Factors affecting the integration of immigrant nurses into the nursing workforce: A double hermeneutic study

Author version made available in accordance with the publisher's policy for non-mandated open access submission. Under Elsevier's copyright, non-mandated authors are permitted to make work available in an institutional repository. NOTICE: this is the author’s version of a work that was accepted for publication in the International Journal of Nursing Studies. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in International Journal of Nursing Studies, [VOL 51, ISSUE 4, (April 2014)] DO:10.1016/j.ijnurstu.2013.08.005Background: Variations in nursing practice and communication difficulties pose a challenge for the successful integration into the workforce of immigrant nurses. Evidence for this is found in cultural clashes, interpersonal conflicts, communication problems, prejudiced attitudes and discrimination towards immigrant nurses. While the evidence shows that integrating immigrant nurses into the nursing workforce is shaped by factors that are socially constructed, studies that examine social structures affecting workforce integration are sparse. Objectives: The aim of this study was to examine interplaying relationships between social structures and nurses’ actions that either enabled or inhibited workforce integration in hospital settings. Design: Giddens’ Structuration Theory with double hermeneutic methodology was used to interpret 24 immigrant and 20 senior nurses’ perceptions of factors affecting workforce integration. Results: Four themes were identified from the data. These were: 1) employer-sponsored visa as a constraint on adaptation, 2) two-way learning and adaptation in multicultural teams, 3) unacknowledged experiences and expertise as barriers to integration, and 4) unquestioned sub-group norms as barriers for group cohesion. The themes presented a critical perspective that unsuitable social structures (policies and resources) constrained nurses’ performance in workforce integration in the context of nurse immigration. The direction of structural changes needed to improve workforce integration is illustrated throughout the discussions of policies and resources required for workforce integration at national and organisational levels, conditions for positive group interactions and group cohesion in organisations. Conclusion: Our study reveals inadequate rules and resources used to recruit, classify and utilise immigrant nurses at national and healthcare organisational levels can become structural constraints on their adaptation to professional nursing practice and integration into the workforce in a host country. Learning from each other in multicultural teams and positive intergroup interaction in promoting intercultural understanding are enablers contributing to immigrant nurses’ adaptation and workforce integration. Key words: Cultural diversity, Health care organisations, Double hermeneutic, Hospital nursing staff, Immigrant nurses, Nursing administration research, overseas-educated nurse

Cross–cultural care program for aged care staff : workbook for staff

This publication is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) license .Cultural and linguistic diversity between residents and staff is significant in residential aged care homes in Australia. Residents are from over 170 countries with 31% born overseas and 20% born in a non-English speaking country (AIHW, 2016). Staff who care for residents are also from culturally and linguistically diverse backgrounds. It is estimated that 32% of staff were born overseas and 26% were born in a non-English speaking country (Mavromaras et al., 2017). The majority of overseas-born residents come from Europe while the majority of overseas-born staff come from Asian and African regions (Mavromaras et al., 2017, AIHW, 2016). This diversity generates many opportunities for aged care organisations to address equitable and culturally appropriate care for residents. However, the diversity can also be a challenge to achieving high-quality care for residents and to staff cohesion. The program is developed from a 2-year action research project entitled ‘Developing the multicultural workforce to improve the quality of care for residents’. The project is funded by the Australian Government Department of Health under the ‘Service Improvement and Healthy Ageing Grants’ in 2015. During the project life, the project team worked with residents and staff in four participating residential aged care homes to implement and evaluate the program. The details of the research project are presented in the project final report (Xiao et al., 2017). The program has been adapted into an online self-learning program using the Massive Open Online Course (MOOC) and is free to access. Instruction for accessing the online program is attached as Appendix 1: Instructions for accessing the online Cross-cultural Care Program for Aged Care Staff

The implementation of intentional rounding using participatory action research

Author version made available according to Publisher copyright policy.‘Intentional’/’hourly rounding’ is defined as regular checks of individual patients carried out by health professionals at set intervals, rather than a response to a summons via a call bell. Intentional rounding places patients at the heart of the ward routine including the acknowledgement of patient preferences and in anticipation of their needs. The aim of this study was to implement intentional rounding using Participatory Action Research to increase patient care, increase staff productivity and the satisfaction of care provision from both patients and staff. Outcomes of the study revealed a drop in call bell use, no observable threats to patient safety, nursing staff and patient satisfaction with care provision. However, any future studies should consider staff skill mix issues, including the needs of newly graduated nursing staff as well as the cognitive status of patients when implementing intentional rounding on acute care wards

