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Aims and objectives: To examine the psychological well‐being and quality of life of Hong Kong Chinese adolescents with congenital heart disease. Background: Congenital heart disease (CHD) in adolescents is associated with having negative psychological impact and impairment to quality of life. A literature review revealed that most studies on the impact of CHD on the psychological well‐being and quality of life of adolescents to date have been conducted in Western populations. Method: A cross‐sectional design was employed. Adolescents aged 12–18 with CHD attending an outpatient clinic in an acute public hospital were invited to participate. Another similar age group of healthy Chinese adolescents was also invited to participate for comparison purposes. Subjects were asked to respond to the Chinese version of the Pediatric Quality of Life Inventory 4.0 Generic Core Scales, Center for Epidemiologic Studies Depression Scale for Children, Rosenberg Self‐Esteem Scale and a demographic sheet. A STROBE checklist was completed. Results: Adolescents with CHD exhibited more depressive symptoms, lower self‐esteem and poorer quality of life than their healthy counterparts. Disease severity might affect the self‐esteem, depressive symptoms and quality of life of adolescents with CHD. Disease severity, depressive symptoms, self‐esteem level and types of treatment received were associated with the quality of life of adolescents with CHD. Conclusions: Hong Kong Chinese adolescents suffering from CHD experience negative impacts on their psychological well‐being and quality of life. In this group, disease severity may affect psychological well‐being and quality of life. Specifically, quality of life of adolescents with CHD was associated with disease severity, depressive symptoms, self‐esteem level and the type of treatment received. Relevance to clinical practice: The findings contribute to clinical care guidelines and serve as a reference in developing nursing intervention to adolescents with CHD so as to uphold quality of care. Clinical trial registration: NCT03255850 (Clinical trial.gov). [ABSTRACT FROM AUTHOR]

Aims and objectives: This study evaluates the clinical effectiveness of a multicomponent aroma‐massage with an acupressure treatment protocol and compared it to cognitive training for the management of behavioural and psychological symptoms of dementia. Background: Pharmacological interventions have been unsatisfactory in managing behavioural and psychological symptoms of dementia; thus, complementary and alternative medicine has been extensively researched to identify an adjunct safe and cost‐effective intervention. Design: This randomised clinical trial utilised a three‐arm parallel group design. Cognitive training was used as a conventional intervention to manage behavioural and psychological symptoms of dementia, whereas exercise was considered “treatment as usual” in this study; both were used as comparisons with the experimental protocol. There were three treatment groups: Group 1: aroma‐massage with acupressure + exercise, Group 2: cognitive training + exercise and Group 3: aroma‐massage with acupressure + cognitive training. Method: Sixty older adults were recruited and randomly assigned to the three groups (20 each). Using the 29‐item Chinese Version of the Cohen‐Mansfield Agitation Inventory, Neuropsychiatric Inventory, Mini‐mental State Examination and Barthel Index‐20, the outcome measures were assessed at preintervention, postintervention and the 3‐month follow‐up to assess behaviour, Activities of Daily Living, cognition, and behavioural and psychological symptoms of dementia severity and distress. Multiple comparisons performed through repeated measures were analysed to detect between‐group differences and within‐subject differences, as well as the interaction effects between groups and times. Results: The Group 1 and 3 participants showed a significant reduction in the severity and distress caused by behavioural and psychological symptoms of dementia, whereas Group 2 did not demonstrate similar effects. Conclusions: This clinical study suggests that aroma‐massage with acupressure is as effective as cognitive training and can enhance cognitive training in reducing the severity and distress of behavioural and psychological symptoms of dementia. Relevance to clinical practice: Aroma‐massage with acupressure may serve as an adjunct therapy to reduce behavioural and psychological symptoms of dementia. This therapy is safe, cost‐effective and can be implemented by caregivers and family members who are not professionally trained. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the effects of a home exercise programme on patients' perceptions of the barriers and benefits to exercise and adherence to the programme. Background Great efforts have been made to encourage dialysis patients to participate in rehabilitation regimens. The promotion of exercise in this population is still limited. Design This was a post hoc analysis of a randomised, two-group parallel study. Methods A total of 113 adult patients recruited from the haemodialysis units were randomised into two groups on a 1:1 ratio. Both groups received in-centre group exercise training weekly for 6 weeks. The intervention group patients were provided with an additional individualised nurse-led home exercise prescription and behavioural support for 12 weeks. The patients' perceptions of the barriers and benefits to exercise, adherence to the home exercise prescription and their exercise level at weeks 6 and 12 were evaluated. Results There was a significant between-group difference in the score on patient perceptions of the barriers and benefits to exercise, with the intervention group reporting a greater reduction in perceived barriers to exercise. Significant group differences were noted in exercise level upon the completion of the programme, with the intervention group reporting higher such levels. The average adherence rate to the negotiated exercise plans was 78.9%. The intervention group of patients did better at meeting or exceeding the minimum exercise goal than did the control group. Conclusion Home exercise prescriptions and behavioural support provided by trained nurses are effective at helping patients to remove barriers to engaging in exercise training. Relevance to clinical practice Physical exercise in a clinical arena should not be considered the exclusive domain of physical therapists; the team could collaborate with nurses to play a core role in making physical exercise for patients an essential practice of care in a multidisciplinary team. [ABSTRACT FROM AUTHOR]

