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Background: Vietnam is one of the most rapidly aging countries in the world and the likelihood that someone may have dementia rises dramatically as the population ages. Although caring for persons living with dementia is important, little is known about the circumstances under which community healthcare professionals in Vietnam provide dementia care. This study aimed to describe the practice of caring for persons with dementia among community healthcare professionals in Vietnam. Methods: This qualitative descriptive study was conducted with 23 community healthcare professionals recruited from 10 primary healthcare centers, representing 10 of 24 districts in Ho Chi Minh City, Vietnam. Participants were physicians (n = 11), physician's assistants (n = 8) and community nurses (n = 4). Data were collected through in-depth face-to-face semi-structured interviews. Interview data were audio recorded, transcribed verbatim, and analyzed using content analysis. Results: The mean age of the 23 participants was 44.6 ± 8.8 years; most were female (n = 16, 69.6%); and the mean time of working in the field of dementia care was 15.9 ± 8.4 years. Analysis of the interview data revealed five categories, which informed how care was provided: 1) Knowledge about dementia and its prevalence among older adults; 2) Identification of dementia in Vietnam; 3) Lack of attention to early diagnosis of dementia and difficulty in providing continuous care; 4) Dependence on family members for prompt and continuous care; and 5) challenges to providing dementia care. Despite having knowledge about dementia, some healthcare professionals incorrectly viewed dementia as an inevitable part of the ageing process. Participants reported that their limited training and practical experience in caring for persons with dementia caused a lack of confidence in dementia care. Conclusions: The quality of care provided to persons living with dementia was negatively impacted by the limited training of healthcare personnel. The diagnosis, treatment, and provision of supportive services to persons living with dementia and their families are substantial challenges for the Vietnamese healthcare system. It is crucial to initiate and cultivate dementia care education programs aimed at expanding curricula for physicians, physicians' assistants, and nurses. [ABSTRACT FROM AUTHOR]

A critical shortage of nurses worldwide makes research necessary to address the problem. Research examining whether and how temperament and character may lead to nurses' professional turnover intention can offer insights to address the nurse shortage issue. To examine the impact of temperament and character on nurses' intention and actions to improve professional capabilities and professional turnover intention. This study surveyed 502 nurses in a major medical centre in Taiwan in 2018. The measures came from the literature. Structural Equation Modeling was used for analysis. Self-directedness, cooperativeness, and persistence were positively related to intention (or actions) to improve professional capabilities. Harm avoidance was negatively related to actions to improve professional capabilities. Such actions were subsequently negatively related to nurses' professional turnover intention. This study contributes to the literature by being the first to clarify how nurses' temperament and character dimensions may lead to professional turnover intention. Our findings contribute insights for healthcare managers, i.e. they should pay particular attention to nurses with high levels of harm avoidance or low levels of persistence, self-directedness, and cooperativeness to retain nurses and, thus, improve the quality of a healthcare system. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To test how the three components of professional commitment (i.e. affective, continuance and normative professional commitment) are associated with nurse‐reported patient‐centred care and care quality. Background: Patient‐centred care and care quality are the two critical care outcomes. However, no study has yet examined how the three components of professional commitment are related to nurse‐reported patient‐centred care and care quality, showing a research gap. Design: This study adopted a two‐wave design (first wave in 2017 and second wave in 2019), which is known to reduce the possibility of reverse causality, and which was conducted in a large hospital in Northern Taiwan. Methods: Proportionate random sampling was used. Full‐time nurses were surveyed, while nursing students, interns, nurse practitioners and nursing supervisors were excluded. The first wave included 524 nurses, and 438 nurses were retained in the second wave. We used confirmatory factor analysis to verify the psychometric properties of the measures. Structural equation modelling was used to implement hypothesis testing. We used the Professional Commitment Scale of Meyer et al. (Journal of Applied Psychology, 1993, 78, 538), the Patient‐Centered Care Scale of Laird‐Fick et al. (Patient Education and Counseling, 2011, 84, 90) and the Care Quality Perceptions Scale of Teng et al. (Journal of Nursing Management, 2010, 18, 275). The STROBE statement was chosen as the EQUATOR checklist. Results: Affective professional commitment was positively associated with nurse‐reported patient‐centred care (β =.18, p =.002 and.01), which was positively associated with nurse‐reported care quality (β =.85, p <.001). Affective and normative professional commitment were also positively associated with nurse‐reported care quality (β =.17, p <.001). Conclusions: Our findings offer insights for nursing managers that nurses' affective and normative professional commitment could help upgrade care outcomes. Hospital managers should consider professional commitment as relevant to their workforce. Relevance to clinical practice: Nursing managers could publicise reports documenting nurses' significant contributions to public health. This could strengthen affective professional commitment among nurses. [ABSTRACT FROM AUTHOR]

