Mobile Health Application-Based Interventions to Improve Self-management of Chemotherapy-Related Symptoms Among People with Breast Cancer Who Are Undergoing Chemotherapy: A Systematic Review.

BACKGROUND: Since the COVID-19 pandemic, there have been an increasing number of studies on using mobile health (mHealth) to support the symptom self-management of patients with breast cancer (BC). However, the components of such programs remain unexplored. This systematic review aimed to identify the components of existing mHealth app-based interventions for patients with BC who are undergoing chemotherapy and to uncover self-efficacy enhancement elements from among them. METHODS: A systematic review was conducted for randomized controlled trials published from 2010 to 2021. Two strategies were used to assess the mHealth apps: The Omaha System, a structured classification system for patient care, and Bandura's self-efficacy theory, which assesses sources of influence that determine an individual's confidence in being able to manage a problem. Intervention components identified in the studies were grouped under the 4 domains of the intervention scheme of the Omaha System. Four hierarchical sources of self-efficacy enhancement elements were extracted from the studies using Bandura's self-efficacy theory. RESULTS: The search uncovered 1,668 records. Full-text screening was conducted on 44 articles, and 5 randomized controlled trials (n = 537 participants) were included. Self-monitoring under the domain of "Treatments and procedure" was the most frequently used mHealth intervention for improving symptom self-management in patients with BC undergoing chemotherapy. Most mHealth apps used various "mastery experience" strategies including reminders, self-care advice, videos, and learning forums. CONCLUSION: Self-monitoring was commonly utilized in mHealth-based interventions for patients with BC undergoing chemotherapy. Our survey uncovered evident variation in strategies to support self-management of symptoms and standardized reporting is required. More evidence is required to make conclusive recommendations related to mHealth tools for BC chemotherapy self-management.

A Nurse-Led mHealth Self-Management Program (mChemotherapy) for Breast Cancer Patients Undergoing Chemotherapy: Study Protocol of a Randomized Controlled Pilot Study.

BACKGROUND: The global pandemic has caused breast cancer (BC) patients who are receiving chemotherapy to face more challenges in taking care of themselves than usual. A novel nurse-led mHealth program (mChemotherapy) is designed to foster self-management for this population. The aim of the pilot study is to determine the feasibility, usability, and acceptability of an mChemotherapy program for breast cancer patients undergoing chemotherapy. The objective also is to evaluate the preliminary effects of this program on adherence to app usage, self-efficacy, quality of life, symptom burden, and healthcare utilization among this group of patients. METHODS: This is a single-blinded randomized controlled pilot study that includes one intervention group (mChemotherapy group) and one control group (routine care group). Ninety-four breast cancer patients who commence chemotherapy in a university-affiliated hospital will be recruited. Based on the Individual and Family Self-management Theory, this 6-week mChemotherapy program, which includes a combination of self-regulation activities and nurse-led support, will be provided. Data collection will be conducted at baseline, week 3 (T1), and week 6 (T2). A general linear model will be utilized for identifying the between-group, within-group, and interaction effects. Qualitative content analysis will be adopted to analyze, extract, and categorize the interview transcripts. DISCUSSIONS: Breast cancer patients receiving chemotherapy are a population that often experiences a heavy symptom burden. During the pandemic, they have had difficulties in self-managing the side effects of chemotherapy due to the lack of face-to-face professional support. An mChemotherapy program will be adopted through a self-regulation process and with the provision of nurse-led real-time professional support for these patients. If proven effective, BC patients who engage in this program will be more likely to take an active role in managing their symptoms, take responsibility for their own health, and subsequently improve their self-efficacy and adherence to the use of the app.

Symptom Burden of Children with Cancer and Parental Quality of Life: The Mediating Role of Parental Stress.

BACKGROUND: The aim of this study was to investigate the association between children's reported symptom burden and their parents' quality of life, and whether parents' perceived stress mediates this relationship. METHOD: this was a cross-sectional quantitative research study. Convenience sampling was used to recruit 80 pairs of parents and their children with cancer. Advanced statistical methods were used to analyse the mediating effects of parental stress between children's symptom burden and parents' quality of life. RESULTS: The results showed that parental stress was the mediator in the relationship between children's reported symptom burden and their parents' quality of life. CONCLUSIONS: Symptom burden was prevalent in Chinese children with cancer living in the community. Children's symptom burden is an important factor in predicting parental stress level, which simultaneously and directly lower parents' quality of life. The evidence in this study enlarges the knowledge base about the mediating effect of parental stress on the association between the symptom burden of children with cancer and their parents' quality of life. This evidence is crucial in paving the way for the development of interventions that improve the parental quality of life through stress-reduction programs.

