The Healing through Arts (HeARTS) program for children bereaved by cancer: Pilot study findings from Singapore.

OBJECTIVES: The article aims to investigate the feasibility, acceptability, and initial efficacy of a short-term 3-day art therapy group for children who have experienced parental death to cancer. METHODS: The study utilized a pretest-posttest design and included children (n = 20) aged 7-12 years. The feasibility of the intervention was measured by recruitment ability, study compliance, and intervention adherence, while acceptability was assessed using a child-reported satisfaction survey. Efficacy was examined using the child-reported Pediatric Quality of Life Inventory (PedsQL), while the emotional, social, and behavioral functioning of children was measured using the parent-reported Strengths and Difficulties Questionnaire. Paired sample t-tests were used for analyses. RESULTS: The intervention was found to be feasible (80% recruitment rate and 100% session adherence). Acceptability was high, and all participants were satisfied and found the intervention to be helpful. While results did not reach statistical significance, improvements in psychosocial and physical quality of life were reported by all the children post-intervention and at the 3-month follow-up. Parent-reported a decrease in behavioral difficulties scores and an increase in prosocial behavior scores at post-intervention and at the 3-month follow-up. SIGNIFICANCE OF RESULTS: The 3-day art therapy group intervention was shown to be feasible to conduct and acceptable to the recipients. The intervention shows promise in improving post-death adjustment and quality of life outcomes of children bereaved by parental death due to cancer that were maintained after 3 months. The use of art therapy groups to ameliorate difficulties associated with parental loss and to assist children in coping day-to-day difficulties should be further investigated.

A qualitative systematic review on nurses' experiences of workplace bullying and implications for nursing practice.

AIMS: To explore nurses' experiences of workplace bullying and ways to prevent such occurrences. DESIGN: A qualitative systematic review was conducted. DATA SOURCES: Five electronic databases were searched from each database's inception to December 2020. REVIEW METHODS: Meta-summary and meta-synthesis were conducted using Sandelowski and Barroso's approach. RESULTS: Twenty-seven studies were included in this review. The overarching theme, 'The Vicious Cycle of Bullying in Nursing', and four themes were synthesized: (a) different 'faces' of bullying, (b) the hidden drivers of bullying, (c) impact of being bullied and (d) responses to bullying. CONCLUSION: The nursing code of ethics and anti-bullying policies should be consistently enforced by each organization's upper management. Nurses should be provided a safe space to voice their concerns on bullying within the organization.

Effectiveness of COVID-19 Vaccination against Severe Symptoms and Death Among Geriatric Inpatients: A Retrospective Cohort Study in Macao.

Monitoring the effectiveness of COVID-19 vaccination is critical for understanding if the vaccinated population, especially the elderly, is adequately protected from the emergence of new SARS-CoV-2 variants. This study aimed to investigate the effects of COVID-19 vaccination on the severity of symptoms and mortality in hospitalized geriatric patients during the Omicron BF.7 surge in Macao. Data from electronic health records and vaccination registry of inpatients aged 60 years or above admitted to Kiang Wu Hospital from 12 December 2022 to 12 March 2023 were retrospectively analyzed. The study involved 848 people, including 426 vaccinated and 422 unvaccinated individuals. The mean CXR scores (8.95 ± 9.49 vs. 11.41 ± 10.81, p < 0.001) and the mean MEWS scores (0.96 ± 2.01 vs. 1.49 ± 2.45, p < 0.001) were lower in the vaccinated group. By comparing the dose counts, no significant difference was seen in the odds of death. Based on the time of the last vaccination, 128 people were categorized as complete and 298 as incomplete vaccination. The complete vaccination group showed a 54% (95% CI 0.23-0.91) reduction in mortality risk (p = 0.026). The study findings not only reconfirm the effectiveness of COVID-19 vaccination but, more importantly, highlight the importance of vaccination timing to maximize vaccines' protective effect.

Impact of Implementing New ICF-Based Practices on Staff Valence of Disability Practitioners: An Experience in Hong Kong.

