United Kingdom Survey of Culture-Negative Peritonitis and Dialysate Sampling Practice

Peritonitis is a major cause of technique failure in peritoneal dialysis (PD) and accurate diagnosis ensures successful management and avoids unnecessary antibiotic exposure. United Kingdom (UK) registry data on peritonitis rates are not routinely reported. We conducted an electronic survey amongst senior PD nurses and microbiologists to obtain information about PD effluent sampling and processing practices in the UK. The survey was completed by 53 of 79 centres (67% response rate). The median annual culture-negative rate was 15% (range 5 – 38%). The main findings were wide variation in reported sampling volumes and processing methods that may in part explain the variation in culture-negative rates. Adherence to guidelines might reduce culture-negative rates informed by reporting data into national registries.Peritonitis is a major cause of technique failure in peritoneal dialysis (PD), and accurate diagnosis ensures successful management and avoids unnecessary antibiotic exposure. International guidelines recommend PD centers aim for culture-negative peritonitis rates of < 20% per year and suggest < 10% is achievable in centers of excellence (1). The most accurate and cost-effective way of achieving this is not known, and United Kingdom (UK) registry data on peritonitis rates are not routinely reported. We aimed to obtain information about PD effluent sampling and processing practices in the UK.     

A pilot study on nurses' attitudes toward perinatal bereavement support: a cluster analysis

AIM: Nurses' attitudes towards perinatal bereavement care are explored by identifying profiles of nurses working in a Hong Kong Obstetrics and Gynaecology (OAG) unit. Relationships between nurses' attitudes towards bereavement support, need for bereavement training and hospital policy are explored. RESEARCH METHOD: 110 nurses recruited from the OAG unit of a large Hong Kong public hospital completed a structured questionnaire. OUTCOME MEASURES: Attitudes towards perinatal bereavement support; required support and training needs for nurses on bereavement care. RESULTS: Two-step cluster analysis yielded two clusters. Cluster A consisted of 55.5% (n = 49) and cluster B consisted of 44.5% (n = 61) of nurses. Cluster A nurses were younger, had less OAG experience, more junior ranking and less education than cluster B nurses. Cluster B nurses had additional midwifery and bereavement care training, personal grieving experiences and experience handling grieving clients. The majority held positive bereavement care attitudes. Significant differences towards perinatal bereavement support were found. Only 25.5% (n = 28) had bereavement related training. Attitudes towards bereavement care were positively correlated with training needs (rs = 0.59) and hospital policy support (rs = 0.60). CONCLUSION: Hong Kong nurses emphasized need for increased bereavement care knowledge and experience, improved communication skills, and greater hospital and team members' support. Findings may be used to improve support of nurses, to ensure sensitive bereavement care in perinatal settings, and to enhance nursing curricula.     

Advanced Nursing Experience Is Beneficial for Lowering the Peritonitis Rate in Patients on Peritoneal Dialysis

♦ Objectives: We explored the relationship between the experience level of nurses and the peritonitis risk in peritoneal dialysis (PD) patients.♦ Methods: Our observational cohort study followed 305 incident PD patients until a first episode of peritonitis, death, or censoring. Patients were divided into 3 groups according to the work experience in general medicine of their nurses—that is, least experience (<10 years), moderate experience (10 to <15 years), and advanced experience (≥15 years). Demographic characteristics, baseline biochemistry, and residual renal function were also recorded. Multivariate Cox regression was used to analyze the association of risks for all-cause and gram-positive peritonitis with patient training provided by nurses at different experience levels.♦ Results: Of the 305 patients, 91 were trained at the initiation of PD by nurses with advanced experience, 100 by nurses with moderate experience, and 114 by nurses with the least experience. Demographic and clinical variables did not vary significantly between the groups. During 13 582 patient–months of follow-up, 129 first episodes of peritonitis were observed, with 48 episodes being attributed to gram-positive organisms. Kaplan–Meier analysis showed that training by nurses with advanced experience predicted the longest period free of first-episode gram-positive peritonitis. After adjustment for some recognized confounders, the advanced experience group was still associated with the lowest risk for first-episode gram-positive peritonitis. The level of nursing experience was not significantly correlated with all-cause peritonitis risk.♦ Conclusions: The experience in general medicine of nurses might help to lower the risk of gram-positive peritonitis among PD patients. These data are the first to indicate that nursing experience in areas other than PD practice can be vital in the training of PD patients.     

