Development of Artificial Intelligence-Teaching Assistant System for Undergraduate Nursing Students: A Field-Testing Study.

Keeping students engaged and motivated during online or class discussion may be challenging. Artificial intelligence has potential to facilitate active learning by enhancing student engagement, motivation, and learning outcomes. The purpose of this study was to develop, test usability of, and explore undergraduate nursing students' perceptions toward the Artificial Intelligence-Teaching Assistant System. The system was developed based on three main components: machine tutor intelligence, a graphical user interface, and a communication connector. They were included in the system to support contextual machine tutoring. A field-testing study design, a mixed-method approach, was utilized with questionnaires and focus group interview. Twenty-one undergraduate nursing students participated in this study, and they interacted with the system for 2 hours following the required activity checklist. The students completed the validated usability questionnaires and then participated in the focus group interview. Descriptive statistics were used to analyze quantitative data, and thematic analysis was used to analyze qualitative data from the focus group interviews. The results showed that the Artificial Intelligence-Teaching Assistant System was user-friendly. Four main themes emerged, namely, functionality, feasibility, artificial unintelligence, and suggested learning modality. However, Artificial Intelligence-Teaching Assistant System functions, user interface, and content can be improved before full implementation.

Living with COPD: understanding patient experiences through the lens of photovoice.

BACKGROUND: Conventional quantitative or qualitative methodologies may not encompass the wide array of experiences of individuals living with Chronic Obstructive Pulmonary Disease (COPD). We used a novel approach - photovoice-to understand the impact of COPD on activities of daily living (ADLs) in a multicultural Asian country. METHODS: We recruited a purposive sample of eight patients from the outpatient clinics of the National University Health System, Singapore, between December 2020 and August 2021. We adopted a photovoice approach for data collection; participants were invited to take photos of how ADLs were impacted by COPD and attend a follow-up interview. An Interpretative Phenomenological Analysis method was used to analyze the data. Data saturation was reached by the seventh patient. RESULTS: COPD and the resulting breathlessness had a profound and diverse impact on our participants' lives. Living with COPD required substantial changes to how everyday tasks are performed, and participants learnt new strategies to deal with such tasks. A mixture of active and passive coping styles was evident. Feelings of frustration, anxiety and a sense of isolation were also reported. Contextual factors impacting ADLs included challenging climatic conditions and the local popularity of traditional or alternative medicine. CONCLUSION: The photovoice technique improved our understanding of the lived experiences of COPD patients and can benefit those who struggle to articulate their views by offering a different way to communicate beyond conventional interviewing.

Nurses' perceptions about bereavement care in critical care units: A qualitative study.

AIM: To explore critical care nurses' perceptions of bereavement nursing care in critical care settings at a tertiary hospital in Singapore. BACKGROUND: Grief and bereavement are stressful life experiences associated with significant health problems. Critical care nurses play important roles in supporting bereaved family members, and their self-competence affects the quality of the care they deliver. Exploring critical care nurses' perceptions of bereavement nursing care is thus essential. METHODS: An exploratory descriptive qualitative study design was adopted. A total of 16 nurses were recruited. One-on-one interviews were conducted using a semi-structured interview guide and were audio-recorded. The data collected were analysed using thematic analysis. This study was reported according to the Consolidated Criteria for Reporting Qualitative Research checklist. FINDINGS: Five themes surfaced in the study, namely, family responses, holistic care, psychological impact, self-competence and organisational dynamics. CONCLUSION: This study highlighted the key roles of critical care nurses in providing bereavement care, how their self-competence impacts care delivery and the significant impacts of organisational policies on their capacity to provide care. IMPLICATIONS FOR NURSING AND NURSING POLICY: Nursing administrators should provide enhanced organisational support to critical care nurses who provide bereavement nursing care, and implement training work plans to ensure nurses are adequately prepared to provide culturally appropriate care. Strategies should be introduced to reduce administrative burden, expand the role of critical care nurses in providing bereavement nursing care, and establish and enlist role models as drivers of bereavement nursing care.

Continuing chronic care services during a pandemic: results of a mixed-method study.

