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The aim of the study was to understand older Chinese migrants’ perceptions of social cohesion and access to health to manage chronic diseases during the COVID-19 pandemic in Australia. This study employed a qualitative descriptive study design. Participants were recruited from a Chinese community organisation in an Australian state. Data were collected via online interviews with participants using Zoom and WeChat Apps. A semistructured interview guide informed by the social determinants of health framework was used in the interview. The data collection period was between August and October, 2020. Thematic analysis was used in data analysis. In total, 24 participants including 17 older Chinese migrants with noncommunicable chronic diseases and seven family carers participated in the study. Of the 17 older Chinese migrants, 10 were male and seven were female. Their mean age was 76 years (ranging from 65 to 86) and they spoke little English. All seven carers were females with a mean age of 61 years (ranging from 35 to 76). Three main themes were identified in the study and described as: increased loneliness, anxiety, and depression; increased difficulties in accessing healthcare services; and various experiences in telehealth. In conclusion, older Chinese-Australians who spoke little English and lived with chronic diseases experienced the loss of their only social capital during the COVID-19 pandemic. They faced language barriers for accessing and utilising primary care to manage their chronic diseases when these care services were changed into telehealth during the COVID-19 pandemic. Findings provide a clear direction for stakeholders to take actions to address the lack of social cohesion and health inequalities for the most vulnerable populations in the community during the COVID-19 pandemic and beyond.

Falls are a great concern for poststroke patients. Various interventions have been developed over the past few decades to prevent falls. However, the effectiveness of these interventions remains to be investigated. These authors aimed to evaluate the effects of exercise interventions on the prevention of poststroke falls. CNKI, Wan Fang, VIP, SinoMed, PubMed, Embase, Cochrane Library, and CINAHL were searched for randomized controlled trials (RCTs) on the prevention of falls after stroke from inception to September 2021. The primary result was the number of falls. Two reviewers independently screened and extracted data and assessed the risk of bias for all studies. In Stata 15.1, the effects of multiple interventions were compared using Bayesian networks. A total of 15 RCTs with 8 kinds of exercise interventions were included. Balance training (BT) was the most effective way to prevent falls (odds ratio [OR] = 0.24, 95% confidence interval [CI] = 0.13-0.46, p 0.05). Moreover, cognition and movement multitask training (CMM) (OR = 0.30, 95% CI = 0.09-0.96, p 0.05); Multimodal Exercise (OR = 0.31, 95% CI = 0.11-0.84, p 0.05) and Resistance Exercise (OR = 0.35, 95% CI = 0.15-0.84, p 0.05) were ranked as second, third and fourth most effective, respectively. The effect of Walking-based Intervention was the worst (OR = 1.63, 95% CI = 0.57-4.67, p 0.05). BT and CMM are the preferred exercise interventions for the prevention of poststroke falls. A further investigation is needed to compare the effectiveness between BT and CMM for populations at high risk of falling after stroke.

To explore the shared experiences of people with stroke and caregivers in preparedness to manage post-discharge care.People with stroke and caregivers show dyadic effects in dealing with post-discharge care challenges. However, few studies have explored their shared experiences and unique challenges for each dyadic member in preparedness to manage post-discharge care. This study addresses this research gap.An interpretive approach underpinned by Gadamer's philosophical hermeneutics.Semi-structured interviews were conducted with people with stroke and caregivers in 5 days before hospital discharge (n = 26) or 2 weeks after discharge (n = 4) between July and December 2019. The study followed a five-step data analysis method aligning with Gadamerian hermeneutics. The study reporting followed the COREQ checklist.Three themes and six subthemes were identified. First, both people with stroke and caregivers experienced psychological stress, although the sources differed. Second, stroke dyads demonstrated resilience built on positive thoughts, confidence, and support from family and health professionals. Third, stroke dyads exhibited different levels of certainty about post-discharge care. They desired to be equal partners in co-developing and co-implementing discharge plans.Similarities and differences in perceived preparedness to manage post-discharge care existed between stroke dyadic members. A co-design approach to developing and implementing discharge plans would enhance planned post-discharge care.Hospital-to-home transition is a challenging time for people with stroke and their caregivers. Understanding the shared experiences of stroke dyads in preparedness for post-discharge care enables nurses to take proactive actions to enhance managing post-discharge care. Early identification of those at risk of developing psychological stress will enable nurses to co-develop stress-coping strategies. These will have a positive influence on the dyad when facing setbacks due to stroke-related complications.

Older people in nursing homes are at a high risk of being infected by coronavirus disease 2019 (COVID-19). They also experienced nursing home lockdowns that harm their psychological wellbeing. Better support for this vulnerable population requires understanding their perceptions of challenges and coping strategies during the COVID-19 pandemic. A qualitative descriptive study was conducted using semi-structured interviews. Thematic analysis approach was used to analyze the data. Participants were recruited from six nursing homes in three cities in Hunan Province, China. Fourteen nursing home residents participated in the study. Four themes were identified from interviews and described as: mental stress and coping strategies, self-regulation to respond to lockdown, the lack of social connection and coping strategies, and the need for medical care services and coping strategies. This study revealed that nursing home residents perceived stress during the nursing home lockdown, but they reported initiating activities to maintain health and connections with their families and peers. Resilience improvement interventions are necessary to enable residents’ autonomy and develop their resilience in coping with difficulties and hardship during crises. The findings also indicate that a supportive environment with interactions from families, peers, and staffs played a key role in enabling residents’ positive health and wellbeing during the lockdown.

