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Introduction and objectives: Functional decline frequently occurs in older adults in hospitals. The aim of this project was to promote evidence-based strategies for physical activity to prevent functional decline in hospitalized older adults in a medical center in southern Taiwan. Methods: This project was guided by the JBI Evidence Implementation Framework. Seven audit criteria were derived from a JBI evidence summary and a baseline audit involving 25 nurses and 30 hospitalized older adults was conducted to compare current practice with best practice recommendations. The JBI Getting Research into Practice (GRiP) approach was used to identify barriers to implementation, and strategies were developed to overcome those barriers. A follow-up audit was conducted to measure any changes in compliance. Results: After implementing the strategies, the pass rate of nursing staff improved in the physical activity knowledge test, rising from 56% to 88%. Compliance of nursing staff with providing physical activity instructions using evidence-based guidelines to hospitalized older adults reached 80%. The incidence of functional decline among hospitalized older adults decreased from 36.7% to 20%. Conclusions: The results of this best practice implementation project suggest that initiating physical activity as early as possible for hospitalized older adults once their medical condition has stabilized can help prevent functional decline. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization has identified methadone maintenance therapy (MMT) as the most effective treatment for reducing patient dependence on heroin. In Taiwan, MMT has been used as a heroin harm reduction strategy since 2006. Although the effectiveness of MMT in reducing heroin addiction has been examined quantitatively in prison samples, little attention has been paid to the experiences and perspectives of patients with heroin addiction receiving MMT. This study was designed to address this gap in scientific knowledge. Purpose: The aim of this study was to investigate the experiences of individuals struggling with heroin addiction who are receiving MMT in the community. Methods: A qualitative descriptive research approach and semistructured interviews were used in this study. We interviewed 14 participants who had received MMT in a medical center in central Taiwan. All of the interview data were recorded, transcribed, and analyzed using qualitative content analysis. Results: Four themes emerged: (a) a chance to change one's life, (b) the helpfulness of MMT, (c) a sense of being restricted and controlled, and (d) need for support. Conclusions/Implications for Practice: This article fills a gap in current scholarly understanding of patient experiences and their perspectives on the helpfulness of MMT. Understanding patient experiences and perspectives is critical to informing and developing concrete strategies for clinical practice and MMT policy. Clinical professionals should assess patient needs and concerns to determine whether they are met by current treatment programs. Policymakers should design more flexible policies to facilitate easier access by patients to methadone to reduce the risk of relapse. [ABSTRACT FROM AUTHOR]

Background: The demand for certified nurse aides (CNAs) in long-term care institutions is gradually increasing. Factors such as well-being that positively influence the work of CNAs have been inadequately explored in the literature. Purpose: This study was designed to examine the relationships among social support, self-efficacy, demographics, and psychological well-being in CNAs during the recent COVID-19 pandemic and to assess the moderating role of social support on self-efficacy and well-being in this population. Methods: In this quantitative correlational study, CNAs from 24 legally registered long-term care institutions were recruited as participants. Data were collected using a demographic questionnaire, the General Self-Efficacy Scale, the Social Support Scale, and the Chinese Happiness Inventory. Partial least squares structural equation modeling was used to test the research hypotheses model. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was followed in this cross-sectional study. Results: A total of 148 CNAs were enrolled as participants. The mean age of the participants was 46.48 years. Social support and having children were identified as being significantly and positively correlated with well-being, and self-efficacy was identified as having no significant impact on well-being. Importantly, social support was found to moderate the relationship between self-efficacy and well-being. Overall, social support and having children were important predictors of well-being, with a combined explanatory power of 41.6% (Q² = .28, f 2 = 0.40). Conclusions/Implications for Practice: Self-efficacy was found to be less predictive of well-being in the presence of higher levels of social support. Being a parent was also identified as an important factor affecting the well-being of CNAs under stress. Managers of long-term care institutions should intervene to improve the CNA's social support. Also, CNAs who do not have children should pay more attention to their well-being. [ABSTRACT FROM AUTHOR]

Background: The Gratitude at Work Scale, originally developed by American scholars, has been widely administered to mental health professionals and human service workers to explore gratitude in the workplace. No Chinese-language instrument is currently available for assessing workplace gratitude. Purposes: The aims of this study were to (a) translate the original English version of the Gratitude at Work Scale into a traditional Chinese version (TC-GAWS), confirm its factor structure, and analyze its psychometric properties among newly employed nurses and (b) develop and evaluate the psychometric properties of the TC-GAWS short form. Methods: A psychometric study using a cross-sectional webbased design was conducted in Taiwan. Three hundred twentytwo employed nurses completed a battery of self-administered online questionnaires that included a demographic datasheet, the Gratitude Questionnaire–Six-Item Form, the Connor–Davidson Resilience Scale-10, and the Thoughts of Quitting Scale. IBM SPSS 24.0 and AMOS 28.0 were used for data analysis, and Cronbach's alpha and Pearson's correlation were used to assess reliability and concurrent validity. Exploratory factor analysis and confirmatory factor analysis (CFA) were conducted. Results: The internal consistency and stability of the TC-GAWS total scale were .88 and .91, respectively. The exploratory factor analysis showed a satisfactory Kaiser–Meyer–Olkin value of .88 and a Bartlett's test value of 654.01 (p < .001), suggesting that 64.55% of the total variance was explained by the two-factor TC-GAWS. After item reduction, the CFA of the six remaining items of the TC-GAWS short form revealed adequate fit statistics for a two-factor structure and a second-order factor. Strong correlations were found between the 10-item and six-item TCGAWS (r > .94) in the two samples, suggesting good concurrent validity. The overall scores for the 10-item and six-item TCGAWS had similar convergent validity, with moderate-tostrong correlations for the Gratitude Questionnaire–Six-Item Form (r = .45 and .540), Connor–Davidson Resilience Scale-10 (r = .49 and .51), and Thoughts of Quitting Scale (r = −.57 and −.53). The CFA yielded a two-factor, six-item model that exhibited good fit with the latent constructs of χ² /df = 11.06/8 = 1.38, p = .198, comparative fit index = .996, goodness-of-fit index = .979, root mean square error of approximation = .045, root mean square residual = .030, and standardized root mean squared residual = .023. Conclusions/Implications for Practice: Both the 10- and sixitem TC-GAWS instruments demonstrated good reliability and validity in nurse participants. The TC-GAWS may be used to measure gratitude in nurses in the workplace. This instrument has the potential to facilitate a better understanding of gratitude in nurses, which may be applied to the improvement of nursing management, research, and education. [ABSTRACT FROM AUTHOR]

Background and Objectives: Many studies have confirmed the influences of various service quality dimensions on patient satisfaction and loyalty, but no existing theoretical model accounts for variation in how different types of patients evaluate service quality’s soft and hard attributes. This research gap may cause problems for administrators needing to decide how to distribute resources appropriately across multiple departments. Therefore, this study establishes a theoretical model of the differences between inpatients’ and outpatients’ evaluations of hard and soft qualities and compares such evaluations’ influences on patient satisfaction and loyalty. Also, to supplement statistical analysis and respond to scholars’ calls for more mixed-methods studies of health care quality, this research incorporates analysis of online reviews to provide a holistic, close to real-time picture of patients’ service experience perceptions. Methods: This study’s survey sample comprised 292 inpatients and 137 outpatients from a Taiwanese hospital. We used partial least squares structural equation modeling to test the hypothetical model and importanceperformance map analysis to identify factors that were significant to the service process but performed poorly. Finally, we used a text-mining technique to scrape 536 reviews posted on Google Maps, and Leximancer Portal to perform automated content and sentiment analyses on those data, as a means of mapping the critical concepts and themes that influenced patient experiences. Results: This study’s analyses support the ideas that both hard and soft qualities are critical dimensions of service quality, and that each has different influences on inpatients’ and outpatients’ satisfaction and loyalty. Specifically, the sampled inpatients strongly valued the hard qualities of the hospital but were not satisfied with it. On the other hand, soft qualities attracted outpatients’ attention and influenced their satisfaction and loyalty. In addition, content analysis revealed that soft qualities were the main reason patients left comments, whether positive or negative. Waiting time emerged as another critical element in triggering patients’ unfavorable reviews. Conclusions: Patient population type, whether inpatient or outpatient, has been found to impact perceptions of service quality within health care institutions. As such, health care administrators should be cognizant of this phenomenon and make informed and tailored decisions when addressing quality within their respective services. Emphasis on the development of both interpersonal and professional skills among health care personnel may prove beneficial in enhancing the patient experience and ultimately fostering positive online reviews. [ABSTRACT FROM AUTHOR]

