The effectiveness of a psychoeducational intervention on health outcomes of patients undergoing haemodialysis: A randomized controlled trial.

AIM: The aim of this work is to examine the effectiveness of a psychoeducational intervention on self-efficacy (primary outcome), anxiety, depression, treatment adherence, and health-related quality of life (HRQoL) of patients undergoing haemodialysis. METHODS: A two-group randomized controlled trial of 124 patients (65 and 59 patients in the intervention and control groups, respectively) recruited from a tertiary hospital in Singapore was conducted. Data were collected from January 2015 to June 2016. Outcomes were measured at baseline and 1, 3, and 6 months after the intervention. General linear model was used to analyse data. RESULTS: Our findings showed significant group effect on HRQoL (effects of kidney disease on daily life; p = 0.041), time effect on all outcomes (p < 0.05; except for treatment adherence behaviours and HRQoL [burden of kidney disease]), and group * time interaction effect on anxiety (p = 0.040) and depression (p = 0.003), with the intervention group reporting better outcomes. CONCLUSIONS: The positive effects of our intervention on patients' self-efficacy, psychological well-being, treatment adherence attitudes, and HRQoL implied its potential use in dialysis/renal centres to improve patients' self-care and health outcomes.

Effects of postoperative pain management educational interventions on the outcomes of parents and their children who underwent an inpatient elective surgery: A randomized controlled trial.

AIM: To examine the effects of a postoperative pain management educational intervention on the outcomes of parents and their children who underwent inpatient elective surgery. BACKGROUND: Equipping parents with knowledge and skills to manage their children's postoperative pains is essential. Very limited studies have examined the effects of educational interventions on parents' knowledge, attitudes and use of pharmacological and non-pharmacological pain relief methods. DESIGN: Three-group pre- and post-test randomized controlled trial. METHODS: Parent-child pairs (N = 152) were recruited from September 2013-January 2015 and randomly assigned to either the control group or one of the two intervention groups. Valid and reliable instruments and diary entries were used to collect data at the baseline, 6, 12 and 24 hr and 2 weeks after the surgery. IBM SPSS 23.0 was used to analyse the data. RESULTS: Parents reported moderate levels of knowledge, attitudes, pain relief methods used and children's postoperative pain. Except for parents' knowledge, types and frequencies of non-pharmacological methods used, there were no statistically significant differences among the three groups in parents' attitudes on pain management and pain medication, their uses of pain relief strategies (questionnaire data), satisfaction with postoperative pain management and children's worst postoperative pain in 2 weeks after surgery. CONCLUSION: Education seemed effective in improving parents' knowledge and use of non-pharmacological methods, but not attitudes, satisfaction with pain management and children's postoperative pain. Future studies are needed to develop modern digitalized ways for educating and supporting parents to optimize their children's postoperative pain management. TRIAL REGISTRATION: This study has been registered with BioMed Central Ltd. (Registration No.: ISRCTN24910957).

A randomized controlled trial of the effectiveness of a postnatal psychoeducation programme on outcomes of primiparas: study protocol.

AIM: To report a trial protocol that evaluates the effectiveness of postnatal psychoeducation programme in improving maternal parental self-efficacy and social support and in reducing postnatal depression among primiparas. BACKGROUND: Primiparas encounter physical, psychosocial and newborn care challenges in the early postnatal period. However, primiparas do not receive adequate professional support after early discharge from hospitals, thus hindering their adaptation to new role as mothers and smooth transition to motherhood. Postnatal psychoeducation programmes have been shown to be effective in improving pregnant women's health. However, there is a lack of theory-based, postnatal psychoeducation interventions for primiparas. DESIGN: A randomized controlled trial of two-group pretest and repeated posttests is proposed. METHODS: The study will recruit a minimum of 114 primiparas on the day of discharge from a Singaporean public hospital (protocol approved in May 2012). Eligible participants will be randomly allocated to either a control group (receiving routine care) or an experimental group (receiving a postnatal psychoeducation programme besides routine care). Outcome measures include maternal parental self-efficacy, social support and postnatal depression. Data will be collected at baseline (on the day of discharge), 6 and 12 weeks postpartum. DISCUSSION: This will be the first study of its kind that will use rigorous study design to evaluate a theory-based innovative postnatal psychoeducation programme on maternal outcomes. The study may identify a potentially effective way of enhancing primiparas' self-efficacy and social support, which may in turn reduce their risk of postnatal depression. The Sigma Theta Tau International Upsilon Eta Chapter funded this study.

