Sek Ying Chair

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.

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 effect of nursing interventions utilizing music therapy or sensory information on Chinese patients' anxiety prior to cardiac catheterization: a pilot study.

Background: Unrelieved anxiety can produce an increase in sympathetic nervous system activity leading to an increase in cardiac workload. Nursing interventions using music therapy or sensory information among patients with coronary artery disease has resulted in anxiety reduction, though results in Chinese subjects has not previously been published. Aims: To determine the effects of using nursing interventions of music therapy or sensory information, on reducing anxiety and uncertainty, and improving negative mood among Chinese subjects immediately prior to cardiac catheterization. Methods: An experimental three-group repeated measures design for this pilot study was used. Forty-five hospitalized adults (15/group) undergoing cardiac catheterization were randomly assigned to either (1) a music therapy intervention, (2) a sensory information intervention or (3) treatment as usual (control). Anxiety, uncertainty and mood state were measured using self-reported questionnaires and physiological measures were made at baseline, post-intervention to determine their effect and post-cardiac catheterization to determine whether these interventions had any long-lasting effect. Results: The control group was found to be significantly older (P=0.001) than the two experimental groups. Older age was associated with lower anxiety scores (r=−0.31, P=0.04 at baseline; r=−0.30, P=0.04 post-intervention; r=−0.22, P=0.15 post-cardiac catheterization). After controlling for age, the use of music therapy or sensory information did not significantly reduce anxiety, improve mood state, reduce uncertainty, decrease heart or respiratory rate among subjects undergoing cardiac catheterization. Conclusion: The non-significant result may have been affected by the small sample, and the social and cultural expectations regarding the public display of emotions among Chinese populations.

Diurnal Temperature Range and Daily Cardiovascular Mortalities Among the Elderly in Hong Kong

ABSTRACT The authors aimed to examine the association between diurnal temperature range (DTR) and daily mortalities due to cardiovascular disease among people aged 65 years and older in Hong Kong, China. The authors used a generalized additive model to regress daily mortalities of the elderly due to cardiovascular disease on DTR and daily concentrations of air pollutants from 1997 to 2002. They also tested the effects of different lag days of DTR on mortality. Results indicate significant associations between cardiovascular mortality and DTR at lag day 1 and at lag days 0–1 to 0–5. The largest effect was at lag days 0–3 (relative risks = 1.017; 95% confidence interval = 1.003–1.031). The authors recommend that special attention be paid to the elderly population to protect them from excessive diurnal variations in temperature.

Effects of home-based rehabilitation on health-related quality of life and psychological status in Chinese patients recovering from acute myocardial infarction

OBJECTIVE This study evaluated the effects of a home-based rehabilitation program for Chinese patients with myocardial infarction in terms of health-related quality of life and psychological status. METHODS This was a randomized, controlled trial with data collected at 2 university-affiliated public general hospitals in Xian (Shaanxi Province, Peoples Republic of China). One hundred and sixty patients with a myocardial infarction were randomly assigned to either the interventional group (a home-based cardiac rehabilitation program using a self-help manual) or the control group (usual care). Health-related quality of life (generic, Chinese Short Form 36-Item Health Survey; disease-specific, Chinese Myocardial Infarction Dimensional Assessment Scale) and psychological status (the Chinese Hospital Anxiety and Depression Scale) were measured at baseline, program completion (6 weeks), and 3 and 6 months after hospital discharge. RESULTS Significant differences were evident in the main outcomes when the home-based group was compared with the usual care group at 6 weeks, 3 months, and 6 months. The home-based group had significantly higher scores on 4 of the 8 domains of the Chinese Short Form 36-Item Health Survey and on 3 of the 7 dimensions of the Chinese Myocardial Infarction Dimensional Assessment Scale, with significantly lower scores on the anxiety, but not the depression, subscale of the Chinese Hospital Anxiety and Depression Scale. CONCLUSIONS A simple, home-based cardiac rehabilitation program for patients with acute myocardial infarction, using a self-help manual, improves health-related quality of life and reduces anxiety. It appears feasible and acceptable, and does not produce inferior outcomes compared with usualcare in China.

Relationship between job stress level and coping strategies used by Hong Kong nurses working in an acute surgical unit

OBJECTIVE The aim of this study is to explore the relationship between job stress and coping strategies of Hong Kong nurses working in an acute surgical unit. METHOD This is a descriptive correlational study. Data were collected from 98 Hong Kong surgical nurses using the Nursing Stress Scale and the Jalowiec Coping Scale. RESULTS Results showed that workload (M = 15.36), lack of support (M = 13.32), and inadequate preparation (M = 12.33) are the most common stressors for Hong Kong surgical nurses. The most frequent strategies used by nurses to cope with stress can be characterized as evasive (M = 19.23), confrontive (M = 17.46), and optimistic (M = 15.81), all of which are also rated as the most effective strategies in reducing stress levels. Only the confrontive, optimistic, supportant, and emotive coping strategies reveal significant correlations (p < .05) with the stress levels of nurses, whereas the evasive, fatalistic, palliative, and self-reliant strategies showed no significant correlation with stress levels (p > .05). CONCLUSION Recognizing the impacts of job-related stress and making use of effective coping methods play a vital role in reducing nurses stress. A change in leadership styles from the managerial level and reallocation of manpower may help reduce job stress. The use of confrontive and optimistic coping strategies in reducing job-related stress for surgical nurses should be advocated and promoted in their daily work.

