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The author discusses how many papers can be published from one study. The issue of how many papers can be presented in a single study is a matter of debate for researchers, editors and publishers. The practice of publishing multiple outputs from a single study is called salami slicing. Researchers opting to address broader "lumped" rather than more focused "split" questions often generate more data.

ABSTRACT Background Poor nursing adherence to evidence-based guidelines has negative consequences leading to higher mortality rates, delayed recovery and longer length of stay. Evidence-based practice has the potential to minimize complications and discrepancies between nurses. Aim This study aimed to assess nurses' practice and perception of their knowledge and responsibility in relation to enteral nutrition ( EN) in the critically ill. Design and methods This descriptive correlational design was applied to nurses working in intensive care units ( ICUs) from three health care sectors in Jordan (Governmental, Military and Private sectors). Nurses were recruited using a stratified sampling technique. A pre-prepared questionnaire focusing on nurses' practice and perception towards EN was used. Results A total of 253 ICU nurses completed the questionnaire. Nurses revealed a tendency to undertake nutritional care despite the recognition clinical nutrition is a secondary role. In terms of nursing processes, nurses showed greater levels of knowledge and responsibility for 'preventing complications' and 'evaluation' more than 'assessment' and 'identifying goals'. Nurses inadequately assess both gastric residuals and tube placement before feeding. Diarrhoea was the most frequent complication followed by abdominal pain, vomiting, tube dislodgment and weight loss. However, nurses realized that the incidences of complications is less likely when applying evidence-based protocol. Conclusion It is necessary to establish a preliminary assessment for patients' nutritional needs prior to using EN. Aspiration reduction measures are still deficient and need further attention. An evidence-based protocol for EN should be adopted in the critically ill. Relevance to clinical practice This article provides insight into the current practice of Jordanian intensive care nurses in different health care sectors. The study can contribute to redirect the perception of nurses towards nutrition in the critically ill in addition to enhance positive adherence to evidence base. [ABSTRACT FROM AUTHOR]

Aims and objectives To gain an in-depth understanding of women's experiences of performing pelvic floor muscle exercises for urinary incontinence and the impact on their sexuality. Background Urinary incontinence is not a life-threatening disorder; however, it has been shown to have detrimental effects on quality of life in terms of psychological, social and sexual dysfunction. Pelvic floor muscle exercises is the first recommended strategy for managing mild to moderate urinary incontinence as it is noninvasive and cost effective. Pelvic floor muscle exercises reduce incontinence and strengthen the pelvic floor muscles, which positively affects sexual function in women. Currently, the data are scarce for qualitative literature regarding the subjective experiences of Taiwanese women undergoing pelvic floor muscle exercises and the impact on their urinary incontinence and sexuality. Design Qualitative exploratory study. Methods Semi-structured in depth interviews were undertaken with twelve women who had completed a pelvic floor muscle exercises program in Taiwan. Data were analysed using thematic analysis. Results Themes were related to Taiwanese women's initial feelings that urinary incontinence was inevitable and the effects on their sexuality. Three core themes were identified: perceptions of inevitability, developing awareness and gaining control and sexual taboo. Through developing awareness and control of their pelvic floor muscles women expressed improvement in urinary incontinence. Sexual enjoyment, body image, self confidence and sexuality were also enhanced. Conclusion Pelvic floor muscle exercises had a positive effect on urinary incontinence and sexuality. The findings demonstrated that sex is a taboo topic for many Taiwanese women. With the sensitive management of pelvic floor muscle exercises programs this issue can be addressed. Relevance to clinical practice This study raises awareness of healthcare professionals by identifying how Taiwanese women perceive pelvic floor muscles. The positive impact of pelvic floor muscle exercises upon both urinary incontinence and sexuality within the Taiwanese context are addressed. Nurses may also, with greater confidence initiate discussion of women's sexual concerns as part of managing urinary incontinence. [ABSTRACT FROM AUTHOR]

