Lifestyle Medicine And Health Research Centre


Recent Submissions

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    Decision-making in Nursing Research and Practice—Application of the Cognitive Continuum Theory: A Meta-Aggregative Systematic Review
    (Wiley, 2023-12) O'Connor, Tricia; Gibson, Jo; Lewis, Joanne; Strickland, Karen; Paterson, Catherine
    Aim To explore how the Cognitive Continuum Theory has been used in qualitative nursing research and to what extent it has been integrated in the research process using the Qualitative Network for Theory Use and Methodology (QUANTUM). Background Theory, research and nursing are intrinsically linked, as are decision-making and nursing practice. With increasing pressure on nurses to improve patient outcomes, systematic knowledge regarding decision-making is critical and urgent. Design A meta-aggregative systematic review. Methods Databases CINAHL, Medline, PsycINFO, Embase and PubMed were searched from inception until May 2022 for peer-reviewed research published in English. Seven studies were included and assessed for methodological quality using the Joanna Briggs Institute checklist for qualitative research. A meta-aggregative synthesis was conducted using Joanna Briggs methodology. The QUANTUM typology was used to evaluate the visibility of the Cognitive Continuum Theory in the research process. Results The review identified five synthesised findings, namely: 1. the decision-making capacity of the individual nurse, 2. nurses’ level of experience, 3. availability of decision support tools, 4. the availability of resources and 5. access to senior staff and peers. Only two of seven studies rigorously applied the theory. The included studies were mainly descriptive-exploratory in nature. Conclusion The transferability of the Cognitive Continuum Theory was demonstrated; however, evolution or critique was absent. A gap in the provision of a patient-centric approach to decision-making was identified. Education, support and research is needed to assist decision-making. A new Person-Centred Nursing Model of the Cognitive Continuum Theory has been proposed to guide future research in clinical decision-making. Relevance to Clinical Practice Nurses make numerous decisions every day that directly impact patient care, therefore development and testing of new theories, modification and revision of older theories to reflect advances in knowledge and technology in contemporary health care are essential.
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    A Point Prevalence Study of Healthcare Associated Urinary Tract Infections in Australian Acute and Aged Care Faciltiies
    (2016-11-01) Gardner, Anne; Bennett, Noleen; Beckingham, Wendy; Fasugba, Oyebola; Mitchell, Brett G.

    Most healthcare-associated urinary tract infections (HAUTIs) including catheter associated urinary tract infections (CAUTIs) are potentially preventable through implementation of effective strategies. To provide the foundation for a national point prevalence study of HAUTIs including CAUTIs, a three phase project was developed. This study reports the findings of Phase II which aimed to (1) pilot an online process including online database for conducting point prevalence survey of HAUTIs and CAUTIs and (2) determine the point prevalence of HAUTIs and CAUTIs in acute and aged care facilities

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    Antimicrobial Resistance Among Urinary Tract Infection Isolates of Escheria Coli in an Australian Population-Based Sample
    (2014-08-01) Mitchell, Brett G.; Mnatzaganian, George; Gardner, Anne; Fasugba, Oyebola
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    Roles, Responsibilities and Scope of Practice: Describing the ‘State of Play’ for Infection Control Professionals in Australia and New Zealand
    (2015-03-01) Mitchell, Brett G.; Gardner, Anne; MacBeth, Deborough; Halton, Kate; Hall, Lisa

    Background: In the past decade the policy and practice context for infection control in Australia and New Zealand has changed, with infection control professionals (ICPs) now involved in the implementation of a large number of national strategies. Little is known about the current ICP workforce and what they do in their day-to-day positions. The aim of this study was to describe the ICP workforce in Australia and New Zealand with a focus on roles, responsibilities, and scope of practice.

    Methods: A cross-sectional design using snowball recruitment was employed. ICPs completed an anonymous web-based survey with questions on demographics; qualifications held; level of experience; workplace characteristics; and roles and responsibilities. Chi-squared tests were used to determine if any factors were associated with how often activities were undertaken.