BACKGROUND: Patients with chronic diseases have seen unprecedented changes to healthcare practices since the emergence of COVID-19. Traditional 'on-site' clinics have had to innovate to continue services. Whether these changes are acceptable to patients and are effective for care continuation are largely unreported. METHODS: We evaluated the effectiveness of care provision at a re-structured chronic care clinic and elicited the patient experiences of care and self-management. We conducted a convergent, parallel, mixed-methods study. Adult patients attending a chronic care clinic were included. We extracted data from 4,849 clinic visits before and during the COVID-19 pandemic, including operational metrics and attendee profile. We also conducted fifteen interviews with patients from the same clinic using a semi-structured interview guide. RESULTS: Re-structuring the chronic clinic, including the introduction of teleconsultations, home-delivery of prescriptions and use of community-based phlebotomy services, served to maintain continuity of care while adhering to COVID-19 containment measures. Qualitatively, five themes emerged. Patients were able to adjust to healthcare practice changes and adapt their own lifestyles, although poor self-management practices were adopted. While most were apprehensive about attending the clinic, they valued ongoing care access and were reassured by the on-site containment measures. CONCLUSIONS: Continuation of routine services is desired by patients and can be achieved through the adoption of containment measures, by greater collaboration with community partners, and the use of technology. Patients adapted to service changes, but poor self-management was evident. To prevent chronic disease relapse, services must strive to innovate rather than suspend services during pandemics.

Achieving healthy ageing through the perspective of sense of coherence among senior-only households: a qualitative study.

Objectives: Explore perceptions towards healthy ageing through the perspective of sense of coherence among older adults residing in senior-only households.Methods: A qualitative study using focus group interviews was conducted and appreciative inquiry was adopted as a strengths-based interviewing approach. 27 older adults who either live alone or with their spouses only were involved in six focus group discussions at a community centre in Singapore. Data saturation was achieved and thematic analysis was performed to analyse the data.Results: The four emerging themes were (1) contending evolving vulnerabilities, (2) intrinsic value of health, (3) taking care of oneself is a personal responsibility, and (4) taking one day at a time: outlook towards later part of life. Older adults' underlying pathogenic orientation towards health contributed to their perceived unpredictable confrontations with vicissitudes including illness and death. This played a part to their short outlook towards old age. Consequently, this could limit their will and abilities to seek meaningful pursuits or valued aspirations and movement towards the salutogenic health pole.Conclusion: By reframing the definition of health to pursuing and fulfilling valued accomplishments, optimal health can be achieved regardless of physical health state. This study suggested that sense of coherence towards the pursuit of healthy ageing can be addressed by reducing the unpredictability of ageing-related processes and vulnerabilities (comprehensibility), supporting active adoption of actions which promotes physical, mental and social health (manageability) and individual reflection in making sense of old age to seek motivation in living each day purposefully (meaningfulness).

Supporting the mobilization of health assets among older community dwellers residing in senior-only households in Singapore: a qualitative study.

BACKGROUND: Care activities provided by community health practitioners for older adults primarily focused on disease prevention and management. However, healthy longevity can go beyond disease prevention and management and promote greater well-being by tapping into the accrual of resources that older adults possess using the salutogenic approach. This study explored how health resources are used among older adults who are residing in senior-only households to promote and maintain health, with the intent of providing insights into how community health practitioners can support these older adults via asset-based strategies. METHODS: We adopted a descriptive qualitative study design using focus group discussions. Twenty-seven older adults who either lived alone or with their spouses were purposively sampled from an elderly populated residential estate in Singapore. Six focus group discussions, conducted from December 2016 to May 2017, were audio-recorded, transcribed, and analyzed using thematic analysis. RESULTS: The themes that emerged were 'tapping on internal self-care repository', 'maintaining and preserving informal social support', and 'enabling self by using environmental aids', and an eco-map of aging assets was used to capture an overview of internal and external resources. With the repository of personal strengths, knowledge, and experiences, these older adults were generally resourceful in navigating around their resource-rich environments to cope with everyday life stressors and promote health. However, they were occasionally limited by individual factors that affected their comprehension, access, maintenance, and utilization of resources. CONCLUSION: The eco-map of aging assets can be used as an assessment framework by community health practitioners to recognize, consider, and build a repertoire of resources among these older adults. It serves as a gentle reminder to adopt an ecological approach in considering and tapping into older adults' wide-ranging personal, social, and environmental resources. Community health practitioners can support resource integration as resource facilitators via cognitive, behavioral, and motivational salutogenic pathways to overcome resource mobilization barriers faced by older adults. Such an approach helps older adults to find their internal capabilities and abilities to know who, where, what, and how to seek external resources to identify solutions, creating the intrinsic value to sustain their actions on resource utility.

Missed nursing care in patient education: A qualitative study of different levels of nurses' perspectives.

