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Background: Frailty is common in patients with heart failure. Specific scales, including the Clinical Frailty Scale, exist but have not undergone thorough psychometric validation among patients with heart failure., Objective: The aim of this study was to develop and validate the Frailty Assessment Scale for Heart Failure (FAS-HF) in patients with heart failure., Methods: This study included 3 phases. In phase I, conceptualization and item generation, the FAS-HF was initially developed through the analysis of qualitative research data and a literature review. In phase II, item selection and content validity, the Delphi method was used to gather experts' opinions and suggestions regarding the FAS-HF. In phase III, field testing and psychometric evaluation, a cross-sectional study of 184 patients with heart failure in northern Taiwan was conducted to test the reliability and validity of the FAS-HF., Results: The 15-item FAS-HF included the physical, psychological, and social frailty domains. The total score ranged from 0 to 45, with higher scores representing frailer individuals. Exploratory factor analysis revealed that the cumulative loading variance was 57.39%. In the confirmatory factor analysis, the goodness-of-fit index (0.91), adjusted goodness-of-fit index (0.87), and root mean square error of approximation (0.06) were acceptable for model fit. Acceptable reliability was found, with a Cronbach α coefficient of 0.87 and a test-retest reliability of 0.99. Compared with the Fried frailty phenotype, the area under the receiver operating characteristic curve was 0.94, and the optimal cutoff score for frailty was 20., Conclusions: The FAS-HF has good reliability, validity, and discrimination and can be used as a frailty indicator for patients with heart failure., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Poor sleep quality is associated with multiple factors in cardiac surgery patients., Aim: To examine the trajectory of sleep quality and its associated factors over 3 months in Taiwanese patients undergoing cardiac surgery., Study Design: A longitudinal study. This study enrolled 95 patients undergoing cardiac surgery in northern Taiwan. Sleep quality was measured using the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale before surgery, at discharge, and at 1 month and 3 months postsurgery., Results: The majority of participants reported poor sleep quality before cardiac surgery (76.8%) and at discharge (81.6%), and they showed significant improvements in sleep quality at 1 month (B = -0.93, p = .023) and 3 months postsurgery (B = -1.50, p < .001). Significant daytime sleepiness was reported by 25.3% of patients before cardiac surgery, and this proportion significantly decreased at 3 months postsurgery (B = -2.59, p < .001). The significant predictors of sleep quality in cardiac surgery patients were symptom distress, sleep medications, occupation, left ventricular ejection fraction, ACE-I drugs and potassium ions, which explained 53.7% of the total variance in sleep quality. Having a nap habit was an independent predictor of daytime sleepiness in cardiac surgery patients, which could explain 3.7% of the total variation., Conclusion: Poor sleep quality was common in patients undergoing cardiac surgery and was associated with multiple factors, including symptom distress, cardiac function, medications, and psychosocial and environmental factors., Relevance to Clinical Practice: Poor sleep quality was observed in cardiac surgical patients before surgery and at discharge postsurgery. Patient education on symptom management, medication adherence and sleep hygiene are suggested to improve sleep quality in patients undergoing cardiac surgery., (© 2024 British Association of Critical Care Nurses.)

Objective: This study aims to investigate the effectiveness of an upper limb rehabilitation program on the quality of life in patients who had been first diagnosed breast cancer and subsequently underwent mastectomy., Data Sources: This randomized controlled trial enrolled 48 breast cancer patients who underwent mastectomy at a medical center in Taiwan. The patients were randomly assigned to either the intervention group (n = 24) or control group (n = 24). The patients in the intervention group participated in a 12-week upper limb rehabilitation program involving face-to-face upper limb rehabilitation education and once-a month monitoring of their upper extremity activity. The control group received standard nursing care. Quality of life was assessed through EORTC QLQ-C30 and QLQ-BR 23 questionnaires at baseline and weeks 4, 8, and 12 after enrollment., Results: Both the intervention and control groups had significantly improved their levels of functioning, symptoms, and quality of life from baseline to week 12 after enrollment. The intervention group showed greater improvements in functioning and symptom levels after the intervention compared to the control group; however, no statistically significant differences were found. Additionally, the levels of global health status/quality of life in both groups gradually increased from baseline to week 12 CONCLUSION: An upper limb rehabilitation program is effective in improving the functioning and symptoms of breast cancer patients who have undergone mastectomy., Implications for Nursing Practice: Patients are encouraged to undergo upper limb rehabilitation in order to improve their functioning, symptoms and quality of life., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Purpose: Heart failure (HF) is a highly recurrent disease with a high sudden death rate and a substantial influence on disease-related quality of life (QOL). Social support, symptom distress, care needs, and meaning in life all have significant impacts on QOL. We hypothesized that meaning in life plays a mediating role in the relationship of social support, symptom distress, and care needs with QOL among patients with chronic HF., Methods: Based on cross-sectional analysis, we recruited 186 HF outpatients who completed structured questionnaires for social support, symptom distress, care needs, meaning in life, and QOL. Structural equation modeling was used to analyze the mediating role of meaning in life in the relationship of social support, symptom distress, and care needs with QOL., Results: The final model showed good model fit. Meaning in life was associated with global QOL (β = 0.18, p = .032). Although symptom distress (β = -0.26, p = .005) and care needs (β = -0.36, p = .021) were negatively associated with global QOL, meaning in life played a partial mediating role between symptom distress and global QOL (β = -0.02, p = .023) and between care needs and global QOL (β = -0.07, p = .030). However, meaning in life played a complete mediating role between social support and global QOL (β = 0.08, p = .047). The model showed that meaning in life, symptom distress, and care needs explained 50% of global QOL., Conclusions: In patients with chronic HF, meaning in life played a mediating role in the relationship of social support, symptom distress, and care needs with QOL. Implementing an intervention to enrich meaning in life may help patients manage the issues caused by symptoms and alleviate their unmet needs., Competing Interests: Conflict of interest No potential conflicts of interest relevant to this article are reported., (Copyright © 2023. Published by Elsevier B.V.)

