Search

BackgroundWorkplace bullying has been measured in many studies to investigate its effects on mental health issues. However, none have used web-based computerized adaptive testing (CAT) with bully classifications and convolutional neural networks (CNN) for reporting the extent of individual bullying in the workplace. ObjectiveThis study aims to build a model using CNN to develop an app for automatic detection and classification of nurse bullying-levels, incorporated with online Rasch computerized adaptive testing, to help assess nurse bullying at an earlier stage. MethodsWe recruited 960 nurses working in a Taiwan Ch-Mei hospital group to fill out the 22-item Negative Acts Questionnaire-Revised (NAQ-R) in August 2012. The k-mean and the CNN were used as unsupervised and supervised learnings, respectively, for: (1) dividing nurses into three classes (n=918, 29, and 13 with suspicious mild, moderate, and severe extent of being bullied, respectively); and (2) building a bully prediction model to estimate 69 different parameters. Finally, data were separated into training and testing sets in a proportion of 70:30, where the former was used to predict the latter. We calculated the sensitivity, specificity, and receiver operating characteristic curve (area under the curve [AUC]), along with the accuracy across studies for comparison. An app predicting the respondent bullying-level was developed, involving the model’s 69 estimated parameters and the online Rasch CAT module as a website assessment. ResultsWe observed that: (1) the 22-item model yields higher accuracy rates for three categories, with an accuracy of 94% for the total 960 cases, and accuracies of 99% (AUC 0.99; 95% CI 0.99-1.00) and 83% (AUC 0.94; 95% CI 0.82-0.99) for the lower and upper groups (cutoff points at 49 and 66 points) based on the 947 cases and 42 cases, respectively; and (2) the 700-case training set, with 95% accuracy, predicts the 260-case testing set reaching an accuracy of 97. Thus, a NAQ-R app for nurses that predicts bullying-level was successfully developed and demonstrated in this study. ConclusionsThe 22-item CNN model, combined with the Rasch online CAT, is recommended for improving the accuracy of the nurse NAQ-R assessment. An app developed for helping nurses self-assess workplace bullying at an early stage is required for application in the future.

BackgroundWorkplace bullying is a prevalent problem in contemporary work places that has adverse effects on both the victims of bullying and organizations. With the rapid development of computer technology in recent years, there is an urgent need to prove whether item response theory–based computerized adaptive testing (CAT) can be applied to measure exposure to workplace bullying. ObjectiveThe purpose of this study was to evaluate the relative efficiency and measurement precision of a CAT-based test for hospital nurses compared to traditional nonadaptive testing (NAT). Under the preliminary conditions of a single domain derived from the scale, a CAT module bullying scale model with polytomously scored items is provided as an example for evaluation purposes. MethodsA total of 300 nurses were recruited and responded to the 22-item Negative Acts Questionnaire-Revised (NAQ-R). All NAT (or CAT-selected) items were calibrated with the Rasch rating scale model and all respondents were randomly selected for a comparison of the advantages of CAT and NAT in efficiency and precision by paired t tests and the area under the receiver operating characteristic curve (AUROC). ResultsThe NAQ-R is a unidimensional construct that can be applied to measure exposure to workplace bullying through CAT-based administration. Nursing measures derived from both tests (CAT and NAT) were highly correlated (r=.97) and their measurement precisions were not statistically different (P=.49) as expected. CAT required fewer items than NAT (an efficiency gain of 32%), suggesting a reduced burden for respondents. There were significant differences in work tenure between the 2 groups (bullied and nonbullied) at a cutoff point of 6 years at 1 worksite. An AUROC of 0.75 (95% CI 0.68-0.79) with logits greater than –4.2 (or >30 in summation) was defined as being highly likely bullied in a workplace. ConclusionsWith CAT-based administration of the NAQ-R for nurses, their burden was substantially reduced without compromising measurement precision.

Aims and Objectives: To examine the current status of dementia care competence of nurses working in acute care settings as well as the relationship between competence and demographic attributes. Background: Most people with dementia are older individuals when they are admitted to unfamiliar acute care settings for treatment, and they are prone to displaying BPSD. If nurses working in acute care settings are not sufficiently competent in dementia care, providing proper patient care is difficult. Design: The study used a one‐sample descriptive‐correlation design. Methods: This study enrolled nurses at two medical centres in southern Taiwan as the research participants and performed a stratified random sampling according to the units where they served. The Dementia Care Competence Scale was used for data collection. An independent samples t test, ANOVA and Pearson's product–moment correlation were performed for data analysis (See STROBE). Results: A total of 308 valid questionnaires were collected. The results showed that dementia care competence of nurses working in acute care settings was moderate. In particular, they had insufficient knowledge of the special needs related to dementia and lacked the skills and patience necessary for identifying, preventing and managing BPSD. Additionally, although the nurses tended to have a positive attitude, they seldom communicated with people with dementia. This study also found that dementia care competence was better in nurses who were older, who had more seniority, who had taken care of people with dementia for a longer period of time and who had received training in dementia care. Conclusions: Dementia care training topics for nurses working in acute care settings should include palliative care for dementia, skills for managing behavioural and psychological symptoms of dementia and communication techniques for improving person‐centred care. Nurses should also be encouraged to maintain a warm, friendly attitude when providing patient care. Relevance to Clinical Practice: Continuing education in managing behavioural and psychological symptoms of dementia is necessary for currently practicing acute care nursing staff and should be developed according to the staff's educational background and needs. [ABSTRACT FROM AUTHOR]

