Diana T.F. Lee

Issues and Challenges of Instrument Translation

The purpose of this article was to discuss the challenges of instrument translation, using the translation of the Medical Outcomes Study Social Support Survey into Chinese as an example. Brislin’s model of translation, which highlights the need for forward and backward translation, was used. Major considerations in conducting translation, and the strategies used to overcome the challenges arising from cultural and linguistic differences between the source and target languages, were discussed. Examples were used to illustrate how difficulties, such as maintenance of the original intent of the questionnaire, maximization of the cultural relevancy of the concept in question, and enhancement of the comprehensibility of the translated questionnaire, were handled. The importance of literal and cultural adaptation of a developed instrument, rather than its simple word translation in the maintenance of an equivalent translation is highlighted.

Living with chronic heart failure: a review of qualitative studies of older people

AIM This paper is a report of a systematic review of qualitative studies of how older people live with chronic heart failure. BACKGROUND Chronic heart failure is a global epidemic mainly affecting an ageing population. Understanding how older people live with this disease is important to help promote their adjustment to the distressing illness experience. DATA SOURCES Eligible studies published in 1997-2007 were identified from several databases (Medline, CINAHL, PsycINFO and Sociological Abstracts). A manual search was conducted of bibliographies of the identified studies and relevant journals. REVIEW METHODS Two researchers independently reviewed the studies and extracted the data. Key concepts from the papers were compared for similarities and differences. The transactional model of stress was used to guide data synthesis. FINDINGS Fourteen qualitative studies were identified. Most described the illness experiences of older people with chronic heart failure and associated coping strategies. There was some emerging work exploring the adjustment process. The findings indicated that living with chronic heart failure was characterized by distressing symptoms, compromised physical functioning, feelings of powerlessness and hopelessness, and social and role dysfunction. There were gender differences in the way the disease was conceived. Adjustment required patients to make sense of the illness experience, accept the prognosis, and get on with living with the condition. CONCLUSION Empowering older people to manage chronic heart failure, instilling hope and bolstering support system are means of promoting successful adjustment to the disease. Further research needs to explore the cultural differences in the adjustment process.

Health-related quality of life in patients with congestive heart failure.

Despite abundant evidence attesting to poor physical, psychological and social functioning of congestive heart failure (CHF) patients, little is known about the impact of the disease itself on health‐related quality of life (HRQL). Most previous work has focused on general quality of life issues rather than specifically on the impact of CHF on HRQL.

Case management: A review of the definitions and practices

Case management has been suggested as an innovative strategy which facilitates the linking of quality and cost-effective care. However, there is little consensus about what is actually being introduced under the name of case management. It is suggested that this absence of a clear understanding of case management has been an obstacle in moving forward case management practice and research. This paper presents a critical review of the confusion surrounding case management with an attempt to unravel issues relevant to the implementation of case management into community nursing practice in Hong Kong. It is concluded that there is a need for different definitions of case management as a result of the differences in the cultural and health care context in which it is being practised. Also, if case management programmes are to be advanced, there needs to be more co-ordinated effort in researching not only the expected outcomes but also the structures and processes of these programmes so that findings of similar case management programmes can be compared for ways of future improvement.

Tai Chi and Health-Related Quality of Life in Nursing Home Residents

PURPOSE Health-related quality of life (HRQOL) that is good is regarded as the goal of elderly residential care. However, limited evidence exists indicating a promising intervention that can achieve this goal. The aim of this study is to examine the effect of Tai Chi on HRQOL in nursing home residents. DESIGN A nonequivalent pretest-posttest control-group design. METHODS A convenience sample of 139 residents from six nursing homes in Hong Kong was used. The experimental group (n=66) joined a 26-week Tai Chi program, while the control group (n=73) continued with usual daily activities. The physical and mental components of HRQOL were designated as the dependent variables. Resident satisfaction was considered as a covariate. Doubly multivariate repeated measures analysis of covariance was done to examine the intervention effect. FINDINGS After adjusting for the confounding effect of resident satisfaction, a statistically significant difference (p<0.05) in the physical and mental components of HRQOL between the experimental and control groups was found. Findings showed significant improvement in HRQOL after residents practiced Tai Chi. CONCLUSIONS These investigators contribute additional knowledge about the health benefits of Tai Chi among nursing home residents and indicates support for its use in this population to improve HRQOL. CLINICAL RELEVANCE Tai Chi has unique characteristics as a health exercise that is particularly suitable for nursing home residents. The inclusion of Tai Chi exercise in elderly residential care practice is recommended.

Fatigue among older people: a review of the research literature.

BACKGROUND Fatigue is a complex phenomenon associated with multiple antecedents and detrimental consequences. Although this symptom is prevalent in the older population, it is not easily recognized by nurses and has been under treated. AIM The purpose of this review is to describe the existing research on fatigue on older adults with focus on the lived experience of fatigue, factors related to such fatigue experience and the impact of fatigue on overall health. METHODS A systematic search of the literature was undertaken to identify research evidence on fatigue among the older population. Three databases (i.e. OvidMedline, CINAHL and PsycINFO) were searched, resulting in 15 eligible studies. Three aspects about the fatigue phenomenon in older people were identified: the lived experience of fatigue, relating factors of fatigue, and impact of fatigue on overall health. FINDINGS The key findings suggest that fatigue is an overwhelming experience constrains physical capacity and the energy reserve required for appropriate functioning and social participation, as well as worsens their morbidity and mortality outcomes. Yet, its heterogeneous etiologies and multi-dimensional manifestations pose a huge challenge on its diagnosis and treatment. Indeed, there was inadequate research-base evidence on fatigue management for older people. This gap in literature may imply that this problem is poorly recognized and under-treated in older people. CONCLUSIONS The findings highlight that fatigue is a substantial problem in older people that deserves early recognition and prompt treatment. Nurses need to be sensitive to the risk factors of fatigue in the older population and conduct a comprehensive fatigue assessment on the high risk case. Although this review only identified limited research-base evidence, the findings do give directions to the development of interventions for fatigue management for older people.

