Adult Burn Survivors and Burn Care Staff Perceptions Regarding Transitioning From the Burn Unit: A Cross-Country Qualitative Study in Ghana and China.

Rehabilitative care for burn patients in developing countries is often wrought with several issues. Post-discharge support is equally challenging as there is often limited rehabilitative care as the burn survivors and their families transition. To inform practice, this study sought to explore the perspectives of adult burn survivors and burn care staff regarding transitioning from the burn unit and the development of a transitional rehabilitation programme. We employed interpretive description for this study. Semi-structured face-to-face interviews were conducted with adult burn survivors and burn care staff across two tertiary healthcare facilities in Lanzhou, Gansu Province of China, and Ghana. The thematic analytical approach was employed to analyse the data. Forty-six participants comprising 26 adult burn survivors and 20 burn care staff participated in this study. Two themes and five subthemes emerged from the data. Transitioning from the burn unit to the home was described as complex with varied biopsychosocial needs emerging. However, available support was not comprehensive to resolve these needs. Existing pre-discharge support is limited across both settings. Burn survivors expressed interest in taking on an active role in the rehabilitation process and being able to self-manage their post-burn symptoms following discharge. Transitional rehabilitative support should include an active follow-up system, ensure patient- and family-centred support, and offer a bundle of comprehensive rehabilitative services using locally available items which do not financially burden burn survivors and their families. In conclusion, transitioning from the burn unit is filled with varied health needs. Transitional rehabilitative care is required to bridge the pre-discharge and post-discharge periods.

What affects self-regulated learning ability in undergraduate nursing students: A structural equation modelling approach.

AIM: To examine how the effects of hardiness, self-efficacy and positive academic emotion related to the SRL ability of undergraduate nursing students. DESIGN: A cross-sectional survey was designed. METHODS: A total of 395 Chinese undergraduate nursing students from two undergraduate colleges filled out the questionnaires from May to June 2019. The relationships between hardiness, self-efficacy, positive academic emotion and SRL ability were analysed by structural equation modelling. RESULTS: The response rate was 94.05%. SRL ability was significantly positive correlated with hardiness, self-efficacy and positive academic emotion in undergraduate nursing students. Self-efficacy (ß = 0.417, p < 0.001) and positive academic emotion (ß = 0.232, p < 0.001) showed a direct effect on the SRL ability. Although hardiness showed no direct effect on the SRL ability, it affected SRL ability through three indirect ways: self-efficacy (77.778%), positive academic emotion (14.184%) and the chain mediating effect from self-efficacy to positive academic emotion (8.038%). CONCLUSIONS: Nursing students with a higher level of hardiness would have higher self-efficacy, and more positive and stable academic emotions to obtain the better SRL ability. The produced model provides insights into several factors associated with SRL ability of nursing students. Hardiness, self-efficacy and positive academic emotion should be emphasized in the education of nursing students because these factors could improve their SRL ability and promote their life-long learning.

Challenges of nurses and family members of burn patients: Integrative review.

AIMS: To identify the challenges facing burn care nurses and burn patients' family members and to explore the relationship between the above challenges. DESIGN: Whittemore and Knafl's integrative review. METHODS: Databases used for this review included Cochrane Library, Web of Science, PubMed and Embase. The original research published from January 2010 to November 2021 was selected. Studies reporting the challenges of family members or nurses of burn patients identified through extensive database search were considered for inclusion. The Mixed-Method Appraisal-Tool was applied for the evaluation of the quality of the literature. The analysis approach used was content analysis. RESULTS: Of the 2746 identified studies, 17 studies were included. Key findings related to the challenges facing nurses and family members of burn patients were extracted. The themes relating to burn care nurses included ethical and religious issues, clinical issues, work-life imbalance and limited support. The themes relating to family members included family's different views on prognosis and treatment, work-life imbalance, psychological issues and lack of multifaceted support. The challenges for the formal and informal caregivers are similar and there is existence of some shared concerns. If the above challenges are not resolved, support for the burn patients may be adversely affected. Corresponding measures should be taken to overcome such challenges.

A visualization analysis of hotspots and frontiers of cardiovascular diseases with frailty.

