Infection control practices among hospital health and support workers in Hong Kong.

A report by the Hong Kong government noted that hospital infection control standards were inadequate, requiring audit, development and implementation. In addition, hospital staff needed training in infection control measures. We investigated infection control practices among 162 hospital health workers (109 nurses, 45 doctors and 8 therapists) and 44 support workers in one acute hospital and two rehabilitation hospitals using a non-blinded, observational design. We examined compliance with isolation precautions and infection control guidelines, including proper wearing of a mask, goggles/face shield, or gown; handling patient care equipment, linen, and laundry; routine and terminal cleaning; and terminal cleaning of an isolation room. One major breakdown in compliance was use of sleeveless disposable plastic aprons instead of long-sleeved gowns during procedures likely to generate splashes or sprays of blood and body fluids. In more than half of the observed episodes, participants failed to disinfect medical devices, such as stethoscopes, before re-use. Thorough cleansing of commodes between patients was also lacking. Overall compliance with local and international infection control guidelines was satisfactory, but several aspects required improvement.

An evaluation of SARS and droplet infection control practices in acute and rehabilitation hospitals in Hong Kong.

1. This study has demonstrated that great efforts have been made by the Hospital Authority and the studied hospital cluster to contain and prevent infection, and that high levels of vigilance have been enforced in anticipation of future outbreaks of SARS and other droplet infections. 2. Most health care workers and support workers have good hospital infection control and isolation precaution knowledge levels. 3. Compliance with infection control guidelines is satisfactory and has increased compared with previous studies. 4. Most participants had positive perceptions of the guidelines and found the training programmes useful. 5. This study has identified several structures and infection control practice areas that need strengthening, including improving the clarity of some guidelines and minimising barriers to their implementation.

The nursing gaze: power relations in a study of nurse-resident interactions in learning disability.

The researchers observed nurse-resident interactions in learning disability units in Hong Kong and interviewed a purposeful sample of nurses who had varying levels of interaction. The median interaction rate between nurses and residents was 27.5% with most interactions relating to physical care. When not interacting with residents, nurses performed administrative tasks. Factors that influenced nurses' interactions revolve around their orientation to a new clinical setting, stresses in the care setting and nurses' coping strategies, contextual constraints, and nurses' prioritization of care. Support for Goffman's self-mortification principle, Foucault's notion of the clinical gaze and infantilism theory were evident in the practice of the nurses studied.

A pilot study of the effects of cognitive-behavioral group therapy and peer support/counseling in decreasing psychologic distress and improving quality of life in Chinese patients with symptomatic HIV disease.

Forty-six Chinese patients with symptomatic human immunodeficiency virus (HIV) participated in a comparative study assessing the effectiveness of cognitive-behavioral group therapy (CBT) and peer support/counseling group therapy (PSC) in relation to improving mood and quality of life and decreasing uncertainty in illness as compared to a group receiving routine treatment with no formal psychosocial intervention. The CBT group consisted of 10 subjects, the PSC group of 10 subjects, and the comparison group of 26 subjects. There was a 24% attrition rate. The intervention groups received 12 weekly sessions of therapy over 3 months. Assessment of mood states was carried out before randomization (baseline data), immediately postintervention (3-month time point) and followed-up 3 months later (6-month time point). Assessment of quality of life and uncertainty in illness was carried out before randomization and at the 6-month follow-up time point. Results indicated that the mood of the participants in the CBT group improved in terms of anger, tension-anxiety, depression, confusion, and overall mood. The quality of life in this group was significantly improved compared to the other two groups, as was uncertainty in illness. In the PSC group a worsening of psychologic functioning was observed immediately postintervention, but this picture dramatically improved at the follow-up assessment with improvements of up to 34%. Quality of life also improved over time in this group by almost 5%, but results did not reach statistical significance. This study demonstrated that psychologic interventions could decrease psychologic distress and improve quality of life in symptomatic HIV patients, indicating their use should be incorporated in the management of care of people living with HIV/AIDS.

Evaluating psychosocial nursing interventions for cardiac clients and their caregivers: a case study of the community rehabilitation network in Hong Kong.

AIM OF THE STUDY: The purpose of this exploratory study was to describe the type and nature of psychosocial nursing interventions provided for cardiac clients in Hong Kong's Community Rehabilitation Centres (CRNs). DESIGN/METHODS: Using a two-phase case study design data were collected from nurses, cardiac clients and their caregivers. The initial phase focused on identifying the types of psychosocial interventions provided. These data were obtained by observing nursing activities and the keeping of daily journals by the nurses. The second phase acquired data from structured telephone interviews, that reviewed clients' perceptions of the psychosocial interventions provided by the nurses and face-to-face interviews with clients and their caregivers. FINDINGS: These findings revealed that the nurses' interpersonal skills of information giving, social support and counselling were highly valued by cardiac clients and their caregivers. Both clients and caregivers outlined a concern about the lack of individual care and this was reflected in the focus of the CRN on group processes. CONCLUSION: Recommendations for psychosocial cardiac care are made for public health nurses and nurses working in community settings.

