Search

Introduction: Burn survivors often experience a plethora of post-burn residual needs following their discharge including psychological issues and poor sleep. These needs are often overlooked with a significant focus on resolving physical issues. Aftercare support is particularly limited. The emergence of the Coronavirus pandemic worsened the situation as burn survivors were unable to return to utilise available services outpatient basis. Thus, an innovative nurse-led aftercare programme was developed and delivered via WeChat social medial platform. The current study sought to examine the effects of the intervention on anxiety, depression, and sleep pattern among adult burn survivors., Methods: This is a randomised controlled trial. Sixty adult burn survivors were randomly assigned to intervention and control groups. Participants in the intervention group received the nurse-led aftercare programme which involved pre-discharge support and active follow-up on WeChat over an 8-week period and an additional 4 weeks to examine the sustained effects of the intervention. Data were collected at three timepoints: baseline (T0), post-intervention (T1), and follow-up (T2). Generalised estimating equation was employed to ascertain the group, time, and interaction effects., Results: Using Bonferroni corrected p value (0.017), Anxiety and depression improved at T1 and sustained at T2 with mean scores demonstrating a reduction in both variables and total score. No statistically significant improvement was however observed regarding sleep., Conclusion: Continuous, comprehensive support is required by burn survivors following discharge to improve psychological outcomes. Delivering aftercare via WeChat should be considered a feasible option to supporting burn survivors following discharge., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The use of wearable monitoring devices (WMDs), such as smartwatches, is advancing support and care for community-dwelling older adults across the globe. Despite existing evidence of the importance of WMDs in preventing problems and promoting health, significant concerns remain about the decline in use after a period of time, which warrant an understanding of how older adults experience the devices., Objective: This study aims to explore and describe the experiences of community-dwelling older adults after receiving our interventional program, which included the use of a smartwatch with support from a community health workers, nurses, and social workers, including the challenges that they experienced while using the device, the perceived benefits, and strategies to promote their sustained use of the device., Methods: We used a qualitative descriptive approach in this study. Older adults who had taken part in an interventional study involving the use of smartwatches and who were receiving regular health and social support were invited to participate in focus group discussions at the end of the trial. Purposive sampling was used to recruit potential participants. Older adults who agreed to participate were assigned to focus groups based on their community. The focus group discussions were facilitated and moderated by 2 members of the research team. All discussions were recorded and transcribed verbatim. We used the constant comparison analytical approach to analyze the focus group data., Results: A total of 22 participants assigned to 6 focus groups participated in the study. The experiences of community-dwelling older adults emerged as (1) challenges associated with the use of WMDs, (2) the perceived benefits of using the WMDs, and (3) strategies to promote the use of WMDs. In addition, the findings also demonstrate a hierarchical pattern of health-seeking behaviors by older adults: seeking assistance first from older adult volunteers, then from social workers, and finally from nurses., Conclusions: Ongoing use of the WMDs is potentially possible, but it is important to ensure the availability of technical support, maintain active professional follow-ups by nurses and social workers, and include older adult volunteers to support other older adults in such programs., (©Arkers Kwan Ching Wong, Jonathan Bayuo, Jing Jing Su, Karen Kit Sum Chow, Siu Man Wong, Bonnie Po Wong, Athena Yin Lam Lee, Frances Kam Yuet Wong. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 07.08.2024.)

Although concerns regarding intimacy abound among burn survivors, these are often not captured during rehabilitation. Considering that sexuality remains a part of humans suggests a critical need to pay attention to this aspect. To guide further work, this review sought to examine existing studies to ascertain what is known about factors associated with sexual role functioning, sexual satisfaction, and intimacy, the scree ning tools employed, and the preparedness of burn care staff in initiating discussions about these. We employed a scoping review approach with extensive searches in 4 peer-reviewed databases for studies reporting on the phenomenon, published in English from 2010 to date. A total of 17 studies comprising of 13 studies reporting on the burn survivors and 4 reporting on burn care staff were retained. Though we identified both sociodemographic and clinical factors associated with postburn sexual role functioning, sexual satisfaction, and intimacy, the existing evidence appear limited which made it rather difficult to draw definitive conclusions. The sexuality subscale of the Burn-Specific Health Scale-Brief emerged as the commonly used screening/assessment tool. The evidence suggest that burn care staff are generally unprepared to initiate discussions regarding sexual role functioning, sexual satisfaction, and intimacy and often, there is no personnel assigned to this task. There is a great need for studies to strengthen the evidence base regarding the factors associated with postburn sexual role functioning, sexual satisfaction, and intimacy. In addition, it is imperative to build capacity of burn care practitioners with the requisite know-how needed to navigate through sexual issues., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Introduction: Psychosocial intervention is imperative for treating alcohol use disorder (AUD), but there is no comprehensive evidence regarding its effectiveness. Therefore, this study aimed to determine the effectiveness of psychosocial interventions in treating AUD amongadolescents and young adults., Methods: In this systematic review and meta-analysis, articles were searched from EMBASE, PubMed, Medline, CINAHL, Web of Science, PsycINFO, and Scopus. Also, articles were retrieved from gray literature. The quality of articles has been assessed using the Cochrane risk of bias assessment., Results: A total of 12 randomized controlled trials were included. Integrated family and CBT, CBT, guided self-change, and ecologically based family therapy had a mild effect in reducing alcohol use frequency. On the other hand, integrated motivational enhancement therapy and CBT (-0.71 [95% CI: -0.97, -0.45]) and common elements treatment approaches (4.5 [95% CI: 6.9, 2.2]) had the highest effect size for reducing alcohol use frequency and amount, respectively. In conclusion, most of the interventions had no significant effect on different drinking outcomes. Nonetheless, the effectiveness of combined interventions surpassed that of the single interventions. The effect of psychosocial interventions on abstinence was inconclusive. Therefore, future studies will explore alternative, newly emerged third-wave therapeutic approaches., Systematic Review Registration: PROSPERO, CRD42023435011, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=435011., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Belay, Mak, Wong, Lam, Liu, Yang, Mao, Wu and Ho.)

Background: Childhood Cancer Survivors (CCSs) are more likely to report sexual dysfunction than people without cancer history. Sexual functioning encompasses more than just sexual dysfunction. The scarcity of information regarding the status and influencing factors of sexual functioning in CCSs, hampers to devise suitable screening or interventions. This review aims to summarize research progress on sexual functioning and associated factors among CCSs., Methods: This review protocol is registered in PROSPERO(CRD42023427939) and performed according to PRISMA guidelines. From inception to November 15, 2023, a comprehensive search was conducted in PubMed, EMBASE, CINAHL, Web of Science, SCOPUS, PsycINFO, CNKI Database, Wanfang of Chinese Database, SinoMed Database and Cochrane Library on sexual functioning and childhood cancer survivors. Inclusion criteria were English or Chinese studies focusing on sexual functioning and related factors of cancer survivors, who diagnosed with cancer before 18 years old, and were adult and disease-free when participating in the study. Studies were excluded if the focus was on adult cancer patients or without age information., Findings: 395 records were retrieved, and 22 studies were finally included in this review. Results suggest that CCSs experience a substantial burden of sexual issues, including delayed psychosexual development, low satisfaction, and high prevalence of dysfunction. Underlying factors related to sexual functioning of CCSs were identified, including demographic, cancer treatment-related, psychological, and physiological factors. The historical change in research on sexual functioning was summarized., Interpretation: Research on sexual functioning among CCSs is limited. The extent to which cancer and related treatments affect sexual functioning remains largely unknown. The relationships between various factors and mechanisms underlying sexual functioning need to be confirmed by more rigorous studies to enable effective interventions to be developed., Funding: None., Competing Interests: All authors declare that they have no conflict of interest., (© 2024 The Authors.)

