Transitional, Supportive & Palliative Care
Externally Funded Projects
Background: The use of mobile health (mHealth) has become common in recent years and is regarded as one of the most effective interventions for developing disease-specific management skills and establishing confidence in making preventive health behavior changes and accomplishing health-related goals among community-dwelling older adults. Most mHealth designs adopt a reactive care approach whereby health care professionals do not respond until they receive abnormal assessment results from the database or a message or signal from the client. The purpose of this study is to determine the effectiveness of a proactive mobile health application program with the support of a community health-social care team for older adults dwelling in the community on improving their self-care health management.
Methods: This is a three-armed, randomized controlled trial. The study will be conducted in 7 community centers with an estimated sample size of 282 participants. The participants will be randomly assigned to mHealth with interactivity, mHealth, and control groups when they are (1) aged 60 or above, (2) complaining chiefly of pain, hypertension, or diabetes mellitus, (3) living within the service areas, and (4) smartphone users. Subjects in the mHealth with interactivity group will receive 2 main elements, the mHealth application and nurse case management supported by a social service team. The mHealth group will receive the mHealth application only. The primary outcome measure will be self-efficacy, and secondary outcomes will include self-management outcomes (pain score, blood pressure, capillary blood glucose), client outcomes (quality of life, depression), and health service utilization outcomes (institutionalization and health service utilization [general practitioner, outpatient clinic, emergency room, hospital admission]). Data will be collected before intervention, after intervention, and 3 months after intervention.
Discussion: The incremental benefits of adding interactivity in the mHealth program have not been confirmed. This present study will add valuable information to the knowledge gap of whether mHealth with nurse interaction supported by a health-social partnership can improve self-care management among community-dwelling older adults.
Background: The future practice of our graduates is no longer stable and predictable. Graduates are required to be not only knowledgeable and skillful, but also adaptive to the changing demands of work . The increasing use of simulation-based education (SBE) is to prepare nursing students for their practice. However, the standardized approaches with pre-determined outcomes only allow students to learn what is planned and delivered. The individualist and cognitive perspectives adopted in simulation are also insufficient to understand the process of how learning takes place in the complex professional practice. This understanding has an important implication for fidelity/realness in simulation since such scenarios cannot capture the full range of behaviours and interactions, most significantly within the embodied and material world of the nurse, notably the interface with physical tools, monitoring equipment, protocols, which shape and engineer practice. Hence emphasizing only the human or the social and the intended learning over the material and the unintended learning in SBE will undoubtedly limit our understanding of how knowledge is developed through SBE.
Purpose: The purpose of this study is to explore an innovative approach to student learning on palliative care communication through SBE, based on the sociomaterial perspective. Globally, palliative care is becoming increasingly complex, with ever more sophisticated treatment options and education needs for advanced care planning. This reality, combined with the tension and high emotions of patients, families, and nurses, is a clarion call to the importance of preparing nursing students through SBE to develop better communication with this population and their families prior to their clinical practice.
Method: An ethnographic approach will be adopted to examine SBE for nursing students' palliative care communication based on sociomaterial perspectives. In addition to a document review, data will be collected from field observations before simulations, video-recordings during simulations, focus group interviews through debriefings, and interviews with students after their subsequent clinical practice. There will be a collaborative analysis of data from field notes and videotapes; a content analysis of the focus group debriefings and follow-ups of students in practice, and a document and artifact analysis to determine how nurse-patient palliative care communication can be enhanced using the sociomaterial approach.
Relevance to simulation/clinical practice: The sociomaterial approach in SBE will help to attune us to the multiple ways in which human and non-human elements relate, which might otherwise go unnoticed during the simulation learning of palliative care communication.
Background: Although homebound older adults are among the highest users in hospital services, the existing health and social services that provided to them in the community are limited and fragmented. This study tries to bring this group of older adults to the providers’ attention and design a health-social oriented self-care mobile Health (mHealth) program and subject it to empirical testing.
Methods: This is a randomized controlled trial. The study is supported by five community centers with an estimated sample size of 68 subjects. The subjects will be randomly assigned to video-based mHealth and control groups when they are (1) aged 60 or above, (2) going outdoor less than once per week in current six months, (3) living within the service areas, and (4) using smartphone. Subjects in the video-based mHealth group will receive two main elements, which include nurse case management that supported by a social service team and an individual-specific video messages covering self-care topics that delivered via smartphone. The control group will receive usual care only. Data will be collected at two time points—pre-intervention (T1) and post-intervention (T2). The primary outcome measure will be activity of daily living and secondary outcomes will include health outcomes (blood pressure, capillary blood glucose, instrumental activities of daily living, medication adherence), perceived well-being outcomes (quality of life, self-efficacy, depression), and health service utilization outcomes (outpatient clinic, emergency room, hospital admission).
