Search

Introduction: The lack of a consistent and effective assessment tool for older adults with dementia in home care in Taiwan, and the inability of home care nurses to provide pharmacological and non-pharmacological pain management, may affect the quality of life of patients with dementia., Objectives: The aim of this project was to promote evidence-based practices for pain assessment and management of patients with dementia living in the community., Methods: The project followed the JBI Evidence-based Healthcare Model and the seven-phase JBI Evidence Implementation Framework. Eight audit criteria were used, representing best practice recommendations. Through a Getting Research into Practice (GRiP) analysis, we identified three barriers to changing practice and implemented improvement strategies. A follow-up audit was conducted to measure changes in compliance., Results: This project was conducted in five home care institutions. Fourteen home care nurses and 109 patients with dementia participated in the project. The follow-up audit showed that compliance rates had improved significantly. Specifically, the compliance rate increased from 14.29%, 1.83%, 1.83% to 100% for Criteria 1-3, respectively. For Criteria 4-8, compliance increased from 0% to 100%. In addition, the average score of the home care nurses' perceptions of pain care for patients with dementia increased from 44.29 points before the intervention to 82.86 points, and all 14 home care nurses achieved a score of 100 points in the Objective Structured Clinical Examination scenario-based exercises, which was a good learning outcome., Conclusions: Leadership, knowledge-sharing, learning-by-doing teaching strategies, and open communication were key factors in the successful implementation of this study., Spanish Abstract: http://links.lww.com/IJEBH/A294., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 JBI. Unauthorized reproduction of this article is prohibited.)

Introduction: Pain conditions are common in elderly individuals, including those with dementia. However, symptoms associated with dementia may lead to poor recognition, assessment and management of pain. In this study, we incorporated the variables based on questionnaires into a machine learning algorithm to build a prediction model for the pain index of elderly individuals with dementia., Materials and Methods: In this study, 113 cases were collected through questionnaires and used to build prediction models for the patient's pain index. Three machine learning algorithms were incorporated for comparison in this study. To interpret the prediction model, SHapley additive explanations values were used to depict the ranking importance of variables and the relationship between features and pain index., Results: In the comparison of models, random forests with feature selection outperformed in terms of root mean square error and mean absolute error. A total of 11 features were selected based on embedded method. The results showed that the Karnofsky scale played a key role in predicting pain index for elderly individuals with dementia and was positively associated with pain index. Arthritis is the most important disease to predicting the pain index., Conclusions: Our findings provided the key insights to predict the pain index of elderly patients with dementia. In the future, it can be used to develop an application system or webpage, which can reduce the use of labour and improve the efficiency., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Competing Interests: Declaration of competing interest The authors have no conflicts of interest relevant to this article.

Competing Interests: Competing interests: The authors report no conflicts of interest.

Aims and Objectives: This study aims to analyse the trends in the incidence, prevalence and medical costs of pressure injuries (PIs) among genders in Taiwan., Background: The treatment of PIs is complex and costly, often leading to complications and increased mortality. This issue significantly impacts healthcare quality and incurs substantial medical and social costs, warranting attention., Methods: A retrospective cohort study was conducted using data from Taiwan's National Health Insurance Database to obtain and calculate the incidence, prevalence, and medical costs of PIs in the country between 2001 and 2015 as well as to analyse high-risk groups and the medical care utilisation of patients following the STROBE reporting guidelines., Results: Between 2001 and 2015, 15,327 incident case of PIs were diagnosed. During the study period, the prevalence rate of PIs per 100,000 population rose from 26.3 to 189.6, with approximately 11.5%-16.3% of patients undergoing surgical debridement. The PIs prevalence rate increased by 7.2-fold, and hospitalisation costs accounted for 91.7%-96.0% of the total medical costs. Patients with older age, comorbidities, poorer financial status and lower education levels were found to be likely to develop PIs. These predisposing factors differed between males and females. The prevalence of PIs was higher in patients ≥75 years old than in patients from other age groups. Moreover, PI-related medical expenses have been increasing annually., Conclusions: In Taiwan, the rising incidence of PIs is driving up medical costs. Effective care and prevention of PIs necessitate a comprehensive plan from the entire healthcare system., Relevance to Clinical Practice: This research fills a gap in the available data on the incidence, prevalence, and medical costs of PIs in Taiwan and Asia., Patient or Public Contribution: The findings can be used to help develop clinical guidelines for preventive education and treatment of PIs., (© 2024 John Wiley & Sons Ltd.)

Competing Interests: Declaration of competing interest The authors declare that they have no competing interests.