Purpose: A significant portion of parents of children diagnosed with sarcoma experience excessive stress and anxiety disorder. This quality improvement project aimed to implement a psychological support service program tailored for parents of children with sarcoma and evaluate its effects., Design and Methods: An interprofessional team was formed through a health-social partnership to deliver comprehensive psychological support service program involving multiple cognitive-behavioral components to parents of children with sarcoma. Parents who were identified as having excessive stress and/or anxiety disorder and voluntarily agreed to participate were enrolled. Pre- and post-intervention assessments were conducted, and previously recorded data from parents of children hospitalized in the year prior to this quality improvement project were included as historical controls., Results: A total of 48 parents, including 35 mothers and 13 fathers, participated in the quality improvement project. Results showed that participants achieved greater reduction in emotional, somatic, and behavioral stress when compared with historical controls (all p < .001). Significantly lower prevalence of moderate to severe anxiety disorder was also found (4.2% vs. 85.4%, p < .001)., Conclusions: The implementation of a psychological support service program, informed by cognitive-behavioral theory and delivered through a health-social partnership, effectively alleviated multiple facets of stress and anxiety disorder in parents of children newly diagnosed with sarcoma., Practice Implications: Nurses can facilitate and coordinate the collaboration among interprofessional team to deliver specialized psychological support services and ensure that parents of children with sarcoma have access to these services, ultimately enhancing their psychological well-being., Competing Interests: Declaration of competing interest The authors declare no potential conflict of interest with the research, authorship, and/or publication of this article., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Rehabilitative care for burn patients in developing countries is often wrought with several issues. Post-discharge support is equally challenging as there is often limited rehabilitative care as the burn survivors and their families transition. To inform practice, this study sought to explore the perspectives of adult burn survivors and burn care staff regarding transitioning from the burn unit and the development of a transitional rehabilitation programme. We employed interpretive description for this study. Semi-structured face-to-face interviews were conducted with adult burn survivors and burn care staff across two tertiary healthcare facilities in Lanzhou, Gansu Province of China, and Ghana. The thematic analytical approach was employed to analyse the data. Forty-six participants comprising 26 adult burn survivors and 20 burn care staff participated in this study. Two themes and five subthemes emerged from the data. Transitioning from the burn unit to the home was described as complex with varied biopsychosocial needs emerging. However, available support was not comprehensive to resolve these needs. Existing pre-discharge support is limited across both settings. Burn survivors expressed interest in taking on an active role in the rehabilitation process and being able to self-manage their post-burn symptoms following discharge. Transitional rehabilitative support should include an active follow-up system, ensure patient- and family-centred support, and offer a bundle of comprehensive rehabilitative services using locally available items which do not financially burden burn survivors and their families. In conclusion, transitioning from the burn unit is filled with varied health needs. Transitional rehabilitative care is required to bridge the pre-discharge and post-discharge periods., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: As the population ages, a plethora of digital and mobile health applications for assistance with independent living have emerged. Still unknown, however, is how older adults sustain the use of these applications., Aim: This study sought to explore the experiences of older adults following their participation in a programme that combined the use of an mHealth application with proactive telecare nursing support., Methods: We employed a concurrent mixed-methods design for this study. The quantitative strand included a survey, whereas the qualitative strand included open-ended questions as part of the survey to understand the participants' experiences. Participants for this study were community-dwelling older adults who had taken part in an interventional study that sought to examine the effects of mHealth and nurse support. A convenience sampling approach was employed to recruit potential participants for this study., Findings: Fifty-five older adults participated. The majority expressed positive attitudes and satisfaction with the app and the nurses' support. The app and nurses' support helped participants to understand their health status and obtain health information. Reasons to halt app usage included technical issues and limited social support., Conclusion: Mobile apps with professional follow-up support could potentially support older adults in the community, although emerging concerns need to be addressed to sustain long-term usage of these apps., (© 2024. The Author(s).)

Aim: To evaluate the clinical effectiveness and implementation strategies of telecare consultations in post-stroke nurse-led clinics., Background: Telecare consultations could be an alternative to conventional in-person consultations and improve continuity of care for stroke survivors following their discharge from hospital. Previous studies utilizing telecare consultations only focused on testing their clinical effectiveness on stroke survivors; the appropriateness and feasibility of adopting this new delivery modality in a real-world setting were not examined., Design: A Type II hybrid effectiveness-implementation design will be adopted., Methods: Eligible stroke survivor participants will be randomly assigned to the intervention group (telecare consultation) or control group (usual in-person clinic consultation). Both groups will receive the same nursing intervention but delivered through different channels. The Reach, Effectiveness, Adoption, Implementation, Maintenance framework will be used to evaluate the clinical effectiveness and implementation outcomes. The primary outcome is the non-inferiority of the degree of disability between the two groups at 3 months into the intervention and at 3 months post-intervention. The paper complies with the SPIRIT guidelines for study protocols adapted for designing and reporting parallel group randomized trials., Conclusion: The findings of this study will provide key insights into the processes for implementing and adopting telecare consultations into long-term services for post-stroke patients., Impact: This study contributes to the translation of telecare consultations for stroke survivors into real-life settings. If effective, this program may provide guidance for expanding telecare consultations to other post-stroke nurse-led clinics or to patients with other chronic diseases., Trial Registration: This study has been registered at clinicaltrials.gov (identifier: NCT05183672). Registered on 10 January 2022., (© 2023 John Wiley & Sons Ltd.)

Objective: To compare and contrast the perceived care needs of children with life-limiting conditions (CLLC) from the perspectives of the children, parents and healthcare providers., Design: A qualitative case study method using semistructured interviews was employed with a within-case and across-case analysis. Themes and subthemes emerging from the cases were compared and contrasted in the across-case analysis to explore the similarities and variations in participant perceptions., Setting/participants: The setting was the paediatric departments of five regional hospitals in Hong Kong. Twenty-five sets of informants (CLLC-parent-healthcare provider) were recruited, with 65 individual interviews conducted., Results: A total of 3784 units of analysis were identified, resulting in three themes with subthemes. 'Living with the disease' (55.8%) occupied the largest proportion, followed by 'information and understanding about the disease' (27.4%), and 'care support and palliative care' (16.8%). Healthcare provider support mainly focused on physical concerns. Family and social support were present, but carer stress created tension between couples. Doctors were the primary source of medical information, but the parents had to seek further information via the internet and support from patient groups. There was a perceived need for better coordination and collaboration of care. The palliative care approach coordinated by nurses was seen as helpful in addressing the care needs of the CLLC., Conclusions: This original study identified the importance of palliative care with active engagement of parents which can address the service gap for CLLC., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The ageing population requires seamless, integrated health and social care services in the community to promote the health of older adults. However, inadequate financial resources, a lack of clear operational guidelines, and various organisational work cultures may affect the implementation quality and sustainability of these services. As a unique approach, this study seeks to examine the preliminary effects of a health-social partnership programme on the health self-management of community-dwelling older adults in Hong Kong. Additionally, the study seeks to ascertain key insights into the mechanisms and processes required to implement and sustain a self-care management programme in broader practice in community settings., Methods: This study will use a hybrid effectiveness-implementation design. During the 3-month programme, subjects in the intervention group will receive four Zoom video conference sessions and four telephone calls conducted by a health-social service team that will include a nurse case manager, community workers, general practitioners, a Chinese medicine practitioner, and social workers. Subjects in the control group will receive a monthly social telephone call from a trained research assistant to rule out the possible social effect of the intervention. The reach, effectiveness, adoption, implementation, and maintenance framework (i.e. RE-AIM framework) will be used to evaluate the implementation and effectiveness outcomes. Of the five dimensions included in the RE-AIM framework, only effectiveness and maintenance outcomes will be collected from both the intervention and control groups. The outcomes of the other three dimensions-reach, adoption, and implementation-will only be collected from subjects in the intervention group. Data will be collected pre-intervention, immediately post-intervention, and 3 months after the intervention is completed to evaluate the maintenance effect of the programme., Discussion: This programme will aim to enhance health-promoting self-care management behaviours in older adults dwelling in the community. This will be the first study in Hong Kong to use the hybrid effectiveness-implementation design and involve key stakeholders in the evaluation and implementation of a health self-management programme using a health-social service partnership approach. The programme, which will be rooted in the community, may be used as a model, if proven successful, for similar types of services., Trial Registration: Clinicaltrials.gov, NCT04442867. Submitted 19 June 2020., (© 2023. The Author(s).)

