Wan-Yim Ip

Effects of a needs-based education programme for family carers with a relative in an intensive care unit: A quasi-experimental study

Abstract Critical illness and subsequent hospitalisation of a relative to an intensive care unit (ICU) can result in many physiological and psychosocial problems for patients and their family members. Caring for the anxiety and frustration of these families is an integral part of critical care nursing. The purpose of this study was to examine the effect of a needs-based education programme provided within the first 3 days of patients’ hospitalisation, on the anxiety levels and satisfaction of psychosocial needs of their families. This was a quasi-experimental study with pre- and post-test design. A convenience sample was recruited over a period of three months, consisting of one primary family carer of each critically ill patient who had been admitted to an ICU in Hong Kong. Conducted by an ICU nurse specially assigned for the purpose, family carers in the experimental group ( n = 34 ) received an individual education programme based on the results of a literature review and an individual family needs assessment carried out at the time of patient admission, using the Critical Care Family Needs Inventory. The subjects in the control group ( n = 32 ) received the usual orientation and explanation given by the ICU nurses. Anxiety and need satisfaction were measured in the two groups at pre- and post-test and their mean scores were compared. Of the ten most important statements identified by the family carers in the two groups, the statements regarding the needs for information and assurance were found to predominate. After the needs-based intervention, the experimental group reported significantly lower levels of anxiety and higher levels of satisfaction of family needs than the control group at the post-test. The findings support the effectiveness of providing families of newly admitted critically ill patients, with a needs-based educational intervention to allay anxiety and satisfy immediate psychosocial needs. The formulation of a family education programme should be based on the results of a needs assessment, in order to meet family carers’ individual needs.

An educational intervention to improve women’s ability to cope with childbirth

AIM AND OBJECTIVE To test the effectiveness of an efficacy-enhancing educational intervention to promote womens self-efficacy for childbirth and coping ability in reducing anxiety and pain during labour. BACKGROUND The evidence of the effective application of the self-efficacy theory in health-promoting interventions has been well established. Little effort has been made by health professionals to integrate self-efficacy theory into childbirth care. DESIGN Randomised controlled trial. METHODS An efficacy-enhancing educational intervention based on Banduras self-efficacy theory was evaluated. The eligible Chinese first-time pregnant women were randomly assigned to either an experimental group (n = 60) or a control group (n = 73). The experimental group received two 90-minute sessions of the educational programme in between the 33rd-35th weeks of pregnancy. Follow-up assessments on outcome measures were conducted within 48 hours after delivery. The short form of the Chinese Childbirth Self-Efficacy Inventory was used to measure maternal self-efficacy prior to labour. Evaluation of pain and anxiety during the three stages of labour and performance of coping behaviour during labour were measured by the Visual Analogue Scale and Childbirth Coping Behaviour Scale respectively. RESULTS The experimental group was significantly more likely than the control group to demonstrate higher levels of self-efficacy for childbirth (p < 0.0001), lower perceived anxiety (p < 0.001, early stage and p = 0.02, middle stage) and pain (p < 0.01, early stage and p = 0.01, middle stage) and greater performance of coping behaviour during labour (p < 0.01). CONCLUSIONS The educational intervention based on Banduras self-efficacy theory is effective in promoting pregnant womens self-efficacy for childbirth and reducing their perceived pain and anxiety in the first two stages of labour. RELEVANCE TO CLINICAL PRACTICE Relief of pain and anxiety is an important issue for both women and childbirth health professionals. The efficacy-enhancing educational intervention should be further developed and integrated into childbirth educational interventions for promoting womens coping ability during childbirth.

MATERNAL ANXIETY AND FEELINGS OF CONTROL DURING LABOUR: A STUDY OF CHINESE FIRST-TIME PREGNANT WOMEN

Abstract Objective to explore and examine the relationship between maternal anxiety levels and feelings of control during labour among Hong Kong Chinese first-time pregnant women. Design an exploratory descriptive correlation design. Data were collected on three occasions: during latent phase of labour, during active phase of labour and within 24–48 hrs after delivery. Setting an obstetric unit of a public teaching hospital in Hong Kong. Participants a convenience sample of 90 Hong Kong Chinese first-time mothers. Measurements and findings the Labour Agentry Scale (LAS) is a self-report scale designed to measure feelings of control during childbirth. A Visual Analogue Scale for anxiety (VAS-A) was used to measure womens self-reported level of anxiety during labour. Pearson Product Moment Correlation coefficient test indicated a significant negative relationship between the feelings of control and maternal anxiety during labour. No statistical relationships were detected between womens attendance at antenatal classes and feelings of control during labour. Key conclusions the study showed a significant negative relationship between maternal anxiety and feelings of control during labour. Implications for practice midwives should work with women to enhance their personal control during labour and satisfaction with their birth. The insignificant relationship between attendance at antenatal classes and feelings of control suggests the need to evaluate the content of childbirth education in order to empower womens control during labour.