Nurses' attitudes towards perinatal bereavement support in Hong Kong: a pilot study

The purpose of this study is to explore nurses' attitudes towards perinatal bereavement care and to identify required support and training needs for nurses on bereavement care in Hong Kong. Data were collected through a structured questionnaire, and 110 nurses were recruited from the obstetrics and gynaecology unit in one of the largest public hospitals in Hong Kong. The majority of nurses held a positive attitude towards bereavement care. A significant difference in nurses' attitudes towards bereavement support was found in terms of demographics, practical experiences and training factors. The results showed that only 25.5% (n = 28) of nurses had bereavement-related training. In contrast, 90.9% of nurses showed a positive response to grief training and 90.0% would share experiences with colleagues and seek support when feeling under stress. The findings also suggest that nurses' attitudes towards bereavement care are positively correlated with bereavement care training needs (r = 0.53) and hospital policy support (r = 0.55). Hong Kong nurses' attitudes towards perinatal care emphasized their need for increased knowledge and experience, improved communication skills, and greater support from team members and the hospital. These findings may be used for Hong Kong health care professionals to improve support of nurses, to ensure delivery of sensitive bereavement care in perinatal settings and to enhance nursing school curricula.     

A profile of the caring attributes of Hong Kong and Thailand psychiatric nurses

Despite the unique cultural characteristics of psychiatric nurses in Hong Kong and Thailand little has been written about them or their caring practices. This study set out to examine the caring practices and demographic features of nurses working in these two countries where the development of the nursing education system has distinct similarities, yet where culture, career paths and qualifications differ. The Caring Attributes Questionnaire (CAQ), previously used in general nursing samples, was modified and validated for the study and administered to 275 and 227 psychiatric nurses in Hong Kong and Thailand, respectively. The results showed that more of the Hong Kong nurses were educated at the degree level and they tended to be younger, while both had around the same number of years of experience. The CAQ scores increase significantly with position, age and years of experience in the Hong Kong sample yet not for qualifications, while there were no significant differences detected in the Thai sample. The Thai sample had significantly lower CAQ scores and the results suggest that neither education nor experience modify these qualities of a psychiatric nurse, and it may be that nurses are still learning "on the job" rather than in the school. These findings are discussed in the light of findings from other international studies and recommendations for future studies are made.     

Beliefs and attitudes towards complementary medicine among registered nurses in Hong Kong

Background

The personal use of and professional recommendation for complementary and alternative medicine (CAM) has been found to be related to nurses’ knowledge and type of training background. Little, however, is known about CAM usage among nurses from Hong Kong who while of Chinese origin, are educated in western medical principles while exhibiting both folk knowledge and lay use of CAM in their daily lives.

Objective

The purpose of this study was to investigate the beliefs and attitudes towards CAM in a population of Hong Kong registered nurses. A particular focus was the sources of CAM information and the nurse's professional communication exchanges about CAM usage.

Design

Cross-sectional survey.

Setting and participants

The survey was conducted from March to June 2006 with registered nurses (N = 187) drawn form the Hong Kong College of Nursing.

Results

Nearly three quarters (71.9%) of the nurses agreed that CAM should be integrated into mainstream Western medicine. The majority (89.8%) of participants did not agree that CAM should not be taken when using Western medicine. The most common sources for the nurses surveyed to obtain CAM information were, in order of frequency, newspapers and magazines (64.2%), friends (57.2%) and books (43.9%). Approximately one in three (28.0-35.3%) participants had either sometimes or frequently initiated a discussion about CAM or a discussion about the interaction between CAM and Western medicine with nursing colleague. Consistently, nurses who had previously received training on CAM (48.9%) were also more likely to initiate CAM discussions than those who had not received such training (30.7%, p < 0.05).

