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

The aim of this study was to develop and psychometrically test a new instrument for measuring nurse's positive energy of retention (NPER).The shortage of professional nurses is an unresolved global issue. Few studies explored the issue of the retention of nurses in terms of a positive psychological viewpoint.Methodological study.Data collection was from June 2016-August 2017. Nurses (N = 947) recruited from northern, central and southern Taiwan covering different levels of hospitals were divided into three samples, which were used for explaratory factor analysis (EFA), confirmatory factor analysis (CFA) and cross-validation respectively.EFA resulted in a three-factor solution: proactive and persevering characteristics, nursing professional identity and passion accounting for 61.8% of total variance. The proposed three-factor model was confirmed by CFA. Cross-validation provided further evidence for the construct validity of the NPER instrument with 24 items. Cronbach's alpha coefficient of three subscales of the instrument were 0.95, 0.89, and 0.92 separately and 0.96 for the total scale.Psychometric properties indicate that the newly formulated NPER instrument is a valid and reliable assessment tool to recruit nurses who are more likely to remain in nursing.The study addressed the personal intrinsic factors, which are very important for nurses' retention. The NPER instrument consisted of three subscales is a reliable and psychometrically valid new instrument. Managers could apply the NPER instrument to recruit nurses possessing the attributes of positive energy of retention. Furthermore, researchers could use the rigorous process provided in the study to establish a new instrument.目的: 本研究的目的是开发一种从积极心理学角度进行的测量护士护理人员留任意愿(NPER)的新型工具并对该方法进行心理测量。 背景: 专业护士短缺是一个尚未得到解决的全球性问题。很少有研究从积极心理学角度探讨护士留任问题。 设计: 方法研究。 方法: 本研究收集了2016年6月至2017年8月期间的数据,将来自台湾北部、中部及南部不同层级医院的护士(N = 947)分为三个样本,对样本分别进行了解释性因子分析(EFA)、验证性因子分析(CFA)及交叉验证。 结果: 解释性因子分析的结果显示为三因子解:积极和坚持的特点,护理专业认同和激情共占总方差的61.8%。提出的三因素模型得到了验证性因子分析的验证。交叉验证为24项NPER工具的结构有效性提供了进一步的证明。量表三个方面的克朗巴哈系数分别为0.95、0.89和0.92,总分为0.96。 结论: 心理测量学特性表明,新编制的NPER量表是一种有效、可靠的评估工具,可用于招聘更有可能继续留任的护士。 影响: 本研究探讨了个人内在因素对护士留任意愿的影响。NPER量表由三个分量表组成,是一种可靠的、心理测量有用的新型量表。管理者可以应用NPER量表招聘具有更愿意留任的护士。此外,研究人员可以利用研究中提供的严谨结果以编制其他新型量表。.

Aim. To determine the inter-rater reliability, internal consistency, construct and concurrent validity and feasibility of the pain assessment scale for preterm infants. Background. Repeated exposure to painful procedures has an adverse impact on preterm infants’ health outcomes. Although many scales are available for assessing these infants’ pain, only a few reliably and validly assess pain and no gold standard has been established in clinical practice. Design. Instrument development and psychometric analysis. Methods. Preterm infants (n = 60) born 27·6–36·3 weeks gestational age were assessed for pain 3 minutes before (phase I), during (phase II), 3 minutes after (phase III) and the tenth minute after (phase IV) heel-stick procedures. Pain scores were independently coded from video recordings and observations by three trained nurses using our pain-assessment scale, premature infant pain profile and visual analogue scale. Results. Scores on the pain assessment scale for preterm infants differed significantly across four phases of heel-stick procedures (F = 56·86, p 27 weeks. Further examination of the scale’s psychometrics is recommended with diverse samples of infants and different painful procedures. Relevance to clinical practice. The pain assessment scale for preterm infants clearly defines item scoring and weighting, consistently discriminates different levels of pain and helps nurses to recognise infants’ pain. Nurses can easily remember the definition of each item, allowing them to use our scale to evaluate preterm infants’ pain at any time and to provide pain-relief interventions when needed.

Aims. The purpose of this study was to explore the relationships between specific nurse care-giving behaviours and preterm infant behavioural responses during bathing and to identify nurse behaviours associated with infant ‘stress’. Background. Although recent advances in medical technology have improved neonatal intensive care, the high mortality and morbidity rates in preterm infants have not decreased proportionally. As caregivers strive to reduce infant mortality and morbidity, a factor for consideration is which caregiver behaviours are associated with preterm infant well-being. Design. A descriptive correlational design. Method. Convenience samples of 24 preterm infants and 12 nurses were recruited. A total of 120 baths were videotaped. Infant and nurse behaviours were measured using the coding schemes developed by the researchers. Pearson coefficient correlation, non-parametric Kruskal–Wallis test, t-test and generalised linear models were methods for data analysis. Results. As nurses provided more support, stress was reduced in the infants, and their self-regulation during the bath was enhanced especially by the use of ‘containment’ and ‘positional support’. Conversely, non-therapeutic caregiver behaviours including ‘rapid and rough handling’ of the baby, ‘chatting with other people’ and ‘inappropriate handling’ increased infant ‘stress’ during the bath. Conclusion. The findings provide new information about the link between care-giving and infant responses and how caregivers can better interact with preterm infants during a very sensitive period of brain development. Relevance to clinical practice. How nurses take care of the preterm infants influences their responses to care-giving stimuli. To interact better with the infant during care-giving procedures, nurses need to provide more supportive care-giving behaviours especially ‘position support’ and ‘containment’ based on the infant’s needs, and avoid care-giving that may be too rough and occur too quickly without attending the baby’s stressful signals, positioning the baby in hyperextension posture, or chatting with other people during procedures.