Needs of young children with cancer during their initial hospitalization: an observational study.

The aim of this study was to describe young (under the age of 7) children's needs as expressed by their behavior, body language and verbal expression through observations during their initial hospitalization after being diagnosed with cancer. Twelve children under the age of seven were followed during 26 hours with non-participant unstructured observations. Field notes were written after each observation and transcribed into a narrative text, which was analyzed by content analysis at both manifest and latent level. Five themes were identified, of which "need to have the parent close by" was the most prominent. The other themes were "need to play and feel joy," "need for participation in care and treatment," "need for a good relationship with the staff," and "need for physical and emotional satisfaction." The results indicate that the children needed their parents and the parents' presence helped the children to express other needs. Professionals need to support the child and his or her parents so that the parents in their turn can support and alleviate their child's hospitalization and cancer treatment.     

Needs of families with a relative in a critical care unit in Hong Kong

The aim of this study is to explore family members' perceptions of their immediate needs following admission of a relative to a critical care unit in Hong Kong. A convenience sample of 30 family members was drawn from those available during the first 96 hours of hospitalization of their relative. Self-reported questionnaires, consisting of a demographic data sheet, a modified Chinese version of the 45-item Critical Care Family Needs Inventory (CCFNI) and semistructured interviews, are the instruments used to examine family members' perceptions of need importance and to ascertain whether or not these needs are met. Doctors and nurses are identified as the most suitable people to meet most immediate family needs. Conclusions are drawn as to the best focus of nursing interventions in order to provide quality care to patients and families.     

The qualitative experience of Chinese parents with children diagnosed of cancer

Aim. The present study aimed to describe the coping experiences of Chinese parents with children diagnosed as having cancer during the treatment stage. Background. Cancer is the second major cause of death among children in Hong Kong, it claims the lives of 60–70 children per year. Childhood cancer has tremendous impact on the family, especially the parents. It is, therefore, important to understand parents’ psychological functioning and coping experience. Methods. A phenomenological approach was used. Data were collected by qualitative interviews and analysed following Colaizzi's phenomenological methodology. A purposive sample of nine parents whose children were diagnosed of having childhood cancer was recruited from a regional hospital in Hong Kong. Results. Four themes emerged describing parents’ coping experiences: shock and denial, establishing the meaning or the situation, confronting the reality and establishing a new perspective. The initial reactions of the parents to the diagnosis were shock, denial and worry. However, they quickly accepted the reality and regarded their child's illness as their ‘fate’ that they had to accept. They were committed to the care of the sick child and seek informational and emotional support to cope with the situation. All of them were able to identify positive aspects from the illness experience and establish hope for the future. Chinese cultural beliefs might help the parents cope positively and avoid negative emotions. Conclusion. This study found some commonalities of coping experience in both Western and Chinese culture. It adds knowledge to the coping experience of Chinese parents at the treatment phase of their children's illness and highlighted the need for emotional and information support for parents. Relevance to clinical practice. Education programme and mutual support group would be helpful to parents. Nurses have to learn how different cultural groups and subcultural groups in the society cope to provide competent cultural care.     

An Exploratory Study on Needs of Parents of Adults with a Severe Learning Disability in a Residential Setting

Parents are the key figures in the lifelong rehabilitation of adult children with a learning disability, including those who have a severe learning disability (i.e., having an IQ level between 20-25 and 35-40) (Hong Kong Rehabilitation Programme Plan, 1999). To provide specialized care, parents have to cope with a great deal of parenting demands. The purpose of this study was to explore parental needs in caring for adult children with a severe learning disability in residential setting. Focus group research design was adopted. Twenty-five parents of adults with a severe learning disability from a hospital in Hong Kong were invited to participate in five focus group interviews. The data were analysed by content analysis. Inter-coder reliability was established with inter-coder agreement of 0.8. Six broad categories of parental needs were revealed. Findings of the study may assist nurses to plan appropriate care for both the parents and the residents.     

Understanding the supportive care needs of parents of children with cancer: an approach to local needs assessment.

