Background Nosocomial infection is a crucial problem and cause of morbidity and mortality especially in cardiac surgery settings. The risk of acquiring such infection is even higher because cardiac surgery patients require intensive care postoperatively. The phenomenon is evidenced by longer length of hospital stay and increased cost of care. Pneumonia and surgical site infections were ranked among the top three most common hospital acquired infections. The usual practice for mouth care is diluted thymol gargle solution for intubated patients after cardiac surgery in Hong Kong. No local studies examine the effect of oronasopharyngeal care on minimizing such infections. An evidence based guideline in oral and nasopharyngeal nursing care is necessary to implement in hospitals for improving patient surgical outcome. Objective To develop an evidence based practice guideline for pre- and postoperative oronasopharyngeal care of in-patients undergoing cardiac surgery with implementation planning and discussion on evaluation. Methods The most recent publications were searched till August 2011. Randomized controlled trials with oropharyngeal and/ or nasopharyngeal care with outcome measures on surgical site infection and/ or nosocomial pneumonia were reviewed. Essential data were extracted with quality assessed methodologically. Results Six randomized controlled trials comparing oropharyngeal and/ or nasopharyngeal care intervention with usual care were reviewed. The studies mostly included middle-aged male patients undergoing cardiac surgery. The results showed positively of interventions on nosocomial pneumonia and surgical site infection when compared with usual care. In view of quality assessments and statistically significant findings, the proposed change that could improve surgical outcome of patients is to use chlorhexidine gluconate on oronasopharyngeal care in the guideline. It mainly carries out in in-hospital settings both by patients with education from nurses preoperatively, and by nurses postoperatively. Conclusion Reviewed evidence shown that the oronasopharyngeal care interventions help effectively on minimizing the occurrence of nosocomial pneumonia and surgical site infections for patients undergoing heart surgery. It could be potentially adopted for nurses working in cardiac surgical ward and cardiac intensive care unit. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Enteral feeding is commonly used in paedaitric patients. It helps to improve the digestive, absorptive, immunologic and nutrition status. However, poor handling in enteral feeding can lead to bacterial contaminations and severe consequences resulting in significant morbidity and mortality. At present, there are no definite guidelines on the handling of enteral feeding in local setting, therefore developing evidence based guideline on enteral feeding is critically important to eliminate inconsistent practices and prevent nosocomial infections related to enteral feeding. This dissertation is a translational nursing research that aims at developing evidence based guideline on enteral feeding in infants. The objectives of this thesis are to search for existing literatures on enteral feeding; perform a critical appraisal on the literatures; develop guideline on enteral feeding in infants; assess the implementation potential of the proposed guidelines, and develop the implementation and evaluation plans. The ultimate goal is to reduce the nosocomial infections in infants with enteral feeding in an acute hospital. A systemic search for relevant and valid evidence was performed using three electronic databases and nine relevant studies were retrieved. Critical appraisals on the nine studies were performed and the level of evidence for each study was graded according to the Scottish Intercollegiate Guidelines Network (SIGN). By synthesizing the data from nine studies, it is concluded that optimal hang time and proper hand hygiene appeared to have significant effect in reducing nosocomial infections related to enteral feeding. The implementation potential of the innovation was assessed in terms of the transferability, feasibility and cost benefit ratio. After assessing the implementation potential, it is found that the evidence is transferable and feasible to implement the proposed guideline in the target paeditaric setting. An evidence based guideline on enteral feeding in infants was developed. An implementation plan of the new guideline included a comprehensive communication plan with both administration and nurses and a pilot test were developed to ensure a smooth implementation and optimize the transferability and effectiveness of the evidence based guideline in the target population. A systematic evaluation plan on patient outcomes, health care provider outcomes and systemic outcomes was developed. The evidence based guideline on enteral feeding was expected to be implemented in the long run to reduce the risk of nosocomial infections in infants with enteral feeding. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Pain is a common problem that affects nearly all cancer patients (Kwekkeboom, 2008). There are various factors that constitute suffering to cancer patients. Apart from physical pain, cancer patients usually experience emotional crisis and spiritual struggles (Magill, 2008). Music therapy is believed to be one of the most effective treatments for cancer patients. It provides a holistic care to patients with cancer. It will not only manage the physical sensation, but also address the psychological, social and spiritual parts of the patients (Magill, 2009). Although current studies have suggested the benefits of using music therapy in reducing pain for cancer patients, it is not a common practice in Hong Kong. As the administration rate of music therapy relies heavily on the knowledge of the nurses (Kwekkeboom, 2008). Therefore, this paper aims at providing evidence on the use of music therapy. In the hope of a clinical guideline, it can increase the administration rate of music therapy for cancer pain management in clinical setting. Apart from the clinical guideline, an implementation and evaluation plan on music therapy will also be discussed in this paper. There will be a full description from preparation to evaluation. Nurses can make use of this reference guide to provide music therapy for their cancer patients in respect to pain management. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Introduction: Patients having total joint replacement often experience moderate to severe pain postoperatively. Postoperative pain can reduce patients’ mobility, affecting their motivation to participate in any rehabilitation activities. For patients having total join replacement, rehabilitation plays an important role in promoting their early recovery. Therefore, it is crucial for healthcare professionals to develop and evaluate intervention that can better control patients’ post-operative pain. In the clinical setting that I am working, pharmacological method is the major means of postoperative pain management. However, many Chinese patients are reluctant to use analgesic to control their post-operative pain because of the side effects and adverse reactions of the drugs. In this dissertation, music therapy, a non-pharmacological method that can be managed by nurses, is adopted for postoperative pain control. It is used to promote rehabilitation for patients who have undergone total joint replacement. Objectives: The objectives of this study are (1) to review the published research articles that investigated the effects of music therapy in reducing the post-operative pain and promoting rehabilitation for patients having total joint replacement; and (2) to establish an evidence-based guideline for the use of music therapy by nurses to control postoperative pain and to facilitate rehabilitation for patients having total joint replacement. Methods: A comprehensive literature search on four electronic databases including CHINAL, Medline (OvidSP), PubMed and the British Nursing Index were conducted. A total of eight RCTs and two non-randomized controlled trials were eventually identified. Results: All the reviewed studies showed that music therapy has a statistically significant effect on reducing postoperative pain. Sedative or relaxation music (music which has no lyrics, sustained melodic quality; rate of 60-80 beats per minutes; absence of strong rhythms or percussion) are recommended in the guideline. The target setting is a total joint replacement centre in a public hospital of Hong Kong. The target clients are adult patients (aged 19 or above) that are referred by the orthopedic out-patient department and are pending for their total knee/ hip replacement in the center. The transferability and feasibility of the literature are high. The guideline is developed based on the evidence in reviewed literature. A pilot testing plan is established to detect the potential barrier and friction of the guideline before the implementation. After that, an evaluation plan for patients, healthcare providers and system outcomes was also proposed. Conclusion: An evidence based guideline is developed for the total joint replacement center. It is anticipated that, with the use of this guideline by nurses, it will not only facilitate better rehabilitation for patients having total joint replacement, but also enhances nurses’ autonomy in their nursing practice. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Oral mucositis is a common adverse side-effect caused by cancer treatments and can lead to mucosa toxicity. Patients with oral mucositis may experience extreme pain and may not be able to eat, drink and talk and, as a result, their quality of life is impaired. Thirty to eighty five percent of patients undergoing chemotherapy would develop oral mucositis. Preventing or reducing incidence of oral mucositis and its severity can help reduce patients’ sufferings. One of the methods to achieve this objective is the oral cryotherapy, which is a prophylactic intervention. However, there is no evidence-based guideline to instruct nurses on providing oral cryotherapy to cancer patients. The aims of this study are 1) to establish an evidence-based guideline on applying cryotherapy to reduce the incidence and severity of chemotherapy-induced oral mucositis, 2) to develop a standard nursing care and assess its transferability and feasibility, and 3) to develop a communication plan and evaluation plan for this guideline in an oncology ii- department for the targeted local hospitals in Hong Kong. A systematic search of four electronic journal databases identified seven articles corresponding to 6 randomized controlled trials (RCTs) on using oral cryotherapy for adult cancer patients. Five RCTs with high to weak quality reported supporting evidence for the beneficial effect of oral cryotherapy on chemotherapy-induced oral mucositis, whereas 1 RCT with moderate quality failed to identify supportive evidence for the use of oral cryotherapy. However, potential confounding factors were identified to be presented in that insignificant RCT. Hence, there was sufficient evidence to show that oral cryotherapy can significantly reduce chemotherapy-induced oral mucositis in adult cancer patients. An evidence based guideline for using cryotherapy on chemotherapy-induced oral mucositis in adult cancer patients was established. The transferability and feasibility of the proposed oral cryotherapy guideline were assessed. As identified, the clinical situation and patient characteristics in the local settings are similar to those who reported in the reviewed studies. Staff readiness, skills and resources are also readily available in the target clinical settings. Findings from the reviewed studies of oral cryotherapy can be transferred to the local target settings and are feasible to be implemented. It is also estimated that the innovated guidelines for cryotherapy can save HK$3,210,745 per year for the target setting. Stakeholders for the innovated guideline in the local setting were identified. And a communication plan was developed. A pilot study lasting for 10 weeks will be conducted to test the feasibility of the staff training session and the implementation of the oral cryotherapy guideline. Modification of innovated guidelines will be made after evaluating the data collected from the pilot study. Eventually, the final version of the evidence-based guideline will be established. A six months evaluation plan will be used to evaluate the implementation of the new guideline. The policy for adopting the oral cryotherapy will be determined with the outcome measures, including the incidence of chemotherapy-induced oral mucositis, mean of the oral mucositis score, staff satisfaction level, and the cost and benefit ratio of the innovated guideline. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Background Coronary heart disease deprives millions of lives in the world annually and this number has increased steadily in recent years. In Hong Kong, coronary heart disease claimed 4360 lives in 2009 and it is one of the major burdens of the healthcare system. In order to reduce cardiac mortality and morbidity and to enhance patients’ quality of life, cardiac rehabilitation program is developed. Exercise training is a pivotal part of the cardiac rehabilitation program. Objective The main objective of this translational nursing research is to translate quality research evidences regarding the effects of exercise training in improving quality of life of patients with coronary heart disease to the local setting. This is achieved by developing an evidence-based protocol. Methods A systematic search of literature was conducted in 5 electronic databases. 8 relevant randomized controlled trials were eventually obtained. Then, the 8 identified studies were summarized to form a table of evidence and the critical appraisal was performed using the Scottish Intercollegiate Guidelines Network (SIGN) checklist. After performing the quality assessment, evidences were assembled for synthesis and recommendations are made for developing the evidence-based protocol. Since the implementation potential of the proposed exercise training program is considered to be high, an evidence-based protocol is developed for the local context. In order to implement the evidence-based protocol smoothly, implementation plan is developed in which a communication plan and a pilot test are included. Lastly, evaluation plan is established to assess the effectiveness of the program in fulfilling its objectives. Results In total, 7 recommendations are made based on the 8 appraised studies. According to the SIGN’s “Grades of recommendation”, all the recommendations in the protocol are graded with “A”. The significance of this evidence-based protocol is that it adds a symptom-limited exercise test for evaluating participant’s level of exercise tolerance before the start of exercise training, so that exercise intensity can be tailored. It is relatively safer than the current practice. Conclusion A 6-week exercise training program for patients with coronary heart disease is effective in improving their quality of life and increasing their level of physical activity. Since the program has a high implementation potential in the local context and is safer than the current practice, the evidence-based exercise training protocol is worthwhile to be introduced to the cardiac units in Hong Kong. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Background and Purpose Stroke is the loss of brain’s function caused by hypoxia of brain cells depending on the severity and the location of the stroke. In Hong Kong, strokes are the 4th leading cause of death and morbidity in the year of 2010. Dysphagia is a common morbidity related to stroke. Approximately, 50% of stroke patients with dysphagia are suffered with aspiration and aspiration pneumonia which may lead to increased length of stay in hospitals, mortality rate and medical costs. An early nursing dysphagic screening and assessment protocol can help in early detect of dysphagia and therefore help to reduce incidence of aspiration and pneumonia. In order to understand the effectiveness of the nursing dysphagic screening and assessment protocol for the acute stroke patients, a number of studies have been reviewed to gather evidences for the translational research. A bedside nursing swallowing screening and assessment for patients with stroke is developed by incorporating findings from the literature review. Review Question In comparison to the routine care, is the nursing dysphagia assessment intended for the acute stroke patients more effective in reducing (1) the waiting time for having swallow assessment and the (2) the incidence of aspiration and pneumonia? Methods A systematic review of literatures from Ovid Medline (from 1946 to 2012), Pubmed (all dates), CINAHL Plus (from 1971 to 2012) and China Journal Net (from 1912 to 2012) was conducted. Five studies of bedside swallow screening and assessment that can be performed by nurses were selected and critically appraised using the recognized assessment criteria. Results The key components identified from the reviewed studies including swallowing assessment should be performed by trained nurses and acute stroke patients should be alert and able and can keep the sit up position during the swallowing assessment. Moreover, water swallowing test must be included as a part of the swallow assessment and assessment should best be performed in daily basic. Patients should be keeping nil of mouth when they failed the screening and referred for further assessment and management. Implementation potential in terms of transferability, feasibility and the cost benefit ratio of the proposed innovation were assessed. A communication plan was developed for the integration of the proposed innovation into the clinical setting. Outcome measures such as positive predictive value of detecting dysphagia, mean waiting time of waiting the initial swallow screening, occurrence of pneumonia, staff knowledge and compliance were identified to evaluate the effectiveness of the proposed innovation and guideline. Conclusion The findings of this systematic review showed that the nursing dysphagic swallow screening and assessment is effective in detecting the dysphagia of the acute stroke patients. Further development of the proposed innovation will be conducted in the clinical setting in order to satisfy the needs of the acute stroke patients. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Osteoporosis is a serious health problem worldwide and most commonly affects postmenopausal women (World Health Organization, 1994). Of the variety of complications associated with osteoporosis in postmenopausal women, osteoporotic fracture is the most prevalent and serious one. It affects their quality of life and puts heavy burden on the healthcare system in Hong Kong. Since osteoporosis exercise program can help to reduce bone loss, it seems to be an effective strategy to prevent and manage osteoporosis in postmenopausal women. The purpose of this study is to develop an evidence-based osteoporosis exercise education program for postmenopausal women, based on the best available evidence, with an aim of helping them to prevent and manage osteoporosis through the prevention and reduction of bone loss and its related fractures. A search of literature from four databases, including Pubmed (1997 to August 2011), CINAHL Plus (1937 to August 2011), Cochrane Library (1996 to Issue 8 of 2011) and EMBASE Classic + EMBASE (1947 to August 2011), was done to identify relevant randomized controlled trials (RCTs). The methodology checklist for RCTs developed by the Scottish Intercollegiate Guidelines Network (SIGN, 2008) was used to evaluate the quality of the selected studies. A total of nine studies met the inclusion criteria and did not violate the exclusion criteria. The findings of these studies showed that exercise intervention or program significantly reduced postmenopausal women’s likelihood of having fracture and also improved their bone mass density slightly. Among the reviewed