Aims and objectives This study aimed to investigate the feasibility and efficacy of swaddling to control procedural pain among preterm infants. Background Swaddling has been recommended for controlling neonatal pain. However, the feasibility for use is uncertain and insufficient evidence is available among preterm infants. Design A two-arm randomised controlled trial with repeated measures. Method The study was conducted in a 21-bed neonatal intensive care unit of a regional hospital in Hong Kong. Preterm infants who required heelstick procedure were eligible. Fifty-four preterm infants between 30-37 gestational weeks were randomly assigned to swaddling ( n = 27) and control (standard care, n = 27) groups. Pain assessment was performed pre, during, immediate, two, four, six and eight minutes after heelstick procedure using the Premature Infant Pain Profile. Results The mean Premature Infant Pain Profile scores were significantly reduced in the intervention group compared to the control group during, immediate, two, four, and six minutes after the heelstick procedure. The mean changes of heart rate and oxygen saturation in the intervention group were significantly lower than that of the control group at all measured time points. Notably, the swaddled infants quickly resumed to the baseline level at two minutes whereas the control group reached the stable state at an extended period of six minutes. Conclusion The findings show that swaddling is feasible and efficacious in controlling pain for heelstick procedure among preterm infants. No adverse effects were observed. Relevance to clinical practice This article presents the feasibility and efficacy of swaddling as a non-pharmacological and non-invasive intervention to relieve pain during the heelstick procedures among preterm infants. Swaddling can contribute to control minor procedural pain in neonates as one of the simple, safe, cost effective, humanistic and natural analgesia alternatives. [ABSTRACT FROM AUTHOR]

Aims and objectives To assess the effects of motivational interviewing for obese children and telephone consultation for parents to promote weight loss in obese children. Background Childhood obesity is a worldwide health problem that leads to serious metabolic and physiological consequences. An effective intervention to manage obesity is essential. Motivational interviewing is designed to resolve ambivalence, enhance intrinsic motivation and promote confidence in a person's ability to make behaviour changes. It has shown promise in the adult obesity literature as effecting positive health behaviour changes. Motivational interviewing has also been proposed as an effective method for improving the weight loss of obese children. Design A pre-post quasi-experimental design with repeated measures was used. Methods The study was conducted in four primary schools over an 11-month period in 2010-2011. Obese children ( n = 185) were screened from 791 school children studying the equivalent to UK grades 5 and 6 and were divided into three groups: motivational interviewing, motivational interviewing+ and a control group. The motivational interviewing group ( n = 70) children were provided with motivational interviewing counselling; the motivational interviewing+ group ( n = 66) children were provided with motivational interviewing counselling while telephone consultation was provided for their parents; and the control group did not receive any intervention ( n = 49). Results Children in both the motivational interviewing and motivational interviewing+ groups showed significant improvement in their weight-related behaviour and obesity-related anthropometric measures from the baseline to the end of the 14-week intervention, while the control group had significant deterioration in their anthropometric measures. Conclusion Motivational interviewing appears to be a promising intervention for promoting weight loss in obese children. Motivational interviewing counselling may be extended to obese children of different age groups. Relevance to clinical practice This study indicates that motivational interviewing is a useful method for improving behaviour changes in eating, physical activity and weight loss for obese children, suggesting the benefits of such intervention. [ABSTRACT FROM AUTHOR]

