Leisure-Time Physical Activity and Depressive Symptoms Among Patients With Coronary Heart Disease: The Mediating Role of Physical Activity Self-Efficacy.

BACKGROUND: Despite the positive effect of physical activity on reducing depressive symptoms among patients with coronary heart disease (CHD), the effect of physical activity on depressive symptoms is poorly understood. AIMS: To examine the mediating role of physical activity self-efficacy in the relationship between leisure-time physical activity and depressive symptoms in CHD patients. METHODS: This was a secondary data analysis study. A total of 593 CHD patients were included. Data on leisure-time physical activity, physical activity self-efficacy, and depressive symptoms were collected by validated questionnaires. Sociodemographic and clinical data were collected via patient interviews and medical records reviewing. The approach of Baron and Kenny was adopted to examine the mediating effect of physical activity self-efficacy on the association between leisure-time physical activity and depressive symptoms. RESULTS: On average, participants aged 56.9 (± 12.5) years old, with 66% male. Statistical analyses showed that leisure-time physical activity was significantly associated with depressive symptoms (ß = -0.041, p = .040) and physical activity self-efficacy (ß = 0.197, p = .001), and physical activity self-efficacy was significantly associated with depressive symptoms (ß = -0.223, p = .001) after adjusting for leisure-time physical activity. The indirect effect of leisure-time physical activity on depressive symptoms through physical activity self-efficacy was also significant (ß = -0.044, 95% confidence interval: -0.064, -0.027), suggesting a mediating role of physical activity self-efficacy on the relationship between leisure-time physical activity and depressive symptoms. LINKING EVIDENCE TO ACTION: Leisure-time physical activity is associated with reduced depressive symptoms among CHD patients, and this association is mediated by physical activity self-efficacy. This mediating model has important clinical implications, where integrating physical activity that is enjoyable and pleasant, and self-efficacy building elements in physical activity regimens should be considered, so as to improve psychological outcomes among CHD patients.

Disaster resilience in tertiary hospitals: a cross-sectional survey in Shandong Province, China.

BACKGROUND: Hospital disaster resilience can be defined as a hospital's ability to resist, absorb, and respond to the shock of disasters while maintaining critical functions, and then to recover to its original state or adapt to a new one. This study aims to explore the status of resilience among tertiary hospitals in Shandong Province, China. METHODS: A stratified random sample (n = 50) was derived from tertiary A, tertiary B, and tertiary C hospitals in Shandong Province, and was surveyed by questionnaire. Data on hospital characteristics and 8 key domains of hospital resilience were collected and analysed. Variables were binary, and analysed using descriptive statistics such as frequencies. RESULTS: A response rate of 82% (n = 41) was attained. Factor analysis identified four key factors from eight domains which appear to reflect the overall level of disaster resilience. These were hospital safety, disaster management mechanisms, disaster resources and disaster medical care capability. The survey demonstrated that in regard to hospital safety, 93% had syndromic surveillance systems for infectious diseases and 68% had evaluated their safety standards. In regard to disaster management mechanisms, all had general plans, while only 20% had specific plans for individual hazards. 49% had a public communication protocol and 43.9% attended the local coordination meetings. In regard to disaster resources, 75.6% and 87.5% stockpiled emergency drugs and materials respectively, while less than a third (30%) had a signed Memorandum of Understanding with other hospitals to share these resources. Finally in regard to medical care, 66% could dispatch an on-site medical rescue team, but only 5% had a 'portable hospital' function and 36.6% and 12% of the hospitals could surge their beds and staff capacity respectively. The average beds surge capacity within 1 day was 13%. CONCLUSIONS: This study validated the broad utility of a framework for understanding and measuring the level of hospital resilience. The survey demonstrated considerable variability in disaster resilience arrangements of tertiary hospitals in Shandong province, and the difference between tertiary A hospitals and tertiary B hospitals was also identified in essential areas.

Resiliencia: propuesta y desarrollo de la definición y del marco conceptual en relación a los desastres en el ámbito sanitario / Proposing and developing a definition and conceptual framework for health care resilience to cope with disasters

