Engle Angela Chan

Effect of music on depression levels and physiological responses in community-based older adults

Many people over the age of 65 do not regard depression as a treatable mental disorder and find it difficult to express themselves verbally. Listening to music can facilitate the non-verbal expression of emotion and allow peoples inner feelings to be expressed without being threatened. The aim of this study was to determine the effect of music on depression levels in elderly people. A randomized controlled study was conducted with 47 elderly people (23 using music and 24 controls) who completed the study after being recruited in Hong Kong. Blood pressure, heart rate (HR), respiratory rate (RR), and depression level variables were collected. In the music group, there were statistically-significant decreases in depression scores (P < 0.001) and blood pressure (P = 0.001), HR (P < 0.001), and RR (P < 0.001) after 1 month. The implication is that nurses may utilize music as an effective nursing intervention for patients with depressive symptoms in the community setting.

Two nurse teachers reflect on acquiring their nursing identity

As nurse teachers, researchers and practitioners, we live within a changing landscape of the nursing profession. There is a continuous search for a clear definition of what nursing is and what role it plays on the social and political stage. We believe that one way to approach the task of delineating our professional identity as nurses is through individual self‐reflection on, and sharing of, our personal and professional narratives. We suggest that this exploration may be attained through the reflective process of narrative inquiry, which is at once the method and the phenomenon of study. Further, Connelly and Clandinin build on Dewey’s work on experience, and postulate that we bring all of our personal life experiences into our professional life. Consequently, by examining what personal experiences each of us brings into the profession we learn about who we are professionally. By knowing who we are professionally as individual nurses we have the potential to become clearer on what nursing is and what it does. Similarly, by striving to understand our individual professional identity we as nurses contribute to the creation of the nursing profession as a whole. Therefore, through the telling and retelling of these life experiences we may gain deeper understanding of who we are as individual nurses within the context of the nursing profession.

A virtual caravan—A metaphor for home-internationalization through social media: A qualitative content analysis

BACKGROUND An internationalized curriculum in nursing education was created in response to the rise of globalization and the need to provide nursing care to people of diverse cultures. Through technology, internationalization at home can facilitate intercultural experiences for more nursing students. OBJECTIVES The aim of this study is to explore and describe how a virtual course in intercultural communication between students of two universities, through internationalization at home, can support the development of cultural competence. DESIGN Qualitative research PARTICIPANTS Junior year nursing students METHOD Qualitative content analysis of transcribed written and oral presentations during a course on intercultural communication. RESULTS Four major themes, which are not mutually exclusive, were identified. CONCLUSION Through this intercultural experience, without leaving home, students uncovered their cultural selves and others based on their own reflective understanding and collaborative discourse with each other and the use of social media for communication. Through experiential intercultural encounters beyond textbook and online materials, they learned to appreciate each other as people with cultural differences yet with much in common, and to recognize their assumptions and the value of subtleties and nuances. They were able to explore solutions within an unfamiliar context through their own efforts and with the support of peers and teachers. This led to a deeper understanding of cultural sensitivity and competence.

Implications for school nursing through interprofessional education and practice

AIMS AND OBJECTIVES To explore the interprofessional collaboration between nursing and social work professionals in their delivery of health services for schoolchildren. BACKGROUND Interprofessional education has long been recommended as a way to meet the need for effective collaboration in school health service with a view to improving the quality of health care. No local study in Hong Kong has looked specifically at how nursing and social work professionals carry out school health services through interprofessional education and practice. Therefore, an examination was conducted of collaboration on a community-based school caring project. DESIGN A qualitative design was employed, using semi-structured interviews, field observation and field debriefing. METHODS Seven nursing students and five social work students were recruited and interviewed in 2011. The transcripts were analysed using qualitative content analysis. RESULTS Three themes were identified: (1) early identification of childrens needs through interprofessional collaboration for health promotion, (2) prompt referral for schoolchildren in need, and (3) comprehensive planning and implementation of school health service. CONCLUSION The strength of collaborative work between nursing and social work professionals is that it helps to identify and address these complex health needs of children. Healthcare providers are hence able to develop a fuller understanding of childrens problems, which in turn enables them to provide appropriate and effective health promotion interventions. RELEVANCE TO CLINICAL PRACTICE The development of interprofessional education for school health services should be envisaged by the local higher educational institute and policy makers to reduce childrens risk-taking behaviours and promote their health and well-being. Health educators and health policy makers can better understand how interprofessional education and collaboration can promote children health service for regional and national policy and practice.

