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Aims: Psychological insulin resistance is a common barrier to initiation and persistence with insulin therapy that affects approximately 42.7% of people living with type II diabetes mellitus, which may negatively impact self‐management. This study aimed to assess patients' levels of psychological insulin resistance and to identify factors associated with self‐management in patients with type II diabetes mellitus treated with insulin therapy. Methods: We adopted a cross‐sectional design. Subjects from the metabolism and endocrinology outpatient departments of a regional teaching hospital in central Taiwan were recruited by consecutive sampling. Patients were assessed for psychological insulin resistance and self‐management using the barriers to insulin treatment questionnaire and the partners in health scale. Results: A total of 222 patients with type II diabetes mellitus were recruited. Patients had an average psychological insulin resistance score of 3.14 (maximum of 8). Positive self‐management was associated with insulin therapy injection by patient, fewer expectations regarding positive insulin‐related outcomes, no diabetes‐related complications, less fear of injection and self‐testing, no hypoglycaemia within the previous year, and younger age. Conclusion: Insulin therapy injection by patient and no diabetes‐related complications were the most common factors associated with overall self‐management and with each domain of self‐management in patients with type II diabetes mellitus treated with insulin therapy. Insulin therapy education should be offered to improve patients' beliefs about insulin therapy and enhance patients' ability to perform self‐management. Summary statement: What is already known about this topic? Psychological insulin resistance is a common psychological barrier to initiation and persistence with insulin therapy.Psychological insulin resistance causes poor glycaemic control and diabetes‐related complications.Psychological insulin resistance may negatively impact self‐management in patients with type II diabetes mellitus. What is the contribution of this paper? Positive self‐management was associated with insulin therapy injection by patient, fewer expectations regarding positive insulin‐related outcomes, no diabetes‐related complications, less fear of injection and self‐testing, no hypoglycaemia within the previous year, and younger age.Insulin therapy injection by patient and no diabetes‐related complications were the most common factors associated with overall self‐management and with each domain of self‐management in patients with type II diabetes mellitus treated with insulin therapy.Patients with poor self‐management had statistically significantly higher levels of overall psychological insulin resistance, fear of injections and self‐testing, expectations regarding positive insulin‐related outcomes, and stigmatization by insulin injections, compared to those with appropriate self‐management. What are the implications of this paper? Knowing in advance the factors associated with diabetes self‐management will allow healthcare professionals prevent psychological insulin resistance in patients with type II diabetes mellitus treated with insulin therapy.Healthcare professionals can design and provide patient‐centred diabetes education based on education level to enhance self‐management. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Parenting experiences are a great challenge but also a meaningful achievement for mothers diagnosed with schizophrenia (MDWSs).Most previous studies focused on the parenting experiences of Chinese mothers diagnosed with depression rather than those diagnosed with schizophrenia, who usually experience psychiatric symptoms. What this paper adds to existing knowledge?: Unlike in Western society, Chinese society is characterised by a family‐centred culture. This study insightfully explores MDWSs' parenting and family life experiences addressing their intrapersonal mindsets, interpersonal connections with family members across generations and extrapersonal roles such as traditional social expectations as a mother, wife and daughter‐in‐law.While Western studies have mainly focused on MDWSs' personal resilience, this study insightfully explored MDWSs' resilient dimensions including their personal, familial and cultural issues within the Chinese society. What are the implications for practice?: This study develops a comprehensive and professional understanding of the parenting experiences and family interactions of MDWSs who struggle to achieve their motherly role and re‐establish connections with intimate family members.The findings highlight the following important considerations when offering family‐based nursing cares: (1) assess power relationships, familial dynamics and cultural influences between MDWSs and their family members; (2) extend family members' involvement, such as parents‐in‐law, while offering psychoeducation to MDWSs and their family members. Introduction: In Chinese culture, raising the next generation is recognised as a crucial family matter involving intergenerational participation. Mothers diagnosed with schizophrenia (MDWSs) usually experience high stress due to psychiatric symptoms, different parenting values across generations and traditional expectations associated with motherly roles. MDWSs need urgent professional assistance. Aim: To explore MDWSs' parenting experiences and family life in Chinese cultural contexts. Method: In‐depth interviews were conducted with 20 MDWSs. Data were analysed using interpretative phenomenological analyses. Results: The superordinate theme was identified as 'You are not a qualified mother'. Three major themes were elicited: experiencing crises in parenting, family life and self‐stability; striving to be a good mother and wife under humiliation; and developing wisdom and courage to move forward. Discussion: A dehumanised attitude of family members in a paternalistic culture was found. While Western society focuses on personal resilience and family‐based nursing care for nuclear families, Chinese society intensively focuses on MDWSs' relationship with nuclear family members as well as extended family members such as parents‐in‐law. Implications for Practice: The results highlighted the significance of culturally sensitive nursing care for MDWSs and family‐centred psychoeducation that clarifies familial dynamics and improves effective communication between MDWSs and their family members. [ABSTRACT FROM AUTHOR]

Aims: To assess the effectiveness of an unsupervised home‐based pulmonary rehabilitation with self‐management program in patients with chronic obstructive pulmonary disease (COPD). Background: A few recent studies have shown that unsupervised home‐based pulmonary rehabilitation can improve the clinical outcome of patients with COPD. More studies are needed to prove its benefits. Design: This study used a quasi‐experimental design. Methods: Seventy‐two admitted COPD patients were assigned to experimental group or control group through purposeful sampling. Data were collected from March 2016 to November 2017 in the Thoracic Intensive Care Unit of a Medical Center in Taiwan. The Medical Research Council dyspnea scale, the COPD Self‐Efficacy Scale and the Clinical COPD Questionnaire were measured before education and at the first, second and third months after discharge. Results: The Medical Research Council dyspnea scale and COPD Self‐Efficacy Scale results in the experimental group were significantly improved compared with the control group in the third month after discharge. The Clinical COPD Questionnaire score continued to improve in both groups in the third month after discharge, and there was no difference between the two groups. Conclusion: A short‐term unsupervised home‐based pulmonary rehabilitation with self‐ management program had significant benefits for patients with COPD. The long‐term effects need to be confirmed. Summary statement: What is already known about this topic? The literature emphasizes the importance of alternative supervision of home‐based pulmonary rehabilitation rather than center‐based pulmonary rehabilitation for patients who find this inconvenient to access.Few studies have shown that unsupervised home‐based pulmonary rehabilitation can improve the clinical outcome of patients with chronic obstructive pulmonary disease (COPD). What this paper adds? This study demonstrates that a short‐term unsupervised home‐based pulmonary rehabilitation with self‐management program can improve dyspnea during physical activity, self‐care efficacy in certain activities and quality of life after discharge in patients with COPD. The implications of this paper: The findings of this study can be used as the basis for providing a short‐term unsupervised home‐based pulmonary rehabilitation with self‐management program for patients with COPD after discharge.We recommend that patients with COPD undergo unsupervised home‐based pulmonary rehabilitation with self‐management for 3 months after discharge, especially if regular hospital visits for this are not convenient.The effect of longer‐term unsupervised home‐based pulmonary rehabilitation can be further studied in the future. [ABSTRACT FROM AUTHOR]

Aim: Repeated occupational exposure and increased stress and fatigue levels contribute to a high risk of coronavirus disease 2019 (COVID‐19) infection among frontline nurses. This study aimed to explore the relationships among teamwork, work environment and resources, work–life balance, stress perception and burnout among nurses working at a dedicated infectious disease control hospital. Methods: The participants were 389 nurses at a dedicated infectious disease control hospital in Taipei City, Taiwan. This study adopted survey design with a questionnaire using the Safety Attitude Questionnaire. Results: The work–life balance among nurses at the dedicated hospital significantly mediated the effects of teamwork and work environment and resources on burnout. In addition, stress perception had interaction effects on work–life balance and burnout. Conclusion: This study's results provide important recommendations for managing teamwork, work environment and resources, work–life balance, stress perception and burnout prevention in nurses to help them better prepare and cope with emergencies. Findings can serve as a reference for developing relevant hospital management policies. Summary statement: What is known about the topic? Organizational changes, information scarcity and shortages of personal protective equipment were the primary factors driving uncertainty when the pandemic began.Work environments can significantly affect burnout, job satisfaction and perceived stress among nurses.Teamwork is an important factor affecting nurse burnout. What this paper adds? Repeated occupational exposure and increased stress and fatigue levels contribute to a high risk of COVID‐19 infection among frontline nurses.Healthcare systems should emphasize the issues of teamwork, work environment and resources and work–life balance among nurses to help them prepare for and cope with emergencies.Nurse supervisors should constantly monitor for burnout among subordinates and eliminate their stressors. The implications of this paper: When teaching nursing management skills during an epidemic, it is essential to focus on strengthening the nursing supervisors' communication role, particularly during an outbreak.To reduce nurse burnout, key leadership and culture aspects in the work environment include prioritizing infection control measures, providing social support, encouraging strong multidisciplinary teamwork, ensuring adequate resources are available and receiving support from hospital superiors and the government. By addressing these factors, healthcare organizations can create a positive work environment that supports nurses' well‐being and promotes better patient outcomes.To manage nurses in the postpandemic era, healthcare organizations can implement routine training programs, new models of cross‐teamwork, emergency response plans, effective systematic monitoring and mental health intervention programs. These strategies can help promote collaboration, support nurses' mental health and ensure preparedness for future crises. Healthcare organizations can create a more effective healthcare system by adopting these measures. [ABSTRACT FROM AUTHOR]

