Stroke caregivers' perception on instant messaging application use for psychological intervention: a qualitative study.

In caring for patients with stroke, the leading cause of death and disability affecting over 80 million people worldwide, caregivers experience substantial psychological and physical burdens and difficulties in help-seeking owing to physical and time-constraints. Social distancing measures imposed during the coronavirus disease 2019 (COVID-19) pandemic further restricted them from using caregiver support services. While the use of telehealth emerged as a global prevailing trend during the COVID-19 pandemic, evidence for utilising instant messaging (IM) applications for psychological intervention is scanty. This study aimed to explore stroke caregivers' perceived potential utility of IM-delivered psychological intervention. Between January and August 2020, 36 adult family stroke caregivers in Hong Kong were recruited to individual telephone semi-structured interviews using purposive sampling. The interviews were audio-recorded, transcribed verbatim and analysed using an interpretive description approach. Three themes of caregivers' perceptions towards IM-delivered psychological intervention emerged: perceived high convenience and ease of use, perceived advantages that overcome existing barriers to services and message delivery tailored to individual needs. Our findings suggested that there is an imminent need among stroke caregivers for personalised psychological interventions and that IM is a potential modality for overcoming existing barriers in delivering accessible support to caregivers in real-time, real-world settings. Our study highlighted caregivers' acceptance and perceived benefits of IM-delivered psychological intervention and provided practical insights into the design of IM-delivered psychological interventions.

Qualitative Study of Chinese Stroke Caregivers' Caregiving Experience During the COVID-19 Pandemic.

BACKGROUND AND PURPOSE: The coronavirus disease 2019 (COVID-19) outbreak has led to disruptions in health care service delivery worldwide, inevitably affecting stroke survivors requiring ongoing rehabilitation and chronic illness management. To date, no published research has been found on stroke caregiving during the COVID-19 pandemic. This study aimed to explore Hong Kong stroke caregivers' caregiving experiences in the midst of this difficult time. METHODS: Individual semistructured interviews were conducted with 25 Chinese adult primary stroke caregivers from May to June 2020 via telephone. Interviews were transcribed verbatim and analyzed using an interpretive description approach and constant comparison strategy. RESULTS: Five themes of the stroke caregiving experience during the COVID-19 pandemic emerged: care service adversities, additional caregiving workload and strain, threatened relationship between caregiver and stroke survivors, threats to caregivers' physical and psychological well-being, and needs for continuing caregiving roles. Our findings suggested that caregivers have worsened physical and psychological well-being because of increases in care burden with simultaneously reduced formal and informal support. The relationship between caregiver and stroke survivor was subsequently affected, placing some survivors at heightened risk of abuse. CONCLUSIONS: Our study provides valuable findings about stroke caregiving experiences and needs during the pandemic. Delivery of psychological support, telemedicine, and household hygiene resources would be useful to mitigate caregivers' psychological distress during the COVID-19 pandemic.

Associations Between COVID-19 Misinformation Exposure and Belief With COVID-19 Knowledge and Preventive Behaviors: Cross-Sectional Online Study.

BACKGROUND: Online misinformation proliferation during the COVID-19 pandemic has become a major public health concern. OBJECTIVE: We aimed to assess the prevalence of COVID-19 misinformation exposure and beliefs, associated factors including psychological distress with misinformation exposure, and the associations between COVID-19 knowledge and number of preventive behaviors. METHODS: A cross-sectional online survey was conducted with 1049 South Korean adults in April 2020. Respondents were asked about receiving COVID-19 misinformation using 12 items identified by the World Health Organization. Logistic regression was used to compute adjusted odds ratios (aORs) for the association of receiving misinformation with sociodemographic characteristics, source of information, COVID-19 misinformation belief, and psychological distress, as well as the associations of COVID-19 misinformation belief with COVID-19 knowledge and the number of COVID-19 preventive behaviors among those who received the misinformation. All data were weighted according to the Korea census data in 2018. RESULTS: Overall, 67.78% (n=711) of respondents reported exposure to at least one COVID-19 misinformation item. Misinformation exposure was associated with younger age, higher education levels, and lower income. Sources of information associated with misinformation exposure were social networking services (aOR 1.67, 95% CI 1.20-2.32) and instant messaging (aOR 1.79, 1.27-2.51). Misinformation exposure was also associated with psychological distress including anxiety (aOR 1.80, 1.24-2.61), depressive (aOR 1.47, 1.09-2.00), and posttraumatic stress disorder symptoms (aOR 1.97, 1.42-2.73), as well as misinformation belief (aOR 7.33, 5.17-10.38). Misinformation belief was associated with poorer COVID-19 knowledge (high: aOR 0.62, 0.45-0.84) and fewer preventive behaviors (≥7 behaviors: aOR 0.54, 0.39-0.74). CONCLUSIONS: COVID-19 misinformation exposure was associated with misinformation belief, while misinformation belief was associated with fewer preventive behaviors. Given the potential of misinformation to undermine global efforts in COVID-19 disease control, up-to-date public health strategies are required to counter the proliferation of misinformation.