AIM: To explore the different levels of nurses' perspectives in the delivery of patient education in postoperative care. BACKGROUND: Patient education is a frequently reported missed nursing care and can lead to postoperative complications and hospital readmissions. METHODS: Descriptive exploratory qualitative study involving eight focus groups with 35 nurses was conducted in an acute hospital. Interviews were audio-recorded and transcribed verbatim. Data were thematically analysed. RESULTS: The analysis yielded three themes: 'Role ambiguity' between the levels of nurses concerning their roles in patient education; 'Not a priority nursing care' for patient education due to competing work demands and the missing workplace culture to teach; and 'Informal teaching' carried out conversationally during nursing care activities. CONCLUSION: This study augments the need to develop strategies, including informal teaching, to strengthen the delivery of patient education to avert missed nursing care. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers and educators are instrumental in establishing role clarity between ward nurses and specialty care nurses for patient education, recognizing patient education as the next nurse-sensitive indicator in reflecting quality of care, fostering positive workplace cultures to teach and providing ward nurses with trainings on communication strategies to provide effective informal teaching at bedside.

Effect of a mHealth programme on coronary heart disease prevention among working population in Singapore: A single group pretest-post-test design.

AIM: The aim of this study was to develop and examine the effectiveness of a 4-week Mobile Health (mHealth) programme using the smartphone app Care4Heart on awareness, knowledge, perceived stress, and a heart-related lifestyle among working population in Singapore. DESIGN: A quasi-experimental single group pretest and repeated post-test design. METHODS: A total of 160 nonhealth-related working adults were recruited from February 2016-April 2016. The Care4Heart app was installed on the participants' phones. Outcome measures, including the Heart Disease Fact Questionnaire-2, the Behavioral Risk Factor Surveillance System, and the Perceived Stress Scale were collected online at baseline, 4th week, and 6th month from baseline. RESULTS: Compared with the baseline, the participants had significantly higher total mean scores for awareness and knowledge of coronary heart disease (CHD) after study intervention at 4 weeks and 6 months from baseline. However, there were no significant differences in perceived stress levels and heart-related lifestyle behaviours before and after the intervention. CONCLUSIONS: The study contributed some evidence that the mHealth app helped to improve awareness and knowledge of CHD. IMPACT: Coronary heart disease remains one of the major causes of death and disability. It imposes a heavy financial burden on working adults. However, working adults were less able to identify the risk factors and adopt healthy lifestyles due to gaps in knowledge and awareness. This study demonstrated some effects of a mHealth programme in improving awareness and knowledge of CHD among the working population. mHealth provides a potential avenue for primary prevention of CHD.

The Development of a Diabetes Application for Patients With Poorly Controlled Type 2 Diabetes Mellitus.

The prevalence of patients with diabetes mellitus has increased in recent years. This has resulted in increased demand for face-to-face diabetes education by diabetes nurse clinicians. The use of mobile-health technologies in diabetes education is an innovative way of learning and has the potential to engage patients and influence positive health behaviors, including meeting desired goals and diabetes-related outcomes. The aim of the study was to develop and test the usability and feasibility of an empirical diabetes application for patients with type 2 diabetes mellitus. The mobile-based, gamified Diabetes Application was developed based on a full systems development life-cycle framework. Eight patients with poorly controlled type 2 diabetes mellitus completed a pilot study that consisted of a postapplication survey to assess the usability and feasibility of the diabetes application. The findings affirmed the usefulness and feasibility of the diabetes application for patients with diabetes mellitus. It increased awareness, enriched knowledge, promoted user engagement, motivated positive behaviors, and affirmed patient belief in diabetes self-management. This article discusses the development and evaluation of the diabetes application, including modifications made based on the results of the pilot study.

A review on healthy ageing interventions addressing physical, mental and social health of independent community-dwelling older adults.

Healthy ageing is a multi-dimensional concept which appertains to all older adults. This study reviewed the intervention characteristics, intervention content and effectiveness of multi-dimensional healthy ageing interventions (MHAIs) addressing physical, mental and social health among independent community-dwelling older adults. A search was conducted in PubMed, CINAHL, Embase, Scopus, and PsycINFO for studies published from Jan 2007 to October 2016. 18 publications were included, accounting for 15 studies. The review reflected the complexity, variations and methodological considerations of developing a comprehensive MHAI. It demonstrated the possibility of integrating person-focused to environment-focused content topics in future MHAIs, beyond the physical, mental and social health dimensions. Among the reviewed studies, health education programs reported improvements in quality of life and life satisfaction while health assessment and education programs promoted positive health behaviors. Future MHAIs studies need to employ more robust research methods and greater contextual information reports to build stronger evidence base.

