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Aims and objectives. To investigate the prevalence of oral health problems in patients hospitalised with acute medical conditions. Background. Increases in our knowledge of oral health and its effects on overall well-being have helped us elucidate the relationship between oral health, disease and treatment. Currently, little is known regarding the number of patients requiring oral care at the time of hospitalisation. Design. This was a cross-sectional study that assessed patients hospitalised with acute medical conditions using the Revised Oral Assessment Guide (ROAG). Methods. The ROAG was translated into Danish, and three experienced nurses performed the assessments. A visual guide was used to calibrate the assessments. The data were analysed with spss to determine the percentage of participants who exhibited specific clinical characteristics. Results. Ninety-one per cent of the newly admitted patients in this study had one or more oral health problems. Common oral problems, listed in order of the most frequent first, included the following: local plaque or debris, decayed teeth or damaged dentures and dryness and/or changes in the colour of the tongue. There was a correlation between age and the number of oral health problems. Conclusions. In this study, oral health was severely affected at the time that patients were hospitalised for acute medical issues. Relevance to clinical practice. Highlights the need for standardised oral health assessments of acutely hospitalised patients, which should begin as soon as the patient's condition allows. Without these oral health assessments, a number of oral problems may not be detected and may increase in severity. [ABSTRACT FROM AUTHOR]

Aim. To examine the health-related quality of life in a cohort of individuals with irritable bowel syndrome and to explore the use of several data-mining methods to identify which socio-demographic and irritable bowel syndrome symptoms are most highly associated with impaired health-related quality of life. Background. Health-related quality of life can be adversely affected by irritable bowel syndrome. Little is presently known about the predictive factors that may influence the quality of life in these patients. Design. Cross-sectional survey design involving the general population of the UK. Methods. Individuals with symptoms of irritable bowel syndrome were recruited to a longitudinal cohort survey via a UK-wide newspaper advert. Health-related quality of life was measured using a battery of validated questionnaires. Several data-mining models to determine which factors are associated with impaired health-related quality of life are considered in this study and include logistic regression, a classification tree and artificial neural networks. Results. As well as irritable bowel syndrome symptom severity, results indicate that psychological morbidity and socio-demographic factors such as marital status and employment status also have a major influence on health-related quality of life in irritable bowel syndrome. Conclusion. Health-related quality of life is impaired in community-based individuals in the UK with irritable bowel syndrome. Although not always as easily interpreted as logistic regression, data-mining techniques indicate subsets of factors that are highly associated with impaired quality of life. These models tend to include subsets of irritable bowel syndrome symptoms and psychosocial factors. Relevance to clinical practice. Identification of the role of psychological and socio-demographic factors on health-related quality of life may provide more insight into the nature of irritable bowel syndrome. Greater understanding of these factors will facilitate more flexible and efficient nursing assessment and management of this patient group. [ABSTRACT FROM AUTHOR]

Aims and objectives. The purpose of this study was to describe knowledge about stroke warning signs and risk factors in patients with previous stroke or transient ischaemic attacks in China and to investigate the relationship between socio-demographic characteristics & health status and patients' knowledge about stroke. Background. Stroke is the leading cause of death and functional impairment in China. Survivors are at high risk of new vascular events. Secondary prevention after stroke or transient ischaemic attacks is not satisfactory. Previous research suggests that awareness of stroke plays an important role in facilitating secondary prevention. However, little is known about knowledge of stroke warning signs and risk factors among patients with previous stroke/transient ischaemic attacks. Design. A cross-sectional questionnaire study. Methods. This study was conducted in Hunan Province, China, between July and December in 2010. Subjects were recruited using a cluster sampling method. A questionnaire was administered to 1600 patients with stroke/transient ischaemic attacks diagnose from eight hospitals, and 1200 patients (75%) responded. Patients' knowledge about stroke warning signs and risk factors were collected and analysed. Results. Patients' knowledge about stroke warning signs was very poor (only 3·3% identified all warning signs and 28·3% identified three). Patients' knowledge about important risk factors (e.g. atrial fibrillation, diabetes, metabolic syndrome, etc.) was also very poor (<30%). Patients' action in emergency was extremely poor (only 9·2% reported to call emergency service). The age, education, stroke-related diagnoses and family history of cardiovascular disease were significantly associated with patients' knowledge about stroke. Conclusions. Knowledge about stroke warning signs and risk factors was very poor in patients with previous stroke or transient ischaemic attacks in China. Relevance to clinical practice. Dissemination of stroke knowledge should be a core responsibility for Chinese clinical nurse. Future clinical education to improve patient's knowledge about stroke and further intervention to manage cardiovascular risk factors are indicated. [ABSTRACT FROM AUTHOR]

Aim and objectives. To identify maternal, newborn and obstetric factors associated with birth-related perineal trauma in one independent birth centre. Background. Risk factors for birth-related perineal trauma include episiotomy, maternal age, ethnicity, parity and interventions during labour including use of oxytocin, maternal position at time of birth and infant birth weight. Understanding more about these factors could support the management of vaginal birth to prevent spontaneous perineal trauma, in line with initiatives to reduce routine use of episiotomy. Design. Cross-sectional study. Methods. Data were retrospectively collected from one independent birth centre in Brazil, during 2006-2009. The dependent variable (perineal trauma) was classified as: (1) intact perineum or first-degree laceration, (2) second-degree laceration and (3) episiotomy (right mediolateral or median). Results. There were 1079 births during the study period. Parity, use of oxytocin during labour, position at time of giving birth and infant birth weight were associated with second-degree lacerations and episiotomies. After adjusting for parity, oxytocin, maternal position at the expulsive stage of labour and infant birth weight influenced perineal outcomes among primiparae only. Conclusions. Although the overall rate of episiotomies in this study was low compared with national data, it was observed that younger women were most vulnerable to this intervention. In this age group in particular, the use of oxytocin as well as semi-upright positions at the time of birth was associated with second-degree lacerations and episiotomies. Relevance to clinical practice. The use of upright alternative positions for birth and avoidance of use of oxytocin could reduce the risk of perineal trauma from lacerations and need to perform episiotomy. [ABSTRACT FROM AUTHOR]

Aim. To define the needs of intensive care unit patients' families in the specific suburban/rural population of Crete Island. Background. Families of intensive care unit patients have specific needs that should also be addressed by the intensive care unit-care team. Current research has mostly concentrated on families from an urban setting, therefore may not be applicable to other populations. Design. Prospective cohort study. Methods. Family members of patients admitted in the intensive care unit for ≥48 hours over 18 months, in a mixed medical-surgical, 11 bed closed intensive care unit. Questionnaire: The Greek translation of Critical Care Family Need Inventory, which consists of 45 need items covering the information, reassurance, proximity, support and comfort domains. Each item was scored on a four-point scale (1 = very important to 4 = not important). Participants were also asked to single out the most important need from the Critical Care Family Need Inventory and complete a questionnaire on basic demographic characteristics. Results. Two hundred and thirty (65%) family members completed the questionnaire. Mean score for each of the 45 items ranged from 1·03-3 (scale from 1: very important-4: not important). Fourteen items were rated by responders as very important (mean score <1·25). Reassurance need items were consistently singled out as most important regardless of the participant's background. Participants with a lower educational and socio-economical status rated support need items as more important than those with a higher status. Conclusion. In this particular suburban/rural population, both 'universal' reassurance needs and specific support needs related to responders' educational or socio-economical background were identified. Relevance to clinical practice. Enhanced recognition of these needs may improve quality of care offered by intensive care unit-care team to families of their patients. [ABSTRACT FROM AUTHOR]

