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Younger and adults tend to consume energy drinks due to the benefit received as promoted by the manufacturer. This retrospective, cross-sectional study aimed to investigate factors associated with energy-drink consumption in a group of construction workers in Indonesia. Literate construction workers who have consumed any brand of energy drink at least once per week were recruited. Demographic data and health literacy were self-reported. The short version of the test functional health literacy for adults (S-TOFHLA) tool was used to examine health literacy. Kidney function was determined by an estimated glomerulus filtration rate (EGFR). An average EGFR of 83.76 mL/min/1.73 m2 was retrieved from 114 participants. Health literacy (p=.016), pre-existing disease (p=.001), and intensity (p=.029) showed a significant difference with decreased kidney function. Age of the first-time experiencing energy drinks (r=-0.260) and pre-existing disease (r=-0.282) showed negative significance correlations (p=

Background Patients receiving hemodialysis (HD) often experience multiple symptoms concurrently and these symptoms may impact their quality of life. A valid and reliable tool is needed to assess the symptom distress of patients receiving HD in terms of the perspective of symptom clusters. Although many studies have explored symptom clusters related to patients receiving HD, the clusters formed had problems with overlapping, vagueness, lack of cluster-specificity, and difficulty in discerning their common mechanism under the cluster. Aims To develop reliable measurement tool to identify the symptom clusters of patients undergoing HD. Design A cross-sectional descriptive study. Methods To examine the physiological properties of the HD symptom distress (HSD) scale, 216 participants were recruited from a HD center of a medical university hospital in southern Taiwan from February 2019 to April 2019. Construct validity was evaluated by exploratory factor analysis (EFA), and the internal consistency and test–retest reliability were estimated by Cronbach’s alpha and intraclass correlation coefficient (ICC). Results The CVI value of the HSD was 0.89. The HSD scale was composed of five factors with 22 items, including insufficient energy/vitality, cardiac–pulmonary distress, sleep disturbance, musculoskeletal distress, and gastrointestinal distress, with factor loading ranging from 0.62 to 0.87, explaining 65.5% of the total variance. Cronbach’s alpha coefficient of the HSD total scale was 0.93, and five subscales ranged from 0.73 to 0.89. The test-retest reliability was 0.92 (p Conclusion / implication Theoretical testing from our study indicated that the HSD-22 scale had satisfactory validity and reliability. Therefore, this assessment tool can be employed to identify the symptom clusters of patients receiving HD in the clinical setting. Such identification enables healthcare professionals to provide interventions to release patients’ symptom distress efficiently.

Aim The aim of this study was to probe the rigorousness of the factor structure of the HDSMI and to test the instrument's construct validity. Design Cross‐sectional study. Methods The hemodialysis unit of four hospitals in Taiwan provided data from 628 patients with end‐stage renal disease (ESRD), through the period of September to December in 2012. The patients were divided into a calibration sample for CFA and model modification, and a validation sample for cross‐validation of the postmodification model. Goodness of fit was tested with standard fit indices. Results The four latent variables (i.e. partnership, self‐care, problem‐solving and emotional management) were verified as dimensions of HDSMI through CFA. The construct validity of the HDSMI was improved by omitting two items, allowing one inter‐item correlation and transferring the loading of one item. These modifications improved fit indices of the calibration sample. Cross‐validation of the validation sample verified the construct validity of the modified HDSMI‐18.

Aims and objectives This study aims to explore the current state of self-management behaviours among persons with type 2 diabetes mellitus in the Solomon Islands and to discuss the factors influencing these behaviours. Background The prevalence of diabetes and diabetes complications is increasing in the Solomon Islands. However, the effective diabetes prevention and care are not provided in the country. Design This is a cross-sectional study. Methods A convenience sample of 150 persons with type 2 diabetes mellitus was recruited from a hospital in the Solomon Islands from August 2017-September 2017. Self-report questionnaires were used to measure the self-management behaviours, diabetes knowledge and illness perception. In addition, the study adhered to the EQUATOR checklist, STROBE (see Appendix S1). Results The overall score for self-management was 56.9 ± 13.2 and diabetes knowledge and illness perception, as influencing factors of self-management, earned total scores of 13.3 ± 4.0 and 55.8 ± 12.0, respectively. Stepwise regression analysis identified illness perception, diabetes knowledge and smoking as significant influencing factors, explaining 20.8% of the total variance in self-management. Conclusions The level of diabetes self-management behaviours demonstrated by persons with type 2 diabetes mellitus in this study was rated as less than ideal. Diabetes knowledge and illness perception were the two main factors influencing patient self-management in the Solomon Islands. Relevance to clinical practice The study addressed the current state of the self-management behaviours of persons with diabetes and discussed the factors influencing these behaviours. The findings indicated that knowledge and illness perception of diabetes were the two main factors and provided baseline information for policymakers, health planners and healthcare providers highlighting diabetes as an important issue in Solomon Islands.

Aims and objectives The purpose of this study was to explore the self-management of patients with early-stage chronic kidney disease (CKD) and its influencing factors. Methods A convenient sample of 226 patients with early-stage CKD was recruited from 63 Public Health Centers in Indonesia, from June to September 2020. Demographic characteristics, health literacy, illness perception, self-efficacy and self-management were assessed using self-reported questionnaires. Stepwise multiple linear regression analysis was performed to identify the factors influencing self-management. This study adhered to the EQUATOR checklist, STROBE. Results The mean estimated glomerular filtration rate was 63.45 ml/min/1.73 m2 (standard deviation [SD] = 15.34). The average scores for health literacy, illness perception, self-efficacy and self-management were 32.11 (SD = 4.46), 4.57 (SD = 1.46), 183.64 (SD = 38.23) and 76.92 (SD = 9.45), respectively. The influencing factors were education level, monthly income, family history of comorbidity, health literacy and self-efficacy, which accounted for 45% of total self-management score. Conclusions Indonesian patients with early-stage CKD showed low level of health literacy, but positive illness perception and self-efficacy; these factors significantly affected CKD self-management. Health literacy was found to influence all dimensions of self-management: self-integration, problem-solving, seeking social support and adherence to the recommended regimen. Relevance to clinical practice Adherence to the recommended regimen is the most challenging dimension of CKD self-management. Health literacy was found to be a major determinant of self-management. Improving health literacy and motivation of patients with early-stage CKD may help sustain positive illness perception and self-efficacy, and improve self-management.

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

Aim To identify the 'positive energy' that inspires nurses' retention in the profession. Background Previous studies focused on the negative extrinsic factors associated with nurses leaving the profession. However, scant research explored the personal intrinsic essence regarding why nurses remain in the profession. Method This study used a qualitative descriptive design. Ten focus groups including 53 participants were recruited by purposive sampling from five hospitals in Taiwan. Data were collected between March 2015 and January 2016 through semi-structured focus group interviews. The data were examined by content analysis. Results Six themes were identified, including sense of mission, achievement, passion, meaning of nursing, personal characteristics and intrinsic coping. Conclusion Findings emerged from this study characterizing 'positive energy' as a steady inner strength, not easily changed with the external environment, which inspires the retention of staff nurses. Implications for nursing management The themes identified in this study can be used to develop an instrument for assessing nurses' inner attributes which may help managers recruit nurses possessing 'positive energy' of retention. Future researchers may develop an intervention programme to cultivate nurses 'positive energy' and further test its effect on nurse retention.

