http://hdl.handle.net/10397/934 Search the Channel search http://repository.lib.polyu.edu.hk/jspui/simple-search http://hdl.handle.net/10397/5730 Title: The effects of a transitional care programme using holistic care interventions for Chinese stroke survivors and their care providers : a randomized controlled trial<br/><br/>Authors: Yeung, Siu Ming<br/><br/>Abstract: Background: Stroke is a sudden and catastrophic event affecting all aspects of survivors' life as well as their caregivers. In reviewing a variety of stroke RCT studies, it is found that the majority focused on interventions that enhanced physical functioning and cognitive behavioral conditions. Some studies examined specific stroke consequences and their relationships with psychosocial outcomes and quality of life. However, only a paucity of studies addressed the holistic health status of stroke survivors and their families. It is noted that at the system level, transitional care programmes have been developed to investigate the effects of continuous services in the transitional stage of care on selected groups of chronically ill clients such as elderly patients or patients with coronary health disease, but unfortunately, the stroke client group was not included. In view of the gap, this study aims at developing a transitional care programme with six strands of holistic care interventions. Based on the evidenced-based protocols, the transitional care programme focuses on addressing the holistic concerns of stroke survivors. Aim: This purpose of this study is to develop a holistic and transitional stroke care model and evaluate its effectiveness within a sample of Chinese stroke survivors in Hong Kong. Method: There were two stages in this study. In stage one, the stroke transitional care programme with interventions was developed based on Marshall's (2006) Evidence Based Practice (EBP) model. It contained six standardized protocols including (1) prerequisite and training of holistic case managers (HCMs), (2) application of the Omaha System as nursing documentation, (3) family meeting guided by motivational interviewing, (4) home visit, (5) telephone follow-up and (6) health and community care referral system which was implemented by HCMs. The HCMs are experienced community health nurses. A holistic care patient self-management log book was also developed in line with the interventions to provide holistic care health information and to empower health adherence behaviors of the stroke clients. In stage two, a randomized controlled trial was designed to evaluate the effects of the interventions. Subjects were recruited in hospitals within a cluster of the Hong Kong Hospital Authority system from August 2010 to September 2011. One hundred and eight stroke subjects were randomly assigned into the study group (n= 54) and control group (n= 54). The subjects in the study group received the holistic transitional care programme which commenced one-week before discharge and lasted till the fourth week in transition to home. One trained HCM from each community nursing center in the cluster was responsible for the provision of holistic care interventions and transitional care follow-ups. In contrast, the subjects in the control group received usual poststroke care. In addition to the main study, a qualitative study using focus groups was adopted to explore the caregiving experiences of the informal family caregivers and the health care providers. The qualitative data served to illuminate the findings of the statistical outcomes. Outcome Measures: The outcome indicators included the health-related quality of life (QOL), QOL in spirituality, religion and personal belief (SRPB-QOL), holistic health status and patient satisfaction with care on the patient-related aspect. The clinical outcomes involving functional performance, poststroke depression and utilization of health care services were also examined.; Results: Repeated measures analysis of variance with intention-to-treat strategy was used to examine the outcomes. There were significant differences in the between-group over time effects in the PCS (F= 10.15, p= 0.002) and the MCS (F= 8.41, p= 0.005), the SRPB-QOL (F= 20.97, p< 0.001) and three facets of the holistic health status (p<0.004). Stroke subjects in the study group showed a significant improvement in the general QOL and well being in the physical, psychological, social and spiritual dimensions, but the improvement did not sustain over time. However, they had a progressive improvement in the physical function achieving between-group difference (F= 5.50, p= 0.021) though significant differences within-group (F= 14.06, p< 0.001) was also detected. There was significant interaction effect between group and time (F= 4.81, p< 0.031). Besides, the results of the functional performance reported similar positive pattern of changes. Furthermore, patients in the study group showed a significantly higher level of patient satisfaction with care. There were statistically significant differences in the between-group at T1 (study 54.4 vs. control 33.5, p< 0.001) and T2 (study 52.7 vs. control 35.7, p< 0.001) in T2. Significant decrease in the poststroke depressive symptoms were found in the between-group differences at T1 (Z= -4.89, p< 0.001) and T2 (Z= -4.82, p< 