Cardiovascular diseases (CVD) and frailty are common health problems among the elderly. This research aims to investigate the hotspots and frontiers of the field of CVD with frailty. Data of publications between 2000 and 2021 were collected from the Web of Science Core Collection (WoSCC) and CiteSpace was used for analyzing the hotspots and frontiers of cardiovascular diseases with frailty research from high-impact countries/regions, institutions, authors, cited references, cited journals, high-frequency keywords, and burst keywords. The results showed that the USA, England, and Canada were the leading countries/regions in research on CVD with frailty. Other countries/regions and regions lagged behind these developed countries/regions. There is a need to establish cooperation between developed countries/regions and developing countries/regions. Research hotspots focused on frailty in the elderly with CVD, exercise intervention, assessment for CVD patients with frailty, quality of life, and common diseases related to CVD with frailty. The frontier fields include care and intervention of CVD patients with frailty, social frailty, and validation of CVD with frailty.

Healthcare provider's experiences of supporting breastfeeding: protocol for a systematic review of qualitative evidence.

INTRODUCTION: Breastfeeding provides various health benefits to both mothers and infants. Despite the efforts that have been made, breastfeeding rates remain lower than recommended worldwide. Healthcare providers often fail to provide the support women need due to various reasons such as lack of time and competency, discontinuity of care and so on. Synthesis of the primary qualitative studies exploring healthcare providers' experience with supporting breastfeeding can provide greater insights into their perceived barriers and facilitators and further provide evidence for the implementation of interventions to improve breastfeeding services. METHODS AND ANALYSIS: Qualitative studies exploring healthcare providers' experiences with breastfeeding services will be searched in the following databases: PubMed, Embase, CINAHL, Scopus, ProQuest, PsycINFO, the Cochrane Library, Web of Science, China Biology Medicine disc, China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals, Chinese Wanfang Data, ProQuest Dissertations and Theses, Open Grey collection. Studies reported in English or Chinese and conducted between January 1990 to July 2021 will be included. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research will be used to assess the methodological quality of included studies. The JBI standardised data extraction tools will be used to extract data. The JBI meta-aggregation method will be used to synthesise the data. The synthesised findings will be graded finally according to the ConQual approach to establish confidence. Two authors will independently screen and select the search output, extract data, assess methodological quality and cluster findings. Any disagreements that arise between the two reviewers will be adjudicated by a third reviewer to reach a consensus. ETHICS AND DISSEMINATION: This review will use published data, so it will not require ethical approval. The findings of this systematic review will be disseminated via an international peer-reviewed journal publication and several scientific conference presentations. PROSPERO REGISTRATION NUMBER: CRD42021254542.

Biomarkers for the early detection of pressure injury: A systematic review and meta-analysis.

BACKGROUND: Pressure injury imposes a significant burden for patients and healthcare systems and the majority of pressure injuries are preventable. The early identification of pressure injury is critical for its prevention. As an objective measure, biomarkers have preliminarily shown the potential to identify individuals at risk for developing pressure injury before it is visually observed to occur. However, these results have not been synthesized. OBJECTIVE: To assess and synthesise the predictive effect of different biomarkers in the early detection of pressure injury formation. DESIGN: A systematic review and meta-analysis. DATA SOURCES: PubMed, EMBASE, CINAHL Complete and the Cochrane Library were comprehensively searched for articles up to June 2021. No restrictions were applied to study design type, language, country, race or date of publication. REVIEW METHODS: Two reviewers independently extracted data from all original eligible studies using a specified data extraction form, resolved disagreements through discussion and the involvement of an additional reviewer. Methodological quality of all included studies was independently appraised by two authors with the Joanna Briggs Institute (JBI) Critical Appraisal Checklist and the Newcastle-Ottawa Quality Assessment Scale (NOS). Heterogeneity of each study was estimated using the I2 statistic, and the data was synthesized using StataSE15. RESULTS: Eight observational studies involving 10595 participants were included. The overall pooled area under curve (AUC) and the 95% confidence intervals (CIs) of Serum albumin (Alb) was 0.66(0.62-0.70), and the Serum haemoglobin (Hb) was 0.67(0.60-0.74). The AUC and 95% CI of C-reactive protein (CRP) was 0.62(0.50-0.74), Braden score was 0.56 (0.429-0.691), Waterlow score was 0.729(0.654-0.803), Alb with Waterlow was 0.741(0.694-0.787), and the combination of Hb, CRP, Alb, Age and Gender was 0.79(0.682-0.898). Besides, the chemokine interferon-γ-induced protein of 10kd/CXCL10, cytokine interferon-α, tumor necrosis factor-alpha (TNF-α), granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin-15 (IL-15) and combination of creatine kinase (CK), myoglobin (Mb), heart-type fatty acid binding protein (H-FABP) and CRP may prove potential for detecting pressure injury. CONCLUSION: The findings suggest the combination of Hb, CRP, Alb, Age and Gender is superior to other biomarkers. However, the predictive effect of biomarkers needs to be confirmed by more researches and patient-level data.

