Simon Ching Lam

Universal to standard precautions in disease prevention: Preliminary development of compliance scale for clinical nursing

BACKGROUND The Center for Disease Control and Prevention revised the infection control practice from Universal Precautions to Standard Precautions in 1996. Although the practice of Standard Precautions has been implemented for almost 15 years in clinical settings, recent local research still adopts the Universal Precautions Scale to measure the compliance with the current infection control practice of general frontline nursing staff and students. Despite the scales sound psychometric properties, that its items may not be sensitive and comprehensive enough to reflect the current compliance of frontline staff to Standard Precautions is questionable. AIM The present study aims to develop a Compliance with Standard Precautions Scale (CSPS) for use by the general frontline nurses and nursing students in clinical settings. METHODS The current study employed a recognized instrumentation design. In addition, a preliminary assessment of reliability and validity was described. The CSPS was developed through the modification of the Universal Precautions Scale through five steps: reviewing the infection control guidelines, modifying the items of the Universal Precautions Scale, examining the relevance and adequacy of new items by an expert panel, verifying the linguistic and grammatical issues, and examining the understandability of the items and acceptability of the entire instrument by stakeholders. Internal consistency was examined using Cronbachs alpha statistic. RESULTS The original 15-item Universal Precautions Scale was revised to the 20-item CSPS, in which 13 items were revised in wording and concept, 2 items were deleted, and 7 items were added. The 20-item new scale obtained the overall content validity index of 0.90, and 100% understandability and acceptability in face validity, and Cronbachs alpha of 0.73. CONCLUSION With the explicit justification on each generated item and the satisfactory results of the psychometric testing, the CSPS is a preliminary reliable and valid instrument in measuring the compliance with Standard Precautions of frontline nurses and nursing students in clinical settings.

RELIABILITY AND VALIDITY OF THE ABBREVIATED MENTAL TEST (HONG KONG VERSION) IN RESIDENTIAL CARE HOMES

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Validation and cross-cultural pilot testing of compliance with standard precautions scale: self-administered instrument for clinical nurses.

OBJECTIVE To perform detailed psychometric testing of the compliance with standard precautions scale (CSPS) in measuring compliance with standard precautions of clinical nurses and to conduct cross-cultural pilot testing and assess the relevance of the CSPS on an international platform. DESIGN A cross-sectional and correlational design with repeated measures. SETTING Nursing students from a local registered nurse training university, nurses from different hospitals in Hong Kong, and experts in an international conference. METHODS The psychometric properties of the CSPS were evaluated via internal consistency, 2-week and 3-month test-retest reliability, concurrent validation, and construct validation. The cross-cultural pilot testing and relevance check was examined by experts on infection control from various developed and developing regions. RESULTS Among 453 participants, 193 were nursing students, 165 were enrolled nurses, and 95 were registered nurses. The results showed that the CSPS had satisfactory reliability (Cronbach α = 0.73; intraclass correlation coefficient, 0.79 for 2-week test-retest and 0.74 for 3-month test-retest) and validity (optimum correlation with criterion measure; r = 0.76, P < .001; satisfactory results on known-group method and hypothesis testing). A total of 19 experts from 16 countries assured that most of the CSPS findings were relevant and globally applicable. CONCLUSIONS The CSPS demonstrated satisfactory results on the basis of the standard international criteria on psychometric testing, which ascertained the reliability and validity of this instrument in measuring the compliance of clinical nurses with standard precautions. The cross-cultural pilot testing further reinforced the instruments relevance and applicability in most developed and developing regions.

The benefit of mindfulness-based stress reduction to patients with terminal cancer

Owing to poor prognosis and pain, patients with terminal cancer are under overwhelming stress by which severity of their diseases escalates (Groenwald et al. 1993). Nevertheless, the current palliative therapies in Hong Kong unconsciously but profoundly separate body and mind of patients with cancer where they receive symptomatic treatments from physicians but acquire psychological support from other disciplines according to an ‘as prescribed, if necessary’ basis (Chan 2002). It does not align with modern approach of palliative care where elements of improving the will to live, satisfaction and instilling hope are emphasised (Chan 2002). New element is needed in addition to the current practice to bridge the gaps between treatments for body and mind of these helpless patients.

Difference in compliance with Standard Precautions by nursing staff in Brazil versus Hong Kong

The Standard Precautions (SP) are measures to reduce the risk of transmission of bloodborne and other pathogens, and should be used by health professionals in the care of all patients regardless of their condition of infection. However, suboptimal compliance with SP has been consistently reported in the nursing literature. This study evaluated the differences of compliance with SP among nurses from Brazil and Hong Kong. This cross-sectional study was conducted in 2 countries-Hong Kong and Brazil-with nurses working in hospitals who responded to a self-administered questionnaire with demographic data and responses to a 20-item Compliance with Standard Precautions Scale. The compliance rate of 560 nurses was 69.4% for the Brazilian sample and 57.4% for the Hong Kong sample. The additional clinical experience of the Brazilian nurses versus those in Hong Kong may be related to differences in compliance with SP between nurses.

