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

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

Background: Fatigue is associated with multidimensional factors in heart failure patients. Investigating longitudinal changes in fatigue and its association in patients undergoing cardiac surgery is needed to create interventions for improving fatigue during recovery. Aims: This study examined the trajectory of fatigue and its associated factors over time in patients undergoing cardiac surgery. Methods: This longitudinal study enrolled 125 patients undergoing cardiac surgery in northern Taiwan. Patients completed questionnaires before surgery, at discharge, and at 1, 3 and 6 months post‐discharge. Fatigue was measured using the General Fatigue Scale. Generalised estimating equation models were fitted to identify variables associated with fatigue over time. This study complied with the STROBE checklist. Results: The sample (mean age = 60.70 ± 10.42) was mostly male (68%). High fatigue was found in 73.6% of patients before cardiac surgery and significantly decreased over the six months after discharge. NYHA III/IV, lower haemoglobin level, more symptom distress, poor sleep quality, higher anxiety and depression and lower social and family support were significantly associated with an increase in fatigue levels over time. Compared with before discharge, decreases in sleep quality at 1, 3 and 6 months were significantly associated with an increase in fatigue levels (p <.001). The increases in social support (B = 0.20, p =.016) and family support (B = 0.37, p =.002) at 6 months were significantly associated with an increase in the fatigue scores. Conclusion: Fatigue was common and associated with symptoms, sleep quality, emotion and social support in patients undergoing cardiac surgery. In addition to symptom management, improving sleep quality and social support are important to manage fatigue for the long‐term care of patients undergoing cardiac surgery. Relevance to clinical practice: Patient education on symptom management, sleep hygiene and family support is suggested to improve fatigue in patients recovering from cardiac surgery. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate the support needs identified by Taiwanese breast cancer diagnosed mothers for themselves and their 6–12‐year‐old children for implementation in a support group. Background: Mothers with dependent children are burdened with diverse child‐centered concerns while battling breast cancer. A better understanding of the concomitant support needs of mothers and their children can yield tailored support for ill mothers and their children. Design: A qualitative descriptive study employing content analysis of collected data. Methods: Between February and June of 2020, semi‐structured individual interviews were conducted with 20 mothers who had been diagnosed with breast cancer in the last 2 years. Qualitative content analysis was used. This study followed the COREQ guidelines. Results: Ill mothers favoured a hybrid format for support groups, consisting of mother‐only, child‐only, and mother–child group sessions. The content analysis yielded four themes for mother‐only group sessions: (1) learning to reach out to children; (2) dealing with negative emotions; (3) how to say goodbye to children; and (4) resetting for the future. Three themes related to child‐only group sessions emerged: (1) emotional and health education; (2) getting along with a sick mother; and (3) preparing for uncertainty. The core theme for mother–child group sessions was relationship enhancement. Conclusion: The findings revealed that mother‐reported support needs of ill mothers and their children included support for improving children's emotional well‐being and mothers' emotional coping, preparing for uncertainty, and promoting intimacy in the mother–child relationship. Relevance to clinical practice: A relation‐focused approach to psychosocial support group development that allows mother–child mutual influences on each other's coping to be addressed bilaterally is suggested. Patient or public contribution: Mothers diagnosed with breast cancer were interviewed for data collection and invited to review and validate the synthesised data for enhancing the credibility of the study. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This study examined the changes in patients' parental functioning and the associated factors, including manic, depressive symptoms and social support from before discharge to 6 months post‐discharge. Background: For parents with bipolar disorder and major depression, parenting is a recovery factor for patients, but little research examines the dynamic parental functioning from acute hospitalisation to a remission stage. Design: A longitudinal design was used. The STROBE Checklist were used in presenting this research. Methods: Participants were inpatients with bipolar disorder or major depression (n = 33) recruited within one week before discharge from the acute psychiatric ward in Taiwan. Data on parental functioning was collected four times: before discharge (T1), the 1st (T2), the 3rd (T3) and the 6th (T4) months of post‐discharge. Baseline parental functioning before admitting to the acute word was retrospectively assessed at T0. The questionnaires included positive and negative domains of parenting practice, hypomanic/manic symptoms, depressive symptoms and social support. Generalised estimating equations were applied for data analysis. Results: The negative parenting domains (poor monitoring, inconsistent discipline) decreased during hospitalisation but increased at one month post‐discharge, except corporal punishment at 3‐months discharge. The positive parenting domains (parental involvement and nurturance/responsiveness) did not recovery to baseline. While clinical symptoms remained stable during 6 months post‐discharge, social support decreased at 3 and 6 months post‐discharge. Higher depressive symptoms and low social support were associated with positive parenting domains but not related to negative parenting domains. Manic symptoms were not associated with positive or negative parenting domains. Conclusions: Positive parenting domains did not fully return to the usual situation during 6 months post‐discharge. Relevance to clinical practice: Parenting functioning recovery program targeting at the impacts of depressive symptoms on the parenting functioning and insufficient social support is needed from hospitalisation to post‐discharge. [ABSTRACT FROM AUTHOR]

Aim and objectives: To explore factors associated with nurses' willingness and competency to provide anticipatory grief counselling for the family caregivers of patients with terminal cancer. Background: Family caregivers often experience anticipatory grief due to the imminence of a loved one's death. However, few studies have identified factors associated with nurses' willingness or competency to provide anticipatory grief counselling for the family caregivers of patients with terminal cancer. Methods: This descriptive correlational study recruited a convenience sample of nurses from cancer‐related wards at a regional teaching hospital in Taiwan. The Anticipatory Grief Counseling Willingness Scale and Anticipatory Grief Counseling Competency Scale were employed. This cross‐sectional study followed the STROBE checklist. Results: The nurses' average scores for willingness and competency to provide anticipatory grief counselling for the family caregivers of patients with terminal cancer were 44.28 ± 8.36 and 171.84 ± 30.83, respectively. Multivariate linear regression revealed that interest in participating in anticipatory grief counselling for the family caregivers of patients with terminal cancer was significantly associated with the nurses' willingness to provide such counselling. Similarly, their willingness to provide such counselling was significantly associated with their counselling competency. Conclusions: Nurses' willingness and competency to provide anticipatory grief counselling for the family caregivers of patients with terminal cancer can be enhanced through in‐service education programmes, including bedside teaching and scenario simulation. Relevance to clinical practice: To improve nurses' competency in anticipatory grief counselling for the family caregivers of patients with terminal cancer, factors related to nurses' willingness to provide such grief counselling must be addressed. Diverse strategies of in‐service education can be adopted to promote nurses' competency in anticipatory grief counselling. [ABSTRACT FROM AUTHOR]

Aim and Objectives: This study explored the effect of transdermal buprenorphine on quality of life and six symptoms in cancer patients with pain. Background: Transdermal opioids offer advantages over traditional routes of administration. The impact of transdermal buprenorphine on quality of life for patients with cancer in Asian populations is unknown. Design: This study employed a single‐arm observational repeated measures design. Cancer patients with pain were evaluated prior to treatment (baseline). Over a 4‐week treatment period, quality of life and symptoms were assessed at 2 and 4 weeks. This study adhered to the recommendations of STROBE guidelines. Methods: This multi‐site study was conducted in six hospitals located across northern, middle and southern Taiwan. Adult cancer patients whose pain was previously stable with opioid analgesics and, based on clinical judgement, were able to convert to transdermal buprenorphine treatment were invited to participate. Quality of life was measured with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ‐C30). Results: Generalised estimating equations showed participants who completed at least one follow‐up measurement (N = 80) over 4‐weeks had a significant improvement in overall quality of life. Functional status only improved for social functioning. However, symptom severity decreased significantly for nausea/vomiting, pain, insomnia and constipation. Conclusions: The study provides initial evidence supporting transdermal buprenorphine for providing beneficial effects of improving quality of life and reducing severity of symptoms in Asian patients with cancer. Relevance to clinical practice: The findings of this study can inform the clinical practice that the use of transdermal buprenorphine in cancer patients with pain may also reduce the severity of other symptoms and improve overall quality of life. Trial registration details: This study was registered in ClinicalTrials.gov. Identifier: NCT04315831. [ABSTRACT FROM AUTHOR]

Aims and objectives: To determine whether interventions that use the Specific Thematic Nursing Care Action Modules (STNC‐AM) platform improve patients' psychological health over a two‐month period. Background: Stroke survivors often are left with a disability after a stroke, which can have an impact on their physical and mental health. Therefore, it is necessary for stroke patients to have tailored programmes in the face of post‐stroke mental health concerns and the need for care information. Design: A non‐randomised controlled pilot study was conducted. Methods: Participants included 44 post‐stroke patients at a medical university hospital, between 1 August 2019–28 February 2021, of whom 24 were assigned to the control group and 20 were assigned to the intervention (STNC‐AM). Data were analysed on an intention‐to‐treat basis. We used the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist (case–control studies) for this study. Results: There were no statistical differences between the two groups at baseline. At the end of two months, however, the scores for resilience, depression and positive factors illness representation were statistically different between the two groups (p <.05). The results of the generalised estimating equation model analysis indicated that resilience and anxiety remained more significant in decreasing depression in the intervention group than in the control group. Conclusion: This preliminary trial suggests that, although action modules may be associated with a decrease in depression post‐stroke, part of this effect was likely associated with an increase in resilience and a decrease in anxiety of the patients. Relevance to clinical practice: The STNC‐AM platform provides a coaching platform that helps patients and caregivers to be effective and accessible. [ABSTRACT FROM AUTHOR]

