A Mixed-Methods Study of Unmet Supportive Care Needs Among Head and Neck Cancer Survivors.

BACKGROUND: Head and neck cancer (HNC) survivors face increasing challenges to adjust to the diagnosis and late effects of treatment. Identifying unmet needs among HNC survivors is therefore important to provide a comprehensive supportive care service for them. OBJECTIVE: The aim of this study was to examine the unmet supportive care needs (SCNs) of HNC survivors in the first year after treatment. METHODS: An explanatory sequential mixed-method design with 2 phases was used. In the quantitative phase, standardized questionnaires were administered to 285 Chinese HNC survivors to solicit their demographic and clinical characteristics, unmet SCNs, and access to various support services. In the qualitative phase, individual semistructured interviews were conducted with 53 participants to explore their unmet needs in more detail. RESULTS: The most prevalent unmet SCNs among the survivors were in the health system and information domain. Five categories of unmet needs emerged from the interview data: physical, psychological, health system and information, patient care and support, and sexuality. The findings reflect the inadequacy of the healthcare services for these survivors. CONCLUSION: Chinese HNC survivors experienced a variety of unmet SCNs, particularly in the areas of symptom management and healthcare system and information provision. IMPLICATIONS FOR PRACTICE: The study provides insights that can (1) inform future service development, including regular symptom identification and management, improvements in communication, and counseling services and (2) identify the specific needs of these survivors as the basis for tailoring care to meet their needs.

A Theory-Based and Culturally Aligned Training Program on Breast and Cervical Cancer Prevention for South Asian Community Health Workers: A Feasibility Study.

BACKGROUND: Cancer screening uptake among South Asian ethnic minorities is reported to be relatively low. An outreach program, led by community health workers (CHWs), may increase the minority group's awareness of the importance of cancer screening. OBJECTIVE: The aim of this study was to assess the feasibility and effectiveness of a theory-based, culturally sensitive program to train South Asian women in Hong Kong as CHWs. METHODS: A CHW training program, guided by the Empowerment Model and the Health Belief Model, was developed and implemented. Its feasibility was evaluated through the recruitment of South Asian women to the program and their satisfaction with it. Its effectiveness was assessed by a test of knowledge, the participants' self-efficacy and competence, and their readiness to work as CHWs. RESULTS: Five South Asian women were recruited to the training program. Outcomes included increased participants' knowledge of cancer and improved self-efficacy and competence in working as CHWs. All participants were highly satisfied with the program, although the addition of practical sessions in the South Asian community was suggested as a further improvement. CONCLUSION: It seems to be feasible to train South Asian CHWs to deliver interventions to promote their peers' awareness of breast and cervical cancer prevention, although challenges exist in recruitment of trainees. More hands-on practical opportunities as CHWs would likely increase their effectiveness. IMPLICATIONS FOR PRACTICE: The theoretical framework of our CHW training program and the incorporated cultural components could be useful for the development of future programs for training South Asian CHWs in delivering interventions on cancer prevention.

Emotional Intelligence, Pain Knowledge, and Attitudes of Nursing Students in Hong Kong.

Research on nursing students' pain knowledge and attitudes is limited. Although emotions play a role in pain assessment, no study has examined the associations between emotional intelligence and pain knowledge and the attitudes of nursing students. This cross-sectional quantitative study aimed to address this research gap by assessing the pain knowledge and attitudes of nursing students in Hong Kong and examining associations between emotional intelligence and the pain knowledge and attitudes of nursing students. A total of 104 postgraduate nursing students (45 Year 1 students and 59 Year 3 students) completed a questionnaire that included demographic information, the Schutte Emotional Intelligence Scale (SEIS) and the Knowledge and Attitudes Survey Regarding Pain (KASRP). Data analyses included descriptive statistics, correlational analyses, chi-square test and t-tests. The pain knowledge and attitudes of both Year 1 students (M = 20.40, SD = 3.78) and Year 3 students (M = 21.36, SD = 3.15) were suboptimal, t(102) = -1.41, p = .16. Year 1 students had higher emotional intelligence (M = 122.44, SD = 8.90) than Year 3 students (M = 117.71, SD = 14.34), t(98.35) = 2.07, p = .04. For Year 1 students, emotional intelligence was negatively correlated with pain knowledge and attitudes, but the correlation was not significant (r = -.15, p = .33). For Year 3 students, emotional intelligence, pain knowledge and attitudes were negatively correlated, but the correlation was significant (r = -.31, p = .02). These results suggest that nursing students' pain knowledge and attitudes could be improved. Implications for nurse educators to enhance emotional intelligence and pain education for nursing students are discussed.