Parental Stress as the Mediator Between Symptom Burden and the Quality of Life of Chinese Children With Cancer.

BACKGROUND: Because of their cancer and treatment adverse effects, most pediatric oncology patients will experience 1 or more symptoms at one time that can seriously affect their quality of life. Because these children are attached to parents, their symptom burden directly influences the parental stress level and parental interpretations of their children's quality of life. OBJECTIVE: The aim of this study was to examine the association between child-reported symptom burden and the pediatric quality of life reported by children with cancer and their parents, and whether parental perceived stress mediates these relationships. METHODS: In a cross-sectional design, convenience sampling was used to recruit 80 parent-child dyads. Advanced statistical methods were adopted to analyze the mediating effects of parental stress between children's symptom burden and their quality of life. RESULTS: The results revealed that parental stress was the mediator in the relationship between child-reported symptom burden and children's quality of life reported by parents. The results also showed that parental stress was not a mediator in the relationship between child-reported symptom burden and their quality of life. This underscored the differences in interpretations of quality of life reported by children and their parents. CONCLUSION: Children's symptom burden is an important factor in predicting parental stress level and the quality of life reported by the children. Children's voice should be incorporated whenever possible. IMPLICATIONS FOR PRACTICE: The knowledge gained from this study will facilitate intervention development to enhance parents' abilities in stress management and symptom management for their children with the support of the nursing profession.

Effects of Urban Green Space on Cardiovascular and Respiratory Biomarkers in Chinese Adults: Panel Study Using Digital Tracking Devices.

BACKGROUND: The health benefits of urban green space have been widely reported in the literature; however, the biological mechanisms remain unexplored, and a causal relationship cannot be established between green space exposure and cardiorespiratory health. OBJECTIVE: Our aim was to conduct a panel study using personal tracking devices to continuously collect individual exposure data from healthy Chinese adults aged 50 to 64 years living in Hong Kong. METHODS: A panel of cardiorespiratory biomarkers was tested each week for a period of 5 consecutive weeks. Data on weekly exposure to green space, air pollution, and the physical activities of individual participants were collected by personal tracking devices. The effects of green space exposure measured by the normalized difference vegetation index (NDVI) at buffer zones of 100, 250, and 500 meters on a panel of cardiorespiratory biomarkers were estimated by a generalized linear mixed-effects model, with adjustment for confounding variables of sociodemographic characteristics, exposure to air pollutants and noise, exercise, and nutrient intake. RESULTS: A total of 39 participants (mean age 56.4 years, range 50-63 years) were recruited and followed up for 5 consecutive weeks. After adjustment for sex, income, occupation, physical activities, dietary intake, noise, and air pollution, significant negative associations with the NDVI for the 250-meter buffer zone were found in total cholesterol (-21.6% per IQR increase in NDVI, 95% CI -32.7% to -10.6%), low-density lipoprotein (-14.9%, 95% CI -23.4% to -6.4%), glucose (-11.2%, 95% CI -21.9% to -0.5%), and high-sensitivity C-reactive protein (-41.3%, 95% CI -81.7% to -0.9%). Similar effect estimates were found for the 100-meter and 250-meter buffer zones. After adjustment for multiple testing, the effect estimates of glucose and high-sensitivity C-reactive protein were no longer significant. CONCLUSIONS: The health benefits of green space can be found in some metabolic and inflammatory biomarkers. Further studies are warranted to establish the causal relationship between green space and cardiorespiratory health.

Perceived Family Impact During Children's Hospitalization for Treatment of Acute Lymphoblastic Leukemia: A Cross-sectional Study.

