Global migration and factors influencing retention of Asian internationally educated nurses: a systematic review.

BACKGROUND: Given nurses' increasing international mobility, Asian internationally educated nurses (IENs) represent a critical human resource highly sought after within the global healthcare workforce. Developed countries have grown excessively reliant on them, leading to heightened competition among these countries. Hence, this review aims to uncover factors underlying the retention of Asian IENs in host countries to facilitate the development of more effective staff retention strategies. METHODS: A mixed-methods systematic review was conducted using the Joanna Briggs Institute methodology for mixed-method systematic review. A search was undertaken across the following electronic databases for studies published in English during 2013-2022: CINAHL, Embase, PubMed, Scopus, Web of Science and PsycINFO. Two of the researchers critically appraised included articles independently using the Joanna Briggs Critical Appraisal Tools and Mixed Methods Appraisal Tool (version 2018). A data-based convergent integrated approach was adopted for data synthesis. RESULTS: Of the 27 included articles (19 qualitative and eight quantitative), five each were conducted in Asia (Japan, Taiwan, Singapore and Malaysia), Australia and Europe (Italy, Norway and the United Kingdom); four each in the United States and the Middle East (Saudi Arabia and Kuwait); two in Canada; and one each in New Zealand and South Africa. Five themes emerged from the data synthesis: (1) desire for better career prospects, (2) occupational downward mobility, (3) inequality in career advancement, (4) acculturation and (5) support system. CONCLUSION: This systematic review investigated the factors influencing AMN retention and identified several promising retention strategies: granting them permanent residency, ensuring transparency in credentialing assessment, providing equal opportunities for career advancement, instituting induction programmes for newly employed Asian IENs, enabling families to be with them and building workplace social support. Retention strategies that embrace the Asian IENs' perspectives and experiences are envisioned to ensure a sustainable nursing workforce.

Perceptions of community care among nursing students: A cross-sectional study with implications to nursing workforce.

BACKGROUND: A shift of health care services towards community care has driven the need to develop the community care nursing workforce. However, challenges exist in attracting nursing graduates to a career in community care. AIM: To examine perceptions of community care and placement preference among undergraduate nursing students across different years of study in a Singapore university. METHODS: This study examined perceptions of community care and placement preference among undergraduate nursing students across different years of study. A cross-sectional study was conducted using the 'Scale on COmmunity care Perceptions' (SCOPE). RESULTS: Only 31.3 % of the 501 nursing students who completed the survey preferred community care placement. They rated opportunities for advancement, work status and enthusiastic colleagues in community care with relatively lower scores in the SCOPE. Students' placement preferences and year of study were predictive factors of their perceptions of community care nursing. Students who indicated their placement preference in home-based care (p < 0.001) and intermediate long-term care (p < 0.05) reported significantly positive perceptions towards community nursing as compared to students who indicated acute care as their preferred placement. Despite pre-perceived ideas among the year 1 cohort, the community care placement within their course curriculum had an impact on year 2 to 4 students' perceptions of community care. CONCLUSIONS: These findings identified key strategies to increase the community care nursing workforce which include promoting a better understanding of the role of a community nurse, providing quality community placement opportunities supported by preceptors who are good role models and fostering an optimistic career outlook and advancement in community nursing.

Artificial Intelligence Versus Human-Controlled Doctor in Virtual Reality Simulation for Sepsis Team Training: Randomized Controlled Study.