Background: Informed consent is essential for the ethical conduct of clinical research and is a culturally sensitive issue. But, a measurable Chinese version of the scale to evaluate the informed consent process has not yet been explored in the existing literature. Research objectives: This study aimed to develop and psychometrically test the Chinese version of the Informed Consent Process Scale. Research design: Back-translation was conducted to develop the Chinese version of the questionnaire. A cross-sectional survey was administered, after which an exploratory factor analysis was conducted. Participants: We recruited a total of 375 participants who had experience in signing an informed consent form within the previous 3 years in Taiwan. Ethical considerations: This study was approved by two Institutional Review Boards and the autonomy of the participants was respected. Findings: The Chinese version of the Informed Consent Process Scale is composed of three factors with 23 items showing evidence of acceptable reliability and validity. Three major factors were extracted and labeled: Factor 1 – ‘Understanding of the research’, Factor 2 – ‘Trust and confidence’ and Factor 3 – ‘Doubt and uncertainty’. The three factors accounted for is 52.954 of the total variance with Cronbach’s α of .917. Discussion and conclusion: The finding corroborates previous studies showing that participants had too little understanding on the informed consent forms they signed and implied the need to clarify the critical points in clinical research. The psychometric results indicated good internal consistency and validity for this newly constructed instrument, and it was found worthy of conducting further testing and application.

Additional file 1.

This review aims to identify attributes of patient-centered self-management (PCSM) in the current literature and explore its implementation in resolving patient obstacles in chronic kidney disease (CKD) treatment and management. A search of relevant articles and literature on PCSM, integrated care, and challenges of CKD management was conducted. Vital attributes of PCSM and current self-management interventions employed to resolve patient obstacles in CKD management were identified from inclusion studies. Findings affirm that PCSM strategies have positive effects on CKD management, but a lack of quality primary study, and long-term evidence presents the need for further development. Future research should focus on the development of a standardized and universal integrated PCSM model and a uniform system of data collection in the clinical setting. The difficulty of CKD management lies in how it is a comorbid and progressive disease. A pure biomedical approach is inadequate. Our review recommends that an integrated PCSM approach with health literacy and information technology intervention, which unifies and integrates patient education, can address the difficulties that are contributing to unsuccessful treatment outcomes. An integrated PCSM model should be implemented systematically and methodologically into future CKD management and health policies.

Wen-Chun Chen,1– 3 Chiu-Chu Lin,2,4,5 Chia-Chi Kuo,6,7 Chia-Chen Wu,8 Tz-Jie Liu,9 Mei-Tsu Chen9 1Department of Community Medicine, St. Martin De Porres Hospital, Chiayi, Taiwan; 2School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan; 3Department of Nursing, Chang Jung University of Science and Technology, Chiayi Campus, Tainan, Taiwan; 4Department of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 5Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 6Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan; 7Department of Nursing, Chang Jung Christian University, Tainan, Taiwan; 8School of Nursing, Fooyin University, Kaohsiung, Taiwan; 9Health Management Center, St. Martin De Porres Hospital, Chiayi, TaiwanCorrespondence: Chiu-Chu Lin Email chiuchu@kmu.edu.twObjective: To improve the quality of peer leader training, this study developed a theory-based self-management training program for older adult peer leaders with diabetes and assessed its feasibility.Background: Current self-management programs are designed mainly to be implemented by healthcare professionals, but healthcare staff may not fully perceive the needs and obstacles of older adults in disease management due to a lack of similar illness experience. To target this problem, peer leaders with successful self-management experiences, similar cultural backgrounds and languages, and related illness experiences are trained to guide and mentor peer patients in self-management programs.Study Design and Methods: This study was conducted in two stages. In stage 1, a peer leader training program was developed based on experiential learning theory as the framework and self-regulation theory as the activity design strategy. In stage 2, program feasibility was assessed via participants’ feedback toward the training program by three indicators: attendance, future willingness to lead the peer-led self-management program, and leadership skills evaluated by a peer leader training assessment tool.Results: In this study, peer leaders demonstrated good leadership skills by expressing active willingness to lead self-management programs in the community. Peer leaders’ feedback indicated that the program’s training content was helpful in preparing peer leaders to guide older adults in learning self-management skills and in improving the abilities and confidence of peer leaders in mentoring self-management.Conclusion: Findings in this study showed that peer leader training can impact the effectiveness and success of self-management in older adults with diabetes. Even in a small-scale study, the impact was evident, which demonstrated the feasibility of the program. More large-scale studies on the effectiveness of various peer leader training programs in diverse disciplines are recommended.Clinical Trials Registry: ClinicalTrials.gov Identifier: NCT04298424 (the Peer-Led Self-Management Program).Keywords: older adult, peer leader, diabetes, theory-based, peer-led, self-management

BACKGROUND eElectronic health (eHealth) chronic kidney disease (CKD) information is readily available over the mobile devices and placed as mobile-health (mHealth) information resources. The field of mHealth on CKD is promising in that it can empower individuals and delay the progress of the disease. OBJECTIVE This study aims to critically review published papers on the eHealth and its implication on mHealth of CKD. METHODS The academic databases EBSCO (CINAHL and PROQUEST), MEDLINE, PubMed, and Cochrane were systematically searched. Eight studies investigated the specific role of mHealth on CKD, including the detailed contents related to the conceptual acceptance and usage of technology in daily life, user, health care professionals, and the system’s bonding, mobile eHealth, content and evaluation of mHealth on CKD. RESULTS The available evidence on mHealth of CKD is limited and the findings indicate a discrepancy of the wording concept of mHealth. Those evidences might be caused by the scarce evidence on the effectiveness of using mHealth on CKD. CONCLUSIONS The limitation on the availability of CKD’s mobile health interventions that focus on patient education, behavior change and prevention contributes to inconsistent usage. Inadequate evidence might interrupt the development of mHealth intervention for individuals with CKD. Our findings illustrate the need on the conceptualizing of mHealth on CKD, acceptance and accessed, content, and evaluation focused on evidence-based will advance the quality of mHealth services, facilitate the continuity of mHealth application, and proposed patient-center-care.

Aims: To develop a theoretical and psychometrical reliable measurement tool to identify the symptom clusters of patients undergoing hemodialysis (HD).Design: A cross-sectional descriptive study.Methods: To examine the psychometric properties of the HD symptom distress (HSD) scale, 216 subjects were recruited from a HD center of medical university hospital in Southern Taiwan from February, 2019 to April, 2019. Construct validity was evaluated by exploratory factor analysis (EFA), and the internal consistency and test–retest reliability were estimated by Cronbach’s alpha and intraclass correlation coefficient (ICC).Results: The HSD scale was composed of five factors with 22 items, including insufficient energy/vitality, cardiac–pulmonary distress, sleep disturbance, musculoskeletal distress, and gastrointestinal distress, with factor loading ranging from 0.62 to 0.87, explaining 65.5% of the total variance. Cronbach’s alpha coefficient of the HSD total scale was 0.93, and five subscales ranged from 0.73 to 0.87. The test-retest reliability was 0.92 (p < 0.001) by using the intraclass correlation coefficient (ICC) for HSD-22 scale.Conclusion: Results indicated that the HSD-22 scale had initial satisfactory validity and reliability. Therefore, this tool can be used to identify the symptom clusters of patients receiving HD.Impact: Patients receiving HD often experienced multiple symptoms concurrently and may impact their quality of life. A valid and reliable tool is needed to assess the symptom distress of patients receiving HD in terms of the perspective of symptom clusters. Although many studies had explored symptom clusters related to patients receiving HD, the clusters form had problems with overlapping, vagueness, lack of cluster-specific, and difficulty in discerning their common mechanism under the cluster. Psychometric testing from our study indicated that the HSD-22 scale can be employed to identify the symptom clusters of patients receiving HD in the clinical setting. Such identification enables healthcare professionals provide interventions to release patients’ symptom distress efficiently.