Aims and objectives. To investigate how many critically ill patients developed deep vein thrombosis (DVT) during their admission to intensive care units (ICU) and to compare the characteristics of patients with and without deep vein thrombosis. Background. Critically ill patients are a high-risk group for deep vein thrombosis because they typically have multiple risk factors, such as prolonged immobility, mechanical ventilation and old age. Design. A prospective observational study was employed. Methods. The subjects were 90 patients who were older than 18 years of age, who were admitted to an intensive care unit for more than five days and were not provided any prophylactic measures. Data were collected at a university hospital for five months. A duplex scan was performed on day 2·4 on average and repeated between days 5-7 to diagnose deep vein thrombosis. The iliac, femoral, popliteal and tibial veins were examined by compression and colour Doppler methods of the duplex scan by one technician. Results. Age, gender and body mass index were significant factors for deep vein thrombosis development ( p < 0·05). Ten patients (11·1%) developed deep vein thrombosis during their stay in the intensive care units. Conclusions. The incidence was lower than in Western studies in which patients were not provided prophylaxis, but may increase with an extended observation period as in previous studies. Relevance to clinical practice. The results of this study could allow ICU nurses to recognise the DVT incidence in critically ill patients. This result could lead to more active prevention and monitoring of DVT by ICU nurses, especially for high-risk patients, such as older or obese patients. [ABSTRACT FROM AUTHOR]

Aims and objectives. To evaluate the symptoms and self-assessment of quality of life in men with localised prostate cancer after having had a radical prostatectomy or brachytherapy treatment. Background. Prostate cancer is a significant growing disease among men in Taiwan. Quality of life issues for the men who are living with this disease and the consequences of treatment. Design. A postal questionnaire survey. Methods. The study population came from one 1170-bed hospital in Kaohsiung County, Taiwan. Data was collected from 20 August 2007-20 November 2009. Seventy-eight men met the inclusion criteria. The researchers mailed a survey to each participant, which they completed at home and returned in a pre-stamped, addressed envelope. Sixty-four subjects participated and self-reported using a structured questionnaire. The reliability of overall prostate cancer index was 0·90 and 0·85, 0·93 and 0·72 for each subscale, respectively. Results. The results indicate that the number of months post-treatment was positively correlated with urinary function and age was negatively correlated with sexual, bowel function and bowel bothers. One predictor (month post-treatment) was related to urinary function; one predictor (treatment method) was related to bowel function and four predictors (marital status, age, treatment method and month post-treatment) were related to sexual function. Findings showed that patients who received brachytherapy have better urinary functions, as compared with prostatectomy patients. Conclusion. Study findings suggest that healthcare providers should have a better understanding of patients' complications after treatment and this can ultimately raise the quality of life for prostate cancer patients. Relevance to clinical practice. The impact of quality of life among post prostate cancer treatment is common. Urological nurses should therefore take the responsibility regarding the consequence of urinary incontinence and sexual function and seeking appropriate nursing interventions for these complications. [ABSTRACT FROM AUTHOR]

Aims. To explore the depression level of a group of vitiligo patients in Singapore and to identify factors associated with depression. Background. Unlike most internal illness, skin disease is often immediately visible to others and therefore people suffers from dermatological conditions may suffer psychological consequences. Design. A descriptive survey was conducted during the period October 2009-August 2010 in Singapore; 145 vitiligo patients aged 21+ completed a structured questionnaire. Methods. Three main outcome variables were employed in the study: demographic characteristics, clinical and psychosocial outcomes. Results. Among the patients, 17·2% ( n = 25) had been identified as depressed. Multiple logistic regression analyses were used to identify a model to predict vitiligo patients who will have depression. The results showed that females ( p = 0·05), aged below 50 years old ( p = 0·016), having 5+ years of illness ( p = 0·021) and with low self-esteem ( p = 0·002) and poor quality of life scores ( p = 0·004) were significant risk factors for depression. Conclusion. Providing a suitable health care consultation for vitiligo patients may reduces depressive symptoms and maintaining their psychological health may be crucial for preventing suffering from depressive symptoms. Apart from the findings, these conclusions resonate with recent Singapore guidance on managing depression in vitiligo patients. This stresses the importance of prevention, early detection and stepped care with a multifaceted approach to management. Relevance to clinical practice. It is important to regularly screen for depressive symptoms among vitiligo patients. Focusing on vitiligo patients with enhancing self-esteem and improving quality of life should help in both the prevention and recognition of onset of depression among vitiligo patients. [ABSTRACT FROM AUTHOR]

Aim and objective. To investigate health differences between nurses who report meeting the daily physical activity recommendations in or away from the workplace. Background. Adhering to the national physical activity recommendations has known health benefits. Whilst often considered a workplace active profession, data are emerging of poor health amongst nurses. However, health differences between workplace or leisure-time physically active nurses are understudied. Design. The investigation is an observation study of Australian and New Zealand nurses. Data were generated from the longitudinal, population-based, observational e-Cohort nursing survey. Methods. Data were informed and groups defined by the self-reported minutes per day of moderate physical activity collected from a large international survey of practicing nurses ( n = 2264). Groups were: Group (G) 1 - high workplace (≥30 minutes/day)/high leisure (≥30 minutes/day), G2 - high workplace/low leisure (<30 minutes/day), G3 - low workplace/low leisure (<30 minutes/day) and G4 - low workplace/high leisure. Results. G2 had a high BMI and were younger than G4. G4 were significantly more active away from work and more likely to report cycling to work than G2. In contrast, G2 were most likely to have taken sick days because of their health (χ2 = 19·101), have difficulty sleeping most of the time and have a medical history of diagnosed anxiety and depression. Conclusions. This study shows that improved well-being can be achieved in nursing cohort through leisure-time physical activity. Relevance to clinical practice. This research shows that nurse should consider leisure-time physical activity necessary to maintain and prolong health and that workplace activity is not a sufficient stimulus. This has important implications for workforce planners and administrators. [ABSTRACT FROM AUTHOR]

Aims and objectives. To evaluate the correlation between maternal fatigue and uterine contraction pattern at the beginning of the active phase of labour. Background. Fatigue is one of the most common complaints in pregnant women that often continues until delivery. Maternal fatigue prolongs the labour process and increases the rate of cesarian section. Studies on the pattern of uterine contractions have shown that the length of the fall time is longer in prolonged labours than in normal deliveries. Design. A cross-sectional study. Methods. This study was conducted on 100 primiparous women who were referred to Ommolbanin Hospital (Mashhad, Iran) in 2011. Maternal fatigue was assessed at the beginning of the active phase of labour. Then, the pattern of uterine contractions was monitored for 30 minutes by an external tocodynamometer. The F/ R ratio was determined by measuring the time for a contraction to return to its baseline from its peak and the time for a contraction to rise to its peak. The data were analysed by chi-square and anova tests. Results. The results showed that there was a significant relationship between maternal fatigue and uterine contraction pattern. The F/R ratio was increased with increase in fatigue severity. Conclusions. Fatigue causes changes in the pattern of uterine contractions. The return time of a contraction from its peak to its baseline (fall) is increased with increase in fatigue severity. Relevance to clinical practice. Offering strategies to prevent tiredness and reduce the related fatigue complications. [ABSTRACT FROM AUTHOR]

