Diana Tze Fan Lee

The study aims to investigate registered nurses' perceptions of their practice environment in public hospitals. A 12-month repeated cross-sectional study with quarterly surveys was conducted in 71 adult medical and surgical wards in four public hospitals in Hong Kong. The perceptions of nurses' practice environment were measured by the 31-item Practice Environment Scale of the Nursing Work Index administered in four quarterly survey waves (ranging from 604 to 865 participants). Four of the five subscales scored above 2.5 on average, indicating that these wards were considered favorable practice environments. The only subscale rated unfavorably was "Staffing and resource adequacy."

Aim: To investigate the associations between nurse staffing levels, nurse educational level, and nurse‐sensitive patient outcomes among patients in medical and surgical wards.Background: Patient outcomes are affected by a variety of factors, including nurse staffing and registered nurse (RN) educational levels. An examination of the associations between these factors and patient outcomes will help identify the impact that nurses make on patient care, including health and safety.Methods: A 12‐month prospective observational study was conducted in four major hospitals in Hong Kong. Data on nurse staffing were collected daily, while data on nurse‐sensitive patient outcomes were retrieved from patient records and nursing documentation. Multiple regression was used to examine the association between each of the outcomes and the explanatory variables including nurse‐to‐patient ratio and educational qualifications at the ward level. The STROBE guidelines were followed in this study.Results: The average monthly nurse‐to‐patient ratio per ward was 1:9.2 (1:7.4 for day (morning and afternoon) and 1:19.1 for night shifts). The percentage of RNs with a bachelor's or higher degree was 83.6%. A higher nurse‐to‐patient ratio was significantly associated with a larger number of patients with physical restraints and catheter‐associated urinary tract infections. A significant association was also found between a higher percentage of RNs with a bachelor's or higher degree and a smaller number of physical restraints used.Conclusions: Nurse staffing and educational levels were associated with key patient outcomes such as physical restraint use and incidence of catheter‐associated urinary tract infections.Implications for nursing and health policy: Current nurse staffing strategies should be refined in light of these findings in order to enhance patient health and safety outcomes.

Background: The prevalence of dementia in Tanzania, as in other developing countries is progressively increasing.¹ Yet the screening instruments for the pre‐clinical stage of the diseases are lacking. This study examined the diagnostic accuracy of the Montreal Cognitive Assessment‐5‐minutes protocol (MoCA‐5‐min) among older adult in the rural Tanzania.Methods: After cultural adaptation following Brislin’s approach,² the MoCA‐5‐min and the IDEA cognitive screening were concurrently administered to community‐dwelling older adults (n=202) in Chamwino district and 40 re‐evaluated at 6 weeks. Exploratory factor analysis (EFA) using principal component method and oblique rotation was performed to determine the underlying factor structure of the scale. The concurrent and the diagnostic accuracy of the MoCA‐5‐min were examined by comparing its score with IDEA cognitive screening and the psychiatrist’s diagnosis using DSM‐V criteria respectively.Results: The EFA found that all the MoCA‐5‐min items highly loaded into one component, with factor loading ranging from 0.550 to 0.879. The intraclass correlation coefficient for 6 weeks test‐retest reliability was 0.85. Its strong significant correlation with the IDEA screening (Pearson's r = 0.614, p < 0.001) demonstrated a good concurrent validity. Using the psychiatrist’s rating as a gold standard, the area under the curve (AUC) was 0.861, (95% CI = 0.799 – 0.922) (Figure 1). With the optimal cut‐off score for MCI at 22, the sensitivity was 80% and specificity was 74%. As for dementia, at a score of 16 the sensitivity was 90% and specificity was 80%, whereas the AUC was 0.910, (95%CI = 0.852 – 0.967) (Figure 2). Upon stratifying the sample into different age groups, the optimal cut‐off scores tended to decrease with the increase in age (Table 1).Conclusion: The MoCA‐5‐min is reliable and provides a valid and accurate measure of cognitive decline among older population in the rural settings of Tanzania. The use of varying cut‐off scores across age groups may ensure a more precise discriminatory power of the MoCA‐5‐min. References: 1. WHO. Dementia: Key facts [Internet]. World Health Organization ‐ Fact Sheets. 2019 [cited 2019 Nov 11]. p. 1–5. Available from: https://www.who.int/news‐room/fact‐sheets/detail/dementia. 2. Brislin RW. Back‐translation for cross‐cultural research. J Crosss Cult Psychol. 1970;1(3):185–216.