Effects of a nurse-led transitional burns rehabilitation programme (4Cs-TBuRP) for adult burn survivors: protocol for a randomised controlled trial.

BACKGROUND: Transitioning from the burn unit to the home/community can be chaotic with limited professional support. Some adult burn survivors may face varied concerns leading to poor outcomes in the early post-discharge period with limited access to professional help. Based on these, a nurse-led transitional burns rehabilitation programme has been developed and the current trial aims to ascertain its effects as well as explore the implementation process. METHODS: A single-centre, double-arm randomised controlled trial with a process evaluation phase will be utilised for this study. All adult burn survivors aged ≥ 18 years with burn size ≥ 10% total burn surface area at the site during the study period will be screened for eligibility at least 72 h to discharge. A sample size of 150 will be block randomised to treatment (receiving the nurse-led transitional care programme and routine post-discharge service) and control groups (receiving routine post-discharge service). The nurse-led transitional care programme comprises of predischarge and follow-up phases with the delivery of bundle of holistic interventions lasting for 8 weeks. There are three timelines for data collection: baseline, immediate post intervention, and 4 weeks post-intervention. DISCUSSION: The findings from this study can potentially inform the development and organisation of post-discharge care and affirm the need for ongoing comprehensive home-based care for burn survivors and their families TRIAL REGISTRATION: ClinicalTrials.gov NCT04517721 . Registered on 20 August 2020.

Clinical teaching behaviour effects professional identity and transition shock in new nurses in western china: A cross-sectional study.

AIM: To examine the interrelationship between professional identity, clinical teaching behaviour and transition shock for new nurses in Western China. DESIGN: A cross-sectional design. METHODS: A total of 779 new nurses were recruited in Gansu province and Lanzhou city from June to July 2019. Each patient was given three questionnaires to complete, and structural equation modelling was used to identify the relationships. RESULTS: The overall mean scores for the transition shock, professional identity and clinical teaching behaviour were 92.53(SD = 22.17), 89.74(SD = 16.57) 80.12(SD = 12.38), respectively. The most important aspects identified were the Physical aspect, the Sense of Mastery and Committing to Teaching. Professional identity and clinical teaching behaviour were negatively related to transition shock, a better sense of identity coupled with supportive clinical teaching were keys to a smoother journey from new to experienced nurses.

Reflections on volunteer nurses' work and caring experiences during COVID-19: a phenomenological study.

BACKGROUND: With epidemics emerging at a hastened pace, a phenomenological study allows researchers to cast aside their perceptions to understand nurses' lived experiences, and from there to discover previously unavailable insights at the epicentre of a pandemic. AIMS: To understand volunteer nurses' lived experiences in Wuhan. METHODS: A descriptive phenomenological study with a purposive sampling strategy was used to describe volunteer nurses' experiences in Wuhan. Interviews continued until data saturation. Ten semi-structured interviews of 30 to 60 minutes duration were conducted from 27 to 30 March 2020. The narrative data were audiotaped, transcribed and analysed using Colaizzi's method. RESULTS: Four themes emerged: mission and challenges denoted the participants' realisation of the grim challenges ahead; challenges called for actions that described the concerted actions through partnerships and familial bonds; caring acts from all around revealed an external support system; and actions that made a difference portrayed the interplay of actions with feelings, thoughts and further actions to accomplish the mission. CONCLUSIONS: This phenomenological study showed the interplay of nurses' intentions and actions, and 'actions speak louder than words' when nurses were motivated by workmates' actions to change their feelings, thoughts and actions. The concerted efforts can be used to develop educational programmes, management strategies and institutional policy on structure, system and resource utilisation, as well as dissemination of scientific knowledge to global healthcare workers and the public.

