Co-designing restrictive practice elimination: A systems thinking approach with mental health service users and practitioners in rural/regional Australia.

Elimination of restrictive practices (physical/mechanical restraint and seclusion) from adult acute mental health care services has been demanded internationally for many decades. This study aimed to: (1) Identify priority issues in the elimination of and use of alternative approaches to restrictive practices (seclusion and physical/mechanical restraint) in rural/regional acute adult mental healthcare services, as told by mental healthcare service users and practitioners, (2) identify the community-based, system-level feedback loops that enhance or reduce the use of restrictive practices and viable alternatives and, (3) identify potential action areas to improve system structures to increase regional mental healthcare services' ability to eliminate restrictive practices and use alternative approaches. Group model building (GMB) workshops were held with a small group (n = 9) of mental healthcare practitioners and service users with lived experience of restrictive practice use. This participatory approach enables exploration and visual mapping of local structures causing behaviour patterns of practitioner and service user concern over time - in this case, the barriers, and enablers to alternative approaches to restrictive practices in adult acute mental healthcare services within the Geelong-Barwon region. This is the first study that specifically applies GMB in the discussion of the elimination of restrictive practices in mental health in the non-metropolitan regional/rural context. Participants identified four key priorities in relation to eliminating restrictive practices: (1) self-advocacy, (2) continuity of care, (3) early intervention, and (4) safety for all. The study findings were distilled into a novel preliminary set of mental healthcare practitioner and service user action ideas.

When primary healthcare meets queerstory: community-based system dynamics influencing regional/rural LGBTQ + people's access to quality primary healthcare in Australia.

BACKGROUND: Lesbian, gay, bisexual, transgender, Queer, and people of any other minority sexuality or gender identity (LGBTQ + or "Queer") are often marginalised from accessing quality primary healthcare (PHC) in their local community. This is largely due to Queerphobic, cis-heteronormative/sexist systems pathologising Queer life and identities. The study aims were to: (1) identify key priorities for increasing Queer people's access to quality PHC as told by Queer people themselves, (2) identify the feedback loops that reduce or support Queer people's access to quality PHC in non-metropolitan, regional/rural communities, and (3) identify potential action areas to improve system structures to increase Queer people's access to quality PHC. METHODS: Group Model Building (GMB) workshops were held with a small group (n = 8) of LGBTQ + people in regional Victoria with lived experience of using PHC services. This participatory approach permits exploration and visual mapping of local structures causing behaviour patterns of community concern over time - in this case, Queer people's ability to access quality PHC in the Geelong-Barwon region. This is the first study that specially applies GMB in Queer PHC in the non-metropolitan regional/rural context. RESULTS: Key community identified PHC priorities were: (a) providers' level of Queer Literacy, (b) the responsibility of Queer Advocacy (at individual, systemic, and collective levels), (c) support from safe Queer Spaces, (d) strength from a Queer Presence, and (e) power from Intersectional Queer Life. These priorities interconnected, creating system-level feedback loops reinforcing barriers and enablers to Queer people's access to quality PHC in the Geelong-Barwon region; with potential action areas identified. CONCLUSIONS: Improving Queer people's access to quality PHC in the Geelong-Barwon region requires embedding principles of Queer Literacy, Queer Advocacy, Queer Space, Queer Presence, and Intersectional Queer Life within practices and service systems. The study findings were distilled into a novel, preliminary set of Queer Equity Principles. These need to be taken back to regional Queer communities for further co-design and planning for translation across PHC practices and systems, with potential applicability in other areas of the healthcare spectrum.

LGBTQ+ Loss and Grief in a Cis-Heteronormative Pandemic: A Qualitative Evidence Synthesis of the COVID-19 Literature.

LGBTQ+ people are no stranger to loss and grief, particularly during times of pandemic such as the 1980s-90s HIV/AIDS pandemic and now, the COVID-19 pandemic. Current COVID-19 loss and grief research remains relatively silent on LGBTQ+ peoples' loss and grief experiences. The aim of this research was to conduct a qualitative evidence synthesis of LGBTQ+ people's COVID-19 loss and grief experiences reported in the literature. A systematic search and inclusion strategy identified 22 relevant articles for review. Inductive thematic synthesis resulted in five loss-focused themes across the articles: (1) loss of work and livelihood, (2) loss of social and kinship connection, (3) loss of LGBTQ+ community connection, (4) loss of physical and mental health supports and (5) loss of LGBTQ+ identity authenticity, affirmation and visibility. Discussion of these themes highlights the many layered and often disenfranchised nature of LGBTQ+ people's loss during the COVID-19 pandemic.

