An Exploratory Study on Participation Following Brachial Plexus Injury.

Consequences of brachial plexus injuries (BPI) would likely impact participation, but outcomes are not well understood. This exploratory study aimed to report the participation in productive, leisure and social roles for individuals following BPI. Fourteen male participants were diagnosed with a traumatic, BPI. Descriptive data reported included demographic, injury, surgical, and participation measures. Two-sample t-tests were conducted for comparative analysis with other studies following life altering conditions.Just over two-thirds reported feeling satisfied to very satisfied with their participation in everyday life. This long-term follow up study found on-going and profound impact on participation in a range of life situations for this diagnostic group. Participation in productive roles, home duties, and physical exercise were particularly impacted and need to be prioritized during rehabilitation.

Effective long-term management of brachial plexus injury following surgery: What is needed from hand therapists' perspectives.

INTRODUCTION: Traumatic, brachial plexus injuries (BPI) result represent a significant cost to the individual and society. Recovery involves multiple surgeries, takes years, and often results in permanent physical dysfunction. While the last couple of decades have seen advancements in surgical management, the BPI rehabilitation literature has not kept pace with these developments. PURPOSE: We aim to explore the experience of public and privately employed hand therapists' in delivering effective long-term rehabilitation services to inviduals with BPI in Australia. METHODS: An interpretative qualitative study. Two focus groups were conducted with Australian hand therapists' (n = 10). Data were analyzed using an inductive thematic approach. RESULTS: Three key themes were generated from the data. The first theme 'Falling through the gaps: overlooked components of therapy for BPI' captures participants' thoughts on postinjury health care and rehabilitation services. The second 'Developing a therapeutic alliance: underpinned by time and trust' relates to the relationship building challenges and opportunities following trauma that will withstand the long-term recovery of individuals following BPI. The last theme, 'Factors required for professional development: knowledge and support,' considers the variation seen with these clients in relation to therapy needs and outcomes. CONCLUSIONS: The findings of this study highlight the need to better equip hand therapists' skills and knowledge in responding to pain and psychological management post BPI. Our results reinforce the benefit of interdisciplinary models of care in the management of individuals with BPI.

The Readiness of Australian Health Care Students to Encounter Patients Experiencing Partner Abuse.

Partner abuse is a significant contributor to mortality and morbidity worldwide, and has been identified as a priority health care issue. Most health care students rarely receive education on partner abuse and report not feeling ready to encounter patients experiencing partner abuse. Analysis of the current readiness of health care students and can inform educational needs to address this gap. The READIness to encounter partner abuse patients Scale was delivered to a convenience sample of Australian prequalification health care students. Participant demographics and estimated hours of education were also reported. Mean readiness scores were calculated by discipline. The relationship between hours of education and readiness scores was calculated using linear regression. A total of 926 participants were included in the analysis. Approximately half of the participants (47.5%) reported less than two hours of education. Mean readiness of students was 4.99 out of 7 (SD 0.73, range 4.39-5.95). Linear regression revealed a significant association between hours of education and readiness, r(925) = .497, p < .000. Australian health care students receive little education about partner abuse, and do not report feeling ready to encounter patients experiencing partner abuse. An individual's confidence and belief in their abilities appear to be the key factor influencing overall readiness. Participants indicated a strong belief that responding to partner abuse was part of their professional role, which is a positive change from previous research. Higher hours of education is associated with higher readiness, though which educational methodologies are most impactful remains unclear.

A secondary analysis to develop a scale for measuring unemployed workers' experiences of Australian employment services.

BACKGROUND: Research consistently shows that Australian employment services are failing those they are intended to serve. Based on findings in other human service areas, a valid and reliable instrument to measure unemployed workers' experiences may provide an opportunity for improvement in this sector. OBJECTIVE: To establish a basis for developing a suitable rating scale. METHODS: An exploratory factor analysis combined with qualitative cross check for face validity of an existing large survey of Australian unemployed workers. RESULTS: Six factors appear to be important elements of service delivery: (F1) useful and competent, (F2) client-centred, (F3) receptive to feedback, (F4) trustworthy, (F5) fair, and (F6) friendly. CONCLUSIONS: While each of these factors have been either described explicitly or referred to implicitly in previous studies, this study is the first to attempt to combine these factors and is a precursor to establishing a valid and reliable rating scale for use by unemployed workers in evaluating their employment service providers. At a time when Australia is exploring new approaches to employment services, such a scale using a robust set of factors may allow for the improvement of employment services and thus be held accountable to a significant stakeholder group whom they aim to serve -unemployed workers.

Exploring Diabetes Educators' Core Competencies in the Kingdom of Saudi Arabia.

BACKGROUND: Diabetes education provided by qualified and competent diabetes educators (DEs) is effective in reducing risks of diabetes complications. Globally, the DE workforce comprises a mixture of professions, with the majority being nurses. It is necessary to regularly assess DEs' competence and knowledge to ensure that quality diabetes education is being delivered. OBJECTIVE: This study explored the self-perceived competence and the diabetes knowledge of DEs in the Kingdom of Saudi Arabia (KSA). METHODS: This study explored the self-perceived competence and the diabetes knowledge of DEs in the Kingdom of Saudi Arabia (KSA), using a quantitative, cross-sectional survey, administered at 20 diabetes centres. A total of 368 DEs were invited to participate in the study. RESULTS: Surveys were completed by 324 DEs (response rate = 88%), 84% (n=271) were nurses. From a possible overall range between 63-252, the mean (M) was 168.59 and standard deviation (SD) was (35.6) hence perceived competence of the DEs was low, Of a maximum possible score of 45 for the diabetes knowledge test, response scores ranged from 9 to 40, with M = 26.2 (6.0). Perceived competence and diabetes knowledge varied depending on age, nationality, educational qualification, primary profession, and whether or not the DE held a specialised diabetes qualification. CONCLUSION: DEs in the KSA need to develop and enhance their competence and knowledge in order to provide quality diabetes care and education. The low perceived competence and scores in the knowledge test show that intervention measures are needed to regularly assess and improve the core competencies of DEs. Further research is required to identify DEs' barriers to having sufficient competencies and knowledge.