Aims: To examine the relationships among effort ensuring robots' smooth operation (EERSO), time pressure, missed care, and nurses' turnover intention, and how robot performance moderates such relations. Background: Robots may reduce nurses' workload but typically still require some effort of nurses for robots' smooth operation. However, the negative impact of EERSO on nurses' workplace outcomes is unknown. Methods: This study used a two‐wave follow‐up design. Data were collected in a medical center in Taiwan, with first wave collected in 2019 and second wave collected between 2019 and 2020. A total of 331 participants were followed through the two waves. Results: EERSO is positively linked to missed care and time pressure. Time pressure is also positively linked to missed care and turnover intention. Positive robot performance weakens the positive link between EERSO and time pressure. Conclusion: Using robots may help reduce nurses' workload, but it also requires nurses' efforts to maintain robots' continuous operation, that is, EERSO. It may adversely impact nursing professional workplaces. Implications for Nursing Management: Nurse managers should reduce nurses' time pressure whilst suggest hospital managers to seek robots that require minimal EERSO. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study is to examine the relationship between psychological ownership of the nursing profession and turnover intention. Background: There is a severe shortage of nurses worldwide. Research is needed to understand how nurses' intention to leave hospitals and the nursing profession can be alleviated. Methods: This study adopted a cross‐sectional design and a survey method. Proportionate random sampling was used to ensure sample representativeness. This study surveyed 430 registered nurses in a medical centre in Taiwan between December 2021 and January 2022. We used Turnover Scale and Self‐Efficacy Scale and developed Having a Place Scale. Results: Psychological ownership comprises three dimensions: self‐efficacy, nurse identity and 'having a place' in the nursing profession. This research is the first to examine how these three dimensions of psychological ownership of the nursing profession are related to the intention to leave a hospital or the nursing profession. Self‐efficacy and 'having a place' are negatively related to nurses' intention to leave a hospital (r = −.23 and −.31, p <.001). Nurse identity is negatively related to nurses' intention to leave the nursing profession (r = −.38, p <.001). Intention to leave a hospital is positively related to nurses' intention to leave the profession (r =.76, p <.001). Conclusion: The findings provide novel insights for retaining nurses. Nurse managers could use strategies such as including nurses in making workplace decisions and encouraging them to personalize their workspace. Implications for Nursing Management: Nurse managers can enhance nurses' self‐efficacy and sense of 'having a place' to retain nurses in hospitals, while enhancing nurse identity to retain nurses in the profession. [ABSTRACT FROM AUTHOR]

Aims: To ascertain how professional turnover intention impacts nurse‐assessed care outcomes, including patient‐centered care and care quality. Background: Patient‐centered care and care quality are critical to care outcomes. However, we do not know whether care outcomes would be improved by reducing nurses' professional turnover intention. Design: We implemented a two‐wave correlational follow‐up design. Methods: This study was conducted in a large‐scale general in Taiwan during January and February 2018, and January and February 2019. We successfully obtained responses from 448 nurses in 2018 and subsequently followed up (in 2019). Most were women (97.5%), reflecting the profile of the local nurse population. Structural equation modeling was used to test hypotheses. Results: Our findings indicate that nurses' professional turnover intention is negatively related to nurse‐assessed, patient‐centered care. Nurses' professional turnover intention is also negatively related to all the five perceptions of nurse‐assessed care quality: that is, assurance, reliability, responsiveness, empathy, and tangibles. Moreover, years of working as a nurse is also positively related to nurse‐assessed, patient‐centered care and all the five perceptions of nurse‐assessed care quality. Conclusion: This study examined nurses' professional turnover intention as an antecedent of nurse‐assessed, patient‐centered care and care quality. Our study shows that professional turnover intention may predict care outcomes. Overall, our study suggests that professional turnover intention not only impacts workforce stability but also impacts health‐care outcomes. Impact: Our findings suggest that reduction of nurses' turnover intentions could benefit care outcomes. Hospital managers should know that nurses' turnover negatively impacts care outcomes. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine how the three dimensions of professional commitment impact professional capabilities improvement and five key dimensions of care quality. Background: While professional commitment is known to retain nurses, we do not know how its three dimensions—affective, continuance and normative commitment—formulate five care quality dimensions: assurance, reliability, responsiveness, empathy and tangibles. Design: We used a three‐wave, follow‐up design to follow a sample of nurse participants. Methods: We collected responses from 430 nurses who worked for a medical centre in Northern Taiwan during 2017–2019. Most (78.9%) of the respondents had an age between 20–40 years. We used Professional Commitment Scale of Meyer et al. (Journal of Applied Psychology, 1993, 78, 538) and Care Quality Scale of Teng et al. (Journal of Nursing Scholarship, 2010, 41, 301). STROBE statement was chosen as EQUATOR checklist. Results: We found that affective professional commitment is positively related to intention to improve professional capabilities, action to improve professional capabilities and thus to four dimensions of care quality: assurance, reliability, responsiveness and empathy. Conclusions: Our model explains how three key dimensions of professional commitment contribute to care quality. Our findings support the link between action to improve professional capabilities and dimensions of care quality. Relevance to clinical practice: Nursing managers can inform nurses of positive patient feedback, thus enhancing nurses' affective professional commitment, which would likely motivate their devotion to upgrading their professional capabilities, thus further contributing to the quality of the care they provide. [ABSTRACT FROM AUTHOR]