Aim. (1) To explore the prognostic factors of patients with chronic obstructive pulmonary disease. (2) To calculate the recrudescence time (the time from discharge to acute exacerbation again) of postdischarge patients with chronic obstructive pulmonary disease. Background. Chronic obstructive pulmonary disease is an airflow limitation illness that is preventable and treatable. To find out the prognostic factors will make effective postdischarge care, which can help patients reduce readmission times and prolong recrudescent time. Design. Cohort study. Method. From November 2007-October 2008, 136 patients with acute exacerbation of chronic obstructive pulmonary disease were analysed by gender, age, career, education level, body mass index, smoking, oxygen therapy, drug-taken compliance, respiratory function exercise, blood gas, lung function, six-minute walking test and degree of dyspnoea. Factors related to prognosis were analysed by univariate and multivariate Cox regression. Kaplan-Meier method was used for survival analysis and log-rank test for comparison of survival curve. Results. A total of 121 patients recrudesced up to October 2009. Recrudescence rate was 7·35% in a month, 25·00% in three months, 55·62% in six months and 88·23% in 12 months. Higher drug-taken compliance and respiratory function exercise were the factors influencing patients' acute exacerbation ( p < 0·05). The median recrudescence time of drug taken or not was six and four months, and doing respiratory function exercise or not was eight and six months. Conclusion. Respiratory function exercise and higher drug-taken compliance can prolong recrudescence time and reduce recrudescence rate. Relevance to clinical practice. Clinical nurses who know more risk factors about acute exacerbation of patients with chronic obstructive pulmonary disease can provide effective discharge planning, which will increase patients' quality of life and decrease mortality. [ABSTRACT FROM AUTHOR]

Aims and objectives. This study explored decision-making experiences of patients with stage 5 chronic kidney disease when opting for conservative management of their renal failure. Background. Dialysis is an invasive treatment, and for some older patients, there is an associated treatment burden of dialysis-related symptoms. An alternative choice is conservative management, but little is known about those who make this decision and how they are supported through the process. Design. Qualitative practitioner research study. Method. Data were generated from nine patients' naturally occurring clinic consultations with a renal clinical nurse specialist between May 2010 - July 2010. Interviews were transcribed verbatim and findings fed back at three multi-disciplinary meetings to check for relevance and resonance. Common themes were identified and codes applied. Results. Patients reported age and having to travel three times a week to hospital for dialysis as reasons not to opt for treatment. Others felt well without dialysis not wanting to upset the 'status quo' or to burden loved ones. Most felt equipped to make the decision following explanation and discussion with the clinical nurse specialist in the renal clinic. Conclusions. Patients opting for conservative management give numerous reasons for this including old age, travel limitations, feeling well without dialysis and not wanting to be a burden, but appear content with their decision. One-to-one discussions with the clinical nurse specialist appear helpful during the decision-making process presenting an opportunity for advancing nursing roles in the chronic kidney disease service. Relevance to clinical practice. Understanding patients' reasons for refusing dialysis assists in supporting until death. There is an opportunity for developing nursing practice to meet the multi-faceted needs of this group. [ABSTRACT FROM AUTHOR]

Aims and objectives. To examine the associations between pain-related psychological and social factors and pregnancy-related lumbopelvic pain intensity and interference after controlling biological factors. Background. Pregnancy-related lumbopelvic pain is prevalent and has been shown to interfere with women's quality of life. Although pain is a multidimensional phenomenon known to be influenced by psychosocial factors, the majority of previous research on this pregnancy-related lumbopelvic pain has focused on biological factors. Design. Cross-sectional correlational research. Method. A sample of 183 pregnant women with lumbopelvic pain was recruited from a medical center in northern Taiwan. Study participants provided demographic information and were administered the Brief Pain Inventory and a modified Catastrophising subscale of the Coping Strategies Questionnaire. Multiple regressions were used to examine the associations among the study variables. Results. Analyses indicated that lower education level was associated with higher pain intensity. Higher pain intensity during pregnancy and catastrophising cognitions were associated significantly with higher pain interference. Moreover, age moderated the strength of the association between pain intensity and pain interference. This association was stronger for older than for younger women. Conclusions. This study identified the psychosocial factors associated with pregnancy-related lumbopelvic pain intensity (educational level) and interference (pain intensity and catastrophising) and also a variable (age) that moderated the association between pain intensity and pain interference. The findings support a biopsychosocial approach in understanding the experience and impact of pregnancy-related lumbopelvic pain. Relevance to clinical practice. Nurses should assess pregnant clients' age, educational level, pain intensity and pain catastrophising thoughts to help identify women who are more at risk for higher lumbopelvic pain intensity or interference. Women endorsing catastrophising cognitions should be referred to or provided with treatment to reduce the frequency of these cognitions that are known to have a negative impact on quality of life in other pain populations. [ABSTRACT FROM AUTHOR]

Aims. The purpose of this study was (1) to explore postoperative pain experience among Chinese thoracotomy patients during hospitalisation; (2) to identify patient-related barriers to pain management; and (3) to explore how these barriers were related to patients' pain experience. Background. Major thoracotomy causes severe pain and extreme stress for patients. Unrelieved postoperative pain leads to high risks of postoperative complications and chronic post-thoracotomy pain syndrome, compromising the quality of life for those patients. Design. Cross-sectional design. Methods. A tertiary general hospital in mainland China was selected for this study. A total of 94 patients undergoing scheduled major thoracotomy operations participated in the study. All patients completed Brief Pain Inventory-Chinese version, the Barrier Questionnaire-Taiwan Form Surgical version and a demographic questionnaire. Results. Patients suffered moderate to severe pain and experienced extremely high interferences with daily activities after major thoracotomy operation. Patients reported the four highest barrier scores in the subscale of Barrier Questionnaire-Taiwan Form Surgical version were fear of tolerance, inhibition of wound healing, time intervals and distracting the physician from treating the disease. Patient's demographic data had no significant impact on their concerns about communicating pain and using of analgesics with exception of the subscale 'fatalism' of the Barrier Questionnaire-Taiwan Form Surgical version in patients with higher education levels or patients with 'non-farmer' occupation. However, there were no significant correlations indicated either between Barrier Questionnaire-Taiwan Form Surgical version score and pain severity or pain interference. Conclusions. Patients were underexposure of pain treatment after thoracotomy operation in the study, while patients' concerns about reporting pain and using analgesics had minimal impacts on their pain experience. Relevance to clinical practice. Education approach for patients is inadequate to improve the status of unrelieved postoperative pain. Appropriate pain management regime together with attentive nursing care should be provided to achieve better pain relief for Chinese patients. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aims of the present study were to identify the levels of preoperative anxiety in patients undergoing elective surgery and the relationship between preoperative anxiety and social support. In addition, predictors of preoperative anxiety were studied in surgical inpatients. Background. Major life changes are significant factors that cause anxiety; hospitalisation and surgery are among such changes. Social support may decrease the anxiety associated with surgery. Design. This is a descriptive study that included 500 patients in a surgery clinic. Methods. The data collected included: A Patient Information Form, Multidimensional Scale of Perceived Social Support and the Surgical Anxiety Scale. The results were analysed using the Chi-square test and logistic regression analysis. Results. Five hundred patients participated in this research: 59·6% were female, 54·6% were 65 years of age or older, 80·6% were married, 70·4% were literate and 62% of the patients had moderate level surgery. There was a significant relationship between the sociodemographic patient features, the level of preoperative anxiety ( p < 0·05), the presence of social support and the severity of anxiety ( p = 0·001). The age and level of anxiety were not significant factors. The mean anxiety score for all patients was 31·91 (SD 6·30) and the mean social support score was 66·38 (SD 13·69). Conclusion. The results of this study showed that the preoperative anxiety of patients awaiting surgery was associated with demographic characteristics as well as social support resources. Relevance to clinical practice. Anxiety testing is feasible during the preoperative period. Such testing allows for the detection of patients with high anxiety, and for clinicians to take the appropriate steps to ameliorate this problem. Identification of patient anxiety allows for providing a focus on social support in an attempt to reduce the level of anxiety. [ABSTRACT FROM AUTHOR]

