Factors Impacting on Patient-Centered Communication Skills and Their Opportunities to Be Involved in Decision-making From the Perspective of Patients With Cancer, Informal Caregivers, and/or Healthcare Professionals: A Systematic Review

BACKGROUND

Active participation of cancer patients and their caregivers in decision-making, along with high-quality communication, is crucial in patient-centered cancer management. Although numerous factors affecting patients' communication and decision-making involvement have been identified, it is still unclear which ones are the most prevalent and critical.

OBJECTIVE

To identify factors that contribute to high-quality patient-centered communication and decision-making participation from the perspectives of cancer patients, informal caregivers, and/or healthcare professionals.

METHODS

A systematic review was conducted, using 9 databases to retrieve primary research articles published from 2010 to February 17, 2023, updated on December 13, 2023. Methodological quality was assessed using the Mixed Methods Appraisal Tool (version 18). The socioecological model of communication was utilized as analytical framework for summarizing the results.

RESULTS

Fifty-two studies were included. The most frequently reported factors were predominantly articulated at the individual, interpersonal, and societal levels. Although the patients' lack of knowledge and limited language proficiency were the frequent patient-level barriers, the perceived lack of knowledge and lack of training of professionals were the crucial and current professional-level barriers, as reported in studies published in 2016 onward. To circumvent these factors, it is critical to enhance professionals' knowledge, communication skills, and patient relationships.

CONCLUSIONS

Recognizing barriers and facilitators could help in the development of strategies to overcome these barriers and enhance patient participation in clinical communication.

IMPLICATION FOR PRACTICE

The findings could guide the development of programs to enhance patient-professional communication skills. Further cross-cultural studies are needed to understand culture's impact on communication effectiveness and decision-making participation.

"Am I different?" Coping and mental health among teenagers with adolescent idiopathic scoliosis: A qualitative study

PURPOSE

To explore the stressors, coping strategies, and mental health of adolescents diagnosed with idiopathic scoliosis.

DESIGN AND METHODS

This study adopted a descriptive qualitative study design. Twelve participants were recruited from a local non-government organization in Hong Kong. Semi-structured interviews were conducted to collect data. Verbatim transcriptions of interviews were coded and analyzed using thematic analysis. The guideline of the Consolidated Criteria for Reporting Qualitative Studies was used to report the findings.

RESULTS

Five themes were identified: "Disease- and treatment-induced changes and stressors", "Cognitive assessment and personal perceptions", "Behavioral and emotional coping strategies", "Social interactions and social support", and "Deteriorating or thriving in psychological development and well-being".

CONCLUSIONS

Adolescents with idiopathic scoliosis experienced a variety of physical and psychological stressors. It is imperative to prioritize efforts to promote adaptive coping and activate social support systems to achieve better outcomes in this population.

PRACTICAL IMPLICATIONS

Healthcare providers should aim to comprehend the experiences of adolescents with idiopathic scoliosis for improved clinical interactions and holistic care. Future research should prioritize coping-based interventions, to enhance adaptive coping behaviors and the well-being of this population.

Providing compassionate care via eHealth

BACKGROUND

eHealth was widely used during the COVID-19 pandemic. Much attention was given to the technical aspects of eHealth, such as infrastructure and cost, while the soft skill of compassion remained underexplored. The wide belief in compassionate care is more compatible with in-person interactions but difficult to deliver via e-platforms where personal and environmental clues were lacking urges studying this topic.

PURPOSE

to explore the experience of delivering compassionate care via an eHealth platform among healthcare professionals working to contain the COVID-19 pandemic.

METHODS

A qualitative study design with an interpretative phenomenological analysis approach was used. Twenty healthcare professionals (fifteen nurses and five physicians) who provided care using technology platforms, such as telephone hotlines, mobile apps, and social media, were interviewed individually.

ETHICAL CONSIDERATIONS

Permission to conduct the study was obtained from the Institutional Review Board.

RESULTS

Participants stated that "eHealth enabled compassionate care during the pandemic" by ensuring patient care availability and accessibility. They shared experiences of "communicating compassionate care via eHealth" with suggestions of addressing patients' needs with empathy, adopting a structured protocol to guide eHealth communication, and using more advanced visual-media methods to promote human-to-human interaction. They recommended "setting realistic mutual expectations" considering the limitations of eHealth in handling complex health situations and staffing shortages. Participants considered "low eHealth literacy hinders compassion." Additionally, they recommended the need for "institutional/system-level support to foster compassionate care."

CONCLUSION

Participants recognized the importance of integrating compassion into eHealth services. Promotion of compassionate care requires standardization of eHealth services with institutional and system-level support. This also includes preparing adequate staffing who can communicate compassionate care via eHealth, set realistic expectation, and adjust communication to eHealth literacy level while meeting the needs of their patients.

Students' learning in theory-based simulation: A socio-material study

BACKGROUND

Simulation-based education (SBE) is crucial to prepare nursing students prior to their clinical learning experience. Theory-based simulation learning is increasingly important for analysing how students learn. This study describes and analyses how nursing students learn through simulation in the context of palliative care communication under a socio-material approach and explores the transfer of their knowledge and skills from simulation to clinical practice.

METHODS

Twenty-seven final-year nursing students in six groups participated in two simulated scenarios, followed by a debriefing and post-clinical focus groups to capture their reflections and learning. Fourteen of them joined the post-clinical focus groups after completing their clinical placements. Video recordings of the simulation, and the audio recordings from the debriefing, and post-clinical focus groups were transcribed and coded based on the human and non-human elements that were observed. These were triangulated with data collected through team participant observations, an analysis of the existing syllabi and curriculum, and a participant mapping exercise after the simulation. These various data sources illustrate how student learning and reflections took place.

