Search

To investigate the effect of sensory impairment on quality of life in older adults and to assess the role of physical function as a mediator of the effect of the sensory impairment on quality of life.A cross-sectional study.Older adults aged ≥65 years (N = 600) were recruited from January 2019 to May 2020. Hearing and visual function were measured with pure-tone audiometry and Snellen visual acuity tests, respectively. Quality of life (World Health Organization Quality of Life Scale Brief Version), physical function (Multidimensional Functional Assessment Questionnaire) and sociodemographic characteristics were reported by participants using interviewer-administered questionnaires. Propensity score weighting analysis was conducted based on generalized propensity scores via multinominal logistic regression for age, gender, education, income, and comorbidities. The difference in the quality of life was tested by applying a one-way analysis of variance. Multiple mediation analysis was conducted to explore the direct, indirect, and total effects of sensory impairment on quality of life through physical function.After propensity score weighting adjustment, when compared with participants with no sensory impairment, participants with dual sensory impairment had the worst quality of life, followed by visual impairment and then hearing impairment. Physical function statistically significantly mediated the effect of hearing impairment, visual impairment and dual sensory impairment on quality of life in older adults.Our findings demonstrated that the negative effect of the sensory impairment on quality of life in older adults was mediated through physical function.The convergence of an increasing ageing population and the prevalence of sensory impairment presents a significant global health burden. This study demonstrated that physical function was a mediator of quality of life in older adults. Designing appropriate physical activity interventions for older adults with sensory impairment could serve to enhance physio-psychological health and improve quality of life.

To develop and test the psychometric properties of the Taiwanese safety climate instrument suitable for nurses handling chemotherapy drugs.This is an instrument development study.All four stages, including questionnaire design, expert consultation, cognitive testing and psychometric validation, were used in this study. The data were collected between August and December 2018. Nurses with experience in handling chemotherapy drugs (N = 484) at one medical centre and two regional hospitals in Taiwan completed this instrument. Data were randomly split into two groups: one group (N = 237) for exploratory factor analysis and the other (N = 247) for confirmatory factor analysis.The instruments' items were based on qualitative research, and the content validity index levels exceeded the acceptable value. An exploratory factor analysis revealed 43 items remaining in six factors, which accounted for 74.4% of variance. The result of the confirmatory factor analysis verified the acceptability of a 43-item model. The composite reliability values, Cronbach's alpha values, convergent validity and discriminant validity for each factor exceeded the acceptable value.Most climate safety instruments used in the health care sector focus mainly on patient safety outcomes. Furthermore, there is no safety climate instrument for handling chemotherapy drugs, and there is a cultural difference. Through the development and validation process, we have developed a new instrument suitable for nurses handling chemotherapy drugs, which has good psychometric properties.This instrument is valuable as its development was based on the concept of a safety climate for health care perceptions and qualitative survey findings. Hospital managers can use this instrument regularly to evaluate nurses' perceptions of the safety climate to determine the strengths and weaknesses of their workplace, thereby assisting organizational managers in proposing concrete actions.

Patient safety is a primary concern in the medical and healthcare industry. The safety climate (or culture) of a hospital is determined by the overall perception of its safety policies and the safety-related behaviors of medical staff that affect the quality of care provided by the organization and risk of occupational injury. The perceptions of nurses related to the hospital safety climate relate positively to their behavior in the workplace. An organization's safety culture determines the risk of patient care. Patankar and Sabin (2010) identified safety values, safety leadership, safety climate, and safety performance as important factors affecting the development and improvement of an organization's safety climate. Several papers in the literature have examined the characteristics (Lin et al., 2017), influencing factors (Wagner et al., 2020), outcomes (Arzahan et al., 2022), and improvement strategies (Lee et al., 2019) related to hospital safety climates. The occupational safety of medical staff and their compliance with safety regulations relate closely to patient safety and care outcomes (HesselsLarson, 2016). The most frequently used outcome indicators of hospital safety culture are mortality rate, length of stay, infection rates, and patient satisfaction. However, unsafe medical environments and work stress may hinder the compliance of medical staff with safety behaviors and affect the value they place on these behaviors. Furthermore, perceiving a working environment as "unsafe" induces physical and mental health problems and dissatisfaction, leading to work stress and causing occupational injuries, physical and mental health issues, increased turnover, and decreased work satisfaction (Arzahan et al., 2022; Kalteh et al., 2021). The working environment of nurses is highly complex and uncertain, and considered to be one of the most hazardous occupational settings. However, guaranteeing a safe and friendly working environment is the responsibility of every organization and also a basic employee right. The International Council of Nurses (International Council of Nurses, 2017) advocates that every nurse has the right to work in a healthy and safe environment that minimizes the risks of injury and illness. Therefore, patient health outcomes should not be the only focus when discussing hospital safety culture, and more attention should be paid to promoting a safe working environment for medical staff as well. In their study conducted in Taiwan, Lin et al. (2022) proposed that the safety climate of hospitals covers six dimensions. Three of these, including "experience of clinical jobs hindering the use of personal protective equipment," "perception of comfort using personal protective equipment," and "easy usage of personal protective equipment", have not been addressed in studies conducted elsewhere. These three dimensions, which all relate directly to work environment safety, earned relatively low mean scores from the nurses surveyed, with "comfort in using personal protective equipment" earning the lowest mean score of all. Although the safety of working environments in medical organizations includes many dimensions (International Council of Nurses, 2017), including biological (infection risk), chemical (chemotherapy drugs), ergonomic (improper design, lifting), physical (radiation, needle stick injuries), and psychological (workload, workplace violence), the accumulated evidence provides insights that administrators may use to further improve hospital safety environments. Lin et al. (2022)'s investigation of nursing management practices related to hazardous antineoplastic drugs found the availability of adequate and appropriate personal protective equipment to be essential to promoting a safe working environment. During the current coronavirus disease pandemic, the three Taiwan-specific dimensions related to personal protective equipment have great value in helping nurse administrators foster and assess the safety climate in their hospitals. In addition to showing that nurses use personal protective equipment for self-protection and the protection of clients, these dimensions also provide to nurse administrators specific directions for creating a safe working environment by providing to nurses adequate, comfortable, and easy-to-use personal protection equipment.病人安全奠基於工作環境安全.病人安全議題已經是醫療及健康照護產業的首要議題，醫院安全風氣或醫院安全文化是醫護人員所感受到醫院安全政策與行為的整體認知，會影響到所表現的安全行為，進一步影響照護品質及可能造成之職業傷害。護理人員對醫院安全風氣的感受與其安全行為呈正相關，組織的安全文化會決定病人照護的風險，Patankar及Sabin（2010）提出可以由安全價值觀、安全領導、安全風氣、安全表現等四個面向來發展及提升組織內的安全風氣，目前已有一些文獻針對醫療產業探討醫院安全風氣的特徵（Lin et al., 2017）、影響因素（Wagner et al., 2020）、結果（Arzahan et al., 2022）及改善策略（Lee et al., 2019）等。醫護人員執業安全與其遵從安全規範行為，與病人安全與照護結果息息相關（HesselsLarson, 2016），在探討醫院安全文化時，最常以病人安全為結果，例如，死亡率、住院日數、感染、滿意度等指標；但當醫護人員被期待要遵守及重視安全行為時，醫護人員的安全行為可能因不安全的醫療環境與工作壓力而受影響，不安全的工作環境知覺會造成醫護人員身體及心理的健康問題及不滿，導致工作壓力，造成的結果包括職業傷害、身心健康、留任意願及工作滿意度等問題（Arzahan et al., 2022; Kalteh et al., 2021）。醫療環境的複雜性高、不確定性高，被視為是最危險的執業環境之一，而護理師在其中更有可能暴露於各種健康危害，提供一個安全友善的工作環境是機構的承諾，也是員工的基本權利，國際護理協會（International Council of Nurses, 2017）提出每位護理師都有權在不會造成傷害及疾病風險之健康與安全的環境中工作，所以醫療產業在討論醫院安全文化時，不能只著重外部顧客（病人）的健康結果，更要重視促進內部顧客（醫護人員）的工作安全環境。在臺灣本土的研究，Lin等（2022）所提出的醫院安全風氣包括六個面向，其中三個面向「阻礙使用個人防護裝備的臨床工作經驗」、「使用個人防護裝備舒適度感受」與「個人防護裝備易用性」是國外研究未包含的面向，這三個面向都和工作環境安全相關，且這三面向護理師的感受平均值均較低，且以「使用個人防護裝備舒適度感受」平均值最低，雖然醫療工作環境安全包含的面向很多（International Council of Nurses, 2017），例如生物性（感染風險）、化學性（化學治療藥物）、人因工程性（不當設計、用力）、物理性（輻射、針扎）和心理性（工作負荷、職場暴力）等，這些都是管理者可以重視及改善的方向，Lin等（2022）研究結果雖是以護理師處理抗癌危害藥品為例，發現提供足夠和適當的個人防護設備對於工作環境安全非常重要。在新冠肺炎疫情期間，在醫院安全風氣所呈現的三個與個人防護裝備有關的臺灣特有面向更具參考價值，除了顯示護理師使用個人防護裝備來自我保護及維護服務對象的表現外，也提供護理管理者對於營造安全工作環境方面，可由提供人員充分及舒適易用的個人防護裝備來提升安全工作環境的具體方向。.

