Barriers and facilitators to the formation of professional identity among nursing students: A four-year longitudinal qualitative study.

BACKGROUND: Nursing professional identity (NPI) is essential for nurses to develop their nursing profession. It reflects the competencies consistent with the professional practices of nurses and contributes to them providing better healthcare and public health. The formation process of NPI started with undergraduate nursing education and continued throughout the nursing career. OBJECTIVE: To explore nursing students' perceptions of facilitators and barriers to the formation of NPI during their study. METHODS: A 4-year longitudinal, qualitative research design with yearly semi-structured interviews undertaken from 2019 to 2022. The reflexive thematic analysis methodology was applied for the data analysis. RESULTS: Ninety-three nursing students were recruited, joining a group or individual interview. The four-year nursing baccalaureate program revealed a dynamic formation process of NPI: "Outsider of nursing", "Entering the nursing courses", "Building nursing competence", and "Thinking and acting like a nurse". A total of 12 themes were identified to present the barriers and facilitators to the NPI formation at different stages. Specifically, the six barriers include conflict between their ideals and reality, sociocultural stereotypes about nursing, the negative impact of COVID-19, the pre-internship concerns, struggling to meet expectations, and potential danger and discrimination in the healthcare settings. The enablers were: self-motivation and inner belief towards the nursing profession, the power of role models, the improvement of nursing capacity, well integration into the healthcare professional teams, understanding of the clinical environment, and recognition and encouragement from others. CONCLUSIONS: The formation of nursing students' NPI is an ever-changing process, with various intrinsic and extrinsic influences during their four-year study. Nursing educators are suggested to prepare and develop students' professional comportment in their theoretical and clinical practice to develop their professional identity as a nurse.

The integrated common-sense model of illness self-regulation: predicting healthy eating, exercise behaviors, and health among individuals at risk of metabolic syndrome.

BACKGROUND: Little is known about the potential mechanisms of healthy eating and exercise change, and design interventions which aim to promote healthy eating and exercise change among individuals at risk of metabolic syndrome. This study aimed to identify key determinants of healthy eating, exercise behaviors, and health among individuals at risk of metabolic syndrome using the integrated common-sense model of illness self-regulation. METHOD: A cross-sectional study with a multi-wave data collection strategy. A total of 275 participants at risk of metabolic syndrome based on the clinical prediction model were included in the final analysis. Path analysis was employed to explore the pattern of relationships between key variables using AMOS. RESULTS: The mediation analysis suggested that personal and treatment control, and coherence can positively affect self-reported health via intentions and health behaviors (exercise and healthy eating). Additionally, relationships between self-efficacy (exercise and healthy eating) and health outcomes can be mediated by health behaviors, and both intentions and health behaviors. CONCLUSIONS: This current research used the integrated common-sense model of illness self-regulation to predict healthy eating, exercise behaviors, and self-reported health among individuals at risk of metabolic syndrome. The results suggested that self-efficacy, intention, consequences, personal control, treatment control, and coherence were the key determinants of behavior and health, which can help design interventions to encourage healthy eating and exercise changes among individuals with a high risk of MetS.

Stroke survivors', caregivers' and nurse coaches' perspectives on health coaching program towards hospital-to-home transition care: A qualitative descriptive process evaluation.

AIMS AND OBJECTIVES: To explore the perspectives of stroke survivors, caregivers and nurse coaches on a health coaching program during hospital-to-home transitional care. BACKGROUND: Stroke is a major public health problem that seriously affects the health and safety of people in China. Nurse-led health coaching is a promising support option in enabling smooth hospital-to-home transition for stroke survivors and family caregivers. A qualitative study is valuable for gaining insight into their perspectives on using this program. DESIGN: An exploratory, descriptive qualitative process evaluation was conducted parallel with a former randomised controlled trial. Data were obtained from 26 stroke survivors, 33 caregivers and four nurse coaches with semi-structured interviews. The inductive reflexive thematic analysis approach was used for data analysis. The COREQ checklist was followed in reporting this study. RESULTS: Seven themes were generated from the data: (1) the applicability of individualised health coaching sessions, (2) driving self-efficacy to establish self-care skills, (3) the key role of nurse coaches, (4) coordination among healthcare teams during the transition, (5) adequate community and social support, (6) insufficient rehabilitative services after discharge and (7) perceived extra workload for nurse coaches. CONCLUSIONS: The study captured perspectives on a nurse-led health coaching program towards hospital-to-home transition care from stroke survivors, caregivers and nurse coaches. Individualised health coaching sessions and driving self-efficacy were perceived as facilitators for empowering the self-care skills of stroke survivors and caregivers. The key role of nurse coaches in coordinating healthcare teams and adequate community and social support were detected as the power frame of the program's implementation. However, health system obstacles, such as insufficient rehabilitative services and the high workload of nurses, still need to be addressed to ensure the sustainability of health coaching intervention in transitional care. RELEVANCE TO CLINICAL PRACTICE: The study suggested the feasibility of implementing nurse-led health coaching to smooth post-stroke hospital-to-home transitional care. The findings also highlighted the importance of qualitative process evaluation when implementing evidence-based interventions in health care. TRIAL REGISTRATION: The trial was registered with the Australia New Zealand Clinical Trials Registry (ID: ACTRN12619000321145).

