Australian academics are faced with increased occupational stress, exacerbated by exposure to non-constructive, anonymous Student Evaluations of Teaching (SET). Using a qualitative, reflexive approach, we aimed to explore the perspectives of postgraduate students who give and receive SET. We conducted three focus groups (n = 15) and six interviews with postgraduate students from three universities (one private, one regional and one Group of Eight). Using reflexive thematic analysis, we identified four themes: (i) The Dialectical Nature of SET, Both Valuable and Flawed, (ii) The Emotional Labyrinth of SET, A Powerful Tool for Dislikes, (iii) The Double-Edged Sword of Anonymity in SET, (iv) Recommendations for SET Improvement by Integrating Diverse Evaluation Strategies. Participants valued SET for improving teaching but noted its misuse for venting student frustrations. Negative feedback, linked to student dissatisfaction with grades, overshadowed constructive criticism. Anonymity allowed for honest critique but also harmful, vitriolic comments. Participants suggested integrating non-anonymous class discussions and mid-term anonymised feedback with class representatives. Our findings highlight the need for a balanced approach to SET that supports early-career educators' well-being and professional development. By addressing these issues, universities can create a more effective and equitable feedback system, ultimately improving educational outcomes for students and educators.

Minimising formal coercion, such as seclusion, physical restraint, and forced medication, remains a global priority in acute mental health units. However, key drivers beyond individual-level features are poorly understood. This exploratory analysis was intended to identify the top functional, contextual, and interventional features linked to formal coercion in three Australian acute adult mental health inpatient units. Nested within a mixed concurrent control study, this feature analysis examined nurses' reports of 2955 de-escalation events over 324 days, from March 2024 to April 2025, including nurses' commentaries on the behavioural functions that triggered de-escalations. Fifteen inductively coded functional features were analysed alongside 15 contextual and 16 interventional features. Studied target variables included seclusion and physical restraint events and their durations, as-needed intramuscular psychotropic events, physical injury events, and Code Black activations. Features were analysed using bivariate statistics and machine learning techniques, including the Boruta algorithm for feature selection and random forest regressions for predictive modelling. Top drivers for the use of formal coercion included behavioural 'Responses to Challenging, Physical and External Stimuli,' incidents of self-harm, incidents directed towards nurses, and the application of specific de-escalation techniques. A hierarchy of behavioural functions is proposed as a by-product of this analysis. These findings provide nuanced insights into the drivers of formal coercion and the underlying value arrangements, as well as elevate the merit of ecological, bottom-up approaches in early warning signs work.

Interventions aimed at reducing restrictive practices are also designed to enhance the service experience in acute mental health units. However, people with experience of coercive engagement with these services are seldom involved as active contributors in evaluative research on interventions to reduce restrictive practices. With the meaningful involvement of lived experience practitioners, this research was aimed at examining care recipients' service experiences and perspectives on nurses' therapeutic responses during the implementation of a de-escalation intervention in three adult inpatient units within New South Wales, Australia, from March 2024 to April 2025. Nested within a larger study employing a mixed concurrent control design, this research evaluated the effectiveness and process of the Safe Steps for De-escalation through comparisons of unmatched measures of empowerment, dehumanisation, and staff actions on violence prevention across three time points, as well as through a reflective thematic analysis of semi-structured interviews. Safe Steps is a structured approach for therapeutic responding, targeting nurses' relationship-promotion behaviours to increase focus on minimising the use of restrictive practices. Eighty-six inpatients completed the unmatched measures, with nine participating in interviews following discharge. No significant changes were noted in quantitative measures over time. Five themes emerged from the qualitative analysis: (i) Clarity calms; confusion harms, (ii) Control cuts deep, (iii) Systems strain; people break, (iv) Connection is treatment in itself, and (v) Meaning-making outweighs medicine. These findings cast acute inpatient units in a light akin to a power circuit, elevating the need to make inpatient admissions more reflective of everyday life outside the units.