Mindful energy and information flow: A reflective account of S.E.L.F connection during COVID-19.

Life during the COVID-19 pandemic is uncertain, intense, and traumatic. At the same time, there is room for hope, inspiration, and meaning for social workers through mindfully connecting with energy-information flow as it influences our Safety, Emotions, Loss, and Future - S.E.L.F. As adapted from the Sanctuary Model®, this S.E.L.F connection is an opportunity to discover within ourselves our unwavering core that is grounded, present, and connected and sustain an ethical and compassionate approach to social work practice, education, and research during this time of pandemic. The aim in this reflective essay is to provide an example of S.E.L.F. connection from the perspective of a Buddhist and social work academic at an Australian university during the COVID-19 pandemic. While beneficial, ongoing S.E.L.F. connections are necessary for social workers if we are to stay mindful of energy-information flow and steer this flow towards the creation of a story of relationship, compassion, and connection into the future.

The Factors Influencing Adherence to Standard Precautions Scale - Student version (FIASP- SV): A psychometric validation.

BACKGROUND: Standard Precautions have been demonstrated to limit infection transmission in the healthcare setting. Despite their mandated use, adherence by healthcare professionals remains suboptimal. A nursing curriculum embedding infection prevention and control is essential in equipping future healthcare professionals with the skills and knowledge to improve patient safety. There are no psychometrically-validated tools that specifically assess influences on nursing students' adherence to standard precautions. METHODS: The aim in this study was to determine the reliability and validity of the five-factor Factors Influencing Adherence to Standard Precautions within a sample of undergraduate nursing students studying at one Australian University. RESULTS: Data from 321 participants were used to test the 5 factors structure, using Confirmatory Factor Analysis. The goodness of fit indices did not support adequate fit of the data and the data were submitted to a random split-half sample factor analysis process. A four-factor solution was extracted with good to acceptable internal reliabilities (α = .66 -.80). CONCLUSION: There are distinctive differences in the factors that influence student versus registered nurses' behaviour and clinical decision-making in relation to use of SP. The Factors Influencing Adherence to Standard Precautions (Student Version) has good psychometric properties and is suitable for use with nursing students. Having measures specific to students is essential as measures developed for healthcare professionals might not be applicable to a nursing student population.

COVID-19 distress and worries: The role of attitudes, social support, and positive coping during social isolation.

As the COVID-19 pandemic accelerates, one public health response has been for governments to impose quarantine 'lockdowns' which require people to socially isolate. In this study, we explored the level of psychological distress that people experienced in social isolation and the factors which might ameliorate or exacerbate it. Two hundred and thirteen participants (69% female) with a mean age of 37.82 years participated in an online study. They completed a series of questions designed as part of a larger cross-national study. A positive attitude towards social isolation introduced by government as a strategy to reduce the transmission of COVID-19 was predictive of positive coping strategies, and both attitude and coping predicted reduced psychological distress. Participants' worries about contagion of COVID-19, their financial status, and the economic and political impact of the COVID-19 pandemic predicted increases in their psychological distress. Social support from family and work colleagues was not significant in reducing worries or psychological distress but it did positively predict engagement in coping. The findings and recommendations are discussed. PRACTITIONER POINTS: Fostering a positive attitude towards social isolation in clients: reduces psychological distress, fosters engagement in positive coping behaviours. Enhancing clients' level of social support received will serve to increase positive coping and indirectly reduce psychological distress during social isolation. Strategies to reduce clients' COVID-19 worries are important as worry contributes to their overall level of psychological distress.

Psychological flexibility: positive implications for mental health and life satisfaction.

New wave therapies such as Acceptance and Commitment Therapy aim to cultivate people's psychological flexibility in order for them to live a satisfying life. Psychological flexibility has also a role in promoting mental health, which may mediate the relationship with life satisfaction. The aim of this study was to determine whether mental health mediates the effect of psychological flexibility on life satisfaction. A convenience sample of 140 adults (32 males, M = 36.50 years, SD = 12.22; 107 females, M = 38.46 years, SD = 12.81; and a 45-year-old person of unknown gender) completed an online questionnaire assessing psychological flexibility, mental health and life satisfaction. Three of the four hypothesized components of psychological flexibility (experiential acceptance, cognitive alternatives and cognitive control) contributed to the latent construct of psychological flexibility, but cognitive defusion failed to contribute. Psychological flexibility had a direct, positive effect on life satisfaction and the hypothesis that mental health would mediate this relationship was supported. The results suggest that psychological flexibility is important for one's mental health and that both are integral to life satisfaction. The results also support a continued focus on third-wave therapies in cultivating psychological flexibility.