BACKGROUND: Improved survival rates of acute lymphoblastic leukemia (ALL) in children are often associated with repeated and prolonged hospitalization, creating an immensely stressful situation for the family. OBJECTIVE: The aims of this study were to assess perceived family impact and coping during the child's hospitalization for ALL treatment and identify potential predictors of perceived family impact. INTERVENTIONS/METHODS: A total of 212 families with children hospitalized participated. The hospitalization impact and coping scales were used to assess perceived family impact and coping, respectively. RESULTS: The mean (SD) total score for perceived family impact was 88.11 (22.39); social impact received the highest average score. The mean (SD) total score for family coping was 39.02 (9.84). A significant decrease in family coping was associated with more readmissions. Predictors of perceived family impact were severity of the child's illness, total days of all admissions, and coping, accounting for 37% of the observed variance. CONCLUSIONS: Families were moderately affected by children's hospitalizations; social functioning was most affected. Families' perceived coping effectiveness decreased as the readmissions increased. The higher risk category a child's diagnosis is, the longer a child's hospitalization is, and the less perceived coping effectiveness, the higher family perceived impact. IMPLICATIONS FOR PRACTICE: The findings provide a direction for the development of family-centered supportive intervention programs. Nurses should be aware that the total days of admission and severity of a child's illness are significant factors associated with perceived family impact and likely justify special attention. Family coping enhancement interventions could alleviate perceived family impact.

Influence of Urban Green Space and Facility Accessibility on Exercise and Healthy Diet in Hong Kong.

Background A cross-sectional study using a convenience sampling method was conducted to understand how green space and accessibility of common public open spaces in compact urban areas affect physical activity and healthy diets of residents. Methods A total of 554 residents completed a structured questionnaire on quality of life, physical activity level and healthy eating practice. Particularly, categories of physical activity and durations were obtained by using the short form Chinese International Physical Activity Questionnaire (IPAQ-C), then the Metabolic Equivalent of Task (MET)-minutes/week was calculated using the formulae (walking minutes × walking days × 3.3) + (moderate-intensity activity minutes × moderate days × 4.0) + (vigorous-intensity activity minutes × vigorous-intensity days × 8.0). The percentage of green space was calculated based on a spatial buffer with a 500 m radius from participants' geocoded addresses using a SPOT ('Satellite Pour l'Observation de la Terre' in French) satellite image-derived vegetation dataset. Parks, promenade and sports facilities were examples of open spaces. Results The sampled population who lived with green space averaged 10.11% ± 7.95% (ranged 1.56-32.90%), with the majority (90%) performing physical activities at medium and high levels. MET-minutes/week was significantly associated (Pearson r = 0.092; p < 0.05) with the green space percentage. Relatively active residents commonly used open spaces within the district for performing exercise, in particular, parks and promenades were mostly used by older residents, while sports facilities by the younger groups at age 25-44 and <25 years. Conclusions Current findings suggested promotion of exercise could be achieved by the design or redesign of built environment to include more parks accessible to the residents with the increase of vegetation.

A Brief Hope Intervention to Increase Hope Level and Improve Well-Being in Rehabilitating Cancer Patients: A Feasibility Test.

This article reports on the feasibility and effect of the brief hope intervention (BHI) in terms of increasing the hope level and psychological and physical health outcomes of rehabilitating cancer patients (RCP). Chinese RCP living in the community were invited to join the study. The BHI consisted of four one-on-one sessions: two (1-hour) face-to-face sessions and two (30-minute) telephone follow-up sessions in between. There were three core features in the hope therapy: (a) goal thoughts: finding workable goals, (b) pathway thoughts: finding ways to reach the targets, and (c) agency thoughts: positive self-talk to optimize their motivation to accomplish the set goals. A one-group pre- and postintervention design was used. Outcome measures included the Memorial Symptom Assessment Scale, the Center for Epidemiological Studies Depression Scale (CES-D), and the State Hope Scale. Recruitment, attrition, and qualitative feedback were collected to understand their comments on BHI. A total of 40 participants were recruited (female 92.3%). The mean age was 57.2 years (SD = 6.7). The participants had significant improvement in all aspects of the Memorial Symptom Assessment Scale, with moderate-to-large effect sizes (d = 0.49-0.74). The changes in present hope and depression scores were insignificant, with small effect sizes (d = 0.17-0.34). The BHI seemed to be promising in producing both physical and psychological benefits in RCP.

Assessing quality of life using WHOQOL-BREF: a cross-sectional study on the association between quality of life and neighborhood environmental satisfaction, and the mediating effect of health-related behaviors.