Multicultural workforce development model and resources in aged care

This publication is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) license. Full-text embargoed for 24 months until 31 Dec 2019

Developing the multicultural workforce to improve the quality of care for residents: Final report

This publication is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) license. This report is made available following 24 month embargo from date of publication (November 2017).Cultural and linguistic diversity between residents and staff is significant in residential aged care homes in Australia. The diversity generates many opportunities for aged care organisations to address equitable and culturally appropriate care for residents. However, diversity can also be a challenge to achieving high-quality care for residents and to staff cohesion. This final report describes the project: ‘Developing the multicultural workforce to improve the quality of care for residents’. This project was funded by the Australian Government Department of Health under the ‘Service Improvement and Healthy Ageing Grants’ in 2015. Flinders University, AnglicareSA Inc. and Resthaven Inc. formed the consortium to undertake the project led by Flinders University. Participating sites from these organisations included four residential aged care homes (RACHs). The aim of the project was to work with stakeholders to develop, implement and evaluate a multicultural workforce development model (MCWD), an education program and resources to support the implementation of the model. A Critical Action Research approach was applied to achieve the aims and objectives described above. The project was completed in two phases over a 2-year period. In phase one (12 months), the project team undertook a study of residents and staff experiences in cross-cultural care services in the four participating sites. Findings from the literature review and the study informed the development of the MCWD model and resources to support the implementation of the model. In phase two (12 months), a site champion in each participating site was appointed by their organisation to implement the MCWD model, cross-cultural care toolkit, cross-cultural care self-reflection toolkit and cross-cultural care program for aged care staff. The implementation of the Multicultural Workforce Development (MCWD) Model and resources using the site champion model was associated with improved resident satisfaction with cross-cultural care services, staff perceptions of cultural competence, and experiences in cross-cultural interactions with residents and co-workers. There is a need to embed and sustain the MCWD model in residential aged care homes using the site champion model

Identification of a BRCA2-Specific modifier locus at 6p24 related to breast cancer risk

Common genetic variants contribute to the observed variation in breast cancer risk for BRCA2 mutation carriers; those known to date have all been found through population-based genome-wide association studies (GWAS). To comprehensively identify breast cancer risk modifying loci for BRCA2 mutation carriers, we conducted a deep replication of an ongoing GWAS discovery study. Using the ranked P-values of the breast cancer associations with the imputed genotype of 1.4 M SNPs, 19,029 SNPs were selected and designed for inclusion on a custom Illumina array that included a total of 211,155 SNPs as part of a multi-consortial project. DNA samples from 3,881 breast cancer affected and 4,330 unaffected BRCA2 mutation carriers from 47 studies belonging to the Consortium of Investigators of Modifiers of BRCA1/2 were genotyped and available for analysis. We replicated previously reported breast cancer susceptibility alleles in these BRCA2 mutation carriers and for several regions (including FGFR2, MAP3K1, CDKN2A/B, and PTHLH) identified SNPs that have stronger evidence of association than those previously published. We also identified a novel susceptibility allele at 6p24 that was inversely associated with risk in BRCA2 mutation carriers (rs9348512; per allele HR = 0.85, 95% CI 0.80-0.90, P = 3.9×10−8). This SNP was not associated with breast cancer risk either in the general population or in BRCA1 mutation carriers. The locus lies within a region containing TFAP2A, which encodes a transcriptional activation protein that interacts with several tumor suppressor genes. This report identifies the first breast cancer risk locus specific to a BRCA2 mutation background. This comprehensive update of novel and previously reported breast cancer susceptibility loci contributes to the establishment of a panel of SNPs that modify breast cancer risk in BRCA2 mutation carriers. This panel may have clinical utility for women with BRCA2 mutations weighing options for medical prevention of breast cancer

An original phylogenetic approach identified mitochondrial haplogroup T1a1 as inversely associated with breast cancer risk in BRCA2 mutation carriers