RESULTS

The three themes of student learning derived from the results and analysis were (1) students' expanded learning of health care communication through a socio-material approach in the context of palliative care; 2) students' discovery of the diverse and complex relations and interactions between humans and materials and (3) students' new perspectives on health care communication and the transfer of knowledge and skills through a socio-material approach in clinical practice.

CONCLUSIONS

This study highlights how SBE can be further expanded using a socio-material approach to prepare students to learn beyond standardised and cognitively driven approaches and procedures. Student learning demonstrates that SBE may develop beyond high fidelity and standardisation to leave room for emergent learning and increased awareness in learning for students and teachers to optimise learning outcomes and competence.

Social engagement and depressive symptoms mediate the relationship between age-related hearing loss and cognitive status

BACKGROUND AND OBJECTIVES

Age-related hearing loss (ARHL) is the third leading cause of years lived with disability. Connections among ARHL, depressive symptoms, social engagement and cognitive status are increasingly reported but the underlying mechanisms leading to these relationships are largely unknown. Exploring these mechanisms is a worthy goal, especially in older adults. This study aimed to examine the mediating effect of social engagement and depressive symptoms on the relationship between ARHL and cognitive status.

METHODS

Structural equation modeling (SEM) with path analysis were performed with data from a cross-sectional study conducted in 11 community centers in 2021, which assessed older adults' intrinsic and sensory capacities using the WHO ICOPE framework. Demographic information, health profile, a binary measure of hearing capacity, depressive symptoms, social engagement, and cognitive status of participants were gathered.

RESULTS

A total of 304 participants were included. ARHL was positively associated with depressive symptoms (β = 0.18, p = 0.009) and negatively related to social engagement (β = -0.13, p = 0.026). Social engagement was positively associated with cognitive status (β = 0.17, p = 0.005) and negatively associated with depressive symptoms (β = -0.23, p < 0.001). Greater depressive symptoms were negatively associated with the participants' cognition (β = -0.13, p = 0.009). Both social engagement (β = -0.02, p = 0.029) and depressive symptoms (β = -0.02, p = 0.032) mediated the negative associations between ARHL and cognitive status.

CONCLUSIONS

Addressing hearing loss, depressive symptoms, and enhancing social engagement should be investigated as a potential means of minimizing cognitive decline. Well-designed studies are needed to comprehensively inform the clinical practice development, particularly large prospective studies that will facilitate further elucidate possible causal mechanisms behind these observed associations.

A new pedagogical approach to enhance palliative care and communication learning: A mixed method study

BACKGROUND

As palliative care increases in importance due to chronic illnesses in ageing populations, there is a need to develop primary palliative care, including patient-centred communication for nursing graduates. Simulation-based education was adopted to develop students clinical skills and communication in a safer and more controlled environment prior to their clinical practice. However curricula in palliative care and communication remain limited. The current study was to develop a simulation-based programme with clinical modelling prior to the simulation experience. Authentic case scenarios were also constructed through collaboration between the researchers and clinical colleagues in palliative care.

OBJECTIVES

To explore the effects of palliative care simulation-based experience on nursing students' palliative care and caring communication.

DESIGN

Mixed-methods with pre- and post-questionnaires and focus groups after the simulation-based experience.

SETTINGS

A nursing school at a university in Hong Kong.

PARTICIPANTS

Twenty-nine senior-year undergraduate nursing students.

METHODS

Students shadowed senior nurses in a palliative clinical setting, then engaged in simulation learning with two palliative scenarios in a laboratory environment. Focus group debriefings were conducted after the simulations.

RESULTS

Quantitatively, findings from the pre- and post-questionnaires revealed an improvement in the students' knowledge (t = -2.83, p = 0.02), attitudes (t = -4.21, p = 0.00), and efficacy (t = -2.07, p = 0.05) in palliative care after participating in this study. Results from the focus groups also indicated an enhancement in the students' learning of palliative care and communication.

CONCLUSION

This collaborative design of palliative scenarios and clinical shallowing with senior nurses in a palliative care setting followed by simulation enhanced the students' confidence, knowledge, skills, and attitudes in palliative care and communication.

Motivations and deterrents of blood donation among blood donors during the COVID-19 pandemic in Hong Kong

BACKGROUND

The COVID-19 pandemic has resulted in a reduction in blood donations and limited blood supply in many countries. The theory of planned behaviour has been widely used in past studies to understand the factors influencing blood donation. However, this theory limits analyses to the individual level. Furthermore, most research on the determinants of blood donation during the COVID-19 pandemic is quantitative in nature, with relevant qualitative research being rare.

OBJECTIVES

To investigate the motivators and demotivators for donating blood among current blood donors during COVID-19 pandemic.

DESIGN

Forty in-depth, individual semistructured interviews were conducted with current blood donors from December 2020 to March 2021 in Hong Kong. Thematic content analysis was adopted in the data analysis.

RESULTS

The majority of the participants (n = 37) were demotivated from donating blood during the COVID-19 pandemic. Factors at the perceptual, social and institutional levels interacted to cause this reluctance. Only three participants felt more motivated to donate blood. The data revealed that sociocultural forces and government pandemic prevention policies strongly affected the participants' motivations to donate blood during the pandemic.

CONCLUSION

This study presents a macro understanding of blood donation behaviour by investigating the institutional, social and perceptual factors influencing current blood donors during the COVID-19 pandemic. This adds a more comprehensive understanding of blood donation where the theory of planned behaviour is widely used in past studies.

