"How are You Doing?" on the Healthy Aging of the Community-Dwelling Oldest-Old in the Shadow of the COVID-19 Pandemic.

OBJECTIVE: Globally, the oldest-old population is growing rapidly. Little is known about the perceived well-being of the community-dwelling oldest-old, especially during the COVID-19 pandemic. This study examined the oldest-old's perceptions of aging well and the COVID-related impacts on them. METHODS: Semi-structured in-depth interviews with 22 adults aged 85 or above were conducted with purposive sampling methods. Transcripts were analyzed using thematic analysis. RESULTS: Four main themes emerged: 1) sustaining functional ability; 2) staying active with a positive attitude; 3) feeling grateful for support from society and family; 4) COVID-19-related anxieties and policies destabilizing their well-being. DISCUSSION: This study provides direct evidence from the oldest-old on how they maintained their well-being. While they valued support from society and family, COVID-19-related measures disturbed their routines and prevented them from self-attaining well-being. The findings should be considered when developing interventions for this vulnerable group.

Psychological first aid training in disaster preparedness for nurses working with emergencies and traumas.

AIM: This study aimed at evaluating the effects of a modified psychological first aid (PFA) training program on nurses' psychological preparedness for emergencies and disasters. BACKGROUND: Nurses need to be psychologically prepared in order to mitigate the impact of conflicts and disasters. The PFA training could ensure their psychological preparedness in responding to different emergencies and disasters. DESIGN: A nonequivalent controlled group trial was conducted between July 2019 and August 2019. METHODS: Nurses working in the trauma units from five hospitals in Palestine were allocated into two arms: a control arm and an intervention arm incorporating a 9-hour modified PFA training program. Both groups were assessed at start (pretest) and upon completion of the program (post test) using a number of validated self-reports. RESULTS: Eighty-four nurses were allocated to each arm, and 75 in each arm completed baseline data (n = 150). The results of generalized estimating equation estimates revealed that PFA training imposed a significant group-by-time effect on psychological preparedness (p = 0.013). The mean scores of psychological preparedness showed greater improvement in the intervention group than in the control group at posttest (37.81 vs. 32.64). Improved group-by-time effect was further identified in relation to optimism (p = 0.009), self-esteem (p = 0.008), and self-efficacy (p = 0.033). The intervention effect was large (Cohen d = 1.41). CONCLUSION: PFA training may help to build nurses' capacity in being better prepared to respond to psychological issues during and after emergencies and disasters. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nurses should be adequately equipped with knowledge and skills to deal with different emergencies and disasters. Health policy needs to address psychological preparedness for emergencies and disasters of all healthcare workers. Healthcare policymakers and educators could adopt PFA training on a regular basis to consolidate psychological preparedness of nurses.

Visual Art Intervention for People With Stroke on Holistic Well-Being: A Critical Review.

Background: After a stroke, a person usually experiences physical, psychosocial, and spiritual consequences, causing distortion of holistic well-being. Existing studies using visual art interventions found some benefits to physiological, psychosocial, and/or spiritual well-being of people with stroke, but little is known about holistic well-being. Objectives: This critical review to identify how visual art interventions are delivered to people with stroke on holistic well-being. Methods: Databases were searched up to September 30, 2019, for published studies on "stroke" AND "art*/visual art*," AND "holistic well*being." Results: Ten studies were included. Heterogeneity was found in study characteristics, intervention modalities, outcome measures, and methodology issues or a lack of clarity in theoretical application. Most participants were people with stroke, with only two studies recruited older people with stroke. All studies were conducted in rehabilitation units or communities, and none in residential care settings. One study reported the effects on holistic well-being. The appraised quality of the included studies was variable. Conclusion: Stroke impacts the holistic well-being of a person, but little has been known for older people with stroke. It remains unclear how visual art interventions can be delivered and benefit the holistic well-being of older people with stroke in residential care settings.

Implications of COVID-19 on the Loneliness of Older Adults in Residential Care Homes.