A Review of Psychoeducational Interventions to Improve Sexual Functioning, Quality of Life, and Psychological Outcomes in Gynecological Cancer Patients.

BACKGROUND: Psychoeducational interventions are recommended for use with clinical gynecological cancer patients to improve their patient care outcomes. However, the evidence of their effectiveness is far from conclusive. OBJECTIVE: The objective of this study was to identify the best available research evidence related to the effects of psychoeducational interventions on sexual functioning, quality of life, and psychological outcomes in gynecological cancer patients. METHODS: A systematic search was conducted to identify English and Chinese articles from the inception of the databases to April 2012 and included 13 English databases and 7 Chinese databases. Gray literature or unpublished studies were also searched. RESULTS: A total of 11 studies involving 975 gynecological cancer patients were included in the review. Meta-analysis results for 4 comparable studies indicated that psychoeducational interventions were effective in treating depressive symptoms among gynecological cancer patients (standardized mean difference = -0.80; 95% confidence interval, -1.05 to -0.54), whereas information provision significantly improved the mental aspect of quality of life (standardized mean difference = -0.41; 95% confidence interval, -0.74 to -0.08). With regard to sexual functioning, psychoeducational interventions appeared to have benefits in improving the sexual life of patients. CONCLUSIONS: Findings confirm the effectiveness of psychoeducational interventions on depressive symptoms and mental aspect of the quality of life in gynecological cancer patients. IMPLICATIONS FOR PRACTICE: The authors discuss the implications of review findings for the effective design of psychoeducational interventions including components, provider, provision time frame, and duration for clinical practice, as well as psychoeducational intervention research.

Nursing students' assessment of pain and decision of triage for different ethnic groups: An experimental study.

BACKGROUND: Pain management is a priority in nursing care but little is known about the factors that affect nursing students' assessment of pain expressed by patients of different ethnic backgrounds. OBJECTIVES: This study examined undergraduate nursing students' assessment of pain and decision of triage when pain was expressed in different languages and their relation to students' empathy and social identity. Comparison between students with and without clinical experience was also carried out. DESIGN: This is a cross-sectional quantitative design. SETTING: This study took place at a university in Hong Kong. PARTICIPANTS: 74 female undergraduate nursing students. METHODS: Students listened to eight audio recordings in which an individual expressed pain in one of the two dialects of Chinese, either Cantonese or Putonghua. For each dialect, two recordings depicted mild pain and two depicted severe pain. After listening to each recording, students rated the pain level and indicated their decision of triage. Subsequently, students completed a questionnaire that measured their empathy and social identity and reported their demographics. The data were analyzed by descriptive statistics, correlational analyses, and t-tests. RESULTS: Severe pain described in Putonghua was rated as more intense than that described in Cantonese but it was not classified as more urgent. Students with clinical experience tended to perceive mild pain as less painful and less urgent than those without clinical experience. For mild pain described in Cantonese, students with clinical experience evaluated it as more urgent than those without such experience. The empathy level of students with and without clinical experience was comparable. Students with more empathy, especially those without clinical experience, reported heightened perceived intensity of severe pain described in Putonghua. CONCLUSIONS: Nurse educators should note that empathy, social identity, and clinical experience may alter students' pain assessment of patients from different ethnicities. Pain education needs to be reinforced.

Pain knowledge and attitudes of nursing students: a literature review.

