruption. While these measures are necessary to prevent catastrophic trauma and grief, many people are experiencing heightened stress and fear. Public health measures, risks of COVID-19 and stress responses compound existing inequities in our community. First Nations communities are particularly at risk due to historical trauma, ongoing socio-economic deprivation, and lack of trust in government authorities as a result of colonization. The objective of this study was to review evidence for trauma-informed public health emergency responses to inform development of a culturally-responsive trauma-informed public health emergency framework for First Nations communities. We searched relevant databases from 1/1/2000 to 13/11/2020 inclusive, which identified 40 primary studies (and eight associated references) for inclusion in this review. Extracted data were subjected to framework and thematic synthesis. No studies reported evaluations of a trauma-informed public health emergency response. However, included studies highlighted key elements of a "trauma-informed lens," which may help to consider implications, reduce risks and foster a sense of security, wellbeing, self- and collective-efficacy, hope and resilience for First Nations communities during COVID-19. We identified key elements for minimizing the impact of compounding trauma on First Nations communities, including: a commitment to equity and human rights, cultural responsiveness, good communication, and positive leadership. The six principles guiding trauma-informed culturally-responsive public health emergency frameworks included: (i) safety, (ii) empowerment, (iii) holistic support, (iv) connectedness and collaboration, (v) compassion and caring, and (vi) trust and transparency in multi-level responses, well-functioning social systems, and provision of basic services. These findings will be discussed with First Nations public health experts, together with data on the experiences of First Nations families and communities during COVID-19, to develop a trauma-integrated public health emergency response framework or "lens" to minimize compounding trauma for First Nations communities.

Australian medical students' and junior doctors' perceptions of gender discrepancies in obstetrics and gynaecology.

BACKGROUND: There is currently a gender imbalance 85:15 female/male in the intake into specialist training for the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). AIMS: To determine the views and perceptions of Australian medical students, and junior doctors in the first five years of practice, toward obstetrics and gynaecology (O&G) as a career, including whether there are any perceived barriers to the pursuit of such a career. MATERIALS AND METHODS: A semi-structured questionnaire was developed with members of the RANZCOG Gender Equity and Diversity Working Group There were two separate studies: the first involved telephone interviews of medical students across three campuses of a medical school in North Queensland. The second study surveyed junior doctors in Queensland who are members of the Australian Medical Association. Responses were analysed and compared using quantitative and qualitative methods. RESULTS: Both studies found that experiences with O&G as a medical student influenced the decision to pursue O&G as a career. Exclusion from clinical scenarios and difficulty establishing good relationship with midwives within busy birthing suites were some reasons deterring male students from O&G. In addition, students felt poorly informed about the specialty in their preclinical years, affecting their early decisions in choice of specialty. Post-rotation, more female than male students reported positive experiences and were considering O&G as a career. CONCLUSIONS: Both groups see medical student experience as critical in attitudes toward the specialty as a possible career. This experience plays a significant role in encouraging female students toward a career in O&G and discouraging male students. More exposure to the specialty in the preclinical years, and attention to improving clinical rotations for all students, is required.

Rates and Patterns of Australian Emergency Department Presentations of People Who Use Stimulants: A Systematic Literature Review.