BACKGROUND: Interprofessional communication is needed to enhance the early recognition and management of patients with sepsis. Preparing medical and nursing students using virtual reality simulation has been shown to be an effective learning approach for sepsis team training. However, its scalability is constrained by unequal cohort sizes between medical and nursing students. An artificial intelligence (AI) medical team member can be implemented in a virtual reality simulation to engage nursing students in sepsis team training. OBJECTIVE: This study aimed to evaluate the effectiveness of an AI-powered doctor versus a human-controlled doctor in training nursing students for sepsis care and interprofessional communication. METHODS: A randomized controlled trial study was conducted with 64 nursing students who were randomly assigned to undertake sepsis team training with an AI-powered doctor (AI-powered group) or with medical students using virtual reality simulation (human-controlled group). Participants from both groups were tested on their sepsis and communication performance through simulation-based assessments (posttest). Participants' sepsis knowledge and self-efficacy in interprofessional communication were also evaluated before and after the study interventions. RESULTS: A total of 32 nursing students from each group completed the simulation-based assessment, sepsis and communication knowledge test, and self-efficacy questionnaire. Compared with the baseline scores, both the AI-powered and human-controlled groups demonstrated significant improvements in communication knowledge (P=.001) and self-efficacy in interprofessional communication (P<.001) in posttest scores. For sepsis care knowledge, a significant improvement in sepsis care knowledge from the baseline was observed in the AI-powered group (P<.001) but not in the human-controlled group (P=.16). Although no significant differences were found in sepsis care performance between the groups (AI-powered group: mean 13.63, SD 4.23, vs human-controlled group: mean 12.75, SD 3.85, P=.39), the AI-powered group (mean 9.06, SD 1.78) had statistically significantly higher sepsis posttest knowledge scores (P=.009) than the human-controlled group (mean 7.75, SD 2.08). No significant differences were found in interprofessional communication performance between the 2 groups (AI-powered group: mean 29.34, SD 8.37, vs human-controlled group: mean 27.06, SD 5.69, P=.21). However, the human-controlled group (mean 69.6, SD 14.4) reported a significantly higher level of self-efficacy in interprofessional communication (P=.008) than the AI-powered group (mean 60.1, SD 13.3). CONCLUSIONS: Our study suggested that AI-powered doctors are not inferior to human-controlled virtual reality simulations with respect to sepsis care and interprofessional communication performance, which supports the viability of implementing AI-powered doctors to achieve scalability in sepsis team training. Our findings also suggested that future innovations should focus on the sociability of AI-powered doctors to enhance users' interprofessional communication training. Perhaps in the nearer term, future studies should examine how to best blend AI-powered training with human-controlled virtual reality simulation to optimize clinical performance in sepsis care and interprofessional communication. TRIAL REGISTRATION: ClinicalTrials.gov NCT05953441; https://clinicaltrials.gov/study/NCT05953441.

Artificial intelligence in virtual reality simulation for interprofessional communication training: Mixed method study.

BACKGROUND: Virtual reality simulations are shown to be an effective approach for interprofessional nurse-physician communication training. However, its scalability is constrained by unequal medical-nursing cohort size, rendering a great challenge for all nursing students to form an interprofessional team with medical students. With the evolution of artificial intelligence (AI), an AI medical team player can be integrated into virtual reality simulations for more nursing students to engage in interprofessional team training. OBJECTIVES: To describe the development of a novel AI-enabled virtual reality simulation (AI-enabled VRS) and to evaluate nursing students' competencies and experiences in communicating with an AI medical doctor. METHODS: A mixed-methods design using a one-group pretest-posttest design and focus group discussions were employed in the evaluation phase. Nursing students from a university were recruited to undertake the 2-hour AI-enabled VRS. Pre-test and post-tests were administered to evaluate the participants' communication knowledge and self-efficacy. Survey questionnaires were administered to examine their experiences with the virtual reality environment and the AI doctor. Five focus group discussions were conducted to gain deeper insight into their learning experiences. RESULTS: The participants demonstrated significant improvements in communication knowledge and interprofessional communication self-efficacy after the learning. They reported positively on the acceptability, feasibility and usability of the AI-enabled VRS. The subscale of "human-like" feature of the AI medical doctor was rated the lowest. Three themes surrounding participants' experiences of the virtual learning emerged: "relate to the real world", "artificial intelligence versus human intelligence" and "complement with face-to-face learning". CONCLUSIONS: This study demonstrates initial evidence on the potential of AI-enabled VRS in fostering nursing students' learning on interprofessional communication skills. The findings have also provided insights on how to improve the AI-enabled VRS, in particular, the expressiveness of the AI pedagogical agent and facilitating more dialogue trainings with learner-agent conversations.

Salutogenic-based interventions among community-dwelling older adults: a systematic review and meta-analysis.