Purpose: The prevalence of frailty among patients with heart failure is about 45%. Frailty may result in patients' functional decline, falls, disability, and decreased quality of life. Qualitative studies can explore older patients' perceptions of frailty and help patients cope with it. However, a qualitative approach that explores the experience of frailty in older patients living with heart failure is lacking. This study aimed to explore the lived experience of frailty in older patients with heart failure., Methods: This qualitative study applies Giorgi's phenomenological method. Data were collected from October 2019 to August 2020. Thirteen older patients with heart failure aged at least 60 years were recruited using purposive sampling from a medical center in Taiwan. The participants participated in an in-depth interview using a semistructured interview guide., Results: Seven themes were identified: "being reborn at the end of the road but having difficulty recovering", "living with a disease with an ineffable feeling", "feeling like being drained: physical weakness and a dysfunctional body", "struggling with impaired physical mobility and facing unexpected events", "suffering from mental exhaustion", "receiving care from loved ones", and "turning over a new leaf"., Conclusions: Frailty in older patients with heart failure was obscure and difficult to describe. Frailty could be improved by medical intervention, self-management, and social support but was difficult to reverse. Patients with heart failure should be evaluated for frailty using multidimensional assessment tools at first diagnosis and provided frailty-related information so that patients have proper insight into their disease as early as possible., Competing Interests: Conflict of interest None., (Copyright © 2023. Published by Elsevier B.V.)

Background: 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., Aims: This study examined the trajectory of fatigue and its associated factors over time in patients undergoing cardiac surgery., Methods: 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., Results: 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., Conclusion: 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., Relevance to Clinical Practice: Patient education on symptom management, sleep hygiene and family support is suggested to improve fatigue in patients recovering from cardiac surgery., (© 2022 John Wiley & Sons Ltd.)