Aim: To identify and classify the transitional and aftercare needs of persons hospitalised with and recovering from COVID-19., Background: Several studies exist that describe the patient needs at the acute phase of COVID-19. The transitional and aftercare needs that emerge during recovery, however, remain vague., Methods: A scoping review was conducted and reported according to the PRISMA extension guidelines for scoping reviews (PRISMA-ScR). Primary studies were identified from database search. Narrative synthesis was undertaken, with the Omaha System as a framework., Results: Forty studies were included. Persons recovering from the infection may have several needs in all domains of the Omaha System. Although the severity and persistence of the needs may be unrelated to the severity of the initial infection, they may vary based on factors such as age and pre-morbid factors., Conclusion: Recovering from COVID-19 is associated with varied biopsychosocial-environmental needs which can adversely affect the quality-of-life experience. The review findings represent an inventory of needs that can guide the development of multi-disciplinary post-acute or aftercare programmes., Relevance to Clinical Practice: Recovering from COVID-19 can be a protracted process requiring ongoing professional support after discharge. Policies are required to support the development and implementation of post-acute programmes of care. Comprehensive transitional and aftercare rehabilitative programmes are needed to support the recovery process., (© 2023 John Wiley & Sons Ltd.)

Background: Globally, nurse-led post-acute stroke clinics have been developed to provide secondary care services to stroke survivors. Although synthesized evidence supports the idea that the secondary prevention services delivered by nurses in these clinics can improve the functional ability of stroke survivors and reduce their readmission rates, long travel and waiting times, high costs, and the pandemic have limited the utilization of such clinics. Telecare consultations are a new modality for expanding public access to healthcare services, although how it can be applied in nurse-led clinics has not been reported., Objective: The aim of this study is to determine the feasibility and effects of telecare consultations in nurse-led post-acute stroke clinics., Methods: The study adopts a quasi-experimental design. The participants will receive three secondary stroke care consultations in 3 months provided via telecare by experienced advanced practice nurses. The outcome measures include feasibility (reasons for refusing to participate and for dropping-out, the attitudes and satisfaction of both the advanced practice nurses and their patients towards the programme), and preliminary effectiveness (degree of disability after stroke, activities of daily living, instrumental activities of daily living, health-related quality of life, depression) outcomes. Data will be collected at pre-(T1) and post-(T2) intervention., Conclusions: The findings of this study may help facilitate the implementation of telecare consultations in a nurse-led post-acute stroke clinic, which may benefit the stroke survivors who are having mobility restrictions from accessing customary healthcare services and may protect them from being exposed to the infectious risk., (© The Author(s) 2023.)

Aims: To identify the challenges facing burn care nurses and burn patients' family members and to explore the relationship between the above challenges., Design: Whittemore and Knafl's integrative review., Methods: Databases used for this review included Cochrane Library, Web of Science, PubMed and Embase. The original research published from January 2010 to November 2021 was selected. Studies reporting the challenges of family members or nurses of burn patients identified through extensive database search were considered for inclusion. The Mixed-Method Appraisal-Tool was applied for the evaluation of the quality of the literature. The analysis approach used was content analysis., Results: Of the 2746 identified studies, 17 studies were included. Key findings related to the challenges facing nurses and family members of burn patients were extracted. The themes relating to burn care nurses included ethical and religious issues, clinical issues, work-life imbalance and limited support. The themes relating to family members included family's different views on prognosis and treatment, work-life imbalance, psychological issues and lack of multifaceted support. The challenges for the formal and informal caregivers are similar and there is existence of some shared concerns. If the above challenges are not resolved, support for the burn patients may be adversely affected. Corresponding measures should be taken to overcome such challenges., (© 2023 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Objective: The ongoing pandemic has accentuated the use of telecare services; however, only limited progress has been made in understanding the barriers and facilitators to using these services. In order to move towards sustaining such essential services, the present study aimed to ascertain the experiences of stroke survivors and healthcare providers regarding the utilization of a post-stroke telecare service in Hong Kong., Methods: Interpretive description was employed for this study. Semi-structured discussions and interviews were undertaken with nine stroke survivors and four stroke nurses who delivered the telecare services. The principles of thematic analysis were inductively followed to analyse the data. The Standards for Reporting Qualitative Research checklist was used to guide the reporting of the data., Results: Three themes emerged: (a) pre-existing post-discharge service pathways; (b) push factors/facilitators for telecare usage; and (c) barriers to telecare usage. Overall, the telecare service was considered a significant alternative and one that complements conventional face-to-face follow-ups. Stroke survivors were motivated to use the service because it was convenient and flexible. However, significant barriers exist, including technical issues and a lack of guidelines and training opportunities for healthcare providers., Conclusions: Although telecare is still evolving, several factors drive stroke survivors to use the service. Attention needs to be paid to the emerging barriers to improve long-term usage of the service. Clear guidelines are needed to underpin the development and implementation of telecare services., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Background: Although mobile health application (mHealth app) programs have effectively promoted disease self-management behaviors in the last decade, usage rates have tended to fall over time., Objective: We used a case management approach led by a nurse and supported by a health-social partnership team with the aim of sustaining app usage among community-dwelling older adults and evaluated the outcome differences (i.e, self-efficacy, levels of depression, and total health service usages) between those who continued to use the app., Methods: This was a 3-arm randomized controlled trial. A total of 221 older adults with hypertension, diabetes, or chronic pain were randomized into 3 groups: mHealth (n=71), mHealth with interactivity (mHealth+I; n=74), and the control (n=76). The mHealth application was given to the mHealth and mHealth+I groups. The mHealth+I group also received 8 proactive calls in 3 months from a nurse to encourage use of the app. The control group received no interventions. Data were collected at preintervention (T1), postintervention (T2), and at 3 months' postintervention (T3) to ascertain the sustained effect., Results: A total of 37.8% of mHealth+I and 18.3% of mHealth group participants continued using the mHealth app at least twice per week until the end of the sixth month. The difference in app usage across the 2 groups between T2 and T3 was significant (χ 2 1 =6.81, P=.009). Improvements in self-efficacy (β=4.30, 95% CI 0.25-8.35, P=.04) and depression levels (β=-1.98, 95% CI -3.78 to -0.19, P=.03) from T1 to T3 were observed in the mHealth group participants who continued using the app. Although self-efficacy and depression scores improved from T1 to T2 in the mHealth+I group, the mean values decreased at T3. Health service usage decreased for all groups from T1 to T2 (β=-1.38, 95% CI -1.98 to -0.78, P<.001), with a marginal increase at T3., Conclusions: The relatively low rates of mHealth app usage at follow-up are comparable to those reported in the literature. More work is needed to merge the technology-driven and in-person aspects of mHealth., Trial Registration: ClinicalTrials.gov NCT03878212; https://clinicaltrials.gov/ct2/show/NCT03878212., International Registered Report Identifier (irrid): RR2-10.1159/000509129., (©Arkers Kwan Ching Wong, Jonathan Bayuo, Frances Kam Yuet Wong, Karen Kit Sum Chow, Siu Man Wong, Avis Cheuk Ki Lau. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 01.05.2023.)

