Testing the psychometric properties of a Chinese version of Dyadic Relationship Scale for families of people with hypertension in China.

BACKGROUND: Interventions for people with chronic illness have increasingly got involvement and partnership with family members in China and worldwide. The patient-family interactions in chronic illness care can greatly influence not only family dyadic relationship or collaboration in caregiving but also both patient's and caregiver's health and well-being. To date, very few instruments have been developed to measure the family dyadic relationship; and none has been found in Chinese language. This study aimed to translate the original English Dyadic Relationship Scales (DRS), including DRS-patient and DRS-caregiver, into simplified Chinese language (DRS-C) and examine their psychometric properties in Chinese people with hypertension in a rural community. METHODS: The Brislin's model of translation was adopted for translation. Face and content validity and semantic equivalence of the translated Chinese version of the two DRS-patient and DRS-caregiver scales were examined. A sample of 132 adults with hypertension and their family caregivers were recruited to test the psychometric properties of the DRS-C scales. RESULTS: The DRS-C scales indicated very satisfactory face validity with 10 family dyads in hypertension care, content validity rated by five experts (Item CVI = 0.8-1.0; Scale CVI = 0.98) and semantic equivalence rated by 22 panel members (i.e., all items were rated as 3 = relevant or 4 = very relevant by > 18 members). A well-fitting model of DRS-C-patient was identified with χ2/df = 1.47, p = 0.04, RMSEA = 0.06, GFI = 0.941, CFI = 0.961, TLI = 0.947, and SRMR = 0.019. A well-fitting model of DRS-C-caregiver was identified with χ2/df = 1.340, p = 0.092, RMSEA = 0.039, GFI = 0.940, CFI = 0.975, TLI = 0.965, and SRMR = 0.014. The Chinese DRS-patient and DRS-caregiver had satisfactory internal consistency with Cronbach's α coefficients of 0.82 and 0.83, respectively, and test-retest reliabilities with intra-correlation coefficients of 0.97 and 0.96, respectively. The convergent validities of the Chinese versions of the DRS-patient and DRS-caregiver were very satisfactory with the self-efficacy subscale of Hypertension Self-Care Profile, and Zarit Burden Interview, respectively (Pearson's r = - 0.70 and 0.79; both p < 0.001). Significant differences on mean scores of the Chinese versions of the DRS-patient (t = - 8.10, p < 0.001) and the DRS-caregiver (t = - 9.15, p < 0.001), between the groups of adults with hypertension and normal blood pressure counterparts. CONCLUSION: Both Chinese versions of the DRS-patient and DRS-caregiver have sound psychometric properties and similar factor structure to the original English version. The Chinese versions can be valid measures of family dyadic relationship among Chinese adults with hypertension.

Effects of a family dyadic partnership program for people with hypertension in a rural community: A pilot randomised controlled trial.

OBJECTIVE: To evaluate the feasibility, acceptability and preliminary effectiveness of a theory-based patient-family carer partnership intervention for people with hypertension in a Chinese rural community. DESIGN: A pilot randomised controlled trial using pretest and post-test design. SETTING: Rural China PARTICIPANTS: Forty-four hypertensive patients and their family carers (family dyads) were randomly recruited from a village clinic located in China between November 2019 and January 2020. INTERVENTIONS: Participants were randomised to either an intervention group receiving a five-session patient-family carer partnership intervention over 10 weeks or a control group receiving usual care. MAIN OUTCOME MEASURES: The feasibility and acceptability of patient-family carer partnership intervention and the changes in patients' systolic blood pressure, diastolic blood pressure and percentage of normal controlled blood pressure. RESULTS: The patient-family carer partnership intervention was a feasible and acceptable program with high recruitment (81.5%) and completion rates (95.5%) and positive feedback from participants. Greater improvement in the percentage of normal controlled blood pressure was identified in the intervention group tested by the χ2 tests, with P = .03. Two-way ANOVA results indicated its interaction (Group × Time) effects on patients' systolic blood pressure (P < .001), diastolic blood pressure (P < .001), dyadic partnership quality (P = .002), self-care (P < .001), self-efficacy (P = .02), antihypertensive drug treatment rate (P = .02), prescription adjustment (P = .03), perceived anxiety (P < .001) and health-related quality of life (EuroQol five-dimensional five-level: P = .02; EuroQol visual analogue scale: P < .001); family carers' dyadic partnership quality (P = .002), perceived depression (P = .04) and health-related quality of life (P = .02) were significant. CONCLUSION: Our findings support the feasibility and acceptability of the patient-family carer partnership intervention and indicate benefits in improving patients' blood pressure control, dyadic relationship and psychological well-being of family dyads in rural area. Further research to test the longer-term effect in a large-sized population is recommended.

Construction of evaluation indexes of nursing students' quality and safety competencies: A Delphi study in China.

