Iris Fung-Kam Lee

Anxiety, depression and pain intensity in patients with low back pain who are admitted to acute care hospitals.

AIM This study examines the relationship between anxiety, depression and pain intensity in patients with low back pain who are newly admitted to an acute care hospital setting. BACKGROUND Previous studies have supported the idea that anxiety and depression play a significant role in chronic low back pain, but the relationship between anxiety, depression and pain intensity in patients with low back pain who are newly admitted to hospital has not been adequately explored. METHOD The study reported here was descriptive correlational in design. The sample was 102 Chinese patients with low back pain who were newly admitted to an acute care hospital in Hong Kong. Data were collected through individual interviews, using an 11-point numerical pain rating scale and the Hospital Anxiety and Depression Scale. In addition, demographic data were identified from the medical record. RESULTS There were 48 male and 54 female adult participants in the study. The average anxiety and depression level of the participants was 19.46 (SD 9.02) on a scale of 0-42, which is higher than the normal level. The level of anxiety and depression was significantly positively correlated with pain intensity (r = 0.471, p < 0.0005) and was also a significant predictor of pain intensity (t = 3.918, p < 0.0005, 95% CI 0.050-0.154). CONCLUSION The results of this study showed that anxiety and depression are not only associated with pain intensity but that they also, partly, predict pain intensity in patients with low back pain who are newly admitted to an acute care hospital. Relevance to clinical practice. The results of this study support the assessment of and intervention in anxiety and depression symptoms in the provision of pain-relief nursing treatment in patients with low back pain who are admitted to acute care hospitals.

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).

Promoting self-reflection in clinical practice among Chinese nursing undergraduates in Hong Kong

This study evaluated the effect of a structured education programme on improving the self-reflection skills of Chinese nursing undergraduates in managing clinical situations. Johns’ Structured Reflection Model was used as a framework for the development of the education programme. Thirty-eight nursing undergraduates attended a 3-hour interactive workshop on reflective skills and were encouraged to practise the skills learned under the guidance of a nurse instructor during their 4-week clinical practicum. The findings indicated that the programme was helpful in improving the undergraduates’ reflective skills though only a few of them reached the highest level as critical reflectors. Some undergraduates identified time constraints and the lack of a trusting relationship with their nurse instructor as barriers to their reflective learning. The findings may help nurse educators develop education programmes with structured learning strategies to promote nursing undergraduates’ self-refection in clinical practice.

Predicting Influenza Vaccination Intent Among At-Risk Chinese Older Adults in Hong Kong

BackgroundOlder adults with major chronic illnesses are very susceptible to influenza and its serious complications, but many do not obtain vaccinations. Little is known about factors associated with intention to obtain influenza vaccination among at-risk Chinese older adults in Hong Kong. ObjectivesThe aim of this study was to identify factors associated with intent to obtain influenza vaccination among at-risk Chinese older adults in Hong Kong. MethodsThis multicenter descriptive correlational study recruited a convenience sample of 306 Chinese older adults with medical risk factors for influenza and its serious complications from the general outpatient clinics in Hong Kong. Interviews were conducted to assess intent to obtain influenza vaccination for the coming year, health beliefs about influenza, and discomfort following past vaccinations. ResultsThe current influenza vaccination rate was 58.5%; only 36.3% intended to get vaccinated the following year. After controlling for clinical and demographic factors in a logistic regression model, perceived susceptibility predicted intention to obtain future vaccination (OR = 1.42, 95% CI [1.14, 1.78]), whereas postvaccination discomfort was negatively associated with intention (OR = 0.063, 95% CI [0.006, 0.63]). ConclusionsIntention to obtain influenza vaccination was low among at-risk Chinese older adults. Strengthening health beliefs and creating strategies to provide positive influenza vaccination experiences are possible approaches to interventions to improve uptake of influenza vaccination rates.

The effect of a virtual ward program on emergency services utilization and quality of life in frail elderly patients after discharge: a pilot study.