Aims. To explore nurses' attitudes and level of satisfaction in using the Hospital Information System in clinical practice. Background. Application of the Hospital Information System is increasing and there is substantial evidence suggesting that the successful implementation of Hospital Information System is significantly related to nurses' attitudes. However, little information is currently available on the factors influencing those attitudes and their level of satisfaction in Hospital Information System use. Design. Cross-sectional survey. Methods. A stratified, random sampling of 342 nurses working in a Hong Kong private hospital and using Hospital Information System was recruited. A questionnaire was used to collect data on perceptions, level of satisfaction and attitudes towards Hospital Information System usage. Correlations and linear regressions were used to analyse the data. Results. Multiple linear regression analysis showed that work units, perceived usefulness and information technology support are the three predictors of nurses' attitudes and level of satisfaction with the system. In addition, nurses who have higher perceived ease of use and better satisfaction towards using the system are associated with positive attitude. Conclusion. The study results serve to guide the nurse managers to develop information systems based on the nurses' needs. Previous studies regarded nurses' level of satisfaction as a part of nurses' attitude. What is of interest in this study is that nurses' satisfaction level can be viewed as an individual factor affecting nurses' attitudes. With a user-friendly system, nurses tend to be more satisfied and therefore potentially more engaged in its use. This may indirectly improve patient care by saving time on documentation and enhancing communication among departments. Relevance to clinical practice. The nurse managers should promote an institutional culture to motivate staff towards positive acceptance of innovation. An effective collaboration with the information technology team would enhance a more efficient exchange of information to understand the complex factors of IT implementation. [ABSTRACT FROM AUTHOR]

Aim. To describe the relationship between self-appraised problem-solving abilities and psychological distress, burden and perceived social support in informal, family stroke caregivers. Background. Previous research suggests that self-appraised problem-solving abilities play a significant role in the well-being of family caregivers of patients with chronic illness. However, little is known about its role in caregivers of stroke survivors. Design. Prospective correlational study. Methods. One week before discharge, 103 family caregivers of survivors of a first stroke were assessed for their perceived problem-solving abilities, social support, anxiety, depression and physical well-being. At three months postdischarge, 85 of these caregivers (83% retention) were reassessed on the same measures. In addition, their levels of burden and perceived difficulties were also measured. Results. Using multiple regression, overall self-appraised problem-solving abilities and its subscale 'confidence in problem-solving' at one week before discharge were significant predictors of caregiver perceived social support ( R2 = 29%) and perceived physical well-being ( R2 = 42%) at three months postdischarge. Other relationships were non-significant. Conclusions. Caregivers' perceived social support and physical well-being were significantly predicted by confidence in problem-solving. Relevance to clinical practice. This study is timely given the challenges facing health systems in Hong Kong to effectively manage chronic illness through family-centred care. The significant relationships between caregiver self-appraised problem-solving, perceived social support and well-being suggest that interventions maximising caregiver confidence in problem-solving might be valuable in supporting family caregivers of stroke survivors. Nurses working with families caring for stroke survivors both close to discharge and in the early transition stages back at home may be in an ideal position to offer this support. [ABSTRACT FROM AUTHOR]

Aims. To describe and compare the lifestyle behaviours and psychosocial well-being of Chinese adolescents aged 10-19 in the two cities of Hong Kong and Guangzhou and to identify the factors that most influence adolescents' lifestyle patterns in these two cities. Background. Health-promoting lifestyle behaviours of adolescents are influenced by economic growth and societal changes. Design. A cross-sectional comparative survey. Methods. The Chinese version of the Adolescent Lifestyle Questionnaire was used to measure the adolescents' lifestyle behaviours and psychosocial well-being in the primary and secondary schools. Results. A total of 2014 adolescents aged 10-19 responded to the survey in Hong Kong ( n = 1008) and Guangzhou ( n = 1006). Adolescents in Guangzhou practised healthier lifestyle behaviours and psychosocial well-being than adolescents in Hong Kong, with statistically significant differences in all the seven dimensions. Adolescents in Guangzhou, when compared with those in Hong Kong, obtained higher mean scores in 'physical participation' (9·6 vs. 8·9, p < 0·001), 'nutrition' (20·2 vs. 17·6, p < 0·001), 'social support' (19·6 vs. 18·9, p = 0·001), 'stress management' (9·6 vs. 9·3, p = 0·022), 'identity awareness' (25·7 vs. 23·5, p < 0·001), 'health practices awareness' (9·2 vs. 8·3, p < 0·001) and 'safety' (21·6 vs. 20·6, p < 0·001). Demographic factors that contributed to adolescents' lifestyle behaviours were living in Guangzhou (OR = 1·92, 95% CI 1·56, 2·44), being in the younger age group (10-14 years old) (OR = 2·44, 95% CI 2·00, 3·03) and living with both parents (OR = 1·92, 95% CI 1·12, 3·27). Conclusions. Socio-economic disparities, family composition and age group are the key factors associated with adolescents' healthy lifestyle behaviours. Further research is needed to understand the complex causal pathways between ethnicity, social environment and health behaviours. Relevance to clinical practice. Parental lifestyles inevitably influence the lifestyles of their young. Therefore, nurses should emphasise the health education of both parents and youth as future parents and support parents in modelling health-promoting lifestyles. [ABSTRACT FROM AUTHOR]

