Factors influencing nursing leadership effectiveness in Hong Kong

BACKGROUND: Nursing education in Hong Kong has undergone major reform in recent years, similar to that in Australia and the United Kingdom (UK), involving the introduction of degree level preparation. Although there were some changes in the nursing education system, the reform was considered slow. While a combination of complex factors contributed to the reform, the effects of nurse leaders was instrumental in influencing policy development. AIM: This study investigated the factors that influenced the effectiveness of nursing leadership in the reform of nursing education in Hong Kong. DESIGN: A case study approach was used. Methods of data collection included document search and semi-structured interviews (n = 27). The time frame of the study extended from the first proposal of nursing degree programme in the year 1985 to 2000 by which 200 nursing degree places were secured. RESULTS: Situational variables that impacted on leadership effectiveness were categorized as barriers and facilitators. Barriers were related to nursing professional socialization in a health care system that was dominated by the medical profession. Facilitators were related to socio-politic-economical changes in the wider environment. CONCLUSION: This study suggests the importance of education, positive socialization and unity in promoting nursing leadership development.     

香港医院手术室人性化护理见闻

香港医院手术室护理处处体现以人为本的护理理念。手术室环境布置体现以病人为本；家人进入手术室陪伴手术患儿；手术后病人疼痛处理及时到位；重视术中病人的保温、预防压疮及下肢静脉血栓形成等手术中护理。“日间手术室”的特色服务，体现了人性化服务。     

Development of basic nursing education in China and Hong Kong

Hong Kong returned to the sovereignty of the People's Republic of China in July 1997. In the past, Hong Kong has been greatly influenced by the British system of nurses' training, which was very different from that in mainland China. As Hong Kong is now a part of China again, there is an increased opportunity for the exchange of experience and ideas among nurse educators. The First China-Hong Kong Nursing Education Conference has provided opportunities for the authors to gain a deeper understanding of the development of nursing education in China and Hong Kong. The authors believe that it is also important for China and Hong Kong to increase networking with the international nursing community. This paper has been written largely based on the information gathered from papers presented in the Conference and the discussion with nurse educators who attended the Conference, together with a review of literature. This paper focuses on comparing the history and present development of basic nursing education in both places. The future direction for the development of nursing education in these two places will also be discussed.     

Health care reform and the transformation of nursing in Hong Kong

Health care reform in Hong Kong in the 1990s has brought about dramatic change to the nursing discipline. This paper reports an ethnographic study which aimed at exploring the transformation of nursing in a regional hospital in Hong Kong during this period of reform. In the study, the restructuring of nursing work, its associated dynamics and resulting impacts upon the nursing profession were examined. A methodological triangulation approach to data collection encompassing interviews, participant observation and review of documents was used. The findings in this study suggest that the majority of nurses working in the case study hospital continue to be subject to medical dominance and are under management control. The emphasis on cost-effective care has however, fostered qualified nurses to claim more ownership of their professional judgement and autonomy. The health care reform has confirmed the status of two newly established groups of nurses, the nurse specialists and nurse managers. The development of the nursing profession is found to be closely connected to its work development. The preparation of the new generation of nurses, as revealed in this study, needs to emphasize the cognitive dimension of the professional competence. Some nurses need to be further educated in specialist practice and clinical management to maximize the contribution of nursing in health care delivery.     

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.     

香港护理教育见闻与启示

介绍香港护理教育概况、特点及与内地的异同。在香港,护理教育以本科为主,课程设置切合临床护理工作的实际需要,重视实践教学环节并突出对学生实际工作能力的培养;教学模式多元化且基本没有固定教材;师资实力雄厚,整体素质比较高。其教学管理有序、高效,教学任务分配较合理,教师有充分的发展空间,此外对学生的评价方式多样并以形成式评价为主。发展内地护理教育,需尽快更新教学及相应的管理理念,加快改革各个教学环节。     

我国香港、台湾地区护理管理立法可鉴之处一览

中华人民共和国卫生部颁布的《护士管理办法》,自1994年开始实施至今已经十年有余了。随着我国医疗卫生体制改革的推进,随着医疗服务市场的不断发展《,护士管理办法》的内容有待完善和修改。笔者仅以此文,介绍一下我国港台地区在护理管理方面具有特色的一些立法规定,相信会对日后完善内地护理管理工作有益。     