Objectives The aim of this review was to provide a synthesis of research on perceptions of safety and quality of care of patients from culturally and linguistically diverse backgrounds during acute and critical illness. Review method used An integrative literature review based on the four-stage framework of Whittemore and Knafl was conducted including problem identification, a systematic literature search strategy, critical review of selected research articles, and integration of findings. Data sources Primary research articles published between January 2008 and October 2020 were identified from seven databases: PubMed, the Cumulative Index to Nursing and Allied Health Literature, Web of Science, Medical Literature Analysis and Retrieval System Online (Medline), PsycINFO, the Cochrane Library, and Scopus electronic databases. The comprehensive search also included a manual search of citations and references from the selected articles. Review methods Data extracted from studies included authors, year, country of origin, methodology and method, sample or participants, key findings, strengths, and limitations. The Critical Appraisal Skill Programme was used to evaluate the quality of studies. Results Sixteen studies were included in the final analysis after critical appraisal. Four themes were identified: communication; the influence of culture, spirituality, and religion on care expectations; end-of-life care; and organisational structure, policy, and culture. Conclusion Research into patients from culturally and linguistically diverse backgrounds requiring care in acute and critical care areas is limited, in both the Australian and global context. There is an opportunity for future research in this area to inform the safety and quality of health care for this patient population and to enhance staff education and training programs.

Aims and objectives To synthesise qualitative research evidence on the experience of stroke survivors and informal caregivers in hospital-to-home transitional care. Background Due to a shortened hospital stay, stroke survivors/caregivers must take over complex care on discharge from hospital to home. Gaps in the literature warrant a meta-synthesis of qualitative studies on perceived enablers and barriers during this crucial period. Design A systematic review and meta-synthesis. Methods A review was guided by Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) checklist where six databases were searched from April to June 2020 including CINAHL Plus, MEDLINE, PsycINFO, Scopus, Web of Science and ProQuest and ProQuest Dissertations and Theses. There was no date limit to the search. Selected studies were critically appraised. A thematic synthesis approach was applied. Results The synthesis of 29 studies identified three major findings. First, partnerships with stroke survivors/caregivers empower discharge preparation, foster competence to navigate health and social care systems and activate self-management capabilities. Second, gaps in discharge planning and the lack of timely postdischarge support contribute to unmet care needs for stroke survivors/caregivers and affect their ability to cope with poststroke changes. Third, stroke survivors/caregivers expect integrated transitional care that promotes shared decision-making and enables long-term self-management at home. Conclusions Hospital-to-home transition is a challenging period in the trajectory of poststroke rehabilitation and recovery. Further research is required to deepen understandings of all stakeholders' views and address unmet needs during transitional care. Relevance to clinical practice Protocols and clinical guidelines relating to discharge planning and transitional care need to be reviewed to ensure partnership approach with survivors/caregivers in the design and delivery of individualised transitional care. Stroke nurses are in a unique position to lead timely support for survivors/caregivers and to bridge service gaps in hospital-to-home transitional care.

Background Home-based dementia care is common in the Chinese-Australian community. However, dementia education programs for Chinese-Australians in the language of their choice are scarce. The World Health Organization has developed iSupport for Dementia, an online education program for informal caregivers. Cultural adaptation of the program for Chinese-Australian caregivers is an opportunity to address this gap in caregiver support. Aim The aims of the study were (1) to understand stakeholders’ perspectives on the cultural and linguistic appropriateness of the Chinese iSupport for Dementia content and design and (2) to explore factors affecting the future implementation of the Chinese iSupport program in Australia. Methods A qualitative descriptive design was applied to address the aims of the study. Focus group discussions with Chinese-Australian caregivers and community aged care workers were conducted to collect data. Thematic analysis was used to analyse data. Results In total, six focus groups were conducted with 18 Chinese-Australian caregivers and 17 care workers. Six themes were identified and described as follows: (1) appropriateness of the Chinese iSupport content; (2) acceptability of the online Chinese iSupport design; (3) motivations to engage in the iSupport program; (4) desire to interact with peers and professional facilitators; (5) concerns about program accessibility; and (6) the need to extend the iSupport program to care workers. Conclusions Engagement with Chinese-Australian caregivers and care workers will inform further revisions of the Chinese iSupport program contents to ensure the program is culturally congruent to Chinese-Australian caregivers. Factors affecting the implementation of the program identified in the study will be considered in the intervention phase of the program.

To explore and compare staff perceived challenges and facilitators in supporting resident self-determination in ethno-specific and mainstream nursing homes.Staff and residents in ethno-specific and mainstream nursing homes in most developed countries have shown increased cultural and linguistic diversity. This socio-demographic change poses significant challenges for staff to support resident self-determination of their own care. In-depth understanding of those challenges in the two types of nursing homes is much needed to inform practice in nurse-led nursing home care settings.A qualitative description approach with thematic analysis was used in the study. Data were collected through five focus groups with 29 various direct care workers from two ethno-specific nursing homes and a mainstream nursing home in Australia between March-September 2020. The study report followed the COREQ checklist.Four themes were identified from focus group data. First, participants perceived communication challenges in identifying residents' preferences, especially in ethno-specific nursing homes. Second, team efforts that included residents and their family members were highly valued as a way to meet residents' preferences. Third, participants described various levels of staff engagement in residents' care planning. In addition, staff in ethno-specific nursing homes possessed richer resources to maintain meaningful relationships for residents compared with their counterparts in the mainstream nursing home.Staff in ethno-specific nursing homes experience more challenges in supporting resident self-determination but have richer resources to develop culturally safe and culturally competent care compared with their counterparts in the mainstream nursing home.Findings provide new insights into challenges and practical solutions in supporting residents to self-determine their own care in cross-cultural aged care.This study was co-designed with three aged care organisations who funded the study. Staff employed by these organisations participated in the study.