The International Classification of Functioning, Disability, and Health (ICF) was endorsed by The World Health Organization (WHO) in 2001. However, Hong Kong is at the beginning stage of implementing and testing ICF-based practices. This study examines any changes in the valences of disability practitioners in an organization under the newly introduced ICF-based practices. It was hypothesized that the involved staff members' self-perceived valences in relation to the ICF would be enhanced. A pretest-posttest design was adopted. The 27-item Scale on Staff Valence under ICF-based practice (SSV-ICF) was used to measure the impact on staff valence of a pilot scheme in which ICF-based practice was implemented. Self-report questionnaires were completed by the involved staff members at the beginning of the pilot scheme and 12 months later. Analyses used paired samples t-tests and one-way repeated measures ANOVAs, performed by SPSS software, version 25. In total, 91 participants took part in the study. Results showed that participants achieved positive changes in all domains of valences, while participants' level of involvement in the new ICF-based intervention had significant effects on their score differences in the "Competence" domain (r = 0.262, p < 0.05), "Intrapersonal" domain (r = 0.242, p < 0.05), and "Total Score" of SSV-ICF (r = 0.210, p < 0.05). The study demonstrated that disability practitioners who implemented ICF-based practices developed higher staff valences, which, in turn, benefited service users. Implementation of ICF-based practices also contributed to a more positive organizational culture.

Protocol for a mixed-methods randomised controlled trial evaluating the effectiveness of a dyadic expressive arts-based intervention in improving the psychosocial well-being of children with intellectual disability in special schools and their mothers.

INTRODUCTION: Mothers of children with intellectual disability (ID) are often distressed because of intensive workloads and difficulties in communicating with their children. Given the interdependence between the psychosocial well-being of such dyads, interventions that promote parent-child relationships and mutual communication would be beneficial. Arts provide alternative avenues for expression and offer an imaginative and playful environment for discovering new communication strategies. Given the lack of studies on arts-based dyadic interventions, this study aims to examine the effectiveness of dyadic expressive arts-based intervention (EXAT) in improving the psychosocial outcomes of children with ID and their mothers and the mother-child relationships. METHODS AND ANALYSIS: This study will adopt a mixed-methods randomised controlled trial design, wherein 154 dyads of children with ID and their mothers will be randomised into either the dyadic EXAT group or the treatment-as-usual waitlist control group. Quantitative data will be collected at four time points: baseline (T0), postintervention (T1), 3-month postintervention (T2) and 6-month postintervention (T3). Qualitative data will be collected from a subset of 30 mothers in the intervention group at T1 and T3 to document their experiences and perceived changes after the intervention. Mixed-effects models and path analysis will be adopted to analyse the quantitative data, whereas thematic analysis will be applied to the qualitative data. Both sets of data will be triangulated for an integrated view of the effectiveness and mechanism of the intervention. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Human Research Ethics Committee of the University of Hong Kong (Ref. no.: EA200329). Written consent forms will be obtained from all recruited participants (mothers, children with ID and teachers/social workers) before data collection. The study findings will be disseminated in international conferences and peer-reviewed academic journals. TRIAL REGISTRATION NUMBER: NCT05214859.

Searching for a dynamic equilibrium in decision making: the voices of adults with mild intellectual disability and their significant others in Hong Kong.