What is Known on the Subject?: People living with schizophrenia have reduced physical function and are more likely to experience loneliness than those without condition.Low physical function is associated with greater loneliness in people with psychosis. However, it is unclear whether social isolation and loneliness contribute to impaired physical function in this population.Loneliness is linked to an increased risk of physical function impairment among older individuals, but research on patients living with schizophrenia is limited. What This Paper Adds to Existing Knowledge?: This study is the first to evaluate the longitudinal association of social isolation and loneliness with physical function among inpatients living with schizophrenia.It showed that more than one third of the participants experienced a decline in physical function over a 2‐year period.Loneliness, rather than social isolation, was associated with an increase in physical function impairment over 2 years among inpatients living with schizophrenia. What are the Implications for Practice?: Healthcare professionals should recognize loneliness as a potential risk factor for impaired physical function among inpatients diagnosed with schizophrenia.It is recommended that people living with schizophrenia are assessed for loneliness and that interventions are offered to alleviate their feelings of loneliness.Implementing interventions to reduce loneliness may help improve physical function and overall quality of life for individuals living with schizophrenia. Introduction: Patients living with schizophrenia often experience low physical function, which is associated with negative health outcomes. Therefore, investigating the risk factors for physical function is crucial in this population. Aim: This study examined the longitudinal association of social isolation and loneliness with physical function among inpatients living with schizophrenia. Methods: Physical function was assessed using measures of activities daily living (ADL), instrumental activities daily living (IADL) and the combination scores of ADL/IADL. Social isolation was indexed with five types of social connection and loneliness was measured using UCLA Loneliness Scale. Results: Social isolation was not associated with the measures of physical function over 2 years. Loneliness exhibited an association with IADL and ADL/IADL at follow‐up, after adjustment for baseline levels of the outcomes. These associations remained when both social isolation and loneliness were simultaneously entered into the model. Discussion: Loneliness, rather than social isolation, was associated with increased physical function impairment over 2 years among inpatients living with schizophrenia. Implications for Practice: Healthcare professionals should consider loneliness as a potential risk factor for impaired physical function. It would be beneficial to assess patients for loneliness and implement interventions to reduce feelings of loneliness. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: People diagnosed with serious mental illness have a high risk of diabetes and are more likely to develop type 2 diabetes at ages below 60 years.Effective diabetes self‐care behaviours among people diagnosed with serious mental illness can improve glycaemic control and reduce vascular complications.Few studies have investigated diabetes self‐care behaviours and their associations with health literacy and self‐efficacy in people diagnosed with serious mental illness. What the paper adds to existing knowledge?: Diabetes self‐care behaviours in people diagnosed with serious mental illness were suboptimal; the least frequently performed self‐care activities were self‐monitoring of blood glucose.Factors associated with diabetes self‐care behaviours are gender, age, communicative and critical health literacy and self‐efficacy.Self‐efficacy is the strongest predictor of self‐care behaviours among people diagnosed with comorbid serious mental illness and type 2 diabetes. What are the implications of practice?: Mental health nurses should assess diabetes‐specific health literacy of people diagnosed with serious mental illness to ensure that they possess the knowledge and skills related to diabetes self‐care.When treating young people and those with newly diagnosed type 2 diabetes, nurses should incorporate strategies to minimise their perceptions of diabetes‐related distress and increase their confidence in managing comorbid diabetes. Introduction: People diagnosed with serious mental illness (SMI) experience greater challenges in managing their type 2 diabetes mellitus (T2DM) than do those diagnosed with T2DM alone. Aim: This study investigated diabetes self‐care activities and the factors associated with these activities in people diagnosed with SMI in a hospital setting. Methods: A cross‐sectional correlational study was conducted among 126 people diagnosed with comorbid SMI and T2DM in Taipei, Taiwan, between October 2020 and April 2021. Data were collected using self‐report questionnaires and a chart review. Three‐step hierarchical multiple regression analysis was used to identify factors associated with diabetes self‐care behaviours. Results: Diabetes self‐care behaviours in people diagnosed with SMI were suboptimal overall. Hierarchical multiple regression analyses revealed that age (β = 0.18, p =.037) and self‐efficacy (β = 0.27, p =.004) significantly associated with diabetes self‐care behaviours. Discussion: Self‐efficacy is the strongest predictor of self‐care behaviours among people diagnosed with comorbid SMI and T2DM. Implications for Practice: Mental health professionals should focus on enhancing confidence in managing comorbid diabetes in people diagnosed with comorbid SMI, especially young people and those with newly diagnosed T2DM. [ABSTRACT FROM AUTHOR]

Mu P-F. International Journal of Nursing Practice 2010; : 645-646 [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Because the definition of spirituality is complex and has cultural and individual dimensions, it is important to be receptive to individual differences in the perception of spirituality during clinical practice of mental health nurses.Although enhancing spiritual care is beneficial to patients diagnosed with mental illnesses, the extrinsic (e.g., education) and intrinsic factors that would affect nurses' attitudes towards spiritual care have not been investigated.Notwithstanding the known impact of certain intrinsic factors (e.g., personality‐related) of mental health nurses on their coping strategies as well as their emotional and mental health, the link to their spiritual care attitudes has received little attention. What this paper adds to existing knowledge?: This paper is the first to identify the beneficial impacts of extrinsic factors including postgraduate education, working experience, participation in palliative care education programmes, and spiritual care experience on spiritual care attitudes among mental health nurses.Certain intrinsic factors, including those personality‐related such as "Extraversion," "Openness/Intellect," "Conscientiousness," and "Agreeableness," were also associated with higher awareness of providing spiritual care among mental health nurses. What are the implications for practice?: The finding of an association of certain intrinsic factors with more positive attitudes towards spiritual care could encourage further studies to explore possible links between these factors and attitudes of spiritual care.Those less aware of the patients' spiritual needs may benefit through participating in relevant education and on‐the‐job training programmes that involves actual practice and collaboration in a multidisciplinary team. Introduction: Although enhancing spiritual care can facilitate the communication of mental health nurses with patients diagnosed with mental illnesses, extrinsic and intrinsic factors that may influence their spiritual care attitudes remain unclear. Aim: To conduct a questionnaire‐based survey on mental health nurses from eight hospitals. Method: A total of 239 psychiatric nurses were assessed based on (1) "big‐five Mini‐Markers" questionnaire and (2) spiritual care attitudes scale on three components (i.e., core values, growth, and nursing) to investigate the associations of spiritual care attitudes with social/occupational characteristics and personality. Results: A positive attitude was significantly associated with working experience, higher educational level, previous participation in palliative care education programmes, spiritual care experience, and personality factors including "Extraversion," "Openness/Intellect," "Conscientiousness," and "Agreeableness." Discussion: Despite demonstrating impacts of intrinsic factors (e.g., personality) on mental health nurses' spiritual care attitudes, other modifiable extrinsic factors (e.g., education) were important in enhancing their awareness towards spiritual care. Implications for Practice: Our findings encourage further studies to explore possible links between intrinsic factors and attitudes of mental health nurses towards spiritual care as well as suggest benefits of continuing education and on‐the‐job training that involves actual practice and collaboration in a multidisciplinary team to provide spiritual care. [ABSTRACT FROM AUTHOR]

Aim: This quasi‐experimental study aimed to explore effects of walking exercise on disease activity, sleep quality, and quality of life among individuals with systemic lupus erythematosus. Methods: After recruiting people with systemic lupus erythematosus from a hospital in Taiwan between October 2020 and June 2021, participants were free to opt to receive one walking exercise programme plus standard care for 3 months or to membership of a control group receiving routine care. Primary outcomes included Systemic Lupus Erythematosus Disease Activity Score, the Pittsburgh Sleep Quality Scale, and a quality‐of‐life scale for patients with systemic lupus erythematosus, namely, LupusQoL. These scales were administered first, at baseline and later, within 1 week following completion of the intervention. Between‐group effects were compared using generalized estimating equations with adjustment for baseline variables. Results: The experimental and control groups each included 40 participants. Multivariate analysis indicated that adding the walking exercise programme into routine care elevated sleep quality and LupusQoL (the latter in the subscales of physical health, planning, and intimate relationships), except for disease activity. Conclusion: Findings of this study supported the addition of walking exercise as part of routine care for people with systemic lupus erythematosus and may be a reference in the provision of adequate care for these patients. Summary statements: What is already known about this topic? Systemic lupus erythematosus is a lifelong autoimmune disease that affects any organs throughout the body, thus insidiously causing negative impacts on the affected patients.Today, use of exercise programmes such as walking exercise has been studied as a remedy for many medical conditions, but its effectiveness in minimizing the symptoms of distress among people with systemic lupus erythematosus is unknown. What this study adds? Participants with systemic lupus erythematosus who opt to receive the walking exercise programme for 3 months in addition to routine care experience improved sleep quality and quality of life compared with those receiving routine care alone. The implications of this paper: In accordance with the belief that "an ounce of prevention is worth a pound of cure," early implementation of an exercise programme should be considered in addition to routine care for patients with systemic lupus erythematosus.Evidence from this research could provide empirically informed and robust data for healthcare policymakers and in turn might help to reduce the incidence of morbidity among patients with systemic lupus erythematosus. [ABSTRACT FROM AUTHOR]

Aim: The aim of this work is to explore the effectiveness of a mobile app to support oral mucositis care to improve the nutritional status and reduce the occurrence of oral mucositis of patients with head and neck cancer undergoing concurrent chemoradiotherapy. Background: Concurrent chemoradiotherapy is the optimal treatment for head and neck cancer, but oral mucositis and malnutrition are common complications. Design Quasi‐experimental study using a pre‐post design was used in this work. Method: Participants were recruited from a major regional hospital in Taiwan from July 2018 to July 2020. There were 32 participants in each group: the mobile app group (Intervention Group) or routine care (Control Group). The primary outcome measure was Patient‐Generated Subjective Global Assessment (PG‐SGA). We also collected data on grade of oral mucositis, painNnumeric Rating Scale (NRS), weight loss, haemoglobin (Hb), albumin and quality of life (QoL). Result: The PG‐SGA score was significantly lower in the intervention than the control group at all three time points. Hb and albumin decreased less significantly in the intervention than the control group after 2 months. The oral mucositis grade was significantly less severe in the intervention than the control group at all three time points; for the NRS, at T2 and T3. Conclusion: Using the mobile app effectively improved nutritional status, alleviated the side effects, and improved the QoL of head and neck cancer patients with concurrent chemoradiotherapy. Summary statement: What is already known about this topic? Oral mucositis leads to malnutrition and hinders treatment in cancer patients.An oral health care mobile application ('app') is an easy‐to‐access health care resource What this paper adds? A mobile app improved oral mucositis, pain sensation score, nutrition status and QoL for patients with head and neck cancer undergoing concurrent chemoradiotherapy.A mobile app could increase the accessibility of a large amount of care information to patients. The implications of this paper: A mobile app could be used to establish an efficient communication platform; to provide feedback for patient self‐management to alleviate the feeling of suffering, and could enhance patients' competency to manage their oral mucositis. [ABSTRACT FROM AUTHOR]