Salutogenesis is a health-promoting orientation and sense of coherence (SOC) is a vital coping factor associated with quality of life (QOL) and self-efficacy. Although salutogenic-based interventions showed potential in improving health outcomes, the application of salutogenic concepts and effectiveness on SOC, QOL and self-efficacy among community-dwelling older adults remained unclear. This review aimed to consolidate evidence on salutogenic approaches and evaluate the effectiveness of salutogenic-based interventions on SOC, QOL and self-efficacy in community-dwelling older adults. Databases systematically searched include PubMed, CINAHL, Embase, Cochrane Central Register of Controlled Trials, Scopus, Medline, PsycINFO and ProQuest Dissertations & Theses Global electronic databases. Two reviewers screened study eligibility, assessed risk of bias and extracted data of included studies independently. Meta-analyses on SOC and QOL were performed using RevMan. Where meta-analysis was not possible, narrative synthesis was employed. Eight studies involving 1201 older adults were included in this review. Subgroup analysis on SOC showed significant effects favouring salutogenic-based interventions using the empowering self-management model or strengths/resource-based approaches. However, results were mixed for the reflection-based approach. No significant effect favouring salutogenic-based interventions on QOL outcomes were found. High heterogeneity was observed for the outcome on self-efficacy. Two SOC strengthening processes, empowerment and reflection, were found to potentially underlie salutogenic-based intervention mechanisms. Effectiveness of salutogenic-based interventions on SOC, QOL and self-efficacy among community-dwelling older adults remained inconclusive due to high heterogeneity. Future salutogenic-based interventions should employ longitudinal designs and standardization on intervention delivery, utilizing a dual pathway via empowerment and reflection.

Salutogenic Healthy Ageing Programme Embracement (SHAPE)- an upstream health resource intervention for older adults living alone and with their spouses only: complex intervention development and pilot randomized controlled trial.

BACKGROUND: In view of age-related health concerns and resource vulnerabilities challenging older adults to age in place, upstream health resource interventions can inform older adults about the availability, accessibility, and utility of resources and equip them with better coping behaviours to maintain health and independence. This paper described the development process and evaluated the feasibility of an upstream health resource intervention, titled Salutogenic Healthy Ageing Programme Embracement (SHAPE), for older adults living alone or with spouses only. METHODS: A pilot randomised controlled trial design was adopted. SHAPE was designed to equip older adults with resource information and personal conviction to cope with stressors of healthy aging. This 12-week intervention comprised 12 weekly structured group sessions, at least two individual home visits and a resource book. Both the intervention and control groups received usual care provided in the community. Feasibility of SHAPE intervention was evaluated using recruitment rate, intervention adherence, data collection completion rate, satisfaction survey and post-intervention interview. Outcome measures (sense of coherence, health-promoting lifestyle behaviours, quality of life, self-efficacy, and self-rated health) were assessed at baseline and post-intervention. Paired t-tests were used to examine within-group changes in outcome measures. Content analysis was used to analysed qualitative data. RESULTS: Thirty-four participants were recruited and randomised. While recruitment rate was low (8.9%), intervention adherence (93.75%) and data collection completion (100%) were high. Participants expressed high satisfaction towards SHAPE intervention and found it useful. Participants experienced mindset growth towards personal and ageing experiences, and they were more proactive in adopting healthful behaviours. Although the programme was tailored according to needs of older adults, it required refinement. Intention-to-treat analysis showed significant increase in overall health-promoting lifestyle behaviours, health responsibility, physical activity, spiritual growth, and stress management among intervention participants. However, they reported a significant drop in autonomy post-intervention. CONCLUSION: Findings of this pilot trial suggested that with protocol modifications, SHAPE can be a feasible and beneficial health resource intervention for older adults. Modifications on recruitment strategies, eligibility criteria, selection of outcome measures, training of resource facilitators and strong collaboration bonds with community partners would be needed to increase feasibility robustness and scientific rigor of this complex intervention. TRIAL REGISTRATION: This study has been registered with clinicaltrials.gov on 10/05/2017. The trial registration number is NCT03147625.

