Parallel Session 6 - Achieving Nursing Excellence through Contemporary Approach II – Innovation and Clinical Research

Accurate verification of nasogastric tube (NGT) placement is critical to prevent serious complications 
such as aspiration pneumonia. Conventional methods like pH testing and X-ray are limited by 
inconsistent reliability and unnecessary radiation exposure. Point-of-care ultrasonography (POCUS) has 
emerged as a promising, noninvasive, and real-time alternative for NGT placement confirmation. This
study evaluates the diagnostic accuracy of POCUS in a pilot phase and an evidence-based protocol for 
application in the main study.


Objectives
The study aims to: (1) assess the diagnostic accuracy of POCUS compared to X-ray (reference standard), 
(2) analyze time efficiency and cost savings in a pilot study, and (3) examine the roles of an evidencebased protocol in the main study.


Methodology
The study comprised two phases. Phase I was a prospective pilot study (n=67) using convenience 
sampling, conducted across five community clusters. Investigators received standardized training to 
ensure interrater reliability. Phase II will enroll 530 participants across six community centres and four 
acute or rehabilitation hospitals, employing a validated protocol with standardized imaging techniques, 
compliance audits, and adherence to STARD guidelines. Diagnostic accuracy was measured using 
sensitivity, specificity, and interrater reliability. Time and cost comparisons between POCUS and X-ray 
were analyzed using paired t-tests.


Results
The pilot study demonstrated 100% sensitivity and 93.55% specificity. The mean time lag between 
POCUS and X-ray confirmation was 4.47 hours, with potential cost savings of HKD 270,310. Interrater 
reliability was high (Cronbach's α = 0.875; ICC = 0.778–0.875, p < 0.001), and protocol adherence was 
100% in pre-study audits.


Conclusion
POCUS is a clinically effective, time-efficient, and cost-saving method for NGT verification. The
evidence-based protocol, supported by robust methodology and high interrater reliability, ensures 
consistency, reduces bias and lies in statistical rigor. Phase II will further validate these findings in a 
larger cohort, reinforcing POCUS as a viable first-line tool for NGT placement verification.

Introduction: 
Urinary tract stone is one of the commonest conditions in urology. A first episode of urinary tract stone disease confers a lifetime risk of further stone formation having a 30% to 40% risk of recurrence within 5 years. 


Urinary pH is an important factor linked to renal stone disease. It is also a useful marker in the treatment of urolithiasis. 
 
Objective:
To study the viability of applying a validated hand-held urine pH meter to check the urine pH for the urinary tract stone formers who can receive prompt treatment at outpatient setting.


Materials and Method:
Patients attending the stone clinic with confirmed urinary tract stones were instructed to save urine for pH. The urine pH was measured by three commonly used methods: pH paper, hand-held pH meter and hospital's laboratory pH meter for comparative measurement. 
The urine pH reading from both pH paper or hand-held pH meter were performed by 2 separated nurses in stone clinic Both were blinded to each other's results. The readings were compared with laboratory pH meter.


Result:
There were 634 attendances from June 2022 to Dec 2024 in which 63.5% were male and 36.5% were female. The mean age was 64.6. Apparently, there were more stone recurrent patients (87.8% versus 62.8%) benefited at stone clinic by using a hand-held pH meter versus pH paper to measure urine pH value. In addition, the cost of using hand-held pH meter and calibration solutions for 64 specimens were only HK$213 if compared with the cost HK$8000 required in laboratory. 


Conclusion:
Hand-held urine pH meter is a reliable pH measuring device which is more accurate compared to pH paper. Hand-held urine pH meter is simple to use. Patients with recurrent stone are beneficial from (1) shorten hospital journey; (2) prompt medication management and (3) cost effective.