The Impact of Nurses' Uniforms on Nurse-Patient Interactions: Patients' Perspectives.

OBJECTIVES: The aim of this study was to explore patients' perceptions toward the nursing uniforms used in a hospital in Singapore and how different uniforms impact nurse-patient interactions. BACKGROUND: Nursing uniforms act as a form of nonverbal communication. However, implications of the increasing variety of nursing uniforms on patients' perceptions of nurses and nurse-patient interactions are unexplored. METHODS: An exploratory qualitative study design using semistructured interviews was adopted for the study. Twenty-one patients agreed to be interviewed. An audio recorder was used during data collection. The thematic analysis method was used for data analysis. RESULTS: Four major themes were identified: identity, subjectivity, suitability, and inconsequential. Nurses' uniform was regarded as a representation of identity. Suitability of the uniform for nurses was a main concern for patients. However, nurses' uniforms were inconsequential to nurse-patient interactions. CONCLUSION: Patients' perceptions of nurses' uniforms were highly subjective and have no substantial impact on nurse-patient interactions.

Salutogenic Healthy Ageing Programme Embracement (SHAPE) for senior-only households: A study protocol.

AIMS: To evaluate the effectiveness of a multi-dimensional community-based health promotion and risk prevention programme, named Salutogenic Healthy Ageing Programme Embracement (SHAPE) for senior-only households in Singapore. BACKGROUND: In view of ageing population and its significant impacts on economy, societal structure and policy-making, healthy ageing emerges as an important concept in maintaining health through the engagement of health-promoting behaviour and risk prevention actions in older people. DESIGN: A stratified randomized control trial with process evaluation is proposed. METHODOLOGY: The salutogenic model, which focuses on positive well-being and optimizing health outcomes, provides an underpinning theoretical framework for this study. SHAPE is a 12-week intervention programme comprising of both weekly group-based activity sessions and home visits. One hundred and fifty-four eligible participants will be stratified and randomly allocated to either the SHAPE intervention or the control group. Both outcome and process evaluation will be conducted. Outcome measures include sense of coherence, quality of life, health-promoting behaviours, self-efficacy and other health-related outcomes. These data will be collected at four time points: baseline, 3 months, 6 months and 12 months. Individual qualitative face-to-face interviews will be conducted for older people receiving SHAPE to explore their views on the programme. DISCUSSION: The use of salutogenic model breaks away from the negatively connoted conventional biomedical model and addresses optimization of positive health, providing an overall holistic approach to care of older people. The intervention SHAPE seeks to identify, equip and strengthen resources for senior-only households, encouraging the adaption of health-promoting and risk-preventing actions to achieve better health outcomes and higher quality of life.

Expectations and experiences of patients with osteoarthritis undergoing total joint arthroplasty: An integrative review.

BACKGROUND: The effectiveness of educational interventions for osteoarthritic patients undergoing total joint arthroplasty remains inconclusive. It is essential to understand the educational needs of these patients from their perspectives. AIM: The aim of this study was to systematically summarize and synthesize osteoarthritic patients' expectations and experiences in undergoing total joint arthroplasty to identify their educational needs. DESIGN: An integrative review was conducted. METHODS: Twenty studies (13 qualitative and 7 quantitative), published between 2006 and 2016, were independently appraised by 2 reviewers using the Critical Appraisal Skills Programme checklist for qualitative studies and the Joanna Briggs Institute Critical Appraisal Tools for quantitative studies. Data were analysed using thematic analysis, and the findings were synthesized in a narrative summary. RESULTS: Six themes describing patients' preoperative and post-operative educational needs were identified: (1) preoperative anxiety, (2) unrealistic expectations of recovery, (3) post-operative pain, (4) regaining functional abilities, (5) physical and psychological sense of loss, and (6) lack of continuity of care. CONCLUSION: This review is the first to capture the osteoarthritic patients' educational needs from their perspectives. The biopsychosocial model can address the multidimensionality (biological, psychological, and social) of patients' educational needs. A robust infrastructure supporting interprofessional collaborative practice and continuity of care should be adopted to enhance current educational efforts.

Development of an e-Learning Research Module Using Multimedia Instruction Approach.

