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BackgroundWith the rapid advance of genetics, the application of genetic testing has become increasingly popular. Test results have had a tremendous impact on individuals who receive the test and his or her family. The ethical, legal, and social implications (ELSI) of genetic testing cannot be overlooked. The Internet is a potential tool for public engagement. ObjectivesThis study aimed at establishing ethical guidelines for genetic testing in Taiwan through a participatory citizen consensus approach via the Internet. MethodsThe research method used was a citizen consensus conference modified by an Internet application and the Delphi technique. The citizen consensus conference is one of the public participation mechanisms. The draft ethical guidelines for genetic testing were written by an expert panel of 10. The Delphi technique was applied to a citizen panel recruited via the Internet until a consensus was reached. Our research population was restricted to people who had Internet access. ResultsIncluded in the citizen panel were 100 individuals. A total of 3 individuals dropped out of the process. The citizen panel was exposed to the issues through Internet learning and sharing. In all, 3 rounds of anonymous questionnaires were administered before a consensus was reached in terms of importance and feasibility. The result was ethical guidelines composed of 4 categories and 25 items. The 4 categories encompassed decision making (6 items), management of tissue samples (5 items), release of results (8 items), and information flow (6 items). On a scale of 1 to 10, the average (SD) importance score for the decision-making category was 9.41 (SD 0.58); for the management of tissue samples category, the average score was 9.62 (SD 0.49); for the release of results category, the average score was 9.34 (SD= 0.59); and for the information flow category, the average score was 9.6 (SD = 0.43). Exploratory analyses indicated that participants with higher education tended to attribute more importance to these guidelines. ConclusionsThe resulting recommended ethical guidelines had 4 categories and 25 items. We hope through the implementation of these guidelines that mutual trust can be established between health care profession and the general public with respect to genetic tests.

This cross‐sectional study explored the prevalence of sarcopenia in older adults with type 2 diabetes and investigated the effects of diet and physical activity on sarcopenia. In total, 577 older adults with diabetes were recruited from a teaching hospital in Taiwan. Diet and physical activity were assessed using self‐rated questionnaires, including the Healthy Diet Inventory, the Mini Nutritional Assessment‐Short Form, and the International Physical Activity Questionnaire‐Short Form. Sarcopenia was defined in accordance with the Asian Working Group for Sarcopenia 2019 guidelines. In total, 51.12% of participants had either possible sarcopenia, sarcopenia, or severe sarcopenia. Participants who were female, old age, prolonged sedentary times, poor nutritional status, and lower level of moderate‐to‐vigorous physical activity were identified as risk factors for possible to severe sarcopenia. Older adults with diabetes and possible to severe sarcopenia had poor nutrition status and engaged in inadequate physical activity. The findings indicate that sarcopenia may be related to nutrition status and physical activity, especially in older adults with diabetes. [ABSTRACT FROM AUTHOR]

Objectives: Cognitive frailty combines physical frailty and cognitive impairment in the absence of dementia. The prompt detection of cognitive frailty and early implementation of preventive interventions may reduce the incidence of dementia. However, intervention studies of exergaming in older adults with cognitive frailty are scant. Therefore, we aim to investigate the effectiveness of exergaming on cognitive functions and loneliness among older adults with cognitive frailty. Design: Quasi‐experimental design. Methods: Participants were recruited from four community settings. The experimental group participated in two 40‐min group exergaming sessions weekly for eight weeks; the control group received usual care. The outcome measures were the Montreal Cognitive Assessment (MoCA) and the Chinese Version of the Loneliness Scale. Analyses of covariance were conducted to analyze whether exergaming influenced participants' cognitive functions and loneliness. In addition, the effect size of the posttest of the experimental group relative to its baseline value was calculated to determine the effectiveness of the intervention. Result: 69 older adults with cognitive frailty were included, and 35 and 34 were assigned to the experimental and control groups, respectively. The exergaming effectively improved the cognitive function of older adults with cognitive frailty. Conclusions: Exergaming interventions can effectively improve the cognitive functions of older adults with cognitive frailty but do not positively affect loneliness. We provide evidence to healthcare workers to apply exergaming interventions for older adults with cognitive frailty to improve cognitive function. Key points: This paper highlights that an exergaming intervention can effectively improve the cognitive functions of older adults with cognitive frailty.Older adults with cognitive frailty are a crucial group in the gerontology field, and this study emphasizes that healthcare workers can apply exergaming to achieve improvements in cognitive function based on our research results. [ABSTRACT FROM AUTHOR]