Discussion: The current study will add to the knowledge gap in using mHealth supported by a health-social team in enhancing quality of life and self-care and meeting the needs of these particularly vulnerable older adults.
This is a randomized controlled trial embedded with a longitudinal mixed-method process evaluation which aims to (1) examine the effectiveness of ZTEx, a lifestyle-integrated physical activity programme, in inactive adults with insomnia disorder; (2) collect pilot evidence on the effect of WhatsApp Anti-inertia Reminders on exercise adherence. The process evaluation will identify the facilitators and barriers of subjects’ exercise adherence and explore the possible mechanisms of impact on the study outcomes.
This study consists of two phases. In the first phase (baseline to week 8), 136 subjects will be randomly allocated to the ZTEx intervention group or the sleep hygiene education (SHE) comparison group. They will receive two two-hour ZTEx training or SHE lessons and practice ZTEx or follow the sleep hygiene instruction for 24 weeks. After assessment at week 8, for the second phase of the study (weeks 9-24) which is a proof-of-concept pilot, subjects in the ZTEx group will be randomly divided into ZTEx with WhatsApp reminder (ZTEx+R) or ZTEx without WhatsApp reminder (ZTEx alone) subgroup to evaluate the effects of WhatsApp reminders on exercise adherence. Post-training and post-follow-up qualitative focus group interviews will be conducted for process evaluation.
The primary outcome measure is the severity of insomnia symptoms and daytime impairments by the Insomnia Severity Index (ISI) at week 8, 16, and 24. The secondary outcomes include subjective sleep diary and objective actigraphy; objective cognitive functioning, anxiety and depressive symptoms, fatigue level, and quality of life; objective physical activity level and exercise adherence will be assessed by waist-worn accelerometers. ZTEx and SHE groups will be compared using a mixed-effects model. Exercise adherence in the ZTEx+R and ZTEx alone subgroups will be compared.
This study will be the world’s first randomized controlled trial to provide rigorous scientific evidence on the effectiveness of lifestyle-integrated exercise for insomnia disorder. ZTEx is a brief intervention that can be easily disseminated in the community by briefly trained healthcare professionals to help people to relieve their insomnia and prevent the negative consequences of physical inactivity.
ObjectiveThis pilot RCT will preliminary examine the effects of an electromoxibustion device and knee health education on reliving knee osteoarthritis pain.
Method Design-This pilot RCT will embed a two-arm randomized control trial. The project will recruit 48 participants with knee OA. Eligible participants will be randomized into 2 groups – (1) Electromoxibustion, or (2) knee health education at 1:1 ratio. Major assessments will be performed at baseline and 4.
Participants- A total of 48 participants aged 60 years or more with knee pain will be recruited from the community through the Neighborhood Elderly Centres of Yan Chai Hospital.
Interventions- Participants in the intervention group will receive electromoxibustion using a knee-brace-like device which produces thermal stimulation with a moxa pad inside. The treatment will be delivered by a registered Chinese medicine practitioner 3 times per week for 4 weeks.
Control- Participants in the control group will attend 2 sessions (120 minutes each, 1-week apart) of health education related to knee osteoarthritis symptom management. The instructor will be a registered physiotherapist or nurse.
Outcome measures- (1) Pain severity numerical rating scale, NRS (Primary outcome); (2) Western Ontario and McMaster University Osteoarthritis Index (WOMAC) for pain, physical function, and stiffness related to knee osteoarthritis; (3) Short Form-6D for quality of life; (4) Timed Up & Go Test (TUG); (5) Fast Gait Speed (FGS) for knee functioning.
Objectives: To evaluate the short- and medium-term effectiveness of self-administered acupressure taught by a short training course on reducing knee osteoarthritis (OA) pain in middle-aged and older adults.
Hypothesis: The self-administered acupressure group would have a greater pain relief compared to the knee health education (KHE) control in subjects with knee OA at week 4 (short-term) and 12 (medium-term).
Design and subjects: In this fully-powered randomized controlled trial, 314 participants with knee OA recruited from the community will be randomized to self-administered acupressure or KHE group in a 1: 1 ratio.
Study instrument: Numerical rating scale (NRS) will be used to assess pain intensity in the knee.
