Examining advanced nursing practice in Hong Kong and Guangzhou.

OBJECTIVE: There were studies evaluating advanced nursing practice independently in the mainland and Hong Kong Special Administrative Region of China, but there was no attempt to make a comparison of practice between them. This study employed a case study method to examine and compare advanced nursing practice in Hong Kong and Guangzhou. METHOD: Purposive sampling method was used to recruit 24 advanced practice nurses (APN) who came from the specialty of medical, surgical and pediatric in Hong Kong and Guangzhou. A questionnaire survey and semi-structured interview were conducted to solicit quantitative and qualitative data for exploring the structure-process-outcome of advanced nursing practice. The structure component explored the factors influencing advanced nursing practice. The process part examined APN role components and illustrations of exemplary advanced nursing practice. The outcomes described outcome indicators that best reflected advanced nursing practice. FINDINGS: Findings revealed that in the structure domain, APN education and career development, team approach in healthcare, and support from management, physicians and professional associations were important contextual factors for APN development in both cities. For the process domain, participants had at least 80% of their time practicing independently/interdependently and were engaged in APN activities including direct/indirect patient care, research/project work, initiation of staff and patient protocols. All participants demonstrated competencies with impacts on patient, service and profession in their description of exemplary practice. Participants from both cities ranked patient-related outcomes as top indicators for their advanced nursing practice. CONCLUSION: This study has revealed that APNs in Guangzhou and Hong Kong shared similar work involvement and impacts and their demonstrated competencies were on par with international counterparts. Continued efforts need to be put in establishing formal APN education, clear clinical career pathway and title protection to empower nurses to provide optimal care to the fullest extent that they are prepared for.

The effects of a nurse-supervised home exercise programme on improving patients' perceptions of the benefits and barriers to exercise: A randomised controlled trial.

AIMS AND OBJECTIVES: To explore the effects of a home exercise programme on patients' perceptions of the barriers and benefits to exercise and adherence to the programme. BACKGROUND: Great efforts have been made to encourage dialysis patients to participate in rehabilitation regimens. The promotion of exercise in this population is still limited. DESIGN: This was a post hoc analysis of a randomised, two-group parallel study. METHODS: A total of 113 adult patients recruited from the haemodialysis units were randomised into two groups on a 1:1 ratio. Both groups received in-centre group exercise training weekly for 6 weeks. The intervention group patients were provided with an additional individualised nurse-led home exercise prescription and behavioural support for 12 weeks. The patients' perceptions of the barriers and benefits to exercise, adherence to the home exercise prescription and their exercise level at weeks 6 and 12 were evaluated. RESULTS: There was a significant between-group difference in the score on patient perceptions of the barriers and benefits to exercise, with the intervention group reporting a greater reduction in perceived barriers to exercise. Significant group differences were noted in exercise level upon the completion of the programme, with the intervention group reporting higher such levels. The average adherence rate to the negotiated exercise plans was 78.9%. The intervention group of patients did better at meeting or exceeding the minimum exercise goal than did the control group. CONCLUSION: Home exercise prescriptions and behavioural support provided by trained nurses are effective at helping patients to remove barriers to engaging in exercise training. RELEVANCE TO CLINICAL PRACTICE: Physical exercise in a clinical arena should not be considered the exclusive domain of physical therapists; the team could collaborate with nurses to play a core role in making physical exercise for patients an essential practice of care in a multidisciplinary team.

The reliability and validity of the Chinese version of the Short-form Chronic Disease Self-Efficacy Scales for older adults.

AIMS AND OBJECTIVES: To examine the reliability and validity of the Chinese version of the Short-form Chronic Disease Self Efficacy Scales. BACKGROUND: The prevalence of chronic disease is accelerating globally, advancing across every region and pervading all socioeconomic classes. Among the interventions, self-management programmes focusing on increasing self-efficacy have demonstrated significant patient outcomes, including the improvement of quality of life and functional status. The Chronic Disease Self-Efficacy Scales (CDSES) system developed by Lorig in 1996 has been widely used by healthcare professionals from different disciplines to measure self-efficacy for chronic disease patients due to their tested psychometric properties. The Short-form of the scales system is used today, as it takes substantially less time to administer. DESIGN: This study used psychometric testing to establish the validity and reliability of the Short-form Chronic Disease Self-Efficacy Scales (CDSES). METHODS: A convenience sample of 163 older patients with chronic diseases were recruited. The Chinese version of the CDSES, short-form CDSES, SF-36 and self-rated health were used to test for construct validity, concurrent validity, convergent validity and internal consistency. RESULTS: Short-form CDSES had a single-factor structure with high internal consistency (0·96) and demonstrated no floor or ceiling effects. High intraclass correlation, 0·98, was demonstrated in test-retest. Correlations with the domain scores of the CDSES were found to be r = 0·97 and 0·98. The scale also demonstrated significant moderate correlations with SF-36 and self-rated health. CONCLUSION: The Chinese version of the Short-form CDSES has shown statistically acceptable levels of reliability and validity for assessing self-efficacy in older patients with chronic diseases. RELEVANCE TO CLINICAL PRACTICE: The scale is particularly valuable for use among older patients with chronic illness. The questionnaire can be used to assess nursing interventions focusing on increasing patients' self-efficacy or routine patient screening in carrying out daily activities.