Esther Mok

Family experience caring for terminally ill patients with cancer in Hong Kong.

In this study, 24 family caregivers of terminally ill patients participated in in-depth interviews regarding their experiences of giving care. The data were analyzed using grounded theory qualitative method. Commitment emerged as the precondition of the caregiving process. The caregivers did not perceive the work of caring as a burden. Rather, they felt that despite any personal hardships, what they were doing was important to their loved ones and therefore meaningful to them as caregivers. The components of commitment can be described as relational commitment, the act of showing love, and determination. The process of caregiving includes four phases: 1) holding onto hope for a miracle, 2) taking care, 3) preparing for death, and 4) adjusting to another phase of life. A patient-caregiver relationship, Confucian concepts of yi (appropriateness or rightness), and filial duty are reflected in the process of caregiving. Consequences of the process include finding meaning in life and peace of heart and mind. The emotional aspect of the caregiving experience can be described as an intense emotional experience filled with feelings of hope and hopelessness, guilt, fear, and regret. As a result of the caregiving experience, most participants found they have had a change of worldviews and treasure their lives. Findings show a significant need for interventions at each phase of the caregiving process designed to provide effective and culturally sensitive support and affirmation to family members as they care for their loved ones with terminal illnesses.

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.

The impact of assessment methods on the learning of nursing students

Assessment methods can influence the learning approaches of nursing students. Assessments designed to assess understanding rather than rote learning can contribute to a deep learning approach. Multiple-choice questions can be formulated at high cognitive levels for nursing assessments. This study aimed to examine the effect of high quality multiple-choice tests on the learning approaches of students enrolled in a mental health nursing course as measured by the revised two-factor study process questionnaire (R-SPQ-2F). Data were collected from 136 students in a higher diploma (HD) in nursing programme and 142 baccalaureate (BSN) nursing students. Two-step cluster analysis yielded three clusters represented by students who were predominantly deep, predominantly surface or intermediate in their orientation to learning. There was a general decrease in the deep learning score and an increase in the surface learning score of the students on the course, possibly related to the excessive workload in nursing studies. However, there was no direct association with multiple-choice assessment. The academic achievement of students correlated negatively with their surface learning approach. Students (n=31) in four focus group interviews believed that assessments constructed using scenario-based questions, simulated role-play situations and case studies could direct desired learning in order to facilitate their understanding of knowledge, their use of critical thinking, and their application of knowledge.

Individual Empowerment among Chinese Cancer Patients in Hong Kong

Among the various chronic diseases, cancer is the leading cause of death in Hong Kong. This article presents the process of how cancer patients are being enabled and strengthened to overcome powerlessness based on the interviewfindings of 12 participants. Interviews were analyzed using constant comparison. The basic social process of empowerment included finding meaning in life, seeking mastery over illness, and acceptance of illness. This study’s unique findings suggest that the process of empowering cancer patients consists of more than giving patients control, choice, or resources, such as knowledge and skills. Nurses have an important role in facilitating patients to find meaning in life, as well as in the transformation of thoughts and attitudes. Nurses’ personal qualities and skills embedded in the nurse-patient relationship constitute an important source of empowerment for patients.

Effectiveness of music intervention on the quality of life of older people

AIM This paper is a report of a study of the effect of music on the quality of life of community-dwelling older Chinese people in Hong Kong. BACKGROUND Older peoples quality of life can be improved by preparing for the transition into old age. Listening to music, as a vehicle for feeling, can facilitate the non-verbal expression of emotion, reaching peoples inner feelings without being threatening, and it can be a tool for emotional catharsis. METHOD A randomized controlled trial design was conducted from in 2007 in a community centre in Hong Kong. A total of 66 older people (31 in music group and 35 in control group), aged from 65 to 90 years were randomly assigned to undergo either a 30-minute music intervention or a rest period for 4 weeks; quality of life outcomes were then measured. RESULTS Quality of life improved weekly in the music group, indicating a cumulative dose effect, and a statistically significantly better quality of life was found over time in each sub-score for those in the music group compared with the controls. However, in the music group, there were no statistically significant improvements of quality of life in each sub-score over the 4 weeks. CONCLUSION Being engaged in music activities can help a person to connect with their life experiences and with other people, and to be more stimulated. Music is a non-invasive, simple and inexpensive therapeutic method of improving quality of life in community-dwelling elders.

Educating nurses to care for the dying in Hong Kong: a problem-based learning approach.