Aims To identify the reasons why workers decide to enter, stay or leave the aged care workforce; and the factors influencing them to transition between community and residential sectors in Australia. Background Factors affecting the recruitment and retention of suitable care workers in aged care are complex and influenced by personal, institutional and societal factors. Methods A qualitative description study design. Results In total, 32 staff participated in the study. Five main themes were identified: entering aged care with a passion for the job; entering aged care as it is the only employment option; factors attracting care workers to stay in aged care; factors influencing care workers to leave the job; and preferring to work in residential aged care rather than community aged care. Conclusion Issues relating to the attraction and retention of aged care workers are influenced by personal, institutional and societal factors. Critical shortages in the aged care workforce make the industry more susceptible to crises such as COVID-19 outbreaks. Implication for nursing practice Aged care organizations need to create a positive psychosocial work environment for staff to improve the attraction and retention of skilled care workers. They also need to develop staff recruitment guidelines to ensure care workers with the appropriate skills and training and a passion for working with older adults are selected. Staff development programmes need to focus on learning activities that enable staff to build peers support in the work environment. Implications for health policy There is a need to mandate curriculum to enable nursing students to receive more gerontological education and exposure to aged care throughout their education. Aged care quality standards need to mandate transition support for new graduate nurses.

To systematically analyse health coaching strategies in transition care and synthesise the effect of these strategies on health care outcomes for stroke survivors.A systematic search of nine databases in two languages was conducted. Meta-analysis was conducted when data were available.Twenty-five randomised controlled trials met the inclusion criteria. The meta-analysis revealed that health coaching strategies in transition care interventions significantly improve quality of life (QoL) (p0.001), activities of daily living (ADL) (p = 0.002) and reduce depression (p = 0.001) for stroke survivors at 3 months. Further subgroup analysis demonstrated that transition care interventions with a greater number of health coaching strategies are associated with a larger effect size on QoL (SMD=1.15) and ADL (SMD=1.177) at 3 months, and a medium effect size (SMD=0.674) on depression reduction. However, the effects of health coaching strategies on readmission, mortality and falls in stroke survivors remain inconclusive.This review provides evidence that incorporating health coaching strategies in transitional care improves health outcomes of stroke survivors.More trials of health coaching interventions to improve transition care with a rigorous study design are much needed to address the lack of support for stroke survivors and their caregivers in this crucial care period.

To explore effectiveness and acceptability of non-pharmacological interventions in mild cognitive impairment (MCI).Overview of systematic reviews and network meta-analysis were conducted. Systematic reviews (SRs) were searched via seven databases from June 2015 to June 2020. Randomized controlled trials (RCTs) were retrieved. The Methodological quality was assessed by AMSTAR 2 and RoB 2. Outcomes were effectiveness and acceptability measured by standardized mean differences (SMDs) and odd ratios (ORs) with 95% confidence interval (CI). Pairwise meta-analysis was first conducted, followed by network meta-analysis.A total of 22 SRs and 42 RCTs with 4401 participants were included. The methodological quality of included SRs and RCTs were moderate. There were four interventions, with three types of physical activity (aerobic, muscle-strengthening, and mind-body), three types of cognitive (rehearsal-based, compensatory, and mixed), multicomponent (physical and cognitive component), and nutrition intervention. No significant inconsistency was identified. Regarding intervention effectiveness, muscle-strengthening (SMDs 0.87, 95% CI 0.31-1.43; rank 1), mind-body (0.76, 0.38-1.14; rank 2) and aerobic (0.34, 0.13-0.50; rank 3) were significantly better than the control group and there was no significant difference among these types of intervention . Cognitive intervention of rehearsal-based (1.33, 0.30-2.35; rank 1) and mixed (0.55, 0.00-1.11; rank 2) were significantly better than the control group and there was no significant difference among these types of intervention. Multicomponent intervention (0.32, 0.02-0.62) were significantly better than the control group but not better than the single component group. Regarding acceptability, there was no significant difference among types of intervention.Physical activity, cognitive, and multicomponent intervention could be provided regardless of their types and acceptability due to their effectiveness on improved cognitive function for people with MCI.

Background: China has the largest population living with dementia globally and urban-rural differences are significant in prevalence, risk factors, and health resources. Epidemiologic studies on cognitive impairment in rural areas are limited in China and other low- and middle-income countries. Objective: This study investigated cognitive impairment and associated factors in rural elderly aged 65 years and over in China. Methods: In total, 1,250 participants from ten villages in North China were recruited from June to September, 2017. Face-to-face structured interviews were conducted for data collection. The interviews included socio-demographic information, health status, and psychological assessments. Cognitive function was assessed using the Chinese version of the Mini-Mental State Examination. A multivariate logistic regression model with backward method was employed to identify factors associated with cognitive impairment. Results: The positive rate of cognitive impairment among rural Chinese elderly aged 65 years and older was 42.9% (95% CI, 40.1–45.6). No significant differences were found in cognitive impairment by age or gender before the age of 75 years. Older age, lack of formal school education, reliance on the basic living allowance as the only income source, poor hearing and vision function, diabetes, and activities of daily living dependence were associated with higher rate of cognitive impairment, while tea consumption and fatty liver disease were associated with lower cognitive impairment rate. Conclusion: A very high percentage of rural elderly in China had cognitive impairment. Education programs and prevention interventions targeting modifiable risk factors among high-risk populations should be developed through collective efforts involving all stakeholders.

