Sally Wai-Chi Chan

Depression, perceived stress, and social support among first-time Chinese mothers and fathers in the postpartum period.

We compared the prevalence of depression in the postpartum period and its relationship with perceived stress and social support in first-time mothers and fathers. A cross-sectional study was conducted in mainland China with a convenience sample of 130 pairs of parents. Measures taken at 6-8 weeks after delivery included the Edinburgh Postnatal Depression Scale, the Perceived Stress Scale, and the Social Support Rating Scale. Eighteen (13.8%) of the mothers and 14 (10.8%) of the fathers were suffering from depression. No signficant differences were found in their prevalence rates. Perceived stress, social support, and partners depression were significantly associated with depression. These findings suggest counseling, support, and routine screening for depression should be provided to both mothers and fathers.

Evaluation of a psychoeducation program for Chinese clients with schizophrenia and their family caregivers

OBJECTIVES To evaluate the effectiveness of a psychoeducation program for Chinese clients with schizophrenia and their family caregivers. METHODS A randomized controlled trial was conducted. Seventy-three clients with a diagnosis of schizophrenia and their caregivers (n=73) were recruited and randomized into a study (n=36) and control group (n=37). Ten psychoeducation sessions were provided to the study group. The outcomes were measured at the baseline, immediately after (post-1), six months (post-2), and 12 months after the intervention (post-3). RESULTS There were significant treatment effects across time for all client outcomes: adherence to medication (p<0.01), mental status (p<0.01), and insight into illness (p<0.01). However, no significant differences were found between groups at the post-3 measures for all client outcomes. For the caregivers, significant group differences were only detected in self-efficacy at the post-1 (p=0.007) and post-2 (p<0.001) measures, the level of satisfaction at the post-1 (p=0.033) and post-2 (p<0.021) measures, and the perception of family burden at the post-2 measures (p=0.043). CONCLUSION A psychoeducation intervention had positive effects on Chinese clients and their caregivers. However, these effects might not be sustained 12 months after the intervention. PRACTICE IMPLICATIONS To substantiate its effects, psychoeducation should be an ongoing intervention, with its outcomes constantly evaluated.

Motivational interviewing: a useful approach to improving cardiovascular health?

AIM To review and synthesise, systematically, the research findings regarding motivational interviewing and to inform education, research and practice in relation to cardiovascular health. BACKGROUND Motivational interviewing is designed to engage ambivalent or resistant clients in the process of health behaviour change, and it has been widely used in different clinical conditions such as substance abuse, dietary adherence and smoking cessation. Motivational interviewing has also been proposed as a method for improving modifiable coronary heart disease risk factors of patients. DESIGN Systematic review. METHOD Eligible studies published in 1999-2009 were identified from the following databases: CINAHL, Medline, PsycINFO, Cochrane Library, EBSCO, Web of Science, Embase and British Nursing Index. A manual search was conducted of bibliographies of the identified studies and relevant journals. Two researchers independently reviewed the studies. RESULTS Four meta-analyses, one systematic review and three literature reviews of motivational interviewing and five primary studies of motivational interviewing pertaining to cardiovascular health were identified. Despite a dearth of primary studies in cardiovascular health settings, there appears to be strong evidence that motivational interviewing is an effective approach focusing on eliciting the persons intrinsic motivation for change of behaviour. CONCLUSION Motivational interviewing is an effective approach to changing behaviour. It offers promise in improving cardiovascular health status. RELEVANCE TO CLINICAL PRACTICE This review indicates that motivational interviewing is a useful method to help nurses improve health behaviour in people with coronary risk factors.

Collaboration between hospital physicians and nurses: An integrated literature review

BACKGROUND Ineffective physician-nurse collaboration has been shown to cause work dissatisfaction among physicians and nurses and compromised the quality of patient care. AIM The review sought to explore: (1) attitudes of physicians and nurses toward physician-nurse collaboration; (2) factors affecting physician-nurse collaboration; and (3) strategies to improve physician-nurse collaboration. METHODS A literature search was conducted in the following databases: CINAHL, PubMed, Wiley Online Library and Scopus from year 2002 to 2012, to include papers that reported studies on physician-nurse collaboration in the hospital setting. FINDINGS Seventeen papers were included in this review. Three of the reviewed articles were qualitative studies and the other 14 were quantitative studies. Three key themes emerged from this review: (1) attitudes towards physician-nurse collaboration, where physicians viewed physician-nurse collaboration as less important than nurses but rated the quality of collaboration higher than nurses; (2) factors affecting physician-nurse collaboration, including communication, respect and trust, unequal power, understanding professional roles, and task prioritizing; and (3) improvement strategies for physician-nurse collaboration, involving inter-professional education and interdisciplinary ward rounds. CONCLUSION This review has highlighted important aspects of physician-nurse collaboration that could be addressed by future research studies. These include: developing a comprehensive instrument to assess collaboration in greater depth; conducting rigorous intervention studies to evaluate the effectiveness of improvement strategies for physician-nurse collaboration; and examining the role of senior physicians and nurses in facilitating collaboration among junior physicians and nurses. Other implications include inter-professional education to empower nurses in making clinical decisions and putting in place policies to resolve workplace issues.