Professional socialisation of nursing students in a collectivist culture: a qualitative study.

BACKGROUND: Beyond the formal curriculum of skill attainment, nursing students are able to undergo the professional socialisation process in clinical contexts and establish their identity as healthcare providers. However, the cultural context that affects the socialisation process in clinical placements is less discussed. We aimed to explore nursing students' learning and professional socialisation during clinical placements by considering the socio-cultural contexts in South Korea. METHODS: A grounded theory approach was used for this research. Four rounds of in-depth and intensive interviews were carried out, with the recruitment of 16 nursing students, four nurses and two university lecturers in South Korea (29 interviews in total). A constructivist grounded theory framework was adopted to analyse the interview data. NVivo 11 was used to manage the interview data for analysis. RESULTS: The researchers identified the process of learning and professional socialisation under three core themes: 1) Struggling at the bottom of the hierarchy, 2) Acceptance and conformity, and 3) The need for 'nunchi' (in Korean, it means to study the atmosphere and discover the embedded intention of others' behaviour). The results offered insights into the challenges encountered by nursing students on clinical placements and how students attempt to adapt and conform to the difficulties encountered in clinical education to maximise their learning and for their professional socialisation. The significance of the hidden curriculum was discussed. CONCLUSIONS: While experiential learning is a great opportunity for students to build on their coping skills and professional socialisation, a lack of support can result in failure to manage the hidden curriculum and theoretical and practical skills. Nursing educators therefore need to orientate students to the professional culture prior to beginning clinical placements.

Sex Differences in Disease Profiles, Management, and Outcomes Among People with Atrial Fibrillation After Ischemic Stroke: Aggregated and Individual Participant Data Meta-Analyses.

Objectives: To examine sex differences in disease profiles, management, and survival at 1 and 5 years after ischemic stroke (IS) among people with atrial fibrillation (AF). Methods: We performed a systematic literature search of reports of AF at IS onset according to sex. We undertook an individual participant data meta-analysis (IPDMA) of nine population-based stroke incidence studies conducted in Australasia, Europe, and South America (1993-2014). Poisson regression was used to estimate women:men mortality rate ratios (MRRs). Study-specific MRRs were combined using random effects meta-analysis. Results: In our meta-analysis based on aggregated data from 101 studies, the pooled AF prevalence was 23% (95% confidence interval [CI]: 22%-25%) in women and 17% (15%-18%) in men. Our IPDMA is of 1,862 IS-AF cases, with women (79.2 ± 9.1, years) being older than men (76.5 ± 9.5, years). Crude pooled mortality rate was greater for women than for men (1-year MRR 1.24; 1.01-1.51; 5-year 1.12; 1.03-1.22). However, the sex difference was greatly attenuated after accounting for age, prestroke function, and stroke severity (1-year 1.09; 0.97-1.22; 5-year 0.98; 0.84-1.16). Women were less likely to have anticoagulant prescription at discharge (odds ratio [OR] 0.94; 95% CI: 0.89-0.98) than men when pooling IPDMA and aggregated data. Conclusions: AF was more prevalent after IS among women than among men. Among IS-AF cases, women were less likely to receive anticoagulant agents at discharge; however, greater mortality rate in women was mostly attributable to prestroke factors. Further information needs to be collected in population-based studies to understand the reasons for lower treatment of AF in women.

Nursing students' learning dynamics with clinical information and communication technology: A constructive grounded theory approach.

