Knowledge, attitudes and practices of South Asian immigrants in developed countries regarding oral cancer : an integrative review

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

Perceptions and practices of general practitioners towards oral cancer and emerging risk factors among Indian immigrants in Australia : a qualitative study

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

Protocol for developing a healthcare transition intervention for young people with spinal cord injuries using a participatory action research approach

Introduction: While healthcare transition (HCT) interventions are recognised as an important area in paediatric rehabilitation, there has been limited research focusing on young people with spinal cord injuries (SCI). In this study, researchers will collaborate with young people with SCI and their parents/caregivers to develop, implement and evaluate the feasibility and acceptability of a HCT intervention aimed at supporting young people with SCI during their transition from paediatric to adult healthcare services. Methods and analysis: A participatory action research (PAR) approach will be used to co-develop the HCT intervention with young people with SCI aged 14–25 years and their parents/caregivers. Three phases will be conducted to address the five objectives of this study. Phase 1 will use semi-structured interviews to explore young people and parent/caregivers’ experiences of HCT. In Phase 2a, both young people and parent/caregivers will be co-researchers. They will be included in the analysis of the interviews and will be asked to participate in co-design workshops to inform the development of a prototype HCT intervention. In Phase 2b, using focus groups, feedback on the prototype HCT intervention will be collected. In Phase 3, the refined prototype HCT intervention will be implemented, and young people with SCI and parent/ caregivers will evaluate the feasibility and acceptability of the HCT intervention in semi-structured interviews. A reference group, including stakeholders and end users, will be consulted at different time points. Ethics and dissemination The study has received ethics approval from Western Sydney University Human Research and Ethics Committee (H14029). The researcher will use the results of this study as chapters in a thesis to obtain a Doctor of Philosophy degree. The findings will be disseminated via publication in peer-reviewed journals and will be presented at local, national or international conferences. Trial registration number ACTRN1262100050085

Managing approaches to nursing care delivery

In this chapter we look at models of nursing care, the key roles and responsibilities of nurses, managing workload and time management, setting priorities and planning in clinical practice, mentorship and preceptorship, and measuring the outcomes of nursing care. The discussion relates particularly to moving from senior undergraduate student to newly registered nurse, and the skills required in making this transition

Managing approaches to nursing care delivery

Contemporary healthcare systems are characterised by their complexity and also the pressures they experience due to increased demand, technological complexity and fiscal constraints. Nursing is a dynamic profession, delivered in a wide variety of settings and in a range of models and regulatory frameworks. The role, scope and function of nursing practice are driven by the social, political and economic contexts in which the care is delivered. For exan1ple, in countries such as the USA there is a greater emphasis on independent nursing practice, whereas in other countries (such as Australia) there is less of an emphasis on these roles because of opposition in introducing these roles. It is only in recent years in Australia that the nurse practitioner role has been included in healthcare delivety models4 Encouraging _a range of policy changes has enabled the enacttnent of the nurse practitioner role. In recent times funding and policy changes have seen the rapid development of the nursing role in Australian general practice. This represents an exciting time for the nursing role in primary care

Managing approaches to nursing care delivery

Nursing is a dynamic profession, delivered in a wide variety of settings and in a range of models and regulatory frameworks where the roles, scope and function of nursing practice are driven by the social, political and economic contexts in which the care is delivered. For example, in countries such as the United States, there is a greater emphasis on independent nursing practice, whereas in other countries (such as Australia), there is less of an emphasis on these roles because of the later introduction of advanced practice roles, as well as opposition from some sectors in introducing these roles. It is only in recent years in Australia that the nurse practitioner role has been included in healthcare delivery models. Encouraging a range of policy changes has enabled the enactment of the nurse practitioner role. In recent times, funding and policy changes have seen the rapid development of the nursing role in Australian general practice. This represents an exciting time for the nursing role in primary care

Predictors of heart disease knowledge among older and younger Asian Indian adults