Aims and objectives: This study investigated the factors of pressure injuries in patients in intensive care units (ICU). Background: Pressure injuries among patients in ICUs can be prevented by the early assessment of risk factors and taking appropriate preventative measures. Design: A retrospective study. Methods: ICU patients who suffered from pressure injuries between January 2016 and August 2018 at a hospital in Taiwan were selected. Patient medical histories and data associated with pressure injuries and medical treatment were collected from electronic medical records. A total of 256 patients were included in our analysis. The study adhered to the STROBE checklist. Results: A multivariate model of multinomial logistic regression analysis indicated that when compared to Stage 1 pressure injuries, Stage 2–4 pressure injuries were associated with albumin levels. Patients with lower albumin levels were at greater odds of Stage 2–4 pressure injuries than Stage 1 pressure injuries. In addition, when compared to unstageable pressure injuries or deep tissue injuries, Stage 1 pressure injuries were associated with the use of fentanyl and haemoglobin levels. Patients using fentanyl were more likely to suffer from unstageable pressure injuries, and those with lower haemoglobin levels were more likely to suffer from unstageable pressure injuries or deep tissue injuries. Conclusion: When patients were simultaneously on ventilators and taking midazolam or fentanyl, the incidence of pressure injuries with greater severity became higher. Furthermore, ICU patients with lower albumin and haemoglobin levels were more likely to suffer from pressure injuries of greater severity. Relevance to clinical practice: For critically ill patients on ventilators, it is recommended to devise a means of assessing each patient daily as well as systematically reduce their dosage of midazolam or fentanyl. Furthermore, regularly monitoring albumin and haemoglobin levels to understand their nutritional status is necessary. [ABSTRACT FROM AUTHOR]

Aims: The study compares the differences in self‐care knowledge, self‐efficacy, psychological distress and self‐management between patients with early‐ and end‐stage chronic kidney disease (CKD), and predicts the influential factors of self‐management. Design: A cross‐sectional study. Methods: A total of 185 subjects by using convenience sampling from one teaching hospital were collected. The research instruments included the Chronic Kidney Disease Self‐Care Instrument Knowledge, the Chronic Kidney Disease Self‐Efficacy Instrument, the Hospital Anxiety and Depression Scale, and the Chronic Kidney Disease Self‐Management Instrument. Descriptive statistics is used frequency, percentage, mean and standard deviation. Inferential statistics is used independent t‐test, one‐way ANOVA and multiple linear regression analysis. STROBE checklist was used as the guideline for this study. Results: Our results showed that a significant difference was found in the age (p = 0.005), systolic pressure (p =.006), self‐care knowledge (p =.011) and depression level (p =.003) between patients with early‐ and end‐stage CKD. Furthermore, patients with early‐stage CKD have less self‐care knowledge and lower depression levels compared with patients with end‐stage CKD. However, self‐efficacy is the most significant predictor of self‐management for patients with early‐ and end‐stage CKD. For patients with early‐stage CKD, self‐efficacy explained 69.1% of the variation in self‐management. Conclusion: According to our results, the management of depression in patients with CKD may improve their outcomes. Improving self‐care knowledge of patients with end‐stage CKD may improve their self‐management. Therefore, our findings suggest various interventions with different necessary and prioritised precision care at early‐ and late‐stage of CKD. Relevance to clinical practice: Nurses should strive to improve the self‐care knowledge of patients with early‐stage CKD to delay the progression of the disease to end‐stage. Screening for depression among patients with end‐stage CKD is relevant, and these patients should be referred to professional counsellors when necessary. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To investigate the characteristics and prevalence of demoralisation syndrome among heart transplantation patients in Taiwan. Background: Patients with end‐stage heart failure who have undergone cardiac transplantation are at risk of demoralisation syndrome. Demoralisation syndrome has been studied in cancer populations, but our understanding of the syndrome among heart transplant recipients is limited. Design and Methods: The study adopted a cross‐sectional design and analysed the baseline data from a longitudinal study with cardiac transplant patients at a heart centre in northern Taiwan. A structured questionnaire, namely the Demoralization Scale‐Mandarin Version (DS‐MV), was used to assess demoralisation syndrome. Hierarchical regression was applied to determine the predictors of demoralisation. Reporting was consistent with the STROBE checklist. Results: There were a total of 84 participants with an average age of 51.9 years and a time since heart transplantation of around 4.1 years. Among them, the prevalence of demoralisation syndrome was 35.8%, and 57.1% coped well with stress. In addition, on the DS‐MV, participants tended to choose sentences with positive rather than negative wording. Our data showed that cardiac transplant recipients with stress have higher possibility suffering from demoralisation syndrome; poor renal function and those who cannot relive from stress are predictors for loss of meaning. Conclusions: Chinese individuals tend to hide their weaknesses; nevertheless, demoralisation syndrome among cardiac transplant recipients, as related to stress status and kidney function, is still remarkable. Relevance to clinical practice: Since demoralisation is preventable, further research on this phenomenon in the cardiac transplant population is warranted and needs to be developed. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To examine the current status of dementia care competence of nurses working in acute care settings as well as the relationship between competence and demographic attributes. Background: Most people with dementia are older individuals when they are admitted to unfamiliar acute care settings for treatment, and they are prone to displaying BPSD. If nurses working in acute care settings are not sufficiently competent in dementia care, providing proper patient care is difficult. Design: The study used a one‐sample descriptive‐correlation design. Methods: This study enrolled nurses at two medical centres in southern Taiwan as the research participants and performed a stratified random sampling according to the units where they served. The Dementia Care Competence Scale was used for data collection. An independent samples t test, ANOVA and Pearson's product–moment correlation were performed for data analysis (See STROBE). Results: A total of 308 valid questionnaires were collected. The results showed that dementia care competence of nurses working in acute care settings was moderate. In particular, they had insufficient knowledge of the special needs related to dementia and lacked the skills and patience necessary for identifying, preventing and managing BPSD. Additionally, although the nurses tended to have a positive attitude, they seldom communicated with people with dementia. This study also found that dementia care competence was better in nurses who were older, who had more seniority, who had taken care of people with dementia for a longer period of time and who had received training in dementia care. Conclusions: Dementia care training topics for nurses working in acute care settings should include palliative care for dementia, skills for managing behavioural and psychological symptoms of dementia and communication techniques for improving person‐centred care. Nurses should also be encouraged to maintain a warm, friendly attitude when providing patient care. Relevance to Clinical Practice: Continuing education in managing behavioural and psychological symptoms of dementia is necessary for currently practicing acute care nursing staff and should be developed according to the staff's educational background and needs. [ABSTRACT FROM AUTHOR]

Aims and objectives: This study's purpose was to identify the correlates of sleep quality in older adults with chronic disease. Background: Sleep quality is a common problem in older adults that may be affected by physical and mental status. Design: A cross‐sectional correlational design was employed. Methods: The study was conducted between July 2019 and April 2020 in a teaching hospital of southern Taiwan. The Geriatric Depression Scale, Pittsburgh Sleep Quality Index and Numerical Rating Scale were used to assess depression, sleep quality and physical pain respectively. Results: Of the 120 older adults (age >65 years) with chronic disease, the average Pittsburgh Sleep Quality Index score was 5.67. A total of 45.8% subjects had sleep disturbance. Older adults who were living with a partner and those who urinated at night were significantly more likely to report sleep disturbance. The presence of sleep disturbance was associated with greater levels of depression and higher levels of physical pain. Conclusion: Living with a partner, nocturia, physical pain and depression were associated with the presence of sleep disturbance in older adults with chronic disease. Relevance to clinical practice: The results of this study can help healthcare providers understand the factors associated with sleep disturbance in older adults with chronic disease, thereby facilitating the early resolution of sleep disturbance issues in this population. [ABSTRACT FROM AUTHOR]

Aims and objectives: The aims of the study were to (i) estimate the prevalence of frailty among older adults with type 2 diabetes, and (ii) investigate risk factors associated with frailty in the study group. Background: The high prevalence of frailty among older adults and its adverse health impacts including higher risks for physical disabilities and a higher mortality rate is quickly evolving to become an important public health issue. Design: A cross‐sectional design. Methods: Data were collected from the Clinical Diabetes Centre of our study group. Frailty was assessed using the Chinese version of the Tilburg frailty indicator. Other questionnaires included Activities of Daily Living, Mini‐Mental State Examination, Taiwan Geriatric Depression Scale and Instrumental Activities of Daily Living. Multivariable logistic regression was established to identify factors associated with frailty. The STrengthening the Reporting of OBservational studies in Epidemiology checklist was used preparing the manuscript. Results: A total of 248 subjects were recruited in this study, a total of 66 participants had frailty (26.6%). Our results showed that factors including age, number of chronic diseases, cerebrovascular accident, renal diseases, frequency of falling, frequency of hyperglycaemia, Activities of Daily Living, depression, Mini‐Mental State Examination, and Instrumental Activities of Daily Living ≧1 task disability were correlated with frailty in older adults with type 2 diabetes. After adjusting for confounding factors, multivariate logistic regression analyses showed a significant increase in the probability of frailty by 1.72‐times when comparing type 2 diabetes subjects with depression to those without depression. Conclusion: This study revealed that depression is a significant factor associated with the occurrence of frailty among older adults with type 2 diabetes. Relevance to clinical practice: Our results provided strong clinical evidence showing depression as an important factor associated with the risk of frailty in older individuals with type 2 diabetes. We recommend early detection via routine screenings for symptoms of depression during diabetes care to achieve early prevention or the delay of frailty and its implicated adverse health consequences. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate the relationships of sociodemographic factors, self‐stigma, glycaemic control (measured by glycated haemoglobin (A1C)) and self‐care behaviours in young adults with type 2 diabetes. Background: Young adults aged 25–44 years are in their most productive period. Once diagnosed with diabetes, this population tends to experience poor glycaemic control and perform poorly in self‐care activities. Such patterns may raise perceptions of self‐stigma and further decrease motivations to engage in self‐care behaviours in patients with diabetes. Design: A cross‐sectional, correlational research design. Methods: The STROBE guidelines for cross‐sectional studies were followed. A convenience sample of 115 participants was recruited from a medical centre in southern Taiwan. Instruments included the Self‐Stigma Scale–Chinese version and the Diabetes Self‐Care Behaviours Scale. Data were analysed using a three‐step hierarchical regression analysis and the Sobel test. Results: The average age of the participants was 36.7 years. Marital status, employment status, self‐stigma and A1C were significantly associated with self‐care behaviours, and these four variables explained 43.6% of the variance in self‐care behaviours. However, A1C (β = −.58, p <.001) was found to be the only determinant of self‐care behaviours in the last regression model. The Sobel test showed that A1C had mediating effects on self‐stigma and self‐care behaviours as well as employment status and self‐care behaviours. Conclusion: This study supports the interactive relationship among self‐stigma, employment status, glycaemic control and self‐care behaviours in young adults with type 2 diabetes. Strategies aimed at optimising glycaemic control can help reduce the effects of self‐stigma perceptions and employment status on the self‐care behaviours of such patients. Relevance to clinical practice: More effective educational programmes should be designed to improve glycaemic control, lower the effects of employment and decrease perceptions of self‐stigma to further motivate young adults to engage in better diabetes self‐care behaviours. [ABSTRACT FROM AUTHOR]