Background: Health care industriesmust consider their sustainable development, and employee well-being is a crucial environmental, social, and governance indicator that should be prioritized. During events such as the COVID-19 pandemic, information transparency is a concern for health care workers. Authentic leaders can build trust by openly sharing their thoughts and feelings. Understanding how authentic leadership affects employee well-being through job stress and how emotional intelligence reduces job stress is essential for health care workers. Purposes: This study investigated the effect of authentic leadership on employee well-being and considered the mediating role of job stress and moderating role of emotional intelligence in this effect. Methodology/Approach: A time-lagged survey of 452 full-time health care workers (comprising nurses, allied health professionals, and administrative workers) from a general hospital in Taiwan was conducted. Findings: Authentic leadershipwas positively associatedwith employee well-being, and job stressmediated the effects of authentic leadership on employee well-being. Among the employees who perceived leadership to be authentic, those with higher emotional intelligence felt less job stress. Conclusion: From the perspective of conservation of resources theory, authentic leadership was identified as a crucial factor influencing how health care workers reduce job stress and improve theirwell-being. Emotional intelligence was identified as essential in enhancing the effects of authentic leadership on reducing the job stress of health care workers. Practice Implications: Organizations should promote authentic interactions between leaders and followers and provide training for developing authentic leadership. They should also provide training to improve their employees' emotional intelligence. [ABSTRACT FROM AUTHOR]

Background: High-quality patient care requires nurses with strong clinical competency. Thus, it is essential to examine the factors associated with clinical competency. Purpose: This studywas designed to (a) investigate head nurse leadership, staff nurse demographics, and clinical competency; (b) examine the impact of demographics on the clinical competency of staff nurses; (c) analyze the correlation between head nurse leadership and staff nurse clinical competency; and (d) examine the effects of demographics on clinical competency after controlling for the head nurse leadership. Methods: A cluster sampling method was used to collect data from 200 staff nurses at a national medical center in Taiwan. Questionnaires were used to gather information on head nurse leadership style and staff nurse clinical competency. Descriptive and inferential statistical analyses were conducted, including Mann--Whitney U test, Kruskal--Wallis test, Spearman's rank correlation coefficient, and multivariate analysis of covariance. Results: The average score for transformational leadership style among the head nurses was 2.89, whereas transactional leadership style scored an average of 2.49. The average scores for the components of clinical competency, listed from highest to lowest, were as follows: patient care (3.35), professionalism (3.28), communication skills (3.18), management (2.84), and knowledge (2.73). In addition, statistically significant differences were found in clinical competency based on demographic factors, including age, marital status, educational level, job title, and length of employment. Also, a statistically significant, positive correlation between the head nurse transformational leadership style and nurse clinical competency was found. The main effect of length of employment on the five competency components was statistically significant after controlling for transformational leadership. Furthermore, post hoc analysis of covariance revealed a significant effect of length of employment on patient care, knowledge, communication skills, and management. Conclusions: The findings of this study indicate transformational leadership and employment length impact the clinical competency of staff nurses, particularly in terms of patient care, communication skills, management, and knowledge. Providing education and training in leadership and management to current and prospective head nurses may be expected to enhance clinical competency in staff nurses and create a more nurturing work environment. Moreover, targeted training may help current head nurses gain insight into their leadership styles and acquire skills to promote transformational leadership. In addition, leadership development may help equip prospective head nurses with critical competencies before assuming leadership responsibilities. [ABSTRACT FROM AUTHOR]

Background: The prevalence of end-stage renal disease (ESRD) in Taiwan is among the highest in the world. Although kidney transplant is the most effective treatment for ESRD, the willingness of patients with ESRD to undergo kidney transplantation is low in Taiwan. The factors associated with willingness to accept kidney transplantation remain unclear, and studies on kidney transplant willingness and associated factors among Taiwanese patients with ESRD are scarce. Purpose: The aim of this studywas to assesswillingness to undergo a kidney transplant and related factors among patients with ESRD in Taiwan. Methods: A cross-sectional design was employed. Two hundred fourteen participants from a single medical center in Taiwan were recruited, and 209 valid questionnaires were collected (valid response rate: 97.7%). The study instruments included a kidney transplant knowledge scale, a kidney transplant attitude scale, and a kidney transplant willingness scale. Data were analyzed using Pearson's product--moment correlations, t tests, one-way analyses of variance, andmultiple regressions. Results: The mean kidney transplant willingness in the sample was 13.23 (out of 20). Being male, younger, married, or employed; having a college education or above; and having a shorter dialysis duration were all associated with higher kidney transplant willingness. Sociodemographics, dialysis duration, knowledge, and attitudes explained 45.4% of the variance in kidney transplant willingness, with two of these, kidney transplant attitudes (β = .61, p < .001) and dialysis duration (β = -.11, p = .041), identified as significant. Conclusions/Implications for Practice: The findings support the important role of cultivating positive attitudes in patients with ESRD to increasing willingness to undergo kidney transplantation interventions. [ABSTRACT FROM AUTHOR]

Objective: This nationwide cohort study aimed to examine the association between PM2.5 and diabetes mellitus (DM) risk. Methods: We recorded annual average PM2.5 exposure levels at participants' locations. PM2.5 concentrations were categorized into quartiles: Q1 (<29.5 μg/m³), Q2 (29.5-33.3 μg/m³), Q3 (33.4 41.2 μg/m³), and Q4 (>41.2 μg/m³). Results: A total of 158,038 patients (69,688 men and 88,350 women) were enrolled. Diabetes mellitus incidence increased with higher annual PM2.5 concentrations (2.81 in QI, 3.06 in Q2, 3.65 in Q3, and 3.89 in Q4 per 10,000 person-years). After adjusting for confounders, patients exposed to PM2.5 in Q2, Q3, and Q4 had adjusted hazard ratios of 1.14 (95% CI: 1.05-1.23), 1.40 (95% CI: 1.30-1.50), and 1.42 (95% CI: 1.32-1.53), respectively, for developing DM compared with those exposed to Q1 -PM2.5 concentrations. Conclusions: This study observed an increased risk of DM associated with PM2.5 exposure. [ABSTRACT FROM AUTHOR]

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: Multiple role theory has proven effective in predicting variations in health, and a growing body of research has shown the importance of taking women's roles into account when analyzing physical activity levels. Nonetheless, researchers have yet to characterize the interaction between the various roles played by women and their physical activity. Purpose: The objectives of this study were to elucidate the relationship between multiple roles and leisure-time physical activities (LTPAs) and to determine whether LTPA varies among women across different roles. Methods: Data were derived from the 2013 National Health Interview Survey database provided by the Health Promotion Administration of Taiwan's Ministry of Health and Welfare, which includes 5,147 working-age women. The current study focused on women aged 20–50 years. The roles considered in this study included living with a partner, living with children, and employment status. LTPA levels were categorized as regular, inactive, or insufficient based on the LTPA metabolic equivalent in the previous week. The associations among level of LTPA, multiple roles, and demographic characteristics were analyzed using multiple regression analysis. Results: We found single mothers with children to be more inactive than partnered mothers, and women living with a partner and those living with children were more likely to be inactive, whereas women working full-time were not at risk of inactivity. Women who assumed a larger number of roles were at a greater risk of inactivity. These findings are consistent with role strain theory. Conclusions: Single mothers with children are more inactive than partnered mothers, and appropriate social support programs are necessary to reduce further disparities. Second, multiple demands on working-age women limit the time available for LTPAs, particularly among women living with a partner and children and engaged in full-time work. A physical activity intervention is a program or initiative designed to promote physical activity and improve health outcomes. We should develop and provide sustainable physical activity resources through the help of partners' housework to better promote physical activity intervention for working-age women. [ABSTRACT FROM AUTHOR]