Introduction Attendance at emergency departments and unplanned hospital readmissions are common for frail older patients after discharge from hospitals. A virtual ward service was piloted to deliver “hospital-at-home” services by community nurses and geriatricians to frail older patients immediately after their discharge from hospital to reduce emergency services utilization. Objectives This study examined the impacts of the virtual ward service on changes in the patients’ emergency attendance and medical readmissions, and their quality of life (QOL). Methods A matched-control quasi-experimental study was conducted at four hospitals, with three providing the virtual ward service (intervention) and one providing the usual community nursing care (control). Subjects in the intervention group were those who are at high risk of readmission and who are supported by home carers recruited from the three hospitals providing the virtual ward service. Matched control patients were those recruited from the hospital providing usual care. Outcome measures include emergency attendance and medical readmission in the past 90 days as identified from medical records, and patient-reported QOL as measured by the modified Quality-of-Life Concerns in the End of Life Questionnaire (Chinese version). Wilcoxon signed-rank tests compared the changes in the outcome variables between groups. Results A total of 39 patients in each of the two groups were recruited. The virtual ward group showed a greater significant reduction in the number of unplanned emergency hospital readmissions (−1.41±1.23 versus −0.77±1.31; P=0.049) and a significant improvement in their overall QOL (n=18; 0.60±0.56 versus 0.07±0.56; P=0.02), but there was no significant difference in the number of emergency attendances (−1.51±1.25 versus −1.08±1.48; P=0.29). Conclusion The study results support the effectiveness of the virtual ward service in reducing unplanned emergency medical readmissions and in improving the QOL in frail older patients after discharge.

Effects of Lifestyle Intervention on Physiological Outcomes in Chinese Adults With, or at High Risk of, Metabolic Syndrome.

Background: Metabolic syndrome (MS) increases the risk of cardiovascular events and the development of diabetes. This article reports the effects of lifestyle intervention on the physiological outcomes of people with or at high risk of MS in the community setting of Hong Kong. Methods: Chinese adults with 2 or more MS components were recruited from 13 community centers, which were cluster-randomized to the intervention or control group. The intervention group received a low-intensity lifestyle intervention program for people with MS consisting of group sessions, individual counseling, and telephone follow-ups over 3 months. The control group received standard care plus an attention placebo. The primary outcomes were body weight and waist circumference, whereas the secondary outcomes included blood pressure, lipids, glucose, and number of MS components. Linear mixed-effects models were used to compare the effects of the program between the 2 groups. Results: The final sample consisted of 183 adults (19.1% male) with a mean (SD) age of 54.0 (7.8) years. At 3 months, overall MS prevalence was reduced to 13.8%. Compared with the control group, subjects in the intervention group exhibited a reduced waist circumference (&bgr; = −.146, P = .008) when the interaction effects of time and group were considered simultaneously. However, no significant differences were found for changes in the other measured outcomes. Conclusion: A low-intensity lifestyle intervention program for people with MS can reduce central obesity among people with or at high risk for MS. Further research is necessary to confirm the long-term physiological effects of the intervention.

Knowledge of metabolic syndrome in Chinese adults: Implications for health education

Objective: The objective of this study was to assess knowledge of metabolic syndrome (MS) among Chinese adults and provide directions for designing healthcare promotion schemes for improving MS awareness in the community. Design: The study adopted a cross-sectional design and a convenience sampling method. Method: Chinese adults aged 18–65 years and living in the community completed a self-administered questionnaire, providing socio-demographic information and indicating their knowledge of MS using a validated knowledge of MS (K-MS) scale comprising 10 multiple-choice questions. The scores of K-MS can range from 0 to 100. Results: A total of 297 participants were recruited (mean age = 51.3 ± 8.9 years), 66.7% of whom were women. More than half of all participants (n = 154) were identified as having MS and numerous participants were obese (n = 158). The mean K-MS score was 44.9 out of 100; most participants (61%) scored below 50, indicating a poor level of MS knowledge. Participants who were older, had a lower level of education or were unemployed scored the lowest. Conclusion: Acquiring knowledge of MS is crucial for preventing the development of type 2 diabetes and cardiovascular diseases. However, Chinese adults in a community setting exhibited poor understanding of MS. Public health efforts regarding primary prevention of cardiovascular diseases should be targeted at improving MS knowledge. Additional measures are needed to assist people in the low socioeconomic classes.