The objective of this study was to conduct an assessment of supportive care needs from the perspective of parents of children diagnosed with cancer within an urban-rural region in Eastern Ontario, Canada. Guided by a conceptual framework for supportive care, the exploratory, mixed-method study used a standard needs survey and semistructured interviews. Fifteen parents completed (75% response rate) the survey, and 3 parents participated as key informants in the follow-up interview. Parents reported needs in all 6 of the need categories outlined within the Supportive Care Needs Framework. The proportion of parents expressing a need ranged from 23% to 39%. Dealing with the fear of their child's cancer spreading was frequently identified by parents. Emotional and informational needs were the 2 most frequently acknowledged categories of need. With further refinement, the use of the conceptual framework will provide a methodology for planning care based on the individual needs identified by parents of children with cancer.     

An exploratory study on needs of parents of adults with a severe learning disability in a residential setting

Parents are the key figures in the lifelong rehabilitation of adult children with a learning disability, including those who have a severe learning disability (i.e., having an IQ level between 20-25 and 35-40) (Hong Kong Rehabilitation Programme Plan, 1999). To provide specialized care, parents have to cope with a great deal of parenting demands. The purpose of this study was to explore parental needs in caring for adult children with a severe learning disability in residential setting. Focus group research design was adopted. Twenty-five parents of adults with a severe learning disability from a hospital in Hong Kong were invited to participate in five focus group interviews. The data were analysed by content analysis. Inter-coder reliability was established with inter-coder agreement of 0.8. Six broad categories of parental needs were revealed. Findings of the study may assist nurses to plan appropriate care for both the parents and the residents.     

Transitioning to survivorship: a pilot study.

There are no clear transition guidelines for adolescent and young adult cancer patients, their parents, and their primary care providers (PCPs) when completing active therapy and within the first few years after therapy. The purpose of this pilot study was to identify needs and concerns of recently treated adolescent cancer patients and their parents, young adult cancer survivors, and the community PCPs of adolescent patients. Four focus group interviews were conducted with survivors and parents, and 3 in-depth interviews were conducted with PCPs. All interviews were audiotaped and transcribed for content analysis. A range of needs were identified, including lack of adequate written and verbal information about their prior treatment, its potential side effects, and appropriate follow-up care. The best sources for education were identified as the primary oncologist, nurse practitioner, or nurse. At completion of treatment, parents and adult survivors felt a lack of psychosocial support. Suggestions from participants included use of informational videos for survivors, weekend education and support programs, ongoing support groups, use of the Internet, and educational newsletters. The PCPs reported a lack of general pediatric oncology knowledge and specific patient information, time constraints in their patient schedules, and having few survivors in their practices as barriers to optimal survivorship care. Further research is needed to look at the unmet educational and psychological needs of childhood cancer survivors and their parents during the critical time when they transition off treatment.     

Health needs of Hong Kong Chinese pregnant adolescents

BACKGROUND: The outcomes of adolescent pregnancy have been associated with health risks such as obstetric complications and depression, and educational risks such as school dropout and reduced employment opportunities. These outcomes arise from a range of needs including perceived health needs, which are the focus of this paper. AIM: This paper reports a study to identify the perceived needs of Hong Kong Chinese adolescents following confirmation of an unintended pregnancy. METHODS: An exploratory qualitative approach was used with a purposive sample of 10 Hong Kong Chinese pregnant adolescents. The study was undertaken during their stay in a non-government organization maternal shelter. Semi-structured interviews were used to explore adolescents' perceptions of their psychological, social and health needs and the extent to which each of these needs was met. FINDINGS: Six major categories were identified within the context of need, of which three were related to health needs: acceptance of the pregnancy; psychological reactions to the pregnancy; and use of contraception and health advice. CONCLUSIONS: The findings contribute to an understanding of the perceived health needs of Chinese adolescents, in particular those that are culturally determined. Implications for nursing practice indicate the significance of comprehensive health assessments and health promotion strategies to help adolescents increase their knowledge about sexual health and contraception.     

Patient-related barriers to cancer pain management in a palliative care setting in Hong Kong.