PUBLIC CONTRIBUTION

The participants shared their experiences in the interviews. Their experiences provide hints for explaining the decreasing blood donation during the pandemic times.

Advancing pedagogy of undergraduate nursing students' cultural awareness through internationalization webinars: A qualitative study

In today's world, nurses increasingly care for individuals from different cultures. Because culturally sensitive care can improve patient satisfaction in care, nurses need to develop cultural competence in their practice. To develop cultural competence, one option is to build cultural awareness by exposing students to nursing practices in other cultures through online internationalization-at-home activities. However, little is known about the process of cultural awareness development through internationalization activities. Therefore, this qualitative study aimed to identify the development process of cultural awareness in nursing students, who participated in a series of internationalization-at-home activities. A total of 31 nursing students from Australia, Hong Kong, and Sweden volunteered to participate in student-led learning groups. Groups consisted of two to four students from each university, who engaged in four weekly webinars and online reflections about nursing practice based on a case scenario. Data were collected from participants' ongoing reflective journal entries, and after the webinars ended, from three focus groups. A semi-structured interview guide was used to understand how the internationalization-at-home activities impacted their cultural awareness and knowledge of nursing. Data were analyzed using interpretive description. Following four levels of thematic analysis (i.e., comprehension, synthesis, theorizing, reconceptualization), we identified four themes in the development of cultural awareness: 1) nurturing reciprocity through comparisons of nursing culture; 2) discovering common ethical values of the nursing profession; 3) developing cultural awareness in nursing ideology and practice; and 4) transforming understanding of nursing in the context of their healthcare systems. By the end of the internationalization activities, students appeared to have developed relational skills to facilitate their own inner dialogue about ethical ideals of "self" and "other" in the context of being part of the global nursing community. Future research should develop and assess teaching strategies that can further facilitate the four themes in cultural awareness development.

Knowledge level and motivation of Hong Kong young adults towards blood donation: a cross-sectional survey

OBJECTIVES

This study aimed to (1) determine the knowledge level of young adults towards blood donation, and (2) to understand their donor identity and the meanings of blood donation to them.

DESIGN

A questionnaire-based cross-sectional survey.

SETTING AND PARTICIPANTS

Undergraduate students of a university in Hong Kong recruited by convenience sampling, at public facilities in campus such as student canteens and the Campus Blood Donor Centre of the university.

OUTCOME MEASURES

The questionnaire which consisted of three parts was used for data collection. Part 1 collected sociodemographic information and items associated with blood donation; part 2 related to knowledge on blood donation and part 3 focused on blood donor identity. Univariate and multivariate logistic regression analyses were conducted to determine the OR and identify the predictors for blood donation.

RESULTS

Among the 542 respondents, 274 were non-blood donors and 268 were blood donors. Blood donors generally have a better knowledge towards blood donation than non-blood donors. The results of univariate analyses indicated that being a female (OR=1.99, p<0.001), aged 22 years or above (OR=234, p<0.001), studying at year 4 or 5 (OR=2.12, p=0.003), studying health-related programmes (OR=1.96, p<0.001), being registered as an organ donor (OR=6.59, p<0.001), had prior experience of receiving blood (OR=7.60, p<0.001) or prior experience of being refused for blood donation (OR=5.14, p<0.001) were significantly associated with being a blood donor. Having prior experience of receiving blood was the strongest predictor for being a blood donor, followed by being registered as an organ donor, after controlling for all other factors in the logistic regression model.

CONCLUSIONS

The findings are consistent with self-determination theory, which hypothesises that people are more likely to abide with blood donation behaviours that are internally rather than externally motivated.

Large optical depth frequency modulation spectroscopy

Band-resolved frequency modulation spectroscopy is a common method to measure weak signals of radiative ensembles. When the optical depth of the medium is large, the signal drops exponentially and the technique becomes ineffective. In this situation, we show that a signal can be recovered when a larger modulation index is applied. Noticeably, this signal can be dominated by the natural linewidth of the resonance, regardless of the presence of inhomogeneous line broadening. We implement this technique on a cesium vapor, and then explore its main spectroscopic features. This work opens the road towards measurement of cooperative emission effects in bulk atomic ensemble.

Psychological outcomes of life story work for community-dwelling seniors: A randomised controlled trial

BACKGROUND AND OBJECTIVE

Life story work has a long tradition in the caring sciences and has been found to serve a number of psychological functions. The effects of life story work on the psychological well-being of community-dwelling older people were examined in this study.

DESIGN AND METHODS

For this randomised controlled trial, 244 community-dwelling participants in 17 social centres run by a non-governmental organisation were recruited. The participants were randomly allocated to intervention (n = 124) and control (n = 120) groups. Each member of the intervention group worked with a volunteer to prepare his/her life storybook, while those in the control group participated in a social program. Data were collected at baseline, immediately postintervention, and at three and six months postintervention. The outcomes included measures of life satisfaction, self-esteem, general mental well-being and depressive symptoms.

RESULTS

No significant interaction effect was observed between the groups over time, except for an improvement in the general mental well-being of the control group at three months postintervention.

CONCLUSIONS

A comparison of the findings in the literature showed that some positive results were reported for LSW studies conducted in nursing homes, whereas in community studies, the results were not always positive. Life story work for seniors in the community did not have the same positive outcomes as previously observed among nursing home residents. It is possible that the intervention had a greater effect on more deprived individuals. Community-dwelling seniors can be encouraged to participate in social activities, which apparently can lead to similar outcomes.

IMPLICATIONS FOR PRACTICE

Clinicians should not assume that similar interventions can have similar effects when delivered in a different setting. Community-dwelling seniors can be encouraged to participate in social activities, which can also promote psychological wellbeing similar to to the effects of activities related to life story work.