BACKGROUND: Quality of life (QOL) is an important component in assessing people's health. Environmental quality can influence people's QOL in the physical health, psychological, social relationships and environment domains. QOL in the four domains, overall QOL and general heath of residents living in the Kowloon Peninsula of Hong Kong were assessed. The association between satisfaction with the neighborhood environment and QOL, and health-related behaviors which mediated the effect were investigated. METHODS: A sample of 317 residents completed a questionnaire which comprised the WHOQOL-BREF (Hong Kong version) to assess QOL, the International Physical Activity Questionnaire (IPAQ) to study physical activities, and questions on satisfaction with the neighborhood environment, health-related behaviors and socio-demographics. One-way ANOVA and linear regression were used to study the associations between environmental satisfaction and QOL in the four domains, overall QOL and general health, followed by assessing the relationships between environmental satisfaction and the potential health-related behavior mediators with regression tests. Mediation analysis was conducted using multiple linear regressions to study the effects of environmental satisfaction on QOL in the four domains, overall QOL and general health, as well as the potential mediating roles played by various health-related behaviors. A P-value of < 0.05 was considered as statistically significant. RESULTS: The residents had a relatively higher physical health mean score of 70.83 ± 12.69, and a lower environmental mean score of 61.98 ± 13.76. Moderate satisfaction with the neighborhood environment had a significant relationship with QOL in the psychological domain (ß = 0.170, P = 0.006), however, this effect was partially mediated by the non-smoking behavior of the residents (ß = 0.143, P = 0.022). CONCLUSIONS: Our residents had lower QOL in the physical health and psychological domains but similar QOL in the social relationships and environmental domains compared to other countries. Only QOL in the psychological domain could be predicted by the satisfaction with the neighborhood environment, and non-smoking status was a partial mediator of the effect of moderate environmental satisfaction on QOL in the psychological domain. Refrain from smoking seems to be able to lower the influence of neighborhood environment on people's QOL in the psychological domain to a certain extent.

Nursing Intervention Practices for Smoking Cessation: A Large Survey in Hong Kong.

Previous studies have shown that nursing interventions are effective in helping people to stop smoking, but that the participation of nurses in tobacco control activities has been far from satisfactory. The primary objective of this study is to identify factors that encourage or discourage nurses from participating in providing smoking-cessation interventions to their clients, based on the 5 A's (ask, advise, assess, assist, arrange) framework. A cross-sectional survey was conducted among 4413 nurses in Hong Kong from different clinical specialties. A logistics regression analysis found that predictors for the practicing of all of the 5 A's are nurses who want to receive training in smoking-cessation interventions, those who have received such training, and those who are primarily working in a medical unit or in ambulatory/outpatient settings. The regression model also showed that attitude towards smoking cessation was positively associated with all of the 5 A's. The results indicate a need to encourage and provide nurses with opportunities to receive training on smoking-cessation interventions. Strategies to persuade nurses to provide smoking-cessation interventions are also important, since nurses are motivated to perform smoking-cessation interventions when they feel a stronger sense of mission to control tobacco use.

Psychometric Validation of an Instrument to Measure Family Coping During a Child's Hospitalization for Cancer.

BACKGROUND: Families with children hospitalized for cancer treatment experience multiple, serious challenges. Family coping is a crucial moderator between family stress and family adaptation. A newly developed instrument, the Hospitalization Coping Scale (HCS), measures the effectiveness of family coping during a child's hospitalization. OBJECTIVE: The aims of this study were to revise and validate the psychometric properties of the HCS for families with children hospitalized for cancer treatment in pediatric oncology departments in Mainland China. METHODS: Psychometric properties of the HCS were examined among 253 families with children hospitalized in pediatric oncology departments in 4 hospitals. Reliability, construct validity, known-group validity, and concurrent validity of the revised HCS were examined. RESULTS: The revised 15-item HCS contains 3 renamed factors: maintaining mental stability, mutual support for child care, and seeking support from external systems. Cronbach's α coefficients for the total and 3 factors were .87, .78, .83, and .79, respectively. The revised scale demonstrated sound known-group validity and concurrent validity. CONCLUSIONS: The revised 15-item HCS is a reliable and valid instrument to measure coping effectiveness of families with children hospitalized for cancer treatment. IMPLICATIONS FOR PRACTICE: The HCS can be used by pediatric oncology nurses to assess the effectiveness of family coping during a hospitalization of their child with cancer and may help pediatric oncology nurses to develop and implement realistic support strategies based on assessments of family coping effectiveness.

Substitution of SF-36 by SF-12 Among Hong Kong Chinese Older Adults: Secondary Analysis of Randomized Controlled Trials.

