Personal noise exposure assessment of Kuwaiti printing industry workers.

Recent technological improvements in the printing industry may have altered noise exposures in printeries. Of the eight printery noise assessments published since 2000, none assessed the exposure of workers using computer-to-plate machines and only two used personal noise dosimetry. This method measures noise levels as the worker moves about and permits examination of the impulsiveness of noise levels. In this study, 104 workers wore personal noise dosimeters for one full shift. Computer-to-plate operators experienced noise exposures of 75 dB(A) on average and were rarely exposed to noise levels greater than 85 dB(A). Noise exposure in excess of 85 dB(A) was still common among offset printer operators. In fact, all workers operating web-fed offset machines spent more than half the shift experiencing noise levels greater than 85 dB(A). We found that the 5-min rolling SD of noise levels accurately reflected the impulsivity observed in the noise level profile.

Inhalation exposure to volatile organic compounds in the printing industry.

This study reports on the occupational inhalation exposure to VOCs of workers in the Kuwaiti printing industry. Using the evacuated canister methodology, we targeted 72 VOCs in three printeries and compared the concentrations to previous reports and relevant occupational exposure levels (OELs). We found that recent efforts in the printing industry to reduce VOC usage had been successful, as concentrations of key hazardous VOCs were substantially lower than anticipated. On the other hand, nearly all target VOCs were found. Non-production areas were sampled along with the offset printing areas, another strength of this study, and revealed exposures to hazardous VOCs among administers and digital printer and CTP operators. Exposure to ototoxic VOCs amounted to 1-3% of the OEL, consisting mostly of ethylbenzene, which was likely in use in two of the study printeries. Exposure to carcinogenic or probably carcinogenic VOCs was 15-20% of the OEL at four locations across the three printeries, consisting mostly of vinyl chloride and benzyl chloride. Vinyl chloride VOC was partially sourced from outdoors, but was also likely used inside the study printeries. Interestingly, concentrations of vinyl chloride were similar in most sampling locations to that of CFC-114, a CFC banned by the Montreal Protocol and not commonly used as a refrigerant. This unexpected finding suggests further study is warranted to identify the use of these VOCs in printeries. Exposure to hazardous VOCs up to nearly 50% of the OEL, consisting largely of bromoform and vinyl chloride. Bromoform was found in all the study printeries, sourced partially from outdoor air. The higher concentrations found inside the study printeries likely resulted from the use of the desalinated water for washing. This finding raises of emissions from sources other than blanket washes, and inks, etc. adding to the total VOC load in printery indoor air. Implications: Results from this study indicate that efforts to reduce worker exposure to VOCs particularly dangerous to human health in recent years have been successful, but there is still much to be done to protect workers. Exposures to ototoxic and carcinogenic VOCs were identified, among both production and non-production workers. Unexpected findings included the apparent use in printing activities of the carcinogen vinyl chloride and CFC-114, banned under the Montreal Protocol. Observed lapses in safety procedures included failure to utilize ventilation systems and closing doors between work areas, indicating management and worker education should remain a priority.

Australian general practitioners' perspective on the role of the workplace Return-to-Work Coordinator.

General practitioners (GPs) play a key role in the return-to-work process, and yet their experiences working with workplace Return-to-Work Coordinators (RTWCs) have rarely been studied. The aim of this paper is to provide insights from the GP perspective about their experiences with workplace RTWCs and their preparedness for the role. GPs from Australian states and territories where legislation mandates workplaces employ a RTWC were requested to complete a questionnaire on their experiences with workplace RTWCs. Fifty GPs completed a questionnaire on the preparedness of RTWCs in relation to their role, with 58% (n=29) indicating RTWCs require more training. A total of 78% (n=39) of respondents considered RTWCs were important in assisting injured workers return to work, with 98% (n=49) ranking trustworthiness, respectfulness and ethicalness as the most important or an important trait for a RTWC to possess. Interestingly, 40% (n=20) of respondents themselves reported having no training in the return-to-work process. GPs acknowledge the importance of the workplace RTWC in the return-to-work process, and the results highlight the need for RTWCs to possess specific traits and undergo appropriate training for the facilitation of a successful return to work for injured workers.

Musculoskeletal discomfort and use of computers in the university environment.

