Can heart rate variability be a bio-index of hope? A pilot study.

Background: Hope can affect the thinking habits, emotional regulations, and behaviors of individuals. Hope is considered as a positive trait by clinicians, who often assess the level of hope in psychological evaluations. Previous measurements of hope were largely based on self-reported questionnaires leading to the problem of subjectivity. Heart Rate Variability (HRV) is a bio index that is an objective, quick, cost effective, and non-invasive measurement. HRV has been used in the evaluation of physical health and some psychiatric conditions. However, it has not been tested for its potential to be a bio-index of the level of hope. Method: This pilot cross-sectional observational study aimed to examine the relationships between HRV and the level of hope among adult Chinese people in Hong Kong. Convenience sampling was used and 97 healthy participants were recruited. Their level of hope was measured by the Dispositional Hope Scale-Chinese (DHS-C), and their HRV was quantified by emWave Pro Plus, a reliable sensor of HRV. Spearman's correlation coefficient analysis was performed on the HRV measurements and DHS-C. Results: The DHS-C's overall mean score was 45.49. The mean scores of the subscale DHS-C (Agency) was 22.46, and the mean scores of DHS-C (Pathway) was 23.03. It was also revealed that there were significant, weak, and negative correlations between the level of hope and four out of ten HRV metrics. One HRV metric was found to have a significant, weak, and positive correlation with the level of hope. Conclusion: This study provided initial evidence to support the use of HRV as a bio-index of hope. Implications of the current study and recommendations for future research directions are discussed.

Attitudes towards family involvement in nursing care among psychiatric nurses in Hong Kong: A cross-sectional descriptive study.

WHAT IS KNOWN ON THE SUBJECT?: Family-involved interventions can result in better outcomes than traditional mental health care for both service users and their families. Nurses' attitudes towards family involvement can affect family participation in care. Earlier studies on psychiatric nurses' attitudes towards family involvement in care report ambiguous findings. Hong Kong's unique integrated cultures may influence Hong Kong psychiatric nurses' attitudes towards family involvement in nursing care. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The majority of psychiatric nurses had positive views on family involvement in care in Hong Kong. Four variables (i.e. gender, clinical experience, nature of working unit and family nursing training) of psychiatric nurses are associated with their attitudes towards family involvement in care in Hong Kong. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Policy makers should develop strategies to increase psychiatric nurses' awareness of the importance of family involvement in patient care. Nurse educators help to design family nursing training to enhance psychiatric nurses' competence in collaborating with families of people suffering from mental disorders. ABSTRACT: INTRODUCTION: In Hong Kong, involving the family in nursing care is still optional and mainly depends on nurses' attitudes and the willingness of the family. Hong Kong psychiatric nurses' attitudes towards family involvement in nursing care may be influenced by the unique integrated Eastern and Western cultures, however earlier studies report ambiguous findings. AIMS: This study aimed to assess Hong Kong psychiatric registered nurses' attitudes towards family involvement in care and its associated factors. METHODS: This study is a cross-sectional descriptive online survey with convenience sampling based on the Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) instrument. RESULTS: Most of the psychiatric nurses had supportive attitudes towards family involvement in care. Females with more clinical experience, working in a rehabilitation-related unit and having attended a family nursing education course were associated with positive attitudes towards family involvement in care. DISCUSSION: The supportive attitude of psychiatric nurses may be explained by the shift of mental health nursing care from hospital care to community care in recent decades. IMPLICATIONS FOR PRACTICE: Mental health nurse education and training in Hong Kong could place more emphasis on building family work skills, particularly for newly qualified nurses and those working in acute inpatient settings.

Cross-Cultural Adaptation and Psychometric Validation of the Constipation Assessment Scale among Chinese Adult Psychiatric Patients.