Aim and objectives: The aim of this study was to develop a theory to help guide patients with end‐stage renal disease to adapt to peritoneal dialysis. Background: Taiwan ranks first worldwide in end‐stage renal disease incidence and dialysis prevalence. Many patients cannot accept long‐term dialysis treatment and thus face several physical and psychological suffering. No theory has yet been developed to help guide patients with end‐stage renal disease to adapt to peritoneal dialysis. Design: A grounded theory approach was used in this study. Methods: A theoretical sampling was performed after interviewing 25 patients who had adapted to peritoneal dialysis at a medical centre in Taiwan from January 2018 to September 2018; data saturation was achieved. Data were analysed using open, axial and selective coding and while using the constant comparison technique. COREQ reporting guidelines were utilised. Results: A substantive theory was developed to help guide patients with end‐stage renal disease to adapt to peritoneal dialysis. The core category that emerged from the data collected was 'Confronting peritoneal dialysis to live and co‐exist with peritoneal dialysis'. Other key categories linked to and embraced in this core category were as follows: positive self‐regulation, regulation of daily life and the process of adaptation to dialysis method. Conclusion: The results could help healthcare professionals to better understand the process of end‐stage renal disease patients' adaptation to peritoneal dialysis, thereby facilitating patients' adaptation to dialysis in their daily life, enhancing their quality of life and improving the quality of medical care. Relevance to clinical practice: Healthcare professionals could use this theory as reference when providing care for peritoneal dialysis patients to assist them in adapting to life with peritoneal dialysis as soon as possible through positive self‐regulation, daily life adjustments and the process of adapting to the dialysis method. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the practice related to mobile instant messaging applications usage among home healthcare providers in Taiwan; and based on the unified theory of acceptance and usage of technology and perceived risk theory to examine the influencing factors. Background: Previous work has indicated the potential for using mobile instant messaging applications in chronic disease, disasters and public health emergencies. However, few studies have conducted to understand how healthcare professionals use them. Design: A cross‐sectional design was used in the study. Methods: A wide‐ranging empirical investigation was conducted in Taiwan. A total of 102 home agencies participated in this study, and 331 valid data were collected. The ODS guideline was followed. Results: 69% of the participants had used mobile instant messaging applications, with high functionality and interesting value can integrate various messages and contribute to adoption. Performance expectancy, effort expectancy, and social influence were significantly positively correlated with behavioral intention. The perceived risk had a significant negative correlation with performance expectancy and use behavior. Among the relevant influencing factors, different types of organization, job position, and institutional policy were related to significant differences in use behaviors. Conclusions: Our research reported on mobile instant messaging applications usage and behavioral intention among home healthcare providers. This study also highlighted the need to establish regulations within the applications and improve safety and security guidelines. Further research may extend the understanding of the organizations' influencing factors. Relevance to clinical practice: This study may help programmers, managers and policymakers improve their strategies for expanding usage of mobile instant messaging applications. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the relationships among emotional distress, cognitive function and life satisfaction in people living with type 2 diabetes mellitus (T2DM), and to verify the mediating role of cognitive function. Background: People with T2DM face cognitive decline caused by age and disease complications. Emotional distress will reduce their life satisfaction, and cognitive function will also affect the life satisfaction, but whether cognitive function mediates the effect of emotional distress on life satisfaction has not been verified. Design: A cross‐sectional study. Methods: A total of 200 people living with T2DM in the community by convenience sampling were enrolled from November–December 2018. Data collection involved a demographic and disease characteristic questionnaire, Problem Areas in Diabetes Scale, Subjective and Objective Cognitive Function Evaluation and Life Satisfaction Questionnaire. Data analysis included descriptive statistics and structural equation modelling. This report followed the STROBE guideline. Results: The emotional distress and subjective memory complaints of cognitive function had a significant positive correlation, while both emotional distress and cognitive function showed significant negative correlations with life satisfaction. In addition, cognitive function completely mediated the relationship between emotional distress and life satisfaction. Conclusion: The cognitive function played a mediating role in life satisfaction and explains how emotional distress affects life satisfaction of people with T2DM. Therefore, it is suggested that diabetes nurses should early identify the decline of cognitive function, and to intervene at an early stage. Relevance to clinical practice: This study provides opinions on the mediating factors of cognitive function. Coping strategies and supporting resources to help the T2DM people to improve their life satisfaction are suggested. [ABSTRACT FROM AUTHOR]

Aim and objectives: The study aimed to investigate the associations of suicide risk, self‐efficacy and mental health help‐seeking among the lesbian, gay, bisexual and transgender (LGBT). Background: The LGBT individuals were found to have higher risk of suicide. However, mental health promotion and suicide prevention strategies were lacking in this population. Design: A cross‐sectional survey with two‐group comparison. Methods: The LGBT group was recruited through snowballing method, which was then age‐matched with the comparison group as the reference. The questionnaire contained demographics, self‐rated health, suicide risk assessment and help‐seeking indicators including formal (e.g. medical or psychiatric services) and informal (e.g. family or friends) help sought. Chi‐square tests, t‐tests, two‐way ANOVA and multivariable regression were performed to test the differences between two groups. The methods followed STROBE criteria. Results: The LGBT group had a significantly higher prevalence of lifetime/recent suicide ideation, prior suicide attempts and mental distress or depressive symptoms. Their self‐rated health and health‐related self‐efficacy were poorer than those of the comparison group and were associated with increased suicide risk levels. Among the 27.1% of LGBT who intended to seek help for depression, one in five visited psychiatric services. The LGBT were 2–4 times more likely than the comparison group to disclose their distress or seek informal help. However, psychiatric and medical service contacts were relatively low for suicide high‐risk individuals in the LGBT group. Conclusions: The LGBT individuals had a lower level of self‐efficacy and higher suicidal risks than the general public. Healthcare professionals and the public should be aware of their informal help‐seeking signals such as disclosure of suicide ideation to friends/relatives and connect them to proper mental health resources for further assessment. Relevance to clinical practice: The LGBT with suicide risks require early detection and proper referrals by first‐line nurses to promote suicide prevention in this population. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine how changes in physical activity, sitting time and sleep duration through pre‐, mid‐ and late pregnancy are in association with Caesarean section, medically indicated Caesarean section and small for gestational age. Background: While circadian activities could change throughout pregnancy, studies exploring the effect of change in those activities on pregnancy outcomes remain limited. Design: This study applied a prospective panel design. Methods: A self‐reported questionnaire was used to assess the three activities before and during pregnancy and was administered three times from August 2015–July 2017. Multiple logistic regression models were used. The analysis included 488, 477 and 455 participants in the models for Caesarean section, medically indicated Caesarean section and small for gestational age, respectively. This study followed the STROBE guidelines. Results: The mean age of participants was 32.18 years, and more than half (54.90%) were primiparous. Sleep duration of >8 hr/day before pregnancy and experiencing a decrease in mid‐pregnancy was a risk factor for Caesarean section and medically indicated Caesarean section. Sitting ≥8 hr/weekday in pre‐, mid‐ and late pregnancy had a protective effect for Caesarean section and medically indicated Caesarean section. Sitting <8 hr in mid‐pregnancy and experiencing a decrease in late pregnancy was a risk factor for small‐for‐gestational‐age infants. Physical activity was not significantly related to pregnancy outcomes. Conclusion: Sleep duration of 7–8 hr and sitting time of more than 8 hr/day seem beneficial for women both before and during pregnancy. Relevance to clinical practice: Health professionals could assess pregnant women or those intending to become pregnant regarding their sleep and sitting behaviour and provide relevant interventions. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine the effect of an illness representation‐focused patient education intervention on illness representations and self‐care behaviours in patients with heart failure 3 months after discharge from the hospital. Background: Few intervention studies have examined the effect of illness representation‐focused interventions on illness representations and self‐care in patients with heart failure. Design: A randomised clinical trial based on the Consolidated Standard of Reporting Trials—CONSORT 2010—guidelines was employed. The Clinical Trial Registry number is TCTR20190903002. Methods: One hundred and seven participants were randomly assigned to 2 groups, and 62 participants (n = 30 in the intervention group and n = 32 in the usual care group) completed the baseline and one‐ and three‐month postdischarge follow‐up assessments. The instruments included the Survey of Illness Beliefs in Heart Failure and the Self‐care of Heart Failure Index. The intervention group received illness representation‐focused patient education while hospitalised and telephone follow‐ups after discharge. Data were analysed with linear mixed‐effects model analysis. Results: The 107 participants had a mean age of 62.17 years and a mean left ventricular ejection of 53.03%. At baseline, the two groups tended to have accurate illness beliefs but insufficient self‐care confidence and self‐care maintenance. The analysis showed no significant differences between groups in the illness representation total scores, dimension scores or self‐care maintenance scores but did show a significant difference in the self‐care confidence scores (F = 3.42, p <.05) over the three months. Conclusion: The study did not show an effect of the intervention on illness representations or self‐care maintenance behaviours. However, the intervention did maintain participants' self‐care confidence three months after discharge. Relevance to clinical practice: It is necessary to conduct long‐term follow‐ups of patients' illness representations, discuss the implementation of self‐care behaviours with patients, enhance patients' self‐care confidence, and involve family members or caregivers in self‐care practices when needed. [ABSTRACT FROM AUTHOR]

