Social support and locus of control as correlates of UK nurses' health-related behaviours

Social support and locus of control as correlates of UK nurses' health-related behaviours ¶ Background : Despite the number of studies describing nurses' health-related behaviours, few have investigated psychosocial factors that influence these behaviours. Aim : To investigate the relationship of social support and locus of control to nurses' health-related behaviours. Design: A cross-sectional survey was used. Subjects : 114 nurses' attending tertiary level education courses in London and Essex. Measures : The Health and Behaviour Survey, The Six Item Social Support Questionnaire and the Multidimensional Health Locus of Control Scale. Results: Social support did not significantly relate to any health-related behaviour except eating fruit. Subjects high on internal locus of control also significantly reported eating less red meat, eating three meals per day on a regular basis and eating fewer between meal snacks. Conclusions: Locus of control is more strongly associated with United Kingdom nurses' health-related behaviours than social support. Given the empirical links between nurses' health-related behaviours and their tendency to counsel clients about health issues, attempts to improve nurses' internal locus of control may ultimately improve their health promotion role.     

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.     

Wife battering in Hong Kong: Accident and emergency nurses' attitudes and beliefs

A questionnaire was sent to all nurses working in Accident and Emergency departments in Hong Kong, to survey their attitudes, beliefs and practice in the handling of wife battering cases presenting to the Emergency department. Questions about incidence, epidemiology, rationale for intervention and effects on children of abused women were included. Traditional cultural beliefs were found to be an important factor influencing nurses' attitude in this issue. Nurses on the whole were not well prepared to handle victims of domestic violence. The importance of training and nurse protocol for the handling of these patients was discussed.     

Validation of an instrument to assess patient attitudes towards prescribing of pharmaceuticals by doctors

OBJECTIVES: To establish the reliability and validity of a questionnaire designed to assess Chinese patients' attitudes towards pharmaceuticals that may influence the prescribing behaviours of their doctors. STUDY DESIGN: A draft questionnaire of 48 items was designed in English, translated into Chinese, and then back-translated into English. After establishing for content and face validity, it was administered to a convenience sample of patients. Responses were factor analysed to establish construct validity and to reduce the questionnaire's length. POPULATION: Hong Kong Chinese patients (n = 387) who visited one of 24 primary care doctors. OUTCOMES MEASURED: Derived factor score means were compared among various age, gender and education groupings. RESULTS: A final 21-item questionnaire was produced. Spearman's rank correlations indicated the instrument was relatively stable over repeated applications. Patients' attitudes were found to be multidimensional. The three-factor solution achieved a simple structure and accounted for 40% of the variance among the 21 items. Items loading heavily on each construct were internally consistent. Nine items measured patients' attitudes towards careful use of medications. Six questions measured a preference for information exchanges between patients and doctors. Six items measured patients' scepticism concerning the need for pharmaceuticals to hasten recovery from most illnesses. The three factors yielded factor score means that discriminated among the patients as expected. CONCLUSIONS: The questionnaire met adequate standards for reliability and validity. It is suitable for further use in investigating Chinese patients' attitudes concerning pharmaceuticals and how these attitudes might influence their physicians' prescribing behaviours.     

Perceptions of the benefits and challenges of the role of advanced practice nurses in nurse‐led out‐of‐hours care in Hong Kong: a questionnaire study