BACKGROUND: Pain management is a priority in nursing care but nursing students often find it a challenge. To prepare nursing students adequately, nurse educators need to understand nursing students' pain knowledge and attitudes and design interventions to enhance their readiness for pain management. OBJECTIVES: The objective of this literature review is to identify, summarize and critically appraise current evidence on (i) pain knowledge and attitudes of nursing students and (ii) pain education programs for nursing students. DESIGN: A thorough analysis of the literatures on the topic of pain and nursing students was done. Data sources were as follows: MEDLINE, CINAHL, PsycINFO, British Nursing Index and GoogleScholar. Review methods were as follows: A systematic search was conducted in the named data sources from 2004 to 2014 to identify English-language articles with the two keywords "nursing student" and "pain." Two authors assessed all identified articles independently for inclusion into review. RESULTS: A total of 11 studies were included in the review: seven of these studies focused on the assessment of pain knowledge and attitudes, and four of them aimed at evaluating pain education programs. The findings indicated that nursing students worldwide had inadequate pain knowledge and misconceptions on pain management. Pain education programs, in general, were found to be effective in improving nursing students' pain knowledge and attitudes. CONCLUSIONS: Studies consistently revealed the inadequacy of pain knowledge and inappropriate pain management attitudes of nursing students. Pain education programs are limited in number, but they demonstrated effectiveness in improving nursing students' pain knowledge and attitudes. Implications for research on pain knowledge and attitudes, and the implementation of pain education programs for nursing students are discussed.

A feasibility study of a psychoeducational intervention program for gynecological cancer patients.

PURPOSE OF THE RESEARCH: This study aimed to test the feasibility of implementing a psychoeducational intervention program for gynecological cancer patients. METHODS AND SAMPLE: A single-blinded randomized controlled trial and mixed-method design were used. Study subjects were newly diagnosed gynecological cancer patients with surgery as the first-line treatment. They were randomly assigned to the intervention group, in which a psychoeducational intervention program based on a thematic counseling model was offered, or to the attention control group. Quantitative data on sexual functioning, quality of life, uncertainty, anxiety, depression and social support were collected at recruitment, post-operative and during the in-hospital period, and eight weeks after the operation. Participants in the intervention group and three nurses working in the clinical setting were invited to have semi-structured interviews. KEY RESULTS: Of the 30 eligible subjects, 26 were successfully recruited into the study. Following the psychoeducational intervention program, there was significant improvement in the level of inconsistent information about the illness within the category of uncertainty among participants in the intervention group. In addition, trends towards improvement were demonstrated in quality of life, uncertainty, depression and perceived social support with the provision of the interventions. Qualitative data indicated the interventions were desired and appreciated by the participants, as well as being feasible and practical to implement in Hong Kong clinical settings. CONCLUSIONS: The findings suggest that it is feasible to deliver the psychoeducational intervention program and it may have beneficial effects in gynecological cancer patients. A full-scale study is warranted to confirm the results.

Conflict management styles, emotional intelligence and implicit theories of personality of nursing students: a cross-sectional study.

BACKGROUND: Conflict management is an essential skill that nursing students need to master as conflict is unavoidable in clinical settings. Examining nursing students' conflict management styles and the associating factors can inform nurse educators on how to equip nursing students for effective conflict management. OBJECTIVES: This study aimed at examining undergraduate nursing students conflict management styles in managing conflict with their supervisors in clinical placement. The associations of emotional intelligence and implicit theories of personality with conflict management styles were also investigated. DESIGN: This is a cross-sectional quantitative survey. SETTING: This study took place at a nursing school at a university in Hong Kong. PARTICIPANTS: 568 undergraduate nursing students participated in the study. METHODS: Students completed a questionnaire which consisted of demographics, Measure of Implicit Theories of Personality, The Schutte Emotional Intelligence Scale (SEIS) and The Rahim Organizational Conflict Inventory-II (ROCI-II) and received a HKD 20 book coupon as compensation. The data were analyzed by descriptive statistics, reliability analyses, t-tests, correlational and linear regression analyses. RESULTS: For managing conflict with clinical supervisors, students used obliging and integrating most frequently whereas used dominating least. Emotional intelligence was a significant predictor of all five conflict management styles. The higher the emotional intelligence, the more students used integrating, obliging, compromising and dominating. The lower the emotional intelligence, the more students used avoiding. There was a significant association between implicit theories of personality and compromising. The less malleable students perceived personality to be, the more they used compromising. CONCLUSIONS: Emotional intelligence was significantly associated with all five conflict management styles while implicit theories of personality were significantly associated with compromising style only. Efforts of nurse educators to enhance students' conflict management skills and emotional intelligence to face conflicts in clinical settings are discussed.

Effects of psychoeducational interventions on sexual functioning, quality of life and psychological outcomes in patients with gynaecological cancer: A systematic review.

