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Aims and objectives To investigate Taiwanese women's mental health trajectories from the third trimester of pregnancy to four weeks postpartum and the correlations of these trajectories with perceived social support and demographic characteristics. Background Previous studies have reported differences between prenatal and postpartum mental health status. Design A repeated design study was conducted in a medical hospital in Southern Taiwan. Methods One-hundred and ninety-four Taiwanese women completed the Chinese Health Questionnaire and Social Support Scale at the 36th prenatal week and first and fourth week postpartum. Results Three linear mental health trajectories for perinatal women were identified. Consistently poor perinatal mental health was reported by 16·0% of the participants. Less social support was associated with lower prenatal mental health scores. Younger age was a risk factor for consistently poor perinatal health. Vaginal delivery was associated with improved mental health after childbirth. Conclusions Mental health was worse in the third trimester of pregnancy than postpartum. Less social support was associated with lower prenatal mental health scores, and this association was similarly distributed between women with consistently poor and improved mental health after birth. Relevance to clinical practice Health care providers should assess women's mental health status and provide timely interventions during the perinatal period. Social support should be provided for pregnant women, especially younger women or those with lower perceived social support. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the relationship between staff characteristics, perceived work environment and person-centred care in residential aged care units. Background Person-centred care is often described as the model of choice in residential aged care and in the care of persons with dementia. Few empirical studies have reported on the relationship between how staff experience different aspects of their work and person-centred care. Design The study had a cross-sectional quantitative design. Methods Staff in 151 residential aged care units in Sweden ( n = 1169) completed surveys which included questions about staff characteristics, valid and reliable measures of person-centred care, satisfaction with work and care, job strain, stress of conscience and psychosocial unit climate. Statistical analyses of correlations, group differences and multiple linear regression analysis estimated with generalised estimating equation were conducted. Results Higher levels of staff satisfaction, lower levels of job strain, lower levels of stress of conscience, higher levels of a supportive psychosocial unit climate and a higher proportion of staff with continuing education in dementia care were associated with higher levels of person-centred care. Job strain and a supportive psychosocial climate, explained most of the variation in person-centred care. Conclusions This study shows that the work environment as perceived by staff is associated with the extent to which staff perceive the care as being person-centred in residential aged care. These empirical findings support the theoretical postulation that the work environment is an important aspect of person-centred care. Relevance to clinical practice Promoting a positive and supportive psychosocial climate and a work environment where staff experience balance between demands and control in their work, to enable person-centred care practice, seems to be important implications for managers and leaders in residential aged care. [ABSTRACT FROM AUTHOR]

Aims and objectives The aim of this study was to investigate the effects of Tai-Chi in conjunction with thera-band resistance exercise on functional fitness and muscle strength in community-based older people. Background Tai-Chi is known to improve functional fitness in older people. Tai-Chi is usually performed with free hands without resistance training and usually focuses on training lower limbs. To date, no study has examined the use of Tai-Chi in conjunction with thera-band resistance exercise in this population. Design Cluster randomised trial design. Methods Older people at six senior day care centres in Taiwan were assigned to thera-band resistance exercise or control group using a cluster randomisation. The thera-band resistance exercise group ( n = 48) received sixty minute thera-band resistance exercise twice weekly for a period of 16 weeks. The control group ( n = 47) underwent routine activities in the day care centre, receiving no Tai-Chi or resistance exercise. Results After receiving the thera-band resistance exercise, intervention participants displayed a significant increase in muscle strength of upper and lower extremities. Significant improvements were recorded on most measures of the Senior Fitness Test, with the exception of the chair-stand and back-scratch test. Conclusion Thera-band resistance exercise has the potential to improve functional fitness and muscle strength in community-based older people. Relevance to clinical practice Thera-band resistance exercise potentially offers a safe and appropriate form of physical activity that nursing staff can easily incorporate into the daily routine of older people in day care centres, potentially improving functional performance and muscle strength. [ABSTRACT FROM AUTHOR]

Aims and objectives To identify the prevalence, preventability, and severity of adverse drug events in randomly selected adult hospital inpatients, and to study the association between adverse drug events and patient-specific factors. Background Adverse drug events represent one of the major concerns in patient safety. Design A retrospective record review. Methods The study was conducted in an 800-bed university hospital in Finland within a 12-month period. Retrospective reviews of randomly selected discharged patients' ( n = 463) records using the Global Trigger Tool method were undertaken. The prevalence, preventability, and severity of adverse drug events were studied, and the association between patient-specific factors and adverse drug events were examined using a binary logistic regression model and Pearson's chi-squared tests. Results A total of 180 adverse drug events were detected in 125 (27%) patients, of which 74 (41·1%) were preventable, and 94·4% caused temporary harm. An abnormal level of potassium in the blood was the most frequent adverse drug event ( n = 37). The risk of adverse drug events increased with the length of hospital stay and the increased number of drugs patients used. The patients with coronary diseases ( n = 130) had a 2·5 times higher risk of experiencing adverse drug events. In addition, the risk of adverse drug events during hospitalisation increased together with the co-morbidity of patients. Conclusions Adverse drug events were experienced by a quarter of inpatients, while severe adverse drug events were rare. The risk of adverse drug events increased with patients' prolonged hospital stay, polypharmacy, and morbidity. In addition, information of the usefulness of the Global Trigger tool can be used for future development of the method. Relevance to clinical practice Patient-specific risk factors were identified using the Global Trigger Tool method revealing that more efficient monitoring of inpatients with these risk factors may be profitable for decreasing adverse drug events. [ABSTRACT FROM AUTHOR]

Aims and objectives. To prospectively identify different coping strategies among newly diagnosed amyotrophic lateral sclerosis patients and whether they change over time and to determine whether physical function, psychological well-being, age and gender correlated with the use of different coping strategies. Background. Amyotrophic lateral sclerosis is a fatal disease with impact on both physical function and psychological well-being. Different coping strategies are used to manage symptoms and disease progression, but knowledge about coping in newly diagnosed amyotrophic lateral sclerosis patients is scarce. Design. This was a prospective study with a longitudinal and descriptive design. Methods. A total of 33 patients were included and evaluation was made at two time points, one to three months and six months after diagnosis. Patients were asked to complete the Motor Neuron Disease Coping Scale and the Hospital Anxiety and Depression Scale. Physical function was estimated using the revised Amyotrophic Lateral Sclerosis Functional Rating Scale. Results. The most commonly used strategies were support and independence. Avoidance/venting and information seeking were seldom used at both time points. The use of information seeking decreased between the two time points. Men did not differ from women, but patients <64 years used positive action more often than older patients. Amyotrophic Lateral Sclerosis Functional Rating Scale was positively correlated with positive action at time point 1, but not at time point 2. Patients' psychological well-being was correlated with the use of different coping strategies. Conclusions. Support and independence were the most used coping strategies, and the use of different strategies changed over time. Psychological well-being was correlated with different coping strategies in newly diagnosed amyotrophic lateral sclerosis patients. Relevance to clinical practice. The knowledge about coping strategies in early stage of the disease may help the nurses to improve and develop the care and support for these patients. [ABSTRACT FROM AUTHOR]

Aims and objectives. To determine older diabetic patients' attitudes and beliefs about illness and health. Background. Prevention of metabolic complications and treatment for cardiovascular risk factors are the main aims of the care and treatment of older diabetic patients. For the effective management of diabetes, it is crucial to recognise patients' beliefs and attitudes about and behaviours towards their health and illness. Design. A descriptive study. Methods. The sample included 70 diabetic patients aged 65 and older. Data were collected using a socio-demographic form and the Health Belief Model Scale. The data were analysed using descriptive statistics, Mann-Whitney U-test, t-test, Kruskal-Wallis test, Welch variance analysis and Spearman correlation. Results. Results showed that older diabetic patients' attitudes about illness and health were negative. Among individuals aged 65-70 years with more than secondary education and previous employment, mean perceived severity scores were found to be significantly higher than in other groups. The mean perceived barriers scores were found to be higher than in other groups, and this difference was statistically significant for older participants who declared a good economic status, who exhibited good/very good adherence to nutritional therapy and who were exercising and checking their blood sugar regularly. The perceived benefits and recommended activities scores of patients needing more education were significantly higher. Conclusions. Patients who were female, aged 70 and older, and of low educational and economic statuses; who showed poor adherence to treatment and medical nutrition therapy; and who needed diabetes-related training had negative health beliefs and were particularly at risk. Relevance to clinical practice. Determining the personal factors that influence health behaviours can support the development of educational activities for diabetes management, complication prevention and treatment adherence improvement. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore and understand medical-surgical nurses' perceived self-confidence and leadership abilities as first responders in recognising and responding to clinical deterioration prior to the arrival of an emergency response team. Background Patients are admitted to hospitals with multiple, complex health issues who are more likely to experience clinical deterioration. The majority of clinical deterioration events occur on medical-surgical units, and medical-surgical nurses are frequently the first healthcare professionals to identify signs and symptoms of clinical deterioration and initiate life-saving interventions. Design A prospective, cross-sectional, descriptive quantitative design using a survey method was used. Methods Nurses were recruited from an integrated healthcare system located in the south-east United States. Nurses completed a demographic, a self-confidence and a leadership ability questionnaire. Results One hundred and forty-eight nurses participated in the study. Nurses felt moderately self-confident in recognising, assessing and intervening during clinical deterioration events. In addition, nurses felt moderately comfortable performing leadership skills prior to the arrival of an emergency response team. A significant, positive relationship was found between perceived self-confidence and leadership abilities. Age and certification status were significant predictors of nurses' leadership ability. Conclusion Although nurses felt moderately self-confident and comfortable with executing leadership abilities, improvement is needed to ensure nurses are competent in recognising patients' deterioration cues and making sound decisions in taking appropriate, timely actions to rescue patients. Further strategies need to be developed to increase nurses' self-confidence and execution of leadership abilities in handling deterioration events for positive patient outcomes. Relevance to clinical practice Educational provisions should focus on various clinical deterioration events to build nurses' self-confidence and leadership abilities in handling clinical deterioration. Nurses should obtain national certification to increase their knowledge and clinical reasoning skills. [ABSTRACT FROM AUTHOR]