This article reviews a study of pain management and its barriers in Hong Kong. Using an interview technique, several measures were used to understand the level of concern in patients about pain, the patients' hesitancy in reporting pain, use of analgesics, and adequacy of medication for pain. A total of nine barriers were identified, which include "addiction," "tolerance," "side effects," "physician distraction," "good patient," "fear of injection," "time interval," "fatalism," and "disease progression." Thirty-nine interviews were carried out. The interviewees were all cancer patients with pain in a palliative setting in Hong Kong. When the findings in Taiwan and the United States were compared, it was found that the cancer patients in Hong Kong had a higher level of concern toward the patient-related barriers. It was also found that the level of concern was generally higher in the group with hesitancy in reporting pain and using analgesics. Last of all, this project also identified the educational needs of patients and health care workers in Hong Kong.     

Parents' experiences of participation in the care of hospitalised children: a qualitative study

BACKGROUND: The introduction of unrestricted visiting hours has led to the encouragement of parents to stay with and participate in the care of their hospitalised child. In order to stay with the hospitalised child, parents have to be away from home or work, which in turn impacts on their personal and family life. However, no published study on parents' experiences of childcare participation during paediatric hospitalisation has been found for a Chinese population. OBJECTIVES: This study explored Chinese parents' experiences of their participation in taking care of their hospitalised child. DESIGN: A qualitative exploratory design was adopted to capture parents' experiences of participation. SETTINGS: The study was conducted in four paediatric wards of a regional acute general hospital in the New Territories, a major geographical region of Hong Kong. PARTICIPANTS: Nineteen parents (16 mothers and three fathers) who had a child hospitalised for more than 48 h and identified themselves as staying comparatively longer with the child than their counterpart were recruited. METHODS: Data were collection by tape-recorded semi-structured interview. RESULTS: Four major categories that illustrated parents' experiences of participation in childcare were identified: reasons for staying with the child, rescheduling of family's routine, expectations of nurses, and comments on facility provisions. The findings highlight parents' desire for participation in caring for their hospitalised child, their unexpressed needs for communication and concern about the non-monetary costs of participation. CONCLUSIONS: Most parents viewed accompanying their hospitalised child as an unconditional aspect of being a parent and had a strong desire for participation. Parents' need for communication and emotional support during their participation of childcare in paediatric unit are universal. As Chinese parents are passive in seeking help, nurses should take the initiative in assessing their needs and offering them support accordingly.     

Parents' perceptions of care-giving to a child with attention deficit hyperactivity disorder: an exploratory study

Attention deficit hyperactivity disorder (ADHD) is the most common neurobehavioral childhood disorder in which parental care-giving is found very stressful. Limited qualitative research is found on their care-giving experiences. This study aimed to explore Chinese parents' experiences of care-giving to a child with ADHD at home. It was conducted at one Child and Adolescent Mental Health Unit in Hong Kong using qualitative exploratory approach. A purposive sample of 12 parents was recruited. Semi-structured interviews were conducted, each lasting about one hour. Content analysis was used to analyze the data. From the interview data, four themes were identified, including: concept of the illness, barriers to child care in ADHD, psychological effects in care-giving, and positive aspects of care-giving. The parents indicated a variety of life problems and health concerns in care-giving. The findings may help nurses understand the perceptions and barriers towards parental care of a child with ADHD in a Chinese population and consider parents' educational needs in care-giving.     

The perceptions and experiences of nurses and bereaved families towards bereavement care in an oncology unit

Background

Existing bereavement literature focuses on the care provided in palliative care units or community settings. However, nurses in oncology units are in a unique position to provide bereavement care, which is care extended to the families after the death of cancer patients. This study aimed to explore the perceptions and experiences of bereavement care among nurses and bereaved family members in an oncology unit in Hong Kong.

Method

Semi-structured qualitative interviews were carried out in one oncology unit in Hong Kong with 15 nurses and ten bereaved family members. All interviews were audiotaped, transcribed verbatim and analysed by using qualitative content analysis.

Results

Among the bereaved family members, three themes emerged: being informed, being supported and being with the patient before and after the patient’s death. Among the oncology nurses, however, the three identified themes were: elements of good bereavement care, emotional response in providing bereavement care and educational needs in the provision of bereavement care. Comparatively, the experiences of and the opinions on bereavement care identified by the bereaved were more specific than those identified by the nurses.

Conclusion

The findings revealed that there is room for improvement in current bereavement care. Family members were committed to patient care and they expressed their need for more involvement in the patient care, which could result in a positive impact on their grief and loss experience. Nurses were committed to quality care, and they expressed their need for more training on knowledge, skills and attitudes to improve their readiness and competencies in the provision of bereavement care.     

