Cerebrovascular Disease Profiles of Culturally and Linguistically Diverse Communities in South Western Sydney and New South Wales.

INTRODUCTION: Culturally and linguistically diverse (CALD) communities are growing globally. Understanding patterns of cerebrovascular disease in CALD communities may improve health outcomes through culturally specific interventions. We compared rates of transient ischaemic attack (TIA)/stroke (ischaemic stroke, intracerebral haemorrhage) and stroke risk factor prevalence in overseas and Australian-born people in South Western Sydney (SWS) and New South Wales (NSW). METHODS: This was a 10-year retrospective analysis (2011-2020) of SWS and NSW age-standardized rates per 100,000 person-years of TIA/stroke. Data were extracted from Health Information Exchange and Secure Analytics for Population Health Research and Intelligence systems. Rates of hypertension, type 2 diabetes mellitus (T2DM), atrial fibrillation (AF), smoking, and obesity were also calculated. RESULTS: The SWS and NSW age-standardized rate of TIA/stroke for people born in Australia was 100 per 100,000 person-years (100/100,000/year). In SWS, 56.6% of people were overseas-born compared to 29.8% for NSW. The age-standardized rate of TIA/stroke for Polynesian-born people was more than double that of Australian-born people (p < 0.001). Hypertension (33 [SWS] vs. 27/100,000/year [NSW]) and T2DM (36 [SWS] vs. 26/100,000/year [NSW]) were the most common risk factors with rates >50/100,000/year (hypertension) and >80/100,000/year (T2DM) for people born in Polynesia, Melanesia, and Central America. Rates of T2DM, AF, and obesity for Polynesian-born people were over threefold greater than people born in Australia. DISCUSSION/CONCLUSION: Greater rates of TIA/stroke were observed in specific CALD communities, with increased rates of cerebrovascular risk factors. Culturally specific, targeted interventions may bridge health inequalities in cerebrovascular disease.

A Multicentre Study Comparing Cerebrovascular Disease Profiles in Pacific Islander and Caucasian Populations Presenting with Stroke and Transient Ischaemic Attack.

INTRODUCTION: In a multicentre study, we contrasted cerebrovascular disease profiles in Pacific Island (PI)-born patients (Indigenous Polynesian [IP] or Indo-Fijian [IF]) presenting with transient ischaemic attack (TIA), ischaemic stroke (IS) or intracerebral haemorrhage (ICH) with those of Caucasians (CSs). METHODS: Using a retrospective case-control design, we compared PI-born patients with age- and gender-matched CS controls. Consecutive patients were admitted to 3 centres in South Western Sydney (July 2013-June 2020). Demographic and clinical data studied included vascular risk factors, stroke subtypes, and imaging characteristics. RESULTS: There were 340 CS, 183 (27%) IP, and 157 (23%) IF patients; mean age 65 years; and 302 (44.4%) female. Of these, 587 and patients presented with TIA/IS and 93 (13.6%) had ICH. Both IP and IF patients were significantly more likely to present >24 h from symptom onset (odds ratios [ORs] vs. CS 1.87 and 2.23). IP patients more commonly had body mass indexes >30 (OR 1.94). Current smoking and excess alcohol intake were higher in CS. Hypertension, diabetes, and chronic kidney disease were significantly higher in both IP and IF groups in comparison to CS. IP patients had higher rates of AF and those with known AF were more commonly undertreated than both IF and CS patients (OR 2.24, p = 0.007). ICH was more common in IP patients (OR 2.32, p = 0.005), while more IF patients had intracranial arterial disease (OR 5.10, p < 0.001). DISCUSSION/CONCLUSION: Distinct cerebrovascular disease profiles are identifiable in PI-born patients who present with TIA or stroke symptoms in Australia. These may be used in the future to direct targeted approaches to stroke prevention and care in culturally and linguistically diverse populations.

Scope of practice conflict in nursing: a new war or just the same battle?