Aim: To explore the significance of culture, professional support in the community, social interactions and intrapersonal determinants of adults' preferences for life‐sustaining treatments and palliative care. Methods: A cross‐sectional design with a Social Ecological Model was used. Between 1 October 2012 and 31 December 2012, 474 adults aged ≥20 years living in a city of Southern Taiwan completed the survey. Data were analysed using hierarchical multiple regression. Results: The life‐sustaining measures model was significant with 15.3% (p < 0.0001) of the variance in the Modified Emmanuel Medical Directives being explained by variables of death of self and healthcare services' support. The palliative care model was significant with 18% (p < 0.0001) of the variance in the Modified Hospice Attitude Scale being explained by variables of palliative care knowledge, death of self and social interactions. However, cultural value adherence did not predict adults' preferences for life‐sustaining measures and community resources support did not predict palliative care preference. Conclusions: Findings enhance our understanding of the significance of different societal levels on adults' preferences for end‐of‐life care. Palliative care knowledge, fear of death, healthcare services' support and social interactions are essential factors that need to be taken into consideration when it comes to discussion about life‐sustaining treatments and palliative care. Summary statement: What is already known about this topic? End‐of‐life (EOL) preferences can be shaped not just by knowledge, values and individuals' attitudes but rather a host of social influences.Few studies with theoretical frameworks or models in the literature are available to provide a comprehensive understanding of factors contributing to responses at the EOL. What this paper adds? The findings advance the knowledge of the influence of social interactions, healthcare services' support, palliative care understanding and fear of death on adults' preferences for life‐sustaining treatments and palliative care.The identified relationships in the context of life‐sustaining treatments and palliative care provide practical guidelines, which can help to inform appropriate supportive interventions for EOL care planning. The implications of this paper: Healthcare services that provide a mediating structure where a person belongs should focus on enhancing community resources regarding EOL healthcare planning, knowledge about palliative care and reinforcing life and death education.The social support network and emotional ties with a person's significant others should also be taken into consideration to facilitate EOL healthcare planning and to promote good quality of life at EOL. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Individuals diagnosed with substance use disorders may perceive stigma and suffer from mental health problems.Perceived stigma is related to poor mental health among individuals diagnosed with substance use disorders.The social support deterioration deterrence model proposes that stressors (e.g. perceived stigma) negatively affect mental health via reduced perceived social support. To the best of the present authors' knowledge, the model has never been tested in the context of perceived stigma among individuals diagnosed with substance use disorders. What the paper adds to existing knowledge?: The paper used structural equation modelling to show that the social support deterioration deterrence model could explain the relationship between perceived stigma and depression among individuals diagnosed with substance use disorders.Perceived support from family and perceived support from friends are mediators in the association between perceived stigma and depression among individuals diagnosed with substance use disorders. What are the implications for practice?: Psychosocial interventions to increase perceived support from family and friends would be helpful in addressing perceived stigma effects on mental health. Introduction: Although the relationship between perceived stigma and mental health outcomes is documented in the existing literature, very few studies have investigated the mechanism linking perceived stigma and mental health outcomes among individuals diagnosed with substance use disorders. To the best of the present authors' knowledge, the social support deterioration deterrence model has never been tested in the context of perceived stigma among individuals diagnosed with substance use disorders. Aim/Question: Guided by the social support deterioration deterrence model, the present study investigated the mediating role of perceived support from three types of social network members (i.e. significant others, family members, and friends) in the association between perceived stigma and depression in individuals diagnosed with substance use disorders. Method: The study employed a cross‐sectional survey design comprising 300 participants diagnosed with substance use disorders in Taiwan. Results: Results of a structural equation modelling analysis indicated that perceived stigma was significantly associated with depression. The relationship between perceived stigma and depression was partially mediated by perceived family support and perceived friend support. Discussion: Consistent with the prediction of the social support deterioration deterrence model, the negative effect of perceived stigma on depression for individuals diagnosed with substance use disorders is through the mediating effect of social support. Implications for practices: Based on the present study's results, psychosocial interventions to increase perceived support from family and friends would be helpful in addressing negative effects of perceived stigma on mental health among individuals diagnosed with substance use disorders. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to evaluate the effects of an intervention involving earplug placement during nocturnal sleep in non‐ventilated intensive care unit patients. Methods: A randomized controlled trial was conducted in 107 adult patients between January 2017 and December 2018. Participants in the intervention group (n = 55) slept with earplugs between 10 pm and 7 am on the second night of their intensive care unit stay. In the control group, participants slept with no earplugs. Outcome parameters included sleep, urinary 6‐sulfatoxymelatonin levels, relaxation responses measured using the Richards–Campbell Sleep Questionnaire, liquid chromatography‐mass spectrometry results and vital signs. Urine was collected between 10 pm and 7 am. Results: Overall, 28.03% of participants showed virtually no 6‐sulfatoxymelatonin excretion in the collected urine. Outcome parameters were not significantly different between the groups, indicating that wearing earplugs alone did not affect sleep quality, urinary 6‐sulfatoxymelatonin and vital signs. Conclusions: The effects of using earplugs alone on sleep quality, urinary 6‐sulfatoxymelatonin and relaxation responses in patients admitted to the intensive care unit were inconclusive. Additional research is required before earplugs alone can be widely used to improve sleep quality. Summary statement: What is already known about this topic? Excessive noise exposure causes numerous adverse health outcomes, which not only contributes to noise‐induced stress and hearing loss but also affect patients' sleep.Wearing earplugs might be a practical nonpharmacological strategy used by nurses to improve ICU patients' quality of sleep. What this paper adds? Wearing earplugs alone did not affect patients' urinary 6‐sulfatoxymelatonin level in the ICU.Wearing earplugs alone did not increase patients' subjective sleep quality in the ICU. The implications of this paper: The findings of the present study on the effects of using earplugs alone on sleep quality, urinary MT6s level and vital signs in ICU patients extend the literature, particularly with respect to the limited research on using earplugs alone.Prolonged effect of earplug intervention on sleep quality is unknown. A longer intervention may help elicit any difference in sleep quality. [ABSTRACT FROM AUTHOR]

Background: Weight control is a widespread phenomenon among young adults, especially in women. Aim: This study aimed to determine the prediction factors of weight control intention in a young Chinese sample. Methods: A cross‐sectional study was conducted with 963 (276 male and 687 female; mean age 21.8 ± 4.4 years) adult students from a university in Taiwan. The data were collected from October 2016 to January 2017. Body mass index (BMI), the Chinese version of the Weight Self‐Stigma Questionnaire, the Body Areas Satisfaction Scale and the Media Influence Questionnaire were used as data collection instruments. Results: The participants with weight control intention had higher BMI, weight self‐stigma and media influence scores and lower body satisfaction scores than those without the intention. Female sex, BMI, weight self‐stigma, body satisfaction and media influence were significant predictors of weight control intention for all participants. Conclusion: Before conducting weight loss programmes, the perception of weight self‐stigma and the influence of social media on body image should be confirmed, particularly in women with intention to lose weight. SUMMARY STATEMENT: What is already known about this topic? Weight loss is a popular issue in the health field, owing to the effect of obesity on multiple aspects of life.Females have a higher intention than males to control their weight.People with obesity are more likely to internalize weight stigma from public attitudes and influences and are more dissatisfied than others with their body appearance. What this paper adds? Females have a higher perception of weight self‐stigma and are more dissatisfied than males with their body and the influence of social media on body image.The Chinese young adults with weight control intention had a higher body mass index, weight self‐stigma, body dissatisfaction and media influence than adults without weight control intention.Weight self‐stigma, body dissatisfaction, influence of mass media and body mass index may play synergistic roles in triggering weight control intention in Chinese young adults, particularly in women. The implications of this paper Nurses should pay attention to young adult females with normal BMI and intention to lose weight.Nurses and other healthcare professionals who conduct weight loss programmes should confirm with young adults, particularly with women, their perception of weight self‐stigma, body dissatisfaction and social media influence.Healthy and non‐prejudiced advice should be included in weight loss consultation. [ABSTRACT FROM AUTHOR]

Purpose During the survival period of breast cancer patients, an understanding of and ability to implement health knowledge may be important for survivors' physical and mental quality of life (QOL). This study aims to investigate the health literacy and predictors of QOL for survivors of breast cancer. Method: A cross‐sectional design was used, and convenience sampling was performed. Eighty‐six survivors with breast cancer were recruited from a general hospital in northern Taiwan from February to August 2017. Taiwan's health literacy scale and SF‐12 questionnaire were used for data collection. Results: The average health literacy score was 3.28. Education level and breast cancer stage were significant factors for the health literacy of survivors with breast cancer. Age, body mass index and health literacy were predictors of physical health‐related QOL. Health literacy also was a predictor of mental health‐related QOL. Conclusion: The results provide the factors associated health literacy as well as health‐related QOL. Nurses should understand the health literacy among survivors with breast cancer and improve health literacy to optimize their quality of life. SUMMARY STATEMENT: What is already known about this topic? Individuals with lower health literacy generally had fewer communications with medical personnel regarding their own risk of disease.Individuals with higher health literacy tend to have better social‐related QOL. What this paper adds? Survivors with early‐stage breast cancer tended to be younger (aged 60 years or less) had normal body mass index, continued working, had no other illnesses and better physical health.Survivors with normal body mass index who had not received chemotherapy had better mental health.Health literacy was the main predictor and accounted for 20% of the variance in physical health and for 18.8% of the variance in mental health. Implications of this paper: Nurses should understand the importance of health literacy, which is a key factor to improve QOL for survivors with breast cancer.Nurses should develop individualized care plans for survivors based on different levels of health literacy to improve the efficiency of the nurse–patient dialogue. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Intellectual disability (ID) involves problems with general mental abilities and affects intellectual functioning and adaptive functioning.People diagnosed with ID present higher levels of functional disability, which means they usually have difficulty or the inability to independently perform basic activities of daily living.Little to no attention has been paid to the issues of the mental health of people diagnosed with ID. Specifically, healthcare workers' experiences of caring for patients with IDPD have been neglected. What does the paper add to existing knowledge?: The findings increase our understanding and partially address the knowledge gap regarding the situations and circumstances faced by healthcare workers in caring for patients diagnosed with intellectual disability co‐occurrent with psychiatric disorders (IDPD).In cases of insufficient staffing, healthcare workers may be forced to ignore the individualized needs of patients so as to facilitate management.Healthcare workers may also feel frustrated by not being able to anticipate or deal with patients' unexpected problem behaviours or accidents. They adapt by adjusting their expectations of their patients. What are the implications for practice?: Healthcare administrators need to understand the difficulties faced by staff in caring for patients diagnosed with IDPD, arrange appropriate in‐service education to increase the healthcare workers' knowledge and skills in caring for patients diagnosed with IDPD, and create warm and supportive environments for them.The government department responsible for the management of ID patient care institutions should be able to regularly monitor the overall staffing and quality of care in these institutions. Introduction: When intellectual disability co‐occurs diagnosed with psychiatric disorders (IDPD), the impact of the burden of illness on the affected individuals, their caregivers, their family and friends, and the services that provide for them is particularly high. The issues of the mental health of people diagnosed with ID have received little, if any, attention. One specific area of neglect is healthcare workers' experiences of caring for patients diagnosed with IDPD. Aim: The aim of this study was to understand healthcare workers' experiences of caring for patients diagnosed with IDPD. Methods: A qualitative descriptive research approach and semi‐structured interviews were used in this study. We interviewed 15 participants who had experience in caring for patients diagnosed with a dual diagnosis of IDPD. Findings: Four themes were found, as follows: (1) Negative impacts of insufficient staffing on the quality of care, (2) Constantly worrying about harmful incidents, (3) Discovering effective ways to provide individual patient care and (4) Adjusting expectations and attitudes towards patients. Participants' experiences revealed that they perceived the importance and effectiveness of providing individualized care for IDPD patients. However, when staffing is insufficient, they may be forced to ignore the individualized needs of patients so as to facilitate management. They may also feel frustrated by not being able to anticipate or deal with patients' unexpected problem behaviours or accidents. In addition, they adapt by adjusting their expectations of the patients. Discussion: The findings from this research help to fill the knowledge gap in our understanding of healthcare workers' experiences of and their perspectives on caring for patients diagnosed with IDPD. Implications for Practice: Healthcare administrators need to understand the difficulties faced by staff in caring for patients diagnosed with IDPD, arrange appropriate in‐service education to increase the healthcare workers' knowledge and skills in caring for patients diagnosed with IDPD, and create warm and supportive environments for them. The government department overseeing the management of institutions providing ID patient care should be empowered to conduct regular monitoring of the overall staffing and quality of care in such institutions. [ABSTRACT FROM AUTHOR]

