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This umbrella review aimed to examine and synthesize qualitative studies that explored the barriers and facilitators of advance care planning for persons with dementia, their families, and their healthcare professionals and caregivers. The modified umbrella review approach developed by the Joanna Briggs Institute was followed. Five major English databases were searched. Four reviews based on 38 primary qualitative studies were included. The methodological quality of the included reviews was moderate to high. The synthesis yielded 16 descriptive themes and five analytical themes: making the wishes/preferences of persons with dementia visible; constructive collaboration based on stakeholders having positive relationships; emotional chaos in facing end-of-life substitute decision-making; initiating the advance care planning process; and preparedness and commitment of healthcare providers to advance care planning. Comprehensive and workable strategies are required to overcome complex and interrelated barriers involving not only healthcare professionals but also organizational and systemic challenges.

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OBJECTIVE: The objective of this review is to summarize current best evidence for advance care planning in older adults with dementia and their families. INTRODUCTION: Contemporary end-of-life care cannot be fully achieved without high quality advance care planning practice, which facilitates the expression of patient preferences for treatment if they lose the capacity to decide or communicate their wishes. However, advance care planning for people experiencing dementia can be highly complex and requires additional knowledge and skills. Improving advance care planning for this vulnerable patient group is an urgent matter. INCLUSION CRITERIA: The review will include systematic reviews of quantitative, qualitative, and mixed-method studies examining advance care planning for older adults with dementia and their families, published from 2000. METHODS: Published and unpublished reviews will be identified from searches of the major international databases and relevant databases for gray literature, respectively. Two independent reviewers will conduct screening, critical appraisal, and data extraction for included studies. The extracted data will include specific details about the study characteristics (e.g. setting/context, participants, and the intervention/phenomena of interest), quantitative results (including heterogeneity), and qualitative findings relevant to the review. Results of systematic reviews will be presented in tabular format and accompanied by narrative synthesis. Qualitative results will include the overall synthesis of findings. Overlap of original research studies of any design across multiple systematic reviews will be clearly identified.

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BACKGROUND: Contraception is a field in which good doctor-patient communication is crucial and core to shared decision making. Despite the centrality of contraception to primary health care in Australia, little is known about how doctors manage the contraceptive consultation. In particular, little is known about how doctors discuss sexual issues related to contraception. METHODS: Fifteen contraceptive providers participated in qualitative interviews averaging 45 min. Interviews were audio recorded, transcribed verbatim, and analysed using an inductive thematic approach. RESULTS: We found doctors were aware that they had to modify their illness-based 'scripts' in consultations about contraception, and said it was challenging always to adhere to a shared model of decision making. Prescribing behaviour reflected personal preferences in relation to some forms of contraception, and doctors were enthusiastic about the levonorgestrel-releasing intrauterine system. Doctors identified gaps in training in relation to sexuality and reported feeling tentative in raising sexual issues, even within contraceptive consultations. CONCLUSIONS: A range of factors-including tendencies to use illness scripts, personal preferences, and discomfort with communications about sexuality-appear to influence doctors' approaches to contraceptive management. Medical training that enables doctors to move out of an illness-treating framework and to improve their understanding of and comfort in discussing sexuality issues will improve their management of healthy women seeking contraception.

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Women's liberation and the sexual revolution have changed the social landscape for heterosexual women in the West over the past 50 years, but exploration of women's lived experiences of contraceptive use in the context of their sexual lives is comparatively recent. We conducted 94 in-depth open-ended interviews with women of reproductive age (16-49 years) living in New South Wales, Australia. Interviews were audio-recorded, transcribed verbatim and analysed using an inductive thematic approach. Four major themes are explored here: (1) what women do and do not do: unspoken gendered assumptions; (2) focus on partner's pleasure; (3) juggling responsibilities: sex as a chore; and (4) women's sexual motivations. Findings suggest sexual double standards and gender expectations continue to pervade women's sexual and contraceptive practices. We found that women performed their femininity by focusing on enabling their male partner's pleasure, while simultaneously ignoring their own sexual desires, wishes or interests. Accompanying new-found freedoms are new-found responsibilities, as women now add managing modern contraceptives and a good sex life to their list of tasks alongside paid employment, domestic labour and childrearing. Our research findings suggest that women may derive different pleasures from sex, including what we term 'connection pleasure'.