Background: Rheumatoid arthritis is the most common form of inflammatory arthritis and can lead to pain, joint deformity, and disability, resulting in poor sleep quality and lower quality of life. The efficacy of aromatherapy massage on pain levels and sleep quality among rheumatoid arthritis patients remains unclear., Aims: To investigate the effects of aromatherapy on pain and sleep quality among rheumatoid arthritis patients., Methods: This randomized controlled trial enrolled 102 patients with rheumatoid arthritis from one regional hospital in Taoyuan, Taiwan. Patients were randomly assigned to the intervention (n = 32), placebo (n = 36), or control groups (n = 34). The intervention and placebo groups underwent self-aromatherapy hand massage guided by a self-aromatherapy hand massage manual and video for 10 minutes 3 times a week for 3 weeks. The intervention group used 5% compound essential oils, the placebo group used sweet almond oil, and the control group had no intervention. Pain, sleep quality and sleepiness were measured by using the numerical rating scale for pain, the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale at baseline and at 1, 2, and 3 weeks after the intervention., Results: The intervention and placebo groups had significantly decreased sleep quality and sleepiness scores from baseline to 3 weeks after aromatherapy massage. Compared with the control group, the intervention group showed statistically significant improvement in the sleep quality scores in the first weeks after aromatherapy massage (B = -1.19, 95% confidence interval [CI]: -2.35, -0.02, P =.046), but no statistically significant differences were found in the changes in pain levels from baseline to the three time points., Conclusions: Aromatherapy massage is effective in improving sleep quality in rheumatoid arthritis patients. More studies are needed to evaluate the effects of aromatherapy hand massage on the pain levels of rheumatoid arthritis patients., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Depressive symptoms are common among older adults. This quasi-experimental study aims to examine the effects of a social media intergenerational program on depressive symptoms, intergenerational relationships, social support, and well-being in older adults. This study enrolled 100 older adults who were divided into the intervention group (n=50) and control group (n=50). The intervention group received 5 weeks of the social media intergenerational program. The control group maintained their daily routines. Data were collected using structured questionnaires at baseline and 5 and 9 weeks after enrollment. We found that approximately 35% of older adults had mild to severe depressive symptoms. Compared to the control group, the intervention group exhibited significantly greater improvements in depressive symptoms, intergenerational relationships, social support, and well-being in the fifth week and the ninth week after intervention. Intergenerational social media activities were recommended for older adults to improve their depressive symptoms, and promote intergenerational relationships and well-being., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Frailty is common in older cancer patients undergoing colorectal surgery, but few studies have focused on frailty and its associations in this population., Objective: The aim of this study was to investigate the prevalence of frailty and its associations in older cancer patients undergoing colorectal surgery., Methods: A convenience sample of 88 cancer patients 60 years or older undergoing colorectal surgery was recruited from 1 medical center. Frailty, physical activity, functional status, anxiety, depression, and social support of the patients were assessed before surgery, at discharge post surgery, and at 1 month post surgery., Results: The prevalence of frailty in cancer patients undergoing colorectal surgery was 22.7% before surgery, decreased to 19.3% before discharge, and was 12.7% at 1 month after surgery. The proportion of prefrail patients significantly increased from 47.7% before surgery to 71.1% before discharge and was 64.6% at 1 month after surgery. Frail patients were more likely to be older and unmarried, have a lower albumin level, have lower physical activity, and be more dependent on others than nonfrail patients., Conclusion: Older cancer patients undergoing colorectal surgery were more likely to be prefrail after surgery than before surgery. Assessment of frailty and its associated factors is necessary for older cancer patients undergoing colorectal surgery before and after surgery., Implications for Practice: Frailty may occur in cancer patients after colorectal surgery and is related to malnutrition and low physical activity. Appropriate discharge planning with physical activity tracking and an appropriate diet is encouraged to prevent frailty in cancer patients after colorectal surgery., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Although patients with coronary artery disease can benefit from adequate physical activity, low physical activity levels have been reported among these patients. Gender-based disparities might contribute to variations in physical activity. However, knowledge regarding gender differences in factors associated with physical activity among patients with coronary artery disease is limited., Objective: This study aimed to examine gender differences in factors associated with physical activity in Taiwanese patients with coronary artery disease., Methods: A cross-sectional design was used. A convenience sample of 215 patients with coronary artery disease was recruited from 1 medical center in northern Taiwan. Participants were interviewed using structured questionnaires to obtain information regarding their demographics, physical conditions, physical activity, self-efficacy, social support, and community exercise environment., Results: Only 17.8% of male patients and 20% of female patients reported performing the recommended physical activity level. Men performed more vigorous and work-related activities, whereas women engaged in more household activities. In both genders, physical activity was significantly associated with age, disease symptoms, social support, self-efficacy, and environmental appraisal. Self-efficacy and age were significantly associated with physical activity in the linear regression analysis. Among male patients, physical activity was also related to work status, angina, comorbidity, medication, and hospitalizations, whereas disease duration was associated with physical activity among female patients., Conclusion: Patients of both genders reported low levels of physical activity. Nurses should recognize gender differences in factors associated with physical activity in patients with coronary artery disease and develop individualized physical activity programs to improve patients' physical activity., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Frailty may increase the risk of complications and mortality in patients undergoing cardiac surgery. Few studies on frailty and its associated factors have been conducted in these patients., Objective: The aim of this study was to explore frailty and related factors in patients undergoing cardiac surgery., Methods: A total of 154 patients undergoing cardiac surgery in northern Taiwan were recruited using a longitudinal study design and interviewed using structured questionnaires assessing physical activity, anxiety and depression, and social support before surgery and at 1 month and 3 months after surgery., Results: The prevalence of frailty in patients undergoing cardiac surgery was 16.2%, 20.5%, and 16.6% before surgery and at 1 month and 3 months after surgery, respectively. Frail and prefrail patients undergoing cardiac surgery were more likely to be unemployed, have gout, have a higher New York Heart Association class, have preoperative dysrhythmia, undergo cardiopulmonary bypass, have a lower functional ability, have a higher European System for Cardiac Operative Risk Evaluation score, have a longer anesthesia time, have longer endotracheal tube and extracorporeal circulation times, have longer intensive care unit and hospital stays, have lower hemoglobin and albumin levels, have higher anxiety and depression levels, and have lower Mini-Mental State Examination scores. The significant predictors of prefrailty and frailty included unemployment, the presence of gout, higher New York Heart Association classes, less independence in activities of daily living, lower hemoglobin levels, and higher levels of depression., Conclusions: Frailty was associated with patients' functional status, perioperative conditions and psychosocial factors. Preoperative assessments of frailty and appropriate interventions are needed to improve frailty in patients undergoing cardiac surgery., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Postoperative delirium (POD) is a common complication that may occur from 24 to 72 h after cardiac surgery. Frailty is a chronic syndrome that leads to a decline in physiological reserve and to disability. The associations between frailty and POD are unclear., Aims: To investigate associations between POD and frailty in patients undergoing cardiac surgery and to analyse predictors of POD., Methods and Results: Convenience sampling was used to recruit 152 patients who underwent cardiac surgery in two medical centres in northern Taiwan. Preoperative frailty in these patients was evaluated using Fried's frailty phenotype. Delirium in patients was assessed from postoperative day 1 to day 5 using the confusion assessment method for intensive care units. A total of 152 patients who underwent cardiac surgery included 68 (44.74%) prefrail patients and 21 (13.81%) patients with frailty after the surgery. Ten patients (6.58%) developed delirium after cardiac surgery. The occurrence of delirium peaked at postoperative day 2, and the average duration of delirium was 3 days. A case-control comparison revealed a significant correlation between preoperative frailty and POD. Significant predictors of POD in patients undergoing cardiac surgery included the European System for Cardiac Operative Risk Evaluation II, preoperative arrhythmia, and preoperative anxiety and depression., Conclusion: Preoperative frailty was correlated with POD. Preoperative arrhythmia, anxiety, and depression are predictors of POD. Nurses should perform preoperative assessments of surgical risk and physiological and psychological conditions of patients undergoing cardiac surgery and monitor the occurrence of POD., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.)

Background: Patients with heart failure (HF) experience continuous changes in symptom distress, care needs, social support, and meaning in life from acute decompensation to chronic phases. The longitudinal relationship between these four factors and quality of life (QOL) was not fully explored., Aims: To simultaneously investigate the relationship between all factors and QOL from hospitalization to 6 months after discharge, and the impact of the changes in these factors on QOL at different time points., Methods: A longitudinal design with panel research (4 time points) was used. From January 2017 to December 2019, patients hospitalized due to acute decompensated HF were consecutively enrolled and followed up for 6 months. Patients were interviewed with questionnaires assessing symptom distress, care needs, social support, meaning in life and QOL at hospitalization and 1, 3 and 6 months after discharge., Results: A total of 184 patients completed 6 months of follow-up. From baseline to 6 months, QOL continuously improved along with decreases in symptoms and care needs, but increases in social support and meaning in life. Better QOL was associated with younger age, higher education level, economic independence, less symptom distress and care needs, and stronger meaning in life (p < 0.05). Compared with hospitalization, decreases in care needs and increases in meaning in life at 1, 3 and 6 months were associated with an increase in physical QOL (p < 0.01). The decrease in care needs and increase in meaning in life at 3 months were associated with an increase in mental QOL (p < 0.05). The increase in social support at 6 months was associated with increases in both physical and mental QOL (p < 0.01). Changes in symptom distress were not correlated with changes in QOL from baseline to all time points. In the multivariable analysis, these findings were independent of age, educational level and economic status., Conclusions: Although symptom distress is associated with QOL after acute decompensated HF, QOL cannot be improved only by improvement in symptoms. With differential duration of improvement in each factor, the integration of alleviation in care needs and strengthening in social support and meaning in life might provide additional benefits in QOL., (© 2021. The Author(s).)