Aims: This study was to explore the student nurses' bullying, social support and their health status during clinical practicum programmes and the predictors of health status among student nurses during clinical practicum programmes. Methods: A cross‐sectional design with structured questionnaires was used, recruiting 200 student nurses in a 5‐year junior college programme in south Taiwan. Results: The significant predictors of nursing students' health status during clinical practicum programmes were 'whether experiencing bullying situations during clinical practicum' and 'low social support'. Conclusion: In order to prevent bullying during clinical practicum, encouraging nursing students to report all the clinical practicum bullying incidents, providing counselling to nursing students and arranging clinical practicum bullying prevention courses to students were important. Moreover, providing instructors and nursing staff with teaching, communication and feedback skills might help nursing students prevent bullying incidents during clinical practicum programmes. A longitudinal study design was suggested for the future study in order to assess the cause–effect relationship of the bullying and social support on health among students during clinical practicum SUMMARY STATEMENT: What is already known about this topic? Nurses' exposure to workplace bullying will result in their health problems. What this paper adds? Student nurses' exposure to bullying during clinical practicum and low social support might impact on their health status. The implications of this paper: Establishing supportive practicum environments is important to help nursing students prevent bullying incidents during clinical practicum programmes.Nurse educators might include the results of this study into the contents of the educational programmes to increase students' knowledge on student nurses' bullying and its risks. [ABSTRACT FROM AUTHOR]

Aims: This study aims to explore nurses' demographic data, assertiveness, psychosocial work condition, and workplace bullying, and find the predictors of workplace bullying. Methods: This study adopted a cross‐sectional design. A stratified sample comprising 241 nurses from a regi onal teaching hospitals in Taiwan was selected from the 10th to the 23rd September, 2018. Data were analysed by using the SPSS Statistics 17.0. Descriptive statistics (frequency, percentage, mean, and standard deviation), one‐way Anova, t test, Pearson's correlation, and multiple linear regressions were used. Results: The results showed that the participants with "past bullying experience," "lower self‐assertiveness," "higher work psychological demands," "lower workplace justice," "lower labour participation," and "lower overall social support" are more likely to experience workplace bullying. Conclusions: Hospital managers should pay attention to the problem of nursing workplace bullying. First of all, hospital managers should encourage curriculum on nursing workplace bullying and incorporate nursing workplace bullying prevention training courses in curriculum planning. SUMMARY STATEMENT: What is already known about this topic? Workplace bullying can cause physical and psychological disorders in nurses and affect patients' safety.Understanding the affecting factors related to workplace bullying may be beneficial for decreasing the incidence of workplace bullying in nurses. What this paper adds? Past bullying experience, self‐assertiveness, work psychological demands, workplace justice, labour participation, and overall social support were predictors of workplace bullying. The implications of this paper: The establishment of a friendly workplace environment is important, such as, building up justice policies and involving nurses' opinions whilst setting up all policies.Nurse managers may provide educational programs to nurses in order to improve their knowledge and skills to deal with workplace bullying. [ABSTRACT FROM AUTHOR]

Aim: The present study aimed to evaluate the effectiveness of individualized exercise counselling in changing exercise behaviour and relieving pregnancy‐related distress symptoms in pregnant women. Methods: A quasi‐experimental design and convenience sampling technique were used. Participants were recruited from the prenatal outpatient departments of medical centre hospitals in Taipei, Taiwan. The experimental group (n = 52) received face‐to‐face exercise counselling followed by 8 weeks of exercise sessions in their homes. The control group (n = 49) received no exercise counselling. Pregnancy‐related distress symptoms were assessed before and after 8 weeks in both groups. Results: The after‐counselling scores of total (t = 2.46, P < 0.05) and physical (t = 3.18, P < 0.01) distress symptoms were significantly lower than the before‐counselling scores in the experimental group. The total, physical and psychological distress scores significantly differed between groups and before and after counselling. The adjusted R2 values for total, physical and psychological distress symptoms ranged from 0.59 to 0.70. Participants' exercise habits increased from prepregnancy (19.2%) to after counselling (71.2%). Conclusion: Exercise counselling may effectively increase exercise habits and reduce pregnancy‐related distress symptoms among pregnant women. Women with higher pretest symptom distress scores also had higher posttest symptom distress scores. Based on our outcomes, health care providers should routinely provide exercise counselling to pregnant women. SUMMARY STATEMENT: What is already known about this topic? Previous studies have found that exercise can be very beneficial for pregnant women by relieving pregnancy‐related distress.Women also commonly reported that advice regarding exercise during pregnancy is generally vague (not individualized), constantly changing and often limited to a continuation of their previous routine or simply increased walking.Studies on the effectiveness of individual face‐to‐face exercise counselling for pregnant women for relieving their pregnancy‐related distress symptoms are limited. What this paper adds? Individual face‐to‐face exercise counselling can reduce pregnancy‐related symptoms in pregnant women.The pretest score was a significant factor that influenced the degree of relief from symptom distress. The implications of this paper: This study could help health care providers to provide pregnant women with exercise counselling as part of their routine prenatal care to relieve pregnancy‐related distress. [ABSTRACT FROM AUTHOR]

Aim: Recurrent miscarriage is considered a major life event. The main purposes of this study were to compare the differences in stress, anxiety, social support, sleep quality and depressive symptoms in couples experiencing recurrent miscarriage compared to peers who experience full‐term normal childbirth in southern Taiwan. Methods: Convenience sampling and snowball sampling were used respectively to recruit 78 couples with and 80 couples without recurrent miscarriage from October 2014 to July 2015. Five structured questionnaires including Perceived Stress Scale, State‐ Anxiety Inventory, Interpersonal Support Evaluation List, Pittsburgh Sleep Quality Index and Edinburgh Depression Scale were administered. Results: Women who experienced recurrent miscarriage perceived significantly higher levels of stress, anxiety and depressive symptoms than their husbands. Women in the recurrent miscarriage group reported significantly greater depressive symptoms than women of the other group. A stepwise multiple regression analysis indicated key predictors of depressive symptoms among women of childbearing age, accounting for 62.9% of the variance, were anxiety, stress, social support and history of recurrent miscarriage. Conclusion: Women with recurrent miscarriage suffer mild to moderate depressive symptoms and a greater incidence of depression than their peers who experienced normal childbirth. Health professionals can use the knowledge gained from these findings to evaluate women with recurrent miscarriage for stress, anxiety and depressive symptoms and develop supportive interventions. SUMMARY STATEMENT: What is already known about this topic? Recurrent miscarriage is considered a major life event and, for some, a failure to fulfil a core responsibility for the family lineage.Research about the differences between genders in both the type and degree of emotional response to a miscarriage is limited. What this paper adds? Women with recurrent miscarriage suffer mild to moderate depressive symptoms and a greater incidence of depression than women without recurrent miscarriage.The key predictors of depressive symptoms among women of childbearing age were anxiety, stress, social support and history of recurrent miscarriage, accounting for 62.9% of the variance. The implications of this paper: This study highlights the need to increase healthcare professionals' awareness of the importance of evaluating stress, anxiety and depressive symptoms in women with recurrent miscarriage.It is recommended that future studies develop and test supportive care protocols for couples experiencing recurrent miscarriage. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: The meaning in life consists of an individual's values, experiences, goals and beliefs. It has been shown to be negatively associated with depression, hopelessness and suicidal ideation.Depression and hopelessness are related to increased suicidal ideation. Meaning in life has been shown to be a protective factor against depression, hopelessness and suicidal ideation. What the paper adds to existing knowledge: A path model was developed to clarify the associations among meaning in life, depression, hopelessness and suicidal ideation. For clarity, the outcomes were depression and suicidal ideation, the independent variable was hopelessness, and the mediator was meaning in life. Hopelessness had a direct association with meaning in life, and meaning in life had a direct association with depression, supporting the mediating effect of meaning in life from hopelessness to depression.Meaning in life had the strongest association with depression, and depression had the strongest association with suicidal ideation. Meaning in life did not have a significant direct association with suicidal ideation; it did have an indirect association with suicidal ideation through depression. This study estimated that one‐point increase in meaning in life score was associated with 0.47‐point decrease in depression score and 0.13‐point decrease in suicidal ideation score, respectively. What are the implications for practice: Logotherapy is a meaning‐centred therapy to find meaning in life. This study reveals that increased levels of meaning in life are associated with decreasing degrees of depression. Mental health nurses could help patients to find meaning in life by logotherapy and thus associated with reductions in depression.Mental health nurses could help patients to find hope by exploring meaning in life and promoting positive attitudes towards life from meaningless life to meaningful life, there is a reduction in depression, which in turn reduces suicidal ideation indirectly. Introduction: Meaning in life can be good protective factor against depression, hopelessness and suicidal ideation. Aim: To analyse the mediating effect of meaning in life on the associations among hopelessness, depression and suicidal ideation. Method: A cross‐sectional study was conducted among 90 patients diagnosed with depression. A structural equation modelling approach was applied for this path analysis to examine the mediating effect of meaning in life on the association among hopelessness, depression and suicidal ideation. Results: The results showed that meaning in life mediated the association between hopelessness and depression. Hopelessness had a direct positive association with depression (β = 0.23, p <.03), and meaning in life had a direct negative association with depression (β = −0.51, p <.01) and indirect association with suicidal ideation through depression; this indirect association was −0.21 (p <.01). Discussion: Meaning in life revealed strong mediating association with the relationship between hopelessness and depression. By reducing the level of depression, meaning in life demonstrated its mediator association with suicidal ideation. Implications for Practice: Logotherapy is a meaning‐centred therapy to find meaning in life. Mental health nurses could help patients to manage their depression through logotherapy, thus leading to reductions in suicidal ideation. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Sexual minority individuals are more likely to experience depressive disorders than heterosexual individuals.Factors associated with depressive symptoms among sexual minority individuals have been explored and examined; however, there is a limited evidence to understand the factors among sexual minority women in non‐western countries. What the paper adds to existing knowledge?: To the best our knowledge, this is the first study examining internalized homophobia, self‐esteem, social support and depressive symptoms among sexual minority women in Taiwan.Sexual minority women at risk of having depressive symptoms had a higher level of internalized homophobia, lower self‐esteem and fewer support from partners, friends, and families.Specifically, being single, being a student and having a higher personal income increased the risk of having depressive symptoms among sexual minority women. What are the implications for practice?: Mental health practitioners and nurses should be aware of and assess sexual minority women's level of internalized homophobia, self‐esteem, and received social support to reduce the risk of depressive symptoms and thus help prevent suicidal ideation.LGBT sex education and government involvement are essential to buffer the negative influences of a homophobic society on the mental health of sexual minority women. Introduction: Sexual minority women are more likely to report depressive symptoms than sexual minority men. However, there is a lack of evidence to understand factors associated with depressive symptoms among sexual minority women in non‐western countries. Aim: This study examined internalized homophobia, self‐esteem, social support and depressive symptoms among Taiwanese sexual minority women. Method: A total of 581 Taiwanese sexual minority women (Age range 20–48 years old, Mean 26.96, SD 5.718) completed an online survey. Results: Taiwanese sexual minority women at risk of having depressive symptoms had a higher level of internalized homophobia and lower self‐esteem. Perceived support from participants' partners, friends and families was related to lower risk of depressive symptoms. Being single, being a student and having a higher personal income were also found to increase the risk of having depressive symptoms among the women. Discussion: Mental health interventions are essential for sexual minority women with internalized homophobia and low self‐esteem. Implications for Practice: Mental health practitioners and nurses should be aware of and assess the concerns that sexual minority women have regarding healthcare services and provide culturally competent care to reduce the risk of depressive symptoms. [ABSTRACT FROM AUTHOR]