Aim To determine nursing home staff experiences in mentorship programmes, and staff perceptions of the enablers and barriers to implement mentorship programmes. Background Mentorship programmes are perceived as playing an important role in improving the quality of care in nursing homes. However, little is known about research evidence across the global about staff's experiences in the programmes. Methods A search for studies published from the earliest available date to April 2019 was undertaken. Two reviewers performed data extraction and an appraisal of eight studies using tools from the Joanna Briggs Institute. A pragmatic meta-aggregative approach was applied to synthesise the findings. The qualitative research that was included was analysed to identify 63 findings that were organised into 12 categories and combined into three syntheses. Results The implementation of effective mentorship programmes is influenced by three factors: mentor capability, opportunity in the mentorship programmes, and motivation in the mentorship programmes. Conclusions There are a number of studies of nursing home staff experiences of mentorship programmes. However, systematic reviews that synthesise findings in this field are lacking. It is crucial to tailor the programme design to suit each unique nursing home care setting. We identified barriers and enablers, and learned that no barriers are insurmountable. Implications for nursing management Findings will inform nurse managers of an ideal environment for the implementation of a successful mentorship programme. Nursing homes need to establish and sustain mentorship programmes to help improve workforce capacity in delivering high-quality care for residents.

To describe a nurse-led multicentre randomized controlled trial protocol developed to evaluate the effectiveness and cost-effectiveness of a Chinese iSupport for Dementia program in Australia and Greater China including mainland China, Taiwan, Hong Kong and Macau.A multicentre randomized controlled trial following the SPIRIT checklist.Participants in the study will be recruited from Australia and Greater China and will be randomly assigned to the intervention group or the usual care group. Interventions will include self-learning of the iSupport program, virtual peer support and nurse program facilitator support for 6 months. Primary outcome measures will be the 12-Item Short-Form Health Survey. Secondary outcome measures will include: Revised Scale for Caregiving Self-efficacy; Quality of Social Support Scale; Revised Memory and Behaviour Problem Checklist; the Quality of Life in Alzheimer's Disease-Proxy; usages of care services; and cost-effectiveness of the intervention. Outcomes will be measured at baseline, 6 months and 9 months from the baseline. Caregivers' experiences of the peer support will be explored. This project was funded by the National Foundation for Australia-China Relations, Australian Government (Project ID: NFACR216). The total amount is $440,000 Australian dollars (or £ 236,231).Approximately, 20% of people living with dementia in the world live in Australia and Greater China. Older Chinese are usually cared for by family caregivers at home due to the influence of Confucianism. However, free and online psychoeducation programs for this large cohort of caregivers are not available or accessible. The World Health Organization iSupport for Dementia is an evidence-based online psychoeducation program for caregivers. Implementing a culturally adapted Chinese iSupport program will address this gap in supporting caregivers.This study will provide research evidence on effectiveness and cost-effectiveness of an online psychoeducation program for caregivers. Findings will inform policy and practice development.

Background There are about 9.5 million people with dementia in China. Up to 99% of them are cared for by their family caregivers. Family caregivers are confronted with considerable difficulties and challenges while providing care. They often experience high levels of emotional, physical, financial, and social burdens. Caregivers in rural areas experience an even higher level of burden compared to their counterparts in urban areas due to fewer health resources for dementia care. However, so far, no intervention study has been conducted to support family caregivers in rural areas of China. The aim of this proposed study is to adapt and evaluate an evidence-based and culturally-tailored individualized telephone-based care support (ITBCS) program for family caregivers of people with dementia in rural China. Methods A cluster randomized controlled trial (RCT) will be conducted to evaluate the effectiveness of the ITBCS compared with usual care for Chinese rural family caregivers of people with dementia. A total sample of 168 rural family caregivers will be recruited. The intervention components consist of a 3-month intensive telephone-based care support intervention followed by telephone-based follow-up consultations for 6 months. The control group will receive usual care services available for them. Outcome measures include carers’ subjective burden, depressive symptoms, health-related quality of life, social support, caregiving self-efficacy, and care recipients’ difficult behaviours and competence in activities of daily living at 3, 9 and 15 months after baseline. The potential cost-effectiveness of the ITBCS compared with usual care will be assessed as well. Discussion If effective, the ITBCS program can be adapted and used in rural areas of China as a blueprint to improve the quality of home-based care for people with dementia. Findings from the present study are significant for developing evidence-based dementia care policy in rural China. Trial registration Chinese Clinical Trial Registry, ChiCTR2000038821, Registered 4 April 2020, http://www.chictr.org.cn/showprojen.aspx?proj=62268.

