Search

Background: Poor functional status relating to heart failure (HF) negatively affects health-related quality of life (HRQOL). Patients with HF, especially those with New York Heart Association (NYHA) Class III or IV HF, often exhibit poor HRQOL because of physical limitations and HF-related symptoms. Although sense of coherence (SOC) has been reported to be a determinant of HRQOL, its role as a mediator between functional status and HRQOL remains unclear, and few studies have explored the prevalence of HF in patients in NYHA Classes I and II. Purpose: This study was designed to investigate SOC as a mediator between different functional status classes and HRQOL in patients with HF. Methods: A cross-sectional study was conducted on patients with HF recruited from a hospital in northern Taiwan from April 2020 to September 2020. The Minnesota Living with Heart Failure Questionnaire and a questionnaire on sociodemographic characteristics; functional classification in terms of NYHA Classes I, II, and III; and SOC were administered. The PROCESS v3.5 (by Andrew F. Hayes) macro was applied to analyze the effects, and Model 4 was used to examine the mediating role of SOC on the relationship between NYHA functional class and HRQOL. Results: Of the 295 participants, SOC was found to mediate the effects of functional status on HRQOL more significantly in patients in Class II than those in Class III but not more significantly in patients in Class I than those in Class III. A weaker mediating effect of SOC was noted on the relationship between functional status and HRQOL in patients with HF in NYHA Class II than those in Class III. Conclusions: In patients with HF, poor functional status often reduces HRQOL significantly. SOC mediates the relationship between functional status and HRQOL more significantly in those in NYHA Class II than those in Class III. Nursing staff should work to increase patients' SOC by strengthening their coping capacity and improving their functional status to improve their HRQOL. [ABSTRACT FROM AUTHOR]

Background: Abnormal sleep duration affects recovery in older adults with hip fracture and diabetes mellitus (DM) negatively. However, the predictors of abnormal sleep duration in this population remain unknown. Purpose: This study was designed to explore the predictors of abnormal sleep duration among older adults with hip fracture and DM within 6 months of hospital discharge. Methods: A longitudinal study using secondary data from a randomized controlled trial was implemented. Data on fracture-related factors (diagnosis, surgical methods) were collected from medical charts. Information on the duration of DM, methods of DM control, and diabetes-related peripheral vascular disease was collected by asking simple questions. Diabetic peripheral neuropathy was assessed using the Michigan Neuropathy Screening Instrument. Sleep duration outcomes were determined using data collected from a SenseWear armband. Results: Having more comorbidities (OR = 3.14, p =.04), having undergone open reduction (OR = 2.65, p =.005), having undergone closed reduction with internal fixation (OR = 1.39, p =.04), and having DM (OR = 1.18, p =.01), diabetic peripheral neuropathy (OR = 9.60, p =.02), or diabetic peripheral vascular disease for a longer duration (OR = 15.62, p =.006) were all associated with a higher risk of abnormal sleep duration. Conclusions: The findings indicate that patients with more comorbidities or who had undergone internal fixation, had a long DM history, or had complications are more likely to have abnormal sleep duration. Thus, greater attention should be focused on the sleep duration of diabetic older adults with hip fracture who are affected by these factors to achieve better postoperative recovery. [ABSTRACT FROM AUTHOR]

Providing artificial nutrition and hydration (ANH) to patients w ith terminal cancer can worsen their symptoms at the end of life. However, withholding or withdrawing ANH raises ethical, emotional, and cultural challenges for health professionals, especially in the intensive care unit (ICU). This study aimed to identify the factors associated with ICU nurses' behavioral intentions toward providing ANH to patients with terminal cancer. A questionnaire survey study was conducted with 616 ICU nurses from 2 medical centers in Taiwan. The results showed that " food and water as basic care," "requests from patients with terminal cancer for artificial nutrition and hydration ," "ethical acceptability of withholding artificial nutrition and hydration ," physicians, and knowledge of ANH affected nurses' behavioral intentions (adjusted R2 = 0.175). Physician input was most influential on nurses' behavioral intentions toward providing ANH to patients with terminal cancer; thus, nurses should be encouraged to discuss medical decisions with physicians. The study results also suggest that nurses' knowledge of ANH and ethical judgment can be enhanced by scenario-based teaching materials and multidisciplinary team discussions. [ABSTRACT FROM AUTHOR]

Background: Healthcare professionals play an important role in end-of-life care decisions. Although the factors affecting end-of-life care in long-term care facilities have been well studied in Western contexts, few studies have examined factors affecting end-of-life care discussions for residents with dementia among multidisciplinary professionals in Asian or Taiwanese contexts. Purpose: The aim of this study was to explore the factors related to the end-of-life care discussions of registered nurses, social workers, and physicians with residents with dementia and their families. Methods: This is a cross-sectional and correlational study. A stratified random sampling was conducted, and self-administered questionnaires were mailed to physicians, registered nurses, and social workers who work in long-term care facilities with accreditation ranks ≥ Grade A in Taiwan. Results: Questionnaires were returned by 478 participants (response rate = 94.1%). Fewer than 10% of the participants reported often discussing end-of-life care with residents with dementia and their families. Physicians were significantly more likely to discuss life-sustaining treatment than nurses and social workers. The frequency of professionals discussing advance directives and life-sustaining treatment for residents with dementia was predicted by higher confidence in end-of-life care skills and greater perceived facility support. Conclusions/Implications for Practice: Most professionals did not frequently discuss end-of-life care with residents with dementia and their caregivers. Discussions of end-of-life care in long-term care facilities should be promoted by enhancing the confidence of these professionals in providing end-of-life care and creating a supportive environment for end-of-life discussions and care. [ABSTRACT FROM AUTHOR]