Purpose: This study explored the consistency between preferences for end-of-life care for elderly hospitalized patients and their primary caregivers and predictors of consistency. Patients and Methods: This cross-sectional correlational study recruited 100 dyads of elderly hospitalized patients and their primary caregivers from a medical center in Central Taiwan. A structural questionnaire about preferences for seven end-of-life medical treatment options involved cardiopulmonary resuscitation, intravenous therapy, nasogastric tube feeding, intensive care unit, blood transfusion, tracheotomy, and hemodialysis. Results: The consistency was 42.28% for preferences of end-of-life medical care between patients and caregivers. The Kappa values for seven life-sustaining medical treatments ranged from 0.001 to 0.155. Logistic regression showed that the predictors of consistency for preferences of treatment were: a patient with a signed living will (odds ratio [OR] = 6.20, p< 0.01) and a male family caregiver (OR= 0.23, p< 0.01) for cardiopulmonary resuscitation; a patient who visited relatives in the intensive care unit (OR= 2.94, p< 0.05) and a spouse caregiver (OR= 3.07, p< 0.05) for nasogastric tube feeding; a spouse caregiver (OR=3.12, p< 0.05) and a caregiver who visited the intensive care unit (OR= 5.50, p< 0.01) for tracheotomy; and a spouse caregiver (OR= 2.76, p< 0.05) and a caregiver who visited the intensive care unit (OR= 4.42, p< 0.05) for hemodialysis. Conclusion: End-of-life medical treatment preferences were inconsistent between patients and family caregivers, which might be influenced by Asian culture, the nature of the relationship and individual experiences. Implementation of advance care planning that respects the patient's autonomy and preferences about end-of-life care is recommended. [ABSTRACT FROM AUTHOR]

Background: Few studies had examined whether headaches impact emotional exhaustion among nurses, and nurses' intentions to leave the hospital (current employer) or nursing profession. Objectives/Aims/Hypotheses: To examine the impact of headaches on nurses' self-efficacy and emotional exhaustion, and nurses' intentions to leave the hospital or the profession. Design: A cross-sectional survey design with proportional random sampling was used to collect data. Methods: This study was conducted in one medical center in Taiwan during February and March 2017. Inclusion criteria were full-time registered nurses. Totally, 570 full-time registered nurses were surveyed. Results: Nurse headaches were positively related to emotional exhaustion, which was positively related to the intention to leave the hospital, further positively related to the intention to leave the profession. Self-efficacy was negatively related to the intention to leave the profession. Impact statement and Conclusions: Our findings advise nurse managers to take actions to reduce nurses' headaches. [ABSTRACT FROM AUTHOR]

ABSTRACTBackground:To develop a theoretical model explaining the longitudinal changes in the caregiving process for family caregivers of persons with mild cognitive impairment (MCI) in Taiwan.Methods: A longitudinal, grounded theory approach using in-depth face-to-face interviews and an open-ended interview guide. We conducted 42 interviews over a two-year period; each participant was interviewed at least once every six months. All participants were interviewed in their home. The participants total of 13 family caregivers of persons with MCI.Results: One core theme emerged: "protective preparation." This reflected the family caregiving process of preparation for a further decline in cognitive function, and protection from the impact of low self-esteem, accidents, and symptoms of comorbidities for the family member with MCI. Protective preparation contained three components: ambivalent normalization, vigilant preparation, and protective management.Conclusions: Interventions to help family caregivers manage the changes in persons with MCI can reduce caregiver burden. Our findings could provide a knowledge base for use by healthcare providers to develop and implement strategies to reduce caregiver burden for family caregivers of persons with MCI. [ABSTRACT FROM AUTHOR]

ABSTRACTBackground:Advance directives are important for nursing home residents with dementia; for those with advanced dementia, surrogates determine medical decisions. However, in Taiwan, little is known about what influences the completion of these advance directives. The purpose of this study was to identify factors, which influence the presence of advance directives for nursing home residents with dementia in Taiwan.Method: Our cross-sectional study analyzed a convenience sample of 143 nursing home dyads comprised of residents with dementia and family surrogates. Documentation of residents' advance directives, physical and cognitive status was obtained from medical charts. Surrogates completed the stress of end-of-life care decision scale and a questionnaire regarding their demographic characteristics. Nursing home characteristics were obtained from each chief administrator.Results: Less than half of the nursing home residents (39.2%) had advance directives and most (96.4%) had been completed by family surrogates. The following were predictors of an advance directive: surrogates had previously signed a do-not-resuscitate as a proxy and had been informed of advance directives by a healthcare provider; nursing homes had policies for advance directives and a religious affiliation.Conclusions: Advance directives were uncommon for nursing home residents with dementia. Presence of an advance directive was associated with surrogate characteristics and the nursing home facilities; there was no association with characteristics of the nursing home resident. Our findings emphasize the need to develop policies and strategies, which ensure that all residents of nursing homes and their surrogates are aware of their right to an advance directive. [ABSTRACT FROM AUTHOR]

