Preferences for end-of-life care and decision-making among Chinese community-dwelling older adults: A comparative cross-sectional study in Hong Kong and Wuhan in China.

This study aimed to describe and compare end-of-life care and decision-making preferences among Chinese community-dwelling older adults between Wuhan and Hong Kong in China. The study adopted a cross-sectional correlation design and recruited a convenience sample of 259 older adults, aged ≥65 years old from five community centers in Wuhan and Hong Kong. Participants completed a validated structured questionnaire that measured their end-of-life care and decision-making preferences. Multivariate logistic regression analyses were conducted. Results showed that Wuhan participants were significantly more likely to view "trying every means to extend the life span" as very important/important; and they perceived "support from religious personnel" as unimportant/very unimportant. Different from those older adults in Hong Kong, the Wuhan participants significantly chose their home as the preferred place for end-of-life care and death. They also tended to prefer family members to enact the decision-maker role in end-of-life decision situations. The study suggests older adults in Hong Kong and Wuhan have some differences in preferences for end-of-life care and decision-making, which provides the basis for future development of culturally relevant community-based end-of-life care.

Decision-making preferences on end-of-life care for older people: Exploration and comparison of Japan, the Hong Kong SAR and South Korea in East Asia.

AIMS AND OBJECTIVES: The aim of this study was to examine and compare decision-making preferences on end-of-life care for older people in Japan, the Hong Kong SAR and South Korea. BACKGROUND: Cultural values and beliefs influence decision-making on end-of-life care. DESIGN: A cross-sectional design was adopted. METHODS: Community-dwelling people aged ≥65 with additional requirements were recruited in 2016-2017 in the three regions. Their decision-making preferences on end-of-life care were assessed using Pang et al.'s questionnaire. These preferences and their sociodemographic and personal experience variables were compared and analysed using univariate and multiple logistic regressions. The STROBE checklist was followed. RESULTS: This study involved 415 participants. In all three regions, the most preferred decision maker and person with whom to discuss end-of-life care issues was a family member. Participants in the Hong Kong SAR were less likely to select a family member as their preferred decision maker than those in Japan (adjusted odds ratio = 0.129). Koreans were less likely to discuss end-of-life care issues with medical professionals than people in Japan (adjusted odds ratio = 0.278). More than 70% of the participants in each region indicated that they would not prefer to leave an advance directive to decide their end-of-life care. CONCLUSION: Older Asians prefer to make their own decisions after consulting others. Family members play an important role in helping older people plan their preferred end-of-life care arrangements, even acting as decision makers when older people become incapable of deciding for themselves. RELEVANCE TO CLINICAL PRACTICE: Sufficient information should be provided to older people and their families for the older people to determine their preferred care. Helping families to understand and support the planned care and advance directives is a strategy for maximising family compliance with the care. Continuous efforts should be made to promote advance care planning and advance directives.

Associations between demographic characteristics, perceived threat, perceived stress, coping responses and adherence to COVID-19 prevention measures among Chinese healthcare students.

AIM: To investigate the associations between demographic characteristics, perceived threat, perceived stress, coping responses and adherence to COVID-19 prevention measures in Chinese Healthcare students. DESIGN: A cross-sectional survey collecting data in Hong Kong and Fujian Province of China in April 2020. METHODS: A convenience and snowball sample of 2706 students aged 18 years or older and studying a healthcare programme were recruited in tertiary education institutions/universities in Hong Kong and Putian. The participants completed the questionnaire with six scales: Social Distancing Scale; Personal Hygiene Scale; Empathic Responding Scale; Wishful Thinking Scale; Perceived Stress Scale and Perceived Threat Scale. Path analysis was performed to identify factors associated with the preventive measures outcomes. p value < .05 was considered as statistical significance. RESULTS: The participants reported high compliances to both social distancing (SoD) and personal hygiene measures (PHM). Confidence to manage the current situation, wishful thinking and empathetic responding directly predicted compliance with SoD and PHM. The final model constructed demonstrated a very good fit to the data. CONCLUSION: The findings suggest that students who are male, habituate in Hong Kong, have more clinical experience and weak confidence to manage the threat tend to have lower compliance with the COVID-19 preventive measures. IMPACT: The predictive model constructed is the first one to explore factors associating with the compliance with infection control measures in healthcare students amid the COVID-19 outbreak. As the infection control behaviours of healthcare students, whom are still under training and are the high-risk group of being infected and infecting others in the community, are rarely reported in literature, this study has provided empirical evidence to nurses and other healthcare professionals to identify students susceptible to poor compliance and provide early monitoring and education to suppress the COVID-19 transmission.

