Measuring exercise self-efficacy in Hong Kong Chinese adults with cardiovascular risk: Validation of a Chinese version of the Cardiac Exercise Self-efficacy Instrument.

About one-third of adults are physically inactive and thus prone to cardiovascular diseases. While self-efficacy mediates health behavior, its influences on exercise behavior among Chinese is yet to be explored by a validated instrument. This study aimed to examine the psychometric properties of the Hong Kong Chinese version of the Cardiac Exercise Self-efficacy Instrument (CESEI-C), which had been translated previously by these authors. The psychometric properties of the CESEI-C were tested with 160 Hong Kong Chinese with cardiovascular risk. Participants were asked to complete the CESEI-C, a physical activity assessment tool, and perform the exercise stress test. Exploratory factor analysis identified a unidimensional structure of the CESEI-C. Good internal consistency (Cronbach's alpha = 0.91) and good content validity (content validity indices: 0.93-1.00) had been reported previously. The convergent validity of the CESEI-C was supported by the significant positive correlations between the CESEI-C score and the amount of moderate-to-vigorous exercise (r = 0.18, p = 0.03), and exercise capacity (r = 0.30, p < 0.01). A comparison of CESEI-C scores by exercise capacities indicated that those with moderate-to-high exercise capacity had significantly higher CESEI scores than those with low exercise capacity (t = 2.105, p = 0.04). Thus, the CESEI-C is a valid and reliable instrument to measure exercise self-efficacy among Hong Kong Chinese.

A longitudinal examination of the association between nurse staffing levels, the practice environment and nurse-sensitive patient outcomes in hospitals.

BACKGROUND: The level of patient safety and outcomes accomplished depends on the quality of care provided. Previous studies found that nurse-to-patient ratio, practice environment, and nursing education were significant predictors of patient outcomes. However, the outcomes measured in previous studies were mainly inpatient mortality and failure-to-rescue rates. Few nurse-sensitive patient outcomes have been measured that quantify nurses' contribution to patient care. Selecting appropriate outcomes that reflect the clinically relevant effect of nursing care is important. Moreover previous studies were largely cross-sectional and retrospective. These research designs are limited in their ability to explain the casual links between the variables examined. This study is aimed at determining the associations among staffing levels, skill mix of baccalaureate-prepared registered nurses, and practice environment on nurse-sensitive outcomes for medical and surgical patients in public hospitals in Hong Kong. METHOD/DESIGNS: A multi-method research design will be adopted. The sample includes all medical and surgical wards of four major public hospitals that offer 24-h accident and emergency services. Multiple responses from registered nurses who work in the study wards will be collected over 12 months to examine their individual characteristics and perceptions of the practice environment. A 12-month prospective observational study will be performed to determine the association between nurse staffing levels, the practice environment, and nurse-sensitive patient outcomes including pressure ulcers, falls and restraint prevalence, urinary catheter-associated urinary tract infections, and central line catheter-associated bloodstream infections. Multilevel Cox proportional hazards models will be employed to examine the association between these patient outcomes and the explanatory nursing factors of primary interest (nurse staffing levels, education composition, and practice environment), with adjustment for all patient-, ward- and hospital-level potential confounders (age, sex, diagnosis, comorbidities, level of surgical invasiveness, mortality, length of stay, and type of admission). DISCUSSION: It is anticipated that knowledge of the association between nurse staffing levels, the practice environment, and nurse-sensitive outcomes will inform the provision of quality and timely patient care. This study will provide a landmark report that is of relevance and importance to patients and to hospital stakeholders and managers, health policy makers, nurses, and educators who advocate patient benefits. TRIAL REGISTRATION: Clinical Trials Registry CCTCTR CUHK_CCT00460 . Date of trial registration: 02 July 2015.

Predicting influenza vaccination intent among at-risk chinese older adults in Hong Kong.