Aim and Objectives: This study aimed to explore the effects of person‐centred care on their job productivity, job satisfaction and organisational commitment among employees in long‐term care facilities. Background: Person‐centred care has been regarded as the best caregiving model for long‐term care facilities. Few studies tested the impact of person‐centred care on employee performance. Design: A cross‐sectional study was employed. Methods: This study sent 373 samples with self‐report questionnaires to the employees of sixteen long‐term care facilities in Taiwan. A total of 366 valid samples were collected. A 33‐item person‐centred care questionnaire with Likert‐scale responses was developed to assess the extent of person‐centred care. We adopted hierarchical multiple regression analysis to test the impact of person‐centred care on employee performance. We adopted the STROBE guidelines. Results: Friendly environment level and personalised care, respectively, scored the highest with a mean of 4.19 among five dimensions of person‐centred care. Personalised care, residents' self‐realisation and relationships, and organisational support had significant positive correlations with job productivity. Friendly environment level and organisational support had significant correlations with job satisfaction. Friendly environment level, residents' self‐realisation and relationships, and organisational support had significant correlations with organisational commitment. Conclusion: Person‐centred care has beneficial impact on job satisfaction, job productivity and organisational commitment of employees in long‐term care facilities. Relevance to clinical practice: Person‐centred care appears to be a crucial factor of employee performance in long‐term care facilities. The five‐dimensional person‐centred care questionnaire in this study can serve as an important management tool for improving the effectiveness of person‐centred care. [ABSTRACT FROM AUTHOR]

Aims and objectives: To compare and contrast the competence in clinical performance between pregraduate nursing students and hospital nurses. The study also explored the most difficult technical skills for the participants to perform. Background: Assessment, communication and critical thinking are competencies that help in providing safe and appropriate care for patients. Yet, self‐perceived competence was mostly measured while performance competence that reflected nurses' performance in real cases has seldom been explored in literature. Design: A cross‐sectional design was applied. The study adhered to the STROBE guidelines to improve reporting quality. Method: Fifty‐two nurses and 50 nursing students completed the Computerized Model of Performance‐Based Measurement system, which measures performance competence including the steps of critical thinking, conflict resolutions and common clinical technical problems. Six case scenarios containing 107 test questions were completed. Results: Only 53.85% of nurses and 20.0% of students achieved a satisfactory level of performance competence. They showed low scores on the steps of critical thinking: "collecting data from on‐site physical assessment," "processing information," "recognising/prioritising problems" and "arranging a course of action for patient care," as well as solving common technical problems and conflicts. The three most difficult skills to perform were CPR, reading EKGs and venipuncture/starting intravenous lines. Conclusions: The study captured the participants' weaknesses in the critical thinking process and the nursing skills that were difficult to perform. These skills are imperative to nursing care and need to be strengthened in school and in‐service education. The academic curriculum and course design for students as well as training programmes for nurses need to be reviewed to address the challenges to be faced in a clinical setting. Relevance to clinical practice: Teaching‐learning strategies that focus on enhancing critical thinking and performing difficult skills need to be designed and implemented both in practice and in school. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To identify determinants of quality of life among patients who had experienced hypoglycaemia and who were undergoing insulin treatment. Background: Patients with diabetes receiving insulin treatment are at high risk for hypoglycaemia, which tends to affect their quality of life. Design: With a cross‐sectional and observational study design (see the STROBE checklist and Appendix S1). Methods: One hundred and fifty patients with type 2 diabetes who had received insulin treatment and had experienced hypoglycaemia (<70 mg/dl) in the last 6 months were recruited. Data were collected from May 2016–February 2018 using the Knowledge of Hypoglycaemia Scale, Fear of Hypoglycaemia Scale, Social Support Scale and the simplified Taiwanese version of the Quality of Life Scale developed by the World Health Organization. Results: Factors found to be associated with quality of life in patients with hypoglycaemia included having an educational level of senior high school or above, being on an insulin regimen only, engaging in regular exercise, diabetes complications, fear of hypoglycaemia and greater social support, which accounted for 28.5% of the total variance. Conclusions: During the process of glycaemic control, patients inevitably experience hypoglycaemic episodes. Therefore, healthcare providers should assist patients with disease management to improve their quality of life. Future studies should also recruit patients who claim to have experienced hypoglycaemic symptoms, rather than considering only those with blood glucose levels below 70 mg/dl, to expand the generalisability of the findings. Future studies may also focus on the management of hypoglycaemia in patients on an insulin regimen, and on examining the effect of health education programmes on prevention of hypoglycaemia. Relevance to clinical practice: The present findings could provide a reference for healthcare providers to consolidate nursing care guidelines and to improve such patients' quality of life. [ABSTRACT FROM AUTHOR]

Aims and objectives: The primary aim of this study is to explore the influence of obesity, healthy lifestyle and sleep quality of endometrial cancer survivors on their fatigue level. Background: As many as 30% of endometrial cancer survivors still suffer from fatigue 5 years after completing therapy. Fatigue may hinder cancer survivors from participating in daily activities or returning to their original roles and functions, thus affecting their health‐related quality of life. Design: This study adopted a cross‐sectional correlational research design. The STROBE checklist for cross‐sectional studies was used as a reference for reporting the study. Methods: A consecutive sample of 134 endometrial cancer survivors was recruited from the outpatient clinics of a medical centre in Taipei, Taiwan. Data were collected using structured questionnaires. Results: Study subjects scored 44 points (SD = 7.09) on average for the fatigue levels. Results of linear regression showed that sleep quality (ß = −0.38), comorbidity index (ß = −0.024) and age (ß = 0.20) were important predictors of fatigue. However, differences in obesity, vegetable and fruit intake, physical activity did not lead to significant differences in fatigue level. Conclusions: Survivors who had poorer sleep quality, higher comorbidity index and younger age reported higher fatigue. Relevance to clinical practice: The study findings are relevant for assessing and preventing fatigue in endometrial cancer survivors. Those with poorer sleep quality, higher comorbidity index and younger age are at a greater risk for fatigue and deserve further attention. Although the study results failed to support the link between obesity, vegetable and fruit intake, physical activity and fatigue, the ratio of survivors who comply with recommended healthy lifestyles was low. Hence, it is of urgent necessity that this population receives the help to maintain a healthy lifestyle. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This study applied structural equation modelling to explore the relationships among agitated behaviours, depression, cognitive function and activities of daily living, as well as associations between these factors and urinary incontinence). Background: A high prevalence of urinary incontinence is found among institutional older adults with dementia. People with urinary incontinence suffer from increased financial burden and social isolation and experience reduced quality of life. Design: Cross‐sectional correlational research. The study complied with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Methods: In total, 226 older adults with dementia were recruited through convenience sampling at 15 long‐term care facilities in southern Taiwan. The urinary incontinence frequency, agitated behaviours, depression, cognitive function and activities of daily living were evaluated using bladder records, the Cohen‐Mansfield Agitation Inventory, the Cornell Scale for Depression in Dementia, the Mini‐Mental State Examination and the Barthel Index, respectively. Results: Activities of daily living performance was found to be significantly associated with urinary incontinence; however, age, cognitive function, depression and agitated behaviours were not significantly related to urinary incontinence. Age did not have effects on any of the variables tested in this model, whereas activities of daily living performance was significantly associated with cognitive function and depression. Results further showed that cognitive function and depression were mediators between activities of daily living and agitated behaviours. Conclusion: Enhanced activities of daily living independency directly reduced urinary incontinence, improved cognitive function, decreased degrees of depression and indirectly reduced agitated behaviours. Relevance to clinical practice: The findings could serve as a valuable reference for long‐term care facilities in providing effective urinary incontinence care and prevention to older adults with dementia. [ABSTRACT FROM AUTHOR]

Aims and objective: To explore new nurses' processes of growth in the workplace in order to understand the challenges they face. Background: Quantitative and qualitative research to date has not adequately explored the complex ways in which initial work experiences may shape new nurses' very high quit rate and, consequently, impact the long‐term nursing shortage in Taiwan. Design/Methods: We conducted in‐depth interviews with new nurses to explore their professional development, including the challenges they faced, and their feelings about staying or quitting. Twenty newly registered nurses who had worked in a hospital setting full‐time for a year or less in two southern Taiwan medical centres were interviewed. Data were collected from March–November 2016. EQUATOR guidelines were followed, using the COREQ checklist. Results: Interview transcripts were analysed and coded; three stages of growth were discovered: Feeling disillusioned and shocked, Gaining experiential knowledge and Making a place for oneself. Most nurses (n = 18/20) went through these three stages within 9 months and continued to work in nursing at follow‐up 2 years later. Conclusions: Job continuity was contingent upon new nurses' enduring a painful process of adjustment in the first two stages when new nurses were unsure of themselves and their interactions with preceptors were wrought with social tensions. New nurse development and retention efforts should make explicit the possibility of these tensions and how to deal with them. Relevance to clinical practice: A better understanding of new nurses' growth processes and adjustment pains can help refocus professional development and retention efforts towards how new nurses can succeed in finding a place for themselves. [ABSTRACT FROM AUTHOR]