Interventions: Participants in the self-administered acupressure will attend two 2-hour training sessions (1 week apart) to learn self-administered acupressure and practice twice daily for 12 weeks. Participants in the control group will receive knee health education of the same schedule and duration.
Main outcome measures: The primary outcome measure is the NRS score at 12 weeks. Other outcomes include Western Ontario and McMaster University Osteoarthritis Index, Short Form Six Dimensions, Timed Up & Go Test, Fast Gait Speed, pain medication usage. Compliance of self-administered acupressure will also be evaluated.
Data Analysis: Differences in the scale scores and test parameters will be examined using a linear mixed-effects model.
Expected results: Subjects in the self-administered acupressure group will have greater improvement in NRS and other related parameters compared to those in the KHE group at week 4 and 12.
Objectives Children with life-limiting diseases (LLD) and their families face enormous challenges. While the disease is non-curative, the children and families have tremendous needs requiring physical-psycho-social-spiritual support. It is recommended that pediatric palliative care (PPC) should be initiated once diagnosis is made. There is a paucity of knowledge of the essential elements that should be included in the PPC model that suits local needs. Our study aims to explore the needs of pediatric patients with LLD from the perspectives of the children, parents and the healthcare providers, as the exploratory phase towards the building of a PPC model.
Methods A multiple-case study research design. Purposive sampling of 25 sets of cases, with each case comprises of 3 informants, i.e. the child, family and the healthcare provider, that result in 75 individual interviews in total. Inclusion criteria are LLD children aged from 8 to 19, their parents and key healthcare providers. Data will be collected through in-depth semi-structured interview with the interview guide constructed to solicit the perceived needs on physical-psychosocial-spiritual support, informational support and the views on palliative care approach. Inductive thematic analysis will be used to analyze the data. Within-case and cross-case comparison will be executed to denote patterns, similarities and differences.
Expected result: This study will help inform healthcare policy makers and providers to build a palliative care model for the LLD children and their families to receive help that is coordinated and proactive for patients’ quality of life and potentially reduce unnecessary use of hospital services.
Purpose: The primary purpose of this study is to explore the impacts of SBE on caring communication in helping nursing students’ development of the knowledge, skills, and attitude to work in palliative care. The secondary purpose is to discern whether or not communication education using simulation enhance nursing students’ perceived self-efficacy in caring communication in palliative care.
Method: This is a mixed-method concurrent triagulation design with four phases. Phase 1 consists of students’ reflective value clarification with a pre and post questionnaire survey. Phase 2 included observations of nurse experts in real clinical settings and debriefing with nurse experts. Phase 3 refers to students’ demonstration of their communication skills through simulations with standardized patients, and the last phase consists of focus groups for students’ reflections on the simulated performances and the overall process. While quantitative data will be analysed through descriptive statistics and paired sample T-tests, the qualitative data will be evaluated by a content analysis.
Conclusion: The findings of this study will facilitate the learning of valued-based caring communication and the use of the various assessments in this study. This, in turn, will further our understanding of the best way for the students to learn holistic caring communication based on the concepts of trust, knowing, and presence as laid out in caring theories.
Setting: The study was conducted in a university. Participants: Twenty-four final year baccalaureate nursing students, who were identified in the quantitative phase of the study as having scores indicating the following: a) low resilience and high burnout; b) high resilience and low burnout. Method: Ten focus group interviews were conducted using a semi-structured interview guide. The interviews were digitally recorded and transcribed verbatim in Chinese for a thematic analysis. Results: Two main themes were identified from the interviews: a) stressors arising from students’ expectations of the clinical placement (i.e., the practice demands of busy wards, striving for learning opportunities, and discovering the social rules), and b) coping as a process of fitting into the ward culture. While the students all reported similar stressors, the coping mechanisms that they used to deal with these stressors differed between the two groups. Those students with high resilience and low burnout scores had a self-directed goal and used self-regulation strategies. Students with high burnout and low resilience adopted external orientation and self-blame strategies. Conclusions: The resilience and burnout scores of the student nurses provide insight into the way that nursing students deal with stressors. To build and maintain resilience in the students, the following are recommended: interventions to enable the students to actively fit into the clinical environment; encourage engagement in reflection to facilitate self-awareness; and encourage flexible use of personal and external resources.
