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BackgroundClinical deterioration of adult patients in acute medical-surgical wards continues to occur, despite a range of systems and processes designed to minimize this risk. In Australia, a standardized template for adult observation charts using human factors design principles and decision-support characteristics was developed to improve the detection of and response to abnormal vital signs. ObjectiveTo describe the study protocol for the clinical testing of these observation and response charts (ORCs). MethodsWe propose a two-phase multisite multiple-methods design to test the initial clinical utility of the charts in 10 hospitals of differing types and sizes across state jurisdictions in Australia. Data collection in the first phase includes user surveys, observations and field notes by project officers, handover de-briefs (short interviews with small groups of staff), and an audit of ORC documentation completion compared to the site’s existing observation chart. For the second phase, data will be collected using a retrospective audit of observation documentation from the previous hospital observation chart, prospective audit of observation documentation following implementation of the selected ORC, user focus groups, observational field notes, and patient outcome data from routinely collected organizational data sources. ResultsSite selection and preparation, project officer training, chart selection and implementation, participant recruitment, and data collection has been completed and the analysis of these results are in progress. ConclusionsThis detailed description of these study methods and data collection approaches will enable a comprehensive assessment of the clinical utility of these newly developed track and trigger charts and will be useful for clinicians and researchers when planning and implementing similar studies. Potential methodological limitations are also noted.

Aims. To understand what domains of acculturation are experienced by Chinese immigrants with cardiovascular disease (CVD) in Australia and how these domains of acculturation influence their CVD self‐care behaviours. Design. A qualitative descriptive design. Methods. Individual phone interviews were conducted among Chinese immigrants with CVD in Sydney, recruited from Chinese Community associations and social media. Inductive and deductive thematic analysis was employed, guided by the Middle‐Range Theory of Self‐Care of Chronic Illness and the conceptual model of acculturation. Results. Twenty participants, mean age 69.9 years, were interviewed. The domains of acculturation in relation to CVD self‐care behaviours encompassed cultural practices, cultural values, healthcare system navigation, and new living environment. Retaining their Chinese culture and integrating into Australian culture regarding dietary practices, social networks, traditional values and family relationships served as both enablers and barriers of self‐care maintenance through factors such as heart‐healthy diets, physical activity, stress management and medication adherence. Many participants denied encountering difficulties to utilize primary care services, but language barriers deterred them from accessing acute services and heart‐health information from mainstream sources. Some preserved beliefs and practices in Traditional Chinese Medicine may complicate their self‐care maintenance (medication adherence) and self‐care management (responding to acute angina episodes). Conclusion. The influence of acculturation on CVD self‐care behaviours among Chinese immigrants is multifaceted and individualized. Clinicians and community health workers should assess patients' acculturation experiences to enable culturally sensitive practices. The lack of culturally and linguistically appropriate heart health information in the community should be addressed urgently to mitigate the cardiac health disparity. Collaboration with Chinese community associations offers an opportunity for co‐design and dissemination of information about Australian healthcare systems and heart health education to upskill CVD self‐care practices and mitigate the health inequities experienced by Chinese immigrants. [ABSTRACT FROM AUTHOR]

Background: Regular contact with specialist care has been linked to better diabetes outcomes for young people with type 1 diabetes (YPwT1D), but evidence is limited to population‐based service usage and outcomes. Aims: This observational 5‐year study sought to capture YPwT1D living in the study catchment area (covering metropolitan, regional and rural Australia) as they transitioned to adult‐based diabetes healthcare services and to describe their glycaemic control and complication rates, service usage and associated factors. Methods: Records between 2010 and 2014 in a public healthcare specialist diabetes database were extracted, care processes and outcomes were described, and associations were sought between episodes of care (EOC) and potentially predictive variables. Results: Annual cohort numbers increased yearly, but without significant differences in demographic characteristics. Each year around 40% had no reported planned specialist care, and the average number of planned EOC decreased significantly year on year. Overall, mean HbA1c levels also reduced significantly, but with higher values recorded for those living in non‐metropolitan than metropolitan areas (achieving significance in 3 out of 5 years). Diabetes complication assessments were only reported in 37–46%, indicating one in five with retinopathy and hypertension affecting one in three to five young people. Conclusions: Findings highlight the importance of investment to address the specific needs of adolescents and young adults and demonstrate the need for better support during these vulnerable early years, particularly for non‐metropolitan residents. This will entail changes to funding mechanisms, the health workforce and infrastructure, and new models of care to provide equity of access and quality of specialist care. [ABSTRACT FROM AUTHOR]

Background: Recent research has focused on the potential benefits of physical activity in occupational settings in addition to leisure time. However, occupational physical activity (OPA) differs substantially for occupations that require heavy and repetitive physical work, such as nursing. We explored associations between leisure time and OPA and health outcomes in working nurses and midwives. Methods: Nurses who were enrolled in the Fit For the Future study (New South Wales, Australia) and who completed physical activity questionnaires (n = 4343) were classified according to high (HO) or low (LO) occupational and high (HL) or low (LL) leisure-time physical activity (LTPA): HO performed walking/heavy labor most/all of the time at work; HL met the guidelines of 150 minutes per week moderate to vigorous LTPA, creating 4 categories: HOLL, HOHL, LOHL, and LOLL. Results: HL predicted better self-rated health (unstandardized B = 0.51, 95% confidence interval, 0.44 to 0.57) and lower likelihood of ≥3 sick days in the past 12 months (OR: 0.71, 95% confidence interval, 0.61 to 0.83), whereas HO predicted higher likelihood of ≥3 sick days (OR: 1.17, 95% confidence interval, 1.01 to 1.35), adjusting for all variables. Conclusions: OPA may not confer the same health benefits as LTPA for nurses. Health-promoting interventions should emphasize the importance of achieving adequate moderate to vigorous LTPA for all, including those undertaking substantial OPA. [ABSTRACT FROM AUTHOR]

Aims and objectives: This review aimed to demonstrate the self‐care behaviours of first‐generation Chinese immigrants with cardiovascular disease in western countries and identify related cultural factors. Background: Self‐care is the cornerstone to mitigate disease symptoms and maintain health status. Chinese immigrants to western countries, operating within a cross‐cultural context, may find self‐care to manage their cardiovascular disease challenging. Design: An integrative review was conducted. Methods: Seven databases were searched Scopus, ProQuest Health & Medicine, Medline (Ovid), Embase (Ovid), AMED (Ovid), PsycINFO and CINAHL, with output limited to peer‐reviewed studies published from 2000 to 2020 in English or Chinese. Initially, 2037 papers were screened. Six papers were retained and critiqued using the Joanna Briggs Institute critical appraisal tools. Deductive and inductive approaches were utilised to analyse the findings. The PRISMA 2020 checklist informed review reportage. Result: In general, Chinese immigrants with cardiovascular disease took an active role in management of their cardiovascular disease, including through diet and activity adaptation and adherence to western medication. Families also played a significant role in disease decision‐making and management. However, language and cultural barriers impeded their access to health information and resources in host countries. Relevance to clinical practice: Understanding self‐care behaviours and associated cultural factors among Chinese immigrants with cardiovascular disease is important to improve nurses' culturally sensitive practices and provide tailored health education interventions to promote self‐care behaviours among immigrant populations. The scarcity of literature on self‐care behaviours among Chinese first‐generation immigrants with cardiovascular disease indicates the need for further research in this area. Development of culturally and linguistically sensitive health resources and education programs is urgently needed. [ABSTRACT FROM AUTHOR]