Aims and objectives To evaluate the effectiveness of an individualised programme to promote self-care in sleep-activity in patients with coronary artery disease. Background Recent scientific findings have shown that low physical exercise and stress interfere with coronary artery disease patients' sleep quality and sleep efficiency independent of gender, age and co-morbidity. Design A randomised pretest-post-test control design. Methods Forty-seven patients who had undergone a coronary revascularisation procedure and/or pharmacological treatment three to seven weeks earlier at a general hospital were randomised to either an intervention group or a control group. Data collection was carried out by questionnaires, a study-specific sleep diary and actigraphy registration for 10 consecutive 24-hour periods, with a follow-up after three to four months. The intervention group underwent a nurse-led individualised education programme to promote self-care of sleep-activity. Sleep habits and sleep-related lifestyle together formed the basis for setting up individual goals together with the nurse. Individual advice on physical training, relaxation exercise and a CD-based relaxation programme was provided by a physiotherapist. Both groups received a brochure about sleep and stress. Results At a three- to four-month follow-up, the main improvements were seen in the intervention group regarding sleep quality, sleep duration and sleep efficiency in the sleep diary and sleep efficiency in actigraphy. Statistical improvements in health-related quality of life were revealed. This was not so obvious in the control group. Conclusions An individualised intervention programme to promote self-care of sleep-activity including relaxation in patients with coronary artery disease led by a nurse may improve sleep quality. However, a longitudinal study to promote self-care in sleep-activity should be performed using a larger sample and multiple sites with continuous follow-ups to determine whether any positive effects remain stable over time. Relevance to clinical practice Implementation of a multiprofessional individualised programme to promote self-care of sleep-activity including relaxation based on patients' needs, supported by a healthcare team and led by nurses, is important in clinical practice. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine the pretreatment symptoms and symptom clusters that women awaiting breast cancer surgery are experiencing and the impact of these symptoms on their quality of life. Background Most women diagnosed with breast cancer will have surgery as a first-line treatment. The presence of presurgery symptoms may be significant in contributing to distress and impaired quality of life. While it seems that women with breast cancer may experience the symptoms of fatigue, pain, depression and sleep disturbance as a cluster, this has not yet been confirmed by empirical research in the presurgery time period. Design A multiple-point prospective longitudinal cohort panel design is used. Methods Presurgery symptoms and quality of life were assessed using the Hospital Anxiety and Depression Scale, Insomnia Severity Index, Functional Assessment of Cancer Therapy-Fatigue, Brief Pain Inventory and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30(3). Results Participants ( n = 94, age range 30-92) experienced symptoms prior to surgery, with pain being a more prevalent symptom (35%) than fatigue (32%), sleep disturbances (25·5%) or depression (11%). global quality of life was significantly impacted on by fatigue and showed a moderate correlation with emotional functioning and a weak correlation with physical and social functioning. Hierarchical cluster analysis identified the presence of five clusters with symptoms present in differing intensities in each cluster. Conclusion In this cohort of women, healthy other than having a diagnosis of breast cancer, symptoms were impacting on quality of life. It is evident that clusters of symptoms are present presurgery that must be assessed and managed. Relevance to practice Healthcare delivery systems must ensure that early symptoms are addressed effectively in the presurgery period to improve quality of life and reduce adverse outcomes postsurgery. [ABSTRACT FROM AUTHOR]

Aims and objectivies To analyse the efficacy of improving disease management after implementing a self-management programme for people with type 2 diabetes administered by healthcare workers who have received special training. Background The needs for diabetic care include increased training for healthcare providers to enhance their confidence and skills in managing patients, both physically and mentally. Design Quasi-experimental design. Methods This study recruited participants from outpatient clinics in 10 hospitals in Taiwan. In 2010, purposive sampling was used to recruit 228 participants from two medical centres, five regional hospitals and three district hospitals. Participants were enrolled in a 'diabetes self-management programme' (watching patient videos, reading a diabetes self-care handbook, participating in four consultation courses of diabetes self-efficacy improvement, telephone follow-up and positive reinforcement). Efficacy analysis of post-test diabetes outcome variables of the experimental group was carried out. Sex, age and pretest score were used as the control variables for ancova test. Results Patients in the experimental group had significant improvement in body mass index ( p < 0·01), waistline circumference ( p < 0·001), haemoglobin A1C levels ( p < 0·001), degrees of anxiety and depression ( p < 0·001), self-efficacy ( p < 0·001) and levels of self-care ( p < 0·001). Conclusion Self-efficacy of people with diabetes can be effectively improved by planned implementation of a 'diabetes self-management programme' by trained healthcare workers. Relevance to clinical practice The diabetes care professionals are provided the self-management programme to strengthen the awareness and importance of self-management in diabetes care. [ABSTRACT FROM AUTHOR]

Aims and objectives To evaluate the incidence of winged scapula following surgical breast cancer treatment, determine its evolution over time and correlate factors that might influence this incidence. Background Winged scapula is a complication that may occur as a result of exposing the long thoracic nerve during axillary lymphadenectomy for the treatment for breast cancer. There is no consensus in the literature about the incidence of this complication after surgical treatment for breast cancer, and complication rates range from 1·5-74%. Design This is a prospective cohort study. Methods A prospective cohort study was conducted including 57 patients with breast cancer who underwent surgical treatment. Each patient was assessed before and after the surgery, by means of Hoppenfeld manoeuvre. The incidence rate of winged scapula was calculated at four different times. Results At the preoperative assessment, none of the patients presented with winged scapula, while 16 patients (28·1%) were shown to have this complication after the procedure. The incidence of winged scapula decreased over time. Factors associated with winged scapula were as follows: patients younger than 50 years, clinical stage I and II and no neoadjuvant chemotherapy. Other factors that were evaluated, such as type of surgery, number of lymph nodes compromised and removed, as well as body mass index, were not associated with the risk of winged scapula. Conclusions This study demonstrated that the incidence of winged scapula is low and decreased over time. Furthermore, a greater incidence of winged scapula was noted in young women at an initial stage of the disease who had not been treated with neoadjuvant chemotherapy. Relevance to clinical practice The result of this work may have great impact, for demonstrating what risk factors are significantly associated with winged scapula after surgical treatment for breast cancer. [ABSTRACT FROM AUTHOR]

Aims and objectives To describe and explore how partners rate their intimate relationship before and after the patients' first myocardial infarction. A further aim was to investigate the association between partners' rating of their intimate relationship and self-rated health. Background To date, information on how partners experience the intimate relationship before and after a patient's myocardial infarction is sparse. Design A descriptive and exploratory design with longitudinal data collection. Methods The study comprised 127 partners, aged 34-87 years. Data collection included self-reported information on socio-demographic data, intimate relationship and self-rated health one year before and one year after patients' first myocardial infarction. Intimate relationship was assessed by the Swedish version of the Relationship Assessment Scale. Self-rated health was evaluated by the EuroQoL visual analogue scale. Results In general, partners reported high satisfaction with their intimate relationship both before and after the patients' myocardial infarction. Women reported somewhat lower ratings in their intimate relationship than men before the myocardial infarction. Women increased their ratings after one year, while men on average decreased their ratings. Partners with higher education reported lower ratings for intimate relationship after one year. Those with children living at home rated intimate relationship lower than those without children living at home after one year. Partners' self-rated health status was stable over time. No significant association between intimate relationship and self-rated health was found. Conclusions This study provides important insights regarding couples' relationships from the perspective of the partner. Socio-demographic factors such as sex, educational level, having children living at home and employment status may influence how the relationship, from the partners' perspective, is affected by a myocardial infarction event. Relevance to clinical practice This study provides insight into how partners rate their intimate relationship and self-rated health over time before and after patients' myocardial infarction. [ABSTRACT FROM AUTHOR]