Aim: Unfavourable communication increases missed nursing care. Oncology wards have more communication complexity than general wards; therefore, creating a positive communication environment is important for ensuring quality care. This study aimed to understand the relationship between organizational communication satisfaction and missed nursing care in Taiwan. Design: This cross‐sectional study was performed to measure organizational communication satisfaction and missed nursing care in six oncology wards at a stand‐alone cancer centre hospital in Taipei, Taiwan in December, 2018. Methods: The study collected data using the Communication Satisfaction Questionnaire and the MISSCARE survey. The data were analysed using descriptive statistics, t test, analysis of variance and Pearson product–moment correlation analysis in December 16, 2018. Results: A total of 111 questionnaires were collected, and the response rate was 92.5%. The study showed that nurses tended to miss nursing care when they were dissatisfied with the unit's manpower status organizational communication environment, horizontal and diagonal communication and informal communication. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes mellitus (T2DM), common in older people, is an important reason for muscle loss in Japanese and Taiwanese populations. However, little is known about the association between lifestyle behaviours and muscle quality. We aimed to compare the lifestyle behaviours of Japanese and Taiwanese older adults with T2DM and to the identify lifestyle factors associated with muscle quality. Methods: This cross‐sectional study was conducted among community‐dwelling individuals with T2DM aged ≥65 years in Taiwan and Japan. Totally, 114 Japanese and 226 Taiwanese participants were enrolled in the study. Outcomes were measured by blood biochemical examinations, body composition analyses and structured self‐reported questionnaires to assess lifestyle behaviours and muscle quality. Linear regression models were used to examine the relationship between lifestyle factors and muscle quality using SPSS version 27.0 with a statistical significance level of P < 0.05. Results: Japanese subjects were more likely to be smokers and alcohol consumers, and they were less likely to have well‐balanced diets and engage in more physical activity as compared to Taiwanese subjects. The muscle quality in the Japanese subjects was significantly poorer than that in the Taiwanese subjects. Physical activity, dietary habits and smoking were associated with muscle quality, after adjusting for age, gender and body mass index. Conclusions: Physical activity of insufficient intensity, unhealthy dietary habits and smoking could be risk factors for poor muscle quality. These findings can contribute to the development of effective strategies to improve muscle quality in community‐dwelling older Asian people with T2DM. [ABSTRACT FROM AUTHOR]

Purpose: Shared decision making promotes patient participation in medical decisions. This study aims to explore the decision-making situation and influencing factors in patients with cancer. Patients and methods: A cross-sectional descriptive study was conducted for patient with cancers in regional teaching hospitals in northern Taiwan using short-form Mandarin Health Literacy Scale (s-MHLS) and Shared Decision Making Questionnaire (SDM-Q-9), with total 120 cases collected from January 15 to April 30, 2018. Results: Overall health literacy in patients with cancer is 86.52%, and degree of shared decision making is 89.63%; higher education level indicated better health literacy (p<0.001); health literacy is significantly correlated with Shared decision making (r=0.258, p=0.004). Increasing education level by one grade elevated health literacy by 0.623. Expanding health knowledge by one source increased health literacy by 0.307 points, one point increase in health literacy enhanced shared decision making by 0.128 points. Using path analysis, we found education level affects health literacy, which in turn influences shared decision making. Conclusion: Improving health literacy is indispensable to promote patient participation in shared decision making in the highly professional medical field. Education level directly affects health literacy; therefore, in the future, providing disease-matching health education is crucial for patients with lower education levels to enhance their health literacy. Health literacy directly affects shared decision making; therefore, more active assistance in achieving patient health literacy is crucial to implement shared decision making. [ABSTRACT FROM AUTHOR]