The use of illicit stimulants continues to pose a significant challenge to different health sectors. In Australia, four particular stimulants, namely amphetamines and their derivatives, methamphetamine, ecstasy or 3,4-methylenedioxy-methamphetamine (MDMA), and cocaine cause a significant challenge to EDs as managing patients who use stimulants can be labor and resource intensive. While Australian data are available for stimulant-related ambulance attendances and hospitalizations, little is known about ED presentations of people who use stimulants. The aim of this paper is to systematically review the available literature related to the rates and patterns of ED presentations of people who use stimulants in Australia. A search was conducted on EBSCOhost, CINAHL Complete, and PubMed databases, as well as Google Scholar. Search terms consisted of combinations of the following terms: 1) stimulant AND ED AND Australia; 2) stimulants AND emergency presentations OR accident and emergency AND Australia, 3) amphetamine OR methamphetamine OR ecstasy OR cocaine AND ED AND Australia. Articles that met the inclusion criteria were included in the review and subjected to a quality appraisal. Data were extracted from the selected papers, including patient demographics, presentation rates, type of stimulant, reasons for presentations, police or ambulance service involvement, comorbidities, mental health issues, triage codes, admissions, and separations. The results of the review are reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies were eligible if they were English-language peer-reviewed articles published between January 2011 and December 2021 and if they included data on Australian ED presentations of people who use non-prescription illicit stimulants. Studies were excluded if they did not include stimulant-related ED presentations or focused on ED presentations related to prescription stimulants, including Ritalin and Adderall, non-stimulant drugs, or caffeine for attention deficit disorder (ADD) or attention-deficit hyperactivity disorder (ADHD). The selected articles were appraised for quality, rigor, and risk of bias by two authors. The studies were assessed using the Newcastle Ottawa Scale (NOS) for cross-sectional, cohort, and case-control studies depending on the methodology identified in the study. A total of 19 articles were included in this study. Males represented 53 to 85% of ED presentations of people who use stimulants with an age range of 0 to 65 and are more likely to be transported by police or ambulance. People who use stimulants presented to EDs with varying psychological and behavioral concerns such as psychosis, self-harm, suicidal ideations, hallucinations, agitations, and aggressiveness, as well as medical conditions, including heart palpitations, nausea and vomiting, and significant physical injuries.

Comparison of Stimulant-Related Presentations to Victorian Emergency Departments Pre-pandemic and During the COVID-19 Pandemic.

Introduction Victoria, Australia, holds the unenviable record for the longest number of lockdown days in the world (262 days) and some of the most rigid restrictions. The purpose of this study was to determine whether changes in harmful drug use occurred during the pandemic by comparing stimulant-related presentations to Victorian emergency departments before and during the COVID-19 pandemic. Methods A retrospective analysis of data from the Victorian Injury Surveillance Unit was undertaken for two time periods, March 2019 to September 2019 and March 2020 to September 2020. Results The proportion of people presenting to an ED who used methylamphetamine/methamphetamine/amphetamine significantly increased from 2019 to 2020. Conversely, there was a significant reduction in ED presentations among people who used 3,4-methylenedioxy​methamphetamine (MDMA) and ecstasy during the study period. Conclusions COVID-19-related restrictions can affect mental health due to depression, or anxiety, particularly if people also experience loss of employment and income. In addition, mental health issues may affect substance use, including increased frequency of use and dose. This has implications for policy and planning during a pandemic and may be overlooked as the focus is on planning and resources for patients with COVID-19.

"Complexity, safety and challenges: Emergency responders' experience of people affected by methamphetamines".

Providing care to methamphetamine-related callout events in the prehospital environment is often complex and resource-intensive, requiring staff to manage agitation and violence-related side effects of methamphetamines. In Australia, emergency responders are increasingly required to attend events related to methamphetamines, even though reports suggest methamphetamine use across Australia has declined. The aim of the study was to explore Australian police and paramedic experiences attending methamphetamine-related events. A qualitative descriptive phenomenology design was employed using semi-structured interviews with employed police (10) and paramedics (8) from Australia. Data were analyzed using thematic analysis. Participants described the complexities associated with providing prehospital care to people affected by methamphetamines. Participants described associated domestic/family violence, increased levels of violence, challenges with communication, and responder emotional and psychological distress and physical injury. Violence associated with methamphetamine use is a critical factor in prehospital care. Workplace violence and family/domestic violence are important issues that require further research to ensure families and staff are well supported and have the services they need to continue responding to people affected by methamphetamine use.

Mixed Methods Study Integration: Nursing student experiences and opinions of intentional rounding.

AIMS: To explore pre-registration nursing students' understandings and experience of intentional rounding in education and clinical sectors. Intentional rounding is a patient safety intervention used in clinical settings to regularly check and document patients' welfare and environment throughout the course of a shift. DESIGN: An explanatory sequential mixed methods design using convenience sampling was used for this study, with an underlying pragmatic paradigm. Integration occurred in the design, methods, implementation and reporting phases of the study. METHODS: Data were collected between August 2017 and August 2018 using a previously validated Nursing Perceptions of Patient Rounding quantitative online survey followed by individual qualitative interviews using the same cohort. RESULTS: Using the Pillar Integration Process, this paper displays and discusses the final results. The integration and mixing throughout the study generated insights into the perceived benefits of intentional rounding for nursing students and patients but also indicated a theory-practice gap that affects nursing students' confidence in undertaking this intervention. CONCLUSION: Students find this patient safety intervention helpful, but further clarity in the education surrounding it is required. IMPACT: This study addresses pre-registration nursing students' understanding and perceptions of intentional rounding. Intentional rounding benefits nursing students as a patient safety strategy and organization tool. Educational opportunities around the topic could be enhanced, reducing the ongoing theory-practice gap. Clinicians, academics and educators who support pre-registration nursing students in clinical and tertiary education settings can benefit from this work.

