Professor Andrew Cashin

The government plans to redirect some children off the National Disability Insurance Scheme (NDIS) and onto a new program called Thriving Kids. When announcing the change last month, health and disability minister Mark Butler explained:
Tens and tens of thousands of young children with mild to moderate developmental delay or autism are on a scheme set up for permanent disability.

This seemed to imply autism is something people “grow out of”. It’s not: autism spectrum disorder is a lifelong neurodevelopmental condition.
The government’s announcement about redirecting people off the NDIS has also raised concerns about what supports will remain available for autistic people as they grow older.
So what should support look like for autistic adults?

Aim : To survey registered nurses' familiarity with delegation standards and confidence to delegate to unlicenced workers within their practice.
Design: Cross‐sectional exploratory survey design.
Methods: The survey focused on Australian registered nurses ( n = 420). Initial descriptive analysis was undertaken. Additionally, inferential analysis was undertaken between two independent variables focused on familiarity of delegation policy, and confidence to delegate, and several demographic and workplace variables. Stepwise linear regression was undertaken to determine predictors of the two delegation variables. The cross‐sectional study was undertaken according to the STROBE reporting checklist.
Results: The majority of respondents were somewhat familiar, or not familiar at all with delegation standards. This pattern was followed for results relevant to confidence delegating to unlicenced workers. Nurses working in adult acute, intensive care and emergency department reported the lowest levels of familiarity with delegation. Additionally, intensive care nurses were significantly less likely to feel very confident delegating to unlicenced support workers. Stepwise regression revealed identifying as male, and working in the public sector were less likely to be confident delegating. Nurses working in the acute setting and public sector were less familiar with delegation standards.
Conclusion : The findings of this study highlight the nuanced nature of delegation to unlicenced workers in Australian nursing settings, with nurses from certain contexts being far less likely to be familiar with or confident undertaking the practice. Implications for Clinical Practice The findings of this study have significant implications to increase understanding of nurses diverse contexts of practice and how delegation standards might not be implemented in practice in a confident manner.

Background: The nursing workforce has been under prolonged strain, beginning with the pandemic and continuing into a post-pandemic inflationary economic crisis. Research published in 2017 in Australia identified registered nurse practice to be person-centred. This practice is embedded as a foundational concept in the Australian Registered Nurse standards for practice, and it was determined to represent actual, rather than aspirational practice at the time of the underpinning research.
Results: This critical paper examines whether the practice has shifted to a biomedical or system-centred model of nursing care in response to sustained stress.
Conclusion: The practice appears to have shifted to a biomedical or system-centered model of nursing care. This shift has not been a consciously decided upon course of action, but rather a regression to an older vision of nursing. The reinvigoration of bureaucratic hierarchical models of care, which impinge on role autonomy, is conceived as a mechanism of the shift, arising through ambivalence.

Aim: To explore the prescribing practices and behaviours of Advanced Practice Nurses (APN) and pharmacist prescribers in Singapore, assess their confidence in key prescribing competencies, examine their use of information sources, and understand their views on the consequences of prescribing errors.
Design: Cross-sectional national survey.
Methods: A census survey of all registered APN and pharmacist prescribers in Singapore was conducted from February to May2024 using a validated 96-item instrument. The survey assessed prescribing practices, confidence in prescribing competencies, use of information sources, and prescribing safety. Descriptive statistics were used for analysis.
Results: Ninety-one prescribers (54 APNs, 37 pharmacists) responded (32% response rate), most of whom worked in public medical/surgical settings. Prescribing comprised a median of 75% of their practice. Most time was spent prescribing continued medications, with less on initiating new medicines. Participants reported high confidence in communication, therapeutic partnerships, and working within professional standards. Greatest confidence was seen in educating patients, legal prescribing, and monitoring treatment response. Lower confidence was noted in complementary medicine-related tasks. Professional literature and colleagues were the most valued information sources. Most participants acknowledged the serious consequences of prescribing errors, though many believed such errors would likely be intercepted.
Conclusion: APNs and pharmacists demonstrate strong competencies in safe, holistic prescribing. However, cultural factors may limit patient engagement, highlighting the need to strengthen shared decision-making and collaborative practice.
Implications for the Profession: Refining governance structures, adopting tiered prescriber autonomy, and enhancing training in complex prescribing are essential. Standardising deprescribing, improving access to decision-support tools, and promoting interprofessional collaboration and patient involvement can strengthen care quality and team-based delivery.
Impact: This study offers the first national insight into Singapore's Collaborative Prescribing Framework and informs training, policy, and workforce development for non-physician prescribers locally and in similar international contexts.
Reporting Method: STROBE checklist.
Patient or Public Contribution: This study did not include patient or public involvement in its design, conduct, or reporting.

The concept of person-centred care is embraced internationally as a fundamental aspiration for nursing and health professions more broadly. For many, person-centred care is seen as a fundamental part of the art of nursing. The available research suggests that while an aspiration of the profession, person-centred care is not actual nursing practice. A limited body of research has identified positive impacts on patient outcomes attributable to person-centred care. In the context of care for people with autism and/or intellectual disability, reasonable adjustments are an example of person-centred care. This national cross-sectional survey aimed to determine the degree of awareness of the concept of reasonable adjustments, the types of self-reported adjustments made, and the relationship between making adjustments and the individual factors of self-efficacy, ambivalence, and role autonomy. From the 422 Australian registered nurse respondents, it was identified that 54% of respondents were aware of the concept of reasonable adjustments, and the majority did not report making person-centred adjustments to practice for this group. Further, it was found that people with autism and/or intellectual disability are least likely to experience person-centred care in acute hospitals and aged care contexts. It was identified that person-centred care, indicated by the example of reasonable adjustments, is not the predominant current model of care as self-reported by registered nurses in Australia. This is contrary to the current national standards for practice.