Aim: To obtain an in‐depth understanding of the lived experiences, values, and beliefs of Taiwanese women with breast cancer who withdrew from cancer treatment. Background: Fear of side effects, negative experiences and personal beliefs were identified as reasons for withdrawing from cancer treatments. Body–mind consciousness and body autonomy play a crucial role in cancer treatment decisions. Design: Descriptive phenomenological approach. Methods: We conducted semi‐structured, face‐to‐face and in‐depth interviews with 16 women diagnosed with breast cancer. Participants were purposefully selected from the Cancer Registry database. Employing a phenomenological approach, our aim was to explore the lived experiences of these individuals. Data analysis followed Giorgi's five‐step process. To ensure a comprehensive report the COREQ checklist was applied. Findings: 'The Determination to Preserve Me' is the essence of treatment withdrawal, identified by three themes and seven sub‐themes. 'Raising Body‐Mind Consciousness' was generated using body autonomy and preventing repeated psychological trauma from the participant's view. Their lifestyles, maintaining the family role, and returning to a normal trajectory help develop 'Maintaining Stability for Being a Patient and a Family Carer'. 'Self‐Defending Against the Body Harm' was generated by concerns about maintaining health and preventing harm. Conclusion: Women's behaviours became transformed by suffering. Actions were influenced by physical and psychological distress, misconceptions about treatments, and appearance changes by self‐determination through self‐protection. Relevance to clinical practice: Healthcare professionals should respect women's autonomy and work collaboratively to ensure their decision‐making with accurate information and awareness of the potential risks and benefits of treatment withdrawal need to concern. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To develop a Chinese version of a chronic wound health‐related quality of life (QoL) instrument and to examine the psychometric properties of this instrument. Background: Existing QoL instruments are not tailored to the linguistic and cultural characteristics of Chinese‐speaking patients; a version addressing this gap will increase clinical understanding of their healthcare experience and may help guide chronic wound care. Design: A methodological study. Methods: The method advanced by DeVellis (2017) was used to develop the instrument. An initial pool of 38 items was created. To optimize scale length and test reliability and validity, exploratory and confirmatory factor analyses were conducted. A total of 23 items formed the final pool. After two rounds of expert discussions, the average content validity index of the final 23 items was.89. Results: A total of 226 patients completed the instrument and were divided into two groups for further analysis. Exploratory factor analysis revealed that 15 items remained in four factors (social activity restrictions, physical and psychological disturbance, wound burden and daily life limitation), which accounted for 64.87% of the variance. Confirmatory factor analysis revealed an acceptable fit of the hypothesized factor structure and the convergent and discriminant validities were achieved. Cronbach's α coefficients for each factor were.807,.773,.799 and.713, respectively. Conclusion: The Chinese version of a chronic wound health‐related QoL instrument consists of 15 items in four subscales and demonstrates good reliability and validity. Relevance to Clinical Practice: This instrument can be used intermittently or continuously to evaluate the treatment effect of chronic wounds by assessing health‐related QoL. Scholars in Chinese‐speaking regions may find this culturally compatible instrument useful when conducting studies related to chronic wounds. Patient or Public Contribution: Two hundred twenty‐six participants provided their perspectives on health‐related QoL. [ABSTRACT FROM AUTHOR]

Aims and objectives. This paper analysed the scholarly discourse about the influence of Taiwanese culture on beliefs about expressing anxiety and engaging in physical activity from literature review. Background. The well-being of individuals with mental illness is promoted by the World Health Organization. Reducing barriers to treatment and care in community health-service systems requires cultural understanding. However, little is known about the influence of Taiwanese culture on physical activity programmes for people with anxiety disorders in Taiwan. Design. A discursive analysis of the literature. Method. Literature was used to examine the impact of Taiwanese culture on beliefs about anxiety and physical activity from historical, economic, social, political and geographical perspectives. Results. Taiwanese cultural beliefs about anxiety and physical activity can be summarised into six themes. Beliefs about anxiety are reflected in three themes: anxiety and shame, beliefs against direct communication and beliefs about anxiety and external forces. Beliefs about engaging in physical activity are reflected in three themes: beliefs about human action, the relationship between health and physical activity and priority of academic achievement. Conclusion. This paper exposes the hidden power of culture to influence Taiwanese beliefs about anxiety and physical activity. Three negative beliefs about anxiety influence the expression of anxiety symptoms and help-seeking behaviours. Two positive and one negative belief about physical activity significantly affect choice of activity type and level of participation in physical activity. Anxiety and physical activity have a dynamic relationship and both are deeply influenced by Taiwanese culture. Relevance to clinical practice. An awareness of cultural influences on beliefs about anxiety and physical activity is important when encouraging Taiwanese people with anxiety disorders to engage in physical activity. This awareness may help nurses understand better how their patients perceive anxiety and physical activity, leading to more appropriate physical activity programmes to improve both physical and psychological well-being. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This study aimed to investigate factors associated with facial pressure injury (FPI) in patients receiving non‐invasive positive pressure ventilation (NIPPV) during hospitalisation in the intensive care unit (ICU) and to identify predictors of FPI. Background: Non‐invasive positive pressure ventilation is a method of treating patients with acute and chronic respiratory failure. However, FPI may occur due to unsuitable nasal‐oral NIPPV masks and discomfort in contact with the skin surface. Design: A retrospective case–control study. Methods: From January 2018 to October 2020, a total of 397 patients admitted to a national hospital in Taiwan were enrolled. Patients received NIPPV and routinely used under‐mask prophylactic dressings during hospitalisation. Patients were divided into the non‐FPI group (n = 357) and the FPI group (n = 40). Demographic, clinical characteristics, acute physiology and chronic health evaluation II scores, and Braden Scale scores were collected from medical records. Logistic regression analysis was performed to examine the contribution of each factor to the FPI, and odds ratios were reported. The STROBE checklist was used in this retrospective case–control study. Results: There were significant differences between the groups in age, serum albumin, C‐reactive protein, body mass index (BMI), disease severity, Braden Scale score, length of stay, duration of mechanical ventilation and use of corticosteroids. Logistic regression analysis revealed that the risk factor for FPI was the Braden Scale score [OR = 1.630 (1.176–2.260)], BMI [OR = 0.396 (0.210–1.784)] and corticosteroids [OR = 0.394 (0.159–1.811)], which were predictors of FPI in patients with NIPPV. Conclusions: Facial pressure injury may still occur in patients who routinely use prophylactic dressings under NIPPV masks. This study provides information on continuing education training for FPI to more accurately identify high‐risk and timely preventive measures to reduce FPI. Relevance to Clinical Practice: Addressing FPI‐related factors to prevent facial skin damage and reduce comorbidities in patients using NIPPV masks. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Suicide is a global mental health issue. Taking care of suicidal individuals is a substantial challenge. Most studies emphasize the suicidal individual. Few studies have emphasized the family caregivers of suicidal individuals., No study has explored the relationship between family caregivers' caring stress with suicidal attitudes and suicide care ability., What this paper adds to existing knowledge? The main results indicated that the older family caregivers tended to have a more negative attitude towards suicidal individuals. Female family caregivers' stress was higher than that of male family caregivers., A mild level of caring stress would help family caregivers have a more positive attitude towards suicidal individuals. Furthermore, a positive attitude would help family caregivers improve their caring ability., What are the implications for practice? Mental health nurses could help family caregivers, especially female family caregivers, reduce their holistic caring burden by looking for support resources and enhancing their coping strategies., Mental health nurses could help family caregivers promote positive attitudes towards suicidal relatives by understanding suicidal individuals' suffering., Abstract Introduction Suicide is a global mental health issue. Family caregivers play a key role in preventing suicide attempts. Aims The aim of this study was to examine the relationship among stress due to the family caregiver's role, suicidal attitude of the family caregiver and suicide care ability among family caregivers. Additionally, instruments of caring stress, attitudes towards suicidal relatives and caring abilities used in the study were tested to measure construct validity. Methods A cross-sectional correlational study was conducted with 164 family caregivers of people who are suicidal. The following three questionnaires were used: the Caring Stress Scale, the Suicidal Attitudes Scale and the Suicidal Caring Ability Scale. Structural equation modelling was performed using SPSS AMOS 19.0 to examine the path relationships among variables. Results Bivariate analyses showed that age was negatively correlated with suicidal attitude. In the final path model, caring stress had a positive effect on suicidal attitudes. Suicidal attitude and suicide care ability were highly positively correlated. Gender had a direct effect on caring stress, which indicated that female family caregivers experienced more stress from their role. Implications for practice: Mental health nurses could help family caregivers become aware of the emotional pain that suicidal people experience and then promote their positive attitudes towards their suicidal relatives. Furthermore, family caregivers could increase their ability to care for their suicidal relatives, which could reduce the numbers of suicides. [ABSTRACT FROM AUTHOR]

Background: Low physical activity is common in systemic lupus erythematosus populations. Aim: To evaluate the effect of physical activity counselling on physical activity and the association between physical activity changes and changes in fatigue, quality of sleep, and quality of life in women with systemic lupus erythematosus. Methods: A randomized, controlled, single‐blind trial was conducted from March 2015 to August 2016. Seventy‐six women with systemic lupus erythematosus were randomly assigned to the intervention or control groups. The intervention group received three sessions of physical activity counselling at 1, 4, and 8 weeks and three telephone follow‐ups over 13 weeks. Outcome measures, which include daily steps, fatigue, quality of sleep, and the quality of life, were collected at baseline and 8 and 12 weeks. Results: The study showed that daily steps, quality of sleep, and vitality in the intervention group were significantly improved compared with those in the control group at weeks 8 and 12. Mental health was significantly improved only at week 8 in the counselling group. A positive correlation between physical activity changes and changes in vitality and mental health was observed. Conclusions: Physical activity counselling can improve physical activity. As physical activity increases, systemic lupus erythematosus women feel more energetic and happier. SUMMARY STATEMENT: What is already known about this topic? Patients with systemic lupus erythematosus (SLE) have inactive lifestyles, and few of them exercise regularly.Patients with SLE have poor aerobic fitness and muscle strength.Fatigue, poor sleep, and low quality of life are common in patients with SLE. What this paper adds? The five A's physical activity counselling model is feasible and can enhance SLE patients' physical activity levels.Vitality and mental health improvement are associated with an increase in physical activity. The implications of this paper: Health care professionals could provide physical activity counselling to SLE patients during every clinical visit.Health care professionals could encourage patients with SLE to use a pedometer as a monitor to record their daily steps. [ABSTRACT FROM AUTHOR]