Both alternative medicine and western medicine have been commonly used to treat pediatric cancer patients in Taiwan. Each has its own intrinsic strengths and weaknesses and they can be complementary. Little is known about medical help-seeking behaviors of parents of pediatric cancer patients, especially those related to alternative therapies. This study investigated the extent and parental expectations on use of alternative therapies. All primary caregivers of 63 eligible patients were interviewed. Use of alternative therapies, regardless of education level or social status of their families, is prevalent (n = 46, 73%) in Taiwan. Commonly used alternative therapies included, in order of popularity, formulated functional food (n = 22, 48%), temple worship/shamanism (n = 19, 40%), traditional Chinese medicine (n = 9, 20%), secret recipes/herbs (n = 13, 28%), and diet supplements (n = 9, 19%). Such practices generally occur without medical guidance from oncologists, largely because of poor interactions between parents and oncologists. Future efforts should be made to encourage both parents and oncologists to discuss this issue. Nurses may serve as mediators by developing mutual trust and a sharing relationship between these groups. [ABSTRACT FROM AUTHOR]

Background: Attending health checkups as a primary prevention strategy benefits older adults in facilitating the identification of health issues and risk factors for disease. Little is known about factors influencing participation in and satisfaction with a free annual elderly health checkup program (EHCP) in Taiwan. This study aimed to extend current knowledge related to the uptake of this service and individuals' views of the service., Methods: This was a cross-sectional study using a telephone interview survey method to compare influencing factors and satisfaction between participants and non-participants of an EHCP. The individuals involved were older adults in Taipei, Taiwan. The random sampling method included 1,100 people, 550 older adults who had participated in the EHCP within the last 3 years, and 550 older adults who had not. A questionnaire containing personal characteristics and satisfaction with the EHCP was used. Independent t -test and Pearson's Chi-squared test were used to evaluate differences between the two groups. Associations between individual characteristics and health checkup attendance were estimated using log-binomial models., Results: Results showed that 51.64% of participants reported being satisfied with the checkups; however, only 41.09% of non-participants were satisfied. In the association analysis, age, educational level, chronic diseases, and subjective satisfaction were related to older persons' participation. Furthermore, having a stroke was associated with a higher attendance rate [prevalence ratio: 1.49; 95% confidence interval: (1.13, 1.96)]., Conclusions: The EHCP had a high proportion of satisfaction among participants, but the proportion was low among non-participants. Several factors were associated with participation and might lead to unequal healthcare service uptake. Health checkups need to increase among people at a young age, those with low educational backgrounds, and those without chronic diseases., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Chen, Lin, Feng and Chiu.)

Background: The nursing shortage in medical institutions in Taiwan averaged 9% in 2012, considerably higher than the 5% indicated in the literature. As a result, many hospitals have been forced to close wards or reduce beds. Despite the acute need, the percentage of registered nurses who are employed as nurses in Taiwan (60.4%) is considerably lower than those in Canada or the United States. This low rate may be because of the poor working environment for nurses in Taiwan., Purpose: This study aimed to develop a set of nursing work environment quality indicators for Taiwan and to test the reliability and validity of the resulting survey tool., Methods: Multiple methods were used in this study. In Phase 1, we organized an expert panel, reviewed the literature, and conducted seven rounds of expert panel discussion and six focus group discussions with nursing directors. The goal was to draft indicators representing a quality nursing work environment to fit current conditions in Taiwan. In Phase 2, we conducted an expert review for content validity, held three public hearings, and conducted a survey. Four hundred twenty-seven questionnaires were sent out, with 381 returned. The goal was to test the content validity, construct validity, and internal consistency reliability., Results: The study produced a set of indicators of a quality nursing work environment with eight dimensions and 65 items. The content validity index for importance and suitability dimensions were 1.0, whereas the internal consistency was 0.91. The eight dimensions were safe practice environment (16 items), quality and quantity of staff (four items), salary and welfare (seven items), professional specialization and teamwork (seven items), work simplification (five items), informatics (five items), career development (nine items), and support and caring (12 items). The overall load for the indicators was 77.57%., Conclusions/implications for Practice: The developed indicators may be used to evaluate the quality of nursing work environments. Furthermore, the indicators may be used in hospital surveys to establish baseline conditions and for outcome research that measures improvement in nursing work environments after interventions.