(1) Background: Research indicates that most elderly widows are at a high risk of experiencing negative psychological symptoms. It is common for elderly women in rural and remote areas to live alone without family support to cope with stress due to the mass rural-to-urban migration of China’s youth labor force. Such a situation further worsens their psychological health and well-being. However, the prevalence of and risk factors associated with negative psychological symptoms (loneliness, depression, and anxiety) among remote elderly widows living alone in China are currently unclear; (2) Methods: A cross-sectional study was conducted in Hunan Province, China. The loneliness was assessed through the University of California at Los Angeles Loneliness Scale (ULS-8). The depression and anxiety were assessed with the Short Form Geriatric Depression Scale (GDS-15) and Generalized Anxiety Disorder Scale (GAD-7), respectively. The Chi-square test and correlation analysis were conducted to identify factors associated with negative psychological symptoms. Logistic regression was performed to predict risk and protective factors contributing to loneliness, depression, and anxiety symptoms. The significance level was set as p < 0.05; (3) Results: A total of 271 remote elderly widows living alone were enrolled in the present study. Additionally, 234 valid questionnaires were returned (valid response rate = 86.3%). The prevalence of loneliness, depression and anxiety was 8.1%, 44.0%, and 16.7%, respectively. Acute or chronic medical conditions, marital happiness, being the primary caregiver before widowhood and anticipating the death of the spouse differed significantly in the distribution of negative psychological symptoms. Logistic regression analysis predicted that participants who were satisfied with their marriage had a lower likelihood to experience loneliness, depression, and anxiety (p < 0.05). Being the spouse’s primary caregiver before widowhood was more likely to have symptoms of loneliness (p < 0.01). Those with various acute or chronic medical conditions were more likely to suffer from depression (p < 0.01); (4) Conclusions: Remote elderly widows living alone in China are prone to loneliness, depression, and anxiety symptoms. Being the primary caregiver before widowhood and having many acute or chronic medical conditions are risk factors for loneliness and depression, respectively. Marital happiness is the protective factor against negative psychological symptoms. To accomplish the goal of equitable access to mental health care in China, evidence-based policy and resource development to support psycho-social interventions that prevent and manage negative psychological symptoms for remote elderly widows living alone are urgently needed.

A large proportion of nursing home residents in developed countries come from ethnic minority groups. Unmet care needs and poor quality of care for this resident population have been widely reported. This systematic review aimed to explore social conditions affecting ethnic minority residents' ability to exercise their autonomy in communication and care while in nursing homes. In total, 19 studies were included in the review. Findings revealed that ethno-specific nursing homes create the ideal social condition for residents to express their care needs and preferences in a language of choice. In nonethno-specific nursing homes, staff cultural competence and nursing home commitment to culturally safe care are crucial social conditions that enable this group of residents to fulfil their autonomy in communicating and in participating in their care. In contrast, social conditions that undermine residents' ability to express their care needs and preferences include low levels of staff cultural awareness and cultural desire, negative attitudes towards residents and limited organisational support for staff to improve culturally responsive and culturally safe care. In conclusion, it is important to optimise the social conditions to support ethnic minority residents to communicate their care needs and preferences.

BACKGROUND Dementia is a global public health priority with an estimated prevalence of 150 million by 2050, nearly two-thirds of whom will live in the Asia-Pacific region. Dementia creates significant care needs for people with the disease, their families, and carers. iSupport is a self-help platform developed by the World Health Organization (WHO) to provide education, skills training, and support to dementia carers. It has been adapted in some contexts (Australia, India, the Netherlands, and Portugal). Carers using the existing adapted versions have identified the need to have a more user-friendly version that enables them to identify solutions for immediate problems quickly in real time. The iSupport virtual assistant (iSupport VA) is being developed to address this gap and will be evaluated in a randomized controlled trial (RCT). OBJECTIVE This paper reports the protocol of a pilot RCT evaluating the iSupport VA. METHODS Seven versions of iSupport VA will be evaluated in Australia, Indonesia, New Zealand, and Vietnam in a pilot RCT. Feasibility, acceptability, intention to use, and preliminary impact on carer-perceived stress of the iSupport VA intervention will be assessed. RESULTS This study was funded by the e-ASIA Joint Research Program in November 2020. From January to July 2023, we will enroll 140 dementia carers (20 carers per iSupport VA version) for the pilot RCT. The study has been approved by the Human Research Committee, University of South Australia, Australia (203455). CONCLUSIONS This protocol outlines how a technologically enhanced version of the WHO iSupport program—the iSupport VA—will be evaluated. The findings from this intervention study will provide evidence on the feasibility and acceptability of the iSupport VA intervention, which will be the basis for conducting a full RCT to assess the effectiveness of the iSupport VA. The study will be an important reference for countries planning to adapt and enhance the WHO iSupport program using digital health solutions. CLINICALTRIAL Australian New Zealand Clinical Trials Registry ACTRN12621001452886; https://tinyurl.com/afum5tjz INTERNATIONAL REGISTERED REPORT PRR1-10.2196/33572

Background: Hypertension and diabetes are two of the high prevalent non-communicable diseases. Inadequate care coordination among health systems and between health professionals as well as limited self-care capability of patients lead to the suboptimal care for people with hypertension and diabetes. Person-centred integrated care aiming to address these three levels of barriers has been proposed by World Health Organization as a global strategy to enhance the quality of care for people with chronic diseases. However, the effectiveness and characteristics of integrated care for community-dwelling people with hypertension and diabetes has not been systematically assessed.Methods: A systematic literature search will be conducted in seven databases including MEDLINE, Emcare, CINAHL, EMBASE, Cochrane Library of systematic reviews, Scopus and ProQuest. Additional studies will be identified through manual searching of reference lists and grey literatures. Quantitative studies (e.g. randomized controlled trials, quasi-randomized trials, before-and-after studies) evaluating the effects of integrated care for community-dwelling people with hypertension and diabetes will be included. Primary outcomes will be systolic and diastolic blood pressure. Secondary outcomes will include the proportion of patients achieving target blood pressure, glycated haemoglobin, fasting blood glucose, blood lipid, treatment adherence, health knowledge, mortality, quality of life, hospitalisation, emergency department use, patient satisfaction, adverse events and caregiver burden. Two reviewers will independently screen articles, extract data and assess study quality. Methodological quality of the selected studies will be assessed using the Revised Cochrane risk-of-bias tool and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Disagreements will be resolved through team discussion. Random effects model will be used for data synthesis if feasible.Discussion: This systematic review will summarise the evidence regarding the overall effectiveness, core components and implementation mechanism of integrated care interventions for people with hypertension and diabetes. Findings from the review will provide crucial evidence to inform the development of health policy, clinical practice and health resources to relieve the burden of hypertension and diabetes on healthcare systems.Registration: The protocol is registered with PROSPERO (registration number CRD42021271338)