Background: Self-care behaviour is important for patients with heart failure to prevent disease progression. More than half of patients have poor self-care behaviour. Self-regulation theory emphasizes that patients need to initiate monitoring of their symptoms, identify their own problems, and perform appropriate self-care behaviour. However, studies focused on interventions based on self-regulation theory for patients with heart failure are limited., Objectives: To investigate the effects of a self-regulation programme on self-care behaviour in patients with heart failure., Design: A randomized controlled trial., Participants and Setting: Eighty-two patients with heart failure were recruited from a cardiovascular outpatient department at a teaching hospital in northern Taiwan., Methods: Participants were randomly assigned to the intervention (n = 41) or control group (n = 41). The intervention group participated in a 4-week self-regulation programme, including one 20-to-30-min, face-to-face individual self-regulation education session and 15- to 20-min telephone follow-up counselling sessions twice per week for four weeks. The control group received only routine outpatient care. Self-care behaviour was measured by the Self-Care of Heart Failure Index at baseline, 4 weeks and 8 weeks after patients were enroled., Results: The intervention group reported improvements in self-care behaviours, including self-maintenance and self-confidence subscale scores, after four weeks of the self-regulation programme. In contrast, the control group showed no significant differences. Compared with the control group, the intervention group exhibited significantly greater improvements in self-care maintenance (B = 3.74, p = 0.01), self-care management (B = 6.33, p = 0.004), and self-care confidence (B = 5.15, p = 0.003) at four weeks but showed significantly greater improvements only in self-care management (B = 6.97, p = 0.03) and self-care confidence (B = 6.24, p = 0.001) at 8 weeks., Conclusions: This study confirmed that a self-regulation programme could effectively improve self-care behaviour in patients with heart failure. Further studies with multicentre randomized controlled trials and larger populations of heart failure patients are necessary to evaluate the effect of this self-regulation programme in various regions and countries. Tweetable abstract: A home-based self-regulation programme could effectively improve self-care behaviour in patients with heart failure., Competing Interests: Declaraion of Competing Interest The authors declare that there is no conflict of interest., (Copyright © 2020. Published by Elsevier Ltd.)

Background: Meaning in life serves as a protective mechanism for coping with persistent, often distressful symptoms in patients with heart failure. However, meaning in life and its associated factors are not adequately explored in patients after acute hospitalisation for heart failure., Aims: To explore the associated factors of meaning in life in patients with heart failure from acute hospitalisation to 3 months post-discharge., Methods: A total of 103 hospitalised patients with heart failure in Northern Taiwan were recruited using a longitudinal study design and interviewed with structured questionnaires including meaning in life, symptom distress, care needs, and social support at hospitalisation, 1 month and 3 months post-discharge., Results: A total of 83 patients completed the 3 months follow-up. The presence of meaning in life significantly increased from hospitalisation to 3 months post-discharge. Decreases in care needs (B=-0.10, P=0.020) and social support (B=-0.18, P=0.016) from hospitalisation to 3 months post-discharge were significantly associated with an increase in the presence of meaning in life, while a decrease in social support was associated with an increase in the search for meaning in life (B=-0.17, P=0.034)., Conclusion: Care needs and social support were pivotal factors for developing meaning in life for patients with heart failure. Assessments of care needs and social support might help strengthen their meaning in life., (© The European Society of Cardiology 2020.)

Background: Sedentary behaviours may be related to factors such as self-efficacy, mood and social support. However, there is a paucity of longitudinal follow-up studies examining factors related to sedentary behaviour from physical-psychosocial perspectives in patients with heart failure., Aims: The purpose of this study was to explore the multidimensional associated factors and impacts of sedentary behaviour in heart failure patients., Methods: A longitudinal design was used. A convenience sample of 128 heart failure patients recruited from two large medical centres in northern Taiwan was obtained. Patients were interviewed with structured questionnaires to assess physical activity, symptom distress, exercise self-efficacy, anxiety and depression, social support, sleep quality and quality of life before discharge and at 3 and 6 months after discharge., Results: Heart failure patients reported low physical activity and tended to be sedentary. Sedentary behaviour was gradually reduced from hospitalization to 6 months after discharge. Sleep quality, quality of life, analgesic use, symptom distress and exercise self-efficacy were significant associated factors that explained 42.1-51% of the variance in sedentary behaviour. Patients with high sedentary behaviour had significantly greater depression and poorer sleep and quality of life than those with low sedentary behaviour at hospitalization and showed a significant improvement in depression at 3 and 6 months after discharge., Conclusion: Sedentary behaviour is common in heart failure patients and has impacts on depression and quality of life. An appropriate physical activity programme focusing on disease self-management and enhancing self-efficacy is needed for heart failure patients to improve their sedentary behaviour and quality of life.