The Effectiveness of Technology-Based Cardiopulmonary Resuscitation Training on the Skills and Knowledge of Adolescents: Systematic Review and Meta-analysis.

BACKGROUND: Cardiopulmonary resuscitation (CPR) training for adolescents is a prominent strategy to increase the number of community first responders who can recognize cardiac arrest and initiate CPR. More schools are adopting technology-based CPR training modalities to reduce class time and reliance on instructor availability and increase their capacity for wider training dissemination. However, it remains unclear whether these technology-based modalities are comparable with standard training. OBJECTIVE: This study aimed to systematically review and perform meta-analyses to evaluate the effectiveness of technology-based CPR training on adolescents' CPR skills and knowledge. METHODS: Searches were conducted in PubMed, Embase, Cochrane Library, Ovid MEDLINE, CINAHL, PsycINFO, Education Resources Information Center, ProQuest Dissertations and Theses Global, and Scopus from inception to June 25, 2021. Eligible randomized controlled trials (RCTs) compared technology-based training with standard training for adolescents aged 12 to 18 years. Studies were appraised using the Cochrane risk-of-bias tool. Random-effects meta-analyses were performed using Review Manager (The Cochrane Collaboration). Subgroup analyses were conducted to explore sources of heterogeneity. Overall certainty of evidence was appraised using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS: Seventeen RCTs involving 5578 adolescents were included. Most of the studies had unclear risks of selection bias (9/17, 53%) and high risks of performance bias (16/17, 94%). Interventions that included instructor guidance increased the likelihood of adolescents checking the responsiveness of the person experiencing cardiac arrest (risk ratio 1.39, 95% CI 1.19-1.63) and calling the emergency medical services (risk ratio 1.11, 95% CI 1.00-1.24). Self-directed technology-based CPR training without instructor guidance was associated with poorer overall skill performance (Cohen d=-0.74, 95% CI -1.02 to -0.45). Training without hands-on practice increased mean compression rates (mean difference 9.38, 95% CI 5.75-13.01), whereas real-time feedback potentially yielded slower compression rates. Instructor-guided training with hands-on practice (Cohen d=0.45, 95% CI 0.13-0.78) and the use of computer programs or mobile apps (Cohen d=0.62, 95% CI 0.37-0.86) improved knowledge scores. However, certainty of evidence was very low. CONCLUSIONS: Instructor-guided technology-based CPR training that includes hands-on practice and real-time feedback is noninferior to standard training in CPR skills and knowledge among adolescents. Our findings supported the use of technology-based components such as videos, computer programs, or mobile apps for self-directed theoretical instruction. However, instructor guidance, hands-on practice, and real-time feedback are still necessary components of training to achieve better learning outcomes for adolescents. Such a blended learning approach may reduce class time and reliance on instructor availability. Because of the high heterogeneity of the studies reviewed, the findings from this study should be interpreted with caution. More high-quality RCTs with large sample sizes and follow-up data are needed. Finally, technology-based training can be considered a routine refresher training modality in schools for future research.

Re-orienting healthcare for healthy living communities: A qualitative exploration of nursing students utilising the salutogenic theory for community health practice.

BACKGROUND: Salutogenesis is a resource-oriented approach that focuses on health creation. With the shift in focus from healthcare to health, there is a need to develop salutogenic inquiry and capacity of future nurses to promote good health and well-being in the community. OBJECTIVE: This study explored nursing students' perspectives on utilising the salutogenic theory in the community for health promotion, including the scope, perceived benefits, and challenges of theory application. DESIGN: A qualitative study using framework analysis. SETTING: A tertiary institution in Singapore. PARTICIPANTS: Nursing students who were taught the salutogenic theory for 'Healthy Community Living' module. METHODS: Data were gathered from four focus group discussions (n = 18) and 32 students' written assignments. They were analysed based on five components of knowledge framework. RESULTS: Four themes were identified: re-orienting healthcare for healthy living communities; ambivalent learning experiences; attracting early adopters of salutogenic paradigm; and practices for positive health development in complex systems: future directions. Findings reflected the value, versatility, and usefulness of introducing the salutogenic paradigm into the curriculum of healthcare education. Practical know-hows of applying the theory in community practice and development of health intervention were elicited. CONCLUSION: Much work is needed to future-proof the next generation of nurses in embracing and unifying the concept of salutogenic science into the existing pathogenic-driven care model. The real challenge would be the continual support of nursing education and health system to provide salutogenic care in the community.