SARS--a perspective from a school of nursing in Hong Kong

Background. Severe acute respiratory syndrome (SARS) is a new infectious disease with significant morbidity and mortality that has had a major impact on health and health care services worldwide. Hong Kong has had a significant number of cases and deaths. Nurses, at the vanguard of the clinical health care team, have been particularly affected by it. The outbreak prompted the health authorities to implement a series of public health measures and hospital policies, including a guideline for the diagnosis and management of patients with SARS. Aims and objectives. This paper aims at providing an overview of what is known about SARS and the impact it has had in Hong Kong and to highlight from the perspective of a school of nursing the major clinical, educational and public health implications. Conclusions. The lack of understanding and uncertainty about the disease led to significant variation in the provision of information, contributing to the confusion and anxiety in the community. Therefore, there is a need to revise the nursing curriculum, to provide continuing education to all health care professionals, particularly with regard to infection control measures, and to revisit the range of public health policies to ensure the health of the community is protected by these policies. There also has been a reaffirmation of the importance of health promotion that highlights the importance of the partnership between nurses, health policy makers and public health personnel. It is evident that the organization and delivery of clinical practice, teaching and health promotion have to be flexible and responsive to a changing health scenario. Relevance to clinical practice. Nurses must play a crucial role in the prevention, detection and containment of SARS. They will need to implement and ensure strict adherence to infection control measures and, in some circumstances, isolation and quarantine may be warranted. Attention to the psychological state of patients and family members should not be overlooked. Paramount is education of patients, families and members of the public at large.     

Students' perceptions of the effectiveness of mentors in an undergraduate nursing programme in Hong Kong

AIM OF THE PAPER: This paper reports the results of a multiple-phase study on a mentoring scheme for nursing students in one of the universities in Hong Kong. Using a qualitative approach, students' perceptions of the various roles of mentors were collected, and this information was used as the basis to design a tool for subsequent evaluation of the mentoring scheme. BACKGROUND: The nursing department in one of the universities in Hong Kong initiated and developed the idea of an 'Honorary Clinical Instructors' scheme (HCI scheme) for the supervision of the pre-registration nurses. The scheme was examined in a local context, where the Chinese culture dominated, so that a standardized protocol that takes into account the potential cultural dimensions could be established. DESIGN: The mentoring roles outlined by the English National Board (ENB) for Nursing, Midwifery, Health Visiting were used as a framework to identify undergraduate nursing students' perception of the effectiveness of mentors. Information gathered from interviews with Year 2 students (n=12) and Year 3 students (n=10) was used as the basis to design a questionnaire for subsequent programme evaluation. An evaluation questionnaire based on the interviewing results was developed for further evaluation of the mentoring scheme. FINDINGS: After the mentoring scheme was evaluated in semester one, a series of strategies were designed to improve the preparation of mentors and the implementation of the scheme. The strategies were identified as effective by the significant differences in the perceptions students had towards the mentoring scheme in semester one and semester two (t189=-4.80, P < 0.001), with semester two (n=81) having a mean score difference of 8.69 higher than in semester one (n=110). CONCLUSIONS: It was concluded that the questionnaire developed in the project could be adopted as a useful instrument to evaluate the effectiveness of mentoring programmes for nursing courses, and that the results of this study may also stimulate more research interest in this area to improve the quality of clinical teaching in the pre-registration nursing education programmes in the future.     

Critical care nursing research priorities in Hong Kong

BACKGROUND: Research is vital to nursing practice especially in an area such as critical care, where nursing practice continues to increase in complexity and nurses assume greater responsibility and accountability for patient care. However, without knowledge of what are the most significant problems or questions affecting the welfare of critically ill patients in Hong Kong, nurses' research efforts may be directed to areas that are not of highest priority in today's climate of decreasing health care resources and changing health care provision. AIM: To identify and prioritize research questions of importance to Hong Kong critical care nurses. METHOD: A three-round Delphi technique was used to solicit, identify and prioritize problems for critical care nursing research. RESULTS: Respondents who completed the third round had a mean of 6.25 years of critical care nursing experience. Ninety-one research topics were ranked important or extremely important. Twenty-seven research priorities ranked as extremely important included topics relating to patient care, family care, nursing, technology, alternative interventions, and illness prevention/health promotion research domains. Thirteen research topics were ranked as least important. None of the participants ranked research topics as not important. STUDY LIMITATIONS: Only full-time active members of the Hong Kong Association of Critical Care Nurses participated in this study and they may not necessarily represent the views of all critical care nurses in Hong Kong. In addition, no attempts were made to compare research priorities between specialty groups of nurses. CONCLUSION: With the re-structuring of Hong Kong's health care system, critical care nurses are expected to take an active role in advancing the profession, and to be accountable for improving patient outcomes by use of effective, evidence-based interventions. The research priorities identified in this study may provide impetus and direction for critical care nursing research initiatives.     

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.     

Use of physical restraints on elderly patients: an exploratory study of the perceptions of nurses in Hong Kong

A qualitative study was designed to explore nurses' perceptions of the use of physical restraints on elderly patients in Hong Kong. Content analysis of semi-structured interviews with 20 registered nurses working in medical and geriatric settings of two regional hospitals revealed that although nurses generally had mixed feelings about the use of physical restraints on elderly patients, they did not question this 'routine' practice and their knowledge about the consequences and alternatives to the use of restraint was limited. It was found that nurses had an overriding concern in ensuring elderly patients' physical safety and using restraints therefore provided them with a sense of security. The deleterious impact of restraint on the care received by elderly patients was largely unrecognized. Implications for practice and future studies are discussed in the light of these findings.     