Aims and objectives To identify preoperative risk factors that potentially affect postoperative length of stay of patients undergoing total hip replacement. Background With limited health resources and an ageing population, alongside an increasing prevalence of osteoarthritis and the growing need for total hip replacement, reducing length of stay is a mainstay of effective and cost-efficient orthopaedic practice. Design A retrospective observational study. Methods Data from a convenience sample of 243 patients having undergone an elective unilateral total hip replacement between January 2008-December 2009 were collected. Demographic data were studied and allied against the main preoperative risk factors - with length of stay being the main outcome measure. Results Pearson's correlation demonstrated a moderate positive correlation between age and a longer postoperative stay. The number of comorbidities did not have an impact on length of stay. Demographic findings included almost half the cohort lived with hypertension, and 66% of the available cases ( n = 196) were deemed overweight. Conclusions Collecting accurate and comprehensive assessment information relating to preoperative risk factors for total hip replacement, significantly impacts on postoperative outcomes specifically related to length of stay. Relevance to clinical practice In complex healthcare systems, where there is a need for quality client outcomes tempered against limited resources, this study highlights the benefits of accurate preassessment of orthopaedic clients undergoing major surgical intervention against the desirable outcomes of reduced lengths of admission. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore whether self-rated health acts as a potential mediator in the association between functional status and health-related quality of life in Parkinson's disease. Background Older persons (as most patients with Parkinson's disease are) who reported poor self-rated health compared with those with excellent self-rated health were two-and-a-half times more likely to have experienced a decline in functional ability. Design Cross-sectional. Methods Socio-demographic and clinical data of the patients ( n = 176) were obtained during a structured interview and from medical records. Functional status was measured with the Unified Parkinson's Disease Rating Scale (total score), self-rated health with the first item of the Short-Form 36-item Health Survey Questionnaire and health-related quality of life with the disease-specific questionnaire called the Parkinson's Disease Quality of Life Questionnaire-39. Multiple linear regression analyses and the Sobel test were employed to assess mediation. Results Self-rated health seems to have a mediating effect on the association between functional status and health-related quality of life. The Sobel test confirmed an indirect effect of functional status via self-rated health on health-related quality of life and showed a statistically significant indirect effect of functional status on health-related quality of life via self-rated health against the direct route without the mediator. Conclusions Self-rated health partially mediates the deteriorating effect of functional status on health-related quality of life. Relevance to clinical practice Supportive and adaptation psychosocial intervention programmes leading to restored self-rated health may enhance the quality of life regardless of disability in Parkinson's disease. [ABSTRACT FROM AUTHOR]

Aims and objectives To describe the perceived learning needs of Syrian patients who underwent coronary artery bypass graft surgery before hospital discharge and to examine the differences in the mean scores of the categories (subscales) of the modified Cardiac Patients Learning Needs Inventory according to the demographic characteristics of the participants. Background Knowledge about the learning needs of patients who underwent coronary artery bypass graft surgery can help nurses in coronary care units to provide them with the information that they need. This might improve their quality of life through decreasing complications, length of stay in the hospital and hospital readmissions. Design A descriptive design was used for this study. Methods A convenience sample of 135 patients participated in this study and completed the demographic form and the modified Cardiac Patients Learning Needs Inventory. Results Information about chest and leg wound care, complications, medication and physical activity was the most important learning needs. There were significant differences between patients' perceptions of learning needs and their age, chronic illnesses and their working status. Conclusion Syrian patients who underwent coronary artery bypass graft surgery were able to identify their learning needs that should be the focus of nursing practice. Relevance to clinical practice Meeting the needs of patients who underwent coronary artery bypass graft surgery should be emphasised in nursing practice. Meeting these needs might enhance their self-care behaviours. [ABSTRACT FROM AUTHOR]

Aims and objectives To assess the predictive value of two instruments (the Morse Fall Scale ( MFS) and the Heindrich II Fall Risk Model ( HFRM)] in a Middle Eastern country ( Lebanon) and to evaluate the factors that are related to falls. Design A prospective observational cross-sectional design was used. Background Falls and fall-related injuries in the acute care settings contribute a substantial health and economic burden on patients and organisations. Preventing falls is a priority for most healthcare organisations. While the risk of falling cannot be eliminated, it can be significantly reduced through accurate assessment of patients' risk of falling. Methods Data from 1815 inpatients at the American University of Beirut Medical Center ( AUBMC) in Lebanon were evaluated using two instruments to predict falls: the MFS and the HFRM. Results The incidence of falls was 2·7% in one year. The results indicate that while the instruments were significantly correlated, the HFRM was more sensitive in predicting falls than the MFS. The internal consistency of both scales was moderate, but inter-rater reliability was high. Patients using antiepileptic drugs and assistance devises had higher odds of falling. Conclusions Although both instruments were easy to use in a Middle Eastern country, the HFRM rather than the MFS is recommended for inpatients in an acute care setting as it had higher sensitivity and specificity. Relevance to clinical practice It is recommended that while the HFRM had adequate sensitivity, it is not seamless, and as such, nurses should not rely entirely on it. Rather, nurses should use their expert clinical judgement, their ethical obligations and cultural considerations to implement a safer environment of care for the patient. [ABSTRACT FROM AUTHOR]

Aims and objectives To better understand chronic obstructive pulmonary disease patients' informational needs and associated factors using the Predisposing, Reinforcing and Enabling Causes in Educational Diagnosis and Evaluation model. Background Despite the increase in the incidence of chronic obstructive pulmonary disease, little research has been carried out on the information needs from a patient perspective. Design A cross-sectional, correlational design was used. Methods A convenience sample of 107 subjects was recruited from four Taiwanese hospitals. Multiple regression analyses were conducted to identify the total informational needs and related factors. Results Major findings were that (1) patients' top informational need was daily care, and (2) variables associated with the total information needs were younger age, greater health internal locus of control, less dyspnoea severity and greater social support. Conclusions Patients' perceived chronic obstructive pulmonary disease informational needs are not congruent with the information received from healthcare professionals. Relevance to clinical practice Healthcare professionals need to be sensitive to the fact that treatment-related information was not the top priority of patients with chronic obstructive pulmonary disease. Healthcare professionals also need to target the special subpopulation of chronic obstructive pulmonary disease patients with greater total informational need to maximise educational impact. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate the prevalence of physical and emotional symptoms and the associations between symptoms and meaning-in-life in a cognitively intact nursing-home population. Background Meaning has been found to be a strong individual predictor of successful ageing and life satisfaction as well as an important psychological variable that promotes well-being. Meaning serves as a mediating variable in both psychological and physical health. Design and methods The study employed a cross-sectional design. Data were collected in 2008 and 2009 using the QLQ-C15- PAL quality-of-life questionnaire, the purpose-in-life test and the Hospital Anxiety and Depression Scale. A total of 250 cognitively intact nursing-home patients who met the inclusion criteria were approached and 202 attended. Results The prevalence of symptoms was fairly high, with fatigue (57%), pain (49%), constipation (43%) and dyspnoea (41%) as the most frequent physical symptoms, while 30% were depressed and 12% had anxiety. Significant correlations between meaning-in-life and symptom severity were displayed. Conclusions The level of symptom severity among cognitively intact nursing-home patients is high, requiring highly competent staff nurses. Meaning-in-life might be an important resource in relation to a patient's physical and emotional health and global well-being. Relevance to clinical practice Facilitating patients' meaning-in-life might help reducing symptom severity and fostering quality of life in cognitively intact nursing-home patients. However, advancing staff nurses' competence in palliative care, symptom management and nurse-patient interaction is important for care quality and quality if life in nursing homes. [ABSTRACT FROM AUTHOR]

Aims and objectives To determine patient factors associated with aggressive (code grey) events in the setting of a metropolitan hospital during a six-month period, to inform screening and prevention practices. Background Patient aggression continues to place nurses and patients at risk. Nurses need to be able to identify situations that are likely to escalate into aggression in order to ensure their own safety and the quality of care they can provide. Research has focussed on emergency departments and psychiatric units. Approaches that are appropriate for these settings may not fit for the general inpatient setting. Design A structured audit and epidemiological analysis of hospital population, regarding incidence of aggression. Methods A retrospective audit of code grey event reports and medical records of patients admitted to 16 general medical-surgical wards, during a six-month period. All available records of 121 code grey events were audited. Demographic factors for patients with code grey events were compared with factors for 6472 patients admitted. Statistical tests included chi-squared, bivariate and logistic regression. Results Diagnoses associated with increased risk of code grey were the following: delirium (11 times more likely) and dementia (seven times). Patients were more likely to have a code grey event if they were over 65 years of age (more than twice), were male (more than twice), were a recipient of Veterans' Affairs pension (four times), had never been married or had been admitted through the emergency department (almost twice). Conclusion This study adds to the current knowledge of the distinctive profile of patients in medical-surgical settings who are associated with aggressive events. Relevance to clinical practice It is recommended that nurses increase their focus on assessment of identified risk factors and documentation of behaviours, to help predict aggressive events, and that this focus be supported by hospital safety and care policy. [ABSTRACT FROM AUTHOR]