    Results: A total of 300 ICPs from all Australian states and territories and New Zealand participated. Most ICPs were female (94%); 53% were aged over 50, and 93% were employed in registered nursing roles. Scope of practice was diverse: all ICPs indicated they undertook a large number and variety of activities as part of their roles. Some activities were undertaken on a less frequent basis by sole practitioners and ICPs in small teams.

    Conclusion: This survey provides useful information on the current education, experience levels and scope of practice of ICPs in Australia and New Zealand. Work is now required to establish the best mechanisms to support and potentially streamline scope of practice, so that infection-control practice is optimised.

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    Tasmanian Acute Public Hospitals Healthcare Associated Infection Surveillance Report 24 - Quarter 4 2014
    (2015-11-01) McGregor, Alistair; Wilson, Fiona; Wells, Anne; Mitchell, Brett G.

    This quarterly surveillance report provides an overview of the Tasmanian acute public hospitals healthcare associated infection surveillance. The TIPCU website ( contains details of the surveillance program and the methodologies used in data collection, validation and analysis. These details are not contained in this report but are freely available online should further information be required.

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    Evaluating Environmental Cleanliness in Hospitals and Other Healthcare Settings
    (2012-03-01) Dancer, Stephanie; McGregor, Alistair; Brown, Saffron; Ware, Chris; Wilson, Fiona; Mitchell, Brett G.

    The purpose of this review is to describe some of the main methodologies currently used in assessing environmental cleanliness as well as document current local, national and international practices.

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    The Epidemiology of Cryptosporidiosis in Victoria, 2001-2009
    (2011-06-01) McPherson, Michelle; Higgins, Nasra; Kent, Lillian

    Cryptosporidiosis is a protozoan parasitic infection that most commonly presents as gastroenteritis and less commonly infects the respiratory and biliary tracts. Enteric symptoms usually include diarrhoea, bloating, cramping, abdominal pain, vomiting and fever. The disease is usually mild and self-limiting but in immunocompromised individuals is prolonged and can lead to death. The infective dose in humans is low and the incubation period ranges from one to 12 days, with an average of seven days. The infectious period lasts from the onset of symptoms, as the oocysts are excreted in the stool, until several weeks after symptoms resolve.

    The oocysts are widespread and may remain infective outside the body for two to six months, particularly if the environment is moist. They are highly resistant to standard levels of chemical disinfection of water such as chlorine. Outbreaks have been reported in day care centres, and been associated with drinking water, recreational water (waterslides, swimming pools and lakes) and consumption of contaminated beverages. In Australia, increases in notifications tend to occur in the warmer months and over irregular cycles, with more than 3000 cases notified in Australia in 2002, 2005 and 2006.

    Cryptosporidiosis became notifiable in both Australia and Victoria in 2001, with more than 15,000 cases notified between 2002 and 2009. The aim of this study was to describe the epidemiology of notified cases of cryptosporidiosis in Victoria for the period 2001 to 2009 in terms of age, sex, location and season.

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    Breakfast Size is Related to Body Mass Index for Men, but not Women
    (2010-04-01) Worsley, Anthony; Kent, Lillian

    The objective of this study was to examine the effect of self-reported breakfast size, daily eating, and other health habits on body mass index (BMI). We hypothesized that a consumption of a substantial breakfast compared with skipping or small breakfasts would be associated with lower BMI. Three independent, cross-sectional, screening surveys were conducted by Sydney Adventist Hospital in 1976, 1986, and 2005 in the surrounding community. The archived survey forms of 384 men and 338 women in 1976, 244 men and 229 women in 1986, and 270 men and 62 women in 2005 were randomly selected. Body mass index was determined from height and weight measured by hospital staff. The reported amount consumed at breakfast was one of several eating habits that predicted BMI for men but not women. It explained 5% to 6% of the variance in male BMI in all 3 years examined. As the reported breakfast amount increased, men's BMI decreased. Lifestyle confounders including vegetarianism and physical activity did not affect this relationship. However, the consumption of breakfast was significantly positively associated with consumption of cereals, bread, fruit, and spreads, while coffee consumption was significantly associated with smaller breakfasts or breakfast skipping. The consumption of relatively large breakfasts may influence BMI in men, and its promotion may help reduce the prevalence of obesity in Australia and elsewhere.

