Navigating changes: A qualitative study exploring the health-related quality of life of breast cancer survivors during the coronavirus disease 2019 pandemic.

AIMS: To explore the impact of the coronavirus disease 2019 pandemic on the health-related quality of life (HRQoL) of breast cancer survivors. DESIGN: We utilized a qualitative descriptive approach to facilitate interviews among 25 participants, all of whom are survivors of breast cancer and have received treatment in Hong Kong within the preceding 3 years. METHODS: Content analysis was performed to understand how patients' HRQoL views and experiences changed during coronavirus disease 2019 pandemic. RESULTS: The results included six themes delineating the impact of the coronavirus disease 2019 pandemic: (i) survivor sensitivities in pandemic times, (ii) coping and conditioning in pandemic times, (iii) transforming work and home dynamics in pandemic times, (iv) cognitive resilience and adaptation to the COVID-19 protective measures, (v) social resilience in pandemic times and (vi) healthcare adaptation and coping in pandemic times. CONCLUSION: This study provides insights into the experiences and challenges of breast cancer survivors during the coronavirus disease 2019 pandemic. Some survivors had new physical and psychological symptoms, including fear and anxiety, isolation, pain, lymphoedema and burnout, which potentially have long-term impact upon HRQoL. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: This study highlights the unique challenges faced by breast cancer survivors during the coronavirus disease 2019 pandemic, including accessing healthcare services and the impact of social isolation. Healthcare providers should consider the holistic needs of breast cancer survivors in the provision of health care and develop supportive interventions, including telehealth services and online support groups, to address these challenges and improve their HRQoL. IMPACT: Surgery aimed at treating breast cancer or reducing its risk generally influences the appearance of breast areas and donor sites. The continuing effects of these changes on body image and HRQoL are well-reported, although studies have ineffectively examined the initial experiences of women regarding their postoperative appearance, particularly during the pandemic. REPORTING METHOD: The checklist of consolidated criteria for reporting qualitative research (COREQ) was utilized. PATIENT OR PUBLIC CONTRIBUTION: A small selection on breast cancer survivors contributed to the design of this study, in particular the content of the semi-structured interviews.

Young Adults' Perspectives on the Implications of an Augmented Reality Mobile Game for Communities' Public Health: A Qualitative Study.

Objectives: Several physical, psychological, and social health consequences are caused by smartphone users' addiction to games. A location-based game (LBG), Pokémon GO, recently garnered significant attention from young people. This study aims to explore their experiences with this game and motivations for playing, investigating their perspectives on the game's implications for themselves and the public health of their communities. Methods: Ten qualitative focus group interviews were conducted. Young adults, aged 18-25 years (n = 60), were recruited in Hong Kong. Data were analyzed using a thematic approach. Results: Five themes emerged: 1) missing out or self-regulation, 2) childhood memories of Pokémon, 3) extending virtual-reality exploration, 4) spending more time outdoors walking and exercising, and 5) getting together with others and social interaction. Conclusions: This study showcases the motivational factors of young adults and their cohorts in societies worldwide. LBGs may impact players' physical and social activity levels, and behavior. Nonetheless, certain negatives were identified (i.e., addiction and behavior resulting from a loss of self-control). These negatives deserve health practitioners' attention and future studies should explore possible public health interventions.

Heartbreak and Loneliness Due to Family Separations and Limited Visiting during COVID-19: A Qualitative Study.

