Effects of Ving Tsun sticking-hand training on upper-limb sensorimotor performance in community-dwelling middle-aged and older adults: A randomized controlled trial.

OBJECTIVE: To evaluate the effects of Ving Tsun (VT) sticking-hand training on upper-limb joint position sense and muscular performance in community-dwelling middle-aged and older adults. METHODS: Thirty-three adults were randomly allocated to either a VT group or a control group. The VT group received VT sticking-hand training twice per week for 3 months. Measurements were taken before and after the intervention period. The primary outcome was elbow-joint repositioning error, which was measured by an elbow-joint passive positioning and active repositioning test using a universal goniometer. Secondary outcomes were upper-limb muscles' peak force and time taken to reach peak force as measured by a hand-held dynamometer. RESULTS: No significant time, group or time-by-group interaction effects were found for elbow-joint repositioning error or upper-limb muscle peak force outcomes. Shoulder flexor time to peak force decreased by 33.8% from pre-test to post-test in the VT group (P = 0.007). Shoulder abductor, internal and external rotator, and elbow extensor times to peak force decreased by 30.0%-35.9% in the VT group (P < 0.05) and by 30.4%-37.1% in the control group (P < 0.05). CONCLUSIONS: VT sticking-hand training does not improve elbow-joint position sense or the maximum strength of upper-limb muscles in middle-aged and older adults. However, VT can improve shoulder flexor muscles' time to reach peak force in these populations. VT had no obvious effect on the time required to reach peak force in other shoulder muscles and elbow extensors.

Neuromuscular training for children with developmental coordination disorder: A randomized controlled trial.

BACKGROUND: Adaptive balance control is often compromised in children with developmental coordination disorder (DCD). Neuromuscular training (NMT) is commonly used in clinical settings to improve neuromuscular control and hence balance performance in these children. However, its effectiveness has not been proven scientifically. This randomized controlled study aimed to explore the effectiveness of NMT for improving adaptive balance performance and the associated leg muscle activation times in children with DCD. METHODS: Eighty-eight children with DCD were randomly assigned to the NMT or control group (44 per group). The NMT group received two 40-minute NMT sessions/week for 3 months, whereas the control group received no intervention. The outcomes were measured at baseline and 3 and 6 months. The primary outcome was the sway energy score (SES) in both the toes-up and toes-down conditions as derived using the Adaptation Test (ADT). Secondary outcomes included the medial gastrocnemius, medial hamstring, tibialis anterior and rectus femoris muscle activation onset latencies during ADT, measured using surface electromyography and accelerometry. Data were analyzed using a repeated measures analysis of covariance based on the intention-to-treat principle. RESULTS: At 3 months, no significant within-group or between-group differences were noted in the SESs for either group. At 6 months, the toes-down SES decreased by 6.8% compared to the baseline value in exclusively the NMT group (P = .004). No significant time, group or group-by-time interaction effects were observed in any leg muscle activation outcomes. CONCLUSIONS: Short-term NMT failed to improve adaptive balance performance and leg muscle activation times in children with DCD. Further studies should explore the clinical applications of longer-term task-specific interventions intended to improve the adaptive balance performance of these children.

An iterative approach to enhance the clinical learning experience in Macao nursing education.

OBJECTIVE: The aim of this study was to reduce or eliminate the stressors to enhance nursing students' clinical learning experience through implementation of an iterative approach that developed a personalised response to student stress. METHODS: A prospective cohort research design was applied to collect data from a sample of undergraduate nursing students across the four study years. An iterative approach was employed to improve students' learning experience and the Stressors in Nursing Students Scale-Chinese Version (SINS-CN) was used to measure student stress. Key problems encountered by students were identified, refined and the responding solutions were worked out and implemented among this group of students through their first year to fourth year. RESULTS: The overall SINS-CN mean score (2.17-2.82) of students was declined to a moderate level. CONCLUSIONS: Having implemented iterative approach to address factors that led to stressful environments encountered by the nursing students, the overall stress score and each sub-dimension score decreased significantly. Therefore, it is recommended that this approach could be adopted by other colleagues in the nursing arena around the world.

