Sex among men has been existed in all society with variety of reasons. They are often stigmatized by other people. As a result, men who have sex with men (MSM) are less willing to expose themselves even if they have health problems. To increase the awareness of the public and establish trust relationship within health organizations and MSM, Internet is a good platform to promote health concepts and health education. In recent 10 years, Internet becomes popular. There was an increasing trend that MSM people are using Internet to seek partners. As a result, the sexually transmitted infections (STI) among MSM people had been increasing in recent years. The global population of HIV infection among MSM increased from3.9 million in 2007 to 20.4 million in 2010. It is predicted that the number will further increase to 23.3 million in 2015 (Joint United Nations Programme on HIV and AIDS [UNAIDS], 2011). In Hong Kong the HIV infection rate among MSM is still increasing around 42.4% of HIV infected cases were MSM (Department of Health, 2010).Therefore, a comprehensive health promotion program is needed to promote safer sex and prevent further spread of STI in Hong Kong. Internet-based Sex Education Program is a health promotion program that was held in many countries. Those studies used webpage containing sex education materials such as STI knowledge, STI prevention methods, information about risky sexual behavior, knowledge of condom using skills, negotiation skills with partners and information of STI screening. Results showed that internet-based sex education program is successful in most countries. Three electron bibliographical databases MEDLINE, CINAHL and Cochrane Library were used to search the relevant primary studies. After assessing the quality of the studies, six studies were found fulfilling the criteria of the program. By comparing the transferability and feasibility of the interventions of the six reviewed literatures, a new guideline was set. Stake holders were identified and through communication with the stake holders, a pilot study plan was designed and data collected from the pilot study would be used to modify the online health education program and provide a better nursing care for MSM clients. Online health education program for MSM contributes a better platform to promote sexual health through internet. The program helps to prevent STI and HIV transmission and it is expected that the guideline of the program can be used by different health care settings such as hospitals or clinics when they are providing health education to MSM clients. A decrease of STI and HIV infection among MSM clients is expected since the program is carried out in public settings and hoping that MSM clients could gain benefit from it. / published_or_final_version / Nursing Studies / Master / Master of Nursing

In Hong Kong, the number of colon cancer patients has increased over the years. But at the same time, early detection of colon cancer has also become more readily available due to the recent technological advancement and increased accessibility to medical care. In recent years, more patients have become eligible for having curative sphincter saving operation and one of the objectives of this operation is to preserve continence function without stoma formation. However, colon cancer patients’ journeys do not finish after their operation. For instance, they may have bowel disorder after the operation, namely ‘Anterior Resection Syndrome’. This debilitating condition may not be amenable by surgical technique or medical therapy and it affects the bio-psycho-social wellbeing of the patient. One of the responsibilities of nurses is to promote the general wellbeing of the clients. Therefore, in this study, the possible methods of alleviating the condition of Anterior Resection Syndrome among colon cancer patients were inspected. By using strategic search of current evidences, this study found that several primary studies support the use of biofeedback to alleviate the condition. After conducting a comprehensive review of the selected studies, the biofeedback treatment was considered as an appropriate recommendation for the current clinical setting. After assessing the implementation potential of the current practice, an evidence-based protocol with considerations of local factors was established. In addition, in order to minimize resistance on the change of current practice, plans on communicating with stakeholders, pilot study and evaluation were carefully established. The purpose of this study is to provide professional nursing care by using evidence based practice for those in need. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Although effective anti-tuberculosis agents have been available for over thirty years, tuberculosis (TB) is still a global health concern and the incident rate in Hong Kong remains high. Directly Observed Therapy, Short-course (DOTS) strategy, in combination with patient education are proved to be more effective in reducing TB incidence than the DOTS strategy alone. However, there is a lack of evidence based protocol to guide nurses through the implementation of health education for TB patients. This dissertation is a translational nursing research aims at developing an evidence-based health education guideline for nurses to deliver health education to TB patients to improve treatment adherence. The objectives are to gather evidence on the effectiveness of nursing health education in promoting treatment adherence among TB patients, conduct quality assessment of the reviewed articles, develop evidence-based health education protocol for TB patients, assess the implementation potential of the innovation and discuss its implementation and evaluation plan. In this dissertation, a systematic review of 8 relevant and up-to-date research papers was performed and a guideline was then generated based on the extracted data. The guideline consists of 3 components: effective individual health education, essential elements for health education booklet and training for nurses. The implementation potential of the guideline is considered to be high while the implementation and evaluation plan of the guideline are also discussed. With the implementation of the evidence-based protocol on TB health education, the treatment adherence of the TB patients is expected to be increased. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Psoriasis is a chronic, inflammatory skin disorder and approximately 1% to 3% of the world’s populations are suffering from it. As numerous studies have shown that psoriasis is highly correlated with psychological distresses, one of the critical issues in the psoriasis patient care is the psychological problem. However, in the existing care for psoriasis, no guideline has been developed for patients’ psychological issue. Therefore, the aim of this translational research is to develop an evidence-based psychological care guideline with an implementation and evaluation plan for psoriasis patients in a dermatology setting. In this dissertation, 11 studies were selected after assessing the relevance of the obtained full texts. Data of these studies were extracted, and the quality of data was assessed by the Critical Appraisal Skills Programme and the Scottish Intercollegiate Guidelines Network. Evidences obtained from the literature review were aggregated and also critically reviewed. After these processes, an Evidence Based Protocol was developed. In the guideline, information related to the psychological assessment and interventions for psoriasis are included. Then the implementation potential of the guideline produced was examined in terms of the transferability, feasibility and the cost-benefit ratio. A pilot test was also conducted to identify any problems of the actual implementation of the mentioned guideline. Both process and outcome evaluation would be as used to assess the feasibility and the effectiveness of the guideline. In the end, this guideline isexpected to manage psychological aspects of psoriasis patients so as to improve their quality of life. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Evidence-based practice has resulted in better patient outcomes, higher patient satisfaction, and effective patient-centered care. Leadership of a large teaching hospital determined that new nurses lacked the education and experience to design and implement an evidence-based project at the bedside, which was an expected outcome for completion of the established nurse residency program. The purpose of this project was to develop a design-only project in which Masters of Science in Nursing-prepared mentors were added to the residency program to establish the required evidence-based project. A mentor workshop was developed to guide the mentors in this role using Benner's novice to expert theoretical model. A team of stakeholders, including an expert in the field of nursing education, provided ongoing process evaluation in the development of the outcome products including the Mentor Facilitation Guide, Mentor Workshop Curriculum, Mentoring Toolkit, Pre-and Post-Mentor Workshop Survey Assessment, and Mentor Implementation Plan. Stakeholders completed a summative evaluation on the processes, outcomes, and student leadership of the project. Findings showed that the project met 100% of the stated goals and objectives, as evidenced by the stakeholders' responses to the summative evaluation regarding the degree of effectiveness for the project, process, and leadership skills. Implementation and evaluation of the project, which was developed for use in the hospitals' existing nurse residency program, will occur post-graduation. Social change will occur if new nurses learn to use evidence-based practice to support their nursing actions, resulting in improved patient care outcomes and population health.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Untreated depression has a detrimental effect in the lives of the adolescents suffering from this disorder. Depression is a multidimensional phenomenon that has been linked to biological, psychosocial and cognitive risk factors. Adolescents may be at risk for depression because adolescence is a time of physical, hormonal, emotional and intellectual changes. Depression may lead to impaired social and school performances and to poor physical health. In addition to a reduced quality of life, depression has also been linked to suicidal ideation and attempts. Suicide is the third cause of death in adolescents in the United States.The purpose of this practice inquiry was to conduct a critical review and synthesis of the literature on evidence-based treatment of unipolar depression in adolescents and to make recommendations for health care providers. This topic was chosen because of the high prevalence of depression in adolescents and because of the devastating effects of not treating this disorder.The methods used to synthesize the literature are described in the Guide for Literature Reviews by Cooper (1998). After the problem was identified, a literature search was conducted in PubMed, Cinahl, Psych Info, Complementary and Alternative Medicine and AMED. Next, the literature yielded 93 articles. The evidence from the literature was ranked according to the Oncology Nursing Society (ONS), Putting Evidence into Practice (PEP), Levels of Evidence scale. This system is an adaptation of the Rating the Quality of Evidence for Clinical Practice Guidelines developed by Hadorn and others (1996). Lastly, the recommendations for practice were made based on the ONS PEP, Weight of Evidence Classification Schema by Mitchell & Friese. Based on the evidence found in the literature, a guideline with the recommendations for practice was developed.The need for the treatment of adolescents with depression was supported in this synthesis of the literature. Future research is needed to explore treatment modalities tailored to the developmental, biological, psychosocial and cultural needs of adolescents and their families.