Conclusion

More knowledge of CAM was in general, welcomed among nurses, with 93.6% of the nurses surveyed reporting an interest in further learning. A major recommendation is that HK registered nurses receive professional CAM training as a means to enhance patient care.     

Knowledge of inter-facility transport among emergency nurses in Hong Kong: a questionnaire survey

INTRODUCTION: Inter-facility transport (IFT) is a dynamic process and its quality largely depends on pre-transport preparation, emergency equipment support and recognition of possible en route adverse events. This study aims to evaluate knowledge of IFT among emergency nurses of three Accident and Emergency Departments in Hong Kong. METHODS: Questionnaires were distributed to registered nurses of the three departments. Data was sought on participants' characteristics, knowledge on equipment preparation and management of en route adverse events. Four clinical IFT scenarios were set for participants and answers were scored. Measured outcomes were defined as (1) relationships between clinical experience and relevant training in IFT with questionnaire results, (2) staff knowledge of the equipment carried routinely in ambulances and (3) the en route adverse events encountered according to the participants' past experience. RESULTS: Participants' test scores ranged from 24 to 37 (out of 40) with a mean of 30.6 (95% confidence interval 29.7-31.5). Participants with more clinical experience demonstrated significantly better test scores (p<0.05). Most participants were familiar with the monitoring devices carried in ambulances but were less familiar with the pharmacologic agents and airway devices available routinely in Hong Kong ambulances. Thirty participants (59%) had encountered en route adverse events in the past. CONCLUSION: Nurses in emergency departments in Hong Kong have good knowledge of IFT. Extensive clinical experience is related to better IFT knowledge. IFT training for nurses should emphasize available ambulance service resources and capabilities.     

香港地区40例慢性病病人心理反应与分析

探讨慢性病人对疾病的情绪反应 ,以及影响这些情绪反应的因素 ,40例香港慢性病病人接受了访问。访问围绕病人的病史和治疗过程、总的健康状况、患病期间的感受、主要的忧虑、疾病对日常生活的影响 ,以及如何应付由慢性病引起的压力等。对于搜集到的定性数据进行分析表明 ,病人典型的反应包括无用感、内疚、忧虑和恐惧。病人能否成功地适应取决于他们是否得到来自家庭、其他病人以及护理人员的支持。作者讨论了中国文化对于病人心理反应的影响。本研究的结果有助于护理人员为病人提供有效的护理     

Psychiatric nurses' attitudes to antipsychotic depots in Hong Kong and comparison with London

Psychiatric nurses' attitudes to depots have only been explored in the UK. We conducted a cross-sectional attitudinal study for Hong Kong psychiatric nurses and also conducted international comparisons for nurses' views about depots. A pre-existing UK questionnaire on clinicians' attitudes and knowledge regarding depots was updated for the present study. Participants were 98 psychiatric nurses who attended an academic meeting. The majority of respondents had positive views regarding their role in depot administration; most reported that they had sufficient training (84%). However, many did not feel involved in treatment decision making (60%) and other negative views were expressed including: (1) most patients always prefer to have oral (vs. depot) (80%); and (2) force is sometimes required when administering a depot (40%). Interestingly, most reported that patients' friends and family were more accepting of depot (vs. oral) (69%). When compared with a former sample of London community psychiatric nurses, Hong Kong nurses had less favourable patient-focussed attitudes (mean 56% vs. 60%, P = 0.051) and depot-specific attitudes regarding depots (mean 63% vs. 69%, P < 0.001). In conclusion, therefore, international variation exists and encompasses clinical practice aspects for both the patient and the depot formulation per se. Our participants wanted more involvement in treatment decision making.     

Peritoneal dialysis in Asia: an external perspective.