BACKGROUND: Constipation is a functional gastrointestinal disorder that presents with signs and symptoms, which are typically assessed subjectively. Various measurement scales, such as the Constipation Assessment Scale (CAS), are commonly used to evaluate constipation among the general population. However, the instruments should be culturally and contextually relevant in adult psychiatric patients to generate valid and reliable evidence. PURPOSE: This study aimed to cross-culturally adapt and psychometrically validate the traditional Chinese version of the CAS among adult psychiatric patients in Hong Kong. METHOD: Using the Brislin protocol and Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines, the CAS was translated into traditional Chinese and tested for internal consistency, test-retest reliability, content validity, and construct validity among psychiatric patients in Hong Kong. RESULTS: The CAS was successfully translated into CAS-TC. The CAS-TC version demonstrated good content validity (scale level CVI = 97%), internal consistency (Cronbach's alpha = 0.79), and test-retest reliability (ICC = 0.722 [95% CI, 0.587-0.812]). The CAS-TC showed a two-factor loading for the construct validity, which explained 54% of the total variance. CONCLUSIONS: The CAS-TC is valid and reliable and can be employed to assess constipation among adult psychiatric patients.

Nurses', patients', and informal caregivers' attitudes toward aggression in psychiatric hospitals: A comparative survey study.

Attitudes toward aggression is a controversial phenomenon in psychiatry. This study examined and compared attitudes toward patient aggression in psychiatric hospitals from the perspectives of nurses, patients and informal caregivers and identified factors associated to these attitudes. A total of 2,424 participants completed a self-reported instrument regarding attitudes toward aggression (12-items Perception of Aggression Scale; POAS-S). We analysed data from nurses (n = 782), patients (n = 886), and informal caregivers (n = 765). Pearson's r correlations were used to examine associations between variables. Differences between group scores were analysed using ANOVA/MANOVA with post-hoc Sheffe tests. Multivariate logistic regression models and logistic regression analysis were used to examine the effects of respondents' characteristics on their attitudes toward aggression. Nurses had significantly more negative and less tolerant perceptions toward aggression (mean [SD] 47.1 [7.5], p<0.001) than the patients (mean [SD] 44.4 [8.2]) and the informal caregivers (mean [SD] 45.0 [6.9), according to the POAS-S total scores. The same trend was found with the dysfunction and function sub-scores (mean [SD] 25.3 [4.1] and 15.0 [3.6], respectively); the differences between the groups were statistically significant (p <0.001) when nurses' scores were compared to those of both the patients (mean [SD] 23.7 [5.3] and 14.0 [4.1], respectively) and the informal caregivers (mean [SD] 24.4 [4.2] and 13.9 [3.5], respectively). The study offers new understanding of aggressive behavior in different treatment settings where attitudes toward patient behavior raises ethical and practical dilemmas. These results indicate a need for more targeted on-the-job training for nursing staff, aggression management rehabilitation programs for patients, and peer-support programs for informal caregivers focused on patient aggression.

Nurses' attitudes towards the use of physical restraint in psychiatric care: A systematic review of qualitative and quantitative studies.

WHAT IS KNOWN ON THE SUBJECT?: Application of physical restraint is a common practice to protect service users and staff in psychiatric care. Nurses' attitudes towards physical restraint and its influencing factors in psychiatric settings in different countries are variable. Previous reviews include studies on different coercive methods, making it difficult to differentiate attitudes specific to physical restraint. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Nurses' attitudes were marked by negative feelings and moral conflict towards the use of physical restraint and consider it a necessary nursing intervention and a last resort. The barriers for restraint-free environment practice included contextual demand, lack of knowledge on restraint and lack of alternatives to restraint. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurse educators should develop and evaluate related educational training programmes to promote the development of alternative effective skills in handling violence instead of physical restraint. Policy makers should develop strategies to remove the barriers to a restraint-free environments. ABSTRACT: Introduction Physical restraint is common in psychiatric care; nurses' attitudes are crucial as nurses often implement the procedure. Previous reviews include studies exploring coercive methods but do not specifically focus on physical restraint. Aims This integrated mixed-method systematic review aimed to examine nurses' attitudes towards the use of physical restraint in psychiatric care and the factors influencing these attitudes. Methods Six databases were searched from 2000 to 2021. Thematic integrative analysis was used to synthesize the data. Results Ten studies were included. Five themes encapsulate nurses' attitudes towards physical restraint: "emotional responses," "moral conflicts," "ensuring safety for all," "a necessary nursing intervention" and "a last resort." Three themes were identified for factors influencing attitudes: "contextual demands," "level of knowledge" and "alternatives to restraint." Discussion Nurses' attitudes were marked by negative feelings and moral conflict towards the use of physical restraint. However, nurses applied physical restraint as an ordinary nursing intervention. Educational interventions and the leadership role may facilitate the change of current practice to a restraint-free environment. Implications for Practice Mental health nurses should work to remove the barriers to restraint-free environment and develop effective skills that can be used as alternatives to physical restraint.