A global overview of healthcare workers' turnover intention amid COVID-19 pandemic: a systematic review with future directions.

BACKGROUND: Globally, the health workforce has long suffered from labour shortages. This has been exacerbated by the workload increase caused by the COVID-19 pandemic. Major collapses in healthcare systems across the world during the peak of the pandemic led to calls for strategies to alleviate the increasing job attrition problem within the healthcare sector. This turnover may worsen given the overwhelming pressures experienced by the health workforce during the pandemic, and proactive measures should be taken to retain healthcare workers. This review aims to examine the factors affecting turnover intention among healthcare workers during the COVID-19 pandemic. METHODS: A mixed studies systematic review was conducted. The PubMed, Embase, Scopus, CINAHL, Web of Science and PsycINFO databases were searched from January 2020 to March 2022. The Joanna Briggs Institute's Critical Appraisal Tools and the Mixed Methods Appraisal Tool version 2018 were applied by two independent researchers to critically appraise the methodological quality. Findings were synthesised using a convergent integrated approach and categorised thematically. RESULTS: Forty-three studies, including 39 quantitative, two qualitative and two mixed methods studies were included in this review. Eighteen were conducted in the Middle East, ten in the Americas, nine in the Asia-Pacific region and six in Europe. Nurses (n = 35) were included in the majority of the studies, while physicians (n = 13), allied health workers (n = 11) and healthcare administrative or management staff (n = 7) were included in a smaller proportion. Five themes emerged from the data synthesis: (1) fear of COVID-19 exposure, (2) psychological responses to stress, (3) socio-demographic characteristics, (4) adverse working conditions, and (5) organisational support. CONCLUSIONS: A wide range of factors influence healthcare workers' turnover intention in times of pandemic. Future research should be more focused on specific factors, such as working conditions or burnout, and specific vulnerable groups, including migrant healthcare workers and healthcare profession minorities, to aid policymakers in adopting strategies to support and incentivise them to retain them in their healthcare jobs.

Simulation-Based Mastery Learning to Facilitate Transition to Nursing Practice.

BACKGROUND: Simulation-based mastery learning (SBML) was developed and implemented to facilitate nursing students' transition to clinical practice. PURPOSE: To evaluate nursing students' perspectives on the impact of SBML on their transition to clinical practice. METHOD: A descriptive qualitative study using focus group discussions was conducted with final-year nursing students who had completed their clinical practicum and SBML. RESULTS: Three themes emerged: authenticity of simulations, whereby students were able to draw some parallels between their simulations and clinical experiences; self-efficacy in clinical practice, which was gained through deliberate practice; and application of cognitive tools, which provided mental frameworks to guide clinical performances. CONCLUSION: This study highlights the need to ensure the fidelity of the simulations to achieve authentic experiences, provide deliberate practice to develop self-efficacy, and use cognitive tools for mental model formation to create a high-quality SBML program to foster better transfer of simulation learning to real-life setting.

Virtual Simulation to Enhance Clinical Reasoning in Nursing: A Systematic Review and Meta-analysis.

Background: The COVID-19 pandemic has given rise to more virtual simulation training. This study aimed to review the effectiveness of virtual simulations and their design features in developing clinical reasoning skills among nurses and nursing students. Method: A systematic search in CINAHL, PubMed, Cochrane Library, Embase, ProQuest, PsycINFO, and Scopus was conducted. The PRISMA guidelines, Cochrane's risk of bias, and GRADE was used to assess the articles. Meta-analyses and random-effects meta-regression were performed. Results: The search retrieved 11,105 articles, and 12 randomized controlled trials (RCTs) were included. Meta-analysis demonstrated a significant improvement in clinical reasoning based on applied knowledge and clinical performance among learners in the virtual simulation group compared with the control group. Meta-regression did not identify any significant covariates. Subgroup analyses revealed that virtual simulations with patient management contents, using multiple scenarios with nonimmersive experiences, conducted more than 30-minutes and postscenario feedback were more effective. Conclusions: Virtual simulations can improve clinical reasoning skill. This study may inform nurse educators on how virtual simulation should be designed to optimize the development of clinical reasoning.