Work environments at healthcare organizations involve biological, chemical, and physical risks. Healthcare providers adhere to safe work practices and promote organizational activities proactively to improve practice safety and patient safety, both of which are closely linked to quality of care. In light of the limited research on safety culture and employee safety performance in the healthcare industry, this paper was developed to introduce the concept of hospital safety climate; the factors known to influence the safety climate in hospitals and safety performance and outcomes; and related safety climate measurement tools from the perspective of promoting safe performance among hospital healthcare providers. We recommend management create a safe work environment to reinforce employees' positive perceptions about the commitment of management to safety and subsequently promote shared beliefs regarding workplace safety and motivate employees to create a safer work environment. In addition, healthcare providers' perceptions of the safety climate should be assessed to identify strengths and weaknesses in the safety climate, guide the development of related improvement measures, and enhance the safety-climate perceptions of employees.醫院安全風氣的概念與測量工具.醫療機構工作環境潛藏著生物性、化學性與物理性的工作危害，醫護人員遵守安全工作行為與積極參加組織提升執業安全與病人安全活動，與照護品質息息相關。有鑑於醫療產業對於安全風氣與員工安全表現的研究較少，本文從促進醫護人員安全表現的角度介紹醫院安全風氣概念、影響醫院安全風氣的因素、醫院安全風氣與安全表現及安全結果的關係，及安全風氣測量之工具。建議管理階層營造安全工作環境以提升員工對管理階層安全承諾之正向感受，再由員工彼此分享對工作環境安全感受並由同儕行為互相影響，形成更安全的工作環境。此外，可藉由測量員工對安全風氣感受以確認安全風氣的優勢與劣勢，進而提出改善措施，此過程亦可提升員工對安全風氣的感受。.

Introduction Sleep disturbances are commonly reported by parents of children and adolescents with epilepsy. However, evidence synthesis including quality and quantity of sleep in parents of children and adolescents with epilepsy is lacking. A greater understanding of the characteristics of sleep patterns and sleep problems in parents of children with epilepsy is needed because when the sleep of the parents is compromised, the parents’ ability to provide quality care for the child may be hampered. The purpose of this systematic review and meta-analysis was to synthesize published studies examining sleep and its disturbance in parents of children and adolescents with epilepsy. Methods Five electronic databases, PubMed, Medline, Embase, PsychINFO, and CINAHL, were systematically searched from inception to September 2021. Studies examining parents or caregivers of pediatric patients aged < 18 years with epilepsy using a quantitative measure of sleep duration, sleep quality, or sleep disturbance were included. Available data were pooled using random-effects or fixed-effects models on the basis of heterogeneity between studies. Results Eleven observational studies with a total of 934 parents of children and adolescents with epilepsy were reviewed. The pooled nocturnal sleep duration was only 5.93 hours (95% CI: 4.64 to 7.21 hours). Overall sleep quality as estimated by the bias-adjusted pooled Pittsburgh Sleep Quality Index total score was 6.65 (95% CI: 5.98 to 7.33). Parents of children with epilepsy had significantly higher Pittsburgh Sleep Quality Index total scores in comparison to parents of healthy children (differences in means: 1.84, 95% CI: 1.29 to 2.39). The pooled estimated prevalence of parental sleep disturbances was 58.1% (95% CI: 45.7% to 69.6%). Conclusion Our findings demonstrate a high prevalence of sleep disturbances with poor sleep quality and substantial reductions in sleep time in parents of children and adolescents with epilepsy. Healthcare professionals in pediatric neurology clinics should initiate screening of sleep disturbances in parents and refer parents to a sleep specialist when necessary. Support (if any) This work was supported by Ministry of Science and Technology, Taiwan, MOST 110-2628-B-002-039.

The purpose of this research is to elucidate whether metabolic syndrome affects the rate of adoption of a new multiple cancer screening programme, based on the Diffusion of Innovation theory. The time to attend the screening programme, conducted in Keelung, Taiwan, within 10 years was assessed by innovativeness (innovators, early adaptors, early majority, late majority and laggard) using data from 79,303 residents, with the information on metabolic syndrome accrued from routine adult health check-ups. The median time of adopting the programme and the relative rates of early adoption by metabolic syndrome and its severity score were estimated. The results show that the estimated times to adopt the programme ranged from 3 months for innovators to 10 years for the laggard. The rate of early adoption was 34% higher for participants without metabolic syndrome than for those with the disease, and the gradient relationship of disease severity was noted. The adjusted median time to adopt innovativeness was 0.82 years earlier for participants who were disease-free than those with the disease. Meanwhile, the adjusted median time was wider by up to 2.25 years for those with severe disease. The study suggests that innovation should prioritise the potential risk of the metabolic syndrome population.

Aims To evaluate the effects of mobile health (mHealth)-based interventions on health literacy and related factors BACKGROUND: Few reviews exist on the effects of mHealth-based interventions on the improvement and changes in health literacy and related factors. Evaluation A systematic review was conducted using the Mixed Methods Appraisal Tool to evaluate the quality of articles. Results Outcome variables included eHealth literacy, mHealth literacy, and health literacy. Two studies showed that health literacy was significantly enhanced after mHealth application use, particularly among those with low education and health literacy levels. Two articles reported that health information seeking and health information appraisal improved after mHealth-based interventions, thereby increasing health literacy levels. In one article, no significant relationship was found between health literacy levels and mHealth literacy. Conclusion mHealth can enhance health literacy; furthermore, mobile applications effectively improve patient health literacy. However, measurement tools used for evaluating health literacy indicators are inconsistent, with the concept and components of these tools being not specifically designed for evaluating health literacy indicators. Implications for nursing management To successfully and effectively overcome health problems in diverse clinical settings, the theory-based mHealth services should be adopted while considering their intensity, frequency, duration and credibility.