BACKGROUND: Older adults with major chronic illnesses are very susceptible to influenza and its serious complications, but many do not obtain vaccinations. Little is known about factors associated with intention to obtain influenza vaccination among at-risk Chinese older adults in Hong Kong. OBJECTIVES: The aim of this study was to identify factors associated with intent to obtain influenza vaccination among at-risk Chinese older adults in Hong Kong. METHODS: This multicenter descriptive correlational study recruited a convenience sample of 306 Chinese older adults with medical risk factors for influenza and its serious complications from the general outpatient clinics in Hong Kong. Interviews were conducted to assess intent to obtain influenza vaccination for the coming year, health beliefs about influenza, and discomfort following past vaccinations. RESULTS: The current influenza vaccination rate was 58.5%; only 36.3% intended to get vaccinated the following year. After controlling for clinical and demographic factors in a logistic regression model, perceived susceptibility predicted intention to obtain future vaccination (OR = 1.42, 95% CI [1.14, 1.78]), whereas postvaccination discomfort was negatively associated with intention (OR = 0.063, 95% CI [0.006, 0.63]). CONCLUSIONS: Intention to obtain influenza vaccination was low among at-risk Chinese older adults. Strengthening health beliefs and creating strategies to provide positive influenza vaccination experiences are possible approaches to interventions to improve uptake of influenza vaccination rates.

Preoperative patient teaching: the practice and perceptions among surgical ward nurses.

AIMS AND OBJECTIVES: To explore the consistency between the perceptions and actual practice of preoperative patient teaching and also the factors affecting the provision of teaching from the perspective of nurses working in surgical wards. BACKGROUND: Preoperative teaching is beneficial to surgical patients in alleviating their anxiety and promoting their postoperative recovery. Despite the leading role in patient teaching by nurses, sparse studies have been addressed the consistency between nurses' perceptions and their actual practice of preoperative teaching in surgical wards. DESIGN: A cross-sectional survey. METHOD: Data were collected by using self-reported preoperative teaching questionnaires together with nurse demographic data sheets. Sampling setting was an acute public hospital and all nurses working in surgical wards (n = 100) were approached in the study. RESULTS: A total of 86 nurses returned the questionnaires. 'Details of anaesthesia' was the most prominent preoperative teaching component rated by nurses although their major teaching was pertained to 'preoperative preparation'. In addition, oral explanation was reported as the most prevalent way of information delivery and internet was the least preferred method. Discrepancies between nurses' perceptions and actual practice were found in this study. Moreover, nurses' time availability, language barriers and tight operation schedules were perceived as top factors affecting the provision of preoperative teaching. Furthermore, nurses' satisfaction with such patient teaching was significantly associated with their professional training and their daily workload in the clinical setting. CONCLUSIONS: Preoperative patient teaching was not fully achieved by nurses in this study, and the results highlighted the conflicting issues related to the implementation process that could be resolved by means of proper planning and management in clinical practice. RELEVANCE TO CLINICAL PRACTICE: Healthcare organisations and nurse managers should periodically review the existing clinical resources so that sufficient preoperative teaching strategies can be provided. Nurses' perceptions and satisfaction towards preoperative teaching can be compared with those of the patients in further studies so that the insights for developing an effective preoperative teaching programme can be more comprehensive.

Promoting self-reflection in clinical practice among Chinese nursing undergraduates in Hong Kong.

This study evaluated the effect of a structured education programme on improving the self-reflection skills of Chinese nursing undergraduates in managing clinical situations. Johns' Structured Reflection Model was used as a framework for the development of the education programme. Thirty-eight nursing undergraduates attended a 3-hour interactive workshop on reflective skills and were encouraged to practise the skills learned under the guidance of a nurse instructor during their 4-week clinical practicum. The findings indicated that the programme was helpful in improving the undergraduates' reflective skills though only a few of them reached the highest level as critical reflectors. Some undergraduates identified time constraints and the lack of a trusting relationship with their nurse instructor as barriers to their reflective learning. The findings may help nurse educators develop education programmes with structured learning strategies to promote nursing undergraduates' self-refection in clinical practice.

A survey of registered nurses' perceptions of the code of professional conduct in Hong Kong.

