Loretta Chung

Effects of music intervention on physiological stress response and anxiety level of mechanically ventilated patients in China: a randomised controlled trial

AIM To examine the effects of music intervention on the physiological stress response and the anxiety level among mechanically ventilated patients in intensive care unit. BACKGROUND Despite the fact that previous studies have found music interventions to be effective in stress and anxiety reduction, effects of music on the Chinese population are inconclusive and warranted systematic study to evaluate its effect fully for a different Asian culture. DESIGN A randomised placebo-controlled trial. METHODS A total of 137 patients receiving mechanical ventilation were randomly assigned to either music listening group, headphone group or control group. Outcome measures included the Chinese version of Spielberger State-Trait Anxiety Scale and physiological parameters (heart rate, respiratory rate, saturation of oxygen and blood pressure). RESULTS Comparison of mean differences (pretest score-posttest score) showed significant differences in heart rate, respiratory rate, systolic blood pressure and diastolic blood pressure as well as the Chinese version of Spielberger State-Trait Anxiety Scale, but not in SaO(2) among the three groups (ranging from p < 0.001 to p = 0.007), of which greater mean differences were found in music listening group. A significant reduction in physiological stress response (heart rate and respiratory rate) over time was found in music listening group (p < 0.001 for both variables) and a significant increase in heart rate and respiratory rate over time in control group (p < 0.001 and p = 0.032), with no significant change over time in headphone group. Within group pretest-posttest comparison of the Chinese version of Spielberger State-Trait Anxiety Scale demonstrated a significant reduction in anxiety for the music listening group (p < 0.001) and headphone group (p < 0.001) but not the control group. CONCLUSIONS Our findings confirm that short-term therapeutic effects of music listening results in substantial reduction in physiological stress responses arising from anxiety in mechanically ventilated patients. RELEVANCE TO CLINICAL PRACTICE Music as a non-pharmacological nursing intervention can be used as complementary adjunct in the care of patients with low-energy states who tire easily, such as those requiring mechanical ventilator support.

Can home visits help reduce hospital readmissions? Randomized controlled trial

AIM This paper is a report of a study to determine whether home visits can reduce hospital readmissions. Background. The phenomenon of hospital readmission raises concerns about the quality of care and appropriate use of resources. Home visits after hospital discharge have been introduced to help reduce hospital readmission rates, but the results have not been conclusive. METHOD A randomized controlled trial was carried out from 2003 to 2005 . The control group (n = 166) received routine care and the study group (n = 166) received home visits from community nurses within 30 days of hospital discharge. Data were collected at baseline before discharge and 30 days after discharge. FINDINGS Patients in the study group were statistically significantly more satisfied with their care. There were no statistically significant differences in other outcomes, including readmission rate, ADL score, self-perceived life satisfaction and self-perceived health. Regression analysis revealed that self-perceived life satisfaction, self-perceived health and disease category other than general symptoms were three statistically significant variables predicting hospital readmissions. CONCLUSION Preventive home visits were not effective in reducing hospital readmissions, but satisfaction with care was enhanced. Subjective well-being is a key variable that warrants attention in the planning and evaluation of postdischarge home care.

Framework for Adopting a Problem-Based Learning Approach in a Simulated Clinical Setting

The problem-based learning (PBL) approach applied in the clinical setting is different from that applied in the classroom setting. This study analyzed a learning and teaching episode in a simulated clinical situation using the PBL approach. Conversation analysis was used to examine the scenario. Data analysis revealed six key manifestations of this learning arrangement: collection of information, data analysis, formulation of hypotheses, validation, discussion and reflection, and learning synthesis. The simulated clinical environment provided realism in learning and allowed students to experience a full range of learning issues within a short time frame. Problem-based learning was a deliberate approach that helped students achieve the following learning outcomes: patient-focused care, student-directed learning, inductive learning, and translation of theoretical knowledge into practical information. Learning was further enhanced with postsimulation self-evaluation and peer analyses. The incorporation of the PBL approach can bring out the optimal effects in a simulated learning environment.

Identifying patient readmission subtypes from unplanned readmissions to hospitals in Hong Kong : a cluster analysis

It has been conjectured with regard to patient readmission patterns that there might be significant differences in patient characteristics, need factors, enabling resources, and health behavior. The aim of this study was to identify the profiles of readmitted patients in Hong Kong (n = 120) based on their predisposing characteristics, needs, health behavior, and enabling resources. All the readmitted patients were recruited to the study in three hospitals from 2003 to 2005. A cluster analysis yielded three clusters: Clusters 1, 2, and 3 constituted 27.5% (n = 33), 27.5% (n = 33), and 45.0% (n = 54) of the total sample, respectively. The study results show that community nurse services do affect the rate at which patients are admitted to hospital for a second time. The findings might help by providing important information that will enable health-care policy-makers to identify strategies to target a specific group of patients in the hope of reducing its readmission rate.