Introduction Efforts to reduce restrictive practices in acute mental health units require more than operational reform; they also need to give voice to clinicians who implement these changes.Aim This paper forms part of a broader evaluation of the Safe Steps for De-escalation, which was aimed at investigating the impact of the Safe Steps implementation on the perceived professional quality of life of the nurse participants. This paper also presents a qualitative assessment of the process, aimed at identifying the factors that influence the successful implementation of the Safe Steps from the perspective of the nurse participants.Methods Safe Steps is a structured approach for de-escalation, intended to reduce restrictive practices and promote the development and maintenance of therapeutic relationships, as well as individuals' self-management. It was implemented in three adult inpatient units in New South Wales, Australia, from March 2024 to April 2025. This paper was nested within a mixed concurrent control study and was informed by a pragmatic and complex intervention research framework. Nurse focus group discussions were analysed using reflexive thematic analysis. Paired measures of compassion satisfaction, burnout, and compassion fatigue before and after one-year implementation were compared.Results Scores after implementation indicated a decline in compassion satisfaction and an increase in burnout, compared to the baseline. Two superordinate themes were identified from seven focus groups, with twenty-six nurse participants: (i) de-escalation is a relational, adaptive, and collective nursing practice, and (ii) ecological pressures shape the practice of de-escalation. These superordinate themes were developed from seven subordinate themes.Discussion A cautious interpretation of the quantitative measures is warranted, given the challenges of obtaining follow-up responses in busy, under-resourced inpatient units. The thematic findings suggest that successful implementation depends on the organisational and relational contexts in which interventions are deployed.Recommendations Future evaluations of the Safe Steps need to consider extending beyond nurses' relational capabilities to encompass the relational responsiveness of multidisciplinary teams.

ObjectivesDe-escalation is widely endorsed as an intentional strategy to replace and reduce restrictive practices in acute mental health units. However, high-quality evidence for its effective implementation remains limited. In response, a pragmatic, complexity-informed evaluation was undertaken to generate empirical support for the impact of an intervention, Safe Steps for De-escalation, on restrictive practices. The intervention centres on a four-step framework for therapeutic responding, with implementation supported by co-designed training and restrictive practice reviews.MethodsA mixed concurrent control study was conducted in three adult inpatient units in New South Wales, Australia, from March 2023 to April 2025. A priori weighted linear, linear mixed-effects, and generalised linear mixed-effects models were fitted between and within groups, to assess the impact of the intervention on restrictive practice events, including seclusion, physical restraint, as-needed intramuscular psychotropics, event duration, and physical injury. A priori hierarchical cluster analysis and between-cluster comparison were used to examine the most active de-escalation response components and any associated concurrent supplementary strategies contributing to the overall impact.ResultsCompared to three control sites, implementation sites had a lower total restrictive practice event rate (incidence rate ratio [IRR] = 0.65, 95% CI [0.60, 0.69], p <.001) over a twelve-month intervention period. At a granular level, implementation sites had lower IRRs for seclusion and as-needed intramuscular psychotropics than controls; however, within-group rates fluctuated over the year. Two clusters of de-escalation responses and additional supplementary strategies (including stimulus reduction, music, and one-on-one staff time) were noted. The differential associations between clusters and the outcomes were insignificant.ConclusionDespite mixed results, the evaluation offers support that structured therapeutic responding helps minimise restrictive practices, without evidence suggesting a substitution of one form of coercion for another.

A structured process of reviewing incidents of seclusion and physical restraint supports nurses in managing the emotional and relational impact of restrictive practices. However, these reviews are not a routine feature of everyday acute care provision, and have historically been influenced by practices that reflect a managerial or disciplinary focus. A retrospective before-and-after study was conducted in an adult acute mental health inpatient unit in regional New South Wales, Australia. The goal was to determine the impact of strengths-based restrictive practice review meetings from January 2019 to March 2020, with an equivalent timeframe before its implementation (October 2017-December 2018). The events of seclusion, physical restraint, and Code Blacks (emergency codes requiring security personnel in response to personal safety threats) were compared before and after the implementation of review meetings, with covariate balancing applied to enhance comparability. The reduction in the rate of seclusion was statistically significant post-implementation (incidence rate ratios [IRR] = 0.37, 95% CI [0.24, 0.57], p < 0.001). At the same time, physical restraint showed a statistically insignificant reduction (IRR = 0.76, 95% CI [0.53, 1.09], p = 0.14). Code Black incidents remained stable (IRR = 1.02, 95% CI [0.70, 1.49], p = 0.91). These mixed results indicate that strengths-based reviews play a role in reducing coercion, although additional strategies may be needed to achieve significant reductions in restrictive practice outcomes. Intervention development requires broader service-level changes, with open and robust evaluations that enhance accountability and capture key influencing factors.