AIMS To explore the overall benefits and challenges for the mentee, the mentor, and the hospital (stakeholders) in hospital-sponsored mentoring programs. BACKGROUND Formal mentoring programs are widely used to assist nurses to adapt to clinical practice, facilitate their career development, and improve workforce retention. However, the overall benefits and challenges for stakeholders involved in formal mentoring programs remain largely unknown due to a lack of systematic reviews to synthesize relevant studies in this important area. DESIGN A systematic integrated review. DATA SOURCES A systematic search of six databases including CINAHL, Web of Science, MEDLINE, Scopus, Science Direct, and ProQuest was undertaken. REVIEW METHODS Studies that met the inclusion criteria were assessed for methodological quality using the Joanna Briggs Institute critical appraisal tools. Findings from qualitative, quantitative, and mixed-methods studies were extracted and synthesized thematically using a convergent synthesis method. RESULTS Twenty-two original studies were included in the review. Findings are presented under five themes: the benefits for mentees, the benefits for mentors, the benefits for the hospital, challenges perceived by mentees and mentors, and mismatched mentor-mentee pairs. CONCLUSION Mentoring programs that build on reciprocal relationships among mentees and mentors generate substantial benefits for all if mentees are able to navigate the challenges of the complex and dynamic nature of the clinical practice environment. Organizational support is important in overcoming these challenges.

ObjectiveThis prediction model quantifies the risk of cognitive impairment. This aim of this study was to develop and validate a prediction model to calculate the 6-year risk of cognitive impairment.MethodsParticipants from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) 2008–2014 and 2011–2018 surveys were included for developing the cognitive impairment prediction model. The least absolute shrinkage and selection operator, clinical knowledge, and previous experience were performed to select predictors. The Cox proportional hazard model and Fine-Gray analysis adjusting for death were conducted to construct the model. The discriminative ability was measured using C-statistics. The model was evaluated externally using the temporal validation method via the CLHLS 2002–2008 survey. A nomogram was conducted to enhance the practical use. The population attributable fraction was calculated.ResultsA total of 10,053 older adults were included for model development. During a median of 5.68 years, 1,750 (17.4%) participants experienced cognitive impairment. Eight easy-to-obtain predictors were used to develop the model. The overall proportion of death was 43.3%. The effect of age on cognitive impairment reduced after adjusting the competing risk of death. The Cox and Fine–Gray models showed a similar discriminative ability, with average C-statistics of 0.71 and 0.69 in development and external validation datasets, respectively. The model performed better in younger older adults (65–74 years). The proportion of 6-year cognitive impairment due to modifiable risk factors was 47.7%.ConclusionThis model could be used to identify older adults aged 65 years and above at high risk of cognitive impairment and initiate timely interventions on modifiable factors to prevent nearly half of dementia.

Background In Australia, informal caregivers (family, friends and neighbours) play a crucial role in supporting people with dementia to remain at home. Within the community aged care policy, informal caregivers are acknowledged as assisting with managing care. However, they usually receive very limited dementia care education and training to support them in their role. The World Health Organization (WHO) developed iSupport for Dementia, a comprehensive online dementia education and skill training programme, to address the gap in supporting informal caregivers. Aim The aim of the study was to identify stakeholders’ perspectives regarding adapting the WHO iSupport for use by informal caregivers of people with dementia in Australia. Methods An interpretive description study design was used. Data were collected in focus groups with informal caregivers and care staff of dementia and aged care service providers conducted in May–July 2018. A thematic analysis was utilised to analyse data and identify findings. Results In total, 16 informal caregivers and 20 care staff participated in the study. Five themes were identified. First, informal caregivers perceived iSupport as an opportunity to provide an online one-stop shop to meet their education needs and their needs to manage care services. Second, both informal caregivers and care staff believed that an integrated caregiver network moderated by a health professional was much needed to enable informal caregivers to share learning experiences and enhance social support. Third, both informal caregivers and care staff strongly suggested that dementia and aged care service providers had a role to play in promoting the iSupport. Fourth, informal caregivers were concerned about the time commitment to participate in the iSupport programme. Finally, informal caregivers expected the iSupport to be user-friendly. Conclusion Stakeholders perceived the adaptation of the WHO iSupport in Australia would strengthen informal caregiver education and optimise support for informal caregivers.