Background The postoperative nursing intervention with immediate cryotherapy and continuous passive motion (CPM) remains elusive regarding the postoperative pain and range of motion (ROM) for patients undergoing computer-assisted total knee arthroplasty (CAS-TKA). Methods A prospective, randomized controlled trial with a purposive sampling method was utilized. Sixty patients scheduled for a unilateral CAS-TKA at a medical center were randomly assigned to the intervention group (n = 30) and control group (n = 30). The intervention group applied programed cryotherapy and CPM within 1 h while returning to the ward on the day of surgery, while the control group did not. Data were analyzed using mixed models to compare the numeric rating scale (NRS) for pain, ROM, and swelling at postoperative day (POD) 4. Results There was no significant difference in the NRS score between the groups (p = 0.168). The intervention group had significantly higher ROM than the control group (98° vs. 91°, p = 0.004) at POD 4. Although no significant difference in joint swelling was found between groups (p = 0.157), the intervention group had lower mean joint swelling (32.2 cm) than the control group (33.9 cm). Conclusions Immediate programmed cryotherapy and continuous passive motion could help to improve ROM quickly after CAS-TKA. It should be incorporated into the daily nursing plan for patients undergoing CAS-TKA. Trial registration ClinicalTrials.gov, NCT04136431. Registered 23 October 2019—retrospectively registered

Background: Cryotherapy and continuous passive motion (CPM) are commonly used for conventional total knee arthroplasty (TKA) to reduce postoperative pain and increase of the range of motion (ROM). However, this postoperative nursing intervention remains elusive for patients undergoing computer-assisted total knee arthroplasty (CAS-TKA) Methods: A prospective, randomized controlled trial with a purposive sampling method was utilized. Sixty patients scheduled for a unilateral CAS-TKA at a medical center were randomly assigned to the intervention group (n=30) and control group (n=30). The intervention group applied programed cryotherapy and CPM within one hour while returning to the ward on the day of surgery, while the control group did not. Data were analyzed using mixed models to compare numeric rating scale (NRS) for pain, ROM, and swelling at postoperative day (POD) 4. Results: There was no significant difference in the NRS score between the groups ( p = 0.168). The intervention group had significantly higher ROM than the control group (98 degrees vs. 91 degrees, p = 0.004) at POD 4. Although no significant difference in joint swelling was found between groups ( p = 0.157), the intervention group had lower mean joint swelling (32.2 cm) than the control group (33.9 cm). Conclusions: Programmed cryotherapy and continuous passive motion can improve the range of motion after CAS-TKA. It should be incorporated into the daily nursing plan for patients undergoing CAS-TKA.

Background The prevalence of end-stage renal disease in Taiwan is the highest in the world. The rate of signing advance directives in Taiwan is lower than in Western countries, and most of the barriers that have been identified relate to initiating advance care planning (ACP). Purpose This study was designed to explore the barriers to discussing ACP with patients with chronic kidney disease faced by nephrology nurses. Methods A descriptive qualitative study design was adopted. The Consolidated Criteria for Reporting Qualitative Research was used to report the findings of this study. Data were collected using purposive sampling. A total of 34 nephrology nurses were recruited from hospitals in northern (2 groups, 10 participants), central (1 group, 4 participants), and southern (5 groups, 20 participants) Taiwan. A qualitative content analysis was conducted to analyze the transcripts of the eight focus groups. Results Five themes were identified, including (a) lacking the confidence to discuss ACP, (b) difficulty in finding an appropriate opportunity to initiate ACP discussion, (c) personally lacking the characteristics to discuss ACP, (d) conflicting perspectives between doctors and nurses over ACP, and (e) culture and belief-based barriers to discussing ACP. Conclusions/implications for practice The findings obtained from the interviews revealed that nurses must enhance their ACP-related knowledge and communication skills and foster personal confidence in initiating ACP discussions. Furthermore, nurses must be empowered to work with other healthcare professionals. To implement the initial process of discussing ACP in clinical settings, clinical guidelines should be developed for healthcare professionals on initiating ACP. These measures may facilitate improved collaboration in healthcare settings and further encourage patients and their families to participate in shared decision-making that may help patients complete advance directives and thereby achieve better care quality at the end of life.

The lack of knowledge of advance care planning and training of communication skills among nurses in Taiwan is one of the main reasons for the low rate of advance directive signing. However, there is no specific and effective solution to this problem. The purposes of this study were (1) to develop and pilot testing of an advance care planning simulation-based communication training program and (2) to evaluate the feasibility and acceptability of the program. This study was conducted in three phases. Phase 1: Developing an advance care planning simulation-based communication training program; Phase 2: Conducting a pilot test; Phase 3: Evaluating the feasibility and acceptability of the program. Twelve convenient participants from a medical center in central Taiwan were selected. The participants believed that team-based learning was beneficial for several reasons. First, it helped to clarify the participants’ understanding of advance care planning and improve their communication skills. Second, role-playing, as one of the components, was helpful for discovering their own shortcomings in communication skills while debriefing enabled them to identify their blind spots in the communication process. Finally, the reflection log documented their weekly performance so they were able to reflect upon their weekly performance, improve their performance, and become more confident. All twelve participants signed the consent form and completed the whole training program. The participants were satisfied with the program, affirming that the timing and content of the program were appropriate and that the expected learning outcomes could be achieved. According to participant feedback, the program was beneficial in improving their knowledge of advance care planning and confidence in communication. Thus, it is feasible and acceptable to introduce communication of advance care planning programs into the staff training protocols of healthcare organizations. Clinical trial registration: NCT04312295.

The shared decision making (SDM) is an innovative, emerging clinical medical decision model in Taiwan. This model allows patients to understand the possible benefits, hazards, and risks of different treatment options and to choose the treatment option that best aligns with their values and preferences, thereby reducing patients' decisional conflicts. The survival rate of patients with end-stage renal disease (ESRD) has improved, in part due to the rapid development of medical technologies and treatment modalities. However, survival requires that patients face the choice conflicts associated with renal replacement therapy. All of the various renal replacement therapy treatment options impact the physical state of patients, cause changes in their daily life, and undermine their normal work and social roles. Patients often deal with conflict, uncertainty, and hesitation when they engage in making decisions about renal replacement therapy, as the course of treatment is long-term and the effects accompany the patients for the remainder of their life. This article discusses the decisional conflicts of ESRD patients in renal replacement therapy and its influencing factors. The authors propose the SDM approach to renal replacement therapy as a care reference for clinical health professionals.應用共享決策於末期腎臟疾病病人腎臟替代療法的決策衝突.共享決策是台灣近年新興的臨床醫療決策模式，此模式可讓病人了解不同的治療方案可能帶來的益處、傷害和風險，讓最終的選擇更符合自己的價值觀及偏好，進而降低其決策衝突。高品質的醫療服務雖使得末期腎臟疾病病人得到良好的醫療照護而提升其存活率，但也使得病人須面對腎臟替代療法的選擇。腎臟替代療法有不同的治療方式；每一種治療方式可能都對身體造成衝擊，也可能會影響其未來日常生活的變動程度，以及工作、社會角色能否延續等問題。面對這種須終身相伴的治療方式選擇，病人常感受到矛盾、不確定與猶豫而難以做出決定。本文論述末期腎臟疾病病人面臨腎臟替代療法的決策衝突及其影響因素，提出腎臟替代療法的共享決策模式，以供臨床健康專業人員照護病人時之參考。.

