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The objective of the review is to assess the association between health literacy levels and self-management behaviors in people with coronary heart disease.Initiating and maintaining self-management behaviors following a coronary event can be challenging. The capacity to initiate behavioral changes requires adequate health literacy, which is the ability to understand and use health care information to make appropriate health decisions.This review will consider studies including individuals at any age who have been diagnosed with coronary heart disease. Studies that used a standardized measure of health literacy with the primary outcome of self-management behaviors or an element of self-management (eg, medication adherence) will be considered for inclusion.The review will be conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases to be searched include CINAHL, Embase, PubMed, APA PsycINFO, Cochrane, Scopus, ScienceDirect, ProQuest Dissertations and Theses, Google Scholar, and OpenGrey. This will be followed by a forward and backward search of relevant articles. Cross-sectional, case-control, cohort, and mixed methods studies (quantitative component only) will be included. Studies will be screened by 2 independent reviewers and undergo a critical appraisal process. Included studies will be assessed for methodological quality, and data will be extracted using a JBI data extraction tool in the JBI System for the Unified Management, Assessment and Review of Information. The results will be presented as a narrative synthesis and, where possible, a meta-analysis will be conducted. The Grading of Recommendations, Assessment, Development, and Evaluation approach will be used to assess the certainty of evidence.PROSPERO CRD42021257407.

Objective: Oral cancer is widespread in South Asia, particularly India. In Australia, Indians are one of the fastest‐growing communities. This study aimed to explore the oral cancer‐related knowledge, attitudes and practices of Indian immigrants in Australia. Methods: Fourteen semi‐structured interviews were conducted with Indian immigrants residing across New South Wales and Victoria. Purposive and snowball sampling were used for recruitment. Data were analysed through a directed content analysis approach. Results: All participants were knowledgeable of oral cancer risks associated with tobacco and alcohol, but few were familiar with the harmful effects of areca nut preparations. Varied attitudes were evident with most participants acknowledging the importance of oral cancer check‐ups, yet very few followed this practice. All participants admitted engaging in oral cancer risk practices including areca nut use at least once or more in their lifetime. Conclusion: Oral cancer risk practices are common among Indian immigrants in Australia who possess limited knowledge with varying attitudes in this area. Implications for public health: Preventative strategies are needed to limit the use of oral cancer risk products among Indian immigrants. General practitioners and community organisations can play a key role in raising awareness in this area.

Aim To identify and summarize evidence of objective achievements and subjective indicators associated with professional success of men in nursing. Background Despite being a minority group, men in nursing are purported to enjoy hidden advantages. Evaluation In this integrative review, studies from seven databases were retrieved and independently evaluated using the quality appraisal tools in accordance with PRISMA guidelines. Inductive content analysis and narrative synthesis were conducted, guided by the aim of this review. Key issues In total, 12 studies published between 1987 and 2021 were included. Two themes with related subthemes supporting or refuting professional success of men were identified. These were (a) evidence of professional success and (b) challenges to professional success. Conclusion As a minority group, men are highly visible in nursing, which is a double-edged sword. Although men were overrepresented in senior nursing positions of higher salaries than women, they also experienced gender stereotyping, prejudice, and discrimination, which reduced the duration of men staying in a specific nursing position. Implications for nursing management Findings of this study highlighted the need for nurse leaders to proactively address specific gender issues that are unique to men in the nursing workforce.

Oral cancer is highly prevalent in the Indian subcontinent. With the increasing immigration of Indians to Australia, a potential rise in oral cancer cases can be expected if they continue engaging in oral cancer risk practices. Unfortunately, little is known on this topic in the Australian context. This study aimed to generate new insights into this area by examining Indian immigrants’ knowledge, attitudes and practices regarding oral cancer in Australia and their perceived role of general practitioners in raising oral cancer awareness. Exploring these aspects could determine the oral cancer risk behaviours of Indians in Australia along with any contributing factors which could help identify potential preventative strategies. A cross-sectional survey was undertaken of 164 Indians across Australia. Data were analysed using SPSS software with descriptive statistics. Respondents had varying levels of knowledge about oral cancer (mean total score 61%), particularly around risk factors such as alcohol and areca nut use as well as oral cancer-related signs/symptoms. The majority (87.7%) had not received any information about oral cancer in a health care setting but were receptive (71–90%) to general practitioners playing a more active role in this area. Respondents were engaging in positive preventative oral health care though few were currently (6.7%) or previously (14.7%) chewing tobacco preparations. Further research is needed through larger studies to confirm the study findings and inform the development of culturally tailored strategies particularly involving general practitioners, to raise oral cancer awareness and provide early screening for Indian immigrants.

Aim: To evaluate whether a two‐part culture improvement programme aimed at nurses in clinical and managerial positions in an inpatient mental health service was associated with culture change, and safety‐related behaviour and knowledge improvements. Background: Due to serious failings in the delivery of physiological care to mentally disordered inpatients, it was deemed important that interventions be applied to improve service culture. Methods: A pre‐test and post‐test study was conducted to evaluate change associated with a mandated intervention aimed at culture change. Nurses in clinical and managerial positions at all levels attended relevant sessions. All were invited to participate in evaluation measures. Results: N = 241 nurses participated in the evaluation (n = 137 and n = 104, pre‐test and post‐test, respectively). There was a small but significant change in organisational culture indicating greater adhocracy and less clan culture in the second survey period and a small decline in reported safety behaviour. Measures of safety culture, knowledge and emergency‐related educational satisfaction were unchanged. Conclusion: Only a small change in measured culture was associated with the programme. Implications for Nursing Management: Attempts to evaluate culture change need to align anticipated outcomes with appropriate outcome measures. A mandated programme of culture change had little tangible effect on the outcomes measured.