Aim. The aim of this study was to evaluate a pressure ulcer prevention programme for nursing homes to ascertain the feasibility of its implementation, impact on care staff and outcomes for pressure ulcer knowledge and skills and pressure ulcer reduction. Background. No pressure ulcer prevention protocol for long-term care settings has been established to date. The first author of this study thus developed a pressure ulcer prevention programme for nursing homes. Design. A quasi-experimental pretest and post-test design was adopted. Methods. Forty-one non-licensed care providers and eleven nurses from a government-subsidised nursing home voluntarily participated in the study. Knowledge and skills of the non-licensed care providers were assessed before, immediately after and six weeks after the training course, and pressure ulcer prevalence and incidence were recorded before and during the protocol implementation. At the end of the programme implementation, focus group interviews with the subjects were conducted to explore their views on the programme. Results. A statistically significant improvement in knowledge and skills scores amongst non-licensed care providers was noted. Pressure ulcer prevalence and incidence rates dropped from 9-2·5% and 2·5-0·8%, respectively, after programme implementation. The focus group findings indicated that the programme enhanced the motivation of non-licensed care providers to improve their performance of pressure ulcer prevention care and increased communication and cooperation amongst care staff, but use of the modified Braden scale was considered by nurses to increase their workload. Conclusion. A pressure ulcer prevention programme for nursing homes, which was feasible and acceptable, with positive impact and outcome in a nursing home was empirically developed. Relevance to clinical practice. The study findings can be employed to modify the programme and its outcomes for an evaluation of effectiveness of the programme through a randomised controlled trial. [ABSTRACT FROM AUTHOR]

Aims. To explore and describe the distinctive role of nurses in delivering school health services for primary and secondary school students in Hong Kong. Background. The practical responsibility of nurses in delivering school health services has not been established. There is no literature on this topic and, in particular, nothing has been written from the perspective of the practitioner in communities in Hong Kong. Design. A qualitative design using semi-structured interviews was employed. Methods. Thirteen school nurses were recruited and interviewed in 2006. The narratives were analysed using content analysis steps to identify categories. Results. Seven categories were formulated. School nurses described their roles as providers, counsellors, leaders, promoters, collaborators, referrers and administrators and housekeepers. The school nurses also reported that they needed to maintain a diverse range of skills and knowledge, such as effective communication skills and clinical updated knowledge, to cope with the demands and the diversity of their roles and to support the health and educational needs of the students and their local communities. Conclusion. The future development of the 'one school, one nurse' policy envisaged by the current government for ordinary schools in Hong Kong will not occur unless the role of school nurses is clearly delineated and valued by society as reducing school children's and adolescents' risk-taking behaviours and promoting the health and well-being of school children and adolescents. Relevance to clinical practice. The findings provide relevant information for school nurse leaders and school nurse policy makers to understand how school nurses are practicing and promoting child and adolescent health services, which can inform regional and national policy and practice. [ABSTRACT FROM AUTHOR]

The article discusses the results of a study on the role of a family-led mutual support program (FMSP) in enhancing the quality of life of caregivers of patients with dementia in Hong Kong, China. According to the authors, FMSP helps alleviate the psychological distress suffered by caregivers, delay the deterioration of the patients' illness after completing the intervention, and enhance caregivers' quality of life. They indicate that FMSP can lower the rate of institutionalization of patients.