Aim: The current study sought to assess the perceptions of eHealth technology of nurses and nursing students in China and to examine the association between these perceptions and demographic factors., Background: Despite the increasing use of eHealth technologies in China and across the globe, the perceptions of practicing and student nurses remain minimally explored. Findings from such an inquiry can potentially inform actions and policies to improve the uptake of eHealth technologies among Chinese nurses., Design: This was a cross-sectional study with a real-time online survey., Methods: A convenience sample of 1338 nurses and nursing students from Mainland China participated in the study. Their perceptions of eHealth technology were collected using the Chinese version of the Perceptions of eHealth Technology Scale. The Kruskal-Wallis test and multiple linear regression analysis were used to examine the relationship between demographic variables (age group, gender, occupation, education level, position and clinical experience) and perceptions of eHealth technology. All study procedures adhered to the STROBE guidelines., Results: Most participants were aged between 20 and 29 (55.8%). Nearly half (42.5%) were frontline clinical nursing staff, some were nursing students (36.2%), academic nursing staff (12.3%) and clinical nursing management staff (9.0%). Regardless of the differences in their demographic characteristics, the participants had higher mean scores in "Perception of eHealth applications" and lower mean scores in "Knowledge of eHealth technology". Participants with doctoral degree had a higher mean total score and higher sub-scale scores in knowledge of eHealth technology, perception of the advantages of eHealth technology and perception of eHealth applications; and the lowest scores in perception of the disadvantages of eHealth technology and perception of eHealth applications. Occupation, position and clinical experience were found to be the demographic characteristics associated with eHealth perceptions, before adjusting for age and gender. Education level was associated with eHealth perceptions regardless of adjustment., Conclusion: Overall, participants had higher scores on perceptions of eHealth applications but lower scores on knowledge of eHealth technology. Considering the association between education and all subscales and overall scores, it may be essential to implement continuing professional education for nurses to improve their knowledge of eHealth applications. Encouragement to use available eHealth digital technologies may also be helpful to improve perceptions of eHealth., Competing Interests: Conflict of interest None., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Introduction: Cancer and its treatment affect children's physical, psychological and social well-being throughout the disease trajectory. Spiritual well-being is a fundamental dimension of people's overall health and is considered a source of strength to motivate patients to cope with and adapt to their disease. Appropriate spiritual interventions are important to mitigate the psychological impact of cancer on children, with an ultimate goal of improving their quality of life (QoL) throughout the treatment course. However, the overall effectiveness of spiritual interventions for paediatric patients with cancer remains unclear. This paper describes a protocol to systematically summarise the characteristics of studies related to existing spiritual interventions and synthesise their effectiveness on psychological outcomes and QoL among children with cancer., Methods and Analysis: Ten databases will be searched to identify appropriate literature: MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, PsycINFO, LILACS, OpenSIGLE, the Chinese Biomedical Literature Database, the Chinese Medical Current Contents and the Chinese National Knowledge Infrastructure. All randomised controlled trials that meet our inclusion criteria will be included. The primary outcome will be QoL as evaluated by self-reported measures. The secondary outcomes will be self-reported or objectively measured psychological outcomes, including anxiety and depression. Review Manager V.5.3 will be used to synthesise the data, calculate treatment effects, perform any subgroup analyses and assess the risk of bias in included studies., Ethical and Dissemination: The results will be presented at international conferences and published in peer-reviewed journals. As no individual data will be involved in this review, ethical approval is not required., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Determining the core competence of advanced practice nurses is foundational for promoting optimal design and implementation of advanced practice nursing roles. Core competencies specific to the contexts of the advanced practice nurse in Hong Kong have been developed, but not yet validated. Thus, this study aims to assess the construct validity of advanced practice nurse core competence scale in Hong Kong., Methods: We performed a cross-sectional study using an online self-report survey. Exploratory factor analysis was used to examine the factor structure of a 54-item advanced practice nurse core competence scale through principal axis factoring with direct oblique oblimin rotation. A parallel analysis was conducted to determine the number of factors to be extracted. The Cronbach's α was computed to evaluate the internal consistency of the confirmed scale. The STROBE checklist was used as reporting guideline., Results: A total of 192 advanced practice nurse responses were obtained. Exploratory factor analysis led to the final 51-item scale with a three-factor structure, which accounted for 69.27% of the total variance. The factor loadings of all items ranged from 0.412 to 0.917. The Cronbach's alpha of the total scale and three factors ranged from 0.945 to 0.980, indicating robust internal consistency., Conclusion: This study identified a three-factor structure of the advanced practice nurse core competency scale: client-related competencies, advanced leadership competencies, and professional development and system-related competencies. Future studies are recommended to validate the core competence content and construct in different contexts. Moreover, the validated scale could provide a cornerstone framework for advanced practice nursing roles development, education, and practice, and inform future competency research nationally and internationally., (© 2023. The Author(s).)

Diabetes Mellitus (DM) is a chronic disease characterized by abnormally uncontrolled high blood glucose level. The Risk Assessment and Management Program (RAMP) in Hong Kong has been providing long-term face-to-face follow-up to DM patients in the government out-patient clinics since 2009. However, under the current outbreak of COVID-19, these face-to-face consultations were ceased over and over again to lower the risk of disease transmission. With the advancement in technology, the recent emergence of telecare has provided an alternative to replace the conventional consultations in the clinics. Its clinical effectiveness on DM patients has also been supported by numerous studies. Yet, there is only a paucity of literatures discussing the practicality of such implementation design in the real-world settings. This study aims at studying both the effectiveness and implementation outcomes of telecare in Hong Kong DM patients. It adopts a type 2 hybrid effectiveness-implementation design. It will be conducted in seven government out-patient clinics in Hong Kong. The subjects will be randomly assigned to an intervention group or a control group when they 1) are aged 18 or above, 2) have a confirmed diagnosis of diabetes, and 3) are having regular follow-up appointment in the clinic. Subjects in the intervention group will receive a 84-week Risk Assessment and Management Program (RAMP) in an alternate telecare and face-to-face consultations mode, while the control group will receive the same program but in usual face-to-face consultation mode. RE-AIM is employed as the implementation and effectiveness outcome evaluation framework. The primary outcome measure will be HbA1c. Data will be collected pre-intervention (T1), 42-week (T2), and 84-week (T3). The study will provide effectiveness-implementation assessment of telecare mode for DM patients in Hong Kong, as an alternative or in addition to conventional face-to-face consultations. It also aimed to provide insights for the future adoption in a broader health care setting.

Background: Spiritual well-being is a strength for childhood cancer patients to cope with cancer. The availability of a valid and reliable instrument for assessing spiritual well-being is crucial. This study translated and adapted the Functional Assessment of Chronic Illness Therapy Spiritual Well-being scale (FACIT-Sp) for Chinese childhood cancer patients and examined the psychometric properties and factor structure in this population., Methods: This was a methodological study. The FACIT-Sp was translated into Chinese. Adaptation was based on our qualitative study. For psychometric evaluation, a convenience sample of 412 were recruited based on the suggested sample size for the exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Childhood cancer patients were included if they aged 8-17 years, with parental consent to participate, able to communicate that they were being treated for cancer, and able to communicate and read Chinese. Participants answered the Chinese version of the adapted FACIT-Sp, the Center for Epidemiology Studies Depression Scale for Children (CES-DC), and the Pediatric Quality of Life Inventory 3.0 Cancer Module (PedsQL). Content validity, convergent validity, internal consistency and test-retest reliability were examined. Both EFA and CFA assessed the structural validity of the adapted FACIT-Sp., Results: The content validity index values for items ranged 0.8-1.0 and that for the scale was 0.84, indicating appropriate content validity. The scale had good internal consistency, with a Cronbach's alpha of 0.815. The FACIT-Sp scores positively correlated with the CES-DC scores, and negatively correlated with PedsQL scores, suggesting that the Chinese version of the adapted FACIT-Sp had reasonable convergent validity. EFA yielded a four-factor (meaning, peace, faith, and connection with others) model. The CFA results revealed that the four-factor model achieved a better fit than the original three-factor model (Chi-Square Mean/Degree of Freedom = 2.240 vs. 3.557, Comparative Fit Index = 0.953 vs. 0.916, Goodness of Fit Index = 0.909 vs. 0.884, Root Mean Square Error of Approximation = 0.078 vs. 0.112)., Conclusion: The Chinese version of the adapted FACIT-Sp is a reliable and valid instrument for assessing spiritual well-being among Chinese childhood cancer patients. This instrument can be applied in clinical settings for routine assessment., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Liu, Ho, Lam, Lam, Cheng, Ching, Belay and Wong.)