Correlates of quality of life in symptomatic HIV patients living in Hong Kong.

This cross-sectional study assessed quality of life (QOL), coping styles, mood and uncertainty in illness in a non-random sample of 46 (out of 91 eligible) symptomatic HIV patients living in Hong Kong. QOL was moderate and the main concerns were related to the environmental aspects of QOL, spirituality and social relationships. Considerable mood disturbance was demonstrated in the sample, especially with regards to depression, fatigue and tension/anxiety. High levels of uncertainty in illness were also reported. A median split of the uncertainty score demonstrated that high uncertainty was related to lower levels of overall QOL (p = 0.04), higher psychological dysfunction (p = 0.05), worse adjustment with the environment (p < 0.001) and higher mood disturbance (p = 0.008). The sample predominantly used internal coping, which also correlated well with higher QOL scores. Through regression analysis it was shown that QOL could be predicted with the combined effects of uncertainty in illness and fatigue (adjusted R2 = 0.51, p < 0.001). Findings indicate that efforts should be directed towards improving QOL issues in the Chinese HIV patients and interventions could be introduced to alleviate those factors that were found to affect QOL. It is suggested that such interventions may include group or individual psychological therapies, management of fatigue and teaching patients more effective coping techniques.

The evaluation of the effectiveness of health education interventions in clinical practice: a continuing methodological challenge.

AIM: This paper examines the methodological issues arising from an evaluation of the effectiveness of a health education project undertaken to increase Hong Kong Chinese women's knowledge of the prevention of cervical cancer and the uptake of screening. BACKGROUND: The significance of health promotion to the prevention of diseases currently affecting contemporary society has become increasingly recognized. Within the context of health promotion health education continues to provide an important preventive strategy. Indeed the leading causes of mortality such as coronary heart disease and cancer lend themselves well to health education interventions. However the evaluation of the effectiveness of health education remains complex and raises some important methodological issues. DESIGN: The project used a health education intervention as the major preventive strategy and employed multiple methods of evaluation to assess its effectiveness. Outcome evaluation consisted of a confidential questionnaire administered at two points in time to measure changes in health-related behaviour and knowledge. It also included the collection of data from service providers to assess changes in the uptake of cervical cancer screening. Process evaluation involved the use of focus groups with randomly selected groups of women who had participated in the health education intervention and a diary kept by the project nurse. FINDINGS: Methodological issues identified in the evaluation of the project included the extent to which changes in health-related knowledge and behaviour could be attributed to the intervention, the sensitivity of outcome measures and challenges in developing methods of process evaluation appropriate to the target population. CONCLUSIONS: The findings highlight the complexity of designing effective evaluation strategies for health education and the need to consider these issues in the development of both process and outcome evaluation.

Assessment of needs of adult symptomatic HIV patients in Hong Kong.

A cross-sectional survey was designed to assess the physical, psychosocial, health behaviour and informational needs of symptomatic HIV patients in Hong Kong, using both quantitative and qualitative data collection methods. Forty-six consenting adults from an outpatient clinic of a hospital in Hong Kong participated in the study. Results showed that up to 67.3% of the sample had partially or completely unmet needs in one or more areas of functioning. Major needs were related to income, social networking, family processes, money management and financial assistance. Only half the sample was satisfied with the information received related to their HIV infection and its management. Unsafe sexual practices were common, as well as smoking. Meeting these needs through policy making or practice could contribute to the enhancement of the quality of care and support provided to people living with HIV/AIDS in Hong Kong.

Chinese women's experiences and images of the Pap smear examination.

Cervical cancer remains a significant cause of mortality and morbidity in Chinese women, despite the efficacy of the screening procedure for the disease. This article focuses on specific gender and culturally related experiences of Chinese women presenting for Papancolaou (Pap) tests. The first phase of a descriptive exploratory study involved the administration of a questionnaire to a total population of female Hong Kong Chinese clerical and technical staff working in academic departments of a tertiary institution. The second phase consisted of in-depth semistructured interviews with a purposive sample of women to explore experiences of Pap smear screening. Of these women, 68.2% associated pain with a Pap smear. In addition, 78.6% of the women associated a Pap smear with embarrassment. Older women were more likely to experience pain and embarrassment during the procedure. In the qualitative data, women's personal images and experiences reflected four subthemes including pain, sexual connotations of the procedure, vulnerability, and diminished embarrassment after childbirth. The second substantive theme, characteristics of the practitioner, highlighted the importance of procedural, interpersonal, and culturally sensitive skills, particularly in respect to information-giving and interaction with women. The conclusion outlines the nursing implications for Chinese women presenting for Pap smears in terms of cultural sensitivity as a means of enhancing attendance patterns.