Background Oral cancer is a public health concern and is widespread in developing countries, particularly in South Asia. However, oral cancer cases are also rising in developed nations due to various factors, including smoking, viruses and increased migration from South Asia. In this context, the role of general medical practitioners (GPs) in identifying oral cancer is becoming increasingly important and, while some studies have explored their perspective about oral cancer, a synthesis of these results has not been undertaken. Objective The objective of this integrative review is to synthesize existing evidence regarding oral cancer-related knowledge, attitudes and practices of GPs in developed countries. Methods Four electronic databases were searched to identify studies focussing on the objective of this review. The inclusion criteria were: peer-reviewed English language publications; studies conducted in developed countries involving GPs; explored at least one study outcome (knowledge/attitudes/practices). No restrictions were placed on the publication date. Results A total of 21 studies involving 3409 GPs were reviewed. Most studies revealed limited knowledge of GPs about emerging risk factors, such as betel nut chewing (0.8–50%). Significant variation (7–70%) was evident in routine oral examination practices of GPs. Most GPs felt unsure about diagnosing oral cancer and many (38–94%) raised the need for further education. No study explored the specific relevance of GPs’ practices concerning South Asian immigrants. Conclusion This review suggests the need for educational programs to enhance GPs’ knowledge regarding oral cancer. Further research exploring oral cancer-related practices of GPs caring for South Asian immigrants is warranted.

Aims and objectives This study sought to explore undergraduate nursing students' perceptions of the role and value of their bioscience tutors in a blended learning curriculum. Background Blended learning approaches typically have reduced face-to-face contact with tutors-particularly in bioscience subjects which nursing students have traditionally found difficult, and the move to more web-based learning resources may compound this difficulty. Design Qualitative descriptive study. Methods This qualitative study was conducted with 19 undergraduate nursing students enrolled in bioscience subjects, at a large university in outer metropolitan Sydney, Australia in 2016. Semi-structured interviews were conducted over the telephone or face-to-face. Duration of interviews ranged from 13 to 71 min. Results were thematically analysed. EQUATOR guidelines for qualitative research (COREQ) applied. Results Two main themes with accompanying sub-themes were identified. The first theme identified the importance of the tutor in bioscience, including their qualities, expertise and contextualisation of learning. The second theme provided insights into students' perceptions of what they considered good and poor approaches to learning. Conclusions This study has clearly shown that while nursing students appreciated the flexibility offered by the online component of a blended learning curriculum, they still wanted an experienced bioscience tutor with clinical experience for their face-to-face classes. While the tutor was seen as crucial to providing clarification and context for content that was often challenging, they also played a key role in engaging and motivating students and creating a learning environment where students felt empowered to ask questions and debate issues with their peers. Given the increased use of online learning, further research could determine if the current study findings are also applicable in nonscience areas of study. Relevance to clinical practice The importance of students having a sound understanding of the biosciences for safe, effective clinical practice cannot be underestimated.

Introduction Quantification of the social climate of mental health care environments has received considerable attention. Investigations of the resulting measures indicate that social climate is associated with individual outcomes including patient satisfaction and staff burnout. Interest has grown in developing interventions to improve social climate in anticipation of subsequent related benefits. This study aimed to identify and critically review research about the effectiveness of interventions for improving social climate in inpatient adult acute mental health settings. Methods Systematic review reported in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Comprehensive terms were used to search multiple electronic databases from inception to July 2019. Information about intervention type(s), complexity was extracted and study quality was assessed. Results Twenty-three papers met inclusion criteria of which 20 used a pretest–posttest study design and three employed randomized and/or controlled designs. Interventions were environmental/structural, operational/process-oriented and developmental/person-oriented in nature and they ranged in complexity. The Ward Atmosphere Scale was the most common outcome measure used. Following quality assessment, six studies were judged to be sufficiently robust in terms of quality, theory-base, user-inclusion, and outcomes evaluation to contribute credibly to the evidence base. Of these, four complex person- and process-oriented intervention studies and two less complex structural/environmental intervention studies resulted in positive outcomes. Conclusion There is limited strong evidence that interventions positively influence measures of ward social climate in acute adult mental health settings. Such measures should not be the sole criterion of success when evaluating change. Decisions about implementing change to improve social climate should be informed by meaningful proxy measures including the views and preferences of service users and other stakeholders. Studies using stronger designs are required to establish the ability of interventions to improve social climate.