This chapter explores the development of empathic understanding in working with individuals experiencing psychosis. Traditional psychiatric approaches, which often focus on biological explanations and pharmacological treatments, have historically overlooked the importance of understanding the lived experiences of those with psychosis. A phenomenological, person-centred approach invites clinicians to explore the unique internal worlds of individuals, fostering curiosity and open, externalizing conversations about their experiences, such as hearing voices or holding delusional beliefs. Empathizing with individuals who hear voices involves exploring the content and qualities of the voices, acknowledging both distress and comfort, and creating a safe space free from stigma or fear of medical intervention. Delusions, often rooted in emotional concerns like anxiety, guilt, or shame, require careful validation of the associated emotions without reinforcing inaccurate beliefs. Cognitive-behavioural and acceptance and commitment therapy techniques offer strategies for improving psychological flexibility, helping individuals separate emotions from reality. By connecting with the emotional dimensions of psychotic experiences, clinicians can offer practical support, strengthen therapeutic alliances, and help individuals develop coping strategies that promote recovery. Empathy, in this context, moves beyond mere validation of distress, focusing on the deeper understanding of how psychotic experiences affect emotions and perceptions.

There is a shared goal of organising reform efforts in mental health services to eliminate restrictive practices and improve therapeutic relationships. However, evidence on high-quality, culturally safe, co-produced, and strengths-based interventions and evaluations is limited, especially for complex interventions centred on therapeutic responding. In response, a multi-centre, mixed concurrent control study is underway to evaluate the Safe Steps for De-escalation, a multi-component intervention focused on a structured framework for mental health nurses' therapeutic responses to emotional distress and interpersonal conflict in acute adult mental health inpatient units. The aims of this evaluation were: 1) What is the effectiveness of Safe Steps in reducing restrictive practice events and duration and physical injuries? 2) Does Safe Steps improve people's service experience, perceived staff action towards violence prevention, and nurses' professional quality of life and emotionally intelligent workplace behaviours? 3) What factors influence the successful implementation of Safe Steps? It is hypothesised that: a) intervention sites will demonstrate more significant decreases in restrictive practice events and duration and physical injuries, compared to within-group baseline and control group, and b) measures of people's experiences and perceptions and nurses' outcomes and behaviours will improve, compared to within-group baseline. Safe Steps has three components: i) a structured de-escalation framework, ii) an in-person and online training programme, and iii) a regular conduct of strengths-based, data-informed restrictive practice review meetings. The control group will be usual care. Other outcomes include nursing intervention clusters, their associations with various outcomes, and factors influencing intervention implementation and restrictive practice use. There is no randomisation, but inverse probability weighting will be applied. The sample sizes were determined through power analyses and supporting evidence on saturation in qualitative research. Various quantitative and qualitative data treatments and measures will be undertaken to minimise research biases.

AIM:An analysis of mental health nursing de-escalation logs for 249 days from a regional adult inpatient unit in New South Wales, Australia, was completed to identify groups of cooccurring nursing therapeutic responses to aggression and examine their associations with reductions in restrictive practices and situational aggression. DESIGN:A single-centre retrospective study was undertaken. METHOD:Hierarchical clustering of nursing interventions established groups of cooccurring nursing responses. Poisson mixed-effect models were then used to determine the associations of the intervention clusters with restrictive practices. RESULTS:Two intervention clusters emerged: Cluster 1 involved verbal de-escalation with active listening and rapport building, whereas Cluster 2 included additional limit setting and problem-solving, distraction, sensory modulation, environmental change and individual staff time. Cluster 1 was linked with a reduction in seclusion use by 83% [IRR = 0.17, 95% CI (0.07, 0.41), p < 0.001], physical restraint by 79% [IRR = 0.21, 95% CI (0.11, 0.40), p < 0.001] and average judged situational aggression by 1.56 [95% CI (0.86, 2.25), p < 0.001]. Cluster 2 was related to statistically insignificant increases in the three studied outcomes. CONCLUSIONS:The intervention clusters prove the value of supplementary tools in surfacing nurses' therapeutic potential. The differences in restrictive practice use between intervention clusters signal the structure and progression of forming therapeutic relationships in aid of de-escalation and the possibility of assessing de-escalation components robustly. RELEVANCE TO CLINICAL PRACTICE:Acknowledging and supporting nurses' therapeutic work support the development of recovery-oriented care and a positive professional identity for nurses. REPORTING METHOD:This study followed the applicable STROBE guidelines. PATIENT OR PUBLIC INVOLVEMENT:Due to the study's retrospective nature, there was no service user or public involvement.