La creación del término resiliencia en salud es un paso importante hacia la construcción de comunidades más resilientes para afrontar mejor los desastres futuros. Hasta la fecha, sin embargo, parece que hay poca literatura sobre cómo el concepto de resiliencia en salud debe ser definido. Este artículo tiene como objetivo construir un enfoque de gestión de desastres de salud integral guiado por el concepto de resiliencia. Se realizaron busquedas en bases de datos electrónicas de salud para recuperar publicaciones críticas que pueden haber contribuido a los fines y objetivos de la investigación. Un total de 61 publicaciones se incluyeron en el análisis final de este documento, que se centraron en aquéllas que proporcionan una descripción completa de las teorías y definiciones de resiliencia ante los desastres y las que proponen una definición y un marco conceptual para la capacidad de resiliencia en salud. La resiliencia es una capacidad inherente de adaptación para hacer frente a la incertidumbre del futuro. Esto implica el uso de múltiples estrategias, un enfoque de riesgos máximos y tratar de lograr un resultado positivo a través de la vinculación y cooperación entre los distintos elementosde la comunidad. Resiliencia en salud puede definirse como la capacidad de las organizaciones de salud para resistir, absorber, y responder al impacto de los desastres, mientras mantiene las funciones esenciales y se recupera a su investigación futura de su medición

Building health care resilience is an important step towards creating more resilient communities to better cope with future disasters. To date, however, there appears to be little literature on how the concept of health care resilience should be defined and operational zed. This article aims to build a comprehensive health care disaster management approach guided by the concept of resilience. Health electronic databases were searched to retrieve critical publications that may have made a contribution to the research aims and objectives. A total of 61 publications were included in the final analysis. These papers were those offering a comprehensive description of theories and definitions of disaster resilience and proposing a definition and conceptual framework for health care resilience. Resilience is an inherent, adaptive ability to cope with future uncertainty. It implies the use of multiple strategies and an all-hazards approach. It also seeks to achieve a positive outcome through linkage and cooperation between various elements of the community. Health care resilience can be defined as the ability of health care organizations to resist, absorb, and respond to the shock of disasters while maintaining essential functions and recovering to their original state or adapting to a new state. It can be assessed by criteria such as robustness, redundancy, resourcefulness and rapidity and includes the key dimensions of vulnerability and safety, disaster resources and preparedness, continuity of essential health service, recovery, and adaptation. This new concept places health care organizations’ disaster capabilities, management tasks, activities, and disaster outcomes together into a comprehensive system, using an integrated approach and with an achievable goal. Future investigation of its measurement is urgently needed

Effectiveness of audiovisual interventions on stress responses in adolescents with ENT surgery in hospital: randomized controlled trial protocol.

AIM: To investigate the circadian pattern of cortisol secretion and other stress indictors in association with audiovisual stimuli in adolescents having otorhinolaryngological surgery in hospital. BACKGROUND: Hospitalization for surgery is a major stressful life event for adolescents causing negative consequences, including anxiety. Recent studies suggest that entertaining and educational interventions might be effective at reducing such adversities, but little is known about the pattern of these responses and effects. DESIGN: Randomized controlled trial. METHODS: Adolescents with otorhinolaryngological surgery in hospital without any contraindictions for salivary cortisol enzyme immunoassays will be recruited and randomly allocated to experimental, placebo and control. Stress indicators will be collected regularly for 5 days. Standard audiovisual interventions will be displayed for experimental and placebo groups including a simultaneous video-recording of facial and behavioural changes on the second afternoon postadmission and stress indicators will be collected pre- and three times with 20-minute interval postintervention. Follow-up will be conducted to evaluate the longer term effects at 2 weeks, 1-month and 3 months postadmission, respectively. Descriptive and comparative analyses of stress indicators will be performed to examine group differences. Competitive funding was obtained from the Independent Innovation Foundation of Shandong University for interdisciplinary research in 2012. DISCUSSION: This study will help identify timeslots for interventions for integrating strength-building into stress response reduction in adolescents hospitalized for surgery.

Development of hospital disaster resilience: conceptual framework and potential measurement.

OBJECTIVE: Despite 'hospital resilience' gaining prominence in recent years, it remains poorly defined. This article aims to define hospital resilience, build a preliminary conceptual framework and highlight possible approaches to measurement. METHODS: Searches were conducted of the commonly used health databases to identify relevant literature and reports. Search terms included 'resilience and framework or model' or 'evaluation or assess or measure and hospital and disaster or emergency or mass casualty and resilience or capacity or preparedness or response or safety'. Articles were retrieved that focussed on disaster resilience frameworks and the evaluation of various hospital capacities. RESULT: A total of 1480 potentially eligible publications were retrieved initially but the final analysis was conducted on 47 articles, which appeared to contribute to the study objectives. Four disaster resilience frameworks and 11 evaluation instruments of hospital disaster capacity were included. DISCUSSION AND CONCLUSION: Hospital resilience is a comprehensive concept derived from existing disaster resilience frameworks. It has four key domains: hospital safety; disaster preparedness and resources; continuity of essential medical services; recovery and adaptation. These domains were categorised according to four criteria, namely, robustness, redundancy, resourcefulness and rapidity. A conceptual understanding of hospital resilience is essential for an intellectual basis for an integrated approach to system development. This article (1) defines hospital resilience; (2) constructs conceptual framework (including key domains); (3) proposes comprehensive measures for possible inclusion in an evaluation instrument; and (4) develops a matrix of critical issues to enhance hospital resilience to cope with future disasters.