There are almost 30,000 patients maintained on peritoneal dialysis (PD) in Asia, representing about 8% of all Asian dialysis patients. The largest numbers of PD patients are in Japan and China, but the highest PD penetration is in Hong Kong, Korea, and Singapore. Notable features of PD in Asia include the varying rates of use across the different countries. The reasons for this are reviewed here, with particular emphasis on the significance of whether dialysis providers are predominantly private or public. The excellent rates of both patient and technique survival in the richer Asian countries are also examined and interpreted in the context of recent data showing that Asian patients living in North America have generally superior survival on dialysis and better compliance with PD than their Caucasian counterparts. It is concluded that the healthier baseline health status in South East Asian patients, in particular, contributes to their impressive outcomes. The approach to both clearance and ultrafiltration is less aggressive in Asian countries than in the West. Studies looking at the relationship between clearance and clinical outcome in Asia are reviewed and it is concluded that the benefits of higher clearances have been harder to show than in North America because of the relatively better outcomes of the patients. The concern about sclerosing encapsulating peritonitis in Japan particularly is emphasized. The Hong Kong model of dialysis delivery with its high use of PD and the arguments for and against it are also reviewed.     

Disaster preparedness among Hong Kong nurses

Title.  Disaster preparedness among Hong Kong nurses
Aim.  This paper is a report of a survey to explore Hong Kong nurses' disaster preparedness.
Background.  Increasingly frequent global disasters are posing threats to human health and life. The World Health Organization has called for countries to have detailed plans at all levels in order to be prepared for disasters that may arise.
Method.  A questionnaire was distributed to convenience samples of practising Registered Nurses studying in Master's degree programmes at a Hong Kong university in 2007.
Results.  Of a possible 174, 164 questionnaires were returned (Response rate 94%). Almost all nurses (97·6%) considered the government health department to be the organization most involved in disastrous situations. The majority (84·8%) were aware of the existence of a protocol on disaster management at their workplace. About one-third would respond in accordance with protocol (38·4%) or rely on directions from their immediate supervisors (34·8%) if a disaster occurred. Almost all the nurses (97%) considered themselves not adequately prepared for disasters. They recognized that a protocol for disaster management (85·4%) and training and drills for disasters (both 84·1%) are useful tools.
Conclusion.  Nurses in Hong Kong are not adequately prepared for disasters, but are aware of the need for such preparation. Disaster management training should be included in the basic education of nurses.     

A prospective study of the efficacy of local application of gentamicin versus mupirocin in the prevention of peritoneal dialysis catheter-related infections

BACKGROUND: Peritoneal dialysis (PD)-related infections are the major cause of technique failure. Exit-site infections (ESI) can be prevented by local application of antibiotics. Mupirocin (M) is the most extensively studied drug for this application. Long-term use can result in the development of resistance. Gentamicin (G) is an attractive alternative, with both gram-positive and gram-negative activities. We studied the comparative efficacy of G cream versus M ointment in the prevention of PD-related infections in a Chinese cohort. METHODS: This was a prospective study of adult PD patients of the Princess Margaret Hospital, Hong Kong. Patients were excluded if they had active infection, recent ESI or peritontiis, history of allergy to either drug, or were unable to apply the drug or give consent. Patients were taught to apply the drug daily to the exit site after routine exitsite care. Records were tracked prospectively during hospital admissions and clinic follow-ups. RESULTS: 95 patients were recruited; 14 discontinued the study. The ESI rates were 0.38 and 0.20 episodes/patient-year for the G group and the M group respectively (p = 0.36). Gram-positive ESI rates were 0.18 and 0 episodes/patient-year for the G group and the M group respectively. Gram-negative ESI rates were 0.20 episodes/patient-year for both groups (p = 0.62). The overall peritonitis rates were similar in the two groups (p = 0.91). Discussion: In addition to good perioperative care and strict exit-site care, local antibiotic application can prevent ESI. Mupirocin has been extensively studied and shown to be effective. Similar if not superior effects of G cream have been demonstrated. In this study, neither antibiotic gave significantly better results in the prevention of either ESI or peritonitis. CONCLUSIONS: Both gentamicin and mupirocin were effective as prophylaxis for ESI. Longer study is required to determine the long-term efficacy and the potential beneficial effect on the prevention of peritonitis.     