The effectiveness of a pressure injury prevention program for nursing assistants in private for-profit nursing homes: A cluster randomized controlled trial.

AIM: To examine the effectiveness of a pressure injury prevention program for private for-profit nursing homes. DESIGN: This study was a two-arm cluster randomized controlled trial. Ten private for-profit nursing homes made up the clusters. METHODS: The participants were nursing home residents who aged 60 or above regardless of whether or not having pre-existing pressure injuries and also three types of nursing home assistants who provided direct care to the residents from 10 private for-profit nursing homes. These 10 nursing homes were randomly assigned to either the experimental or the control group. There were 477 and 536 resident participants and 51 and 62 nursing assistant participants in the experimental and control groups, respectively. The residents were the study participants and the nursing assistant participants were the interveners. The experimental group had the pressure injury prevention program implemented while the control group received the usual care. The primary study outcome which was the pressure injury incidence was analysed by GEE. Significance was set at a p-value of ≤.05. The data were collected between September 2017-March 2018. RESULT: There were significant interactive effects of time and group on the incidence of pressure injuries (p = .0015) and on the skill performance of the nursing assistant participants (p < .0001). CONCLUSIONS: An evidence-based pressure injury prevention program reduced the development of the pressure injuries and improved the skill performance of the nursing assistant participants. It is highly recommended that private for-profit nursing homes with high proportion of non-professional nursing assistants and insufficient nurses adopt this program for improving the prevention care of pressure injuries. IMPACT: This research has an impact on prevention care of pressure injury in private for-profit nursing homes with high proportion non-professional nursing assistants which have the similar characteristics as the nursing homes studied in various regions and countries. TRIAL REGISTRATION: The Controlled Trial registration ID is NCT02270385.

Emergency nurses' perceptions of their roles and practices during epidemics: a qualitative study.

BACKGROUND: although emergency nurses have a pivotal role in the public health response to epidemics, little is known about their responsibilities and practice in terms of epidemic management. AIMS: this study aimed to explore how emergency nurses understand and perform their professional roles and practice during epidemics. METHODS: a qualitative descriptive study design was used. Data were collected from 24 participants through semistructured interviews and subjected to thematic analysis. FINDINGS: the analysis yielded two overarching themes: expansion in the practice of emergency care; and the altered role of emergency nurses. CONCLUSION: emergency nurses perceive their practice during the management of an epidemic expanded in that they shouldered a greater responsibility in the control of infectious diseases. This expansion led to role ambiguity among them.

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.

An individualized exercise programme with and without behavioural change enhancement strategies for managing fatigue among frail older people: a quasi-experimental pilot study.

OBJECTIVE: To evaluate the feasibility and preliminary effects of an individualized exercise programme with and without behavioural change enhancement strategies for frail older people with fatigue. DESIGN: A three-arm, single-blinded, quasi-experimental pilot study. SETTING: Community health centres. PARTICIPANTS: A total of 79 frail older people with fatigue, mean age 79.32 years (±7.72). INTERVENTIONS: The combined group received a 16-week combined intervention consisting of exercise training and a behavioural change enhancement programme. The exercise group received exercise training and health talks, whereas the control group received only health talks. MAIN OUTCOME MEASURE(S): Feasibility was assessed through the participants' recruitment, retention, attendance and adherence, feedback, and reports of adverse events. The preliminary effects were assessed by the participants' level of fatigue, physical endurance, self-efficacy, and self-perceived compliance with exercise. RESULTS: Feasibility was achievable with high recruitment (87.2%) and low overall attrition (7.1%) rates. A similar reduction in fatigue was identified in all groups, but a trend of greater improvement in physical endurance was observed in the combined group than in the other two groups. The combined group also had a significantly better attendance rate [F(2,76) = 5.64, p < 0.01)] and higher self-perceived exercise compliance than the exercise group. CONCLUSION: The combined intervention has the potential to enhance the participants' adherence to exercise regimens by improving their attendance in training sessions and their self-perceived exercise compliance. They are important to maintaining an appropriate level of engagement in daily exercises, especially at the beginning stages of behavioural change, when the participants are establishing the habit of exercising daily.