Background: Heart failure is an intense, unpredictable, and stressful chronic disease caused by the decline in cardiac pumping function. The influence of heart failure affects patients not only in terms of physical capabilities but also in terms of their emotional and social dimensions, with patients in different functional classes experiencing different levels of effect. Although resilience and health-related quality of life have been studied in populations with heart failure, the scholarly understanding of different functional classes is limited. Purpose: This study was designed to investigate the relationship between resilience and health-related quality of life among patients with heart failure in different physical functional classes in Taiwan. Methods: A cross-sectional design was applied to study patients with heart failure in northern Taiwan. Two structured questionnaires, including the Resilience Scale for Adults and the 12-item Short Form Health Survey, were used to assess resilience and health-related quality of life. New York Heart Association functional class was used to determine physical function status, and canonical correlation analysis was used to determine the weight of each resilience and quality-oflife domain for the different functional classes. Results: The 100 participants had an average age of 65.52 years. Slightly over half (56%) were classified as Functional Class II. A group difference in health-related quality of life was observed. Personal strength (rs = .759) and social competence (rs = −.576) were found to influence the resilience and emotional role dimension of quality of life (rs = −.996) in the Functional Class II group. In addition, family cohesion (rs = −.922), dominant resilience, physical function (rs = .467), and bodily pain (rs = .465) were found to influence quality of life in the Functional Class III group. Conclusions/Implications for Practice: The efficacy of measures taken to increase resilience to heart failure varied in patients in different functional classes. Functional Class II individuals were better able to manage the disease using their personal strength, whereas Functional Class III individuals relied more heavily on family support and assistance for this effort. Furthermore, participant feelings about quality of life also varied by functional class, with physical function and bodily pain taking on significantly more importance for Functional Class III individuals. [ABSTRACT FROM AUTHOR]

Background: Salary impacts nurse retention rates and thus is a factor affecting the nursing shortage both in Taiwan and around the world. Nurses in Taiwan earn a low salary compared with other health professionals and may be undervalued compared with their international counterparts. Purpose: This study was designed to analyze the factors associated with nurse salary (NS) in Organisation for Economic Co-operation and Development (OECD) countries and to compare NS in Taiwan with those in OECD member states. Methods: Data were extracted from the OECD statistics database and official statistics for Taiwan. For the 28 OECD member countries considered in this study and Taiwan, 21 indicators characterizing healthcare systems, including demographics, socioeconomic status, health behaviors and risks, healthcare resources, health financing, healthcare utilization, health outcomes, and economic inequality, were examined for the period of 2009-2018. A random-effects model (REM) and a fixed-effects model (FEM) were used to investigate the associations between these indicators and annual NS levels. The expected annual NS for Taiwan was estimated and compared with the actual NS for Taiwan using the REM. Results: In the REM, higher NS in OECD countries was shown to be positively associated with gross domestic product per capita (0.49, 95% confidence interval [CI] [0.41, 0.56]), proportion of population aged 65 years and over (2.72, 95% CI [2.17, 3.26]), crude birth rate (1.02, 95% CI [0.56, 1.49]), number of computerized tomography scanners per million population (0.26, 95% CI [0.17, 0.35]), alcohol consumption per person (0.94, 95% CI [0.26, 1.61]), and prevalence of obesity (0.64, 95% CI [0.40, 0.89]) and to be in inversely associated with infant mortality rate (-3.13, 95% CI [-3.94, -2.32]), bed density (-0.99, 95% CI [-1.72, -0.25]), number of hospital discharges (-0.08, 95% CI [-0.11, -0.05]), household out-of-pocket expenditure as a percentage of health expenditure (-0.34, 95% CI [-0.56, -0.11]), and the Gini coefficient (-0.25, 95% CI [-0.50, -0.01]). The FEM results were similar to those of the REM. The predicted annual NS for Taiwan based on the REM rose from 29,390 U.S. dollars (corrected for purchasing power parity; 95% CI [22,532, 36,247]) in 2009 to 49,891 U.S. dollars (95% CI [42,344, 57,438]) in 2018. The actual annual NS in Taiwan in 2018 was approximately 12% lower than the model-predicted value. Conclusions/Implications for Practice: Taiwan has a lower NS compared with its OECD counterparts. These findings may help policymakers, healthcare managers, and nurse organizations develop effective strategies to improve the remuneration system for nurses in Taiwan. [ABSTRACT FROM AUTHOR]

Background: Because nurses often work in medical environments characterized by high workloads and high levels of stress and pressure, they are particularly vulnerable to workplace burnout and their well-being may suffer. Related studies on burnout, resilience, and well-being have focused primarily on teachers, social workers, and students, with few studies addressing the situation faced by nursing staff. It is important to understand the factors affecting the well-being of nursing staff. Purpose: This study explores the status quo and correlations among nursing-staff demographic characteristics, workplace burnout, well-being-related resilience, and the predictive factors of well-being in nurses. Methods: A cross-sectional, descriptive, correlational research design and purposive sampling were used in this study. Nursing staff who had worked for more than 6 months at a medical center in central Taiwan were recruited as participants, with data from 289 participants collected. A structured questionnaire was used to collect data on demographic characteristics, workplace burnout, resilience, and well-being. Results: The average scores for workplace burnout, resilience, and well-being were 40.40/(0- to 100-point scale), 26.79/(10- to 50-point scale), and 43.25/(24- to 96-point scale), respectively. The result of the regression analysis explained about 51.6% of the variance in well-being. Furthermore, resilience (28.4%), self-perceived health (14.3%), workplace burnout (4.5%), exercise frequency (1.8%), job title (1.2%), interpersonal pressure relief resilience (0.9%), and marital status (0.5%)were other important predictive factors of well-being in the participants. [ABSTRACT FROM AUTHOR]

Background: Patients with serious mental illness (SMI) are more likely to have Type 2 diabetes mellitus (T2DM). However, studies that discuss the eating habits of patients with both T2DM and SMI are lacking. Purpose: This study was designed to explore the beliefs and experiences of Taiwanese patients with SMI who also have T2DM. Methods: Fieldwork for this study included 2 years of participant observation and individual interviews with 13 patients with SMI. Data from transcripts of observational field notes and interviews were transcribed verbatim and analyzed. Results: The participants described their experiences and concerns regarding dietary management during the period after receiving their T2DM diagnosis. The results of the data analysis were distinguished into three categories, including (a) increased difficulty in life, (b) positive view of dietary control, and (c) inability to abide by dietary restrictions. Conclusions: The findings suggest that healthcare professionals should work to better understand the challenges faced by patients with SMI and T2DM in implementing changes and resisting the temptation to eat unhealthy food and provide suggestions tailored to their cultural background, lifestyle, and eating characteristics. [ABSTRACT FROM AUTHOR]

Objectives: Studies have identified many nursing interventions that can prevent delirium and fall accidents in clinical patients, detect and treat delirium early to prevent functional decline in the patient, shorten hospitalization duration, and lower the death rate. This study aimed to explore delirium care by intensive care unit (ICU) nurses in a medical center of southern Taiwan. Methods: This study conducted 3 semistructured focus group interviews, each for a single medical ICU, involving groups of 6 to 8 nurses each. The nurses were recruited through purposive sampling. This research was approved by an institutional review board in the medical center of southern Taiwan from March 31, 2020, to January 30, 2021. The co-principal investigator described the purpose and process of this study to the participants before they provided their written informed consents. The interviews were conducted in the meeting room and were audiotape recorded. The recordings were transcribed and subject to content analysis to identify the themes of delirium care. Results: For nursing interventions of delirium, satisfying the patient's physical needs: comfort care, massages, and early rehabilitation; and psychological care: being presence, communication, and ensuring familial support were included. In terms of environmental interventions for delirium, providing reorientation, music, light, belongings with sentimental value, and audiovisual equipment were included. However, according to the recruited medical ICU nurses, these nonpharmacological interventions, although effective, do not have long-lasting effects. Finally, nurses reported themselves as having been attacked by patients with delirium. Thus, they all agreed that restraining patients with delirium may be necessary, but restraining is a double-edged sword for ICU delirium patients. Conclusions: Research team suggests for future studies to extend their evidence-based findings of physical, psychological, and environmental care for ICU delirium patients toward integrating the efforts of various health care professionals. [ABSTRACT FROM AUTHOR]

Introduction and aims: Voiding dysfunction is a common perinatal condition. Appropriate bladder management and monitoring during labor and postpartum improves bladder function and reduces the incidence of infections and complications. This project aimed to promote evidence-based bladder management strategies for perinatal women at a maternity hospital in Taiwan. Methods: The project was implemented using the JBI framework and the JBI Practical Application of Clinical Evidence System. Implementation audits were conducted by examining nurses and intrapartum and postpartum women. Ten criteria were applied in the baseline audit, and two follow-up audits were conducted to assess actual compliance with best-practice recommendations. Through a Getting Research into Practice analysis, we identified three barriers to changing practice. Results: A comparison of the audit outcomes revealed that all criteria had improved by the second follow-up audit cycle. Specifically, the compliance rate increased from37% and 50% to 100% for criteria 1 and 2, respectively; from0% to 100% for criteria 3, 5, and 10; and from7%, 28%, 50%, and 17%to 100%, 100%, 97%, and 100% for criteria 4, 6, 8, and 9, respectively. Following implementation, the frequency of intrapartum intermittent catheterization (53.44-38.30%) and the postpartum incidence of urinary retention (9.09-8.51%) decreased. The time to first voiding after vaginal delivery and between the first and the second voiding decreased from 5.51 and 4.01 h to 2.32 and 2.29 h, respectively. Conclusions: This evidence-based implementation project achieved substantial improvements in bladder management. Relational leadership theory, which integrates empowerment, purposefulness, ethical behaviors, and process orientation, underpinned the project. [ABSTRACT FROM AUTHOR]