Social and economic problems related to population aging are becoming increasingly prevalent in many industrialized nations. Moreover, life-related stresses is causing caregivers to become fatigued and exhausted, with some even choosing to end their life due to their overwhelming burdens of care. Evidence demonstrates that failure to cope effectively with the burdens of care greatly increases the risk of personal physical, mental, and family problems for the caregivers. Therefore, caregiver burden is an increasingly important issue and challenge for the long-term care service system. Positive psychology has been studied widely in recent years, and current related research has focused on exploring caregivers' positive coping experiences. Empirical studies indicate that caregivers overcome crisis because they acquire coping strategies and learn to adjust during the caring process. Furthermore, these articles show the successful handling of caring stress to be highly correlated with resilience. This research examined caregiver's burden and resilience. The findings suggest how nurses may identify the potential of caregivers in the caring processing and what kind of support that nurses should provide to caregivers. Further, this study elaborates on how caregivers build resilience. According to the literature, current nursing interventions should enhance caregiver's resilience. In general, this research aimed to offer a new direction for long-term care based on positive energy and caregiver resilience. It is hoped that this introduction provides insights for healthcare professionals in clinical practices.在逆境中堅強—運用復原力概念於照顧者負荷.人口高齡化在世界各國衍生長期照護、支出增加等社經問題，沈重的生活壓力讓照顧者身心俱疲，甚至有照顧者不堪負荷選擇結束生命。由此可知，照顧壓力全面性地影響照顧者生理、心理以及全家的生活，「照顧負荷」成為健康照護體制中不得不面對的問題與挑戰。近年，正向心理學崛起，照顧負荷的研究逐漸轉為探究照顧者的正向經驗及調適的過程。研究指出照顧者在照護過程中學習因應策略進而渡過危機，他們能成功因應似乎與復原力的展現高度相關。因此，藉由本文可了解照顧者負荷及復原力的內涵，以及護理人員如何在照顧過程中察覺照顧者的復原力潛能，為其提供個別性的協助。最後，文中針對照顧者復原力發展的過程加以說明，並綜整文獻後提出諸項提升照顧者復原力的護理措施。本文提供了一個協助長照壓力下的照顧者，運用正向能量與其復原力的新思維，期盼本文能提供健康照護專業人員之照護參考。.

Background: To identify the gastric cancer burden in Indigenous Taiwanese peoples and conduct a project to evaluate how to reduce the disparities most effectively in Indigenous communities. Methods: First, we quantified the gastric cancer burden for Indigenous peoples using data from Taiwan Cancer and Mortality Registries. Risk factor analyses were carried out based on literature review and data from ongoing mass screening for other cancers. Second, we identified parameters that might be associated with Helicobacter pylori infection or help identify a good eradication strategy. Findings: Gastric cancer incidence (24·4 vs. 12·3 per 100,000 person-years) and mortality rates (15·8 vs. 6·8 per 100,000 person-years) were higher in Indigenous peoples than in non-Indigenous, with 2·19-fold (95% Confidence Interval [CI]: 2·06-2·33) and 2·47-fold (2·28-2·67) increased risk, respectively. Despite similar cancer stage at diagnosis, the survival rate in Indigenous peoples was 9·6% (0·1-20·1%) lower. Helicobacter pylori infection is a well-documented risk factor and smoking for >10 years increased the risk by 26·3% (7·9-47·8%). In Indigenous communities, both H. pylori infection (56·1%, 95% CI: 53·6-58·6%) and smoking (28·4%, 95% CI: 25·7-31·0%) were prevalent. Program eradication rates using clarithromycin-based triple therapy were suboptimal (73·7%, 95% CI: 70·0-77·4%); the habits of smoking (1·49-fold, 95% CI: 1·10-2·02) and betel nut chewing (1·40-fold, 95% CI: 1·03-1·89) were associated with the higher risk of treatment failure. Interpretation: Gastric cancer burden is higher in Indigenous Taiwanese than in their non-Indigenous counterparts. Eliminating risk factors, including H. pylori eradication and smoking cessation, is a top priority to reduce this health disparity. Funding: Health Promotion Administration, Ministry of Health and Welfare, Taiwan. Declaration of Interest: The authors report no conflicts of interest. Ethical Approval: The Research Ethics Committee of National Taiwan University Hospital (201804108RINB) and the Council of Indigenous Peoples in Taiwan (1070056368) approved the protocol for this program. The informed consent has been obtained from each participant.

This qualitative study was designed to identify patients’ experiences and perceptions related to living with late-stage chronic kidney disease. Interviews were held for 15 patients with late-stage chronic kidney disease from two medical centers in Taiwan. Five themes were identified using content analysis: experiencing moderate to severe symptoms and signs; tracing back to causes; realizing the long-term, irreversible nature of the disease; facing the consequence of unavoidable deterioration; and coping with the disease. The findings present the special lived experiences of Taiwanese chronic kidney disease patients and highlight the need for healthcare providers to assess patients’ illness representation before offering interventions for patients coping with chronic kidney disease.

The World Health Organization has promoted age-friendly city (AFC) projects in response to the aging population. Taiwan has also promoted AFC policies. This study was conducted in Taitung County, where 15.37% of the population is older adults in Taiwan. The aim was to understand the perceptions of older adults and service providers with regard to the current status of AFC policies to influence future policies. The participants of this study were older adults and service providers in various regions of Taitung. Quantitative questionnaires were completed by older adults and qualitative interviews were held with focus groups. The older adults were the most satisfied with the AFC domains of &ldquo, respect and social inclusion&rdquo, and &ldquo, community and health services&rdquo, and the least satisfied with &ldquo, transportation&rdquo, civic participation and employment&rdquo, Homogeneity existed between the older adults&rsquo, satisfaction levels in different regions and the service providers&rsquo, opinions, however, there were notable differences between them. Both economic development and the ethnicity of groups in different regions are influential factors that determine the success of government policies. In promoting AFC policies, local governments should consider their applicability based on local conditions and resources to meet the needs of the aging population in rural areas.