Aims and objectives. To analyse the relationships between depressive symptoms, sense of coherence and emotional and social loneliness among nursing home residents without cognitive impairment. Background. Depression symptoms and loneliness are major health problems for older people. Sense of coherence, which is based on a salutogenic theoretical framework, is a strong determinant of positive health and successful coping and is associated with well-being and depression among older people. Few studies have explored the relationships between depression symptoms, sense of coherence and emotional and social loneliness among nursing home residents. Design. A cross-sectional, descriptive, correlational design. Methods. Sample - 227 residents 65-102 years old from 30 nursing home residing ≥ six months. All had a Clinical Dementia Rating ≤0·5 and could converse. Residents were interviewed using the Social Provisions Scale, Geriatric Depression Scale and Sense of Coherence Scale (SOC-13). Possible relationships between these were analysed, controlled for sex, age, marital status, education, length of stay and comorbidity. Results. Before adjustment, Geriatric Depression Scale was associated with attachment and social integration. After adjustment, Geriatric Depression Scale was still associated with attachment and social integration. Further adjusting for Sense of Coherence Scale reduced the association between Geriatric Depression Scale and attachment and even more so for the association between Geriatric Depression Scale and social integration. Sense of coherence and Geriatric Depression Scale did not interact, and SOC-13 was associated with attachment and social integration. Conclusions. Depression symptoms contribute to emotional and social loneliness. Independent of sense of coherence, depression symptoms are associated with emotional loneliness, sense of coherence influence emotional and social loneliness. Relevance to clinical practice. Clinical nurses should observe residents closely for signs of depression and loneliness and support their sense of coherence to reduce emotional and social loneliness. [ABSTRACT FROM AUTHOR]

Aims. The aims of this study were to explore nurses' assessments of individualised care in long-term care wards and to examine how their sociodemographic variables were associated with their views of such care. Background. Although the importance of individualised care is highlighted both by nurses and by older people, there is a limited amount of research about individualised care, especially in the long-term care of older people. Design. An exploratory design was employed. Methods. Data were collected using questionnaires [Individualised Care Scale (ICS)-Nurse] from nurses ( n = 283, n = 215, response rate 76%) working in the long-term care wards ( n = 19) of four institutions in 2009. Data were analysed statistically. Results. Overall, nurses perceived that they supported patient individuality during nursing activities but the care they provided was not so individualised. Nurses perceived that they supported older peoples' individuality in the clinical situation and in decisional control over care well but supported older peoples' individual life situation to a lesser extent. The higher the nurses' age, the longer the working experience in health care or experience in the current ward, the more positive views they had about the support of individuality. Conclusions. This study identified some shortcomings in the realisation of individuality in the care of older people. Nurses seem to think they generally provide individualised care but this was not necessarily realised in the current evaluations of the care they delivered. Relevance to clinical practice. There is need to identify issues that may help in developing individualised care in clinical practice. Nurses' attitude to older people in the geriatric care settings needs exploration. Nurses may focus on physiological needs that may hinder the recognition of older patient's individuality. [ABSTRACT FROM AUTHOR]

Aims and objectives. The study examined events before and after incidents of self-harm and attempted suicide and the characteristics of patients who engage in these behaviours. Background. Psychiatric inpatient populations have an elevated risk of self-harm and suicide, but relatively little is known about the circumstances of these events during an admission. Design. Retrospective case note analysis. Method. Data were collected on conflict (aggression, rule breaking, etc.) and containment (coerced medication, restraint, etc.) during the first two weeks of admission for a sample of 522 acute psychiatric inpatients. Results. One in 10 patients self-harmed, and 4% attempted suicide. Aggression, attempting to leave the ward without permission and medication refusal were frequent precursors to incidents. Pro re nata medication and de-escalation were the most frequent interventions to follow an incident. Self-harm and attempted suicides during the current admission were significantly associated with younger age and a history of self-harm. Conclusions. A minority of the sample were involved in these behaviours, but incidents occurred soon after admission and sometimes repeatedly during the course of a day. Assessment of risk should be completed as early as possible. Relevance to clinical practice. At-risk patients should be monitored for signs of withdrawal from ward activity, wanting to leave the ward without permission or non-compliance with medication to enable early intervention. [ABSTRACT FROM AUTHOR]

Aims. The study compared the levels of symptoms and uncertainty, their associated factors, relationships between them and predictors of uncertainty by treatment trajectory among breast cancer survivors. Background. Little is known with regard to how uncertainty and symptoms are related to treatment trajectory among breast cancer survivors. Design. A cross-sectional descriptive design was used. Method. A total of 252 women with breast cancer, receiving cancer therapy, or having completed their therapy were recruited from the National Cancer Center in Korea. Measurements used included symptom subscales of the European Organization of Research and Therapy for Cancer QLQ-C30 and Breast Cancer Module BR23 and the Mishel Uncertainty in Illness Scale. Results. Women in treatment reported more severe symptoms and higher levels of uncertainty than women having completed treatment. During treatment, most symptoms were positively correlated with the level of uncertainty, whereas, in women who had completed treatment, only dyspnoea, insomnia, systemic therapy side effects and arm symptoms positively correlated with uncertainty. There were also differences in predictors of uncertainty by treatment trajectory. Age, marital status and pain were significant predictors of uncertainty during treatment, while monthly income, dyspnoea and insomnia were predictors of uncertainty after treatment. Conclusions. Among breast cancer survivors, levels of symptoms and uncertainty, associated factors, relationships between them and predictors of uncertainty differed depending on treatment trajectory. Relevance to clinical practice. To provide trajectory-sensitive nursing intervention for uncertainty among breast cancer survivors, age, marital status and pain should be considered during treatment, while factors such as economic status, dyspnoea and insomnia should be taken into account after treatment. [ABSTRACT FROM AUTHOR]

Aims. The aims of this study were to examine the relationships among religion, religious involvement, anxiety, depressive symptoms and quality of life in older adults with psychological problems and whether religious involvement moderated anxiety and depressive symptoms on the outcome of quality of life. Evidence for the mechanism through which religious involvement exerts its moderated effect on anxiety and depressive symptoms was provided. Background. Older adults suffering from stress may consequently have anxiety or depressive symptoms and their quality of life is also influenced. The meanings of religious involvement are well documented but less is known about moderating characteristics that determine which older adults with psychological problems are most likely to benefit. Design. A correlational, cross-sectional study. Methods. The study was conducted in 2007-2008 with a purposive sample of 115 older adults who were 60 years of age or older at a psychiatric centre in Taiwan. Three reliable and valid questionnaires and a demographic sheet were administered. Results. Approximately 75% of older adults had mild to severe anxiety; 76·5% had depressive symptoms; and 67·8% of participants who had depressive symptoms also had comorbid anxiety. Findings indicated that there was a significant moderating effect for religious involvement on the quality of life outcome. Religious involvement significantly moderated anxiety and depressive symptoms on quality of life. Moreover, religious participants had a better quality of life and had lower anxiety and depressive symptoms than non-religious participants. Conclusion. Testing for moderating effects provides important information regarding the benefits of religious involvement. The current study reveals that religious participants have lower levels of depressive symptoms and anxiety and better quality of life than non-religious ones. Religious involvement plays a role in buffering the relationship between psychological problems and quality of life. Relevance to clinical practice. Nurses can encourage individuals with health problems to participate in religious involvement, which may help individuals to experience a feeling of support and enhance their quality of life. [ABSTRACT FROM AUTHOR]