Introduction Multimorbidity is highly prevalent among older patients and has been shown to be associated with poor health outcomes and lower quality of life. Adherence to medication treatments is essential in order to maximise the efficacy of treatments and improve health outcomes. However, nearly half of the older patients with multimorbidity fail to adhere to their medications, which can result in an increased risk of adverse health events, lower quality of life and higher healthcare cost. Only a few studies have explored the underlying mechanism and influencing factors of medication adherence among older patients with multimorbidity, which are inadequate to provide robust evidence for the development and evaluation of the medication adherence interventions. This study aims to examine and adapt the information–motivation–behavioural skills (IMB) model, a widely used social behaviour theory, to explain the medication adherence behaviour among community-dwelling older patients with multimorbidity. Methods and analysis A cross-sectional study will be conducted in community settings in China. Around 309 older patients with multimorbidity will be recruited to complete questionnaires on adherence knowledge, adherence motivation, adherence self-efficacy, medication adherence, medication treatment satisfaction, depressive symptoms, treatment burden, disease burden and basic demographic information. Structural equation modelling will be used to analyse and validate the relationships among variables in the IMB model. Ethics and dissemination This study has been approved by the Survey and Behavioral Research Ethics Committee of the Chinese University of Hong Kong (reference number SBRE-18-675). The study results will be published in peer-reviewed journals and presented in academic conferences and workshops. Trial registration number ChiCTR1900024804.

A global report found that the quality of dying in Hong Kong lagged behind that of other high-income economies. This study aims to examine the service gaps by conducting a qualitative exploratory study from multiple stakeholders’ perspectives. Purposive and snowball sampling strategies were used to maximize variation in the sample. We interviewed 131 participants, including patients, family members, health care providers, administrators, lawyers, and policy makers. The situation analysis helped identify the facilitators and barriers at individual, organizational, and socio-cultural levels that affect service development. Findings showed that awareness on palliative and end-of-life care is growing, but the existing care is limited in terms of acceptability, coverage, variation in practices, continuity, and sustainability. A number of policy, economic, socio-cultural, environmental, and legal factors were also found to hinder service development. Findings of this study demonstrated that the development of palliative and end-of-life care services involved a paradigm shift relating to society as a whole. The overarching theme is to formulate a government-led policy framework. Furthermore, a public health approach has been advocated to create a supportive environment for service development.

Meaning in caregiving plays an influential role in stroke family caregiver’s perception and adaptation to caregiving. Although the role meaning plays in stroke family caregiving has been recognized, knowledge about this subject among the Chinese population is fragmented and sparse. Therefore, a hermeneutic phenomenological study was conducted as a first step in a program of research focused on Chinese caregivers utilizing a purposive sample of five stroke family caregivers living in China to explore the meaning of the lived caregiving experience. Data were collected through in-depth interviews and analyzed by a phenomenological hermeneutic interpretation. Meaning in stroke family caregiving was interpreted as suffering, an obligation, a personal choice, a meaningful opportunity, and a natural part of living. These meanings were dynamic and interconnected and were affected deeply by the Chinese culture in how caregivers experience, interpret, and cope with caregiving. Findings highlight the need to understand the culture-shaped meanings in caregiving to better support family caregivers and develop culturally tailored interventions.

Introduction: Previous studies evaluating home-based rehabilitation service (HBRS) merely focused on the period immediately after the patients’ discharge from hospitals. The present study focuses on HBRS that covers clients who have not been recently hospitalized. HBRS aims to meet older clients’ rehabilitation needs and support their caregivers in the community. This study intended to evaluate the impact of HBRS on the older clients’ health outcomes and hospital services utilization, and caregivers’ strain in providing care for clients. Methods: This study used a matched-control quasi-experimental design with a 3-month follow-up to evaluate HBRS. The health outcome measures used for the older clients included Elderly Mobility Scale, Timed Up and Go test, Modified Barthel Index, Lawton’s Instrumental Activities of Daily Living Scale, Mini-Mental State Examination, and World Health Organization Quality of Life Scale, Short Form, Hong Kong version (WHOQOL-BREF [HK]). Meanwhile, the Caregiver Strain Index was used to measure the caregivers’ caregiving strain. Data on clients’ hospital services utilization 3 and 6 months before and after the study were also collected and evaluated. Results: The final sample consisted of 122 pairs of older clients and caregivers who live in a community in Hong Kong. In the follow-up after 3 months, the intervention group showed immensely substantial improvements across all the health outcome measures compared with the control group. The intervention group also demonstrated substantial reduction in the clients’ hospital services utilization compared with the control group. However, no significant differences in the clients’ hospital services utilization exist between the two groups in the follow-up after 6 months. Conclusion: HBRS of this study is an effective intervention service to improve health outcomes and reduce hospital services utilization among older people living in the community. Moreover, HBRS of this study was effective in reducing the caregivers’ caregiving strain.

As the aging population, including frail older people, continues to grow in Mainland China, quality of life and end-of-life care for frail older people has attracted much attention. Advance care planning is an effective way to improve end-of-life care for people with advanced diseases, and it is widely used in developed countries; however, it is a new concept in Mainland China. The effects of advance care planning and its acceptability in Mainland China are uncertain because of its culture-sensitive characteristics. The objective of this article is to discuss the serious social issue of caring for frail older people and illustrate the possibility of implementing advance care planning in nursing homes in Mainland China through a review of relevant literature, which will focus on legislation, healthcare system engagement, public engagement, and cultural issues. Recommendations to promote and implement advance care planning include choosing nursing homes as a proper setting, establishing an ethical climate, and enhancing public awareness.