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This study explores the challenges experienced by Australian healthcare professionals (HCPs) in delivering type 2 diabetes care to people of culturally and linguistically diverse (CALD) backgrounds. We examined how sociocultural, linguistic and health systems factors influence their clinical practice.
A qualitative study employing semi-structured interviews was conducted from April to October 2024. Data were analysed using Braun and Clarke’s reflexive thematic analysis to identify patterns and themes in HCPs’ experiences, guided by a constructivist perspective.
The study was conducted in metropolitan Melbourne, Australia, across primary and tertiary healthcare settings.
A purposive sample of 11 Australian HCPs from diverse disciplines, including general practice, pharmacy, nursing, endocrinology, dietetics and podiatry, participated. All had provided type 2 diabetes care to people of CALD backgrounds within the previous 12 months. Participants included both male and female professionals, many from ethnically diverse backgrounds.
Three overarching themes were identified, reflecting HCPs’ perceived challenges to providing culturally responsive type 2 diabetes care to people of CALD backgrounds. These themes illustrated the multilevel challenges encountered by HCPs at the patient, organisational and provider levels, namely: (1) healthcare provision across diverse health literacy and cultural contexts, (2) navigating system gaps in multicultural clinical practice and (3) workforce preparedness gaps in culturally responsive care.
HCPs remain committed to providing culturally responsive type 2 diabetes care but continue to face constraints, including limited cross-cultural training and exposure, inadequate interpreter access, time pressures and insufficient culturally adapted resources. Effective care in multicultural settings requires recognising patients’ culturally shaped beliefs about health and illness and embedding cultural humility, reflexivity and competence within professional practice, essential steps towards advancing equitable type 2 diabetes care across Australia’s diverse communities.
To describe patient outcomes for patients at high risk of mortality (with a prognosis of three months or less to live) where a Palliative Care Nurse Consultant (PCNC) was embedded in a General Medicine team. To explore patients and/or their carers feedback and allied health, nursing professionals' perspectives on integrating a palliative care approach in the General Medicine ward.
Prospective exploratory study.
SQUIRE reporting guidelines was adopted for the study reporting. This study was conducted over six weeks in a general medicine ward at Monash Medical Centre in Melbourne, Australia. Participants were 20 patients aged > 65 years with non-malignant, chronic conditions at high risk of mortality within three months and had 18 nursing and allied health professionals involved in their care. Quantitative data were analysed descriptively and qualitative survey data were analysed thematically.
Twenty patients participated, with an average age of 87 years. 55% spoke a language other than English. PCNC interventions, focused on care coordination and family liaison, were found to facilitate timely referrals to other support services, improve communication and better address end-of-life care needs. Healthcare professionals recognised the benefits of PCNC involvement; however, a key qualitative theme was staff reluctance to raise palliative care needs due to perceived role boundaries and limited confidence. While PCNC presence improved communication and advocacy, barriers included time constraints and patient/family resistance.
Embedding a PCNC in a general medicine team appears to enhance care coordination and support timely palliative care integration. Addressing barriers and optimising workflow can improve patient, carer and clinician experience as well as improve resource utilisation.
The model has the potential to enhance patient-centred care and clinician support in acute general medicine settings.
The research will have an impact on acute care settings, particularly general medicine units, by informing models of integrated palliative care for patients with complex needs and enhancing staff capability and confidence in providing timely, person-centred care.
Patients or members of the public were not involved in the design, conduct, analysis or manuscript preparation of this study. The project was a prospective observational study with limited scope and resources, which did not include a formal patient or public involvement component.
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