Jui-O Chen,1,2,* Jui-Fang Liu,1,3–5,* Yu-qi Liu,6 Yu-Mu Chen,7 Mei-Lien Tu,4 Hong-Ren Yu,8 Meng-Chih Lin,3,7 Chiu-Chu Lin,2 Shih-Feng Liu3,7 1Department of Nursing, Tajen University, Pingtung, Taiwan; 2College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan; 3Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital-Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 4Respiratory Care, Chang Gung University of Science and Technology, Taoyuan, Taiwan; 5Department of Education, National Kaohsiung Normal University, Kaohsiung, Taiwan; 6Department of Intensive Care unit, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China; 7Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 8Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan *These authors contributed equally to this work Purpose: It is unclear whether the effectiveness of pulmonary rehabilitation program (PRP) after cardiac surgery differs between patients with and without COPD. This study aimed to compare the effectiveness of PRP between patients with and without COPD undergoing coronary artery bypass graft (CABG) surgery. Patients and methods: We retrospectively included patients who underwent CABG surgery and received 3-week PRP from January 2009 to December 2013. We excluded patients who underwent emergency surgery, had an unstable hemodynamic status, were ventilator dependent or did not complete the PRP. Demographics, muscle strength, degree of dyspnea, pulmonary function and postoperative complications were compared. Results: Seventy-eight patients were enrolled (COPD group, n=40; non-COPD group, n=38). Maximal inspiratory pressure (MIP; −34.52 cmH2O vs −43.25 cmH2O, P

Aim To synthesize the effects of Internet empowerment-based self-management interventions on adults with metabolic diseases. Background Metabolic diseases are prevalent and burden healthcare systems; they have become a major health problem worldwide. The effects of IESMIs on lifestyle changes have been shown to improve adults' physiological and psychological conditions. However, we found no systematic review evaluating these effects. Design Systematic review and meta-analysis of randomized and non-randomized controlled trials, conducted according to the Cochrane handbook. Data resources A literature search was conducted using the Airiti Library, Association for Computing Machinery, CINAHL, Cochrane Library, Embase, ProQuest, PubMed/MEDLINE and Index of the Taiwan Periodical Literature System databases (earliest-June 2016). Review methods Two reviewers used the Cochrane Collaboration bias assessment tool to assess the methodological quality of included studies. Extracted data were entered and analysed using RevMan 5.3.5 software. Inverse variance was used to estimate effect sizes. Weighted and standardized mean differences with 95% confidence intervals were calculated using a random effects model. Subgroup and sensitivity analyses were performed. Results Twenty-one randomized controlled trials were reviewed. Meta-analysis showed that the intervention significantly improved adults' exercise habits, glycated haemoglobin (HbA1c) levels, body weight, empowerment levels and quality of life. Conclusion The intervention significantly improve the health status of adults with metabolic diseases, in particular their exercise habits, HbA1c levels, body weight, empowerment and quality of life. The intervention provides more convenient and faster access to healthcare for busy individuals with time constraints. These results suggest that healthcare professionals could develop accessible and friendly interactive online interfaces for patients to expand the use of these interventions in the clinical setting.

This study tested the maintenance outcomes of a 3-month Sit Less, Walk More (SLWM) workplace intervention for office workers compared with usual care at 12 months from the baseline.A quasi-experimental study was conducted in two workplaces. The intervention group (n = 51) received multi-component intervention and the comparison group (n = 50) received newsletters only. The outcomes of the study (self-reported psychosocial, physical activity, sitting, and lost productivity; objectively measured cardiometabolic biomarkers) were compared at baseline, 3, and 12 months.Generalized estimating equations analyses found that the intervention group had significant improvements in self-regulation for sitting less and moving more (P = 0.017), walking (P = 0.003), weight (P = 0.013), waist circumference (P = 0.002), and insulin (P = 0.000) at 12 months compared with the comparison group.The SLWM intervention was effective in improving self-regulation, walking, and some cardiometabolic biomarkers in office workers.

Objective PANSS-8 and PANSS-6 are derived from the 30-item Positive and Negative Syndrome Scale (PANSS-30). We investigate whether PANSS-8 or PANSS-6 is a reliable, valid, sensitive to change measure, and scalable, and whether early improvement using them can predict response/remission. Method Data were from 3 trials for 270 schizophrenia inpatients receiving antipsychotics. Internal consistency, validity, sensitivity to change, and scalability using PANSS-30, PANSS-8, and PANSS-6 at each assessment were examined. Early improvement was defined as at least 20% reduction of PANSS-30, PANSS-8, or PANSS-6 scores at week 2. Response was defined as at least 40% reduction of PANSS-30 and remission as a score of PANSS-8 ≤ 3 on each item at endpoint. Receiver operating characteristic analysis was used to determine which rating scale had better discriminative capacity. Results PANSS-8 and PANSS-6 showed acceptable internal consistency, were highly correlated with PANSS-30, and had sensitivity to change. PANSS-8 and PANSS-6 were scalable at each assessment, except for PANSS-6 at baseline. Early improvement using PANSS-8 or PANSS-6 had comparable predictive values with that of PANSS-30 for response/remission. Conclusion PANSS-8 and PANSS-6 are clinically useful measures. Early improvement, regardless of whether PANSS-30, PANSS-8, or PANSS-6 is used, is a statistically significant predictor of response/remission.

Prediabetes mellitus (pre-DM) is an important predictive indicator of Type 2 diabetes. A person with pre-DM is eight times more likely to develop diabetes than a person without pre-DM. Prior research suggests that proactive interventions may delay the progression of this disease and reduce the rate of disease development.The purposes of this preliminary study were to develop a multitheory-driven lifestyle intervention protocol for adults with pre-DM and to evaluate its feasibility and impacts on knowledge regarding pre-DM, dietary behaviors, and physical activity (primary outcomes) as well as to describe the disease progression indicators (secondary outcomes).A single-group, longitudinal study design was used. Thirty-nine participants were included in the analysis. A generalized estimating equation model was used to determine the trends in changes in the outcomes. All of the participants underwent testing at baseline (T0) and at 3 (T1), 6 (T2), and 12 (T3) months after the 4-week lifestyle intervention.There were significantly increasing trends for each study parameter (Pre-DM Knowledge Assessment Form-12, p.01; Dietary Behavior Scale, p.01) and significantly positive changes in body weight (p.01), body mass index (p.01), fasting glucose level (p.01), and glycated hemoglobin level (p.01) over the 12-month study period.This study supports the feasibility of the developed multitheory-driven lifestyle intervention protocol and suggests that its application may improve the effectiveness of diabetes prevention programs in clinical settings. Further randomized controlled trials are needed.

Changes in lifestyle and increasing age are associated with an increased risk of metabolic syndrome. In order to better control the incidence of metabolic syndrome nationwide, healthcare providers must provide age-appropriate care information to their elderly patients that addresses critical factors such as physiological function, social psychology, and emotional and health literacy in order to empower these patients to self-manage their condition and to enhance their self-care-related motivation and confidence. Using peer leaders with relevant experience may be helpful in promoting the learning of self-management skills, as these leaders share backgrounds that are similar to elderly patients in terms of culture and disease-care needs. The present paper proposes a peer-led, self-management program for metabolic syndrome for the elderly that is based on a theoretical framework of self-efficacy. We expect to test this program for effectiveness and feasibility in clinical practice in the future.老年代謝症候群同儕領導自我管理方案之建構 _.隨著國人生活型態改變，導致代謝症候群的發生率隨之增加，而年齡越大，代謝症候群盛行率亦隨之提升。老年患者因生理功能、社會心理、情緒和健康素養之影響，導致在自我管理上缺乏動機及自信。若能透過具成功自我管理經驗且具相同文化背景與疾病照護生活經驗的同儕領導者，引導老年患者學習自我管理技能，更能事半功倍。為改善此現況，故本文將以代謝症候群為例，提出以自我效能理論為基礎的老年代謝症候群同儕領導自我管理方案，期望未來能與研究相結合，進一步測試其成效及可行性，逐步在臨床實務中推廣。.

