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Patients who miss scheduled appointments reduce clinical productivity and delay access to care for other patients. Reminders have improved attendance for healthcare appointments previously, but it is not known if short message service (SMS) implementation reduces incidence of patients unable to attend (UTA) or who fail to attend (FTA) appointments in the public dental service. This paper studied the effectiveness of SMS reminders in increasing appointment attendance at outpatient public dental services in Queensland. Data were sourced from the adult service and the children and adolescent oral health service (CAOHS) at West Moreton Hospital and Health Service, a public dental service in Queensland. A total of 63,238 appointments pre‐implementation of SMS reminders and 55,028 appointments post‐implementation over a period of 2 years were analysed for rates of attendance, UTA and FTA. Characteristics of UTA and FTA appointments were analysed to identify factors that hindered improvement after implementation of reminders. For the CAOHS, the attendance rate decreased 4% (95% CI: 2%, 6%) following SMS implementation. The UTA rate also increased by 20% (95% CI: 15%, 25%). Following SMS implementation in the adult service, the attendance rate increased from 73.5 (95% CI: 72.6, 74.4) to 77.7 (95% CI: 76.6–78.8) per 100 appointments. The FTA rate post‐implementation was 1.08 (95% CI: 1.00, 1.16) times that from pre‐intervention, and the UTA rate decreased from 21.7 (95% CI: 21.2, 22.2) to 17.1 (95% CI: 16.6, 17.7) per 100 appointments. The SMS reminders had a mixed effect on the attendance, UTA and FTA rates for the CAOHS and adult services. Reminders reduced the rates of UTA for the CAOHS service and increased the rate of attendance for the adult service. There was an increase in the FTA rate for both services. [ABSTRACT FROM AUTHOR]

Aim This paper aims to identify and explore key obstacles preventing ward managers from effectively performing the human resource management (HRM) responsibilities required in their role. Background In the context of increasing costs and the decentralisation of responsibility to ward level, the relevance of the ward manager role within the 'black box' between human resource management and firm performance is becoming increasingly pertinent. Methods This paper presents an intensive case study including 37 interviews across all levels of a hospital where senior management attempted to shift to a high performance model of human resource management. Results The findings indicated that ward managers played a critical role in maintaining and improving employee performance, although they were restricted from effectively performing their responsibilities due to budget pressure and limited managerial skill development. Conclusions Our findings support the contention that hospitals would benefit from focusing on the critical role of the ward manager as the central locus of influence in high performance human resource management (HPHRM) systems. Implications for nursing management Investment into high performance human resource management is discouraged if the hospital cannot adequately enable ward managers who are responsible for implementation. Introduction of managerial skills training to potential and existing ward managers is critical. [ABSTRACT FROM AUTHOR]

Aim This paper reports on the outcomes of a locally designed educational programme to support leadership capability of junior registered nurses. Background The Developing Leader Programme is an in-house programme delivered in three face-to-face workshops, comprising self-directed reflective and application activities. Method Surveys were used to evaluate self-perceived leadership capability over a 9-month period. The survey comprised a Leadership Capability Instrument adapted from two existing tools. Participants completed surveys at the commencement of the programme, after the third and final workshop and approximately 6 months afterwards. In addition, examples of descriptive accounts of programme activities submitted by individual participants were included to enrich data. Results Of 124 participants, 79 completed surveys at the first workshop, 28 at the final workshop and 31 were returned 6 months after completion of the programme. Mean scores for each area of leadership capability significantly improved throughout the duration of the programme ( P < 0.001). Participants also indicated a willingness to enact leadership behaviours through reported activities. Conclusions Survey responses indicated that participants perceived improved leadership capability after completing the Developing Leader Programme. Implications for nursing management Early educational intervention to facilitate the development of leadership skills as well as clinical skills in junior registered nurses can assist with how they interact with the team. Participation of junior registered nurses in a locally designed leadership programme can assist them to develop leadership behaviours for everyday practice. [ABSTRACT FROM AUTHOR]

