Shirley Siu Yin Ching

Prevalence of and risk factors for needlestick and sharps injuries among nursing students in Hong Kong

BACKGROUND Although nursing students are at greater risk for needlestick injuries (NSIs) and sharps injuries (SIs) than staff nurses, there is a lack of research on NSIs and SIs in students, especially in different years of study. The purpose of this study was to identify the risk factors for and prevalence of NSIs and SIs among nursing students in different years of study. METHODS This was a cross-sectional survey study using a questionnaire confirmed to be valid and reliable, with a content validity index of 0.96 and reliability index of 0.82. RESULTS A total of 878 nursing students (response rate, 76.61%), participated in the study. NSIs/SIs, NSIs, and SIs were significantly increased by year of study (P < .001) in both the study period and 12-month prevalence. Four predictors for NSIs/SIs were final-year study (odds ratio [OR], 11.9; 95% confidence interval [CI], 3.9-36.7), perception of not receiving prevention training (OR, 2.8; 95% CI, 1.1-7.5), perception of not using a kidney dish to contain used needles and sharps (OR, 4.2; 95% CI, 1.7-10.3), and perception of not immediately discarding used needles and syringes into a sharps box (OR, 2.9; 95% CI, 1.2-7.4). CONCLUSIONS Preclinical training, reinforcement of kidney dish use, immediate discarding of used needles, and adequate clinical supervision are essential elements in reducing the risk of NSIs and SIs.

Review of bowel dysfunction of rectal cancer patients during the first five years after sphincter-preserving surgery: A population in need of nursing attention

PURPOSE The aim of the review was to summarize the longitudinal changes in bowel dysfunction among patients with rectal cancer within the first five years following sphincter-preserving resection. METHODS A series of literature searches were conducted on six English-language electronic databases. Articles published after 1990 were searched. A total of 29 articles (reporting 27 studies) was found. RESULTS Bowel dysfunction, including an alteration in the frequency of bowel movements, incontinence, abnormal sensations, and difficulties with evacuation, is reported among patients with rectal cancer within the first five years after sphincter-preserving resection. These problems are most frequent and severe within the first year, especially within the first six months, and stabilize after one year. Some of the problems may last for years. CONCLUSION Supportive care for bowel dysfunction is needed, and should include the provision of information and psychological support delivered in multiple steps. Oncology nurses can play an important role in providing supportive care for rectal cancer patients with bowel dysfunction.

Analysis of needlestick injuries among nursing students in Hong Kong

BACKGROUND Research has shown that nursing personnel are exposed to the serious risk of contracting bloodborne diseases from needlestick and sharps injuries (NSIs). Only a few studies have examined the problem among nursing students. In Hong Kong, there is an equal lack of research in this area. METHODS A review of accident reports in one university was employed to determine the injury rate, causation, and epidemiological profile of NSIs. Descriptive statistics, prevalence, incidence density, cumulative incidence, and Fishers exact test were used to analyze the data. RESULTS From January 2002 to December 2006, there were a total of 51 reported cases of NSIs (43 needlestick injuries and 8 sharps injuries). The annual prevalence of NSIs in four academic years from 2002-2003 to 2005-2006 ranged from 0.6 to 1.6 cases while the incidence rate was one new case per 100 nursing students per academic year. The cumulative incidence of NSIs for year-one, year-two and year-three students were 0, 0.03 and 0.004 respectively. The majority of needlestick injuries (n=25; 58.14%) were from contaminated needles. Procedures involved in the needlestick injuries were giving injection (n=22; 51.16%), collecting urine specimen (n=5; 11.63%), removal of urinary catheter (n=4; 9.30%), and checking blood glucose using glucometer (n=3; 6.98%). Giving injection (n=5; 62.50%) also accounted for the highest percentage of sharps injuries. Specific activities that were identified were opening the needle cap, opening ampoules, inserting the needle and mixing dirty and clean material in one kidney dish. CONCLUSIONS Results showed that nursing students are at high risk of occupational exposure to bloodborne pathogens because of NSIs. A hierarchy control involving engineering, administrative and personal behavioral activities is recommended to reduce the occurrence of NSIs among nursing students.