0.001) and within-group over time (p<0.001). As for another clinical outcome, the utilization of health care services, results showed a lower readmission rate (study: 7.4% vs. control: 14.8%, x²= 1.5, p= 0.35), and lower unscheduled emergency reattendance rate (study: 4% vs. control: 18.4%, x²= 4.86, p= 0.06) within the study group as compared with the control group. Furthermore, a significant reduction in the scheduled clinical visits to both government and private clinics (p< 0.027) was reported. With regard to the qualitative information in the caregivers' perspective, thematic expressions of all three focus groups were aggregated into four themes: (1) caregiving challenges to the caregivers, (2) caring for stroke sufferers as a growing process, (3) HCM as a healer, and (4) enhancing the inner strength. The positive caregiving experiences and holistic values of the interventions were elaborated by the informants during interviewing. The pivotal role of connectedness between the HCMs and clients has been identified in the qualitative analysis. Conclusion: Actually, this study is the first study employing a holistic and transitional care approach for Chinese stroke survivors in Hong Kong. The empirical results demonstrate the effectiveness of this programme in improvement the holistic health and quality of life of the stroke subjects, especially their physical function and self-care performance. It is apparent that the immediate physical improvement in turn triggers responses of the total person resulting in improvement on other aspects, such as psychological, social and spiritual dimensions. Besides, the qualitative results indicate the importance of the role of the HCMs. They enhance the caregiving capacity by connecting with the client and their families. Apart from motivating patient self-management, they provide consistent, seamless holistic care service. This service addresses care needs more than merely at the physical level. It should be noted that family involvement plays an important part in the patient's coping with his illness. Family participation and support are especially important in the Chinese cultural context. It is true that spiritual resources including love, hope, faith, reinforce one's inner strength and serenity. They are necessary in building a positive world view, so that the patient can lead a new, fulfilling stroke life. To conclude, in providing holistic care, physical, psychological, social and spiritual aspects of health concerns should be addressed in a culture specific context. Individual dimensions are dynamically interplayed to make the sum of whole which is greater than the parts. It is hoped that this holistic approach is recommended for future tests in other chronic disease patient groups. As for limitations in this study, process evaluation was not conducted. This can be included in future research to obtain more information to help explain the benefits of the programme. Assessing of the intervention fidelity and potency of nurse dose in the holistic transitional care programme may elicit supporting evidence for extending the holistic care model to other chronic disease population.<br/><br/>Description: xx, 366, [83] leaves : ill. ; 30 cm.; PolyU Library Call No.: [THS] LG51 .H577P SN 2012 Yeung Sun, 01 Jan 2012 00:00:00 GMT http://hdl.handle.net/10397/5729 Title: The effects of a TTM-based Exercise Stage-Matched Intervention on patients with coronary heart disease<br/><br/>Authors: Zhu, Lixia<br/><br/>Abstract: Background: Coronary heart disease (CHD) is a leading cause of death and disability among adults worldwide. Regular exercise or exercise-based cardiac rehabilitation has been shown to be beneficial to cardiac patients; however, participation and adherence to exercise programmes is poor. The Transtheoretical Model (TTM) has been demonstrated to be a successful model for changing exercise behaviour in various populations from adolescents to the elderly. However, there have been few studies on the use of the TTM for changing exercise behaviour among CHD patients. Aim: To examine the effects of a TTM-based Exercise Stage-Matched Intervention (ESMI) on sedentary patients with CHD. The primary outcome indicator is change in exercise behaviour. The secondary outcome indicators are anginal attacks and quality of life. Methods: This study involved a randomized controlled trial using consecutive sampling. A total of 196 subjects were recruited and randomly assigned to one of the following three groups: the Conventional (C) Group (n = 67), the Patient Education (PE) Group (n = 64), and the ESMI Group (n = 65). Outcome measures included exercise stages of change, exercise self-efficacy, exercise decisional balance, exercise duration per week, conditions of angina, and quality of life. Data collection was carried out at baseline (T₀), post-intervention (T₁), at the 3-month follow-up period (T₂), and at the 6-month follow-up period (T₃). Data analysis was conducted based on the intention-to-treat principle. Last observation carried forward (LOCF) was employed to handle the missing data. One-way ANOVA, the Kruskal-Wallis test, and Chi-square test were applied to analyze data among the three groups at each time point. One-way repeated ANOVA, the Friedman test, and Cochran's