This study was designed to explore Taiwanese school students’ attitudes toward sexual relationships and premarital sex. This was an exploratory descriptive, qualitative study. Focus groups (N = 8) were conducted with 47 adolescents from three high schools in Taiwan. Transcripts were transcribed and thematically analyzed using Atlas V 5.0. Adolescent attitudes toward sexual relationships and premarital sexual behavior comprise the following three dimensions: (1) external incentives, (2) the developmental process, and (3) internal control. External incentives include the normalization of sexual behavior between peers, the desire to feel included in a group, parental influence, and media influence. The developmental process includes imagining the sexual experience and onset of sexual activity. Internal control includes the fear of pregnancy, the fear of parental rejection, and the fear of being judged. These findings can provide a reference for designing future sex education curricula and counseling programs for adolescents. [ABSTRACT FROM PUBLISHER]

Psychological problems have become a substantial burden on refugee communities, with a considerable impact on refugee children's quality of life and well‐being. The available studies reveal growing mental health disorders in refugee children and adolescents, particularly traumas, anxiety, and depression disorders. This review aims to examine empirical evidence relating to the mental health of refugee children and adolescents in the Middle East. Following the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, this systematic literature review (2010–2020) identified 54 studies about Middle Eastern refugee children and adolescents' mental health. Eighteen studies were excluded based on their lack of relevance to the focus of the review. Of the remaining records, ten reported common mental health disorders, ten reported on Post‐traumatic Stress Disorder, three reported the importance of mental health promotion in schools, while the others discussed protective factors. The results highlight a need to understand the mental health support needs of this group, add knowledge to this area of inquiry and provide baseline data regarding Middle Eastern refugee children and adolescents mental health. Differences across research designs were recorded to contextualize the quality of the study results. There is a paucity of studies investigating the causality, prevalence, risk factors, and interventions of non‐traumatic‐psychiatric disorders as well as the role of teacher in strengthen refugee's mental health. Limited information is available about suicidality and self‐harm, protective factors, adversity, adaptation, acculturation, and social demographics in refugee children. [ABSTRACT FROM AUTHOR]

This study aimed to explore Jordanian nurses’ perspectives on the implementation of evidence-based practice and team-working related to nutritional care in the critically ill. Poor adherence to evidence-based practice and poor collaboration may contribute to nutritional failure. Fourteen critical care nurses from three healthcare sectors in Jordan were selected purposively and interviewed using semi-structured interviews. The information obtained was subjected to a thematic analysis. Four themes emerged from the study: ‘undertaking nutritional responsibilities’, ‘approaching evidence-based practice’, ‘multidisciplinary team working’ and ‘consequences of enteral nutrition care deficits’. Although evidence-based practice was emphasised by nurses, lack of evidence-based resources, and ineffective aspiration reduction measures were found to impede adherence to evidence-based practice. Multidisciplinary team working was introduced as means to improve practice. However, ineffective nursing involvement and poor interaction were obstacles to effective sharing. [ABSTRACT FROM AUTHOR]

Aims and objectives. To determine the efficacy of swaddling and heel warming on pain response in neonates following heel stick. Background. Swaddling has been suggested to reduce pain response in neonates during heel stick. Heel warming is also often performed for drawing blood easily before heel stick. However, the efficacy of both on pain response is unclear. Design. A randomised controlled study was used. Methods. Twenty-five neonates were randomly assigned to each of the control, swaddling and heel-warming groups. Heart rate, oxygen saturation Neonatal Infant Pain Scale and duration of crying were used to assess pain reactivity and pain recovery. A greater heart rate and Neonatal Infant Pain Scale increase, or oxygen saturation decrease, indicated higher pain reactivity. A longer duration of heart rate and oxygen saturation changes after heel stick back to baseline indicated a longer pain recovery. Results. The decrease in oxygen saturation in swaddling group was significantly greater than that in heel-warming group. The increase in the Neonatal Infant Pain Scale in control group was significantly higher than that in swaddling group. The heart rate recovery time in control group and swaddling group was significantly longer than that in heel-warming group. The oxygen saturation recovery time in control group was significantly longer than that in heel-warming group. The duration of crying in control group was significantly longer than those in swaddling group and heel-warming group. Conclusion. Both swaddling and heel warming decreased the pain response of neonates during heel stick. Heel warming resulted in a lower pain response than did swaddling for neonates, particularly in terms of pain recovery. Relevance to clinical practice. Heel warming could become a routine practice to decrease the pain response of neonates during heel stick. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the experiences of people with prediabetes who engage in exercise, from the initiation of exercise to the discontinuation or continuation of exercise. Background People with prediabetes are the high-risk group for developing type 2 diabetes. Engaging in exercise is an important health behaviour to prevent or delay this. However, many people with prediabetes fail to develop and maintain a regular exercise regime. Design A grounded theory study. Methods Data were collected from August 2011-November 2012. Twenty participants with impaired fasting glucose from a medical centre in Taiwan were enrolled in this study for in-depth interview. The data were entered into NVivo 8·0 qualitative data management software after transcription and were analysed by constant comparative method. Results A theory of the process by which people with prediabetes approach the development of exercise behaviour was developed, comprising four stages: developing awareness, creating the health blueprint, action cycle of internal struggle and developing spontaneous regular exercise. Developing awareness was the starting point for the process of implementing exercise. The core category was action cycle of struggle that all participants experienced this stage, and the spontaneous regular exercise was the highest level of exercise process. Conclusion It is not easy for people with prediabetes to develop a regular exercise regime. Exercise behaviour will be either continued or discontinued secondary to driving and resistive forces. Relevance to clinical practice This study provides useful information to help practitioners design exercise intervention strategies and provide psychological support to people with prediabetes. [ABSTRACT FROM AUTHOR]