The experience of stroke survivors and caregivers during hospital-to-home transitional care: A qualitative longitudinal study.

BACKGROUND: Stroke survivors and their caregivers experience different difficulties that arise from certain physical, psychological, social aspects and caring burdens during the hospital-to-home transitional period. Although there are abundant studies that focus on stroke transitional care, there are limited qualitative studies that synthesize the experience of hospital-to-home transitional care for stroke survivors and their caregivers in China. OBJECTIVE: To evaluate the experience of stroke survivors and their family caregivers during hospital-to-home transitional care in China. METHODS: A qualitative longitudinal study based on semi-structured interviews were implemented to address the research objective. Interviews were conducted at two stages, (1) when stroke survivors were close to discharge, and (2) within two months post-discharge. Participants were recruited from one tertiary hospital between April and September 2019. Data were analyzed using reflexive thematic analysis. FINDINGS: Twenty-three stroke survivor/caregiver dyads participated, totaling 92 individual interviews. The thematic framework based on the experience of stroke survivors and caregivers reveals a three-phases of the hospital-to-home trajectory: survived, living in the mist, and crisis at home. The study identified one key theme (the optimism and hope) in the first phase, four key themes in the second (the pre-discharge emotional concerns and reactions, lack of stroke knowledge and stroke care information, difficulties of performing home-based healthcare, expectation of hospital pre-discharge) and in the third phase (high level of post-discharge stress, inaccessible postdischarge care services and health resources, interpersonal relationship disruption and lifestyle changes, financial burdens) respectively. In addition, several interconnected subthemes for stroke survivors' and caregivers' experiences were identified in each phase. CONCLUSION: The experience of stroke survivors and caregivers during hospital-to-home transitional care is a dynamic process with enormous challenges in each phase. These findings have implications for policymakers and health care systems regarding developing an enabling environment that supports successful hospital-to-home transitional care. Collaboration with health care professionals, accessible rehabilitation services and follow-up support after discharge, and available community and social support are warranted to be integrated into transitional care to help stroke survivors and caregivers to facilitate their hospital-to-home trajectory.

Exploring the Presence of Humanoid Social Robots at Home and Capturing Human-Robot Interactions with Older Adults: Experiences from Four Case Studies.

BACKGROUND: Social robots have the potential to bring benefits to aged care. However, it is uncertain whether placing these robots in older people's home is acceptable and whether human-robot interactions would occur or not. METHODS: Four case studies were conducted to understand the experiences of older adults and family caregivers when humanoid social robot Ka Ka was placed in homes for two weeks. RESULTS: Four older adults and three family caregivers were involved. Older adults interacted with the social robot Ka Ka every day during the study period. 'Talking to Ka Ka', 'listening to music', 'using the calendar reminder', and 'listening to the weather report' were the most commonly used features. Qualitative data reported the strengths of Ka Ka, such as providing emotional support to older adults living alone, diversifying their daily activities, and enhancing family relationships. The voice from Ka Ka (female, soft, and pleasing to the ear) was considered as 'bringing a pleasant feeling' to older adults. CONCLUSIONS: In order to support aging-in-place and fill the gaps of the intensified shortage of health and social manpower, it is of prime importance to develop reliable and age-friendly AI-based robotic services that meet the needs and preferences of older adults and caregivers.

Nurse-led health coaching programme to improve hospital-to-home transitional care for stroke survivors: A randomised controlled trial.

OBJECTIVE: To evaluate the effects of a nurse-led health coaching programme for stroke survivors and family caregivers in hospital-to-home transition care. METHODS: A total of 140 dyads of stroke survivors and their family caregivers were recruited and randomly assigned to either the intervention group (received a 12-week nurse-led health coaching programme) or the usual care group. The primary outcome was self-efficacy, and secondary outcomes were quality of life (QoL), stroke-related knowledge, and caregiver-related burden. The outcomes were measured at baseline, 12 and 24 weeks. RESULTS: Stroke survivors in the intervention group demonstrated a significant improvement in self-efficacy at 12 weeks (x̅: 24.9, 95%CI: 20.2-29.6, p < 0.001) and at 24 weeks (x̅: 23.9, 95%CI: 19.2-28.6, p < 0.001) compared to the usual care group. Findings also demonstrated significant increases in stroke survivors' QoL, stroke-related knowledge, and reduction in unplanned hospital readmissions and caregiver-related burden. There were no statistically significant changes in other outcomes between the two groups. CONCLUSION: The nurse-led health coaching programme improved health outcomes for both stroke survivors and their caregivers. PRACTICE IMPACTION: Findings from the study suggest that nurse-led health coaching should be incorporated into routine practice in hospital-to-home transitional care for stroke survivors and their caregivers.

Correction to: A nurse-led health coaching intervention for stroke survivors and their family caregivers in hospital to home transition care in Chongqing, China: a study protocol for a randomized controlled trial.