Planning for discharge and supports beyond hospital for people with disability in Australia involves negotiation of complex care systems. The aims of this study were to examine how the individualised support pathway of the National Disability Insurance Scheme (NDIS) functioned for admitted people with disability who required funded support to leave hospital; and to explore the factors indicative of increased care complexity associated with delays. Retrospective chart reviews of people with disability were conducted. Data on 198 eligible patients were extracted, including NDIS plan approval and plan implementation timeframes and discharge delay. Participants' median age was 52 years (interquartile range = 41–59). The most common disability type was spinal cord injury (41%). The median NDIS plan approval and implementation timeframes were 89 days (63–123) and 39 days (8–131), respectively, and most participants (72%) experienced a delayed discharge. A longer plan implementation timeframe was associated with higher odds of a delay in discharge (OR = 3.41, 95% credible interval = 1.56, 7.11). We did not find any evidence that plan approval timeframe, or any other variable indicative of increased care complexity, was associated with discharge delays. Our findings suggest that a delayed discharge will likely be the reality for people with disability who require funded supports to leave hospital. They also suggest that NDIS plan implementation is a major challenge and a focus for policy and practice improvements. To target solutions, further research should focus on the interactions and negotiations of the multiple intermediaries involved and resource and structural impediments to plan implementation. [ABSTRACT FROM AUTHOR]

Aim(s): To ascertain nurses' perceptions about, and suggestions for, management solutions to workplace violence perpetrated by patients. Background: Violence towards nurses from patients in the workplace is high in Australia. There is a need for good management responses, and experienced nurses can provide logistical suggestions about effective strategies. Method(s): This study uses an exploratory qualitative design. Focus group interviews were undertaken with 23 nurses working in a regional public hospital in Queensland, Australia. The COREQ research reporting checklist was followed, and the qualitative data were transcribed and thematically analysed manually and by NVivo. Results: Policy implementation, training, staff movement, seclusion, debriefing and a full reporting cycle were identified as central themes. Workplace violence management happens before, during and after a violent event. Conclusion(s): Weak processes undermine management; staff training on de‐escalation is needed. Affected staff need freedom to move from the ward. Better medical orders should be in place before an event. A full debriefing and feedback cycle are required, along with easier reporting processes. Implications for Nursing Management: Nursing management can reduce violence by ensuring better institutional support, consistent follow‐up and complete feedback procedures. Legal support, follow‐up mechanisms and staff training in de‐escalation are key points. [ABSTRACT FROM AUTHOR]

The health behaviours related to chronic diseases experienced by South Asian immigrants are interrelated with their culture and socioeconomic conditions. South Asian immigrants experience a disproportionate burden of chronic disease compared with non‐immigrants Australian‐born general population. The primary aim of this study was to gain an in‐depth understanding of health behaviours and healthcare access in the South Asian immigrant population of Australia. Five focus group discussions (FGDs) were conducted with South Asian immigrants (n = 29; 18 females) aged 27–50 years in Brisbane, Australia. Separate FGDs were conducted for males and females in the English language. Semi‐structured guided questions related to the perception, barriers and facilitators of health behaviours. Data were analysed with Nvivo‐12 following a thematic analysis. A conceptual model is proposed to provide a summarised understanding of barriers and facilitators of health behaviours in South Asian immigrants. The major reported constraints for participating in physical activity were cultural beliefs, lack of time, work stress and high fees of fitness activities, while parks and peer modelling were mentioned as a strong motivator for walking, cycling and participating in group sports activities. The cultural and religious connections, cost of cigarettes and drink driving penalties were the most mentioned facilitators for a healthy lifestyle. The important factors related to unhealthy eating habits were the traditional cooking methods, social interactions and the high cost of fruits and vegetables. Community perceptions and language barriers were also acknowledged as the main factors for the decrease in accessing health care services. This study illustrates that cultural beliefs, high cost of healthy food and facilities and social circumstances are mainly linked with the health behaviours and healthcare access in South Asian immigrant's lifestyles. [ABSTRACT FROM AUTHOR]