Objective: this paper is a report of a systematic review and meta-ethnography to explore the impact of peer support in the context of perinatal mental illness (PMI). Method: systematic review methods identified five qualitative studies about women's experiences of PMI, and the impact peer support has on their journey towards emotional well-being. Findings from the identified studies were synthesised into themes, using meta-ethnography. Synthesis and findings: the meta-ethnography produced four themes; 'Isolation: the role of peer support', 'Seeking validation through peer support', 'The importance of social norms of motherhood', and 'Finding affirmation/a way forward; the impact of peer support'. These themes represent women's experiences of PMI, their encounters with peer support groups within that context, and the impact of such encounters on their mental health status. Key conclusion: recognising the risk of isolation and having pathways of referral to peer support networks is important, as are practitioners roles in nurturing peer support networks in perinatal care. More research is required to establish the most successful formats/structures of peer support. Practitioners should also recognise their individual and collective professional duty to challenge stereotypical depictions of motherhood wherever they arise, as this 'gold standard' benchmark of good mothering engenders guilt about not being good enough, often leaving women feeling inadequate. Implications for practice: isolation is a key factor in PMI. Practitioners should be instrumental in their acceptance and development of peer support for PMI, ensuring these networks are valued, nurtured and encouraged. This study illustrates the powerful effect of professional and social forces on how new mothers feel about themselves. [ABSTRACT FROM AUTHOR]

Aims and objectives To identify sources of information and support preferred by young people to understand adolescent practices as adolescents develop a sexual health knowledge base. Background Statistics suggest that adolescents are not always making safe sexual health decisions. It is essential to develop an understanding of preferred sources of information and support to structure health and education services so that adolescents develop skills and knowledge to make safer choices. Design A cross-sectional survey design. Methods A wide-ranging questionnaire was developed using validated questions, drawn from similar adolescent lifestyle surveys and adapted with guidance from an advisory group; 2036 13-16-year-olds responded. Two questions, reporting information sources adolescents find useful and sources of approachable support, are considered here. Results Adolescents find informal sources more useful and experience higher levels of comfort accessing informal support especially from their best friends and mothers. Of formal provision, school-based sources are preferred; however, sexual health information seeking is gendered and changes across year groups. The range of sexual health information sources adolescents access increases with age, and how they access these information sources changes as sexual activity increases and the information becomes more relevant. Conclusions The findings support the targeting of sexual health provision in relation to age and gender and suggest a youth-focused approach to formal provision, including outreach working and a collaborative relationship with adolescents and parents. Relevance to clinical practice The findings contribute to an understanding of sources of information and support preferred by adolescents. In particular, they need to reconsider how services external to the school may be developed so they are youth-focused and approachable. Nurses need to consider how best to work in partnership with adolescents and their families to disseminate accurate information and develop relevant services. [ABSTRACT FROM AUTHOR]