Aim: The purposes of this study were to describe the degree of knowledge and explore the factors associated with knowledge of infertility among women of childbearing age with breast cancer. Methods: In this cross‐sectional study, we recruited women of childbearing age with a diagnosis of breast cancer who had completed chemotherapy at a hospital in Taipei from 2015 through 2016. Face‐to‐face interviews were completed with 201 (62%) of 324 eligible women, asking about sociodemographic variables, disease and treatment characteristics, fertility intention, and infertility‐related knowledge. Results: The result showed one in 10 women had thought about becoming pregnant after completion of breast cancer chemotherapy. The mean score of infertility knowledge among participants was low, especially for general knowledge. Women with higher levels of education had better knowledge scores. Fertility intention score, especially for the domain of the pregnant risk, was negatively associated with infertility knowledge score. Conclusion: Women with breast cancer lacked knowledge about infertility and underestimated the possibility of infertility. We suggest future patient education on infertility after cancer treatment and about reproductive technology in oncologic practice before treatment begins. SUMMARY STATEMENT: What is known about this topic? Women with cancer diagnosed during the reproductive age are interested in a subsequent pregnancy.Less than half of childbearing‐age women with cancer have a comprehensive discussion about the potential impact of cancer therapy on fertility with the oncology physician.Reproductive‐age women with breast cancer have gaps in their knowledge of fertility planning as breast cancer survivors. What this paper adds? One in 10 women had thought about becoming pregnant after completion of breast cancer chemotherapy.Most women with breast cancer lack sufficient general and cancer‐specific knowledge about infertility.Factors associated with knowledge of infertility are fertility intention and education level. The implications of this paper: Results offer oncological nurses an understanding of fertility needs and infertility‐related knowledge in childbearing‐age women with breast cancer.Clinical nurses should continue to assess fertility willingness and knowledge of infertility in women with cancer both before and after cancer treatments.Comprehensive education about fertility and infertility in Taiwan is suggested. [ABSTRACT FROM AUTHOR]

This paper is a report of a study to examine the influence of demographic, learning involvement and learning performance variables on metacognition of undergraduate nursing students in a blended learning environment. A cross-sectional, correlational survey design was adopted. Ninety-nine students invited to participate in the study were enrolled in a professional nursing ethics course at a public nursing college. The blended learning intervention is basically an assimilation of classroom learning and online learning. Simple linear regression showed significant associations between frequency of online dialogues, the Case Analysis Attitude Scale scores, the Case Analysis Self Evaluation Scale scores, the Blended Learning Satisfaction Scale scores, and Metacognition Scale scores. Multiple linear regression indicated that frequency of online dialogues, the Case Analysis Self Evaluation Scale and the Blended Learning Satisfaction Scale were significant independent predictors of metacognition. Overall, the model accounted for almost half of the variance in metacognition. The blended learning module developed in this study proved successful in the end as a catalyst for the exercising of metacognitive abilities by the sample of nursing students. Learners are able to develop metacognitive ability in comprehension, argumentation, reasoning and various forms of higher order thinking through the blended learning process. [ABSTRACT FROM AUTHOR]

Aims This paper is a report on the effectiveness of a self-management programme based on the self-efficacy construct, in older people with heart failure. Background Heart failure is a major health problem worldwide, with high mortality and morbidity, making it a leading cause of hospitalization. Heart failure is associated with a complex set of symptoms that arise from problems in fluid and sodium retention. Hence, managing salt and fluid intake is important and can be enhanced by improving patients' self-efficacy in changing their behaviour. Design Randomized controlled trial. Methods Heart failure patients attending cardiac clinics in northern Taiwan from October 2006-May 2007 were randomly assigned to two groups: control ( n = 46) and intervention ( n = 47). The intervention group received a 12-week self-management programme that emphasized self-monitoring of salt/fluid intake and heart failure-related symptoms. Data were collected at baseline as well as 4 and 12 weeks later. Data analysis to test the hypotheses used repeated-measures anova models. Results Participants who received the intervention programme had significantly better self-efficacy for salt and fluid control, self-management behaviour and their heart failure-related symptoms were significantly lower than participants in the control group. However, the two groups did not differ significantly in health service use. Conclusion The self-management programme improved self-efficacy for salt and fluid control, self-management behaviours, and decreased heart failure-related symptoms in older Taiwanese outpatients with heart failure. Nursing interventions to improve health-related outcomes for patients with heart failure should emphasize self-efficacy in the self-management of their disease. [ABSTRACT FROM AUTHOR]

lin s.-c., tsai k.-w., chen m.-w. & koo m. (2012) Association between fatigue and Internet addiction in female hospital nurses. Journal of Advanced Nursing 69(2), 374-383. doi: 10.1111/j.1365-2648.2012.06016.x Abstract Aims. To report a study conducted to examine the association between fatigue and Internet addiction among female hospital nurses. Background. The Internet provides unprecedented convenience for social interaction and information retrieval. Although excessive Internet use has been demonstrated to correlate with fatigue in adolescents, no studies have examined whether it is associated with fatigue in nurses. Design. Cross-sectional survey. Methods. The study was conducted in August 2010. Female Registered Nurses working in a regional teaching hospital in southern Taiwan were asked to complete a paper-based questionnaire. The questionnaire included questions on demographics, the Chen Internet Addiction Scale and the Chalder Fatigue Scale. Multiple linear regression analysis was performed using Chalder fatigue scale as the dependent variable. Results. Of the 564 (79% response) valid questionnaires returned, 6 and 10% of the participants were classified as diagnostic cases and possible cases of Internet addiction, respectively. Fatigue levels, adjusting for other potential confounders including work unit, shift work, regular self-medication, and self-perceived health status, was significantly associated with both possible cases of Internet addiction and diagnostic cases of Internet addiction. Conclusion. This study is the first in reporting a statistically significant association between fatigue levels and Internet addiction in female hospital nurses. Relevance to clinical practice. Nurses should pay attention to their Internet activity and whether it adds to their fatigue levels. Addictive behaviour should promptly be dealt with to ensure that the best care is provided to patients. [ABSTRACT FROM AUTHOR]

Aim: Human immunodeficiency virus (HIV) stigma in people living with HIV is associated with depression and poor treatment adherence. The current literature lacks a Chinese instrument to measure HIV stigma in Taiwan. Thus, the purpose of this study was to develop an abbreviated Chinese translation version of Berger's HIV Stigma Scale. Methods: The instrument development process was guided by Brislin's Translation Model of establishment of construct validity and convergent validity and verification of reliability. Results: This study recruited 540 HIV‐infected adults (January‐November 2015). Data analysis using confirmatory factor analysis resulted in an 18‐item abbreviated Chinese version of Berger's HIV Stigma Scale, consisting with four factors: personalized stigma (seven items), disclosure concerns (three items), negative self‐image (four items), and concerns with public attitudes toward people with HIV (four items). The final model demonstrated a good fit. A positive correlation between HIV stigma and depression was found. The Cronbach α for internal consistency was 0.92. Conclusion: The 18‐item abbreviated Chinese version of Berger's HIV Stigma Scale demonstrated adequate reliability and validity to assess HIV stigma among Chinese people living with HIV. It is a feasible tool that allows for rapid assessment of HIV‐related stigma. SUMMARY STATEMENT: What is already known about the topic? People living with HIV experience challenges including unemployment, unavailability of rental housing, isolation, and alienation by friends and families. Prolonged experience of stigma may result in poor adherence to antiretroviral therapy.Berger's HIV Stigma Scale is a commonly used, valid instrument to measure HIV‐related stigma in people living with HIV. What this paper adds? In Taiwan, there is a lack of self‐report instrument to assess HIV‐related stigma in people living with HIV. Therefore, the authors developed an abbreviated Chinese version of Berger's HIV Stigma Scale for Chinese people living with HIV and established the psychometric properties.This study used confirmatory factor analysis (CFA) to verify effectiveness and test construct validity of the 18‐item abbreviated Chinese version of Berger's HIV Stigma Scale.This study revised Berger's 40‐item HIV Stigma Scale to an abbreviated 18‐item abbreviated Chinese version of Berger's HIV Stigma Scale to increase validity and to allow for rapid and effective assessment of HIV‐related stigma in people living with HIV. The implications of this paper: The 18‐item abbreviated Chinese version of Berger's HIV Stigma Scale has adequate reliability and validity to be used for Chinese people living with HIV.The 18‐item abbreviated Chinese version of Berger's HIV Stigma Scale is a feasible tool that allows for rapid assessment of HIV‐related stigma in Chinese people living with HIV.The 18‐item abbreviated Chinese version of Berger's HIV Stigma Scale assists clinicians to explore HIV‐related stigma in Chinese people living with HIV and to evaluate effectiveness of interventions in reducing the stigma. [ABSTRACT FROM AUTHOR]

Aims: The aim of the study is to compare the efficacy of an 8‐week pelvic floor muscle training program with surface electromyography feedback, performed in different body positions (supine, sitting, and standing), in women with stress urinary incontinence. Design This is a prospective observational study performed January 2014 to May 2016. Methods: The training program was performed by 110 women with stress urinary incontinence, each completing 4 individual training sessions. The main outcome was the electromyography activity of the pelvic floor muscles and of the synergistic abdominal muscles. Outcome measures were evaluated at 4 time points, namely at baseline and at 2, 4, and 8 weeks of training. Results: A notable effect of training was identified at week 2, which was sustained through to week 8. Training yielded a significant improvement in increased sustained voluntary contraction of the pelvic floor muscles in all 3 positions. The efficacy of training was influenced by the duration of training, age, body mass index, and history of vaginal delivery. Conclusion: Training of the pelvic floor muscles, with positive reinforcement by surface electromyography feedback of the pelvic floor muscles and of the synergistic abdominal muscles, was effective for the treatment of stress urinary incontinence in women and should be considered as a feasible option by healthcare providers. SUMMARY STATEMENT: What is already known about this topic? In women with stress urinary incontinence, the sudden loss of urine negatively affects their quality of life.Conservative treatment remains the mainstay for managing this condition, for which pelvic floor muscle training is regarded an effective treatment.Biofeedback provides positive reinforcement during pelvic floor muscle training and can be achieved via several methods including electromyography, manometry, or ultrasonography. What this paper adds? An 8‐week training program, using surface electromyography as feedback, was effective in reducing female stress urinary incontinence; the effect was notable after 2, 4, and 8 weeks of training.The program was effective when performed in supine, standing, and sitting positions, with the greatest improvement obtained in the supine position.The duration of training, age, body mass index, and history of vaginal delivery were significant factors influencing training outcome. The implications of this paper: Health care professions should be adept at evaluating the severity of stress urinary incontinence symptoms to provide the best treatment.Nurses should acknowledge the benefits of the pelvic floor muscle training with bio‐assisted surface electromyography feedback and encourage patients with stress urinary incontinence to consider the program.Factors that might influence the efficacy of the training, namely age, body mass index, and history of vaginal delivery, should be considered during treatment counselling and treatment. [ABSTRACT FROM AUTHOR]