Asthma is a chronic disease that affects 8.4 million children in the United States (American Lung Association [ALA], 2007). Adolescents with asthma need tailored management of their care with attention given to particular developmental concerns. Standards of care, such as the National Heart, Lung, Blood Institute [NHLBI] 2007 asthma guidelines (NHLBI, 2007), exist to guide patient care and in this case, also address specific adolescent needs. Advanced practice nurses should incorporate "national standards of care as a framework for managing patient care" (American Association of Nurse Practitioners [AANP], 2007, p. 2). There is a lack of research about nurse practitioner use of standards of care, especially in caring for adolescents with asthma.The purpose of this practice inquiry was to explore patterns of practice and perceptions of practice by the nurse practitioners who care for adolescents with asthma, and to evaluate the current patterns of practice in comparison with national standards for providing care to adolescents with asthma at the Larry Combest Community Health Wellness Center [LCCHWC]. The design for this practice inquiry was descriptive retrospective, using mixed methods for process evaluation of a program through description of nurse practitioner practice at an academic nurse-managed primary care clinic.The nurse practitioners addressed all components of the process of care recommended by the AANP (2007), which includes assessment, diagnosis, development and implementation of a treatment plan, and evaluation of the patient status. However, despite comments about the importance of using evidence based practice in the form of guidelines, results from health records review indicate that nurse practitioners have not fully integrated the NHLBI 2007 asthma guidelines into providing care to adolescents with asthma. This study establishes a baseline measure of adoption of the NHLBI 2007 asthma guidelines by nurse practitioners at this clinic site. The results of this study may ultimately contribute to nurse practitioners' awareness of use of standards of care and improved quality of care for adolescents with asthma.

Context: A relatively recent focus on evidence based management has been influenced strongly by evidence based medicine. Healthcare administrators are encouraged to utilize similar principles to optimize their decision making. There are no known studies that address whether or not and how evidence is used by healthcare administrators in decision making practice and process. Objectives: This study explores how evidence is conceptualized by public hospital executives and whether or not, and how, evidence is brought to bear on strategic decision making. Design: The study undertook a qualitative design, using a grounded theory approach. The focus was to uncover how evidence is conceptualized by decision makers, whether or not and how evidence as defined is brought to bear, and under what conditions and why evidence is brought to bear. The study included four public hospitals in the Greater Toronto Area, two academic health sciences centres and two community teaching hospitals. Hospital CEOs were asked to identify three strategic decisions (one clinical expansion, one partnership, and one decision on prioritizing quality improvement). Interviews were conducted with 19 healthcare leaders and decision makers, and content analysis was undertaken for 64 supporting documents. Results: Strategic decision makers in this study bring an amalgam of evidence to bear on strategic decisions. Evidence comes from sources internal and external to the organization, and includes a series of types of evidence ranging from published research to local business evidence. The reasons for bringing evidence to bear are highly intertwined. Evidence was sought, developed, and brought to bear on decisions in a formalized manner, and was used in concert with conditions internal and externalto the organization, and informed by the decision maker characteristics. Conclusion: Evidence plays a prominent role in strategic decision making. Strategic decisions were supported by processes requiring evidence to be brought to bear.