Pre- and post evaluations of the effects of the Connect, Ask, Respond and Empathise (CARE) protocol on nursing handover: A case study of a bilingual hospital in Hong Kong

AIMS AND OBJECTIVES

To evaluate (a) the perceived effects of the training provided to nurses under a standardised Connect, Ask, Respond and Empathise (CARE) protocol; (b) the ability to enhance the effectiveness of the ISBAR checklist; (c) any increase in nurses' spoken interactions and/or improved comprehension of the patient conditions upon the transfer of responsibility.

BACKGROUND

Nursing handover is a pivotal act of communication with effects on both patient safety and risk management. Previous studies of critical incidents have highlighted ineffective communication, including a lack of interaction and incomplete and unstructured handovers, as a major contributor to patient harm.

DESIGN

A pre- and post evaluation study involving a questionnaire survey before and after the 3-hours training.

METHODS

Forty-nine randomly selected bilingual nurses with no previous professional development experience in handover communication were trained according to the CARE protocol, and their perceptions of nursing handovers were assessed before and after training using questionnaire. The STROBE checklist is used (See File S1).

RESULTS

Training of the CARE protocol improved key areas of the handover process. All participating nurses exhibited significant improvements in their perceptions of effective handover from before to after training. Particularly, improvements were observed in the interactive frequency and quality and completeness of the presented patient information per handover.

CONCLUSIONS

The nurses reported a deeper understanding of their perceptions of handover after a patient-centred intervention, a better quality of interactions (e.g., querying and checking by incoming nurses), a greater focus when managing handovers and a more complete and comprehensive transfer of information between nurses.

RELEVANCE TO CLINICAL PRACTICE

CARE protocol-based training yielded significant improvements in nursing handover practice.

An ethnographic inquiry into the psychosocial care for oncology patients in the community: Healing from the 4Es

PURPOSE

The aim of this study was to explore how the provision of community care in a cancer support center can help cancer patients and survivors cope with the demands of cancer and its treatment.

METHODS

A focused ethnographic approach was adopted. Data were collected through participant observations and focus groups with various stakeholders. The data from the focus groups were transcribed verbatim and analyzed using constant comparative analysis.

RESULTS

Four main themes emerged: 1. Enabling users to achieve mental well-being on their coping journey, 2. Empowering users to deal with their uncertainties, 3. Enhancing meaningful nurturing interactions through the design of spaces and colors in the Centre, and 4. Evolving through seeing more value in themselves. These 4Es occurred through intimate human interaction in the Centre, which resulted in psychological renewal and the rebuilding of a sense of self among the users.

CONCLUSIONS

This study provides insights on the provision of community support services for cancer patients/users, specifically on how to help them to regain control over their lives, not only through providing services for psychosocial renewal by engaging in intimate human interactions, but also by contributing to an understanding of the effect of the physical environment and space on healing. The results also reveal a virtuous circle of the 4Es as the synergies from the services, activities and the environment in the Centre, which provide a harmonious context for the users in coping with their cancer journey.

Patients' perceptions of their experiences with nurse-patient communication in oncology settings: A focused ethnographic study

Background

The nursing shortage and its impact on patient care are well-documented global issues. Patients living with cancer as a chronic illness have many psychosocial problems and often lack adequate support as a result of ineffective nurse-patient communication. A review of the literature on factors influencing the delivery of psychosocial care to cancer patients indicates that the delivery of psychosocial care in routine cancer nursing within a biomedical healthcare system has not been widely explored.

Objective

To explore patients’ perceptions of their experiences with nurse-patient communication in an oncological clinical environment.

Method

A focused ethnographic study was undertaken in two oncology wards of a hospital in Hong Kong. Data were collected through observations of the ward environment, the activities and instances of nurse-patient communication, semi-structured interviews with patients, and a review of nursing documents.

Results

Two main themes were identified: 1. Nurses’ workload and the environment and 2. Nurse-patient partnership and role expectations. Within these two themes were related subthemes on: Sympathy for the busy nurses; Prioritizing calls to the nurses; Partnership through relationship; Nurses’ role in psychosocial care; and Reduction of psychosocial concerns through physical care.

Conclusions

Many cancer patients do not expect to receive psychosocial care in the form of emotional talks or counseling from busy nurses, but appreciate the attention paid by nurses to their physiological and physical needs. Nurse-patient partnerships in cancer care may reduce the potential workload of nurses. The psychosocial needs of cancer patients could be optimized by providing good physical care through effective communication within a time-constrained oncology setting.

Nursing as universal and recognisable: Nursing students'perceptions of learning outcomes from intercultural peer learning webinars: A qualitative study

Nursing students need to be prepared for the increasingly culturally diverse health care. Therefore, providing students with international perspectives remains the mission of higher education. However, given the logistic and financial constraints, not all students will be able to travel overseas for their international experiences. A feasible alternative to study abroad is internationalisation-at-home where intercultural dimensions are incorporated into curriculum, without students leaving their home universities. This paper presents findings from a collaboration between nursing programmes in Sweden and Hong Kong. The aim of the project was to explore how undergraduate nursing students' perceived achieved learning outcomes after participating in a web-based intercultural peer-learning intervention.

Speak-up culture in an intensive care unit in Hong Kong: a cross-sectional survey exploring the communication openness perceptions of Chinese doctors and nurses

OBJECTIVES

Despite growing recognition of the importance of speaking up to protect patient safety in critical care, little research has been performed in this area in an intensive care unit (ICU) context. This study explored the communication openness perceptions of Chinese doctors and nurses and identified their perceptions of issues in ICU communication, their reasons for speaking up and the possible factors and strategies involved in promoting the practice of speaking up.