Caring for dying patients is an essential and major aspect of nursing care. However, previous studies have revealed that nurses felt uncomfortable and inadequate in dealing with the dying patients and their families. This study reports the effectiveness of a problem-based learning approach in death education among a group of registered nurses in Hong Kong. Three problems, with three segmented scenarios related to cancer nursing, were used. Students went through the problem-based learning process and documented their learning throughout the course in journals. A total of 72 sets of journals were collected and analyzed. The strategies of within case and cross-case analysis were employed. The within case analysis explored the learning development of students for each problem. The cross-case analysis compared and contrasted findings of the within case analysis. Three themes have been derived from the findings. They were: nurses acknowledging their emotions in facing death and dying, a need for the nurses to be better equipped in communication and counseling, and a holistic and family-centered approach to care. This study provides evidence showing that problem-based learning is an effective strategy to enhance nurses’ self-awareness of death and dying issues, and to stimulate nurses to formulate a plan that addresses the physical, psychological, and social aspects of care. Findings also reveal that nurses need to take into account the particular reactions of death and dying in the Chinese culture when planning care.

Effect of a life review program for Chinese patients with advanced cancer: a randomized controlled trial.

BACKGROUND Empirical data suggest that life review is an effective psychospiritual intervention. However, it has not been applied to Chinese patients with advanced cancer, and its effects on this population remain unknown. OBJECTIVE The aim of the study was to determine the effect of a life review program on quality of life among Chinese patients with advanced cancer. METHODS In this prospective randomized controlled trial, a total of 80 patients were randomly assigned to the life review program group and the control group. The 3-weekly life review program included reviewing a life and formulating a life review booklet. Outcome data were assessed by a collector who was blinded to group assignment before and immediately after the program and at a 3-week follow-up. RESULTS Significantly better scores in overall quality of life, support, negative emotions, sense of alienation, existential distress, and value of life were found in the life review group immediately after the program and at the 3-week follow-up. CONCLUSION This study provides additional data on the potential role of a life review in improving quality of life, particularly psychospiritual well being; it also indicates that the life review program could enable Chinese patients with advanced cancer to express their views on life and death. IMPLICATIONS FOR PRACTICE The life review program offers advanced cancer patients an opportunity to integrate their whole life experiences and discuss end-of-life issues, which lays the ground for further active intervention in their psychospiritual distress. The program could be integrated into daily home care to enhance the psychospiritual well-being of Chinese patients with advanced cancer.

An exploratory study of nurses suffering from severe acute respiratory syndrome (SARS)

In 2003, severe acute respiratory syndrome (SARS) came to be recognized as a newly emergent form of disease that is highly contagious. The aim of this study was to describe the perceptions of nurses with SARS in Hong Kong, as the perceptions of nurses who have suffered from SARS have not been studied. Ten nurses who had suffered from SARS were interviewed, either face‐to‐face or by telephone, about their subjective experiences. These interviews provided in‐depth, descriptive data, which were analysed using content analysis. Nine broad categories were identified: uncertainty, information control, feelings of anger and guilt, lack of preparation and fear of death, feelings of isolation and loneliness, physical effects, support, change of perspective of life, and change of perspective of nursing. Although the dreaded disease affected the nurses tremendously, both physically and psychologically, it has also had its positive side. As a result of experiencing the illness, the participants came to treasure relationships, health and everyday life more. In caring for patients, they came to see the world more from the perspective of the patients. They found that they need to take the time to reassure patients and families and to seriously listen to all of their concerns.

Seeking harmony in the provision of care to the stroke-impaired : views of Chinese family caregivers

AIMS To explore the coping strategies of Chinese family caregivers of stroke-impaired older relatives. BACKGROUND Many stroke-impaired patients rely heavily on support from their families, and the daily lives of such family caregivers are severely impacted. However, services and support for family caregivers of stroke-impaired relatives in the home setting have received little attention. Appropriate and relevant information and support to family caregivers are important in facilitating the care-giving task. It is, therefore, necessary to understand the nature and demands of care-giving before planning specific educational and support programmes. DESIGN Grounded theory. METHODS Fifteen Chinese family caregivers of stroke-impaired older relatives were recruited and interviewed in 2003 and 2004. Theoretical sampling and constant comparative analysis were used to recruit the sample and perform data analysis. RESULTS Seeking harmony to provide care for the stroke-impaired was the core category for describing and guiding the family care-giving process, with five main stages: (1) living with ambiguity, (2) monitoring the recovery progress, (3) accepting the downfalls, (4) meeting family obligations and (5) reconciling with harmony. These issues were seldom discussed openly with health professionals. CONCLUSIONS The findings indicated that Chinese family caregivers determine their own needs by seeking harmony to continue to provide care without thinking about getting help from others or their own health problems. These findings help to define some of the complex dynamics that have an impact on the development of partnership care and might challenge nurses practising in the community. RELEVANCE TO CLINICAL PRACTICE Community nurses should assess and understand the coping strategies of family caregivers and assist them to engage in stress-reducing practices. This is an important partnership to be formed in stroke care for family caregivers in the community. The study findings will guide further development of family care-giving aspects in nursing practice.