Challenge Based Learning nurtures creative thinking: An evaluative study.

BACKGROUND: The demand for more creative and innovative nurses and together with the rapid expansion of nurse education in Mainland China have called for new approaches to student learning. Challenge Based Learning, an active student-directed approach was incorporated into an elective course in an undergraduate nursing programme. Initially, the students were given some big ideas about the real world. They worked together in small groups to identify the most challenging problems from these ideas, develop some innovative solutions, formulate an action plan for a selected solution, carry out the actions and evaluate the outcome. OBJECTIVES: To evaluate the effectiveness of Challenge Based Learning on students' creativity and innovativeness. DESIGN: Quasi-experimental. SETTINGS: A medical university in Guangzhou, China. METHOD AND PARTICIPANTS: A convenience sample of 48 undergraduate nursing students from the bilingual class, who enrolled in the elective course, Innovation and Creative Thinking was invited to participate in the evaluative study. They completed the Creativity and Innovation Effectiveness Profile before and after the course. RESULTS: Apart from descriptive statistics, the mean scores of the Creativity and Innovation Effectiveness Profile between the pretest and posttest assessments were analyzed using the Wilcoxon signed ranks test. The results showed that the mean scores of all 7 domains (i.e. creative consciousness, levels of curiosity, pattern breaking skills, idea nurturing ability, willingness to experiment and take risks, courage and resilience and energetic persistence) of Creativity and Innovation Effectiveness were significantly higher in the posttest. CONCLUSION: Students can enhance their ability to innovate and create through learning. The successful practical experience of using CBL in the study provides a good reference for nurse teachers who want their students to be self-directed, creative and innovative.

Association of Genetic Factors and Gene-Environment Interactions With Risk of Developing Posttraumatic Stress Disorder in a Case-Control Study.

BACKGROUND: The dopamine receptor D2 (DRD2) and serotonin transporter (5-HTT) genes are associated with posttraumatic stress disorder (PTSD). However, it remains largely unknown whether these genes interact with environmental factors to affect the development of PTSD. PURPOSE: The purpose of this study was to examine the associations of gene polymorphisms and gene-environment interactions with the risk of developing PTSD among adolescent earthquake survivors. METHOD: A total of 183 adolescent survivors from an earthquake-stricken area participated in this study. Measures included a questionnaire about demographic characteristics and earthquake exposure, the PTSD Checklist-Civilian Version and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition disorders. Genotypes were analyzed by using the polymerase chain reaction-based restriction fragment length polymorphism. RESULTS: The 5-HTTLPR and 5-HTTVNTR polymorphisms and earthquake exposure had statistically significant positive effects on PTSD. The interaction effects of 5-HTTLPR × Earthquake Exposure and 5-HTTVNTR × Earthquake Exposure were statistically significant. CONCLUSION: The development of PTSD is the result not only of a genetic effect and environmental factors but also of the interactive effect between gene and environment.

Learning experience of Chinese nursing students in an online clinical English course: qualitative study.

The low English proficiency of Chinese nurse/nursing students affects their performance when they work in English-speaking countries. However, limited resources are available to help them improve their workplace English, i.e. English used in a clinical setting. To this end, it is essential to look for an appropriate and effective means to assist them in improving their clinical English. The objective of this study is to evaluate the learning experience of Chinese nursing students after they have completed an online clinical English course. Focus group interview was used to explore their learning experience. 100 students in nursing programs at Tung Wah College were recruited. The inclusion criteria were: (1) currently enrolled in a nursing program; and (2) having clinical experience. Eligible participants self-registered for the online English course, and were required to complete the course within 3 months. After that, semi-structured interviews were conducted on students whom completed the whole and less than half of the course. One of the researchers joined each of the interviews as a facilitator and an observer. Thematic analysis was used to analyze the data. Finally, 7 themes emerged from the interviews: technical issues, adequacy of support, time requirement, motivation, clarity of course instruction, course design, and relevancy of the course. Participants had varied opinions on the 2 themes: motivation and relevancy of the course. Overall, results of this study suggest that the online English course helped students improve their English. Factors which support their learning are interactive course design, no time constraint, and relevancy to their work/study. Factors which detracted from their learning are poor accessibility, poor technical and learning support and no peer support throughout the course.