Psychometric properties of the clinical learning environment, Supervision and Nurse Teacher scale (CLES+T) for undergraduate nursing students in Hong Kong.

The Clinical Learning Environment, Supervision and Nurse Teacher Evaluation Scale is useful for understanding students' perceptions towards clinical placement and for measuring the quality of clinical education. Validated versions of the scale are only available for Western countries. Therefore, this study aimed to establish the validity and reliability of the Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale for undergraduate nursing students in Hong Kong. Six experts including clinical mentors, clinical teachers, advanced practice nurse and nursing students participated in phase 1. Fifteen nursing students participated in phase 2 and 178 nursing students participated in phase 3 of this study during January 2017 to June 2017. The Scale-Content Validity Index was 0.93 and the Item-Content Validity indexes ranged from 0.83 to 1. Exploratory factor analysis indicated a 6-factor solution (i.e. "supervisory relationship", "role of nurse teacher", "leadership style of ward manager", "premises of nursing on the ward appreciated", "interaction with staff" and "learning atmosphere"). The internal consistency was good (Cronbach's alpha = 0.94) and test-retest reliability over a 2-week interval was satisfactory (Pearson's coefficient = 0.85). The Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale showed acceptable psychometric properties for use as an evaluation scale in Hong Kong.

One- and Five-Ringgit Malaysia banknotes reader with counterfeit detection for visually impaired person using backlight mechanism and image processing techniques.

Visually impaired persons face challenges in running business activities, especially in handling banknotes. Malaysia researchers had proposed some Ringgit banknotes recognition systems to aid visually impaired persons recognize and classify Ringgit banknotes. However, these electronic banknote readers can only recognize Malaysian Banknotes' Ringgit value, they have no counterfeit detection features. The purpose of this study is to develop a banknote reader that not only can help visually impaired persons recognize the banknote value, but also to detect the counterfeit of the banknote, safeguarding their losses. This paper proposed a Malaysian banknote reader using backlight mechanism and image processing techniques to read and detect counterfeit for one Ringgit and five Ringgit Malaysian banknotes. The developed handheld banknote reader used visual type sensor to capture banknote image, passed to raspberry pi controller to perform image processing on banknote value and the extracted watermarks features. The developed image processing algorithm will trace out the region of interests: 1)see-thru windows, 2)Crescent and Star, 3)Perfect see though register and detect the watermarks features accordingly. The processed result will be passed back to the handheld banknote reader and broadcast on an attached mini speaker to aid the visually impaired understand the holding banknote, whether it is a real one Ringgit, real five Ringgit or none of them. The experimental result shown by this approach able to accomplish numerous round of banknote reading attempts with successful outcomes. Confusion matrix is further employed to study the performance of the banknote reader, in terms of true positive, true negative, false positive and false negative. Details analysis had been focused on the critical false positive cases (predicted real banknote and actually is fake banknote) and false negative cases (predicted fake banknote and it is actually real banknote).

Natural Wolbachia infection in field-collected Anopheles and other mosquito species from Malaysia.