AIM: To examine the perceptions of the code of professional conduct among practising registered nurses in Hong Kong. BACKGROUND: A code of professional conduct is intended to guide nurses in their practice and to ensure congruence with nursing goals and objectives. Such a code for nurses in Hong Kong has been in effect for two decades but, to date, no study has examined the perceptions of it among practising nurses. DESIGN: A survey of 320 practising registered nurses working in a hospital cluster in Hong Kong (mean postregistration experience=11.8 years). METHODS: A questionnaire developed to assess nurses' perceptions of the Code of Professional Conduct devised by the Nursing Council of Hong Kong. RESULTS: Providing safe and competent care, practising in accordance with the law and maintaining agreed standards were ranked in order as the three most important aspects. Safeguarding informed decision-making for patients who were mentally incapacitated or unable to speak for themselves, participating in continuing nursing education and raising objections to practices that compromise safe and appropriate care were considered the most challenging aspects to achieve in professional nursing practice. CONCLUSIONS: To educate nurses to become more assertive in safeguarding patients' rights and to encourage and support lifelong learning remains a major challenge in professional nursing practice. The profession and statutory bodies need to consider how best to enable practising nurses to address these issues. RELEVANCE TO CLINICAL PRACTICE: Examining the perceptions of practising nurses about the professional code is necessary to ensure that the profession is prepared to meet the ever-changing demands and expectations of the public whom it claims to serve.

Professional nursing values among baccalaureate nursing students in Hong Kong.

The development of a nursing code of professional conduct is to guide nurses to make appropriate clinical decision, in particular when facing ethical dilemma. It is of paramount importance that nurse educators understand baccalaureate nursing students' perceptions of the importance of the code of professional conduct and the level of difficulties in implementing this code while preparing them for future practicing nurses. The Code of Professional Conduct in Hong Kong has been developed to guide nursing practice for over two decades. Nevertheless, no study has examined Hong Kong baccalaureate nursing students' perception about this professional code. The aim of this paper was to examine the perceptions of 263 baccalaureate nursing students about this professional code using a cross sectional survey design. The results indicated that most items in the professional code were rated as important and "provide safe and competent care" was rated as the most important one. A few areas that the students perceived as difficult to implement were discussed and future research was recommended. The significant differences identified among students from different years of study also highlighted areas for consideration in planning educational program to further equip students with the ability to deal with challenges in professional practice.

Correlates of functional limitations in older Chinese patients with chronic obstructive pulmonary disease in Hong Kong.

BACKGROUND: Few studies have examined functional limitations in Chinese elders with chronic obstructive pulmonary disease (COPD). OBJECTIVES: The objective was to describe the functional limitations, respiratory status, and psychologic status of Chinese elders with COPD; to examine the relationships between functional limitations and selected variables including age, gender, duration of COPD, and hospital readmission history; and to identify the variables that predict functional limitations in Chinese elders with COPD. METHOD: A correlational predictive study was performed with a sample of 97 Chinese elders with COPD. The subjects were 65 years or older and recruited from two hospitals in Hong Kong. Data were individually collected on the day the individual was to be discharged from the hospital, by using the Barthel Index for functional limitations, forced expiratory volume in 1 second percent predicted for respiratory status, and General Health Questionnaire (28 items) for psychologic status. Information on age, gender, duration of COPD, and hospital readmission history were also identified from the medical record. RESULTS: Functional limitations in Chinese elders with COPD were significantly correlated with poorer respiratory status and more depressive symptoms. Multiple regression analysis indicated that depressive symptoms were a significant predictor of functional limitations after controlling for the effect of respiratory status. DISCUSSION: The results of this study demonstrate that depressive symptoms to some extent predict functional limitations in Chinese elders with COPD. Investigation of the effect of appropriate screening and interventions for depressive symptoms on preventing, delaying, or reducing functional limitations in this patient group is suggested.

The effect of a virtual ward program on emergency services utilization and quality of life in frail elderly patients after discharge: a pilot study.