Background While the impact of burnout on organisational commitment has been widely observed, its impact on nursing professional commitment has not previously been investigated. The literature has clarified that professional commitment has three distinct components: affective, continuance and normative. Aims This study aims to investigate the relationships between burnout and the three components of nursing professional commitment. Methods This was a cross-sectional study using questionnaires to collect data in one large medical centre. Responses from 571 nurses were used for regression analysis. Among the sampled nurses, 90.9% had <15 years of nursing experience. MBI- HSS was used for measuring burnout. Three components of nursing professional commitment came from Meyer et al. (J Appl Psychol, 78, 1993 and 538) a formally validated instrument. Results Analytical results indicated that burnout is negatively related to affective and normative professional commitment (B ≤ −0.09, p < 0.01), but not related to continuance professional commitment (B = 0.05, p > 0.05). Linking evidence to action Nurse managers aiming to improve nurses' professional commitment should consider reducing nurses' burnout, for example improving nursing optimism and reducing administrative tasks, as suggested by the literature. [ABSTRACT FROM AUTHOR]

Background: Little is known about the relationship of the American Society of Anesthesiologists Physical Status Classification scores (ASA scores) on patient outcomes following hip fracture surgery in Asian countries. Therefore, this study explored the association of patients' preoperative ASA scores on trajectories of recovery in physical functioning and health outcomes during the first year following postoperative discharge for older adults with hip-fracture surgery in Taiwan.Methods: The data for this study was generated from three prior studies. Participants (N = 226) were older hip-fracture patients from an observational study (n = 86) and two clinical trials (n = 61 and n = 79). Participants were recruited from the trauma wards of one medical center in northern Taiwan and data was collected prior to discharge and at 1, 3, 6, and 12 months after hospital discharge. Participants were grouped as ASA class 1-2 (50.5%; ASA Class 1, n = 7; ASA Class 2, n = 107) and ASA class 3 (49.5%, n = 112). Measures for mortality, service utilization, activities of daily living (ADL), measured by the Chinese Barthel Index, and health related quality of life, measured by Medical Outcomes Study Short Form-36, were assessed for the two groups. Generalized estimating equations (GEE) were used to analyze the changes over time for the two groups.Results: During the first year following hip-fracture surgery, ASA class 1-2 participants had significantly fewer rehospitalizations (6%, p = .02) and better scores for mental health (mean = 70.29, standard deviation = 19.03) at 6- and 12-months following discharge than those classified as ASA 3. In addition, recovery of walking ability (70%, p = .001) and general health (adjusted mean = 58.31, p = .003) was also significantly better than ASA 3 participants.Conclusions: There was a significant association of hip-fracture patients classified as ASA 1-2 with better recovery and service utilization during the first year following surgery. Interventions for hip fractured patients with high ASA scores should be developed to improve recovery and quality of life. [ABSTRACT FROM AUTHOR]

Objectives:Spouse caregivers have been the predominant family members who care for persons with dementia in Taiwan. Although studies in western countries have described the caregiving experiences and changes in the marital relationship for these spouse caregivers, this information is lacking in Taiwan. This study explored the experiences of spouse caregivers caring for persons with dementia in Taiwan. Methods:A grounded theory approach was used for this qualitative descriptive study. Data were collected through recorded in-depth interviews and observations with 15 spouse caregivers of persons with dementia. Constant comparative analysis was used to analyse the transcripts and field notes. Results:Analysis of interview transcripts revealed that the experiences of caregiving for spouse caregivers who lived with persons with dementia could be described as ‘progressive compensatory symbiosis.’ This core category included three components: awareness of unbalanced intimacy, making a commitment and implementing a compensatory scheme. These experiences could be either mutually beneficial or unbalanced and fluctuated as the disease progressed through the phases of ‘subtle,’ ‘revealed’ and ‘confirmed,’ which also influence the pace, transition and evolution of the compensatory symbiosis. Conclusion:This exploratory study describes the family caregiving experiences for 15 spouse caregivers of persons with dementia in Taiwan. These results can provide guidance for developing interventions to prepare, facilitate and promote a mutually beneficial adjustment for spousal caregivers and their spouses as dementia progresses. The findings are worthy of further investigation with a larger sample and a prospective design. [ABSTRACT FROM AUTHOR]

Objective: Hip fracture usually affects psychological functions of the elderly, and comorbidities often interfere with their recovery. However, little is known about the influence of number of comorbidities on their psychological outcomes. Method: Data from a previous study of 461 hip-fractured elders treated at a medical center in northern Taiwan were analyzed by the generalized estimating equation approach. Outcomes were assessed at 1, 3, 6, 12 months following discharge by the Geriatric Depression Scale (GDS), Mini-Mental State Examination, and two subscales of the Medical Outcomes Study Short Form 36: role limitations due to emotional problems, and Mental Health (MH). Results: Hip-fractured elders with more comorbidities were more likely to have cognitive impairment (β = 0.224, p = .004), higher GDS scores (β = 0.328, p = .001), and worse MH (β = −1.784, p = .009) during the first year following discharge. Discussion: Having more comorbidities negatively influenced the psychological outcomes of elderly patients with hip fracture. [ABSTRACT FROM AUTHOR]