Aims and objectives: To analyse the relationship among hospital nurses' socio‐demographic data, work stress, humor and health conditions, and to determine the predictors of nurses' health status. Background: Humor can decrease the feelings of helplessness, fear and anxiety, and that may result in the development of positive emotions, which might have a good impact on health. Design: This research applied cross‐sectional designs and used structured questionnaires which included socio‐demographic data, an Effort‐Reward Imbalance questionnaire (ERI), humor and 12‐item Chinese health questionnaires (CHQ). A total of 236 nurses in a regional hospital in Taiwan were recruited. SPSS was used for the data analysis in the study. The STROBE was chosen as a checklist for this study. Results: The results showed that the significant predictors of the participants' health were "whether experienced significant life events during the past 3 months," "the degree of work stress" and the level of "humor." Conclusions: It is recommended that administrators pay attention to the cultivation of nursing staff's humor, such as providing nurses with musical CDs or humorous books and providing stress management training courses to nurses. Relevance to clinical practice: It is necessary for hospital managers to determine and deal with the causes of work stress to avoid the development of health problems in the nursing personnel. Furthermore, in order to develop stress‐releasing strategies, it is necessary to provide nurses with stress management and resilience enhancement courses. Cultivating a humor competency of nurses is also recommended to alleviate the work stress. [ABSTRACT FROM AUTHOR]

Aims and objectives: To assess the willingness of nurses to receive vaccines as recommended by Taiwan's "Immunization Recommendations for Healthcare Personnel" (IRHCP), as well as the factors associated with their willingness. Background: Immunisation for healthcare personnel (HCP) is a means of reducing pathogen transmission. Also, vaccinating HCP reduces personnel and labour costs during an epidemic. Methods: A cross‐sectional study was conducted. A self‐administered questionnaire survey targeting nurses working in various service units at three hospitals was used. In total, 413 nurses completed the questionnaire. The main outcome measure was the willingness to receive vaccines recommended by the IRHCP, and the variables we assessed included knowledge regarding the IRHCP, individual perceptions (perceived risk of contracting the infection, perceived severity of the infection and perceived transmissibility after disease onset), perceived benefits and barriers to the vaccination, cues to the vaccination and demographics. This study followed the STROBE checklist for reporting this study. Results: The willingness of nurses to receive vaccines recommended by the IRHCP was high; the highest level of willingness was for the hepatitis B vaccine. The nurses' willingness to receive various vaccines recommended by the IRHCP was predicted by the knowledge regarding the IRHCP and perceived transmissibility after disease onset. Except the diphtheria–tetanus–acellular pertussis vaccine, perceived benefits and perceived barriers were also predictors of the willingness to receive vaccines. Conclusions: Our results showed that interventions focusing on increasing the knowledge regarding the IRHCP and perceived transmissibility after disease onset, emphasising the benefits of the vaccination and reducing the perceived barriers to the vaccination are needed to increase nurses' willingness to receive vaccines. Relevance to clinical practice: It is suggested using health education courses and mass media broadcasts at the individual and societal levels to raise awareness regarding the benefits of vaccines and enhance nurse' confidence in vaccination programs. [ABSTRACT FROM AUTHOR]

Aims and objectives: To test the construct and concurrent validity and reliability of the incident‐reporting attitude scale used for staff in long‐term care facilities (IRA‐LTC) by the two‐phase cross‐validation method. Background: Lack of accurate measurement on incident‐reporting attitude might hinder improvements of safety practice in long‐term care facilities. Design/Methods: A two‐phase cross‐sectional questionnaire survey was conducted in Taiwan. A fixed proportion of long‐term care facilities were randomly selected that included 20 and 15 long‐term care facilities at phases one and two separately. Nursing and administrative staffs in these facilities were recruited at the first phase (N = 207) for testing the validity and reliability of the newly developed scale and for cross‐validation of the scale at the second phase (N = 251). The scale of IRA‐LTC was a self‐developed structured questionnaire consisting of 31 items. The data were analysed using spss for Windows 20.0 and AMOS 24.0. Descriptive statistics, correlation analysis, Cronbach's α, exploratory and confirmatory factory analysis were carried to examine the homogeneity of items, reliability, construct and concurrent validity. The STROBE checklist was adhered (See Appendix S1). Results: The IRA‐LTC scale comprised two dimensions: "cognition and intention to report" and "barriers to report." The two‐factor structure explained 60.20%–61.89% of the total variance at two phases. Validation of the initial factorial model gained at the first phase was satisfactorily supported at the second phase. Concurrent validity of the IRA‐LTC scale was satisfied. Cronbach's α for the scale and subscales was 0.94–0.97. Conclusions: This IRA‐LTC scale is valid and reliable and can be recommended to evaluate the incident‐reporting attitude among all kinds of staff in long‐term care facilities. Relevance to clinical practice: Positive incident‐reporting attitude can lead to positive incident‐reporting behaviour. Using the IRA‐LTC scale for assessing staff's incident‐reporting attitude is recommended as the first step to enhance staff's safety performance in long‐term care facilities. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine the gender‐specific lifestyles of adults with metabolic syndrome in the Taiwanese community. Background: Many studies show different prevalence of metabolic syndrome in males and females; however, few studies have investigated gender‐specific lifestyle risk factors, which are important for effectively reducing prevalence. Design: A cross‐sectional study design was used. Methods: Between 2012 and 2015, a total of 1,066 individuals were recruited in northern Taiwan. Data were collected by questionnaires and analysed by descriptive statistics, chi‐square tests and logistic regression. This study followed the STROBE guidelines. Results: The prevalence of metabolic syndrome was 40.8% in men and 36.0% in women. Women had healthier dietary habits, a higher rate of moderate–vigorous physical activity, and a lower rate of smoking and obesity than men. Men, who were overweight or obese, lacked vigorous physical activity, often consumed excess amounts of salt and fat, and seldom consumed appropriate amounts of protein tended to have metabolic syndrome. Women with an unhealthy metabolism tended to be overweight or obese and seldom consumed dairy products. Conclusions: Men, who had normal body weight, performed vigorous physical activity, seldom consumed excess amounts of salt and fat, and often consumed appropriate amounts of protein tended not to have metabolic syndrome. Women with a healthy metabolism were of normal body weight and often consumed dairy products. There exist gender differences in health habits with metabolic syndrome. Relevance to clinical practice: Although the associated risk factors differed between men and women, controlling body weight and maintaining a healthy lifestyle may reduce the risk of metabolic syndrome. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine changes in patients' bowel function and to compare patients' outcome among different operation and treatment after rectal resection. Background: Anal‐preserving surgery is the trend of treatment of colorectal cancer and bowel function after surgery needs to be concerned. Design: Prospective cohort study. Methods: A total of 38 patients with convenience sampling were recruited from a teaching hospital. The low anterior resection syndrome (LARS) score was used to assess bowel function disturbances before discharge and at 1 week, 1 month and 3 months after discharge. We followed the STROBE checklist to ensure rigour in our study. Results: Approximately half of the patients experienced major LARS, including daily stool frequency of more than seven times and stool clustering at least once a week. The LARS scores observed at 1 month after discharge were significantly higher than those observed before discharge. Patients who received intersphincteric resection had higher LARS scores compared with those who received other surgeries. Furthermore, patients who underwent concurrent chemoradiotherapy, operation (OP) and chemotherapy had the highest LARS scores compared with those who underwent only an OP. Conclusion: The patients experienced varied intestinal dysfunction after surgery based on their treatment plan and surgical method. Nurses should provide individualised health education for these patients. Relevance to clinical practice: A health education booklet is recommended to educate patients about LARS symptoms and the techniques to adapt in their daily lives after surgery. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine the relationships among nursing students' perceived nursing image, caring behaviours and gender‐friendliness barriers to determine whether gender‐friendliness barriers affect nursing image and caring behaviour among male nursing students. Background: Because caring is typically seen as a feminine trait, male nurses face gender‐role strains in the current nursing environment. Gender‐friendliness barriers may have an impact on the vital relationship between professional nursing image and caring behaviour. Design: This study used a quantitative and cross‐sectional research design. Methods: Participants were 141 male students who had obtained at least 1 month of clinical practice experience. We collected data using three instruments: The Caring Assessment Report Evaluation Q‐sort (CARE‐Q), Gender‐Friendliness Barriers in Nursing Programs (GFB‐NP), and Nursing Image—as a Profession Questionnaire (NIPQ). Data were collected from August 2016–July 2017. Partial least squares structural equation modelling (PLS‐SEM) with bootstrapping was used to test the hypothesis model. Results: The full model results indicated a direct positive and significant path from professional nursing image to caring behaviour (β = 0.47, 95% CI = 0.32 to 0.61, t = 6.19, p < 0.001). Gender‐friendliness barriers had a direct and significant negative relationship between professional nursing image (β = −0.31, 95% CI = −0.49 to −0.12, t = 3.17, p < 0.01) and caring behaviour (β = −0.18, 95% CI = −0.35 to −0.02, t = 2.18, p < 0.05). In addition, the variable of student‐perceived barriers to gender‐friendliness was indirectly and significantly negatively related to caring behaviour (β = −0.15, 95% CI = −0.27 to −0.05, t = 2.57, p < 0.05) through professional nursing image. Conclusion: Male nursing students with a higher nursing image engage in greater caring behaviour. Gender‐friendliness barriers, however, decrease students' nursing image and caring behaviour. Relevance to clinical practice: As applied to nursing education, the goal should be to improve male nursing students' caring behaviours and professional nursing image and decrease gender‐friendliness barriers. [ABSTRACT FROM AUTHOR]