Background: This study explored the relationship between handgrip strength (HGS) and pulmonary function, respiratory muscle strength, and cardiopulmonary endurance in older adults. Methods: We recruited 128 community-dwelling older adults. Correlations between HGS, pulmonary function parameters, respiratory muscle strength, and cardiopulmonary endurance were analyzed. Results: Forced vital capacity (r = 0.180, P <.05), maximum voluntary ventilation (r = 0.180, P <.05), and 2-minute step test (r = 0.204, P <.05) were weakly correlated with HGS. Maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) had moderate correlations with HGS (r = 0.431 for MIP, 0.492 for MEP, P <.001). Conclusion: HGS was correlated with pulmonary function, respiratory muscle strength, and cardiorespiratory endurance. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare the acute effects of 3 warm-up protocols on knee flexor and extensor muscles performance in elite female collegiate handball players. Ten female handball players with poor hamstring flexibility completed 3 randomly sequenced experimental visits. During each visit, a different warm-up protocol (general running warm-up [GW], dynamic stretching [DS], or DS combined with vibration foam rolling [DS + VR]) was delivered before the subsequent tests: quadriceps and hamstring muscle stiffness, knee extension and flexion range of motion (ROM), knee joint position sense, knee extension and flexion isokinetic strength with hamstring-quadriceps strength ratio, and muscle endurance during fatiguing exercise. Relative to the GW, the DS + VR protocol resulted in significantly greater knee flexion ROM (mean ± SD: DS + VR = 79.4° ± 7.7°; GW = 69.3° ± 9.6°) and lower hamstring muscle stiffness (DS + VR = 253.33 ± 36.20 N·m-1; GW = 292.89 ± 24.28 N·m-1). In addition, the DS + VR protocol also yielded greater hamstring muscle endurance than the other 2 protocols did (fatigue percentage: DS + VR = 30.24% ± 10.84%; GW = 41.40% ± 8.98%; DS = 42.22% ± 9.42%). Therefore, the results of this experiment suggest that it can be more beneficial for the female handball players to warm-up with the DS + VR, rather than the GW and DS protocols. [ABSTRACT FROM AUTHOR]

Background: The supportive care needs trajectories in patients with advanced non-small-cell lung cancer (NSCLC) during chemotherapy and the related factors have yet to be explored or addressed in the literature. Purpose: This study was designed to investigate supportive care needs trajectories in patients withadvanced NSCLC receiving chemotherapy and the association between the sociodemographic and disease characteristics of these patients over the four cycles of chemotherapy. Methods: For this longitudinal study, 95 patients with advanced NSCLC were recruited using convenience sampling at a medical center in Taiwan. The supportive care needs of the participants were assessed in each of the four chemotherapy cycles using the Needs Evaluation Questionnaire–Chinese version (NEQ-C) with 23 dichotomous items on the day before and the seventh day after the end of each cycle. Group-based trajectory modeling was applied to identify the classes of supportive care needs trajectories, whereas chi-square tests were used to examine the factors related to these classes. Results: Seventy-one participants completed all eight questionnaire sessions across the four cycles. The mean NEQ-C scores for these participants ranged between 14.4 and 14.6. Three classes of supportive care needs trajectories (low, moderate, and high) were identified for the entire NEQ-C and for each domain. Marital status was found to be associated with the classes of trajectories related to supportive care and assistance/care needs, spouse as the primary caregiver was found to be associated with the classes of trajectories related to information needs, and educational level was found to be associated with the classes of trajectories related to psychoemotional support needs. Conclusions: The results of this study indicate that marital status and spouse as primary caregiver relate significantly to supportive care needs trajectories in patients with advanced NSCLC during chemotherapy. Healthcare professionals should provide continuous, tailored supportive care interventions that address the needs of patients and their spouses/partners. [ABSTRACT FROM AUTHOR]

Clinical ladder programs were designed to support nurse retention and professional development. Hospital systems are vigorously working to recover from the critical staffing shortages exacerbated by the pandemic. The Centers for Disease Control and Prevention framework for program evaluation was utilized to assess a hospital professional nurse clinical ladder. These findings suggest favorable outcomes in commitment to stay and professional development. This evaluation can serve as a potential resource for organizations to evaluate and enhance programs to support nurse retention. [ABSTRACT FROM AUTHOR]

Quality of life is an important outcome for people with cancer throughout their cancer trajectory. Having a valid and reliable instrument to measure the quality of life is critical. This cross-sectional study examined the psychometric properties of the Taiwanese version of the Hospice Quality of Life Index among patients with advanced cancer in Taiwan. There were 3 phases: (1) translation of the Hospice Quality of Life Index from English to Mandarin, (2) pilot testing among 30 targeted participants, and (3) field testing to examine validity and reliability. The results of confirmatory factor analysis indicated that the original factor structure of the Hospice Quality of Life Index did not fit the data. After 5 items were deleted from the original questionnaire, principal factor extraction with oblique rotation for exploratory factor analysis yielded 3 subscales: Social/Spiritual Well-Being, Psychological Well-Being, and Functional/Physiological Well-Being. For convergent validity, the small to moderate strength of associations showed shared variance with the Memorial Symptom Assessment Scale. The internal consistency was supported by Cronbach α ranging from 0.77 to 0.86. This study shows early evidence that the quality of life of people with advanced cancer can be appropriately assessed by the Taiwanese Hospice Quality of Life Index. [ABSTRACT FROM AUTHOR]

Background: Irritability is a common experience of depressed Chinese patients but is understudied and poorly measured. Objective: We aimed to assess psychometric properties of a new measure of irritability in Chinese cancer patients across the social and political spectrum. Methods: The Irritability Scale–Initial Version (TISi) was translated into Chinese and tested in two samples of Chinese cancer patients undergoing treatments: 52 patients in Beijing, China, between 2018 and 2019 and 65 patients in Taipei, Taiwan, in 2020. Results: The Chinese version of TISi demonstrated high internal consistency, high reliability based on the split-half method in the two samples, and satisfactory discriminant validity using the Chinese version of the 17-item Hamilton Rating Scale for Depression and the seven-item depression subscale of the Hospital Anxiety and Depression Scale in the Beijing sample. A confirmatory factor analysis produced factor loadings in both samples, which resembled a sample of American cancer patients. Three TISi items were loaded more highly on the physical instead of the original behavioral subscale in the Beijing sample. A possible influence of cultures was explained. Conclusion: The Chinese version of TISi has satisfactory psychometric properties for assessing the level of irritability in Chinese cancer patients. Future large-sample studies are needed to further determine TISi's factorial structure, test–retest reliability, sensitivity to change, and predictive validity for depression in Chinese cancer patients. [ABSTRACT FROM AUTHOR]

Background: With the population aging, examining the relationship between polypharmacy and mortality based on population data sources is important for clinical management and policy direction. Objectives: This study aimed to examine the association between the number of chronic medications and the risk of mortality in older adults. Methods: This population-based retrospective cohort study used data from the National Health Insurance Research Database in Taiwan for information regarding chronic medication use (over 4 years) in older adults aged 65 years and older. The association between medication use and mortality numbers was analyzed using Cox proportional hazards regression models adjusted for demographic variables and comorbidity. Results: The number of medications was significantly associated with high mortality risk. Within polypharmacy, being 65–74 years old, male, living in northern Taiwan, having one type of comorbid disease, and receiving <84 days of refillable chronic prescription were associated with greater mortality risk. Subgroup analyses' results regarding comorbidity showed significant positive associations between the number of medications and mortality in most comorbid diseases except for mental disorders and diseases of the skin and subcutaneous tissue. Discussion: General practitioners should know that chronic polypharmacy is associated with increased mortality risk. Recognizing the possible adverse effects of multiple medication use could help physicians optimize drug regimens in the future. [ABSTRACT FROM AUTHOR]

