Factors affecting nursing students' intention to work with older people in China

Author version made available here in accordance with Publisher's copyright policy. NOTICE: this is the author’s version of a work that was accepted for publication in Nurse Education Today. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Shen J, Xiao LD. Factors affecting nursing students' intention to work with older people in China. Nurse Education Today. 2012 Apr;32(3):219-23. doi: 10.1016/j.nedt.2011.03.016.Summary Background In Western countries, caring for older people was viewed as an unattractive area by nursing students. The literature reported a number of barriers, including ageism that contributed to this undesirable situation. Aim The purpose of this study was to explore factors affecting nursing students' intention to work with older people in a university in China. Method A cross-sectional survey was conducted with 622 nursing students enrolled in a 4-year Bachelor of Nursing programme at the university. Data analysis methods mainly included Chi-Square test, Mann–Whitney test, factor analysis and logistical regression. Results Working with older people was ranked as the second to least preferred area by nursing students. Ageist attitudes described as Prejudice was negatively associated with intention to work with older people; while students aged under-20 were more positively associated with an intention to work with older people. Conclusion Nursing curriculum should be designed to target ageist attitude, by promoting socialisation with older people and creating more supportive learning environments in the care setting of older people

A Gate Keeper for Axonal Transport

The axon and dendritic arbor of neurons require different sets of membrane proteins to carry out their functions. In this issue, Song et al. (2009) describe how a cytoplasmic diffusion barrier in the axon initial segment of rat hippocampal neurons ensures that only axonal (and not dendritic) membrane proteins enter the axon

Cross-cultural comparison of attitudes and preferences for care of the elderly among Australian and Chinese nursing students

Author version made available here in accordance with Publisher's copyright policy.Purpose: The aim of this study was to compare Australian and Chinese nursing students’ attitudes and intentions to care for the elderly and the factors affecting these intentions. Method: A cross-sectional design employed two questionnaires to survey 256 Australian nursing students and 204 Chinese nursing students within the first weeks of their nursing curriculum. Factor analysis and logistical regression analysis were performed to identify predictors of intent to care for the elderly. Results: The percentage of students more likely to care for the elderly was significantly higher among the Chinese group (72.1%) than the Australian group (45.3%). Work experience with older people and being under the age of 20 were found to be positive predictors, whereas factors such as prejudice toward the elderly and beliefs that elders should live in separate housing were negatively associated with an intention to care for the elderly. Conclusions: The collectivist culture has a more positive influence on nursing students’ attitudes toward the elderly compared with the individualist culture. Implications for Research and Practice: It is highly recommended that elderly care settings should be incorporated in clinical placements and further research is needed to explore how clinical experience affects students’ career choice

General practitioners' knowledge of ageing and attitudes towards older people in China

Author version made available in accordance with Publisher copyright. 12 month embargo from date of publication [Oct 9 2013]. This is the accepted version of the following article: [Yang, Y., Xiao, L. D., Ullah, S. and Deng, L. (2013), General practitioners' knowledge of ageing and attitudes towards older people in China. Australasian Journal on Ageing. ], which has been published in final form at [doi: 10.1111/ajag.12105]. In addition, authors may also transmit, print and share copies with colleagues, provided that there is no systematic distribution of the submitted version, e.g. posting on a listserve, network or automated delivery.Aim To explore general practitioners (GPs)' knowledge of ageing, attitudes towards older people and factors affecting their knowledge and attitudes in a Chinese context. Methods Four hundred GPs were surveyed using the Chinese version of the Aging Semantic Differential (CASD) and the Chinese version of the Facts on Aging Quiz (CFAQ1) scale. Results The CASD scores indicated that GPs had a neutral attitude towards older people. The CFAQ1 scores indicated a low level of knowledge about ageing. GPs' awareness of the mental and social facts of ageing was poorer compared to that of physical facts. Male GPs had a significantly higher negative bias score than female GPs. No other variables had a statistically significant influence on knowledge and attitudes. Conclusions The findings suggest the need for education interventions for GPs regarding knowledge of ageing and also provide evidence to guide future development of continuing medical programs for this group of medical doctors

Endoglin Is Essential for the Maintenance of Self-Renewal and Chemoresistance in Renal Cancer Stem Cells.