Aim: To explore the association between the sociodemographic factors and the needs of patients undergoing haemodialysis in Taiwan. Background: Concomitant discomfort, including physical and mental aspects, affects the patients' quality of life and their willingness to undergo haemodialysis. Maslow's hierarchy of needs is a well‐known tool to assess different levels of human needs. Method: We conducted a small‐scale cross‐sectional observational study using a structured needs assessment questionnaire on 159 patients from the Taipei Veterans General Hospital haemodialysis unit. Results: The overall mean scores of physical, mental, spiritual, other needs and needs in relation to medical staff care were 4.0 ± 0.8, 3.2 ± 0.8, 2.7 ± 1.0, 3.1 ± 0.9 and 4.1 ± 0.7, respectively. The results showed that the patients' highest need was in relation to medical staff care, followed by physical needs. Further analysis showed that patients who are still employed during the treatment process have higher mental, spiritual and other needs. Patient who is financially supported by their family has higher physical needs. Patients taken care of by paid caregivers have lower spiritual needs and other needs. This is also the same with patients who are religious as opposed to those who are nonreligious. Patients who have attained tertiary education have higher other needs compared with patients who have only achieved up to primary or secondary education. Conclusion: The study is the first in Taiwan to identify and quantify the needs of patients undergoing haemodialysis. When the needs of the patients are identified in relation to their sociodemographic factors, the medical staff can give the appropriate treatment in order to meet the needs and improve the patients' well‐being. Relevance to clinical practice: Healthcare providers should not only focus on the patients' physiological needs, but should determine and address their other needs in various aspects in order to improve the quality and efficacy of the dialysis care process. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore and describe the experience of social adjustment of adolescents with Tourette syndrome in Taiwan. Background: Although Tourette syndrome is a non‐life‐threatening disease, the inherent difficulties in controlling tics and comorbidities can cause long‐term physical and psychological issues, as well as social maladjustment among adolescents. Good social adjustment can promote mental health among adolescents. Currently, it is not clear how adolescents with Tourette syndrome can self‐adjust and maintain harmonious social interaction with others. Design: Descriptive phenomenological approach was used in this study. Four criteria were applied to establish the trustworthiness or methodological rigour. Methods: Sixteen adolescents with Tourette syndrome were recruited by purposive sampling from a medical centre in Northern Taiwan. Semistructured one‐on‐one interviews were performed from March 2014–April 2015 for data collection. Every participant was interviewed once or twice, and each interview lasted for duration of around 60–90 min. Data were analysed with Giorgi's phenomenological method for data analysis. Results: Three themes were identified from the adolescent' interviews. The themes were included visible and invisible destitution, moulding a socially acceptable self and coexisting friends and foes. Conclusions: Adolescents with Tourette syndrome experienced that tics are often not understood nor accepted during social interactions with others. However, with age and autonomy of adolescents, they were able to adjust and develop a socially acceptable body image and maintain amicable social interactions with others. Accompanied by positive thinking, support from friends and families, the adolescents could achieve good social adjustments for living with Tourette syndrome. Relevance to clinical practice: The experiences and feelings highlighted in this study can bring awareness to nurses and healthcare professionals for developing interventions that promote healthy social adjustment and mental health for adolescents with Tourette syndrome. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore triggers of and decision‐making patterns for older adults with knee osteoarthritis to receive total knee arthroplasty. Background: Older adults with knee osteoarthritis pain are often reluctant to undergo total knee arthroplasty until their physical health and psychological health have deteriorated. This delay may lead to poor long‐term outcomes after the surgery. Thus, it is important to help these older adults decide to undergo total knee arthroplasty in an appropriate time frame. Design: A qualitative descriptive study. Methods: Older adult outpatients scheduled to receive total knee arthroplasty within 1 month (N = 79) were recruited by convenience from two medical centres and one regional hospital in northern Taiwan. Data were collected in individual interviews using a semistructured guide and analysed by thematic analysis. Results: The main triggers for older adults to receive total knee arthroplasty were severe pain and inability to walk. We identified four decision‐making patterns for undergoing total knee arthroplasty: tried everything to relieve pain and surgery was the last choice; previously received total knee arthroplasty; perceived oneself as still young and wanted to enjoy life; and adjusted work characteristics, but in vain. Conclusion: Healthcare providers of older patients with knee osteoarthritis must carefully assess their characteristics, especially age, occupation and previous total knee arthroplasty, to guide them in deciding to undergo total knee arthroplasty. Clinicians also need to provide appropriate information about osteoarthritis care, pain medications, total knee arthroplasty, the relationship between knee osteoarthritis pain and quality of life, as well as the relationship between preoperative status and postoperative long‐term outcomes for older adults to maintain their quality of life. Relevance to clinical practice: Our findings provide evidence for healthcare providers to offer information and support to their older adult patients with knee‐osteoarthritis pain who are deciding whether to undergo total knee arthroplasty. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate the construct validity and reliability of the Chinese Comfort, Afford, Respect, and Expect scale, which can be used to determine clinical nurses’ competence. The results can also serve to promote nursing competence and improve patient satisfaction. Background: Nurse–patient interaction is critical for improving nursing care quality. However, to date, no relevant validated instrument has been proposed for assessing caring nurse–patient interaction competence in clinical practice. This study adapted and validated the Chinese version of the caring nurse–patient interaction scale. Design: A cross‐cultural adaptation and validation study. Methods: A psychometric analysis of the four major constructs of the Chinese Comfort, Afford, Respect, and Expect scale was conducted on a sample of 356 nurses from a medical centre in China. Item analysis and exploratory factor analysis were adopted to extract the main components, both the internal consistency and correlation coefficients were used to examine reliability and a confirmatory factor analysis was adopted to verify the construct validity. Results: The goodness‐of‐fit results of the model were strong. The standardised factor loadings of the Chinese Comfort, Afford, Respect, and Expect scale ranged from 0.73–0.95, indicating that the validity and reliability of this instrument were favourable. Moreover, the 12 extracted items explained 95.9% of the measured content of the Chinese Comfort, Afford, Respect, and Expect scale. Conclusions: The results serve as empirical evidence regarding the validity and reliability of the Chinese Comfort, Afford, Respect, and Expect scale. Relevance to clinical practice: Hospital nurses increasingly demand help from patients and their family members in identifying health problems and assisting with medical decision‐making. Therefore, enhancing nurses’ competence in nurse–patient interactions is crucial for nursing and hospital managers to improve nursing care quality. The Chinese caring nurse–patient interaction scale can serve as an effective tool for nursing and hospital managers to evaluate the caring nurse–patient interaction confidence of nurses and improve inpatient satisfaction and quality of care. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate the distribution and risk factors associated with undiagnosed obstructive sleep apnoea among hypertensive patients. Background: Obstructive sleep Apnoea has been deemed a cardinal risk factor affecting cardiovascular event, and the condition is still frequently overlooked clinically. The lack of advanced diagnosis often causes hypertensive patients with obstructive sleep apnoea to miss opportunities for preventing chronic diseases. Design: A cross‐sectional design. Methods: A total of 215 hypertensive participants were recruited from the cardiovascular outpatients of medical centre in northern and middle Taiwan. The Chinese version of Pittsburgh Sleep Quality Index, the Chinese version of the Epworth Sleep Scale and a portable sleep monitoring device were used for data collection. Logistic regression analysis was conducted to identify the factors affecting hypertensive patients with obstructive sleep apnoea, and a multinomial logistic regression analysis was used to examine the major influence factors for each obstructive sleep apnoea severity level. Results: 81.9% of the hypertensive participants were found having obstructive sleep apnoea. Concerning to the obstructive sleep apnoea severity, 50.0% of participants had mild obstructive sleep apnoea. After controlling the confounding variables, the supine position (odds ratio, 1.04; 95% CI, 1.01–1.07), SO2 (odds ratio, 0.58; 95% CI, 0.38–0.89) and oxygen desaturation index (odds ratio, 2.70; 95% CI, 1.18–6.18) were significantly associated with obstructive sleep apnoea. Furthermore, severe obstructive sleep apnoea was significantly correlated with gender (odds ratio, 0.04; 95% CI, 0.00–0.66), excessive daytime sleepiness (odds ratio, 20.27; 95% CI, 1.58–26.97) and oxygen desaturation index (odds ratio, 4.05; 95% CI, 1.86–8.81). Conclusions: Nearly 82% of the hypertensive participants were found having undiagnosed obstructive sleep apnoea, and 80% of them were mild or moderate severity. Oxygen desaturation index, SO2 and the supine position were found to be major predictors for obstructive sleep apnoea. Remarkably, oxygen desaturation index was the most significant predictor for mild, moderate and severe obstructive sleep apnoea. Relevance to clinical practice: Healthcare providers should enhance their sensitivities to hypertensive patients at a high risk for obstructive sleep apnoea by actively assessing common obstructive sleep apnoea symptoms and providing strategies to alleviate obstructive sleep apnoea symptoms. [ABSTRACT FROM AUTHOR]