Home-based care nurses' lived experiences and perceived competency needs: A phenomenological study.

AIM: The aim of this work is to explore home-based care nurses' practice experiences in order to understand their competency and needs. BACKGROUND: The demand for home-based care is increasing in many countries. Nurses perform a broader range of competencies with a significant degree of independence in home-based care. However, little is known about nurses' day-to-day experiences and their perceived competency and needs. METHODS: The study adopted a descriptive phenomenological design. Individual interviews with 17 nurses from four service providers were performed. Colaizzi's analysis method was used for data analysis. Reflective diary approaches were adopted to guide the bracketing process. RESULTS: Following data analysis, four themes emerged: (1) Full spectrum of patient care, (2) autonomy in nursing practice, (3) beliefs in person-centred care and (4) enhancing supportive systems. CONCLUSION: Findings suggest a need for better understanding of the broader scope of nursing practice in home-based care to improve nurses' transition experience. This includes performing autonomous assessments, making decisions and managing social related matters. IMPLICATIONS FOR NURSING MANAGEMENT: It should be a priority to identify a clear scope of practices in home-based nursing care in order for organizations to improve nurses' readiness for and experiences in home-based care. Nursing leaders should also expand practical experience opportunities in home-based care to transitioning nurses with supportive workplace systems.

To Volunteer or Not? Perspectives towards Pre-Registered Nursing Students Volunteering Frontline during COVID-19 Pandemic to Ease Healthcare Workforce: A Qualitative Study.

COVID-19 has caused a shortage of healthcare workers and has strained healthcare systems globally. Pre-registered healthcare students with training have a duty of care and can support the healthcare workforce. This study explored factors influencing the willingness of final-year nursing students to volunteer during the COVID-19 pandemic, the role of professional identity in volunteering as healthcare workers, and strategies to improve future volunteering uptakes and processes. A qualitative study using focus-group discussions was conducted. Final-year nursing students who volunteered, students who did not volunteer, and lecturers who supervised student volunteers were recruited. Interviews were conducted online, video-recorded, and transcribed verbatim. A thematic analysis was used. The themes were "wavering thoughts on volunteering", "bringing out 'the nurse' in students through volunteering" and "gearing up to volunteer". Findings suggested the need to look beyond the simplicity of altruism to the role of professional identity, operational, and motivational factors to explain nursing students' decision to volunteer and their volunteer behavior. Providing accommodation, monetary and academic-related incentives, supporting the transitionary phase from students to "professional volunteers", promoting cohesive and positive staff-student volunteer relationships, and establishing a volunteer management team are strategies identified to improve volunteering uptake and operational processes. Our findings advocate strategic partnerships between hospitals/communities and academic institutions in providing various healthcare 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.

Effectiveness of internal Qigong on quality of life, depressive symptoms and self-efficacy among community-dwelling older adults with chronic disease: A systematic review and meta-analysis.