Background Type 1 diabetes (T1D) is more prevalent in adolescents than in adults, and the self-management of insulin-dependent diabetes is complex. T1D requires injections of insulin, self-management of blood testing, regular physical activity, and diet monitoring, which are challenging for growing and developing adolescents. Adolescents are often more concerned with how they are perceived by their peers than how they perceive themselves. Positive peer responses influence the self-care management of adolescents with T1D in school settings. By contrast, negative peer responses and avoidance behaviors threaten to negatively affect the health outcomes of adolescents with T1D. Evidence indicates that peer influence is crucial to the successful self-management of diabetes in adolescents. However, very few studies have investigated the effect of peer influence on adolescents with T1D. Purpose This article describes how adolescents with T1D perceive the responses of their peers to their diabetes self-management in school settings. Methods Ten 12- to 17-year-old adolescents with diabetes were recruited from a pediatric endocrinology clinic at a university hospital in Taiwan. Audio-recorded interview data were transcribed verbatim and reviewed for accuracy. A thematic analysis approach was used to analyze the narrative content of semistructured interviews with participants. The rigor of the data collection and analysis was emphasized. Results Analysis of peer responses to the diabetes care practices of the participants revealed six themes: knowledge seeking, curiosity, enthusiasm, empathy, fearfulness, and isolation and bullying. Subthemes were categorized to illustrate how adolescents with T1D balance the challenge of diabetes self-care regimens and normal peer interactions. They were coping with the requirements of their T1D regimen and hoping to determine the perceptions of their peers toward this regimen and themselves. Conclusions/implications for practice Understanding the perception of peer identity for adolescents with T1D provides information for diabetes education and assists school nurses to facilitate successful T1D management in adolescents.

Hsiu-Yu Ho,1,2 Mei-Hui Chen,2,3 Meei-Fang Lou1 1School of Nursing, College of Medicine, National Taiwan University, 2Department of Nursing, Yuanpei University of Medical Technology, 3National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, Republic of China Background: Many people with diabetes have comorbidities, even multimorbidities, which have a far-reaching impact on the older adults, their family, and society. However, little is known of the experience of older adults living with comorbidities that include diabetes. Aim: The aim of this study was to explore the experience of older adults living with comorbidities including diabetes. Methods: A qualitative approach was employed. Data were collected from a selected field of 12 patients with diabetes mellitus in a medical center in northern Taiwan. The data were analyzed by Colaizzi’s phenomenological methodology, and four criteria of Lincoln and Guba were used to evaluate the rigor of the study. Results: The following 5 themes and 14 subthemes were derived: 1) expecting to heal or reduce the symptoms of the disease (trying to alleviate the distress of symptoms and trusting in health practitioners combining the use of Chinese and Western medicines); 2) comparing complex medical treatments (differences in physician practices and presentation, conditionally adhering to medical treatment, and partnering with medical professionals); 3) inconsistent information (inconsistent health information and inconsistent medical advice); 4) impacting on daily life (activities are limited and hobbies cannot be maintained and psychological distress); and 5)weighing the pros and cons (taking the initiative to deal with issues, limiting activity, adjusting mental outlook and pace of life, developing strategies for individual health regimens, and seeking support). Surmounting these challenges in order to live a normal life was explored. Conclusion: This study found that the experience of older adults living with comorbidities including diabetes was similar to that of a single disease, but the extent was greater than a single disease. The biggest difference is that the elderly think that their most serious problem is not diabetes, but rather, the comorbidities causing life limitations. Therefore, compared to the elderly suffering from a single disease of diabetes, medical professionals not only care about physiological data of the elderly but also pay attention to the impact of comorbidity on their lives. Keywords: diabetes, comorbidity, multimorbidity, elderly, older adult, life experience

The Life-Space Assessment (LSA) is a comprehensive tool for assessing mobility in older adults, but the evidence of its psychometric properties in Chinese older adults is lacking. The aim was to adapt and validate the psychometric properties of the Chinese version of the Life-Space Assessment (LSA-C) in community-dwelling older adults. A cross-sectional study was designed with 225 community-dwelling older adults. The content validity of the LSA-C was satisfactory. The criterion validity was supported by significant correlation between the LSA-C and the Multidimensional Functional Assessment Questionnaire (MFAQ). Additionally, the LSA-C was negatively correlated with the 10-item Center for Epidemiological Studies Depression Scale (CESD-10) and positively correlated with the General Health subscale of the Short-Form-36 Health Survey (GH of the SF-36), implying good construct validity. Finally, the LSA-C showed excellent stability (intraclass correlation coefficient = 0.88). The LSA-C demonstrates adequate psychometric properties, supporting its use in future research in the Chinese context.

Aim To understand the factors affecting willingness to use telemedicine in patients with coronary artery disease after coronary intervention. Background Telemedicine is a relatively new service provided to discharged patients in Taiwan, therefore, public acceptance is low. Method This mixed-methods study conducted between January and June 2014 used convenience sampling. In total, 140 patients were offered a two-week free trial of telemedicine services before hospital discharge. Participants completed structured questionnaires and answered semi-structured qualitative questions related to willingness to use telemedicine services. Results Patients' willingness to use telemedicine was not significantly correlated with experience using technology, perceived ease of use or computer self-efficacy; instead, it was based on trust in the hospital staff, opinions of the staff and ongoing support from the case manager. Reasons for their lack of willingness to use the service were mainly related to diseases, technology/equipment and environmental factors. Conclusion Staff support through telephonic tracking and real-time feedback can increase willingness to use telemedicine. Implications for nursing management Case managers can collect necessary personal information and offer the patients 24-hr services as a monitor, an instructor and a companion, thereby accommodating more patients, building value and strengthening telemedicine services.