Developments in nursing practice in primary health care in Hong Kong: opportunities and challenges.

The significance of primary health care to the health of individuals and communities has been well established but the development of primary health care and nursing practice within the context of primary health care remains varied in different countries and settings. This paper focuses on developments in nursing practice in primary health care in Hong Kong, using three community-based research projects to identify the opportunities and challenges created for nurses working in these settings. The projects were established in response to identified health needs and to target cancer education, HIV/AIDS and chronic health problems. Opportunities include the development of professional autonomy, innovative approaches to clinical practice, and developing skills in working with a diverse range of professionals and communities. Challenges include managing uncertainty and the development of evaluation systems to demonstrate health gains from nursing interventions.

Determining the needs of chinese parents during the hospitalization of Their child diagnosed with cancer: an exploratory study.

In Hong Kong, as in other modern societies, cancer is the second cause of death among children. Studies show that childhood cancer affects all family members who frequently experience emotional and social problems resulting from managing the stress created by the disease and side effects of treatment. This subsequently results in parents experiencing a range of different needs. There is little evidence available of the needs of Chinese parents during the hospitalization of their child. An exploratory study was undertaken using in-depth semistructured interviews with 5 parents recruited from the pediatric oncology ward of a regional hospital in Hong Kong. The parents were interviewed twice during the active treatment phase to explore their changing needs during this initial period of hospitalization. All interviews were tape-recorded, transcribed, and translated into English before content analysis. The analysis of the parents' data identified 6 main categories common to both interviews: (i) the need for recognition of their reaction, (ii) the need for recognition of their fear of hospitalization, (iii) the need for support, (iv) the need for information, (v) the need for personal time, and (vi) finally the need for help in parenting skills were identified. The implications of these findings for nursing practice are presented.

Increasing uptake rates of cervical cancer screening amongst Hong Kong Chinese women: the role of the practitioner.

Women's attendance for regular cervical screening has been identified as a significant factor in the prevention of cervical cancer. Evidence suggests, however, that both extrinsic and intrinsic factors influence women's attendance patterns for screening. Extrinsic factors, in particular the practitioner undertaking the screening procedure, have been shown to influence women's return rates for further screening. In Hong Kong, where uptake rates amongst Chinese women remain comparatively low, a study was undertaken to examine Chinese women's experiences and perceptions of cervical screening undertaken by either a female doctor or nurse. A multiple case study design using both qualitative and quantitative methods of data collection was employed. This paper reports the findings from the qualitative data obtained from 52 women participating in 12 focus group interviews held in the two case studies. Thematic analysis of the data demonstrated the importance of the caring nature, communication skills, experience and expertise of the practitioner to women's attendance pattern for screening. The experience and expertise of the practitioner, described by women as teaching, minimizing pain and discomfort and being considerate, were considered more influential to uptake rates than the professional discipline of the practitioner. Findings such as these indicate the importance of the influence of the practitioner in determining uptake rates for cervical screening amongst this population group.

Social aspects of women's health.

An understanding of the multifactorial nature of health has shifted the traditional narrow focus on women's reproductive health to an acknowledgement of the influence of social, cultural, and economic factors on the health status of women. The changing roles of women have also contributed to their health status. In Hong Kong, as in other developed societies, factors such as multiple roles, discrimination, and sexual health influence women's health status. A consistent issue to emerge from the literature is the need for women to share concerns about their health with practitioners who are sensitive to their particular needs. The evidence also demonstrates the need for sensitivity to gender issues-in particular, to women's health-in the development and implementation of national health policies.

A case study of the effectiveness of nurse-led screening programmes for cervical cancer among Hong Kong Chinese women.

Cervical cancer remains a cause of morbidity and mortality among women despite the efficacy of Pap smear screening. Uptake rates for Papanicolaou (Pap) smears among Hong Kong Chinese women remain low and evidence suggests that both intrinsic and extrinsic factors influence women's attendance for Pap smear screening, particularly the practitioner taking the smear. This study examined the experiences and perceptions of Hong Kong Chinese women of having a Pap smear taken by a female doctor or a female nurse using a case study design. A convenience sample of 50 women was selected from the two case study settings. Data collection involved a confidential structured interview, followed by focus group interviews with a sample of women participating in the structured interview. The findings relating to the technical quality and outcome of care provide the focus for this paper. Although women were highly satisfied with the care provided by both practitioners, women were more satisfied with the information given about the procedure by the nurse (P = 0.0130) and had more confidence in the nurse (P = 0.024). One of the five criteria used to assess the quality of smears demonstrated the doctor achieved a statistically significant higher number of smears containing the required percentage of endocervical cells (P = 0. 0180). Nevertheless, none of the smears taken by the nurse required repeating due to an inadequate specimen. These findings suggest, despite the need for audit of Pap smears, that appropriately qualified nurses can make an important contribution to the uptake of Pap smears among this population.