With little understandings on the loneliness of older adults in residential care homes structured by social contact restrictions, the provision of person-centered care was jeopardized during the pandemic. This study employed hermeneutic phenomenology to explore the lived experiences of loneliness of this population during a 5-month period of the COVID-19 pandemic. We conducted unstructured face-to-face interviews with 15 older adults living in seven residential care homes. Thematic analysis was guided by Van Manen's approach. The essence of loneliness was uncovered as "A deprived sense of self-significance in a familiar world contributes to older adult's disconnection with prior commitments." A sub-theme "From collapse to dissolution of self-understanding" revealed how COVID-19 structured their loneliness. Another sub-theme, "Restoring meanings by establishing connections with entities" illustrated the ways to mitigate loneliness during the pandemic. Activities fostering alternative self-interpretation are important to protect older adults against loneliness.

The mentorship experience of students and nurses in pre-registration nursing education: A thematic synthesis of qualitative studies.

Mentorship is considered to play a paramount role in empowering nursing students to recieve superlative benefit from clinical placement. Although the new standards for student supervision and assessment approved by the Nursing and Midwifery Council in 2018 seemed to lead to the disillusionment of mentorship, they support clinical education and devotion to nursing students' clinical learning globally. The aim of this synthesis was to review and explore the experiences of mentorship of preregistration nursing students and nurses. A systematic search of databases was performed for qualitative studies published in English from 2000 to 2018. Eleven qualitative studies were selected, from which three analytical themes emerged: mentors' capabilities and readiness for preregistration nursing student mentorship, humanistic approach as foundation to the effectiveness of preregistration nursing student mentorship, and the collaboration of stakeholders in health care and educational settings to enhance preregistration nursing student mentorship. A thematic framework of mentorship in preregistration nursing education was introduced. The thematic synthesis sheds light on how to improve a formal system of mentorship and clinical supervision for nursing education.

Measurement invariances of the PHQ-9 across gender and age groups in Chinese adolescents.

INTRODUCTION: The nine-item Patient Health Questionnaire (PHQ-9) is widely used to determine the severity of depression in adult populations, but its psychometric properties with regard to adolescents has been poorly explored. The present study aims to identify the factor structure and examine the measurement invariance of this instrument across genders and age groups in a Chinese adolescent sample. METHODS: A large sample of Chinese schoolchildren completed the PHQ-9 in a cross-sectional survey in Hong Kong (N = 10 933). A confirmatory factor analysis (CFA) to test the factor structure and a multiple group CFA to test the gender and age invariances of the PHQ-9 in adolescents were conducted. Cronbach alpha was used to assess the reliability of the questionnaire, and Pearson correlations with anxiety, self-esteem, and perceived control were used to assess its construct validity. RESULTS: The CFA results indicate that a one-factor model with three pairs of item correlations fitted the PHQ-9 data well, and measurement invariances by age and gender were supported. The PHQ-9 also possesses adequate internal consistency (>.84) and is strongly correlated with anxiety (>.77), self-esteem (<-.57), and perceived control (<-.56) in the expected directions in the overall sample and in the gender and age subsamples. DISCUSSION: The results support the claim that the PHQ-9 is a reliable and valid scale and can be used to assess and compare depressive severity across ages and genders during the period of adolescence.

Experiences of Tobacco Use among Chinese Individuals with Schizophrenia in Community-Based Residential Settings: A Qualitative Study.

Although there is a high prevalence of smoking among individuals with schizophrenia, no previous attempt has been made to explore experiences of tobacco use and cessation within a Chinese sample of this population. A qualitative descriptive study was conducted to explore through the use of individual and semi-structured interviews the experiences of tobacco use and quitting in a sample Chinese population with schizophrenia. Twenty-three eligible participants with schizophrenia who currently smoke were recruited from three community residential mental health service settings. Four main themes representing the experiences of the participants were uncovered in this study: (1) smoking and illness; (2) environment and culture; (3) reasons for smoking; and (4) beliefs about cessation methods. The findings indicated that the participants considered the disease to be far more harmful than smoking, and perceived many benefits to smoking. Although some thought of quitting at times, most gave up the idea or failed to quit due to internal factors such as disease-related suffering, the use of an avoidance coping strategy, and a lack of cessation support. The most notable finding concerns the use of avoidance coping by the participants, who relied on smoking as a way to avoid the suffering brought about by the disease.