Aim. To explore nurses' views and experiences regarding job satisfaction and their intention to leave in Shanghai. Background. The widespread nursing shortage and nurses' high turnover rate has become a global issue. Job satisfaction is the most consistent predictor of nurses' intention to leave and has been reported as explaining most of the variance on their intention to leave. Design. A cross-sectional survey. Methods. A convenience sample of nurses was recruited from 19 large general hospitals in Shanghai and the research assistants distributed 2850 questionnaires to nurses. The response rate of this study was 78·95%, and 2250 nurses completed the questionnaire. Results. Regarding the overall job satisfaction, 50·2% nurses were dissatisfied and 40·4% nurses reported that they had intention to leave the current employment. Respondents' characteristics had an impact on job satisfaction and their intention to leave. The results showed that age, marital status, work experience, overall job satisfaction, job satisfaction: extrinsic rewards, interaction, praise/recognition and control/responsibility were significant factors contributing to nurses' intention to leave. Conclusions. The finding may be a cause of concern for hospital management and highlights the importance of the two concepts (job satisfaction and intention to leave) in Shanghai. Innovative and adaptable managerial interventions need to be taken to improve nurses' job satisfaction and to strengthen their intention to stay. Relevance to clinical practice. Our findings outline some issues contributing to these problems and provide nurse administrators with information regarding specific influences on nurses' job satisfaction and intention to leave in Shanghai and innovative and adaptable managerial interventions that are needed. Our findings may also provide direction for nurse managers and healthcare management to implement strategies to improve nurses' job satisfaction and their intention to stay. [ABSTRACT FROM AUTHOR]

Aims and objectives. To assess the relationship between self-care agency scores, disability levels and factors regarding these situations among Turkish patients with rheumatoid arthritis. Background. Rheumatoid arthritis is characterised by severe to slight synovial joint inflammation that can lead to pain, stiffness and joint destruction with subsequent physical deformities, disabilities and reduced self-care. Self-care is an important component of comprehensive chronic disease management such as rheumatoid arthritis. If patients have high levels of self-care and adhere to rheumatoid arthritis treatment, it can be expected that they will have fewer symptoms and better functional capabilities. Design. A cross-sectional, design was used. Method. This study was conducted with 467 rheumatoid arthritis patients who applied at the Rheumatology Outpatient Department of Gaziantep University between September 2008-February 2009. The data collection instruments used in this study were the Demographic Data Form, Health Assessment Questionnaire (including disability index and pain scale) and Self-as-Carer Inventory. The frequency, mean, Student's t-test, one-way anova, Kruskal-Wallis, chi-square, correlation and regression analysis were used; p < 0·05 was accepted as statistically significant. Results. For patients the self-care agency classification of 13·7% and 86·3% were 'moderate' and 'poor', respectively; while the disability levels of 12·2 51·2 and 36·6% were 'mild', 'moderate' and 'severe', respectively; and their pain average was 'moderate'. It was also determined that, as the patients' self-agency scores declined, their disability levels deteriorated even further and their pain levels increased even more. Conclusions. In conclusion we found that in Turkish patients with Rheumatoid Arthritis, the higher disability and pain rate were, the lower self-care agency score was. Relevance to clinical practice. Nurses should strive to provide individuals with RA the knowledge, skills and resources necessary for active participation in self-care, as this might promote the capacity for self-care. [ABSTRACT FROM AUTHOR]

Aim. The aim was to investigate the associations between perceived social support and depression in a general population in relation to gender and age. Background. Social support is seen as one of the social determinants for overall health in the general population. Studies have found higher probability of experiencing depression among people who have a lack of social support; evidence from the general population has been more limited. Subjective perception that support would be available if needed may reduce and prevent depression and unnecessary suffering. Design. A cross-sectional survey with self-reported health was used. Method. A total of 40,659 men and women aged 20-89 years living in Nord-Trøndelag County of Norway with valid ratings of depression subscale of the Hospital Anxiety and Depression Scale in the The Nord-Trøndelag Health Study 3 were used. Logistic regression was used to quantify associations between two types of perceived support (emotional and tangible) and depression. Gender, age and interaction effects were controlled for in the final model. Results. The main finding was that self-rated perceived support was significantly associated with Hospital Anxiety and Depression Scale-defined depression, even after controlling for age and gender; emotional support (OR = 3·14) and tangible support (OR = 2·93). The effects of emotional and tangible support differ between genders. Interaction effects were found for age groups and both emotional and tangible support. Conclusion. Self-rated perceived functional social support is associated with Hospital Anxiety and Depression Scale-defined depression. In the group of older people who have a lack of social support, women seem to need more emotional support and men tangible support. Relevance to clinical practice. Health care providers should consider the close association between social support and depression in their continuing care, particularly in the older people. [ABSTRACT FROM AUTHOR]

Aim. This study investigated intensive care unit nurses' knowledge, attitudes and practices of oral care for intubated patients together with the associated factors of the same. Background. Effective oral care improves patient comfort and prevents oral infection. Although oral care is a common requirement of nursing practice, providing intubated patients with oral care is a challenging task. Design. A descriptive, cross-sectional design. Methods. This study applied purposive sampling method at 12 adult intensive care units in one medical centre in northern Taiwan. Two hundred and five nurses were recruited. Data were collected by structured questionnaires which consisted of four sections: knowledge, attitudes and practices of oral care for intubated patients and demographic information for the nurses. Results. The average percentages indicating the intensive care unit nurses' oral care knowledge, attitudes and practices were 58·8, 79·4 and 49·8%, respectively. Higher scores on oral care knowledge were associated with nurses performing oral care more frequently. Nurses learning about oral care from reading related studies and materials of their own accord may increase the frequency with which they provide oral care to intubated patients. The nurses' age and the type of intensive care unit they work in were significant factors related to the frequency of performing practices related to oral care. Conclusion. Findings show that nurses who have more resources for learning about oral care have greater knowledge about it and provide oral care to intubated patients more frequently. Relevance to clinical practice. Encouraging nurses to learn more about oral care using diverse educational resources will enhance their knowledge and improve their practice. Nursing administrators are encouraged to establish policies and procedures for oral care of intubated patients based on the type of patients cared for, in addition to holding in-service training, with a view to enhancing the quality of oral care for critically ill patients. [ABSTRACT FROM AUTHOR]

Aim. The aim is to study the health-related quality of life in a school sample of children and adolescents aged 8-18 years and to examine the relationship between health-related quality of life and the following variables; age, gender, perceived pain, body image, body mass index and bullying. Background. The study of health-related quality of life in children and adolescents have received little attention compared with adults in health care research and still little is known about the associations between health-related quality of life and other variables. Design. A cross-sectional design was chosen. Method. We measured the health-related quality of life using the generic questionnaire KIDSCREEN-10. We administered the KIDSCREEN 52-item, and the 10 items were selected from this according to the KIDSCREEN manual. Multilevel regression models were used to evaluate the associations between health-related quality of life and the independent variables. Results. The sample included 1066 children and adolescents, 576 girls and 490 boys, with a response rate of 74%. The results show that body mass index was not significant associated with health-related quality of life in full model. However, in addition to age, being bullied, pain and body image were significant associated with health-related quality of life. Of these predictors, body image has the strongest impact in terms of explained variance in health-related quality of life. Conclusion. The subjective sense of satisfaction or dissatisfaction with one's body, perceived body image, is a powerful predictor of health-related quality of life. Relevance to clinical practice. Knowledge about predictors of health-related quality of life is especially important for public health nurses. Health promotion and intervention programmes that aim to strengthen psychosocial well-being, especially those that strengthen body image, should be developed for both genders. [ABSTRACT FROM AUTHOR]