Background: An effective organizational infrastructure is essential to successfully implement and sustain an evidence-based nursing (EBN) practice. Although EBN has been promoted in Taiwan for more than 10 years, variations in the organizational policies and strategies necessary to support EBN among healthcare organizations have prevented effective implementation. Barriers to the implementation of EBN located at the organizational level have also been reported. The need for a model that focuses on the organizational infrastructure to promote EBN in Taiwan has therefore become increasingly apparent., Purpose: This study aims to develop a model that contains the key contextual elements of organizational infrastructure necessary to effectively promote EBN, especially in hospital settings., Methods: A steering committee drafted the components and related strategies of the proposed model. Delphi technique was used to obtain consensus on the proposed model among a group of experts with expertise in EBN. Thirty experts participated in all three rounds of the Delphi survey. To confirm the appropriateness of the proposed model for clinical settings, the model was further reviewed by a focus group composed of experts with experience in implementing EBN or evidence-based medicine in hospitals. The strategies were then further modified based on the suggestions of this focus group, and only those strategies that best fit hospital settings were retained., Results: Five key contextual elements and related strategic processes were identified, including equipment, policy, training courses, outcome indicators, and reward plans. The resultant model was named EPCOR, an acronym composed of the names of each identified element., Conclusions/implications for Practice: EPCOR is a comprehensive model of organizational infrastructure and strategic procedures for implementing EBN in hospital-based settings in Taiwan. Organizations may use the EPCOR model to initiate and implement EBN practices and then to evaluate their effectiveness.

Background: Adequate nursing workforce is critical to ensure patient safety and reduce the incidence of adverse events., Purpose: This study explores and compares the nursing workforce allocation situation in the acute care general wards of Taiwan's three hospital tiers and, based on findings, develops standards for adequate nursing workforce allocation and nurse-to-patient ratios in acute care general wards at each tier., Methods: This study uses multiple research methods, including literature review, questionnaire survey, and expert focus group discussion. Final consensus is achieved using a public hearing and questionnaire survey., Results: The severity of patient conditions differs among hospital tiers. Therefore, each tier requires a nursing workforce allocation standard appropriate to its situation. Study findings indicate that nurse-to-bed ratios and nursing hours are valid indicators of nursing workforce allocation needs. The results of expert discussions and public hearings recommend 0.53 nurses per bed and 2.8 nursing hours for academic medical centers, 0.49 nurses per bed and 2.6 nursing hours for metropolitan hospitals, and 0.40 nurses per bed and 2.1 nursing hours for local community hospitals for the current stage of healthcare development; 0.57 nurses per bed and 3.0 nursing hours for academic medical centers, 0.53 nurses per bed and 2.8 nursing hours for metropolitan hospitals, and 0.44 nurses per bed and 2.3 nursing hours for local community hospitals in 3 years; and 0.61 nurses per bed and 3.2 nursing hours for academic medical centers, 0.57 nurses per bed and 3.0 nursing hours for metropolitan hospitals, and 0.48 nurses per bed and 2.5 nursing hours for local community hospitals in 5 years., Conclusions: Study results may provide a basis for better allocating nursing workforce in hospitals, setting formal standards for minimum nurse-to-patient ratios, and assessing nursing workforce needs at the national level.

Nosocomial infection represents an important indicator of healthcare quality and patient safety. Based on the experience gained during the outbreak of Severe Acute Respiratory Syndrome (SARS) in Taiwan in 2003, we gained greater awareness of the potential threat from patient-hired attendants and outsourced workers as bacteria carriers and transmitters. This study built a training model and evaluated training effectiveness in terms of improved knowledge. The training model included nosocomial infection control guidelines, a training CD, training program, evaluation form, and descriptive procedures for conducting training and evaluation. The training course for this study was conducted in 17 hospitals in Taiwan, with a total of 1,467 participants attending 27 seminars and 1,265 effective samples (return rate = 86.2%). Results of the study showed a statistical difference of < .001 before and after the training course on participant understanding of nosocomial infection control. Advantages of applying this training model include knowledge enhancement and reduced implementation time, manpower input and budget outlay. In addition to greater flexibility, the model can also positively influence clinical practice, improve patient safety and reduce hospital nosocomial infection rates. This program is worth promoting in hospitals and other healthcare institutions.