A randomized controlled trial of the effectiveness of an educational intervention on outcomes of parents and their children undergoing inpatient elective surgery: study protocol.

AIM: To report a study protocol that tests the effectiveness of an educational intervention on outcomes of parents and their children who undergo inpatient elective surgery. BACKGROUND: Inadequate children's postoperative pain management remains a global problem. Parents are required to be involved in their child's pain assessment and management, yet they often lack relevant knowledge and skills. Education is an effective strategy for enhancing a person's knowledge, attitudes and behaviour. However, few studies have examined its effectiveness in parents and their children undergoing inpatient elective surgery. DESIGN: Randomized controlled trial and embedded qualitative process evaluation. METHODS: One hundred and sixty-two pairs of participants (each comprised of one parent and his/her child undergoing inpatient elective surgery) will be recruited (protocol approved in January 2013). Participants will be randomized to either a Control group (routine care), an Intervention group 1 (routine care and an educational intervention with face-to-face teaching), or an Intervention group 2 (routine care and an educational intervention without face-to-face teaching). Outcome measures will include parents' knowledge, attitude and behaviour related to postoperative pain management; their child's postoperative pain; and parents' satisfaction with their child's pain management at baseline and around 6, 12 and 24 hours after the operation. DISCUSSION: A standardized educational intervention protocol and detailed study procedure have been developed in this study to improve parents' knowledge, attitude and behaviour related to postoperative pain management and reduce their child's postoperative pain.

A mixed-method study of effects of a therapeutic play intervention for children on parental anxiety and parents' perceptions of the intervention.

AIM: To examine the effects of a therapeutic play intervention for children on parents' perioperative anxiety, the relationship between parents' and their children's anxiety and to explore parents' perceptions of the intervention. BACKGROUND: Therapeutic play intervention was found to reduce children's perioperative anxiety. Little is known about how such an intervention for children affects their parents' anxiety. DESIGN: A mixed method of randomized controlled trial with qualitative process evaluation was used. METHODS: Ninety-five pairs of parents and children were recruited between November 2011-August 2013 and randomized into a control or an intervention group. The State Anxiety Scale for Children and the State Anxiety Scale for Adults were used to measure children's and parents' anxiety, respectively, at baseline, on surgery day and around 24 hours after surgery. Parents were interviewed about their perceptions of the intervention. Data were analysed using SPSS version 22·0 and thematic analysis. RESULTS: There was no difference in parents' anxiety after participating with their child in the intervention compared with usual care. There were significantly positive relationships between parents' and their children's baseline anxiety and parents' postoperative anxiety and their children's pre-operative anxiety. Four themes were identified: reducing anxiety, increasing knowledge and understanding about anaesthetic procedure, the worthiness of attending the intervention and suggestions for improvement of the intervention. CONCLUSIONS: Therapeutic play intervention had no significant effect on parents' perioperative anxiety. Parents' and their children's perioperative anxiety are correlated. Parents perceived the intervention as helpful preparation for themselves and for their children undergoing elective surgery.

Perioperative anxiety and postoperative pain in children and adolescents undergoing elective surgical procedures: a quantitative systematic review.

AIMS: To examine the relationship between perioperative anxiety and postoperative pain in children and adolescents undergoing elective surgical procedures and the differences in children's perioperative anxiety and postoperative pain among subgroups of demographics. BACKGROUND: While anxiety and pain are regarded as two common problems experienced by children and adolescents perioperatively and the relationship between them has been reported in previous studies, there has been no review paper examining this phenomenon. DESIGN: A quantitative systematic review. DATA SOURCES: Nine electronic databases were searched for studies published in English from the inception date of the databases to December 2010, using various combinations of search terms of 'adolescents', 'anxiety', 'child', 'pain', 'surgery' and 'correlation/relationship'. REVIEW METHODS: Using the Joanna Briggs Institute's comprehensive systematic review strategies, relevant studies were independently appraised and extracted by two reviewers using the standardized critical appraisal instruments and data extraction tool from Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument. RESULTS: Ten studies were included in this review from 943 studies initially retrieved. Children and adolescents who had higher level of perioperative anxiety experienced a higher level of postoperative pain. Inconclusive evidence was found regarding differences of perioperative anxiety and postoperative pain between demographic subgroups of gender, age and past surgical experience. CONCLUSION: Results of this review inform healthcare providers of the role perioperative anxiety plays on children's and adolescents' postoperative pain and indicate the need to use interventions to reduce perioperative anxiety and, therefore, optimize their postoperative pain management during the perioperative period.

