The perceived relationship quality with migrant domestic workers is correlated with a lower level of loneliness among community-dwelling older adults: A cross-sectional study.

PURPOSE: To explore older adults' perceived relationship quality with migrant domestic workers (MDWs) and examine the correlation between older adult/MDW (O-M) relationship quality and loneliness of community-dwelling older adults. MATERIALS AND METHODS: In this cross-sectional study, older adults living with MDWs were conveniently recruited from neighbourhood elderly centers in Hong Kong. Loneliness and O-M relationship quality were assessed by the 6-item De Jong Gierveld Loneliness Scale and the mutuality scale, respectively. Older adults' demographic and functional characteristics, and MDW's nationality, spoken language and years of service in the dyad were also collected. Hierarchical multiple regression analyses were conducted to examine the contributions of 1) demographic variables and functional status, 2) MDW characteristics, 3) perceived social network and 4) perceived O-M relationship quality on loneliness. RESULTS: The 178 participants [mean age 83.44 (SD 7.05 years); 155 (87.1%) women and 23 men (22.9%)] were socially lonely (1.07 ± 1.15) and close to being lonely overall (1.90 ± 1.68), and emotionally (0.84 ± 0.97). The mean O-M relationship quality was poor (1.42 ± 0.79), which was significantly correlated with overall (ß= -0.33, 95% CI: -0.65 to -0.01, P value = 0.045), and social (ß= -0.24, 95% CI: -0.46 to -0.01, P value = 0.04) loneliness, but not significantly correlated to emotional loneliness. CONCLUSION: Better perceived O-M relationship quality is correlated with a lower level of loneliness among older adults. Strategies to improve O-M relationship quality may alleviate loneliness among older adults.

Factors affecting nursing students' intention to use a 3D game to learn field triage skills: a structural equation modelling analysis.

BACKGROUND: As mass casualty incidents are low-probability events, students often do not have the chance to practise field triage skills during their clinical placement. This study used a 3D game to engage participants in experiential learning in a realistic virtual environment. The purpose of the study was to explore factors affecting nursing students' intention to use a 3D game to learn field triage skills. METHODS: This was a cross-sectional survey study. The technology acceptance model augmented by computer self-efficacy was used as a research model and a questionnaire was used to evaluate students' intention to use the 3D game to learn field triage. Data was collected from nursing students of a degree-awarding higher education institution in Hong Kong. RESULTS: A total of 177 valid questionnaires were returned, and structural equation modeling was used to test the research model and hypotheses. Consistent with the technology acceptance model, perceived usefulness (0.21, p < 0.05) and perceived ease of use (0.91, p < 0.001) had a positive effect on the behavioral intention to use the 3D game. Computer self-efficacy positively influenced both perceived usefulness (0.66, p < 0.001) and perceived ease of use (0.73, p < 0.001). The research model explained 42 percent of the variance in the behavioral intention to use the 3D game. CONCLUSION: Students believed that using the 3D game would enhance their field triage skills and found the game easy to use. Using 3D games to facilitate learning is a worthwhile educational approach for preparing healthcare professionals to handle low-probability clinical tasks, such as field triage in mass casualty incidents. Insights provided by findings of this study included the best way to design and promote interactive education programmes in a virtual environment.

Perceptions of optimal end-of-life care in hospitals: A cross-sectional study of nurses in three locations.

AIM: To examine whether nurses' location of employment, demographics, or training influences their perceptions of what constitutes optimal care for dying patients in hospital. DESIGN: Questionnaire-based, cross-sectional study. METHODS: Between December 2016-June 2018, 582 registered or enrolled nurses from Australia (N = 153), South Korea (N = 241), and Hong Kong (N = 188) employed in a variety of hospital care units rated the extent to which they agreed with 29 indicators of optimal end-of-life care across four domains: patient, family, healthcare team, and healthcare system. Latent class analysis identified classes of respondents with similar responses. RESULTS: Top five indicators rated by participants included: 'physical symptoms managed well'; 'private rooms and unlimited visiting hours'; 'spend as much time with the patient as families wish'; 'end-of-life care documents stored well and easily accessed' and 'families know and follow patient's wishes'. Four latent classes were generated: 'Whole system/holistic' (Class 1); 'Patient/provider-dominated' (Class 2); 'Family-dominated' (Class 3) and 'System-dominated' (Class 4). Class 1 had the highest proportion of nurses responding positively for all indicators. Location was an important correlate of perceptions, even after controlling for individual characteristics. CONCLUSION: Nurses' perceptions of optimal end-of-life care are associated with location, but perhaps not in the direction that stereotypes would suggest. Findings highlight the importance of developing and implementing location-specific approaches to optimize end-of-life care in hospitals. IMPACT: The findings may be useful to guide education and policy initiatives in Asian and Western countries that stress that end-of-life care is more than symptom management. Indicators can be used to collect data that help quantify differences between optimal care and the care actually being delivered, thereby determining where improvements might be made.