Aims and objectives: To evaluate the effects of empowerment case management on the physical health of patients with type 2 diabetes. Background: Diabetes is a global health issue. Case management is often used on diabetes management at various levels. Empowerment has been used for chronic situation management, but its effects have not been widely studied in diabetic populations. Design: Purposive sampling was used to recruit 125 participants with type 2 diabetes aged 18 years or older from a regional teaching hospital in Taiwan. Methods: Empowerment case management was applied for 42 participants, while the other 83 received normal case management. Survey items included demographics, preprandial (AC) and postprandial (PC) blood sugar levels, glycated haemoglobin (HbA1C), systolic and diastolic blood pressure, total cholesterol, and the presence or absence of acute and chronic complications. Descriptive statistics and a generalised estimating equation were used to analyse the model's effects on the two groups. Results: The PC blood sugar levels of patients receiving empowerment case management declined at 3 months (B = −34.26, p < .01), and this decrease was maintained at 6 months (B = −83.66, p < .001). As of 6 months after starting the intervention, patients receiving empowerment case management enjoyed better physical health. These patients' AC blood sugar levels (B = −50.16, p < .001), HbA1C (B = −0.98, p < .001), systolic blood pressure (B = −8.24, p < .001), diastolic blood pressure (B = −5.73, p < .01) and total cholesterol (B = −13.74, p < .05) all experienced a continuous drop and were controlled well, and no diabetes‐related acute or chronic complications were observed either. Patients with type 2 diabetes who received empowerment case management managed their physical health better. Moreover, its greatest effect was that patients were able to form exercise groups and continue to maintain their health. Conclusions: Empowerment case management was shown to have a substantial effect on the physical health and self‐care of patients with diabetes, thus making it a suitable intervention tool for managing diabetes cases. Relevance to clinical practice: The study results showed that empowerment case management is suitable for managing diabetes cases. It has a substantial effect on the maintenance of physical health, occurrence of complications and effectiveness of self‐care among patients with diabetes. For better care outcomes, empowerment case management should be integrated into the guidelines of diabetes management. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the meaning of rituals that women and their families perform after a stillbirth. Background: A cultural taboo in Taiwan prohibits discussing death; thus, parents of stillborn babies have no established public mourning or burial ceremonies to perform for their stillborn children. Stillbirths are often treated as if they had never happened. Design: Qualitative descriptive study. Methods: In‐depth interviews, which were transcribed and content analysed, were conducted with a purposive sample of 16 women discharged from two teaching hospitals in Taiwan after they had a stillbirth. Results: Families engaged in rituals for two underlying reasons: to benefit the deceased child and the immediate family. The meanings of the rituals for the child are presented through three themes: (i) sending the baby's spirit to a safe place, (ii) protecting it from suffering and (iii) preparing it for a better reincarnation. The meanings of rituals for the families are presented through four themes: (i) releasing parental guilt by doing their best for the deceased child, (ii) cutting bonds with the child, (iii) avoiding additional misfortune should they mishandle the funeral and (iv) praying for a successful subsequent pregnancy. Conclusions: Death‐related rituals are highly culturally diverse. This study fills a gap about Asian cultures. Participating in rituals permits a mother to do something for her deceased child, helps relieve her guilt and lets her cope with the stillbirth. Rituals after a stillbirth can help a woman recover from grieving and allow her to hope for a successful subsequent pregnancy. Relevance to clinical practice: Health professionals should discuss with bereaved parents what rituals they would like to perform and then respect their decisions. A continuum of care and support that exists from the prenatal diagnosis through the stillbirth and beyond is recommended for parents and families during this difficult time. [ABSTRACT FROM AUTHOR]

Aim and objectives: To predict the risk factors related to newly diagnosed psychiatric disorders resulting from spinal cord injuries (SCIs). Background: SCIs are a common result of devastating accidents; they can have an essential negative impact on the psychological health of those so afflicted. Psychiatric disorders commonly occur worldwide and are often associated with pain and disability; however, few studies have investigated the risk factors of psychiatric disorders among persons with SCIs. Design: A retrospective cohort study design with data obtained from the Taiwan Health Insurance Research Database (THIRD). THIRD involves the claims data on recipients recorded in the Taiwan National Health Insurance (TNHI), which was set up in 1995 and covers about 99% of the 23 million persons in Taiwan. Methods: We used THIRD to predict the risk factors related to newly diagnosed psychiatric disorders among victims of spinal cord injury. Results: The majority of persons with SCI were men (51.2%), and their average age was 52.8 years. All 5,828 newly diagnosed psychiatric disorders were included from 1997–2009 in 64,907 SCI in the THIRD data set. These results demonstrated notable differences in hazard risk (HR); the injured persons were inspected for the level of SCI, age, hypertension and chronic obstructive pulmonary disease (HR: 1.637, 95% CI: 1.452–1.844, p < .0001; HR: 1.005, 95% CI: 1.002–1.009, p = .0019; HR: 0.724, 95% CI: 0.642–0.816; HR: 1.267, 95% CI: 1.105–1.454, p = .0007; HR: 1.368, 95% CI: 1.183–1.582, p < .0001, respectively); the persons with SCI exhibited significant independent associations with psychiatric disorders. Conclusions: The results revealed that the level of SCI, female gender and age, respectively, affects the incidence of newly diagnosed psychiatric disorder related to SCI. Relevance to clinical practice: This study showed that psychiatric disorders may be associated with the development of SCI, and that this risk was more predominant in females with SCI. Our results are of direct clinical relevance as they are meant to assist clinical assessment, counselling, guidance of symptomatic monitoring and early clinical intervention. [ABSTRACT FROM AUTHOR]

Aims and objectives: To develop the Health of Body, Mind and Spirit Scale (HBMSS), which was designed to assess drug abusers' health condition. Background: Helping drug abusers to become healthy is important to healthcare professionals. However, no instrument exists to assess drug abusers' state of health. Design: A cross‐sectional questionnaire survey was implemented to examine the validity of the HBMSS. Methods: Data were collected from 2015–2016 at one drug abuse prevention centre in Taiwan. Participants (N = 320) who had abused drugs were invited to complete a preliminary 64‐item version of the HBMSS. An item analysis, criterion‐related validity analysis (using the Relapse Prediction Scale [RPS] score), split‐half reliability testing and confirmatory factor analysis (CFA) were conducted to examine the psychometric properties of the HBMSS. Results: The final version of the HBMSS contained 15 items that were divided into three subscales: the health of the body, mind and spirit. Cronbach's α and split‐half reliability coefficients were all above .85. The factor loading of each item was between .74–.95. The HBMSS had satisfactory criterion‐related validity with the RPS score (r = −.50, p < .001). A second‐order CFA was conducted on the HBMSS. The fit indexes were good, χ2 = 184.060, df = 94, χ2/df = 1.958 (p = .000). Conclusions: The entire HBMSS and the subscales had satisfactory reliability and validity. Relevance to clinical practice: Healthcare professionals could use the HBMSS to evaluate the condition of the health of individuals with a drug abuse history. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate the suitability of asthma education materials for school‐age children with asthma and elucidate how these children used their health‐literacy abilities to identify whether the materials can be accepted, comprehended and applied. Background: Effective asthma self‐management education is influenced by the suitability of materials and an individual's health literacy. Design: A mixed‐method research design was developed using quantitative and qualitative surveys. Methods: The suitability of the materials was assessed on the basis of the Chinese version of the Suitability Assessment of Materials by five experts. In addition, five school‐age children (age: 8–12 years) were recruited and interviewed. Results: In total, 25 pieces of asthma education material for children were collected. On the basis of their type, the materials were categorised as nine brochures, 11 leaflets and five videos. Of the 25 materials, 17 were rated as superior materials, whereas eight were rated as adequate materials. The suitability scores of the video‐based materials were significantly higher than those of the brochures and leaflets (p = .006). One print material was considered to have a reading level suitable for fifth‐grade or younger children, whereas the remaining materials were considered suitable for sixth‐grade or older children. The following six health‐literacy domains were identified: recognising asthma through body knowledge, posing reflective questions, identifying self‐care difficulties, receiving adult guidance, learning with enjoyment and addressing learning requirements. Conclusions: The video‐based materials had integrated content and were appealing to children. Cartoon animations, interactive computer games, and skill demonstrations may enhance learning stimulation and motivation and increase learning effects in children. Relevance to clinical practice: The present results may help healthcare providers to understand children's capacities to manage their disease, effectively address children's requirements and function as a key resource for children to strengthen their literacy in asthma management. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate the incidence of and contributors to demoralisation syndrome among patients before and after cardiac surgery. Background: Demoralisation syndrome is a common but neglected phenomenon in nursing practice. Patients who require cardiac surgery experience demoralisation syndrome more often than they experience depression. Design: A prospective correlational design was applied. Methods: A convenience sample of 76 participants undergoing cardiac surgery was recruited from the cardiovascular wards of two medical centres in Taiwan. The instruments applied included the Demoralization Scale (DS), the Patient Outcome Questionnaire-9 (PHQ-9) and the Perception of Intensive Care Unit (ICU) Stay Questionnaire. Results: High demoralisation was present in 44.7% of the participants before surgery but significantly decreased to 36.8% after surgery (p < .05); conversely, depression was present in 15.8% of participants before surgery and did not significantly decrease after surgery (rate after surgery, 9.2%; p > .05). A multiple regression analysis using the backward-selection method showed that depression (p < .001) and retirement (p < .05) were important predictors of pre-operative demoralisation syndrome (R2 = 0.250), whereas depression (p < .001) and perceptions of ICU stay (p > .05) remained in the regression model after surgery (R2 = 0.291). Conclusions: The study findings suggest that demoralisation syndrome is highly prevalent in patients undergoing cardiac surgery but is significantly reduced after cardiac surgery. Before surgery, depression and retirement were significant predictors of demoralisation. After surgery, depression was the only predictor. Although the perception of ICU stay was not an important predictor, it was significantly correlated with demoralisation. Relevance to clinical practice: Before cardiac surgery, nurses should emphasise the importance of demoralisation development among patients who suffer from depressive symptoms and are retired. After cardiac surgery, continued follow-up is needed for the early detection and minimisation of the effect of depression and the development of demoralisation. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate the knowledge of and attitudes towards palliative care for advanced dementia and their associations with demographics among nursing staff, including nurses and nursing assistants, in long-term care settings. Background: Nursing facilities are places where persons with dementia die; therefore, providing quality end-of-life care to residents with advanced dementia is crucial. To date, little attention has been paid to palliative care practice for patients with advanced dementia. Design: A descriptive, cross-sectional, survey design was used. Methods: In total, a sample of 300 nurses (n = 125) and nursing assistants (n = 175) working in long-term care settings in Taiwan participated in this study. Two instruments were administered: demographic characteristics and responses to the Questionnaire of Palliative Care for Advanced Dementia. Descriptive statistics and multiple regression were used for data analysis. Results: Overall, the nurses and nursing assistants had moderate mean scores for both knowledge of and attitudes regarding palliative care for advanced dementia. Additionally, nursing staff who were nurses with greater work experience and those who had received palliative care and hospice training had greater knowledge of palliative care. In addition, nursing staff who had received dementia care training and who had worked in nursing homes had higher levels of positive attitudes towards palliative care. Conclusions: This study indicates the need to provide nurses and nursing assistants with more information about palliative care practice for people with advanced dementia. Particularly, providing education to those who are nursing assistants, who have less working experience, who have not received palliative and dementia care training, and who have not worked in nursing homes can improve overall nursing staff knowledge of and attitudes towards palliative care. Relevance to clinical practice: Continuing education in principles of palliative care for advanced dementia is necessary for currently practicing nursing staff and should be developed according to their educational background and needs. [ABSTRACT FROM AUTHOR]