2010-2011 Queensland floods: using Haddon's Matrix to define and categorise public safety strategies.

OBJECTIVE: The 2010-2011 Queensland floods resulted in the most deaths from a single flood event in Australia since 1916. This article analyses the information on these deaths for comparison with those from previous floods in modern Australia in an attempt to identify factors that have contributed to those deaths. Haddon's Matrix, originally designed for prevention of road trauma, offers a framework for understanding the interplay between contributing factors and helps facilitate a clearer understanding of the varied strategies required to ensure people's safety for particular flood types. METHODS: Public reports and flood relevant literature were searched using key words 'flood', 'fatality', 'mortality', 'death', 'injury' and 'victim' through Google Scholar, PubMed, ProQuest and EBSCO. Data relating to reported deaths during the 2010-2011 Queensland floods, and relevant data of previous Australian flood fatality (1997-2009) were collected from these available sources. These sources were also used to identify contributing factors. RESULTS: There were 33 deaths directly attributed to the event, of which 54.5% were swept away in a flash flood on 10 January 2011. A further 15.1% of fatalities were caused by inappropriate behaviours. This is different to floods in modern Australia where over 90% of deaths are related to the choices made by individuals. There is no single reason why people drown in floods, but rather a complex interplay of factors. CONCLUSIONS: The present study and its integration of research findings and conceptual frameworks might assist governments and communities to develop policies and strategies to prevent flood injury and fatalities.

An interdisciplinary educational trial for adolescent health and development in urbanising China.

AIMS AND OBJECTIVES: To evaluate the effects on master student participants of an intensive interdisciplinary educational programme aiming at improving adolescent health and development services in urbanising China. BACKGROUND: There is a need for interdisciplinary education and collaborative practice in health, but few educational programmes have been reported. DESIGN: Experimental design including a qualitative component. METHODS: Purposive sampling was used to identify master students in relevant disciplinary areas for the four-day classroom learning, four-day field learning and a half-day reflection, focusing on key aspects of adolescent health and development in the face of rapid urbanisation. Data about family function, cognitive development, adolescent health and development competency, and difficulties caused by health conditions were collected using quantitative and qualitative methods. RESULT: Master student participants reported positive outcomes in adolescent health and development competency, and cognitive development. Six themes were identified about the programme and its impact: 'programme evaluation', 'programme characteristics', 'changed views about nursing and nurses', 'lessons learned', 'participation benefits' and 'suggestions for future action'. CONCLUSION: Interdisciplinary educational programmes are possible and beneficial at masters level but may be very challenging given the need for administrative, financial and human resources. RELEVANCE TO CLINICAL PRACTICE: Interdisciplinary educational programmes require to start with small health sector trials to accumulate evidence and skills. Faculty development is a prerequisite for such programmes towards collaborative practice.

The applicability of WHODAS 2.0 in adolescents in China.

AIMS AND OBJECTIVES: This study was designed to examine the applicability of World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in adolescents in China for internal consistency and factorial validity. BACKGROUND: The conceptualisation of impairments, activity limitation and participation restriction as disability underpins WHODAS 2.0. Available evidence is mainly about the use of WHODAS 2.0 in adults with little attention to adolescents. DESIGN: Survey design. METHODS: A total 314 adolescent inpatients were recruited using a purposive sampling strategy and self-measured with a range of scales related to puberty development, family function, 36-item WHODAS 2.0, extended version of Strength and Difficulties Questionnaire (Ext-SDQ). The same amount of junior high school student data was randomly selected to facilitate the model invariance examination through confirmatory factor analysis with the assistance of amos 19 and spss 19. RESULTS: Adolescents (mean, 14.07; SD, 2.866) varied greatly in demography, health conditions, body mass index, puberty development, family function, disability and difficulties as well as prosocial status. After the removal of the item on sexual activity, the internal consistency for the 35-item WHODAS is satisfactory, overall and dimensional. The six-factor WHODAS model was found to be a good model fit, moderately correlated with the overall difficulty measured by the 20-item four-factor SDQ, with the ability to differentiate the group of adolescent inpatients and junior high school students. CONCLUSION: The 35-item WHODAS is useful with adolescents with satisfactory internal reliability and factorial validity. RELEVANCE TO CLINICAL PRACTICE: This study supports the use of 35-item WHODAS in adolescents with or without health conditions in school and hospital settings, which paves the way for a better understanding about and health service delivery to adolescents during the transition from childhood to adulthood.