Exploring research cultures through internationalization at home for doctoral students in Hong Kong and Sweden.

Cultural skills are fundamental to developing global academic scholars. Internationalization at home can facilitate the acquisition of these skills without students having to go abroad. However, research on the effect of internationalization of higher education is scarce, despite apparent benefits to incorporating cultural sensitivity in research. Further, little is known about the role information and communication technology plays. In this pilot study, we describe the experience of doctoral students with an internationalization-at-home program, and its impact on developing an understanding about different research cultures. Eight doctoral nursing students from Sweden and Hong Kong participated in five webinars as "critical friends". The study followed a descriptive, qualitative design. The results demonstrated that students observed cultural differences in others' research training programs. However, while cultural differences reinforced friendship among local peers, they challenged engagement with critical friends. Challenges led to the perception of one another not as critical friends but as "distant" friends. We discuss the possible reasons for these outcomes, and emphasize a need to nurture connectivity and common goals. This would prepare students to identify, translate, and recognize cultural differences to help develop knowledge of diverse research cultures.

Study protocol of a cluster randomized controlled trial evaluating the efficacy of a comprehensive pressure ulcer prevention programme for private for-profit nursing homes.

BACKGROUND: Because the demand for government-subsidized nursing homes in Hong Kong outstrips the supply, the number of for-profit private nursing homes has been increasing rapidly. However, the standard of care in such homes is always criticized. Pressure ulcers are a major long-term care issue that is closely associated with the quality of care delivered in nursing home settings. The aim of this study is to evaluate the effectiveness of a pressure ulcer prevention programme for residents in private for-profit nursing homes. METHODS/DESIGN: This is a two-arm cluster randomized controlled trial with an estimated sample size of 1088 residents and 74 care staff from eight for-profit private nursing homes. Eligible nursing homes will be those classified as category A2 homes in the Enhanced Bought Place Scheme (EBPS), having a capacity of around 130-150 beds, and no structured PU prevention protocol and/or programmes in place. Care staff will be health workers, personal care workers, and nurses who are front-line staff providing direct care to residents. Eight nursing homes will be randomly assigned to either an experimental or control group. The experimental group will be provided with an intensive training programme and will be involved in the implementation of a 16-week pressure ulcer prevention protocol, while the control group will deliver the usual pressure ulcer prevention care. The study outcomes are the pressure ulcer prevention knowledge and skills of the care staff and the prevalence and incidence of pressure ulcers. Data on the knowledge and skills of care staff, and prevalence of pressure ulcer will be collected at the base line, and then at the 8(th) week and at completion of the implementation of the protocol. The assessment of the incidence of pressures will start from before the commencement of the intensive training course to the end of the implementation of the protocol. DISCUSSION: In view of the negative impact of pressure ulcers, it is important to have an effective and evidence-based pressure ulcer prevention programme to improve preventive care in private for-profit nursing homes. The programme will potentially improve the knowledge and skills of care staff on the prevention of pressure ulcers and also lead to a reduction in the development of pressure ulcers in nursing homes. TRIAL REGISTRATION: The Current Controlled Trial is NCT02270385, 18 October 2014.

Improvement of pressure ulcer prevention care in private for-profit residential care homes: an action research study.