The knowledge, skill competencies, and psychological preparedness of nurses for disasters: A systematic review.

BACKGROUND: Disasters and the magnitude of destruction are increasing worldwide. Nurses constitute the largest number of healthcare providers and have major roles in disaster response and care. They need to have sufficient knowledge, skill competencies, and preparedness in responding to disasters. This review aimed to evaluate nursing preparedness to disasters in terms of knowledge, skill competencies, and psychological preparedness to disasters. METHODS: A systematic review was conducted from recent research articles published between 2001 and 2018, which included searches from five databases: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Medline, and ScienceDirect. Quality of the selected studies was assessed using Mixed Methods Appraisal Tool (MMAT), and the review results were generated through an iterative narrative process of synthesis to identify common themes. RESULTS: Twelve studies, with a total of 1443 nurses involved, met the inclusion criteria. The articles revealed the need for further development of disaster preparedness of nurses in the aspects of knowledge and skill competencies; and in particular with more focus on the education of nurses to achieve better psychological preparedness. CONCLUSION: The results of this review showed that it is important to enhance the psychological preparedness of nurses, in addition to knowledge and skill competencies, so that they can provide the best care possible to affected individuals as well as for themselves.

A feminist phenomenology on the emotional labor and morality of live-in migrant care workers caring for older people in the community.

BACKGROUND: Global societal changes, such as increasing longevity and a shortage of family caregivers, have given rise to a popular worldwide trend of employing live-in migrant care workers (MCWs) to provide homecare for older people. However, the emotional labor and morality inherent in their interactions with older people are largely unknown. The aim of the present study is to understand the corporeal experiences of live-in migrant care workers in the delivery of emotional labor as seen in their interactions with older people by: (1) describing the ways by which they manage emotional displays with older people; and (2) exploring their morality as enacted through emotional labor. METHODS: We performed a secondary analysis drawing on feminist phenomenology to thematically analyze data from interviews with 11 female MCWs. Follow-up interviews were conducted with 10 participants. The participants had two to 15 years of experience in caring for older people in their homes in Hong Kong. RESULTS: Performing emotional labor by suppressing and inducing emotions is morally demanding for live-in MCWs, who experience socio-culturally oppressive relationships. However, developing genuine emotions in their relationships with older people prompted the MCWs to protect the interests of older people. Through demonstrating both fake and genuine emotions, emotional labor was a tactic that live-in MCWs demonstrated to interact morally with older people. CONCLUSIONS: Emotional labor allowed live-in MCWs to avoid conflict with older people, and to further protect their own welfare and that of others. This study highlights the significance of empowering live-in MCWs by training them in ways that will help them to adapt to working conditions where they will encounter diverse customs and older people who will develop an increasing dependence on them. Thus, there is a need to develop culturally appropriate interventions to empower live-in MCWs to deliver emotional labor in a moral manner.

The technology implications of master's level education in the professionalization of nursing: A narrative inquiry.

AIMS: (a) To explore the meanings of master's education in the professionalization of nursing; and (b) to describe the core attributes that nurses gained through master's study. DESIGN: Narrative inquiry. METHODS: From June 2017 to June 2018, unstructured interviews were conducted with 12 master-prepared nurses at advanced nursing position with minimum 5 years of postregistration experience. Collaborative thematic narrative analysis was conducted on verbatim transcripts. Members checking, peer validation and audience validation assured verisimilitude and utility. RESULTS: There was a need to fit one's own assertion for professional growth in nursing career structure. Master's study equipped nurses with specialty skills and knowledge with enhanced reflexivity, which nurtured morality, problem-solving ability and capacity to collaborate inter-professionally. Master-prepared nurses demonstrated effective clinical leadership through acting as change agents. CONCLUSIONS: Master's level education and master-prepared nurses are instrumental to the professionalization of nursing by expanding the roles of nurses. Nursing career mentoring will maximize nurses' agency in healthcare system. Developing innovative inter-professional pedagogy will nurture the reflexivity of master-prepared nurses.

When Foreign Domestic Helpers Care for and About Older People in Their Homes: I Am a Maid or a Friend.

