Helen Rawson

Deaths from chickenpox in England and Wales 1995-7: analysis of routine mortality data

Abstract Objective: To evaluate the epidemiology and impact of mortality from chickenpox in England and Wales. Design: Review of death certificates from the Office for National Statistics on which codes for “chickenpox” or “varicella” were mentioned. Further information ascertained from certifying physician. Participants: Those certified as having died from chickenpox in England and Wales, 1995-7. Main outcome measures: Diagnosis and age and sex distributions of deaths from chickenpox. Results: On average, 25 people a year die from chickenpox. Overall case fatality was 9.22 per 100 000 consultations for chickenpox. Adults accounted for 81% of deaths and 19% of consultations. Deaths were twice as common in men as in women. More of those who died were born outside United Kingdom than expected (12% v 4%). Conclusions: Chickenpox is not a mild disease. Deaths in adults are increasing, both in number and proportion. What is already known on this topic Chickenpox can be fatal, especially in immunosuppressed people and adults The age distribution of cases has been shifting upwards for about 30 years What this study adds About 80% of deaths certified as due to chickenpox are due to chickenpox Chickenpox accounts for about 25 deaths annually in England and Wales, more than from measles, mumps, pertussis, and Hib meningitis combined Mortality in adults has been increasing for at least 30 years and now 80% of deaths from chickenpox are in adults Deaths were twice as common in men as in women

Culture and sex education: the acquisition of sexual knowledge for a group of Vietnamese Australian young women

Background. This paper explores how a group of Vietnamese Australian young women acquire knowledge of sexual issues, and the impact the traditional Vietnamese culture has on the acquisition of this knowledge. It is based on a qualitative study that examined the factors which shape the sexual behaviour of Vietnamese Australian young women living in Australia. Methods. A Grounded Theory methodology was employed in this investigation, and involved in-depth interviews with 15 Vietnamese Australian young women aged 18–25 years, who reside in Victoria, Australia. Results. The findings illustrated three key elements involved in the acquisition of knowledge of sexual issues: ‘Accepting parental silence’, ‘Exploring sources of knowledge’ and ‘Needing culturally targeted information’. The young women desired discussion about sexual issues but accepted that cultural ‘barriers’ were formidable. Their desire conflicted with the traditional familial norm of ‘silence’ regarding sexual matters. Consequently, knowledge was sought outside the home, specifically from peers and the media. The importance of culturally appropriate and adequate sexual discussions for Vietnamese Australian young people was stressed, so that informed decisions could be made about their sexual lives. Conclusion. It is imperative for young people to have adequate and appropriate sexual education so that informed and safe sexual choices can be made. For young people from diverse cultural backgrounds, this education must be culturally appropriate and accessible, taking into consideration cultural mores regarding gender and sexual matters, as well as current beliefs in the ‘mainstream’ youth culture.

Laughter and humor therapy in dialysis.

Laughter and humor therapy have been used in health care to achieve physiological and psychological health‐related benefits. The application of these therapies to the dialysis context remains unclear. This paper reviews the evidence related to laughter and humor therapy as a medical therapy relevant to the dialysis patient population. Studies from other groups such as children, the elderly, and persons with mental health, cancer, and other chronic conditions are included to inform potential applications of laughter therapy to the dialysis population. Therapeutic interventions could range from humorous videos, stories, laughter clowns through to raucous simulated laughter and Laughter Yoga. The effect of laughter and humor on depression, anxiety, pain, immunity, fatigue, sleep quality, respiratory function and blood glucose may have applications to the dialysis context and require further research.

Nursing Roles and Strategies in End-of-Life Decision Making Concerning Elderly Immigrants Admitted to Acute Care Hospitals: An Australian Study.

Purpose: There is a lack of clarity regarding nursing roles and strategies in providing culturally meaningful end-of-life care to elderly immigrants admitted to Australian hospitals. This article redresses this ambiguity. Method: A qualitative exploratory descriptive approach was used. Data were obtained by conducting in-depth interviews with a purposeful sample of 22 registered nurses, recruited from four health services. Interview transcripts were analyzed using content and thematic analysis strategies. Results: Despite feeling underprepared for their role, participants fostered culturally meaningful care by “doing the ground work,” “facilitating families,” “fostering trust,” and “allaying fear.” Discussion and Conclusion: The Australian nursing profession has a significant role to play in leading policy, education, practice, and consumer engagement initiatives aimed at ensuring a culturally responsive approach to end-of-life care for Australia’s aging immigrant population. Implications for Practice: Enabling elderly immigrants to experience a “good death” at the end of their lives requires highly nuanced and culturally informed nursing care.

Assuaging death anxiety in older overseas-born Australians of culturally and linguistically diverse backgrounds hospitalised for end-of-life care

Background: Death anxiety is a known phenomenon in older people of culturally and linguistically diverse backgrounds (CALD) hospitalised for end-of-life (EOL) care . Little is known about how nurses assuage death anxiety in this population. Aims: To investigate strategies used by nurses to assuage death anxiety and facilitate a good death in older CALD Australians hospitalised for EOL care. Methods: Advanced as a qualitative descriptive inquiry, a purposeful sample of 22 nurses was recruited from four Victorian healthcare services. Interviews were transcribed verbatim and analysed using thematic analysis processes. Findings: Nurses used three key strategies: recognising death anxiety; delineating its dimensions; and initiating conventional nursingcaring behaviours to help contain it. Contrary to expectations, cultural similarities rather than differences were found in the strategies used. Conclusions: Nursing strategies for recognising, delineating, and managing death anxiety in older CALD people hospitalised at the EOL is an important component of quality EOL care.