BACKGROUND: The learning of nursing students can be facilitated through direct and/or indirect experiences of using clinical information and communication technology during clinical placements. However, nursing students experience difficulties in using technology for learning. Despite the difficulties, nursing students' learning dynamics with technology in real clinical contexts is poorly understood. OBJECTIVES: To develop a theoretical model by identifying nursing students' learning dynamics with clinical information and communication technology and the factors influencing the dynamics. DESIGN: A constructivist grounded theory approach was employed in order to develop the theoretical model. SETTINGS: This research was conducted by recruiting nursing students from four universities in Seoul, South Korea. PARTICIPANTS: Sixteen fourth year nursing students were recruited by purposive sampling. METHODS: This research collected qualitative interview data in up to four rounds of interviews using open-ended and semi-structured interview questions. A total of 23 interviews were conducted. The data were transcribed verbatim. All interview data were analysed using three coding methods; initial, focused, and theoretical coding. NVivo 11 was used for data management. RESULTS: This research developed a theoretical model of nursing students' learning dynamics with clinical information and communication technology. The model explains three dynamics that influence nursing students' use of clinical information and communication technology (interpersonal, organisational and emotional dynamics) and the students' responses regarding the dynamics for learning in clinical contexts. CONCLUSIONS: Nursing educators can use the theoretical model to understand how best to support nursing students in navigating their clinical environments to build competency in using clinical information and communication technology.

Sex differences in blood pressure after stroke: a systematic review and meta-analysis.

OBJECTIVES: Evidence about sex differences in blood pressure (BP) at the time of acute stroke presentation is scarce. We aimed to summarize available data on sex differences in BP at the time of acute stroke presentation, including stratification by prior history of hypertension and stroke subtype. METHODS: We performed a systematic literature search across MEDLINE and Embase, from inception to 21 December 2018, to identify all population-based observational studies that reported BP at the time of acute stroke presentation. We extracted data on patient demographics, stroke-type (ischaemic or haemorrhagic), stroke severity, vascular risk factors, and SBP and DBP at the time of stroke presentation. Wherever possible, data were pooled for meta-analysis with weighted mean difference (WMD) and corresponding 95% confidence intervals (CI) using random effects meta-analysis. RESULTS: We included 128 138 stroke patients from 43 studies. Women had higher SBP at presentation than men (WMD, 1.46; 95% CI, 0.65-2.26); this difference was significant in ischaemic stroke (1.49; 0.25-2.72 mmHg), but not in intracerebral haemorrhage (0.19; -4.21 to 4.59 mmHg). Meta regression show that sex differences in SBP were consistent with increasing age, stroke severity, other comorbidities and medication history. CONCLUSION: This systematic review and meta-analysis indicates that women have higher SBP at the time of presentation with acute stroke. These differences are consistent with sex differences in hypertension patterns in older age, and may be explained by the fact that women are more likely to have a premorbid hypertension. This highlights the need for effective sex-specific blood pressure control in patients at high risk for stroke.

How do Korean nursing students build knowledge? A constructivist grounded theory study.

INTRODUCTION: Nursing is a knowledge-intensive profession. Therefore, to cope with the demands of the nursing role, nursing students need to become competent in managing information to build nursing knowledge. However, nursing students' knowledge building process is poorly understood. This research aimed to explore (1) nursing students' dynamics of how they process nursing information for knowledge building and (2) nursing students' learning context in South Korea for their knowledge building. METHODS: A constructivist grounded theory approach was used for this research. Data collection was achieved through four rounds of intensive individual and group interviews with 16 fourth year nursing students in South Korea. The collected data were coded by initial, focused and theoretical coding methods. Constant comparison analysis between data, codes, memos and categories was applied. RESULTS: This research identified knowledge building dynamics consisting of three cognitive processes: connecting with information, deciding to accept information and building knowledge. Five motivational factors, including learners' interest, necessity of information, volition to learn, utility of information and the frequency of information that influence the processes were discovered. Moreover, four knowledge stages of memorising, understanding, synthesising and applying and creating emerged. CONCLUSIONS: This is the first empirical study on knowledge building dynamics in educational environments for healthcare professionals. The findings of this research provide nursing educators with a practical model that can be used to improve nursing curricula in facilitating students' knowledge building processes. Moreover, a deeper understanding of sociocultural influences on nursing education can assist educators to adapt and generalise the findings to their pedagogical contexts, providing a culturally sensitive and relevant approach to nursing education.