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    Trends in BMI, Diet and Lifestyle Between 1976 and 2005 in North Sydney
    (2009-01-01) Worsley, Anthony; Kent, Lillian

    Although the prevalence of overweight and obesity in Australia has increased during the past 30 years, little is known about the dietary and behavioural antecedents of body mass index (BMI). We examined changes in mean BMI, diet, and other lifestyle behaviours between 1976 and 2005 and described the cross-sectional associations between these factors and BMI. A series of biennial biomedical surveys by Sydney Adventist Hospital from 1976 to 2005 allowed examination of BMI trends, while the selection of three surveys enabled detailed examination of likely dietary and lifestyle associations. Subjects included in this study were: 384 men and 338 women in 1976; 160 men and 146 women in 1978; 166 men and 141 women in 1980; 164 men and 142 women in 1982; 177 men and 13 women in 1984; 239 men and 227 women in 1986; 210 men and 225 women in 1988; 165 men and 148 women in 1990; 138 men and 167 women in 1992 and 270 men and 62 women in 2005. Height and weight were measured by hospital staff. Mean BMI increased in the early 1990s. Salt, coffee, cola, alcohol and meat consumption, dieting to lose weight and eating between meals were positively associated with BMI while physical activity, food variety, large breakfasts and consumption of spreads were negatively associated. Food consumption and daily activities have important associations with BMI, though their specific associations differ by sex. “Affluent” lifestyle patterns appear to contribute to higher BMI, while a more “prudent” lifestyle seems to protect from such increases.

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    Preventing Healthcare Associated Infections: The Role of Surveillance
    (2015-02-04) Russo, Philip; Mitchell, Brett G.

    Surveillance of healthcare-associated infections is central to healthcare epidemiology and infection control programmes and a critical factor in the prevention of these infections. By definition, the term ‘infection prevention’ implies that healthcare-associated infections may be preventable. The purpose of surveillance is to provide quality data that can be used in an effective monitoring and alert system and to reduce the incidence of preventable healthcare-associated infections. This article examines the purpose of surveillance, explains key epidemiological terms, provides an overview of approaches to surveillance and discusses the importance of validation.

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    Salmonellosis Outbreak Linked to the Consumption of Fried Ice-Cream
    (2011-12-01) Patel, M; Gregory, J; Kent, Lillian

    On 8 April 2011, the Communicable Disease Prevention and Control Unit (CDPCU) of the Victorian Department of Health was advised that three adolescents from the same family had been admitted to a metropolitan hospital for treatment of dehydration secondary to diarrhoea. Other symptoms included fever and vomiting. Initial enquires suggested that the adolescents may have become infected after eating fried eggs for breakfast at their aunt’s home over three consecutive days, or dinner at a Chinese restaurant. Six days later two more notifications of salmonellosis were received by CDPCU; both cases had eaten at the same Chinese restaurant. Also on this day, the Department was notified that Salmonella spp. was isolated from two of the original adolescent’s faecal specimens.

    An investigation was initiated to characterise the outbreak, identify the source and possible cause of the infection and to prevent ongoing transmission of the infection.

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    Does the Prescriptive Lifestyle of Seventh-day Adventists Provide Immunity from the Secular Effects of Changes in BMI?
    (2009-04-01) Worsley, Anthony; Kent, Lillian

    Objective: To examine the effect of Seventh-day Adventist (SDA) membership on ‘immunity’ to the secular effects of changes in BMI.

    Design: Three independent, cross-sectional, screening surveys conducted by Sydney Adventist Hospital in 1976, 1986 and 1988 and a survey conducted among residents of Melbourne in 2006.

    Subjects: Two hundred and fifty-two SDA and 464 non-SDA in 1976; 166 SDA and 291 non-SDA in 1986; 120 SDA and 300-non SDA in 1988; and 251 SDA and 294 non-SDA in 2006.

    Measurements: Height and weight measured by hospital staff in 1976, 1986 and 1988; self-reported by respondents in 2006.