The objective of this study was to explore factors influencing Taiwanese older adults' end-of-life (EOL) care preferences. A cross-sectional questionnaire survey was conducted in 2 geriatric wards of a veterans' hospital. Fifty-five older adults aged 65 years or older were included. Structured questionnaires were used to collect data regarding demographic characteristics, EOL care preferences, stages of change for advance care planning behaviors, and reluctance to burden others. The study revealed that nearly 60% of the participants preferred to let their spouses, adult children, or health care professionals make the decisions. Furthermore, 83.6% of the participants lived with their family members and were moderately to severely disabled with a certain degree of dependence on their family members. Sex, independence, discussion of advance care planning with family members, and completion of advance directives were significantly correlated with EOL care preferences. The regression model showed that the participants' discussion of advance care planning with their family members influenced their EOL care preferences. The results demonstrate that family is an essential consideration for older adults choosing EOL care. Accordingly, because Chinese culture focuses on family harmony, improving communication between older adults and their family members is crucial for promoting advance care planning. [ABSTRACT FROM AUTHOR]

Objectives: This evidence implementation project aimed to identify barriers leading to needle-stick injuries (NSIs) and to develop implementation strategies to prevent NSIs in the acute ward of a hospital in central Taiwan. Introduction: The incidence rate of NSIs was 5.6% in the acute ward of a hospital in Taiwan. NSIs commonly occur during the drawing of blood, intravenous insertion, needle recapping, or performing any procedure involving sharp medical devices. NSIs are critical occupational risks among healthcare workers, possibly leading to transmission of infectious diseases, especially blood-borne viruses, such as HIV, hepatitis B, and hepatitis C. Methods: A clinical audit was undertaken using the JBI Practical Application of Clinical Evidence System (PACES) and the Getting Research into Practice (GRiP) approach. Five audit criteria that represented best practice recommendations for prevention of NSIs were used. Baseline data were collected from 177 nurses in five acute wards, followed by the implementation of multiple strategies during a 20-week period of the project. Both baseline and postimplementation audits were undertaken to determine changes in practice. Results: According to the pre-audit concerning the use of safety-engineered injection devices and safe use and disposal of needles, there was 14–15% compliance, which indicated poor compliance with current best-practice criteria. Following the project implementation, the nursing staff were educated about the well tolerated use and disposal of sharps and the improved compliance rate ranged from 40 to 96.6%, with safety needle use increasing from 16 to 95.5%, safety needle operation procedure awareness increasing from 14 to 96%, needles not recapped after use increasing from 47 to 85%, and placing used needles in the sharps collection box increasing from 75 to 80%. Conclusion: This article suggests that standardized puncture prevention education and training enhanced nurses' awareness in the acute ward. [ABSTRACT FROM AUTHOR]

Background: Recurrent falls are more likely to cause injuries and disabilities than single falls. Purpose: This study investigated the incidence and risk factors of recurrent falls among inpatients. Methods: We analyzed inpatient fall data from the anomaly event notification database and electronic medical records of a hospital. We collected data regarding 1059 inpatients who had fallen during their hospital stay. Among these inpatients, 390 (36.83%) had fallen within the previous year. Results: Inpatients in the orthopedics and neurology wards were at a higher risk of recurrent falls than those in surgical wards; inpatients who were physically dependent were at a higher risk of recurrent falls than those who were physically independent; inpatients with poor vision were at a lower risk of recurrent falls than those without this issue; and inpatients who were using antidepressants were at a higher risk of recurrent falls than those who were not using antidepressants. Conclusion: The risk of recurrent falls is highly correlated with ward type, physical independence, self-perceived good vision, and use of antidepressants. [ABSTRACT FROM AUTHOR]

This pilot study investigated a manualized lifestyle-based intervention, Physically Active Lifestyle Modification (PALM) program, designed to increase physical activity in the daily life routines of Taiwanese older adults and improve their quality of life. Thirty older adults who attended a Senior Citizens Learning Camp in Taiwan participated in the program. Quantitative measures and qualitative interviews were employed to study the intervention's effect on quality of life and to capture participants' subjective experiences in the program. Results revealed significant improvement in both physical and mental component summary of the RAND 36-Item Short Form Health Survey. Interview data revealed 4 key themes: change in action, self-awareness of occupational pattern, acquisition of health information, and social participation. [ABSTRACT FROM AUTHOR]

Background: Nurse practitioners (NPs) play an important role in addressing growing health care needs. Among NPs, organizational empowerment is positively associated with overall practice outcomes. Therefore, efforts to promote organizational empowerment in practice are necessary to increase job satisfaction among NPs as well as decrease the stress and intention to leave. Purpose: This study investigated the relationships of organizational empowerment and practice outcomes of job satisfaction, work stress, and intention to leave in acute care practices. Methodological orientation: This study was conducted as a cross-sectional design with a national survey of 946 acute care NPs. Questionnaires contained demographic and practice characteristics, Misener Nurse Practitioner Job Satisfaction Scale, Condition for Work Effectiveness Questionnaire II, and the work stress VAS scale. Hierarchical Linear Model (HLM) was used to investigate individual NP-level or organization-level effects on job satisfaction. The factors associated with job satisfaction were examined by stepwise multiple regression. Results: The organizational empowerment was low, work stress was moderately high, and job satisfaction was between slightly unsatisfied and slightly satisfied. The HLM results indicated that organization-level effects did not affect the job satisfaction of NPs. Nurse practitioners with greater formal power, resources, and informal power had higher job satisfaction. Conversely, NPs with an intention to leave and a higher level of stress showed lower job satisfaction. Conclusions: Organizational empowerment, intention to leave, and stress affect job satisfaction of acute care NPs in Taiwan. Implications for practic: To enhance the job satisfaction of NPs, health care administrators should empower NPs by providing access to opportunity, support, information, and resources in the health care delivery system. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between the risk of stroke and exposure to particulate matter with an aerodynamic diameter less than 2.5 µm (PM2.5) over various exposure periods. Methods: This was a nationwide population-based case--control study in which 10,035 incident patients with a primary diagnosis of ischemic stroke each were matched with two randomly selected controls for sex, age, Charlson Comorbidity Index, year of stroke diagnosis, and level of urbanization. Multiple logistic models adjusted for potential confounders were used to assess the association of PM2.5 with ischemic stroke incidence. Results: There were significant short-term, medium-term, and long-term relationships between PM2.5 exposure and ischemic stroke incidence. Conclusions: This study supports existing evidence that PM2.5 should be considered a risk factor for ischemic stroke. [ABSTRACT FROM AUTHOR]

Objective: The aim of this evidence implementation project was to identify the barriers and omissions affecting adequacy of hemodialysis and to develop implementable strategies to maintain hemodialysis adequacy among hemodialysis patients with end-stage renal disease. Introduction: Assessing adequacy of hemodialysis and improving quality of life are important issues for patients with end-stage renal disease. However, they are often inadequately addressed, and evidence-based practices are not always followed. Methods: A clinical audit was undertaken using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice approaches. Seven audit criteria that represent best practice recommendations for maintaining hemodialysis adequacy among hemodialysis patients were used. A baseline audit was performed, which was followed by the implementation of multiple improvement strategies over 20 weeks and the outcomes finalized using a follow-up audit to determine the change to be implemented in practice. Results: The baseline audit results showed that most audit criteria were less than 77% in practice. The compliance rates for nurses who had received education regarding hemodialysis, checking the prescription order for each patient at each session, and using the prescribed dialyzer for every session were determined to have reached 100% at the follow-up audit. The compliance rates for completion prehemodialysis checks, using a sterile technique when inserting an arteriovenous catheter, matching a blood flow rate with the prescription, and maintaining a blood flow rate throughout the treatment session were found to be 73-95% at the follow-up audit. The most significant finding was the proportion of hemodialysis patients with inadequate urea reduction ratio was reduced from 4.6 to 3.2% after implementation of the best practice approaches. Conclusion: The implementation of institution-specific evidence-based resources brought about immediate improvements in hemodialysis adequacy management and practice. A variety of strategies contributed to the success of this implementation project, such as scenario simulation education, Objective Structured Clinical Examination, the interrelation response system Kahoot, the use of hemodialysis International Organization for Standardization job descriptions, regular weekly audits, and collaboration with physicians when caring for patients during clinical practice. [ABSTRACT FROM AUTHOR]