The COVID-19 pandemic has greatly impacted the healthcare system. In the pediatric unit, stress, uncertainty, and many unexpected challenges for many parents were frequently reported. Research has shown that parents had less contact with their children during the pandemic due to hospital restrictions. However, it is unknown how parents perceived their experiences in a pediatric unit. This study aimed to describe the lived experiences of parents who had a child in the pediatric unit during the pandemic. A qualitative descriptive approach was used to investigate parents' experiences of having children admitted to the pediatric unit during the pandemic in Hong Kong. Eight Chinese parents participated in the interview. Three major themes emerged: (1) parents' pediatric ward experiences during COVID-19 were emotionally isolating and overwhelming, (2) the family and family-centered care were disrupted, and (3) interactions with pediatric providers intensified or alleviated emotional distress. Integrating the above themes of experiences of emotional distress was the main characteristic of the parents' experiences during the pandemic. Therefore, policymakers should understand the lived experiences of parents of children diagnosed with COVID-19 and should make prompt decisions to deal with both parental concerns and safety issues.

Thoughts and experiences regarding leg amputation among patients with diabetic foot ulcers: A phenomenological study.

Despite lower-limb amputation being common among patients with diabetic foot ulcers, few studies have qualitatively investigated the patients' perspectives. Therefore, this study aimed to explore the thoughts and experiences of patients with diabetic foot ulcers regarding lower-limb amputation in Hong Kong. A phenomenological study using individual, semi-structured interviews was conducted with 18 participants with foot ulcers recruited in Hong Kong between July and September 2022. The interviews were audio-recorded, transcribed verbatim, and analysed using an interpretative phenomenological approach and a constant comparison strategy. The results highlighted four substantial themes: (a) coping or being alone and taciturn, (b) altered appearance impacting one's sense of maintaining social relations, (c) thoughts about self-efficacy and encountering a new normal, and (d) the possibility of a reduced gap in physical consequences between the old and new self. This study provided different perspectives of patients with a history of diabetic foot ulcers, even in cases where lower-limb amputation has not yet been performed. The results demonstrate that lower-limb amputation is considered a forbidden topic. This makes it culturally difficult for Chinese patients to discuss the matter with healthcare authorities and family members. Healthcare workers should be aware of how they communicate regarding lower-limb amputation.

The Lived Experiences of Women without COVID-19 in Breastfeeding Their Infants during the Pandemic: A Descriptive Phenomenological Study.

The coronavirus disease 2019 (COVID-19) outbreak in 2020 has led to several changes and disturbances in the daily lives of the general public. Particularly for new (first-time) mothers, there has been a significant impact on the practices of raising and feeding their babies. Social distancing measures everywhere have made mothers hesitant to breastfeed their babies anywhere else but at home. Combined with the fear of being infected with COVID-19, the present situation has created unprecedented barriers for breastfeeding mothers to accessing various types of support: emotional, instrumental, informational, and appraisal. There has been no research on the influence of the pandemic on social support regarding breastfeeding in Hong Kong. This study aimed to explore the social support and impact of COVID-19 on mothers breastfeeding their babies. Semi-structured interviews were conducted with 20 currently breastfeeding women in Hong Kong. Colaizzi's seven-step method was used for data analysis. Two key themes emerged from the interview data: (1) positive influences on breastfeeding support during COVID-19 and (2) negative influences on breastfeeding support during COVID-19. Our findings may help mothers prepare to breastfeed their babies in places other than their homes.

Psychological Experiences of Patients with Coronavirus Disease 2019 (COVID-19) during and after Hospitalization: A Descriptive Phenomenological Study.

During an infectious disease pandemic, patients may experience various psychological issues. Few studies have focused on survivors' experiences in Hong Kong. This study aimed to assess the psychological impacts of coronavirus disease 2019 (COVID-19) on survivors during admission to and discharge from COVID-19 wards using a descriptive phenomenological design. Purposive sampling was used to recruit 20 participants aged 30-77 years recently discharged from an isolation ward at an acute care facility and transferred to a community center specializing in pulmonary rehabilitation. Sampling was performed from 1 March 2022 to 3 April 2022. Semi-structured in-person interviews were conducted and transcribed verbatim; data analysis was performed using Colaizzi's approach. The patients experienced two exclusive psychological phases during and after admission. The analysis of the patients' experiences revealed three themes: (i) navigating uncertainties with mixed feelings and emotions during admission, (ii) adjusting to normal daily life after discharge, and (iii) self-growth after discharge. Our findings may provide empirical evidence for formulating pre-emptive strategies to mitigate the long-term psychological impacts of COVID-19. This investigation is timely and internationally relevant, and policymakers can use these findings to make informed decisions when developing guidelines for structuring the care of patients with COVID-19 during and after hospitalization. Based on our findings, we recommended that psychological support, particularly the provision of time to address patients' concerns, may be integrated into the care of patients with COVID-19. Additionally, the structure of care may extend beyond the biomedical aspects of the illness to encompass the emotional and social dimension of the patients. To reduce stigmatization, we advise that public health authorities release clear information timely to clarify the misconceptions of the local community.