Introduction: Individuals carrying pathogenic mutations in the BRCA1 and BRCA2 genes have a high lifetime risk of breast cancer. BRCA1 and BRCA2 are involved in DNA double-strand break repair, DNA alterations that can be caused by exposure to reactive oxygen species, a main source of which are mitochondria. Mitochondrial genome variations affect electron transport chain efficiency and reactive oxygen species production. Individuals with different mitochondrial haplogroups differ in their metabolism and sensitivity to oxidative stress. Variability in mitochondrial genetic background can alter reactive oxygen species production, leading to cancer risk. In the present study, we tested the hypothesis that mitochondrial haplogroups modify breast cancer risk in BRCA1/2 mutation carriers. Methods: We genotyped 22,214 (11,421 affected, 10,793 unaffected) mutation carriers belonging to the Consortium of Investigators of Modifiers of BRCA1/2 for 129 mitochondrial polymorphisms using the iCOGS array. Haplogroup inference and association detection were performed using a phylogenetic approach. ALTree was applied to explore the reference mitochondrial evolutionary tree and detect subclades enriched in affected or unaffected individuals. Results: We discovered that subclade T1a1 was depleted in affected BRCA2 mutation carriers compared with the rest of clade T (hazard ratio (HR) = 0.55; 95% confidence interval (CI), 0.34 to 0.88; P = 0.01). Compared with the most frequent haplogroup in the general population (that is, H and T clades), the T1a1 haplogroup has a HR of 0.62 (95% CI, 0.40 to 0.95; P = 0.03). We also identified three potential susceptibility loci, including G13708A/rs28359178, which has demonstrated an inverse association with familial breast cancer risk. Conclusions: This study illustrates how original approaches such as the phylogeny-based method we used can empower classical molecular epidemiological studies aimed at identifying association or risk modification effects.Peer reviewe

Genome-Wide Association Study in BRCA1 Mutation Carriers Identifies Novel Loci Associated with Breast and Ovarian Cancer Risk

BRCA1-associated breast and ovarian cancer risks can be modified by common genetic variants. To identify further cancer risk-modifying loci, we performed a multi-stage GWAS of 11,705 BRCA1 carriers (of whom 5,920 were diagnosed with breast and 1,839 were diagnosed with ovarian cancer), with a further replication in an additional sample of 2,646 BRCA1 carriers. We identified a novel breast cancer risk modifier locus at 1q32 for BRCA1 carriers (rs2290854, P = 2.7×10-8, HR = 1.14, 95% CI: 1.09-1.20). In addition, we identified two novel ovarian cancer risk modifier loci: 17q21.31 (rs17631303, P = 1.4×10-8, HR = 1.27, 95% CI: 1.17-1.38) and 4q32.3 (rs4691139, P = 3.4×10-8, HR = 1.20, 95% CI: 1.17-1.38). The 4q32.3 locus was not associated with ovarian cancer risk in the general population or BRCA2 carriers, suggesting a BRCA1-specific associat

Cross-cultural care program for aged care staff : facilitator manual

This publication is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) license .Cultural and linguistic diversity between residents and staff is significant in residential aged care homes in Australia. Residents are from over 170 countries with 31% born overseas and 20% born in a non-English speaking country (AIHW, 2016). Staff who care for residents are also from culturally and linguistically diverse backgrounds. It is estimated that 32% of staff were born overseas and 26% were born in a non-English speaking country (Mavromaras et al., 2017). The majority of overseas-born residents come from Europe while the majority of overseas-born staff come from south Asian and African regions (Mavromaras et al., 2017, AIHW, 2016). This diversity generates many opportunities for aged care organisations to address equitable and culturally appropriate care for residents. However, the diversity can also be a challenge to achieving high-quality care for residents and to staff cohesion. The program is developed from a 2-year action research project entitled ‘Developing the multicultural workforce to improve the quality of care for residents’. The project is funded by the Australian Government Department of Health under the ‘Service Improvement and Healthy Ageing Grants’ in 2015. During the project life, the project team worked with residents and staff in four participating residential aged care homes to implement and evaluate the program. The details of the research project are presented in the project final report (Xiao et al., 2017). The program has been adapted into an online self-learning program using the Massive Open Online Course (MOOC) and is free to access. Instructions for accessing the online program are attached as Appendix 1: Instructions for accessing the online Cross-cultural Care Program for Aged Care Staff