Aims and objectives To develop and test the feasibility of an instrument to support patients' nursing home to emergency room transfer. Background Transfers from a nursing home care facility to an acute care facility such as a hospital emergency room are common. However, the prevalence of an information gap for transferring residents' health data to acute care facility is high. An evidence-based transfer instrument, which could fill this gap, is lacking. Design Development of a nursing home to emergency room transfer checklist, validation of items using the Delphi method and testing the feasibility and benefits of using the nursing home to emergency room transfer checklist. Methods Items were developed based on qualitative data from previous research. Delphi validation, retrospective chart review (baseline data) and a 6-month prospective study design were applied to test the feasibility of using the checklist. Variables for testing the feasibility of the checklist included residents' 30-day readmission rate and length of hospital stay. Results Development of the nursing home to emergency room transfer checklist resulted in four main parts: (i) demographic data of the nursing home resident; (ii) critical data for nursing home to emergency room transfer; (iii) contact information and (iv) critical data for emergency room to nursing home transfer. Two rounds of Delphi validation resulted in a mean score (standard deviation) ranging from 4.39 (1.13)-4.98 (.15). Time required to complete the checklist was 3-5 min. Use of the nursing home to emergency room transfer checklist resulted in a 30-day readmission rate of 13.4%, which was lower than the baseline rate of 15.9%. Conclusions The nursing home to emergency room transfer checklist was developed for transferring nursing home residents to an emergency room. The instrument was found to be an effective tool for this process. Relevance to clinical practice Use of the nursing home to emergency room transfer checklist for nursing home transfers could fill the information gap that exists when transferring older adults between facilities such as nursing homes and hospitals. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore decisional conflict and its influencing factors on choosing dialysis modality in patients with end-stage renal diseases. The influencing factors investigated include demographics, predialysis education, dialysis knowledge, decision self-efficacy and social support. Background Making dialysis modality decisions can be challenging for patients with end-stage renal diseases; there are pros and cons to both haemodialysis and peritoneal dialysis. Patients are often uncertain as to which one will be the best alternative for them. This decisional conflict increases the likelihood of making a decision that is not based on the patient's values or preferences and may result in undesirable postdecisional consequences. Addressing factors predisposing patients to decisional conflict helps to facilitate informed decision-making and then to improve healthcare quality. Design A predictive correlational cross-sectional study design was used. Methods Seventy patients were recruited from the outpatient dialysis clinics of two general hospitals in Taiwan. Data were collected with study questionnaires, including questions on demographics, dialysis modality and predialysis education, the Dialysis Knowledge Scale, the Decision Self-Efficacy scale, the Social Support Scale, and the Decisional Conflict Scale. Results The mean score on the Decisional Conflict Scale was 29.26 ( SD = 22.18). Decision self-efficacy, dialysis modality, predialysis education, professional support and dialysis knowledge together explained 76.4% of the variance in decisional conflict. Conclusions Individuals who had lower decision self-efficacy, did not receive predialysis education on both haemodialysis and peritoneal dialysis, had lower dialysis knowledge and perceived lower professional support reported higher decisional conflict on choosing dialysis modality. Relevance to clinical practice When providing decisional support to predialysis stage patients, practitioners need to increase patients' decision self-efficacy, provide both haemodialysis and peritoneal dialysis predialysis education, increase dialysis knowledge and provide professional support. [ABSTRACT FROM AUTHOR]

Aims and objectives To (i) investigate the characteristics of health-related quality of life and satisfaction with case management and (ii) to identify factors associated with health-related quality of life in cancer survivors. Background The level of health-related quality of life can reflect treatment efficacy and satisfaction with cancer care. Design A cross-sectional study design was adopted. Methods Subjects from the outpatient setting of a cancer centre in northern Taiwan were recruited by consecutive sampling. A set of questionnaires were employed, including a background information form, case management service satisfaction survey ( CMSS) and The European Quality of Life Scale ( EQ-5D). Descriptive statistics were used to examine levels of health-related quality of life and satisfaction with case management. Pearson's correlation was used to identify relationships between treatment characteristics, satisfaction with case management and health-related quality of life. Multiple stepwise regression was used to identify factors associated with health-related quality of life. Results A total of 252 cancer patients were recruited. The three lowest scores for items of health-related quality of life were mobility, self-care and usual activities. Cancer survivors with higher mobility, less pain and discomfort, and lower anxiety and depression were more likely to have better health-related quality of life. Conclusion Mobility, pain and discomfort, and anxiety and depression are important predictive factors of high health-related quality of life in cancer survivors. Relevance to clinical practice In clinical care, patients' physical mobility, pain and discomfort, and anxiety and depression are important indicators of health-related quality of life. Case managers should include self-care and symptom management into survivorship care plans to improve health-related quality of life during survival after treatment concludes. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore couples' perceptions of the effects of perinatal loss on their marital relationship, social support and grief 1 year postloss, and analyse what factors changed the severity of their grief. Background Perinatal losses are traumatic events in the lives of families and can have serious long-term consequences for the psychological health of parents and any subsequent children. Design A prospective follow-up study. Methods We recruited, at a teaching hospital in southern Taiwan, a convenience sample of 30 couples whose babies either miscarried or were stillborn. At 1 month (T1), 3 months (T2), 6 months (T3) and 1 year (T4) after the pregnancy loss, all participants completed four questionnaires. To analyse the changing status of their grief and its related factors, we used a generalised estimating equation (GEE) to account for correlations between repeated observations. Results Postbereavement grief levels fell over the four time-points. Mothers reported feeling more grief than did the fathers. Couples with a history of infertility, no religious beliefs or no living children before the loss felt more grief from a perinatal miscarriage or stillbirth. Furthermore, couples reported more grief if their marital satisfaction level was low, if their socioemotional support from husband's parents was low or if they had never participated in a ritual for their deceased baby. Conclusions Six months postloss is the crucial period for bereaved parents after a perinatal loss. Being a mother, having no previous living children and low-level socioemotional support from the husband's parents are significant high-risk factors for a high level of grief 1 year after perinatal death. Relevance to clinical practice We recommend that health professionals increase their ability to identify the factors that psychologically affect postloss grief. Active postloss follow-up programmes should focus on these factors to offer specific support and counselling. [ABSTRACT FROM AUTHOR]

Aims and objectives To determine the individual and mutual predictors of the marital satisfaction of couples in which the husband experienced prostate cancer. Background Marital satisfaction of patients with prostate cancer has been insufficiently studied in Asian countries as compared with Western countries. Design This study used a prospective and repeated-measures design. Methods Seventy Taiwanese couples in which the husband had prostate cancer completed measures at 6 and 12 months post-treatment. Assessments of physical symptoms, marital satisfaction, coping behaviour and psychological distress were made. Multiple linear regression was used to analyse the data. Results The marital satisfaction of patients with prostate cancer and that of their spouses were significantly correlated. At 6 months, spouses' marital satisfaction, patients' appraisal of prostate cancer as a threat and patients' serum prostate-specific antigen levels were found to be the predictors of patients' marital satisfaction. Furthermore, patients' marital satisfaction and their spouses' psychological distress were predictors of spouses' marital satisfaction. At 12 months, spouses' marital satisfaction and patients' appraisal of prostate cancer as harm were predictors of patients' marital satisfaction. Finally, spouses' marital satisfaction (at 6 months) and appraisal of prostate cancer as a threat were predictors of spouses' marital satisfaction. Conclusions At 6 months post-treatment, patients' and spouses' marital satisfaction will influence each other. However, at 12 months, patients' marital satisfaction exerts an insignificant effect on spouses' marital satisfaction. Moreover, patients' serum prostate-specific antigen level or the negative appraisal of prostate cancer affects their marital satisfaction. Spouses' marital satisfaction is affected by psychological distress and their negative appraisal of prostate cancer. Relevance to clinical practice The results can be used to develop interventions for prostate cancer couples. Such an intervention can be used to modify couples' appraisal of prostate cancer by changing incorrect thinking or to ease the psychological distress to improve marital satisfaction. [ABSTRACT FROM AUTHOR]