Further studies regarding the potentiometric response to heparin of polymeric membranes doped with lipophilic quaternary ammonium salts are reported. Among a wide range of membrane formulations examined, optimum response toward macromolecular heparin is achieved using tridodecylmethylammonium chloride as the active membrane component within poly(vinyl chloride) or poly(vinyl chloride)/(vinyl acetate) films plasticized with dioctyl sebacate. Although such membranes are shown to exhibit a typical Hofmeister potentiometric selectivity pattern toward small inorganic and organic anions, a very large and reproducible response to heparin at submicromolar levels is observed in the presence of physiological saline (0.12-0.15 M NaCl), as well as in citrated whole blood. Equal response on a mass basis occurs with fragments of heparin as small as 2500 Da. Complexation of heparin's anionic sites by macromolecules that bind heparin with high affinity (e.g., protamine and poly(L-lysine)) reduces the membrane electrode's heparin response, indicating that the electrode detects biologically available (unbound) heparin levels in solution. Quantitative potentiometric titrations of protamine with porcine mucosa heparin followed by the sensor yield stoichiometric values in good agreement with the literature. The biomedical utility of the sensor is demonstrated by measuring its response in whole blood from patients undergoing open heart surgery before and after heparin therapy and correlating such response to conventional blood clotting time measurements.

The incorporation of tridodecylmethylammonium chloride (TDMAC) into ion-selective electrodes results in the fabrication of a viable heparin-selective electrochemical sensor. The TDMAC's strong heparin-associative property facilitates the role of the compound as a carrier for heparin molecules. The structure of the quaternary ammonium salt used in forming the electrode affects the magnitude of the potentiometric response of the membrane to heparin. The electrode's heparin detection occurs within two to five minutes at therapeutic doses of one to ten units/mL.

Objectives: The aim of the study was to examine the relationship between workplace bullying, mental health and an intention to leave among nurses, and the mediating role of self-efficacy.Material and Methods: This cross-sectional study was conducted among 385 nurses in Taiwan. Data were collected by means of self-report questionnaires, including the Negative Acts Questionnaire-Revised, the General Self-Efficacy Scale, the Chinese Health Questionnaire, and the Employee's Turnover Intentions and Job Destination Choices Scale. Descriptive statistics, Pearson's correlation and hierarchical regression analyses were used.Results: Bullying was found to negatively correlate with self-efficacy and mental health, and positively with an intention to leave. Self-efficacy positively correlated with mental health, and negatively with an intention to leave. Hierarchical regression showed that bullying and self-efficacy were significant predictors of both mental health and an intention to leave. Self-efficacy partially mediated the relationship between bullying and mental health, as well as an intention to leave.Conclusions: Self-efficacy acted as a mediator of workplace bullying, mental health and an intention to leave among nurses. It could protect victims from the devastating effects of bullying behaviors. Int J Occup Med Environ Health. 2019;32(2):245-54. [ABSTRACT FROM AUTHOR]

Background: Workplace bullying is a prevalent problem in contemporary work places that has adverse effects on both the victims of bullying and organizations. With the rapid development of computer technology in recent years, there is an urgent need to prove whether item response theory-based computerized adaptive testing (CAT) can be applied to measure exposure to workplace bullying.Objective: The purpose of this study was to evaluate the relative efficiency and measurement precision of a CAT-based test for hospital nurses compared to traditional nonadaptive testing (NAT). Under the preliminary conditions of a single domain derived from the scale, a CAT module bullying scale model with polytomously scored items is provided as an example for evaluation purposes.Methods: A total of 300 nurses were recruited and responded to the 22-item Negative Acts Questionnaire-Revised (NAQ-R). All NAT (or CAT-selected) items were calibrated with the Rasch rating scale model and all respondents were randomly selected for a comparison of the advantages of CAT and NAT in efficiency and precision by paired t tests and the area under the receiver operating characteristic curve (AUROC).Results: The NAQ-R is a unidimensional construct that can be applied to measure exposure to workplace bullying through CAT-based administration. Nursing measures derived from both tests (CAT and NAT) were highly correlated (r=.97) and their measurement precisions were not statistically different (P=.49) as expected. CAT required fewer items than NAT (an efficiency gain of 32%), suggesting a reduced burden for respondents. There were significant differences in work tenure between the 2 groups (bullied and nonbullied) at a cutoff point of 6 years at 1 worksite. An AUROC of 0.75 (95% CI 0.68-0.79) with logits greater than -4.2 (or >30 in summation) was defined as being highly likely bullied in a workplace.Conclusions: With CAT-based administration of the NAQ-R for nurses, their burden was substantially reduced without compromising measurement precision. [ABSTRACT FROM AUTHOR]