Aims and objectives. The aim of the study was to identify the factors that nurses perceive may facilitate or hinder the development of advanced practice nurse roles in Hong Kong. Background. Advanced practice nurses are increasingly prominent in nurse‐led out‐of‐hours care in Hong Kong in response to changes to junior doctors’ hours of work. Setting. Three five‐day workshops for Hong Kong‐based advanced practice nurses were offered in partnership with UK clinicians. The aim of the workshops was to share UK experiences of implementation of the ‘Hospital at Night’ model of care delivery. The questionnaire study undertaken was not part of the workshop programme. However, the workshops gave the authors a unique opportunity to access relatively large numbers of Hong Kong‐based advanced practice nurses. Participants. The workshops were attended by experienced nurses who had been or were about to be appointed as advanced practice nurses. All nurses who attended one of the three workshops (n = 120) agreed to participate in the study. Methods. Responses to two open questions posed in the questionnaire were the subject of a content analysis. Results.  A prominent finding of the study was that respondents viewed the benefits of introducing advanced practice nurse roles in Hong Kong as outweighing any challenges. One of the main features of the perceived benefits relates to improving the quality and safety of patient care. The greatest challenges associated with the role related to acceptance of the role by other healthcare professionals, and difficulties associated with the general public’s traditional attitudes to healthcare provision in Hong Kong. Conclusions. Education of the public concerning the implementation of such roles is of crucial importance. Relevance to clinical practice. Findings from this study enhance understanding of the factors that hinder or facilitate advanced practice roles in out‐of‐hours care in Hong Kong.     

Diploma-prepared nurses' use of technological equipment in clinical practice

Increasingly, nurses throughout the western world are receiving their educational preparation for initial registration in a tertiary environment at either the diploma or bachelor degree level The length of time spent in the clinical setting has been reduced considerably, with the elimination of the apprenticeship system and the role of the student nurse as paid staff member Concurrently, the amount of technological equipment used in the health care sector is both increasing rapidly and now found in general wards, not just the traditional 'high tech' environments It is important to evaluate how well the tertiary experience prepares students in terms of their ability to handle common technological equipment such as infusion control devices or suction pumps In the study reported here 245 diploma-prepared registered nurses completed a questionnaire designed to assess how nurses from tertiary institutions perceived their ability to handle technical equipment in the workplace The majority of the respondents had been working for 7 to 12 months No significant relationship was found between the frequency of use of specific items of clinical equipment and whether that item caused the nurse concern in practice There was also no significant relationship between the frequency of use of an item and whether participants believed that competence should be acquired in relation to that item prior to tertiary graduation Although moderate levels of comfort in the use of technical equipment were reported upon entry to the workplace, subjects rapidly acquired high levels of comfort in relation to equipment handling The implications for hospital administrators and tertiary teaching programmes are discussed     

Knowledge and attitudes in pain management: Hong Kong nurses' perspective

Effective pain management requires accurate knowledge, attitudes and assessment skills. To determine the current knowledge level and attitudes of nurses in pain management, 1,604 registered nurses working in three different hospitals in Hong Kong were invited to participate in this study. The sample consisted of 601 registered nurses, 63 nursing officers, and 14 nursing specialists (N = 678). The response rate was 43%. The Nurses' Knowledge and Attitudes Survey Instrument questionnaire developed by McCaffery and Ferrell was translated into Chinese and used with permission. To ensure the contextual relevancy and consistency of the questionnaire, content validity and test-retest reliability tests were performed. The content validity index was 0.87 and the test-retest reliability (Spearman's p coefficient) was 0.812. The percentage of correctly answered questions was 44%. There was statistical significant in educational preparation and clinical experiences with correct scores. The findings of our study support the concern of inadequate knowledge and attitudes in relation to pain management. Further intensive continuing education and staff development is highly indicated for nurses in Hong Kong.     

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.     

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.     

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.     

The validity and reliability of the World Health Organization Mental Disorders Checklist for use in a telehealth clinic in Hong Kong

This research aimed to test the validity and reliability of the 'World Health Organization Mental Disorders Checklist' for use in a telehealth clinic in Hong Kong. The Checklist adopted four subscales: (i) depression; (ii) anxiety; (iii) alcohol use disorders; and (vi) functioning and disablement, and was translated from English into Chinese. It was validated by a panel of five experts to confirm its content validity (content validity index = 0.98) and cultural appropriateness in Hong Kong. The reliability of the checklist was supported by the findings of a test-retest procedure (Pearson correlation = 0.66-0.88, P < 0.01), internal consistency reliability (Cronbach's alpha = 0.54-0.83), and interrater reliability (Kendall's coefficient of concordance = 0.58-1.00, P < 0.01) involving a sample of 197 subjects from one telehealth clinic in Hong Kong.     