Renal cell carcinoma (RCC) is a deadly malignancy due to its tendency to metastasize and resistance to chemotherapy. Stem-like tumor cells often confer these aggressive behaviors. We discovered an endoglin (CD105)-expressing subpopulation in human RCC xenografts and patient samples with a greater capability to form spheres in vitro and tumors in mice at low dilutions than parental cells. Knockdown of CD105 by short hairpin RNA and CRISPR/cas9 reduced stemness markers and sphere-formation ability while accelerating senescence in vitro. Importantly, downregulation of CD105 significantly decreased the tumorigenicity and gemcitabine resistance. This loss of stem-like properties can be rescued by CDA, MYC, or NANOG, and CDA might act as a demethylase maintaining MYC and NANOG. In this study, we showed that Endoglin (CD105) expression not only demarcates a cancer stem cell subpopulation but also confers self-renewal ability and contributes to chemoresistance in RCC

An Innovative Continuing Nursing Education Program Targeting Key Geriatric Conditions for Hospitalized Older People in China

This article under embargo for 18 months from the date of publication due to publisher copyright restrictions. "This is an Accepted Manuscript of an article published by Taylor & Francis i nEducational Gerontology on 23 May 2013, available online: http://wwww.tandfonline.com/10.1080/03601277.2012.704233."A lack of knowledge in registered nurses about geriatric conditions is one of major factors that contribute to these conditions being overlooked in hospitalised older people. In China an innovative geriatric continuing nursing education program aimed at developing registered nurses’ understanding of the complex care needs of hospitalised older people with common geriatric conditions were conducted and evaluated. The program consisted of didactic sessions focused on evidence-based practice and unfolding case study designed to simulate the care trajectory of an older person with a hip fracture and key geriatric conditions. Findings from the program evaluations revealed a significant increase in attitudes towards older people and knowledge concerning common geriatric conditions. The satisfactory rate ranked by program participants was 90%. The study therefore drew the conclusion that effective geriatric continuing nursing education should target participants’ learning needs, support evidence-based practice and engage participants in active learning

Family caregiver challenges in dementia care in a country with undeveloped dementia services

Author version made available in accordance with Publisher's copyright policy. This is the accepted version of the following article: Wang J., Xiao L.D., He G.-P. & De Bellis A. (2014) Family caregiver challenges in dementia care in a country with undeveloped dementia services. Journal of Advanced Nursing 70(6), 1369–1380. , which has been published in final form at [doi: 10.1111/jan.12299]. In addition, authors may also transmit, print and share copies with colleagues, provided that there is no systematic distribution of the submitted version, e.g. posting on a listserve, network or automated delivery.Aims To examine socially, culturally and politically constructed factors affecting family caregiver practice in dementia care, and to identify possible changes in a country with undeveloped dementia services. Background In China and many other low- and middle-income countries, social transformations are weakening the family care model, which has an impact on the population with dementia. Exploring the challenges that caregivers face may help the international healthcare community to improve dementia services. Design A double hermeneutic approach informed by Giddens' Structuration Theory was used. Methods In-depth semi-structured interviews with 23 family caregivers of people with dementia were conducted in 2012. The interviews were audiotaped, transcribed and analysed. Findings Analyses revealed three consequences of socially constructed factors in dementia care, which constrained caregiver practice. First, caregivers were unable to manage behavioural and psychological symptoms of dementia. Untreated aggressive behaviours caused harm to the person with dementia and endangered the caregiver and the public. Second, the burden on the primary caregiver was evident and caregivers received limited support. Third, there was little coordination between primary and specialist care services for people with dementia. On critical reflection of potential changes that could improve dementia services, caregivers suggested that community nurses have a leading role in coordinating dementia services and supporting caregivers. Conclusion Relying on family caregivers to care for people with dementia without the prevision of dementia services by the public healthcare system generates negative health outcomes for both care recipients and caregivers. The nursing workforce should be developed to support dementia services

Nurse-led cognitive screening model for older adults in primary care

Author version made available in accordance with publisher copyright. Under 12 month embargo from date of publication [26 September 2014]. This is the accepted version of the following article: [Yang, Y., Xiao, L. D., Deng, L., Wang, Y., Li, M. and Ullah, S. (2014), Nurse-led cognitive screening model for older adults in primary care. Geriatrics & Gerontology International.], which has been published in final form at [doi: 10.1111/ggi.12339]. In addition, authors may also transmit, print and share copies with colleagues, provided that there is no systematic distribution of the submitted version, e.g. posting on a listserve, network or automated delivery.Aim The present study aimed to establish a nurse-led cognitive screening model for community-dwelling older adults with subjective memory complaints from seven communities in Chongqing, China, and report the findings of this model. Methods Screenings took place from July 2012 to June 2013. Cognitive screening was incorporated into the annual health assessment for older adults with subjective memory complaints in a primary care setting. Two community nurses were trained to implement the screening using the Mini-Mental State Examination and Montreal Cognitive Assessment. Results Of 733 older adults, 495 (67.5%) reported having subjective memory complaints. Of the 249 individuals who participated in the cognitive screening, 102 (41%) had mild cognitive impairment, whereas 32 (12.9%) had cognitive impairment. A total of 80 participants (78.4%) with mild cognitive impairment agreed to participate in a memory support program. Participants with cognitive impairment were referred to specialists for further examination and diagnosis; only one reported that he had seen a specialist and had been diagnosed with dementia. Conclusions Incorporating cognitive screening into the annual health assessment for older adults with subjective memory complaints was feasible, though referral rates from primary care providers remained unchanged. The present study highlights the urgent need for simple screenings as well as community-based support services in primary care for older adults with cognitive or mild cognitive impairments