Medication is the most common strategy for addressing the healthcare needs of older adults. In order to treat disease, maintain health, prevent further declines in health, prolong survival, and improve quality of life, the proper use of medicine is of great importance in the care of older patients (de Oliveira Alves, Schuelter-Trevisol,Trevisol, 2014). Since the physician Dr. Beers put forward the concept of potentially inappropriate medication (PIM) almost thirty years ago in 1991 (Beers et al., 1991), scholars around the world have issued explicit criteria related to PIM for clinical and research purposes. It is necessary for the first-line medical personnel who are involved in caring for older patients to increase their knowledge and understanding of the medication status of their older patients, clarify the indications of medicines taken by these patients, and become familiar with the tools used to assess the appropriateness of medications in order to assist the medical team to identify PIM and to serve as a channel between older patients and the medical team. A systematic literature review found prevalences of PIM among older individuals ranging from 3.6% to 92.0% (Nothelle, Sharma, Oakes, Jackson,Segal, 2017; Redston, Hilmer, McLachlan, Clough,Gnjidic, 2018; Storms, Marquet, Aertgeerts,Claes, 2017), subject to different research samples, study sites, and assessment tools. The prevalence of PIM among older patients in Taiwan has been estimated at 9.8%-91.2% (Chang et al., 2011; Huang, Yeh, Hung, Hsieh,Tsai, 2011; Lin, Peng, Chen, Lin,Hwang, 2011; Shen, 2008), which indicates that the problem of PIM among older patients in Taiwan is no less serious than in Europe or the United States. A survey of medication used by older adult inpatients at a medical center in northern Taiwan found the incidences of PIM in the sample to be 76.3%, 80.9%, 70.0%, 69.1%, and 75.2%, respectively, at hospital admission, during hospitalization, at discharge, at the first return visit, and 3 months after discharge (Ho, 2017). This not only revealed a high prevalence of PIM among older people in Taiwan but also suggests that PIM may initially decrease and subsequently increase over time after hospital discharge. This possible trend deserves further assessment and attention. Nurses, especially homecare nurses, are frontline personnel in medical care who play an important role in reviewing medication safety. Lou (2016) used focus group research to explore the challenges of medication safety faced by older patients under the care of homecare nurses. The study found that homecare nurses lack the self-confidence necessary to review of the appropriateness of medication due to several factors, including medication complexity, lack of clinical experience, the regular introduction of new drugs, and the fact that homecare nurses are not medical experts. Lou further used PIM-Taiwan criteria (version 1) to design and develop an application software program (app) that reviews automatically the appropriateness of medications given to older patients. This app is a supplemental assistance device for non-drug experts and facilitates the timely reporting of medication review results to prescribing physicians. The app was further shown to have a positive and significant impact in a demonstration trial. The administration of medication is a key part of the routine work of nurses. In addition to administering correct dosages, nurses should have a better understanding of the appropriateness of medications. Nurses should not only be familiar with the medicines that they give to their older patients but should also be able to identify their appropriateness. They should make good use of explicit criteria to identify the appropriateness of medications and apply related technological products in clinical situations in order to improve quality of care in terms of medication safety for older patients.老人用藥適當性之現況與展望.藥物是老人健康照護最常見的治療措施，為了治療急慢性病，維持目前健康、預防進一步的衰退、延長存活時間和提高生活品質，正確使用藥物對老人健康照護是非常重要的（de Oliveira Alves, Schuelter-Trevisol,Trevisol, 2014）。1991年由Beers醫師等人提出潛在不適當用藥（potentially inappropriate medication, PIM）概念迄今已將近30年，世界各國學者也陸續發表明確列舉式準則以供臨床與研究使用，身為老人照護第一線醫療人員，更應加強詢問和瞭解老人的藥品狀況，釐清老人目前服用這些藥品的適應症及藥品訴求或目的，熟悉並善用藥品適當性評估工具，以協助醫療團隊有效率地找出老人PIM，做為老人與醫療團隊之間溝通的橋樑。由系統性文獻回顧發現，隨著研究樣本、研究場所及評估工具的不同，老人PIM使用之盛行率約3.6%–92.0%（Nothelle, Sharma, Oakes, Jackson,Segal, 2017; Redston, Hilmer, McLachlan, Clough,Gnjidic, 2018; Storms, Marquet, Aertgeerts,Claes, 2017）。在臺灣老人PIM使用之盛行率則為9.8%–91.2%（沈，2008；黃、葉、洪、謝、蔡，2011；Chang et al., 2011; Lin, Peng, Chen, Lin,Hwang, 2011），顯示臺灣老人PIM使用的問題嚴重性並不亞於歐美各國。最近以臺灣北部某醫學中心住院老人用藥研究發現，住院時、住院中、出院時、出院後第一次回診和出院後三個月，至少有一種老人PIM之盛行率分別是76.3%、80.9%、70.0%、69.1%和75.2%（何，2017）。顯示臺灣住院老人PIM盛行率高，即使在出院後略有下降，但隨著出院後時間的推移，老人PIM之盛行率有逐漸上升之趨勢，不容吾等忽視。護理人員，尤其是居家護理師，為醫療照護之第一線人員，對於用藥安全審查更為重要，因此，為了了解居家護理師對於老人用藥安全之挑戰，羅（2016）以焦點團體研究發現，由於老人用藥複雜性高、臨床經驗不足、新藥推陳出新，以及居家護理師非藥物專家等，導致居家護理師缺乏老人用藥審查適當性之自信度，羅進一步運用PIM-Taiwan第一版設計開發應用軟體（application, app），提供居家護理師用以審查老人用藥適當性，以補非藥物專家之憾，並將老人用藥審查結果適時反應給開處方醫師，作為調整藥物與否之依據，成效是顯著的。給藥是護理師常規工作中非常重要的一環，護理人員除了著重給藥正確及作用外，期望進一步對藥品適當性有所認知。護理人員除了要熟知老人常用藥品外，更要能識別老人用藥適當性，善用明確列舉式準則作為識別老人用藥適當性的依據，以紙本或開發成科技產品，應用於臨床情境，以提升老人用藥安全之照護品質。.

The prevalence of potentially inappropriate medication (PIM) use is high, presenting a serious public health problem. In older adults, PIM increases the risks of adverse drug events, falls, hospitalizations, and emergency treatments as well as related medical expenses. The currently popular criteria for determining medication appropriateness and several common medication appropriateness assessment tools are introduced in this paper, including the Medication Appropriateness Index, the Beers criteria series, the Screening Tool of Older Person's Prescriptions (STOPP) and the Screening Tool to Alert doctors to Right Treatment (START) series, Thailand criteria, and the PIM-Taiwan criteria, with the goal of facilitating their application by medical professionals in clinical practice.簡介老人藥品使用適當性之評估工具.老人潛在不適當藥品（potentially inappropriate medication, PIM）使用盛行率很高，乃是一個嚴重的社區健康照護問題，老人PIM使用會增加不良藥品事件、跌倒、住院、急診求診等問題，而導致醫療費用支出增加。本文目的在介紹藥品適當性的判定準則，並簡介幾種常見的藥品適當性評估工具，包括藥品適當性指標（Medication Appropriateness Index）、Beers準則系列六種、老人處方篩檢工具（Screening Tool of Older Person's Prescriptions, STOPP）和提醒醫師正確治療篩檢工具（Screening Tool to Alert doctors to Right Treatment, START）系列二種、泰國準則，以及臺灣版潛在性不適當用藥（PIM-Taiwan）準則，以利臨床醫護人員於臨床實務中可視情況加以應用。.

Nurses taking measures regarding the safe handling of hazardous drugs (HDs) can reduce their risk of exposure and environmental contamination. However, the findings of studies examining factors influencing the use of HD safe handling precautions by nurses have been inconsistent.An integrative review of the Embase® and Scopus® electronic databases was performed.The search strategy yielded 907 articles. Ten quantitative studies and two qualitative studies met the inclusion criteria. The Health Evidence Bulletin Wales checklist was used to evaluate the quality of the articles.The outcome variables were categorized as engineering controls, work practice controls, and personal protective equipment (PPE) use. The frequency of PPE use was measured as an outcome variable in all reviewed studies. Associated factors were based on the behavioral-diagnostic model. Perceived barriers to PPE use, perceived safety climate, and workload were common factors related to the use of safety precautions.Nurses should proactively obtain information about the safe handling of HDs and share their perceptions and experiences of it with their colleagues. Managers should actively construct a safe environment by adopting high reliability principles and provide nurses with sufficient and easy-to-use PPE.

Adolescent obesity is a crucial public health concern, and understanding its risk factors can facilitate the establishment of prevention policies. In this study we investigated the prevalence of adolescent obesity in Taiwan, determined the influential factors, and compared the prevalence of obesity in our study population with international indices. The cross-sectional study was an analysis of data from the 2010-2011 Nutrition and Health Survey in Taiwan, an anthropometric measurement and questionnaire survey of adolescents aged 11-18 years. Our sample was 1,826 adolescents (910 males and 916 females). Data were analyzed using logistic regression modeling. Based on body mass index standards specific to Taiwan norms, the prevalence of overweight and obesity in Taiwan adolescents was 12.4% and 16.8%, respectively. The prevalence was lower when international indices of overweight and obesity were applied. In logistic regression, obesity was linked to male gender, an obese father, overweight or obese mother, poor dietary attitudes, and perceived low dietary benefits. Monitoring and preventing adolescent obesity should focus on both adolescents and their parents. When planning behavioral change and education for adolescent obesity, health professionals and policy-makers should view the family as a unit. © 2016 Wiley Periodicals, Inc.