Many older adults are unable to use social media, which may affect their social support and intergenerational relationships and cause depression. To examine this impact on older Taiwanese adults, we used purposive sampling, a cross-sectional, correlational study design, and a structured questionnaire to collect data on participants' characteristics, social media usage, social support, intergenerational relationships, and depressive symptoms. We studied 153 older adults (aged 60 years and above) and found higher levels of depressive symptoms among participants who took medication, did not exercise regularly or participate in leisure activities, experienced poor health and sleep quality, and had poorer functional ability compared to their counterparts. Depressive symptoms were significantly associated with social media usage, social support, and intergenerational relationships. We recommend considering risk factors and offsetting depressive symptoms by promoting the use of social media and regular exercise to increase social interactions, social support, and intergenerational relationships among older adults., Competing Interests: Declarations of Competing Interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Heart failure is a complex syndrome that causes substantial functional impairment and poor outcomes. Although multidisciplinary disease management programmes are effective, the role of additional outpatient-based exercise training and the effects of multidisciplinary disease management programmes for patients with contraindications to exercise training are unclear., Objectives: To compare the effects of the multidisciplinary disease management programme with and without exercise training on heart failure-related rehospitalization, disease knowledge, and functional capacity., Design: Secondary analysis of a randomized controlled trial., Participants and Setting: Data for 212 patients hospitalized for heart failure at a local teaching hospital in Taiwan were analysed., Methods: Patients' data were assigned to three groups: control (n = 71), multidisciplinary disease management programme without exercise training (n = 70) or multidisciplinary disease management programme with exercise training (n = 71). The multidisciplinary disease management programme included comprehensive assessments, individualized education, optimizing medications, pre-scheduled clinic visits, and encouraging regular physical activity at home. Outpatient-based exercise training was performed only in the multidisciplinary disease management programme with exercise training group. The control and the multidisciplinary disease management programme without exercise training groups were further divided into subgroups with and without contraindications to exercise training. Patients were followed up monthly for heart failure-related rehospitalizations for 1 year. Cox proportional hazard models and Kaplan-Meier analyses were used to identify the significant predictors of heart failure-related rehospitalizations. A generalized estimation equation model was used to analyse the secondary outcomes, including disease knowledge and 6-min walking distance at baseline and 6 and 12 months after discharge., Results: At 12 months after discharge, the multidisciplinary disease management programme with and without exercise training groups had significantly lower heart failure-related rehospitalization rates and better disease knowledge compared with the control group (p < 0.01). Only the multidisciplinary disease management programme with exercise training group had a significant improvement in 6-min walking distance (p < 0.05). For patients with contraindications to exercise, the multidisciplinary disease management programme significantly reduced heart failure-related rehospitalization rates at 12 months after discharge (p < 0.05). For those without contraindications, the event-lowering effect was only noted for the multidisciplinary disease management programme with exercise training group (p < 0.05)., Conclusions: Outpatient-based exercise training is recommended to be incorporated into multidisciplinary disease management programmes for patients without exercise contraindications to improve disease outcomes and functional capacity. For patients with contraindications to exercise, a multidisciplinary disease management programme is recommended to improve patient outcomes., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Aims: The purpose of this study was to examine the effects of Baduanjin exercise on fatigue and quality of life in patients with heart failure., Methods: The study was a randomized controlled trial. Participants diagnosed with heart failure were recruited from two large medical centers in northern Taiwan. Participants were randomly assigned to the intervention ( n=39) or control ( n=41) groups. Patients in the intervention group underwent a 12-week Baduanjin exercise program, which included Baduanjin exercise three times per week for 12 weeks at home, a 35-minute Baduanjin exercise demonstration video, a picture-based educational brochure, and a performance record form. The control group received usual care and received no intervention. Fatigue and quality of life were assessed using a structural questionnaire at baseline, four weeks, eight weeks, and 12 weeks after the intervention., Results: Participants in the Baduanjin exercise group showed significant improvement in fatigue ( F=5.08, p=0.009) and quality of life ( F=9.11, p=0.001) over time from baseline to week 12 after the intervention. Those in the control group showed significantly worse fatigue ( F=3.46, p=0.033) over time from baseline to week 12 and no significant changes in quality of life ( F=0.70, p=0.518). Compared to the control group, the exercise group demonstrated significantly greater improvement in fatigue and quality of life at four weeks, eight weeks, and 12 weeks., Conclusions: This simple traditional exercise is recommended for Taiwanese patients with heart failure in order to improve their fatigue and quality of life.

Objective: This study investigated whether multidisciplinary disease management programs (MDPs) exert the same effects in heart failure (HF) patients across risk levels stratified by galectin-3 (Gal-3) level and what factors are associated with inadequate effectiveness of MDP., Methods: We used a longitudinal follow-up design based on a previous randomized trial. A total of 355 stabilized hospitalized HF patients were enrolled. The effects of MDP on death and HF-related rehospitalization were analyzed according to Gal-3 levels., Results: During the 4-year follow-up, Gal-3 levels predicted mortality and composite events ( p < .001). Multivariable analysis demonstrated the event-lowering effect of MDP (hazard ratio [HR] = 0.49, p = .001 for death and HR = 0.50, p < .001 for composite events). However, the effect of MDP was inadequate for those with high Gal-3 levels (≥17.9 ng/ml), whose 4-year composite event rate was 43% in the MDP arm. Further analysis showed that, in patients with Gal-3 ≥ 17.9 ng/ml, the independent factors associated with a high composite event rate were no MDP, older age, worse New York Heart Association functional class, no angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker use, higher predischarge natriuretic peptide levels, and wider QRS complexes., Conclusions: The effectiveness of MDP for HF patients at high risk was inadequate. Our findings identified the characteristics of these MDP nonresponders. Better integration of advanced care plans based on strategies guided by Gal-3 level is needed to improve care quality.