Acute coronary syndromes: cardiac rehabilitation programmes and quality of life

AIMS: This paper reports a study examining the quality of life of clients following hospital admission with acute coronary syndrome in Hong Kong and their use of cardiac rehabilitation. BACKGROUND: Coronary heart disease is a major source of mortality and morbidity in Hong Kong. Western studies have suggested that participation in cardiac rehabilitation improves the quality of life of clients with coronary heart disease yet the use of cardiac rehabilitation has been reported to be low. Better understanding is needed of the psychosocial status of these clients in Hong Kong and their use of cardiac rehabilitation services. METHODS: A prospective, pretest-post-test study was carried out, with data collected over a period of 6 months with convenience sample of 182 participants. Baseline data were obtained within one week after hospital admission for individuals experiencing ACS. The second phase of data collection commenced at 6 months after hospital discharge. Total period of data collection took over 12 months between 2002 and 2003. The Chinese version of the SF-36 was used to assess quality of life, and demographic data and the extent to which clients participated in the cardiac rehabilitation programme were assessed. RESULTS: Only 25% of the participants attended at least one session of the cardiac rehabilitation programme. Significant improvement occurred in all clients' perceived quality of life 6 months following initial hospital admission. No significant group differences in perceived quality of life were found according to whether or not clients used the cardiac rehabilitation services. CONCLUSION: Improvement in perceived health-related quality of life was evident over a 6-month period. Yet our findings suggested that participation in the cardiac rehabilitation programme did not have any apparent effects in subjects' perceived quality of life. Further studies using both generic and disease-specific health-related quality of life instruments, as well as the inclusion of control group, are recommended. Continual improvement in cardiac rehabilitation programmes, and consideration of alternative modes of delivery other than the traditional attendance at hospital outpatient services, are also recommended.     

The nurse specialist role in Hong Kong: perceptions of nurse specialists, doctors and staff nurses

AIM: The purpose of this study is to review and delineate the impact in terms of the perceived importance as well as the role components of nurse specialists in Hong Kong. RATIONALE: The Nurse Specialist Scheme was launched in 1994 in Hong Kong. Studies in the West showed that there were impacts on the roles of other members among the health care team. However, minimal local published work has been carried out in reviewing the scheme. DESIGN: The design of the study was nonexperimental. Data were collected by self-administered questionnaires. The questionnaire adopted was developed by O'Mullan (1995), and the five roles studied were administration, clinical practice, consultation, education and research. To ensure the contextual relevancy and consistency of the questionnaire, content validity and test-retest reliability tests were performed. The content validity index was 0.85 and the test-retest reliability (Spearman's rho coefficient) ranged from 0.57 to 0.97. Subjects were obtained by stratified convenience sampling technique. The ratios for subject selection among the doctors, ward managers, nursing officers and registered nurses were 3:1:3:10, respectively. Because of the small numbers for nurse specialists, they were all included in the study. The final sample consisted of 11 nurse specialists, 47 ward managers, 56 nursing officers, 110 registered nurses and 15 doctors (n=239). RESULTS: The results showed that there were significant differences in the perceptions of importance of the administration, clinical practice, education and research roles, and the frequency of occurrence of the clinical practice and research roles. This was further verified by the Fisher's Least Significant Differences (LSD) test. CONCLUSIONS: A regulatory system of the nurse specialist was recommended to monitor the development of the nurse specialist role and practice and to ensure the safety of the public with regard to the emerging role. Both the implications and limitations are discussed.     

