[Show abstract][Hide abstract] ABSTRACT: The objectives of the present study were to describe the knowledge and preferences of Hong Kong Chinese older adults regarding advance directives and end-of-life care decisions, and to investigate the predictors of preferences for advance directive and community end-of-life care in nursing homes.
This was a cross-sectional survey conducted in 140 nursing homes in Hong Kong. A total of 1600 cognitively normal Chinese older adults were recruited. Information on demographics, social, medical diseases, preferences of end-of-life care decisions, and advance directives were collected by face-to-face questionnaire interviews.
The mean age of the participants was 82.4 years; 94.2% of them would prefer to be informed of the diagnosis if they had terminal diseases and 88.0% preferred to have their advance directives regarding medical treatment in the future. Approximately 35% would prefer to die in their nursing homes. The significant independent predictors for the preference of advance directive included asking for relatives' advice, wishing to be informed of their terminal illness diagnoses, absence of stroke, and having no problems in self-care in European Quality of Life-5 Dimensions. For the preference for community end-of-life care and dying in nursing homes, the independent predictors included older age, not having siblings in Hong Kong, Catholic religion, nonbeliever of traditional Chinese religion, not receiving any old age allowance, lower Geriatric Depression Scale score, and being residents of government-subsidized nursing homes.
Most of our cognitively normal Chinese nursing home older adults prefer having an advance directive, and one-third of them would prefer to die in nursing homes.
Journal of the American Medical Directors Association 02/2011; 12(2):143-52. DOI:10.1016/j.jamda.2010.08.015 · 4.78 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aims. This study examined the prevalence and correlates of the use of restraint and force in care for older people in the hospital setting in Hong Kong.Background. The use of restraint and force is common in care for older people. Although some knowledge exists on the potential consequences and characteristics of patients where restraint is used, little is known about the profiles of the nursing staff administering restraint.Design. Descriptive cross-sectional study.Method. Data were collected in 2006. A total of 187 nursing staff provided information on their demographic characteristics, coworker emotional support, burnout symptoms, attitudes toward patients with dementia, as well as their perceptions of the use of restraint and force in care for older people and their experiences with it.Results. More than two-thirds (73·8%) of the participants reported using restraint or force in the past three months, with physical restraint endorsed by 69%, the use of force in examination or treatment endorsed by 48·1% and the use of force in activities of daily living endorsed by 46·5% of the participants. Pearson correlation analysis results show that use of physical restraint was negatively correlated with the age of participants (r = −0·44, p<0·01) and coworker emotional support (r = −0·20, p<0·05), but positively correlated with emotional exhaustion (r = 0·21, p<0·01). Use of force in examination or treatment and in relation to activities of daily living was negatively correlated with the age of participants (r = −0·32 & −0·18, p<0·01 & 0·05), but positively correlated with emotional exhaustion (r = 0·16 & 0·15, p<0·05) and lack of personal achievement (r = 0·18 & 0·19, p<0·05). Years of experience in dementia care, training in dementia care, attitudes toward people with dementia and perception of the use of restraint were not related to the use of physical restraint or force (p > 0·05).Conclusion. The use of restraint and force is common among nurses in hospital medical wards in Hong Kong. To reduce restraint use in patient care, steps need to be taken to mitigate feelings of burnout and to foster sense of social support among nurses.Relevance to clinical practice. The hospital administration can take a leading role in restraint reduction by setting standards of care and by formulating institutional policy regarding the use of restraint or force.
Journal of Nursing and Healthcare of Chronic Illness 05/2009; 1(2):147 - 155. DOI:10.1111/j.1752-9824.2009.01015.x
[Show abstract][Hide abstract] ABSTRACT: A primary care group diabetes care program using telemedicine was developed and its feasibility and acceptability were tested in 22 subjects with Type 2 diabetes mellitus using a one-group, pretest-posttest quasi-experimental design. Compliance with the program was 100%. Significant reductions in total calorie intake as well as body mass index were achieved, with an increase in the percentage of subjects achieving better diabetes control as measured by the 2-hr hemastix. Improvements in diabetes knowledge and disease-specific and generic measures of quality of life were also observed. Most subjects evaluated this mode of service delivery favorably in the questionnaire and focus group discussions. There is potential for the integration of this mode of service delivery into current health services.
Applied Nursing Research 06/2005; 18(2):77-81. DOI:10.1016/j.apnr.2004.11.002 · 1.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the effectiveness of an intensive community nurse (CN)-supported discharge program in preventing hospital readmissions of older patients with chronic lung disease (CLD).
Randomized, controlled trial.
Two acute hospitals in the same health region in Hong Kong.
One hundred fifty-seven hospitalized patients aged 60 and older with a primary diagnosis of CLD and at least one hospital admission in the previous 6 months.
CNs made home visits within 7 days of discharge, then weekly for 4 weeks and monthly until 6 months. CNs coordinated closely with a geriatric or respiratory specialist in hospital. Subjects had telephone access to CNs during normal working hours from Monday to Saturday.
The primary outcome was the rate of unplanned readmission within 6 months. The secondary outcomes were the rate of unplanned readmission within 28 days, number of unplanned readmissions, hospital bed days, accident and emergency room attendance, functional and psychosocial status, and caregiver burden.
One hundred forty hospitalized patients completed the trial. Intervention group subjects had a higher rate of unplanned readmission within 6 months than control group subjects (76% vs 62%, P=.080, chi2 test). There was no significant group difference in any of the secondary outcomes except that intervention group subjects did better on social handicap scores.
There was no evidence that an intensive CN-supported discharge program can prevent hospital readmissions in older patients with CLD.
Journal of the American Geriatrics Society 09/2004; 52(8):1240-6. DOI:10.1111/j.1532-5415.2004.52351.x · 4.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 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.
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.
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.
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.