Nursing students' experiences and perceptions of learner-centred education in a disaster nursing course: A qualitative study.

Learner-centred education has been shown to be an effective teaching method in the healthcare disciplines that integrate practical skills and theoretical knowledge. However, the elements of learner-centred education that influence students' motivation and engagement in learning remain unclear. In this descriptive qualitative research study, 43 nursing students in a baccalaureate nursing programme in Hong Kong who enrolled in a disaster and trauma nursing course were recruited through purposive sampling. Data were collected through semi-structured, face-to-face, focus group interviews. The transcribed interviews were interpreted through the use of qualitative analysis. This study revealed that adopting learner-centred education techniques in a disaster nursing course could cater to the hedonic nature and practical nature of learning disaster nursing, which consequently strengthens student's motivation and engagement in learning. The findings also suggested that learner-centred education could improve nursing students' learning experience and promote their transformation from passive and receptive students into proactive learners. The present study provides a greater and more focused understanding of the elements of learner-centred education that promote motivation and engagement in learning among nursing students. This study could offer insights into the development and evaluation of disaster nursing courses and other subjects in the undergraduate nursing curriculum.

Nurses' perceptions of and barriers to the optimal end-of-life care in hospitals: A cross-sectional study.

AIMS AND OBJECTIVES: To assess nurses' perceptions of what constitutes optimal end-of-life (EOL) care in hospital and evaluate nurses' perceived barriers to EOL care delivery. BACKGROUND: Care of dying patients is common in hospitals. However, little is known about the important elements of and barriers to optimal EOL care from key service providers' perspective, which is crucial for quality EOL care in hospital settings. METHOD: This is a cross-sectional survey. Nurses practising in hospitals recruited by convenience sampling completed self-report survey questionnaires. STROBE checklist was used in study reporting. RESULTS: One hundred and-seventy-five nurses participated in the survey. The majority (70%) had experience in caring for dying patients. The five most highly perceived factors constituting optimal EOL care included the following: "families know and follow patient's EOL wishes"; "patients emotional concerns identified and managed well"; "patients participating in decision-making"; "EOL care documents stored well and easily accessed"; and "provide private rooms and unlimited visiting hours for families of dying patients". Top five barriers were "doctors are too busy"; "nurses are too busy"; "insufficient private room/space"; "nurses have limited training in EOL care"; and "families have unrealistic expectations of patient's prognosis." Multivariate regression analysis identified that nurses without experience in caring for dying patients reported a significantly higher number of perceived barriers towards EOL care (p = .012). Those with postgraduate degree training reported significantly fewer perceived barriers (p = .007). CONCLUSION: Findings identified essential elements for optimal hospital EOL care not only involving patients and families in EOL decision and care, but also documentation and environmental issues in the healthcare system level and the needs for strengthening manpower and expertise at palliative care policy level. RELEVANCE TO CLINICAL PRACTICE: This study revealed quantitative data to inform health service managers and policy makers in terms of training and service development/ re-design for EOL care in hospital settings.

To evaluate the effect of challenge-based learning on the approaches to learning of Chinese nursing students: A quasi-experimental study.

Challenge-based learning (CBL) is a learner-centred, experimental learning strategy that aims to prepare students to manage unforeseeable and complex global issues in the 21st century. It cultivates an active and authentic learning environment that requires students' creative input, collaboration and community involvement. Studies in the past decade have shown that CBL strengthens soft skills essential for future society, such as critical thinking and creativity. However, its effect on students' metacognitive abilities is scarcely mentioned. This study - a quasi-experimental study with non-equivalent groups conducted in a self-financing tertiary institution in Hong Kong - aims to evaluate the effect of CBL on approaches to learning among nursing students. First-year students in the nursing programme who attended a nursing course using CBL were recruited for the intervention group and senior year-one students were included in the control group. Their approach to learning was measured by the Revised Two-Factor Study Process Questionnaire administered at the beginning and at the end of the semester. Analysis of Covariance (ANCOVA) was used to compare the mean difference in scores of deep and surface approaches between the groups. A total of 209 participants were recruited, with 130 in the intervention group and 79 in the control group. The response rates were 65.3% (130/199) and 78.2% (79/101) for the intervention and control groups, respectively. In the intervention group, the mean post-test deep approach score was significantly higher than the pre-test score (F = 5.2, p = 0.023), even though it had only a small effect. There was no statistically significant difference in baseline post-test mean surface scores (F = 2.4, p = 0.125). The results of this study indicate that CBL may facilitate deep learning in nursing students.

The technology implications of master's level education in the professionalization of nursing: A narrative inquiry.