When rationing becomes inevitable in a pandemic: A discussion on the ethical considerations from a public health perspective.

Objectives: Coronavirus Disease 2019 has presented extreme difficulties to healthcare resource allocation worldwide. Health resources, particularly during a pandemic, are limited even in developed countries. The main challenge for healthcare professionals is to be able to ration resources in an ethical manner. Therefore, this leads to ethical considerations that we aim to discuss in this paper, based on which, recommendations can be made for reference by healthcare management, policymakers, and public health practitioners. Study design: This is a discussion paper. Methods: A brief review of the major principles as they relate to the notion of rationing in a pandemic was conducted. We organized an ethical discussion from public health perspectives based on these major principles. Results: Prior to deciding the principles to adopt, a transparent and robust guideline for rationing must be established. There are four considerations that need to be made: transparency, consistency, inclusiveness, and accountability. There does not exist a "perfect" principle to adopt during rationing. However, in the authors' opinion, the most obvious principles that would be unsuitable during a healthcare crisis would be the equal worth and prioritarian principles. This leaves the equity principle, utilitarian and urgent need principles. Conclusion: The recommendation of this discussion paper is to adopt multiple principles according to the situation of each country or even the particular hospital.

Use of thin silicone dressings for prolonged use of filtering facepiece respirators: Lessons from the universal community testing programme during the COVID-19.

A universal community testing programme (UCTP) was initiated by the government of the Hong Kong Special Administrative Region of the People's Republic of China, as part of a territory-wide initiative to enhance the control of the coronavirus disease (COVID-19) pandemic, to facilitate the early identification of asymptomatic patients in the community-transmission chain. The authors (who were also engaged in this programme) observed that, at the end of their 6-hour shift, most of the HCPs sustained medical device-related pressure injuries (MDRPI), frequently on their faces, over the bridge of their nose, the upper cheeks, above the ears, lower jaws, and chin that caused pain and erythema. In this study, our team examined whether two different types of dressing (light silicone foam dressing and soft silicone perforated tape dressing) applied on the anatomical locations (including the bridge of the nose, upper cheek, above the ears, and lower jaw) would enable the wearer to pass the quantitative respirator fit testing that was conducted using a PortaCount Pro+ Respirator Fit Tester 8038. We also investigated if any skin reactions occurred after the participants worn the respirator with our applied dressing materials for 240 minutes in a safe laboratory setting. Lastly, we collected the qualitative feedback concerning how the participants felt about the performance of our dressing materials in preventing MDRPI associated with the prolonged use of tight-fitting FFRs. A small convenience sample of HCPs (n = 24) who participated in the UCTP was recruited. We randomly selected 12 participants for one type of dressing, and the rest for the second type of dressing. Quantitative fit testing showed an adequate seal of the respirators with the use of both types of thin dressings that were available in the clinical settings. All of the participants except one tolerated the dressings for prolonged use without any report of adverse skin reactions. Our findings may move a step forward in assisting the process of developing feasible pre-emptive skincare practice guidelines to reduce MDRPI during the prolonged use of nanofiber bacterial surgical respirators.

Exploring the Gender-Related Perceptions of Male Nursing Students in Clinical Placement in the Asian Context: A Qualitative Study.