BACKGROUND: A need exits to develop a protocol for preventing pressure ulcers (PUs) in private for-profit nursing homes in Hong Kong, where the incidence of PUs is relatively high and which have high proportion of non-professional care staff. The implementation of such protocol would involve changes in the practice of care, likely evoking feelings of fear and uncertainty that may become a barrier to staff adherence. We thus adopted the Systems Model of Action Research in this study to manage the process of change for improving PU prevention care and to develop a pressure ulcer prevention protocol for private for-profit nursing homes. METHODS: A total of 474 residents and care staff who were health workers, personal care workers, and/or nurses from four private, for-profit nursing homes in Hong Kong participated in this study. Three cyclic stages and steps, namely, unfreezing (planning), changing (action), and refreezing (results) were carried out. During each cycle, focus group interviews, field observations of the care staff's practices and inspections of the skin of the residents for pressure ulcers were conducted to evaluate the implementation of the protocol. Qualitative content analysis was adopted to analyse the data. The data and methodological triangulation used in this study increased the credibility and validity of the results. RESULTS: The following nine themes emerged from this study: prevention practices after the occurrence of PUs, the improper use of pressure ulcer prevention materials, non-compliance with several prevention practices, improper prevention practices, the perception that the preventive care was being performed correctly, inadequate readiness to use the risk assessment tool, an undesirable environment, the supplying of unfavorable resources, and various management styles in the homes with or without nurses. At the end of the third cycle, the changes that were identified included improved compliance with the revised risk assessment method, the timely and appropriate use of PU prevention materials, the empowering of staff to improve the quality of PU care, and improved home management. CONCLUSION: Through the action research approach, the care staff were empowered and their PU prevention care practices had improved, which contributed to the decreased incidence of pressure ulcers. A PU prevention protocol that was accepted by the staff was finally developed as the standard of care for such homes.

Bridging the gap between guidelines and practice in the management of emerging infectious diseases: a qualitative study of emergency nurses.

AIMS AND OBJECTIVES: To explore the difficulties and strategies regarding guideline implementation among emergency nurses. BACKGROUND: Emerging infectious diseases remain an underlying source of global health concern. Guidelines for accident and emergency departments would require adjustments for infectious disease management. However, disparities between guidelines and nurses' practice are frequently reported, which undermines the implementation of these guidelines into practice. This article explores the experience of frontline emergency nurses regarding guideline implementation and provides an in-depth account of their strategies in bridging guideline-practice gaps. DESIGN: A qualitative descriptive design was used. METHODS: Semi-structured, face-to-face, individual interviews were conducted between November 2013-May 2014. A purposive sample of 12 frontline emergency nurses from five accident and emergency departments in Hong Kong were recruited. The audio-recorded interviews were transcribed verbatim and analysed with a qualitative content analysis approach. RESULTS: Four key categories associated with guideline-practice gaps emerged, including getting work done, adapting to accelerated infection control measures, compromising care standards and resolving competing clinical judgments across collaborating departments. The results illustrate that the guideline-practice gaps could be associated with inadequate provision of corresponding organisational supports after guidelines are established. CONCLUSIONS: The nurses' experiences have uncovered the difficulties in the implementation of guidelines in emergency care settings and the corresponding strategies used to address these problems. The nurses' experiences reflect their endeavour in adjusting accordingly and adapting themselves to their circumstances in the face of unfeasible guidelines. RELEVANCE TO CLINICAL PRACTICE: It is important to customise guidelines to the needs of frontline nurses. Maintaining cross-departmental consensus on guideline interpretation and operation is also indicated as an important component for effective guideline implementation.

Topical Agents and Dressings for Pilonidal Sinus Wound Healing by Secondary Intention: A Scoping Review.

Pilonidal disease (PD) is a chronic and debilitating condition. The overall aim of the scoping review is to map and summarize a wide range of evidence to examine which topical agent or dressing is effective in promoting pilonidal wound healing by secondary intention. Review of this cumulative body of evidence will inform care and guide dressing selection for PD related wounds and delineate future research priorities based on identified knowledge gaps and clinical practice issues. Overall, there is some evidence to suggest that topical applications of hydrogel, silver, honey, zinc, selected foam materials, negative pressure wound therapy, platelet rich plasma, and plant extracts may promote wound healing. Topical treatment using polyhexamethylene biguanide and silver may be beneficial in reducing bacterial burden. Finally, silver, honey, and hydrocolloid dressings may help alleviate wound related pain. However, evidence remains insufficient in light of methodological limitations and biases of the studies.

Understanding Elderly Chinese Cancer Patients in a Multicultural Clinical Setting: Embracing Mortality and Addressing Misperceptions of Vulnerability.