BACKGROUND: With increasingly aged populations worldwide, the quality of life and psychosocial wellbeing of older adults, especially those with chronic disease, become of increasing importance. There are multiple studies on the use of internal Qigong, a popular mind-body exercise commonly practiced by older adults. However, the effectiveness of internal Qigong on quality of life, depressive symptoms, and self-efficacy on older adults remains unclear. OBJECTIVES: To review updated evidence to determine the effectiveness of internal Qigong interventions on quality of life, depressive symptoms, and self-efficacy among community-dwelling older adults with chronic disease. METHOD: Six databases (PubMed, CENTRAL, CINAHL, Embase, Scopus, CNKI) were systematically searched for studies from January 2008 to December 2018 in English and Chinese. Relevant randomised controlled trials (RCTs) were screened and assessed for risk of bias by two independent reviewers. A meta-analysis on study outcomes of quality of life, depressive symptoms and self-efficacy using the RevMan 5.3 software was performed. RESULTS: The search retrieved 3439 records. After screening, a total of 13 RCTs with 1340 participants were included in this review. Meta-analysis revealed a significant effect favouring internal Qigong on the quality of life (combined MD = 3.72; 95% CI: 2.27-5.18; p = 0.0001) compared to controls. No significant effects were found for depressive symptoms and self-efficacy. Low heterogeneity among the studies was found for quality of life, whereas high heterogeneity was shown for depressive symptoms and self-efficacy. CONCLUSION: Internal Qigong appears to have potential benefits on overall quality of life among community-dwelling older adults with chronic disease. The findings of this study suggest potential use of internal Qigong as an adjunct activity for chronic disease management. Future research may enhance the rigour of trials and explore theoretical underpinnings behind Qigong.

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.

Perceptions of Singaporean patients living with implantable cardioverter defibrillators: an exploratory qualitative study.

BACKGROUND: Despite the increasing use of implantable cardioverter defibrillators (ICDs) as a preventive approach for high-risk patients with arrhythmias, little is known about the perceptions of ICD recipients regarding these devices and their impact on quality of life. OBJECTIVES: To explore perceptions towards quality of life, coping strategies, and learning needs of patients living with ICDs in Singapore. METHODS: 16 participants (age ranges 52 to 84 years old) were purposively recruited and interviewed individually for this exploratory qualitative study. Data collected was analyzed using thematic analysis. RESULTS: Seven themes emerged: experiencing ICD shocks, ambivalent "love-hate" relationship with ICD, receiving support from healthcare professionals and social networks, attaining acceptance and returning to normalcy, physical coping, emotional coping, and readiness and need for enhanced patient education. CONCLUSIONS: With an insight to the perceptions of ICD recipients in Singapore, future practice can focus on addressing their concerns and improve post-implantation quality of life.

The effectiveness of psychological interventions on self-care, psychological and health outcomes in patients with chronic heart failure-A systematic review and meta-analysis.

OBJECTIVE: To review the evidence to determine the effects of psychological interventions on self-care and psychological and health outcomes in patients with chronic heart failure (CHF). METHODS: We evaluated the effectiveness of randomized controlled trials using psychological methods or theory on self-care behaviors, anxiety and depression levels, HRQoL, and physical function. Studies published in English, from January 2006 to December 2016, were considered. We searched published and unpublished studies in the following electronic databases: CINAHL, Cochrane Library, EMBASE, PubMed, PsycINFO, Scopus, Web of Science, and ProQuest Dissertations and Theses. Risk of bias was assessed using a standard procedure based on the Cochrane Collaboration tool described in the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: A total of 29 articles, consisting of 25 studies with 3837 participants, were included in this systematic review. Findings showed that despite heterogeneity between studies, psychological interventions tend to improve self-care in CHF patients without clinical depression and cognitive impairment. Pooled results also revealed that the intervention effect on short-term HRQoL, as measured by the Minnesota Living with Heart Failure Questionnaire (MLHFQ), was in favor of the intervention group (combined MD -7.53, 95% CI -12.83 to -2.23); however, such effect disappeared as the length of time from the intervention increased. The intervention effects on the participants' anxiety level, as measured by HADS, and physical function, as measured by 6MWT, were not statistically significant. DISCUSSION: Efforts aimed at promoting self-care were the cornerstone of HF disease management. Nurses play an important role in patient education and secondary prevention. Compared to other professionals, nurses have more patient contact opportunities and are more holistic in all aspects of disease management; therefore, more nurses can be trained to incorporate the brief psychological techniques (such as motivational interviews and cognitive behavior therapy) to maximize intervention effectiveness. The main limitation of the review is the moderate to high level of heterogeneity among the included studies, which may partially undermine the reliability and reproducibility of the results. Because of the heterogeneity among the studies, a conclusion on the optimal format and forms of the intervention could not be drawn. Replication of the studies will be required in the future to isolate the active intervention component and to identify the ideal intervention format and dosage.