The aim of this study was to test the short-term efficacy of the Sit Less, Walk More (SLWM) workplace intervention.This was a quasi-experimental design. A total of 99 office workers from two workplaces participated in this study. The 12-week intervention included five components: monthly newsletters, motivational tools, pedometer challenge, environmental prompts, and walking route. The comparison group received monthly newsletters only.Generalized estimating equation analyses showed that the intervention group demonstrated significant improvements in weight (P = 0.029), waist circumference (P = 0.038), diastolic blood pressure (P 0.001), walking (P 0.001), moderate-intensity physical activity (P = 0.014), and total physical activity (P = 0.003) relative to the comparison group. A significant improvement in lost-productivity was observed in both groups (P = 0.003 to 0.008).The SLWM workplace intervention can improve worker health and lost-productivity.

Neurogenic bowel dysfunction is a common comorbidity in spinal cord injury patients that may result in fecal incontinence. Abdominal massage is one intestinal training method that is used to improve bowel movement and defecation.To review the effectiveness of abdominal massage on neurogenic bowel dysfunction in patients with spinal cord injury.A systematic review of Chinese and English-language articles was performed in six databases using the following key words: spinal cord injury, abdominal massage, neurogenic bowel dysfunction, and bowel training. Relevant studies published prior to June 2016 that met the inclusion and exclusion criteria were selected. The Downs and Black scale was used to appraise the quality of each of the included studies. Eight studies were included in the final analysis.Four of these studies indicated that abdominal massage significantly improved bowel functions and the regularity and frequency of bowel movements. Although two of the studies indicated that abdominal massage significantly reduced the use of glycerin and laxatives, the remaining six did not. The eight studies earned respective quality scores ranging between 13 and 25.The current literature lacks consensus on the efficacy of abdominal massage in terms of improving bowel dysfunction in patients with spinal cord injuries. Future studies should use more stringent experimental designs such as randomized controlled studies to explore the correlations among massage time and frequency and bowel function improvements in order to provide guidelines for clinical care applications.腹部按摩於改善脊髓損傷者神經性腸道功能障礙之成效—系統性文獻回顧.神經性腸道功能障礙是造成脊髓損傷病人大便失禁常見的合併症，腹部按摩為腸道訓練的步驟之一，可增進腸蠕動與促進排便。.旨在透過系統性文獻回顧研究方式，探討腹部按摩運用於改善脊髓損傷病人神經性腸道功能障礙之成效。.以系統性文獻回顧方式，運用「脊髓損傷」、「腹部按摩」、「神經性腸道功能障礙」、「腸道訓練」等關鍵字，於中、英文6個資料庫進行搜尋。主要選取截至2016年6月符合納入與排除條件之相關文獻，使用Downs 及 Black量表進行文獻評讀，最後納入8篇文獻進行分析。.有4篇文獻顯示腹部按摩介入後，分別在腸道功能、排便時間與排便頻率上有顯著改善；2篇分別顯示在甘油球與瀉劑使用上獲得顯著改善，另兩篇則無成效。分析文獻品質得分介於13至25分之間。.文獻樣本中，以腹部按摩對改善脊髓損傷病人神經性腸道功能障礙之成效仍不一致。未來應以更嚴謹之實驗性研究設計，例如：以隨機對照研究來探討按摩時間、按摩頻率以及腸道功能改善之關係，以提供臨床照護之指引及運用。.

Obtaining informed consent and ensuring patient autonomy are critical to implementing a patient-centered model of healthcare. Informed consent is a complex process of communication that includes three elements: disclosure, competence in making decisions, and voluntariness. However, individual patient factors, doctor-patient interaction, and cultural issues are known to influence the process of obtaining informed consent. Individual patient factors include the ability of patients to understand and determine their intent; doctor-patient interaction includes communication skills; and cultural issues include the expectations of patients with regard to family involvement in medical decision-making and in decision-making motives. After assessing the relevant influencing factors, healthcare providers typically provide patients with comprehensive information on the benefits and risks of treatment as well as related alternatives. Moreover, healthcare providers typically provide patients with audio/video, Internet, and written information with illustrations based on individual patient needs. In addition to the above, we suggest that healthcare providers proactively adopt the perspective of patients in order to better encourage patients to address questions, to engage with patients in more productive discussions, and to take the initiative to explain and clarify patients' questions in order to minimize anxiety. This approach will help ensure that patients are adequately informed and free from coercion so that they make appropriate healthcare-related decisions. However, even under this optimal situation, healthcare providers must emphasize the needs of their patients and respect their decisions.知情同意於護理臨床實務之運用.社會民主化的提升，以病人為中心的照護模式，是落實知情同意與自主權的主要因素。知情同意是複雜的溝通過程，包括：告知、決定能力、自願三大要素。知情同意是醫病溝通的過程，此過程受到病人因素、病人與醫療互動以及文化議題影響。病人層面與病人理解能力和自主決定意向有關；病人與醫療互動層面，與專業人員溝通技巧有關；文化層面則與病人期待家屬參與醫療決策程度，及家屬參與決策動機有關。醫療人員在評估影響因素，周詳地告知病人利益、可能風險、替代方案後，護理人員應就個別需求，選擇影音視聽、網路資源、附圖的書面資料等多元輔助工具，使病人充分理解訊息內容，以作為同意的基礎。臨床上，護理人員應站在病人的立場，鼓勵提問與討論，主動安排團隊人員進一步說明釐清疑惑以降低焦慮感，讓病人能在完全理解的情況下，不被脅迫地以病人需求為最大考量，尊重他依照自我價值觀做出的最佳健康照護決策。.

Background Management of chronic metabolic diseases has recently become an important global health issue. Extensive research on empowerment-based self-management interventions (EBSMIs) for patients with chronic metabolic diseases has been conducted, but no systematic review has evaluated their effects. Aim To evaluate the effects of EBSMIs on patients with chronic metabolic diseases. Methods A systematic review and meta-analysis was conducted. Five electronic databases (Airiti Library, CINAHL, Cochrane Library, PubMed/ MEDLINE, and Index of Taiwan Periodical Literature System) were searched from the earliest year available to October 2012. Controlled trials about the effectiveness of interventions on patients with chronic metabolic diseases were included. Each study was appraised by three reviewers and assigned a level of evidence based on the modified Jadad scale. Extracted data were entered and analyzed using Review Manager 5.2. Findings Nineteen studies were reviewed. Most studies showed that EBSMIs improved patients’ hemoglobin A1c test (HbA1c) (p < .00001), waist circumference (p = .02), and empowerment level (p = .004). Four studies compared the effect on body weight and body mass index, but the overall effect was not significant (p = .33 and .73, respectively). Five studies compared the effect on self-efficacy, four of which indicated significant increase. However, the overall effect on self-efficacy was not compared because studies used different scales. Linking Evidence to Action EBSMIs improved HbA1c test results, waist circumference, self-efficacy, and empowerment level in patients with chronic metabolic diseases. When implementing the EBSMIs, healthcare institutions need to provide training programs related to empowerment from which health professionals can acquire competence in patient empowerment. Moreover, healthcare leaders should assess and overcome barriers (e.g., time, manpower, cost, etc.) to implementing EBSMIs in clinical settings.