Chinese patients face higher risks of gastrointestinal (GI) cancers and greater cancer-related deaths than Canadian-born patients. The older population encounters barriers to quality healthcare, impacting their well-being and survival. Previous studies highlighted Chinese immigrant perceptions of not requiring healthcare support. During the COVID-19 pandemic, their underutilization of healthcare services garnered attention. The present study explores the experiences of older Chinese cancer patients to improve culturally sensitive cancer care. A total of twenty interviews carried out in Cantonese and Mandarin were conducted with Chinese immigrants, aged 60 or above, diagnosed with Stage 3 or 4 GI cancer. These interviews were transcribed verbatim, translated, and subjected to qualitative descriptive analysis. Among older Chinese immigrant patients, a phenomenon termed "Premature Acceptance: Normalizing Death and Dying" was observed. This involved four key themes: 1. acceptance and letting go, 2. family first, 3. self-sufficiency, and 4. barriers to supportive care. Participants displayed an early acceptance of their own mortality, prioritizing family prosperity over their own quality of life. Older Chinese patients normalize the reality of facing death amidst cancer. They adopt a pragmatic outlook, acknowledging life-saving treatments while willingly sacrificing their own support needs to ease family burdens. Efforts to enhance health literacy require culturally sensitive programs tailored to address language barriers and differing values among this population. A strengths-based approach emphasizing family support and practical aspects of care may help build resilience and improve symptom management, thereby enhancing their engagement with healthcare services.

Perceptions of a life review programme among Chinese patients with advanced cancer.

AIMS: The aim of this study was to elicit patients' perceptions of their participation in a life review programme for Chinese patients with advanced cancer. BACKGROUND: Empirical data have supported the suggestion that a life review is an effective psycho-spiritual intervention, particularly with older people. However, no life review programmes have been specifically designed for Chinese patients with advanced cancer, and their views on the life review therefore remain unknown. DESIGN: This study was a descriptive qualitative design. METHOD: In-depth individual interviews were conducted with a sample of 26 patients with advanced cancer receiving home-based palliative care from a hospice after the completion of the programme. RESULTS: The six categories identified in the analysis were as follows: (1) accepting one's unique life; (2) feelings of emotional relief; (3) bolstering a sense of meaning in life; (4) leaving a personal legacy; (5) making future orientations; and (6) barriers to a life review. CONCLUSION: Our life review programme is non-invasive care intervention for improving the psycho-spiritual well-being of Chinese patients with advanced cancer and helping them to prepare for death. This programme not only provides Chinese nurses with a new approach to meeting the unique needs of patients approaching death but also poses a challenge to customary beliefs about death, which is considered a social taboo in China. RELEVANCE TO CLINICAL PRACTICE: The life review programme can be integrated into the usual care arrangements to enhance the psycho-spiritual well-being of Chinese patients with advanced cancer. Nurses should be aware of the challenges involved in the process of conducting a life review.

Compliance with Standard Precaution and Its Relationship with Views on Infection Control and Prevention Policy among Chinese University Students during the COVID-19 Pandemic.

BACKGROUND: COVID-19 has placed tremendous pressure on the global public health system and has changed daily life. AIM: To examine the relationships between the perceived threat, perceived stress, coping responses and infection control practices towards the COVID-19 pandemic among university students in China. METHODS: Using a cross-sectional survey, 4392 students were recruited from six universities in two regions of China. METHODS: Data were collected via an online platform using self-reported questionnaires. Hierarchical multiple regression analyses were performed to predict the variables on COVID-19 infection control practices. RESULTS: Pearson correlation coefficients showed a significant negative relationship between perceived stress and COVID-19 infection control practices. A significant positive relationship was observed between wishful thinking and empathetic responding, and infection control practices. Hierarchical multiple regression analyses revealed that gender, geographical location, perceived stress and emotion-focused and relationship-focused coping responses were predictors of COVID-19 infection control practices. CONCLUSIONS: The findings suggest that university students displayed moderate levels of stress, using wishful thinking and empathetic responses as coping strategies. Counselling services should therefore emphasise reassurance and empathy. Male university students tended to be less compliant with social distancing. Both counselling and public health measures should recognise the importance of gender differences. Nurses should integrate these findings into future health programme planning and interventions.