This cross-sectional study investigated musculoskeletal discomfort and computer use in university staff, through the use of online questionnaires. Results showed a high prevalence of staff reported musculoskeletal discomfort during the preceding year (80%), with neck (60%), shoulder (53%) and lower back discomfort (47%) being the most common. Most believed discomfort was caused by work, although neck discomfort was significantly less in those reporting excellent mental health (OR 0.44, p < 0.01). Computer navigation was performed primarily by mouse (77%); however, using a touch pad increased the odds (OR 1.17, p < 0.01) of wrist discomfort and the belief it was caused by work (OR 1.19, p < 0.01). Few staff attended ergonomic training (16%) or requested workstation assessments (26%). However, high rates of staff reporting musculoskeletal discomfort sought professional treatment (range: 35.2% wrist/hand to 65.0% shoulder). Strategies are needed to address uptake of preventive measures and reduce reliance on medical treatments following musculoskeletal discomfort in universities.

Practices and Processes Used in the Return to Work of Injured New South Wales nurses: Are These Consistent With RTW Best Practice Principles?

Purpose Workplace injury and illness rates are high within the nursing profession, and in conjunction with current nursing shortages, low retention rates, and the high cost of workplace injury, the need for effective return to work (RTW) for injured nurses is highlighted. This study aimed to identify current practices and processes used in the RTW of injured nurses, and determine if these are consistent with the seven principles for successful RTW as described by the Canadian Institute for Work & Health. Method As part of a larger cross-sectional study, survey data were collected from New South Wales nurses who had sustained a major workplace injury or illness. Survey questions were coded and matched to the seven principles for successful RTW. Results Of the 484 surveys eligible for analysis, most were from Registered Nurses (52%) in the Public Hospital Sector (48%). Responses indicated four main areas of concern: a commitment to health and safety by the workplace; early and considerate employer contact; provision of modified work; and individual knowledge of and involvement in the RTW process. Positive participant responses to co-worker and supervisor involvement were identified as areas consistent with best practice principles. Conclusions These findings suggest the practices and processes involved in the RTW of injured nurses are inconsistent with best practice principles for RTW, highlighting the need for interventions such as targeted employer education and training for improved industry RTW outcomes.

Weight Management Advice for Clients with Overweight or Obesity: Allied Health Professional Survey.

The prevalence of obesity is increasing. The potential for allied health professionals to intervene through the provision of lifestyle advice is unknown. This study aimed to determine the knowledge, attitudes and practices of health professionals in the provision of dietary and physical activity advice for clients with overweight or obesity. Dietitians, exercise physiologists, nurses, occupational therapists, physiotherapists and psychologists (n = 296) working in New South Wales were surveyed using paper-based and online methods. The majority of health professionals (71%) believed that providing weight management advice was within their scope of practice; 81% provided physical activity advice but only 57% provided dietary advice. Other than dietitians, few had received training in client weight management during their professional qualification (14%) or continuing education (16%). Providing dietary advice was associated with: believing it was within their scope of practice (OR 3.9, 95% CI 1.9-7.9, p < 0.01), training during their entry-level qualification (OR 7.2, 3.2-16.4, p < 0.01) and having departmental guidelines (OR 4.7, 2.1-10.9, p < 0.01). Most health professionals are willing to provide lifestyle advice to clients with overweight or obesity but few have received required training. Developing guidelines and training for in client weight management may potentially impact on rising obesity levels.

Insights into workplace Return to Work Coordinator training: An Australian perspective.

BACKGROUND: Following brief training, an Australian workplace Return to Work (RTW) Coordinator is expected to provide information to the injured worker, liaise with key stakeholders and maintain workplace policies and procedures in accordance with legislative requirements. OBJECTIVES: The aim of this study was to provide insights into the experiences and perceptions of the Australian Workplace RTW Coordinator in relation to current training practices and to identify any existing inadequacies within the available training. METHOD: Twenty-five workplace RTW Coordinators from five Australian states participated in six focus groups.Participants with a minimum of two years' experience as a workplace RTW Coordinator and involved with the development and implementation of workplace policies and procedures, were included in the study. Thematic analysis was performed to identity meaningful themes and patterns. RESULTS: The findings highlighted specific training requirements and additional support mechanisms recommended by current workplace RTW Coordinators. Four key themes clearly emerged: inadequate training; irrelevant content; the need for specialised trainers; and network support services. CONCLUSION: RTW Coordinators require effective training and support to ensure the appropriate and timely delivery of services to all stakeholders involved in the RTW process. The results of this study may inform future training practices for RTW Coordinators.