Development and assessment of the feasibility of a Nurse-Led Care Program for cancer patients in a Chemotherapy Day Center

Background: The increasing number of cancer patients and inadequate communication in clinics are posing challenges to cancer patients receiving outpatient-based chemotherapy and healthcare providers. A nurse-led care program was proposed as one way of dealing with at least some of these challenges. Objective: The objectives of the pilot study were to assess the feasibility of the subject recruitment, care, and data collection procedures and to explore the acceptability of this program. Methods: A pilot study with a 1-group pretest-posttest design was conducted. Five cancer patients receiving chemotherapy in a chemotherapy day center participated. Each patient had a nurse consultation before chemotherapy and received 2 telephone calls after the first and second cycles of chemotherapy. Four questionnaires were adopted to evaluate the subjects’ quality of life, self-efficacy, symptom experiences, and satisfaction with care. Questionnaires were completed before the chemotherapy and after the second cycle. The subjects were also interviewed to understand their comments on the service. Results: The recruitment, care, and data collection procedures were completed smoothly. Slight changes were observed in quality of life and self-efficacy. All 5 subjects were highly satisfied with the care. Conclusions: The nurse-led care program is feasible and acceptable. Implications for Practice: The effect of the nurse-led care program will be evaluated in a single-center, open, randomized controlled trial. If the encouraging results can be confirmed, it may be an effective approach to improving the quality of ambulatory chemotherapy care. It would also shed light on the development of nurse-led care in other areas.

A Qualitative Exploration of the Experiences of Patients with Breast Cancer Receiving Outpatient‐based Chemotherapy

AIMS The aim of this study was to understand the experiences of patients with breast cancer and their involvement during outpatient-based chemotherapy in Hong Kong. BACKGROUND The outcome evaluation using a mixed-methods approach is not common in interventional studies of nurse-led chemotherapy care programmes. A qualitative approach could provide a deep understanding of the experiences of patients. DESIGN A qualitative study was conducted. METHODS This is part of a randomized controlled trial of a nurse-led care programme (NCT02228200). Individual interviews were conducted in 2013 with 10 patients with breast cancer after they had completed the chemotherapy. Qualitative content analysis was adopted to analyse the interviews. FINDINGS Chemotherapy affected the patients in different ways. Some participants completed the chemotherapy treatment smoothly with minimum side effects, while others encountered many problems during the treatment, which had a great impact on their lives. Guided by their coping attitudes, which were affected by the Chinese culture, most participants adopted behavioural, social, cognitive and emotional strategies to actively cope with the chemotherapy. A few tolerated the treatment passively. Some thought that the process of undergoing chemotherapy was physically bearable, while some equated it with suffering. Others regarded it as a chance to get a new start. CONCLUSION The experience of patients with breast cancer during chemotherapy can be likened to that of going on a hike. They reach the peak through different paths and bear different burdens. Yet, they have to go through until the end, regardless of how much of a burden they bear and how they achieve the peak.

Effects of Qigong on symptom management in cancer patients: A systematic review

PURPOSE Qigong as a complementary and alternative therapy is often used by cancer patients for symptom management. The aim of this systematic review is to critically evaluate the effectiveness of Qigong on symptom management among cancer patients. METHODS A systematic search was conducted in the following databases from their inception through May 2016: Cochrane Library, PubMed/MEDLINE, CINAHL, PsycINFO, PEDRO. All controlled clinical trials of Qigong among cancer patients were included. The strength of the evidence was evaluated for all included studies using the Oxford Centre for Evidence-based Medicine Levels of Evidence. The risk of bias was assessed using the Cochrane Collaborations Tool for Assessing Risk of Bias. RESULTS Twenty-two studies including fifteen randomized controlled trials and eight controlled clinical trials examined the efficacy of Qigong in symptom management among patients with various cancers. Results of these studies indicated that symptoms in the Qigong group were significantly improved or there was an observed positive trend from pre-to post-interventions scores for physical symptoms and psychological symptoms. CONCLUSION The effectiveness of Qigong as a health practice adopted by cancer patients to manage their symptoms during their cancer journey is not proven, but there are promising results that need further verification in future research.

The cost-effectiveness of a nurse-led care program for breast cancer patients undergoing outpatient-based chemotherapy – A feasibility trial