BACKGROUND: Providing quality and safe nursing care is considered the cornerstone of the healthcare system globally. However, there are no comprehensive evaluation indicators of nursing students' quality and safety competencies in China. AIM: To develop the evaluation indicators and achieve experts' consensus on bachelor nursing students' quality and safety competencies at their graduation. METHODS: Based on the framework of the American Association of Colleges of Nursing's Quality and Safety Education for Nurses, literature review, semi-structured interview, and e-Delphi technique, the evaluation indicators were developed and obtained consensus through the participation of 22 nursing educational experts from August 2016 to May 2017. RESULTS: The evaluation indicators consisted of six domains, including safety care, patient-center care, collaboration and teamwork, continuous quality improvement, informatics, and evidence-based practice competencies, and 88 indicators. These indicators obtained ≥76% consensus on the experts' judgments. CONCLUSIONS: The evaluation indicators achieved the consensus on a panel of nursing experts, which were scientific and practicable. It could provide guidance for establishing a nursing curriculum to prepare bachelor nursing students' quality and safety competencies.

A community-based nurse-led medication self-management intervention in the improvement of medication adherence in older patients with multimorbidity: protocol for a randomised controlled trial.

BACKGROUND: Older patients suffering from multimorbidity are at high risk of medication nonadherence. It has been well established that self-management support is an effective strategy to enhance medication adherence for patients with chronic conditions. However, little is known about the effect of the medication self-management intervention in older patients with multimorbidity. This paper presents the protocol for a study that aims to evaluate the effectiveness of a nurse-led medication self-management intervention in improving medication adherence and health outcomes for community-dwelling older patients with multimorbidity. METHODS: The study protocol follows the recommendations of the Standard Protocol Items: Recommendations for Interventional Trials 2013 statement. This study is a multicentre, single-blind, two-arm randomised controlled trial. Older patients with multimorbidity will be recruited from three community health centres in Changsha, China. A total of 136 participants will be randomly allocated to receive usual care or usual care plus the medication self-management intervention. The intervention will be delivered by community nurses. The 6-week intervention includes three face-to-face education sessions and two weekly follow-up phone calls. Participants in the control group continue to receive all respects of usual care offered by community healthcare providers, including chronic disease management, drug prescription, referral to hospital specialists, health education and consultations regarding patients' diseases and treatments during centre visits. The primary outcome is medication adherence as measured by the 5-item Medication Adherence Report Scale. Secondary outcomes include medication self-management capacity (medication knowledge, medication beliefs, medication social support, medication skills, and medication self-efficacy), treatment experiences (medication treatment satisfaction and treatment burden), quality of life, and utilisation of healthcare services. All outcomes will be measured at baseline, immediately post-intervention, and at 3-month post-intervention. DISCUSSION: This study will provide evidence about the effectiveness of a medication self-management intervention, delivered by nurses, for older patients with multimorbidity and adherence problems. It is expected that the results of the study, if proven effective in improving patients' adherence and health outcomes, will provide evidence-based self-management support strategies for healthcare providers in routine chronic disease management in community settings. TRIAL REGISTRATION: The trial is registered at ChiCTR.org.cn ( ChiCTR2000030011 ; date February 19, 2020).

Job Stress, Psychological Capital, Perceived Social Support, and Occupational Burnout Among Hospital Nurses.

PURPOSE: To determine the structural relationships among nurses' occupational burnout, job stress, psychological capital, and perceived support from society. DESIGN: A cross-sectional design was performed to collect data from 766 registered nurses in three general tertiary Class A hospitals from March to August 2018. METHODS: Structural equation modeling was performed to examine the proposed model. FINDINGS: The research data supported the proposed model. Psychological capital, job stress, and perceived social support significantly influenced occupational burnout. Job stress indirectly influenced burnout through perceived social support and psychological capital. The influencing factors accounted for 49% of the variance in explaining burnout. CONCLUSIONS: The findings identified structural relationships among the four studied variables. This study provides new information regarding the preventive role of perceived social support and psychological capital, which perform the mediating role between job stress and occupational burnout. CLINICAL RELEVANCE: Nursing administrators should provide a healthy work environment, effective psychological capital training, and assistance to reduce nurses' occupational burnout.

Examining and adapting the information-motivation-behavioural skills model of medication adherence among community-dwelling older patients with multimorbidity: protocol for a cross-sectional study.

INTRODUCTION: Multimorbidity is highly prevalent among older patients and has been shown to be associated with poor health outcomes and lower quality of life. Adherence to medication treatments is essential in order to maximise the efficacy of treatments and improve health outcomes. However, nearly half of the older patients with multimorbidity fail to adhere to their medications, which can result in an increased risk of adverse health events, lower quality of life and higher healthcare cost. Only a few studies have explored the underlying mechanism and influencing factors of medication adherence among older patients with multimorbidity, which are inadequate to provide robust evidence for the development and evaluation of the medication adherence interventions. This study aims to examine and adapt the information-motivation-behavioural skills (IMB) model, a widely used social behaviour theory, to explain the medication adherence behaviour among community-dwelling older patients with multimorbidity. METHODS AND ANALYSIS: A cross-sectional study will be conducted in community settings in China. Around 309 older patients with multimorbidity will be recruited to complete questionnaires on adherence knowledge, adherence motivation, adherence self-efficacy, medication adherence, medication treatment satisfaction, depressive symptoms, treatment burden, disease burden and basic demographic information. Structural equation modelling will be used to analyse and validate the relationships among variables in the IMB model. ETHICS AND DISSEMINATION: This study has been approved by the Survey and Behavioral Research Ethics Committee of the Chinese University of Hong Kong (reference number SBRE-18-675). The study results will be published in peer-reviewed journals and presented in academic conferences and workshops. TRIAL REGISTRATION NUMBER: ChiCTR1900024804.