A pressure ulcer prevention programme specially designed for nursing homes: does it work?

AIM: The aim of this study was to evaluate a pressure ulcer prevention programme for nursing homes to ascertain the feasibility of its implementation, impact on care staff and outcomes for pressure ulcer knowledge and skills and pressure ulcer reduction. BACKGROUND: No pressure ulcer prevention protocol for long-term care settings has been established to date. The first author of this study thus developed a pressure ulcer prevention programme for nursing homes. DESIGN: A quasi-experimental pretest and post-test design was adopted. METHODS: Forty-one non-licensed care providers and eleven nurses from a government-subsidised nursing home voluntarily participated in the study. Knowledge and skills of the non-licensed care providers were assessed before, immediately after and six weeks after the training course, and pressure ulcer prevalence and incidence were recorded before and during the protocol implementation. At the end of the programme implementation, focus group interviews with the subjects were conducted to explore their views on the programme. RESULTS: A statistically significant improvement in knowledge and skills scores amongst non-licensed care providers was noted. Pressure ulcer prevalence and incidence rates dropped from 9-2·5% and 2·5-0·8%, respectively, after programme implementation. The focus group findings indicated that the programme enhanced the motivation of non-licensed care providers to improve their performance of pressure ulcer prevention care and increased communication and cooperation amongst care staff, but use of the modified Braden scale was considered by nurses to increase their workload. CONCLUSION: A pressure ulcer prevention programme for nursing homes, which was feasible and acceptable, with positive impact and outcome in a nursing home was empirically developed. RELEVANCE TO CLINICAL PRACTICE: The study findings can be employed to modify the programme and its outcomes for an evaluation of effectiveness of the programme through a randomised controlled trial.

Advance care planning and advance directive awareness among East Asian older adults: Japan, Hong Kong and South Korea.

AIM: Population aging is a global phenomenon, and East Asian countries are no exception. However, the use of advance care planning (ACP) and advance directives (ADs) are not widespread in East Asia. This study aimed to examine the awareness of ACP/ADs and its related factors among community-dwelling older persons in Japan, Hong Kong and South Korea. METHODS: This was a cross-sectional, cross-cultural questionnaire conducted among a convenience sample of community-dwelling persons. The questionnaire included information regarding awareness of ACP/ADs and personal information. Multiple logistic regression was used assess relationships between awareness of ACP/ADs and potential related factors. RESULTS: The sample consisted of 404 community-dwelling older adults: 174 (43.0%) from Japan, 132 (32.7%) from Hong Kong and 98 (24.3%) from South Korea. In total, 122 participants (30.2%) had heard of ACP/ADs. Multiple logistic regression analysis revealed that an educational level >12 years was significantly associated with increased ACP/ADs awareness (adjusted odds ratio [AOR]: 2.19, 95% confidence interval (CI): 1.18-4.07, P = 0.01). The rate of those who have heard of ACP/ADs was significantly higher among Japanese than South Koreans were (AOR: 4.54, 95% CI: 1.64-12.58, P < 0.01), those from Hong Kong than South Korea (AOR: 5.15, 95% CI 1.89-14.0, P < 0.01) after some variables with significant differences among the three countries were controlled. CONCLUSIONS: In particular, support tailored to the targets' educational levels will be required. It is also suggested that support is needed to enhance awareness of ACP/ADs in East Asia, although there is a difference in degree of awareness among the three countries. Geriatr Gerontol Int 2021; 21: 71-76.

Influenza vaccine preference and uptake among older people in nine countries.