PURPOSE To evaluate the cost-effectiveness of a nurse-led care program for breast cancer patients receiving outpatient-based chemotherapy. METHOD An open-label, single-center randomized controlled trial was conducted. Patients receiving the nurse-led care and those receiving the routine care were compared in terms of quality of life, as well as in health service utilizations and total cost of care. A cost-utility analysis was conducted. RESULTS A total of 124 patients were recruited. The data of 116 subjects who completed the study were used for the cost-utility analysis. There were 81 unscheduled hospital visits and 43 hospital admissions. The common reasons for utilizing health services were infections and fevers, skin problems, digestive system problems, and mouth/teeth/throat problems. There were no differences in health service utilizations between the nurse-led and routine care groups for subjects receiving four-cycle chemotherapy. For those receiving six-cycle chemotherapy, the estimated number of emergency department visits was 2.188 times (95% Confidence Interval, 1.051 to 4.554) higher for the routine care group when compared with the nurse-led care group (p = .038). The incremental cost-utility ratios were £8856 and £18,936 per quality-adjusted life year gained for subjects receiving four-cycle and six-cycle chemotherapy, respectively. CONCLUSIONS Cancer patients make unscheduled health service visits when receiving outpatient-based chemotherapy, which leads to increased health service costs. The nurse-led care reduces emergency departments visits made by breast cancer patients undergoing six-cycle adjuvant chemotherapy. For breast cancer patients undergoing four-cycle chemotherapy and six-cycle chemotherapy, the nurse-led care could be cost-effective.

The experience of caring for patients at the end-of-life stage in non-palliative care settings: a qualitative study

BackgroundMore patients are dying in non-palliative care settings than in palliative care settings. How health care providers care for adult patients at the end-of-life stage in non-palliative care settings has not been adequately explored. The aim of this study was to explore the experiences of health care providers in caring for patients at the end-of-life stage in non-palliative care settings.MethodsThis is a qualitative study. Twenty-six health care providers from eight health care institutions which are based in Shanghai were interviewed individually between August 2016 and February 2017. Three levels of health care, i.e., acute care, sub-acute care, or primary care, was provided in the health care institutions. The interviews were analyzed using qualitative content analysis.ResultsThree themes emerged from the interviews: (i) Definition of the end-of-life stage: This is mainly defined based on a change in treatment. (ii) Health care at the end-of-life stage: Most patients spent their last weeks in tertiary/secondary hospitals, transferring from one location to another and receiving disease- and symptom-focused treatment. Family-dominated decision making was common when discussing treatment options. Nurses instinctively provided extra care attention to patients, but nursing care is still task-oriented. (iii) Challenges, difficulties, and the future. From the interviews, it was found that pressure from families was the main challenge faced by health care providers. Three urgent tasks before the end-of-life care can become widely available in the future were identified from the interviews, including educating the public on death, extending government support, and creating better health care environment.ConclusionThe end-of-life care system of the future should involve health care institutions at all levels, with established mechanisms of collaboration between institutions. Care should be delivered to patients with various life-threatening diseases in both palliative and non-palliative care settings. But first, it is necessary to address the obstacles to the development of end-of-life care, which involve health care providers, patients and their families, and the health care system as a whole.

Effect of an education program on knowledge, self-care behavior and handwashing competence on prevention of febrile neutropenia among breast cancer patients receiving Doxorubicin and Cyclophosphamide in Chemotherapy Day Centre

Objective: To evaluate the efficacy of an education program on the prevention of febrile neutropenia (FN) among breast cancer patients receiving AC regimen. Methods: Randomized controlled trial with the repeated-measures design was conducted in a Chemotherapy Day Centre of an acute hospital in Hong Kong. Twenty-five subjects in the intervention group received an individual education session followed by three follow-up sessions and routine care. Twenty-four subjects in the control group received routine care. Primary outcomes included the incidence of admission due to FN, the self-care behavior adherence, the knowledge level on prevention of FN and the self-efficacy in self-management, handwashing competence were assessed by self-designed questionnaires, Chinese version of patient activation measure, and handwashing competence checklist. Results: No statistically significant difference between the intervention group and the control group on the incidence of admission due to FN, the self-efficacy in self-management, and the knowledge on prevention of FN. The self-care behavior adherence was significant at cycle 4 of AC regimen in favor of the intervention group (P = 0.036). Handwashing competence improved more significantly among subjects in the intervention group than the control group (P = 0.009). Conclusions: The education program on the prevention of FN had significantly favorable effects on self-care behavior adherence and handwashing competence across time. However, the intervention did not lead to statistically significant improvement on the incidence of admission due to FN, the self-efficacy in self-management and the knowledge level on prevention of FN.

The Computerized OMAHA System in Microsoft Office Excel

The OMAHA System was adopted as the documentation system in an interventional study. To systematically record client care and facilitate data analysis, two Office Excel files were developed. The first Excel file (File A) was designed to record problems, care procedure, and outcomes for individual clients according to the OMAHA System. It was used by the intervention nurses in the study. The second Excel file (File B) was the summary of all clients that had been automatically extracted from File A. Data in File B can be analyzed directly in Excel or imported in PASW for further analysis. Both files have four parts to record basic information and the three parts of the OMAHA System. The computerized OMAHA System simplified the documentation procedure and facilitated the management and analysis of data.