    Results: The mean BMI of non-SDA men increased between 1986 and 2006 (P

    Conclusion: The ‘prudent’ dietary and lifestyle prescriptions of SDA men appear to have ‘immunised’ them to the secular effects of changes that occurred among non-SDA men’s BMI. The dietary and lifestyle trends of SDA women did not reflect the increase in their BMI observed in 2006.

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    Reducing Medication Errors in Nursing Practice
    (2015-01-14) Cloete, Linda

    Medication errors remain one of the most common causes of unintended harm to patients. They contribute to adverse events that compromise patient safety and result in a large financial burden to the health service.

    The prevention of medication errors, which can happen at every stage of the medication preparation and distribution process, is essential to maintain a safe healthcare system. One third of the errors that harm patients occur during the nurse administration phase: administering medication to patients is therefore a high-risk activity.

    This article highlights factors that contribute to medication errors, including the safety culture of institutions. It also discusses factors that relate specifically to nurses, such as patient acuity and nursing workload, the distractions and interruptions that can occur during medication administration, the complexity of some medication calculations and administration methods, and the failure of nurses to adhere to policies or guidelines.

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    Australian Graduating Nurses’ Knowledge, Intentions and Beliefs on Infection Prevention and Control: A Cross-Sectional Study
    (2014-12-12) Matheson, Lucinda; Cloete, Linda; Wilson, Fiona; Wells, Anne; Say, Richard; Mitchell, Brett G.

    Background: In recent year, national bodies have been actively addressing the increasing concern on the spread of healthcare-associated infections (HAIs). The current study measures the knowledge, intentions and beliefs of third-year Australian nursing students on key infection prevention and control (IPC) concepts.

    Methods: A cross-sectional study of final-year undergraduate nursing students from Schools of Nursing at six Australian universities was undertaken. Students were asked to participate in an anonymous survey. The survey explored knowledge of standard precautions and transmission based precautions. In addition intentions and beliefs towards IPC were explored.

    Results: 349 students from six universities completed the study. 59.8% (95% CI 58.8–60.8%) of questions were answered correctly. Significantly more standard precaution questions were correctly answered than transmission-based precaution questions (p < 0.001). No association was found between self-reported compliance with IPC activities and gender or age. Certain infection control issues were correlated with the percentage of correctly answered transmission-based precaution questions. The participants were most likely to seek infection control information from an infection control professional.

    Conclusion: Knowledge on transmission-based precautions was substandard. As transmission-based precautions are the foundation of IPC for serious organisms and infections, education institutions should reflect on the content and style of educational delivery on this topic.

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    An Intervention Aimed at Reducing Plagiarism in Undergraduate Nursing Students
    (2015-05-01) Cloete, Linda; Crawford, Tonia R.; Smedley, Alison

    Plagiarism is a current and developing problem in the tertiary education sector where students access information and reproduce it as their own. It is identified as occurring in many tertiary level degrees including nursing and allied health profession degrees. Nursing specifically, is a profession where standards and ethics are required and honesty is paramount. The aim of this study was to evaluate the change in nursing student’s knowledge and understanding of plagiarism before and after an educational intervention in their first semester of the Bachelor of nursing degree at a private college of higher education in Sydney, Australia. This study concluded that an educational intervention can increase knowledge and awareness of plagiarism among nursing students.

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    Tasmanian Acute Public Hospitals Healthcare Associated Infection Surveillance Report 23 - Quarter 3 2014
    (2014-08-01) Mitchell, Brett G.; McGregor, Alistair; Wilson, Fiona; Wells, Anne

    This annual report provides an overview of the Tasmanian acute public hospitals healthcare associated infection surveillance. This complements the quarterly surveillance data reports that the Tasmanian Infection Prevention and Control Unit (TIPCU) has been publishing since March 2009. The TIPCU website ( contains details of the surveillance program and the methodologies used in data collection, validation and analysis. These details are not contained in this report but are freely available online should further information be required.
    Any form of comparison between hospitals should be done with extreme caution and direct comparisons are not recommended. Information about how Tasmanian rates compare with those of other Australian states (where available), are provided in the Key Points sections of this report. The Appendices in this report contain more detailed information.
    Compared to the quarterly reports published by the TIPCU, this report contains some additional detail, such as infection rates by financial year and antimicrobial use. From this report, the following findings can be made:
    • The rate of healthcare associated Staphylococcus aureus bacteraemia remains low.
    • The rate and number of both hospital identified Clostridium difficile infection (CDI) and healthcare associated – healthcare facility onset Clostridium difficile infection (HCA – HCF CDI) are similar to those in the previous quarter.
    • The occurrence of vancomycin resistant enterococcus remains low.