An analysis of the effectiveness of focus groups as a method of qualitative data collection with Chinese populations in nursing research.

Although there has been a significant increase in the use of focus groups as a qualitative method of data collection in health and nursing research, literature on the use of this method with Chinese populations is limited. This study was therefore undertaken to explore the contribution of focus groups as a method of data collection amongst Hong Kong Chinese women. The study involved the comparison of the data obtained from two concurrent research studies which both employed case study design and focus groups as a major method of data collection. In both studies the samples involved Chinese women. The findings demonstrate that factors such as recruitment to the groups and interaction of group members did not adversely affect the quality of the data. Indeed the depth of data obtained on a range of sensitive topics suggests that the use of focus groups provides an effective method of collecting qualitative data with the Chinese populations in the described studies. However, a particular issue to emerge from this method of collection relates to the complexity of transcription and translation of the Chinese data which in the author's view has implications for the quality of the data. This finding indicates the importance of undertaking data analysis in the language of the interview, rather than that of the translated data, to avoid compromising the quality of data obtained from non-English speaking populations.

An exploratory study examining the influence of translation on the validity and reliability of qualitative data in nursing research.

Although the complexity of undertaking qualitative research with non-English speaking informants has become increasingly recognized, few empirical studies exist which explore the influence of translation on the findings of the study. The aim of this exploratory study was therefore to examine the influence of translation on the reliability and validity of the findings of a qualitative research study. In-depth interviews were undertaken in Cantonese with a convenience sample of six women to explore their perceptions of factors influencing their uptake of Pap smears. Data analysis involved three stages. The first stage involved the translation and transcription of all the interviews into English independently by two translators as well as transcription into Chinese by a third researcher. The second stage involved content analysis of the three data sets to develop categories and themes and the third stage involved a comparison of the categories and themes generated from the Chinese and English data sets. Despite no significant differences in the major categories generated from the Chinese and English data, some minor differences were identified in the themes generated from the data. More significantly the results of the study demonstrated some important issues to consider when using translation in qualitative research, in particular the complexity of managing data when no equivalent word exists in the target language and the influence of the grammatical style on the analysis. In addition the findings raise questions about the significance of the conceptual framework of the research design and sampling to the validity of the study. The importance of using only one translator to maximize the reliability of the study was also demonstrated. In addition the author suggests the findings demonstrate particular problems in using translation in phenomenological research designs.

Methodological issues in the evaluation of the quality of public health nursing: a case study of the maternal and child health centres in Hong Kong.

The demand for the evaluation of the quality of patient and client care has increased in public health nursing as in all disciplines of nursing. In Hong Kong this demand led to the development of a collaborative study with the Department of Health to evaluate the quality of public health nursing in the maternal and child health centres. A multiple case study design was developed to undertake the research using both qualitative and quantitative methods of data collection. The findings from the study demonstrated not only implications for clinical practice which have been reported elsewhere, but also methodological issues for the evaluation of care. These findings indicate three major issues for consideration. The first issue is that of the cultural context of care which includes perceptions of care such as demands on the service and expectations of care. The second issue is the use of health data, including both the methods of recordings as well as the sources of data. The final issue is that of the method of data collection, in particular the implications of the use of language in data collection tools. The findings suggest that both the use of professional language and the need for translation have implications for data collection methods. Indeed in the author's view the development of methodologies for the evaluation of care must address culturally specific issues, particularly where English is not the first language of subjects in the study. In addition the use the use of language in the method of data collection highlights more general issues raised by the use of translation in the collection and analysis of qualitative data.

PIP: In Hong Kong, the demand to evaluate the quality of patient and client care led to the development of a collaborative study with the Department of Health to evaluate the quality of public health nursing in maternal and child health centers. A multiple case study design was developed to conduct the research using both qualitative and quantitative methods of data collection. The study identified implications for clinical practice and methodological issues for the evaluation of care. These findings indicate the following issues for consideration: the cultural context of care, the use of health data, and the method of data collection. Both the use of professional language and the need for translation have implications for data collection methods. The development of methodologies for the evaluation of care must address culturally specific issues, especially where English is not the first language of subjects in the study.