Students nowadays feel more comfortable with new technologies, which increase their motivation and, as a result, improve their academic performance. In the last two decades, the use of information communication technology has been increasing in many disciplines in higher education. Online learning or e-learning has been used and integrated into the curriculum around the world. A team of nursing faculty and educational technology specialists have developed an e-learning research module and integrate it into the nursing curriculum. The aim was to assist master of nursing and postgraduate nursing students in developing their research knowledge before and throughout their enrollment in the research course. This e-learning module includes interactive multimedia such as audiovisual presentation, graphical theme, animation, case-based learning, and pretest and posttest for each topic area. The module focuses on three main topic areas: (1) basic research principles (for review), (2) quantitative method, and (3) qualitative method. The e-learning module is an innovative use of the information and communication technology to enhance student engagement and learning outcomes in a local context. This article discusses the development journey, piloting process, including the variety of evaluation perspectives, and the ways in which the results influenced the e-learning resource before its wider distribution.

Narrative review of health-related quality of life and its predictors among patients with coronary heart disease.

This paper summarizes the empirical evidence concerning health-related quality of life (HRQoL) of patients with coronary heart disease (CHD) and attempts to identify its significant predictors. A systematic search of the literature from 2002 to 2012 was conducted using seven electronic databases (CINAHL, ScienceDirect, Medline, Scopus, PsycINFO, PubMed and Web of Science) using the search terms 'HRQoL'. 'CHD', 'social support', 'depression', 'anxiety', 'psychosocial factors', 'sociodemographic factors', 'clinical factors' and 'predictors'. A total of 1052 studies were retrieved, of which 24 articles were included in this review. Previous studies have consistently demonstrated the negative impact of CHD on HRQoL, citing three major types of predictive factors: sociodemographic, clinical and psychosocial factors. Studies have also highlighted the advantageous use of HRQoL as a gauge for treatment satisfaction and efficacy. There are, however, few studies that collectively investigate the relationship among concepts such as HRQoL, anxiety and depression, social support, and sociodemographic and clinical factors in relation to CHD. This review highlights the need to conduct further study on HRQoL of patients with CHD in the Asian context. Such research will promote patient-centric care and improved patient satisfaction through incorporation of the concept of HRQoL into clinical practice.

Stressors and expectations of undergraduate nursing students during clinical practice in Singapore.

Nursing students have experienced stress because they need to focus on academic performance while being exposed to a clinical environment. The study aimed to identify the contributing factors of stress and the clinical environment expectations of undergraduate nursing students during their clinical practice at a university in Singapore. A cross-sectional descriptive study design using validated surveys was adopted. The Stressors in Nursing Students and the Clinical Learning Environment Inventory questionnaires were used to collect the data in January 2014. A total of 285 nursing students participated in this study. The results showed that third year nursing students had higher stress levels than first year and second year students. Satisfaction in terms of fulfilment among nursing students during clinical practice was found to be the most influential factor in predicting stress. The study suggests that the nursing faculty needs to be more concerned about nursing students' stress level and provide more support to third year students. In addition, students' satisfaction should be considered when developing a clinical curriculum.

Observation of handover process in an intensive care unit (ICU): barriers and quality improvement strategy.

OBJECTIVE: To describe the characteristics and barriers in the handover process in a medical intensive care unit. DESIGN: A cross-sectional descriptive study using a checklist to observe nurses and doctors during handover of patients in and out of the intensive care unit. SETTING: The study was conducted at a 1000-bed tertiary hospital in Singapore. The unit admits all patients under university medicine clusters, except those needing cardiology services. PARTICIPANTS: Handover between 90 pairs (180 participants)-50 nurse-to-nurse (100 nurses) and 40 doctor-to-doctor (80 doctors)--were passively observed in real time during morning and evening shifts over weekdays. MAIN OUTCOME MEASURES: The number and types of distractions and their relationship to the time spent during handover, the information included during handover, and the number of working shifts. RESULTS: The results showed that there were 1.26 (± 1.75) distractions per handover. In 45 (50%) handovers, no distraction occurred. The human factor was the most common distracting factor during handovers, whereas short message service and monitor alarms were not identified as distracting factors. The information included least often was 'do not resuscitate' (DNR). Nurses spent significantly longer during handovers than doctors. CONCLUSION: The findings provide information for improving the handover process during the transfer of patients in and out of the intensive care unit. Distractions during handovers are common and are associated with longer durations. Nurses and doctors rarely address DNR status during handover of ICU patients in this study.