Aims To explore perceptions of low-literate older adults with heart disease about their eating experiences. Background Heart disease has been closely linked with nutrition, and nutritional status is poor in patients with limited education, but no studies have explored the eating experiences of low-literate adults with heart disease. Design Qualitative descriptive study. Methods Data were collected in tape-recorded semi-structured interviews from March - June 2012. A convenience sample of 13 low-literate older adults with heart disease was recruited from a cardiovascular ward of a medical centre in northern Taiwan. Participants were recruited until findings reached saturation and data were analysed using qualitative content analysis. Findings Analysis of participants' interview data on eating experiences identified three main categories: (1) eating-related hardships because of low literacy; (2) eating adjustments due to low literacy; and (3) misinformation about dietary modifications for heart disease. Conclusion Because of their low literacy, these older adults had difficult life experiences, gained inappropriate or inadequate eating information and held a passive, fatalistic perspective about eating with heart disease. Healthcare practitioners caring for this population need to appreciate their unique eating challenges and respect their eating customs. Nurses could play a greater role in educating and supporting low-literate older adults in selecting appropriate foods and preparing meals. Strategies to help this population learn to select, prepare and cook their food should be easy and practical, using specific symbols, concrete signs and simple labels. [ABSTRACT FROM AUTHOR]

Purpose This study examined which aspects of professional commitment can effectively retain nurses in the nursing profession. Design, Settings, and Participants This study used a longitudinal design, simple random sampling, and two-wave data collection to survey and follow up a representative sample of 579 nurses for 1 year in a major medical center in northern Taiwan. Methods Items measuring each aspect of professional commitment came from Meyer et al.'s scale. In the second wave, administrative data were culled to determine whether these nurses remain employed as nurses. Structural equation modeling is used to analyze the data. Results Analytical results indicate that continuance commitment predicts nurse retention in the nursing profession (path coefficient = 0.34, p < .01). Conclusions Institutional efforts to improve continuance commitment (e.g., improved salary structures and enhanced professional development opportunities) likely retain nurses in the nursing profession. Clinical Relevance The findings of this study indicate the importance of continuance intention in retaining nurses. Nursing managers who face staff retention issues may consider making efforts to improve nurse salary and employer-sponsored benefits. [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]

Aim To report a study of the effects of protein-energy malnutrition on the functional recovery of older people with hip fracture who participated in an interdisciplinary intervention. Background It is not clear whether protein-energy malnutrition is associated with worse functional outcomes or it affects the interdisciplinary intervention program on the functional recovery of older people with hip fracture. Design A randomized experimental design. Methods Data were collected between 2002-2006 from older people with hip fracture ( N = 162) in Taiwan. The generalized estimating equations approach was used to evaluate the effect of malnutrition on the functional recovery of older people with hip fracture. Results The majority of older patients with hip fracture were malnourished (48/80, 60% in the experimental group vs. 55/82, 67% in the control group) prior to hospital discharge. The results of the generalized estimating equations analysis demonstrated that subjects suffering from protein-energy malnutrition prior to hospital discharge appeared to have significantly worse performance trajectories for their activities of daily living, instrumental activities of daily living, and recovery of walking ability compared with those without protein-energy malnutrition. In addition, it was found that the intervention is more effective on the performance of activities of daily living and recovery of walking ability in malnourished patients than in non-malnourished patients. Conclusion Healthcare providers should develop a nutritional assessment/management system in their interdisciplinary intervention program to improve the functional recovery of older people with hip fracture. [ABSTRACT FROM AUTHOR]

Aim To report the moderating effects of work-related conditions and interactive family-care-giving variables, including mutuality and preparedness, on caregiver role strain and mental health for family caregivers of patients with dementia. Background Few studies have examined the interrelationships among caregivers' working conditions, care-giving dynamics and caregiver well-being. Design Cross-sectional, correlational study. Methods Data were collected by self-completed questionnaires from 176 primary family caregivers of patients with dementia in Taiwan from May 2005-January 2006. Caregiver role strain and mental health were analysed by multiple regressions using a hierarchical method to enter independent variables and two- and three-way interaction terms after controlling for caregiver age and gender, employment status, and work flexibility and the simple effect of each independent variable. Results More preparedness was associated with less role strain for family caregivers with less work/care-giving conflict. More care-giving demand was associated with poorer mental health only for caregivers with low work/care-giving conflict and with average and low preparedness, but not high preparedness. For family caregivers with less work/care-giving conflict, more preparedness decreased role strain and maintained mental health even when care-giving demand was high. Conclusion These results provide a knowledge base for understanding complex family caregiver phenomena and serve as a guide for developing interventions. Future studies with longitudinal follow-ups are suggested to explore actual causal relationships. [ABSTRACT FROM AUTHOR]

The use of rhythmic music is beneficial in assisting with the exercise intensity at home. This paper investigated the effects of paced walking to music at home with an 80% VO2 peak for patients with COPD. A prospective randomized clinical trial consisting of a treatment group ( n = 20) assigned to a 12-week period of paced walking to music at home, while the patients in the control group ( n = 21) were only given educational information. The treatment response was measured based on the patient's score in the maximal exercise capacity test using the incremental shuttle walking test (ISWT), lung function, health- related quality of life (HRQOL) using the Saint George Respiratory Questionnaire (SGRQ) and their health care utilization during baseline, 4, 8, 12 and 16 weeks. The treatment group increased their distance in the ISWT from 243.5 ± 135.4 at baseline to 16 weeks (306.0 ± 107.3, p < 0.001), Borg RPE-D decreased from 2.2 ± 1.3 at baseline to 0.8 ± 1.1 ( p < 0.001) at 16 weeks, and Borg RPE-L decreased from 1.2 ± 1.4 at baseline to 0.3 ± 0.7 ( p < 0.05) at 16 weeks, and improved all of the domains of the SGRQ, compared to the control group. The paced walking to music at home program helps patients to achieve a higher-intensity exercise. It is easily incorporated into the care of COPD patients, providing them with a convenient, safe and enjoyable exercise. [ABSTRACT FROM AUTHOR]