We examine the lived experiences of foreign domestic helpers (FDH) working with community-dwelling older people in Hong Kong. Unstructured interviews were conducted with 11 female FDHs, and thematically analyzed. The theme inescapable functioning commodity represented the embodied commodification of FDHs to be functional for older people in home care. Another theme, destined reciprocity of companionship, highlighted the FDHs' capacity to commit to home care and be concerned about older people. The waxing and waning of the possibilities of commodified companionship indicated the intermittent capacity of FDHs to find meaning in their care, in which performative nature for functional purposes and emotional engagement took turns to be the foci in migrant home care. This study addresses the transition of FDHs from task-oriented relation to companions of older people through care work. Discussion draws on the development of a kin-like relationship between FDHs and older people with emotional reciprocity grounded in moral values.

Nurses' preparedness for infectious disease outbreaks: A literature review and narrative synthesis of qualitative evidence.

AIMS AND OBJECTIVES: To explore the core components that constitute nurses' preparedness in an epidemic event. BACKGROUND: Healthcare service providers have worked to augment efforts to protect the public from the impact of epidemic events. While constituting the major healthcare taskforce, nurses are frequently tasked with fronting the response to an infectious disease outbreak. Given the crucial role of nurses in the management of prevailing epidemics, the constituents of their preparedness in epidemic events should be identified. DESIGN: A systematic search was undertaken to identify eligible studies from the literature. A narrative synthesis approach was employed to extract and synthesise findings of the reviewed qualitative studies. METHODS: Seven qualitative studies on nurses' experience and perceptions of epidemic events were examined for scientific quality using the Critical Appraisal Skills Programme Qualitative Checklist. Findings of these studies were synthesised adopting a narrative synthesis approach. RESULTS: Three interplaying themes were identified as follows: (i) personal resources, (ii) workplace resources and (iii) situational influences. The findings suggest that an effective epidemic outbreak response would require further effort to reinforce the interplay between individual nurses, healthcare institutions and the governments. CONCLUSIONS: The practical interplay among individual nurses, healthcare institutions and the governments is crucial in establishing an effective epidemic response. Further research on the understanding of the dynamic process of preparedness development is recommended to set future directions in research. RELEVANCE TO CLINICAL PRACTICE: This study offers important insights for devising future strategies in enhancing nurses' preparedness and response to an epidemic event. These include recommendations on providing education and training to nurses regarding infectious diseases, fostering institutional assistance and support in an outbreak and revising government policies and planning.

The effects of Gua sha on symptoms and inflammatory biomarkers associated with chronic low back pain: A randomized active-controlled crossover pilot study in elderly.

OBJECTIVE: To address the challenges for trialing with elderly and the lacking of valid sham/placebo control, a randomized crossover pilot study is designed and its feasibility on elderly subjects is evaluated. DESIGN: A pilot randomized crossover study was conducted with hydrocollator-based hot pack therapy as active control. Pain intensity, physical disability, depression, general health status, and salivary biomarkers were assessed as outcome measures. RESULTS: Despite there was no significant difference observed between any outcome measures attained by the two interventions, several important differences were noted during the one-week follow-up period. The magnitudes of pain reduction (21-25% versus 16-18%) and disability improvement (45-52% versus 39-42%) were greater in the Gua sha-treated group than the hot pack group. Both treatments were shown to improve flexion, extension and bending movements of the lower back, whereas areas of improvement varied between the two interventions. Decreasing trends were observed in both tumor necrosis factor-alpha (TNF-α) and heme-oxygenase-1 (HO-1) levels following Gua sha. However, rebounds of the biomarkers were observed one week following hot pack. Furthermore, in response to Gua sha, the decrease of TNF-α was strongly correlated with the improvement of physical disability, whereas the physical disability was correlated with the VAS pain intensity. CONCLUSION: It demonstrated a feasible clinical trial protocol for evaluating the effectiveness of Gua sha and other therapeutic modalities. Gua sha may exhibit a more long-lasting anti-inflammatory effect relative to hot pack for pain relief and improved mobility in elderly patients with chronic low back pain.

Hermeneutic phenomenological analysis: the 'possibility' beyond 'actuality' in thematic analysis.