Interventions: The PU prevention programme includes a staff training course tailor-made to non-professional care staff and a prevention protocol guiding them to assess the PU risk and provide preventive interventions accordingly. The protocol will be implemented for 12 weeks. The control group will receive usual pressure ulcer prevention care. Main outcome measures: PU prevalence, incidence and risk of residents. Data analysis: Chi-square test will be performed to compare PU prevalence and incidence between the two groups. Mixed between-within subjects ANOVA will be performed to compare PU risk between the two groups and over time. Expected results: The PU prevention programme will significantly reduce PU prevalence, incidence and risk at the 6th week and the end of protocol implementation.
Objective: to test the effectiveness and the cost impact of an 8-week course of acupuncture in the management of chemotherapy-induced peripheral neuropathy (CIPN) in cancer patients receiving neurotoxic chemotherapy.
Hypothesis: Acupuncture is more effective than non-penetrating sham acupuncture or standard care alone in patients experiencing CIPN-related pain.
Design & subjects: Randomised placebo-controlled trial with three groups. 108 lung, breast or gynaecological cancer patients with CIPN-related symptoms. Intervention: Subjects will be randomized to receive a) acupuncture twice weekly for 8 weeks needling 8 specific points, b) placebo non-penetrating acupuncture in non-acupuncture points and c) only standard care. Study instruments: Primary outcome will be pain intensity over the past week.
Secondary measures: CTC grading and WHO scale for neuropathy, and the FACT-COG-Ntx quality of life scale, assessed at baseline, end of treatment (8 weeks), week 14 and week 20 from the beginning of treatment, sensory examination and health economics assessment.
Data Analysis: Intention to treat analysis will be used. Analyses will include analysis of variance to assess between-groups differences, regression analysis and 95% CIs.
Expected Results: New information about the delivery and outcomes of acupuncture in the management of a debilitating symptom/side effect of cancer therapies in order to inform decision-making, policy-making, providers and consumers, contributing to the evidence base for the treatment of chemotherapy-induced peripheral neuropathy. We will provide information that can lead to improvements in the care of cancer patients, have a positive impact on quality of life and may increase the number of patients successfully completing neurotoxic treatments.
2). Hypothesis to be tested: The wActiSleep-BT can assess sleep parameters including total sleep time, wake after sleep onset (awake time after sleep), and sleep efficiency.
Design and subject: A random sample of 50 adults aged 18-64 will be invited to wear both accelerometers on their non-dominant wrist for 7 consecutive days. Study instruments: Sleep parameters will be measured using wActiSleep-BT and Actiwatch 2. The presence of sleeping disorder will be measured by the Chinese version of the Pittsburgh’s Sleeping Quality Index.
Main outcome measures: Total sleeping time, wake after sleep onset, and sleep efficacy. Data analysis: Epochs from both accelerometers will be classified as either sleep or awake using established algorithms (Cole-Kripke, Sadeh, Sazonov), and these data will be transformed to total sleeping time, wake after sleep onset, and sleep efficacy. The agreement of the two accelerometers will be compared using correlations and accuracy by t-test / Wilcoxon signed-rank test. The predictive power of the wActiSleep-BT to monitor sleep/wake status will be evaluated by sensitivity, specificity, accuracy, and ROC analyses. Expect results: The wActiSleep-BT can accurately assess sleep parameters.
Design: Combining cross-sectional quantitative survey and focus group interviews.Subjects and setting: 197 adult Chinese breast! coloreclal cancer survivors who have completed treatment within the past five years will be recruited from hospitalsl community organizations in Hong Kong. Twenty four breast and colorectal cancer survivors will be invited to join focus group interviews through purposive sampling.
Study instruments: Demographic and medical data sheets, modified Health Promoting Lifestyle Questionnaire, Perceived Self-efficacy and Multidimensional Health Locus of Control Scale (MHLOCS) will be adopted in quantitative survey. Interview guide will be used in focus group interview. Interventions: No intervention will be delivered.
Main outcome measures: Questionnaires will be used to collect data on breast and colorectal cancer survivors' perceived locus of control, perceived self-efficacy, and adoption of health promoting lifestyle behaviors. The subjects' adoption of health promoting lifestyles, the influencing factors, and their comments on the serv·lces required will be explored in focus group interview.
Data analysis: Pearson's r correlation will be used to test the existence of relationships between the perceived self-efficacy, perceived locus of control, and health promoting lifestyle. The relationships among all the independent variables and the dependent variable (I.e. health promoting lifestyle) will be evaluated by path analysis. Qualitative content analysis will be used to analyze interview data.
Expected results: Health promoting lifestyle of breast and colorectal cancer survivors may be affected by personal, medical and cultural factors.
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