No feasible screening instrument is available for early detection of children with autism in Taiwan. The existing instruments may not be appropriate for use in Taiwan due to different health care systems and child-rearing cultures. The purpose of this study was to develop and test a screening questionnaire for generic autism. The initial 18-item screening questionnaire was developed by a child psychiatrist using face-to-face interviews with 10 families of children with autism and then tested on a sample of families of 18 children with autism and of 59 typically developing children. Of these 18 items, 15 had fair or better item discrimination (kappa >0.20) and were selected for the revised screening questionnaire. In the revised questionnaire, cutoff scores of 5 and 6 offered 100% sensitivity and 96.5% specificity, with the area under the receiver operating characteristic curve of 0.983. The revised screening instrument has high sensitivity and specificity, making it potentially useful for screening Taiwanese children at risk for autism. This instrument should be further tested in a population-based study. [ABSTRACT FROM AUTHOR]

cheng c.-m., chiu m.-j., wang j.-h., liu h.-c., shyu y.-i.l., huang g.-h. & chen c.c.-h. (2012) Cognitive stimulation during hospitalization improves global cognition of older Taiwanese undergoing elective total knee and hip replacement surgery. Journal of Advanced Nursing 68(6), 1322-1329. Abstract Aim. This article is a report on a pilot study conducted to determine the effects of cognitively stimulating activities in older patients undergoing elective hip and/or knee replacement. Background. Cognitive decline occurs in 16-35·5% of older hospitalized patients. In-hospital interventions, such as cognitively stimulating activities, might combat cognitive decline. However, evidence supporting such interventions is limited. Methods. For this randomized pilot trial, 50 older patients (90% women with a mean age of 72·8 years) were recruited in 2008 from a tertiary medical centre in Taiwan. While hospitalized, participants in the intervention group received a daily nurse-led, individual-based, cognitive-stimulation intervention. The comparison group received usual care. Cognitive function was assessed using Mini-Mental State Examination at admission, discharge and 1 month after discharge. Results. The incidence of cognitive decline (≥2-point decline in cognitive score) by hospital discharge was significantly lower for the intervention group (12%) than the usual care group (44%). The intervention group also had better cognitive scores following hospitalization. Upon discharge, participants in the intervention group scored 1·28 points higher than at admission, whereas participants in the usual care declined by 0·76 points. Improvement in cognitive status persisted for the intervention group (+1·33 points) vs. usual care (−0·26 points) at 1 month after discharge. Group differences in changes were statistically significant both at discharge and 1 month afterwards. Conclusion. Our cognitive-stimulation intervention benefited global cognitive function among older patients undergoing elective hip and/or knee replacement. The benefit persisted at 1 month after discharge. [ABSTRACT FROM AUTHOR]

teng c.-i., shyu y.-i.l., dai y.-t., wong m.-k., chu t.-l. & chou t.-a. (2012) Journal of Nursing Management 20, 311-318 Nursing accreditation system and patient safety Aims This study investigated whether nursing accreditation level affects patient safety. Background The nursing accreditation system evaluates the capabilities of nursing professionals in Taiwan. While this system has been in place for years, few studies have investigated whether nursing accreditation level is associated with patient safety indicators. This study can help in understanding how nursing capabilities affect patient safety and can subsequently contribute to improvements in patient safety. Methods This study adopted a cross-sectional research design using questionnaires to collect responses from nurses working in two major medical centres in northern Taiwan. Regression analyses were conducted to test the study hypothesis. Results The analytical results show that nursing accreditation level is positively related to patient safety indicators. Conclusion Health services managers should encourage nurses to advance their knowledge, skills, and professional capabilities because these may be positively related to patient safety. Implications for Nursing Management Nursing managers who seek to improve patient safety should consider encouraging nurses to advance their accreditation level. [ABSTRACT FROM AUTHOR]

shyu y.-i.l., chen m.-c., liang j. & tseng m.-y. (2012) Trends in health outcomes for family caregivers of hip-fractured elders during the first 12 months after discharge. Journal of Advanced Nursing 68(3), 658-666. Abstract Aim. This article reports on trends in health outcomes for family caregivers of hip-fractured patients and the effects of social support on these outcomes. Background. Little is known about the impact of caregiving on the health outcomes of family caregivers of patients with hip fracture. Method. For this prospective, correlational study, data were collected from 135 family caregivers of hip-fractured elders (2001-2005). Data on health-related quality of life and social support were collected from family caregivers at 1, 3, 6 and 12 months after discharge of the older hip-fractured patient. Findings. During the 12 months after the patients' discharge, family caregivers' scores improved significantly in role performance-related scales, including bodily pain, social function, role limitations due to emotional problems and role limitations due to physical problems. However, caregivers' scores for general health and mental health were significantly lower at 12 months [59·91 ( sd = 24·54) and 65·91 ( sd = 14·36) respectively] than at 1 month after discharge [64·35 ( sd = 23·29) and 67·94 ( sd = 18·47) respectively]. The trends for most subscale scores for health-related quality of life were positively related to perceived availability of social support. Conclusions. Caring for a hip-fractured older family member over a sustained period may enhance family caregivers' role performance, but have a negative impact on their perceived general health and mental health. These results suggest that home care nurses should develop interventions early after discharge to assess and improve family caregivers' health perception, mental health and social support. [ABSTRACT FROM AUTHOR]