To determine the scope of published literature on healthcare transition (HCT) interventions that have been co-designed with adolescents and young adults with chronic conditions, and to undertake feasibility assessments. Using Scopus, CINAHL, Medline-Ovid, Cochrane and PsycINFO databases, publications that included a HCT intervention to support paediatric to adult healthcare transition were included. Study location, design, population, description of the intervention, co-design methods, feasibility evidenced using Bowen and colleagues’ framework, and outcome measures were extracted for review. A total of 21 studies were included, relating to 17 co-designed HCT interventions that ranged across multiple medical specialties. There was no standard HCT intervention; characteristics, format and delivery mode varied. Only three studies reported a detailed description of the co-design method(s) used and none reported on the facilitators or barriers. Among the studies, five of Bowen and colleagues’ eight dimensions of feasibility were measured. Despite the co-design process being neither described or evaluated extensively, all co-designed HCT interventions included in this review were considered to be feasible. Nevertheless, HCT interventions varied in their format and delivery method making it difficult to compare between them. Furthermore, interventions were often condition-specific and not representative of the extensive range of chronic conditions.Implications for RehabilitationHealthcare transition interventions can improve adherence to care, health outcomes, ongoing rehabilitation, and quality of life of adolescents and young adults with chronic conditions.Healthcare transition interventions should maximise long-term functioning and prioritise rehabilitation aimed at enhancing independence and self-management skills, while reducing hospitalisations.The engagement of individuals with lived experience in the co-design of interventions has been strongly advocated as it brings unique knowledge and experience to the research process.Minimal attention has been given to the involvement of adolescents and young adults with chronic conditions in the development of healthcare transition interventions, however, healthcare transition interventions co-designed with adolescents and young adults with chronic conditions are both feasible and acceptable. Healthcare transition interventions can improve adherence to care, health outcomes, ongoing rehabilitation, and quality of life of adolescents and young adults with chronic conditions. Healthcare transition interventions should maximise long-term functioning and prioritise rehabilitation aimed at enhancing independence and self-management skills, while reducing hospitalisations. The engagement of individuals with lived experience in the co-design of interventions has been strongly advocated as it brings unique knowledge and experience to the research process. Minimal attention has been given to the involvement of adolescents and young adults with chronic conditions in the development of healthcare transition interventions, however, healthcare transition interventions co-designed with adolescents and young adults with chronic conditions are both feasible and acceptable.

Background: In Australia, Indian immigrants are one of the fastest-growing communities. Since oral cancer is widespread in India, the indulgence of Indians in customs of areca (betel) nut use in Australia may be linked to the recent rise in oral cancer cases. Since GPs (general practitioners) are primary healthcare providers, it is pivotal to ensure the oral cancer awareness of GPs. This study aimed to explore oral cancer risk-related knowledge, beliefs, and clinical practices of GPs in Australia. Methods: Fourteen semi-structured interviews were conducted with GPs practicing across New South Wales and Victoria. Purposive and snowball sampling were used for recruitment. Data were analysed through a directed content analysis approach. Results: All GPs were knowledgeable of major oral cancer causative factors including tobacco and alcohol, but some had limited understanding about the risks associated with areca nut preparations. Positive attitudes were evident, with all participants acknowledging the importance of oral cancer risk assessment. Most GPs recalled not performing oral cancer routine check-ups. Conclusion: GPs presented good oral cancer knowledge except for emerging risk factors such as areca nut use. Varied beliefs and inconsistent clinical practices relating to oral cancer screening is concerning. Accessible oral cancer training around emerging risk factors may benefit GPs.

Aims and objectives To explore the experiences of food choice and meal service in residential aged care facilities and its impact on autonomy, self-determination and quality of life from the perspectives of both residents and staff. Background Globally, residential aged care is a principal provider of care for older people who can no longer live independently at home. Within this setting, lack of food choice has been identified as a significant factor impacting on residents' self-determination, sense of autonomy and quality of life. Design This study used an exploratory descriptive qualitative approach guided by self-determination theory. Method A total of 14 participants (seven residents and seven staff members) from two Australian residential aged care facilities were recruited through purposive and snowball sampling with assistance from one independent contact nurse at each facility. In-depth, semi-structured interviews were conducted, digitally recorded and transcribed. The COREQ checklist was used in this qualitative study. Results Three main themes were identified from the interview data provided by residents and staff, which were as follows: (a) catering for the masses; (b) organisational barriers to providing choice; and (c) food impacts well-being. Conclusions This study explored the experiences of food choice and service in residential aged care facilities, from the perspectives of both residents and staff. Results of interviews highlighted the importance of providing adequate food choice which has become an enduring issue that requires more attention and commitment to make a positive change for residents living in residential aged care facilities. Relevance to clinical practice Nurses and other staff working in residential aged care facilities need to be aware of the importance of providing adequate food choice, including for residents who require modified diets. As advocates for residents, nursing staff must address the persistent lack of food choice. However, this will require a radical change in organisational culture and strong leadership.

Introduction Clinical supervision and transitional support programs are important in supporting the successful transition and retention of new graduate nurses and their intention to work in specialty settings. However, little is known about which elements of support programs influence this intention. This study aimed to examine new graduate nurses' perceptions of clinical supervision and the practice environment, and how these influenced their intention to stay in critical and non-critical care areas following their transitional support program. Methods Between May 2012 and August 2013, new graduate nurses (n = 87) were surveyed towards the end of their 12-month transitional support program. In addition to demographic and ward details, participants completed the Manchester Clinical Supervision Scale (MCSS) and the Practice Environment Scale Australia (PES-AUS). The ‘Intention to Stay in a Clinical Specialty’ survey was used to measure new graduate nurses’ intention to remain working in their current ward or unit. Results Predictors of new graduate nurses' intention to stay in their current ward/unit were not having to practise beyond personal clinical capability (AOR: 4.215, 95% CI: 1.099–16.167) and working in a critical care specialty (AOR: 6.530, 95% CI: 1.911-22.314). Further analysis of those nurses who indicated an intention to remain in critical care revealed that high satisfaction with clinical supervision (AOR: 3.861, 95% CI: 1.320–11.293) and high satisfaction with unit orientation (AOR: 3.629, 95% CI: 1.236–10.659) were significant predictors. Conclusion While this study identified that new graduates who worked within their scope of practice were more likely to report their intention to remain in their current ward, new graduates assigned to critical care were six times more likely to indicate their intention to remain than new graduates in other wards/units. Ensuring new graduate nurses assigned to critical care areas receive good unit orientation and clinical supervision increases their intention to remain in this setting.