Posttraumatic stress disorder and its risk factors among adolescent survivors three years after an 8.0 magnitude earthquake in China.

BACKGROUND: Serious and long-lasting psychiatric consequences can be found in children and adolescents following earthquake, including the development of posttraumatic stress disorder (PTSD). Although researchers have been focused on PTSD recently, its prevalence and risk factors after a huge natural disaster are still unclear because of limited sample size. The purpose of this study is to explore the prevalence of posttraumatic stress disorder (PTSD) in adolescent survivors three years after the Wenchuan earthquake, describe PTSD symptoms, and to find out risk factors of PTSD. METHODS: A total of 4,604 adolescents from three middle schools which located in earthquake-stricken areas were recruited in this study. Instruments included the demographic questionnaire, questionnaire about earthquake exposure, the Social Support Appraisal Scale (SSA), the Posttraumatic stress disorder Checklist-Civilian Version (PCL-C), and the structured clinical interview for DSM-IV Disorders (SCID). RESULTS: The prevalence rate of PTSD was 5.7% (frequency: n = 261), and the most commonly occurring symptoms of PTSD were distress at reminders (64.5%), difficulty concentration (59.1%), and being easily startled (58.6%). Loss of houses and property, being injured, deaths of family members, and witness of death are positive risk factors of PTSD, and physical exercise and social support are negative risk factors of PTSD. CONCLUSIONS: Professional and effective interventions are needed to reduce the development of PTSD among adolescents after the Wenchuan earthquake, especially for these who lost their houses or property and lost their family members, witnessed death, and lacked of social support in the earthquake. Moreover, injured adolescents and adolescents who lacked of physical exercise also need intervention due to high risk.

Effectiveness of health education programs on exercise behavior among patients with heart disease: a systematic review and meta-analysis.

BACKGROUND AND OBJECTIVE: Regular exercise has been shown to be beneficial to patients with heart disease. Previous studies have indicated that health education can effectively increase participants' physical activity. However, no systematic review was conducted to evaluate the effectiveness of health education programs on changing exercise behavior among patients with heart disease. The aim of this study was to examine the effectiveness of health education programs on exercise behavior among heart disease patients. METHOD: Potential studies were retrieved in the Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, EMbase, PsycINFO, the British Nursing Index and Archive, Science Direct, and ERIC via EBSCOhost. Meta-analysis was done using the random-effect model. RESULTS: Thirty-seven studies were identified. Only 12 studies delivered health education based on various theories/models. Twenty-eight studies were included in the meta-analyses. The results showed that health education had significantly positive effects on exercise adherence (risk ratio = 1.35 to 1.48), exercise duration (SMD = 0.25 to 0.69), exercise frequency (MD = 0.54 to 1.46 session/week), and exercise level (SMD = 0.25), while no significant effects were found on exercise energy expenditure and cognitive exercise behavior. CONCLUSION: Health education has overall positive effects on changing exercise behavior among heart disease patients. Few theoretical underpinning studies were conducted for changing exercise behavior among heart disease patients. The findings suggest that health education improves exercise behavior for heart disease patients. Health professionals should reinforce health education programs for them.

Development and psychometric testing of a Chinese-language instrument for assessing institutionalised older males' motivations for living.