PURPOSE: This study aims to examine the appropriateness of substituting the Short-Form 36 (SF-36) by its shortened version (SF-12) in measuring health-related quality of life (HRQoL) in older Chinese population. METHODS: Secondary analysis of two transitional care management programs, conducted from 2009 to 2012, were analyzed (n = 1188, aged 60-97). Participants were discharged patients with respiratory disease, type 2 diabetes, cardiac disease, and renal disease, and were classified according to number of chronic diseases. SF-36 was administered at baseline and 4-week follow-up. RESULTS: Both overestimations and underestimations of HRQoL by SF-12 were found. Most domain scores of SF-36 and SF-12 were highly correlated (Spearman correlation (ρ) > 0.85), with the exception of General Health (ρ = 0.64) and Vitality subscales (ρ = 0.82). Multiple linear regression adjusted for demographic characteristics showed that the four out of eight domains of SF-36 and SF-12 were equivalent in measuring the difference across numbers of chronic diseases (all p < 0.05). Paired sample t tests in 989 (83.2 %) who completed the SF-36 survey 4 weeks after baseline showed that SF-12 overestimated the 4-week changes in most of the domains. CONCLUSIONS: The use of the Chinese version of SF-12v2 for reporting the change over time in quality of life among medical patients after hospital discharge may need to be interpreted with caution. The SF-12 tends to underestimate the difference when compared with the SF-36.

Systematic review of the predisposing, enabling, and reinforcing factors which influence nursing administration of opioids in the postoperative period.

AIM: To provide an overview of the administration of opioid analgesics by nurses when prescription is on an "as-needed" basis for postoperative pain, and to identify the important factors that determine the decisions of nurses, by using the framework of predisposing, reinforcing, and enabling causes in educational diagnosis and evaluation. METHODS: Multiple databases were searched for the period from 2000-2012. Out of a total of 1755 citations and 148 abstracts retrieved, 39 studies met the criteria for inclusion. Studies were considered eligible for review if they focused on situations or factors influencing a nurse's performance in pain assessment and the administration of opioid analgesics in postoperative pain management. RESULTS: The topics of the descriptive and qualitative studies presented four themes: (i) nurses' knowledge and attitudes about pain management; (ii) the situation of nurses' work practices in administrating range orders for opioid analgesics; (iii) factors that influenced nurses' work practices; and (iv) perceived barriers to effective pain management from the nurse's perspective. The experimental studies investigated the effects of different approaches in nurses' pain management practices in postoperative settings and their outcomes for patients. CONCLUSION: A knowledge deficit was observed to be the reason in most cases for a nurse's failure to administrate adequate analgesics for postoperative pain relief. Pain-related education for nurses is the cornerstone to improve pain management. The integration of enabling and reinforcing factors will help nurses to develop the ability to make the decision to engage in a comprehensive intervention to improve pain management and patient outcomes.

The association between time spent in sedentary behaviors and blood pressure: a systematic review and meta-analysis.

BACKGROUND AND OBJECTIVE: Sedentary behaviors, defined as waking behaviors with low energy expenditure while sitting, are positively associated with several adverse health outcomes. However, the association between sedentary behaviors and blood pressure (BP) is inconclusive. This study aimed to conduct a systematic review and meta-analysis on the association between time spent in sedentary behaviors and BP. METHODS: We searched PubMed, MEDLINE, and Web of Science for papers published before August 2014 that assessed the association between time spent in sedentary behaviors and BP. Studies on both adults and children were included. Only good quality studies were included. The pooled estimates of systolic BP (SBP) and diastolic BP (DBP) increase per hour of time spent in sedentary behaviors a day were computed using a fixed-effects model and a random-effects model, respectively. Another pooled estimate of odds ratio per hour of time spent in sedentary behaviors a day on having high BP was computed using a fixed-effects model. A sub-group analysis was conducted for studies using self-reported and objectively assessed time spent in sedentary behaviors separately. RESULTS: A total of 31 papers of good quality were included in the systematic review, 18 of which found no association between time spent in sedentary behaviors and BP (58.1%). A total of 28 papers were included in the meta-analysis. Pooled effects showed that an additional hour of time spent in sedentary behaviors per day was associated with an increase of 0.06 mmHg (108,228 participants, 95% CI 0.01-0.11, p = 0.01) of SBP and 0.20 mmHg (107,791 participants, 95% CI 0.10-0.29, p < 0.001) of DBP. Accelerometer-assessed time spent in sedentary behaviors was not associated with either SBP (p = 0.06) or DBP (p = 0.33). The odds ratio (OR) of having high BP with an additional hour of time spent in sedentary behaviors per day was 1.02 (98,798 participants, 95% CI 1.003-1.03, p = 0.02). CONCLUSIONS: Self-reported but not accelerometer-assessed time spent in sedentary behaviors was associated with BP. Further studies are warranted to determine the preventive effect of reducing sedentary behaviors on high BP.