Purpose: To compare the prevalence and predictors of depression in Taiwanese and American older patients with arthritis., Design and Methods: A secondary analysis was conducted to assess 151 Taiwanese and 70 American arthritic patients in Taipei, Taiwan and Chicago, USA., Findings: The prevalence of depression of Taiwanese and American older arthritic patients was 34% and 40%, respectively. Depression was explained by life satisfaction and functional ability in Taiwanese patients, and by life satisfaction and level of pain in American patients., Practice Implications: Nurses should assess patients' level of pain and functional ability, as well as their life satisfaction and depression., (© 2015 Wiley Periodicals, Inc.)

Background: Poor health-promoting behaviors increase the risk of chronic disease and disability in older adults. Nevertheless, the predictors of health-promoting behaviors and their relationship with metabolic syndrome have been poorly characterized in older Taiwanese adults., Objective: To explore the determinants of health-promoting behaviors in community-dwelling older adults in Taiwan and the relationship of health-promoting behaviors with metabolic syndrome., Methods: A cross-sectional design was used. A convenience sample of 200 community residents aged 60 years and over was recruited from two large communities in New Taipei City, Taiwan. Data collection included physical examination and a structured questionnaire including measures of health status, health-promoting behaviors, self-efficacy, social support, and metabolic syndrome., Results: Metabolic syndrome was found in 60% of older Taiwanese adults. These participants had higher scores in interpersonal relationships but lower scores in physical activity. Half of the health-promoting behaviors were explained by behavior-specific cognitions and affect, and 44% of behavior-specific cognitions and affect was explained by the health status of the older adult., Conclusions: Physical activity should be promoted in older Taiwanese adults. Positive behavior-specific cognitions and affect and better health status might impact the health-promoting behaviors of these adults., (© The Author(s) 2016.)

Background: Up to 74% of patients with heart failure report poor sleep in Taiwan. Poor symptom management or sleep hygiene may affect patients' sleep quality. An effective educational programme was important to improve patients' sleep quality and psychological distress. However, research related to sleep disturbance in patients with heart failure is limited in Taiwan., Objectives: To examine the effects of a tailored educational supportive care programme on sleep disturbance and psychological distress in patients with heart failure., Design: randomised controlled trial., Participants and Setting: Eighty-four patients with heart failure were recruited from an outpatient department of a medical centre in Taipei, Taiwan. Patients were randomly assigned to the intervention group (n=43) or the control group (n=41)., Methods: Patients in the intervention group received a 12-week tailored educational supportive care programme including individualised education on sleep hygiene, self-care, emotional support through a monthly nursing visit at home, and telephone follow-up counselling every 2 weeks. The control group received routine nursing care. Data were collected at baseline, the 4th, 8th, and 12th weeks after patients' enrollment. Outcome measures included sleep quality, daytime sleepiness, anxiety, and depression., Results: The intervention group exhibited significant improvement in the level of sleep quality and daytime sleepiness after 12 weeks of the supportive nursing care programme, whereas the control group exhibited no significant differences. Anxiety and depression scores were increased significantly in the control group at the 12th week (p<.001). However, anxiety and depression scores in the intervention group remained unchanged after 12 weeks of the supportive nursing care programme (p>.05). Compared with the control group, the intervention group had significantly greater improvement in sleep quality (β=-2.22, p<.001), daytime sleepiness (β=-4.23, p<.001), anxiety (β=-1.94, p<.001), and depression (β=-3.05, p<.001) after 12 weeks of the intervention., Conclusion: This study confirmed that a supportive nursing care programme could effectively improve sleep quality and psychological distress in patients with heart failure. We suggested that this supportive nursing care programme should be applied to clinical practice in cardiovascular nursing., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Aim: This study aims to describe health-promoting behaviors and their predictors in patients with coronary artery disease., Background: Health-promoting behaviors may improve quality of life and reduce cardiac mortality yet more than 80% of heart patients fail to maintain their health-promoting behaviors., Methods: This cross-sectional study recruited 200 patients with coronary artery disease from a medical center in Taiwan. Instruments were used to measure health-promoting behaviors, cognitions and affect, social support, and quality of life. Hierarchical multiple regression analysis was performed to examine the predictive variables on health-promoting behaviors., Results: Participants demonstrated a moderate level of health-promoting behaviors with a lowest mean score on the physical activity subscale; 40.6% of variance of health-promoting behaviors was predicted by no smoking, no obesity, perceived risk factors, self-efficacy, perceived control of health, and family support., Conclusions: Health-promoting behaviors were affected by multidimensional factors including cognitions and affect variables and social support., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Fatigue is a common symptom in patients with heart failure that is easy to ignore. In addition, fatigue may affect patients' physical function and psychosocial conditions that can impair their quality of life. An effective nursing care programme is required to alleviate patients' fatigue and improve their quality of life., Aim: To investigate the effects of a supportive educational nursing care programme on fatigue and quality of life in patients with heart failure., Methods: A randomised controlled trial design was used. Ninety-two patients with heart failure were randomly assigned to an intervention group (n=47) or a control group (n=45). The patients in the intervention group participated in 12 weeks of a supportive educational nursing care programme including fatigue assessment, education, coaching self-care and evaluation. The intervention was conducted by a cardiac nurse during four face-to-face interviews and three follow-up telephone interviews. Fatigue and quality of life were assessed at the baseline and 4 weeks, 8 weeks and 12 weeks after enrollment in both groups., Results: The participants in the intervention group exhibited a significant decrease in the level of fatigue after 12 weeks, whereas those in the control group exhibited no significant changes. Compared with the control group, the intervention group exhibited a significantly greater decrease in the level of fatigue and significantly greater improvement in quality of life after 12 weeks of intervention., Conclusions: The supportive educational nursing care programme was recommended to alleviate fatigue and improve quality of life in patients with heart failure., (© The European Society of Cardiology 2015.)