DESIGN

A mixed-methods design with quantitative and sequential qualitative components was used.

SETTING AND PARTICIPANTS

Eighty ICU staff members from a large public hospital in Hong Kong completed a questionnaire regarding their perceptions of communication openness. Ten clinicians whose survey responses indicated support for open communication were then interviewed about their speak-up practices.

RESULTS

The participating ICU staff members had similar perceptions of their openness to communication. However, the doctors responded more positively than the nurses to many aspects of communication openness. The two groups also had different perceptions of speaking up. The interviewed ICU staff members who indicated a high level of communication openness reported that their primary reasons for speaking up were to seek and clarify information, which was achieved by asking questions. Other factors perceived to influence the motivation to speak up included seniority, relationships and familiarity with patient cases.

CONCLUSIONS

Creating an atmosphere of safety and equality in which team members feel confident in expressing their personal views without fear of reprisal or embarrassment is necessary to encourage ICU staff members, regardless of their position, to speak up. Because harmony and saving face is valued in Chinese culture, training nurses and doctors to speak up by focusing on human factors and values rather than simply addressing conflict management is desirable in this context.

Complexities of emergency communication: clinicians' perceptions of communication challenges in a trilingual emergency department

AIMS AND OBJECTIVES

To understand the challenges that clinicians face in communicating with patients and other clinicians within a Hong Kong trilingual emergency department.

BACKGROUND

Effective communication has long been recognised as fundamental to the delivery of quality health care, especially in high-risk and time-constrained environments such as emergency departments. The issue of effective communication is particularly relevant in Hong Kong emergency departments, due to the high volume of patients and the linguistic complexity of this healthcare context. In Hong Kong, emergency department clinicians are native speakers of Chinese, but have received their medical training in English. The clinicians read and record virtually all of their medical documentation in English, yet they communicate verbally with patients in Cantonese and Mandarin. In addition, communication between clinicians occurs in spoken Cantonese, mixed with medical English. Thus, medical information is translated numerous times within one patient journey. This complex linguistic environment creates the potential for miscommunication.

DESIGN

A mixed-methods design consisting of a quantitative survey with a sequential qualitative interview.

METHODS

Data were collected in a survey from a purposive sample of 58 clinicians and analysed through descriptive statistics. Eighteen of the clinicians were then invited to take part in semi-structured interviews, the data from which were then subjected to a manifest content analysis.

RESULTS

Nearly half of the clinicians surveyed believed that medical information may be omitted or altered through repeated translation in a trilingual emergency department. Eighty-three per cent of clinicians stated that there are communication problems at triage. Over 40% said that they have difficulties in documenting medical information. Around 50% believed that long work hours reduced their ability to communicate effectively with patients. In addition, 34% admitted that they rarely or never listen to patients during a consultation.

CONCLUSION

The findings reveal that the quality of communication in this Hong Kong emergency department is compromised by specific factors inherent in the linguistic complexity of Hong Kong emergency departments. These factors include the constant translation of medical information, inadequate documentation of medical information and significant professional and cultural pressures. Each of these issues increases the likelihood that healthcare communication will be difficult, incomplete or incorrect. This research provides empirical evidence for, and justifies the development of, an effective framework to enable clinicians to overcome communication challenges.

RELEVANCE TO CLINICAL PRACTICE

The findings of this study may shed light on the unique conditions faced by clinicians, particularly in relation to communication, in the complex trilingual healthcare context of an emergency department similar to those in Hong Kong, and provide potential policy solutions for barriers to improve communication in such settings.

Who are the healthy active seniors? A cluster analysis

BACKGROUND

This paper reports a cluster analysis of a sample recruited from a randomized controlled trial that explored the effect of using a life story work approach to improve the psychological outcomes of older people in the community.

METHODS

238 subjects from community centers were included in this analysis. After statistical testing, 169 seniors were assigned to the active ageing (AG) cluster and 69 to the inactive ageing (IG) cluster.

RESULTS

Those in the AG were younger and healthier, with fewer chronic diseases and fewer depressive symptoms than those in the IG. They were more satisfied with their lives, and had higher self-esteem. They met with their family members more frequently, they engaged in more leisure activities and were more likely to have the ability to move freely.

CONCLUSION

In summary, active ageing was observed in people with better health and functional performance. Our results echoed the limited findings reported in the literature.

Interprofessional competence: a qualitative exploration of social work and nursing students' experience

Being a professional in today's health care system carries with it an expectation of becoming interprofessional. This study was designed to explore the perceived development of the participants' interprofessional competence through interprofessional seminars and collaborative community practice. Data were collected from social work and nursing undergraduates through two interprofessional seminar discussions, followed by focus group interviews after the completion of 2 weeks of practice experience. Study findings included: (a) role clarification and enhancement, (b) evolving role emphasis, (c) understanding the importance of and various communications in teamwork, and (d) being more responsive to the meaning of teamwork and the understanding of collaborative interdependence. Through interprofessional collaborative practice, students developed an insight into teamwork, where they witnessed the merits of collaboration and gained an understanding of each other's lack of holistic approach. In addition, not only the particular practice settings but also the role variations involved revealed various dimensions of interprofessional learning.

The relationships between communication, care and time are intertwined: a narrative inquiry exploring the impact of time on registered nurses' work

AIM

To report a qualitative study which explores registered nurses' views on the issue of time in the workplace.

