Eliza Mi-Ling Wong

Effectiveness of an educational intervention on levels of pain, anxiety and self‐efficacy for patients with musculoskeletal trauma

AIM This paper is a report of a study of the effectiveness of a pain management educational intervention on level of pain, anxiety and self-efficacy among patients with musculoskeletal trauma and consequent orthopaedic surgery. BACKGROUND Substantial evidence supports the use of preoperative education to improve patient outcomes. Educational interventions are common in preparing patients for orthopaedic surgery. METHODS A pre- and post-test design (quasi-experimental) was employed in 2006 with patients assigned either to a control (usual care) or an experimental group (usual care plus educational intervention). The 30-minute educational intervention consisted of information about pain, coping strategies and breathing relaxation exercises. The outcome measures were scores for pain, anxiety, self-efficacy, analgesic use and length of hospital stay and these were measured before surgery and on day 2, day 4, day 7, 1 month and 3 months after surgery. RESULTS A total of 125 patients completed the study (control, n = 63; experimental = 62). The experimental group reported statistically significantly lower levels of pain, less anxiety and better self-efficacy during hospitalization (before surgery to day 7), as compared to the control group. The experimental group had more requests for analgesics at day 2 only. There were no statistically significant effects on length of stay. At the 3-month evaluation, a statistically significant effect on anxiety level was found in favour of the experimental group. CONCLUSION Patients may benefit from this educational intervention in terms of relieving pain, anxiety and improving self-efficacy, and the educational intervention could be incorporated as part of routine care to prepare musculoskeletal trauma patients for surgery.

Effectiveness of Emergency Medicine Wards in reducing length of stay and overcrowding in emergency departments

OBJECTIVE This study aims to evaluate the effectiveness of an Emergency Medicine Ward (EMW) in reducing the length of stay (LOS) in the emergency department, length of hospitalization, emergency medical admission rate, and the hospital bed occupancy rate. METHODS This study is a cross-sectional, observational study with a retrospective, quantitative record review conducted at the EMW of a regional acute hospital in Hong Kong from January 2009 to June 2009. RESULTS During the study, a retrospective audit was conducted on 1834 patient records. The five main groups of patients admitted into EMW suffered from cardiac disease (26.5%), pneumonia (19.6%), dizziness (16.2%), Chronic Obstructive Pulmonary Disease (12.3%), and gastroenteritis (7.9%). The mean LOS in the EMW was 1.27 days (SD=0.59). The average emergency medical admission rate within the six-month period was significantly reduced relative to that before the EMW became operational (January 2008 to June 2008). Clinically, the medical in-patient bed occupancy was significantly reduced by 6.2%. The average LOS during in-patient hospitalization after the EMW was established decreased to 4.13 days from the previous length of 5.16 days. CONCLUSIONS EMWs effectively reduce both the LOS during in-patient hospitalization and the avoidable medical admission rate.

Psychometric properties of a Chinese version of the Colorectal Cancer Perceptions Scale in a sample of older Chinese people.

Background: Older adults are more susceptible to colorectal cancer (CRC). Psychosocial constructs in the Health Belief Model are targets for interventional studies. No tool to measure these beliefs of older Chinese people has been validated. Objective: The present study aimed to examine the preliminary psychometric properties of the Chinese version of the Colorectal Cancer Perceptions Scale (CRCPS). Methods: The CRCPS was translated to Chinese language, validated by an expert panel, and tested. Interviewer-administered surveys were carried out with a convenience sample of 219 community-dwelling Chinese adults 60 years or older and were included in the analysis. Results: Six factors were retained, with items on susceptibility and benefits remaining as designed, whereas those on severity formed 2 factors, labeled severity–fear and severity–life impact, and those on barriers again formed 2 factors, labeled psychological barriers and knowledge barriers. Cronbach’s &agr; values ranged from .74 to .88, and test-retest reliability correlations ranged from .38 for psychological barriers to .69 for knowledge barriers. Respondents who had undergone CRC screening had significantly lower mean scores on severity–fear, severity–life impact, psychological barriers, and knowledge barriers compared with those who had not. Conclusions: The results provide preliminary support for the reliability and validity of the Chinese version of the CRCPS. Further psychometric testing is recommended. Implications for Practice: The survey provides a useful tool to assess CRC health beliefs, which interventions should address to improve screening rates among older Chinese adults.