Background: From a baseline of near zero, there has in recent years been a growing number of empirical studies related to mental health nurses’ delivery of healthcare for severely physically deteriorating patients or in medical emergency situations. To date, this evidence-base has not been systematically identified, appraised, and integrated. \ud \ud Objectives: To systematically identify, appraise and synthesise the available empirical evidence about mental health nurses, medical emergencies, and the severely physiologically deteriorating patient. \ud \ud Design: A systematic review in accordance with relevant points of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. \ud \ud Data sources: Multiple electronic databases (CINAHL; PubMed; MedLine; Scopus, ProQuest Dissertations and Theses) were searched using comprehensive terms. \ud \ud Review methods: Inclusion criteria: English language papers describing empirical studies (any design) about i) the effectiveness of interventions to improve any outcome related to mental health nurses' delivery of emergency medical care or care for the severely deteriorating patient; or ii) mental health nurses’ emergency medical care-related knowledge, skills, experience, attitudes, or training needs. Further information was sought from study authors. Included studies were independently assessed for quality. Effect sizes from intervention studies were extracted or calculated where there was sufficient information. An integrative synthesis of study findings was conducted. \ud \ud Results: A total of 22 studies, all but one published since 2011, met inclusion criteria. Ten were intervention studies and twelve were cross-sectional observational or qualitative studies. Intervention studies were all of weak quality overall and utilised pre- post designs mostly with limited post intervention follow-up time. Observational and qualitative studies were generally of good quality but only parts of the evidence from these studies were relevant to emergency physical care since most focused on mental health nurses and their routine physical healthcare practice. \ud \ud Conclusions: There are currently no validated instruments to investigate mental health nurses’ emergency medical care-related attitudes. More rigorous controlled trials of interventions are needed to better establish an evidence-base for educational interventions to improve this groups’ emergency care-related practice.

BACKGROUND Periodontal disease is associated with cardiovascular disease, and patients should be aware of this risk and seek dental care. OBJECTIVE In this study, the authors sought to identify the barriers and predictors for seeking oral healthcare among patients with cardiovascular disease. METHODS With the use of a cross-sectional descriptive study design, 307 patients with cardiovascular disease attending cardiac rehabilitation/outpatient cardiac clinics were surveyed between 2016 and 2017 in Sydney, Australia. Survey items included the prevalence of accessing dental services and a new "barriers to seeking frequent dental care" scale. RESULTS Most respondents (81%) reported at least 1 oral health problem, yet only 10% received any oral health information and more than half (58%) saw a dentist in the preceding 12 months. The barriers to seeking frequent dental care scale was internally consistent (Cronbach's α = 0.82) with 2 subscales, identified as personal-related and system-related barriers to accessing oral healthcare. Respondents were more likely to have seen a dentist in the previous 12 months if they received oral health information (adjusted odds ratio [AOR], 5.08; 95% confidence interval [CI], 1.62-15.93), had private health insurance (AOR, 3.33; 95% CI, 1.91-5.83), reported low barriers (AOR, 2.68; 95% CI, 1.61-4.47), or were born overseas (AOR, 2.13; 95% CI, 1.25-3.63). CONCLUSIONS The accessibility and affordability of dental care, as well as lack of oral health awareness, are key barriers and predictors for patients with cardiovascular disease accessing dental care. Greater emphasis on oral health is needed in the cardiac setting, along with appropriate dental referral pathways.

Background Arab cancer survivors and their caregivers often have high levels of unmet information needs. However, whether these information needs are the same for cancer survivors living in Arab speaking countries compared to Arab migrants is not clear. Objective To identify the information needs and information sources among Arab cancer survivors and their caregivers. Methods Arab cancer survivors (n=143) in Jordan and Australia were surveyed to explore their information needs and information sources. Interviews with cancer survivors and their caregivers, and focus groups with health care providers were conducted in both countries. Findings While lack of information about cancer, its treatment and side effects were common to both groups, Arab Australian cancer survivors expressed greater need for information about managing their illness (P=.027), receiving explanations about tests (P=.016) and the benefits and side-effects of treatments before making choices (P=.041) than Jordanian cancer survivors. Qualitative findings revealed preferences for spoken rather than written information, and the provision of diagrams and drawings. Although information provided by doctors was a trusted source, almost half the participants indicated they used the Internet for information. Despite the use of interpreters, Australian health care providers expressed concern at whether the information they provided had been delivered and understood. Conclusion Arab cancer survivors and their caregivers have unmet cancer information needs resulting in them seeking information from potentially unreliable sources such as the Internet. Arab migrants may need additional assistance to ensure they receive information relevant to their disease and are linked with the most trusted source of information.

Background With the widening of participation in higher education, it is essential in the discipline of nursing that students are able to communicate proficiently to deliver quality patient care. However, undergraduate students can experience significant difficulties with spoken communication critical to professional nursing, which places them ‘at risk’ of failure during the nursing course. Objectives To examine the relationship between students' use of academic literacy support and oral communication skills. Design Prospective, correlational survey design. Setting A large multi-campus university in Western Sydney, Australia. Participants A total of 1699 assessment ratings of first and second year nursing students were completed at both baseline and at the 6-month follow-up in 2015. Methods The CLIP index was embedded as an assessment requirement in four clinical skills-based units and assessed at the end of each semester in the first two years of the Bachelor of Nursing program. In this study, first and second year students were assessed in Semester 1 at baseline and also six months later in Semester 2. Results From Semester 1 to Semester 2, the mean CLIP scores improved from 15.8 (SD: 3.7) to 17.2 (SD: 3.3) and all four components of the mean CLIP index improved. The smallest improvement was in the area of pronunciation while the lexical component had the greatest improvement. In addition, students who attended an academic literacy consultation or workshop for oral language support were over 1.5 times more likely to achieve an improvement in CLIP score (AOR: 1.58, 95% CI: 1.26 to 1.98). Conclusion The CLIP tool can be used to track and monitor students' oral language skills over the course of their study, and identify ‘at risk’ students requiring additional support through on-campus language support programs.