INTRODUCTION: Attendance at emergency departments and unplanned hospital readmissions are common for frail older patients after discharge from hospitals. A virtual ward service was piloted to deliver "hospital-at-home" services by community nurses and geriatricians to frail older patients immediately after their discharge from hospital to reduce emergency services utilization. OBJECTIVES: This study examined the impacts of the virtual ward service on changes in the patients' emergency attendance and medical readmissions, and their quality of life (QOL). METHODS: A matched-control quasi-experimental study was conducted at four hospitals, with three providing the virtual ward service (intervention) and one providing the usual community nursing care (control). Subjects in the intervention group were those who are at high risk of readmission and who are supported by home carers recruited from the three hospitals providing the virtual ward service. Matched control patients were those recruited from the hospital providing usual care. Outcome measures include emergency attendance and medical readmission in the past 90 days as identified from medical records, and patient-reported QOL as measured by the modified Quality-of-Life Concerns in the End of Life Questionnaire (Chinese version). Wilcoxon signed-rank tests compared the changes in the outcome variables between groups. RESULTS: A total of 39 patients in each of the two groups were recruited. The virtual ward group showed a greater significant reduction in the number of unplanned emergency hospital readmissions (-1.41±1.23 versus -0.77±1.31; P=0.049) and a significant improvement in their overall QOL (n=18; 0.60±0.56 versus 0.07±0.56; P=0.02), but there was no significant difference in the number of emergency attendances (-1.51±1.25 versus -1.08±1.48; P=0.29). CONCLUSION: The study results support the effectiveness of the virtual ward service in reducing unplanned emergency medical readmissions and in improving the QOL in frail older patients after discharge.

Effects of a care protocol on care outcomes in older nursing home patients with chronic obstructive pulmonary disease.

OBJECTIVES: To evaluate the effects of a care protocol used by community nurses to support nursing home staff in the care of patients with chronic obstructive pulmonary disease (COPD). DESIGN: Matched, randomized case-control trial. SETTING: Forty-five nursing homes of the New Territories South (NTS) cluster of Hong Kong. PARTICIPANTS: Eighty-nine older people (> or =65, present resident of a nursing home in the NTS region, main diagnosis of COPD, at least one hospital admission in previous 6 months) discharged to the nursing homes from the geriatric units of two hospitals. INTERVENTION: Using a care protocol, community nurses followed up older patients in the experimental group for 6 months after their discharge from the hospitals to the nursing homes. MEASUREMENTS: Data on functional, respiratory, and psychological parameters were collected at entry to study and 6 months later with standard measures. Data on hospital service utilization, nursing home staff, and patient satisfaction were also collected at 6 months. RESULTS: Experimental group participants had significant (P =.008) improvements in psychological well-being. Nursing home staff and experimental group patients were highly satisfied with the use of the protocol. There was no significant difference between the two groups in functional and respiratory outcomes or hospital service utilization. CONCLUSION: Psychological well-being as an important factor in rehabilitation in chronic illness has been much neglected in the literature. Supporting nursing home staff in the care of COPD patients through community nursing visits can enhance older residents' psychological well-being. Psychological aspects of care should be emphasized and incorporated into the delivery of regular nursing home care.

Effects of an osteoporosis educational programme for men.

AIM: This paper reports an evaluation of the effects on knowledge, health beliefs and preventive behaviours of an osteoporosis educational programme for men. BACKGROUND: Osteoporosis is an increasing global health concern, and educational programmes have been identified as a crucial strategy in its prevention. However, the effectiveness of osteoporosis educational programmes has mainly been evaluated in women. METHODS: A randomized controlled trial was carried out to identify the effects of an osteoporosis educational programme for men. The study was conducted between September 2004 to February 2005, and 128 Hong Kong Chinese men were randomly assigned to an intervention or control group, with 64 in each group. The intervention group attended an osteoporosis educational programme. All participants completed pre- and post-test self-administered questionnaires: Osteoporosis Knowledge Test, Osteoporosis Health Belief Scale and Osteoporosis Self-Efficacy Scale. RESULTS: The intervention group showed a statistically significant increase in both knowledge (P < 0.0005) and health beliefs (P = 0.007) about osteoporosis and preventive behaviours in comparison with the control group. However, the difference in self-efficacy between the two groups was not statistically significant (P = 0.154). CONCLUSIONS: An osteoporosis educational programme can increase men's knowledge levels and change their health beliefs about osteoporosis and preventive behaviours. This approach should be more widely used in nursing practice to promoting the adoption of osteoporosis prevention behaviours in men.