Background: Acute postoperative pain (APOP) may cause complications and delay healing. Analgesics alone cannot completely relieve APOP. Preoperative anxiety, optimism, and pain catastrophizing are predictors of APOP. No study author has examined the mediating effect of pain catastrophizing on APOP in patients undergoing cardiac surgery. Objective: The aims of this study were to investigate the relationship between preoperative anxiety, optimism, pain catastrophizing, confounding factors (age, sex, type of surgery, and preoperative pain), and APOP and to examine the mediating effect of pain catastrophizing. Methods: The authors of this cross-sectional study used a convenience sampling method and included 100 adults undergoing cardiac surgery in a southern Taiwanese medical center. The patients were asked to complete the State-Trait Anxiety Inventory-State subscale, Pain Catastrophizing Scale, and Life Orientation Test-Revised questionnaires before surgery. Postoperatively, the patients were asked to report their pain intensity on a numerical rating scale. Results were analyzed using SPSS version 22. Results: Patients had a mild level of anxiety, a moderate level of optimism, and pain catastrophizing before surgery, as well as a moderate level of APOP. Men reported lower levels of APOP than women (z = -2.0, P < .05). APOP was significantly associated with preoperative anxiety (r = 0.48, P < .01), optimism (r = -0.45, P < .01), and pain catastrophizing (r = 0.65, P < .01). Only pain catastrophizing was a significant predictor of APOP (β = 0.60, P < .001) and fully mediated the relationship between anxiety and APOP (z = 4.92, P < .001). The final model explained 42% of the variance in APOP. Conclusions: Pain catastrophizing should be assessed before surgery. Reducing pain catastrophizing would decrease APOP and improve the quality of pain management. [ABSTRACT FROM AUTHOR]

Objective: The relationship between autoimmune rheumatic diseases, inflammatory bowel diseases, and carpal tunnel syndrome is unclear. We aimed to survey the occurrence and characteristics of carpal tunnel syndrome in autoimmune rheumatic diseases and inflammatory bowel diseases, compared with the general population. Methods: We used the Longitudinal Health Insurance Database 2015 from Taiwan's National Health Insurance Research Database. Patients diagnosed with autoimmune rheumatic diseases/inflammatory bowel diseases were identified. The incidence rates and surgical rates of carpal tunnel syndrome among individual diseases were calculated. The hazard ratios when compared with age and sex matched, and 1: 1 ratio control groups were surveyed. Results: A total of 2591 women and 701 men were identified. The incidence rate of carpal tunnel syndrome was highest in Crohn disease (1001 per 100,000 person-years, 95% confidence interval = 0-2747), followed by scleroderma and Sjögren syndrome. The incidence rate in the control group was 571 per 100,000 person-years (95% confidence interval = 314-829). Significantly increased adjusted hazard ratios were seen in Sjögren syndrome (1.44, 95% confidence interval = 1.09-1.90) and rheumatic arthritis (1.33, 95% confidence interval = 1.05-1.70). The overall surgical rate was 0.2% in patients with autoimmune rheumatic diseases/inflammatory bowel diseases and 0.3% in the control group, without a significant difference (P = 0.85). Conclusions: Patients with Sjögren syndrome and rheumatic arthritis are susceptible to carpal tunnel syndrome. Patients with autoimmune rheumatic diseases/inflammatory bowel diseases have similar surgical rates as general population. [ABSTRACT FROM AUTHOR]

Background: Older adults occupy one third of acute care hospital beds, and the regular duties of many nurses include caring for older patients. A working knowledge of geriatric care competencies is necessary for nurses to provide high-quality care to older patients and their families. It is unclear how nurses who work in acute care hospitals self-evaluate their geriatric care competencies and how these self-evaluated abilities differ from the objective abilities of these nurses. Purposes: This study was designed to explore the geriatric care competencies of nurses in hospitals and to identify the factors associated with these competencies. Methods: This was a cross-sectional study. Nurses who were employed and directly caring for patients aged 65 years and older in any of the adult wards of a medical center located in southern Taiwan were recruited as participants. A structured questionnaire was developed based on a review of the relevant literature and validated using expert consensus. This questionnaire included a demographic datasheet, knowledge of geriatric care scale, attitude of geriatric care scale, self-evaluation of geriatric care competency, and geriatric care competency test. Descriptive and inferential statistics were used to analyze the geriatric care competencies of the participants and related factors. Results: One hundred seventy nurses were enrolled as participants. The average self-evaluation score for geriatric care competency was 67.74 (SD = 0.84). However, the average percentage of correct answers given on the geriatric care competency test was much lower (17.6%). The self-evaluation score was found to be significantly associated with job satisfaction and having received continuing education in geriatric care. In addition, age was shown to significantly affect the percentage of correct answers given on the geriatric care competency test. Conclusions/Implications for Practice: A significant gap was found between the self-perceived and actual competencies of nurses in terms of providing geriatric care. Appropriate policies are necessary to improve the geriatric care competencies of nurses working in hospitals and to oversee the implementation of effective educational methods in Taiwan. [ABSTRACT FROM AUTHOR]

Background: The prevention and treatment of hypertension is valued globally. The World Health Organization advocates combining traditional medicines in the prevention and treatment of diseases. Traditional Chinese medicine (TCM) assumes that diseases originate from the attenuation of one's body constitution. A few studies have found that hypertension is correlated with TCM body constitution. However, body constitution is also affected by living environment. Therefore, investigating the correlation between deviations in body constitution and essential hypertension in different living environments is necessary to provide the basis for using TCM in combination with conventional Western medicine to prevent and treat hypertension. Purpose: The aim of this study was to explore the association between TCM body constitution deviation and essential hypertension. Methods: A case--control study was designed. Participants were selected from the outpatient clinics and neighboring communities of a regional teaching hospital in southern Taiwan. The study included 210 hypertension and 210 nonhypertension cases. Blood pressures were measured using an electronic sphygmomanometer to confirm the presence or absence of hypertension. The TCM Body Constitution Questionnaire, demographic datasheet, and hypertension-related factors questionnaire were used to collect data. Results: A higher proportion of patients with body constitution deviation were found in the hypertension group than the nonhypertension group. The proportions of patients with Yin-Xu, Yang-Xu, and stasis constitution were 44.8%, 32.4%, and 30.6%, respectively, in the hypertension group and 28.6%, 25.2%, and 19.6%, respectively, in the nonhypertension group. After performing univariate analysis, the results showed significant differences between the two groups in terms of average body mass index; emotional traits of anger, worry, and fear; hyperlipidemia; hyperuricemia; Yin-Xu constitution; and stasis constitution. However, the multivariate analysis revealed having a Yin-Xu constitution to be a risk factor of essential hypertension after adjusting for age, gender, body mass index, emotional traits, drinking habit, hyperlipidemia, and hyperuricemia. Conclusions/Implications for Practice: The results suggest that Yin-Xu and stasis constitutions are respectively associated with essential hypertension. The findings offer a valuable reference to governments and healthcare professionals to prevent the risk of essential hypertension. Screening and healthcare measures for TCM Yin-Xu or stasis constitution may be included in related prevention plans to minimize public exposure to the risk factors of essential hypertension. [ABSTRACT FROM AUTHOR]

Background: Cyanotic congenital heart disease (CHD) has detrimental effects on behavioral function in children and adolescents. However, few study authors have examined the underlying mechanisms of these effects. Objective: The aims of this study were to investigate the mediating effects of parenting stress in the association between cyanotic CHD and externalizing problems and to explore whether age moderated these mediating effects. Methods: A total of 697 children and adolescents (aged 2-17 years) with CHD (252 with cyanotic CHD and 445 with acyanotic CHD) in Taiwan were enrolled. The Child Behavior Checklist and the Parenting Stress Index were used to assess externalizing problems and parenting stress, respectively. Mediation analysis was performed to determine the mediating effects of parenting stress in the association between cyanotic CHD and externalizing problems. A moderated mediation model was used to investigate the moderating effect of age on the observed mediating effects. Results: Parenting stress significantly mediated the relationship between cyanotic CHD and externalizing problems (unstandardized coefficient B = 0.98; 95% bootstrap confidence interval, 0.23-1.78). Children's age further moderated the mediating effects, with greater effects in older children. Age also moderated the association between cyanotic CHD and parenting stress, such that the effects were only significant in children older than 5.7 years. Conclusions: Our study revealed that age affected the mediating effects of parenting stress in the relationship between cyanotic CHD and externalizing problems. Efforts to reduce externalizing problems in children and adolescents with cyanotic CHD by targeting parenting stress may be more effective when age differences are considered. [ABSTRACT FROM AUTHOR]