AIMS: This article discusses the ways researchers may become open to manifold interpretations of lived experience through thematic analysis that follows the tradition of hermeneutic phenomenology. BACKGROUND: Martin Heidegger's thinking about historical contexts of understandings and the notions of 'aletheia' and 'techne' disclose what he called meaning of lived experience, as the 'unchanging Being of changing beings'. While these notions remain central to hermeneutic phenomenological research, novice phenomenologists usually face the problem of how to incorporate these philosophical tenets into thematic analysis. DESIGN: Discussion paper. DATA SOURCES: This discussion paper is based on our experiences of hermeneutic analysis supported by the writings of Heidegger. Literature reviewed for this paper ranges from 1927 - 2014. We draw on data from a study of foreign domestic helpers in Hong Kong to demonstrate how 'dwelling' in the language of participants' 'ek-sistence' supported us in a process of thematic analysis. Data were collected from December 2013 - February 2016. IMPLICATIONS FOR NURSING: Nurses doing hermeneutic phenomenology have to develop self-awareness of one's own 'taken-for-granted' thinking to disclose the unspoken meanings hidden in the language of participants. Understanding the philosophical tenets of hermeneutic phenomenology allows nurses to preserve possibilities of interpretations in thinking. In so doing, methods of thematic analysis can uncover and present the structure of the meaning of lived experience. CONCLUSION: We provide our readers with vicarious experience of how to begin cultivating thinking that is aligned with hermeneutic phenomenological philosophical tenets to conduct thematic analysis.

A Heuristic Force Model for Haptic Simulation of Nasogastric Tube Insertion Using Fuzzy Logic.

Nasogastric tube (NGT) placement is an essential clinical skill. The training is conventionally performed on rubber mannequins albeit practical limitations. Computer simulation with haptic feedback can potentially offer a more realistic and accessible training method. However, the complex interactions between the tube and the nasogastric passage make it difficult to model the haptic feedback during NGT placement. In this paper, a fuzzy-logic-based approach is proposed to directly transfer the experience of clinicians in NGT placement into the simulation system. Based on their perception of the varying tactile sensation and the conditions during NGT placement, the membership functions and fuzzy rules are defined to develop the force model. Forces created using the model are then combined with friction forces to drive the haptic device and render the insertion forces in real time. A prototype simulator is developed based on the proposed force model and the implementation details are presented. The usability of the prototype is also evaluated by clinical teachers. The proposed methodology has the potential for developing computerized NGT placement training methods for clinical education. It is also applicable for simulation systems involving complicated force interactions or computation-expensive models.

A meta-ethnography of the acculturation and socialization experiences of migrant care workers.

AIM: To report a meta-ethnography of qualitative research studies exploring the acculturation and socialization experiences of migrant care workers. BACKGROUND: Migrant care workers are increasingly participating in health and social care in developed countries. There is a need to understand this increasingly socioculturally diversified workforce. DATA SOURCES: A comprehensive search through 12 databases and a manual search of journals related to transculture for studies on socialization and acculturation experiences (published 1993-2013) was completed. The inclusion criteria were peer-reviewed studies on the acculturation or socialization experiences of migrant care workers published in English in any country, using a qualitative or mixed-methods approach. DESIGN AND REVIEW METHODS: This meta-ethnography employed the seven-phase Noblit and Hare method with reciprocal translation, refutational synthesis and lines-of-argument to synthesize qualitative studies. RESULTS: Three main themes were identified: (a) schema for the migration dream: optimism; (b) the reality of the migration dream: so close, yet so far; and (c) resilience: from chaos to order. A general framework of motivated psychosocial and behavioural adaptation was proposed. This meta-ethnography also revealed the vulnerabilities of migrant nurses in the process of acculturation and socialization. CONCLUSIONS: The general framework of behavioural and psychosocial adaptation revealed factors that impede and facilitate behavioural and psychosocial changes. Strategies to enrich external and internal resources should be targeted at encouraging multiculturalism and at improving the psychosocial resources of migrant care workers. It is suggested that research investigating the prominence of nursing vulnerabilities be conducted.

An evaluation of advanced simulation in nursing: a mixed-method study.