Factors contributing to caregiver burden in dementia in a country without formal caregiver support

This items is under embargo for 12 months from the date of publication according to Publisher's copyright policy. This is an Accepted Manuscript of an article published by Taylor & Francis in Aging & Mental Health on 31 Mar 2014, available online: http://wwww.tandfonline.com/10.1080/13607863.2014.899976Objectives: To investigate caregiver burden in dementia and explore factors associated with different types of burden in a country without formal caregiver support using a province in China as a case.Method: Cross-sectional questionnaire survey was used to collect data. One hundred and fifty-two family caregivers of people with dementia in community settings were recruited from 2012 to 2013 using convenience sampling. Objective burden was measured by caregiving hours and dementia-related financial burden. Subjective burden was measured and analysed using the Caregiver Burden Inventory and the Neuropsychiatric Inventory-Questionnaire. Multivariate regression models were employed to analyse factors associated with each type of subjective burden.Results: Five types of subjective burden were measured by the Caregiver Burden Inventory, namely, physical burden, emotional burden, time-dependence burden, developmental burden, and social burden. Caregiver distress, as a subjective burden, was measured by the Neuropsychiatric Inventory-Questionnaire and reported by relating to the severity of care recipients’ behavioural and psychological symptoms of dementia. This caregiver cohort showed a high level of physical, time-dependence, and developmental burdens, but a low level of emotional and social burdens. Factors contributing to each type of subjective burden measured by the Caregiver Burden Inventory differed from each other.Conclusion: The high level of objective and subjective burdens identified in this study suggests that government-funded formal caregiver support should be established and services should be designed to target different types of burdens and factors contributing to these burdens

Rationed or missed nursing care: Report to the ANMF (Victorian Branch)