BACKGROUND

There is a worldwide shortage of healthcare workers, subsequently time as a healthcare resource is both finite and scarce. As a result, increased attention is being paid to the restructuring of nursing work. However, the experience of time passing is a subjective one and there exists little research which, over a prolonged period of time, describes nurses' experiences of working in time-pressurized environments.

DESIGN

A narrative inquiry.

METHOD

Five registered nurses were individually interviewed a total of three times over a period of 12 months, amounting to a total of 15 interviews and 30 hours of data. Data were collected and analysed following a narrative enquiry approach during the period 2008-2010.

FINDINGS

Participants describe how attempts to work more effectively sometimes resulted in unintended negative consequences for patient care and how time pressure encourages collegiality amongst nurses. Furthermore, the registered nurses' account of how they opportunistically create time for communication with patients compels us to re-evaluate the nature of communication during procedural nursing care.

CONCLUSION

Increasingly nursing work is translated into quantitative data or metrics. This is an inescapable development which seeks to enhance understanding of nursing work. However, qualitative research may also offer a useful approach which captures the otherwise hidden, subjective experiences associated with time and work. Such data can exist alongside nursing metrics, and together these can build a better and more nuanced consideration of nursing practice.

A triadic interplay between academics, practitioners and students in the nursing theory and practice dialectic

AIM

  This article is a report of a descriptive study of the effectiveness of classroom teaching by clinical nurse specialists on students' transfer of theory into practice.

BACKGROUND

  Ongoing concern about a theory-practice merger in nursing has led to collaborative initiatives between academics and practitioners globally. There are different forms of collaborative efforts, but information on their evaluation is scarce and inconclusive. Integration of theory and practice is important for an outcome-based approach, which emphasizes students' clinical competence as the measure of success. The limited nursing discussion on theory and practice collaboration in education was our impetus for the study.

METHODS

  Between 2007 and 2008, focus group interviews were held, first with 75 and then with 35 from the same group of first-year students, regarding their learning experience from the lectures of the two clinical nurse specialists in diabetes and colostomy care, respectively, prior to and after their clinical placements. Six of their clinical instructors and the two clinical nurse specialists were also interviewed. The audiotaped interviews were transcribed verbatim and analysed using content analysis.

FINDINGS

  Three themes were identified: impact of students' vicarious learning from clinical nurse specialists' stories of experience; improving the collaboration between clinical nurse specialists and subject lecturers for junior students' learning experience; continuity in the clinical integration of theory-practice as dialectic through an interplay between academics, practitioners and students.

CONCLUSION

  The theory and practice issue is best addressed as a triadic paradigm in a community of practice with the collaboration among academics, practitioners and students.

Effects of music on depression and sleep quality in elderly people: A randomised controlled trial

OBJECTIVES

To determine the effect of music on sleep quality in elderly people. In addition, we aimed to examine if there were effects on vital signs and depression levels.

BACKGROUND

Sleep disturbances and depression are common in older people, and their impacts on this group, along with its conventional treatment, merit our attention as our population ages. Conventional pharmacological methods might result dependence and impairment in psychomotor and cognitive functioning. Listening to music, which is a non-pharmacological method, might reduce depression and promote sleep quality.

DESIGN

A randomised controlled study was conducted during the period December 2006 to January 2007.

SETTING

At participants' homes in Hong Kong.

PARTICIPANTS

In total, 42 elderly people (21 using music and 21 controls) completed the study after being recruited in one community services centre.

INTERVENTION

Participants listened to their choice of music for 30min per week, for 4 weeks.

MAIN OUTCOME MEASURES

Blood pressure, heart rate, depression levels and sleep quality variables were collected once a week for 4 weeks.

RESULTS

In the experimental group, there were statistically significant reductions in geriatric depression scores and sleep quality at week 4. In the control group, there were no statistically significant reductions in depression and improvement of sleep quality over the 4 weeks. However, for all the outcome measures, no significant differences were found between groups over the 4 weeks.

CONCLUSIONS

The findings contribute to knowledge about the effectiveness of soft slow music used as an intervention to improve depression and sleep quality in elderly people. Whilst there were no statistical differences between groups, there was some indication that music yielder higher improvement on some of the parameters, which are worthy of further investigation in larger trials.

Interprofessional education: the interface of nursing and social work

AIMS

To examine the influence of interdisciplinary seminars on undergraduate nursing and social work students' perceptions of their learning.

BACKGROUND

Collaboration is considered to be important for health professionals in working towards good patient care, and interdisciplinary education is seen as one way of addressing this need for greater collaboration and team work. Today's health professionals are dealing with an increasing number of older and chronically ill patients. The biopsychosocial dimensions inherent in such chronic illnesses bring about a closer working relationship between the nursing and social work professions to foster good patient care. No local research in Hong Kong, however, has looked specifically at how these two professions can develop their collaborative skills and qualities through interdisciplinary education.

DESIGN

Mixed methods design.

METHOD

Data from questionnaires, videotape recordings of the sessions and follow-up phone interviews were used for quantitative and qualitative analyses.

RESULTS

The findings revealed three themes: an increased awareness of each other's professional values and personal judgement, a recognition of each other's disciplinary knowledge emphases and more, and an appreciation for, and learning about each other's roles for future collaboration.

CONCLUSIONS

Whilst, it is usual to identify health professionals as non-judgemental, it is also important to recognise the existence of their personal and professional values and beliefs that shape their decision-making. Equally beneficial for students is their reported understanding of the other discipline's emphasis on the physical or social aspects of care, and the interrelationships and complementary values that lead to students' appreciation of each other's roles and the possibility for their future collaboration in the holistic care of patients.

RELEVANCE TO CLINICAL PRACTICE

The sharing of each other's knowledge and their appreciation of the corresponding roles enhanced students' decision-making capacity and the extension of the holistic approach beyond one profession, which is essential for good patient care.