The effect of educational intervention on pain beliefs and postoperative pain relief among Chinese patients with fractured limbs

Patients’ misconceptions and concerns about analgesic use and their reluctance to report pain are important barriers to effective pain management (Carr 2007). Educational interventions have been proposed to enhance patients’ knowledge of and reduce the barriers to effective pain management (Johansson et al. 2005, Carr 2007). However, previous studies focus on patients experiencing chronic pain or planned surgery (Freeman & Freeman 2005; Johansson et al. 2005). Few studies have investigated Chinese patients with unexpected traumatic limb fractures. A brief educational intervention might be effective for them to enhance better pain management (Freeman & Freeman 2005).

A review of the management of patients after percutaneous coronary intervention.

The exponential increase in the numbers of percutaneous coronary interventions (PCIs) has led to many clinicians having to care for post‐PCI patients. We review the management of early problems seen in post‐PCI patients, such as vascular access site complications, contrast nephropathy, drug‐induced thrombocytopaenia and chest pain. The management of possible restenosis and the use of stress testing are discussed. The complications from dual antiplatelet therapy are addressed. The prognosis of the post‐PCI patient, the implications of co‐existent heart failure and the newer technologies of implantable defibrillator and cardiac resynchronisation therapy are reviewed. We conclude by emphasising the importance of secondary prevention by risk factor modification as well as the communication between the clinician and the cardiologist.

The effects of a lifestyle intervention program on physical outcomes, depression, and quality of life in adults with metabolic syndrome: A randomized clinical trial

BACKGROUND/OBJECTIVES Lifestyle modification is recommended as the primary intervention for metabolic syndrome (MetS). The study was to examine the effects of a lifestyle intervention program (LIP) on physical outcomes, depression, and quality of life (QoL) in Chinese adults with MetS. METHODS A randomized control trial design was used. A three-month LIP guided by the Health Promotion Model was developed, including a lifestyle modification booklet, one session of discharge education, and six telephone follow-ups. Patients with MetS were recruited from the inpatient departments of a hospital and were randomized to receive either the LIP or usual care. The physical outcomes, depression (Depression subscale of Hospital Anxiety and Depression Scale), and QoL (Medical Outcome Study Short Form-12, SF-12) were measured at baseline, one-month (T1) and three-month (T2). The effects of the LIP were examined by the generalized estimating equation (GEE) model. RESULTS The study recruited 173 participants, with 86 in the intervention group and 87 in the control. Continuous improvements were observed in all the study outcomes in the intervention group. The GEE model revealed significant improvements in body weight (T1: p=0.017, T2: p=0.007), body mass index (T1: p=0.015, T2: p=0.009), depression (T1: p=0.027, T2: p<0.001), and physical aspects of QoL at T2 (p=0.02). CONCLUSIONS The current LIP was effective in losing body weight, improving depression and QoL of MetS populations in three-month observation. Considering its low-cost and convenience, the LIP could be applied in clinical practice to improve patient outcomes.

Determinants of participation in colorectal cancer screening among community-dwelling Chinese older people: Testing a comprehensive model using a descriptive correlational study

PURPOSE The prevalence of colorectal cancer (CRC) among older people is high. Screening for CRC presents a cost-effective secondary prevention and control strategy which results in a significant reduction in mortality. This study aims to describe the prevalence of CRC screening and examine its risk factors among Chinese community-dwelling older people guided by a comprehensive model combining Health Belief Model and Extended Parallel Processing Model. METHODS A descriptive correlational study was conducted. A convenience sample of 240 community-dwelling adults aged ≥60 was recruited in May-July in 2012 in Hong Kong. Participants were asked to complete a questionnaire which collected information on demographic variables, CRC-related psychosocial variables and whether they had a CRC screening in the past 10 years. RESULTS Among the participants, 25.4% reported having a CRC screening test. Results of logistic regression analyses indicated that participants with a higher level in cue to action, and lower perceived knowledge barriers and severity-fear were significantly associated with participation in CRC screening. But there were no significant associations between fatalism and cancer fear with screening. CONCLUSIONS The prevalence of CRC screening was low in Hong Kong Chinese community-dwelling elders. A number of modifiable factors associated with CRC screening were identified which provides specific targets for interventions. This study also adds to the knowledge regarding the associations between fatalism and fear with CRC screening behaviors among Chinese older people.