AIMS AND OBJECTIVES: To develop and psychometrically test a Chinese-language instrument, the Motivations for Living Inventory, for use with older adult institutionalised males. BACKGROUND: While tools exist for testing reasons for living among English-speaking individuals, none are available to assess Chinese-speaking older adults' motivation for living. DESIGN: This study had three steps: cross-sectional survey to collect data on instrument items, instrument development and psychometric testing. METHODS: Participants were 247 older male residents of five veterans' homes, including 22 who had attempted suicide in the previous three months and 225 nonsuicide attempters. The Chinese-language instrument, Motivations for Living Inventory, was developed based on individual interviews with older male residents of nursing homes and veterans' homes, focus groups with workers at nursing and veterans' homes, the literature and the authors' clinical experiences. The resulting Inventory was examined by content validity, construct validity, criterion-related validity, internal consistency reliability and test-retest reliability. RESULTS: The inventory had good content validity index (1·00). Factor analysis yielded a five-factor solution, accounting for 82·02% of the variance. Veterans' home male residents who had not attempted suicide tended to have higher scores than residents who had attempted suicide in the previous three months across the global inventory and all its subscales, indicating good criterion validity. Inventory reliability (Cronbach's α for the total scale was 0·86 and for subscales ranged from 0·80-0·94) and intraclass correlation coefficient (0·81) was satisfactory. CONCLUSIONS: The Chinese-language Motivations for Living Inventory can be completed in five to seven minutes and is perceived as easy to complete. Moreover, the inventory yielded highly acceptable parameters of validity and reliability. RELEVANCE TO CLINICAL PRACTICE: The Chinese-language Motivations for Living Inventory can be used to assess reasons for living in Chinese-speaking, institutionalised older male adults.

An extension to the discriminant analysis of near-infrared spectra.

Partial least squares discriminant analysis (PLS-DA) is widely used in multivariate calibration method. Very often, only one single quantitative model is constructed to predict the relationship between the response and the independent variables. This approach can easily misidentify, under or over estimate the important features contained in the independent variables. The results obtained by a single prediction model are thus unstable or correlated to spurious spectral variance, particularly when the training set for PLS-DA is relatively small. A new algorithm developed by applying the Monte Carlo method to PLS-DA, namely MC-PLS-DA, is proposed to classify spectral data obtained from near-infrared blood glucose measurement. Noise in the data is removed by randomly selecting different subsets from the whole training dataset to generate a large number of models. The mean sensitivity and specificity of these models are then calculated to determine the model with the best classification rate. The results show that the MC-PLS-DA method gives more accurate prediction results when compared with other classification methods used for classifying near infrared spectroscopic data of blood glucose. Also, the stability of the PLS-DA model is enhanced.

The structure of stress: confirmatory factor analysis of a Chinese version of the stressors in Nursing Students Scale (SINS).

BACKGROUND: Stress is a feature of the life of nursing students and this had been well studied. However, there are very few instruments to measure stress in nursing students specifically. One such instrument, the Stressors in Nursing Students Scale has been developed in Scotland and applied in studies in Hong Kong and Australia and proved useful alongside other measures of individual differences and psychological distress. OBJECTIVES: To translate the Stressors in Nursing Students Scale into Chinese, test it with Chinese nursing students and explore the psychometric structure of stress in this population. DESIGN: Cross-sectional survey using a self-administered questionnaire. SETTING: A large teaching hospital in Southwest Mainland China. PARTICIPANTS: Nursing students (n=1090) participated (1000 in the classroom and 90 on clinical placement); 862 from the classroom and 79 from clinical placements returned questionnaires (n=914) representing a return rate of 86.3%. METHODS: Principal component analysis and confirmatory factor analysis using structural equation modelling. RESULTS: A four-factor structure was obtained from principal component analysis. This was confirmed (fit indices>0.9 and RMSEA<0.06) using structural equation modelling. The stress-related factors were: Clinical (0.83), Finance (0.81), Confidence (0.82), and Education (0.70). CONCLUSIONS: The original structure of the SINS in English was confirmed in this large sample of Chinese nursing students. This will allow cross-cultural studies of stress in nursing students.

Digitalizing traditional chinese medicine pulse diagnosis with artificial neural network.