BACKGROUND: The endosymbiont bacterium Wolbachia is maternally inherited and naturally infects some filarial nematodes and a diverse range of arthropods, including mosquito vectors responsible for disease transmission in humans. Previously, it has been found infecting most mosquito species but absent in Anopheles and Aedes aegypti. However, recently these two mosquito species were found to be naturally infected with Wolbachia. We report here the extent of Wolbachia infections in field-collected mosquitoes from Malaysia based on PCR amplification of the Wolbachia wsp and 16S rRNA genes. METHODS: The prevalence of Wolbachia in Culicinae mosquitoes was assessed via PCR with wsp primers. For some of the mosquitoes, in which the wsp primers failed to amplify a product, Wolbachia screening was performed using nested PCR targeting the 16S rRNA gene. Wolbachia sequences were aligned using Geneious 9.1.6 software, analyzed with BLAST, and the most similar sequences were downloaded. Phylogenetic analyses were carried out with MEGA 7.0 software. Graphs were drawn with GraphPad Prism 8.0 software. RESULTS: A total of 217 adult mosquitoes representing 26 mosquito species were screened. Of these, infections with Wolbachia were detected in 4 and 15 mosquito species using wsp and 16S rRNA primers, respectively. To our knowledge, this is the first time Wolbachia was detected using 16S rRNA gene amplification, in some Anopheles species (some infected with Plasmodium), Culex sinensis, Culex vishnui, Culex pseudovishnui, Mansonia bonneae and Mansonia annulifera. Phylogenetic analysis based on wsp revealed Wolbachia from most of the mosquitoes belonged to Wolbachia Supergroup B. Based on 16S rRNA phylogenetic analysis, the Wolbachia strain from Anopheles mosquitoes were more closely related to Wolbachia infecting Anopheles from Africa than from Myanmar. CONCLUSIONS: Wolbachia was found infecting Anopheles and other important disease vectors such as Mansonia. Since Wolbachia can affect its host by reducing the life span and provide resistance to pathogen infection, several studies have suggested it as a potential innovative tool for vector/vector-borne disease control. Therefore, it is important to carry out further studies on natural Wolbachia infection in vector mosquitoes' populations as well as their long-term effects in new hosts and pathogen suppression.

Prevention and management of aggressive behaviour in patients at psychiatric hospitals: a document analysis of clinical practice guidelines in Hong Kong.

Patient aggressive behaviour remains a significant public health concern worldwide. The use of restraint and seclusion remains a last resort but not an uncommon practice in clinical psychiatry in the management of aggressive events. There seems to be a paucity of evidenced-based research examining the policy framework guiding the use of restraint and seclusion in Asia contexts. The purpose of this study was to conduct an analysis on the guidelines in psychiatric hospitals in Hong Kong, and to explore the extent to which these guidelines were aligned with the international clinical guidelines for the prevention and management of patient aggression in psychiatry. A descriptive document analysis was used to analyse the guidelines from four psychiatric hospitals in Hong Kong in comparison with the NICE (National Institute of Health and Care Excellence UK) guidelines. Data were collected from December 2017 to June 2018. A total of 91 written documents were retrieved. Preventing violence and aggression has the highest level of agreement (31%,) while the use of restrictive interventions has the lowest level of agreement (12%). The sub-recommendation with most in line with the NICE guidelines were restrictive interventions, de-escalation, and improving service users' experiences. However, for example, staff training, working with police, and reduced use of restrictive interventions seemed to have no agreement with the NICE guidelines. Variation exists between the Asian (Hong Kong) local policy framework/guidelines and the European (UK) national policy framework. There are also large discrepancies in the written guidelines on patient aggressive behaviour when comparing local policy frameworks, cluster-based documents, and departmental practices.

Concept mapping to promote meaningful learning, help relate theory to practice and improve learning self-efficacy in Asian mental health nursing students: A mixed-methods pilot study.

OBJECTIVES: Student nurses are provided with a great deal of knowledge within university, but they can find it difficult to relate theory to nursing practice. This study aimed to test the appropriateness and feasibility of assessing Novak's concept mapping as an educational strategy to strengthen the theory-practice link, encourage meaningful learning and enhance learning self-efficacy in nursing students. DESIGN: This pilot study utilised a mixed-methods quasi-experimental design. SETTING: The study was conducted in a University school of Nursing in Hong Kong. PARTICIPANTS: A total of 40 third-year pre-registration Asian mental health nursing students completed the study; 12 in the concept mapping (CM) group and 28 in the usual teaching methods (UTM) group. METHODS: The impact of concept mapping was evaluated thorough analysis of quantitative changes in students' learning self-efficacy, analysis of the structure and contents of the concept maps (CM group), a quantitative measure of students' opinions about their reflective learning activities and content analysis of qualitative data from reflective written accounts (CM group). RESULTS: There were no significant differences in self-reported learning self-efficacy between the two groups (p=0.38). The concept mapping helped students identify their current level of understanding, but the increased awareness may cause an initial drop in learning self-efficacy. The results highlight that most CM students were able to demonstrate meaningful learning and perceived that concept mapping was a useful reflective learning strategy to help them to link theory and practice. CONCLUSIONS: The results provide preliminary evidence that the concept mapping approach can be useful to help mental health nursing students visualise their learning progress and encourage the integration of theoretical knowledge with clinical knowledge. Combining concept mapping data with quantitative measures and qualitative reflective journal data appears to be a useful way of assessing and understanding the effectiveness of concept mapping. Future studies should utilise a larger sample size and consider using the approach as a targeted intervention immediately before and during clinical learning placements.