Family Caregiving in Dementia: The Asian Perspective of a Global Problem

Background/Aims: With an increasing life expectancy, the number of people suffering from dementia globally will rise to about 115.4 million by 2050. It is projected that in the 21st century, the majority of the world’s older people will be living in Asia. This paper examines the global issues of family caregiving for older persons with dementia from an Asian perspective. Methods: Literature review of published empirical studies from 1990 to October 2010. Results: A full understanding of the specific way that culture could influence family caregivers’ burdens may play an important part in the development of a holistic model for family-centered care. Well-designed psychoeducation interventions or multicomponent interventions could help in reducing caregivers’ burden. With socio-economical and demographical changes, families need to be supported when taking on the caregiving role and be offered alternatives of care. Conclusion: There is a need for future trials with more rigorous randomization and longitudinal follow-up to assess family caregiver burdens at different illness stages. Future studies could focus on protective factors that promote caregivers’ resilience. It is essential to develop psychometrically robust measures for family caregiver burden and gain.

Effectiveness of an educational intervention on levels of pain, anxiety and self‐efficacy for patients with musculoskeletal trauma

AIM This paper is a report of a study of the effectiveness of a pain management educational intervention on level of pain, anxiety and self-efficacy among patients with musculoskeletal trauma and consequent orthopaedic surgery. BACKGROUND Substantial evidence supports the use of preoperative education to improve patient outcomes. Educational interventions are common in preparing patients for orthopaedic surgery. METHODS A pre- and post-test design (quasi-experimental) was employed in 2006 with patients assigned either to a control (usual care) or an experimental group (usual care plus educational intervention). The 30-minute educational intervention consisted of information about pain, coping strategies and breathing relaxation exercises. The outcome measures were scores for pain, anxiety, self-efficacy, analgesic use and length of hospital stay and these were measured before surgery and on day 2, day 4, day 7, 1 month and 3 months after surgery. RESULTS A total of 125 patients completed the study (control, n = 63; experimental = 62). The experimental group reported statistically significantly lower levels of pain, less anxiety and better self-efficacy during hospitalization (before surgery to day 7), as compared to the control group. The experimental group had more requests for analgesics at day 2 only. There were no statistically significant effects on length of stay. At the 3-month evaluation, a statistically significant effect on anxiety level was found in favour of the experimental group. CONCLUSION Patients may benefit from this educational intervention in terms of relieving pain, anxiety and improving self-efficacy, and the educational intervention could be incorporated as part of routine care to prepare musculoskeletal trauma patients for surgery.

The effects of a childbirth psychoeducation program on learned resourcefulness, maternal role competence and perinatal depression: A quasi-experiment

BACKGROUND Learned resourcefulness plays a significant role in facilitating maternal coping during the transition to motherhood. Given the growing evidence of perinatal depression and the frequent feeling of incompetence in the maternal role, the implementation of an effective intervention to promote maternal role competence and emotional well-being is essential. OBJECTIVES To determine the impact of a childbirth psychoeducation program based on the concept of learned resourcefulness on maternal role competence and depressive symptoms in Chinese childbearing women. DESIGN A pretest-posttest, control group quasi-experimental design with repeated measures was used. SETTING The study was conducted in two regional public hospitals in Hong Kong that provide routine childbirth education programs with similar content and structure. One hospital was being randomly selected as the experimental hospital. PARTICIPANTS A convenience sample of 184 Chinese pregnant women attending the childbirth education was recruited between October 2005 and April 2007. Inclusion criteria were primiparous with singleton and uneventful pregnancy, at gestation between 12 and 35 weeks, and did not have a past or familial psychiatric illness. METHODS The intervention was a childbirth psychoeducation program that was incorporated into the routine childbirth education in the experimental hospital. The experimental group (n=92) received the childbirth psychoeducation program and the routine childbirth education. The comparison group (n=92) received the routine childbirth education alone in the comparison hospital. Outcomes were measured by the Self-Control Schedule, Parenting Sense of Competence Scale-Efficacy subscale and Edinburgh Postnatal Depression Scale at baseline, immediately post-intervention, at 6 weeks and 6 months postpartum. Analysis was by intention to treat. RESULTS Women receiving the childbirth psychoeducation program had significant improvement in learned resourcefulness at 6 weeks postpartum (p=0.004) and an overall reduction in depressive symptoms (p=0.01) from baseline to 6 months postpartum compared with those who only received the routine childbirth education after adjusting for baseline group differences on age and social support. No significant group difference was found on maternal role competence. CONCLUSIONS The childbirth psychoeducation program appears to be a very promising intervention for promoting learned resourcefulness and minimizing the risk of perinatal depression in first-time Chinese childbearing women. Future empirical work is required to determine the effectiveness of extending the childbirth psychoeducation program into the early postpartum for the promotion of maternal role competence in Chinese childbearing women.