Effective pain management is crucial for patient recovery after total knee arthroplasty (TKA). Biofeedback therapy, which encourages relaxation and helps alleviate various conditions associated with stress, may help to decrease postoperative pain in patients undergoing TKA. A quasi- experimental design was used to investigate the efficacy of a biofeedback relaxation intervention in reducing pain associated with postoperative continuous passive motion (CPM) therapy. Sixty-six patients admitted to a general hospital in Taiwan for TKA were recruited and randomly assigned to the intervention or control group. The intervention group received biofeedback training twice daily for 5 days, concurrent with CPM therapy, whereas the control group did not receive the biofeedback intervention. Pain was measured using a numeric rating scale before and after each CPM therapy session on postoperative days 1 through 5. The CPM-elicited pain score was calculated by subtracting the pre-CPM pain score from the post-CPM pain score. Results of repeated-measures analysis of variance showed intervention group reported significantly less pain caused by CPM than did the control group (f = 29.70, p

Objective To determine the prevalence of impaired fasting glucose (IFG) in Taiwanese adolescents and important related variables. Subjects and Methods This analysis was based on the Nutrition and Health Survey in Taiwan (NAHSIT) data during 2010 and 2011. The original study was a cross-sectional and national representative survey. A total of 1949 subjects (965 males and 984 females) aged 11–20 years participated. Research tools consisted of questionnaires, anthropometry parameters, and blood biochemical indicators. The acquired data were analyzed using descriptive and inferential statistics. Results The prevalence of IFG in Taiwanese adolescents was 22% (a fasting glucose level between 100 and 125 mg/dL is considered abnormal). Factors that significantly affected IFG levels included sex, age, quality of family dietary environment, overweight, obesity, and the number of cardio-metabolic risk factors. Conclusion The prevalence of IFG in Taiwanese adolescents is a public health issue that should not be ignored. The prevalence may be reduced by adjusting lifestyles. Healthy family environments should be encouraged and appropriate healthy lifestyle counseling plans offered specifically to male adolescents with overweight, obesity, and cardio-metabolic risk factors.

Aim and objective To report an analysis of the concept of safety climate in healthcare providers. Background Compliance with safe work practices is essential to patient safety and care outcomes. Analysing the concept of safety climate from the perspective of healthcare providers could improve understanding of the correlations between safety climate and healthcare provider compliance with safe work practices, thus enhancing quality of patient care. Design Concept analysis. Data sources The electronic databases of CINAHL, MEDLINE, PubMed and Web of Science were searched for literature published between 1995–2015. Searches used the keywords ‘safety climate’ or ‘safety culture’ with ‘hospital’ or ‘healthcare’. Method The concept analysis method of Walker and Avant analysed safety climate from the perspective of healthcare providers. Results Three attributes defined how healthcare providers define safety climate: (1) creation of safe working environment by senior management in healthcare organisations; (2) shared perception of healthcare providers about safety of their work environment; and (3) the effective dissemination of safety information. Antecedents included the characteristics of healthcare providers and healthcare organisations as a whole, and the types of work in which they are engaged. Consequences consisted of safety performance and safety outcomes. Most studies developed and assessed the survey tools of safety climate or safety culture, with a minority consisting of interventional measures for improving safety climate. Conclusion More prospective studies are needed to create interventional measures for improving safety climate of healthcare providers. This study is provided as a reference for use in developing multidimensional safety climate assessment tools and interventional measures. Relevance to clinical practice The values healthcare teams emphasise with regard to safety can serve to improve safety performance. Having an understanding of the concept of and interventional measures for safety climate allows healthcare providers to ensure the safety of their operations and their patients.

Aims To understand the influential factors related to quality of life for adult patients who have undergone extra corporeal membrane oxygenation. Background Extracorporeal membrane oxygenation is an invasive treatment for critically ill patients requiring temporary cardiac or respiratory support. Most studies have focused on survival outcomes for patients; few have evaluated health-related quality of life. Design A cross-sectional design. Methods Data were collected in 2013 from a convenience sample of adult patients who had survived treatment with extracorporeal membrane oxygenation between 2009–2011. Structured questionnaires collected data about health status. The Short Form 36-item questionnaire measured quality of life. Results The 100 participants averaged 48·95 years of age. Pearson's correlation showed two measures of health status had significant correlations with quality of life: the Barthel Index and the Instrumental Activities of Daily Living; two measures had significant negative correlations: Charlson's Comorbidity Index and the Nottingham Health Profile-part II. Mean scores for the physical and mental component summaries of the Short Form-36 questionnaire were 49·25 and 48·13 respectively. These component scores had significant negative correlations with the Nottingham health profile-part II. Stepwise multiple linear regression analysis indicated the number of life areas affected on the Nottingham health profile-part II was a common factor influencing both the mental and physical component summaries scores for quality of life. Conclusions Social participation was a common factor influencing quality of life. Examining health status and quality of life of extracorporeal membrane oxygenation survivors can help nurses determine interventions for effectively improving health-related quality of life.

Aim. This study investigated intensive care unit nurses’ knowledge, attitudes and practices of oral care for intubated patients together with the associated factors of the same. Background. Effective oral care improves patient comfort and prevents oral infection. Although oral care is a common requirement of nursing practice, providing intubated patients with oral care is a challenging task. Design. A descriptive, cross-sectional design. Methods. This study applied purposive sampling method at 12 adult intensive care units in one medical centre in northern Taiwan. Two hundred and five nurses were recruited. Data were collected by structured questionnaires which consisted of four sections: knowledge, attitudes and practices of oral care for intubated patients and demographic information for the nurses. Results. The average percentages indicating the intensive care unit nurses’ oral care knowledge, attitudes and practices were 58·8, 79·4 and 49·8%, respectively. Higher scores on oral care knowledge were associated with nurses performing oral care more frequently. Nurses learning about oral care from reading related studies and materials of their own accord may increase the frequency with which they provide oral care to intubated patients. The nurses’ age and the type of intensive care unit they work in were significant factors related to the frequency of performing practices related to oral care. Conclusion. Findings show that nurses who have more resources for learning about oral care have greater knowledge about it and provide oral care to intubated patients more frequently. Relevance to clinical practice. Encouraging nurses to learn more about oral care using diverse educational resources will enhance their knowledge and improve their practice. Nursing administrators are encouraged to establish policies and procedures for oral care of intubated patients based on the type of patients cared for, in addition to holding in-service training, with a view to enhancing the quality of oral care for critically ill patients.

Background: The well-documented physical benefits of exercise and the value of exercise for improving mental health have raised the profile and role of exercise in healthcare. However, studies evaluating the effects of exercise on neurocognitive function have produced equivocal results. Purpose: This study was designed to examine the effectiveness of exercise on improving cognitive function in older people. Methods: Researchers used a narrative synthesis approach in this review and conducted a computer-based search in MEDLINE, CINAHL, Cochrane Library, and Airiti Library (Chinese) from 2006 to 2009 using the search terms exercise, physical activity, and cognition. Research quality appraisal was rated using Consolidated Standards of Reporting Trials criteria. Result: This review included 12 medium-to high-quality randomized controlled trials. Most studies examined used a 60-minute exercise regimen scheduled three times per week that was continued for 24 weeks. Of the 12 studies, 8 revealed that exercise can improve cognitive function. Five studies focused on healthy older people and three studied older people who had impaired cognition at baseline. Analysis of the studies showed simple, one-component exercise as better for older people with cognitive impairment and multicomponent exercise as better for those without such impairment. Conclusions/Implications for Practice: This systematic review demonstrated that an exercise regimen of 6 weeks and at least 3 times per week for 60 minutes had a positive effect on cognition. Whether multicomponent exercise is significantly more effective in improving cognitive function, particularly in healthy older people, should be tested using larger trials with more rigorous methodology.