Aims and objectives. To describe patients' perceptions of quality of care and to explore combinations of person-related and external objective care conditions as potential predictors of these perceptions. Background. Several studies have examined various single factors of person-related and external objective care conditions in relation to quality of care. None of these has included the effect of over-occupancy on patients' perception of quality of care. Furthermore, little is known about how combinations of different factors are related to each other and to the perception of quality of care using multivariate analysis. Design. A cross-sectional design. Method. A total of 528 patients (83·7%) from 12 medical, surgical or medical-surgical wards in five hospitals in Norway participated. Perceptions of quality of care and person-related conditions were measured with the 'Quality from Patient's Perspective' instrument. Data on external objective care conditions was collected from ward statistics provided by head nurses. Multivariate general linear modelling was used ( p < 0·05). Results. The combination of person-related and external objective care conditions revealed five factors that predict patients' perception of quality of care. Three of these are person-related conditions: sex, age and self-reported psychological well-being and two of them are external objective care conditions: RNs (headcount) on the wards and frequency of over-occupancy. These five factors explained 55% of the model. Patients rated the quality of care high. Conclusions. Sex, age, psychological well-being, frequency of over-occupancy and the number of RNs are important factors that must be emphasised if patients are to perceive the quality of care as high. Relevance to clinical practice. Head nurses and healthcare authorities must continually prepare the wards for over-occupancy and they must consider the number of RNs working on the wards. [ABSTRACT FROM AUTHOR]

The article discusses the results of a study on the development of health promotion framework that integrates the settings and lifespan concepts. According to the author, the integration of health promotion settings and lifespan has resulted in a useable framework to further help practitioners with their health promotion initiative. He adds that most settings can be integrated as a whole because they tend to follow a linear direction that ranges across the total lifespan.

To describe the incidence and intensity of pain, hypotension and other epidural-related side-effects after major abdominal surgery and to identify factors associated with effective epidural analgesia. Evidence exists that up to 30% of patients with epidural analgesia still experience severe pain in clinical practice. When epidurals produce good pain relief, potentially harmful side effects can result. Data were collected prospectively from 480 consecutive general surgical patients in a large District General Hospital in the UK. Fifty-six per cent of patients were hypotensive on day one. Low pain scores were found to be a predicator for postoperative hypotension. Severe pain was associated with emergency patients, male gender, the absence of hypotension and an epidural that did not continue until planned removal. Significantly lower mean pain scores were found in patients who were 70 years of age and over. No correlation exists between chronic pain before surgery and the level of postoperative pain. This study contributes to the epidural versus standard analgesia debate by describing the population in whom epidurals are used and identifies factors associated with both the success and failure of the technique in everyday practice. The Audit Commission has proposed a standard whereby less than 5% of patients should suffer severe pain following surgery. This may prove to be an unrealistic goal with currently available techniques. As it is ward nursing staff who are primarily responsible for monitoring the effectiveness of the technique, it is important for nursing professionals to know the potential risks of postoperative epidural analgesia to be able to respond appropriately. The important measurements of an optimum acute pain assessment have been identified, based on the study results, allowing the development of a national acute pain registry to inform future practice. [ABSTRACT FROM AUTHOR]

The aims were to investigate potential effects of mode of administration on response rate, internal consistency, completeness of data, floor and ceiling effects and interaction effects of mode of administration, gender and age on self-reported health status and emotional distress among Swedish adolescents and young adults. A cross-sectional comparative study. Using a stratified quota sampling scheme, 840 adolescents and young adults (aged 13-23 years) were randomly chosen from the general population. Participants were randomised according to mode of administration, telephone interview or postal questionnaire. The telephone mode resulted in a higher response rate than the postal mode and fewer men than women participated in the postal mode. Mode of administration only had a small effect on self-reports. The youngest adolescents did, in some respects, respond to the modes in a reverse pattern than the older participants. The findings support the use of the SF-36 and the HADS among persons 16-23 years of age. The strengths and weaknesses of a telephone and a postal mode to collect self-report data are discussed. Nurses should consider the findings of this study, e.g. when using self-reports to screen for health status and emotional distress and when designing research studies. [ABSTRACT FROM AUTHOR]

We aimed to study the diagnostic accuracy of the temporal artery thermometer vs. rectal temperature in a large group of children with and without fever, aged 0-18 years. Many have studied the diagnostic accuracy of the temporal artery thermometer in children compared with a reference method, with contradictory outcomes. No studies have been carried out in a large group of children of all ages. Diagnostic accuracy/validation study. Children (0-18 years) with fever ( T > 38·0 °C) were recruited through the emergency department and children with normal temperatures through the day-care department of the Children's Hospital. All children routinely had rectal temperature recordings. Temporal artery temperature was recorded shortly after the rectal recording. The mean absolute difference in temperature, the level of agreement (intraclass correlation coefficient) and the sensitivity and specificity of detecting fever were calculated. A total number of 198 children (121 boys) participated, with a mean age of 5·1 (SD 4·7) years. Of those children, 81 had fever according to the rectal recording. Mean difference between temporal artery temperature and rectal temperature was −0·11 (SD 0·63) °C, with an agreement of 0·812. The sensitivity and specificity of the temporal artery thermometer for detecting fever were 67·9 and 98·3%, respectively. The diagnostic accuracy of the temporal artery thermometer in detecting fever in children of all ages is low. We do not recommend replacement of standard clinical thermometers with temporal artery thermometers. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the risk factors and mental health consequences of physical and psychological violence for clinical nurses working in healthcare settings in Taiwan. Registered nurses working in hospitals in Taiwan report high incidences of workplace violence. However, previous studies rarely report psychological abuse among nursing staff, while the relationships between personal factors and workplace violence remain unclear. This is a cross-sectional study. Participants were invited to complete the Workplace Violence Questionnaire, an instrument designed to assess types of workplace violence (physical violence, verbal abuse, bullying/mobbing and sexual harassment), the characteristics of perpetrators and victims and victims' reactions to their abuse. A total of 521 nurses completed the questionnaire. Of the participants, 102 (19·6%) indicated that they had experienced physical violence, 268 (51·4%) had experienced verbal abuse, 155 (29·8%) had experienced bullying/mobbing and 67 (12·9%) had experienced sexual harassment. Multiple logistic analyses indicated that age under 30 years (odds ratio = 2·4; 95% confidence interval = 1·34-4·46) and anxiety (odds ratio = 4·7; 95% confidence interval = 1·24-18·12) increased the odds of verbal abuse, while bullying was associated with anxiety (odds ratio = 2·7, 95% confidence interval = 1·09-6·93). Night work shift increased the odds of experiencing sexual harassment (odds ratio = 2·3, 95% confidence interval = 1·29-4·16), while physical violence was associated with bachelor's degree (odds ratio = 2·8, 95% confidence interval = 1·20-6·73). The most serious psychological harm was post-traumatic stress disorder. Exposure to psychological violence often has a great impact on clinical nurses. For violence prevention, interventions should be sensitive to personal factors. Healthcare institutions should initiate counselling programs to help nurses cope with the stress related to workplace violence. [ABSTRACT FROM AUTHOR]