Background: Poor sleep quality may have a significant and negative impact on physical and mental health. Poor sleep quality also increases the risk of all-cause mortality. Few studies have explored the sleep quality of community-dwelling older adults in Taiwan., Purpose: This study examined the prevalence of sleep disturbance and potential factors of influence in community-dwelling older people in Taiwan., Methods: We used a cross-sectional design to recruit a total of 160 individuals 60 years of age or older from an urban area in northern Taiwan. All subjects completed a structured questionnaire that included demographic data, physical health status, a social activity/habit survey, as well as the Chinese versions of Barthel's index, Pittsburgh Sleep Quality Index, short form of the Geriatric Depression Scale, the SF-36 Health-Related Quality of Life Survey, and the Physical Activity Scale for the Elderly., Results: Participants reported a rate of sleep disturbance of 41.9%. Sleep disturbance was associated with nocturia and dizziness, hypertension, increased use of medications such as antihypertensives and gastric medicines, poor self-reported functional status, depression, and sedentary lifestyle. Logistic regression showed nocturia, sedentary lifestyle, and mental component summary score as significant predictors of sleep disturbance., Conclusions/implications for Practice: Sleep disturbance should be examined within the context of an individual's physical, mental, and social status. Symptom management education and an active lifestyle are necessary to promote sleep quality in older people.

Background: Sleep disturbance is a major problem for older adults, calling for the development of alternative medicine techniques to help improve sleep quality in this population., Objectives: The purpose of this study was to explore the effectiveness of a Baduanjin exercise program on sleep quality in Taiwanese elderly., Design: A randomized controlled trial, longitudinal research design was employed., Setting and Participants: This study was conducted in an urban area of northern Taiwan. The inclusion criteria for participants were as follows: (1) community-dwelling older adults age 60 years or older; (2) no regular exercise within 6 months; (3) able to communicate; and (4) independent in self-care. Subjects were excluded if they had (1) depression tendency as demonstrated by the Chinese version of the Geriatric Depression Score of eight or higher; (2) impaired mobility; or (3) unstable health status. A total of 202 older people were screened for this study, 87 of whom were eligible according to the inclusion criteria. Of these, 55 completed the 12-week study., Methods: Fifty-five participants were randomly assigned to the exercise group (27) or the control group (28). Those in the exercise group received 12 weeks of Baduanjin exercise training, while those in the control group had no intervention. The Pittsburg Sleep Quality Index was administered to subjects at four time points: before the intervention, and at the 4th, 8th, and 12th week after intervention., Results: Subjects in the Baduanjin exercise group had significantly improved overall sleep quality, subjective sleep quality, sleep latency, sleep duration, sleep efficiency, and daytime dysfunction after 12 weeks of intervention (p<0.001), while those in control group showed no significant difference in sleep quality. Compared with the control group, the Baduanjin exercise group reported significantly better sleep quality after four weeks of intervention which was maintained throughout the 12-week exercise period., Conclusions: This study confirmed that the Baduanjin exercise program can improve sleep quality for Taiwanese community-dwelling older adults. We recommend application of this simple, gentle exercise program in older persons to improve their sleep quality., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Successful rehabilitation of patients after coronary artery bypass grafting (CABG) should include psychosocial outcomes such as sexual activity. However, little has been reported regarding the sexual quality of life of patients after CABG., Objectives: This study aimed to investigate the associations of demographic and disease characteristics, psychosocial factors, and sexual quality of life in patients before and after CABG surgery., Methods: A longitudinal, descriptive design was used. A convenient sample of 70 patients with a diagnosis of coronary artery disease and under preparation for CABG surgery was recruited from the cardiovascular units of a medical center in central Taiwan. Participants were interviewed and completed a structured questionnaire before and 3 months after CABG surgery. Instruments used included EuroSCORE (European System for Cardiac Operative Risk Evaluation), Sexual Knowledge Scale, Spouse Communication Scale, Hospital Anxiety and Depression Scale, Perceived health status, and Sexual Quality of Life Scale., Results: Sexual desire and sexual response of patients were significantly limited after CABG. Before surgery, age, disease duration, and spouse communication were all significant predictors, which explained 33.8% of the variance in the sexual quality-of-life scores. Significant predictors after surgery included sexual knowledge, disease duration, and EuroSCORE, which accounted for 25.6% of the variance of sexual quality of life., Conclusion: This study confirms that CABG surgery may have an impact on patients' sexual quality of life. With the numbers of CABG patients increasing, development of appropriate sexual counseling for cardiac patients is necessary to improve their sexual quality of life.

Aim: To compare the effectiveness of three different oral care protocols in intubated patients., Background: Although oral care is important to improve the oral mucosa integrity in intubated patients, there are few evidence-based nursing protocols to deal with this problem in critical care units., Design: A quasi-experimental design was employed for this study., Methods: Eighty-one orally intubated patients recruited from the intensive care unit of a medical centre in northern Taiwan were employed in this study. Patients were divided into three treatment groups: a control group (n = 27), green tea group (n = 29) and boiled water group (n = 25). Oral mucosal status was monitored using a rating scale for 14 days. All data were analysed by the sas software (version 8.2; SAS Institute, Cary, NC, USA) using descriptive statistics, the Kruskal-Wallis H test and generalised estimating equation regression models., Results: Severity of mucosal change was significantly less on six subscales (labial mucosa, tongue mucosa, gingival colour, gingivitis, salivary status and amount of dental plaque) in the boiled water group than the control group (p < 0·05). In addition, severity was significantly less on two subscales (salivary status and amount of dental plaque) in the green tea group than the control group (p < 0·05)., Conclusions: Both boiled water and green tea oral care protocols may improve mucosal status of orally intubated patients. Mucosal status was significantly more improved by oral care with boiled water than by oral care with green tea., Relevance to Clinical Practice: Because oral care plays an important role in improving mucosal status, nurses are urged to find new effective oral care methods to further reduce the occurrence of oropharyngeal colonisation and ventilator-associated pneumonia in intubated patients., (© 2010 Blackwell Publishing Ltd.)