To identify the core competencies of family and community nurses. The European Union is facing common health challenges in the field of primary care, according to European health policies and the World Health Organization, which need to be addressed through better and innovative ways of working that require joint actions. There is evidence that 'Family and Community Nurses' play a key role in the field of primary care, but there is no agreement on which core competencies they are required to have. An e-Delphi study A 4-round e-Delphi study was conducted from March to July 2018 as part of the Erasmus+ Project "EuropeaN curriculum for fAmily aNd Community nursE" (ENhANCE). A panel of 23 experts from 10 European countries were asked to approve, modify, or add items and then prioritize each skill. This e-Delphi, as part of the ENhANCE project, produced core 28 competencies, which were used by the "ENhANCE" partners to develop the European Core Curriculum for Family and Community Nurses. The ENhANCE partners ensured that the core competencies were consistent with World Health Organization recommendations, the European Skills/Competencies, Qualifications and Occupations (ESCO) and with the European Credit System for Vocational Education and Training (ECVET). The results of this study will provide the basis for universities across Europe to develop their own post-graduate teaching programs with common educational goals for Family and Community Nurses and a cadre of nurse practitioners with transferrable skills across the continent. This e-Delphi, as part of the ENhANCE project, produced 28 competencies for the European Core Curriculum for Family and Community Nurses. • First European study on core competencies for Family and Community Nurses. • Family and Community Nurses core competencies used to develop European curricula. • European common curricula will facilitate recognition and mobility of these nurses. • Family and Community Nurses will improve the primary care of the European Union. [ABSTRACT FROM AUTHOR]

Aims: To critically review the literature in order to describe the themes associated with the experience of critical illness and consider how these inform the patients understanding. Background: Critical illness requires life-saving intervention and application of high technology medicine and intensive nursing within a specialist critical care unit. Whilst an extensive and rapidly advancing knowledge of the physiological basis for treating critical illness exists, understanding how critical illness is experienced by the patient is less well understood. Data sources: Literature was retrieved through systematic searching of electronic databases, hand searches of journals and incremental searching. Review methods: 26 qualitative studies of firsthand experiences of adult patients who had been in a critical care unit were reviewed. Key, common, explicit themes between the studies were identified as well as implicit themes that emerged through preliminary synthesis. Results: Eight common explicit themes were identified. These included: Transformations of perception: Unreal experiences and dreams; Proximity to death; Transformation and perception of the body in illness; Transformation and perception of time; The critical care environment: technology and dependence; Care, communication and relationships with healthcare professionals; The support of family and friends and desire for contact; Transfer from critical care and recovery from critical illness. A further two implicit themes related to the primacy of the critical care unit within the studies; and the focus of recall or personal meaning which divided the literature. Conclusion: The explicit themes highlight the steps taken by researchers to understand what is salient about the critical care experience for those who have been critically ill. Future research exploring the whole illness-recovery trajectory and the way personal meaning contributes to understanding life experiences is justified. [ABSTRACT FROM AUTHOR]

This review aims to evaluate the effectiveness of nutritional intervention in the treatment of pressure ulcers. Four databases were searched systematically using the keywords formulated and papers were selected according to inclusion and exclusion criteria. The literature search period included articles published from 1 January 2000 to 30 December 2011 (inclusive). Six papers on randomized controlled trials were retrieved. All six trials showed positive outcomes in pressure ulcer healing with nutritional interventions. Secondary outcomes such as lower number of dressings required, less time spent on dressing changes and lower occurrence of infections were reported. The main results emerged from this study generally supported the use of nutritional interventions in the treatment of pressure ulcers. Various methodological issues associated with these trials were highlighted. The implications for clinical practice need to bear in mind both the methodological problems raised and limitations of this review. [ABSTRACT FROM AUTHOR]

The article focuses on patients' experiences and expectations regarding implantable cardioverter defibrillators (ICDs) and the role of healthcare professionals in improving these experiences, and researchers conducted a qualitative analysis of studies of patients' experiences.