Importance: Mobile health (mHealth) smartphone apps are becoming increasingly popular among older adults, although the reactive care approach of these apps has limited their usability., Objective: To evaluate the effects of an interactive mHealth program supported by a health-social partnership team on quality of life (QOL) among community-dwelling older adults in Hong Kong., Design, Setting, and Participants: This was a 3-group, randomized clinical trial conducted in 5 community centers in Hong Kong from December 1, 2020, to April 30, 2022, with a last follow-up date of January 31, 2022. Participants included older adults aged at least 60 years who were living within the service area, used a smartphone, and had at least 1 of the following problems: chronic pain, hypertension, or diabetes. Data were analyzed from May 1 to 10, 2022., Interventions: Participants were randomly assigned to the mHealth with interactivity (mHealth+I) group, mHealth group, or control group. Participants in the mHealth+I group received the mHealth app and nurse case management supported by a health-social partnership team. The mHealth group received the mHealth app only. The control group received no mHealth app or health-social care services., Main Outcomes and Measures: The primary outcome was the change in QOL from baseline to 3 months after completion of the intervention., Results: Among 221 participants (mean [SD] age 76.6 [8.0] years; 185 [83.7%] women), 76 were randomized to the control group, 71 were randomized to the mHealth group, and 74 were randomized to the mHealth+I group. The most common chronic diseases or problems were hypertension (147 participants [66.5%]), pain (144 participants [65.2%]), cataracts (72 participants [32.6%]), and diabetes (61 participants [27.6%]). At 3 months after the intervention and compared with the intervention group, there were no statistically significant differences in either the physical component summary (mHealth+I: β = -1.01 [95% CI, -4.13 to 2.11]; P = .53; mHealth: β = 0.22 [95% CI, -3.07 to 3.50]; P = .90) or the mental component summary (mHealth+I: β = -0.87 [95% CI, -4.42 to 2.69]; P = .63; mHealth: β = 1.73 [95% CI, -1.89 to 5.34]; P = .35) QOL scores. Only secondary outcomes, including self-efficacy (β = -2.31 [95% CI, -4.26 to -0.36]; P = .02), systolic blood pressure (β = -2.30 [95% CI, -5.00 to -0.13]; P = .04), pain levels (β = 1.18 [95% CI, 0.52 to 2.00]; P = .02), and health services utilization (β = 0.98 [95% CI, 0.32 to 2.09]; P = .048) improved in the mHealth+I group compared with the control group., Conclusions and Relevance: This randomized clinical trial found no difference in the primary outcome between the mHealth+I group and the control group confirming that there were no incremental benefits to adding interactivity in mHealth programs for older adults with chronic diseases., Trial Registration: Clinicaltrials.gov Identifier: NCT03878212.

Background: The experiences of men in nursing academia remain poorly understood globally as they remain a minority within the underrepresented male nursing populace., Purpose: To develop a comparative understanding of the experiences of male nurse educators., Method: We conducted a systematic review and meta-synthesis. Studies were considered eligible if they employed qualitative methodologies, contained verbatim quotes, published in a peer-reviewed journal and full-text available in English. An interpretive stance inspired by Ricoeur's hermeneutic approach was employed to undertake data analysis., Results: Five studies were retained in the study. Three themes and ten subthemes emerged. Becoming describes why male nurses enter and stay in academia. Although several factors may push them, they often experienced isolation requiring them to overcome leading to professional growth., Conclusion: The space of becoming and overcoming can be a lonely and isolated journey, often with no role models to support the process. Mentorship and peer support programmes are required as male nurses' transition and remain in nursing academia., (Copyright © 2022. Published by Elsevier Inc.)

Significance: Using mHealth apps alone at home without the support of healthcare experts could mean that older adults might not fully utilize the functions of the apps, recognize their benefits, and sustain their use. Incorporating an integrated health-social partnership model to support the app usage when further help is needed by the older adults might maximize the apps' benefits in the long term., Objectives: This study aimed to examine the benefits of adding nursing interaction supported by a health-social partnership model in the use of mHealth, and the sustained beneficial effects on psychological outcomes, including quality of life, self-efficacy, and depression, among older adults after the completion of the program., Methods: A three-arm, randomized controlled trial design was adopted. Community-dwelling older adults with chronic pain, hypertension, or diabetes, were randomly assigned to either the mHealth, mHealth with interactivity, or control group. Subjects in both the mHealth and the mHealth with interactivity groups received the mHealth application. In addition, the mHealth with interactivity group received support from a nurse case manager, who was supported by a health-social partnership team. mHealth apps and services from a nurse case manager were not provided to the control group. The primary outcome measure was quality of life, and secondary outcomes were self-efficacy and depression. Data were collected at pre-intervention (T1), post-intervention (T2), and at 3 months post-intervention to measure the sustained effect of the program., Results: There were 74 mHealth+I, 71 mHealth, and 76 control group subjects enrolled in the program. No statistically significant between-group, within-group, and interaction effects between group and time in both physical component summary (PCS) and mental component summary (MCS) scores were found among the three groups. The mHealth group showed an improvement in PCS and depression scores from T1 to T2, sustained at T3; while the mHealth+I group demonstrated improved self-efficacy from T1 to T2, with a decrease at T3., Conclusion: Adding nurse-directed telephone calls may be of little to no benefit at all in the long term. Future studies may consider a longer intervention period to build and sustain quality of life and self-efficacy levels among community-dwelling older adults., Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03878212., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Wong, Wong, Bayuo, Chow, Wong and Lee.)

Spiritual well-being is the fourth dimension of health, as equally important as physical, mental, and social well-being. The shadow of death associated with cancer triggers children to explore their personal values, meanings, and life goals throughout the illness trajectory, enabling them to identify their unique spiritual needs. Chinese children are generally non-religious, unlike Western children, which affects their spiritual needs. To address the literature gaps, we applied a qualitative, descriptive, phenomenological approach for exploring the spiritual needs of Chinese children hospitalized with cancer. Purposive sampling was conducted in two public hospitals with special wards for pediatric oncology patients in Hunan Province, China. Consequently, 22 children, hospitalized with cancer, were recruited and individually interviewed using a semi-structured interview format. We conducted a thematic analysis of the interview transcripts. Four important themes were identified: the need for self-exploration, inner needs, need for a connection with others, and need for a connection with gods, supernatural powers, and fictional characters. We found that culture significantly influenced the spiritual needs of Chinese children with cancer. Hope was a key factor motivating the children to continue cancer treatment. To address their unique spiritual needs, culturally specific interventions should be developed and incorporated into their care to enhance their spiritual well-being.

Background: A growing body of literature supports the efficacy of the health-social approach for the implementation of complex interventions to enhance self-care health management among community-dwelling older adults. However, there is little research on how interventions with this approach are implemented and disseminated in a real community setting., Methods: This pilot study adopted an effectiveness-implementation hybrid design to 1) evaluate the effectiveness of a community-based Health-Social Partnership Program (HSPP) and 2) explore the reach, adoption, implementation, and maintenance of the HSPP in the community. Potential participants were recruited if they were aged 60 or above, owned a smartphone, and were cognitively competent. The participants received nurse-led case management with support from a social service team. Factors that hindered or facilitated the program delivery were examined to determine the implementation outcomes and sustained effects of the program. Data were collected at pre-intervention (T1), immediately post-intervention (T2), and 3 months post-intervention (T3)., Results: Ninety-two older adults joined and completed the program. The recruitment rate was 76.7%. A significant interaction effect was found for the mean self-efficacy scores from T1 to T2 (Wald χ 2  = 12.28, p ≤ .001). Barriers to widespread program implementation included manpower shortage, lack of experienced staff, and unpredictable environment, whereas facilitators, as suggested by the older adults, providers, and community staff members, included regular communication between the research and service teams, recruitment of participants through community centers with the support of the research team, and seamless partnership among the health-social partnership team members. Strong implementation fidelity was achieved with zero attrition rate., Conclusion: Most conventional randomized controlled trials investigating the effects of community-based programs have tended to control the contextual factors rather than incorporate the program in a real setting. This pilot study was the first to use a hybrid model to test the effectiveness and outcomes of HSPP implementation. The results imply that the program has a high potential sustainability in the real-life context., Trial Registration: This study was registered at clinicaltrials.gov (NCT04442867; date of first registration 23/06/2020)., (© 2022. The Author(s).)