Interventions for Cardiovascular Patients with Type D Personality: A Systematic Review

BACKGROUND Cardiovasculardisease (CVD) is a major cause of death worldwide. Type D personality, a newly identified risk factor for cardiac outcomes, can deteriorate the health outcomes of CVD patients. Several interventional studies have been conducted on CVD patients with type D personality. AIM To provide the best available evidence of the effects and characteristics of interventions applied to cardiac patients with type D personality. METHODS Experimental studies on the effects of interventions for cardiac patients with type D personality were reviewed. English and Chinese electronic databases were searched from inception to December 2014. The eligibility and quality of each article were reviewed by two independent reviewers. The outcomes of interest included psychological health (anxiety & depression), physical functioning, and quality of life. Data were synthesized in a narrative form rather than meta-analysis because of the heterogeneity of studies and the insufficient data for statistical pooling. RESULTS Four studies (one randomized controlled trial and three single-group pre- and posttests) involving 967 cardiac patients were identified. The quality of included studies was moderate, with three studies rated as fair and one study rated as poor. Cardiac rehabilitation programs were the interventions identified in all the included studies, with main components of physical exercise, patient education, psychological intervention, and individual counseling. The findings of this review indicated that cardiac rehabilitation can significantly reduce anxiety and depression, improve physical functioning, and quality of life in cardiac patients with type D personality. The evidence of optimal duration, frequency of interventions, and length of each session was not established. LINKING EVIDENCE TO ACTION This review provides preliminary evidence for the use of cardiac rehabilitation as an effective intervention to improve health outcomes in cardiac patients with type D personality. The optimal delivery format of the intervention for cardiac patients with type D personality needs to be explored.

Factors associated with health-related quality of life among patients with implantable cardioverter defibrillator: identification of foci for nursing intervention.

AIM To explore factors associated with health-related quality of life of patients with implantable cardioverter defibrillators. BACKGROUND Substantial evidence indicates that implantable cardioverter defibrillator is proven to increase survival rate by terminating life-threatening arrhythmia. However, this device can negatively affect health-related quality of life. Little is known about factors associated with health-related quality of life of patients with implantable cardioverter defibrillators, particularly in Asian population. DESIGN A transversal descriptive design was used. METHODS Data were collected from a convenience sample of 139 adult patients with implantable cardioverter defibrillators from 4 January-30 April 2012 using the structured questionnaires administered by the researcher and medical record reviews. The Short Form-36 Health Survey version 2 was used to measure health-related quality of life. RESULTS A total of 139 Chinese patients, including 107 (77·0%) males with a mean age of 63·0 (14·6) years, were selected. The physical component summary was relatively lower, whereas the mental component summary was relatively higher than that of the general Hong Kong Chinese population. Multivariable regression analysis revealed gender, self-care dependence, educational level, atrial fibrillation, diabetes mellitus, anxiety and depression significantly associated with physical or mental quality of life. CONCLUSIONS Depression was a common factor affecting physical and mental quality of life. Self-care dependence, atrial fibrillation, diabetes mellitus, depression and anxiety could be improved. Our findings expand existing knowledge on identifying at-risk patients for having lower quality of life, thus allowing development of appropriate interventions targeting risk factors for improving health-related quality of life of patients with implantable cardioverter defibrillator.

Promoting Holistic Well-being in Chronic Stroke Patients Through Leisure Art-based Creative Engagement

Purpose: To examine the potential value of a creative art-based activity as a caring modality for promoting holistic well-being among chronic stroke patients, and to explore the feelings and meanings that stroke patients derived from their experience in leisure art-based creative engagement (LACE). Design: Qualitative design. Method: Participants were recruited through purposive and snowball sampling. Individual semi-structured interviews were conducted. Qualitative content analysis was performed. The design and implementation of LACE was guided by Watson’s theory of caring. Findings: Twenty-four participants completed the study. Four themes emerged from participants’ account of experiences with the LACE: (1) appreciation of opportunities, (2) appreciation of self, (3) appreciation of others, and (4) appreciation of life. Conclusion: From the perspective of the participants, engaging in LACE enhances their sense of enjoyment and self-expression. Furthermore, they perceived LACE as an affirmation of life and an empowering process strengthening their connection and appreciation with the self and others. Clinical Relevance: This study adds evidence to existing literature on Watson’s theory-guided design and implementation of caring initiatives for community rehabilitation and has laid the groundwork for developing further evidencebased research in leisure art-based caring occasions for promoting holistic well-being in stroke rehabilitation.