Understanding the drivers of seclusion and physical restraint supports the work towards minimising their use in acute mental health units. However, evidence on their most important drivers remains limited and is focused mainly on individual-level features. Employing 249 days of 917 contemporaneous records of nurse de-escalation events in one adult inpatient unit in regional Australia, from January 2019 to March 2020, twenty-three features other than individual demographic, dispositional, and diagnostic factors were extracted. Bivariate statistics and supervised machine learning algorithms for feature selection (i.e. Boruta algorithm) and predictive modelling (i.e. random forest) were applied. Emerging top drivers include incidents in high observation beds, the assessed level of situational aggression before de-escalation, incidents directed towards nurses, verbal de-escalation, and distraction and redirection. These findings elevate the predictive value of contextual and interventional, rather than individual-level, features in understanding the likelihood of restrictive practices.

Contemporary healthcare for those experiencing mental illness requires healthcare practitioners (HCPs) to effectively incorporate the prescription of exercise in their treatment, in accordance with clinical guidelines. However, there has been a lack of effective implementation of such recommendations. The purpose of this review was to identify barriers to exercise prescription in the treatment of people diagnosed with mental illness as perceived by HCPs. APA PsycINFO, CINAHL, MEDLINE, and PubMed electronic databases were searched for relevant articles published in the period from January 2005 to September 2023. A total of 18 papers were included for thematic synthesis. Four key themes were identified across the qualitative (8), quantitative (6), and mixed method (4) papers, including a lack of knowledge and confidence of HCPs in prescribing exercise; role and responsibility; HCPs’ misconceptions of client barriers; and systemic issues impacting exercise prescription practices. A lack of knowledge or confidence was the most common barrier. Some HCPs indicated a desire to develop their skills in exercise prescription, while others indicated a preference for an exercise professional to take responsibility for this aspect of treatment. Systemic barriers were spread across a range of issues, with lack of time, excessive workload, and difficulties accessing qualified staff most commonly cited. This review provides further insight into the barriers to exercise prescription faced by HCPs and makes recommendations regarding how to address these barriers in order to better implement clinical guidelines and thus improve the quality of treatment provided to people diagnosed with a mental illness.

Within Australian higher education, student evaluation of teaching (SET) is regularly conducted and data are utilised for quality control and staff appraisal. Within current methodologies, students can anonymously provide further feedback as written commentary. There is now growing evidence that, once this narrative becomes derogatory or abusive, it may have the potential to create harm. To investigate staff reactions to receiving anonymous non-constructive commentary, a one group point in time design was constructed, and a survey conducted. Participants (N = 741) from a broad cross-section of Australian universities responded to Likert questions asking about their reactions. A significant impact was revealed according to age for mental health, stress and professional confidence, with younger and tenured academics indicating the most vulnerability. There were no differences across gender. Non-health disciplines with teaching loads greater than 50% reported an impact of anonymous SET on mental health and professional confidence. Being casually or seasonally employed or from an ethnic background was shown to have a significant effect on professional confidence. Findings suggest that the potential for higher education academics to be harmed via this process is a continued risk and highlights the need for review and reform of SET systems and protocols.

BACKGROUND:The introduction of the National Disability Insurance Scheme (NDIS) in Australia in 2013 promised significant improvements in the lives of adults with intellectual disabilities. Although the scheme enables support, there are challenges associated with establishing eligibility and administering funds. This scoping review explored perceived barriers and enablers to effectively utilising the NDIS for adults with intellectual disabilities and their families.METHOD:A scoping review of the empirical literature on the NDIS and intellectual disabilities included nine studies in this review. These papers were subjected to thematic analysis and the findings were presented as a narrative synthesis.RESULTS:The key themes identified were: (1) Limited understanding of the NDIS process; (2) Language use and capacity assumptions; (3) Unrealistic goals and progress, and difficulty utilising plans; (4) Expectations of families and associated workloads; (5) Opening up opportunities not previously available; (6) Knowledgeable planners who actively seek to involve adults and their families.CONCLUSION:Although qualitative studies demonstrate that adults with an intellectual disability and their families are largely satisfied with the increased opportunities the NDIS has afforded them, there are various areas in which accessibility to services can be improved. In order for the NDIS to continue to improve, the results from this scoping review underline the need for adults with an intellectual disability and their support systems to have their voices heard and be utilised.