Objective: This study compares the well‐being of rural caregivers with that of the general population and explores the potential drivers of poorer outcomes. Method: Patient–caregiver dyads (n = 241) residing in regional or remote Queensland, Australia, reported on QoL, chronic illness, caregiver burden, depression, anxiety and stress. Caregiver outcomes were compared with population norms and patient outcomes. Multiple regressions were conducted to identify factors associated with poorer caregiver outcomes. Results: Caregivers reported lower mental health‐related QoL (M = 0.436, 95% CI = 0.410–0.462) in comparison with age‐matched population norms (M = 0.556, 95% CI = 0.532–0.580). No differences existed between caregiver and population norms for anxiety, stress and depression. Caregiver chronic illness and higher burden were associated with poorer mental and physical QoL, depression, anxiety and stress (η2s ranging from 0.03 to 0.30). These associations were slightly stronger for male caregivers when compared with female caregivers (η2s ranging from 0.03 to 0.08). Conclusion: It is vital that efforts are made to improve rural caregivers' mental and emotional well‐being. Interventions that support caregivers with chronic conditions reduce caregiver burden and take into consideration the unique experience of male caregivers will go some way to addressing this. Future research is needed to identify other drivers of health outcomes in this group. [ABSTRACT FROM AUTHOR]

We have little knowledge of differences in end‐of‐life care between home settings and residential aged care facilities (RACFs) where people spend most of their last year of life. This study aimed to compare end‐of‐life care between home settings and RACFs from the perspective of Australian general practitioners (GPs). A descriptive study was conducted with 62 GPs from Western Australia, Queensland and Victoria. Participants were asked to provide reports on end‐of‐life care of decedents in their practice using a validated clinic‐based data collection process developed by our team between September 2018 and August 2019. Of the 213 reported expected deaths, 66.2% mainly lived at home in the last year of life. People living at home were more likely to die at a younger age (median 77 vs. 88, p < 0.001), to be male (51.1% vs. 33.3%, p = 0.01) and to die of cancer (53.9% vs. 4.2%, p < 0.001) compared to those in RACFs. There were no significant differences between the two patient groups for seven out of the eight assessed symptoms, except nausea. GPs' perceived roles in caring for patients and levels of their involvement in provision of common palliative care services were comparable between the two groups. The usual accommodation setting was most frequently considered the preferred place of death in both groups. However, more home residents ended up dying in hospital compared to RACF residents. There were significantly higher frequencies of end‐of‐life discussions (ORs ranged 5.46–9.82 for all topic comparisons) with GPs associated with people living at home versus RACFs. One opportunity for improved care is through promoting greater involvement of GPs in end‐of‐life discussions with RACF residents and staff. In general, more Australians could potentially remain at home until death if provided with greater access to essential specialist palliative care services and supportive services in home settings. [ABSTRACT FROM AUTHOR]

Australian and international findings report pharmacy staff are motivated to expand and undertake new roles in public health and expressed a strong interest in providing oral healthcare services to the community. We sought to describe consumer experiences within primary oral healthcare, and views about pharmacy staff roles and boundaries in providing oral health services as perceived by a sample of consumers living within metropolitan Australia. Sampling occurred purposively to enable diverse perspectives on the topic. Socioeconomic status, as defined by the Socio‐Economic Index for Areas, was used as the primary criteria to stratify focus group recruitment. Thematic, in‐depth analysis of focus group discussions was carried out. In all, 34 participants took part in six focus groups, held in metropolitan settings in Queensland, Australia. Findings show that consumers supported pharmacy staff performing non‐invasive oral health services including providing oral health education and advice, reviewing medications and recommending evidence‐based medications. As services became more invasive (i.e., oral screening and fluoride application), questions and concerns were raised around the appropriateness of the community pharmacy setting and the level of training of pharmacy staff to provide these services. This study identifies the need to support greater integration of oral healthcare roles by community pharmacy staff. Future innovative and collaborative research involving additional stakeholder groups are necessary to explore, develop and test the feasibility and effectiveness of pharmacy‐led oral healthcare models. [ABSTRACT FROM AUTHOR]