Aims and objectives To assess the level of fatigue, self-care abilities and level of loneliness in Turkish haemodialysis patients and to determine the relationship between the level of fatigue, self-care and loneliness. Background Dialysis patients experience difficulties such as deterioration in physical performance and self-care abilities, fatigue and social isolation due to the disease and the treatment. Design This is a descriptive study and was conducted at two dialysis treatment centres. Methods The sample included 325 haemodialysis patients. Patients were selected via convenience sampling. Criteria for inclusion of patients undergoing haemodialysis treatment were those who volunteered to take part in the study, who were literate and who were over 18 years of age. Data were gathered using Patient Information Form, Visual Analog Fatigue Scale, UCLA Loneliness Scale and Self-Care Ability Scale. Results Haemodialysis patients reported high level of fatigue, low level of self-care and moderate level of loneliness. The correlation values indicated that as the levels of loneliness and fatigue increased, the self-care abilities decreased. The self-care abilities of the female patients were worse. Patients over the age of 60 years, those with low education level or patients on a low income and those with other chronic diseases had higher levels of loneliness and fatigue, and lower level of self-care. Conclusions In this study, the level of fatigue of haemodialysis patients was high, their self-care ability was very low and their level of perceived loneliness was moderate. Furthermore, fatigue negatively affects patients' self-care; the higher the patients' level of fatigue was, the lower their level of self-care. Relevance to clinical practice In order for haemodialysis patients to manage their fatigue successfully, to improve their self-care abilities and to decrease their levels of loneliness and social isolation, nurses should provide physical, social and emotional support. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate (1) the extent to which shock anxiety and perceived support from healthcare professionals are related to post-traumatic stress disease ( PTSD) symptoms and (2) the extent to which perceived support from healthcare professionals moderates the relationship between shock anxiety and PTSD symptoms in implantable cardioverter defibrillator recipients. An additional aim was to describe the level of PTSD symptoms and perceptions of support from healthcare professionals. Background Studies examining PTSD symptoms among implantable cardioverter defibrillator recipients are still sparse. In addition, little is known about how perceived support from healthcare professionals is related to PTSD symptoms. Design Cross-sectional survey design. Methods Recipients ( n = 167) with implantable cardioverter defibrillator attending an outpatient device clinic completed questionnaires assessing shock anxiety, PTSD symptoms and perceived support from healthcare professionals. Results The results indicated that between ten and 15% of the recipients experienced moderate to severe symptoms of PTSD. Although a majority perceived constructive support from healthcare professionals, 12% perceived nonconstructive support. Regression analysis demonstrated that shock anxiety and perceived nonconstructive support from healthcare professionals had a statistically significant (p < 0·01) association with PTSD symptoms. Moreover, the results suggest that associations between shock anxiety and PTSD symptoms were significantly (p < 0·01) moderated by perceived nonconstructive support from healthcare professionals. Young age, short time since implantation and secondary prevention indication were also significantly associated with PTSD symptoms. Conclusions The results indicate that nonconstructive support from healthcare professionals can increase the tendency to develop PTSD symptoms, particularly in those who experience shock anxiety. Relevance to clinical practice Healthcare professionals should pay more attention to the way in which they communicate information to the recipients during follow-up visits. Clinically based strategies and interventions targeting shock anxiety and PTSD symptoms should be carried out. [ABSTRACT FROM AUTHOR]

Aim and objectives To assess the construct validity and reliability of the Brazilian Portuguese versions of the 29- and 13-item scales of the Antonovsky's Sense of Coherence Scale ( SOC-29 and SOC-13). Background Antonovsky's Sense of Coherence Questionnaire was developed to measure the main construct of the salutogenic theory, the sense of coherence. The use of the sense of coherence by health professionals might help identifying specific coping strategies used by person with chronic illness. Design Cross-sectional study. Methods The SOC-29 has been culturally adapted to Brazilian Portuguese language. In this study, we assessed its psychometric properties (construct validity and internal reliability) tested on 203 cardiac patients. The SOC-13 was tested on another 100 cardiac patients hospitalised in the same hospital. The construct validity of both versions was investigated through Pearson correlation between the measures of sense of coherence and of correlated constructs (self-esteem, depression and age), analysis of the principal components and comparison of distinct groups (male vs. female). The internal reliability for both versions was evaluated by Cronbach's alpha. Results For both versions, the construct validity assessments showed strong positive correlations between sense of coherence and self-esteem and strong negative correlations between sense of coherence and depression (convergent validity), and weak correlation between sense of coherence and age (divergent validity). Principal component analysis supported in part the presence of a single component (unidimensionality). Differences in sense of coherence were found by sex with SOC-29, but not with SOC-13. Cronbach's alpha coefficients showed satisfactory internal consistency in both versions. Conclusions The Brazilian Portuguese versions of SOC-29 and SOC-13 can be considered valid and reliable for the populations studied. More studies need to be performed to assess these proprieties in other Brazilian populations. Relevance to clinical practice This scale can be used in research and clinical practice in Brazil to assess nursing interventions aimed at decreasing stress during cardiac rehabilitation. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore issues related to sexual function and relationships, for men and their wives or partners, following diagnosis and treatment for prostate cancer. Background A diagnosis of prostate cancer and subsequent treatment result in a significant number of men experiencing some impairment to their sexual function. There is scant research into the impact of changed sexual function on these men's masculinity, sexuality, intimate relationships and their needs regarding counselling and supportive care. Design Internet-based survey. Methods Focus groups and couple interviews were used to improve validity for questionnaire items designed to provide insight into men's experiences of prostate cancer in areas such as sexual function and relationships. The questionnaire included both closed and open-ended questions and had the option for the wife or partner to complete a section. Results Qualitative research revealed 17 specific categories within three key themes: sexual dysfunction, loss of libido and masculinity. The questionnaire found, unexpectedly, the majority of men said that they had sufficient emotional and psychological support. Wives/partners confirmed cancer had impacted on their partner's feelings of masculinity (71%), compared to 42% of men who felt that this was the case. Predictors of loss of libido, erectile dysfunction and 'feeling less of a man' were developed. Univariate predictors included hormone therapy, regrets about treatment choice, cancer having impacted on masculinity and distress during the last week. Conclusions Men are not able to clearly identify the challenges prostate cancer brings especially changes to their masculinity. Relevance to clinical practice The findings strongly suggest that for men with prostate cancer, nursing assessments of men's sexual health be augmented by information gained from their partners; further, these assessments should be augmented with a careful exploration of these men's psyche guided by the knowledge that masculinity influences perceptions of self (being a man) and help seeking. [ABSTRACT FROM AUTHOR]

Aims and objectives To evaluate sexual dysfunction and the factors that affect sexual dysfunction in women with chronic disease. Background Sexual dysfunction is one of the most common problems in women with chronic disease. There is limited understanding of the related factors of sexual dysfunction in women with chronic disease, with research currently limited to other problems and problems related to chronic diseases. Design This research was conducted as a descriptive survey. Methods This study involved 100 female inpatients at clinics of internal medicine of a university hospital. Data were collected with a patients identification form and a female sexual function index (KCFI). Kruskal- Wallis test, test of significance of difference between two means and test of significance of difference between two pairs were used in the data analysis. Results Sixty-five percentage of women in the sample were defined to have sexual dysfunction. The majority of women expressed pain during sexual intercourse, problems in orgasm and satisfaction, and reluctance to have sex. Older age, being unemployed, being in menopause, fatigue, sleep disorder, and pain and weakness in extremities were the factors that were found to significantly affect the prevalence of sexual dysfunction ( p < 0·05). Conclusions This study concluded that sexual function of women with chronic disease is affected negatively. Chronic disease-related symptoms, experienced changes in the body and psychosocial problems are changing the lives of women. Ultimately, these changes also affect sexual activity. Relevance to clinical practice Determination of the factors affecting sexual activity in women with chronic disease is important for women' ability to cope with sexual dysfunction and keep it under control. To be able to accomplish this, it is necessary for healthcare personnel, the partners and family to work together. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate nursing students' attitudes towards providing sexual health care in clinical practice and to identify associated factors. Background Sexual health care is an important component of holistic health care. Nurses' personal sexual knowledge and attitudes are shown to influence provision of sexual health care. Design This is a descriptive, cross-sectional study. Methods We selected 146 senior nursing students by convenience sampling from nursing schools in two medical universities in central Taiwan. Data were collected using the Nursing Attitudes on Sexual Health Care scale developed based on the 'Permission/Limited Information/Specific Suggestions/Intensive Therapy' model. Higher scores indicated more positive attitudes. Results Participants' mean age was 22·15 years. Mean total Nursing Attitudes on Sexual Health Care scores ranged from 45-75 (61·40 ± 10·17). Nursing students' most positive attitudes towards Permission/Limited Information/Specific Suggestions/Intensive Therapy sexual healthcare interventions were at the Permission level, and least positive attitudes were at levels of Specific Suggestion and Intensive Therapy. The top three positive items were as follows: accept patients' expression of sexual concerns, initiate discussions and encourage patients to talk. Male nursing students had negative attitudes towards sexual healthcare interventions, which became more positive as age increased, especially at the Limited Information level. Conclusions Nursing students had different attitudes towards different levels of sexual health care in the Permission/Limited Information/Specific Suggestions/Intensive Therapy model. Attitudes were associated with age and gender. The Nursing Attitudes on Sexual Health Care scale is useful and reliable for identifying nurses' attitudes towards providing sexual health care. Relevance to clinical practice The Permission/Limited Information/Specific Suggestions/Intensive Therapy-based Nursing Attitudes on Sexual Health Care scale helps to identify nurses' attitudes. A better understanding of nurses' attitudes towards provisional sexual health care will provide information needed to develop appropriate education programmes to improve delivery of sexual health care. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate differences in sexual risk factors between adolescent girls reporting similar-aged or older sex partners. Background Adolescent girls are at significant risk of heterosexual-acquired HIV infection and other long-term reproductive health issues. Sexual partner age discordance in teen girls has been correlated with STIs, lack of protection, multiple partners and earlier age of sexual transition. Design A descriptive study comparing girls currently involved with age-discordant partners to those with similar-aged partners. Two-sample t-test for continuous variables and chi-squared test or Fisher's exact test for categorical variables were used to compare groups. Methods Baseline data from 738 sexually active, urban, adolescent girls aged 15-19 were analysed to determine which behaviours were more likely to occur in girls with older partners. Data were collected as part of a gender-specific HIV-prevention intervention in a randomised controlled trial (RCT) tailored to adolescent girls. Results Multiple reported sexual risk behaviours were found to significantly differ between the two groups at baseline. Overall, girls with older partners had more episodes of sexual instances (vaginal, anal and oral). Specific sexual risk behaviours were found to be statistically significant between the two groups. Girls with older partners started having sex at earlier ages, had more lifetime sexual partners, higher incidents of STIs and were reluctant to discuss using condoms with their partners. Girls with similar-aged partners were less willing to engage in risky sexual behaviours. Conclusions Findings from this investigation support data from other studies. Relationships with older male partners place adolescent girls at increased risk of HIV/ STIs and unintended pregnancy. Relevance to clinical practice Adolescent girls in age-discordant relationships are at risk of immediate and long-term sexual health morbidities. Identifying girls who are at increased risk by asking tailored questions will enable nurses to recommend appropriate diagnostics for this population and provide age-specific counselling. [ABSTRACT FROM AUTHOR]

