This article presents findings from six focus groups with health care practitioners in an Australian hospital during 2010, which sought to elicit their perspectives on the barriers for people to plan their future health care should they become unwell. Such knowledge is invaluable in overcoming the barriers associated with advance care planning and enhancing the uptake of advance directives and the appointment of an enduring power of attorney for people of all ages. A person's rights to self-determination in health care, including decision making about their wishes for future care in the event they lose cognitive capacity, should not be overlooked against the backdrop of increasing pressure on health care systems. Findings suggest that multiple barriers exist, from practitioners' perspectives, which can be divided into three major categories, namely: patient-centred, practitioner-centred and system-centred barriers. Specifically, patient-centred barriers include lack of knowledge, accessibility concerns, the small 'window of opportunity' to discuss advance care planning, emotional reactions and avoidance when considering one's mortality, and demographic influences. At the practitioner level, barriers relate to a lack of knowledge and uncertainty around advance care planning processes. Systemically, legislative barriers (including a lack of a central registry and conflicting state legislation), procedural issues (particularly in relation to assessing cognitive capacity and making decisions ad hoc) and questions about delegation, roles and responsibilities further compound the barriers to advance care planning.

Issues addressed: The socioeconomic disadvantage and ill-health experienced by Indigenous Australians has continued at alarming rates despite increased research into Indigenous health and the burdens faced by Indigenous peoples. Given the state of ill-health in Indigenous communities, there is increasing recognition of the need for greater understanding of Indigenous health needs and means by which to deal with them. Method: This exploratory research study was designed to assess the meaning of Indigenous Australians' 'wellbeing' and 'spirituality', and the possible connection between these concepts. The study explored these concepts through a series of semi-structured interviews in an Indigenous community of northeastern New South Wales. Results: The research participants consistently described well-being as an all-encompassing and holistic concept. Findings showed that spirituality still occupied a crucial role in Indigenous culture and well-being , despite the challenges to its existence since European invasion. Conclusion: It is evident that the support of Indigenous spirituality, community cohesion and identity will be beneficial, if not essential to the promotion of health and well-being among Australia's Indigenous peoples. The acknowledgement of spirituality as a significant factor in well-being has many implications for diverse fields and practices of health.

No abstract

Objective. This paper reports on the experiences and perspectives of community members in relation to advance healthcare directives and enduring power of attorney, including the factors that encourage or discourage engagement in advance care planning (ACP).Methods. A qualitative methodology was used involving 26 in-depth telephone interviews with community members (mean age 66 years). The aims of the interview question were to gain an understanding of: (1) motivations for engaging in ACP; (2) barriers that prevent people from engaging in ACP; and (3) suggestions for promoting ACP.Results. The findings suggest that: (1) community members lack knowledge about ACP; (2) forms appear inaccessible and complex; (3) community members avoid ACP due to fear, mistrust and concerns over control; and (4) there are misperceptions regarding the relevance of ACP based on age and health.Conclusions. There is unnecessary fear, avoidance and mistrust around ACP activities, largely resulting from misinformation. There is an undoubted need for greater education and support to be offered to individuals and their families regarding ACP, its benefits and its limitations.What is known about the topic? There is a lack of awareness about ACP in Australia, which is compounded by issues in the accessibility of ACP information, forms and support in completing the often complex documentation. Further, studies have indicated health practitioners tend to avoid assisting patients with ACP decision making and formalisation of their wishes for health care should they lose testamentary capacity. What does this paper add? This paper contributes further understanding of the experiences and perceptions of people, particularly older Australians, in relation to ACP, including the motivating and discouraging factors for people in the uptake of advance healthcare directives and enduring power of attorney. People felt discomfort and mistrust about ACP, and lacked understanding of its relevance regardless of age or health status. Those who had engaged in ACP, prompted by family members or experiences in, or witnessing, ill health, felt a sense of security in having formalised their wishes. What are the implications for practitioners? It is now clear that people require improved provision of information and support around ACP-related activities. This support may best be offered by practitioners such as nurses and social workers who are knowledgeable regarding ACP and skilled in counselling. Without discussion of death and dying, and the role of ACP, people will continue to feel a mistrust and avoidance towards formalising their healthcare wishes in advance.Additional keywords: advance directive, aging, community, death and dying, decision making, end-of-life issues, enduring power of attorney.

The literature review identified a number of limitations in the existing research including the lack of standardized reporting of employment outcomes and a need for increased consistency in reporting sample characteristics. In addition, there are gaps in the research about people with newly acquired spinal cord injury, particularly regarding the timing of interventions. Implications for Rehabilitation Spinal cord injury has the potential to disrupt a person's career across their lifespan. Employment rate is the gold standard for evaluating employment outcomes. Broader measures of employment, including job retention and hours worked, have potential in evaluating and improving the quality of employment outcomes for this population. Further research with people with newly acquired spinal cord injuries would better support the provision of vocational rehabilitation services earlier in a person's rehabilitation, potentially preserving jobs.

INTRODUCTION:The design was a narrative review. The objective of the study was to investigate the potential for early vocational rehabilitation (VR) interventions for people with spinal cord injury (SCI) in overcoming barriers in returning to work, and to pinpoint factors contributing to effectiveness in early VR intervention for this population. The setting was at Queensland, Australia. MATERIALS AND METHODS: Synthesis of the findings of a literature search of online databases ProQuest and CINAHL, using keywords relating to the employment situation and VR of people with SCI. Themes were identified and analysed in accordance with the research objectives. RESULTS: Despite increasing government commitment to the workforce and social participation of people with disabilities, Australians living with SCI have significantly diminished employment outcomes compared with the general population. Current VR approaches usually do not commence until some months post discharge, potentially missing a window of opportunity to preserve pre-existing employment or assist in vocational decision making. The review found that there are opportunities for enhancing VR service provision following SCI, namely integrating the VR programme within the primary rehabilitation team thus facilitating early VR intervention. DISCUSSION: Emerging evidence shows promising results for early intervention in VR; however, questions remain regarding ideal intervention approaches, and it is clear that further empirical investigation is required to support the use of early intervention models post SCI. The study was sponsored by Motor Accident Insurance Commission (MAIC).

No abstract

University educators increasingly manage situations where students disclose serious mental health issues. This is a significant issue, particularly for health and human service professions, as the importance of valuing the lived experience of mental illness lies alongside concerns for professional practice standards. Thus the responsibilities of students to disclose their mental health status and the responsibilities of Universities to provide appropriate support within established disability frameworks must be clear. However, students often do not know who they should disclose to, what will happen to disclosed information, and who has access to this information. Student's often fear embarrassment, stigma, and shame about disclosing mental illness, which is compounded by the diverse attitudes, experiences, and beliefs of educators. Consequently, this paper will review existing literature on university responses to, and students' experiences of, mental illness in order to set a research agenda for this topic. The authors argue that such research must be undertaken urgently, in a context of inclusivity in higher education that gives voice to the experiences of students, their families and carers, university staff, and practitioners in the field.