Objectives Evaluation of simulation and coaching training to change ​the self-efficacy of aged care workers to prevent and manage workplace aggressive events. Methods Seventeen aged care workers from a community and residential aged care service provider completed education modules and two half-days of simulation using actors and real-life scenarios, with real-time coaching. Carer self-efficacy to identify, prevent and manage anxiety and aggression was measured before, following and six months after training. Results After training, participants reported significant improvements in preparedness to prevent and manage aggression, identify and manage triggers in their own behaviour, deflect and alter other triggers, and felt safer in the workplace. Six months after training, participants' self-efficacy remained above baseline for all measures and remained significantly improved for feeling safer in the workplace. Conclusion This pilot study supports high-fidelity simulation and coaching to improve the self-efficacy of aged care workers to prevent and manage workplace aggressive events.

Background First-line nursing staff are responsible for protecting residents, the most vulnerable population, from COVID-19 infections. They are at a high risk of being infected with COVID-19 and experience high levels of psychological distress. Aims To explore the challenges and coping strategies perceived by nursing staff during the COVID-19 pandemic in China. Methods In April,2020, we conducted a qualitative study using in-depth semi-structured interviews with nursing staff. Participants were selected from seven nursing homes in three cities in Hunan Province, China. Results A total of 21 nursing staff participated in the study, including seven nurse managers, seven registered nurses and seven nursing assistants. Three main themes were identified. Different groups encountered different sources of stress and adopted various coping strategies to fulfil their responsibilities. Conclusions Nursing home staff were underprepared for dealing with COVID-19-related challenges. Educational programs to improve the ability to deal with COVID-19 prevention and control are needed.

To evaluate the effects of a nurse-led health coaching programme for stroke survivors and family caregivers in hospital-to-home transition care.A total of 140 dyads of stroke survivors and their family caregivers were recruited and randomly assigned to either the intervention group (received a 12-week nurse-led health coaching programme) or the usual care group. The primary outcome was self-efficacy, and secondary outcomes were quality of life (QoL), stroke-related knowledge, and caregiver-related burden. The outcomes were measured at baseline, 12 and 24 weeks.Stroke survivors in the intervention group demonstrated a significant improvement in self-efficacy at 12 weeks (x̅: 24.9, 95%CI: 20.2-29.6, p 0.001) and at 24 weeks (x̅: 23.9, 95%CI: 19.2-28.6, p 0.001) compared to the usual care group. Findings also demonstrated significant increases in stroke survivors' QoL, stroke-related knowledge, and reduction in unplanned hospital readmissions and caregiver-related burden. There were no statistically significant changes in other outcomes between the two groups.The nurse-led health coaching programme improved health outcomes for both stroke survivors and their caregivers.Findings from the study suggest that nurse-led health coaching should be incorporated into routine practice in hospital-to-home transitional care for stroke survivors and their caregivers.

© 2020 John Wiley & Sons Ltd Aims: To identify (a) the challenges for multicultural aged care teams; (b) the opportunities to facilitate teamwork; and (c) the strategies to assist team members in a multicultural work environment. Background: High-income countries have an increasingly culturally diverse aged care workforce. Fostering teamwork in such an environment is challenging. Methods: This systematic review of qualitative studies followed the Joanna Briggs Institute (JBI) meta-aggregation approach. Six databases were searched. Retrieved articles were screened by two reviewers. This review identified 111 findings that were aggregated into 15 categories and five themes. Findings: Aged care workers' awareness of cultural diversity varies, and their knowledge of each other's cultural background is limited. However, cultural skills are demonstrated, contributing to teamwork. Their experience in cross-cultural encounters is broad, and enhanced team cohesion is desired. Conclusions: The cultural competence of the aged care workforce shapes team building, peer support opportunities and positive cross-cultural experiences. Implications for Nursing Management: Recommendations are provided for the adaptation of aged care workers to culturally diverse teams, fostering teamwork to enhance care outcomes for clients. Interventions for improvements in cross-cultural leadership and management, and staff experience of cross-cultural encounters are much needed.

Background Dementia care requires inter-disciplinary collaboration starting from formal health professional education. Yet, little is known about how undergraduate medical and nursing students perceive dementia care in China. The aim of this study was to investigate undergraduate medical and nursing students’ dementia knowledge, attitudes and care approach in China. Methods A cross-sectional survey was conducted. Students enrolled in a 5-year Bachelor of Medicine Program and a 4-year Bachelor of Nursing Program from four universities with campuses across Eastern, Western, Southern and Northern China were recruited into the study. Three validated instruments, Alzheimer’s Disease Knowledge Scale (ADKS), Dementia Care Attitude Scale (DCAS) and Approach to Advanced Dementia Care Questionnaire (ADCQ), were used to examine students’ dementia knowledge, attitudes and perceived care approach. Data were collected using a self-administered survey. Results The number of medical and nursing students completing the survey was 526 and 467 respectively. Students’ overall knowledge about dementia was poor, but attitudes were generally positive. The overall mean score of students’ dementia knowledge examined by the ADKS was 19.49 (SD = 2.82) out of 30, students’ attitudes to dementia was 29.92(SD = 3.35) out of 40, and students’ person-centred care approach of dementia was 5.42 (SD = 2.20) out of 13. Medical students demonstrated higher dementia knowledge scores and showed less positive attitude scores than nursing students (p Conclusions Study results highlight the urgent need to implement an inter-disciplinary approach to increasing dementia education among Chinese medical and nursing students, and ensuring that students have adequate knowledge, attitudes and experience in the care of people with dementia.