Non-pharmacological interventions in older people with heart failure: effects of exercise training and relaxation therapy.

Background: Effective management of heart failure relies on optimal use of non-pharmacological therapy alongside medical treatment. Yet, there is an inadequate use of non-pharmacological therapy in caring for older people with heart failure. Objective: To examine the effects of relaxation therapy and exercise training on psychological outcomes and disease-specific quality of life of older heart failure patients. Methods: Subjects undertook relaxation (n = 59), exercise training (n = 32) or received attention placebo (n = 62) for 12 weeks. The relaxation group attended two training sessions, one revision workshop, and continued with twice-daily taped-directed home relaxation practice, with support from the intervener through bi-weekly telephone contact, for 12 weeks. The exercise group undertook 12 weekly sessions of resistance training and aerobic exercise and thrice weekly home exercise. The control group received regular telephone calls for general ‘greetings’. Results: The relaxation and exercise groups reported a significantly greater improvement in psychological [F(2, 149) = 6.69, p = 0.002] and various disease-specific quality of life outcomes [dyspnea: F(2, 149) = 5.72, p = 0.004; fatigue: F(2, 149) = 3.78, p = 0.25; emotion: F(2, 149) = 6.68, p = 0.001], compared with those who received the attention placebo. While relaxation therapy was more effective to reduce psychological distress, with depression in particular (p < 0.001), exercise therapy worked better to control fatigue symptoms (p = 0.03). Conclusion: Relaxation therapy and exercise training are effective to improve the psychological and physical health of older heart failure patients. They should be used as an individual treatment modality, or as care components of a disease management program.

Effects of a Care Protocol on Care Outcomes in Older Nursing Home Patients with Chronic Obstructive Pulmonary Disease

OBJECTIVES: To evaluate the effects of a care protocol used by community nurses to support nursing home staff in the care of patients with chronic obstructive pulmonary disease (COPD).

Exploring the scope of expanding advanced nursing practice in nurse-led clinics: a multiple-case study.

AIM This article is a report on a study to explore the development of expanding advanced nursing practice in nurse-led clinics in Hong Kong. BACKGROUND Nurse-led clinics serviced by advanced practice nurses, a common international practice, have been adopted in Hong Kong since 1990s. Evaluations consistently show that this practice has good clinical outcomes and contributes to containing healthcare cost. However, similar to the international literature, it remains unclear as to what the elements of good advanced nursing practice are, and which directions Hong Kong should adopt for further development of such practice. METHODS A multiple-case study design was adopted with six nurse-led clinics representing three specialties as six case studies, and including two clinics each from continence, diabetes and wound care. Each case had four embedded units of analysis. They included non-participant observation of nursing activities (9 days), nurse interviews (N = 6), doctor interviews (N = 6) and client interviews (N = 12). The data were collected in 2009. Within- and cross-case analyses were conducted. RESULTS The cross-case analysis demonstrated six elements of good advanced nursing practice in nurse-led clinics, and showed a great potential to expand the practice by reshaping four categories of current boundaries, including community-hospital, wellness-illness, public-private and professional-practice boundaries. From these findings, we suggest a model to advance the scope of advanced nursing practice in nurse-led clinics. CONCLUSION The six elements may be applied as audit criteria for evaluation of advanced nursing practice in nurse-led clinics, and the proposed model provides directions for expanding such practice in Hong Kong and beyond.

Improving health-related quality of life of patients with chronic heart failure: effects of relaxation therapy

AIM This paper is a report of a study conducted to examine the effects of a relaxation training programme on the health-related quality of life of Chinese patients with chronic heart failure. BACKGROUND Despite the substantial evidence indicating the beneficial effects of relaxation therapy on the health-related quality of life of various cardiac populations, the value of this intervention in patients with chronic heart failure remains uncertain. Even less is known about its therapeutic effects in Chinese culture. METHOD A total of 121 Chinese patients with chronic heart failure and over 60 years of age were recruited in 2002-2003 and randomly allocated to a relaxation training programme (n = 59) or an attention-control intervention (n = 62). The training included two relaxation training sessions, one skill revision workshop, twice daily relaxation self-practice and biweekly telephone follow-up. The World Health Organization Quality of Life questionnaire was completed at hospital discharge and at the 8th and 14th weeks after discharge. RESULTS Repeated measures analysis of covariance indicated that those who attended the relaxation training programme reported statistically significantly greater improvement in psychological (P = 0.007, eta(2) = 0.043) and social (P = 0.016, eta(2) = 0.035) health-related quality of life than those who received the attention-control intervention over the evaluative period. Comparing outcomes at timepoints showed that the statistically significant group differences in the improvement of psychological and social health-related quality of life occurred mainly during the first evaluative endpoints. CONCLUSION Relaxation techniques are beneficial to the emotional and social health-related quality of life of Chinese patients with chronic heart failure. Combining this intervention with other treatment modalities may produce a more substantial improvement in their health-related quality of life.