AIM: This paper is a report of a study delineating factors that influence older people's preferences and uptake of the influenza vaccine in nine countries. BACKGROUND: Vaccination uptake for the aging population in many countries still remains below the World Health Organization recommended rate. Older people who perceive higher susceptibility to and severity of influenza, and more benefits from vaccination and action cues prompting vaccination, tend to accept the vaccine, but those with more perceived barriers to vaccination are less likely to accept it. METHOD: A total of 208 older people from China, Indonesia, Turkey, Korea, Greece, Canada, the United Kingdom, Brazil and Nigeria were recruited to 14 vaccinated and 12 unvaccinated focus groups. They shared their experiences of influenza, and influenza vaccination, and promotion of influenza vaccination in focus groups. The data were collected in 2007. FINDINGS: We identified five themes and generated a hypothetical framework for in-depth understanding of vaccination behaviour among older people. Participants' vaccine preferences were determined by their behavioural beliefs in vaccination, which were based on their probability calculation of susceptibility to and severity of influenza and vaccine effectiveness, and their utility calculation of vaccine, healthcare and social costs. Action cues prompting vaccination and vaccine access further affected the vaccine uptake of participants with vaccine preferences. Vaccination coverage was likely to be higher in the countries where normative beliefs in favour of vaccination had formed. CONCLUSION: The hypothetical framework can be used to guide healthcare providers in developing strategies to foster normative beliefs of older people in vaccination, provide effective action cues and promote vaccine access.

The effect of Chinese food therapy on community dwelling Chinese hypertensive patients with Yin-deficiency.

OBJECTIVES: The objectives of this study are to evaluate the effectiveness of Chinese food therapy in correcting the Yin-deficiency and to examine its impact on the patients' quality of life and hypertension control. BACKGROUND: Epidemiological studies have shown 14-50% of people with hypertension have Yin-deficiency. Whether restoring the Yin-Yang balance by means of Chinese food therapy can help to better manage patients with hypertension has yet to be examined. DESIGN: Two groups randomised controlled trial. METHODS: Eighty-five hypertensive patients recruited from two community health service centre were divided into two groups. The intervention group (n = 48) received specific dietary instructions and corresponding management of their antihypertensive medication if indicated and brief health education, whilst the control group (n = 37) received routine support involving only brief health education. Data were collected at baseline, after intervention at four, eight, 12 and 16 weeks follow-up. Comparisons were made to examine the effects of Chinese food therapy on Yin-deficiency symptoms, blood pressure and quality of life of hypertensive patients. RESULTS: The intervention group had reduction in the numbers of antihypertensive medication taken as well as improvement in most of the Yin-deficiency symptoms after 12 weeks of Chinese food therapy and mean scores of several SF-36 dimensions were higher than that of in the control group after 12 and 16 weeks follow-up. Significant difference was found in systolic blood pressure in the intervention group when it was compared from baseline to after four and eight weeks respectively. CONCLUSION: Chinese Food Therapy can restore body constitution with Yin-Yang imbalance and may potentially improve hypertensive patients' quality of life. It is also beneficial in controlling blood pressure in hypertensive patients. RELEVANCE TO CLINICAL PRACTICE: Chinese food therapy may become a complementary therapy in health care and it should be a component of nursing education and health education.

Emergency nurses' perceptions regarding the risks appraisal of the threat of the emerging infectious disease situation in emergency departments.

Purpose: Emerging infectious diseases are considered as a pressing challenge to global public health. Throughout public health response to emerging infectious diseases, emergency nurses are situated at the forefront of the healthcare system. The present study has explored emergency nurses' perceptions regarding the risks appraisal of the threat of the emerging infectious disease situation in emergency department context.Methods: The present study used a qualitative descriptive approach. A purposive sampling method was employed to recruit emergency nurses who worked in public hospitals in Hong Kong. Semi-structured interviews were conducted to 24 emergency nurses. The data were interpreted using a thematic analysis strategy.Results: Five overarching themes emerged from the data: (1) the novelty of an emerging infectious disease, (2) the severity of an emerging infectious disease, (3) the proximity to an emerging infectious disease, (4) the complexity of an emerging infectious disease situation, and (5) the response levels towards an emerging infectious disease situation.Conclusion: It is anticipated that the information may help to predict the attitudes and behaviours of emergency nurses in future impending epidemic events, enhancing emergency nurses' preparedness towards in such situations.Abbreviations: EID: Emerging infectious disease; ED: Emergency department; SARS: Severe acute respiratory syndrome; MERS: Middle East respiratory syndrome; WHO: World Health Organization; RN: Registered nurse; APN: Advanced practice nurse; NO: Nursing officer.