Aims and objectives. This paper is a report of a study conducted to investigate differences between nurse practitioners' perceptions of the importance of required competencies and their self-evaluated existing competencies, and the main factors influencing these differences. Background. The difference between nurse practitioners' perceptions of required competencies and their existing competencies has never been investigated. Therefore, it is still uncertain whether these two competencies differ. Design. A nationwide survey study was authorised by the Department of Health (DOH) in Taiwan. Methods. For this nationwide survey study, the Questionnaire of Competencies in the Nurse Practitioner's Role was mailed to all nurse practitioners who qualified for the first annual national NP licence exam in Taiwan. Of 582 questionnaires distributed, 374 valid questionnaires were returned for a response rate of 64·2%. Results. The scores for required competencies were all higher than existing competencies. The competencies with largest differences were (in increasing order) clinical research, direct care, and leadership and reform. The competencies with smallest differences were (in ascending order) medical assistance, communication and coordination, and ethical decision-making. Differences in the total score between required and existing competencies were significantly influenced by nurse practitioners' age, seniority as nurse practitioner, whether the nurse practitioners' institution had a nurse practitioner advancement system, and the number of patients under their care. Conclusions. Nurse practitioners' perceptions of the importance of their expected role competencies were significantly greater in most cases than their actual competencies. Relevance to clinical practice. These findings could serve as a reference to improve cultivation of the NP system in Taiwan, to strengthen professional competencies in NP training programs. [ABSTRACT FROM AUTHOR]

tsai y-f., wong t.k.s., ku y-c. & liu w-c. (2012) Reasons for living among older male chinese residents of veterans' homes. Journal of Advanced Nursing 68(9), 1978-1987. Abstract Aim. The purpose of this paper was to report a study of reasons for living among older male residents of veterans' homes in Taiwan. Background. Suicide rates are high for older persons worldwide. Little is known about protective factors against suicide among elderly Chinese populations. Method. A qualitative descriptive design was used. Two veterans' homes, one government paid and one self-paid, were randomly selected from 18 institutions throughout Taiwan. Participants were 36 residents (≥65 years) who had expressed suicidal ideas in the past 6 months but had never shown suicidal behaviours. Data were collected in individual interviews from 2006 to 2007 and analysed by content analysis. Results. Five major themes related to reasons for living were identified: fear of death, comparative improvement in health condition, maintaining self-dignity, family related concerns and concerns for staff. Conclusion. Fear of death, maintaining self-dignity and family related concerns are similar to reasons for living found in western studies, but not comparatively better health and concerns for staff. These differences may be due to our sample being veterans' home residents rather than community-dwelling elders and residents' perceived social support from staff. Since most healthcare providers are nurses and nurses' aides, they may consider promoting/maintaining older people's health, promoting their self-dignity, and strengthening relationships with family members and staff to strengthen protective factors against suicide in older Chinese/Asians. Given the aging population worldwide, nurses should become aware of protective factors related to suicide among older people to improve care for this population. [ABSTRACT FROM AUTHOR]

chang h.-y.a., wallis m. & tiralongo e. (2012) Predictors of complementary and alternative medicine use by people with type 2 diabetes. Journal of Advanced Nursing 68(6), 1256-1266. Abstract Aims. This paper is a report of a study into factors predicting complementary and alternative medicine use in people with type 2 diabetes. Background. The growing incidence of type 2 diabetes is emerging as a major health issue throughout the world. While the rate of complementary and alternative medicine use in this population is high, it is not clear what predicts its use, in this population. Methods. A cross-sectional survey, using a structured interview, was undertaken among people with type 2 diabetes attending diabetic clinics in three census regions in Taiwan, between July 2006 and February 2007. The survey instrument, derived from a review of Taiwanese and international literature, was developed using the Health Belief Model. Results. A total of 326 participants with type 2 diabetes were interviewed (87·4% response rate). In people with type 2 diabetes, complementary and alternative medicine use was associated with a history of its use, a positive attitude towards it, stronger health beliefs about diabetes and the efficacy of complementary and alternative medicine in treating diabetes, a higher degree of self-care activities by the individual and a longer duration of diabetes. Conclusions. The results of this study indicate that complementary and alternative medicine use in people with type 2 diabetes is influenced by people's experience, beliefs, attitudes towards complementary and alternative medicine, and their behaviour towards disease management rather than their demographic characteristics. Nurses and healthcare professionals should consider the patient's background, health history, health beliefs and cultural background when planning specific strategies designed to modify lifestyle. [ABSTRACT FROM AUTHOR]

liu c.-c., chen y.-c., yeh y.-p. & hsieh y.-s. (2011) Effects of maternal confidence and competence on maternal parenting stress in newborn care. Journal of Advanced Nursing 68(4), 908-918. Abstract Aim. This paper is a report of a correlational study of the relations of maternal confidence and maternal competence to maternal parenting stress during newborn care. Background. Maternal role development is a cognitive and social process influenced by cultural and family contexts and mother and child characteristics. Most knowledge about maternal role development comes from western society. However, perceptions of the maternal role in contemporary Taiwanese society may be affected by contextual and environmental factors. Methods. A prospective correlational design was used to recruit 372 postpartum Taiwanese women and their infants from well-child clinics at 16 health centres in central Taiwan. Inclusion criteria for mothers were gestational age >37 weeks, ≥18 years old, and healthy, with infants <4 months old. Data were collected between August 2007 and January 2008 using a self-report questionnaire on mothers' and infants' demographic variables, maternal confidence, maternal competence and self-perceived maternal parenting stress. Results. After controlling for maternal parity and infant temperament, high maternal confidence and competence were associated with low maternal parenting stress. Maternal confidence influenced maternal parenting stress both directly and indirectly via maternal competence. Conclusion. To assist postpartum women in infant care programmes achieve positive outcomes, nurses should evaluate and bolster mothers' belief in their own abilities. Likewise, nurses should not only consider mothers' infant care skills, but also mothers' parity and infant temperament. Finally, it is crucial for nurses and researchers to recognize that infant care programmes should be tailored to mothers' specific maternal characteristics. [ABSTRACT FROM AUTHOR]

chang h.-y., teng c.-i., chu t.-l., chang h.-t. & hsu w.-h. (2012) Impact of nurse agreeableness and negative mood of nursing supervisors on intention to help colleagues. Journal of Advanced Nursing 68(3), 636-646. Abstract Aims. This paper is a report of a correlational study of the relations of nurse agreeableness and negative supervisor mood to nurses' intentions to help their colleagues. Background. Nursing collaboration is important to high quality care. Previous studies have identified agreeableness and negative mood of supervisors as influential factors in the workplace. In nursing, however, exactly how these factors and their interactions influence nurses' intention to help their colleagues remains unknown. Methods. A cross-sectional design and questionnaires were used to collect data in December 2007. Each sample set comprised of one supervisor and three nurses. A total of 53 sets of questionnaires were distributed, and 46 complete sets of responses were received, yielding a response ratio of 86·8%. Results. The analytical results indicate that nurse agreeableness is positively related to nurses' intentions to help colleagues (path coefficient = 0·54, P < 0·01). However, negative supervisor mood is negatively related to nurses' intentions to help colleagues (path coefficient = −0·13, P < 0·05). Moreover, the analytical results indicated that for highly agreeable nurses, the relationship between negative supervisor mood and nurses' intentions to help colleagues is significantly stronger than for less agreeable nurses. This demonstrates that nurse agreeableness amplifies the negative impact of negative supervisor mood on nurses' intentions to help colleagues. Conclusion. The study findings suggest the pivotal importance of managing negative supervisor mood to increase nurses' intentions to help colleagues. [ABSTRACT FROM AUTHOR]

Aim. This paper explores the leadership style of hospital managers. Background. Leadership has been widely studied in nursing from the perspective of nurses' psychological strain caused by nursing leadership. There is, however, little contained in the Western and Eastern literatures on the leadership style of hospital managers and certainly no study has explored managers' leadership style in Taiwanese hospitals from the nurses' stance. Design. Grounded theory. Methods. A sample of 28 nurses from seven teaching hospitals in Taiwan, Republic of China was selected through theoretical sampling. A multi-step analytic procedure based on the grounded theory approach was used to analyse the qualitative data. Results. The Chinese culture was found to affect the leadership style of Taiwanese hospital managers. They had extreme power and led nurses in a hierarchical manner. Nurse managers followed the autocratic leadership style of their hospital managers. The main category found in this study was thus hierarchical leadership. Conclusions. The Confucian principles of authoritarianism and obedience were found to be part of the Taiwanese hospitals' organisational cultures and strongly impacted on the managers' leadership style. Hospital managers' treatment of doctors and nurses was dependent on their social rankings. Nurses' lowly ranking fed into these enculturated managerial tendencies of using power and obedience thus increasing psychological strain on nurses. Relevance to clinical practice. Managers of the hospitals demonstrate power and misuse obedience through their leadership style, resulting in deterioration of nurses' work environment. Nurses' managers are not given enough power by the hospitals in Taiwan. Subsequently, nurses feel themselves the lowest and most powerless subordinates. This study reveals that the Chinese cultural burdens are embedded in the leadership of Taiwanese hospitals. These findings enhance the knowledge of leadership and add to the understanding of managerial attitudes in Chinese hospitals located worldwide. [ABSTRACT FROM AUTHOR]

chuang l.-l., lin l.-c., cheng p.-j., chen c.-h., wu s.-c. & chang c.-l. (2012) Effects of a relaxation training programme on immediate and prolonged stress responses in women with preterm labour. Journal of Advanced Nursing 68(1), 170-180. Abstract Aim. This paper is a report of an experimental study of the effects of relaxation-training programme on immediate and prolonged stress responses in women with preterm labour. Background. Hospitalized pregnant women with preterm labour experience developmental and situational stress. However, few studies have been performed on stress management in such women. Methods. An experimental pretest and repeated post-test design was used to compare the outcomes for two groups in northern Taiwan from December 2008, to May 2010. A total of 129 women were randomly assigned to an experimental ( n = 68) or control ( n = 61) group. The experimental group participants were instructed to listen daily to a 13-minute relaxation programme. Measurements involved the stress visual analogue scale, finger temperatures, State Trait Anxiety Inventory, Perceived Stress Scale and Pregnancy-related Anxiety. Two-way analysis of variance and hierarchical linear modelling were used to analyse the group differences. Results. Compared with those in the control group, participants in the experimental group showed immediate improvements in the stress visual analogue scale scores and finger temperatures. The State Trait Anxiety Inventory-State subscale score for the experimental group was significantly lower than that for the control group ( P = 0·03). However, no statistically significant differences for the Perceived Stress Scale and Pregnancy-related Anxiety scores were found between the experimental group and the control group. Conclusions. The relaxation-training programme could improve the stress responses of women with preterm labour. [ABSTRACT FROM AUTHOR]

wang j.-j. (2011) A structural model of the bio-psycho-socio-spiritual factors influencing the development towards gerotranscendence in a sample of institutionalized elders. Journal of Advanced Nursing 67(12), 2628-2636. Abstract Aims. This paper is a report of a study to determine the bio-psycho-socio-spiritual factors influencing the development towards gerotranscendence in institutionalized older people. Physical ability, depressive symptoms, social network support, meaning of life and life satisfaction were examined through a Structured Equation Modelling approach. Background. Older people's pursuit of gerotranscendence is believed to facilitate successful ageing and late-life growth. Although a few Scandinavian studies have identified the relationship between psychosocial factors and the development of gerotranscendence, there is little trans-cultural study of the model, which limits the ability of the gerotranscendence theory to be applied worldwide. Methods. Cognitively intact older residents ( N = 195) from six long-term care facilities in southern Taiwan participated in a structured interview using the Gerotranscendence scale, Barthel's Index, the Geriatric Depression Scale short form, the Inventory of Socially supportive Behaviour, the Life Meaning scale, and the Life Satisfaction scale. Data were collected over a 6-month period in 2008. Results. The model-fit indexes of the final model (χ2 = 32·08, d.f. = 14, P = 0·004; CMIN/d.f. = 2·29; GFI = 0·97, AGFI = 0·89, TLI = 0·94, NFI = 0·96) exceeded acceptable levels except for χ2. In the final model, social support, life satisfaction and meaning of life had direct effects on gerotranscendence (standardized regression weight 0·54, 0·43, and 0·76). Conclusion. The gerotranscendence model of healthy ageing is congruent in the Taiwanese population. Findings of this study can guide nursing and other health professionals in planning implementation of best practice in older people's care. [ABSTRACT FROM AUTHOR]