Objectives: To explore burden and its related factors among primary caregivers of patients with cancer., Sample & Setting: This study was conducted in an oncology ward at a medical center in southern Taiwan. A total of 137 dyads of patients with cancer and their primary caregivers were recruited., Methods & Variables: This cross-sectional correlational study used a structured questionnaire to assess the burden of primary caregivers. Data on patients' basic characteristics and disease profiles were extracted from medical records from January to June 2019. Linear regression analysis was used to identify factors associated with the burden of primary caregivers., Results: The majority of primary caregivers were female (70%) and aged younger than 65 years (85%). Overall, the mean primary caregiver burden score was 38.83 (SD = 12.86), with spiritual burden ranking highest among the four domains assessed. Factors related to overall primary caregiver burden included psychiatric symptoms, daily care hours, patient age, and the lack of rotational support., Implications for Nursing: Hospice and oncology nurses can actively identify psychiatric symptoms in primary caregivers, targeting high-risk groups to provide timely resources or psychiatric referrals, aiming to alleviate future caregiver burden.

Workplace bullying is a complicated and imprecise concept. Research findings have highlighted it as an important issue in the nursing environment worldwide. Workplace bullying arises due to malfunctions in workplace organizational and cultural related antecedents and manifests in various forms. Many studies have reported that nurses experiencing workplace bullying face increased levels of physical, psychological and social distress, may adopt suicidal thoughts and negativity towards the nursing profession, and may even abandon the nursing profession completely. Although a large number of papers have discussed the antecedents, forms and interventions related to workplace bullying, there has yet been no systematic concept analysis of workplace bullying. This paper applied Walker and Avant's concept analysis process to verify concept definitions, identify defining attributes, antecedents, and consequences, and provide examples of model, borderline, and contrary cases. Findings can help nursing administrators understand and clarify the meaning of workplace bullying in order to take appropriate measures to improve the working environment for nursing professionals.

Using the nasopharyngeal airway to promote stool drainage is currently limited in general clinical practice. This situation has led to periannal skin care administered by nursing staff not meeting patient expectations for treatment efficacy and speed of recovery. According to previous statistics, the incidence of perianal excoriation was 60.71% in critically ill patients with liquid stool. This project was designed to promote more widespread use of the nasopharyngeal airway to contain watery diarrhea and improve skin lesions. Reasons for not using the nasopharyngeal airway to promote stool drainage identified by the authors included: 1. unclear nursing standards with regard to such procedures; 2. physician resistance to the use of such and 3. lack of education programs related to such procedures. Improvement strategies included: 1. modifying nursing standards with detailed explanations and pictures; 2. earning physician acceptance of such procedures through case conference meetings in ICUs; 3. rescheduling education programs on the implementation of nasopharyngeal airway and skin care for patients with watery diarrhea and 4. establishing case management and nursing consultation systems. Results showed that use of the nasopharyngeal airway increased from an initial 60% to 100% at eight months following project implementation. The perianal excoriation rate fell from 60.71% to 0%. We found that drainage of liquid stool using the nasopharyngeal airway can reduce perianal skin complications. This project may be a valuable reference for other clinical practice to improve care quality.

This study was designed to evaluate the reliability and validity of the Chinese version of the diagnostic and statistical manual (DSM) of mental disorders written by Ely et al as a confusion assessment method for the intensive care unit (CAM-ICU) for diagnosing delirium. Purposive sampling was used to recruit 31 patients in a southern medical center ICU. Data were collected by two interviewers who used CAM-ICU to test inter-rater consistency. DSM served as the delirium diagnosis standard to test CAM-ICU validity and calculate sensitivity and specificity. The inter-rater reliability Kappa value for CAM-ICU applied to delirium diagnosis was .48 (p< .01). The validity PABAK value was .48 (p< .01) and McNemar's test value was p = .72. The sensitivity achieved by the two interviewers was 89%, versus 96% for the doctor. The CAM-ICU is a method that helps ICU nursing staff to detect occurrences of delirium rapidly and easily, permitting early intervention treatment with fewer complications.

Appraisal is a cognitive response by an individual facing an event within a given environment. When the individual has passed through a thought process that gives the event meaning, the coping process is finally completed. Coping heightens an individual's well-being. Negative appraisal will induce an emotional coping response and affect one's quality of life, mental state and health. Several researchers applied the concept of appraisal to their disciplines. The concept of appraisal, however, is poorly defined. This article applies the methodology outlined by Walker and Avant (1995) to analyze the concept of appraisal. The definition of appraisal, examples, and empirical references provided in this paper will be useful in nursing practice in relation to the role of appraisal in coping.