Tri‐focal Model of Care Implementation: Perspectives of Residents and Family

Abstract Purpose To explore residents’ and family members’ perceptions of partnership‐centered long‐term care (LTC) associated with implementation of the Tri‐focal Model of Care. The Model promotes partnership‐centered care, evidence‐based practice, and a positive environment. Its implementation is supported by a specifically designed education program. Methods The Model was implemented over approximately 12 months in seven LTC facilities in Victoria, Australia. A qualitative exploratory‐descriptive approach was used. Data were collected using individual and focus group interviews with residents and family members prior to and following implementation of the Model. Data were analyzed thematically. Findings Prior to implementation of the Model, residents described experiencing a sense of disempowerment, and emphasized the importance of communication, engagement, and being a partner in the staff–resident care relationship. Following implementation, residents reported experiencing improved partnership approaches to care, although there were factors that impacted on having a good experience. Family members described a desire to remain involved in the residents life by establishing good communication and rapport with staff. They acknowledged this was important for partnership‐centered care. Following implementation, they described experiencing a partnership with staff, giving them confidence to assist staff and be included in decisions about the resident. Conclusions The Tri‐focal Model of Care can enable residents, family members, and staff to be partners in resident care in LTC settings. Clinical Relevance With an ageing population, an increasing demand for complex, individualized LTC exists. Delivery of high‐quality LTC requires a strategy to implement a partnership‐centered approach, involving residents, family members, and staff.

Nursing Strategies for Engaging Families of Older Immigrants Hospitalized for End-of-Life Care: An Australian Study

Background: Engaging with families of older non-English-speaking background (NESB) immigrants hospitalized for end-of-life (EOL) care can be challenging, especially when their cultures, lifeways, and family decision-making processes are unfamiliar to the nurses caring for them. Despite the recognized importance of family engagement when providing EOL care, the issue of ethnic minority family engagement has received little attention in the field. Aim: To explore and describe the strategies nurses use to facilitate engagement with families of older immigrant NESB patients hospitalized for EOL care. Methods: A qualitative descriptive approach was used. Data were collected via in-depth interviews conducted with 22 registered nurses recruited from 4 Australian health services. Findings: Using thematic analysis processes, 5 key strategies were identified: listening and understanding families, encouraging family members to speak first, dealing with angst, redressing naive views about the dying process, and managing intergenerational differences. Underpinning these strategies was a profound “will to engage” with the families and their cultural worldviews. Conclusion: Further cross-cultural comparative research is required to inform evidence-based policies, practice, and education on this issue.

Fostering trusting relationships with older immigrants hospitalised for end-of-life care

Background: Trust has been identified as a vital value in the nurse–patient relationship. Although increasingly the subject of empirical inquiries, the specific processes used by nurses to foster trust in nurse–patient relationships with older immigrants of non-English speaking backgrounds hospitalised for end-of-life care have not been investigated. Aims: To explore and describe the specific processes that nurses use to foster trust and overcome possible cultural mistrust when caring for older immigrants of non-English speaking backgrounds hospitalised for end-of-life care. Research design: A qualitative descriptive approach was used. Twenty-two registered nurses were recruited from four metropolitan health services in Melbourne, Australia. Ethical considerations: Research approval was granted by the Human Research Ethics Committees of the host institution and four participating health services. Findings: Thematic analysis revealed that fostering trust encompassed the following three commensurate stages: establishing trust, strengthening trust and sustaining trust. Underpinning the successful achievement of these stages was the nurses’ moral commitment (reflected in their intentional, conscious and conscientious approach) to fostering trust as an essential ingredient of quality end-of-life care. Discussion: This study has shown that while professional competencies are important to providing quality end-of-life care to older immigrant patients of non-English speaking backgrounds, it is a nurse’s moral commitment to fostering trust that may ultimately lay the foundations for a trusting quality care relationship to be established and sustained. Conclusion: This study has captured the processes used by nurses to foster trust as an essential element of quality end-of-life care in older immigrants. The characteristics of trust and the different factors influencing its expression in diverse cultural contexts are, however, under-researched. Accordingly, gaps remain in the knowledge and understanding of the specific cultural nuances and manifestations of trust across and within different cultures. This is an area that is germane to further cross-cultural and international collaborative scholarly inquiry and research.

Characteristics and outcomes of emergency interhospital transfers from subacute to acute care for clinical deterioration

OBJECTIVE To describe characteristics and outcomes of emergency interhospital transfers from subacute to acute hospital care and develop an internally validated predictive model to identify features associated with high risk of emergency interhospital transfer. DESIGN Prospective case-time-control study. SETTING Acute and subacute healthcare facilities from five health services in Victoria, Australia. PARTICIPANTS Cases were patients with an emergency interhospital transfer from subacute to acute hospital care. For every case, two inpatients from the same subacute care ward on the same day of emergency transfer were randomly selected as controls. Admission episode was the unit of measurement and data were collected prospectively. MAIN OUTCOME MEASURES Patient and admission characteristics, transfer characteristics and outcomes (cases), serious adverse events and mortality. RESULTS Data were collected for 603 transfers in 557 patients and 1160 control patients. Cases were significantly more likely to be male, born in a non-English speaking country, have lower functional independence, more frequent vital sign assessments and experience a serious adverse event during first acute care or subacute care admissions. When adjusted for health service, cases had significantly higher inpatient mortality, were more likely to have unplanned intensive care unit admissions and rapid response team calls during their entire hospital admission. CONCLUSIONS Patients who require an emergency interhospital transfer from subacute to acute hospital care have hospital admission rates and in-hospital mortality. Clinical instability during the first acute care admission (serious adverse events or increased surveillance) may prompt reassessment of patient suitability for movement to a separate subacute care hospital.