This paper investigates the moderating effect of national cultural contexts on the relationship between social networks and opportunity recognition. Data obtained from Taiwan and the United States support the proposition that cultural contexts, specifically the individualism-collectivism dimension, moderate the relationship between tie strength, structural holes, and opportunity recognition. Results indicate that in the United States, tie strength is negatively associated with opportunity identification and structural holes are positively associated with opportunity identification; whereas in Taiwan we find the opposite. The results also show that the interaction effect between bridging ties and tie strength on opportunity recognition varies depending on the cultural context. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

tsai m.-c., tsai y.-f., hwang f.-m. & liu c.-y. (2011) Effectiveness of a brief intervention for managing hazardous drinking problems of inpatients in Taiwan. Journal of Advanced Nursing 67(9), 2038-2046. Abstract Aims. This paper is a report of a randomized control trial undertaken to evaluate the efficacy of the Brief Intervention for Alcohol Use in Taiwanese inpatients with hazardous drinking patterns. Background. The Brief Intervention for Alcohol Use has been found to be as effective as medical and psychological treatments for individuals with alcohol use disorders in western countries. However, few studies have examined brief alcohol interventions for a Chinese population. Methods. Patients from the medical and surgical wards of a medical centre in northern Taiwan were enrolled if they had an Alcohol Use Disorders Identification Test score >8. Participants were randomly assigned to the experimental group ( n = 47), which received the Brief Intervention, and the control group ( n = 48), which received no special psychosocial intervention except routine nursing care. Data were collected from February 2005 to March 2006 on hospitalized participants' demographic characteristics and alcohol use. Scores on the Alcohol Use Disorders Identification Test were re-assessed over the telephone 6 months later by a trained assistant blinded to the treatment group. Results. The experimental group had a significantly higher mean improved Alcohol Use Disorders Identification Test score and better outcomes in all three dimensions of the test than the control group. Conclusions. The Brief Intervention for Alcohol Use is recommended for use in clinical settings to help Taiwanese inpatients with hazardous drinking patterns to improve their drinking problems. [ABSTRACT FROM AUTHOR]

This paper investigated the possible predictive and mediating determinates of quality of life in this often forgotten population, focusing specifically on the role of sociodemographics, mental impairments, coping mechanisms, resilience and hope on subjective quality of life. The family members of survivors of man-made trauma are sometimes severely traumatised themselves and may suffer from post-traumatic stress disorder, depression and poor quality of life. Most studies focus on the victims and ignore the effect of the incidents on the victim's family members. Data were collected between October 2007-March 2008, a self-report questionnaire incorporating seven scales was administrated to 175 family members of victims of man-made trauma. One-way was performed to compare the variance in the reported quality of life. The structural equation models of path analysis was used to evaluate the main effects and interactions and interrelations among variables. Of the psychosocial factors, having a personal previous traumatic experience was found to significantly affect post-traumatic stress disorder, depression and physical health. Post-traumatic stress disorder and depression were found to directly and indirectly affect quality of life. Coping mechanism, resilience and a hope state mediated the effect of post-traumatic stress disorder and depression making the three significant predictors of subjective quality of life. Based on these findings and the scores of the different scales, clinicians may be able to design treatment plans that encourage the poorly adapting family members of victims of trauma, especially those with symptoms of post-traumatic stress disorder or depression, to accept changes as a part of life, nurture a positive view of the self, make connections for better social support and maintain or re-create a hopeful outlook towards life goals. Knowledge of the psychosocial factors associated with resistance to severe trauma can also help in the prevention and treatment of individuals at high risk for developing post-traumatic stress disorder or depression. [ABSTRACT FROM AUTHOR]

Aims. This paper is a report of a study of psychometric properties of the Problem-Focused Style of Coping-Chinese version questionnaire. Background. Coping with stress is an important topic in the 21th century, which deserves further attention. Although a variety of instruments have emerged to assess an individual's coping responses to stress, research suggests that numerous problems are associated with the current measurements. Since most coping scales are criticized as lacking valid estimates across occupational samples and cultures, there is an immediate need to develop a reliable and valid coping-style scale. Method. The study used a convenience sample and a sampling frame consisting of 307 nurses from different medical units in two regional hospitals in Taiwan. The data collection period was from May 2009 to June 2009. Exploratory factor analyses and reliability estimates were calculated. Results. The factor analysis revealed three coping factors: reflective, suppressive and reactive. All reliability and validity estimates were satisfactory. Conclusion. The Problem-Focused Style of Coping-Chinese version questionnaire is a valid and reliable measure of nurses' dispositional coping style and can be used for educational training programmes to enhance nurses' stress management skills. [ABSTRACT FROM AUTHOR]

Aims. This paper is a report of a study that examined the effects of work demands, including employment status, work inflexibility and difficulty reconciling work and family caregiving, on role strain and depressive symptoms of adult-child family caregivers of older people with dementia. Background. Family caregivers also employed for pay are known to be affected by work demands, i.e. excessive workload and time pressures. However, few studies have shown how these work demands and reconciliation between work and family caregiving influence caregivers' role strain and depressive symptoms. Method. For this cross-sectional study, secondary data were analysed for 119 adult-child family caregivers of older people with dementia in Taiwan using hierarchical multiple regression. Results. After adjusting for demographic characteristics, resources and role demands overload, family caregivers with full-time jobs (b = 0.25, P < 0.01) and more difficulty reconciling work and caregiving roles (b = 0.36, P < 0.01) reported significantly more role strain than family caregivers working part-time or unemployed. Family caregivers with more work inflexibility reported more depressive symptoms (b = 0.29, P < 0.05). Conclusion. Work demands affected family caregivers' role strain and depressive symptoms. Working full-time and having more difficulty reconciling work and caregiving roles predicted role strain; work inflexibility predicted depressive symptoms. These results can help clinicians identify high-risk groups for role strain and depression. Nurses need to assess family caregivers for work flexibility when screening for high-risk groups and encourage them to reconcile working with family-care responsibilities to reduce role strain. [ABSTRACT FROM AUTHOR]

shyu y.-i.l., chen m.-c., wu c.-c. & cheng h.-s. (2010) Family caregivers' needs predict functional recovery of older care recipients after hip fracture. Journal of Advanced Nursing 66(11), 2450-2459. Aim. This paper is a report of a study of the effect of family caregivers' needs on the functional recovery of elders with a hip fracture during the first 6 months after discharge. Background. Family members are closely involved in the postdischarge care of older Chinese patients. However, the influence of family caregiving-related variables, such as caregiver's needs, on recovery after hip fracture has not been explored. Methods. Data were collected between 2002 and 2005 with elders with hip fracture and their family caregivers at a medical centre in Taiwan. Data were collected at 1, 3 and 6 months after discharge, and 120 people completed all follow-ups. The effect of caregiver needs on elders' recovery was analysed using the generalized estimating equations approach. Findings. Elders whose caregivers reported a need for information on caregiving and related health care were more likely (odds ratio = 1·93, confidence interval = 1·08-3·46) to recover their walking ability than those whose caregivers did not report such need. However, elders whose caregivers reported a need for social services were less likely to recover their walking ability (odds ratio = 0·38, confidence interval = 0·18-0·78), and activities of daily living (odds ratio = 0·40, confidence interval = 0·17-0·94) than those whose caregivers did not report such need. Conclusion. Healthcare providers should include caregivers' needs in their clinical assessment of Chinese elders after surgery for hip fracture. Given the rapidly increasing population of Asian elders in Western countries, the results of this study may be applicable to other countries with Chinese populations. [ABSTRACT FROM AUTHOR]

li-ling h. (2010) Metacognitive Inventory for nursing students in Taiwan: instrument development and testing. Journal of Advanced Nursing 66(11), 2573-2581. Aim. This paper is a report of the development and testing of an instrument that measures metacognitive abilities of nursing students. Background. Metacognition refers to an individual's knowledge, awareness and command of thinking and learning strategies. Nursing students are challenged to think and learn in ways that will prepare them for practical work in a complex healthcare environment. Nursing educators have the responsibility to produce graduates who possess and use metacognitive skills to facilitate the solving of ill-structured problems using a variety of mental processes, such as reasoning, judgment and creativity. Methods. In 2007, the Metacognitive Inventory for Nursing Students was developed, based on previous instruments, and administered to a sample of 802 senior nursing students in two nursing colleges and a university in Taiwan. Principal axis factor analysis and other statistical tests were performed to test the psychometric properties of the questionnaire. Results. Preliminary analysis reduced the original 40 items to 28. Five factors were retained, accounting for 53·09% of the variance, and these five factors were identified as self-monitoring, self-modification, self-awareness, effective learning and problem-solving. The resultant Metacognitive Inventory achieved good internal consistency reliability, with a Cronbach's alpha coefficient of 0·94 and the coefficient for the five factors ranged from 0·73 to 0·90. Conclusion. Nurse educators in Taiwan could use the Metacognitive Inventory for Nursing Students to assess students and facilitate metacognitive skill development in classrooms and in practice settings. [ABSTRACT FROM AUTHOR]

lin p.c., lin l.c., shyu y.i.l. & hua m.s. (2010) Chinese version of the Pain Assessment in Advanced Dementia Scale: initial psychometric evaluation. Journal of Advanced Nursing 66(10), 2360–2368. Aim. This paper is a report of the validity and reliability testing of the Chinese version of the Pain Assessment in Advanced Dementia Scale (PAINAD-C). Background. Pain is under-reported and under-treated for people with dementia, largely due to impairment of communication. An adequate instrument for assessment of pain in this population is essential to improving their quality of life and decreasing disability and behavioural disturbances, but none were found that were appropriate for these purposes. Method. The PAINAD-C was developed in three phases in 2006. First, back-translation was used to create the Chinese version, where five medical and nursing experts assessed content validity. Inter-rater reliability, internal consistency reliability and test–retest reliability were then examined. Finally, principal component analysis and known-group comparisons were used to test construct validity. Participants with dementia were selected from five licensed long-term care facilities in Taiwan. Direct observation was used to collect data. Results. Inter-rater reliability showed an intra-class correlation coefficient of 0·80–0·86, and a test–retest reliability intra-class correlation coefficient of 0·71. The internal consistency reliability was 0·55–0·66. Factor analysis of the PAINAD-C showed two factors that explained 62·48% of variance. The PAINAD-C scores showed statistically significant differences between the non-dementia group and the advanced dementia group as well as significant differences between activities and rest groups. Conclusion. The PAINAD-C is useful in a clinical setting for people with advanced dementia for both research and practice. It is easy to use and is a comprehensive instrument. [ABSTRACT FROM AUTHOR]