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.

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.

Attitudes of healthcare staff and patients' family members towards family presence during resuscitation in adult critical care units.

AIM AND OBJECTIVES: This study examines the attitudes of healthcare staff and patients' family members towards family presence during resuscitation (FPDR) in critical care units in Hong Kong. BACKGROUND: A wealth of literature is available on FPDR in various hospital and healthcare settings. The findings include many anecdotal accounts of both the positive and the negative effects of family presence. There is little documentation on the comparisons of staff and family members' perceptions and the predictors of staff attitudes towards FPDR practice. DESIGN: Cross-sectional survey design. METHOD: A convenience sample of 163 healthcare staff and 69 family members was recruited from the intensive care units. RESULTS: There was significant difference in the attitudes of healthcare staff and patients' families towards FPDR. The regression analysis showed that the healthcare staff would be more supportive to FPDR if family members could share the dying moments with patients, family members were accompanied by a bereavement team member, there was adequate staff to support the family and staff members were adequately trained. If healthcare staff feel that family members may have the impression that the resuscitation is chaotic, witness resuscitation is traumatic experience for the family, family presence will increase risk of litigation and colleagues will not allow family members to stay during resuscitation making them less supportive of FPDR. Nurses were more supportive to FPDR than doctors. CONCLUSION: The results provide information for healthcare professionals on the development of FPDR programmes for patients and their family members. Through multi-disciplinary collaborations, the effective and safe implementation of FPDR practice can be enhanced. RELEVANCE TO CLINICAL PRACTICE: The results could help the clinical staff to develop written guidelines to produce an integrated and consistent approach to this sensitive issue in clinical practice.

Nurses' perceptions and attitudes towards computerisation in a private hospital.

AIMS: To explore nurses' attitudes and level of satisfaction in using the Hospital Information System in clinical practice. BACKGROUND: Application of the Hospital Information System is increasing and there is substantial evidence suggesting that the successful implementation of Hospital Information System is significantly related to nurses' attitudes. However, little information is currently available on the factors influencing those attitudes and their level of satisfaction in Hospital Information System use. DESIGN: Cross-sectional survey. METHODS: A stratified, random sampling of 342 nurses working in a Hong Kong private hospital and using Hospital Information System was recruited. A questionnaire was used to collect data on perceptions, level of satisfaction and attitudes towards Hospital Information System usage. Correlations and linear regressions were used to analyse the data. RESULTS: Multiple linear regression analysis showed that work units, perceived usefulness and information technology support are the three predictors of nurses' attitudes and level of satisfaction with the system. In addition, nurses who have higher perceived ease of use and better satisfaction towards using the system are associated with positive attitude. CONCLUSION: The study results serve to guide the nurse managers to develop information systems based on the nurses' needs. Previous studies regarded nurses' level of satisfaction as a part of nurses' attitude. What is of interest in this study is that nurses' satisfaction level can be viewed as an individual factor affecting nurses' attitudes. With a user-friendly system, nurses tend to be more satisfied and therefore potentially more engaged in its use. This may indirectly improve patient care by saving time on documentation and enhancing communication among departments. RELEVANCE TO CLINICAL PRACTICE: The nurse managers should promote an institutional culture to motivate staff towards positive acceptance of innovation. An effective collaboration with the information technology team would enhance a more efficient exchange of information to understand the complex factors of IT implementation.

The effect of a restraint reduction program on physical restraint rates in rehabilitation settings in Hong Kong.

Background. In view of the adverse effects of using restraints, studies examining the use of restraint reduction programs (RRPs) are needed. Objectives. To investigate the effect of an RRP on the reduction of physical restraint rates in rehabilitation hospitals. Methods. A prospective quasi-experimental clinical trial was conducted. Demographic data, medical and health-related information on recruited patients from two rehabilitation hospitals, as well as facility data on restraint rates were collected. Results. The increase in the restraint rate in the control site was 4.3 times greater than that in the intervention site. Changes in the restraint mode, from continuous to intermittent, and the type of restraint used were found between the pre- and postintervention periods in both the control site and the intervention site. Discussion. Compared with that in the control site, the RRP in the intervention site helped arrest any increase in the restraint rate although it had no effect on physical restraint reduction. The shift of restraint mode from continuous to intermittent in the intervention site was one of the positive outcomes of the RRP.

Factors influencing the practice of exclusive breastfeeding among Hong Kong Chinese women: a questionnaire survey.