Induced abortion in Papua-New Guinea: Experience and opinions of health professionals.

BACKGROUND: Papua-New Guinea (PNG) has one of the highest maternal mortality rates in the world; complications due to unsafe abortion are an important cause. Abortion laws are restrictive, and safe, induced abortions are unavailable to the majority of women, while unsafe abortions are known to be practised throughout the country. The topic of abortion is stigmatised, for women and health professionals. AIM: To conduct a study of PNG health professionals' experience of induced abortion and their views on the provision of safe, accessible abortion services for PNG women. MATERIALS AND METHODS: A questionnaire developed from similar surveys conducted in Australia and New Zealand was distributed in 2017 to doctors working in provincial hospitals of the public health system; in 2020, the questionnaire was distributed to doctors and nursing staff in Port Moresby General Hospital, and to medical, nursing and health sciences students in the University of Papua-New Guinea. RESULTS: Significant numbers of senior medical officers and nurses reported experience of women presenting following unsafe induced abortion. There was wide variation across all respondents with regard to accurate knowledge of PNG's abortion laws, and to views on the provision of safe accessible abortion services in the country's public health system. CONCLUSIONS: Abortion training for service providers and provision of primary care services are necessary to ensure that PNG women have equitable access to abortion care instead of seeking out untrained providers or attempting self-abortion. Innovative approaches also need to be adopted to complement family planning efforts in PNG.

Clinical experience of trainees of The Royal Australian and New Zealand College of Obstetricians and Gynaecologists in insertion of long-acting reversible contraceptives.

BACKGROUND: Long-acting reversible contraceptives (LARCs) include both progestogen-containing implants and intrauterine devices releasing either a progestogen or copper, providing highly effective contraception. Increasing uptake of LARCs is advocated by governments and professional organisations as an important strategy to reduce unintended pregnancy; such uptake requires, among other measures, adequate training of doctors in the areas of obstetrics and gynaecology and women's health. AIMS: To assess The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) trainees' (Fellowship, Diploma or Certificate of Women's Health) experience and training in insertion and removal of LARCs. MATERIALS AND METHODS: An invitation email to participate in an anonymous survey approved by the Continuing Professional Development Committee of RANZCOG was sent to all current RANZCOG trainees in the three categories. The responses were categorised and analysed. RESULTS: Of 1686 invited trainees, 294 (17.4%) responded: 250 in Australia and 44 in New Zealand; 127 were undertaking Fellowship training (8.3% of those invited) and 166 (100% of those invited) were undertaking training for the Diploma (either DRANZCOG and DRANZCOG Advanced) or the Certificate of Women's Health. Significant numbers of all categories of trainees had no or limited experience of insertion or removal of LARCs of all types and/or lacked self-confidence in LARC provision. CONCLUSION: RANZCOG needs to address this training deficiency to continue as the leader in Australia in the provision of women's reproductive healthcare.

Understanding the Impact of Historical Trauma Due to Colonization on the Health and Well-Being of Indigenous Young Peoples: A Systematic Scoping Review.

Introduction: Indigenous Peoples are experiencing the ongoing effects of colonization. This phenomenon, historical trauma (HT), helps to address the current ill-health disparity. Aim of this scoping review was to identify sources of evidence available to understand the impact of HT on Indigenous young peoples. Method: A scoping review was conducted on available evidence-based literature. Article quality was assessed using validated quality appraisal tools. Synthesis was conducted with predefined levels of impact. Results: Consistent with the literature, the themes and levels of impact were interrelated. Despite this, studies predominately reported a singular focus with limited discussion of protective factors. Discussion: HT continues to have a profound impact on Indigenous young peoples across Canada, Australia, New Zealand, and the United States. Protective factors for HT were evident within Indigenous research designs. Future research should ensure a multilevel focus to explore intergenerational strength and how this influences culturally congruent health care.

Nurse and patient satisfaction with intentional rounding in a rural Australian setting.