Background andObjectives: A valid fall risk assessment scale could increase the efficacy of fall prevention programs. Most fall scales were developed for adults, and it is very difficult to predict and prevent falls in pediatric inpatients. This study aimed to investigate the reliability and validity of a pediatric fall assessment scale (PFAS). Methods: This study was conducted as a cohort study in Taichung City, Taiwan. We analyzed the scale for internal consistency, test-retest reliability, and construct validity. A receiver operating characteristic (ROC) curve was generated to show sensitivity and specificity for predicting falls. Results: The results indicated that test-retest reliability was 0.89 (P= .000). The area under the ROC curve was 0.797. For the ROC curves for the pediatric fall risk assessment scale, with 11.5 points being the minimum score for a high risk of fall, sensitivity was 71.8%, specificity 74.6%, and the 95% CI was 0.746-0.848. Conclusion: The results of the data analysis showed that the PFAS is an appropriate scale for assessing the fall risk of hospitalized pediatric patients in Taiwan and potentially in other nations. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study aimed to investigate the impact of patient education using a medical team resource management (TRM)method on the adequacy of bowel preparation. Methods: The study settingwas a single hospital in northern Taiwan, and a total of 2104 (884 female, 1220 male) healthy subjects who underwent a health checkup colonoscopy screening were enrolled before and after the application of the TRM program intervention. The efficacy of the TRM intervention and the factors affecting bowel preparationwere estimated using multivariate logistic regression. Results: The prevalence of adequate bowel preparation improved significantly from the preintervention period to the postintervention and validation periods, which had prevalence of 79.0%, 81.3%, and 84.0%, respectively. Using the preintervention period prevalence as a reference, the adjusted odds ratios (aORs) for adequate bowel preparation in the postintervention and validation periods were 2.199 (95% confidence interval [CI]: 1.538-3.142) and 2.035 (1.525-2.716), respectively. Men had a lower probability of adequate cleansing than women (aOR = 0.757; 95% CI = 0.598-0.957), and purgative containing polyethylene glycol had a lower probability of adequate cleansing than purgative containing sodium phosphate (aOR = 0.366; 95% CI: 0.277-0.483). Conclusions: Bowel preparation quality for colonoscopy could be improved by enhancing patient education via TRM, and we suggest that effective quality improvement schemes should be proposed for health-screening programs. [ABSTRACT FROM AUTHOR]

Because of a lack of proper breastfeeding education to mothers and the visitation policy in the special care nursery, breastfeeding initiation and maintenance can be very challenging for both the mother and her infant who is admitted to the neonatal special care nursery after birth. Difficulties associated with forming initial bonds may contribute to some mothers changing their mind about their initially chosen feeding method. The aim of this quasi-experimental study was to evaluate the effectiveness of an e-learning breastfeeding program on maternal breastfeeding outcomes. Thirty-four mothers in the comparison group received routine care; 34 in the intervention group received an e-learning breastfeeding program and routine care. The program included 28 modules of different topics downloaded to a personal tablet computer. Each module elaborated on a breastfeeding issue and provided video clips to show practice steps. During the mothers' 3- to 5-day stay in the postpartum unit, they could repeatedly watch selected topics related to their situations at their own pace. After adjusting for each infant's birth weight, mothers in the intervention group had better attachment to their infants, greater perceived nurse support, and a higher exclusive breastfeeding rate than mothers in the comparison group. Using a tablet computer device to disseminate breastfeeding education is a feasible and supplemental method for postpartum mothers whose infants are in the special care nursery. Through the demonstrated situations, mothers are better prepared to understand their high-risk infants and the situations they may encounter during breastfeeding. [ABSTRACT FROM AUTHOR]

Background and Objectives: In response to the COVID-19 pandemic outbreak and to ensure the safety of epidemic prevention in the hospital, the hospital has established mitigation strategies in advance including risk assessment and effect analysis to control hospital visitors and accompanying persons. The study aims to assess the effectiveness of mitigation strategies implemented to effectively prevent the invasion and spread of the virus. Method: Conduct a status analysis in accordance with the Healthcare Failure Mode and Effect Analysis (HFMEA) 4-step model, construct a response workflow, confirm the failure mode and potential causes, perform hazard matrix analysis and decision tree analysis, and formulate risk control management measures. Results: For the 4 main processes and 9 subprocesses of the accompanying carers and contract caregivers entering the hospital, 26 potential failure modes and 42 potential causes of failure were analyzed. Following implementing improvement measures including strategies targeting the accompanying person, mitigationworkflowfailure rates decreased from 42 to 13 items, the pass rate for the maximum body temperature cutoff increased from 53.1% to 90.8%, and the compliance rate of hand washing increased from 89.5% to 100%. Conclusion: The HFMEA model can effectively implement preventive risk assessment and workflowmanagement of high-risk medical procedures. The model can adjudicate the health of hospital visitors during the epidemic/pandemic, provide epidemic/pandemic education training and preventive measure health education guidance for hospital visits, and improve their epidemic prevention cognition. When combined, these strategies can prevent nosocomial infection to achieve the best anti-epidemic effect. [ABSTRACT FROM AUTHOR]

Background: Health-related quality of life (HRQoL) in community-dwelling older adults increases as physical activity improves, and age-related frailty has a negative effect on HRQoL. Research on these associations is lacking. Purpose: The aims of this study were to (a) analyze the effect of demographic characteristics on HRQoL, (b) explore the correlation between physical activity and HRQoL, (c) analyze the effect of frailty on HRQoL, and (d) investigate the potential predictors of HRQoL in community-dwelling older adults. Methods: In this cross-sectional study, a convenience sample of 150 older adults was recruited from community care sites in Shilin and Beitou Districts in Taipei City, Taiwan. Data were collected at baseline using a demographic characteristics datasheet, the Center for Epidemiologic Studies Depression Scale, the Physical Activity Scale for the Elderly, and the 12-Item Short Form Health Survey. The Senior Fitness Test and hand-grip strength test were also performed. Student t test, chi-square test, analysis of variance, Pearson correlation coefficient, and hierarchical regression were applied to analyze the statistical results using IBM SPSS Statistics Version 22.0. Results: Being of older age, experiencing a higher number of falls, having more chronic diseases, and having a higher body mass index were identified as factors that significantly affect HRQoL. Moreover, HRQoL was found to be significantly affected by the performance of physical activity or status of frailty. Furthermore, the prefrail period was shown to be an important predictor of HRQoL after adjusting for demographic variables, history of chronic illness, history of falls, and physical activity. Conclusions/Implications for Practice: In this study, HRQoL was found to be significantly affected by upper limb dysfunction and the prefrail period. Community health promotion activities should focus greater attention on the physical functioning of older adults. Furthermore, providing information on age-related frailty and promoting active participation in community activities may increase the attention given by community-dwelling older adults to physical fitness and quality of life. [ABSTRACT FROM AUTHOR]

Background: Authors of several studies have reported differences in the prevalence of metabolic syndrome (MetS) between men and women. However, information is lacking on gender difference among military personnel. Objective: The aim of this study was to examine the prevalence of MetS and its component abnormalities among Taiwanese Air Force personnel by gender and age groups. Methods: A population-based study was conducted including 14 872 Taiwanese Air Force personnel. Data were retrieved from the military's Health Management Information System. Analyses were performed using Student t test, Χ² test, and linear-by-linear Χ² test. Statistical significance was defined as P < .05. Results: The MetS prevalence was 14.0%(15.1%in men and 5.3%in women). Metabolic syndrome was associated with age for both men and women (both Ptrend < .001), with a greater prevalence of MetS in men aged 18 to 44 years than in women, but not in the age group of 45 years or older. In men, MetS was most prevalent in those with increased waist circumference (78.2%), followed by those with elevated blood pressure (75.6%). By contrast, in women, it was most prevalent in those with increased waist circumference (86.5%), followed by those with reduced high-density lipoprotein cholesterol (84.3%). Conclusions: Our findings suggest that military nurses and other health providers should consider the gender- and age-basedMetS prevalence trend among Taiwanese Air Force personnel when designing interventions to identify vulnerable subgroups at a high risk of MetS. Health management programs should be adapted to minimize metabolic risks. [ABSTRACT FROM AUTHOR]