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    Prior Room Occupancy Increases Risk of Methicillin-Resistant Staphylococcus Aureus Acquisition
    (2014-12-01) Ferguson, John K.; Digney, Wilhelmine; Mitchell, Brett G.

    Background: In Australia, little is known about the risk of acquiring methicillin-resistant Staphylococcus aureus(MRSA) from prior room occupants. The aims of the study are to understand the risk ofMRSAacquisition from prior room occupants and to further extend the existing knowledge-base on the role of discharge cleaning in hospitals.

    Methods: A non-concurrent cohort study was undertaken in five wards at a 250-bed general hospital in Tasmania, Australia. All admitted patients were screened for MRSA. Weekly screenings for all patients who remained in hospital were undertaken. New MRSA acquisitions were identified. The exposed group were patients whose immediate prior room occupant had MRSA, while the unexposed prior room occupant did not have MRSA.

    Results: 6228 patients were at risk of acquiringMRSA,with 237 newMRSAacquisitions equating to an acquisition rate of 3.8% for each at-risk patient admission. The unadjusted odds ratio for acquiring MRSA when the prior room occupant had MRSA was 2.9 (95% CI 2.2–3.9). Using logistic regression, exposure to a prior occupant harbouring MRSA remained a significant predictor of subsequent acquisition, after controlling for variables, OR 2.7 (95% CI 2.0–3.6).

    Conclusion: Admission to a room previously occupied by a person with MRSA increased the odds of acquisition for the subsequent patient, independent of other risk factors. It demonstrates the necessity of having effective discharge cleaning practices in place. We believe increased attention to discharge room cleaning in hospitals is required and the reconsideration of additional recommendations for discharge cleaning.

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    Gender Differences in Effectiveness of the Complete Health Improvement Program (CHIP) Lifestyle Intervention: An Australasian Study
    (2014-12-05) Diehl, Hans; Chang, Esther; Mitchell, Brett G.; Rankin, Paul; Morton, Darren; Kent, Lillian

    Issue addressed: Complete Health Improvement Program (CHIP) is a lifestyle modification program that promotes healthy diet, physical activity and stress management techniques. Among US CHIP participants, differences in gender responsiveness to improvements in chronic disease risk factors were demonstrated. This study examined gender differences in outcomes to the CHIP intervention in Australasia.

    Methods: Changes in body weight, blood pressure (BP), blood lipid profile and fasting plasma glucose (FPG) were assessed in 925 participants (34.3% men, mean age = 56.0 ± 12.5 years; 65.7% women, mean age = 54.4 ± 13.5 years) 30 days after program commencement.

    Results: Significant reductions (P < 0.001) in all biometrics measured were found for men and women but were greater among men for total (TC) and low-density lipoprotein cholesterol (LDL), triglycerides (TG), FPG, body mass index (BMI) and TC/high-density lipoprotein cholesterol (HDL) ratio. Participants with highest baseline classifications of BMI, systolic BP, blood lipids and FPG showed greatest reductions in 30 days.

    Conclusions: CHIP more effectively reduced chronic disease risk factors among men than women. All participants, but particularly men, entering the program with the greatest risk achieved the largest reductions. Possible physiological or behavioural factors include food preferences, making commitments and differential support modes.

    So what?: Developers of lifestyle intervention programs should consider gender differences in physiological and behavioural factors when planning interventions. In particular, developers should manage expectations of people entering lifestyle interventions to increase awareness that men tend to respond better than women. In addition, this is a call for further research to identify the underlying mechanisms responsible for the disproportionate responsiveness of males.

  • Publication
    (Avondale Academic Press, 2014-01-01) Perry, Graeme