Internationally there are both current and looming mental health workforce shortages. Mental health nurses who have received specialist education are a vital component to respond to these challenges. AIM:This qualitative study aimed to better understand the efficacy and product quality of mental health nurse workforce preparation through pre-registration nurse education in Australia. METHOD:To meet this aim 19 educators representing 13 different universities were qualitatively interviewed. RESULTS:Thematic analysis found four themes (1) Graduates are under-prepared for safe mental health nurse practice; (2) Essential mental health nurse capabilities are missing in graduates; (3) Barriers to graduate preparation, and (4) Negative impacts of inadequate graduate preparation. DISCUSSION:Findings from this study suggest future workforce shortages would be best addressed through direct undergraduate entry for mental health nursing Implications for Practice: All nurse undergraduate training needs significantly enhanced mental health theory and placement within the course.

Objectives: The review explores current evidence on Australian pre-registration nurse education in preparing graduates to work in mental health settings, from the perspectives of the graduates. Design: A scoping review using the Joanna Briggs Institute framework for scoping reviews and the Preferred Reporting Items for Systematic and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist was undertaken. Results: There were 31 eligible publications, reporting 12 qualitative studies, eight surveys and 11 quasi-experimental studies. All were in English language peer reviewed journals, published between 2000 and July 2023. Five themes emerged: 1. Well-organised and supported clinical placements can reduce stigma; 2. Student concerns regarding mental health clinical placements can be lessened when placements are well-designed; 3. Well-organised and resourced clinical placements can increase interest in mental health nursing; 4. Simulation learning can increase confidence during clinical placements; 5. Teaching by Experts By Experience (EBE) can reduce stigma and improved student attitudes. Conclusion: Evidence from 31 eligible publications indicated that properly resourced, purpose-designed theoretical and clinical learning experiences can be effective in reducing stigmatising attitudes and behaviours in pre-registration nursing students. Involving EBEs in mental health teaching is an important, but so far under-utilised, development in pre-registration nursing programmes in Australia.

Aggression, conflict and restrictive practices present complexities in acute mental health services, as do implementing service changes to reduce them. Existing published literature needs to offer more high-level guidance on the effectiveness of these service changes and their associated implementation factors. As a result, an overview of systematic reviews was undertaken to identify (i) nonpharmacological interventions to reduce conflict, aggression and restrictive practices in acute mental health settings, and (ii) their effects across different clinical outcomes. A parallel re-extraction from primary studies was then utilised (iii) to identify factors influencing successful intervention implementation. Of 124 articles sourced from nine databases and registries, four reviews were retained for the final analysis, using the direction of effect and tabular and narrative summaries. These reviews included programmes or interventions focused on inpatient adolescent, adult and older adult populations. They reported on alternative containment strategies, risk assessments, Safewards, sensory rooms and equipment, Six Core Strategy-based interventions and staff training. The overview found that a combination of interventions intended to improve relationships and reduce interpersonal conflict may help reduce aggression, conflict and restrictive practices. At the same time, stand-alone staff training and sensory rooms and equipment may have mixed effects. The quality of the evidence linking these interventions to reductions in aggression, conflict and restrictive practices is limited. Successful implementation hinges on multiple factors: intervention characteristics, preparation and planning, evaluation and monitoring, outcome interpretation, stakeholder involvement/investment, staff-related factors and contextual factors. Any implementation initiative may benefit from using pragmatic and complexity-informed research methodologies, including integrating meaningful involvement with service users, peer workers and culturally diverse groups.