Teaching abstract concepts in contemporary nursing through spirituality

As nursing becomes both an art and science in contemporary practice, it raises the question: Do we, as nurse educators, really understand and teach the meaning of concepts such as holistic care? Our search to learn about teaching holistic care has led to the epistemology, which rests on our dialogue and reflective stories derived from the concept of spirituality as searching for meaning. We feel our work has implications for spirituality as a foundation for nursing education and practice.

Complexities of emergency communication: clinicians’ perceptions of communication challenges in a trilingual emergency department

AIMS AND OBJECTIVES To understand the challenges that clinicians face in communicating with patients and other clinicians within a Hong Kong trilingual emergency department. BACKGROUND Effective communication has long been recognised as fundamental to the delivery of quality health care, especially in high-risk and time-constrained environments such as emergency departments. The issue of effective communication is particularly relevant in Hong Kong emergency departments, due to the high volume of patients and the linguistic complexity of this healthcare context. In Hong Kong, emergency department clinicians are native speakers of Chinese, but have received their medical training in English. The clinicians read and record virtually all of their medical documentation in English, yet they communicate verbally with patients in Cantonese and Mandarin. In addition, communication between clinicians occurs in spoken Cantonese, mixed with medical English. Thus, medical information is translated numerous times within one patient journey. This complex linguistic environment creates the potential for miscommunication. DESIGN A mixed-methods design consisting of a quantitative survey with a sequential qualitative interview. METHODS Data were collected in a survey from a purposive sample of 58 clinicians and analysed through descriptive statistics. Eighteen of the clinicians were then invited to take part in semi-structured interviews, the data from which were then subjected to a manifest content analysis. RESULTS Nearly half of the clinicians surveyed believed that medical information may be omitted or altered through repeated translation in a trilingual emergency department. Eighty-three per cent of clinicians stated that there are communication problems at triage. Over 40% said that they have difficulties in documenting medical information. Around 50% believed that long work hours reduced their ability to communicate effectively with patients. In addition, 34% admitted that they rarely or never listen to patients during a consultation. CONCLUSION The findings reveal that the quality of communication in this Hong Kong emergency department is compromised by specific factors inherent in the linguistic complexity of Hong Kong emergency departments. These factors include the constant translation of medical information, inadequate documentation of medical information and significant professional and cultural pressures. Each of these issues increases the likelihood that healthcare communication will be difficult, incomplete or incorrect. This research provides empirical evidence for, and justifies the development of, an effective framework to enable clinicians to overcome communication challenges. RELEVANCE TO CLINICAL PRACTICE The findings of this study may shed light on the unique conditions faced by clinicians, particularly in relation to communication, in the complex trilingual healthcare context of an emergency department similar to those in Hong Kong, and provide potential policy solutions for barriers to improve communication in such settings.

Who are the healthy active seniors? A cluster analysis

BackgroundThis paper reports a cluster analysis of a sample recruited from a randomized controlled trial that explored the effect of using a life story work approach to improve the psychological outcomes of older people in the community.Methods238 subjects from community centers were included in this analysis. After statistical testing, 169 seniors were assigned to the active ageing (AG) cluster and 69 to the inactive ageing (IG) cluster.ResultsThose in the AG were younger and healthier, with fewer chronic diseases and fewer depressive symptoms than those in the IG. They were more satisfied with their lives, and had higher self-esteem. They met with their family members more frequently, they engaged in more leisure activities and were more likely to have the ability to move freely.ConclusionIn summary, active ageing was observed in people with better health and functional performance. Our results echoed the limited findings reported in the literature.