AIMS AND OBJECTIVES: The purpose of this article is to explore the relationships between breastfeeding knowledge, self-efficacy and demographic factors on breastfeeding patterns among Hong Kong Chinese primiparous women. Background. There is substantial evidence showing that maternal education, social class, ethnic background and religion are related to the decision to initiate as well as continue breastfeeding. Nevertheless, not much is known about how the controllable factors are able to influence the practice with the Hong Kong Chinese population. DESIGN: A cross-sectional and correlational design. METHODS: A convenience sample of 82 subjects who had normal vaginal delivery in the maternity unit of a regional hospital in Hong Kong was recruited. RESULTS: Linear regression analysis showed that subjects who lived with their mothers-in-law, had higher household income and higher gravida would be associated with a higher score in the Breastfeeding Self-Efficacy Scale. On the other hand, decisions to breastfeed made later in the pregnancy, father-in-law to 'pei-yue' (the Chinese practice whereby the new mother is expected to stay at home and to avoid all household chores and social activities during the first month after giving birth) and older in age would be associated with a lower score. Pei-yue is Chinese ritual of which the woman who has delivered should stay at home for one month and being taken care by others (this Chinese term is used throughout the article to indicate the time period described). Generalised estimating equations model revealed that women who had searched through the Internet for breastfeeding information, who had husbands to 'pei yue', lived in private housing, were married, had a domestic helper to 'pei yue' and who had attained higher education were more likely to practice exclusive breastfeeding. CONCLUSION: The social support from the family and breastfeeding self-efficacy have implications for continuing the practice of breastfeeding for primiparous women. RELEVANCE TO CLINICAL PRACTICE: Future efforts aimed at promoting exclusive breastfeeding could include the modifiable factors into consideration to better tailor interventions for successful, exclusive breastfeeding.

Depression: Problem-solving appraisal and self-rated health among Hong Kong Chinese migrant women.

This cross-sectional survey explored the depression status of new migrant women and its relationship with self-rated health in the Hong Kong Chinese context. A convenience sample of 68 migrant women volunteered to participate in the study. The data were collected by using the Problem Solving Inventory, the Center for Epidemiological Studies-Depression questionnaire, and a self-rated health scale. The respondents were found to have a lesser degree of problem-solving appraisal, compared with other populations, and almost half of the volunteers were found to be depressed. Approximately 50% of the women reported their general health as "excellent", "very good", or "good". The Pearson's correlation showed a positive significant correlation between problem-solving appraisal, depression, and self-rated health. The results of the regression analysis showed that family income, self-rated health, and problem-solving confidence are predictive factors of depression. Community nurses could consider using multidisciplinary interventions that focus on life-skills training in order to promote the psychological and general wellness of migrant women in addition to the use of counseling or medication interventions.

Investigating the health profile of patients with end-stage renal failure receiving peritoneal dialysis: a cluster analysis.

AIM: To determine whether the patients with end stage renal failure can be differentiated into several subtypes based on five main variables. BACKGROUND: There is a lack of interventional research linking to clinical outcomes among the patients with end stage renal failure in Hong Kong and with no clear evidence of differences in terms of their clinical/health outcomes and characteristics. DESIGN: A cross-sectional survey. METHOD: Data were collected using a structured questionnaire. One hundred and fifty-three patients with end stage renal failure were recruited during 2007 at three renal centres in Hong Kong. Five main variables were employed: predisposing characteristic, enabling resources, quality of life, symptom control and self-care adherence. RESULTS: A cluster analysis yielded two clusters. Each cluster represented a different profile of patients with end stage renal failure. Cluster A consisted of 49.7% (n = 76) and Cluster B consisted of 50.3% (n = 77) of the patients. Cluster A patients, more of whom were women, were older, less educated, had higher quality of life scores, a better adherence rate and more had received nursing care supports than patients in Cluster B. CONCLUSIONS: We have identified two groupings of patients with end stage renal failure who were experiencing unique health profile. Nursing support services may have an effect on patient health outcomes but only on a group of patients whose profile is similar to the patients in Cluster A and not for patients in Cluster B. A clear profile may help health care professional make appropriate strategies to target a specific group of patients to improve patient outcomes. RELEVANCE TO CLINICAL PRACTICE: The identification of risk for future health-care use could enable better targeting of interventional strategies in these groups. The results of this study might provide health care professionals with a model to design specified interventions to improve life quality for each profile group.

Community nursing services for postdischarge chronically ill patients.