Web-based versus home-based postnatal psychoeducational interventions for first-time mothers: A randomised controlled trial.

BACKGROUND: Besides physical and mental changes from childbirth, first-time mothers are also confronted with challenges associated with the demands of adapting to their roles as new parents. While positive effects of home-based psychoeducation intervention for mothers have been demonstrated, limited studies have developed and examined more accessible and cost-effective web-based psychoeducational interventions for mothers. OBJECTIVE: To examine the effectiveness of web-based and home-based postnatal psychoeducational interventions for first-time mothers during the early postpartum period. METHODS: A randomized controlled three-group pre-test and post-tests experimental design was adopted. Data were collected over five months, from October 2016 to August 2017, in a public tertiary hospital in Singapore from 204 primiparas who were randomly allocated to the web-based psychoeducation group, the home-based psychoeducation group, or the control group. The measured outcomes included maternal parental self-efficacy, social support, psychological well-being, satisfaction with postnatal care, and cost-effectiveness evaluation. Data were collected at four time points: the baseline, and three post-tests at one month, three and six months post-delivery. RESULTS: When compared to the control group, the web-based intervention improved self-efficacy at post-test 1 (mean difference = 2.68, p = 0.028) and reduced postnatal depression at post-test 3 (mean difference = -1.82, p = 0.044), while the home-based intervention did not show significant effect on these two outcomes at all post-tests. Both web-based and home-based interventions helped mothers to get better social support at all post-tests than those in the control group. Mothers in both web-based and home-based intervention groups were more satisfied with the postnatal care than those in the control group at all post-test time points (except for web-based group at post-test 1). There were no differences in anxiety scores among the three groups. When compared to the home-based intervention, the web-based intervention showed noninferior effect on all outcomes at all post-tests. CONCLUSION: The web-based intervention had better effects on improving self-efficacy, social support, and postnatal depression, which should be introduced to first-time mothers for better postnatal care.

Experiences of Patients With Rheumatoid Arthritis: A Qualitative Study.

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that greatly impacts one's physical and psychosocial well-being. The purpose of this study was to explore the experiences and support needs of adult patients living with RA. A descriptive qualitative study was conducted, and 16 adults with RA were interviewed from October 2013 to January 2014. The transcribed data were analyzed using thematic analysis. Five themes were identified: altered physical capacity and well-being, psychological and emotional challenges, changes in social life, coping strategies, and support received and further support needs. This study provided insights into the experiences and support needs of patients with RA in Singapore. Physical and psychosocial challenges experienced by patients affected their daily and social activities. Patients' needs for variety of support should be addressed.

Predictors of breast feeding self-efficacy among Chinese mothers: a cross-sectional questionnaire survey.

OBJECTIVES: to examine breast feeding self-efficacy and identify its predictors among expectant Chinese mothers in the antenatal period. DESIGN AND SETTING: a cross-sectional descriptive questionnaire survey was conducted in the antenatal clinics of three university hospitals in China between September and December 2011. PARTICIPANTS: expectant mothers planning to breast feed, and who were at least 18 years of age, expecting a single, healthy, full-term baby, and competent in Mandarin (n=201). MEASUREMENTS: a socio-demographic data sheet, the Chinese version of the Breastfeeding Self-Efficacy Scale, and the Perceived Social Support Scale. FINDINGS: the expectant Chinese mothers reported moderate levels of breast feeding self-efficacy. Expectant mothers who had had previous experience in breast feeding, who had watched other mothers breast feed their infants, or who had made the decision to breast feed earlier reported higher breast feeding self-efficacy. Expectant mothers' perceived social support, perceived attitude of significant others, including husband, mothers, and friends, towards breast feeding are correlated with breast feeding self-efficacy. The best-fit regression analysis revealed five variables that explained 34% of the variance in breast feeding self-efficacy in the antenatal period: perceived social support, previous experience of breast feeding, previous experience of watching others breast feed, timing of maternal decision to breast feed, and perceived husband's attitude towards breast feeding. CONCLUSIONS: this study highlighted the importance of improving Chinese mothers' breast feeding self-efficacy by considering the main predictors found in this study. IMPLICATIONS FOR PRACTICE: health care professionals could develop strategies to promote breast feeding self-efficacy, such as providing opportunities for expectant mothers to learn from others' successful experience, adopt a family-centred approach in the provision of breast feeding education, provide breast feeding education at the beginning of pregnancy or even earlier, and rally comprehensive social support for expectant mothers.