lo s.-f., hayter m., hu w.-y., tai c.-y., hsu m.-y. & li y.-f. (2012) Symptom burden and quality of life in patients with malignant fungating wounds. Journal of Advanced Nursing 68(6), 1312-1321. Abstract Aim. This study describes the relationship between symptoms and quality of life in patients with malignant fungating wounds. Background. Malignant fungating wounds are complex wounds that can bleed, become malodorous due to infection and are painful causing physical and psychological distress. However, there is a lack of literature on the impact that such wounds can have on quality of life. Methods. This was a descriptive, cross-sectional multi-centre study of patients with malignant fungating wounds. Participants were recruited from the palliative care, hospice, outpatient clinic and oncology units of three medical centres in Taiwan. Data were collected from February 2008 to August 2009. A structured questionnaire obtained socio-demographic information, medical details, wound assessment information and the Taiwanese version of the McGill quality of life questionnaire was administered by interview. Results. McGill quality of life scores indicated that the participants had the lowest quality of life. The participant's age, dressing change frequency, pain, wound dressing comfort, wound symptom, bleeding and malodour had statistically significant negative correlations with quality of life. Multiple regression analysis showed that age, malodour, pain issues and psychological issues explained 87% of the total variance in quality of life. Conclusion. This study contributes to our understanding of the impact of malignant fungating wounds and how correct assessment and management is necessary to improve quality of life. Educational intervention research is needed for patients and caregivers in countries where this has not yet been performed. Further research should also identify whether nursing competence has a direct impact on quality of life. [ABSTRACT FROM AUTHOR]

Aim. To explore male students' attitudes towards menstruation. Background. Menstruation is a biological event that is often surrounded by secrecy and social stigma that causes anxiety amongst many young girls. A key element of this is the attitudes of young males towards this reproductive health issue. However, the literature around what young males think and feel about menstruation is limited. Design. Qualitative. Methods. A sample of 27 male students aged between 10-12 years participated in five focus groups. Data were then subject to a thematic analysis. Results. Five themes emerged from the data analysis that reflected the boys' feelings, experiences and attitudes towards menstruation: 'A silent topic', 'An unimportant issue', 'Errant information about menstruation'. In addition, according to their experience, participants gradually came to see menstruation from the 'menstrual stereotype' viewpoint. In their social life, they made choices that resulted in gradually regulating their behaviour that affected their 'relationships with girls'. Conclusion. Young boys have misguided knowledge about menstruation and this helps to perpetuate the stigma surrounding this element of reproductive health. Boys also express a desire to learn more but are often restricted in this by home and school. School nurses are the best placed professionals to address this issue. Relevance to clinical practice. Menstrual education with boys should take a greater prominence than it often does in sexual health education in schools. Such inclusion will provide boys with a balanced and accurate knowledge base and therefore help towards reducing the social stigma around menstruation that is often experienced by young girls. [ABSTRACT FROM AUTHOR]

Aim. This study aimed to explore the lived experience of sub-fertility among Chinese couples in Hong Kong. Background. In Chinese culture, the duty of young married couples is to bear children to carry on the family line. Married couples who are unable to bear children often experience personal psychological stress and social pressure. Design. Qualitative, exploratory study. Methods. Seven women and four men in Hong Kong were interviewed to explore their lived experiences of being involuntarily childless. Collaizi's phenomenological methods guided data collection and analysis. Results. Sub-fertile couples reported feelings of incompleteness, guilt, shame and isolation from the 'fertile' world. These couples acknowledged that sub-fertility had implications on their marital relationship and regretted not having treatment earlier. Some found ways to replace their 'loss' and to cope with their situation, and some rationalised by finding reasons that favoured being childless. Discussion. It is recommended that family planning should be incorporated into premarital screening and to provide timely support and counselling. Relevance to clinical practice. Family planning and fertility should be incorporated into premarital counselling. Sub-fertile couples should be encouraged to seek medical help, being provided with early referral for investigation and treatment and with support and counselling. Health care professionals should respect the decisions of sub-fertile couples with regard to investigations or assisted reproductive services. They should also assess how each partner interprets the situation if they encountered difficulty in dealing with the situation. [ABSTRACT FROM AUTHOR]