The lived experience following free functioning muscle transfer for management of pan-brachial plexus injury: reflections from a long-term follow-up study.

BACKGROUND: Traumatic, pan-brachial plexus injuries result in major functional disability. Surgical advancements, such as free-functioning muscle transfers, are restoring physical capacity that was not achieved 3-4 decades ago. Despite reconstructive procedures, brachial plexus injury patients report chronic pain, changes in work circumstances, concerns about their appearance, increased reliance on others, and difficulty completing daily activities. This suggests that recovery needs to be considered to better deliver post-injury health services. OBJECTIVES: Investigate the lived-experience of patients following free-functioning muscle transfers for management of traumatic, pan-brachial plexus injuries.Better understand issues during recovery and implications for rehabilitation with this population. METHODS: A phenomenological, qualitative design was employed that involved 5 participants who underwent surgery between 2007 and 2015. In-depth, semi-structured interviews were conducted and data were analyzed using interpretative phenomenological analysis. RESULTS: Three interrelated themes were generated from the data. The first theme 'Experience of health care systems' captures the participants' reflections of their post-injury experience and health care received. The second 'Psychosocial considerations' consists of emotional responses, relationship disturbance, and coming to terms with the permanence of their changed arm. The last theme, 'Creating a new self-identity', relates to the participants experience of adjustment to their new circumstances. CONCLUSIONS: The findings of this study demonstrate that comprehensive medical coverage and access to expert brachial plexus injury health providers support patients following injury. However, recovery also requires the need for the patient to adjust and establish a new self-concept. Health care providers can assist patients by establishing positive therapeutic relationships, as well as, reducing the number of care providers by providing a continuity of care from the same health professionals.IMPLICATIONS FOR REHABILITATIONIndividuals with pan-brachial plexus injuries felt it was beneficial to work with health care providers with extensive brachial plexus injury knowledge.Stable, long-term relationships with health providers during rehabilitation were reported as beneficial to recovery.Greater consideration of the process of adjustment and creating a new self-identity following pan-brachial plexus injury needs to be considered during rehabilitation.

Core competencies for diabetes educators: A scoping review.

AIMS: Diabetes educators (DEs) play a major role in diabetes education and management. The aims of this scoping review were to compile the currently identified core competencies for DEs and, to review the currently used criteria to assess DEs' core competencies. METHODS: A scoping review was conducted using the methodology of the Joanna Briggs Institute. Five databases (Ovid, CINAHL, Scopus, Web of Science and PubMed) were searched. Keywords as well as inclusion and exclusion criteria were identified as search strategies and study selection for this review. RESULTS: A total of (n = 22) publications comprising sixteen peer-reviewed studies and six professional-organisations (grey literature) were selected for review, as they listed the core competencies of DEs. The most common core competencies were related to knowledge and skills in diabetes self-management education, knowledge of pathophysiology and epidemiology, teaching skills, clinical skills and cultural competency. Evidently, an appropriate tool for assessing DEs' competencies is currently unavailable. CONCLUSIONS: Given the importance of diabetes education in the care of people living with diabetes, it is imperative that DEs possess competencies in diabetes education and management. The review also identified the need to develop a globally applicable core competency assessment tool for DEs.

Core competencies for diabetes educators: a scoping review protocol.

REVIEW QUESTION/OBJECTIVE: The purpose of the proposed review is, firstly, to map the core competencies for diabetes educators, as reported in the literature, and secondly, to review currently used criteria for core competencies in the assessment of diabetes educators.

Enhancing health-care workers' understanding and thinking about people living with co-occurring mental health and substance use issues through consumer-led training.

BACKGROUND: Stigma and judgemental assumptions by health workers have been identified as key barriers to accessing health care for people living with co-occurring mental health and substance use issues (dual diagnosis). OBJECTIVE: To evaluate the effectiveness of consumer-led training by people with dual diagnosis in improving the knowledge, understanding and role adequacy of community health staff to work with this consumer group. METHODS: A controlled before-and-after study design with four waves of quantitative data collection was used. Qualitative data were collected to explore participants' views about training. Participants were staff from two community health services from Victoria, Australia. Recruitment occurred across various work areas: reception, oral health, allied health, counselling and health promotion. At baseline, all participants attended a 4-h clinician-led training session. The intervention consisted of a 3-h consumer-led training session, developed and delivered by seven individuals living with dual diagnosis. Outcome measures included understanding of dual diagnosis, participants' feelings of role adequacy and role legitimacy, personal views, and training outcomes and relevance. RESULTS: Consumer-led training was associated with a significant increase in understanding. The combination of clinician-led and consumer-led training was associated with a positive change in role adequacy. CONCLUSIONS: Consumer-led training is a promising approach to enhance primary health-care workers' understanding of the issues faced by dual-diagnosis consumers, with such positive effects persisting over time. Used alongside other organizational capacity building strategies, consumer-led training has the potential to help address stigma and judgemental attitudes by health workers and improve access to services for this consumer group.