Coronary heart disease (CHD) has been estimated to be the leading cause of mortality in developing countries in 2010, particularly among Asian Indians. When compared to other populations globally, Asian Indians less than 40 years of age are at an increased risk of myocardial infarction. The objective of this study was to identify the predictors of knowledge of heart disease among younger and older Asian Indians adults. A cross-sectional survey was undertaken in Sydney Australia. One hundred and forty-four participants of Asian Indian descent who attended the health promotion stall at the Australia India Friendship Fair in Sydney participated in the study. All participants completed a self-administered questionnaire. The Primary outcome of the survey was knowledge of heart disease as measured by the 25 item Heart Disease Facts Questionnaire. All six modifiable risk factors for heart disease namely smoking, high blood pressure, diabetes, high cholesterol, physical inactivity and overweight were identified by 45.2 % of those aged below 40 and 53.5 % of those aged above 40 years of age respectively. For younger adults, only smoking status was significant and was an independently predictor of knowledge related to CHD (b = −10.6, p = 0.001, sr2 = 0.16). For older adults, smoking status and duration of residence were significant predictors of knowledge related to CHD (b = −7.4, p = 0.000, sr2 = 0.24; b = 0.13, p = 0.001, sr2 = 0.069 respectively). Although suboptimal, there were no statistically significant differences in the level of knowledge among older and younger Asian Indians. Nevertheless, strategies to improve the knowledge of heart disease among this cohort are warranted

Academic engagement and disengagement as predictors of performance in pathophysiology among nursing students

Connecting students with learning activities to promote academic engagement has been a focus of higher education over the past decade, partly driven by an increasing rate of student participation in part-time employment, and a growing concern about the quality of the student experience. Using a prospective survey design, this study selected three elements of academic engagement (homework completion, lecture attendance, and study hours) and academic disengagement (part-time work), to identify predictors of academic performance in a pathophysiology subject in 126 second year nursing students. Homework completion emerged as the strongest positive predictor of academic performance, followed by lecture attendance; however, time spent studying was not a significant predictor of academic performance. Of concern was the finding that the amount of part-time work had a significant and negative impact on academic performance. Combining all elements of academic engagement and disengagement, and controlling for age and ethnicity, the multiple regression model accounted for 34% of the variance in the academic performance of second year nursing students studying pathophysiology. Results from these findings indicate the importance of active learning engagement in influencing academic success, and provide some direction for nursing academics to design effective learning approaches to promote academic engagement of nursing students

Reframing the dilemma of poor attendance at cardiac rehabilitation : an exploration of ambivalence and the decisional balance

Aim. To discuss the problem of poor attendance at cardiac rehabilitation from the alternative perspective of patient ambivalence. Background. Evidence supports the benefits of cardiac rehabilitation as a means for secondary prevention of coronary heart disease, yet current literature continues to document poor attendance at these programmes. Whilst extrinsic factors, such as transportation and lack of physician support have been identified as barriers, patients who choose not to attend these programmes are often described as lacking motivation or being non-compliant. However, it is possible that non-attendance is the result of ambivalence - the experience of simultaneously wanting to and yet not wanting to, or the 'I want to, but I don't want to' dilemma. Design. Discussion paper. Method. This discussion paper draws on the literature of ambivalence and decision-making theory to reframe the issue of poor attendance at cardiac rehabilitation. Conclusions: This paper has demonstrated that the problem of poor attendance may be explained from the perspective of patient ambivalence and that using strategies such as the decisional balance may assist these individuals in exploring their ambivalence to engage in secondary prevention programmes. Relevance to clinical practice. Understanding the dynamics of ambivalence provides an alternative to thinking of patients as lacking motivation, being non-compliant, or even resistant. Helping patients to explore and resolve their ambivalence may be all that is needed to help them make a decision and move forward

Clinical supervision and ward orientation predict new graduate nurses' intention to work in critical care : findings from a prospective observational study

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