studies, programs were most commonly implemented within a 12-month period and two 60-minute supervised exercise sessions were delivered per week. The potential of implementing the proposed program, based on the evidence from the literature review, to local practice was assessed. Based on the assessment, the proposed program is necessary and beneficial for postmenopausal women. An evidence-based osteoporosis exercise education program is developed based on the best available evidence. The SIGN grading system was utilized to provide grades for the recommendations in the guideline. An effective and adequate communication with potential stakeholders to gain their support and cooperation for the proposed program is essential. In addition, a tailor-made pilot test is also crucial for ensuring the successful implementation of the proposed program. The pilot study will be conducted in a local practice and the targeted participants are 124 postmenopausal women. Data analysis will be done by the paired t-test. The proposed evidence-based osteoporosis exercise education program will be considered as effective if (1) there is a reduction of bone loss and an increase in physical activity level in postmenopausal women, and (2) there is an increase of confidence and self-perceived skill on the prevention of management of osteoporosis in nurses. / published_or_final_version / Nursing Studies / Master / Master of Nursing

This report investigates the efficacy of using constraint-induced language therapy (CILT) for treating acquired apraxia of speech (AOS). CILT is a treatment method used with individuals with aphasia in which communication is restricted to verbal output in order to isolate the damaged language areas of the brain and reactivate impaired neural connections (Pulvermuller et al., 2001). CILT employs repetitive, massed practiced stimuli and structured shaping of expressive output within the confines of verbal expression (Pulvermuller et al., 2001). Kirmess and Maher (2010) indirectly discovered that two patients with aphasia and apraxia of speech made gains in both language output and articulatory accuracy after receiving intensive CILT, suggesting possible efficacy for the use of CILT with patients with AOS. / text

Bakgrund: I sjuksköterskans ansvarsområde ingår det att använda omvårdnadsåtgärder för att förebygga komplikationer efter operation. På thoraxkirurgiska vårdavdelningar skiljer sig rutinerna vid postoperativ vård och på vissa avdelningar används Posthorax-västen för att förhindra instabilitet i sternum efter sternotomi. Syfte: Syftet var att undersöka vilka postoperativa omvårdnadsåtgärder sjuksköterskor använder sig av på sternotomerade patienter för att förebygga mediastinit samt hur sjuksköterskor upplever att omvårdnadsåtgärderna påverkar patienterna. Metod: Data samlades in via en enkätundersökning på tre thoraxkirurgiska vårdavdelningar på tre olika sjukhus i Sverige. Resultat: Enkätundersökningen lyfte fram vilka omvårdnadsåtgärder som vanligtvis används på olika avdelningar, vilka omvårdnadsåtgärder som sjuksköterskor ansåg var viktigast samt faktorer som sjuksköterskor uppger främjar och hämmar omvårdnadsåtgärder. Slutsats: Sjuksköterskor uppgav att den viktigaste postoperativa omvårdnadsåtgärden efter sternotomi var Mobiliseringsrestriktioner. De största hindren var postoperativ förvirring, smärta och illamående samt organisatoriska faktorer som hög arbetsbelastning, stress och bristande rutiner. Klinisk betydelse: Denna studie har visat på behovet av vidare forskning genom att ha lyft fram vilka postoperativa omvårdnadsåtgärder som sjuksköterskor uppger att de använder i klinisk praxis på thoraxkirurgiska vårdavdelningar. / Background: Nurses have a responsibility to use nursing interventions to prevent complications after surgery. There is a difference in which procedures are used in thoracic surgical wards for postoperative prevention and some hospitals use the Posthorax vest to prevent sternal instability. Aims: The aim of this study was to investigate nursing interventions used to prevent mediastinitis on patients who have undergone sternotomy and how nursing interventions affect patients according to nurses. Methods: A survey was used to procure data from three different thoracic surgical wards in hospitals in Sweden. Results: The survey has shown the most commonly used nursing interventions in different thoracic surgical wards and what nursing interventions nurses’ state are most important. The survey also found promoting and inhibiting factors for nursing interventions according to nurses. Conclusion: According to nurses the most important nursing intervention was restricting the use of upper body extremities. The most inhibiting factors for nursing interventions were postoperative confusion, pain, nausea and organizational factors as high workload, stress and inadequate procedures. Clinical implications: This study has shown the need for further research by determining the postoperative nursing interventions used in clinical practice in thoracic surgical wards.