PURPOSE: The self-determination of people with intellectual disability (ID) is influenced by their interpersonal environment. This study set out to understand better the experience of Hong Kong adults with mild ID in exercising self-determination and to explore the relational and contextual dynamics of how they make decisions in conjunction with parents and paid carers. METHOD: A qualitative study was conducted using focus groups for data collection. In total, 32 participants including people with mild ID, parents and rehabilitation personnel were recruited using purposive sampling. Five focus group discussions took place and the data were analysed using a thematic approach. RESULTS: Our findings highlight a continuum of autonomy in decision making in which participants with mild ID exercise different levels of autonomy in different contexts. In the triangular relationship with parents and rehabilitation personnel, all three parties are simultaneously looking to establish a dynamic equilibrium in decision making. CONCLUSIONS: The study enriches our understanding of the relational and contextual considerations for people with ID in decision making. They may have their own priorities for all the decisions they make, but these involve a dynamic interaction between all three parties.Implications for RehabilitationThe search for dynamic equilibrium in decision-making is a new finding in studies of the self-determination of people with intellectual disability (ID).The findings embed the considerations of the roles of autonomy and relatedness in the self-determination of people with ID at the intrapersonal level.The findings highlight the importance of understanding the relational concerns people with ID have about those they respect while fostering their self-determination.It is also important to address the dynamic interactions among adults with ID, parents and rehabilitation personnel, and the efforts others make in facilitating the self-determination of people with ID.

Study Protocol for a Randomized Controlled Trial Evaluating the Effectiveness of a Group-Based Self-Determination Enhancement Intervention for Adults with Mild Intellectual Disability and Their Caregivers.

Self-determination is regarded as an adult outcome for people with an intellectual disability (ID). However, self-determination curricula are rarely available in Hong Kong. This paper outlines a protocol for an experimental study that examines the effectiveness of a group-based self-determination enhancement intervention for adults with mild ID and their caregivers. A randomized controlled trial with pre-test, post-test and three-month follow-up is proposed. A total of 120 participants will be randomly assigned to three conditions: self-determination enhancement group, self-determination enhancement PLUS group (with caregivers in a parallel group) and leisure activity group as a control condition. Five groups will be organized for each of the three conditions. There will be 10 sessions per group covering the core components of self-determination including self-knowledge, goal setting and attaining goals, self-regulating and adjusting plans. Components for caregivers include understanding how self-determination and REACH responding skills can support their children to exercise self-determination through positive interaction. Self-determination competencies and personal well-being will be measured at three points in time. The proposed study is the first evidence-based local study aimed at examining a culturally tailored self-determination enhancement intervention for people with ID and fills a research gap in existing interventions. If the intervention is demonstrated to be effective, it will provide new knowledge for a group-based intervention and will be used with Chinese-speaking people with ID in different parts of the world. (Trial registration: ClinicalTrials.gov: NCT05167929).

Vicarious Trauma Experienced by Health Care Providers Involved in Traumatic Childbirths: A Meta-Synthesis.

Health care providers are often "second victims" of traumatic childbirth events and should be adequately supported by their organizations to alleviate occupational stress and burnout. Therefore, this review aimed to explore and understand the vicarious traumatic childbirth experiences of health care providers, including obstetricians, midwives, nurses, and students. A systematic review of qualitative studies was conducted. Seven electronic databases, namely, PubMed, CINAHL, Embase, PsycINFO, Cochrane, Scopus, and Web of Science, were searched from each database's inception to May 2020. In total, 1,575 studies were retrieved and screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seventeen studies were included in this review and were meta-summarized and then meta-synthesized using the Sandelowski and Barroso approach. The overarching theme of "Tunneling through the trauma with a hope of finding an end" was derived, and four main themes along with 15 subthemes were identified. The four main themes were (1) "instantaneous response to the trauma," (2) "finding hope in the midst of chaos," (3) "dealing with the aftermath," and (4) "resolution to move on." Communication and teamwork among health care team members were identified as challenges contributed by professional hierarchy and lack of role clarity. Midwives and labor and delivery nurses expressed powerlessness in advocating for women on many occasions, and health care providers often had feelings of guilt and self-blame after adverse events. Health care providers also reported inadequate support from their colleagues and organizations, which influenced their ability to cope with the aftermath of trauma and their decision to stay in the profession.

Traumatic Childbirth Experiences of New Parents: A Meta-Synthesis.