Nurse provision of healthy lifestyle advice to people who are overweight or obese.

A cross-sectional survey was conducted in a regional area in Australia to measure nurses' perceptions, practices, and knowledge in regard to providing healthy lifestyle advice to people who are overweight or obese. Responses were compared between geographic regions. Participation was voluntary and anonymous. Of the 79 nurse participants, 68% considered that provision of healthy lifestyle advice was within their scope of practice. Only 28% reported frequently estimating body mass index in the practice setting. Nurses often recommended increasing activity levels (44%), but recommended reducing daily caloric intake less often (25%). Nurses' knowledge about weight management was variable and the proportion of correct answers to knowledge items ranged from 33-99%. Nurses have many opportunities to deliver healthy lifestyle advice in a range of practice settings. The variation in practices and knowledge of nurses indicates a need for improved healthy lifestyle education for undergraduate and practicing nurses.

Fruit and vegetable intake assessed by food frequency questionnaire and plasma carotenoids: a validation study in adults.

Dietary validation studies of self-reported fruit and vegetable intake should ideally include measurement of plasma biomarkers of intake. The aim was to conduct a validation study of self-reported fruit and vegetable intakes in adults, using the Australian Eating Survey (AES) food frequency questionnaire (FFQ), against a range of plasma carotenoids. Dietary intakes were assessed using the semi-quantitative 120 item AES FFQ. Fasting plasma carotenoids (α- and ß-carotene, lutein/zeaxanthin, lycopene and cryptoxanthin) were assessed using high performance liquid chromatography in a sample of 38 adult volunteers (66% female). Significant positive correlations were found between FFQ and plasma carotenoids for α-carotene, ß-carotene and lutein/zeaxanthin (52%, 47%, 26%, p < 0.001, 0.003, 0.041; respectively) and relationships between plasma carotenoids (except lycopene) and weight status metrics (BMI, waist circumference, fat mass) were negative and highly significant. The results of the current study demonstrate that carotenoid intakes as assessed by the AES FFQ are significantly related to plasma concentrations of α-carotene, ß-carotene and lutein/zeaxanthin, the carotenoids commonly found in fruit and vegetables. Lower levels of all plasma carotenoids, except lycopene, were found in individuals with higher BMI. We conclude that the AES can be used to measure fruit and vegetable intakes with confidence.

The comparative validity and reproducibility of a diet quality index for adults: the Australian Recommended Food Score.

Adult diet quality indices are shown to predict nutritional adequacy of dietary intake as well as all-cause morbidity and mortality. This study describes the reproducibility and validity of a food-based diet quality index, the Australian Recommended Food Score (ARFS). ARFS was developed to reflect alignment with the Australian Dietary Guidelines and is modelled on the US Recommended Food Score. Dietary intakes of 96 adult participants (31 male, 65 female) age 30 to 75 years were assessed in two rounds, five months apart. Diet was assessed using a 120-question semi-quantitative food frequency questionnaire (FFQ). The ARFS diet quality index was derived using a subset of 70 items from the full FFQ. Reproducibility of the ARFS between round one and round two was confirmed by the overall intraclass correlation coefficient of 0.87 (95% CI 0.83, 0.90), which compared favourably to that for the FFQ at 0.85 (95% CI 0.80, 0.89). ARFS was correlated with FFQ nutrient intakes, particularly fiber, vitamin A, beta-carotene and vitamin C (0.53, 95% CI 0.37-0.67), and with mineral intakes, particularly calcium, magnesium and potassium (0.32, 95% CI 0.23-0.40). ARFS is a suitable brief tool to evaluate diet quality in adults and reliably estimates a range of nutrient intakes.

Self-reported Lupus flare: Association with everyday home and personal product exposure.