The aim of this study was to understand the experience of participants in the Dose Adjustment for Normal Eating programme and to identify factors that influence participants' implementation of the self-management guidelines. The literature revealed that structured education programmes, such as Dose Adjustment for Normal Eating programme, have many positive outcomes for people with Type 1 diabetes including: a decrease in HbA1c levels, reductions in hypoglycaemic events, reduction in hospital admissions and increased and sustained quality of life. Few researchers, however, have gathered participants' perspectives on the impact of participation in a Dose Adjustment for Normal Eating programme on self-management capacity. A grounded theory design focused on description guided by Corbin and Strauss was used. Data collection and analysis were concurrent using the constant comparative technique. Over 24 months, 2006-2008, interviews were undertaken with 40 participants who had completed a Dose Adjustment for Normal Eating programme in one of five study sites across Ireland. Purposive sampling was used, initially, with theoretical relational sampling towards the end of the interviews as concepts emerged. The interviews lasted from 30-60 minutes and were transcribed verbatim. Five factors that influenced participants' self-management of their diabetes following dose adjustment for normal eating were identified. These were knowledge, support, motivation, relationship shift and empowerment, and these were all related to the core category, 'Being in Control'. Understanding the factors that influence self-management in Ireland is important as it broadens prior knowledge and confirms the factors that are important to facilitate self-management. Understanding the factors that influence the implementation of dose adjustment for normal eating principles can help health professionals give more focused and empowering care to persons with diabetes. Using the persons' experience and expertise is essential as it can help them develop their internal resources. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the perceptions of coronary heart disease among a sample of Hong Kong Chinese people. Coronary heart disease is increasing among Chinese populations. Reducing coronary heart disease risk is highly dependant on a person's evaluation of the risks and lifestyle behaviour. However, Chinese perceptions of coronary heart disease and the risks have been underexplored. A qualitative study was conducted using focus group interviews. Focus group interviews were tape recorded and transcribed. The data were analysed using content analysis. The results show that the Hong Kong Chinese participants underestimated the severity of coronary heart disease. Perceptions of risk of coronary heart disease were influenced by the risk factors, symptoms, age, optimism, levels of suffering from coronary heart disease and reliance on medical professionals. Most of the participants perceived that this is because of inadequate understanding of coronary heart disease and lack of resources for coronary heart disease health education. Societal readiness is paramount in imparting accurate coronary heart disease knowledge to mediate the perception of coronary heart disease as a major health problem that affects the Chinese population. Understanding the Chinese participants' perceptions of coronary heart disease is vital in developing illness prevention and health promotion strategies to increase their levels of knowledge of coronary heart disease risk factors reduction. [ABSTRACT FROM AUTHOR]

This study was to describe and compare the health concerns, behaviours and anxiety of advanced age pregnant women (35 years and older) with their younger counterparts. Women have specific health concerns and behaviours during pregnancy. Delayed childbearing has an increased risk of adverse pregnancy outcomes and advanced age pregnant women may have more health concerns than younger ones. A cross-sectional study. Primigravidae Chinese women aged 35 or older ( n = 47) and 188 younger than aged 35 were recruited in February and March of 2005 by convenient sampling from the antenatal clinic of a regional hospital in Hong Kong to complete a questionnaire. Advanced age pregnant women when compared with their counterparts were more likely to have tertiary education (42·6% vs. 28·7%) and a higher family monthly income of Hong Kong $40 001 or more (40·5% vs. 15·4%). They were more likely to be concerned the possibility of miscarriage (63·8% vs. 45·9%) and the physical demands of caring for the newborn (61·7% vs. 45·4%) but were more likely to take up healthy behaviours such as 'eating nutritious food' (100%) and avoiding 'wearing tight clothing and high-heel shoes'(100%). Advanced age women were more likely to be concerned about their 'recovery after childbirth' (63·8% vs. 42·7%), Down's syndrome (70·2% vs. 37·8%) and structural defects of their foetus (78·7% vs. 54·1%). The results of this study provide a background for improving prenatal care catering for the specific health concerns of the advanced aged and promotion of health behaviours among younger pregnant women. Antenatal, obstetric and community health nurses have the responsibility to provide education and support services catering to the special concerns of pregnant women at different ages. Health professionals should promote the prime time for childbearing and deliver messages regarding the potential problems associated with later childbearing at premarital counselling. [ABSTRACT FROM AUTHOR]

To predict important factors in women's postpartum stress. The transition to motherhood is often accompanied by stress, but research on predictors of postpartum stress is scant. A cross-sectional survey was used in the study. Proportional stratified quota sampling based on births at 11 registered general hospitals and seven specialty clinics in the Kaohsiung area of southern Taiwan was used to obtain a high degree of representation. Eight hundred and fifty-nine women participated in the study within six weeks postpartum. The Hung postpartum stress scale, the social support scale and the 12-item Chinese Health Questionnaire were used in this study. Women with minor psychiatric morbidity, one or two children, junior college educational level, formula feeding for their infants, preference for an infant boy and a low level of social support were important predictors for women's postpartum stress. Our findings provide information and data for service planning and community care for the prevention and amelioration of postpartum stress. Postpartum women face a constellation of factors that could put them at risk for high levels of postpartum stress. Postpartum stress could significantly negatively impact women's health status. Nursing interventions should be tailored to decrease women's postpartum stress as a means of promoting postpartum women's pursuit of well-being. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine absconding behaviour (a patient leaving the hospital without permission) in acute and rehabilitation wards of one Australian psychiatric institution to describe the characteristics of the absconding patient and these events. Absconding is a significant issue in psychiatric inpatient settings, with risks that include patient harm, aggression and violence. In spite of this, limited research has been conducted in Australia on patients who abscond while receiving psychiatric care. The study was a retrospective descriptive analysis. Absconding events from three acute and seven rehabilitation wards over a 12-month period were studied. The rate of absconding events by detained patients was 20·82%. Gender was not significantly associated with absconding, although 61·19% of those who absconded were men diagnosed with schizophrenic disorders. Over half of acute care patients who absconded left during their first 21-day detention order. More than half of absconding events were by patients that absconded more than once. There was limited support for the efficacy of locking ward doors. Age and diagnosis emerged as particularly important factors to consider. The study revealed that men are not more likely to abscond than women, that locking ward doors does not deter the determined absconders and that once a person has absconded, they are more likely to do so again. Younger patients and those with a schizophrenic disorder may be particularly likely to abscond. There also appears to be a link between continuing detention orders and an absconding event. Findings provide new data about the profile of absconding patients in Australia. Exploration of the reasons why patients abscond and why many do so repeatedly warrants further investigation. Risk management approaches taking into account factors associated with absconding could be trialled to reduce the incidence of absconding in psychiatric inpatient settings. [ABSTRACT FROM AUTHOR]

To analyse Japan's labour market for nurses and determine reasons for the continuing excess demand. Japan has long been experiencing a shortage of nurses. The situation has been worsening over the past few years, as is reflected in the growing media coverage of the issue. We constructed an economic model of wage setting for Japanese nurses and analysed those wages applying standard labour economics theories. We constructed a nurse labour market data base from various public sets and estimated a few alternative wage functions from this data base. We then interpreted these parameters and the differences of some parameters by function to make an evaluation of relative importance of labour market forces and policies on the setting of the Japanese nurse wages. The government's move to improve the nursing staff-inpatient ratio and the shorter inpatient hospital stays have had a positive impact on the wages of registered nurses (RNs) and licensed practicing nurses (LPNs). Yet, the nursing labour market imbalance remains. The findings show that individual hospitals and clinics could take three steps to help fill the nursing vacancies. First, they could introduce a reorientation program for those nurses no longer in the labour market. Second, they could restructure the working arrangements for those nurses with family responsibilities. Third, they could be instrumental in having the current wage system reassessed. [ABSTRACT FROM AUTHOR]