Preoperative anxiety is a common psychological phenomenon experienced by patients awaiting surgery. Forty-seven percent of patients experienced certain level of preoperative anxiety, with common causes including fear of death, unexpected results of the operation, fear of complications, fear of anesthesia, and post-operative pain. In the high-stakes field of neurosurgery, where procedures are often complex and invasive, this anxiety can be particularly pronounced. Elevated preoperative anxiety not only exacerbates patient discomfort but may also increase stress hormones potentially complicating surgical outcomes. Traditional pre-operative education relies on narrative information delivered to patients via face-to-face interview by nurses and doctors which lack of personalization, and limited ability to engage patients emotionally and cognitively can reduce its effectiveness in mitigating preoperative anxiety.


VR has emerged as a promising tool in this context. By immersing patients in a controlled, calming virtual environment, VR distracts them from anxiety-provoking thoughts and reduces stress. Studies have demonstrated that VR exposure therapy can significantly lower preoperative anxiety levels by providing patients with a sense of control and familiarizing them with the surgical environment. Additionally, VR offers a unique opportunity for patients to visualize their procedure, thereby reducing the fear of the unknown.


This collaborative project with Hong Kong Metropolitan University features a comprehensive virtual reality (VR) program designed to guide patients through their entire surgical journey. The VR content is divided into six distinct scenes, each depicting a different phase from the moment of admission to the operation theatre and post-operative care. Patients engage in a 6-minute VR simulation as part of their pre-operative education, aiming to familiarize them with every step of the operation theatre experience. To assess the effectiveness of this intervention, preoperative anxiety levels are measured before and after the VR simulation using the Amsterdam Preoperative Anxiety and Information Scale (APAIS), which evaluates both anxiety and the patient's perception of the information provided. Satisfaction is gauged using a 5-point Likert scale, offering insights into the patients' overall experience.


The findings reveal a significant reduction in preoperative anxiety following the VR simulation, underscoring the VR intervention's effectiveness. Patient feedback highlights the comprehensive nature of the information provided, which is clear and detailed, effectively reducing anxiety beyond what is achieved through traditional written and verbal instructions alone. This enhancement in patient engagement and anxiety reduction suggests a valuable addition to standard pre-operative education protocols.

Introduction 
Psychiatric simulation training(PST) has been implemented in Community Psychiatric Service (CPS) of Hong Kong East Cluster since 2018. Over the years the training has been developed not only for staff working in out-patient settings, but also for staff working in in-patient settings which involved the participation of psychiatrists, nurses, medical social worker and occupational therapist. In 2023, a cross-cluster PST with CPS of New Territories East Cluster was performed, in view that the development of PST was mature enough to look for outcome evaluation, a study on the effectiveness of PST for staff working in community setting with collaboration with The Hong Kong Polytechnic University was conducted.


Objectives
 To assess the change of caring attitude, clinical competence, and team efficacy of participants trained by psychiatric simulation training from pre-intervention to post intervention and follow-ups at 1-, 3- and 6-month
 To explore the experience of psychiatric simulation training on(i)Caring attitude, (ii) Clinical competence, and (iii) Team efficacy from the perspective of both participants and psychiatric simulation trainers
 To explore the effectiveness of psychiatric simulation training on (i)Caring attitude, (ii) Clinical competence, and (iii)Team efficacy from the perspective of both participants and psychiatric simulation trainers


Methodologies
Both quantitative and qualitative approach has been adopted in data collection in the study. Human factor skills for healthcare instrument (HuFSHI) and Self-evaluation form of skill competence were used to collect participants(n=56)' rating upon pre- & post-training, 1-month, 3-month and 6-month intervals. 6 focus group interviews were conducted 1 month after the training where interviews were digitally recorded and transcribed verbatim for analysis.


Results
Both quantitative and qualitative findings indicate positive changes in participants' performance in caring attitude, team efficacy, and clinical competence. Quantitative study demonstrated significant differences in those dimensions at various time points, and qualitative study summarized the findings in terms of considering perceived improvements in the three domains.


Conclusions
The findings advocate the development of simulation training as a routine practice within community psychiatric healthcare professional development to foster professional competence and service improvement.