Health beliefs and their influence on United Kingdom nurses' health-related behaviours

BACKGROUND: Because there is a demonstrated empirical link between nurses' personal health habits and their tendency to raise health issues with clients, researchers suggest that nurses can improve their health promotion role if they adopt health-related behaviours. Few researchers, however, have identified the factors that influence nurses' health-related behaviours. AIMS: To describe nurses' beliefs about the importance of health-related behaviours, and investigate the relationship between these beliefs and their health-related behaviours. DESIGN: A cross-sectional survey from which nested-case control comparisons were made. SAMPLE: One hundred and thirteen nurses attending tertiary level education courses in London and Essex. MEASURES: Health Behaviour Survey and a scale measuring nurses' beliefs about the importance of health-related behaviours. RESULTS: Nurses' health beliefs significantly influenced the practice of 14 health-related behaviours. CONCLUSIONS: The findings from this study support the view that nurses' practice of many behaviours linked to health and longevity are influenced significantly by their beliefs about the importance of these behaviours. Changing nurses' beliefs about the importance of health-related behaviours through specific health promotion sessions are meaningful as they may improve nurses' health promotion role.     

Prevalence of common chronic pain in Hong Kong adults

OBJECTIVE: Chronic pain is prevalent in many Western countries. Its prevalence in a non-Caucasian population is not known. The authors performed this study to measure the prevalence of chronic pain in the Hong Kong Chinese adult population, as well as the pattern of pain and the demographic characteristics, the impact on social and work function, and the help-seeking behavior of those with pain. DESIGN: Cross-sectional survey using telephone interview with a structured questionnaire. Chronic pain was defined as pain persisting for more than 3 months. SUBJECTS: A random sample of over 1,000 persons out of the entire Chinese adult population of Hong Kong. RESULTS: One thousand fifty-one adults were interviewed. One hundred thirteen (10.8% [95% C.I.: 8.9%-12.7%]) had chronic pain. The median number of pains was two. Of those with chronic pain, 38.3% reported their work was affected, and 19.8% had taken a median of 5 days' sick leave in the past year; 70.8% said the pain had interfered with their daily life, 88.5% had tried self-treatment, and 74.3% had sought medical advice. Only 35.7% considered the treatment definitely helpful. Two risk factors were identified: the female gender (O.R. 1.5, 95% C.I. 1.0-2.3) and age greater than 60 (O.R. 2.2, 95% C.I. 1.3-3.6). CONCLUSIONS: The study showed that the prevalence of chronic pain in Hong Kong adults was approximately 10.8%. Work and daily life are significantly affected and there is considerable demand on the health care system. Despite the ethnic difference, the prevalence, pattern, and demographic characteristics of chronic pain in Hong Kong are very similar to those seen in Western countries.     

Relaxation training methods for nurse managers in Hong Kong: a controlled study

Nurse managers are under increased stress because of excessive workloads and hospitals' restructuring which is affecting their work tasks. High levels of stress could affect their mental health. Yet, few stress management training programmes are provided for this population. The purpose of this study was to apply stretch-release relaxation and cognitive relaxation training to enhance the mental health for nurse managers. A total of 65 nurse managers in Hong Kong were randomly assigned to stretch-release relaxation (n = 17), cognitive relaxation (n = 18), and a test control group (n = 35). Mental health status was assessed using the Chinese version of State-Trait Anxiety Inventory and the Chinese version of the General Health Questionnaire. Participants were assessed at the pretreatment session, the fourth posttreatment session, and at the 1-month follow-up session. The results revealed both the stretch-release and cognitive relaxation training enhanced mental health in nurse managers in Hong Kong. The application of relaxation training in enhancing mental health status for nurses and health professionals is discussed.     

Health-related quality of life of Chinese people with schizophrenia in Hong Kong and Taipei: a cross-sectional analysis

Health-related quality of life is an important outcome indicator of mental health. We assessed the perception of health-related quality of life of persons with schizophrenia in Hong Kong and Taipei. In-person survey interviews were conducted using the Chinese World Health Organization Quality of Life Scale--Brief Version. A convenience sample was recruited from psychiatric outpatient departments: 176 from Hong Kong and 80 from Taipei. We found that both groups were significantly less satisfied with their psychological and social relationship domains compared to other domains. Poor mental health predicted poor perception of health-related quality of life. Schizophrenia has an impact on many aspects of a person's functioning. A rehabilitation model that takes into account symptoms, financial situation, family support, and social functioning is required.