The computerized OMAHA system in microsoft office excel.

The OMAHA System was adopted as the documentation system in an interventional study. To systematically record client care and facilitate data analysis, two Office Excel files were developed. The first Excel file (File A) was designed to record problems, care procedure, and outcomes for individual clients according to the OMAHA System. It was used by the intervention nurses in the study. The second Excel file (File B) was the summary of all clients that had been automatically extracted from File A. Data in File B can be analyzed directly in Excel or imported in PASW for further analysis. Both files have four parts to record basic information and the three parts of the OMAHA System. The computerized OMAHA System simplified the documentation procedure and facilitated the management and analysis of data.

The risk factors for hospital re-admission in medical patients in Singapore.

Unplanned hospital re-admissions are common, expensive and often unpreventable in the community. The study aimed to identify risk factors associated with unplanned hospital re-admission in Singapore. In a cross-sectional survey, 1509 patients admitted to the medical wards of a large acute hospital in Singapore during 2010 were recruited (78.8% response rate), data being collected using a structured questionnaire based on the Andersen behavioural model underlying healthcare use. The dependent variable was re-admission within 28 days, with independent variables in the four areas of predisposing characteristics, needs, enabling resources and health behaviour. Hierarchical logistic regression was used to evaluate the risk factors associated with unplanned hospital re-admission. There were 222 inpatients re-admitted (14.7%) within 28 days and the final model showed that patients who were unemployed (OR = 1.5; 95% CI = 1.1-2.1) and had chronic obstructive pulmonary disease (OR = 2.0; 95% CI = 1.1-3.7) with abnormal respiratory patterns (OR = 1.6; 95% CI = 1.1-2.2) were more likely to be re-admitted. Less likely to be re-admitted were patients doing regular daily activities (OR = 0.7; 95% CI = 0.5-0.9), those assisted by a social worker (OR = 0.3; 95% CI = 0.2-0.6), those referred to other health professionals when sick (OR = 0.6; 95% CI = 0.4-0.7) and those who had received health education programmes before discharge in the previous admission (OR = 0.7; 95% CI = 0.4-0.9). Unplanned re-admissions are a concern to healthcare providers because this suggests that patients are discharged with unresolved problems that reflect ineffective care in hospital. This study provides evidence to prompt more effective discharge educational care programmes that incorporate patients' enabling and need outcomes, thereby reducing re-admission rates. Community-based healthcare should play an important role in reducing patients' re-admission rates.

Nursing education in China: past, present and future.

BACKGROUND: The development of nursing education in China is closely tied with the country's wider context, including the social, political and economic environment. EVALUATION: The source of information includes published materials accessible to the public and the authors' knowledge as content experts of the nursing situation in China. KEY ISSUES: Nursing in China is developing rapidly particularly in the last decade in quantity and quality terms. The education development of nursing is in line with the service development which aims at client-centred care adopting a holistic approach caring for clients at the preventive, curative and rehabilitative levels. CONCLUSIONS: Nursing education in China, both at the pre-registration and post-registration level, plays a key role in building a strong team of nurses to fulfil the health mission of the country. IMPLICATIONS FOR NURSING MANAGEMENT: Managers in nursing education need to continuously revise the curriculum to produce nurses who meet societal needs at present and for the future. At the same time, nurse managers in the service need to make best use of these nursing talents according to the nurses' competence and educational levels.

Postoperative pain experience and barriers to pain management in Chinese adult patients undergoing thoracic surgery.