Effectiveness of a patient education intervention in enhancing the self-efficacy of hospitalized patients to recognize and report acute deteriorating conditions.

OBJECTIVE: To develop and pilot test the effectiveness of a patient education intervention in enhancing the self-efficacy of hospitalized patients to recognize and report symptoms of acute deteriorating conditions. METHOD: Using cluster randomization, acute care general wards were randomized to the experimental and control groups. 34 patients in the experimental group received a 30-minute patient education intervention on Alert Worsening conditions And Report Early (AWARE) while 33 patients in the control group received the routine care only. Levels of self-efficacy to recognize and report symptoms were measured before and after the intervention. RESULTS: The level of self-efficacy reported by the experimental group was significantly higher than the control group (p<0.0001). CONCLUSION: The AWARE intervention was effective in enhancing the self-efficacy of hospitalized patients to recognize and report acute deteriorating conditions. PRACTICAL IMPLICATIONS: Patient engagement through patient education could be included in the rapid response system which aims to reduce hospital mortality and cardiac arrest rates in the general wards.

Postnatal experiences and support needs of first-time mothers in Singapore: a descriptive qualitative study.

OBJECTIVES: to explore first-time mothers' postnatal experiences and support needs after hospital discharge in Singapore. DESIGN AND SETTING: a descriptive qualitative study was adopted in this study. Participants were recruited from a public tertiary hospital in Singapore. Semi-structured interviews were used for data collection and the interview transcripts were analysed using thematic analysis. PARTICIPANTS: a purposive sample of 13 English-speaking first-time mothers of age 21 years and above were interviewed within 7-11 days after their hospital discharge. FINDINGS: five themes emerged from the thematic analysis: (1) mixed emotions: participants experienced anxiety, labile emotions and stress over infant care; (2) breast feeding concerns: low breast milk supply and physical discomfort; (3) social support: many participants had sufficient social support from family members except their husbands; (4) cultural postnatal practice: majority of participants followed traditional postnatal practices of their culture; and (5) professional support needs: participants needed more information, access to health care services and continuity of care. CONCLUSIONS: this study highlighted the importance of providing professional postnatal care to first-time mothers after their discharge from the hospital. Future studies are needed to explore new practices that will enhance the quality of maternity health care and promote positive maternal experiences and well-being in Singapore. IMPLICATIONS FOR PRACTICE: there is a need for more innovative advertisement to promote antenatal classes and improve attendance rate. Health care providers should assist women in establishing proper breast feeding techniques. Alternative models of care in the postnatal period, such as midwifery-led care, could facilitate a more woman-centred approach. Postnatal home visits may be considered within the first week of the mothers' hospital discharge, which may be legislated by public health care policies.

Exploring influencing factors of postoperative pain in school-age children undergoing elective surgery.

PURPOSE: The purpose of this study was to examine the influencing factors of postoperative pain among children undergoing elective surgery. DESIGN AND METHODS: A survey was conducted in 2011 with a convenience sample of 66 children, 6 to 14 years old, in a tertiary hospital in Singapore. RESULTS: Children experienced moderate preoperative anxiety and postoperative pain. Gender, preoperative anxiety, and negative emotional behaviors were significant influencing factors for postoperative pain. Boys reported less postoperative pain than girls. PRACTICE IMPLICATIONS: Effective strategies for assessing and managing children's preoperative anxiety are needed to achieve an optimal postoperative pain management outcome.