The lack of gender diversity in the nursing profession has long been recognized as a cause for concern. Female nurses in many practice settings across nations continue to outnumber their male counterparts. Male nursing students may have perceived differences in the way they are treated in clinical practice; however, limited studies have been conducted to determine the unique perspectives of these students in terms of gender bias in their clinical learning. To address this knowledge gap, this study employed a qualitative descriptive approach to explore the experiences of male nursing students in clinical learning in an Asian context. Specifically, we examined the insights emerging from the thoughts and feelings of male nursing students from interactions with their clinical mentors, patients, and peers in their encounters during their clinical placement. From November 2019 to July 2020, data were collected through semi-structured interviews from 22 male participants aged 21-30 years (mean age: 22.7), enrolled in a prelicensure Bachelor of Nursing (honors) program in Hong Kong. Four themes emerged after a qualitative content analysis: (1) while the School of Nursing welcomes men, clinical settings are another story due to pragmatic considerations; (2) you are welcomed because you may be seen as a helper with greater physical strength; (3) male nursing students feel alienated in the obstetrics and gynecology practicum; (4) more male role models are desired in the clinical setting. Our findings indicate the need to promote gender awareness among faculty and clinical mentors, understand the factors hindering and facilitating the clinical practicum for male nursing students, improve the male nursing experience during the maternity practicum, and ensure access to more male role models to boost role socialization and learning.

The Transformational Experience of Junior Nurses Resulting from Providing Care to COVID-19 Patients: From Facing Hurdles to Achieving Psychological Growth.

The rapid spread of coronavirus disease 2019 (COVID-19) has put significant pressure on junior nursing staff. The objective of this study was to examine the in-depth experiences of junior nurses in providing care for COVID-19 patients within an acute care setting. This study employed a phenomenological method to understand the situation from a first-person perspective. Purposive sampling was used. Interviews were performed with 40 junior nurses (<4 years of clinical experience) who provided direct care to COVID-19 patients in isolation wards in acute care settings in Hong Kong. The interviews were conducted from 1 January 2021 to 24 May 2021 via virtual conferencing software (Zoom) to maintain social distancing, and the responses were analysed using Colaizzi's seven-step method. Junior nurses' psychological experiences of providing direct care to COVID-19 patients were categorised into four main themes. First, there were hurdles in the early stages, in which participants experienced negative emotions, such as fear, anxiety, helplessness, and fatigue. Somatic symptoms, such as headaches and sleep disturbance, were reported. Second, the adoption of self-care coping strategies enabled nurses to confront the hurdles, signifying the start of self-transformation. Third, junior nurses maintained positivity under pressure by appreciating their sources of support (including their families and other important relationships in their lives). Professionalism was also found to reinforce positivity. Fourth, self-transformation resulted in psychological growth, which prepared junior nurses to be resilient and confident in their clinical practice to take up future challenges in the ongoing battle against the pandemic. The hurdles experienced by junior nurses at the early stage of their work in isolation wards provided the foundation upon which self-transformation took place. Being able to employ self-care coping strategies and further sustain positivity characterised the self-transformation process. Eventually, junior nurses became resilient and more capable of understanding both the negativity and positivity of their experiences. The self-transformation process also enabled junior nurses to recognise and appreciate the wider support system from various parties in society.

Ageing parents of children with intellectual disabilities during the COVID-19 epidemic in Hong Kong.

During the outbreak of COVID-19, the situation of aging parents of adolescents with intellectual disabilities (ID) in Hong Kong have encountered great difficulties in their daily lives. Due to the rapid changing conditions of the new virus COVID-19, it posed a lot of uncertainties and risks to the health of the public at large. In this regards, this group of parents and their children with ID are vulnerable to even greater risks and challenges in combating against the new virus. This paper has looked into the difficulties these parents and their children with ID have experienced and how they adjusted to carrying on with their living.