Predictors and correlates of maternal role competence and satisfaction.

Background: Developing a sense of competence and satisfaction in the maternal role enhances positive parenting and healthy development of the child. There is limited longitudinal research on the predictive factors influencing maternal role competence and satisfaction. Objectives: The aim of this study was to determine the predictive and concurrent associations of prenatal perceived maternal role competence, learned resourcefulness, social support, stress, and depression to perceived maternal role competence and satisfaction at 6 weeks postpartum. Method: A longitudinal, descriptive design was used. A convenience sample of 184 first-time pregnant women with a singleton and uneventful pregnancy were recruited from two regional public hospitals in Hong Kong. The Parenting Sense of Competence Scale, Self-control Schedule, Medical Outcomes Study Social Support Survey, Social Readjustment Rating Scale, and Edinburgh Postnatal Depression Scale were used to assess maternal role competence and satisfaction, learned resourcefulness, social support, stress, and depressive symptoms, respectively. Data were collected during pregnancy and at 6 weeks postpartum. Results: Multiple regression analysis showed that perceived maternal role competence and satisfaction at 6 weeks postpartum were predicted by prenatal perceived maternal role competence and learned resourcefulness and were associated with postnatal learned resourcefulness and depression. Social support and stress were not associated directly with perceived maternal role competence and satisfaction at 6 weeks postpartum. Discussion: The present findings suggest that maternal learned resourcefulness and depression are important factors affecting perceived maternal role competence and satisfaction at postpartum. Culturally competent healthcare should be developed to promote the psychological well-being of women and to equip women with the learned resourcefulness skills to facilitate maternal role taking and enhance womens sense of competence and satisfaction in the maternal role.

Psychoeducation Program for Chinese Family Carers of Members With Schizophrenia

The purpose of this study was to evaluate the effectiveness of a psychoeducation program for Chinese family carers of members with schizophrenia in Hong Kong. The participants consisted of 64 carers of clients with schizophrenia who were recruited from a local mental hospital and randomly assigned to the experimental and control arm (32 each). The experimental group received a psychoeducation program developed and implemented by mental health nurses based on Atkinson and Coia’s framework. The control group received routine care. The outcome measures were family burden, self-efficacy, and perception of social support. The findings showed that the experimental group had more improvement on their perception of burden of care (t = 5.25, p< .01), self-efficacy (t = -7.16, p< .01), and social support (t= -5.61, p < .01). This study supports psychoeducation as an effective nursing intervention for Chinese family carers.

Translation and validation of a Chinese version of the parenting sense of competence scale in Chinese mothers

Background: Womens sense of competence and satisfaction in the maternal role are essential for positive parenting practices and child development. Measures of maternal role competence and satisfaction are limited in the Chinese population. Objectives: To translate the Parenting Sense of Competence Scale into Chinese (C-PSOC) and to examine the psychometric properties of the C-PSOC. Methods: A cross-sectional survey was conducted using a convenience sample of 170 mothers recruited from a postnatal unit. Participants completed the C-PSOC, Rosenbergs Self-Esteem Scale, and the Edinburgh Postnatal Depression Scale. A randomly selected subsample of 57 mothers participated in the 4-week retest. Results: The C-PSOC demonstrated good internal consistency (Cronbachs α = .85) and test-retest reliability (intraclass correlation coefficient = .87). Factor analysis supported the two-factor structure reflecting the efficacy and satisfaction dimensions of the original instrument. The scale discriminated between primiparas and multiparas (t = 2.2, p < .05). Significant correlations with Rosenbergs Self-Esteem Scale (r = .60, p < .01) and the Edinburgh Postnatal Depression Scale (r = −.48, p < .01) demonstrated good construct validity. Conclusion: The C-PSOC has satisfactory psychometric properties. It has the potential to be used as a clinical and research instrument for measuring maternal role competence and satisfaction in the Chinese population.