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.

Knowledge of and Attitudes Toward Sex among Chinese Adolescents

This study was conducted to examine the knowledge of and attitudes toward sex of 178 Chinese secondary school students in Hong Kong. The data were collected using a questionnaire that comprised three parts: the Chinese version of the Mathtech Knowledge Test, the Chinese version of the Mathtech Attitude and Value Scale, and a demographic sheet seeking sociodemographic information. In general, students demonstrated a low level of sexual knowledge, especially in relation to adolescent marriage, the probability of pregnancy, and adolescent sexual activity. With regard to attitudes, students indicated positive attitudes toward importance of family and importance of birth control. Male students in comparison with their female counterparts had a higher level of agreement with premarital intercourse and the use of pressure and force in sexual activity.

Childbirth expectations of Chinese first‐time pregnant women

Background.  This topic had not been researched previously and the information gained could have implications for midwives working with Chinese women everywhere. Aims.  To explore the specific childbirth expectations of Hong Kong Chinese first-time pregnant women. Methods.  This was a cross-sectional descriptive survey study and a Chinese version of the Childbirth Expectations Questionnaire was used to collect data. The sample consisted of 186 first-time pregnant women who first attended the antenatal clinic at a large public hospital in a major geographical region of Hong Kong. Results.  Results showed that the Chinese pregnant women, the majority of who had not attended childbirth education classes, had high expectations of support from both their partners and midwives during labour and delivery. Conversely, expectations toward their own ability to cope with pain were relatively low. In addition, the pregnant women expressed concerns about the severity of labour pain and indicated low expectations about minimal use of medical interventions during labour. Conclusions.  This study results add to the existing literature about childbirth expectations of first-time pregnant Hong Kong Chinese women. Midwife educators should incorporate the findings into childbirth education classes to help pregnant women develop realistic and positive expectations.

Translation and Validation of the Hong Kong Chinese version of the breastfeeding self-efficacy scale-short form

Healthcare providers do not have a validated instrument to measure breastfeeding self-efficacy among Hong Kong Chinese. In this study, we sought to translate the breastfeeding self-efficacy scale-short form (BSES-SF) into Hong Kong Chinese and to examine the psychometric properties in a sample of 185 breastfeeding mothers. The construct validity of the translated scale was supported by confirmatory factor analysis and known group analysis. The receiver operating characteristics analysis indicated that the total score of the translated scale at 48-72  hours after delivery could be a useful diagnostic tool for identifying mothers likely to discontinue breastfeeding prematurely, before 6 months postpartum. Further research to cross-validate the suggested cut-off value of the scale is recommended.

Validation of the short form of the chinese childbirth self-efficacy inventory in Mainland China†

Self-efficacy increasingly has been reported as an important outcome measure in childbirth care. The purpose of this study was to evaluate the psychometrics of the short form of the Chinese Childbirth Self-Efficacy Inventory (CBSEI-C32) in mainland China. A convenience sample of 297 pregnant Chinese women who were attending the out-patient clinic of the study hospital in Guangzhou participated in the study. The participants were asked to complete the CBSEI-C32, the Chinese Self-Rating Anxiety Scale (CSAS), the Chinese Self-Efficacy Scale (CSE) and the socio-demographic questionnaire. A subgroup of 75 pregnant women was selected randomly from the total sample using a table of random numbers for test-retest reliability assessment. The findings demonstrate high internal consistency (Cronbachs α = .96) and test-retest reliability (intraclass correlation coefficient = .88) for the CBSEI-C32. Confirmatory factor analysis showed some support for a two-factor structure of the CBSEI-C32, and construct validity was further supported by a significant relationship with CSAS. The CBSEI-C32 has the potential to be used as a clinical and research instrument for measuring childbirth self-efficacy in women in mainland China.

Perceptions of role functions of psychiatric nurse specialists.

Specialized and advanced psychiatric nursing practice is an innovative concept in the health care service in Hong Kong. A clear definition of the role and practice of psychiatric clinical nurse specialists (CNS) is important for the development of expert psychiatric nursing practice but is still in a formative stage. A qualitative exploratory study was conducted to identify the psychiatric CNS’s perceptions of their role and to compare their perceptions with those of their clinical psychiatric nurse colleagues. The main themes emerging from interviews, observations, and personal diary data were compared and condensed. Eight CNSs and 24 clinical nurse colleagues from acute care and community psychiatric nursing units voluntarily participated in the study. A four-component framework, including clinical practice, organization, education, and professional role, was adopted from nursing literature and used for categorization. The findings showed similarities of role perceptions in the clinical practice, organization, and education components between the CNSs and their nursing colleagues. Differences in role perceptions, concerns about inadequate knowledge and autonomy, and limitations in professional role are discussed.