To investigate the evidence of problem-solving approach interventions on symptom management in cancer care. Symptom-related problems are a common challenge in cancer care. The problem-solving approach is one strategy of cognitive behavioural therapy used to help patients with cancer self-manage their symptoms. However, no systematic review has investigated the effectiveness of this approach. Systematic review. A systematic search for intervention studies using randomised controlled designs, controlled clinical trial and quasi-experimental studies designs was conducted using the following electronic databases: EBSCO host, CINAHL (1991-2008), Medline (1975-2009), Electronic Periodical Services (Chinese) and Electronic Theses and Dissertations System (Taiwan). Seven studies published in English between 1975-2009 were included in this systematic review. All studies were randomly assigned and almost all studies demonstrated the positive effects of a problem-solving approach in reducing symptomatic problems in the target participants. Varying protocols and qualities of methodological design (14% good, 43% fair and 43% poor) were found in this review. This systematic review highlighted the potential of a problem-solving approach in the management of symptom problems in patients with cancer. However, more rigourous studies are needed and a better evaluation of the most effective problem-solving approach protocols is required. Cancer care nurses should explore the use of problem-solving approach interventions in their practice as the evidence base suggests the value of this approach - but caution is needed in regard to the precise structure of the problem-solving approach protocol. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of an evaluation of the effectiveness of a multimedia education program in relation to stoma knowledge, self-care attitudes and behaviour with patients with a stoma in the postoperative period. Background. Multimedia education programmes not only give patients with useful information in the absence of health professionals, but can also augment information given in traditional clinical practice. However, the literature on the effectiveness of different approaches to stoma education is limited. Method. A randomized experimental study design was used. Participants were recruited from a surgical unit in a large hospital in Taiwan. A total of 102 patients with a stoma were randomly assigned to either the multimedia education programme (n = 46) or a conventional stoma education programme (n = 56) with a follow-up of 1 week. Outcome variables measured were levels of self-care knowledge, attitudes towards self-care and self-care behaviour. Findings. Patients who received the multimedia education programme improved their overall self-care knowledge, attitudes and behaviour statistically significantly when compared with those who received the conventional stoma education programme. Conclusion. Although further, longer-term follow-up will be useful, this study demonstrates that multimedia packages can enhance patient involvement in their stoma care and can augment stoma education - particularly in resource challenged healthcare environments. [ABSTRACT FROM AUTHOR]

In this article we discuss the findings from a recent study of UK policy and practice in relation to sexual health services for young people, based in - or closely linked with - schools. This study formed part of a larger project, completed in 2009, which also included a systematic review of international research. The findings discussed in this paper are based on analyses of interviews with 51 service managers and questionnaire returns from 205 school nurses. Four themes are discussed. First, we found three main service permutations, in a context of very diverse and uneven implementation. Second, we identified factors within the school context that shaped and often constrained service provision; some of these also have implications for sex and relationships education (SRE). Third, we found contrasting approaches to the relationship between SRE input and sexual health provision. Fourth, we identified some specific barriers that need to be addressed in order to develop 'young people friendly' services in the school context. The relative autonomy available to school head teachers and governors can represent an obstacle to service provision - and inter-professional collaboration - in a climate where, in many schools, there is still considerable ambivalence about discussing 'sex' openly. In conclusion, we identify areas worthy of further research and development, in order to address some obstacles to sexual health service and SRE provision in schools. [ABSTRACT FROM AUTHOR]

Aim. This article is a report of a systematic review and meta-ethnography of women’s experience of menarche. Background. Adolescents may experience menarche at different ages, but menarche remains an important milestone in the female maturation process, representing the transition from childhood to womanhood. Design. Systematic review and meta-ethnography. Methods. Electronic databases were systematically searched and supplemented with reference lists searching. Qualitative studies of women’s experience of menarche were purposely selected and questions proposed by the critical appraisal skills programme was adapted and used to assess papers prior to synthesis. Key themes and concepts were extracted and synthesised using meta-ethnography. Results. Fourteen studies on menarche experience were identified. The majority of studies were descriptive. Five key concepts were identified from all 14 papers as being descriptive of women’s experience of menarche. These included: menarche preparation, significant others’ response to menarche, physical experience of menarche, psychological experience of menarche and social-cultural perspective of menarche. Conclusions. Menarche experience had a major impact on women. Women went through physical, psychological and social-culture changes when their first menstrual flow came. Menarche preparation has been shown to have a beneficial impact on the menarcheal woman. School nurses have accurate knowledge about sexual health; they can and should provide appropriate menstrual education. Relevance to clinical practice. The findings can be used by school nurses working with adolescents as the basis for a framework of intervention strategies directed towards helping adolescents to better accept their menarche and transition into womanhood. [ABSTRACT FROM AUTHOR]