AIMS: (a) To explore the meanings of master's education in the professionalization of nursing; and (b) to describe the core attributes that nurses gained through master's study. DESIGN: Narrative inquiry. METHODS: From June 2017 to June 2018, unstructured interviews were conducted with 12 master-prepared nurses at advanced nursing position with minimum 5 years of postregistration experience. Collaborative thematic narrative analysis was conducted on verbatim transcripts. Members checking, peer validation and audience validation assured verisimilitude and utility. RESULTS: There was a need to fit one's own assertion for professional growth in nursing career structure. Master's study equipped nurses with specialty skills and knowledge with enhanced reflexivity, which nurtured morality, problem-solving ability and capacity to collaborate inter-professionally. Master-prepared nurses demonstrated effective clinical leadership through acting as change agents. CONCLUSIONS: Master's level education and master-prepared nurses are instrumental to the professionalization of nursing by expanding the roles of nurses. Nursing career mentoring will maximize nurses' agency in healthcare system. Developing innovative inter-professional pedagogy will nurture the reflexivity of master-prepared nurses.

Effect of continuous oral suctioning on the development of ventilator-associated pneumonia: a pilot randomized controlled trial.

BACKGROUND: Both continuous and intermittent aspiration of subglottic secretions by means of specially designed endotracheal tubes containing a separate dorsal lumen that opens into the subglottic region have been shown to be useful in reducing ventilator-associated pneumonia (VAP). However, the high cost of these tubes restricts their use. OBJECTIVE: The aim of this pilot randomized controlled trial was to test the effect of a low-cost device (saliva ejector) for continuous oral suctioning (COS) on the incidence of VAP in patients receiving mechanical ventilation. METHODS: The study was conducted in the six-bed medical-surgical ICU of a hospital with over 400 beds that provides comprehensive medical services to the public. The design of this study was a parallel-group randomized controlled trial. While both the experimental and control groups used the conventional endotracheal tube, the saliva ejector was only applied to patients assigned to the experimental group. The device was put between the patient's cheek and teeth, and then connected to 100mmHg of suction for the continuous drainage of saliva. RESULTS: Fourteen patients were randomized to receive COS and 13 patients were randomized to the control group. The two groups were similar in demographics, reasons for intubation, co-morbidity, and risk factors for acquiring VAP. VAP was found in 3 patients (23.1%; 71 episodes of VAP per 1000 ventilation days) receiving COS and in 10 patients (83.3%; 141 episodes of VAP per 1000 ventilation days) in the control group (relative risk, 0.28; 95% confidence interval, 0.10-0.77; p=0.003). The duration of mechanical ventilation in the experimental group was 3.2 days (SD 1.3), while that in the control group was 5.9 days (SD 2.8) (p=0.009); and the length of ICU stay was 4.8 days (SD 1.6) versus 9.8 days (SD 6.3) for the experimental and control groups, respectively (p=0.019). CONCLUSION: Continuous clearance of oral secretion by the saliva ejector may have an important role to play in reducing the rate of VAP, decreasing the duration of mechanical ventilation, and shortening the length of stay of patients in the ICU.

Factors influencing presence in virtual worlds.

Virtual worlds are showing potential as an effective platform for a variety of activities, including learning. The concept of presence (the sensation of "being there" in a mediated environment) has received substantial attention from the virtual reality community, and the effectiveness of virtual worlds has often been linked to the feelings of presence reported by their users. The present study examined the effects of attitude and perceived ease of use on sense of presence in Second Life, which is one of the most known and used virtual worlds. Based on data from a survey of 206 nursing students, hypotheses are empirically tested. Findings suggest that users' attitude toward using Second Life and their perceived ease of use of it have a positive effect on their sense of presence in the virtual environment. This study advances our understanding of factors influencing presence in virtual worlds.

Validity and reliability of the proposed core competency for infection control nurses of hospitals in Hong Kong.

Literature review and the Delphi approach were used to draft the core competency items of hospital infection control nurses in Hong Kong. Content validity, internal consistency, and test-retest reliability of the proposed core competency were ensured. The result serves as the foundation of developing training and assessment tools for infection control nurses in Hong Kong.

Experiences of online learning: students' perspective.

This paper explores students' views of an online learning initiative within a post-registration degree in nursing in Hong Kong. A self-administered questionnaire was used for data collection. One hundred and ninety eight students completed the study. Online learning was seen to be convenient allowing students to study at their own pace and time. Students reported that online learning enabled them to hold a higher level of accountability for their own learning and to learn independently. Not all experiences were positive. A major hindrance to online learning was the inadequate opportunity for human interaction which was deemed necessary for establishing peer support and developing in-depth group discussion on subject matter. These findings provide a guide for further development and improvement in online teaching and learning methodologies.