The article discusses the results of a study on the efficacy of virtual reality computer games in enhancing the mental wellness of children with cancer in a hospital in Hong Kong, China. According to the authors, children receiving therapeutic play interventions had statistically fewer depressive symptoms than children receiving routine nursing care. They found no differences in the two groups in anxiety scores. They indicate that therapeutic play helps promote holistic and quality care.

The aim of this study was to explore Chinese women's perceptions of maternal role competence and factors contributing to maternal role competence during early motherhood. Developing a sense of competence and satisfaction in the maternal role are considered critical components in maternal adaptation, which have a significant impact on parenting behaviours and the psychosocial development of the child. However, qualitative studies that address maternal role competence are limited in the Chinese population. This was an exploratory descriptive study. A purposive sample of 26 Chinese primiparous mothers participated in a childbirth psychoeducation programme and was interviewed at six weeks postpartum. Data were analysed using content analysis. Women perceived a competent mother as being able to make a commitment to caring for the physical and emotional well-being of child, while cultivating appropriate values for childhood. Personal knowledge and experience of infant care, success in breastfeeding, infant's well-being, availability of social support and contradictory information from various sources were major factors affecting maternal role competency. The findings highlight the importance of understanding Chinese cultural attitudes to childrearing and maternal role competence. New Chinese mothers need information on child care, positive experiences of infant care, social support and consistent information to enhance their maternal role competency. Recommendations are made for Chinese culturally specific guidelines and healthcare delivery interventions to enhance maternal role competence in early motherhood. Nursing and midwifery care should always take into account the cultural beliefs and enable adaptation of traditional postpartum practices. Providing consistent information and positive experience on parenting skills and infant behaviour as well as enhancing effective coping strategies could strengthen Chinese women's maternal role competency. [ABSTRACT FROM AUTHOR]

To identify different approaches to end-of-life care decision-making among Chinese frail old age home residents. Advance care planning has been recently introduced to older people, family members and health care providers in the local community with the intention of better preparing them for end-of-life care. However, promoting the concept is challenging as the customary beliefs and previous research findings provide little reassurance that Chinese frail older people are ready for this potentially sensitive discussion. Qualitative study. Semi-structured interviews were used to evaluate the process of advance care planning and the readiness of the participants for such planning. The findings revealed five approaches towards end-of-life care decision-making among the frail old age home residents: holding on to life, planning ahead, weighing benefits, avoiding and deferring. The various approaches to end-of-life care decision-making, which affect the older person's level of engagement in advance care planning, are largely related to individual personal values, beliefs and experiences. The level of readiness of frail residents for advance care planning can be explained as a continuum and has to be interpreted in the personal context. The purpose of identifying various approaches is not to be able to screen for individuals who are more likely to undertake advance care planning. Rather, it is to provide insights into the different responses among frail older people with regard to advance care planning and hence the possible ways of devising a specific emphasis and strategies for engaging individuals in the planning process. [ABSTRACT FROM AUTHOR]

To identify omissions in hand hygiene practice and glove use among hospital workers in Hong Kong. Hospital-acquired infection is the commonest complication affecting hospitalised patients. Even though research evidence suggests that hand hygiene and proper glove use are the most important ways to prevent the spread of disease and infection, compliance with both are reported to be unacceptably low. An observational study of hospital workers in one acute and two convalescence and rehabilitation hospitals in Hong Kong was conducted. The participating clinical areas included the medical and surgical wards, accident and emergency department and intensive care unit. Hand hygiene practice and glove use amongst 206 hospital health and support workers, stratified according to years of working experience, were observed. The number of observed episodes for hand hygiene was 1037 and for glove use 304. Compliance with hand hygiene was 74·7% and with glove use 72·4%. In approximately two-third of episodes, participants washed their hands after each patient contact; though, 78·5% failed to rub their hands together vigorously for at least 15 seconds. The major break in compliance with glove use was failure to change gloves between procedures on the same patient. In 28·6% of observed glove use episodes, participants did not wear gloves during procedures that exposed them to blood, body fluids, excretion, non-intact skin or mucous membranes. Significant differences in performance scores on antiseptic hand rub were found between the two types of hospital and on glove use between the three groups of work experience: ≤5, 6-10, >10 years. Education and reinforcement of proper hand hygiene practice and glove use among hospital health and support workers is needed. [ABSTRACT FROM AUTHOR]