BACKGROUND: The number of chemicals in household products has driven concern about potential adverse health through their use. Most research concentrates on product chemicals with reproductive and carcinogenic consequences, however some evidence exists that immune effects can lead to exacerbation of autoimmune illnesses such as lupus (SLE). OBJECTIVES: This paper examines household and personal product exposure patterns in a pilot case/control study of female Australians. We also examined associations between common product exposure and SLE symptom exacerbation over a year period. METHODS: We enrolled 41 control and 80 SLE participants aged 18-80 years. Qualitative techniques of structured interview and thematic analysis retrospectively explored patterns of product use, and flare history data of SLE participants. Negative binomial regression models explored associations between self-reported flare (SRF) days and exposure to 34 common home product groups. RESULTS: Mean product counts did not differ between participant groups (mean 33.1: SD 11.8), or flare groups (flare mean 32.6:SD 12, no-flare 31.8:SD 6.6). Products used for personal hygiene and general house cleaning were most frequently used.Significant association with increased SRF day relative risk (IRR) was seen for bath oil use (IRR 1.008, CI 1.00-1.02). Paradoxical "protective" effects, (reduced SRF days) were found for cleansing beauty (IRR 0.999, CI 0.998-0.999), make-up (IRR 0.998, CI 0.997-0.999); adhesives (IRR 0.994, CI 0.991-0.997) and paint (IRR 0.99, CI 0.986-0.995). CONCLUSIONS: Everyday product exposures can impact on symptom exacerbation in SLE. Some offering protection and others increased health risk. Identifying environmental associations offer the possibility of life-style interventions to reduce illness impact.

The role of the Australian workplace return to work coordinator: essential qualities and attributes.

INTRODUCTION: In the Australian context, a return to work (RTW) Coordinator assists an injured worker with workplace-based support and regulatory guidance for the duration of their injury. Coordinating the RTW process has been considered an effective approach for managing workplace injuries, however few studies have described the skills, traits or characteristics required to fulfil the role of workplace RTW Coordinator. This study aims to provide insight as to the skills and attributes needed for the role of the workplace RTW Coordinator from their experience and perception. METHOD: Focus groups were conducted with workplace RTW Coordinators from six major Australian cities. Twenty five participants were recruited through a national RTW Coordinator website, and professional RTW interest groups using a snowballing technique. Participating workplace RTW Coordinators were required to have a minimum 2 years' experience and to have been involved with the development and implementation of workplace policies and procedures. Thematic analysis was performed to identify meaningful patterns and themes. RESULTS: The data analysed provided clear insight as to the specific role requirements necessary for working as an Australian workplace RTW Coordinator. Three key themes clearly emerged; communication skills, RTW Coordinator characteristics, and managing the RTW process. CONCLUSION: The findings indicate that RTW Coordinators require a wide range of traits, skills, and attributes to successfully perform this role. Effective management by the RTW Coordinator of the complex RTW process is essential to facilitate a smooth transition for the injured worker, alongside maintaining a professional relationship with the employer and external stakeholders. The results of this study can be utilised to further improve the selection of future RTW Coordinators.

Occupational exposures, smoking and airway inflammation in refractory asthma.

BACKGROUND: The influence of occupation and ex/passive smoking on inflammatory phenotype is not well understood. The aim of this study was to examine the relationship between occupation, past smoking and current passive smoking and airway inflammation in a population of adults with refractory asthma. METHODS: Sixty-six participants with refractory asthma were characterised. Occupational exposure to asthma causing or worsening agents were identified with an asthma-specific job exposure matrix. Exposure to passive cigarette smoke was determined by questionnaire and exhaled carbon monoxide assessment. The carbon content of macrophages was assessed in a sub-group of participants. RESULTS: Nineteen participants had smoked previously with low smoking pack years (median 1.7 years). Ex-smokers more commonly lived with a current smoker (26% vs. 9%, p = 0.11) and were more likely to allow smoking inside their home (26% vs. 4%, p = 0.02) compared to never smokers. Twenty participants had occupations with an identified exposure risk to an asthmagen; thirteen had exposures to irritants such as motor vehicle exhaust and environmental tobacco smoke. Sputum neutrophils were elevated in participants with asthma who had occupational exposures, particularly those who were diagnosed with asthma at a more than 30 years of age. CONCLUSIONS: Sputum neutrophils are elevated in refractory asthma with exposure to occupational asthmagens. In addition to older age, exposure to both environmental and occupational particulate matter may contribute to the presence of neutrophilic asthma. This may help explain asthma heterogeneity and geographical variations in airway inflammatory phenotypes in asthma.

Exploring lifetime occupational exposure and SLE flare: a patient-focussed pilot study.