Aims and Objectives: The purpose of this study was to examine the level of fatigue perceived by patients with heart failure and to explore the potential factors influencing fatigue., Design: A cross-sectional, correlational design was used., Methods: A convenience sample of 105 patients was recruited between July and September 2003 in northern Taiwan. The patients were interviewed, and their perceived fatigue was assessed with the modified Piper Fatigue Scale. The factors influencing fatigue were determined using a stepwise linear regression model., Results: The majority of patients with heart failure experienced mild-to-moderate fatigue. Patients with higher levels of fatigue had worse physical functioning and more severe symptomatic and psychological distress. Symptomatic distress, psychological distress (depression and anxiety), New York Heart Association class, activities of daily living (ADL) and appraisal support by health care providers could explain 57.4% of the total variance of fatigue. Symptomatic distress was the strongest predictor of fatigue., Conclusion: Higher levels of fatigue were found in patients with heart failure who had symptomatic or psychological distress. Additional research focusing on developing effective methods to reduce fatigue in patients with heart failure is recommended., Relevance to Clinical Practice: Nurses should help patients with heart failure to monitor their symptoms and report them to health care providers. Early management of symptoms and support by health care providers may reduce patients' fatigue, help maintain their physical functioning and improve their quality of life.

Background: Studies have demonstrated that improvement in cardiovascular risk factors may contribute to reduced coronary artery disease (CAD) morbidity and mortality, improved patient outcomes, and lower medical costs associated with treating heart disease., Purpose: The purpose of this study was to understand the coronary risk factor profile, to have the knowledge of risk factors, to understand the modifying behaviors, and to understand the factors associated with modifying behaviors of cardiovascular risk factors among patients with CAD in northern Taiwan., Methods: A cross-sectional design was used in this study. Using nonprobability sampling, 156 patients diagnosed with CAD were interviewed and asked to complete a structural questionnaire in cardiovascular clinics at three medical centers in northern Taiwan. Data were analyzed by descriptive analysis, Pearson's correlation, chi-square tests, and stepwise multiple regression., Results: A total of 38% of variance of modifying behaviors was explained by self-efficacy, actual risk factors, work status, and health beliefs. Self-efficacy was the strongest predictor of behavior to modify cardiovascular risk factors. Age and type "A" personality were the two leading cardiovascular risk factors for the participants. Most participants could perform modifying behaviors such as taking medications, eating an appropriate diet, and following specific lifestyle recommendations. However, participants had relatively lower adherence to monitoring blood pressure, exercising regularly, and controlling weight., Conclusions/implications for Practice: Nurses should assess patient cardiovascular risk factors, health beliefs, and self-efficacy and then provide comprehensive and adequate instruction to each based on his or her specific risk factors.

Aim: This study aims to investigate the prevalence of disability, factors influencing disability and pain self-management techniques employed by older arthritis patients in Taiwan., Background: Arthritis is the most common chronic disease in older people. It may result in pain, stiffness and joint deformity, which ultimately lead to disability. Understanding the factors influencing disability is needed to help arthritis sufferers to achieve optimal health status., Design: A cross-sectional design was employed for this study., Methods: One hundred and fifty-one older persons diagnosed with either rheumatoid arthritis or osteoarthritis were interviewed in the rheumatology clinics located in two medical centres in northern Taiwan. Six questionnaires were administered: Barthel Index, Instrumental Activity of Daily Living, Rapid Assessment of Disease Activity in Rheumatology, the Chinese version of Pain Management Inventory, Geriatric Depression Scale and Life Satisfaction Index., Results: Disability was found in 11% of Taiwanese individuals diagnosed with either rheumatoid arthritis or osteoarthritis. Those in disability reported more severe disease activity, pain, depression and lower life satisfaction. Hierarchical multiple regression analysis revealed that 31-46% of the total variance of disability could be explained by age, gender, marriage, joint pain score, diagnosis, disease activity, depression and pain management. Patients with rheumatoid arthritis had significantly higher levels of disability, disease activity during the preceding six months, more depression and less life satisfaction than patients with osteoarthritis., Conclusion: Higher disability was explained by older age, female, unmarried, diagnosed with rheumatoid arthritis, more joint pain, more disease severity, more depression and more use of pain management strategies in arthritis patients., Relevance to Clinical Practice: Nurses are urged to recognise the individual differences among the factors that are thought to contribute most to disability. An individualised, multidimensional and comprehensive treatment plan with informational support is essential to maximise pain management skills of arthritic older people to achieve improvement in pain, level of disability and mental health.

The purpose of this study was to explore the roles of continuing supportive care in increasing the social support and reducing the perceived uncertainty among women newly diagnosed with breast cancer in Taiwan. A longitudinal, quasi-experimental design was used in this study. Sixty-one women younger than 60 years, newly diagnosed with breast cancer and undergoing surgery, were recruited from 2 urban teaching hospitals in northern Taiwan. The experimental group was provided with additional continuing supportive care for 3 months. Two instruments, including the Social Support Questionnaire and an uncertainty questionnaire, were administered to participants at 3 time points: presurgery within 2 weeks after diagnosis, 1 month after surgery, and 3 months after diagnosis. The experimental group reported significantly higher social support and lower disease uncertainty compared with the control group at 1 month after surgery and 3 months after diagnosis. With knowledge of the role that continuing-care intervention plays in social support and disease uncertainty, nurses and other healthcare professionals can continue to explore and strengthen strategies to enhance the coping ability of women with breast cancer in Taiwan.