Background: Ice pack therapy has been widely used in treatment for soft tissue injuries. However, no studies have yet explored the most appropriate and effective duration for ice therapy with ice packs.Purpose: This study explored the antiswelling and analgesic effects of different ice pack therapy durations on soft tissue injuries as well as patient discomfort.Methods: An experimental design including pretest and three posttests with three groups was used in this study. Using convenience sampling and randomized block assignment, 99 participants with soft tissue injuries from the emergency department of a medical center in southern Taiwan were included in this study. With 33 participants in each group, three groups with ice pack therapy for 10, 20, and 30 minutes were indicated to compare skin temperature, swelling, and pain differences in ice treated areas as well as participant discomfort.Results: This study found no significant differences in the effect of different ice pack therapy durations among the three groups. However, this study identified significant differences between pretest and each posttest in terms of changes in skin temperature, pain, and numbness and rash-related discomfort in each group.Conclusion/Implications for Practice: Research results found that the three different ice pack therapy durations could lower skin temperature and reduce partial pain. The different ice pack therapy durations would cause similar discomfort incidence rates in the three groups. Ice pack therapy for 10 minutes could reduce partial swelling and pain effectively. Accordingly, we suggest that 10 minutes is the optimal ice pack therapy duration for persons with soft tissue injuries. However, the ice pack therapy duration should be adjusted according to individual needs and situation.

Background Without intervention, renal function deteriorates in patients with chronic kidney disease (CKD). Aim This pilot study aimed to develop a self-management education program based on self-regulation theory and to evaluate its effects on self-efficacy, self-management behavior, and CKD progression among patients with early-stage CKD. Methods In this single-group, pretest–posttest, repeated-measures, longitudinal study, participants underwent baseline pretesting (T 0 ) and posttesting at 3 (T 1 ), 6 (T 2 ), and 12 (T 3 ) months after a 5-week group-session self-management program. Results Self-efficacy increased significantly at T 2 ( χ 2 =8.97, p =.02) and T 3 ( χ 2 =10.71, p =.01) compared with T 0 , but self-management behavior did not. A marginally significant decrease in serum creatinine levels was observed from T 0 to T 3 ( χ 2 =6.29, p =.07) but estimated glomerular filtration rates remained stable throughout the 12-month period. Conclusions The results of this empirical study suggest that the theory-based intervention is feasible and has potential efficacy in retarding CKD progression.

Background: Chronic kidney disease (CKD) is a public health problem worldwide with an increasing incidence and prevalence and high cost. The role of illness perceptions in understanding health-related behavior has received little attention in patients with early-stage CKD. Purpose: This qualitative study aimed to describe the illness representation and coping process experience of patients with early-stage CKD in Taiwan. Methods: A qualitative content analysis approach was used to analyze semistructured, open-ended, one-on-one interviews with 15 patients with early-stage CKD. Purposive sampling was used to recruit patients diagnosed with early-stage CKD from the nephrology departments of two medical centers in Taiwan. Trustworthiness of the study was evaluated using four criteria suggested by Lincoln and Guba. Results: Six themes emerged from the analysis: experiencing early symptoms, self-interpreting the causes of having CKD, realizing CKD as a long-term disease, believing CKD could be controlled by following doctors' orders, anticipating the consequences of having CKD, and adopting coping strategies to delay the progress of CKD. Conclusions/Implications for Practice: Findings from this study compared with previous studies reveal that education can effectively change patient illness representations as an approach to improve coping behavior. This finding offers healthcare professionals insight into the health education necessary to assess patient illness representation to provide culturally sensitive interventions.

Diabetes is a huge problem that has been recognized as an important healthcare issue by most national governments. Diabetes affects patients not only in terms of physical health but also in terms of mental health. Furthermore, the medical costs that are associated with diabetes are considerable. Many countries have developed integrated care models for the treatment of diabetes and pay particular attention to assisting patients that require complicated care. Evidence from empirical studies shows that the integrated care of diabetes reduces complications, increases patients' health literacy, and decreases medical costs. Accordingly, integrated care has been applied to the treatment and care of diabetes patients. In the integrated care model, patients not only receive multidisciplinary care during hospitalization but also receive medical services after their return to the community. There has been a dearth of scholarly discussions in Taiwan related to the integrated care of diabetes. Therefore, we present in this paper the concept of integrated diabetes care and the role of the advanced practice nurse (APN) in the multidisciplinary model. It is hoped that this introduction provides practical insights for healthcare professionals into the essence of integrated care.糖尿病整合照護之概論.糖尿病的照護問題已被多數國家公認為重要的國安議題，除影響病人的身心健康外，醫療支出也相當可觀，未妥善解決甚至會動搖國本，因此歐美各國均積極發展整合照護模式，來協助糖尿病病人複雜的照護需求。實證研究顯示，糖尿病整合照護確實能有效減少併發症發生、提升病人的健康素養及降低醫療花費。利用整合照護的概念，讓病人在醫院療養時，能接受跨團隊、跨領域的整合照護，出院返回社區後，也能受到持續性的醫療服務，來達到疾病控制及預防的目的。目前，我國在糖尿病整合照護之相關論述較欠缺，故本文將針對糖尿病整合照護之概念，及進階護理師於整合照護模式中扮演的角色與職責進行介紹，期此引發健康專業人員有更寬廣之照護觀。.

The aging population and changing lifestyles have lead to the increased general risk of chronic kidney disease. Taiwan currently has the highest incidence and prevalence of end-stage renal disease (ESRD) of any country or region in the world. Hemodialysis patients must endure comorbidities and face the uncertainties of death. The best way to achieve a good death is for patients to sign advance care planning (ACP). However, the key factors contributing to low ACP signature rates have been the lack of communication skills and related training among medical staffs. This article explores the dilemma of ACP using an example of chronic kidney disease (CKD) and proposes a theory-based approach to develop a theoretical framework for an ACP simulation-situation communication training program that integrates the simulation situation model, PREPARED model, and scaffolding theory. Readers may use this framework to design ACP simulation-situation communication training programs that conform to their own conditions and then test the effectiveness and feasibility of these programs in clinical settings.慢性腎臟病患預立醫療自主計畫模擬情境溝通訓練方案之建構.人口老化及生活型態的改變，導致慢性腎臟疾病風險相對提高，台灣末期腎臟疾病的發生率與盛行率在全球均名列前茅，血液透析病人必須承受共病症的折磨及面臨死亡的不確定性，預立醫療自主計畫（advance care planning, ACP）是保障病人善終最佳的方式。然而病人ACP簽署率仍偏低，分析其關鍵因素乃是醫護人員缺乏ACP教育訓練和溝通能力不足，故本文將以慢性腎臟疾病為例，探討臨床推動ACP的困境，並提出以理論為基礎的ACP模擬情境溝通訓練方案的理論架構，此架構係整合模擬情境模式、PREPARED model及鷹架理論等。期望讀者能利用此架構設計合乎自己實況的ACP模擬情境溝通訓練方案，並進一步測試其在臨床實務的成效及可行性。.

