Hong-Gu He

A randomized controlled trial of the effectiveness of a postnatal psychoeducation programme on self-efficacy, social support and postnatal depression among primiparas

AIM To examine the effectiveness of a postnatal psychoeducation programme in enhancing maternal self-efficacy and social support and reducing postnatal depression among primiparas. BACKGROUND Primiparas experience various challenges during the early postnatal period with low self-efficacy, depression and lack of social support. Support in the form of postnatal educational programmes is needed to improve these outcomes of primiparas. DESIGN A randomized controlled two-group pre-test-post-test design was adopted. METHODS Data were collected from June-December 2012 in a public hospital in Singapore from 122 primiparas, who were randomly assigned to the intervention (n = 61) or control group (n = 61). The intervention group received postnatal psychoeducation programme and routine care while the control group received routine care only. The Maternal Parental Self-Efficacy scale, Perinatal Infant Care Social Support scale and Edinburgh Postnatal Depression Scale were used to measure outcomes of maternal parental self-efficacy, social support and postnatal depression. The mean percentage changes of all three outcome variables from baseline to 6 and 12 weeks postpartum between groups were used when performing repeated measures multivariate analysis of covariance. RESULTS The intervention group had significantly higher scores of maternal parental self-efficacy and social support and lower scores of postnatal depression at 6 and 12 weeks postpartum when compared with the control group. CONCLUSION The postnatal psychoeducation programme was effective in improving maternal outcomes and hence could be introduced as routine care with ongoing evaluation in the postnatal period. Future studies could focus on the effects of this programme on other populations. TRIAL REGISTRATION NO ISRCTN15886353.

Health-related quality of life and social support among Chinese patients with coronary heart disease in mainland China

Aim: This study aimed to explore and identify the relationship between health-related quality of life (HRQoL) and perceived social support among Chinese patients with coronary heart disease (CHD) in mainland China. Methods: A descriptive correlational study was conducted with a convenience sample of 200 Chinese patients with CHD recruited from the cardiac outpatient departments of two university-affiliated hospitals in Xi’an, China. The Chinese Mandarin versions of the Short-form 36-item health survey (CM:SF-36) and the Medical Outcomes Study Social Support Survey (CM:MOS-SSS) were administered to assess HRQoL and perceived social support. Results: The results indicated that Chinese patients with CHD reported a poorer HRQoL and lower social support compared with their Western and Hong Kong counterparts. Multiple regression analyses identified four significant predictors of deteriorated physical health (increasing age, co-morbidity with heart failure or hypertension, and smoking status) and two significant predictors of poor mental health (co-morbidity with heart failure and perceived social support). Conclusions: Health status and social support in Chinese people with CHD should be routinely assessed and, where feasible, addressed through appropriate individually tailored interventions.

The mediating effects of coping on the stress and health relationships among nursing students: a structural equation modelling approach

AIMS To test the impact of stress on psychological and physical health, and examine the mediating effects of coping on the stress-health relationships among nursing students. BACKGROUND Stress is associated with various physical and psychological symptoms in nursing students. Numerous studies examined the relationships among stress, coping and health; nevertheless, a mechanism of coping has not been fully explored in Thai nursing students. DESIGN This study adopted a cross-sectional, descriptive correlational research design. METHODS A convenience sample of 335 nursing students were recruited from a University in Thailand from 2005-2007. We used self-reported questionnaires to collect information; and analysed data using descriptive statistics and structural equation modelling. RESULTS Nursing students with high levels of stress reported poorer physical health and higher psychological distress. Stress had a stronger effect and explained more variances on psychological distress than on poor physical health. The partial mediation of coping was observed. Specifically, 77·00% of the effects of stress on poor physical health and 11·30% on psychological distress were mediated by coping. CONCLUSION Evidence from this study contributes to the nursing science and has implications to nursing practice. Stress among nursing students should be monitored and effectively managed to prevent deleterious effects on their health. Nursing interventions focusing on coping skill training could be developed and delivered. Future research may examine the effectiveness of the interventions and/or to further explore variables associated with psychological distress in nursing students.