Aims. The purpose of the study was to identify the most efficient items from the Mini-Mental State Examination for assessment of cognitive function. Background. The Mini-Mental State Examination is the most frequently used cognitive screening instrument. However, the Mini-Mental State Examination has been criticized for insensitivity to mild cognitive dysfunction, limited memory assessment and variability in level of difficulty of the individual items. Method. This study used secondary data analysis. Item response theory two-parameter model was used to analyse the data from the admission assessment of mental status by the Mini-Mental State Examination for 801 patients. Results. By using item response analysis, 16 items were selected from the original 30-item Mini-Mental State Examination. The 16 items included mainly the measures of orientation, recall and attention and calculation. The internal consistency of the 16-item Mini-Mental State Examination was 0·84. The proposed new cut-off point for the 16-item Mini-Mental State Examination was 11. The correct classification rate was 0·94, the sensitivity was 100% and the specificity was 97·4%, when compared with the original 30-item Mini-Mental State Examination from the cut-off point of 24. This new cut-off point was determined for the purpose of over-identifying patients at risk so as to ensure early detection of and prevention from the onset of cognitive disturbance. Conclusion. Only a few items are needed to describe the subject's cognitive status. Using item response theory analysis, the study found that the Mini-Mental State Examination could be simplified. Relevance to clinical practice. Deleting the items with less variation makes this assessment tool not only shorter, easier to administer and less strenuous for respondents, but also enables one to maintain validity as a cognitive function test for clinical setting.

Background Vascular closure devices such as angioseal are used as alternatives to traditional compression haemostasis. Although the safety and efficacy of angioseal are confirmed, their use remains controversial because of the potential complications of these devices compared with those of traditional compression haemostasis. The aim of this study was to compare the access site complication rate, the predictive factors for these complications, and patient comfort levels after coronary procedures with traditional compression or angioseal haemostasis. Methods Data were collected from a cardiac unit in a medical center in northern Taiwan. A total of 130 adult patients were recruited and equally divided into two groups according to the method of haemostasis used after the coronary procedure: a traditional compression group and an angioseal group. We observed the incidence of access site complications, including bleeding, oozing, haematoma formation, and arteriovenous fistula formation. In addition, we used a 0–10 numeric rating scale to assess soreness, numbness, and back and groin access site pain after 1 h of catheter removal and immediately before getting out of bed. Results The overall incidence of complications was 3.8 % (n = 5), which was not significantly different between the two groups (p = .06). The propensity score—adjusted multivariate analyses revealed that the only independent predictor for access site complications was an age of >70 years (OR, 10.44; 95 % CI, 1.81–60.06; p = .009). Comfort levels were higher in the angioseal group than in the traditional compression group. Conclusions Angioseal used after coronary procedures did not increase the incidence of complications relative to that associated with traditional compression haemostasis; however, it increased patient comfort levels. Health personnel should pay special attention to the predictive factor for access site complications after coronary procedures, such as age >70 years.

Background Incontinence is a common problem faced by family caregivers that is recognized as a major burden and predictor of institutionalization. However, few studies have evaluated the experiences of family caregivers caring for stroke survivors with incontinence. Purpose To describe experiences of caregivers managing incontinence in stroke survivors. Design This qualitative descriptive study employed a grounded-theory approach. Methods Semi-structured in-depth interviews with ten family caregivers of stroke survivors with incontinence were conducted during 2011. Audiotaped interviews were transcribed and analyzed using content analysis. Findings Data analysis identified four themes: chaos, hypervigilance, exhaustion, and creating a new life. There were nine related subcategories: fluster, dirtiness, urgency, fear of potential health-hazard, physically demanding and time-consuming, mentally draining, financial burden, learning by doing, and attitude adjustment. Together, these described a process of struggling to cope with the care of stroke survivors with urinary/fecal incontinence. Of the four categories, “creating a new life” developed gradually over time to orient caregivers to their new life, while the other three categories occurred in a chronological order. Conclusion The research highlighted unique caring experiences of family caregivers of stroke patients, which focused solely on the ‘incontinence issue’. Understanding these experiences may help nurses provide better support and resources for family caregivers when caring for stroke survivors with incontinence.

Summary • The purpose of the study was to describe variations in cognitive/behavioural changes during the course of delirium among older Taiwanese patients after elective surgery. • A total of 106 patients assessed four times (admission, onset of delirium, delirium day 3 and delirium day 5) by the Mini Mental State Examination (MMSE) were included in the analysis to understand the neurocognitive/behaviour change during the course of delirium. • Repeated measures anova was used to analyse within-subject differences across these four time points for those who became delirious and those who did not. • The findings showed that patients who experienced delirium had significantly (P

Objectives: To investigate the incidence of postoperative delirium among elderly patients and to examine the interrelationship between basic vulnerability and precipitating factors for delirium. Design and Methods: This was a prospective cohort study. Data were collected in a tertiary medical center in Taipei, Taiwan. From the 1st to the 5th postoperative day, nurses assessed patients using a confusion-screening tool. Patients with signs of delirium were closely examined for changes in behavior and cognitive status and vital signs, and laboratory data were collected to further validate the organic etiology of delirium. Patients were finally diagnosed according to the DSM-IV criteria in consensus meetings. Subjects: Seven hundred and one elderly patients, that were admitted consecutively for elective orthopedic or urologic surgery, were enrolled in this study. All subjects met the following criteria: (1) 65 years of age or older; (2) able to communicate orally in Chinese, and (3) not unconscious, delirious, deaf, or aphasic upon admission. Results: The overall incidence of delirium among these subjects was 5.1%. Logistic regression analysis identified that older age and preexisting cognitive impairment were vulnerability factors, and that the use of psychoactive drugs was a precipitating factor for delirium. Patients with both basic vulnerability and the precipitating factor had a 56-fold increased probability of delirium (0.28 vs. 0.005 in comparison with those who did not exhibit these factors). Conclusion: Few risk factors of postoperative delirium in the older Chinese sample were identified. The only modifiable risk factor appears to be the use of psychoactive drugs.

Background New graduates report intense stress during the transition from school to their first work settings. Managing this transition is important to reduce turnover rates. This study compared the effects of an externship program and a corporate-academic cooperation program on enhancing junior college students’ nursing competence and retention rates in the first 3 months and 1 year of initial employment. Methods This two-phase study adopted a pretest and posttest quasi-experimental design. All participants were graduating students drawn from a 5-year junior nursing college in Taiwan. There were 19 and 24 students who participated in the phase I externship program and phase II corporate-academic cooperation program, respectively. The nursing competence of the students had to be evaluated by mentors within 48 hours of practicum training and after practicum training. The retention rate was also surveyed at 3 months and 1 year after beginning employment. Results Students who participated in the corporate-academic cooperation program achieved a statistically significant improvement in nursing competence and retention rates relative to those who participated in the externship program (p < 0.01 and p < 0.05, respectively). Conclusions The corporate-academic cooperation program facilitates the transition of junior college nursing students into independent staff nurses, enhances their nursing competence, and boosts retention rates.

Aim To conduct a systematic literature review and to examine the effectiveness and application of mentorship programmes for recently registered nurses. Background The implementation of mentorship programmes is an important strategy that health care institutions employ to retain nurses who have been recently registered. By better understanding the applications and effectiveness of mentorship programmes, the retention rate for these nurses can be enhanced. Evaluation We collected existing literature to examine experimental and quasi-experimental studies that adopted mentorship programmes as an intervention. Five studies were included in the final analysis. Key issues The strength of the evidence provided through the selected studies was ranked at Level III based on the study design. Furthermore, these studies revealed that the implementation of mentorship programmes reduced turnover rates, employee turnover costs and medical negligence rates. Job satisfaction and professional identity were improved. Conclusion The results of this systematic review suggest that mentorship programmes are a beneficial process for mentors and recently registered nurses. In addition, mentorship programmes involve multi-dimensional teaching strategies and training courses and require long-term development. Implications for nursing management The findings of this systematic review on the application and effectiveness of mentorship programmes for nurses who have recently registered can provide references for nursing managers who are selecting mentors and for the design of practical programmes.