Evaluating psychosocial nursing interventions for cardiac clients and their caregivers: a case study of the community rehabilitation network in Hong Kong

AIM OF THE STUDY: The purpose of this exploratory study was to describe the type and nature of psychosocial nursing interventions provided for cardiac clients in Hong Kong's Community Rehabilitation Centres (CRNs). DESIGN/METHODS: Using a two-phase case study design data were collected from nurses, cardiac clients and their caregivers. The initial phase focused on identifying the types of psychosocial interventions provided. These data were obtained by observing nursing activities and the keeping of daily journals by the nurses. The second phase acquired data from structured telephone interviews, that reviewed clients' perceptions of the psychosocial interventions provided by the nurses and face-to-face interviews with clients and their caregivers. FINDINGS: These findings revealed that the nurses' interpersonal skills of information giving, social support and counselling were highly valued by cardiac clients and their caregivers. Both clients and caregivers outlined a concern about the lack of individual care and this was reflected in the focus of the CRN on group processes. CONCLUSION: Recommendations for psychosocial cardiac care are made for public health nurses and nurses working in community settings.     

Caring for dying infants: experiences of neonatal intensive care nurses in Hong Kong

Ten registered nurses working in a neonatal intensive care unit in Hong Kong were interviewed to explore their experiences of caring for infants whose disease is not responsive to curative treatment, their perceptions of palliative care, and factors influencing their care. Eight categories emerged from the content analysis of the interviews: disbelieving; feeling ambivalent and helpless; protecting emotional self; providing optimal physical care to the infant; providing emotional support to the family; expressing empathy; lack of knowledge and counselling skills; and conflicting values in care. The subtle cultural upbringing and socialization in nurse training and workplace environment also contributed to their moral distress. Hospital and nurse administrators should consider different ways of facilitating palliative care in their acute care settings. For example, by culture-specific death education, peer support groups, bereavement teams, modification of departmental policies, and a supportive work environment. Future research could include the identification of family needs and coping as well as ethical decision-making among nurses.     

香港两所护理学院护理硕士课程设置比较与启示

目的：通过对香港两所护理学院全日制、兼读制研究生课程设置进行横向比较,为内地护理研究生课程设置改革提供方向与借鉴。方法采用文献研究法和内容分析法。结果香港两所护理院校课程设置的共同点是课程宗旨,不同点是课程内容、性质、学制等。结论提出进一步厘定护理学术型与专业型硕士课程设置区别,强化分类培养;精简课程数量,提升课程质量;拓展护理二级学科设定,为二级学科课程内容设置提供参考等针对性意见。     

Developments in nursing practice in primary health care in Hong Kong: opportunities and challenges

The significance of primary health care to the health of individuals and communities has been well established but the development of primary health care and nursing practice within the context of primary health care remains varied in different countries and settings. This paper focuses on developments in nursing practice in primary health care in Hong Kong, using three community-based research projects to identify the opportunities and challenges created for nurses working in these settings. The projects were established in response to identified health needs and to target cancer education, HIV/AIDS and chronic health problems. Opportunities include the development of professional autonomy, innovative approaches to clinical practice, and developing skills in working with a diverse range of professionals and communities. Challenges include managing uncertainty and the development of evaluation systems to demonstrate health gains from nursing interventions.     

港冀精神科护士对精神科暴力行为应对能力的对照研究

目的了解香港及河北省两地精神科护士应对精神科暴力行为的能力及差异,为进一步做好精神科护士应对暴力行为知识和技巧培训提供依据。方法采用自制调查问卷,以香港和河北省的部分精神疾病专科医院的护理人员为调查群体,对两地精神科护士应对精神病人暴力行为能力进行对照分析。结果 （1）港冀两地精神科临床暴力行为普遍存在;（2）精神科暴力行为使临床护士感到紧张、焦虑和惧怕;（3）香港各级卫生管理者和护士自身对精神科护士职业安全的关注程度远远高于河北省（χ2=83.03和129.06,P〈0.001）;（4）处理暴力的能力,包括了解掌握、处理暴力先兆、了解掌握应对暴力行为技巧以及处理危险性暴力行为能力方面,港冀两地护士之间差异有极显著意义（χ2=28.55、87.58、59.73和83.22,P〈0.001）;（5）应对暴力的效果：港冀两地护士之间差异有极显著意义（χ2=81.78和206.15,P〈0.001）。结论河北省精神科护士在应对精神科暴力行为能力、应对效果、领导重视程度等方面与香港存在较大差异,要提高领导和护士自身对精神科护理职业安全的重视,加大对精神科护士防暴知识和技巧的培训,减少精神科暴力行为伤害。