Accessible summaryWhat Is Known on the Subject? Service user involvement in mental health nursing education is beneficial in terms of attitudinal change to reduce stigma, clinical skill development and enhancing understandings of recovery‐oriented practice. Service users as experts by experience have not been embedded within pre‐registration nursing programs. Consequently, they remain limited in number, ad hoc and frequently tokenistic. Nurse academics responsible for the design and delivery of pre‐registration mental health nursing curricula have a potentially important role in facilitating expert by experience involvement in mental health nursing education. What this Paper Adds to Existing Knowledge Nurse academics teaching mental health nursing have generally favourable views about the importance of expert by experience involvement. Nurse academics experience significant barriers in supporting the implementation of academic positions for experts by experience, particularly in obtaining funding. The experts by experience could contribute to mental health nursing education does not appear to be clearly understood by nurse academics. What Are the Implications for Practice? Mental health services aspire to adopt a recovery‐oriented approach to practice. Involving experts by experience in mental health nursing education can facilitate increased understanding and appreciation of recovery‐oriented practice. Nurse academics could play an important role in supporting the implementation of experts by experience positions in nursing academia. To do so, they require an understanding of the benefits of EBE involvement in academia and the barriers that can be encountered when attempting to facilitate the implementation of such positions. Experts by experience contribute unique expertise, essential to the development of quality mental health services. Conveying this expertise through the educating the future nursing workforce in mental health is essential. AbstractIntroductionInvolving service users in mental health nursing education is ad hoc and minimal, despite growing evidence of its benefits. Insights and experiences of nurse academics teaching mental health to pre‐registration students have been underrepresented in the research to date.AimTo seek insights and experiences of nurse academics involved in designing and delivering pre‐registration mental health nursing education in Australian universities regarding involving service users in mental health nursing education.MethodsA descriptive qualitative study involving 19 nurse academics from 13 Australian universities, involved in pre‐registration mental health nursing education. Data were analysed thematically.ResultsParticipants reported minimal service user involvement. Most sought an increase and identified barriers. Data analysis resulted in five identified themes: (1) value‐rich, (2) resource‐poor, (3) imperfect processes, (4) ‘part, but not all’ and (5) unrecognised worth.ConclusionsIncreasing meaningful involvement of service‐users in mental health nursing education requires support and investment from multiple stakeholders. Nurse academics are crucial stakeholders in understanding the unique expertise service users bring.Implications for PracticeService users being central to all aspects of mental health services requires their active participation in the education of health professionals. Nurse academics have an important role in realising this goal.

Clinical placements form an integral and important part of preregistration nursing student learning. The theory-practice gap has been identified as problematic, with clinical experience being a key strategy to address this. Despite this, the perceptions of nurse academics teaching preregistration mental health nursing regarding clinical placements have not been widely explored. To garner perspectives and experiences of mental health clinical placements from nurse academics teaching mental health nursing to preregistration nursing students. A descriptive qualitative study involving 19 nurse academics from 13 metropolitan and regional Australian universities, who were involved in the design and delivery of preregistration mental health nursing content. Data were analysed thematically. The study adhered to the Standards for Reporting Qualitative Research (SRQR). Participants reported that inappropriate clinical placements generate negative student experiences. Furthermore, mental health placements in nonspecialist settings such as medical-surgical or aged care compromised student learning and posed a barrier to linking theory to practice. Increasing meaningful and appropriate mental health clinical placements in nurse education requires investment and support from multiple stakeholders. Nurse academics are crucial stakeholders in terms of understanding the impact of mental health clinical placements. Appropriate mental health clinical placements are central to effective comprehensive nurse education. Academics teaching mental health in preregistration curricula are significant stakeholders, and their informed perceptions are central to compel change.

Objective This study aimed to determine the extent to which people admitted to a private psychiatric inpatient unit access and utilise the gymnasium and individualised coaching with an exercise physiologist (EP). Methods An audit of the medical record of 100 consecutive discharges and 60 individuals referred to an EP during the audit period was undertaken. Selected demographic information, physical health status, psychiatric diagnosis and routinely collected outcome data were extracted from files. Results Twenty-four percent of people discharged from the hospital had documentary evidence of having attended the gym. These people were noted to have used the gym regularly and had an exercise prescription documented on discharge. Those with substance use disorder were more likely to use the gym than those diagnosed with an affective disorder. There were no significant differences in outcomes between those who were noted to exercise and those who did not. Conclusion Those who may most benefit from coaching around exercise in the context of hospital admission are not presently the individuals most likely to be referred to an EP. Standardised procedures for assessment, referral, exercise prescription and ongoing monitoring of activity and outcomes are recommended across the care continuum.