PURPOSE: This study aimed to evaluate the development of critical thinking disposition and skills of nursing students and to identify their issues and experience with the application of advanced simulation for experiential learning. DESIGN: The study was conducted with a mixed-method design. METHODS: Quantitative and qualitative data were respectively collected through pre-post questionnaires and focus group interviews over two semesters from a class of 132 undergraduate pre-registration nursing students in Hong Kong, who practised clinical skills with human patient simulator (HPS) during two adult nursing care courses. FINDINGS: Although there were significantly increased analyticity, confidence and overall critical thinking disposition scores, inquisitiveness decreased after the study period. From the qualitative results, advanced simulation with HPS was overall recognized to be interesting, useful, welcomed and preferred by students in this study. CONCLUSIONS: While the result of overall critical thinking disposition score of students in this study showed a significantly increase (p = 0.000) after two semesters, outcomes might improve with higher frequencies of the advanced simulation exercises and measures taken to consider cultural background of the students in such teaching and learning process. CLINICAL RELEVANCE: With the quantitative results and overall positive feedback from students, advanced simulation is reasonably considered for inclusion as a value-added adjunct to clinical learning.

Culturally sensitive, preventive antenatal group cognitive-behavioural therapy for Chinese women with depression.

Postnatal depression (PND) affects 10-15% of postnatal women worldwide, yet it is poorly recognized and managed. Among the psychological interventions, which are used to manage PND, cognitive-behavioural therapy was found to be effective and promising. In the past decade, research efforts have focused on developing effective antenatal interventions to prevent PND. Strong antenatal predictors such as antenatal depressive symptoms have been identified for targeted early intervention or prevention to help reduce the risk of developing depression after childbirth. However, the findings regarding effectiveness of antenatal preventive interventions have been inconsistent. Based on the reports of previous studies, a brief group antenatal intervention using cognitive-behavioural approach is necessary, particularly one with sensitivity for Chinese woman. This paper reports the details of a nurse-led cognitive-behavioural programme developed and tested in, and for use with a sample of Hong Kong pregnant women. The trial run showed that the programme was feasible to be implemented and well received by the participants.

Building life-long learning capacity in undergraduate nursing freshmen within an integrative and small group learning context.

BACKGROUND: Life-long learning involves the development of skills in critical thinking (CT), effective group process (GP), and self-directedness (SDL). Recent studies have shown that small group learning with active interactions is effective in enabling students to develop themselves as independent learners beyond graduation. With a view to integrative learning, the purpose of this study was to evaluate life-long learning outcomes through the work of small group teaching and learning for a class of undergraduate nursing freshmen during one academic year. METHODS: A mixed-methods approach was used to evaluate the CT, GP and SDL of 99 freshmen with a self-assessment questionnaire before and after their learning activities in three nursing courses, and to identify themes from a total of six focus group interviews with the students and teachers. RESULTS: The CT, GP and SDL results obtained from self-assessment did not indicate significant differences. Four themes emerged from the qualitative analysis. DISCUSSION: Many factors contributed to the results on life-long learning skill development of students in this study. The qualitative analysis provided good insights for future teaching and learning development. CONCLUSIONS: With a developmental perspective, life-long learning may be better developed and evaluated over a longer period of time in the nursing program.

Surviving a critical illness through mutually being there with each other: a grounded theory study.

OBJECTIVES: The objectives of this study were to conduct a theoretical analysis of the critically ill patients' perceptions of the impact of informal support and care from their main family carer (MFC) during the time of their stay in the hospital (ICU) and thereafter (and vice versa). RESEARCH DESIGN AND SETTING: The grounded theory method was used to investigate the target phenomenon in the ICU of a large general hospital, and three months later in the community after the patients were discharged. Qualitative data were collected through participant observation and interviews for constant comparative analysis until theoretical saturation. RESULTS: A substantive theory emerged and it illustrated and described the dynamic actions and interactions between critically ill patients and their MFC during the process of recovery. Three categories, 1) being there with, 2) coping and 3) self-relying, comprise the essential components of this theory. CONCLUSION: The theory represents the core process of 'surviving a critical illness through mutually being there with each other' in which both the patients and their MFC are involved. Implications and recommendations were proposed to provide a basis for further research and nursing practice on the phenomenon of informal support and care of critically ill patients and their recovery.