Aims and objectives To synthesise evidence regarding vaccination intention, identify factors contributing to vaccine hesitancy among healthcare professionals and the general populations globally. Background As COVID-19 vaccine becomes available worldwide, attention is being directed to community vaccine uptake, to achieve population-wide immunity. A number of factors have been reported to influence vaccine intention. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search of COVID-19 vaccination intention related literature published on or before 31 December 2020 from seven databases was undertaken. Results Thirty articles were included in this systematic review. Overall COVID-19 vaccination intention during the first year of the pandemic ranged from 27.7% to 93.3%. Findings highlighted that socio-demographic differences, perceptions of risk and susceptibility to COVID-19 and vaccine attributes influenced vaccination intention. Healthcare professionals particularly, nurses have higher vaccine hesitancy reportedly due to concerns regarding vaccine safety and efficacy and mistrust of health authorities. Negative information about COVID-19 vaccines in the social media and low confidence in the health system were associated with lower acceptability among the community. Interestingly, cumulative increase in COVID-19 caseloads of countries over time was not associated with vaccination intention. Conclusions The significant variability in vaccine intention rates worldwide would hamper efforts to achieve immunity against COVID-19. Nurses' concerns about vaccine safety and efficacy need to be addressed to increase vaccine acceptance and maximise their influence on vaccination decision in the community. As misinformation through social media negatively impacts vaccination uptake, authoritative and reliable information on vaccine attributes, disease risks and vaccination benefits are needed. Relevance to clinical practice Concerns about vaccine safety and efficacy including misinformation are important contributors to vaccine hesitancy. Addressing these factors, particularly among nurses who are considered trusted influencers of vaccination decisions in the community is an important strategy for pandemic preparedness.

Purpose: Receiving a cancer diagnosis for young people is likely to adversely impact the individual's quality of life. Mindfulness-based interventions (MBIs) are an emerging strategy used to improv...

Introduction There is increasing evidence linking poor oral health with cardiovascular disease (CVD) and it is recommended that all cardiac care clinicians incorporate oral health into their practice. Yet, it appears oral health is not considered a priority during cardiac care in Australia and cardiovascular patients are not seeking dental care. The focus of this feasibility study was to explore the oral health perceptions, knowledge and practices of patients with CVD and cardiac care clinicians as well as their views of integrating oral health care in cardiac settings. Methods A mixed methods approach was undertaken involving: focus groups/phone interviews with cardiac care clinicians (n=30, mostly nurses) across Australia; interviews (n=12); and surveys (n=318) with patients with CVD across four metropolitan hospitals and outpatient cardiology clinics in Sydney. Thematic analysis, descriptive, inferential and logistic regression statistics were used to summarise the findings. Results Most clinicians interviewed encountered a number of patients with dental problems, yet oral health was not routinely discussed in clinical practice. Many were also unaware of the relationship between oral health and CVD and attributed this knowledge gap to lack of training. Most (82%) patients reported having at least one dental problem and around half had seen a dentist in the last 12 months. Patients had poor oral health knowledge (52%) and only 10.7% had received any information regarding oral healthcare from cardiac care clinicians. Those who received oral health information in the cardiac setting were six times more likely to have seen a dentist in the last 12 months (AOR 5.97, 95% CI: 1.91-18.74). Cardiac clinicians were receptive to the idea of promoting oral health if identified barriers such as availability of resources, training, time constraints and referral pathways were addressed. Patients were also receptive of cardiac nurses providing education (81%), performing oral health assessments (58%) and referral (82%). Discussions There is a high prevalence of dental problems among patients with CVD yet many have limited knowledge and awareness about the importance of oral health. There is also a lack of emphasis regarding oral health among cardiac clinicians due to various barriers. Cardiac nurses are in unique position to promote oral health and they are receptive to this idea along with patients, provided current barriers are addressed. Conclusions Integrating oral health into cardiac care is warranted in Australia. A new model of care is proposed where cardiac nurses are trained to promote oral health, provide risk assessment and referrals to appropriate dental services. Lessons learned Oral health is a neglected part of cardiac care practice in Australia and is an area that could be addressed through an interdisciplinary oral health model of care. Limitations The findings may not be relevant to culturally and linguistically diverse populations with CVD or those living in regional areas Suggestions for future research. A new model of care inclusive of a validated oral health risk assessment tool, evidence based oral health resources and training program needs to be developed and evaluated in the cardiac setting.

BACKGROUND Self-management is important in reducing coronary risk factors and in preventing recurrent cardiac events. An enabling factor that promotes self-management among patients with coronary heart disease (CHD) is self-efficacy. However, there is no standardized measure that captures self-efficacy and self-management concurrently in this population. AIM The authors of this study report on the development and validation of a brief scale to measure self-efficacy and self-management in patients with CHD. METHODS Scale development and testing comprised (1) item generation, (2) content validity, and (3) pilot testing. The Heart Health Self-Efficacy and Self-Management (HH-SESM) scale includes 2 constructs: self-efficacy and self-management, measured concurrently. Components of the HH-SESM scale consisted of items related to behavioral and coronary risk factor modification. Survey data from 143 participants were used in exploratory factor analyses to test the factorial validity and internal consistency of the scale. RESULTS Twelve items with the same response format were included in the exploratory factor analysis. The factor analysis revealed a single-factor solution accounting for 36.7% and 36.5% of the variance in scores of the self-efficacy and self-management scales, respectively. The correlation (r = 0.72, P < .001) between the self-efficacy and self-management constructs indicates moderate convergent validity. Cronbach α of self-efficacy (0.83) and self-management (0.81) constructs showed good internal consistency. CONCLUSION The HH-SESM is a brief, easy-to-administer, and reliable measure of self-efficacy and self-management in patients with CHD.