Testing psychometric properties of a Chinese version of perception of aggression scale.

AIM: This study was to evaluate the psychometric properties of the Chinese version of the 12-item Perception of Aggression Scale (POAS). METHOD: It consists of three phases of testing, including (1) translation and back-translation and content validity; (2) semantic equivalence between translated Chinese and original English version; and (3) construct validity, internal consistency and test-retest reliability. RESULTS: The translated Chinese and back-translated English version showed excellent similarities and agreements between two independent translators. The Chinese version indicated high item- and scale-level content validity indexes (0.86-1.00) and satisfactory semantic equivalence with the original English language version (weighted kappa=0.48-0.90; intraclass correlation coefficient=0.91). Exploratory factor analysis in 249 nursing students resulted in three components (dysfunctional, functional and protective dimensions), explaining 64% of the total variance, with satisfactory internal consistency (Cronbach's alpha=0.76-0.83) and good 2-week test-retest reliability (Pearson's r=0.87). The Chinese version of POAS was found to be a valid and reliable tool to examine nurses' attitudes towards patient aggression. DISCUSSION: Chinese nurses in this study viewed patient aggression to be an undesirable negative behaviour suggestive of uncontrollability behaviour presented by the patient under their care.

Psychometric properties of the Management of Aggression and Violence Attitude Scale in Hong Kong's emergency care setting.

BACKGROUND: Emergency unit is one of the most high-risk areas for patient violence. However, in Hong Kong, little research has been test psychometric properties of assessment tool of Emergency unit nurses' attitude toward violence. METHODS: The Management of Aggression and Violence Attitude Scale's (MAVASs) Scale- and Item-Content Validity Index were established by 5-experts panel. A convenience sample of 123 nurses working in 4 public Emergency Department in Hong Kong was recruited. The construct validity was tested using exploratory factor analysis and the reliability was assessed by Cronbach's alpha and test-retest reliability. RESULTS: The Scale-Content Validity Index was 97.0% and the Item-Content Validity Indexes ranged from 80.0% to 100.0%. Exploratory factor analysis indicated 4-factors solution (i.e., "importance of communication with patients", "perceived effectiveness of interventions", "pitfalls of interventions" and "perceived need for intervention"). Its' internal consistency was satisfactory (Cronbach's alphas=0.40-0.77) across the 4 subscales and test-retest reliability over 4-week interval was satisfactory (Pearson's coefficient=0.85). CONCLUSION: MAVAS was found to be a valid and reliable tool to examine nurses' attitudes towards patients' violence in emergency care setting, and provides useful information to those developing training and intervention programmes for management of aggression.

Self-administered acupressure for treating adult psychiatric patients with constipation: a randomized controlled trial.

BACKGROUND: Constipation has a high prevalence rate (>30 %) in psychiatric patients with psychotropic drugs. Common pharmacological and non-pharmacological interventions for constipation might have longer-term negative and adverse effects that would outweigh their short-term efficacy in symptom reduction. This randomized controlled trial aims to investigate the effect of self-administered acupressure for the management of constipation, in hospitalized psychiatric patients. METHODS: Seventy-eight patients were recruited in matched pairs in terms of gender, age and laxative use from five acute psychiatric wards in Hong Kong. Each of these matched pairs of patients was randomly assigned to either a self-administered acupressure (n = 39) or a sham group (n = 39), using computer-generated random numbers. After baseline measurement, the intervention and sham group received the same training in self-administered acupressure and supervised practice once per day for 10 days, except light pressure on non-acupoints was taught to the sham group. The acupoints chosen for acupressure included Zhongwan (RN12), right and left Tianshu (ST25), right and left Quchi (LI11). Participants' symptoms and quality of life regarding constipation were measured at baseline and immediately and 2 weeks after completion of the interventions with constipation assessment scale and patient assessment of constipation quality of life questionnaire, respectively. RESULTS: After 2 weeks follow-up, participants who had received self-administered acupressure indicated significantly greater improvements in both symptom severity (P = 0.0003) and quality of life (P = 0.0004) when compared with the sham group. CONCLUSION: The psychiatric patients with constipation who practiced self-administered acupressure for 10 days improved their symptom severity and perceived quality of life immediately and 2 weeks after completion of the intervention in comparison with the sham group. TRIAL REGISTRATION: The trial was registered with the ClinicalTrials.gov (Reg. No: NCT02187640).