Anxiety and Depression of Nurses in a North West Province in China During the Period of Novel Coronavirus Pneumonia Outbreak.

PURPOSE: To investigate the anxiety and depression levels of frontline clinical nurses working in 14 hospitals in Gansu Province, China, during this period. DESIGN: A cross-sectional survey was conducted online between February 7 and 10, 2020, with a convenience sample of 22,034 nurses working in 14 prefecture and city hospitals in Gansu Province, located in northwest China. METHODS: A self-reported questionnaire with four parts (demographic characteristics, general questions related to novel coronavirus-infected pneumonia, self-rating anxiety scale, and self-rating depression scale) was administered. Descriptive statistics including frequencies, means, and SDs were computed. The associations between anxiety and depression with sociodemographic characteristics, work-related concerns, and impacts were analyzed, followed by multiple stepwise linear regression to identify factors that best predicted the nurses' anxiety and depression levels. FINDINGS: A total of 21,199 questionnaires were checked to be valid, with an effective recovery rate of 96.21%. The mean ± SD age of the respondents was 31.89 ± 7.084 years, and the mean ± SD length of service was 9.40 ± 7.638 years. The majority of the respondents were female (98.6%) and married (73.1%). Some demographic characteristics, related concerns, and impacts of COVID-19 were found to be significantly associated with both anxiety (p < .001) and depression (p < .001). Nurses who needed to take care of children or elderly relatives, took leave from work because they were worried about COVID-19, avoided contact with family and friends, and wanted to obtain more COVID-19-related knowledge had higher levels of both anxiety and depression. CONCLUSIONS: Results show that nurses faced with the COVID-19 outbreak are at risk for experiencing anxiety and depression. Demographic background, psychosocial factors, and work-related factors predicted the psychological responses. The family responsibilities and burdens of women may explain the higher levels of anxiety and depression among nurses with these obligations as compared to those without. On the other hand, nurses who chose not to take leave from work or who did not avoid going to work during this period were less anxious and depressed. CLINICAL RELEVANCE: Professional commitment might be a protective factor for adverse psychological responses. It is pertinent to provide emotional support for nurses and recognize their professional commitment in providing service to people in need.

Female nurses' sensitivity to male genitalia-related care in mainland China.

AIMS: To discover the latent psychosocial construct of female nurses' sensitivity to male genitalia-related care in the context of sexual conservativeness. BACKGROUND: Many nursing activities involve direct exposure or contact with male external genitalia. In the sexually conservative culture and the predominance of female nurses, this area is the subject of continuing interest and investigation. DESIGN: Methodological research design. METHODS: An item pool related to male genitalia-related care was generated through a panel of experts and then reduced to a short form questionnaire, the Female Nurses' Sensitivity to Male Genitalia Related Care scale. Using data from a purposive sample of 588 female nurses, the structure of the questionnaire was examined using structural equation modelling. The validity was examined against existing scales. RESULTS: The 13-item Female Nurses' Sensitivity to Male Genitalia Related Care scale has a two-factor structure with high internal consistency (α = 0·87) and test-retest reliability of 0·90. Nearly all model fit measures reach the criteria of being an acceptable model fit except chi-squared statistics. Scores on Female Nurses' Sensitivity to Male Genitalia Related Care can be best predicted by that of brief Fear of Negative Evaluation Scale, Embarrassability Scale and Situational Susceptibility to Embarrassment Scale. CONCLUSIONS: The anxiety of projecting a positive image and the pursuit of sexual propriety may underpin female nurses' sensitivity to male genitalia-related care. This trait can be measured by the 13-item female nurses' sensitivity-male genitalia-related care scale with satisfactory psychometric properties including internal consistency, reliability, content validity and construct validity. RELEVANCE TO CLINICAL PRACTICE: Particular attention shall be paid to the negative effects of social rules or norms including sexual propriety rules over (female) nurses' perceptions, attitudes and behaviours. Strengthening nursing education in this regard is important to overcome negative effects on female nurses of male genitalia-related care.

What accounts for hospital readmission?