BACKGROUND: The diagnosis of gynaecological cancer and the effects of related treatment have adverse effects on sexual functioning, quality of life and psychological outcomes of patients. Psychoeducational interventions are recommended for use in clinical areas for gynaecological cancer patients to improve patient outcomes. However, the evidence for its effectiveness is far from conclusive. Moreover, such interventions are still scarce or even absent in most countries. OBJECTIVES: To identify the best available evidence related to the effectiveness of psychoeducational interventions for gynaecological cancer patients on sexual functioning, quality of life and psychological outcomes. INCLUSION CRITERIA: Randomized controlled trials.Adult women who with a primary gynaecological cancer confirmed by pathology test.Psychoeducational interventions that aimed at enhancing the acceptance of the disease and recovery from the illness and treatment among gynaecological cancer patients.Sexual functioning, quality of life and psychological outcomes including, but not limited to, anxiety, depression, distress, adjustment to illness, mood, self-esteem, uncertainty, and coping. SEARCH STRATEGY: Thirty electronic bibliographic databases in English and Chinese were searched from their inception to April 2012. METHODOLOGICAL QUALITY: The Joanna Briggs Institute Critical Appraisal Checklist for experimental studies was used to critically appraise the methodological quality of studies. DATA COLLECTION: Two reviewers extracted and summarized the details of included studies using the Joanna Briggs Institute data extraction form independently. DATA SYNTHESIS: Quantitative results of comparable studies were pooled in statistical meta-analysis. Standardized mean difference and 95% confidence interval were calculated for the summary effect of continuous data measured by different scales. Results were presented in narrative form where statistical pooling was not appropriate. RESULTS: A total of 11 randomized controlled trials involving 975 gynaecological cancer patients were included. Only four studies were comparable to perform meta-analysis. On the basis of two studies examining the outcome of depression, there was a significant improvement in depressive symptoms (SMD: -0.80; 95% CI: -1.05 to -0.54) among participants in the intervention group in which information provision, cognitive-behavioral therapy and counseling were combined together. On the basis of another two studies examining the outcome of quality of life, there was no significant benefit in physical aspect of quality of life (SMD: -0.12; 95% CI: -0.45 to 0.20; p = 0.46) for the intervention group. Conversely, the control group of information-only therapy demonstrated significant effects on mental aspect of quality of life (SMD: -0.41; 95% CI: -0.74 to -0.08; p = 0.01) compared to those receiving psychoeducational interventions. There were no conclusive findings regarding the effects of psychoeducational interventions on the outcomes of sexual functioning, anxiety, distress, adjustment to illness, mood, self-esteem, uncertainty and coping among the gynaecological cancer patients. CONCLUSIONS: The review demonstrated evidence of positive effects of psychoeducational interventions on gynaecological cancer patients.The review suggested that psychoeducational interventions incorporate all four components, i.e. information provision, cognitive-behavioral therapy, social support and counseling. The format could be individual or group, with or without couple participation. A nurse was preferred to be the ideal provider. Provision time frame should be before the start of the treatment and continued after discharge, and the number of sessions could be four. Each session should be between 30 minutes to one hour long.More well-designed randomized controlled trials are needed to further examine the effects of psychoeducational interventions on psychological outcomes in this group of patients. Due to the diversity of these interventions, the optimal format of each also requires investigation.

Effects of competition on students' self-efficacy in vicarious learning.

BACKGROUND: Vicarious learning is one of the fundamental sources of self-efficacy that is frequently employed in educational settings. However, little research has investigated the effects of competition on students' writing self-efficacy when they engage in vicarious learning. AIM: This study compared the effects of competitive and non-competitive classrooms on students' writing self-efficacy when they engaged in vicarious learning. SAMPLE: The participants were 71 grade 7 students in Hong Kong. METHOD: Using prior writing performance for stratified random sampling, students were assigned either to a competitive or a non-competitive classroom. Students learned how to compose similes and metaphors in Chinese. RESULTS: In the competitive classroom, students' self-efficacy decreased when they engaged in vicarious learning. In the non-competitive classroom, students' self-efficacy did not show a significant change when they engaged in vicarious learning. CONCLUSION: The findings suggested that when students engaged in vicarious learning in a competitive classroom, their self-efficacy might be threatened. Implications for efforts to design constructive context for vicarious learning are discussed.