The changing roles within health care teams reflect the rapid pace of change in contemporary health care environments. Traditional nursing roles and responsibilities are being challenged as fiscal constraints drive health reform. How nursing teams are configured in the future and the scope of practice of the individuals within those teams will require clear and unambiguous boundaries. This study explores the relationships in and between scope of practice and communication amongst teams of nurses. Six focus groups with both Registered and Enrolled Nurses were undertaken in three Sydney metropolitan hospitals in New South Wales. Nurses report that confusion surrounding scope of practice particularly in the areas of medication administration, patient allocation and workload are resulting in situations whereby nurses are feeling bullied, stressed and harassed. With the imminent widespread introduction of a third tier of nursing into acute care hospitals in Australia the findings of this study are timely and suggest that unless nursing team members clearly understand their roles and scope of practice there is potential for intra-professional workplace conflict. Furthermore the impact of the conflict may have consequences for both the individual nurse and their patients.

Personal resilience as a strategy for surviving and thriving in the face of workplace adversity: a literature review.

AIM: This paper is a report of a literature review to explore the concept of personal resilience as a strategy for responding to workplace adversity and to identify strategies to enhance personal resilience in nurses. BACKGROUND: Workplace adversity in nursing is associated with excessive workloads, lack of autonomy, bullying and violence and organizational issues such as restructuring, and has been associated with problems retaining nurses in the workforce. However, despite these difficulties many nurses choose to remain in nursing, and survive and even thrive despite a climate of workplace adversity. DATA SOURCES: The literature CINAHL, EBSCO, Medline and Pubmed databases were searched from 1996 to 2006 using the keywords 'resilience', 'resilience in nursing', and 'workplace adversity' together with 'nursing'. Papers in English were included. FINDINGS: Resilience is the ability of an individual to positively adjust to adversity, and can be applied to building personal strengths in nurses through strategies such as: building positive and nurturing professional relationships; maintaining positivity; developing emotional insight; achieving life balance and spirituality; and, becoming more reflective. CONCLUSION: Our findings suggest that nurses can actively participate in the development and strengthening of their own personal resilience to reduce their vulnerability to workplace adversity and thus improve the overall healthcare setting. We recommend that resilience-building be incorporated into nursing education and that professional support should be encouraged through mentorship programmes outside nurses' immediate working environments.

Understanding mentoring and preceptorship: clarifying the quagmire.

Mentoring! Preceptorship! These two terms are widely used within nursing. The vast literature on mentoring and preceptorship defines these concepts as discrete roles. However, confusion exists as to what defines mentorship when compared to preceptorship. It is apparent that these terms are being used interchangeably, despite the obvious and not so obvious differences portrayed in the literature. The authors therefore have questioned whether the roles of a mentor and preceptor are discrete and unique or can be integrated into one role? Furthermore, is one of these constructs more appropriate to new academics whilst the other is more appropriate for nurses in the clinical setting? This discussion paper is a journey into understanding preceptorship and mentoring and the value of sustaining a relationship with both.

Do the ends justify the means? Nursing and the dilemma of whistleblowing.

BACKGROUND: Patient advocacy and a desire to rectify misconduct in the clinical setting are frequently cited reasons for whistleblowing in nursing and healthcare. AIM: This paper explores current knowledge about whistleblowing in nursing and critiques current definitions of whistleblowing. The authors draw on published perspectives of whistleblowing including the media, to reflect on the role of the media in health related whistleblowing. CONCLUSION: Whistleblowing represents a dilemma for nurses. It strikes at the heart of professional values and raises questions about the responsibilities nurses have to communities and clients, the profession, and themselves. In its most damaging forms, whistleblowing necessarily involves a breach of ethical standards, particularly confidentiality. Despite the pain that can be associated with whistleblowing, if the ends are improved professional standards, enhanced outcomes, rectification of wrongdoings, and, increased safety for patients and staff in our health services, then the ends definitely justify the means.

Mothers' perceptions of overweight and obesity in their children.

BACKGROUND: Childhood obesity is a growing health concern and the literature implicates parents, particularly mothers. AIM: To develop understandings into the views of a group of mothers with an overweight or obese child, about their child's overweight or obesity. METHOD: A qualitative design informed by feminist insights. Eleven English speaking mothers of at least one overweight or obese child were drawn from a large urban community in metropolitan Australia to participate in this study. RESULTS: Participants attributed their child's obesity to factors such as slow metabolism, sedentary lifestyle, familial or cultural factors, genetics, eating habits such as not drinking enough water, or not chewing food adequately. Participants were very concerned about their child's weight problems and their immediate concerns focussed on social problems associated with obesity/overweight. CONCLUSION: Understanding parental views about their children's overweight and obesity is a key step in forming effective liaisons between health professionals and parents.