Background: Women with diabetes (type 1 and type 2) have excessive risk of developing cardiovascular disease compared with men with diabetes, so optimizing diabetes control is crucial for women to reduce this risk. Women with diabetes experience role strain, and a scale to measure role strain in the context of diabetes control could help healthcare providers improve diabetes control in women with diabetes. Objective: The aims of the study were to develop a short-form scale for measuring role strain in Taiwanese women with diabetes and test its psychometric properties. Methods: This study was conducted from October 2018 to May 2019 and used a cross-sectional design. Based on literature reviews and results of focus groups, a 28-item role strain scale was developed and administered to 519 women with diabetes in Taiwan. Item analysis, exploratory factor analysis, confirmatory factor analysis, concurrent validity, and reliability testing were used to examine the psychometric characteristics of the scale. Results: A 9-item role strain scale including subscales for role guilt and role conflict, supported by exploratory factor analysis and confirmatory factor analysis, was produced. High role strain significantly correlated with high depression (r = 0.399, P < .001) and high hemoglobin A1c levels (r =0.169, P < .001). The overall and subscale Cronbach's α ranged between 0.78 and 0.86, with test-retest reliability ranging between 0.64 and 0.81. Conclusions: The role strain scale forwomen with diabetes is reliable and valid and can be used to evaluate role strain in women with diabetes. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) could lead to poor cardiopulmonary endurance, which affects quality of life and increases the risk of rehospitalization or mortality. However, studies investigating associated factors of cardiopulmonary endurance for COPD inpatients are scant. Objective: The aim of the study was to investigate whether and how age, gender, COPD severity, body composition, dyspnea, respiratory muscle strength, and lower limb muscle strength and endurance were related to cardiopulmonary endurance in elderly inpatients with COPD. Methods: This was a cross-sectional study using a systematic sampling of older inpatients. Data of demographic characteristics such as age, gender, and disease severity were collected, and body mass index was calculated. Degrees of dyspnea were assessed by the modified Medical Research Council Dyspnea Scale. Respiratory muscle strength was reflected by the maximal inspiratory pressure and the maximal expiratory pressure. Lower limb muscle strength and endurance were assessed by a handheld dynamometer and a 30-second sit-to-stand test, respectively. Finally, cardiopulmonary endurance was assessed by a 6-minute walk test. Results: A total of 83 older COPD inpatients participated. The mean age was 74.01 ± 6.93 years. Cardiopulmonary endurance was associated with age, COPD severity, dyspnea, respiratory muscle strength, lower limb muscle strength, and endurance. Predictors of cardiopulmonary endurance were disease severity, dyspnea, and lower limb muscle endurance. These predictors explained 53% of the variance in cardiopulmonary endurance in older inpatients with COPD. Discussion: Cardiopulmonary endurance of hospitalized older adults with COPD should be strengthened by improving conditions of disease severity, dyspnea, and lower limb muscle endurance. [ABSTRACT FROM AUTHOR]

BACKGROUND: Joint activity and protection are key components in the management of rheumatoid arthritis (RA). Despite a shift from care in health settings to empowering patients to play an active role in the day-to-day management of their own chronic conditions, there is little evidence on RA self-management, especially for Chinese patients. PURPOSE: This pilot study sought to determine the feasibility and acceptability of a self-management program for patients with RA in Taiwan. METHODS: Participants were recruited at a medical center in northern Taiwan. The intervention group participated in a 6-week self-management program; the control group received standard rheumatology care. Both groups underwent baseline assessments before the intervention and at 12 weeks. RESULTS: A total of 32 participants were recruited: 15 in the intervention group and 17 in the control group. Patients in the intervention group found the self-management protocol beneficial to their joint protection and activity behaviors and reported higher motivation to perform RA self-management. The posttest score for joint protection and activity self-management behavior were significantly greater for the intervention group than for the control group (p = .02). CONCLUSIONS: Participants in the intervention group were highly satisfied with home visits (which included peer story-telling and goal setting) and telephone calls to support their daily home-based joint protection and self-management activities (which included self-monitoring and self-evaluation). To mitigate the fear of scammers, researchers should begin by building a trust relationship with participants. [ABSTRACT FROM AUTHOR]

Background: Electronic clinical quality measures (eCQMs) are a method that automatically extract data from electronic health records (EHRs) and compute and generate the results to report and track the quality of care and patient outcomes. Purpose: The purpose of this study was to explore nurses' attitudes toward eCQMs and the factors influencing this attitude. Methods: A descriptive cross-sectional study was conducted using a closed-ended questions survey of 92 nurses in a teaching hospital. Results: The average score for nurses' attitudes toward eCQMs was 3.47 out of 4. Participants with a master's degree had more positive attitudes than those with a baccalaureate degree. Head nurses had more positive attitudes than staff nurses. Conclusions: The nurses in the study hospital have a positive attitude toward eCQMs. Health care organizations should strengthen the attitudes of nurses toward eCQMs. [ABSTRACT FROM AUTHOR]

Background/Objective: No systematic research focuses on the association between splenectomy and herpes zoster. This study aimed to investigate the association between splenectomy and herpes zoster in Taiwan. Methods: A population-based cohort study was conducted using the database of Taiwan National Health Insurance Program. There were 640 individuals aged 20-84 years who were newly diagnosed with splenectomy in 2000-2012 as the splenectomy group and 2546 sex-matched and age-matched individuals without splenectomy as the nonsplenectomy group. The incidence of herpes zoster at the end of 2013 was estimated. The multivariable Cox proportional hazards regression model was used to estimate the hazard ratio and 95% confidence interval (CI) for herpes zoster associated with splenectomy. Results: The overall incidence of herpes zoster was 1.41-fold higher in the splenectomy group than in the nonsplenectomy group (11.3 vs. 8.05 per 1000 person-years, 95% CI 1.11-1.78). After multivariable adjustments, the adjusted hazard ratio of herpes zoster was 1.57 for individuals with splenectomy (95% CI 1.08-2.29), compared with individuals without splenectomy. Conclusion: Individuals with splenectomy are associated with 1.57-fold increased risk for developing herpes zoster in Taiwan. Vaccination against herpes zoster may be considered among these high-risk individuals. [ABSTRACT FROM AUTHOR]

Background: Overweight/obesity is a substantial global public health concern, which can be caused by genetic factors and energy balance-related behaviors (EBRBs). If it occurs in children with congenital heart disease (CCHD), it can yield an extra burden on their health.Most studies on CCHD have taken place inWestern societies, leaving Asian populations understudied, especially children. Objective: We sought (1) to determine body mass index distribution among school-aged CCHD in Taiwan, (2) to ascertain whether the body mass index of CCHD differs from that of the general population, (3) to describe EBRBs in CCHD, and (4) to identify factors associated with underweight and overweight/obesity among CCHD. Methods: In this cross-sectional study, 97 child-parent dyads (53.6% boys; mean age, 9.73 years; 25.8%moderate-to-severe heart conditions) were enrolled. Self-administered questionnaires were used to collect demographics, medical factors, food frequency, physical activity, and sedentary behaviors. Anthropometric measurementswere taken in the hospital. Independent predictors of EBRBs and health conditionswere calculated through logistic regression analysis. Results: Among Taiwanese CCHD, 19.6% were underweight and 14.4% were overweight/obese. Children with moderate-to-severe heart defects were more often underweight. Body mass index did not differ between CCHD and children in the general population. More complex heart defects and asthma were associated with being underweight, whereas sedentary behaviors, cardiomegaly, and the NewYork Heart Association classification II to IV were associated with being overweight/obese. Conclusions: Sedentary lifestyle is seemingly the only EBRB correlatedwith being overweight. Physical activity programs for childrenmay help prevent and treat overweight or obesity in Asian CCHD, similar to Western countries. [ABSTRACT FROM AUTHOR]

Background: In Taiwan, nurse practitioners (NPs) have taken on expanded clinical roles in the intensive care unit (ICU) due to insufficient staffing of attending physicians and resident physicians. Local problem: The objective of this study was to investigate the influence of NP staffing on the quality of patient care in ICUs. Methods: This is a retrospective study that selected patients from the ICUs of three hospitals during 2015. The mortality risks among the three hospitals were compared after adjusting variables using the Cox regression model. The care qualities of the three hospitals were analyzed using the standardized mortality ratio. Interventions: Hospital A consisted of attending physicians and resident physicians. Hospital B consisted of attending physicians and NPs. Hospital C consisted of attending physicians, NPs, and resident physicians. Results: Outcomes were assessed for 2,932 patients. The patients in hospital A had a lower mortality risk than hospital B or C. Septic shock patients received better care quality in hospital B than in hospital A or hospital C. Conclusions: In regional hospitals with lower NP-to-patient ratios, increasing that ratio could reduce the risk of mortality in the ICU and increase the quality of care. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Objective: A new protocol based on the use of a gaming balance board for children with cerebral palsy was tested. Design: A total of 56 children with cerebral palsy were enrolled and randomly divided into two groups: experimental and control. The children in experimental group underwent 12 wks of rehabilitation using their foot to play personal computer games with the proposed balance board, whereas those in the control group played personal computer games with a computer mouse in the standing position. Balance control was assessed before and after the intervention using the Zebris FDM System for measuring the center of pressure. The Pediatric Balance Scale and 2-min walk test were used for evaluating functional balance. Results: In the analysis of covariance, the proposed new balance board used for the personal computer games decreased the postural sway (sway path, F = 6.95, P = 0.011; sway area, F = 11.79, P = 0.001) and improved the performance of the functional balance tests. Conclusions: This study demonstrated the possibility that this new gaming balance board can be used for balance control in children with cerebral palsy. [ABSTRACT FROM AUTHOR]