INTRODUCTION: Environmental effectors, such as ultraviolet radiation exposure, infection and stress, have been established as having a role in exacerbating lupus symptoms. However, unpredictable patterns of flare events still remain a mystery. Occupational effectors have also been suggested as having a contributing role; however, they are not widely researched. In this paper we report a pilot study designed to generate focus areas for future research regarding occupational exposures and systemic lupus erythematosus (SLE). METHODS: The study explored potential links between exposures and the occurrence of patient-reported flare events in 80 Australian women with SLE (American College of Rheumatology (ACR) criteria classified). Specifically, the study assessed the hypothesis that occupational exposure is associated with significant changes in the likelihood of lupus flares. Lifetime employment history was analysed with the Finnish Job Exposure Matrix (FINJEM), 40 different semiquantified exposure class estimates for a wide number of occupations based on probability of exposure (p≥5%=exposed) were analysed with the construction of negative binomial regression models to test relationships between occupational agents and flare days. A backward stepwise elimination was used to generate a parsimonious model. RESULTS: Significant associations were noted for exposure classes of manual handling burden, (p=0.02, incidence rate ratio (IRR) 1.01), Iron (p=0.00, IRR 1.37), wood dust (p=0.00, IRR 3.34) and asbestos (p=0.03, IRR 2.48). CONCLUSION: Exposure assessment results indicated that occupations, such as nursing, with a high manual handling burden, posed increased risk to patients with SLE, however, the greatest risk was associated with wood dust and iron exposure with teachers and specialist labourers.

Validity of the Australian Recommended Food Score as a diet quality index for Pre-schoolers.

BACKGROUND: Diet quality tools provide researchers with brief methods to assess the nutrient adequacy of usual dietary intake. This study describes the development and validation of a pediatric diet quality index, the Australian Recommended Food Scores for Pre-schoolers (ARFS-P), for use with children aged two to five years. METHODS: The ARFS-P was derived from a 120-item food frequency questionnaire, with eight sub-scales, and was scored from zero to 73. Linear regressions were used to estimate the relationship between diet quality score and nutrient intakes, in 142 children (mean age 4 years) in rural localities in New South Wales, Australia. RESULTS: Total ARFS-P and component scores were highly related to dietary intake of the majority of macronutrients and micronutrients including protein, ß-carotene, vitamin C, vitamin A. Total ARFS-P was also positively related to total consumption of nutrient dense foods, such as fruits and vegetables, and negatively related to total consumption of discretionary choices, such as sugar sweetened drinks and packaged snacks. CONCLUSION: ARFS-P is a valid measure that can be used to characterise nutrient intakes for children aged two to five years. Further research could assess the utility of the ARFS-P for monitoring of usual dietary intake over time or as part of clinical management.

Return-to-work coordinators' resourcefulness and the provision of suitable duties for nurses with injuries.

BACKGROUND: There is little health specific literature on returning nurses with injuries to work despite the high incidence of injuries and the workforce shortages of these professionals. OBJECTIVE: To identify enabling factors and barriers to return-to-work for nurses with injuries from the perspective of return-to-work coordinators. PARTICIPANTS: Workplace return-to-workcoordinators employed in a health or disability facility who had worked on a rehabilitation case with a nurse with injuries in the past 12 months in New South Wales (NSW), Australia. METHOD: Five focus groups were conducted with 25 return-to-work coordinators from 14 different organisations, representing different health sectors (aged, disability, public and private hospital and community health) in metropolitan and rural areas of NSW, Australia. RESULTS: This study reports findings specifically relating to the provision of suitable duties for nurses with injuries. Four key themes were identified: suitable duties; supernumerary positions; nurse specialisation and tailoring of return-to-work plans. CONCLUSIONS: This study identified that return-to-work coordinators were resourceful and innovative in their approach to the provision of suitable duties for nurses with injuries and highlighted the importance of including clinical duties in any return-to-work program and of tailoring the return-to-work to the nurses' work and personal circumstances.

Weight management including dietary and physical activity advice provided by Australian physiotherapists: a pilot cross-sectional survey.

Physiotherapists may have an impact on obesity prevention and treatment by providing nutrition and physical activity advice to overweight or obese clients; yet little is known about physiotherapists' beliefs and practices related to client weight management. The aim of this pilot study was to determine the practices, beliefs, attitudes and knowledge of physiotherapists regarding the provision of weight management advice to overweight or obese clients. Physiotherapists (n = 65) working in multiple practice settings completed a self-administered questionnaire. Logistic regression determined factors associated with the provision of dietary and physical activity advice for weight management. The majority of physiotherapists (n = 53 [81.5%]) believed providing weight management advice was within their scope of practice, yet only a minority had received training during their professional entry level education (n = 13 [20%]) or through professional development (n = 7 [11%]). Most physiotherapists (n = 55 [84.6%]) provided physical activity advice for weight management, but a minority (n = 27 [41.5%]) provided dietary advice. Having received training in weight management during their professional entry level education was associated with providing dietary advice (Odds ratio 8.8, 95% confidence interval 2.0-38.9, p = 0.004). Training in weight management may increase the likelihood of physiotherapists providing dietary advice, improving physiotherapists' management of obesity.