Very little is known about the cardiometabolic risk of migrants who settle in Australia. This study investigated differences in cardiometabolic risk markers among ethnic groups attending a tailored healthy lifestyle program in Queensland, Australia; and differences in these markers between those living in Australia for shorter versus longer periods of time. Baseline data collected between October 2014 and June 2017 from the Living Well Multicultural—Lifestyle Modification Program were used. People living in ethnic communities in Queensland who were ≥18 years old, and not underweight were eligible to participate. Independent variables were ethnicity and length of time in Australia. Outcomes were cardiometabolic risk markers including BMI, waist circumference, weight‐to‐height ratio (WHtR) and hypertension. Analyses were done separately for each independent variable. Linear and logistic regressions were run for continuous and binary outcomes with differences/Odds ratios reported respectively. Multivariable analyses showed that Burmese/Vietnamese had an average BMI lower than Afghani/Arabic (3.7 points), Somalian/Sudanese (4.7 points) and Pacific Islander (11.6 points) (p < 0.001) respectively. Differences in waist circumference between Burmese/Vietnamese with Sri Lankan/Bhutanese, Afghani/Arabic, Somalian/Sudanese and Pacific Islander were 6.3, 8.4, 9.1 and 24.0 cm (p < 0.01) respectively. Although Burmese/Vietnamese also had lower average WHtR compared to the others, the differences were not significant for Somalian/Sudanese. Moreover, Sri Lankan/Bhutanese and Pacific Islander were more likely to be hypertensive compared to Burmese/Vietnamese (p < 0.05). Immigrants living in Australia >5years had on average 1.2 points higher BMI, 2.4cm larger waist circumference, and 0.02 points higher WHtR (p < 0.05) compared to those living for ≤5 years. Long‐stay immigrants were also more likely to be hypertensive than short‐stay immigrants (p < 0.01). In conclusion, cardiometabolic risk is significantly different among ethnic groups in Queensland with Pacific Islanders having the highest risk. Immigrants living in Australia >5 years had higher risks compared to those living in Australia for shorter periods of time. [ABSTRACT FROM AUTHOR]

The feasibility of an individualised carer support service delivered in community pharmacies was assessed from the perspective of carer participants using a pre–post questionnaire and semistructured interviews. Eligible pharmacies were required to offer a medication management service relevant to carers and have a semiprivate space for conversations. Carers were required to self‐identify as an unpaid support person for someone with a chronic condition or disability. Between September 2016 and March 2017, staff from 11 community pharmacies in South‐East Queensland, Australia were trained, and provided with ongoing mentoring from a pharmacist and carer to support service implementation. Identification of carers and support to achieve a personal and care‐giving goal were key features of the service. Questionnaires included the EQ‐5D‐3L, the Bakas Caregiving Outcomes Scale, and questions relating to goal achievement, carer roles, and responsibilities. Seven follow‐up carer interviews were undertaken between March and May 2017 and analysed thematically. Pre–post questionnaires were available for 17 carers (one withdrew, two incomplete). Of the 29 goals set, 10 were achieved and 14 partially achieved. EQ‐5D‐3L scores were unchanged, while 7 of the 15 items comprising the Bakas score improved (p < 0.05). Carer service evaluation was generally favourable, and these two main interview themes were the impact of caring and pharmacy experience. The impact of caring, while variable, was significant. Pharmacy experiences were mostly positive and the opportunity for carers to further engage with pharmacy staff was appreciated. The service was feasible and initial reported benefits to carers may support further research potentially in terms of a larger controlled trial. [ABSTRACT FROM AUTHOR]

To measure the prevalence and severity of Generalised Anxiety Disorder ( GAD), hypo- and hypercortisolaemia, and their association in a sample of prostate cancer ( PCa) patients, 97 Australian PCa patients completed a background questionnaire and the GAD-7, and provided a sample of saliva collected 30-45 min after waking. The mean GAD7 score was 9.67 ( SD = 3.09), and prevalence rates for current anxiety were higher than those reported for non- PCa males of a similar age. Mean salivary cortisol concentrations (30.78 nmol/L, SD = 13.97 nmol/L) were also higher than for age-comparative non- PCa men. There was a significant inverse correlation between GAD and cortisol ( r = −. 209, p < .05), and four subgroups of GAD-cortisol patients were able to be identified, with evidence of both hyper- and hypocortisolaemia. These findings provide initial neurobiological evidence of the chronic and profound nature of stress experienced by PCa patients, and also suggest a possible measure that might be used to identify most at-risk PCa patients. [ABSTRACT FROM AUTHOR]