Aims and objectives To assess women's attitudes towards the mechanisms of action of birth control methods. Background When addressing women's knowledge of and attitudes towards birth control methods, researchers frequently focus on side effects, effectiveness or correct use. Women's opinions about mechanisms of action have been much less investigated, and research is usually concentrated on the EC pill. Design Cross-sectional study. Methods Women, aged 18-49, from Germany, France, the UK, Sweden and Romania were randomly selected ( n = 1137). They were asked whether they would use a method that may work after fertilisation or after implantation and whether they would continue using it after learning it may have such effects. Logistic regression was performed to evaluate the influence of certain characteristics on women's attitudes. Results Almost half of women in Romania and Germany would not use methods with postfertilisation effects, while the lowest percentages were found in Sweden and in France. Regarding methods with postimplantation effects, higher percentages were found in all the countries. Highly educated women and those using a highly effective method were more likely to use methods with postfertilisation effects. On the contrary, married women, those who stated that human life begins at fertilisation and women with middle/high religiosity were less likely to consider using methods that may act after fertilisation. Conclusions One-third of European women reported that they would not consider using a method that may have postfertilisation effects. Relevance to clinical practice Given that postfertilisation effects may not be acceptable to some women, informing them of which methods may have these effects is essential to obtaining complete informed consent and to promoting women's autonomy. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine caregiver sleep quality, especially in relation to the daytime and night-time behaviours and psychological symptoms exhibited by persons with dementias. Background Caregivers of persons with dementias experience poorer sleep in comparison with noncaregivers, and poor sleep is related to negative health outcomes. The reasons for caregivers' poor sleep are complex, and it is known that the night-time behaviours of the persons with dementia contribute to caregiver sleep disruption. However, the frequency of behavioural and psychological symptoms of dementia has hitherto not been sufficiently explored as a contributing factor to poor caregiver sleep. Design A nonexperimental cross-sectional design. Methods Eighty caregivers completed questionnaires on the frequency of behavioural and psychological symptoms of the persons with dementia, the Dementia Severity Rating Scale, the Pittsburgh Sleep Quality Index and the Center for Epidemiologic Studies Depression Scale. Results Poor sleep was reported with awakenings by the persons with dementia occurring for more than half of the caregivers. The frequency of behaviours and symptoms did not make a unique contribution to the variance of caregivers' global sleep. The frequency of behaviours, and specifically of agitation and apathy, contributed to the variance in subjective sleep quality, as defined by the caregivers' appraisal of their sleep. Conclusions The findings demonstrate the relationship between (1) daytime and night-time behaviours of persons with dementias and (2) their caregivers' sleep quality and emphasise the complexity of the factors that contribute to caregiver sleep quality. Relevance to clinical practice These findings suggest that nurses should be cognizant of the relationship between daytime behaviours of the persons with dementia and the caregivers' appraisal of their sleep, realising that appraising one's sleep as poor can be a contributing factor to perpetuating sleep problems. Interventions aimed at helping the caregiver manage the persons with dementia's agitation or the caregiver's emotional response to persons with dementia apathy may improve caregivers' perception of their sleep. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate the level of job satisfaction and the impact of personal characteristics and work environment on job satisfaction among nurses. Background Job satisfaction among nurses is of paramount importance to providers of health care because satisfied nurses appear to be endowed with the physical and emotional dexterity and the effort needed to perform their tasks that will enhance the quality of care provided to the patient. Design A cross-sectional survey. Methods The study included nurses of both genders with at least one year of nursing experience, serving in all shifts of various clinical settings ( n = 178 nurses). A modified version of measure of nurses' job satisfaction, developed by Whitley and Putzier, was used to assess the effect of personal characteristics profile and work environment on job satisfaction. Results A total of 140 nurses were (response rate = 78·7%) entered into final data analysis. The study showed that 111 participants (79·3%) were significantly satisfied in their current jobs. Furthermore, 65 nurses (46·4%) were not satisfied with their salaries, and almost half the nurses were not pleased with the nurse/patient ratio, autonomy and enough time to discuss problems with staff. Conclusion This study revealed that almost 50% of nurses are overworked, are unsatisfied with their salaries, and have limited autonomy and inadequate communication with superiors. Strategies must be formulated by hospital and government authorities to decrease workload and empower nurses in controlling their practice in order to retain nurses in their jobs. Relevance to clinical practice The management must provide positive leadership and understand the local issues that affect nurses in order to enhance retaining and avoid shortage. This can be reflected positively on nursing clinical practice and ultimately patient health status. [ABSTRACT FROM AUTHOR]

Aims and objectives To assess Malaysian nurses' perceived job satisfaction and to determine whether any association exists between job satisfaction and intention to leave current employment. Background There is currently a shortage of qualified nurses, and healthcare organisations often face challenges in retaining trained nurses. Job satisfaction has been identified as a factor that influences nurse turnover. However, this has not been widely explored in Malaysia. Design Cross-sectional survey. Methods Registered nurses in a teaching hospital in Malaysia completed a self-administered questionnaire. Of the 150 questionnaires distributed, 141 were returned (response rate = 94%). Results Overall, nurses had a moderate level of job satisfaction, with higher satisfaction for motivational factors. Significant effects were observed between job satisfaction and demographic variables. About 40% of the nurses intended to leave their current employment. Furthermore, age, work experience and nursing education had significant associations with intention to leave. Logistic regression analysis revealed that job satisfaction was a significant and independent predictor of nurses' intention to leave after controlling for demographic variables. Conclusion The results suggest that there is a significant association between job satisfaction and nurses' intention to leave their current employment. It adds to the existing literature on the relationship between nurses' job satisfaction and intention to leave. Relevance to clinical practice Methods for enhancing nurses' job satisfaction are vital to promote the long-term retention of nurses within organisations. Attention must be paid to the needs of younger nurses, as they represent the majority of the nursing workforce and often have lower satisfaction and greater intention to leave than older nurses do. Strategies to nurture younger nurses, such as providing opportunities for further education, greater management decision-making capabilities and flexible working environment, are essential. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine changes in functional capacity, anxiety, depression and BMI in patients who completed a cardiac rehabilitation programme and to determine the influencing factors. Background While the effectiveness of cardiac rehabilitation is long established, more studies are needed to examine the combined effectiveness of this multicomponent intervention and the factors that influence this in the changed profile of patients currently attending cardiac rehabilitation. Design The study was a longitudinal retrospective study of patients following a six- or eight-week Phase III cardiac rehabilitation programme. Methods The study recruited 154 patients. Functional capacity, anxiety, depression, weight, waist circumference and BMI were assessed at the beginning and end of cardiac rehabilitation. t-tests were used to assess changes over time, and multivariate regression analysis was used to determine the influence of factors on these changes. Results Significant improvements were seen in functional capacity, waist circumference, weight and BMI, but not in depression and anxiety. Multivariate analysis revealed that being younger and less fit was associated with greater improvements in functional capacity while reason for referral, gender, depression or BMI did not influence improvements in functional capacity. Models testing the influence of the factors on BMI, anxiety and depression were not significant. Conclusion Cardiac rehabilitation is still an effective method to instigate changes in cardiac risk factors despite the changes in patients profile attending programmes. Relevance to clinical practice Continued encouragement of the historically less typical patients to participate in cardiac rehabilitation is needed as reason for referral, gender, depression or BMI did not influence improvements in functional capacity. Despite psychosocial components within the programme, no significant improvements were observed over cardiac rehabilitation in depression or anxiety. While effectiveness was observed, there is room for further optimisation of practice and research by employing and documenting clearly the use of behavioural techniques. [ABSTRACT FROM AUTHOR]

