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.     

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.     

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.     

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。     

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.     

香港社区护理的概况及管理经验

从家庭健康、长者健康、学生健康、卫生防护中心、健康教育、诊所服务、普通科门诊 ,介绍了香港基层健康服务的范畴。从社康护理服务、精神科社康护理服务等方面介绍了香港社区护理的概况。从社区老人评估服务、个案管理、社康护理专科化及疾病护理规程、外展护士及私营安老院舍服务、出院后病人的支援计划、科技的运用 :社康护理信息系统及PDA系统、遥控录像和电话支持服务等方面介绍了香港社区健康服务的发展及科技的突破。以新界西社区护理模式为例介绍了联网社区的护理模式。论述了社区护士应具备的条件和社康护理服务的发展方向。     

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。     

Socio-cultural perspectives on the image of nursing: the Hong Kong dimension

Using structured interviews a study was undertaken with 19 high school students in Hong Kong to elicit their perceptions of nursing as a profession. The study also sought to gauge the extent of the students' intentions on pursuing a career in nursing. Responses were content analysed to determine the extent of knowledge and understanding held, intentions on choosing nursing as a career and their reasons. Findings suggest the image of nursing to be poor and that nursing as a career is far from desirable amongst the teenagers of Hong Kong. The reasons appear to be related to the notion of monetary rewards and status within the Hong Kong community. There is also a lack of knowledge as to what nurses do. The implications of such findings include the lost potential for recruitment of candidates of high calibre with a lot to offer the profession and their society. It suggests the need for the profession to find ways of publicizing and marketing the positive aspects with elements of realism which the general population in that part of the world could relate to more readily.     

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。     

EMS systems in Hong Kong

Emergency medical services (EMS) in Hong Kong, now a Special Administrative Region of the People's Republic of China, have a distinguished history spanning more than 50 years. This paper outlines the history and the development of the Hong Kong EMS, with a particular focus on the ambulance service, the design of the system and the training of its staff.     

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.     

Rapid assessment of a helpdesk service supporting severe acute respiratory syndrome patients and their relatives

Background. To contain severe acute respiratory syndrome, the Hong Kong Hospital Authority set a policy that stipulated there should be no visitors to hospital wards. A helpdesk service was established with the goal of providing immediate emotional and communication support to relatives while severe acute respiratory syndrome patients were isolated during the acute phase of the illness. Aim. This study describes the results of a rapid assessment of the effectiveness of a helpdesk service designed to meet the immediate needs of relatives of severe acute respiratory syndrome patients in Hong Kong. Design. Survey. Method. Eighty‐three respondents, representing about 46.3% of relatives (179), attending the helpdesk on the day of the study were recruited. Service evaluation data was collected using a self‐administered questionnaire completed by respondents. Results. Nearly 100% of respondents who used the service found the delivery service with on‐site counselling useful for alleviating their anxiety. However, about half of these relatives complained of insufficient information regarding the patient's condition and progress. The majority of respondents were satisfied with the service. In describing the most important traits of the service providers, caring and enthusiasm were mentioned most frequently by respondents who stated that they were very satisfied with the service. Conclusion. The results support the value of the service, and demonstrate that the service is effective in meeting relatives’ immediate needs. These needs include information, aid in fulfilling their role as caretaker for the patient (delivering prepared soup) and psychological support. The results suggest that facilitation of visitation of patients by relatives via video conferencing and education of the public on the nature and course of severe acute respiratory syndrome to reduce the social stigma of having a potentially life‐threatening disease should be introduced in Hong Kong. Relevance to clinical practice. The results highlight important attributes that helpers (nurses) should have in order to alleviate the suffering of severe acute respiratory syndrome patients and their relatives.     

SARS: caring for patients in Hong Kong

Aim and objective. To explore in depth the experiences of nurses' caring for SARS patients in Hong Kong. Background. Severe Acute Respiratory Syndrome (SARS) dramatically demonstrates the global havoc that can be wreaked by a newly emerging infectious disease. The current literature either has a predominantly biomedical focus or deals with the psychological impact on healthcare workers. Published studies on the lived experience of nurses caring for SARS patients are currently lacking. Design. A phenomenological design. Methods. Using methods consistent with Husserl's philosophy, eight Registered Nurses working in three regional hospitals in Hong Kong were invited to participate in sharing their lived experience of caring for SARS patients and data were analysed using Colaizzi's approach. Results. The three major themes explicated were: the various emotions experienced in caring for SARS patients, the concept of uncertainty and revisiting the ‘taken for granted’ features of nursing. Conclusion. These themes, when taken together, describe the essence of the voyage undertaken by nurses who cared for SARS patients during the outbreak. The findings of this study indicate that extensive and ongoing support is needed to prepare and enable nurses to care for SARS patients during a crisis and make it easier for nurses to deal with the various uncertainties. Relevance to clinical practice. The essence of caring for SARS patients is highlighted in this study. The experience of caring for SARS patients prompts nurses to find meaning in their experience(s), and to develop knowledge and attitudes on how best to care for patients and prepare for a new crisis in the future. This paper considers a more in‐depth understanding of the lived experience of nurses during the crisis and the relevance of this perspective for education and support of nurses.     

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.