Background Clinical registry participation is a measure of healthcare quality. Limited knowledge exists on Australian hospitals’ participation in clinical registries and whether this registry data informs quality improvement initiatives. Objective To identify participation in clinical registries, determine if registry data inform quality improvement initiatives, and identify registry participation enablers and clinicians’ educational needs to improve use of registry data to drive practice change. Methods A self-administered survey was distributed to staff coordinating registries in seven hospitals in New South Wales, Australia. Eligible registries were international-, national- and state-based clinical, condition-/disease-specific and device/product registries. Results Response rate was 70% (97/139). Sixty-two (64%) respondents contributed data to 46 eligible registries. Registry reports were most often received by nurses (61%) and infrequently by hospital executives (8.4%). Less than half used registry data ‘always’ or ‘often’ to influence practice improvement (48%) and care pathways (49%). Protected time for data collection (87%) and benchmarking (79%) were ‘very likely’ or ‘likely’ to promote continued participation. Over half ‘strongly agreed’ or ‘agreed’ that clinical practice improvement training (79%) and evidence–practice gap identification (77%) would optimize use of registry data. Conclusions Registry data are generally only visible to local speciality units and not routinely used to inform quality improvement. Centralized on-going registry funding, accessible and transparent integrated information systems combined with data informed improvement science education could be first steps to promote quality data-driven clinical improvement initiatives.

Background Mindfulness-based interventions (MBIs) have demonstrated benefits for adults with chronic illness and are becoming increasingly popular among children and young people. Mindfulness-based interventions could have benefits for young people with cancer throughout the treatment journey, through to survivorship. Objective The aim was to review intervention studies about MBI used with young people with cancer between the ages of 10 and 29 years. Methods Six electronic databases were searched. The methodological quality of the included studies was assessed using the Joanna Briggs Institute critical appraisal tools. Results Six contemporary studies met the inclusion criteria. Three studies adapted MBI to be age appropriate and some studies modified the intervention based on cancer-specific needs of young people. Formal and informal MBI activities were found to be acceptable by young people; however, recruitment of the participants was identified as a barrier. Variability in psychosocial outcomes was noted in the review by some demonstrating improvement in areas such as mindfulness, anxiety, and social isolation and others not eliciting significant benefits. Conclusions Mindfulness-based intervention shows promise as an acceptable intervention that may improve psychosocial well-being for young people with cancer. Future research studies with adequate sample sizes are warranted to determine the effectiveness of MBI among young people with cancer. Implications for practice Mindfulness-based intervention seems to be a promising approach to promote psychosocial well-being and reduce disease burden in young people with cancer. As validated MBI may be implemented without expert training, this could be promoted by healthcare providers, including nurses who care for young people with cancer.

Introduction: Despite the impressive gains achieved by those who attend cardiac rehabilitation, many patients fail to maintain the gains in physical capacity in the longer term. There are likely psychosocial characteristics that can be leveraged to sustain behavior change. Hypothesis: Patients with higher perceived cardiac control, social support, and exercise self-efficacy, without depression, and those who received motivational interviewing (MI) sessions, adjunctive to cardiac rehabilitation, will have a significantly higher physical capacity. Methods: This is a secondary analysis of the data from a randomized controlled trial of MI as a tool to enhance secondary prevention strategies in cardiovascular disease (MICIS study) conducted at three hospitals in Sydney, Australia who attended 6-week phase II cardiac rehabilitation. Two, 1-hour sessions of a nurse-delivered motivational interview focused on increasing physical capacity was implemented and the participants were followed at 6-weeks and 12-months. The outcome for the study was physical capacity measured by distance walked on the six-minute walk test (6MWT). Multiple imputations were used to handle missing data. Descriptive statistics, t-tests, chi-square tests and linear regression for cluster data were used for data analysis. Results: The mean (SD) age of participants (n=110) at baseline was 60.1 (10.57) years and the majority were male (71.8%). (Table). In the adjusted analysis, motivational interviewing (p =0.57), perceived cardiac control (p=0.30), self-efficacy for exercise (p = 0.06) and level of depressive symptoms were not related to 6MWT. With every unit increase in perceived social support score, there was a decrease in distance walked in 6MWT by 1.30 meters (b = -1.30; p= 0.007). Conclusion: In this sample, psychosocial predictors, except social support, were not likely to influence physical capacity. Investigating barriers and facilitators to sustaining the effects of cardiac rehabilitation are needed.

Background There is increasing evidence linking poor oral health with cardiovascular disease and it is recommended that health professionals managing people with cardiac disease (cardiac care providers) promote oral health in their practice. However, the current perceptions of cardiac care providers regarding this aspect of clinical practice are unknown in Australia. Aim To explore oral health perceptions, knowledge and practices of cardiac care providers and their role in promoting oral health. Methods A qualitative study involving focus groups and semi-structured telephone interviews was undertaken with cardiac care providers (27 nurses, two physiotherapists, one exercise physiologist) across Australia between January–March 2016. Interviews/focus groups were transcribed and thematically analysed. Findings Most participants encountered a number of patients with poor oral health and highlighted barriers seeking dental care, including access, cost and lack of awareness. However, oral health was not routinely discussed with patients except when cardiac valve surgeries were required. Many participants were unaware of the relationship between oral health and cardiovascular disease. Overall, participants were comfortable with promoting oral health if barriers such as training, time constraints and referral pathways were addressed. Practical suggestions regarding timing of training, preferred content and delivery format were also provided. Discussion Cardiac care providers have limited oral health knowledge and are not routinely promoting oral health. However, they are receptive to promoting oral health with adequate support. Conclusion Cardiac care providers need to be adequately trained and supported to promote oral health to their patients. Supportive strategies could include training, resources and formalised referral pathways.