Background: With increasing patient age in Western countries, evidence indicates a pervasive pattern of decreasing healthcare expenditures and less aggressive medical care, including end-of-life (EOL) care. However, the impact of age on EOL care for Asian cancer patients has not been investigated.Purpose: To explore how healthcare use at EOL varies by age among adult Taiwanese cancer patients.Methods: Retrospective cohort study using administrative data among 203,743 Taiwanese cancer decedents, 2001–2006. Age was categorized as 18–64, 65–74, 75–84, and ≥85 years.Results: Elderly (≥65 years) Taiwanese cancer patients were significantly less likely than those 18–64 years to receive aggressive treatment in their last month of life, including chemotherapy, >1 emergency room visits, >1 hospital admissions, >14 days of hospitalization, hospital death, intensive care unit admission, cardiopulmonary resuscitation, intubation, and mechanical ventilation. However, they were significantly more likely to receive hospice care in their last year of life.Conclusion: Elderly Taiwanese cancer patients at EOL received less chemotherapy, less aggressive management of health crises associated with the dying process, and fewer life-extending treatments, but they were more likely to receive hospice care in their last year and to achieve the culturally highly valued goal of dying at home. [ABSTRACT FROM PUBLISHER]

Parental explanatory models about autism influence the type of therapy a child receives, the child's well-being, and the parents' own psychological adaptation. This qualitative study explored explanatory models used by parents of children with autism. In-depth interviews were conducted with 13 parents of children with autism from a medical center in Taiwan. Despite high educational background, most of these parents attributed their child's autism to both biomedical and supernatural etiologies without apparent conflicts. These parents chose a wide variety of treatment strategies, including biomedical and alternative treatments, which often created time/energy pressures and financial burden, and were influenced by parents' cause attribution. Parents' illness explanations influence their treatment selections and need to be understood and accepted by health care providers. [ABSTRACT FROM AUTHOR]

Aims and objective. To investigate the relationship between family caregivers’ self-efficacy for managing behavioural problems of older people with dementia and their behavioural problems in Taiwan. Background. Older people with dementia commonly have at least one behavioural problem, which caregivers complain is difficult to handle. To provide interventions that can help caregivers more effectively manage the behavioural problems of care receivers with dementia, caregivers’ self-efficacy on managing behavioural problems must be assessed. However, it is not clear yet how these behavioural problems of older people with dementia may influence caregivers’ self-efficacy for managing behavioural problems. Design. A prospective, correlational study. Method. Eighty dyads of older people with dementia and their family caregivers were recruited from neurological clinics of a medical centre in Taiwan. Care receivers were assessed for behavioural problems using the Chinese version of Cohen-Mansfield Agitation Inventory, community form. Caregivers’ self-efficacy for managing care receivers’ agitation was measured by the research team-developed Agitation Management Self-Efficacy Scale. Results. Caregiver self-efficacy for managing behavioural problems was significantly and positively associated with more caregiver education, greater duration of caregiving and with care receivers’ less physically non-aggressive behaviours. When caregiver characteristics were controlled for in hierarchical regression analysis, physically non-aggressive behaviours explained 6% of the variance in caregiver self-efficacy. Conclusions. Results of this study contradict the general belief that physically aggressive behaviours of elders with dementia are more difficult for family caregivers to handle than other behavioural problems. Clinicians need to address physically non-aggressive problem behaviours. Relevance to clinical practice. Nurses could assess older patients with dementia for physically non-aggressive behaviours and train less educated caregivers to improve their self-efficacy for managing problem behaviours, thus enhancing the quality of life for both caregivers and care receivers. [ABSTRACT FROM AUTHOR]

To evaluate an interdisciplinary intervention program for older people with hip fracture in Taiwan.Randomized experimental design.A 3,800-bed medical center in northern Taiwan.Elderly patients with hip fracture (N=137) were randomly assigned to an experimental (n=68) or control (n=69) group.An interdisciplinary program of geriatric consultation, continuous rehabilitation, and discharge planning.Demographic and outcome variables were measured. Outcome variables included service utilization, clinical outcomes, self-care abilities, health-related quality-of-life (HRQOL) outcomes, and depressive symptoms.Subjects in the experimental group improved significantly more than those in the control group in the following outcomes: ratio of hip flexion 1 month after discharge (P=.02), recovery of previous walking ability at 1 month (P=.04) and 3 months (P=.001) after discharge, and activities of daily living at 1 month (P=.01) and 2 months (P=.001) after discharge. Three months after discharge, the experimental group showed significant improvement in peak force of the fractured limb's quadriceps (P=.04) and the following health outcomes: bodily pain (P=.03), vitality (P<.001), mental health (P=.02), physical function (P<.001), and role physical (P=.006). They also had fewer depressive symptoms (P=.008) 3 months after discharge.This intervention program may benefit older people with hip fractures in Taiwan by improving their clinical outcomes, self-care abilities, and HRQOL and by decreasing depressive symptoms within 3 months after discharge. [ABSTRACT FROM AUTHOR]