Patients' perceptions of their experiences with nurse-patient communication in oncology settings: A focused ethnographic study

Background The nursing shortage and its impact on patient care are well-documented global issues. Patients living with cancer as a chronic illness have many psychosocial problems and often lack adequate support as a result of ineffective nurse-patient communication. A review of the literature on factors influencing the delivery of psychosocial care to cancer patients indicates that the delivery of psychosocial care in routine cancer nursing within a biomedical healthcare system has not been widely explored. Objective To explore patients’ perceptions of their experiences with nurse-patient communication in an oncological clinical environment. Method A focused ethnographic study was undertaken in two oncology wards of a hospital in Hong Kong. Data were collected through observations of the ward environment, the activities and instances of nurse-patient communication, semi-structured interviews with patients, and a review of nursing documents. Results Two main themes were identified: 1. Nurses’ workload and the environment and 2. Nurse-patient partnership and role expectations. Within these two themes were related subthemes on: Sympathy for the busy nurses; Prioritizing calls to the nurses; Partnership through relationship; Nurses’ role in psychosocial care; and Reduction of psychosocial concerns through physical care. Conclusions Many cancer patients do not expect to receive psychosocial care in the form of emotional talks or counseling from busy nurses, but appreciate the attention paid by nurses to their physiological and physical needs. Nurse-patient partnerships in cancer care may reduce the potential workload of nurses. The psychosocial needs of cancer patients could be optimized by providing good physical care through effective communication within a time-constrained oncology setting.

An ethnographic inquiry into the psychosocial care for oncology patients in the community: Healing from the 4Es

PURPOSE The aim of this study was to explore how the provision of community care in a cancer support center can help cancer patients and survivors cope with the demands of cancer and its treatment. METHODS A focused ethnographic approach was adopted. Data were collected through participant observations and focus groups with various stakeholders. The data from the focus groups were transcribed verbatim and analyzed using constant comparative analysis. RESULTS Four main themes emerged: 1. Enabling users to achieve mental well-being on their coping journey, 2. Empowering users to deal with their uncertainties, 3. Enhancing meaningful nurturing interactions through the design of spaces and colors in the Centre, and 4. Evolving through seeing more value in themselves. These 4Es occurred through intimate human interaction in the Centre, which resulted in psychological renewal and the rebuilding of a sense of self among the users. CONCLUSIONS This study provides insights on the provision of community support services for cancer patients/users, specifically on how to help them to regain control over their lives, not only through providing services for psychosocial renewal by engaging in intimate human interactions, but also by contributing to an understanding of the effect of the physical environment and space on healing. The results also reveal a virtuous circle of the 4Es as the synergies from the services, activities and the environment in the Centre, which provide a harmonious context for the users in coping with their cancer journey.

Speak-up culture in an intensive care unit in Hong Kong: a cross-sectional survey exploring the communication openness perceptions of Chinese doctors and nurses

Objectives Despite growing recognition of the importance of speaking up to protect patient safety in critical care, little research has been performed in this area in an intensive care unit (ICU) context. This study explored the communication openness perceptions of Chinese doctors and nurses and identified their perceptions of issues in ICU communication, their reasons for speaking up and the possible factors and strategies involved in promoting the practice of speaking up. Design A mixed-methods design with quantitative and sequential qualitative components was used. Setting and participants Eighty ICU staff members from a large public hospital in Hong Kong completed a questionnaire regarding their perceptions of communication openness. Ten clinicians whose survey responses indicated support for open communication were then interviewed about their speak-up practices. Results The participating ICU staff members had similar perceptions of their openness to communication. However, the doctors responded more positively than the nurses to many aspects of communication openness. The two groups also had different perceptions of speaking up. The interviewed ICU staff members who indicated a high level of communication openness reported that their primary reasons for speaking up were to seek and clarify information, which was achieved by asking questions. Other factors perceived to influence the motivation to speak up included seniority, relationships and familiarity with patient cases. Conclusions Creating an atmosphere of safety and equality in which team members feel confident in expressing their personal views without fear of reprisal or embarrassment is necessary to encourage ICU staff members, regardless of their position, to speak up. Because harmony and saving face is valued in Chinese culture, training nurses and doctors to speak up by focusing on human factors and values rather than simply addressing conflict management is desirable in this context.