OBJECTIVES: The increasing popularities of traditional Chinese medicine (TCM) and telehealth indicate a need for digitalizing major clinical assessment methods used during TCM consultations. In this study, an electronic TCM pulse diagnostic system was developed, and its validity was explored. MATERIALS AND METHODS: The system was developed with an artificial neural network (ANN). The output neurons were TCM pulse qualities operationalized as the intensity of eight elements (depth, rate, regularity, width, length, smoothness, stiffness, and strength) at six locations (left and right cun, guan, and chi). The input neurons were physical parameters of arterial pressure waveform acquired from the six locations by a pulse acquisition device. TCM pulse quality was rated by a TCM doctor on a 0-10 visual analog scale. Physical parameters were extracted from the arterial pressure waveform with a pulse extraction program developed in-house. The model structure, including number of hidden neurons and hidden layers, and training algorithms were manipulated to optimize model performance. The value of r² was the outcome measure indicating model performance. RESULTS: Two hundred twenty-nine subjects were recruited. Four-layer ANN models trained with 45 hidden neurons and the Levenberg-Marquardt algorithm performed the best. The r² ranged from 0.60 to 0.86. CONCLUSIONS: The validity of the proposed system generated by ANN is established and can assist TCM doctors in collecting relevant health data during telehealth consultation.

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.

Meaning making: psychological adjustment to breast cancer by Chinese women.

Based on a study exploring the phenomenon of coping among Hong Kong Chinese women afflicted with breast cancer, from diagnosis to completion of treatment, we report the findings on meaning making by the informants. Using the grounded theory method, we conducted 35 interviews with 24 women suffering from breast cancer. Among them, we followed and interviewed 5 women thrice, from diagnosis to 3 months after completion of treatment. We noted the evolution of reframing as the key category in the adjustment process through which the women identified meaning at different points of time in the cancer experience, to achieve different outcomes. Chinese women identified a sustaining force from minimizing social disturbance during treatment. The integration of cancer into their lives after completion of treatment was achieved through positive transformation in their philosophy of life and social relationships. Nurses should aim to understand the cancer patients' interpretation of the situation, explore personally meaningful sustaining forces, and reflect on their cancer experience.

Reasons for living among older male Chinese residents of veterans' homes.

AIM: The purpose of this paper was to report a study of reasons for living among older male residents of veterans' homes in Taiwan. BACKGROUND: Suicide rates are high for older persons worldwide. Little is known about protective factors against suicide among elderly Chinese populations. METHOD: A qualitative descriptive design was used. Two veterans' homes, one government paid and one self-paid, were randomly selected from 18 institutions throughout Taiwan. Participants were 36 residents (≥65 years) who had expressed suicidal ideas in the past 6 months but had never shown suicidal behaviours. Data were collected in individual interviews from 2006 to 2007 and analysed by content analysis. RESULTS: Five major themes related to reasons for living were identified: fear of death, comparative improvement in health condition, maintaining self-dignity, family related concerns and concerns for staff. CONCLUSION: Fear of death, maintaining self-dignity and family related concerns are similar to reasons for living found in western studies, but not comparatively better health and concerns for staff. These differences may be due to our sample being veterans' home residents rather than community-dwelling elders and residents' perceived social support from staff. Since most healthcare providers are nurses and nurses' aides, they may consider promoting/maintaining older people's health, promoting their self-dignity, and strengthening relationships with family members and staff to strengthen protective factors against suicide in older Chinese/Asians. Given the aging population worldwide, nurses should become aware of protective factors related to suicide among older people to improve care for this population.

Effect of acupressure in treating urodynamic stress incontinence: a randomized controlled trial.