Predictors of Maternal Parental Self-Efficacy Among Primiparas in the Early Postnatal Period:

Maternal parental self-efficacy is a crucial factor for facilitating the smooth transition into motherhood, particularly for primiparas. The aims of this study were to examine the predictors of maternal parental self-efficacy and its relationship with social support, postnatal depression (PND), and socio-demographic variables of primiparas during the early postnatal period. A descriptive correlational study design was adopted. The instruments, Perceived Maternal Parental Self-Efficacy, Perinatal Infant Care Social Support, and Edinburgh Postnatal Depression Scale, were used to collect data from a purposive sample of 122 primiparas on the day of discharge (1-3 days post delivery) in a tertiary public hospital in Singapore. There were significant correlations among maternal parental self-efficacy, social support, and postnatal depression. The main predictors of maternal parental self-efficacy were social support, ethnicity, maternal age, and family income. The maternal parental self-efficacy, social support, and PND should be routinely assessed to provide necessary support to needy mothers.

Salivary Cortisol Reactivity in Preterm Infants in Neonatal Intensive Care: An Integrative Review

Recently, more and more researchers have been using salivary cortisol reactivity to evaluate stress in preterm infants in the neonatal intensive care unit (NICU). The aim of this integrative literature review was to summarize the evidence of interventions leading to a change in salivary cortisol from the baseline in preterm infants in the NICU. The electronic databases of PubMed, CINAHL, Web of Science, and Scopus were searched for relevant studies. The inclusion criteria were studies with preterm infants exposed to an intervention evaluated by salivary cortisol reactivity before discharge from the NICU, which were published in English. In total, 16 studies were included. Eye-screening examination and heel lance provoked an increase in the salivary cortisol level. Music, prone position, and co-bedding among twins decreased the salivary cortisol level. Several studies reported a low rate of successful saliva sampling or did not use control groups. Future studies need to focus on non-painful interventions in order to learn more about salivary cortisol regulation in preterm infants. Moreover, these studies should use study designs comprising homogenous gestational and postnatal age groups, control groups, and reliable analysis methods that are able to detect cortisol in small amounts of saliva.

Fathers’ Feelings and Experience Related to their Wife/Partner’s Delivery in Northern Greece

Objectives: The study aims at exploring the feelings and the experience of fathers about their wife/partner’s delivery. Background: During the last decades birth attendance by fathers is a common phenomenon across many countries. Fathers’ birth attendance may evoke both positive and negative feelings. Methodology: The study was conducted in a city of Northern Greece. The sample consisted of 417 fathers whose wife/partner had given birth during the previous one week to one year. Data were collected using the Kuopio Instrument for Fathers (KIF). Results: Father’s feelings about their wife or partner were very positive as nearly all (82.1%) of the participants were proud to become fathers and agree that they felt love and were grateful to their wife/partner. However, half of the fathers felt anxious and nervous. 40.7% quite agree that the staff was very professional, that they trusted the staff (45%) and that they were grateful to the staff (38.8%). There is correlation between the “feelings related to the wife/partner” and education (r=0.156, p=0.0047), “being afraid during the preparatory visit at the obstetric hospital” (r=-0.238, p=0.009), and “anxiety during the preparatory visit” (r=0.295 p=0.005). The subscale “feelings related to the environment and staff” correlates with “usefulness of preparatory visit” (r=-0.223, p=0.004) and the subscale of “experiences related to delivery” correlates with “usefulness of preparatory visit” (r=-0.357, p=0.001). Conclusions: Our results support the findings of previous studies, which indicated that birth attendance by fathers has evoked positive feelings about their wife/partner, the delivery, the staff and the hospital environment.

Health-related quality of life and its predictors among patients with rheumatoid arthritis

BACKGROUND Limited studies have examined the predictors of HRQoL among patients with rheumatoid arthritis. This study helped to ascertain the predictors of HRQoL from the pool of influencing factors identified by previous studies. AIM This study investigated the health-related quality of life (HRQoL) of adult patients with rheumatoid arthritis and its predictors. METHODS Using a descriptive correlational design, this study explored the relationship between HRQoL and pain, functional disability, anxiety, depression, medication adherence and social support. Eligible outpatients (n=108) were recruited via their attending doctors who were co-investigators of this study. Informed consent forms were distributed and questionnaires administered in a teaching hub by the main researcher. RESULTS Significant correlations were found between HRQoL and all of the study variables. Pain, functional disability and depression were main predictors of HRQoL. CONCLUSIONS Future evidence-based interventions focusing on pain relief, delaying disability or improving functional ability and reducing depressive symptoms are required to enhance the HRQoL of patients with rheumatoid arthritis.