In May to July 2015, 1683 nurses, midwives and personal care workers (PCW) and Assistants in Nursing (AiN) employed in public and private health facilities in Victoria completed the MISSCARE survey. This represents around 3 percent of the total number of nurses and midwives employed in the state of Victoria. The survey was administered via Survey Monkey by a research team from Flinders University in collaboration with the Victorian branch of the Australian Nursing and Midwifery Federation (ANMF Vic Branch). The Victorian MISSCARE survey is a modification on the original design developed by Beatrice Kalisch (2006). It contains eleven demographic questions, 23 questions dealing with working conditions including questions on staffing tools, 21 questions concerning missed care (care that is omitted, postponed, or incomplete) and 20 questions addressing reasons why care is omitted in the settings in which the nurse/midwives practice. Victoria is the only state in Australia to have mandated nurse-patient ratios. The state of Victoria is experiencing rapid growth in population. Missed nursing care is a global phenomena linked to the rationing of health care. Nurse researchers around the world are recording the levels of missed, delayed or rationed care. Nurses have always rationed care tasks, or prioritised them when work intensifies. Nursing assistants known as health assistants in nursing, have been employed in some public hospitals in Victoria since 2009. Patient satisfaction surveys conducted by the public hospitals in Victoria show high rates of satisfaction with nursing care, and the courtesy of nurses, and low scores for organisational issues such as food, restfulness of hospitals and waiting times. There is some overlap between the patient satisfaction surveys conducted in the public hospital system and the MISSCARE survey such as length of time taken for nurses to respond to call bells, patient education, hand hygiene and medication requests. Sixty-seven percent of nurses in Victoria are employed on a permanent part-time basis. This is higher than NSW where 48.3 percent of nurses are employed part-time permanent. Fifty-six percent of nurses work 30 hours or more in Victoria. Sixty-five percent of nurses and midwives prefer to maintain their current schedule. Over 22 percent of nurses said they worked overtime greater than 20 times in the last 3 months. Thirty-four percent of nurses and midwives worked 2 to 3 shifts over the last 3 months even though they were sick or injured, with 32 percent stating they felt an obligation to their colleagues to go to work. Fifty-three percent of nurses and midwives felt that there were adequate staff between 100 and 75 percent of the time. The remaining 47 percent felt staffing was inadequate between 50 and all of the time. Seventy-three percent of nurses and midwives had less than 9 patients per shift, with eighty-six percent reporting that they had fewer than 5 admissions per shift Rounding appears to be used in 53 percent of situations, although many nurses had not heard of the term. Nursing care tasks most often missed include skin and wound care, and glucose monitoring. The care missed is consistent across all three shifts, although some tasks are more likely to be missed on a particular shift; eg afternoon shift has higher scores for missing the promotion of PRN medications, while night shift staff report the omission of managing parenteral devices. Nursing care tasks such as turning patients, oral hygiene, prompt medication administration and patient education are least missed. Missed nursing care can be categorised into low, intermediate and high treatment. Lower priority care includes emotional support, patient education and discharge planning, and high priority care includes handwashing, IV/CVC lines, call bells, BSL, vital signs. Treatment (intermediate) related care is the most likely form of care to be missed. These include nursing specific tasks such as feeding, turning/positioning, wound care, administering medication on time, ambulation, mouth hygiene, and toileting. This finding is consistent with survey results from NSW. Variables with a direct impact on missed care include the hospital location (rural hospitals report higher rates of missed care), the use of rounding impacts on missed care, and staff adequacy. Reasons for missed care include urgent patient situations and unexpected rises in patient volumes which impact upon staffing issues. While just over 50 percent of nurses thought their ward was adequately staffed 75 to 100 percent of the time, unpredictable work increases such as increased admissions and discharges contribute to missed care. Other important reasons for missed care include: ‘Inadequate skill mix for your area’, ‘an unbalanced patient assignment’ together with an ‘inadequate number of assistive and/or clerical personnel’ and ‘supplies/equipment not available when needed’. Two hundred and eighty four nurses and midwives provided qualitative comments within the survey. Responses illustrated a stronger focus on nursing the budget, with participants indicating they were more aware of financial constraints or the need for profits than previous generations of nurses. Midwives reported that early discharge of mothers curtailed adequate patient education. Nurses and midwives targeted cost constraints, lack of adequate numbers of clerical and ancillary staff, particularly on night duty, the lack of mandated nurse-patient ratios in private hospitals, poor access to medical staff, patient acuity, and competing demands placed on nurses who are at the centre of the ward or unit. Consistent with survey results from other states, lack of access to equipment including medications also impacts on missed care. Nurses in Victoria also indicated that poor communication was a factor in missed care. When nurses were asked about personal issues that impacted on missed care they reported that their capacity to deliver uninterrupted care and an inability to attend case conferences as causing missed care. This was followed by the absence of hospital policies and inability to delegate work to others. The frequencies and types of missed care are significantly influenced by both hospital/clinical unit effects including hospital location and by individual nurse/midwife factors. Missed care shows greater variation within Victorian rural hospitals. The average frequency of missed care on Victorian afternoon and night shifts is significantly less than reported in NSW however, the average frequency of missed care on the Victorian day shift is equivalent to that reported in NSW. Employer type (private or public agency) was not associated with missed care by Victorian respondents The use of rounding practices in the clinical arenas presents as contributing to and preventing missed care dependent upon context. The rate and frequency missed care is defined by the type of care missed. Intermediate treatment related care is more likely to be missed than higher priority and lower priority nursing tasks. In Victoria, the morning shift is associated with the greatest volume of missed care, followed by the then afternoon shift and then the night shift. Country of origin of nursing/midwifery qualifications is associated with significant variation in the frequencies and types of care missed in Victoria. Age of the staff providing care shows a mixed but statistically significant influence on missed care in Victoria. The gender and the level of qualifications held by the Victorian nurse/midwife is associated with significant variations in treatment-related missed care. Staff employment status (both full and part-time employment) demonstrates variance in frequencies of Victorian missed care. The complexity of staffs’ ability to manage daily work tasks shows significance variation in missed care in Victoria.. Dissatisfaction with work teams has a statistically significant influence on Victorian missed care. Current job dissatisfaction has a statistically significant influence on Victorian missed care. Staffs’ self-rated level of their current health and the number of hours they are employed for per week are not associated with Victorian missed care. In order of magnitude, the reasons why Victorian care is missed care are issues associated with the provision of resources for care, communication tensions between care providers, workload (un)predictability, (dis)satisfaction levels with members of the team and workload intensity