AIMS AND OBJECTIVES: To compare nurse and patient satisfaction with intentional rounding in a rural Australian hospital setting and examine which aspects of care predict satisfaction. BACKGROUND: Intentional rounding is a systematic process used by healthcare professionals to anticipate and address the fundamental needs of hospitalised patients. Despite a wealth of literature about nurse and patient satisfaction with intentional rounding, no studies have compared nurse and patient satisfaction, and little is known about intentional rounding in a rural setting. DESIGN: A cross-sectional study was undertaken with nursing staff and patients at a rural hospital and reported in accordance with STROBE guidelines. METHODS: Nurses (n = 63) and patients (n = 66) were invited to complete the Patient Satisfaction Survey between April and June 2018. Nurse and patient responses were compared and predictors of nurse and patient satisfaction with intentional rounding care were determined using generalised estimating equation models. RESULTS: Both nurses and patients positively rated satisfaction with all aspects of nursing care provided and received through intentional rounding. Nurses' satisfaction with care provided to patients through intentional rounding was predicted by interest in patients' feelings about their care. Patient satisfaction with the care they received whilst hospitalised was predicted by the ability to see a nurse when they needed to, the provision of pain relief when needed, feeling comfortable and safe, and the perception that nurses were interested in their feelings about their care. CONCLUSION: Intentional rounding is a means for nurses to regularly attend to patients' emotional and physical needs, which is central to patients feeling safe and cared for whilst hospitalised. RELEVANCE TO CLINICAL PRACTICE: Intentional rounding practices ensure that patients feel genuinely cared for by nursing staff whilst hospitalised and can improve nurse and patient interactions, satisfaction and outcomes.

Pre-registration nursing students' perceptions and experience of intentional rounding: A cross-sectional study.

This paper examines pre-registration nursing students' perceptions of the practice of intentional rounding and perceived benefits for nurses and patients. Intentional rounding was developed to ensure nursing staff regularly check on patients to ensure that all care needs are met. It has been linked to a reduction in falls and call bell use, and an increase in patient safety. No previous studies have examined pre-registration nursing students' role in the practice of intentional rounding during clinical placements nor the perceptions of rounding practices, important from a future workforce perspective. A cross-sectional multisite study was undertaken, and pre-registration nursing students completed the Nurses' Perceptions of Patient Rounding Scale between August 2017- June 2018, distributed using online education platforms and email. Strobe reporting guidelines were used to report findings. Participants perceived positive benefits in intentional rounding for nurses and patients. Mixed opinions surrounded the sufficiency of education received around the intervention. Previous nursing experience was linked to opposing opinions of intentional rounding, depending on education levels. Participants had a positive perception of intentional rounding practices overall. Education surrounding intentional rounding needs to be consistent, and introduced before students are expected to actively participate in the practice of rounding on clinical placement.

Views and practices of induced abortion among Australian Fellows and trainees of The Royal Australian and New Zealand College of Obstetricians and Gynaecologists: A second study.

OBJECTIVES: Knowledge of current practices of abortion is important for planning of health services in Australia and for future training. AIMS: To conduct an online survey of the Fellows and specialist trainees of RANZCOG regarding their views and practices of induced abortion and compare these with results of a similar study from 2010. METHODS AND MATERIALS: A questionnaire was distributed to Australian Fellows and specialist trainees. Data collected were descriptively analysed and thematic analysis used for free comments. RESULTS: Approximately 25% of those emailed responded (632 of 2542); 13.7% reported total opposition to abortion on religious or conscientious grounds; the remainder did not. 83.5% believed that abortion should be part of general obstetric and gynaecological practice; 90% believed that education about abortion should be part of the curriculum for RANZCOG trainees. 92% supported public hospital provision of abortion services. A range of views was explored using thematic analysis. DISCUSSION: While a majority of Fellows and trainees do not hold religious or conscientious objections to abortion a significant minority do; this has changed little since 2010. Many respondents distinguish between 'medical' and 'social' indications for abortion although definitions of 'social' appear variable. There was strong support for the inclusion of abortion in the Fellowship training curriculum. CONCLUSION: Although the response rate was lower than for the 2010 survey participants expressed strong support for the provision of abortion services in the public sector in Australia, and for incorporation of information about abortion in the training curriculum for Fellowship of RANZCOG.