Reflecting on the essence of our problem-based learning discussions: the importance of faculty development and our continuous quest for applications of problem-based learning

While problem-based learning (PBL) is a teaching strategy to promote critical thinking, creativity and self-directedness in learning is very important. It is the meaning of the learning, with a contextual understanding, that marks the significance of this approach in our healthcare education. At the 2008 Kaohsiung Medical University International Conference and Workshop on PBL, the scholarly discourse on sharing empirical findings and practical experience with various aspects of PBL brought forth the importance of the teachers' continued learning about the meaning, the dynamics of the process, and the pragmatic details of PBL. This quest for a continuous learning and understanding about PBL parallels our search to extend the classroom PBL into students' clinical experience. The development of clinical teachers in the understanding of PBL was explored as part of their experiential learning in clinical teaching after their PBL workshops. While the clinical teachers who participated in the project appreciated the merits of clinical PBL, the complex balance between patient service and student teaching--in an unpredictable clinical setting--has led to the use of a simulated clinical environment with simulated patients. We also piloted PBL for interprofessional education of undergraduate students of nursing and social work. The ways we can adopt PBL in various settings with different intents will help prepare our healthcare graduates in meeting the challenges of our ever more complex healthcare systems, and the demands of holistic patient care.

Effect of music on depression levels and physiological responses in community-based older adults

Many people over the age of 65 do not regard depression as a treatable mental disorder and find it difficult to express themselves verbally. Listening to music can facilitate the non-verbal expression of emotion and allow people's inner feelings to be expressed without being threatened. The aim of this study was to determine the effect of music on depression levels in elderly people. A randomized controlled study was conducted with 47 elderly people (23 using music and 24 controls) who completed the study after being recruited in Hong Kong. Blood pressure, heart rate (HR), respiratory rate (RR), and depression level variables were collected. In the music group, there were statistically-significant decreases in depression scores (P < 0.001) and blood pressure (P = 0.001), HR (P < 0.001), and RR (P < 0.001) after 1 month. The implication is that nurses may utilize music as an effective nursing intervention for patients with depressive symptoms in the community setting.

Evaluating Narrative Pedagogy in Nursing Education in Hong Kong

This column provides a report of the effectiveness of a nursing program in Hong Kong that used narrative pedagogy. The comments of 12 recent graduates from a postgraduate baccalaureate nursing degree program who were willing to participate in a series of focus group meetings were included. The findings show that nursing education based on a human science paradigm helped form the professional nursing identity of the graduates, as they continued retelling, reliving, and reflecting on their caring narratives. A pragmatic approach to theory-enhanced practice is helpful for nursing graduates to sustain their caring practice.

Learning from the severe acute respiratory syndrome (SARS) epidemic

AIMS AND OBJECTIVES

This study uses two models of nursing practice, conventional and modular design, to compare nursing activities, hand hygiene, time efficiency and nurse-patient satisfaction in medical and surgical wards. Background. Learning from the SARS epidemic pointed to the importance of quality nursing practice considerations that minimize cross-transmission of infection while maximizing patient-focused care. Hence, a modular nursing model was adopted.

DESIGN AND METHOD

This study comprised pre- and postintervention phases. Data collection tools to evaluate modular nursing practice included a work sampling observation checklist, focused group interviews with nurses, questionnaires addressing nurses' perceived competence and caring attributes, a patient satisfaction questionnaire, and a hand hygiene audit. A series of education sessions were conducted between the two phases. Quantitative and qualitative analyses were used for data triangulation.

RESULTS

Modular nursing practice, focusing on continuity of care, led to changes in the nature of direct care activities and improvement in patient/family education frequency. Also, a general increase in nurses' hand washing frequency was noted. However, when nurses perceived time pressure, a lapse in hand hygiene compliance was found. Because of human resource and inefficiency issues, some nurses in the studied wards did not embrace geographical separation for infection control. Positive correlations were found for nurses' perceived infection control practice competence and their perceived caring attributes.

RELEVANCE TO CLINICAL PRACTICE

In examining nursing practice models within complex clinical situations, the significance lies not only in the model's effects but also in other operational outcomes.

Application of a virtual reality prototype for pain relief of pediatric burn in Taiwan

AIM

This study examines the usability and effectiveness of virtual reality in reducing pain in wound-care procedures for pediatric burn patients in Taiwan.

BACKGROUND

Virtual reality has continuously gained prominence in the medical arena, for instance, the telepresence for surgery, the management of mental health disorders and pain control of the paediatric burn. Notwithstanding an increased application of virtual reality in the medical arena in North America, there have been no studies investigating its use for paediatric burn patients in Asia.

METHODS

This descriptive study has two phases: Phase I: the development of a virtual reality prototype. Phase II: the implementation of the prototype to discern its usability and efficacy with paediatric burn patients at a local hospital.

RESULTS

The findings suggest that a significant difference is found in the children's reported pain, with or without the virtual reality intervention, over the three phases: before, during and after the dressing change. However, less pain was noted in the intervention group during and after the dressing change.

CONCLUSION

Adding to the existing clinical value of virtual reality identifies the nature of and different children's responses to pain with the use of virtual reality.

RELEVANCE TO CLINICAL PRACTICE

This study is significant since it demonstrates a difference in the child's response to pain based on the nature of presence and distraction. Moreover, given the evidence that a decrease in anxiety was experienced after the dressing change with virtual reality intervention, timing of using the virtual reality intervention before the child develops conditioning anxiety and anticipated pain for the procedure would be of importance.