Aims and objectives To determine the current status of dementia patient's quality of life and compare influencing factors in China and Japan to inform nursing care and potentially improve the patient's quality of life. Background The prevalence of dementia is increasing related to lack of a cure, thus prompting some researchers and clinicians to focus on patient's quality of life. Design A cross-sectional study. Methods A convenience sample of 200 mild-to-moderate dementia patients was obtained in Jinan city and 205 ones in Wakayama city. Then, we measured patient's quality of life and analysed the relation between general demographic information, cognitive function, activities of living, behavioural and psychological symptoms, and the patient's quality of life. Results The total score of Dementia Quality of Life in Jinan city was 89·82 ± 15·11; multiple linear regression showed that the influencing factors of quality of life were marital, economics, characteristics, activities of living, hypertension and irritability. And the total score in Wakayama city was 118·30 ± 14·56; the influencing factors were education, body mass index, activities of living and depression. Conclusions The total score of Dementia Quality of Life in Jinan city was significantly lower than Wakayama city. The same influencing factor between these two cities was activities of living. Relevance to clinical practice Nurses could implement interventions to focus on many of the patient's influencing factors, so that to improve their mental and physical health, which may slow the disease process and further improve the patient's quality of life. In addition, Chinese government could learn some experience from Japanese government, such as perfect the system of nursing insurance for elderly and introduce professional geriatric nursing talents to provide better service for the elderly. [ABSTRACT FROM AUTHOR]

Aims and objectives To develop and to test the psychometric properties of the Chinese Health Literacy Scale for Diabetes. Background Patients with diabetes encounter many challenges when making health decisions in their daily lives, as they have access to many different kinds of health information. Health literacy issues are new topics in Chinese society. Without a valid and reliable instrument in Chinese, it is difficult to measure the level of health literacy and promote the concept of health literacy in Chinese societies. Design A methodological study with a sample of 137 patients with type 2 diabetes aged 65 years or older. Method Chinese Health Literacy Scale for Diabetes was developed with reference to the revised Bloom's taxonomy model. Psychometric tests (content validity, item analysis, construct validity, discriminative ability and test-retest reliability) were conducted. Correlations between Chinese Health Literacy Scale for Diabetes and four relevant measures were tested. Cronbach's alpha and alpha if item deleted were calculated to assess internal consistency. Results Cronbach's alpha for Chinese Health Literacy Scale for Diabetes and its four subscales (remembering, understanding, applying and analysing) were 0·884, 0·885, 0·667, 0·654 and 0·717, respectively. The Chinese Health Literacy Scale for Diabetes was significantly correlated with the Diabetic Knowledge Scale ( r = 0·398, p < 0·001), the Diabetic Management Self- Efficacy Scale ( r = 0·257, p < 0·001), the Preschool and Primary Chinese Literacy Scale ( r = 0·822, p < 0·001) and the Chinese Value of Learning Scale ( r = 0·303, p < 0·001). It took an average of seven minutes to complete this 34-item instrument. Conclusion The findings of this study support the Chinese Health Literacy Scale for Diabetes as a reliable and valid instrument for measuring the health literacy of Chinese patients with diabetes. Relevance to clinical practice We recommend that clinicians use this tool to assess patients' health literacy before conducting any kind of health promotion. [ABSTRACT FROM AUTHOR]

Aims and objectives To identify factors associated with health-related quality of life among overweight or obese adults. Background The obesity epidemic presents a global challenge. Obesity is associated with lower health-related quality of life; however, no study has comprehensively examined correlates of health-related quality of life in this population. Design A cross-sectional design. Methods The physical component score, mental component score and eight domain scores of the Short Form-36 v2 were used to assess health-related quality of life. We identified 23 possible correlates of health-related quality of life, including age, body mass index, health and weight histories, perceived stress, cholesterol-lowering diet self-efficacy, problem-solving, binge eating, dietary intake and physical activity. Correlational analyses were used to examine the bivariate associations between correlates and health-related quality of life variables. All possible subsets regression was used to develop predictive models of health-related quality of life. Results The sample ( n = 210) was predominantly White (84·8%), female (78·1%) and middle-aged (average age = 46·80 years). Age, body mass index, education, having children at home, and being hypertensive were identified as the best predictors of physical component score, explaining about 9% of the variance. Age, marital status, having hyperlipidaemia, perceived stress, problem-solving, self-efficacy, binge eating and barriers to healthy eating predicted mental component score, explaining approximately 48% of the variance. Physical functioning and role physical domains of health-related quality of life had similar sets of predictors, with 15% and 13% of the variance explained, respectively, while similar predictors were identified for bodily pain (6%), general health (26%), vitality (40%), social functioning (32%), role emotional (42%) and mental health (46%) domains. Conclusions Psychosocial factors were associated with the mental-related quality of life. Further exploration of factors related to physical-related quality of life is warranted in this population. Relevance to clinical practice When working with overweight/obese adults who are trying to lose weight, nurses need to consider socio-demographic and psychosocial factors in the development of a treatment plan that will improve health-related quality of life in this population. [ABSTRACT FROM AUTHOR]

Aims and objectives To describe factors associated with the subjective quality of life of individuals who had attempted suicide. Background Although quality of life has been a focus of concern in mental health care, data are lacking on what life is like and what factors are related to an individual's quality of life after a suicide attempt. Design A cross-sectional, descriptive design was used. Methods Participants comprised a convenience sample of 103 individuals who had attempted suicide within the previous three months and received follow-up care from one suicide-prevention centre in northern Taiwan. Participants were assessed for depression and quality of life using the Beck Depression Inventory, Taiwan version and the World Health Organisation Quality of Life Instrument- BREF, Taiwan version, respectively. Results Almost half the participants ( n = 49) had severe depression and one-third of them ( n = 30) reattempted suicide while receiving follow-up care. Depression and quality-of-life scores were statistically significantly inversely correlated. participants' quality-of-life scores were most associated with their depressive level, reattempting suicide during suicidal follow-up care, high educational level and older age. Conclusions The present study indicates that factors associated with quality of life decreased more in individuals with moderate/severe depression than in those with mild depression. In addition, individuals who reattempted suicide during follow-up care were more likely to suffer from poor life quality. Relevance to clinical practice Mental health professionals should include frequent evaluation of depressive status and quality of life in follow-up care for patients who have recently attempted suicide. Particularly, mental health professionals must treat suicidal individuals with a high tendency to reattempt suicide by establishing trust with them and allowing them to narrate their painful experiences during follow-up care. [ABSTRACT FROM AUTHOR]

Aims and objective. To verify association between PU development with nursing workload and illness severity and to verify whether nursing workload and illness severity are related with Braden Scale scores. Background. Critically ill patients are more susceptible to treatment complications because of the severity of their clinical condition. Design. Prospective descriptive study. Methods. Patients consecutively admitted to three intensive care units (ICUs) of a public university hospital located in Sao Paulo, Brazil and without pressure ulcer (PU) at admission and a minimum stay of 24 hours were included in the sample. Prospective data collection included demographic, clinical and hospitalisation data, Nursing Activities Score (NAS), Simplified Acute Physiology Score (SAPSII) and Braden Scale. Multivariate linear regression analysis was applied to verify whether nursing workload and illness severity are related with Braden Scale scores. Multivariate logistic regression analysis was used to verify whether nursing workload and illness severity were risk factors associated with PU development. Results. The study sample included 160 patients. The mean Braden score was 12·0 and PU incidence was 34·4%. Multivariate linear regression analysis identified as factors related to variation of Braden scores: illness severity (SAPSII), nursing workload (NAS) and age. Multivariate logistic regression showed a model with risk factors associated with PU development: sex, length of ICU stay, illness severity and nursing workload. Conclusion. Nursing workload, severity of illness, sex and length of ICU stay were identified as risk factors associated with PU development. However, nursing workload acted as a protective factor. Illness severity, nursing workload and age were related to Braden scores. Relevance to clinical practice. Accurate identification of risk factors and the use of clinical judgment in skin assessment are prerequisites for determining appropriate strategies to prevent pressure ulcers, to improve quality of care for patient safety and to reduce length of ICU and hospital stay and costs. [ABSTRACT FROM AUTHOR]