The efficacy of acupressure therapy in managing urodynamic stress incontinence has not been fully investigated. This study evaluates the effects of a validated acupressure protocol for treating women with urodynamic stress incontinence. A randomized, single-blinded, placebo-controlled trial with a before-and-after study design was conducted. Eighty-one women aged between 18 and 60 were recruited at a urogynecology clinic in an acute hospital in Hong Kong. Participants were randomly assigned to an intervention (acupressure) group, a sham group, or a usual care (control) group. A validated acupressure protocol was employed in the intervention group. The intervention comprised three weekly sessions of 30 minutes each for a total of thirty sessions. Outcome measures included pelvic floor muscle strength, number of episodes of urine leakage over four days, self-reported severity of urine leakage, and responses on the Chinese version of the King's Health Questionnaire. No adverse effects were reported. Five percent of the participants dropped out of the study. Intention-to-treat analysis was conducted, the results indicated significant differences in pelvic floor muscle strength across the three groups (H =7.05, p =0.03) and in self-reported severity of urine leakage between the intervention and control groups (Z = -2.48, p = 0.01). Significant improvement in all domains of the Chinese version of the King's Health Questionnaire was evident in the intervention group. Acupressure is a simple and non-invasive intervention that appears to have positive physiological and psychological effects on women with urodynamic stress incontinence. The findings support acupressure as an intervention option for managing urodynamic stress incontinence in women.

Prevalence and risk factors associated with prehypertension: identification of foci for primary prevention of hypertension.

BACKGROUND AND RESEARCH OBJECTIVE: Prehypertension (pre-HT) has become an important public health issue in China because it identifies people at higher risk for hypertension (HT) and cardiovascular diseases. The aims of this study were to (1) examine the prevalence of pre-HT, (2) identify risk factors of pre-HT, and (3) identify factors that increase the likelihood of developing HT among the pre-HT group. SUBJECT AND METHODS: This was a cross-sectional descriptive study. Community-dwelling residents of an urban district in Wuhan, central China (obtained from stratified random sampling), aged between 35 and 74 years completed the study. Data were collected by using a structured self-reporting questionnaire and a standardized protocol for blood pressure measurement and risk screening. Blood pressure categories were defined according to the results of the seventh report of the Joint National Committee on the Prevention, Detection and Treatment of High Blood Pressure. RESULTS: Among the 1,448 participants, 618 (42.7%) had pre-HT. Multivariate logistic regression analysis revealed the risk factors of being overweight (adjusted odds ratio [aOR], 1.93; 95% confidence interval [CI], 1.26-2.98) or obese (aOR, 8.9; 95% CI, 1.14-62.3) and having above-optimal triglyceride level (aOR, 1.67; 95% CI, 1.24-2.26) were associated with pre-HT. Age and lower educational level were also associated with pre-HT risk. There was a clear trend toward an increased risk of HT among the pre-HT group with every 10-year increment in age starting from 45 years (aORs were 3.47, 6.82, and 7.58, respectively). Participants with Pre-HT currently engaging in sedentary work were also found to have a higher risk of developing HT. Other risk factors for HT included being overweight (aOR, 2.0; 95% CI, 1.50-2.68), a known family history of HT (aOR, 2.54; 95% CI, 1.98-3.26), and presence of diabetes mellitus (aOR, 2.51; 95% CI, 1.66-3.80). CONCLUSION: Prehypertension is common among residents in an urban district in central China. Findings of this study serve to identify the at-risk groups. Targeting these people early with therapeutic lifestyle changes may provide important long-term benefit for HT prevention.

Reframing: psychological adjustment of Chinese women at the beginning of the breast cancer experience.

In this article, we present findings from a larger study that explored how Chinese women cope with breast cancer. We report on the process of early psychological adjustment, along with contextual factors and how they influence the women's coping mechanisms at the beginning of the cancer experience. Twenty-four women with diagnoses of breast cancer were interviewed. The grounded theory method was adopted in data collection and analysis. "Reframing" was the core category of the early adjustment process. Focus and approach were the two contextual conditions. Women adopted "fighting," "following the natural course," "struggling," and "bearing" modes in coping with the disease. These findings highlight the significance of focusing on coping and realizing the role of the self in creating a subjective positive interpretation, which subsequently enhances acceptance of the disease at the beginning of the cancer experience. Characteristics of the Chinese people with respect to coping include the collaborative meaning of control and the philosophy of acquiescence to fate.

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.