Background There is increasing concern regarding autonomy and quality of life for older people living in residential aged care. Failure to provide food choices and suitable dining environments has been reported to negatively impact their nutritional status, undermining their sense of autonomy and quality of life. Aim This paper presents an integrative review of studies on food choices in residential aged care and explores the relationships between food choices, autonomy and quality of life. Methods Search of nine databases CINAHL, PubMed, Scopus, PsycINFO, ProQuest, Cochrane, Embase, AMED, and Social Science Citation Index, identified nine primary articles. The Critical Appraisal Skill Program tool was used to examine the quality of these articles. Findings Three key themes were identified: (1) Prevalence of food choices and catering for residents' preference; (2) Importance of food choices to nutritional status; (3) Impact of food choices on autonomy and quality of life. The importance of increasing staff awareness and a need to develop aged care regulation to ensure adequate food choices provided. Discussion The importance of increasing staff awareness regarding the interrelatedness of respecting older people's food choices, autonomy and quality of life is identified. The needs of determining aged care regulation and accreditation standards were also highlighted. Conclusion Failure to provide satisfying food choices impacts older people's quality of life. However, the strength of the relationships between food choices, autonomy and quality of life requires further study.

The objective of this study was to assess the migration intention of students enrolled in pre-registration nursing programs in Nepal, and to explore factors influencing this intention. Using an embedded mixed methods design, 799 nursing students were surveyed, followed by 12 semi-structured face-to-face interviews. The result showed that the majority (92.5%) expressed some intention to migrate, with three quarters of these listed furthering their study abroad as the primary reason. In the multiple regression analysis, those with lower professional identity, and those who reported nursing was not their first choice were likely to express migration intention. Interview data identified low salaries, unemployment, poor working conditions, insufficient postgraduate education, and a lack of professional autonomy in Nepal as reasons for their intention to migrate. Increasing opportunities for nurses to undertake postgraduate education in Nepal, promoting a positive image of nursing, and facilitating a supportive learning environment during undergraduate nursing education could help address the potential loss of nurses from Nepal.

Graduate entry nursing (GEN) programs were designed to address the predicted nursing shortfall. In Australia, although these programs attract students from culturally and linguistically diverse (CALD) backgrounds, the workload is compounded by cultural differences and a new academic learning environment which presents additional challenges. This qualitative descriptive study explored the experiences of GEN students enrolled in the introductory unit of their nursing program with embedded academic literacy support in Sydney, Australia. Twenty-four commencing GEN students were interviewed in January 2016. Interviews were transcribed verbatim and thematically analysed. Three main themes emerged which illustrated that GEN students were 'diamonds in the rough'. They possessed a raw natural beauty that required some shaping and polishing to ensure academic needs were met. To ensure retention is high, institutions need to evaluate how best to support and harness the potential of these unique students.

Background Rater variability in performance-based assessments is well-documented, yet limited research has explored this in undergraduate nursing programs. Methods A prospective follow up study design was used to determine the extent of assessor stringency in clinical skills assessments in an undergraduate nursing program at a large multi-campus university in Sydney, Australia. Grades for students' clinical skills assessments in three units (semesters one, three and five) were extracted from an administrative database. Results were matched to student demographic data (age, gender, language spoken at home, country of birth) and the assessor. Results A total of 2339 graded clinical skills assessments of students in the undergraduate nursing program were available for analysis, representing 75% of students enrolled in three nursing skills units. Overseas-born students had lower pass grades than Australian-born students (78% vs. 85%; p χ 2 : 32.32, df : 2, p χ 2 : 17.81, df : 2, p p Conclusions The strongest predictor of a student passing their nursing skill assessment was the leniency of the assessor. A proactive approach to detecting and correcting variability in clinical skills assessments, including reviewing assessor training and support, is needed in light of the high-stakes nature of these assessments.