Childbirth is usually a joyous occasion. However, a significant proportion of parents experienced traumatic childbirths and suffered post-traumatic consequences, which needs urgent attention. Therefore, this review aimed to explore and understand the traumatic childbirth experiences of parents. A systematic review of qualitative studies was done. The consolidated evidence was meta-summarized and meta-synthesized based on Sandelowski and Barroso's approach for synthesizing qualitative research. Seven electronic databases, including PubMed, CINAHL, Embase, PsycINFO, Cochrane, Scopus, and Web of Science, were searched from each database's inception to April 2020. Retrieved studies were screened using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and 19 studies were included in this review. All included studies were meta-summarized and meta-synthesized. An overarching theme, "traumatic birth: an evolving voyage," with three main themes, (1) "proceedings to traumatic birth," (2) "internal and external battles," and (3) "muddling through to beating the odds," and 10 subthemes were identified. Overall, parents felt fluctuations of emotions that seemed to be never-ending journeys. They expressed that various factors led to their traumatic birth experiences, especially health care providers' dismissive attitudes. Parents commonly reported feelings of powerlessness and fear for the safety of mothers and infants. Their constant battles to overcome traumatic experiences affected some of their relationships. To deal with the trauma, some mothers displayed avoidance behaviors while others relied on social support. As health care providers play important roles in influencing outcomes of childbirth, they should be mindful of the care provided during labors and childbirths.

Development and validation of the scale on staff valence under ICF-based practice (SSV-ICF).

PURPOSE: The application of the International Classification of Functioning, Disability and Health (ICF) model in the field of disability has become a global trend since 2001. However, very little attention has been paid to the impact of ICF-based practices on the staff members involved in implementing them. This study develops and validates a scale with which to measure staff members' readiness to carry out ICF-based practices, as well as their competency and perceived valences in doing so. METHODS: Staff members holding diverse positions in a non-governmental organisation providing disability services were recruited. An exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA) were conducted to confirm the factorial structure. RESULTS: Data for a total of 338 participants were used in the analysis. A CFA of the data collected from the second sub-sample (n = 169) demonstrated that the goodness-of-fit indices of the five-factor model were acceptable. Those five factors are: perceived knowledge, perceived competence, intrapersonal valence, relational valence and perceived meaning. The whole scale achieved excellent reliability (Cronbach's α = 0.981). CONCLUSIONS: The Scale on Staff Valence under ICF-based practice (SSV-ICF) is a valid and reliable scale to measure disability personnel's perceived valences under a new ICF-based practice.Implications for RehabilitationThe Scale on Staff Valence under ICF-based Practice (SSV-ICF) is a new scale for measuring the impact of ICF-based practices on staff and to developing evidence-based ICF-related staff training programmes.The 27-item five-factor structured SSV-ICF demonstrated acceptable psychometric properties and almost perfect internal consistency.The SSV-ICF offers a promising tool for identifying the merits of ICF-based practices and for developing evidence-based staff interventions among different disciplines.

Self-Determination Competencies, (Dis)Agreement in Decision-Making, and Personal Well-Being of Adults with Mild Intellectual Disabilities in Hong Kong.

BACKGROUND: The self-determination of people with an intellectual disability (ID) in the contexts of adulthood and Chinese culture is under-examined in the field of ID, even though the concept of self-determination has vigorously developed in recent decades. This study examined the relationship between self-determination competencies and the personal well-being of adults with mild ID in Hong Kong, as well as their personal goals and decision-making (dis)agreements with their significant others. METHODS: We interviewed 170 participants using the AIR Self-Determination Scale-Chinese Version (AIR SDS-C) and the Personal Well-Being-Intellectual Disability (Cantonese) (PWI-C), along with a self-constructed questionnaire. RESULTS: When the demographic characteristics were controlled, self-determination competencies correlated positively with personal well-being (r = 0.313, p < 0.001), diverse personal goals were identified, and agreement with significant others was dominant in both daily and major decision-making. CONCLUSIONS: A positive correlation between self-determination and personal well-being was confirmed in a Chinese population with mild ID. These findings expand the understanding of the types of personal goals and agreement patterns of people with mild ID and yield implications for further research and practices.