Q test were used to analyze data within groups over time.; Results: A total of 150 subjects completed the whole study. The findings showed that significantly positive effects on changes in exercise behaviour were found in the ESMI group, in terms of a more positive shift in the exercise stages of change (p < 0.001), higher exercise self-efficacy (p < 0.001), greater exercise benefits (p < 0.001), fewer exercise barriers (p < 0.001), longer total exercise duration (minutes/week) (p < 0.001), and longer moderate exercise duration (minutes/week) (p < 0.001), after the completion of the 8-week ESMI when compared with the C and PE groups. With regard to anginal attacks, no significant differences in frequency, severity, and duration of anginal attacks were found among the three groups at each time point. The ESMI group demonstrated significantly better quality of life, in terms of improvements in physical limitation (p < 0.01), treatment satisfaction (p < 0.001), and disease perception (p < 0.001) of Seattle Angina Questionnaire (SAQ), and in physical component summary (p < 0.01), mental component summary (p < 0.001), and reported health transition (p < 0.05) of SF-36 after the completion of the 8-week ESMI when compared with the C and PE groups. These significantly positive effects were maintained at the 3- and 6-month follow-up periods, with the exception of those for total exercise duration (minutes/week) and reported health transition, which had disappeared at the 6-month follow-up period. Conclusion: The TTM-based ESMI has significantly positive effects on changes in exercise behaviour and quality of life in sedentary CHD patients. The findings highlight the feasibility and importance of providing CHD patients with a structured or formal patient education programme guided by the TTM.<br/><br/>Description: xviii, 651 p. : ill. ; 30 cm.; PolyU Library Call No.: [THS] LG51 .H577P SN 2012 Zhu Sun, 01 Jan 2012 00:00:00 GMT http://hdl.handle.net/10397/5728 Title: Effectiveness of a pain management programme for Chinese adults undergoing a major thoracotomy operation<br/><br/>Authors: Yin, Haihui<br/><br/>Abstract: Background: A major thoracotomy operation can cause patients to experience an extremely distressing amount of pain. Unrelieved acute post-thoracotomy pain greatly increases the risks of postoperative complications and compromises the quality of life of patients in the long run. There are reports in the literature about the effectiveness of nurse-led pain education interventions in the management of postoperative pain. Educating patients does not, in itself, seem an adequate way to resolve the various conflicting issues related to increasing knowledge and actual behaviors in pain management or to relieve patients from pain suffering in clinical practice. Aim: The purpose of the study was to investigate the effectiveness of a pain management programme on the postoperative experience of pain, barriers to pain management, pain management behaviours, and clinical outcomes related to a major thoracotomy operation for Chinese adult patients. Method: A randomized controlled trial with a single-blinded design was adopted for the present study and conducted in a tertiary general hospital in mainland China. A total of 108 patients who were scheduled to undergo a major thoracotomy were recruited and 94 participants (N=94) completed the study (48 participants in the experimental group, and 46 participants in the comparison group). Preoperative pain education was provided to both groups, while the postoperative pain round was performed only for the experimental group from postoperative day 1 until the patient was discharged. Pain intensity and the interference of pain with daily activities were measured by the Brief Pain Inventory-Chinese version (BPI-C). The concerns of patients about reporting pain and taking analgesics were assessed using the Barrier Questionnaire Taiwan Form-Surgical version (BQT-S). Pain management behaviors (using drug and non-drug methods to relieve pain) were documented by a log-record. Objective clinical outcomes (including the length of hospital stay, and the postoperative recovery from thoracic surgery as the first day to initiate ambulation, length of chest tube insitu, and the occurrence of postoperative complications) were collected from the patients' medical records. Data collection was conducted before preoperative pain education and throughout the entire period of postoperative hospitalization.; Results: The experimental group reported significant lower scores on pain severity and the interference of pain with activities than did the comparison group from postoperative day 1 till day7 (p < 0.05). The experimental group's scores on the total BQT-S and the subscales of BQT-S were lower than those of the comparison group (p < 0.05), except for the subscales of "fear of injections" and "fatalism" (p > 0.05). Patients in the experimental group used more non-drug methods to relieve pain than those in the comparison group from postoperative day 1 to 7 (p < 0.05); and there were no significant differences found here between the experimental group and the comparison group regarding the total amount of analgesic use or using PCA for pain in the postoperative period (p > 0.05). Comparisons of