Background The use of complementary and alternative medicine (CAM) continues to increase in Taiwan. This study examined the use of CAM and beliefs about CAM as expressed by patients with traumatic brain injury (TBI) in Taiwan. Methods TBI patients and their accompanying relatives were interviewed by using a structured questionnaire at an outpatient clinic in a medical center in northern Taiwan. Results A total of 101 patients with TBI participated in the study. Sixty-four (63%) patients had used at least one form of CAM after sustaining TBI. CAM users had used an average of 2.72 forms of CAM after sustaining TBI. The most frequently used CAM category was traditional Chinese medicine (37; 57.8%), followed by folk and religious therapies (30; 46.9%), and dietary supplements (30; 46.9%). The majority of the patients (45; 70.3%) did not report CAM use because they felt it was unnecessary to do so. Patients who used CAM had a significantly stronger positive belief in CAM than those who did not (t = −2.72; P = .008). After using CAM, most of the patients (54; 85%) perceived moderate satisfaction (2.89 ± 0.44), according to a 4-point Likert scale. Conclusion Although the use of CAM is common for TBI patients receiving conventional medical health care in Taiwan, most patients did not inform health care personnel about their CAM use. TBI patients perceive combined use of CAM and conventional medicine as beneficial for their overall health.

This study investigated intensive care unit nurses' knowledge, attitudes and practices of oral care for intubated patients together with the associated factors of the same.Effective oral care improves patient comfort and prevents oral infection. Although oral care is a common requirement of nursing practice, providing intubated patients with oral care is a challenging task.A descriptive, cross-sectional design.This study applied purposive sampling method at 12 adult intensive care units in one medical centre in northern Taiwan. Two hundred and five nurses were recruited. Data were collected by structured questionnaires which consisted of four sections: knowledge, attitudes and practices of oral care for intubated patients and demographic information for the nurses.The average percentages indicating the intensive care unit nurses' oral care knowledge, attitudes and practices were 58·8, 79·4 and 49·8%, respectively. Higher scores on oral care knowledge were associated with nurses performing oral care more frequently. Nurses learning about oral care from reading related studies and materials of their own accord may increase the frequency with which they provide oral care to intubated patients. The nurses' age and the type of intensive care unit they work in were significant factors related to the frequency of performing practices related to oral care.Findings show that nurses who have more resources for learning about oral care have greater knowledge about it and provide oral care to intubated patients more frequently.Encouraging nurses to learn more about oral care using diverse educational resources will enhance their knowledge and improve their practice. Nursing administrators are encouraged to establish policies and procedures for oral care of intubated patients based on the type of patients cared for, in addition to holding in-service training, with a view to enhancing the quality of oral care for critically ill patients.

Effective oral care improves patient comfort and prevents oral infection. While common in general nursing practice, administering oral care to intubated patients is particularly challenging.This study investigated practices and factors associated with oral care of intubated patients in intensive care units (ICUs).This study used a cross-sectional design and recruited nurses using purposive sampling. Data were collected with a structured observational checklist between January and April 2008 at a medical center in northern Taiwan. Observational data reflected oral care procedures performed by thirty-one ICU nurses on intubated patients in six ICUs.Cotton and foam swabs were found to be the main oral care cleaning instruments used with intubated patients, with dilute mouthwash the primary cleaning solution. Nearly three-quarters (72.4%) of participants were found to employ proper oral care procedures. Participants selected different cleaning equipment, cleaning solutions, cleaning solution usage methods and oral endotracheal tube securement methods based on differing conditions. ICU nurse age was positively associated oral care completeness. The level of oral care completeness achieved by participants in medical ICUs was significantly higher those assigned to surgical ICUs.Study findings showed that ICU nurses did not follow procedures and steps recommended by current evidence-based practice (e.g., brushing the teeth and gums; positioning patients in a side or semi- / high-fowlers position when providing oral care to intubated patients). ICUs must establish policies and procedures for oral care of intubated patients that reflect patient characteristics. Furthermore, ICUs should provide oral care related on-the-job training and education in order to improve the quality of oral care administered to critical care patients.

This study reviewed historical nursing intervention studies in Taiwan and analyzed results based on sample characteristics, methodology characteristics, and content characteristics. Historical studies were split into four groups, G1970, G1980, G1990, and G2000, based on the decade in which they were published. A comparison was then made to identify significant differences between G2000 and other groups. A total of 103 nursing intervention studies were analyzed in this study. Results included sample characteristics of studies conducted primarily by single-disciplinary research teams, although multidisciplinary studies showed a growth trend across decades, with the number of multidisciplinary studies significantly greater in G2000 than in other decades. Nursing practice was the main area of research, clients were the major participants studied, and hospitals provided the principal research setting. No statistical difference was noted in the above mentioned variables. In terms of methodology characteristics, questionnaires were used most frequently to collect data. A quasi-experimental design was the primary research design employed. Although the number of experimental designs has increased significantly in recent years, most studies specified their inclusion criteria. Reliability and validity of instruments were more clearly specified in recent decade groups than in earlier decade groups. Methodology rigor has improved in recent years, achieving a statistically significant difference between G2000 and other groups in all categories, with the exception of instrument validity. In terms of content characteristics, health education was the leading intervention type. Most interventions were categorized as tertiary prevention, with perceptual outcome used most often as the outcome indicator. However, no statistical differences in content dimension variables were identified between G2000 and other groups. In summary, the number of nursing intervention research cases has risen, and research methodology rigor has improved in recent decades. However, no statistically significant differences in sample characteristics and content characteristics between the most recent and earlier decade groups were found. Suggestions for future domestic nursing intervention studies based on study findings are made at the conclusion of this article.

Aims. The aim of this study was to examine the rate of unplanned readmissions within the most recent postoperative year for heart transplant patients and the causes and contributing factors leading to such readmissions. Background. Advances in medical technology have significantly increased the survival rate of heart transplant patients. However, several postoperative complications make it common for patients to be readmitted to hospitals. An ‘unplanned readmission’ rate will better reflect the quality of postdischarge care than will mortality rate alone. Little research has been conducted on the heart transplant population in Taiwan. Design. Descriptive, cross-sectional. Methods. Data were collected from a purposive sample by structured questionnaires and medical record reviews. Results. Seventy-one patients were recruited at different times after heart transplantation. The unplanned readmission rate was 35·2% in the most recent postoperative year. The unplanned readmission rate was 52·2% for patients who had received transplantation five years ago or less, which was significantly higher than that for patients who had received transplantation more than five years ago (27·1%). Leading causes of unplanned readmission included infection (31·8%), rejection (25·0%) and cardiac allograft vasculopathy (18·2%). Blood urea nitrogen and creatinine levels were significantly higher in readmitted patients than in patients who were not (t = 2·09, p

Educational evaluation is a priority policy of the Ministry of Education and student learning outcome is an important criterion used in educational evaluation work. The purpose of this study was to evaluate the learning outcome of a newly developed course for doctoral students entitled, Nursing Research Seminar. The course was one semester in length and required students to attend 2 hours of class per week. Student learning outcome was evaluated based on the level of understanding students had of course objectives. The six objectives of this course were: evaluating and integrating research papers; enhancing critical thinking skills; gaining an in-depth understanding of the literature related to topics of interest; enhancing ability to construct research proposals; guiding student dissertation work; and refining critical research skills. Data were collected from the responses provided by 25 students on a 5-point Likert-type evaluation form based on course objectives filled out during the last class of the semester. Descriptive and non-parametric statistics were adopted. Results showed: (1) The average post-course score (24.76 +/- 2.89) was significantly higher than the pre-course score (18.40 +/- 5.52); (2) Students realized significant improvements in all six objectives at the end of the course; (3) There were statistically significant differences in improvement scores in all six objectives for students in different years of their doctoral program; (4) The lower the year in the program, the higher the improvement scores for each course objective; (5) The two objectives of the six that saw the most significant improvements were "gaining an in-depth understanding of the literature related to topics of interest", and "enhancing critical thinking skills". Because of the small sample size, conclusions drawn from this study should be treated as tentative. Findings provide preliminary information supporting the importance and necessity of offering the Nursing Research Seminar course to nursing doctoral students. The course provided different benefits to students at different years in the program and, overall, research results encourage that this course continue to be offered.