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OBJECTIVE: Few studies have explored Australian women's understandings of contraception. This study examined the attitudes towards, and understandings of, the subdermal contraceptive implant expressed by women living in New South Wales (NSW), Australia. STUDY DESIGN: As part of a larger qualitative study using in-depth, open-ended interviews in 2012-2013 with women aged 16-49 years who had ever used contraception (n=94), 65 interviews from women who discussed or mentioned the subdermal implant, but had not previously used the device, were examined and analysed using thematic analysis. RESULTS: The emergent themes were: satisfaction with current method; weak personal opinions and ambivalence; uncertainty due to specific concerns; and strong negative reactions - fear and dislike. Although there were a few positive perceptions expressed by women who had never used the subdermal implant, for the majority of women the perception was predominantly negative. DISCUSSION AND CONCLUSION: Women tended to form negative impressions from the stories of other women about the subdermal implant. Interventions to enhance evidence-informed awareness of the relative advantages and disadvantages of the implant - for example, improved access to supportive contraceptive counselling - need investigation in the Australian context. Avenues to improve women's perceived control over the device could also be usefully investigated.

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BACKGROUND: The number of prescriptions for contraceptive implants has steadily increased in Australia, but implant use is still low. OBJECTIVE: The objectives of the study were to describe women's nuanced responses, and characterise their multidimensional and complex reasons for (dis)continuing use of the contraceptive implant. METHODS: A descriptive qualitative approach was used for this study. A larger qualitative study using in-depth, open-ended interviews, conducted in New South Wales between 2012 and 2013 with 94 women aged 16-49 years who had used contraception, included 10 interviews containing accounts of implant use. The 10 interviews were analysed thematically in the present study. RESULTS: The three main themes analysed from the 10 interviews were perceived benefits, undesirable experiences and perseverance. DISCUSSION: The participants were well informed about the benefits of the implant. Many persevered with it for a significant period of time before discontinuing it, despite experiencing side effects such as bleeding or mood changes. A decision to discontinue was often only made after an accumulation of multiple side effects.

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BACKGROUND: There is a lack of research focused specifically on the contraceptive and sexual health practices of Japanese women living in Australia. OBJECTIVE: This paper reports findings from a cohort of migrant Japanese women who participated in a study of Australian women's understanding and experience of contraceptives. METHODS: In-depth, open-ended interviews were conducted between August 2012 and June 2013 in New South Wales. Audio-recorded interviews of seven Japanese women were transcribed verbatim and analysed thematically. RESULTS: The four prominent themes were the condom and withdrawal methods, varying attitudes to contraceptive practices, discussing contraception and sexual issues with general practitioners (GPs), and the unspoken topic of sexually transmissible infections (STIs). DISCUSSION: Japanese migrants tend to choose the condom and withdrawal methods, which they perceive to be 'standard practice' in Japan. A greater understanding by Australian GPs of Japanese women's attitudes to contraception and sexual health issues could enhance the sexual health of Japanese women.

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OBJECTIVE: To examine the clinical and epidemiological literature addressing contraceptive method change or discontinuation and to assess whether the documented reasons reflected women's experiences. METHODS: Major databases including Medline and PsycINFO were searched using keywords related to contraception and discontinuation, adherence and satisfaction, for articles published between January 2003 and February 2013. Studies in developed countries that focused on women of reproductive age and reasons for method change or discontinuation were included. Reasons reported were categorised and examined. RESULTS: A total of 123 papers were reviewed in detail. Medical terminology was generally used to describe reasons for method discontinuation. The top two reported reasons were bleeding and pregnancy, but there was a lack of consensus about the categorisation of reasons. Broad categories that were not self-explanatory were included in more than half of the papers, often without further explanation. Only 12 studies expanded on categories containing 'other', 'non-medical' or 'personal' reasons. Eight papers included categories that attributed discontinuation to the participant, such as 'dissatisfied with method'. CONCLUSIONS: Studies of reasons for discontinuation of contraceptives do not well describe women's specific reasons. Studies rely heavily on medical terms and often fail to document women's subjective experiences. Future studies should create an opportunity for women to articulate their non-medical reasons in their own words, including those related to their sexual lives. Furthermore, researchers should distinguish, if possible, between reasons for discontinuation of a method and reasons for ceasing participation in a research study.