the two group's clinical outcomes did not significantly differ (p > 0.05), including the length of hospital stay, days of chest drain retention, and the occurrence of postoperative complications. However, the experimental group initiated out-of-bed activities much earlier than did the comparison group, with the difference being significant (p < 0.05). The study also tested the relationships between pain intensity, pain interference, barrier scores, and the use of drug or non-drug methods for pain relief. The patients' scores on pain intensity and the interference of pain with daily activities were significantly positively correlated to their barrier scores; but were significantly negatively correlated to the use of drug or non-drug methods for pain relief in the postoperative period. Conclusion: The findings of the present study provide positive evidence of the effectiveness of nurse-led educational interventions in reducing patient-related barriers to pain management, improving pain management behaviors, and relieving patients from pain suffering after surgery. A pain management programme based on the PRECEDE framework, which integrated preoperative pain education and a reinforcing intervention, can lead to a new model of care to improve the outcomes of postoperative care. This study also provides insights on developing the role of advanced nursing practice to address issues of safety and cost-effectiveness in pain care in mainland China.<br/><br/>Description: xvi, 265 p. : ill. ; 30 cm.; PolyU Library Call No.: [THS] LG51 .H577M SN 2012 Yin Sun, 01 Jan 2012 00:00:00 GMT http://hdl.handle.net/10397/5561 Title: A process model for developing content for certification programmes : the case of infection control nurses in Hong Kong<br/><br/>Authors: Chan, Wai Fong<br/><br/>Abstract: A trend in nursing specialization over the world is for nurse specialists to be regulated by certification systems or other credentialing schemes. In Hong Kong, there is no certification system yet for regulating nursing specialist practice, including infection control nurses. Infection control practice, which is mainly concerned with combating hospital-acquired infection, is context-specific. There is a need in Hong Kong for a certification programme for infection control nurses. The content of this programme would need to be revised periodically, as practices change over time. The aim of this research is two-fold: to establish the content and content-weighting for a certification programme for infection control nurses in the current context of Hong Kong; and to build a process model that informs the development of a content blueprint of a certification programme for regulating the practice of a group of specialists.; A three-phase research design was used. In Phase One, the content and rating scale of the survey questionnaire to be used in Phase Two were created. A list of draft core competency items in categories was established by Delphi experts. The list of proposed core competency items was finalized after its validity and reliability were tested by content experts and former infection control nurses. The functioning of the rating scale of the proposed questionnaire was tested by Rasch measurement. In Phase Two, the views of infection control nurses were collected on the perceived importance of core competency items of infection control practices. A list of core competency items was established by a cross-sectional survey and Rasch measurement. Phase Three established a content blueprint of the certification programme for regulating the practice of Hong Kong infection control nurses. A list of critical (i.e. the most important) competency items for establishing the content blueprint of the certification programme for Hong Kong infection control nurses was decided by local infection control experts and the Rasch-based safety margin. The content weights of individual core competency items were translated by the results of the Rasch measurement in Phase Two. The expert-defined critical competency consisted of 25 competency items. The Rasch-based safety margin added 10 more items, resulting in 35 critical competency items. The content blueprint of the certification programme for infection control nurses of Hong Kong is similar in several aspects to the United States blueprint. The process model of certification content blueprint development that was created for this study is composed of two key elements, namely the core competency identification cycle and Rasch measurement. The core competency identification cycle requires three inputs--from the literature, experts and practitioners--to establish a comprehensive list of core competency items. Rasch measurement yields the core competency scale (identifying the fitting items and determining the importance levels to individual core competency items), defines the true critical competency from the expert consensus and establishes the content weights in the certification content blueprint. This process model can guide the development of content blueprints of certification programmes for other healthcare professionals in other contexts.<br/><br/>Description: xxvi, 462, 178 p. : ill. (some col.) ; 30 cm.; PolyU Library Call No.: [THS] LG51 .H577P SN 2012 Chan Sun, 01 Jan 2012 00:00:00 GMT