This study was to describe and compare the health concerns, behaviours and anxiety of advanced age pregnant women (35 years and older) with their younger counterparts. Women have specific health concerns and behaviours during pregnancy. Delayed childbearing has an increased risk of adverse pregnancy outcomes and advanced age pregnant women may have more health concerns than younger ones. A cross-sectional study. Primigravidae Chinese women aged 35 or older ( n = 47) and 188 younger than aged 35 were recruited in February and March of 2005 by convenient sampling from the antenatal clinic of a regional hospital in Hong Kong to complete a questionnaire. Advanced age pregnant women when compared with their counterparts were more likely to have tertiary education (42·6% vs. 28·7%) and a higher family monthly income of Hong Kong $40 001 or more (40·5% vs. 15·4%). They were more likely to be concerned the possibility of miscarriage (63·8% vs. 45·9%) and the physical demands of caring for the newborn (61·7% vs. 45·4%) but were more likely to take up healthy behaviours such as 'eating nutritious food' (100%) and avoiding 'wearing tight clothing and high-heel shoes'(100%). Advanced age women were more likely to be concerned about their 'recovery after childbirth' (63·8% vs. 42·7%), Down's syndrome (70·2% vs. 37·8%) and structural defects of their foetus (78·7% vs. 54·1%). The results of this study provide a background for improving prenatal care catering for the specific health concerns of the advanced aged and promotion of health behaviours among younger pregnant women. Antenatal, obstetric and community health nurses have the responsibility to provide education and support services catering to the special concerns of pregnant women at different ages. Health professionals should promote the prime time for childbearing and deliver messages regarding the potential problems associated with later childbearing at premarital counselling. [ABSTRACT FROM AUTHOR]

To determine the effect of music on sleep quality in older people. Sleep disturbance is common in older people and its impacts on older adults along with its conventional treatment merit our attention as our population ages. Conventional pharmacological method might result dependence and impairment in psychomotor and cognitive function. Listening to music, which is a non-pharmacological method, might promote relaxation, induce distraction responses and promote sleep quality. A randomised controlled study. The study was conducted from December 2006-January 2007. Forty-two older people (21 using music and 21 controls) completed the study in Hong Kong. Physiological (blood pressure and heart rate) and sleep quality variables were collected once a week for one month. For all vital signs' results, no significant differences were found between both music and control groups within the four weeks. In the music group, there was statistically significant reduction in sleep scores at week 4. In control group, there was no statistically significant improvement of sleep scores in the four weeks. However, no significant difference was found between groups over the four weeks. Whilst there were no statistical differences between groups, there was some indication that music yielder higher improvement on sleep scores, which are worthier of further investigation in larger trials. The implication of this study is that music listening can help nurses build therapeutic relationships with older people. Nurses are recommended to use music as part of their holistic caring for older people. [ABSTRACT FROM AUTHOR]

To examine what factors were associated with functional constipation amongst primary school students. Constipation in school-age children has also been brought to the attention of health care researchers because this requires long-term therapy. The prognosis of functional constipation is vague because it has many causative factors. In fact, the focus on constipation in the health care system is always placed on medical management, rather than prevention. A descriptive survey. The survey was conducted on March 2008 at one primary school in Hong Kong; 383 children who are studying in primary 3-5 aged from 8-10 completed a questionnaire. Three main outcome variables were employed in the study: demographic, constipation assessment scale and dietary and environmental factors. There were 7·3% students with functional constipation. Students who were age ∼10 ( p < 0·001), with a total daily fluid intake (200 ml/cup) of 3-4 cups ( p < 0·001) or +5 cups ( p < 0·001) and preference for eating fruit and vegetables ( p < 0·001) were less likely to have functional constipation. The findings should aid paediatric health care professionals and parents to gain a more profound understanding of the nature and prevention of functional constipation. To help primary school students and their parents to cope with functional constipation, greater familiarity with its prevalence and the characteristics of its contributory factors is needed. It is hoped that this could providing a better understanding and awareness of this issue and that it will encourage setting up strategies to decrease the morbidity and diminish the negative consequences of functional constipation for primary school students. Nurses can act as advocators for primary school students, parents and school teachers in understanding and preventing functional constipation. [ABSTRACT FROM AUTHOR]