Caring in nursing: perceptions of Hong Kong nurses

Ten registered nurses in Hong Kong were interviewed on their perceptions of caring behaviours in their clinical settings, barriers to these behaviours, and possible ways to overcome those barriers. Findings showed that respondents valued the importance of expressive behaviours and interpersonal communication skills in providing holistic patient care. They felt constrained by social, economic, cultural, and personal variables such as staff shortages, the traditional task-orientated approach of nursing, the dominance of medicine in the healthcare system, the influence of Chinese culture on work attitudes, and their limited skills and lack of education. The situation could be improved through better staff education, colleague support, effective human resources allocation, and promotion of a democratic working environment. A creative approach is necessary to integrate these strategies into a healthcare system dominated by technology and economic constraints.     

Caring in context: caring practices in a sample of Hong Kong nurses

In an effort to place the international literature and research in nursing in a Chinese cultural context a study was commenced to examine the caring practices of nurses in Hong Kong. In view of a recent study (Wilkes & Wallis, 1993) which utilised Roach's 5Cs of caring (Roach, 1987, 1992), a pilot study was commenced on a sample of 77 Hong Kong Registered Nurses studying a Diploma of Nursing. An open ended questionnaire was designed which asked nurses to respond to questions about caring in general and the 5Cs: compassion, competence, confidence, conscience and commitment. The questions asked what each of the concepts meant to them as a nurse. Data was analysed into themes based on key words for each of the six areas revealing that the sample of Hong Kong nurses viewed caring in a similar light to those in overseas studies. The sample highlighted compassion and competence as their major features and it is suggested that methodological problems may have inhibited a deeper analysis of their caring attributes and behaviours. When asked to expand on the 5 Cs in terms of their own practice they were able to supply themes which were closely related to Roach's definitions but which may have been more 'textbook' in their origin and certainly lacked a richness of response. The paucity of responses in terms of clarity and richness of data, followed by discussions with the participants led to conclusions about the methodological issues of cross-cultural research and recommendations for future research are made. Highlighted are the problems with attempting to use concepts such as the 5 Cs across cultures and the problems encountered with translation of concepts related to caring from Chinese into English, and vice-versa. The study has provided some insights into the concepts of caring in Hong Kong Chinese nurses. In the light of advances in China and unification of previously separate countries these findings provide and offer insights into nursing in China and are encouraging for future research.     

粤港两地部分急诊科医护人员对哀伤关顾认识的调查分析

目的 调查粤港两地部分急诊科医护人员对哀伤关顾的认识情况,为国内开展哀伤关顾护理提供理论依据.方法 自行设计对哀伤关顾的认识调查问卷,对香港各大联网医院的急诊科医护人员、本省各地区赴港学习的急诊科专科护士和本院急诊科医护人员进行调查,了解他们对哀伤关顾的认识情况.结果 香港急诊科医护人员对哀伤关顾的认识(100.0％)、参加过哀伤关顾培训(100.0％)、实施过哀伤关顾(100.0％)以及具备的哀伤关顾技能(100.0％)都比较好,并认为有必要开展哀伤关顾(98.8％)和愿意加入哀伤关顾小组(86.3％);而赴港学习的本省急诊科专科护士和本院急诊科医护人员对哀伤关顾的认识、参加过哀伤关顾培训、实施哀伤关顾以及所具备的哀伤关顾技能基本处于较少或无的状态,对于是否有必要开展哀伤关顾和愿意加入哀伤关顾小组,赴港学习的本省急诊科专科护士有92.6％认为有必要,85.2％愿意加入;而本院急诊科医护人员84.1％认为有必要,63.2％愿意加入.结论 国内医护人员对哀伤关顾的认识以及对病人实施哀伤关顾较少,学习并引进香港以及国外关于哀伤关顾的知识,结合本国国情发展和完善本土哀伤关顾文化非常重要.     