Financial hardship may affect up to 30% of cancer survivors, however, little research has addressed the effect of employment change on financial hardship. This study compared the self-reported financial hardship of middle-aged (45-64 years) colorectal cancer survivors ( n = 187) at 6 and 12 months following diagnosis with that of a matched general population group ( n = 355). Colorectal cancer survivors were recruited through the Queensland Cancer Registry, Australia; data from the Household Income and Labour Dynamics in Australia (HILDA) Survey were used for the general population group. Pearson chi-square tests were used to assess the differences in proportions between the two groups and McNemar tests to assess differences across time among the same group. Generalised linear modelling was performed to produce prevalence ratios. A higher proportion of workers with colorectal cancer reported financial strain (money shortage for living essentials) at 6 months (15%) but eased and was comparable to the comparison group at 12 months (7%). Middle-aged working cancer survivors who ceased or reduced work were more likely to report not being financially comfortable, compared with those who had continued work (adjusted prevalence ratio 1.66, 95% CI: 1.12, 2.44) at 12 months. Health professionals, employers and government services should address the impact of impaired employment on financial hardship among cancer survivors. [ABSTRACT FROM AUTHOR]

Aim This study examined the importance and performance of middle managers' skills to provide a starting point for a sector-wide leadership and management framework. Background There is an increasing consensus that the quality of management, leadership and performance of any organisation is directly linked to the capabilities of its middle managers and the preparation and on-going training they receive. Method A total of 199 middle managers from three aged care organisations in Australia participated in a questionnaire conducted during 2010-2011. Result This study found that middle managers perceived the need to develop their communication skills, self-awareness, change management, conflict resolution and leadership skills. Conclusion Middle managers perceive a discrepancy between performance and importance of various managerial skills. This study demonstrated that provision of training needs to go beyond clinical skills development and further investigation into managers' needs is necessary, particularly considering the diversity of this critical group in organisations. Implications for nursing management Future training opportunities provided to middle managers need to address the 'softer' skills (e.g. communication) rather than 'technical' skills (e.g. clinical skills). The provision of training in these skills may improve their performance, which may also lead to increased job satisfaction, continuity in leadership and management and ultimately improvements in the quality of care provided. [ABSTRACT FROM AUTHOR]

Purpose To determine the changes in attitudes toward the inclusion of a cardiometabolic health nurse for the physical healthcare management of people with serious mental illness following a 6-month trial. Design and Methods Repeated survey of nurses working in a regional mental health facility. Findings Nurses working in mental health were initially supportive of the role. A 6-month trial of a cardiometabolic health nurse in the workplace reduced ambivalence and increased positivity toward the role. Practice Implications Reduced ambivalence and improved positivity toward the role may facilitate less organization resistance to the implementation of a cardiometabolic health nurse in the mental healthcare setting. Specialized training and role recognition may be needed to further support this role. [ABSTRACT FROM AUTHOR]

Aim To describe and compare standard practice with a revised, assisted method for calculating emergency department nursing workforce requirements (using the emergency nursing workforce tool, ENWT) within 27 Queensland public hospital emergency departments ( ED). Background Despite the presence of several methodologies used for staffing calculations, there is a necessity to refine measures of emergency department complexity and workload to determine appropriate staffing in order to meet patient safety needs and health service key priority indicators. Methods A descriptive comparative study design was employed. Of the 27 ED nurse unit managers ( NUM) invited, 18 (67%) participated. Results No significant difference was noted in the full time equivalent ( FTE) nursing requirement when standard vs. new ( ENWT) methods were compared. The ENWT was more efficient (i.e. timely) and had better predictability than existing methods for calculating FTE nursing requirement. Conclusion The methodology underpinning the ENWT may be useful to apply or adapt to settings other than the ED (e.g. intensive care, operating room) and disciplines within the ED other than nursing (e.g. medicine, allied health, porterage) to inform staffing requirements. Implications for nursing management Findings from this research can be used to inform ED managers and health service planners regarding a standardized approach to calculating emergency nursing workforce needs. [ABSTRACT FROM AUTHOR]

Purpose This article reports baseline data from a randomized controlled trial investigating the impact of a specialist cardiometabolic healthcare nurse on physical health care. Design and Methods Survey of community-based mental health consumers randomized to a cardiometabolic health nurse intervention. Findings Findings show a high prevalence of respiratory conditions, hypercholesterolemia, hypertension, and low quality of life. Participants reported regular blood pressure but infrequent cholesterol and blood glucose testing. Few received advice about smoking cessation, diet, or physical activity. Participants were mostly satisfied with physical healthcare provision; however, positive health behaviors are lacking. Practice Implications An individualized intervention based on knowledge and attitudes may be necessary. [ABSTRACT FROM AUTHOR]