A randomised controlled trial on the effectiveness of a home-based self-management programme for community-dwelling patients with myocardial infarction.

Aim: To examine the effectiveness of a four-week home-based self-management rehabilitation programme on health-related quality of life, anxiety and depression levels, cardiac risks and unplanned visits to the health services among community-dwelling patients with myocardial infarction. Methods: A randomised controlled trial with repeated measurements was used. A convenience sample of 128 patients with myocardial infarction was recruited from outpatient cardiology clinics at a tertiary hospital in Singapore. Participants were randomly assigned to the intervention group or control group. The outcomes were measured using Short Form 12-item Health Survey Version 2, Myocardial Infarction Dimensional Assessment Scale, and Hospital Anxiety and Depression Scale. The cardiac physiological risk parameters and number of unplanned health service use were also assessed. Data were collected at baseline, and at four weeks and 16 weeks from the baseline. Results: Over the 16 weeks, the two groups reported significant differences in physical activity (F = 4.23, p = 0.02), dependency (F = 5.16, p = 0.01), concerns over medication (F = 3.47, p = 0.04) on MIDAS, anxiety level (F = 3.41, p = 0.04) and body mass index (F = 3.12, p = 0.04). A significant difference was also found in unplanned cardiac-related emergency room visits (χ2 = 6.64, p = 0.036) and medical consultation (χ2 = 9.67, p = 0.046) at the 16-week study point. Conclusion: The study may provide a useful tool to help health care professionals to meet the cardiac rehabilitative care needs of community-dwelling patients with myocardial infarction in Singapore.

Physical fitness, health behaviour and health among nursing students: A descriptive correlational study.

BACKGROUND Health behaviour is of great importance for nursing students to achieve optimal health. Healthy students tend to complete their study and remain in the nursing workforce. They will also serve as a role model of for patients. However, there is limited research concerning physical fitness and health behaviour (such as sleep problems) in this population. OBJECTIVES This study aims to examine the relationships among health behaviour, personal variables, physical fitness, perceived physical health and psychological health. DESIGN A cross-sectional descriptive correlational study was used. PARTICIPANTS A total of 335 nursing students who were enrolled in a university in Thailand. METHODS Data were collected by self-administered questionnaires and physical fitness tests. Independent variables were personal variables and health behaviour. Outcome variables included physical fitness, perceived physical health and psychological health. Descriptive statistics and path analyses were used to analyse data. RESULTS Nursing students had poor to moderate levels of total physical fitness, with cardiovascular fitness and body flexibility components having the lowest scores. Students who exercised regularly tended to have better physical fitness, perceived physical health and psychological health. Those who did not have sleep problems had better psychological health. CONCLUSION Some personal variables and health behaviours were associated with health among nursing students. Appropriate interventions are required to promote positive health behaviour in this population.

The experience of older people living independently in Singapore

BACKGROUND Globally, older people are living independently either alone or with their spouse, population continues to age. In Singapore, some may live with an unrelated older person in a public rental apartment. In Asia, these older people are associated with increased risks of poor health and social isolation, have poorer social support and a poor quality of life. Few studies have explored why these older people choose such living arrangements, the challenges they encountered and what has helped or may help them overcome these challenges. AIM To explore older peoples experiences of living independently or with an unrelated older person. METHODS This descriptive qualitative study involved face-to-face interviews with 25 informants, 65 years or older in Singapore. Thematic analysis was adopted. RESULTS Five themes emerged: (1) making own choice--participants decided to live apart from their families, (2) contending with concerns--the availability of external resources for participants was shrinking, (3) coping with the available assistance--depending on available external resources from the community, (4) holding on to their values--participants rely on their internal resources to manage, and (5) preparing for the inevitable--participants were planning for their final years of life and for their death. CONCLUSION Older people have such living arrangements for many reasons. They attain well-being and quality of life by devising strategies, tapping on their limited external resources and relying on their values to manage their diminishing resources and the foreseeable death. IMPLICATIONS FOR NURSING AND/OR HEALTH POLICY Understanding older peoples experiences may help nurses and health professionals to develop health promotion programmes that support older peoples everyday needs and help them to stay healthy. Public health policy must support older people to live in a safe environment near their extended family to reduce their need to relocate.