AIMS: This study was launched to address the knowledge gap regarding factors leading to readmission to hospital. BACKGROUND: Repeated hospital admission is an issue of concern for health care service providers. Research findings reveal that multiple factors can contribute to the phenomenon, but no study has examined the direct and indirect effects of these variables on hospital readmission. DESIGN: A survey conducted during the period from 2003-2005 in three hospitals in Hong Kong. METHODS: Patients who were readmitted to the same hospital within 28 days during the study periods were included. Data were collected using structured interviews. A structural equation model was employed to examine what factors will contribute to hospital readmission. RESULTS: The final model showed that subjective health outcome was the only significant variable that had a direct effect on readmission, and it had indirect effects on readmission mediating through the variables of age, income and satisfaction with care. CONCLUSIONS: A literature review reveals that none of the studies has recognised patients' subjective appraisal of their health condition as a significant variable to predict hospital readmission. Results did not find an association between evaluated and perceived need. In other words, patients who felt a higher need for hospital care were not necessarily sicker. It is possible that if patients can be empowered to manage their own health condition and make a fair appraisal of their well-being, unnecessary use of hospital services can be reduced. RELEVANCE TO CLINICAL PRACTICE: This study provides evidence to support the notion that an effective transitional care programme needs to incorporate patients' own subjective assessment of health in the intervention and measurement of the outcome. We cannot solely use providers' judgment to measure health outcomes, for patients are active agents in seeking health care, and the use of services is to an extent self-selective.

Effects of music intervention on physiological stress response and anxiety level of mechanically ventilated patients in China: a randomised controlled trial.

AIM: To examine the effects of music intervention on the physiological stress response and the anxiety level among mechanically ventilated patients in intensive care unit. BACKGROUND: Despite the fact that previous studies have found music interventions to be effective in stress and anxiety reduction, effects of music on the Chinese population are inconclusive and warranted systematic study to evaluate its effect fully for a different Asian culture. DESIGN: A randomised placebo-controlled trial. METHODS: A total of 137 patients receiving mechanical ventilation were randomly assigned to either music listening group, headphone group or control group. Outcome measures included the Chinese version of Spielberger State-Trait Anxiety Scale and physiological parameters (heart rate, respiratory rate, saturation of oxygen and blood pressure). RESULTS: Comparison of mean differences (pretest score-posttest score) showed significant differences in heart rate, respiratory rate, systolic blood pressure and diastolic blood pressure as well as the Chinese version of Spielberger State-Trait Anxiety Scale, but not in SaO(2) among the three groups (ranging from p < 0.001 to p = 0.007), of which greater mean differences were found in music listening group. A significant reduction in physiological stress response (heart rate and respiratory rate) over time was found in music listening group (p < 0.001 for both variables) and a significant increase in heart rate and respiratory rate over time in control group (p < 0.001 and p = 0.032), with no significant change over time in headphone group. Within group pretest-posttest comparison of the Chinese version of Spielberger State-Trait Anxiety Scale demonstrated a significant reduction in anxiety for the music listening group (p < 0.001) and headphone group (p < 0.001) but not the control group. CONCLUSIONS: Our findings confirm that short-term therapeutic effects of music listening results in substantial reduction in physiological stress responses arising from anxiety in mechanically ventilated patients. RELEVANCE TO CLINICAL PRACTICE: Music as a non-pharmacological nursing intervention can be used as complementary adjunct in the care of patients with low-energy states who tire easily, such as those requiring mechanical ventilator support.

Identifying patient readmission subtypes from unplanned readmissions to hospitals in Hong Kong: a cluster analysis.

It has been conjectured with regard to patient readmission patterns that there might be significant differences in patient characteristics, need factors, enabling resources, and health behavior. The aim of this study was to identify the profiles of readmitted patients in Hong Kong (n = 120) based on their predisposing characteristics, needs, health behavior, and enabling resources. All the readmitted patients were recruited to the study in three hospitals from 2003 to 2005. A cluster analysis yielded three clusters: Clusters 1, 2, and 3 constituted 27.5% (n = 33), 27.5% (n = 33), and 45.0% (n = 54) of the total sample, respectively. The study results show that community nurse services do affect the rate at which patients are admitted to hospital for a second time. The findings might help by providing important information that will enable health-care policy-makers to identify strategies to target a specific group of patients in the hope of reducing its readmission rate.