This study was launched to address the knowledge gap regarding factors leading to readmission to hospital. Repeated hospital admission is an issue of concern for health care service providers. Research findings reveal that multiple factors can contribute to the phenomenon, but no study has examined the direct and indirect effects of these variables on hospital readmission. A survey conducted during the period from 2003-2005 in three hospitals in Hong Kong. Patients who were readmitted to the same hospital within 28 days during the study periods were included. Data were collected using structured interviews. A structural equation model was employed to examine what factors will contribute to hospital readmission. The final model showed that subjective health outcome was the only significant variable that had a direct effect on readmission, and it had indirect effects on readmission mediating through the variables of age, income and satisfaction with care. A literature review reveals that none of the studies has recognised patients' subjective appraisal of their health condition as a significant variable to predict hospital readmission. Results did not find an association between evaluated and perceived need. In other words, patients who felt a higher need for hospital care were not necessarily sicker. It is possible that if patients can be empowered to manage their own health condition and make a fair appraisal of their well-being, unnecessary use of hospital services can be reduced. This study provides evidence to support the notion that an effective transitional care programme needs to incorporate patients' own subjective assessment of health in the intervention and measurement of the outcome. We cannot solely use providers' judgment to measure health outcomes, for patients are active agents in seeking health care, and the use of services is to an extent self-selective. [ABSTRACT FROM AUTHOR]

Aims and objectives To evaluate prevalence, risk factors for urinary incontinence and its impact on lives of Emirati women with diabetes mellitus type 2 ( DM2). Risk factors examined were age, parity, history of urinary tract infections, body mass index ( BMI) and DM2 duration. Background Incontinence is a known complication of DM2 with impact on women's lives. Less is known about incontinence problem among Emirati women with DM2. Design A cross-sectional survey design using probability sampling approach was employed to assess urinary incontinence in Emirati women with DM2. Methods A total of 300 women with DM2, aged 20-65 years, were recruited from six healthcare centres. Data were collected over an 18-month period. A standardised incontinence questionnaire was used to assess type and frequency of incontinence within the past 12 months. Presence of weekly incontinence was the main outcome. Results Of the 300 women, 188 (63%) reported any incontinence, of which 48% had at least weekly episode. Both stress ( n = 154, 51·3%) and urge ( n = 181, 60·3%) were reported by participants, with 48 (31·1%) reporting at least weekly stress and 85 (46·9%) expressing at least weekly urge incontinence. Diabetes duration was a significant risk factor for any, stress and urge incontinence followed by age for only any and stress incontinence. BMI was a risk factor for urge incontinence. Women perceived incontinence as bothersome, disturbing their social activities and daily prayers. Conclusions The prevalence of incontinence in Emirati women with DM2 is higher than that reported by women in other cultures. Risk factors identified were DM2 duration, age and obesity. Emirati women found incontinence to be a bothersome problem influencing their daily lives and prayers. Relevance to clinical practice Nurses in general practice should be alert to the incontinence problem by considering it as part of the routine diabetes evaluation of women, especially of those with longer duration of diabetes, obese and older. Cultural knowledge, sensitivity and individualised treatment plans need to be adopted by nurses working in the UAE to encourage the reporting of incontinence by Emirati Muslim women with DM2. [ABSTRACT FROM AUTHOR]

Aims and objectives. To explore how a stroke or a transient ischemic attack affects quality of life and to identify gender differences. Background. The negative effect of a stroke on the patients' quality of life has previously been studied, while the effect on patients with transient ischemic attack (TIA) is more unknown, especially in relation to gender. As poor quality of life may have a negative effect on rehabilitation it is important to investigate quality of life in this group. Design. A descriptive cross-sectional survey. Methods. All stroke and transient ischemic attack patients appointed to the out-patient stroke clinic between May 2008-August 2009 were asked to complete the Nottingham Health Profile. Results. Of 1048 patients, 379 (50%) of the stroke patients and 117 (40%) of the patients with transient ischemic attack completed the form within the first months after onset. Female stroke patients were significantly more negatively affected in all domains except the social domain than were male stroke patients. Female transient ischemic attack patients were significantly more negatively affected in all domains than were male transient ischemic attack patients. Male stroke patients had a significantly more negatively affected quality of life than male transient ischemic attack patients in the emotional, energy, social and total domains, while female stroke patients and female transient ischemic attack patients were equally negatively affected. Conclusions. This study shows that female stroke patients are more negatively affected in their quality of life than male stroke patients and that female transient ischemic attack patients are as affected as female stroke patients. This indicates that female patients with both stroke and TIA need more attention concerning their life situation. Relevance to clinical practice. Increased knowledge about how transient ischemic attack patients are affected, indicate that this group need support postdischarge to the same extension as stroke patients. [ABSTRACT FROM AUTHOR]

Aims and objectives. To examine cognitive function and its relationships to demographic characteristics and social support among elders in central China. Background. Cognitive decline is prevalent among elders. Few studies have explored the relationship between social support and cognitive function among elders. Design. A cross-sectional, descriptive correlational study. Methods. A quasi-random, point of reference sample of 120 elders residing in central China was recruited for study. Instruments used included a: Socio-demographic Questionnaire, the Multidimensional Scale on Perceived Social Support and the Mini-Mental State Examination. Hierarchical multiple regression was performed to examine the relationships among demographic variables, social support and cognitive function. Results. Age, education and social support accounted for 45·2% of the variance in cognitive function. Family support was the strongest predictor of cognitive function. Elders who had higher educational levels and more family support had better cognitive function. Relevance to clinical practice. Community healthcare providers should consolidate social support among elders in China and use family support interventions to reduce or delay cognitive decline, especially among those of increased age who are illiterate. Conclusion. Elders who had higher educational level and more family support had better cognitive function levels. Interventions that include family support are needed to improve cognitive function among elders in China. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aim of the study was to investigate factors related to the use of restraints and to explore whether the rate of nurses was an influencing factor regarding the use of restraints in German nursing homes and hospitals. Background. Restraints are frequently used measures in hospitals and nursing homes. Risks for falls and small nurse workforces are discussed in relation to the use of restraints. Design. A secondary analysis of a cross-sectional study was carried out. Methods. Data were collected by trained nurses using standardised questionnaires in 76 nursing homes ( n = 5521) and 15 hospitals ( n = 2827). For data analysis, a 3-level random intercept logistic model was used. Results. The prevalence of restraints (bed rails and/or belts) was 9·3% for hospital patients and 26·3% for nursing home residents. Amongst hospital patients, restraint use was more prevalent in women, older patients, patients with a high care dependency, patients who fell during the last two weeks, patients with a perceived risk of falls, polypharmacy, urinary incontinence, disorientation and confinement to bed. In the nursing homes, the restrained residents were significantly younger, more care dependent, had less falls and were more often urinary incontinent, disoriented and bedfast. The rate of nurses was not significantly related to the use of restraints in hospitals, and nursing homes according to the three-level random intercept model. Conclusions. Hospital patients with previous falls were more often restrained, but in the nursing homes, the restrained residents experienced less falls. The number of qualified nursing staff had no significant influence on the use of physical restraints. Relevance to clinical practice. Lower nurse staffing ratios were not related to higher frequencies of restraint use in this study. [ABSTRACT FROM AUTHOR]