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PURPOSE: The purpose of the study was to investigate the experiences of Japanese nurses and their adaptation to their work environment in Australia. Using a qualitative research method and semistructured interviews, the study aimed to discover, describe, and analyze the experiences of 14 Japanese nurses participating in the study. DESIGN: A qualitative study. METHOD: Fourteen Japanese registered nurses working in Australian hospitals participated in the study. Individual semistructured interviews were conducted from April to June in 2008. Thematic analysis was used to identify themes within the data. RESULTS: Analysis of qualitative open-ended questions revealed the participants' adaptation process. It consists of three themes or phases: seeking (S), acclimatizing (A), and settling (S), subsequently named the S.A.S. model. DISCUSSION: The conceptual model of the adaptation processes of 14 Japanese nurses working in Australia includes the seeking, acclimatizing, and settling phases. Although these phases are not mutually exclusive and the process is not necessarily uniformly linear, all participants in this study passed through this S.A.S. model in order to adapt to their new environment. IMPLICATIONS FOR PRACTICE: The S.A.S. model of adaptation helps to describe the experiences of Japanese overseas qualified nurses working in Australian hospitals. Future research is needed to examine whether this model can be applied to nurses from other countries and in other settings outside Australia.

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AIMS AND OBJECTIVES: The aim of this study was to review dementia nursing competencies. The objectives were to explain the relevancy of dementia competencies across care settings and levels of practice. BACKGROUND: Dementia is strongly associated with increasing age and as the world population ages there is an imperative to ensure the healthcare workforce is fully equipped to meet the needs of people with dementia and their carers. DESIGN: A literature review study addressed the research aim and objectives. METHOD: Literature sources were (i) academic databases, (ii) the internet and (iii) snowballing. Search terms were 'dementia', 'care standards', 'training and education' and 'competency'. RESULTS: The sample consisted of 59 reviewed publications. A synthesis of the findings generated 10 dementia competencies: (i) Understanding Dementia; (ii) Recognising Dementia; (iii) Effective Communication; (iv) Assisting with Daily Living Activities; (v) Promoting a Positive Environment; (vi) Ethical and Person-Centred Care; (vii) Therapeutic Work (Interventions); (viii) Responding the needs of Family Carers; (ix) Preventative Work and Health Promotion and (x) Special Needs Groups. There were also five levels of practice: (i) Novice; (ii) Beginner; (iii) Competent; (iv) Proficient and (v) Expert and no care setting specific competencies were generated. CONCLUSION: Government initiatives demonstrate commitments to dementia, such as Australia's adoption of dementia as a National Health Priority and the UK National Dementia Strategy. Registration boards for the nursing workforce in Japan and the UK included dementia competencies in generalist frameworks to emphasise the importance of dementia as a healthcare issue. This study demonstrated that there is no dementia competency framework relevant across care settings or levels of practice. RELEVANCE TO CLINICAL PRACTICE: An empirical study will develop a multi-disciplinary dementia competency framework relevant across care settings and levels of practice to ensure the healthcare workforce can effectively deliver services to people with dementia and their carers.

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Domestic violence is considered to be an important health care issue world wide. In order to provide appropriate support and treatment to women who have been abused, it is essential that nurses understand and recognise domestic violence. This study aimed to explore nurses' understanding of domestic violence issues utilising a grounded theory approach. A total of 41 emergency nurses was interviewed in selected Australian and Japanese emergency departments. Analysis of data identified six groups of nurse perceivers of domestic violence: nave perceivers, inexperienced perceivers, compassionate perceivers, proactive perceivers, acting perceivers and reluctant perceivers. Findings indicate that the provision of ongoing education and instigation of policy and protocol enable nurses to respond in a structured manner when they encounter women who have been abused. As a result, nurses can contribute to the amelioration of violence in society and enhance the wellbeing of these women.

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