Background Given the increasing complexity of acute care settings, high patient acuity and demanding workloads, new graduate nurses continue to require greater levels of support to manage rising patient clinical care needs. Little is known about how change in new graduate nurses’ satisfaction with clinical supervision and the practice environment impacts on their transitioning experience and expectations during first year of practice. This study aimed to examine change in new graduate nurses’ perceptions over the 12-month Transitional Support Program, and identify how organizational factors and elements of clinical supervision influenced their experiences. Methods Using a convergent mixed methods design, a prospective survey with open-ended questions was administered to new graduate nurses’ working in a tertiary level teaching hospital in Sydney, Australia. Nurses were surveyed at baseline (8–10 weeks) and follow-up (10–12 months) between May 2012 and August 2013. Two standardised instruments: the Manchester Clinical Supervision Scale (MCSS-26) and the Practice Environment Scale Australia (PES-AUS) were used. In addition to socio-demographic data, single –item measures were used to rate new graduate nurses’ confidence, clinical capability and support received. Participants were also able to provide open-ended comments explaining their responses. Free-text responses to the open-ended questions were initially reviewed for emergent themes, then coded as either positive or negative aspects of these preliminary themes. Descriptive and inferential statistics were used to analyse the quantitative data and the qualitative data was analysed using conventional content analysis (CCA). The study was approved by the relevant Human Research Ethics Committees. Results Eighty seven new graduate nurses completed the follow-up surveys, representing a 76% response rate. The median age was 23 years (Range: 20 to 53). No change was seen in new graduate nurses’ satisfaction with clinical supervision (mean MCSS-26 scores: 73.2 versus 72.2, p = 0.503), satisfaction with the clinical practice environment (mean PES-AUS scores: 112.4 versus 110.7, p = 0.298), overall satisfaction with the transitional support program (mean: 7.6 versus 7.8, p = 0.337), satisfaction with the number of study days received, orientation days received (mean: 6.4 versus 6.6, p = 0.541), unit orientation (mean: 4.4 versus 4.8, p = 0.081), confidence levels (mean: 3.6 versus 3.5, p = 0.933) and not practising beyond personal clinical capability (mean: 3.9 versus 4.0, p = 0.629). Negative responses to the open-ended questions were associated with increasing workload, mismatch in the level of support against clinical demands and expectations. Emergent themes from qualitative data included i) orientation and Transitional Support Program as a foundation for success; and ii) developing clinical competence. Conclusions While transitional support programs are helpful in supporting new graduate nurses in their first year of practice, there are unmet needs for clinical, social and emotional support. Understanding new graduate nurses’ experiences and their unmet needs during their first year of practice will enable nurse managers, educators and nurses to better support new graduate nurses’ and promote confidence and competence to practice within their scope.

Background There is epidemiological evidence showing an association between periodontal disease and cardiovascular disease (CVD). Despite this evidence* no comprehensive review has been undertaken to identify strategies to improve the oral health of people with CVD. Objectives The aim of this review is to identify current evidence relating to the oral healthcare and management of patients with CVD. Methods A scoping review was undertaken focusing on 4 key areas, namely, the impact of periodontal treatment on CVD, current recommendations regarding oral health and CVD, the role of nurses in promoting oral health, and available resources to support them. Databases were searched using a combination of keywords and search terms and 34 articles were selected. Results Systematic reviews suggest that periodontal treatment may improve CVD outcomes by reducing systemic inflammation and improving endothelial function. However, there is insufficient evidence to confirm or refute these findings. International guidelines recognize the link between periodontal disease and CVD and recommend preventative strategies in this area. Non-oral health professionals, including nurses, can promote oral health and have been undertaking this role in areas like aged care and pregnancy. However, this aspect of nursing care has not been explored in the cardiac setting and no relevant training and assessment tools are available. Conclusions Maintaining oral health among cardiovascular patients is important, yet it appears to be neglected during cardiac care. Cardiac nurses are in an excellent position to promote oral health but further research is required to define their role and develop supporting resources.

Aims and objectives The objectives of this study were to examine a) if those with reported clinical performance issues were more likely to experience course progression issues or withdrew from the program; b) the relationship between clinical and academic performance; c) the relationship between students social-demographic characteristics and clinical performance issues; and d) the utility of Hofstede's cultural dimensions theory in explaining the clinical performance issues students may experience during clinical placement. Method Retrospective textual reports of clinical issues from 2014 to 2018 were collected. A mixed methods design, particularly Embedded Design, was used. The qualitative data was analysed using Directed Content Analysis using Hofstede's six dimensions as the coding categories, which were further broken down into high and low poles, making a total of 12 subcategories. Univariate and multivariate logistic regression was utilised to analyse the quantitative data. Results Using Hofstede's framework, it was determined that nursing students 21 years and younger were more likely to have issues related to low long-term orientation. Male students were more likely to have issues related to low uncertainty avoidance and also displayed masculinity related issues. Overseas-born students were less likely to experience issues related to low power distance and students that had not failed a unit of study were less likely to have issues related to low long-term orientation. The study also found that students experienced issues related to poor psychomotor skills and language barriers. Furthermore, the study identified that students who experienced clinical placement issues were three times more likely to leave the course. Conclusion Hofstede's cultural dimensions framework can be used to explain clinical performance issues among undergraduate nursing students. Early identification of the students likely to experience these issues can lead to targeted and preventative interventions.

Background Oral cancer is a growing problem worldwide, with high incidence rates in South Asian countries. With increasing numbers of South Asian immigrants in developed countries, a possible rise in oral cancer cases is expected given the high prevalence in their source countries and the continued oral cancer risk behaviours of immigrants. The aim of this review is to synthesise existing evidence regarding knowledge, attitudes and practices of South Asian immigrants in developed countries regarding oral cancer. Methods Five electronic databases were systematically searched to identify original, English language articles focussing on oral cancer risk knowledge, attitudes and practices of South Asian immigrants in developed countries. All studies that met the following inclusion criteria were included: conducted among South Asian immigrants in developed countries; explored at least one study outcome (knowledge or attitudes or practices); used either qualitative, quantitative or mixed methods. No restrictions were placed on the publication date, quality and setting of the study. Results A total of 16 studies involving 4772 participants were reviewed. These studies were mainly conducted in the USA, UK, Italy and New Zealand between 1994 and 2018. Findings were categorised into themes of oral cancer knowledge, attitudes and practices. General lack of oral cancer risk knowledge (43–76%) among participants was reported. More than 50% people were found engaging in one or more oral cancer risk practices like smoking, betel quid/pan/gutka chewing. Some of the participants perceived betel quid/pan/gutka chewing habit good for their health (12–43.6%). Conclusion This review has shown that oral cancer risk practices are prevalent among South Asian immigrants who possess limited knowledge and unfavourable attitude in this area. Culturally appropriate targeted interventions and strategies are needed to raise oral cancer awareness among South Asian communities in developed countries.