Dementia care requires inter-disciplinary collaboration starting from formal health professional education. Yet, little is known about how undergraduate medical and nursing students perceive dementia care in China. The aim of this study was to investigate undergraduate medical and nursing students' dementia knowledge, attitudes and care approach in China.A cross-sectional survey was conducted. Students enrolled in a 5-year Bachelor of Medicine Program and a 4-year Bachelor of Nursing Program from four universities with campuses across Eastern, Western, Southern and Northern China were recruited into the study. Three validated instruments, Alzheimer's Disease Knowledge Scale (ADKS), Dementia Care Attitude Scale (DCAS) and Approach to Advanced Dementia Care Questionnaire (ADCQ), were used to examine students' dementia knowledge, attitudes and perceived care approach. Data were collected using a self-administered survey.The number of medical and nursing students completing the survey was 526 and 467 respectively. Students' overall knowledge about dementia was poor, but attitudes were generally positive. The overall mean score of students' dementia knowledge examined by the ADKS was 19.49 (SD = 2.82) out of 30, students' attitudes to dementia was 29.92(SD = 3.35) out of 40, and students' person-centred care approach of dementia was 5.42 (SD = 2.20) out of 13. Medical students demonstrated higher dementia knowledge scores and showed less positive attitude scores than nursing students (p 0.05). Students would not apply a person-centred care approach. There were no statistically significant differences in the mean scores of ADCQ between nursing students and medical students.Study results highlight the urgent need to implement an inter-disciplinary approach to increasing dementia education among Chinese medical and nursing students, and ensuring that students have adequate knowledge, attitudes and experience in the care of people with dementia.

Introduction: Meeting the care needs of disabled residents of nursing homes is a vital element to providing high-quality care in modern society. Therefore, this study aimed to explore the disabled residents’ new care needs in nursing homes based on Maslow’s hierarchy of needs theory from their perspectives in modern society. Method: This was a qualitative study. Semi-structured interviews were conducted with a purposeful sample of 23 disabled residents in a nursing home in China. All data were transcribed and coded for emerging themes. Results: A qualitative data analysis generated 4 dimensions and 12 aspects of needs: intelligent technology (including intelligent health management, intelligent life care, and intelligent psychological care), security (including air and food safety, network security, and protecting privacy), participation (including social relations, self-regulated learning, and volunteer service), and spirituality (including religious beliefs needs, maintaining dignity, and self-determination). Discussion: These findings can inform nursing home health care professionals about the new care needs of disabled residents to improve nursing home care protocols to accommodate residents’ expressed needs, thus fostering better care.

Rural hospitals in sub-Saharan African countries play a key role in dealing with a high level of disease burden, but are usually poorly equipped with resources. Ward nurse managers in rural hospitals are in an ideal position to negotiate resources and bridge gaps in quality improvements. The aim of this study was to explore nurse managers’ perspectives on quality and safe care in rural hospitals in Uganda. This was a qualitative interpretive study in which 11 ward nurse managers with at least two years’ experience in the role were purposively selected to participate in the study. In-depth interviews using a semi-structured interview guide were applied for data collection. Thematic analysis was applied to analyse the data. Four themes were identified from the interviews. These themes explained how nurse managers engaged stakeholders in quality and safe care for patients; supported staff through supervision; improvised practices to cope with resource and equipment constraints; and being constrained by poor working conditions. Nurse managers in rural hospitals in sub-Saharan Africa face unique challenges in ensuring quality and safe care for patients due to a lack of basic human and material resources. The strategies they apply in quality improvements have implications for policy and resource development.

Sleep plays a key role in preserving cognitive function. However, the optimal strategies of sleep for cognition and the underlying mechanism are not well-established.A cross-sectional study was performed using the China Health and Retirement Longitudinal Study (CHARLS), 2011-2012 survey. Self-reported nighttime sleep and afternoon napping data were collected. Fasting blood collected was analyzed for the high-sensitivity C-reactive protein (CRP) and white blood cell.Both nighttime sleep and afternoon napping were significantly associated with cognition after adjusting for confounders (p0.05). Precisely, participants with nighttime sleep of 6.1-7h had the highest cognition scores (p0.05). Participants with less than 30 min afternoon napping had the highest cognition scores (p0.05). The synergistic effect of nighttime sleep and afternoon napping was not significant (p0.05). Nighttime sleep and afternoon napping were significantly related to the white blood cell, but not the high-sensitivity CRP. The white blood cell mediated the association between sleep and cognition (p0.05).Nighttime sleep of six to seven hours and afternoon napping of less than 30 minutes are associated with optimal cognitive function in middle-aged and older people, respectively. Sleep influences cognition partly via the inflammatory profile.

Elders in rural areas of developing countries are particularly vulnerable to cognitive impairment and gender disparities are notable. Yet, evidence related to gender differences in cognitive impairment in these settings is scarce. This study examined gender differences in cognitive impairment among elderly people aged 65 and above in rural China. A multi-site cross-sectional survey was conducted. In total, 550 males and 700 females were recruited. The Chinese version of the Mini-Mental Status Examination was applied for cognitive impairment screening. Demographic information, lifestyle factors, psychosocial factors, and health-related information were assessed. The prevalence of cognitive impairment was 40.0%in males and 45.1% in females, respectively. Females showed significant higher prevalence after age 75 (62.7% vs. 45.4%, p &lt, 0.005). Older age, hearing impairment, and activities of daily living dependence were common factors associated with cognitive impairment in both females and males. For males, living in a neighborhood with poor social interactions and diabetes were risk factors, while tea consumption was a protective factor. For females, vision impairment and illiteracy were additional risk factors. Individualized interventions and standardized measurements of cognitive function should be developed to suit older populations living in rural and less-developed areas, through collective efforts involving all stakeholders and multidisciplinary teamwork.