The Medical Outcomes Study Short Form-36 (SF-36) is a widely used measure of generic health related quality of life. The purpose of this study is to establish the validity and reliability of the SF-36, Taiwan Version, when applied to a sample of elderly patients with hip fracture in Taiwan. Data from two samples were used, the first sample (n=87) from a prospective descriptive study for testing psychometric scaling assumptions, scale responsiveness and criterion validity, and the second sample (n=69) from a clinical trial for examining the validity of the differences in the group. The SF-36 Taiwan version demonstrated good evidence of supporting the scaling assumption. Cronbach’s alpha coefficients above 0.70 for all scales support the internal consistency. The Physical Function (PF) scale had an effect size of 0.88 from months 1 to 3, and 0.59 from months 3 to 6 after discharge, which appears to have the best responsiveness to clinical changes. Notable floor and ceiling effects (>15%) for Role Emotion (RE), Role-Physical (RP) and PF scales were found. High correlation of 0.62 between the PF and measures of activities of daily living (ADLs), and between RP and instrumental activities of daily living (IADLs) (0.63) supports the construct validity. Significantly higher performance in most SF-36 scales in elders without risk for depression than those who were at risk supported the validity of the group differences. In its current form, the SF-36 Taiwan version demonstrated good reliability and validity as applied to patients with hip fracture. [ABSTRACT FROM AUTHOR]

To examine the longitudinal changes in overall and individual physical activities of daily living (PADLs) and instrumental activities of daily living (IADLs), at 1, 3, 6, and 12 months after hospital discharge in elderly subjects, 110 hip fractured elders (mean±SD age, 79.4±7.5; 60.9% females) were enrolled in a prospective study. At 12 months following hospital discharge, 56.1% subjects had recovered their overall PADLs, 37.9% had recovered their overall IADLs, and 74.2% could walk independently or with the aide of a cane. When analyzed by generalized estimating equations (GEE), for individual PADL, bathing and climbing stairs had consistently improved at every time point throughout the 1-year follow-up period, while transferring, toileting, and walking ability only improved significantly in the first 3 months after discharge. For individual IADL, the proportion of recovery for mobility appeared to increase significantly during the first 6 months post-discharge, and the remaining IADLs appeared to be stable. These results indicated that the recovery rate is varied for performance of different activities according to the complexity and the involvement of the lower extremities. We also found that less concomitant diseases, and a shorter hospital stay could predict a better recovery trend of overall and of most individual PADLs. These findings may be applicable to other countries with Chinese populations, and could provide a reference for health care providers to develop specific interventions for Chinese hip fractured elders. [ABSTRACT FROM AUTHOR]

This descriptive, correlational study of family caregivers ( N=125) tested a conceptual framework for family caregiving to frail elders in Taiwan, using the concept of 'finding a balance point' derived from a previous qualitative study. It was hypothesized that caregivers who were better able to find a balance point among competing needs would provide better-quality care to frail elders, which would lead to more positive caregiver and family outcomes. After controlling for the influence of caregiving characteristics and caregiving factors, finding a balance point significantly explained 7% of the variance in overall caregiving consequences. The findings of this study add a new perspective to the caregiving process in Taiwan. © 2002 Wiley Periodicals, Inc. Res Nurs Health 25:111-121, 2002 [ABSTRACT FROM AUTHOR]

Develops a conceptual framework to explain the interaction between the caregiver and the care receiver during the discharge transition. Illustration of the role function mode in Roy Adaptation Theory; Role tuning between caregiver and care receiver during discharge transition; Needs of the families during the discharge transition.

This study investigated the current situation of home nursing services in Taiwan. A total of 93 home nursing agencies (response rate of 75%) responded to a mail survey. The majority of the agencies (63%) had been established within the last 3 years before the survey, were hospital-based (90%), and had less than 60 (89.3%) average total number of visits per month per nurse. Most of the home care nurses had taken home care nursing training courses and had at least 2 years of clinical experience. Half of the agencies provided care for patients on a respirator, and 28% provided in-home hospice care. Almost a third of the agencies performed poorly in the areas of supply management, supervision of home visits, and quality monitoring and improvement mechanisms. Several suggestions for the development of home nursing services in Taiwan are made. [ABSTRACT FROM AUTHOR]

The grounded theory method was used to explore the psychosocial process of family caregiving to frail elders in Taiwan. Interview and observation data from 15 family caregivers were analyzed using constant comparative analysis. Caregivers used the process of finding a balance point to achieve or preserve equilibrium between and within caregiving and family life. Caregivers who did better in finding a balance point provided better quality care to frail elders. Caregivers who were good at finding a balance point anticipated competing needs, conceptualized multiple strategies to meet the needs, and predicted accurately the consequences of the strategies. They described a wide variety of balancing strategies. © 1998 John Wiley & Sons, Inc. Res Nurs Health 21:261-270, 1998 [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented in which editor discusses the interventional studies related to health promotions and healthcare quality improvement, innovative strategies in promoting community health services and web-based education intervention.