Aims and objectives To compare the levels of self-care behaviour, social support and quality of life among type 2 diabetes mellitus patients who underwent three regimens: taking medicine, taking-medicine-while dieting and taking-medicine-while-dieting-with exercise. Background Diabetes treatment is a critical concern worldwide. However, studies on self-care behaviour, social support and quality of life based on diabetes patients' diverse regimens are few. Design This study was a cross-sectional design. Methods We enroled 127 outpatients aged over 40 years who visited a metabolism clinic at a medical centre in Southern Taiwan. The Self-care Behaviour Scale, Social Support Scale and Quality of Life Scale were used to collect data. Results The results indicated that patients with a combined regimen of taking-medicine-while-dieting-with-regular exercise had the highest score at the levels of social support, self-care behaviour and quality of life. Conclusion The study results could offer evidence-based knowledge for healthcare professionals to guide and promote social support, self-care behaviour and quality of life for people diagnosed with type 2 diabetes. Relevance to clinical practice These findings will help healthcare professionals to establish appropriate nursing strategies for type 2 diabetes patients who need to exercise regularly as part of their daily care to enhance their self-care behaviour, social support and quality of life. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the factors associated with the numbers of remaining teeth among type 2 diabetes community residents. Background Promoting oral health is an important nursing role for patients with diabetes, especially in disadvantaged areas. However, limited research has been carried out on the relationship between numbers of remaining teeth, diabetes-related biomarkers and personal oral hygiene among diabetic rural residents. Design A cross-sectional, descriptive design with a simple random sample was used. Methods This study was part of a longitudinal cohort study of health promotion for preventing diabetic foot among rural community diabetic residents. It was carried out in 18 western coastal and inland districts of Chiayi County in central Taiwan. In total, 703 participants were enrolled in this study. Results The findings indicated that a high percentage of the participants (26%) had no remaining natural teeth. Nearly three quarters (74%) had fewer than 20 natural teeth. After controlling for the potential confounding factors, multivariate analysis demonstrated that the factors determining numbers of remaining teeth were age ( p < 0·001), education ( p < 0·001), using dental floss ( p = 0·003), ankle brachial pressure index ( p = 0·028), waist circumference ( p = 0·024) and Hb A1 C ( p = 0·033). Conclusions Except for some unmodifiable factors, the factors most significantly associated with numbers of remaining teeth were less tooth-brushing with dental floss, abnormal ankle brachial pressure and poor glycemic control. Relevance to clinical practice This study highlights the importance of nursing intervention in oral hygiene for patients with type 2 diabetes. It is necessary to initiate oral health promotion activities when diabetes is first diagnosed, especially for older diabetic residents of rural or coastal areas who are poorly educated. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore nursing students' perception of the meanings and roles of non-verbal communication and sensitivity. It also attempts to understand how different factors influence their non-verbal communication style. Background The importance of non-verbal communication in the health arena lies in the need for good communication for efficient healthcare delivery. Understanding nursing students' non-verbal communication with patients and the influential factors is essential to prepare them for field work in the future. Design Qualitative approach based on 16 in-depth interviews. Methods Sixteen nursing students from the Master of Nursing and the Year 3 Bachelor of Nursing program were interviewed. Major points in the recorded interviews were marked down for content analysis. Results Three main themes were developed: (1) understanding students' non-verbal communication, which shows how nursing students value and experience non-verbal communication in the nursing context; (2) factors that influence the expression of non-verbal cues, which reveals the effect of patients' demographic background (gender, age, social status and educational level) and participants' characteristics (character, age, voice and appearance); and (3) metaphors of non-verbal communication, which is further divided into four subthemes: providing assistance, individualisation, dropping hints and promoting interaction. Conclusions Learning about students' non-verbal communication experiences in the clinical setting allowed us to understand their use of non-verbal communication and sensitivity, as well as to understand areas that may need further improvement. Relevance to clinical practice The experiences and perceptions revealed by the nursing students could provoke nurses to reconsider the effects of the different factors suggested in this study. The results might also help students and nurses to learn and ponder their missing gap, leading them to rethink, train and pay more attention to their non-verbal communication style and sensitivity. [ABSTRACT FROM AUTHOR]

Aims and objectives To identify the prevalence of the metabolic syndrome and its individual components in a population of college students at a public higher education institution in Fortaleza, Brazil. Background Scientific evidence has demonstrated the ascent of the metabolic syndrome in the young population. Design Cross-sectional study of 702 Brazilian college students between January- July 2011. Methods Socio-demographic indicators, life habits and the components of the metabolic syndrome were assessed. anova statistical tests were used to associate gender with the metabolic syndrome components, and the chi-square test to associate the number of metabolic syndrome components with gender and body mass index. Results High fasting venous glucose, triglyceride, total cholesterol and LDL-C levels were found in 12·3, 23·0, 9·7 and 5·9% of the sample, respectively. The prevalence of the metabolic syndrome amounted to 1·7%. Nevertheless, 30·4% of students manifested at least one and 12·4% at least two individual components. The prevalence of the metabolic syndrome was higher in men (58·3%) and in people who were overweight (33·3%) and obese (41·7%). It is important to implement public health policies to reduce college students' vulnerability to the metabolic syndrome. Conclusions Most college students who displayed ≥3 metabolic syndrome components were men and already indicated being overweight and/or obesity. Relevance to clinical practice It is important that nurses assess the frequency of metabolic syndrome in college students as a predictor of cardiovascular health. [ABSTRACT FROM AUTHOR]

Aims and objectives To study risks of surgical site infection in breast surgery. The objectives were to measure the association of postoperative infection with patient- and procedure-related factors. Background The infection rate in breast surgery is expected to be low but it varies a lot. The variation is recommended to be assessed by measuring procedure-related factors. Design A retrospective chart review of 982 breast surgery patients was completed. Methods The data on patient demographics, procedure types, patient and surgery-related factors were collected. A multivariate logistic regression model for all breast operations ( n = 982), lumpectomies ( n = 700) and mastectomies ( n = 282) was performed. Results The infection rate was 6·7%. In a multivariate logistic regression model for all operations, a contaminated or dirty wound, high American Society of Anesthesiologists score, high body mass index, use of surgical drains and re-operation predicted increased infection risk. In lumpectomies high body mass index and use of surgical drains predicted increased risk. In mastectomies, the significant predictor was re-operation. Conclusions The surgical site infection rate was high. In addition to the two classical risks (high wound class and anaesthesia risk), high body mass index, re-operation and use of surgical drain increased the infection risk among all patients. Relevance to clinical practice In breast surgery careful assessment, documentation and adherence to aseptic practices are important with all patients. Patients with heavy weight need special attention. The need for antimicrobial prophylaxis in re-operations and the need of surgical drains in lumpectomies are important to consider carefully. [ABSTRACT FROM AUTHOR]

Aims and objectives. To explore the prevalence, types and sources of violence in the nursing workplace and to assess the factors related to violence. Background. Workplace violence in nursing is not a new phenomenon; in recent years, much more attention has been paid to the issue in Taiwan. Few studies, however, have investigated the overall distribution of violence and the reasons for not reporting these incidents in nursing workplaces. Design. This descriptive, correlational study used structured questionnaires to collecting information about workplace violence experienced by nurses over the last year. Methods. Nurses ( n = 880) working in a public hospital in southern Taiwan were invited to complete the questionnaires, with a response rate of 89·9%. Results. Nurses working in outpatient units and emergency rooms experienced more frequent violence than those on surgical wards and intensive care units. Conclusion. These findings provide evidence of workplace violence in hospitals and may aid hospital and nursing administration to reduce and control violence. Relevance to nursing practice. These results provide evidence in relation to the importance of effective communication training to nurses and will assist hospital administrations in establishing higher-quality, healthy workplace environments. [ABSTRACT FROM AUTHOR]

Aims and objectives To compare the perceptions of patients with acute myocardial infarction concerning bed and shower baths and evaluate how antecedent variables influence their perceptions. Background Professionals are often oblivious to the fact that, when performing a bed bath, they are manipulating someone else's body and invading someone's privacy and intimacy. This lack of awareness may trigger various responses in patients, such as dissatisfaction and anxiety. Several studies assessing the perceptions of patients when receiving a bed bath, and most are qualitative. Thus, there is a need to quantify these perceptions. Design The research was a crossover study. Methods The sample consisted of 71 patients with acute myocardial infarction, admitted to coronary units. Patients were evaluated on two occasions: after their second bed bath and after their second shower bath. A Semantic Differential Scale was constructed and validated prior to data collection. Results The perception of patients receiving shower baths was significantly more positive than those of patients receiving bed baths (<0·0001). The only variable that interfered with the general perception of patients was prior hospitalisation ( p = 0·0468). Patients who previously experienced a hospitalisation had a less positive perception, concerning both the bed and shower baths, than those who were hospitalised for the first time. Conclusion The perceptions of patients receiving bed baths were less positive than those of patients receiving shower baths. Relevance to clinical practice The perceptions of patients receiving baths are very important to guiding nursing care and developing strategies to minimise patient dissatisfaction. [ABSTRACT FROM AUTHOR]

Aims and objectives. Hypothesised that sociodemographic factors and illness variables would be associated with mortality and that emotional and social loneliness measured using the Social Provisions Scale would influence mortality among nursing homes residents with cancer. Background. Studies are lacking on how emotional and social loneliness influence mortality among cognitively intact older people in nursing homes with and without a diagnosis of cancer. Design. A cross-sectional design was used at baseline with a five-year follow-up of mortality. Methods. A cohort of 227 cognitively intact (Clinical Dementia Rating scale score ≤0·5) older residents (60 with cancer and 167 without) from 30 nursing homes were followed from 2004-2005 to 2010. Data were collected by face-to-face interview. Sociodemographic variables and medical diagnoses were obtained from the records. Results. Survival did not differ significantly between residents with and without cancer. After adjustment for sociodemographic and illness variables, increasing age, higher education and comorbidity were associated with mortality. In the final model from a backward selection procedure, attachment (emotional loneliness) was associated with mortality. Conclusions. Independent of a cancer diagnosis or not, emotional loneliness, age, education and comorbidity influenced mortality among nursing homes residents without cognitive impairment. Relevance to clinical practice. Nurses should pay attention to emotional loneliness among nursing homes residents independent of cancer and especially give attention to the importance to have a close confidant who provides emotional support. [ABSTRACT FROM AUTHOR]