Pedometer‐Determined Physical Activity and Body Composition in Chinese Working Adults

Purpose: Overweight and obesity are prevalent public health problems in many developed and developing regions. Despite extensive documentation on the health benefits of physical activities, little is known about the level of physical activity in the Hong Kong Chinese population. Working adults, in particular, deserve primary attention because they account for the largest proportion of Hong Kong society. The purposes of this study were to investigate pedometer-determined physical activity and examine the associations between physical activity and body composition variables among Chinese working adults in Hong Kong. Design: This study adopted a descriptive cross-sectional design. Methods: A quota sample of 913 working adults from nine major occupational categories was recruited. Demographic characteristics and body composition parameters (weight, height, and waist and hip circumferences) were assessed. Body mass index and waist-to-hip ratio were then calculated. Physical activity was measured in terms of daily walking steps using a pedometer over 1 week. Participants were then categorized as “inactive,”“somewhat active,” or “regularly active.” Descriptive and inferential statistics (analysis of variance, t test, and χ2 test) were used appropriately. Findings: Of the 913 participants, 893 returned complete step count records. The completion rate was 97.8%. Participants on average walked 8,661 steps per day, suggesting a “somewhat active” populace. Significant differences were found between the group “regularly active” and “inactive” in most of the body composition parameters. However, a significant weak correlation was found between physical activity and body mass index (r= 0.12, p= .001). Such findings deserve further investigation. Conclusions: The Chinese working adults in Hong Kong were found to be somewhat active in physical activity. Clinical Relevance: Findings pose implications for healthcare professionals who are responsible for health promotion in the Asian community setting. Leisure-type physical activity, such as walking, can be incorporated into daily routines.

Respiratory protection by respirators: the predictive value of user seal check for the fit determination in healthcare settings.

The N95 respirator is one type that is recommended by the World Health Organization and the Centers for Disease Control and Prevention (CDC) to prevent inhalation of droplets that may act to transmit respiratory pathogens. However, the reliability of this respirator to prevent transmission is dependent on how well it is fitted to the wearer. For ill-fitting respirators, the average penetration by ambient aerosol was found to be 33%, compared with 4% for well-fitting respirators. Such penetration or leakage may be caused by the gap between the respirator and the wearers face. Therefore, formal fit testing should be carried out prior to the use of N95 respirators. Quantitative fit testing measures “the adequacy of respirator fit by numerically measuring the amount of leakage into the respirator” using an electronic device.

Evaluation of the user seal check on gross leakage detection of 3 different designs of N95 filtering facepiece respirators

Background The use of N95 respirators prevents spread of respiratory infectious agents, but leakage hampers its protection. Manufacturers recommend a user seal check to identify on-site gross leakage. However, no empirical evidence is provided. Therefore, this study aims to examine validity of a user seal check on gross leakage detection in commonly used types of N95 respirators. Methods A convenience sample of 638 nursing students was recruited. On the wearing of 3 different designs of N95 respirators, namely 3M-1860s, 3M-1862, and Kimberly-Clark 46827, the standardized user seal check procedure was carried out to identify gross leakage. Repeated testing of leakage was followed by the use of a quantitative fit testing (QNFT) device in performing normal breathing and deep breathing exercises. Sensitivity, specificity, predictive values, and likelihood ratios were calculated accordingly. Results As indicated by QNFT, prevalence of actual gross leakage was 31.0%-39.2% with the 3M respirators and 65.4%-65.8% with the Kimberly-Clark respirator. Sensitivity and specificity of the user seal check for identifying actual gross leakage were approximately 27.7% and 75.5% for 3M-1860s, 22.1% and 80.5% for 3M-1862, and 26.9% and 80.2% for Kimberly-Clark 46827, respectively. Likelihood ratios were close to 1 (range, 0.89-1.51) for all types of respirators. Conclusions The results did not support user seal checks in detecting any actual gross leakage in the donning of N95 respirators. However, such a check might alert health care workers that donning a tight-fitting respirator should be performed carefully.

Preliminary investigation on prevalence of osteoporosis and osteopenia: Should we tune our focus on healthy adults?

AIM Osteoporosis and osteopenia are global health problems with increasing trend, particularly in developed regions. Apart from traditional well-recognized high-risk groups (i.e. postmenopausal women and elders), prevalence of such problems among adults should not be ignored because of the advantages of early detection and health promotion. Therefore, this preliminary study aims to investigate the prevalence of osteoporosis and osteopenia among adult office workers, which represented a relatively large proportion of the population in urbanized cities. METHODS An GE-Lunar Achilles ultrasonometer was used to screen the bone mineral density (BMD) of 80 participants. RESULTS The BMD T-score ranged from -3 to 3.5. The majority of the participants had normal BMD result (T-score, ≥ -1), whereas 35% was classified as abnormal (T-score, < -1) including 31.3% osteopenia and 3.8% osteoporosis. CONCLUSION High prevalence rate of abnormal BMD among healthy adults should be further studied in this population. The findings also suggest that the current ignorance in adulthood may increase the prevalence of osteoporotic fractures in the future.

Cultural Adaptation and Reliability of the Compliance with Standard Precautions Scale (CSPS) for Nurses in Brazil

ABSTRACT Objective: this study aimed to carry of the cultural adaptation and to evaluate the reliability of the Compliance with Standard Precautions Scale (CSPS) for nurses in Brazil. Method: the adaptation process entailed translation, consensus among judges, back-translation, semantic validation and pretest. The reliability was evaluated by internal consistency (Cronbach alpha) and stability (test-retest). The instrument was administered to a sample group of 300 nurses who worked in a large hospital located in the city of São Paulo/SP, Brazil. Results: through the semantic validation, the items from the scale were considered understandable and deemed important for the nurse´s clinical practice. The CSPS Brazilian Portuguese version (CSPS-PB) revealed excellent interpretability. The Cronbach`s alpha was 0.61 and the intraclass correlation coefficient was 0.85. Conclusion: the initial study showed that CSPS-PB is appropriate to assess compliance with standard precautions among nurses in Brazil. The reliability was considered acceptable. Furhter study is necessary to evaluate its comprehensive psychometric properties.