The processes of case management: a review of the evaluation of a pilot study for elderly people in Hong Kong

Aim This paper is based on research into case management that aimed to evaluate the processes of the introduction of case management for elderly people into the community nursing services in Hong Kong.
Background The Hospital Authority in Hong Kong introduced a pilot Case Management scheme into the Community Nursing Services. A research project was therefore developed to evaluate this case management model.
Method The processes were measured through information gained from group interviews, daily diaries and weekly activity sheets.
Findings The roles and work practices of the Care Co-ordinators and Case Managers are described and the benefits of case management to patients, carers and nurses are highlighted. Difficulties are also discussed and good practices are identified.
Conclusion Staff in the hospital and community need time to get used to the model of case management and to the accompanying documentation. The role of the case manager needs to be clearly dilineated.     

Observed parental needs during their child's hospitalization

Hospitalization involves that parents are in an unfamiliar environment and their parental role changes. The purpose of this study was to study parental needs during the course of events when their child is hospitalized. Thirty-five parents of 24 children (aged 5 months to 18 years) were followed by observers during their child's hospitalization at a pediatric department in Sweden. Field notes were analyzed by manifest and latent coding. Nine themes characterizing parental needs were identified in the analysis. The themes consisted of the need for security, mediating security to the child, communication, control, pleasing staff, being a competent parent, the family, relief, and satisfying personal needs. The most prominent needs were the need for security and mediating security to the child.     

Qigong practice among chronically ill patients during the SARS outbreak

Aims and objectives. This research aimed at exploring the motivations and experiences of chronically ill participants practising qigong during the severe acute respiratory syndrome outbreak in Hong Kong. Background. Although biomedicine is the mainstream medical system in Hong Kong, many people employ complementary and alternative medicine in dealing with their chronic health problems. Practising qigong is one of the most popular forms of complementary and alternative medicine used among chronically ill patients. Little is known about the experiences of the chronically ill patients practising qigong in the severe acute respiratory syndrome outbreak and even less is known how this practice is related to the social context of Hong Kong during the outbreak. Design and methods. Qualitative methods using participant‐observation from three qigong classes in Hong Kong and in‐depth semi‐structured interviews with 30 participants were employed. Content analysis and discourse analysis were used to identify major themes of the data. Results. Both the underlying and trigger motivations could motivate these chronically ill participants to practise qigong. Legitimacy of qigong in health maintenance, deterioration of health and unpleasant experiences in biomedical treatment on their chronic illnesses served as the underlying motivations. Stigmatization of and discrimination against the chronically ill and the sense of searching coping strategy during the severe acute respiratory syndrome outbreak further motivated their practice. Conclusion. To the participants, practising qigong not only could strengthen their health, but was also a coping strategy for them to regain an active control and the sense of security in their health and enabled them to overcome the social stigmatization and discrimination during the outbreak. Relevance to clinical practice. Searching for emotional support and a more active role in health conditions could be seen from the chronically ill participants. Understanding and paying more attention to the particular needs of the chronically ill patients can enable health‐care professionals to provide better care and support for the chronically ill during an epidemic crisis.     

Oncology nursing: professional development as a clinical specialty in Hong Kong

Cancer is a major health problem world-wide. Therefore, it is not surprising that cancer is identified as the top priority disease group for an improvement programme by the Hospital Authority in Hong Kong. Laser therapy for patients with nasopharyngeal carcinoma, for example, is evidence of the advancement of the scientific and technological developments for cancer treatment. Furthermore, the establishment of the Cancer Centre has provided ample opportunities for clinical practices and research studies. In response to the proclamation of the 'urgent need for the establishment of a cancer society in every country' by Searle in 1990, the Oncology Care Society of Hong Kong, which aims to promote both cancer education and cancer research, was established in 1993. Adopted from the core curriculum of the European Oncology Nursing Society, the specialist course of cancer nursing care was first implemented in Hong Kong in 1993 and the nurse specialist is now a permanent part of nursing career structure in Hong Kong. This paper attempts to review the development of oncology nursing in Hong Kong according to these factors and to find ways to improve the current situation.