The nursing gaze: power relations in a study of nurse-resident interactions in learning disability

The researchers observed nurse-resident interactions in learning disability units in Hong Kong and interviewed a purposeful sample of nurses who had varying levels of interaction. The median interaction rate between nurses and residents was 27.5% with most interactions relating to physical care. When not interacting with residents, nurses performed administrative tasks. Factors that influenced nurses' interactions revolve around their orientation to a new clinical setting, stresses in the care setting and nurses' coping strategies, contextual constraints, and nurses' prioritization of care. Support for Goffman's self-mortification principle, Foucault's notion of the clinical gaze and infantilism theory were evident in the practice of the nurses studied.     

Methodological issues in assessing the incidence of peritoneal dialysis-associated peritonitis in children.

OBJECTIVES: To evaluate the distribution of peritonitis incidence and assess the usefulness of patient-specific peritonitis rates in children. DESIGN: 49 children on automated peritoneal dialysis (PD) followed during a 2-year observation period. SETTING: Single-center, academic children's hospital. PATIENTS: 49 children aged 2 months to 18 years; 24 prevalent, 25 incident during the observation period. Cumulative observation time was 639 patient-months. MAIN OUTCOME MEASURES: Cohort-specific peritonitis incidence, median patient-specific peritonitis incidence, mean peritonitis incidence by gamma-Poisson (negative binomial) modeling, peritonitis-free survival by Kaplan-Meier life-table analysis. RESULTS: 68 new peritonitis episodes and 21 relapses occurred in 27 patients.The distribution of patient-specific peritonitis incidence was bimodal, with a large group experiencing no or very few episodes, and another cluster around 1 episode per 6-9 months. Overall cohort-specific peritonitis incidence was 1.28, median subject-specific incidence 0.99, and mean incidence according to negative binomial modeling 1.04 (95% confidence interval 1.02-1.06) episodes per patient-year. Median peritonitis-free survival time was 6.9 months. In those patients who developed peritonitis, subject-specific peritonitis incidence was inversely correlated with patient age (r = -0.42, p < 0.05) and duration of chronic PD at last observation (r = -0.42, p < 0.05). CONCLUSIONS: Since the distribution of peritonitis in children is non-Gaussian, the average risk of peritonitis is more accurately expressed by the median of the individual subject-specific peritonitis rates or by the mean incidence estimate obtained by the negative binomial distribution model. The assignment of a personal peritonitis risk to each patient permits risk factor analysis by routine statistical methods, even in smaller populations.     

Perceptions of ethical practices in Hong Kong public hospitals: inter- and intra-professional similarities and differences

hui e.c. (2010) Journal of Nursing Management  18 , 746–756
Perceptions of ethical practices in Hong Kong public hospitals: inter- and intra-professional similarities and differences Aim To investigate similarities and differences in the perception of hospital ethical practices using different seniority of doctors, nurses and administrators, and between these healthcare professionals (HCPs). Importance Intra- and inter-professional similarities and differences had implications for HCPs’ morale, hospital ethics climate and quality of patient care. Method HCPs (n = 1.910) with different levels of seniority in 14 Hong Kong public hospitals were randomly surveyed between November 2004 and April 2005. Results Intra-professional differences in perception between senior and junior doctors or nurses were found in nine ethical themes including: quality of care, patient satisfaction, disagreements among HCPs and between HCPs and patient family, end-of-life care, professional incompetence and misconducts and communication. Inter-professional similarities in perception were also found among different HCPs in senior positions and as a group they differ from the perceptions of junior HCPs. Conclusions Significant intra-professional and inter-professional polarizations of perception of ethical practices between senior and junior HCPs were found and they potentially undermine the trusting relationships between HCPs. Implications As nursing managers were found to align with senior doctors and administrators, junior nurses might feel unsupported, isolated and frustrated, creating a nursing management challenge that must be faced.