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.

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.

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.

Nurses' perceived and actual level of diabetes mellitus knowledge: results of a cluster analysis.

AIMS: Nurses' perceived and actual diabetes knowledge was explored by identifying profiles of nurses working in two hospitals in Hong Kong. Relationships between nurses' perceived and actual diabetes knowledge are explored. BACKGROUND: In non-specialist clinical settings in Hong Kong, nurses provide diabetes self-management education to patients, therefore, nurse's knowledge and skill in giving diabetes care is very important. Though patients' perceptions are important, if patients solely select and set their own priorities for learning about and managing diabetes, their care could be compromised by knowledge deficits. METHOD: A descriptive correlational survey was conducted during the period September 2004 to July 2005 in two local hospitals in Hong Kong. 245 nurses completed a structured questionnaire. Nurses' demographic data, competence, perceived and actual diabetes mellitus knowledge were collected. RESULTS: Two-step cluster analysis yielded three clusters: Cluster 1 nurses were characterized by relatively good competence and high diabetes knowledge than nurses in Clusters 2 and 3. Cluster 3 nurses reported low competence and diabetes knowledge than nurses in Clusters 1 and 2. Cluster 2 was a large group of nurses holding both positive and moderate competence and diabetes knowledge. Statistically significant differences were found between clusters. Overall, nurses' perceived diabetes knowledge was statistically significant correlated with actual knowledge (r(s) = 0.32). CONCLUSIONS: Nurses have the responsibility to educate patients with correct and updated information, therefore, knowledge should be provided and maintained to a certain standard. RELEVANCE TO CLINICAL PRACTICE: Lack of knowledge among nursing staff has contributed to diabetes patients receiving inadequate health care instruction. As indicated by the results of this study, 'tailor-made' educational programmes should be designed to meet the learning needs of each subgroup. Expertise and nurse education should be recognized when such educational programmes are designed.

Evaluation of an osteoporosis prevention education programme for young adults.

AIM: This paper reports a study exploring the effectiveness of an osteoporosis prevention education programme for young adults. METHODS: A quasi-experimental study was carried out with two groups, using pre-, post- and follow-up measures and was conducted in one integrated services centre during the period July 2005 to November 2005. RESULTS: The results showed statistically significant increases in the reported follow-up for each outcome: osteoporosis knowledge test scores, osteoporosis health brief scores, and osteoporosis self-efficacy scores, for those in the intervention group compared with those in the control group. On the satisfaction score, most participants in the intervention group rated the nurse's performance in the educational programme positively. CONCLUSION: Strategies used in this programme may provide guidance for the design of future programmes.

Attitudes of midwives towards perinatal bereavement in Hong Kong.

OBJECTIVE: to explore attitudes towards perinatal bereavement care among midwives working in Hong Kong through examination of relationships between attitudes towards bereavement support, need for bereavement education and appropriate hospital policy. DESIGN: a descriptive correlational survey. SETTING: the obstetric and gynaecology units at two hospitals. INSTRUMENT: a structured self-report questionnaire on attitudes towards perinatal bereavement support; required support and education needs for midwives on bereavement care. PARTICIPANTS: 154 out of 202 midwives (76.2% response rate) working at the two units. FINDINGS: two-step cluster analysis yielded two clusters. Cluster 1 consisted of 91 (59.1%) midwives and cluster 2 consisted of 63 (40.9%) midwives. Cluster 2 midwives were younger, had less obstetric and gynaecology experience, junior ranking and less post-qualification education than cluster 1 midwives. Cluster 1 midwives had additional personal grieving experiences and experience of caring for grieving parents. Attitudes towards bereavement care were positively correlated with educational needs (r(s)=0.55, p< 0.001) and hospital policy support (r(s)=0.50, p< 0.001). CONCLUSIONS: Hong Kong midwives require increased bereavement care knowledge and experience, improved communication skills, and greater hospital and team member support. Findings may be used to improve support of midwives, to ensure sensitive bereavement care in perinatal settings and to reflect training needs in the midwifery education curricula. Study findings highlight the universality of grief for a lost baby, irrespective of cultural differences in approaching emotional topics. This study may help midwives internationally to gain a broader perspective in this area.