AIMS: The purpose of this study was (1) to explore postoperative pain experience among Chinese thoracotomy patients during hospitalisation; (2) to identify patient-related barriers to pain management; and (3) to explore how these barriers were related to patients' pain experience. BACKGROUND: Major thoracotomy causes severe pain and extreme stress for patients. Unrelieved postoperative pain leads to high risks of postoperative complications and chronic post-thoracotomy pain syndrome, compromising the quality of life for those patients. DESIGN: Cross-sectional design. METHODS: A tertiary general hospital in mainland China was selected for this study. A total of 94 patients undergoing scheduled major thoracotomy operations participated in the study. All patients completed Brief Pain Inventory-Chinese version, the Barrier Questionnaire-Taiwan Form Surgical version and a demographic questionnaire. RESULTS: Patients suffered moderate to severe pain and experienced extremely high interferences with daily activities after major thoracotomy operation. Patients reported the four highest barrier scores in the subscale of Barrier Questionnaire-Taiwan Form Surgical version were fear of tolerance, inhibition of wound healing, time intervals and distracting the physician from treating the disease. Patient's demographic data had no significant impact on their concerns about communicating pain and using of analgesics with exception of the subscale 'fatalism' of the Barrier Questionnaire-Taiwan Form Surgical version in patients with higher education levels or patients with 'non-farmer' occupation. However, there were no significant correlations indicated either between Barrier Questionnaire-Taiwan Form Surgical version score and pain severity or pain interference. CONCLUSIONS: Patients were underexposure of pain treatment after thoracotomy operation in the study, while patients' concerns about reporting pain and using analgesics had minimal impacts on their pain experience. RELEVANCE TO CLINICAL PRACTICE: Education approach for patients is inadequate to improve the status of unrelieved postoperative pain. Appropriate pain management regime together with attentive nursing care should be provided to achieve better pain relief for Chinese patients.

A qualitative study exploring the nurse telephone follow-up of patients returning home with a colostomy.

AIM: The aim of this study was to explore and describe the content of telephone intervention conversations conducted by an enterostomal nurse with patients discharged home with a colostomy. BACKGROUND: People discharged home with a new colostomy often encounter stoma-related difficulties. Postdischarge care with telephone follow-up by an enterostomal nurse is a helpful way to provide support for patients and ensure continuity of care. There is a paucity of studies reporting the content of telephone follow-up of colostomy patients. Information on the content of such follow-up is important in helping to formulate telephone call protocols that can help these patients. DESIGN: A qualitative exploratory study conducted in a university-based cancer centre in China. METHODS: The contents of 25 intervention phone calls to colostomy patients from January-August 2009 were subject to qualitative content analysis. RESULTS: Five themes emerged from the qualitative content analysis: 'education for stoma care', 'access to stoma care', 'encouraging stoma self-care', 'resuming normal living' and 'general postoperative problems'. CONCLUSIONS: Colostomy patients experienced stoma-related problems and difficulties after discharge, most of which could be effectively managed via telephone follow-up by an enterostomal nurse. The telephone follow-up satisfied patients' need for information and facilitated their adjustment to the permanent stoma. The findings suggested that patients had unmet needs after discharge and needed follow-up on returning home. RELEVANCE TO CLINICAL PRACTICE: This study provides important information to guide practice and education. The themes extracted from the qualitative content analysis provide a useful framework to guide the nurse in discussing care with the stoma patients and ensuring patients' adjustment to the permanent stoma. Further work can be done using this framework to develop protocols as standards of care and education materials when educating nurse specialists in stoma care.

What accounts for hospital readmission?

AIMS: This study was launched to address the knowledge gap regarding factors leading to readmission to hospital. BACKGROUND: Repeated hospital admission is an issue of concern for health care service providers. Research findings reveal that multiple factors can contribute to the phenomenon, but no study has examined the direct and indirect effects of these variables on hospital readmission. DESIGN: A survey conducted during the period from 2003-2005 in three hospitals in Hong Kong. METHODS: Patients who were readmitted to the same hospital within 28 days during the study periods were included. Data were collected using structured interviews. A structural equation model was employed to examine what factors will contribute to hospital readmission. RESULTS: The final model showed that subjective health outcome was the only significant variable that had a direct effect on readmission, and it had indirect effects on readmission mediating through the variables of age, income and satisfaction with care. CONCLUSIONS: A literature review reveals that none of the studies has recognised patients' subjective appraisal of their health condition as a significant variable to predict hospital readmission. Results did not find an association between evaluated and perceived need. In other words, patients who felt a higher need for hospital care were not necessarily sicker. It is possible that if patients can be empowered to manage their own health condition and make a fair appraisal of their well-being, unnecessary use of hospital services can be reduced. RELEVANCE TO CLINICAL PRACTICE: This study provides evidence to support the notion that an effective transitional care programme needs to incorporate patients' own subjective assessment of health in the intervention and measurement of the outcome. We cannot solely use providers' judgment to measure health outcomes, for patients are active agents in seeking health care, and the use of services is to an extent self-selective.