Aims and objectives. To examine the relationship between patient satisfaction and the incidence of severe and enduring pain through a health board wide hospital satisfaction questionnaire. Background. The incidence and management of acute postoperative pain and its relationship to patient satisfaction have been of great interest to clinicians over the last 20 years. Evidence suggests that despite many moves to address this problem with the advent of acute pain nurse specialists and dedicated pain teams, severe and enduring pain continues to be a problem. However, patients appear to report high satisfaction levels. Design. The study design was a postal questionnaire the results of which were analysed statistically. Methods. The postal questionnaire was sent to patients who had been discharged from acute hospitals in one health board in the previous two weeks. A total of three large acute hospitals were included. The data were analysed to produce descriptive statistics for all patients on the pain questions and then for patients with severe and enduring pain on the variables of age, gender, ethnic group, responses to pain questions and type of admission. Results. Twenty-six percent of patients reported having pain all or most of the time. Patients suffering from severe and enduring pain were younger females. Conclusion. Acute postoperative pain continues to be a problem, although patients continue reporting moderate satisfaction levels. Relevance to clinical practice. Acute postoperative pain is an ongoing issue for postsurgical patients. It is crucial to understand and recognise issues that can adversely contribute to increased pain severity. [ABSTRACT FROM AUTHOR]

Aim and objectives. To measure health-related quality of life, anxiety and depression ahead of mammography screening and to assess any differences in health-related quality of life compared to reference population. Background. The study of health-related quality of life among attendees prior to mammography screening has received little attention, and increased knowledge is needed to better understand the overall health benefits of participation. Design. A two-group cross-sectional comparative study was performed. Methods. The samples comprised 4,249 attendees to mammography screening and a comparison group of 943 women. We used the SF-36 Health Survey to assess health-related quality of life. Linear regression was used to study any differences between the groups with adjustment for age, level of education, occupation, having children and smoking status. Other normative data were also used. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. Results. Attendees scored statistically significant higher on the SF-36 than the comparison group but were in line with normative data. Attendees had anxiety mean 4 ·1 and depression mean 2 ·6. Conclusions. The majority of the attendees have a high health-related quality of life, low anxiety and depression ahead of screening. Anxiety and depression were less than shown in normative data from Norway. Despite a high health-related quality of life, low anxiety and depression among the majority, healthcare workers should pay special attention to the few women who are anxious and depressed, and have a lower health-related quality of life. Omitted from mammography screening may be women who are unemployed, have lower socioeconomic status, are anxious and are depressed. Further research should be performed with non-attendees and subgroups to improve the screening programme. Relevance to clinical practice. It is important to identify which patients have the greatest need for support and caring in an organised mammography screening and who may be overlooked. [ABSTRACT FROM AUTHOR]

Aims and objectives The aim of this research is to investigate the degree of distress experienced by nurses in response to the challenging behaviour of nursing home residents (residents' challenging behaviour) and their impact on nurses individual resources (general health, burnout and work ability). Background Because of the increasing and ageing population of nursing home residents, professional nursing care faces several challenges. One highly prevalent issue among nursing home residents is the so-called 'challenging behaviour'. However, to date, 'challenging behaviour' has not yet been recognised as an occupational stressor, and the extent of the impact of 'challenging behaviour' on nurses' well-being and functioning is not well understood. Design Cross-sectional study. Method Self-report questionnaire data collected from 731 registered nurses and nursing aides in 56 German nursing homes were used in a secondary data analysis. The level of residents' challenging behaviour-related distress that nurses experienced was assessed using a scale consisting of nine questions. Validated instruments were used for the assessment of individual resources. Results The mean score for residents' challenging behaviour-related distress was 41·3 ( SD 21·2). Twenty-seven per cent of all nurses reported over 50 residents' challenging behaviour. Residents' challenging behaviour had a significant impact on all three measures of individual resources. Specifically, nurses exposed to frequent residents' challenging behaviour reported a significantly lower quality of general health, reduced workability and high burnout levels. Conclusion Our findings indicate that residents' challenging behaviour-related distress is a significant work place stressor for nurses in nursing homes with a clear impact on general health, the risk of burnout and work ability. Relevance to clinical practice Our findings suggest that residents' challenging behaviour is a stressor for nurses in nursing homes. Further scientific and practical attention is necessary from the point of view of working conditions for nurses. The development of preventive concepts for nursing staff and residents is recommended. [ABSTRACT FROM AUTHOR]

Aims and objectives To measure the diagnostic value of the Numeric Rating Scale by comparing it to a Verbal Rating Scale in older patients. Background Pain management in older patients is an important challenge because of their greater susceptibility to adverse effects of analgesics. Nurses play an important role in applying guidelines for postoperative pain treatment. However, effective pain management is dependent upon valid and reliable pain assessment. Design Cross-sectional study. Methods In total, 2674 older patients scored their postoperative pain on an 11-point numeric rating scale ( NRS) and an adjective scale ( VRS) including no pain, little pain, painful but bearable, considerable pain and terrible pain. The diagnostic value of different NRS cut-off values for administering analgesics is determined by an ROC curve. Results Sensitivity of NRS > 3 for 'unbearable' pain in older patients was 72% with a specificity of 97·2%. With a cut-off point NRS > 4, sensitivity increased to 83%, while specificity was 96·7%. With a cut-off point NRS > 5, sensitivity was 94%, while specificity was 85%. A high proportion (75%) of older old patients (≥ 75 years) with 'painful but bearable' considers NRS 4, 5 and 6 to this VRS category. Conclusion Using an NRS cut-off point > 3 or > 4, a large group of older patients with 'bearable' pain would incorrectly classified as 'unbearable'. When we make the assumption that bearable pain means no wish for additional analgesics, this misclassification might result in overtreatment with analgesics, while 3% would be undertreated. With NRS cut-off point > 5, 6% have a risk of overtreatment and 15% of undertreatment. Relevance to clinical practice Nurses should not rely solely on the NRS score in determining pain treatment; they need to communicate with older patients about their pain, the need for analgesics and eventual misconceptions about analgesics. [ABSTRACT FROM AUTHOR]

Aims and objectives. To examine parental self-efficacy experiences for users of a parenting support programme and consider the pertinence of self-efficacy theory to health visiting (public health nursing) practice. Background. Commonly, successful parenting training programmes are underpinned by social learning principles and aim to strengthen parental self-efficacy. However, research examining programme effectiveness rarely discusses how self-efficacy outcomes are achieved. Design. A descriptive survey was completed as the first part of a realistic evaluation study examining how a UK parenting support programme worked. Methods. The first part of the realistic evaluation involved validating outcome measures (the Parenting Self-Agency Measure and Self-Efficacy for Parenting Tasks Index subscales) and administering a questionnaire survey. The questionnaire was completed by adults accessing a parenting support programme during a 10-month period ( n = 168). Data were analysed using descriptive and inferential statistics. Results. Women were the main users of the programme, which included informal drop-in groups as well as more formalised health visiting services and parenting training courses. The Parenting Self-Agency Measure results indicated good general parental self-efficacy; however, the task-specific Self-Efficacy for Parenting Tasks Indexes scales suggested that parents were less self-efficacious in disciplining children. Lower self-efficacy scores correlated with high ratings for 'feeling tired', 'receiving negative comments' and 'giving-in to a child's demands'. Conclusions. Study results indicate that the domain general and task-specific measures provide different, but helpful, insights into parental self-efficacy experiences. By identifying factors associated with the levels of general and task-specific parental self-efficacy, health visitors can gain a fuller appreciation of support needs. Relevance to practice. To maximise potential through parenting support, attention should be given to addressing factors associated with poorer self-efficacy experiences, including parental tiredness. Equally, practice should be directed at developing community environments that offer exposure to positive praise and the opportunity to practice new skills without facing criticism. [ABSTRACT FROM AUTHOR]

Aims and objectives. The primary aim is to provide insight into client characteristics and characteristics of home telecare contacts, which may influence the adoption of home telecare. Secondary aim is to examine the applicability of four perceived attributes in Rogers' diffusion of innovations theory, which may influence the adoption: relative advantage, compatibility, complexity and observability. Background. Western countries face strongly increasing healthcare demands. At the same time, a growing nursing shortage exists. The use of home telecare may be instrumental in improving independence and safety and can provide support to older and chronically ill people, but a precondition for its uptake is that clients consider it as a useful and helpful technological tool. Design. A survey conducted among clients of seven home care organisations in the Netherlands connected to a home telecare system. Methods. In 2007, a postal questionnaire was distributed to 468 older or chronically ill clients: 254 responded (54%). The data were analysed by regression techniques, employing a theoretical model. Results. This study showed that clients' perceived attributes - relative advantage, compatibility, complexity and observability - have a significant effect on adoption of home telecare explaining 61% of the variance. The chance of adoption is higher when a client already receives long-term personal and/or nursing care, he/she lives alone and when there are fixed daily contacts via the home telecare system. The perception of possible benefits can still be enhanced. Conclusions. The concept of perceived attributes, derived from Rogers' diffusion of innovation theory, has been useful to explain clients' adoption of home telecare. Relevance to clinical practice. Home care organisations can best focus on clients already in care and people living alone, in offering home telecare. Nurses, who aim to enhance the client's adoption of home telecare, have to take into account clients' perceived attributes of such new technology. [ABSTRACT FROM AUTHOR]