Title. Nutritional status and health outcomes for older people with dementia living in institutions Aim. This paper is a report of a study to determine changes over a 3-month period among older people with dementia living in long-term care settings, related to: (1) changes in body mass index, and (2) health outcomes and associated factors. Background. Nutritional deficiencies are common problems among older people, but frequently unrecognized, both in long-term care settings and in the community. Method. A cross-sectional design with repeated measures of body weights and medical record reviews was adopted. The study was conducted in 2003 in two long-term care facilities for older people with dementia in Taiwan. Fifty-five residents participated in the study. Results. Eighteen percent of the residents were under-nourished (body mass index

Title. The effectiveness of implementing a bladder ultrasound programme in neurosurgical units Aim. This paper reports an evaluation of the differences among rates of unnecessary catheterization, urinary retention and urinary tract infection before and after implementing a bladder ultrasound programme to assess urine volume. Background. Bladder ultrasound is a non-invasive alternative to urethral catheterization for the determination of bladder urine volume. Much of the literature available on bladder ultrasound technology addresses the accuracy of the equipment, with little research on the clinical outcomes or benefits of the intervention. Methods. A quasi-experimental design was adopted. Data were collected from March 2001 to May 2001 in a control group in two neurosurgical units in Taiwan. During July and August 2001, nurses were taught how to operate a portable ultrasound machine and how to implement the programme. Data were collected from September to November 2001 in the study group. Results. The rates of unnecessary catheterization in the control group and the study group were 35·3% and 7·0%, respectively. The urine volume (more than 500 mL) in the control group and the study group were 13·4% and 20·3%, respectively. The study group had a statistically significantly lower average catheterization volume than that of the control group (676·9 mL vs. 777·1 mL, t = 1·84, P

Pei-Chun Tsai,1 Ping-Keung Yip,2 John Jen Tai,3 Meei-Fang Lou11School of Nursing, College of Medicine, National Taiwan University, Taipei, 2School of Medicine, 3Department of Statistics and Information Science, College of Management, Fu-Jen Catholic University, New Taipei City, TaiwanBackground: After a stroke, patients often suffer from varying degrees of disability that require acute inpatient treatment and extended care at home. Therefore, the caregivers assume multiple responsibilities that can result in stress, particularly when their own needs are inadequately addressed during the patient’s recovery.Objectives: This studyaimed to explore the changing needs of family caregivers of stroke patients and factors related to the needs in four stages, before the transfer from intensive care unit to neurological unit, before discharge, 2weeks post-hospitalization, and 3months post-hospitalization.Methods: The design of this study was based on longitudinal research, and the participants were family caregivers of stroke patients. Sixty family caregivers were recruited in this study. Data were collected at four time points by questionnaire.Results: We found that the total number of needs of family caregivers decreased as the illness duration increased and that needs differed significantly between the four time points (P

The purpose of this study was to test a theoretical model to understand the influences of six predicting variables in post-surgical cognitive disturbance in older Taiwanese patients after elective surgery. The data were collected in a medical center in Taipei, Taiwan. Ninety-three patients were included in the final analysis. The findings showed that cognitive function at admission (beta=0.50, p

This qualitative research was aimed at understanding nurses' experiences of caring for delirious patients. Four in-depth open-ended interviews were analyzed. A model to present the caring experience was developed from the interviews. The experience of caring for the delirious patient is a process of "striving for balance". Informants reported trying to deal with unanticipated patient conditions and the unyielding workloads by balancing these two conditions. Some of the actions pursued included: relying on outer resources, assuring safety, reporting, and supporting each other. Understanding the nurses' caring experience is important for the nurse administrators in helping the nurse manage delirious patients. Suggestions for future research are also made.

This paper reviews the state of the science of interventions using music to decrease the agitated behaviour of the demented elderly person. Seven research articles were located through computerized databases. The review of the literature suggested that music therapy is a useful intervention to help patients deal with a range of behaviour problems. However, overall weakness and limitations of studies are considerable. More rigorous research designs are required to evaluate the immediate and sustained physiological, psychological and sociological effects of music therapy on agitation behaviours of demented elderly. Some recommendations for future research are provided.

BACKGROUND: Stereotactic radiosurgery (SRS) is a common treatment for recurrent or residual pituitary adenomas. The persistence of symptoms and treatment related complications may impair the patient's quality of life (QOL). PURPOSE: The purpose of this study was to examine symptom distress, QOL, and the relationship between them among patients with pituitary tumors who had undergone SRS. METHODS: This study used a cross-sectional design and purposive sampling. We enrolled patients diagnosed with pituitary tumors who had undergone SRS. Data were collected at the CyberKnife Center at a medical center in Northern Taiwan in 2012. A questionnaire survey was used for data collection. Our questionnaire consisted of 3 parts the Pituitary Tumor Symptom Distress Questionnaire, the World Health Organization Quality of Life Instrument Short-Form (WHOQOL-BREF), and a demographic questionnaire. RESULTS: Sixty patients were enrolled in the study. The most common symptoms reported by patients after SRS were memory loss, fatigue, blurred vision, headache, sleep problems, and altered libido. The highest and lowest scores for QOL were in the environmental and psychological domains, respectively. Age was positively correlated with general health and the psychological domains. Level of symptom distress was negatively correlated with overall QOL, general health, physical health, and the psychological and social relationships domains. The scores in the psychological and environmental domains were higher in males than in females. Patients with ≤6 symptoms had better overall QOL, general health, physical health, and psychological and social relationships than those with >6 symptoms. CONCLUSION: Symptom distress can affect different aspects of patient QOL. Levels of symptom distress, number of symptoms, age, and gender were variables significantly correlated with patient QOL. These results may be utilized by healthcare personnel to design educational and targeted interventional programs for symptom management to improve patient QOL.

OBJECTIVE: To explore patients' concerns during the admission transition to cardiac surgery. DESIGN: A descriptive qualitative design. SETTING: Four hospitals in northern Taiwan, Republic of China. PATIENTS: A purposive sample consisting of 40 adult patients (20 men and 20 women) who planned to have cardiac surgery. Age range was 20 to 70 years (mean 50.1 years). OUTCOME MEASURES: The types, levels, components, coping strategies, context, and conceptual framework of patients' concerns. INTERVENTION: Data were collected through semistructured interviews, and then analyzed using qualitative content analysis. RESULTS: Ninety percent of subjects (N = 36) reported two types of concerns: certain (80%) and uncertain (10%). Their certain concerns reflected three levels of concerns: “Caring about” or “Thinking about” (52%); “Worrying about” or “Being afraid of” (43%); and “Experiencing a mortal fear of” (30%), ordered from the weakest to the strongest. The components of patients' concerns were the process of recovery; hospital experiences, including maintaining daily activities, pain at admission, and expectant discomforts and disabilities in the intensive care unit; death; unfinished responsibilities and life goals, significant persons, and places; financial needs; and poor quality of care. Strategies developed to manage their concerns included (1) The use of person-focused effort (both cognitive and psychomotor), (2) Seeking help from others, including family members, friends, other patients, and health professionals, and (3) Turning to metaphysical power. The context for the phenomenon of Taiwanese subjects' concerns concerning cardiac surgery during the admission transition were “Being a person,” resuming normality, and empowerment of self. CONCLUSION: The types, levels, components, and coping strategies of patients' concerns during the admission transition to cardiac surgery were discovered and delineated. The background context and conceptual framework for the phenomenon also were developed from the data analysis to describe and depict this phenomenon.