Background: Stage 5 chronic kidney disease (CKD) patients often experience decisional conflict when faced with the selection between the initiation of dialysis and conservative care. The study examined the effects of a brief hope intervention (BHI) on the levels of hope, decisional conflict and the quality of life for stage 5 CKD patients., Methods: This is a single-blinded, randomized controlled trial (ClinicalTrials.gov identifier: NCT03378700). Eligible patients were recruited from the outpatient department renal clinic of a regional hospital. They were randomly assigned to either the intervention or the control group (intervention: n = 35; control: n = 37). All participants underwent a customized pre-dialysis education class, while the intervention group received also BHI. Data were collected prior to the intervention, immediately afterwards, and one month following the intervention. The Generalized Estimating Equation was used to measure the effects in the level of hope, decisional conflict scores (DCS) and Kidney Disease Quality of life (KDQOL-36) scores. Estimated marginal means and standard errors with 95% confidence intervals of these scores were also reported to examine the within group and between group changes., Results: An increase of the hope score was found from time 1 (29.7, 1.64) to time 3 (34.4, 1.27) in the intervention group. The intervention had a significant effect on the KDQOL-36 sub-scores Mental Component Summary (MCS) (Wald χ 2  = 6.763, P = 0.009) and effects of kidney disease (Wald χ 2  = 3.617, P = 0.004). There was a reduction in decisional conflict in both arms on the DCS total score (Wald χ 2  = 7.885, P = 0.005), but the reduction was significantly greater in the control group (effect size 0.64)., Conclusions: The BHI appeared to increase the level of hope within the intervention arm. Nonetheless, differences across the intervention and control arms were not significant. The KDQOL-36 sub-scores on MCS and Effects of kidney disease were found to have increased and be higher in the intervention group. The DCS total score also showed that hope was associated with reducing decisional conflict., Trial Registration: ClinicalTrials.gov Protocol Registration, NCT03378700 . Registered July 12 2017., (© 2022. The Author(s).)

Background: In recent years, telehealth has become a common channel for health care professionals to use to promote health and provide distance care. COVID-19 has further fostered the widespread use of this new technology, which can improve access to care while protecting the community from exposure to infection by direct personal contact, and reduce the time and cost of traveling for both health care users and providers. This is especially true for community-dwelling older adults who have multiple chronic diseases and require frequent hospital visits. Nurses are globally recognized as health care professionals who provide effective community-based care to older adults, facilitating their desire to age in place. However, to date, it is unclear whether the use of telehealth can facilitate their work of promoting self-care to community-dwelling older adults., Objective: This review aims to summarize findings from randomized controlled trials on the effect of nurse-led telehealth self-care promotion programs compared with the usual on-site or face-to-face services on the quality of life (QoL), self-efficacy, depression, and hospital admissions among community-dwelling older adults., Methods: A search of 6 major databases was undertaken of relevant studies published from May 2011 to April 2021. Standardized mean differences (SMDs) and their 95% CIs were calculated from postintervention outcomes for continuous data, while the odds ratio was obtained for dichotomous data using the Mantel-Haenszel test., Results: From 1173 possible publications, 13 trials involving a total of 4097 participants were included in this meta-analysis. Compared with the control groups, the intervention groups of community-dwelling older adults significantly improved in overall QoL (SMD 0.12; 95% CI 0.03 to 0.20; P=.006; I 2 =21%), self-efficacy (SMD 0.19; 95% CI 0.08 to 0.30; P<.001; I 2 =0%), and depression level (SMD -0.22; 95% CI -0.36 to -0.08; P=.003; I 2 =89%)., Conclusions: This meta-analysis suggests that employing telehealth in nurse-led self-care promotion programs may have a positive impact on older adults, although more studies are needed to strengthen the evidence base, particularly regarding organization and delivery., Trial Registration: PROSPERO (Prospective International Register of Systematic Reviews) CRD42021257299; https://www.crd.york.ac.uk/prospero/display&#95;record.php?RecordID=257299., (©Arkers Kwan Ching Wong, Jonathan Bayuo, Frances Kam Yuet Wong, Wing Shan Yuen, Athena Yin Lam Lee, Pui King Chang, Jojo Tsz Chui Lai. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 21.03.2022.)

Background: Transitioning from the burn unit to the home/community can be chaotic with limited professional support. Some adult burn survivors may face varied concerns leading to poor outcomes in the early post-discharge period with limited access to professional help. Based on these, a nurse-led transitional burns rehabilitation programme has been developed and the current trial aims to ascertain its effects as well as explore the implementation process., Methods: A single-centre, double-arm randomised controlled trial with a process evaluation phase will be utilised for this study. All adult burn survivors aged ≥ 18 years with burn size ≥ 10% total burn surface area at the site during the study period will be screened for eligibility at least 72 h to discharge. A sample size of 150 will be block randomised to treatment (receiving the nurse-led transitional care programme and routine post-discharge service) and control groups (receiving routine post-discharge service). The nurse-led transitional care programme comprises of predischarge and follow-up phases with the delivery of bundle of holistic interventions lasting for 8 weeks. There are three timelines for data collection: baseline, immediate post intervention, and 4 weeks post-intervention., Discussion: The findings from this study can potentially inform the development and organisation of post-discharge care and affirm the need for ongoing comprehensive home-based care for burn survivors and their families TRIAL REGISTRATION: ClinicalTrials.gov NCT04517721 . Registered on 20 August 2020., (© 2021. The Author(s).)

Background: Healthcare providers are facing the challenge of helping cancer patients cope with the impact of outpatient-based chemotherapy. A nurse-led care program was proposed to address this challenge., Objective: The aim of this study was to examine the effects of a nurse-led care program for patients receiving outpatient-based chemotherapy., Methods: This was a single-center, open-label, 2-arm parallel trial with equal randomization (NCT02228200). Breast cancer patients in Hong Kong were randomly allocated to the intervention arm or the control arm. The control arm received routine hospital care. The intervention arm received the nurse-led care plus the routine hospital care. The quality of life, self-efficacy, symptom distress levels, and satisfaction with care were evaluated with questionnaires before randomization (T0), in the middle of chemotherapy (T1), and 1 month after chemotherapy (T2). Individual interviews were conducted with some participants in the intervention arm at T2., Results: The intervention arm participants reported significantly lower distress levels from oral problems, fatigue, peripheral neuropathy, distressful feelings, and higher satisfaction with care. According to the satisfaction evaluation and the interviews, the participants stated that the service was helpful in providing information and communication opportunities, filling the service gap after drug administration, providing psychological support, relieving discomfort, and building confidence., Conclusion: Breast cancer patients received support from the provision of comprehensive, continuous, and individualized care., Implications for Practice: The nurse-led care program could be applied to breast cancer patients in other hospitals in Hong Kong. Exploring its applicability to cancer settings in other countries is recommended.

Purpose: To evaluate the cost-effectiveness of a nurse-led care program for breast cancer patients receiving outpatient-based chemotherapy., Method: An open-label, single-center randomized controlled trial was conducted. Patients receiving the nurse-led care and those receiving the routine care were compared in terms of quality of life, as well as in health service utilizations and total cost of care. A cost-utility analysis was conducted., Results: A total of 124 patients were recruited. The data of 116 subjects who completed the study were used for the cost-utility analysis. There were 81 unscheduled hospital visits and 43 hospital admissions. The common reasons for utilizing health services were infections and fevers, skin problems, digestive system problems, and mouth/teeth/throat problems. There were no differences in health service utilizations between the nurse-led and routine care groups for subjects receiving four-cycle chemotherapy. For those receiving six-cycle chemotherapy, the estimated number of emergency department visits was 2.188 times (95% Confidence Interval, 1.051 to 4.554) higher for the routine care group when compared with the nurse-led care group (p = .038). The incremental cost-utility ratios were £8856 and £18,936 per quality-adjusted life year gained for subjects receiving four-cycle and six-cycle chemotherapy, respectively., Conclusions: Cancer patients make unscheduled health service visits when receiving outpatient-based chemotherapy, which leads to increased health service costs. The nurse-led care reduces emergency departments visits made by breast cancer patients undergoing six-cycle adjuvant chemotherapy. For breast cancer patients undergoing four-cycle chemotherapy and six-cycle chemotherapy, the nurse-led care could be cost-effective., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

This paper discusses the development of advanced nursing practice in China in the context of global development. The scope of nursing is evolving over time, with increasing demands for the management of complex healthcare situations at individual, community and system levels. These demands are aggravated by the specialization of medical practice, with advanced treatment plans and patients requiring care in focused areas. The qualifications and competencies of the initial entrants into nursing practice are not adequate to deal with these demands. Advanced nursing practice (ANP) developed first in response to service demands, and education programs were introduced to prepare nurses for practicing at a higher level. This paper will first review the historical development of ANP in China, followed by a discussion of the differentiation of competence levels in nursing practice and the classification of specializations. It concludes by exploring how education in combination with experience protected by regulation of practice can support nurses to gradually evolve from registered nurse, specialty nurse to advanced practiced nurse.