An evaluation of nursing practice models in the context of the severe acute respiratory syndrome epidemic in Hong Kong: a preliminary study

AIM AND OBJECTIVE

Like other health-care workers, Hong Kong nurses had their professional knowledge and skills seriously challenged during the SARS outbreak. Could current nursing practices support the care of SARS or SARS-like patients in the future? If not, alternative practices would be needed. Providing a preliminary understanding, this paper compares the conventional with different nursing delivery models in a simulated SARS ward and focuses on nurses' efficiency, infection control practices and views of the two models.

DESIGN AND METHODS

This study was conducted in three phases. First, a baseline understanding of nursing practices was achieved through four workflow observations. In an eight-hour day, four research assistants observed nursing activities in the medical and fever wards. These data were used in the second phase to construct two sets of clinical vignettes, pertaining to SARS patient care in both conventional and alternative practice models. These scripts were discussed with nine nurses of various ranks from the hospital under study for their expert validation and input. In the third phase, nurse participants and patient actors enacted the vignettes in a simulated setting. Video-taped observations and four nurse participant interviews were employed. Observational data were analysed through descriptive statistics and independent t-tests. Textual data were coded and categorized for common meanings.

RESULTS

Conventional practice from the findings consisted of cubicle and named nurse nursing. While the former reflected modified team and functional nursing, it did not confine patient care within a cubicle as suggested by its name. The latter depicted a modified primary nursing approach in a team, with delegation of care. Preliminary findings concerning infection control and nurse satisfaction revealed that the alternative model had an advantage over the conventional.

RELEVANCE TO CLINICAL PRACTICE

This study findings lay the foundation for clinical trials, which would evaluate the significance of patient-care quality, cost-effectiveness and better human resource management by restructuring current nursing practices.

A narrative inquiry into the Hong Kong Chinese adults’ concepts of health through their cultural stories

BACKGROUND

Abundant studies have investigated how health concepts held by individuals shape and are shaped by psychosocial and cultural factors, though many were limited to the conceptual level. The meaning and significance of health behaviours are better understood as an expression of something occurring over time.

OBJECTIVES

This narrative study explores how Hong Kong Chinese adults understand the meaning of health and the ways by which they construct and express these meanings in their lives. Additionally, by recognizing the central features of temporality, personal-social interactions within a place/culture in narrative thinking, this narrative inquiry may help health-care professionals to revisit the meaning of health promotion within the context of an individual's life situation.

METHODS

Five participants were recruited for the study. Data were collected through a series of audio-taped unstructured interviews and conversations with each participant.

RESULTS

Findings underscore several features of participants' concepts and expressions of health: the significance of Confucian teachings on roles and responsibilities, Eastern view of self, Western biomedical orientation, and Hong Kong's unique work culture. Their responses not only express the attitudes and behaviours of individuals, but also the ways they engage in their constructed identity.

CONCLUSION

Participants' concepts of health evolved over time according to the personal meanings attached to them at various life stages. While participants recognized the interconnectedness of the mind and body, the physical foci of traditional Western medicine remained salient in their health stories. Furthermore, there is a clear delineation of personal management of the psychological health and professional management of physical health.

The narrative research trail: values of ambiguity and relationships

Engle Angela Chan sets out the experiential function of ambiguity in nursing research through a narrative study of Canadian college nurse educators. Through the methods of conversation, journal writing and participation observation, the author, who was also one of the participants, explored with her colleagues the impact of nursing education and healthcare changes on their teaching lives. The article examines how researcher-participant relationships illuminate research outcomes.

The influence of the human becoming theory on teaching-learning stories in Hangzhou, China

As a nurse educator, human becoming theory was used to enhance my understanding of my experience with students in Hangzhou, China. I describe my initial tension in living simultaneously the uncertainty and the certainty when I was faced with a strange but yet familiar teaching situation. The tension has however enabled me to cross from a traditional teaching approach to a human becoming teaching-learning paradigm where the students were given opportunities to share their practice encounters with patients and families by narrating their lived experiences in a clinical reasoning course. As their meanings of nursing surfaced, the students began to learn about who they were, who they are becoming, and who they want to be as nurses, teachers, and human beings.

A lived experience of dualism between the natural and human science paradigms in nursing

AIM

To describe the use of narrative as both phenomenon and method to illuminate college nurse educators' nursing knowledge development through their day-to-day stories on the institutional landscape, which shape and are shaped by health-care and nursing education changes.

BACKGROUND

The Ontario health-care reform in Canada and a shift in nursing curriculum have brought to light a different dimension of a theory-practice issue. The traditional predominant natural science approach in nursing is now no longer considered responsive to the unique characteristics of patients' health-care needs. Emerging from current nursing education is an emphasis on a human science paradigm. However, as many college nurse educators moved back and forth between their classrooms to clinical settings, they experienced tremendous tensions in living between the new caring paradigm and the old culture of biomedical science ideology. Compounding this challenge is a lack of understanding by the policymakers and administrators of the importance of nurses' contribution vis-à-vis an ailing health-care system. This growing complexity demands that nursing, as a practice discipline, should articulate its unique body of knowledge for advancing contributions in health care.

METHODS

My stories of experience and those of my participants were analysed narratively to determine the knowledge and understanding developed from living the complex and interwoven changes in nursing education and practice.

FINDINGS

Through living, telling, retelling and reliving our stories, my participants and I recognized a false dualism between the seemingly polarized biomedical and human science paradigms.

CONCLUSION

The meaning of certainty-uncertainty inherent in nursing teaching and practice demands that nurse educators rethink how stories of experience play out in their understanding of teaching future graduates the interrelationships between these two approaches.