OBJECTIVE: To examine community nursing services for patients with cardiovascular diseases, chronic respiratory diseases and other general medical conditions, making the transition from hospital to home. DESIGN: The original study design was a randomised controlled trial. This study is a secondary analysis of the hospital records documented by community nurses for the study-group patients. SAMPLE: The sample consisted of 46 subjects, randomly drawn from the main study group of the study. MEASUREMENTS: The community nursing records were analysed using the Omaha System. Self-reported health status and readmission data were retrieved from the data base of the original study. RESULTS: The three groups of patients experienced problems across the four domains in the Omaha System. Community nursing interventions did not differ greatly by disease groups. The primary purpose of home visits was observation, followed by treatment and procedures and health teaching. The community nurses in the study spent more effort providing health teaching to the respiratory group than to their counterparts. The outcome measures are self-reported health status and hospital readmission rates. For self-reported health status, significant differences were observed in the respiratory and cardiovascular group before and after community nursing services. For hospital readmission rate, no significant difference was found. CONCLUSIONS: To improve the well being of chronically ill patients, a comprehensive home intervention programme, emphasising continuous needs of monitoring and case management, is fundamental to producing desired, measurable effects. RELEVANCE TO CLINICAL PRACTICE: This paper adds the understanding of home-care services provided by community nurses to chronically ill patients. The scope of nursing services emphasises the significance of a positive, patient-centred, caring and appropriate client-practitioner relationship to improve the self-reported health of patients.

Coping and caring: support for family caregivers of stroke survivors.

AIMS AND OBJECTIVES: This study examines the physical and emotional burden experienced by caregivers of stroke survivors, compared with caregivers of patients having neurological diseases. BACKGROUND: Stroke survivors have residual neurological impairment, which requires long-term support and care. Anxiety, depression and poor physical health are common sequelae among family caregivers of stroke survivors. There is a reasonably consistent association between patients' levels of disability and emotional state and the emotional distress of their caregivers. DESIGN: A convenience sample of 47 families was recruited: of the 47 families, 23 had a member who suffered from stroke and 24 had a member with neurological disease. METHOD: Two interviews were conducted at three and six months after the occurrence of the index stroke or neurological disease. RESULTS: When the two groups of caregivers were compared for anxiety, depression and physical health status after care giving, the caregivers of stroke patients demonstrated higher levels of anxiety and depression than their counterparts in the neurological disease group (p < 0.001). However, there was no significant difference in physical health status between the two groups. Educational attainment, patient group and physical and cognitive impairment of the patients were the predictors of anxiety and the depressive status of the caregivers, while their age and level of depression contributed significantly to their physical health status. CONCLUSION: The physical and emotional well-being of two groups of family caregivers in a neurosurgical unit were compared in the caring context. The caregivers of stroke survivors are at a greater risk of developing poor physical and emotional health than the caregivers of patients having neurological diseases. RELEVANCE TO CLINICAL PRACTICE: The results illustrated that enhanced discharge planning and nurse follow-up sessions are considered essential in maintaining the well-being of the stroke caregivers and bridging the gap between the hospital and the community.

Evaluation of the Morse Fall Scale: applicability in Chinese hospital populations.

BACKGROUND: Patient falls have been identified as a significant health problem in the general hospital patient population. The Morse Fall Scale (MFS) is an individualized criterion-referenced assessment tool designed for measuring the likelihood of patient falls in hospitals. Despite the scale has demonstrated high validity and reliability in the previous researches, this study is to provide additional validity tests to determine the applicability in the Chinese hospital population. OBJECTIVES: To examine the predictive power of the MFS to predict patient falls. To conduct reliability tests on internal consistency, item analysis, inter-rater and test-retest reliability. DESIGN: The study was a cross-sectional study. SETTINGS: The medical and geriatric units of three rehabilitation hospitals in Hong Kong participated in the study. PARTICIPANTS: A convenience sample of 954 Chinese patients was recruited sequentially upon admission in the hospital ward units. They ranged in age from 17 to 100 years, with a mean of 70.2 years. METHODS: The patients were assessed for fall risk using the MFS on admission. Data was collected on the number of patients who fell rather than the number of falls. RESULTS: The scale had a sensitivity of 31% and a specificity of 83% when the cut-off point was determined at 45. The field test demonstrated excellent inter-rater reliability with an ICC value of 0.97 (95%CI 0.94-0.98). Repeatability was high with an ICC of 0.98 (95% CI 0.98-0.99). The evaluation revealed a low Cronbach's alpha coefficient and a low to moderate item-to-scale correlation. CONCLUSIONS: The evidence collected in this study has shown both the positive and negative aspects of using the MFS in assessing the fall risk of Chinese patients during rehabilitation. The discriminative validity and internal consistency reliability provide researchers and clinicians with a major step in further developing or modifying the scale.