An amendment to this paper has been published and can be accessed via the original article.

The effect of transition care interventions incorporating health coaching strategies for stroke survivors: A systematic review and meta-analysis.

OBJECTIVE: To systematically analyse health coaching strategies in transition care and synthesise the effect of these strategies on health care outcomes for stroke survivors. METHODS: A systematic search of nine databases in two languages was conducted. Meta-analysis was conducted when data were available. RESULTS: Twenty-five randomised controlled trials met the inclusion criteria. The meta-analysis revealed that health coaching strategies in transition care interventions significantly improve quality of life (QoL) (p < 0.001), activities of daily living (ADL) (p = 0.002) and reduce depression (p = 0.001) for stroke survivors at 3 months. Further subgroup analysis demonstrated that transition care interventions with a greater number of health coaching strategies are associated with a larger effect size on QoL (SMD=1.15) and ADL (SMD=1.177) at 3 months, and a medium effect size (SMD=0.674) on depression reduction. However, the effects of health coaching strategies on readmission, mortality and falls in stroke survivors remain inconclusive. CONCLUSIONS: This review provides evidence that incorporating health coaching strategies in transitional care improves health outcomes of stroke survivors. PRACTICE IMPLICATION: More trials of health coaching interventions to improve transition care with a rigorous study design are much needed to address the lack of support for stroke survivors and their caregivers in this crucial care period.

A nurse-led health coaching intervention for stroke survivors and their family caregivers in hospital to home transition care in Chongqing, China: a study protocol for a randomized controlled trial.

BACKGROUND: Hospital to home transition care is a most stressful period for stroke survivors and their caregivers to learn self-management of stroke-related health conditions and to engage in rehabilitation. Health coaching has been identified as a strategy to enhance self-management of poststroke care at home. However, interventions in this field that are informed by a health coaching framework are scarce. This study will address a gap in research by testing the hypothesis that a nurse-led health coaching intervention can improve health outcomes for stroke survivors and their family caregivers in hospital to home transition care. METHODS: This is a single-blind, two-arm parallel randomized controlled trial of a nurse-led health coaching program versus routine care situated in two tertiary hospitals in Chongqing, China. Stroke survivors and their primary family caregivers will be recruited together as "participant dyads", and the estimated sample size is 140 (70 in each group). The intervention includes a 12-week nurse-led health coaching program in hospital to home transition care commencing at discharge from the hospital. The primary outcome is changes in self-efficacy of stroke survivors at 12 weeks from the baseline. The secondary outcomes are changes in stroke survivors' and quality of life, functional ability, stroke-related knowledge, the number of adverse events, and unplanned hospital admissions, and caregivers' self-efficacy and caregiver-related burden at 12 weeks from the baseline. The outcomes will be measured at 12 weeks and 24 weeks from the baseline. DISCUSSION: This study will examine the effect of nurse-led health coaching on hospital to home transition care for stroke survivors and their caregivers. It is anticipated that findings from this trial will provide research evidence to inform policy, and resource and practice development to improve hospital to home transition care for stroke survivors and their caregivers. TRIAL REGISTRATION: The Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12619000321145. Registered on 1 March 2019.

Pain, fatigue, disturbed sleep and distress comprised a symptom cluster that related to quality of life and functional status of lung cancer surgery patients.

AIMS AND OBJECTIVES: To explore the common symptom cluster in lung cancer patients with surgical treatment and to evaluate the relationships between symptom cluster and patients' disease outcomes, including functional status and quality of life. BACKGROUND: Lung cancer is one of the leading causes of cancer-related death for both men and women, and its incidence is increasing in China. Growing number of researches confirmed that symptoms in lung cancer patients with chemotherapy and radiotherapy occurred as 'symptom cluster' across the disease trajectory and influenced disease outcomes. However, few studies focused on the symptom cluster and its effects on quality of life and functional status of lung cancer surgery patients. DESIGN: This is a descriptive, cross-sectional design. METHODS: Symptoms in lung cancer surgery were assessed by M.D. Anderson Symptom Inventory, Karnofsky Performance Scale and Quality of Life Instruments for Cancer Patients - Lung Cancer. One hundred and forty-five individuals were involved in the survey. RESULTS: The top four common and most severe symptoms were pain, fatigue, disturbed sleep and distress for lung cancer surgery patients. 4·8% (n = 7) and 17·2% (n = 25) of patients reported co-occurrence of two or three symptoms of pain, fatigue, disturbed sleep and distress. About 76·6% (n = 111) of patients reported co-occurrence of all the four symptoms. There were strong negative relationships between the top four symptoms and Karnofsky Performance Scale and Quality of Life Instruments for Cancer Patients - Lung Cancer scores. CONCLUSION: Pain, fatigue, disturbed sleep and distress constituted the common symptom cluster during the disease trajectory in patients with lung cancer who got surgical treatment and negatively affected their quality of life and functional status. RELEVANCE TO CLINICAL PRACTICE: Symptoms in lung cancer surgery patients often occurred as cluster during the trajectory of disease. To improve the well-being of patients, attentions need to be focused on developing symptom cluster management strategies.