Quality of life and most prevalent unmet needs of Chinese breast cancer survivors at one year after cancer treatment

PURPOSE This study aims to examine the supportive care needs of Chinese breast cancer survivors, and investigate the relationships with participant characteristics and quality of life. METHODS A total of 163 participants were recruited from a local public hospital and completed a self-administered questionnaire: the 34-item Supportive Care Needs Survey, the supplementary module of access to healthcare and ancillary support services, and the Functional Assessment of Cancer Therapy. RESULTS The five most commonly reported unmet needs were all in the health system information domain (range: 55-63%), and the majority (84%) reported at least one unmet need in relation to information on healthcare. Stepwise multivariable regression analyses revealed that the time spent on travelling from home to hospital, receiving hormonal therapy, and physical and psychological unmet needs were independently associated with poorer quality of life among the participants. CONCLUSIONS Breast cancer survivors perceive various unmet needs, and health system information is the most common one. Those who have more unmet needs in the physical and psychological domains were more likely to perceive a poorer quality of life.

The sustaining effects of Tai chi Qigong on physiological health for COPD patients: A randomized controlled trial

OBJECTIVES To evaluate the sustaining effects of Tai chi Qigong in improving the physiological health for COPD patients at sixth month. DESIGN A randomized controlled trial. Subjects were in three randomly assigned groups: Tai chi Qigong group, exercise group, and control group. SETTING The 206 subjects were recruited from five general outpatient clinics. INTERVENTIONS Tai chi Qigong group completed a 3-month Tai chi Qigong program. Exercise group practiced breathing and walking as an exercise. Control group received usual care. MAIN OUTCOME MEASURES Primary outcomes included six-minute walking distance and lung functions. Secondary outcomes were dyspnea and fatigue levels, number of exacerbations and hospital admissions. RESULTS Tai chi Qigong group showed a steady improvement in exercise capacity (P<.001) from baseline to the sixth month. The mean walking distance increased from 298 to 349 meters (+17%). No significant changes were noted in the other two groups. Tai chi Qigong group also showed improvement in lung functions (P<.001). Mean forced expiratory volume in 1s increased from .89 to .99l (+11%). No significant change was noted in the exercise group. Deterioration was found in the control group, with mean volume decreased from .89 to .84l (-5.67%). Significant decreased in the number of exacerbations was observed in the Tai chi Qigong group. No changes in dyspnea and fatigue levels were noted among the three groups. CONCLUSIONS Tai chi Qigong has sustaining effects in improving the physiological health and is a useful and appropriate exercise for COPD patients.

Perceived unmet needs and health-related quality of life of Chinese cancer survivors at 1 year after treatment.

Background: Although advanced cancer treatments prolong survivors’ lives, a significant proportion experienced poorer health-related quality of life (HRQoL) than general populations. Identifying their needs is essential to develop a health service delivery model to improve patient outcomes. Objective: The objective of this study was to examine the perceived unmet needs and HRQoL of Chinese cancer survivors who completed treatment less than 1 year ago. Methods: Three hundred seventy-six participants completed a self-report survey: the 34-item Supportive Care Needs Survey, the supplementary module of access to healthcare and ancillary support services, and the Functional Assessment of Cancer Therapy: General. Descriptive statistics were used to examine the prevalence of unmet needs. Multivariable logistic regressions were conducted to identify participants’ characteristics that were associated with unmet needs. Multiple linear regression was used to delineate which domains of unmet needs were significantly associated with HRQoL with adjustment for potential confounding factors. Results: Healthcare information was the most common unmet needs among the survivors. Age, stage of cancer, and remission were significantly associated with 1 or more unmet need domains. Participants with unmet needs in physical, psychological, and patient care domains, on average, have poorer HRQoL. Conclusions: Chinese cancer survivors have various unmet needs that might have adverse effects on their HRQoL. Younger age, more advanced stages of cancer, and remission were factors contributing to further unmet needs. Implications for Practice: The results provided useful information on the special needs of survivors that may affect their HRQoL, enabling clinicians to plan better how to allocate existing limited resources to those who most require them.

A psychometric evaluation of a Chinese version of the Cardiac Depression Scale

OBJECTIVE This study aimed to evaluate the validity, reliability, and cultural relevance of the Cardiac Depression Scale (CDS) as a disease-specific screening tool for Chinese cardiac patients. METHODS The language equivalency and content validity of the Chinese version of the CDS (C-CDS) were evaluated. Measurement performance was tested on 200 Chinese cardiac patients and repeated on 40 patients for test-retest reliability. RESULTS One item pertaining to sexual activity was removed from the Chinese version due to poor cultural relevance. The C-CDS demonstrated acceptable internal consistency (Cronbachs alpha of .91 for the total scale and .53-.78 for the subscales). The high correlation (r=.64-.89) between items and the remainder of their own scale provides further evidence of internal consistency. The test-retest reliability was satisfactory with intraclass correlation coefficients of .94 for the overall scale and .73-.92 for the six subscales. The total and subscale scores that were not significantly different (P>.05) over a 2-week period further support the stability of the instrument. There was acceptable concurrent validity with moderate (r>or=.3, P<.001) correlations between the C-CDS and the Chinese version of the Hospital Anxiety and Depression Scale. Principal component analysis revealed six factors, and one dimension was extracted from the data set, which closely resembles the structure of the original instrument. CONCLUSION Empirical data support the C-CDS as a valid and reliable disease-specific tool in assessing depressed mood in Chinese-speaking patients with cardiac disease.