Introduction
Supporting daily living skill (DLS) development for autistic people is a component of occupational therapy practice. DLSs are essential for an increased quality of life (QoL), independent living, and community participation. Autistic young people experience poorer outcomes in terms of QoL and independent living than non‐autistic peers. Finding a balance between targeted DLS support to maximise independent living and improve QoL, while avoiding attempts to ‘normalise’ or ‘change’ autistic people, presents as a dilemma for therapists striving to align with neurodiversity‐affirming practice.

Methods
This theoretical paper explored literature pertaining to DLS and the neurodiversity movement in the context of occupational therapy values and the Canadian Model of Occupational Participation. Consideration of whether targeted DLS support is neurodiversity‐affirming or whether occupational therapists are compelling autistic people to mimic behavioural norms perceived by society was discussed.

Results
DLSs are an important factor for maximising QoL, regardless of neurotype. Occupational therapy values align with the core tenets of the neurodiversity movement, and occupational therapists are equipped with the values and skills to support the development of DLSs utilising affirming practice.

Conclusion
Occupational therapists should critically reflect on their practice to ensure alignment with the professions core values and recent occupational therapy models, to ensure affirming practice. Further research investigating DLS and neurodiversity‐affirming practice would benefit occupational therapists striving to align with neurodiversity‐affirming practice.

Consumer and Community Involvement
No consumer or community involvement. Consumers have been considered throughout the development of this paper through their representation in the literature. This involved a process of reviewing the literature and considering it in the scope of the questions and how occupational therapy sits within the neurodiversity movement.

PLAIN LANGUAGE SUMMARY
It is important to help autistic people to learn to do everyday things. Everyday things include activities like showering, cleaning, and cooking. These things are important so that autistic people can live on their own. It has shown that autistic young people are less likely to be able to do everyday activities on their own. It is important that therapists help autistic people learn how to do everyday things; however, do not try and change who they are. This is because completing everyday activities is an important part of QoL for all people.

Background: Health outcomes of people with Autism Spectrum Disorder and/or Intellectual Disability are poor. Yet there is a paucity of nurse education and preparation to care for people with Autism Spectrum Disorder and Intellectual Disability.
Method: A cross sectional survey of Australian Registered Nurses related to their educational experience, awareness of the national disability support scheme and the concept of making reasonable adjustments.
Results: The majority of Australian Registered Nurses did not experience undergraduate content related to caring for people with Autism Spectrum Disorder and/or Intellectual Disability. Few participants experienced a dedicated clinical placement. Just over one half of the participants were aware of reasonable adjustments. Continuing professional education was significantly related to a greater awareness of reasonable adjustments and less ambivalence.
Conclusion: Education plays a key role in promoting awareness and reducing ambivalence. Education focussed on understanding the diversity in the particular types of neurodiversity is particularly efficacious.

Autism is often considered a disability, but it is more accurately understood as a difference in the way people think and process information. Despite this, many individuals with autism face challenges in social interactions and carrying out daily activities. While autism is often associated with intellectual disability, many individuals with autism have normal or even above-average intelligence. The term "Asperger's Disorder," previously used to describe individuals with autism who have higher intellectual functioning, has now been combined with the autism spectrum diagnosis.
Our understanding of autism continues to evolve. The current focus is not only on observable behaviors but also on the unique ways of thinking and processing information in individuals with autism. By understanding these differences, we can provide more appropriate and effective support. The primary goal in supporting individuals with autism is to help them reach their full potential and participate fully in society. Therapy should be individualized and tailored to each individual's needs. Furthermore, it is important to involve individuals with autism and their families in the decision-making process regarding support.

Aim
This study aimed to understand Indonesian nurses’ familiarity with the concept of reasonable adjustments, and the frequency of its application within their practice.

Background
People with intellectual disability and/or autism are exposed to significant barriers when accessing healthcare and have poorer health outcomes than those without developmental disabilities. Reasonable adjustments can improve accessibility and quality of healthcare for people with disabilities and involves adapting practices and environments to promote equitable healthcare.

Introduction
There is a scarcity of literature focused on the application of reasonable adjustments in the Indonesian nursing context. A greater understanding of the application of reasonable adjustments in this context can help inform nursing curricula and policy.

Methods
A cross-sectional, descriptive survey -was undertaken and is reported in accordance with the Strengthening the Reporting of Evaluations and Non-randomised Designs. Following descriptive analysis, bivariate analyses were undertaken between key demographic, workplace, and self-reported capability variables, and familiarity and implementation of reasonable adjustments.

Results
The majority of respondents were not familiar with the concept of reasonable adjustments and self-reported sometimes applying it within their practice. Higher levels of educational and clinical exposure to intellectual disability and/or autism, and self-capability variables, were significantly associated with familiarity with reasonable adjustments and their application.

Conclusions
An increase in nursing curricula focused on caring for people with intellectual disability and/or autism, including content focused on applying reasonable adjustments, is indicated.

Implications for nursing policy
Given that, internationally, people with intellectual disability and/or autism have disproportionately negative health outcomes and experiences, findings highlighting gaps in understanding and application of reasonable adjustments of Indonesian nurses have substantial implications for nursing policy and curriculum.