Improving awareness, knowledge and heart-related lifestyle of coronary heart disease among working population through a mHealth programme: study protocol.

AIM: To develop a mHealth programme, entitled 'Care4Heart' for the working population in Singapore and thereafter examine its feasibility and effectiveness in increasing the awareness and knowledge of coronary heart disease and improving their heart-related lifestyle. BACKGROUND: Teaching and encouraging the working population to adopt a healthier lifestyle could result in preventing and/or decreasing the incidence of coronary heart disease among this population. The use of mobile application (app) is the next logical wave of healthcare support tools to prevent and manage chronic diseases like coronary heart disease. DESIGN: A quasi-experimental longitudinal study design. METHODS: The study will be conducted in a tertiary university in Singapore. A non-probability, quota sampling of 200 participants will be recruited including 100 academic and research staff, 50 administrative staff and 50 support staff and business owners. Once consent is obtained, the newly developed mobile app will be installed onto the participants' smartphones and a well-trained research assistant will brief the participant on the use of the app. The main outcomes will be measured using the survey questionnaires: Awareness of coronary heart disease, Heart Disease Fact Questionnaire-2, Behavioural Risk Factor Surveillance System and Perceived Stress Scale. Data will be collected at baseline and at the 4th week and 6th month thereafter. DISCUSSION: If this project is successful, Care4Heart - a mHealth and novel prevention educational programme for the working population in Singapore - can be used to promote knowledge and positive heart-related lifestyle changes to prevent coronary heart disease.

Differences in the handover process and perception between nurses and residents in a critical care setting.

AIMS AND OBJECTIVES: To identify the differences in practices and perceptions of handovers between nurses and residents in the critical care setting, so as to improve the quality of the process. BACKGROUND: Critically ill patients with complex problems are ideal for the study of handovers. However, few handover studies have been conducted in intensive care units. DESIGN: Descriptive study using questionnaires. METHODS: We interviewed all nurses and residents involved in handovers of patients admitted to and discharged from a medical intensive care unit over a period of one month. Interviews were guided by a questionnaire and conducted between 24-48 hours of handovers. RESULTS: Out of 672 eligible participants, 580 (290 nurses and 290 residents) agreed to participate in the study (86·3% response rate). Compared to residents, nurses received more training on handovers, covered issues specific to allied health specialties more frequently during handovers, and reviewed patients earlier after handovers. The perceived importance of the different components of handover varied significantly: donor residents, donor nurses, recipient residents and recipient nurses emphasised the overall management plan, case complexity, management plan over the next 48 hours and past medical history, including allergies, respectively. Satisfaction in the handover was related to pre-handover review of electronic medical records, handover training and clarity level in the management plan following the handover, with only the last factor remaining significant on multivariate analysis. CONCLUSIONS: More nurses than residents received prior training in handovers. Nursing handovers were more inclusive of allied health specialties. The perceived importance of the components of handover varied. Greater clarity in management plans was associated with better satisfaction. RELEVANCE TO CLINICAL PRACTICE: Deficiencies in the handover process (lack of prior training in handovers, not including allied health specialties and not reviewing electronic records before handover) were identified, thus providing opportunities for mutual learning between nurses and residents.

Health-related quality of life and its predictors among outpatients with coronary heart disease in Singapore.

AIMS AND BACKGROUND: Coronary heart disease (CHD) is a major cause of death and disability and negatively impacts on patients' health-related quality of life (HRQoL). This study aimed to explore HRQoL and identify its predictors among outpatients with CHD in Singapore. METHODS: A correlational study was conducted with a convenience sample of 106 outpatients with CHD recruited from a public hospital. HRQoL outcomes were measured using the Short Form-12 Health Survey (SF-12), Medical Outcomes Study Social Support Survey (MOS-SSS) and Hospital Anxiety and Depression Scale (HADS). RESULTS: Patients reported a generally high level of HRQoL as assessed by SF-12. Those aged over 65years reported significantly higher mental health and those who were married had higher levels of education or income reported significantly higher physical health. There were significant negative correlations between physical and mental health and anxiety and depression (p<.05). Perceived social support was negatively correlated with anxiety and depression and positively correlated with mental health. Education level and depression significantly predicted physical health, while age, anxiety and depression predicted mental health. CONCLUSION: Anxiety, depression, age and education are significant predictors of HRQoL in this patient population and should be assessed routinely and, where appropriate, addressed through individually-tailored interventions.