“When should we trigger a transfusion?” is always a critical question between the patient’s benefits and risks in red blood cell (RBC) transfusion. A computerized transfusion decision support system (CTDSS) has been used since September 2004 in an academic medical center with 1400 beds. In this study, the factors affecting RBC transfusion were investigated. In total 20,551 RBC-transfusion episodes between January and December 2008 were reviewed. The nearest hemoglobin concentration before transfusion is defined as the transfusion trigger. The physician compliance, the factors associated with the transfusion triggers and posttransfusion hemoglobin increment were investigated. The physician compliance is 83.1%. The transfusion trigger is 8.32±1.84 (mean±standard deviation) g/dL. The transfusion triggers are statistically significant in terms of both different order sources and disease types (p

Aims and objectives. This study aims to develop a valid and reliable chronic kidney disease self-management instrument (CKD-SM) for assessing early stage chronic kidney disease patients’ self-management behaviours. Background. Enhancing early stage chronic kidney disease patients’ self-management plays a key role in delaying the progression of chronic kidney disease. Healthcare provider understanding of early stage chronic kidney disease patients’ self-management behaviours can help develop effective interventions. A valid and reliable instrument for measuring chronic kidney disease patients’ self-management behaviours is needed. Design. A cross-sectional descriptive study collected data for principal components analysis with oblique rotation. Methods. Mandarin- or Taiwanese-speaking adults with chronic kidney disease (n = 252) from two medical centres and one regional hospital in Southern Taiwan completed the CKD-SM. Construct validity was evaluated by exploratory factor analysis. Internal consistency and test–retest reliability were estimated by Cronbach’s alpha and Pearson correlation coefficients. Results. Four factors were extracted and labelled self-integration, problem-solving, seeking social support and adherence to recommended regimen. The four factors accounted for 60·51% of the total variance. Each factor showed acceptable internal reliability with Cronbach’s alpha from 0·77–0·92. The test–retest correlations for the CKD-SM was 0·72. Conclusion. The psychometric quality of the CKD-SM instrument was satisfactory. Research to conduct a confirmatory factor analysis to further validate this new instrument’s construct validity is recommended. Relevance to clinical practice. The CKD-SM instrument is useful for clinicians who wish to identify the problems with self-management among chronic kidney disease patients early. Self-management assessment will be helpful to develop intervention tailored to the needs of the chronic kidney disease population.

Self-management has been associated with positive health outcomes among adults with chronic kidney disease (CKD). Perceived disease-related self-efficacy (DSE) is considered a critical component in the successful self-management of chronic disease. A valid and reliable instrument for measuring CKD patients' self-efficacy is needed. This study aims to develop and test a new instrument to measure the DSE of patients with early stage CKD.A total of 594 Taiwanese patients with early stage CKD recruited from two medical centers and one regional hospital in southern Taiwan completed the questionnaire. The CKD self-efficacy (CKD-SE) was evaluated using exploratory factor analyses (EFA) and measures of reliability.EFA identified four distinct factors with loadings ranging from 0.557 to 0.970: autonomy, self-integration, problem solving and seeking social support, accounting for 64.348% of the total variance. Cronbach's alpha coefficients for the subscales ranged from 0.843 to 0.901.This promising 25-item CKD-SE instrument can be used for the early identification of patients with low DSE, thus allowing the development of interventions to help these patients attain an appropriate level of DSE.

BACKGROUND AND RESEARCH OBJECTIVE Health-related quality of life (HRQOL) has been viewed as the most important clinical outcome of heart failure (HF) management. However, information about the predictors of HRQOL in Taiwanese people with HF is limited, especially for the effects of sleep disturbances on HF. PURPOSE The purpose of this study was to identify predictors of HRQOL in Taiwanese people with HF, especially focusing on the extent to which sleep variables are related to HRQOL. METHODS A cross-sectional, descriptive correlational design was used. A nonprobability sample of 125 participants was recruited from the outpatient departments of 2 hospitals located in southern Taiwan. Participants were face-to-face individually interviewed to complete the Kansas City Cardiomyopathy Questionnaire, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Charlson Comorbidity Index. Data for concomitant health problems and HF characteristics were collected from the medical records. RESULTS The mean Kansas City Cardiomyopathy Questionnaire overall summary score for HRQOL in this sample was 70.50 (SD, 19.63). Health-related quality of life physical symptom had the highest score, and the psychological satisfaction domain had the lowest. Six predictors of the HRQOL were identified by using a 3-step hierarchical multiple regression analysis with forward method. The predictors were education (R² = 0.09), New York Heart Association functional class (R² = 0.398), Charlson Comorbidity Index number (R² = 2.6), subjective sleep quality (R² = 0.037), sleep disturbances (R² = 0.015), and sleep latency (R² = 0.018), and together they accounted for a total of 58.5% of the variance in HRQOL. CONCLUSIONS Nurses should use a holistic perspective to help patients understand and manage the impact of HF on their daily lives. Effective interventions for improving HRQOL should be designed based on patients' needs and lifestyles. The study findings could serve as a baseline for further longitudinal studies to explore the long-term effects of correlates and causal relationships among the variables in this Taiwanese population with HF.

Aim and objective. To examine how prediabetes knowledge, health beliefs and self-efficacy of health behaviour contribute to work site adults adopting a health-promoting lifestyle and to analyse these three factors as independent variables to identify key predictors of adopting health-promoting lifestyles. Background. Health providers use health-promoting lifestyle interventions as the primary approach in preventing diabetes. However, many influential factors make it difficult for individuals to adopt a health-promoting lifestyle. Furthermore, no previous study has examined prediabetes knowledge, health beliefs, self-efficacy of health behaviour and health-promoting lifestyle in work site adults with prediabetes, especially among Asians. Design. This was a cross-sectional study of 260 adults at four work sites in southern Taiwan. Method. Patients with prediabetes were given a cross-sectional questionnaire about prediabetes knowledge, health beliefs, self-efficacy of health behaviour and health-promoting lifestyle. Multiple stepwise regression analysis was used to determine predictors of implementing health-promoting lifestyles. Results. In general, this study found that over age 45 and a BMI above 25 kg/m2 are risk factors for prediabetes. A 47·5% variance in implementing health-promoting lifestyle was explained by a model that included self-efficacy of health behaviour (beta = 0·519, p

Aims and objectives. The purpose of this study was to understand and document the perspectives of Taiwanese patients with type 2 diabetes regarding the processes and strategies used to self-manage their chronic condition. Background. The importance of patients learning self-management through self-regulation has been recognized in the literature, but little of this research has focused on skills to manage symptoms. Besides, studies about how patients self-manage their diabetes in term of patients’ perspectives have been scant. Sociocultural context is also an influencing factor in disease management. Methods. Focus groups were used to collect data from 41 adult participants with type 2 diabetes at three teaching hospitals located in southern Taiwan. The five focus groups ranged in size from six to ten people. The focus groups were recorded, transcribed and analysed. Results. Three themes and ten subthemes were revealed. The first theme ‘the impact of the illness’ includes three subthemes: facing the predicament of stigmatization, concern about inheritance of diabetes and seeking alternative therapy for hope. The second theme ‘self-regulation process’ includes four subthemes: struggling for diet control, adjusting to psychological barriers, identifying body response and developing strategies for dealing with diabetes. The third theme ‘transformation process’ includes three subthemes: resuming conventional illness, support from families and fellow patients and learning to live with the disease. Conclusions. Findings obtained from the themes of the study illustrated that self-management of patients with diabetes is highly related to their own sociocultural environment and experiences. Understanding the cultural features and the meaning of illness can help in the development of interventions tailored to the needs of this cultural group. Relevance to clinical practice. The findings have important implications for healthcare providers to consider individuals’ sociocultural backgrounds in which they make choices about their treatment and manage their illness. This recognition will enhance patients with diabetes to transform being active in self-management through the skills of self-regulation.