Background: self-care is critical to enable community-dwelling older adults to live independently. Complex interventions have emerged as a strategy to support self-care, but their effectiveness is unknown. Our objective was to review systematically their effectiveness on both positive (increased scores in self-rated health, Activities of Daily Living, Instrumental Activities of Daily Living, quality of life) and negative aspects (increased incidence of falls, fear of falling, hospital and nursing home admission, increased depression score), and to determine which intervention components explain the observed effects., Methods: CINAHL, MEDLINE, British Nursing Index, PsycInfo and Cochrane CENTRAL were searched from January 2006 to October 2016. Randomised controlled trials providing at least two of these components: individual assessment, care planning or provision of information were reviewed. Outcomes were pooled by random-effects meta-analysis., Results: twenty-two trials with 14,364 participants were included with a low risk of bias. Pooled effects showed significant benefits on positive aspects including self-rated health [standardised mean difference (SMD) 0.09, 95% confidence interval (CI) 0.01-0.17] and the mental subscale of quality of life (SMD 0.44, 95% CI 0.09-0.80) as well as on the negative aspect of incidence of falls [odds ratio (OR) 0.60, 95% CI 0.46-0.79]. There was no significant improvement in ADL, IADL, overall quality of life, fear of falling, reduction in health service utilisation or depression levels. Meta-regression and subgroup analysis did not identify any specific component or characteristic in complex interventions which explained these effects., Conclusion: based on current evidence, supporting self-care in community-dwelling older adults using complex interventions effectively increases self-rated health, reduces the occurrence of falls and improves the mental subscale of quality of life., (© The Author 2017. Published by Oxford University Press on behalf of the British Geriatrics Society.All rights reserved. For permissions, please email: journals.permissions@oup.com)

Background: Studies have shown positive clinical outcomes of specialist palliative care for end-stage heart failure patients, but cost-effectiveness evaluation is lacking., Aim: To examine the cost-effectiveness of a transitional home-based palliative care program for patients with end-stage heart failure patients as compared to the customary palliative care service., Design: A cost-effectiveness analysis was conducted alongside a randomized controlled trial (Trial number: NCT02086305). The costs included pre-program training, intervention, and hospital use. Quality of life was measured using SF-6D., Setting/participants: The study took place in three hospitals in Hong Kong. The inclusion criteria were meeting clinical indicators for end-stage heart failure patients including clinician-judged last year of life, discharged to home within the service area, and palliative care referral accepted. A total of 84 subjects (study = 43, control = 41) were recruited., Results: When the study group was compared to the control group, the net incremental quality-adjusted life years gain was 0.0012 (28 days)/0.0077 (84 days) and the net incremental costs per case was -HK$7935 (28 days)/-HK$26,084 (84 days). The probability of being cost-effective was 85% (28 days)/100% (84 days) based on the cost-effectiveness thresholds recommended both by National Institute for Health and Clinical Excellence (£20,000/quality-adjusted life years) and World Health Organization (Hong Kong gross domestic product/capita in 2015, HK$328117)., Conclusion: Results suggest that a transitional home-based palliative care program is more cost-effective than customary palliative care service. Limitations of the study include small sample size, study confined to one city, clinic consultation costs, and societal costs including patient costs and unpaid care-giving costs were not included.

Context: Provision of home-based palliative care (PC) for seriously ill patients is important, yet few home-based PC services specifically or exclusively focus on end-stage heart failure (ESHF) patients., Objectives: This study aimed to examine the effect of a home-based palliative heart failure (HPHF) program on quality of life (QOL), symptoms burden, functional status, patient satisfaction, and caregiver burden among patients with ESHF., Methods: This study was a two-group randomized controlled trial undertaken in three hospitals. We recruited a total of 84 hospitalized ESHF patients who were referred to PC. They were randomized to the intervention or control group. The intervention group received a 12-week structured program with regular home visits/telephone calls provided by the nurse case managers. Data were collected at baseline (T1) and at four (T2) and 12 weeks (T3) after discharge., Results: A statistically significant between-group effect was found, with the HPHF group having significantly higher McGill QOL total score than the control group (P = 0.016) and there was significant group × time interaction effect (P = 0.032). There was no significant between-group effects detected for the measures of symptom distress or functional status at 12 weeks. The intervention group had higher satisfaction (P = 0.001) and lower caregiver burden (P = 0.024) than the control group at 12 weeks., Conclusion: The HPHF program is effective in enhancing the QOL of ESHF patients, satisfaction with care, and caregiver burden. The program has potential to reduce distress for some of the symptoms., (Copyright © 2017. Published by Elsevier Inc.)

Background: The hypertension prevalence rate is increasing but the control rate is unsatisfactory. Nurse-led healthcare may be an effective way to improve outcomes for hypertensive patients but more evidence is required especially at the community level., Objective: This study aims to establish a nurse-led hypertension management model and to test its effectiveness at the community level., Design: A single-blind, randomized controlled trial was performed in an urban community healthcare center in China. Hypertensive patients with uncontrolled blood pressure (systolic blood pressure ≥140mmHg and/or diastolic blood pressure ≥90mmHg) were randomly allocated into two groups: the study group (n=67) and the control group (n=67). The nurse-led hypertension management model included four components (delivery system design, decision support, clinical information system and self-management support). Patients in the control group received usual care. Patients in the study group received a 12-week period of hypertension management. The patient outcomes, which involved blood pressure, self-care behaviors, self-efficacy, quality of life and satisfaction, were assessed at three time points: the baseline, immediately after the intervention and 4 weeks after the intervention., Results: After the intervention, the blood pressure of patients in the study group decreased significantly compared to those in the control group, and the mean reduction of systolic/diastolic blood pressure in the study and control groups was 14.37/7.43mmHg and 5.10/2.69mmHg, respectively (p<0.01). In addition, patients in the study group had significantly greater improvement in self-care behaviors than those in the control group (p<0.01). The study group had a higher level of satisfaction with hypertensive care than the control group (p<0.01). No statistically significant difference in self-efficacy and quality of life was detected between the two groups after the intervention., Conclusions: The nurse-led hypertension management model is feasible and effective in improving the outcomes of patients with uncontrolled blood pressure at the community level., (Copyright © 2017. Published by Elsevier Ltd.)

Purpose: To examine the exemplary practice of nurse consultants (NCs) and derive a model to illustrate the highest level of advanced nursing practice., Design: A descriptive study was conducted to examine the practice and outcomes of seven NC roles in varied clinical specialties in Hong Kong. Exemplary practice was examined in relation to competencies for advanced practice nursing in Hong Kong and the United Kingdom., Methods: Data about NC characteristics and their practices were collected using a structured questionnaire and analyzed using descriptive statistics. Health service documents and clinical notes were analyzed using the framework approach., Findings: All NCs demonstrated the competence expected of an advanced practice nurse with impacts on patients, nursing profession, and the organization as identified in the advanced nursing practice framework in Hong Kong. NCs also performed at the highest level of practice delineated by Skills for Health in the United Kingdom. They were involved in diagnostic and therapeutic practice, and identified patient satisfaction and symptom management as key outcomes., Conclusions: This study provides new insight into levels of advanced practice and illustrates the exemplary work of NCs to demonstrate how they have developed and shaped services to bring about positive patient and organizational outcomes. Career laddering that places NCs at the highest level of advanced practice is important for making the best use of nursing expertise to achieve optimal patient and organizational outcomes., Clinical Relevance: This study addresses a knowledge gap to enrich our current understanding of the impact of advanced practice nursing roles by linking NC role practices and competencies to key outcomes., (© 2017 Sigma Theta Tau International.)