Chinese female nurses' perceptions of male genitalia-related care--Part 1.

AIMS: To explore Chinese female nurses' experiences of male genitalia-related care. BACKGROUND: Male patients who require male genitalia-related care may have psychosocial and sexual concerns and needs. Nurses' attitudes and conduct in the provision of male genitalia-related care, if negative, may obviate meeting these needs. Previous research indicates that limited studies have been conducted focusing on nurses' perceptions, responses and attitudes towards male genitalia-related care. There is a dearth of knowledge about the practice of Chinese female nurses delivering male genitalia-related care, particularly given that physical contact between Chinese adults of different genders outside marriage is traditionally prohibited. DESIGN: This study is an exploratory qualitative study. METHODS: Through purposive sampling, eight subjects were approached and semi-structured interviews were conducted. Digitally recorded interviews were transcribed verbatim and thematic analysis was conducted. The strategies of long engagement, member checking, peer debriefing and journal writing were used to establish trustworthiness. RESULTS: Two themes emerged from interviews: 'association with sexuality' and 'consequences'. The theme 'association with sexuality' comprised the sub-themes of 'being sexual', 'impact on intimate relationship' and 'emotional responses'. The theme 'consequences' was constituted by the sub-themes of 'care with preconditions', 'unavoidable responsibilities' and 'limited involvement with implicit approval'. CONCLUSIONS: This study suggests that Chinese female nurses' perceptions, responses and attitudes towards male genitalia-related care may be negative, with the consequence that the quality of male genitalia-related care might be compromised. The Chinese culture of sexual conservativeness may play a critical role. RELEVANCE TO CLINICAL PRACTICE: Risks may be embedded in the practice of male genitalia-related care by Chinese female nurses. Particular attention, therefore, should be drawn to the possibility of adverse effects of Chinese female nurses delivering male genitalia-related care on them and their patients.

Chinese female nurses' perceptions of male genitalia-related care--Part 2.

AIMS: This study was designed to investigate Chinese female nurses' perceptions of certain male genitalia-related care and the influence of their demography and experiences on their perceptions. BACKGROUND: Several physical conditions, in which male genitalia-related care is required, have been found to have considerable negative impact on male patients, leading to decreased quality of life and psychosocial and sexual dysfunctions. Available studies suggest that Chinese female nurses' conduct during the provision of male genitalia-related care is negative. However, the evidence is weak with respect of the degree of Chinese nurses' negativity and what the contributory factors may be. DESIGN: Survey. METHODS: Chinese female nurses in nine units in five hospitals were surveyed. Of 378 returned questionnaires, 312 were usable, and 138 contained textual comments. Numerical data were analysed using spss 14.0, and textual data were analysed using thematic analysis. RESULTS; The majority of participants had never performed genital wound care, perineal area shaving, perineal hygiene, suprapubic and urinary catheterisation. More than half preferred only bladder irrigation and washout to be performed by nurses and preferred the other male genitalia-related care to be performed by a male. Participants tended to agree meatal cleansing, perineal area shaving, perineal hygiene and urinary catheterisation were embarrassing, awkward and intrusive, but to disagree that they were sexual, dirty, stigmatizing or having an impact on the male patient's sexual health. CONCLUSION: This study suggests that Chinese female nurses play limited roles in the practice of male genitalia-related care, but their perceptions of such care are not negative. RELEVANCE TO CLINICAL PRACTICE: Given the increasing move of Chinese female nurses to other countries, sexuality, sexual harassment, privacy and the constraints of traditional Chinese beliefs on sexuality over professional nursing conduct should be emphasised in clinical training programmes.

Framework for adopting a problem-based learning approach in a simulated clinical setting.

The problem-based learning (PBL) approach applied in the clinical setting is different from that applied in the classroom setting. This study analyzed a learning and teaching episode in a simulated clinical situation using the PBL approach. Conversation analysis was used to examine the scenario. Data analysis revealed six key manifestations of this learning arrangement: collection of information, data analysis, formulation of hypotheses, validation, discussion and reflection, and learning synthesis. The simulated clinical environment provided realism in learning and allowed students to experience a full range of learning issues within a short time frame. Problem-based learning was a deliberate approach that helped students achieve the following learning outcomes: patient-focused care, student-directed learning, inductive learning, and translation of theoretical knowledge into practical information. Learning was further enhanced with postsimulation self-evaluation and peer analyses. The incorporation of the PBL approach can bring out the optimal effects in a simulated learning environment.