Aim. This study examined the effectiveness of multimedia learning education programmes (MLEPs) on knowledge, anxiety and pressure garment compliance behaviour of burn patients. Background. MLEPs are increasingly suggested as education methods that can be used by health professionals in daily practice. A systematic review of the effectiveness of computer-based education demonstrates its acceptability to patients. However, few studies have empirically tested this approach. Design. Experimental study. Methods. An experimental study was conducted at a burn centre of a medical centre in Taipei, Taiwan. Participants were randomly assigned to either experimental ( n = 28) or control groups ( n = 30). Both groups were given pre-tests and post-tests to measure their knowledge, anxiety and pressure garment compliance behaviour. Results. At two weeks, the results of this study showed that the MLEP had ‘statistically’ significantly improved patients’ burn knowledge, reduced individual anxiety and enhanced pressure garment compliance behaviour. Conclusion. This controlled study demonstrated that a two week MLEP can be a useful intervention to improve care compliance and reduce anxiety in patients undergoing burns rehabilitation period. Relevance to clinical practice. Burn injury patients undergoing rehabilitation are likely to benefit from multimedia learning education intervention programmes. More comprehensive health economic evaluation needs to be undertaken. Further studies exploring a longer term follow-up are also required. [ABSTRACT FROM AUTHOR]

Aim. To explore the contributing factors and effects of Taiwan’s mental health nurses’ decision-making patterns on care outcomes for patients with borderline personality disorder. Background. Patients with borderline personality disorder have been identified as difficult to care for. Taiwan’s mental health nurses have complained about the lack of successful outcomes with existing care regimes, and few studies have explored these nurses’ perceptions of how their decision-making process impacts quality of care for their clients. Design. Descriptive qualitative research. Methods. Data collected through semi-structured, face-to-face, in-depth interviews were analysed by qualitative content analysis. Fifteen mental health nurses were purposively recruited from a psychiatric centre in northern Taiwan. Results. The informants’ caring outcomes for borderline personality disorder patients were involved with interactions of the following five themes: (a) shifting from the honeymoon to chaos stage, (b) nurses’ expectations for positive vs. negative outcomes, (c) practicing routine vs. individualised nursing care, (d) adequate or inadequate support from healthcare team members and (e) differences in care outcomes (satisfactory experiences, unsatisfactory experiences and superficial relationships). A conceptual framework of a ‘two-stage care process’ was developed to depict the relationships among these five themes with different care outcomes. Conclusions. Although Taiwan’s mental health nurses reported more unsatisfactory than satisfactory care outcomes, more satisfactory patient outcomes might be obtained by nurses’ positive attitudes, unrelenting efforts towards promoting the health of these patients and receiving timely and constant support from healthcare team members. Relevance to clinical practice. Mental health nurses should not give up too readily on borderline personality disorder clients, but adopt a positive attitude and coach them in learning to relax and work with others. Nurses are encouraged to establish supportive team relationships to motivate each other to work for positive care outcomes, to better understand their clients’ needs and to develop individualised in addition to routine care strategies. [ABSTRACT FROM AUTHOR]

Abstract: Background: The issue of relationships between patients in long-term care settings can present nurses with numerous challenges. However, addressing this element of patient care is recognised as an important element of nursing in this sphere of practice. What nurses think about patient sexual relationships and the difficulties of incorporating these into care is closely linked to the care they provide. However, the issue of patients sexual relationships within high security psychiatric hospitals is a relatively poorly researched area of clinical practice. Aim: To explore the attitudes towards patients’ sexual relationships held by nurses working in high security psychiatric hospitals in England. Methods and participants: A qualitative methodology was employed with data collected from 10 in-depth interviews with nurses working within secure psychiatric hospitals in England. Interview data were subjected to thematic analysis. Results: Practitioners reject permissive policy in relation to patients’ sexual relationships on account of perceived perpetuation of abuse and exploitation. Practices and attitudes are dominated by personal (lay) values that seek to restrict patient experience and undermine professional mores whilst also seeming to uphold a professional duty of care. Conclusion: Lay understandings are constructed as moral rights and priorities that are of higher order concern than professional values or the rights of the individual. This constitutes a clash of values and the minimisation of professional mores within the clinical context raises questions about the role of professional teaching, knowledge and policy in relation to professional socialisation. [Copyright &y& Elsevier]