Background: Although interprofessional education has received attention in recent years as a means of providing opportunities for health-care professionals to learn with, from and about other disciplines and enhance the quality of patient care, evidence of its effectiveness is limited. Interprofessional team-based learning was introduced to make it possible for students in different healthcare disciplines to interact with each other, and to prepare them to function effectively within a team in their future career., Objectives: To examine the effects of interprofessional team-based learning for undergraduate nursing students in terms of knowledge level, readiness for interprofessional learning, attitude towards various aspects of team learning, and perceived collective efficacy., Design: The study employed a one-group pretest-posttest quasi-experimental design., Methods: An interprofessional education program was given to students from two universities in Hong Kong who were in different healthcare disciplines including medicine, nursing, pharmacy, biomedical science, and Chinese medicine programs. The program was based on four phases of student learning- individual readiness assessment test, ice breaking session, team readiness assessment test, and application exercise. Nursing students involved in the program were invited to complete anonymous questionnaires to evaluate their interprofessional team experience., Results: A total of 40 nursing students (9 male, 31 female) participated in the study. A statistically significant improvement was identified in their knowledge level (p<0.001), attitude towards readiness for interprofessional learning, team learning, and perceived collective efficacy (p<0.001)., Conclusion: This study suggests that interprofessional team-based learning can enhance cross-disciplinary learning and outcomes resulting from team efforts., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Purpose: Patients with rectal cancer have issues in adjusting to their permanent colostomy after surgery, and support is required to help them resume normal life. However, few studies have explored the experience and factors that affect a patient's decision-making and maladjustment prior to colostomy surgery. The aim of this study was to explore the experience of rectal cancer patients who have to undergo colostomy surgery., Method: A descriptive, qualitative design was used. We studied a purposive sample of 18 patients who had received a diagnosis of primary rectal cancer and were expecting permanent colostomy surgery. The thematic analysis approach was used to analyze the data collected using semi-structured, open-ended questions., Results: The overriding theme that emerged was 'stoma dilemma: a hard decision-making process'. From this main theme, three themes were derived: the resistance stage, the hesitation stage, and the acquiescence stage., Conclusion: It is hard for preoperative rectal patients to choose to undergo stoma surgery or a sphincter-saving operation. From the initial stage of definitive diagnosis to the final consent to stoma surgery, most patients experience the resistance and hesitation stages before reaching the acquiescence stage. Arriving at a decision is a process that nurses can facilitate by eliminating unnecessary misunderstanding surrounding colostomy surgery and by fully respecting patients' right to choose at the various stages., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Patients on maintenance hemodialysis suffer from diminished physical health. Directly supervised exercise programs have been shown to be effective at improving physical function and optimizing well-being. However, nurses seldom include an exercise intervention in the care plan for hemodialysis patients., Objectives: The purpose of this study was to examine the effects of a 12-week nurse-led case management program on home exercise training for hemodialysis patients., Design: The study was a randomized, two-parallel group trial., Settings: Hemodialysis units in two tertiary hospitals in Nanjing, mainland China., Participants: One hundred and thirteen adult patients who have been in stable condition while on dialysis treatment for more than 3 months were recruited and randomly assigned to either the study group (n=57) or the control group (n=56)., Methods: Both groups underwent a brief weekly in-center exercise training session before their dialysis sessions for the first 6 weeks. The study group received additional nurse case management weekly for the first 6 weeks and biweekly for the following 6 weeks. The intervention was to facilitate patients in performing regular exercise at home. Outcome measures, including gait speed, 10-repetition sit-to-stand performance, and quality of life were collected at baseline, and at 6 and 12 weeks into the program., Results: The results revealed that patients in the study group demonstrated greater increases in normal gait speed [F(1,111)=4.42, p=0.038] than the control group. For the study group, a mean increase of 12.02 (±3.03)centimeters/second from baseline to week 12 was found. With regard to the fast gait speed, there was a marginally significant between-group effect [F(1,111)=3.93, p=0.050]. The study group showed a mean improvement of 11.08 (±3.32)cm/s, from baseline to week 12. Patients from both groups showed improvements in their 10-repetition sit-to-stand performance. The between-group differences approached significance [F(1,111)=3.92, p=0.050], with the study group showed greater improvement than the control group. The time taken by the patients in the study group to complete the 10-STS test increased by 5.75 (±3.88)s from baseline to week 12. Significant improvements in quality of life across three time points were found only in the study group., Conclusions: Home exercise using a nurse-led case management approach is practical and effective in improving the physical function and self-perceived health of stable hemodialysis patients., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

This study aims to develop a nurse-led hypertension management model in the community setting and pilot it to an experimental trial. A total of 73 recruited participants were randomly allocated into two groups. The study group received a home visit and 2-4 telephone follow-ups from the trained community nurses assisted by nursing student volunteers. The control group received doctor-led hypertension management. Data was collected at recruitment and immediately after the 8-week program. Outcome measures included blood pressure readings, self-care adherence, self-efficacy, quality of life, and patient satisfaction. Participants from the study group led by nurses had significant improvement in self-care adherence, patient satisfaction post-intervention than those from the control group led by doctors. However, there were no statistical significant differences in blood pressure readings, quality of life and self-efficacy between the two groups. The findings show that the nurse-led hypertension management appears to be a promising way to manage hypertensive patients at the community level, particularly when the healthcare system is better integrated.

Purpose: The aim of the review was to summarize the longitudinal changes in bowel dysfunction among patients with rectal cancer within the first five years following sphincter-preserving resection., Methods: A series of literature searches were conducted on six English-language electronic databases. Articles published after 1990 were searched. A total of 29 articles (reporting 27 studies) was found., Results: Bowel dysfunction, including an alteration in the frequency of bowel movements, incontinence, abnormal sensations, and difficulties with evacuation, is reported among patients with rectal cancer within the first five years after sphincter-preserving resection. These problems are most frequent and severe within the first year, especially within the first six months, and stabilize after one year. Some of the problems may last for years., Conclusion: Supportive care for bowel dysfunction is needed, and should include the provision of information and psychological support delivered in multiple steps. Oncology nurses can play an important role in providing supportive care for rectal cancer patients with bowel dysfunction., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Caring for dying patients can be an emotionally painful, distressing and sometimes threatening experience for nurses as the illness is incurable and death is imminent. The avoidance of discussion of dying in the presence of patients in Chinese culture further increases nurses' anxiety. The purpose of this article is to provide an example of how nurses can be helped when caring for dying patients by using a problem-based learning (PBL) approach in Hong Kong. The process and value of using PBL is discussed from the students' perspective. Students went through the PBL process and documented their learning throughout the course in journals. A total of 96 sets of journals were collected and analysed. The case analysis explored the perception of learning in the process of PBL. Three themes, related to nurses' attitudes and caring behaviours towards death and dying, have been derived from the findings. They were (a) increased self-awareness (b) positive attitudes towards death (c) providing culturally sensitive care. Problem-based learning as a pedagogical strategy for achieving learning in death and dying was well received. Problem-based learning was found to be a highly satisfactory method for enabling nurses to reflect on their own attitudes towards death and understanding of the emotional aspects of death and dying. Independent finding of information not only prompted nurses to find information from books and journals, but nurses also interviewed experts and patients for updated and experiential knowledge. Tutorials serve as a safe environment for discussion and sharing of feelings and information. The results definitely support PBL as an effective teaching strategy for nursing educators in the area of death education., (Copyright 2002 Published by Elsevier Science Ltd.)