Reproducibility and comparative validity of a food frequency questionnaire for Australian adults.

BACKGROUND: Food frequency questionnaires (FFQ) are used in epidemiological studies to investigate the relationship between diet and disease. There is a need for a valid and reliable adult FFQ with a contemporary food list in Australia. AIMS: To evaluate the reproducibility and comparative validity of the Australian Eating Survey (AES) FFQ in adults compared to weighed food records (WFRs). METHODS: Two rounds of AES and three-day WFRs were conducted in 97 adults (31 males, median age and BMI for males of 44.9 years, 26.2 kg/m(2), females 41.3 years, 24.0 kg/m(2). Reproducibility was assessed over six months using Wilcoxon signed-rank tests and comparative validity was assessed by intraclass correlation coefficients (ICC) estimated by fitting a mixed effects model for each nutrient to account for age, sex and BMI to allow estimation of between and within person variance. RESULTS: Reproducibility was found to be good for both WFR and FFQ since there were no significant differences between round 1 and 2 administrations. For comparative validity, FFQ ICCs were at least as large as those for WFR. The ICC of the WFR-FFQ difference for total energy intake was 0.6 (95% CI 0.43, 0.77) and the median ICC for all nutrients was 0.47, with all ICCs between 0.15 (%E from saturated fat) and 0.7 (g/day sugars). CONCLUSIONS: Compared to WFR the AES FFQ is suitable for reliably estimating the dietary intakes of Australian adults across a wide range of nutrients.

The provision of weight management advice: an investigation into occupational therapy practice.

BACKGROUND/AIM: Obesity affects more than half the Australian population and has become epidemic throughout the world. Little is known regarding occupational therapy interventions with clients who are overweight or obese. This study aimed to identify occupational therapy practice in relation to the provision of weight management. This was part of a larger study investigating health professional practice. METHODS: A cross-sectional study design using a self-administered, purpose-designed survey was employed to identify the current practices of occupational therapists working in a regional area of New South Wales, Australia. Participants were recruited via email or mail as publically available. RESULTS: Fifty-one occupational therapists anonymously completed the survey. Results revealed that 53% (n = 26) of respondents did not consider weight management to be within their scope of practice or their workplace role description. The most common intervention was the provision of physical activity advice (65.2%; n = 30). Dietary advice was provided by 20.8% (n = 10), while 77% (n = 32) referred onto dietitian services. During entry-level occupational therapy education, only 7.8% (n = 4) had received weight management advice education. Completion of postgraduate professional development training in this area was reported by 14% (n = 7) of respondents. CONCLUSION: This study provides insight into the current practices of Australian occupational therapists in relation to the provision of weight management advice. This research displays a need to acknowledge both a generic and a discipline-specific role for the provision of healthy lifestyle interventions. This may be achieved through better access to education during entry-level programmes and in the workplace.

Resistance to Care: contributing factors and associated behaviours in healthcare facilities.

AIMS: This article reports results of a study of contributing factors and associated behaviours in specific clinical areas to resistance to care episodes. BACKGROUND: Resistance to Care has previously been studied in aged care settings, and previous studies have reported patient behaviours and appropriate responses. Resistance to Care is a defensive response by patients towards healthcare staff and is demonstrated in various non-compliant behaviours. DESIGN: Cross-sectional study. METHODS: A cross-sectional survey of a representative sample of nurses (n = 5044), who were members of the New South Wales Nurses' Association in Australia, was conducted in 2008-2009. RESULTS: Resistance to Care episodes occur in various clinical settings and may be precipitated by a range of clinical diagnoses and symptoms. They may also be triggered during various nursing activities that nurses recognize as high-risk for these episodes. CONCLUSION: The reported Resistance to Care behaviours are similar to those reported in studies of aggression and violence; however, they require a substantially different response by nurses in various clinical contexts.