Community nursing services for postdischarge chronically ill patients.

OBJECTIVE: To examine community nursing services for patients with cardiovascular diseases, chronic respiratory diseases and other general medical conditions, making the transition from hospital to home. DESIGN: The original study design was a randomised controlled trial. This study is a secondary analysis of the hospital records documented by community nurses for the study-group patients. SAMPLE: The sample consisted of 46 subjects, randomly drawn from the main study group of the study. MEASUREMENTS: The community nursing records were analysed using the Omaha System. Self-reported health status and readmission data were retrieved from the data base of the original study. RESULTS: The three groups of patients experienced problems across the four domains in the Omaha System. Community nursing interventions did not differ greatly by disease groups. The primary purpose of home visits was observation, followed by treatment and procedures and health teaching. The community nurses in the study spent more effort providing health teaching to the respiratory group than to their counterparts. The outcome measures are self-reported health status and hospital readmission rates. For self-reported health status, significant differences were observed in the respiratory and cardiovascular group before and after community nursing services. For hospital readmission rate, no significant difference was found. CONCLUSIONS: To improve the well being of chronically ill patients, a comprehensive home intervention programme, emphasising continuous needs of monitoring and case management, is fundamental to producing desired, measurable effects. RELEVANCE TO CLINICAL PRACTICE: This paper adds the understanding of home-care services provided by community nurses to chronically ill patients. The scope of nursing services emphasises the significance of a positive, patient-centred, caring and appropriate client-practitioner relationship to improve the self-reported health of patients.

Can home visits help reduce hospital readmissions? Randomized controlled trial.

AIM: This paper is a report of a study to determine whether home visits can reduce hospital readmissions. Background. The phenomenon of hospital readmission raises concerns about the quality of care and appropriate use of resources. Home visits after hospital discharge have been introduced to help reduce hospital readmission rates, but the results have not been conclusive. METHOD: A randomized controlled trial was carried out from 2003 to 2005 . The control group (n = 166) received routine care and the study group (n = 166) received home visits from community nurses within 30 days of hospital discharge. Data were collected at baseline before discharge and 30 days after discharge. FINDINGS: Patients in the study group were statistically significantly more satisfied with their care. There were no statistically significant differences in other outcomes, including readmission rate, ADL score, self-perceived life satisfaction and self-perceived health. Regression analysis revealed that self-perceived life satisfaction, self-perceived health and disease category other than general symptoms were three statistically significant variables predicting hospital readmissions. CONCLUSION: Preventive home visits were not effective in reducing hospital readmissions, but satisfaction with care was enhanced. Subjective well-being is a key variable that warrants attention in the planning and evaluation of postdischarge home care.

A review of the psychosocial issues for nurses in male genitalia-related care.

AIM: This literature review aimed to highlight psychosocial issues for nurses in the practice of male genitalia-related care so as to guide the improvement of the teaching and practice of male genitalia-related care. BACKGROUND: Male genitalia-related care is common in hospitals and in the community. In several conditions, e.g. incontinence, postradiotherapy or following operation for cancer of genitalia, bladder, colon or rectum, patients will require male genitalia-related care. Patients who require male genitalia-related care may encounter psychosocial and/or sexual dysfunction. In the holistic approach to men's health, nurses are expected to meet patients' psychosocial and sexual needs, while the literature suggests that nurses' perceptions and attitudes in providing certain male genitalia-related care, e.g. genital hygiene, sexual counselling, are negative. METHOD: Systematic literature review. CONCLUSION: Issues surrounding male genitalia-related care for nurses are complicated and may be related to privacy, intimacy, sexuality, dirty work and emotional discomfort. Age, gender, race and social class could compound these issues. Relevance to clinical practice. Nurses' negative perceptions, responses and attitudes towards male genitalia-related care may exacerbate patients' conditions under which male genitalia-related care is required. Appropriate strategies should be developed to overcome these problems.