Current approaches to treatments for schizophrenia spectrum disorders, part II: psychosocial interventions and patient-focused perspectives in psychiatric care.

Schizophrenia is a disabling psychiatric illness associated with disruptions in cognition, emotion, and psychosocial and occupational functioning. Increasing evidence shows that psychosocial interventions for people with schizophrenia, as an adjunct to medications or usual psychiatric care, can reduce psychotic symptoms and relapse and improve patients' long-term outcomes such as recovery, remission, and illness progression. This critical review of the literature was conducted to identify the common approaches to psychosocial interventions for people with schizophrenia. Treatment planning and outcomes were also explored and discussed to better understand the effects of these interventions in terms of person-focused perspectives such as their perceived quality of life and satisfaction and their acceptability and adherence to treatments or services received. We searched major health care databases such as EMBASE, MEDLINE, and PsycLIT and identified relevant literature in English from these databases. Their reference lists were screened, and studies were selected if they met the criteria of using a randomized controlled trial or systematic review design, giving a clear description of the interventions used, and having a study sample of people primarily diagnosed with schizophrenia. Five main approaches to psychosocial intervention had been used for the treatment of schizophrenia: cognitive therapy (cognitive behavioral and cognitive remediation therapy), psychoeducation, family intervention, social skills training, and assertive community treatment. Most of these five approaches applied to people with schizophrenia have demonstrated satisfactory levels of short- to medium-term clinical efficacy in terms of symptom control or reduction, level of functioning, and/or relapse rate. However, the comparative effects between these five approaches have not been well studied; thus, we are not able to clearly understand the superiority of any of these interventions. With the exception of patient relapse, the longer-term (eg, >2 years) effects of these approaches on most psychosocial outcomes are not well-established among these patients. Despite the fact that patients' perspectives on treatment and care have been increasingly concerned, not many studies have evaluated the effect of interventions on this perspective, and where they did, the findings were inconclusive. To conclude, current approaches to psychosocial interventions for schizophrenia have their strengths and weaknesses, particularly indicating limited evidence on long-term effects. To improve the longer-term outcomes of people with schizophrenia, future treatment strategies should focus on risk identification, early intervention, person-focused therapy, partnership with family caregivers, and the integration of evidence-based psychosocial interventions into existing services.

Nurses' perceived barriers to and facilitators of research utilization in mainland china: a cross-sectional survey.

Despite the drive towards evidence-based practice, the extent to which research evidence is being implemented in nursing practice is unclear, particularly in developing countries. This study was to assess the levels of perceived barriers to and facilitators of research utilization in practice among Chinese nurses and inter-relationships between these barriers and facilitators and their socio-demographic characteristics. A cross-sectional, descriptive survey was conducted in 2011 with 743 registered nurses randomly selected from four general hospitals in China. They completed the Barriers to Research Utilization and Facilitators of Research Utilization scales. Correlation tests were used to test the relationships between the nurses' perceived barriers and facilitators, their demographic characteristics and research training and involvement. The Chinese nurses' level of perceived barriers was moderate on average and lower than that in previous research. Among the 10 top-ranked items, six were from the subscale 'Organizational Characteristics'. Their perceived barriers were correlated positively with age and post-registration experience and negatively with research training undertaken. Junior diplomatic nurses reported a significantly higher degree of barriers than those senior ones with postgraduate education. Higher and more diverse barriers to research utilization in practice are perceived by Chinese nurses than those in Western countries and they are associated with a few socio-demographic factors. Future research on these barriers/facilitators and their relationships with occupational and socio-cultural factors in Chinese and other Asian nurses is recommended.