This study was launched to address the knowledge gap regarding factors leading to readmission to hospital. Repeated hospital admission is an issue of concern for health care service providers. Research findings reveal that multiple factors can contribute to the phenomenon, but no study has examined the direct and indirect effects of these variables on hospital readmission. A survey conducted during the period from 2003-2005 in three hospitals in Hong Kong. Patients who were readmitted to the same hospital within 28 days during the study periods were included. Data were collected using structured interviews. A structural equation model was employed to examine what factors will contribute to hospital readmission. The final model showed that subjective health outcome was the only significant variable that had a direct effect on readmission, and it had indirect effects on readmission mediating through the variables of age, income and satisfaction with care. A literature review reveals that none of the studies has recognised patients' subjective appraisal of their health condition as a significant variable to predict hospital readmission. Results did not find an association between evaluated and perceived need. In other words, patients who felt a higher need for hospital care were not necessarily sicker. It is possible that if patients can be empowered to manage their own health condition and make a fair appraisal of their well-being, unnecessary use of hospital services can be reduced. This study provides evidence to support the notion that an effective transitional care programme needs to incorporate patients' own subjective assessment of health in the intervention and measurement of the outcome. We cannot solely use providers' judgment to measure health outcomes, for patients are active agents in seeking health care, and the use of services is to an extent self-selective. [ABSTRACT FROM AUTHOR]

Aims and objectives. This study attempted to test the plausibility of engaging frail nursing home residents in advance care planning (ACP). Background. Advance care planning fosters communication among individuals, family and health professionals regarding end-of-life care. Yet, such practice seldom takes place in a timely fashion because of its sensitive nature; thus, the concerns of these residents are often left unattended. Design. This was a one-year quasi-experimental study to test the feasibility of the Let Me Talk ACP programme, with its design being inspired by literature and our earlier work, among frail nursing home residents. Method. Three assessments were conducted at six-month intervals to monitor the programme effects. The storytelling approach, which allowed participants to thread together their past, present and future, was the key feature of the programme. Results. Findings showed that the treatment preference stability was significantly higher in the intervention group (κ = 0·53, p ≤ 0·001). Significantly more participants in this group also communicated their treatment preferences to their family or caregivers ( p = 0·012), with an odds ratio of 4·52. The programme also had a positive effect on mitigating participants' existential distress. Conclusions. The programme was found effective in clarifying participants' treatment preferences and encouraging them to communicate their preferences to significant others. However, it was also found that involving participants' family in open discussion remained difficult. Extensive promotion in the community is therefore necessary. Relevance to clinical practice. It is recommended that such ACP programmes should be integrated into nursing home care practice, as they can be initiated in a relaxed atmosphere and maintained as an ongoing process. The trusting relationship between the nurse in the homes and the residents enables in-depth discussion. The nurse is also well placed to play the facilitator role in guiding the process, providing information and mediating the family discussion. [ABSTRACT FROM AUTHOR]

Aims. To describe the process and explore the feasibility of training a colorectal nurse in Hong Kong to perform flexible sigmoidoscopy. Background. Given the shortage and high turnover rate of medical staff, a pilot programme was designed to train and expand the role of colorectal nurse clinicians. It was hoped that such nurses could share some of the clinical duties of the medical staff. An advanced practice nurse was selected for the programme. One of the training components was the performance of flexible sigmoidoscopy. Design. This was a descriptive, case review study. Method. A one-year-structured endoscopic training programme was designed for the nurse clinician. Weekly sessions were conducted by one of the trainers. The training process included the following: (1) procedural observation; (2) supervised withdrawal, advancement and manipulation of the sigmoidoscope and (3) a final assessment of the nurse’s competency in performing sigmoidoscopy independently. Results. In total, 119 outpatients (58 male and 61 female) with a mean age of 57·02 years (SD 14·6 years; range: 18–83 years) underwent flexible sigmoidoscopy by the nurse over 11 months. The mean procedural time was 9·38 minutes (SD 3·5 minutes; range 3–26 minutes). The procedure was terminated prematurely if it could not be tolerated by the patient or if the bowel preparation was inadequate. The mean depth of insertion was 53·5 cm (SD 12·2 cm; range 6–60 cm). In total, 82 patients had a normal exam, 32 patients had abnormalities. There were no procedural complications, and no patient required an unplanned hospital admission after the procedure. Conclusion. In Queen Mary Hospital, nurses can be trained to perform flexible sigmoidoscopy in a safe and effective manner. Relevance to clinical practice. Nurse endoscopists could increase the use of flexible sigmoidoscopy in colorectal cancer screening and can also enhance the professional development of colorectal nurses. [ABSTRACT FROM AUTHOR]