Introduction and Objectives: Bloodstream infections are common in critically ill patients using central venous access devices (CVAD) in intensive care units (ICU). This project aimed to decrease the incidence of central line-associated bloodstream infections (CLABSI) by using evidence-based strategies., Methods: The project applied the JBI audit and feedback methods. Thirty-two nurses and five resident physicians from the medical ICU of a medical center participated in the project. Preintervention compliance was measured for the 11 key evidence-based criteria (six audit criteria of central venous catheter insertion and five audit criteria of dressing and catheter securement). Strategies were implemented to overcome the barriers identified in the baseline assessment. Impact evaluation and sustainability were conducted to change the CLABSI rate and the competence of healthcare professionals in providing CVAD care. The JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit tools were used for the data collection, analysis, and implementation planning., Results: Barriers included insufficient knowledge among nurses and physicians, poor compliance with the standard CVAD insertion procedure by physicians, inadequate cooperation among the CVAD care team members, and lack of CVAD-related equipment. The strategies included education and training in CVAD care, the establishment of a team resource management program, and the provision of appropriate equipment. Following project implementation, the CLABSI rate decreased from 8.38 to 3.9 BSIs/1000 CVAD-days., Conclusions: The project successfully decreased the CLABSI rate and increased the competence of healthcare professionals. Implementation of best practices in clinical care should focus on leadership, team resource management, education, monitoring, and innovation., (Copyright © 2023 JBI. Unauthorized reproduction of this article is prohibited.)

Introduction and Aims: Voiding dysfunction is a common perinatal condition. Appropriate bladder management and monitoring during labor and postpartum improves bladder function and reduces the incidence of infections and complications. This project aimed to promote evidence-based bladder management strategies for perinatal women at a maternity hospital in Taiwan., Methods: The project was implemented using the JBI framework and the JBI Practical Application of Clinical Evidence System. Implementation audits were conducted by examining nurses and intrapartum and postpartum women. Ten criteria were applied in the baseline audit, and two follow-up audits were conducted to assess actual compliance with best-practice recommendations. Through a Getting Research into Practice analysis, we identified three barriers to changing practice., Results: A comparison of the audit outcomes revealed that all criteria had improved by the second follow-up audit cycle. Specifically, the compliance rate increased from 37% and 50% to 100% for criteria 1 and 2, respectively; from 0% to 100% for criteria 3, 5, and 10; and from 7%, 28%, 50%, and 17% to 100%, 100%, 97%, and 100% for criteria 4, 6, 8, and 9, respectively. Following implementation, the frequency of intrapartum intermittent catheterization (53.44-38.30%) and the postpartum incidence of urinary retention (9.09-8.51%) decreased. The time to first voiding after vaginal delivery and between the first and the second voiding decreased from 5.51 and 4.01 h to 2.32 and 2.29 h, respectively., Conclusions: This evidence-based implementation project achieved substantial improvements in bladder management. Relational leadership theory, which integrates empowerment, purposefulness, ethical behaviors, and process orientation, underpinned the project., (Copyright © 2023 JBI. Unauthorized reproduction of this article is prohibited.)

Background: Previous studies have shown that family nurse practitioners (FNPs) provide an important contribution to health promotion and disease management in primary care. Nevertheless, the position of FNP does not exist in Taiwan. In Taiwan, the leading cause of most disability and death is diabetes, for which an FNP has great potential to fulfill healthcare needs. Therefore, establishing how to cultivate competent FNPs is an important issue. It is feasible to train current acute care nurse practitioners (NPs) to become FNPs through enrollment in a transition program., Objectives: The purpose of this study is to develop an FNP transition program, including the necessary competencies and curriculum., Design: A modified Delphi method (use of an expert panel) is used to validate the preliminary curriculum of an FNP transition program., Settings: The Delph method conducted through email and physical meetings., Participants: Four expert panel groups involve in this project with different group has its own mission. Totally, there were 14 experts completed the transition program., Methods: A modified Delphi method was used to validate the competencies and curriculum. Descriptive data analysis was used to evaluate the target consensus of 80%., Results: This study provided the first FNP transition program design in Taiwan, based on the global literature and a local gap analysis., Conclusions: Nursing faculty, healthcare delivery system administration leaders, and policymakers can use the curriculum to train current NPs to become competent FNPs to provide optimal quality of care in the community., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objectives: This study examined the factors associated with better accreditation outcomes among nursing homes., Method: A total of 538 nursing homes in Taiwan were included in this study. Measures included accreditation scores, external factors (household income, Herfindahl-Hirschman Index, old-age dependency ratio, population density, and number of older adult households), organizational factors (hospital-based status, chain-affiliated status, occupancy rate, the number of registered nurses or nurse aides per bed, and bed size), and internal factors (accountability, deficiencies, person-centered care, nursing skills, quality control, and integrated care)., Results: Bed size, hospital-based status, accountability, deficiencies, person-centered care, nursing skills, quality control, and integrated care were found to predict accreditation., Conclusion: Among all variables in this study, the quality indicators contributed to the most variation, followed by organizational factors. External environmental factors played a minor role in predicting accreditation. A focus on quality of care would benefit not only the residents of a nursing home but also facilitate its accreditation.

With the increasing number of people with disabilities caused by an aging global population, the need for long-term care is gradually increasing. Nursing assistants (NAs) are the primary providers of direct care services to older adults with disabilities, whose knowledge, skills, and beliefs affect the quality of care provided. This study aimed to investigate the influential factors affecting NAs' current competences. A total of 255 NAs' valid questionnaires were collected from 20 long-term care institutions in Taiwan through convenience sampling. The questionnaire comprised dimensions of demographics and care competence. The study results indicated that NAs had the greatest care competence in the domain of recognition of patient rights (4.64 ± 0.54 points). The multiple regression indicated that age, religion, job category, disability care experience, the receiving of performance bonuses, and the receiving of year-end bonuses significantly affected the level of care competence ( p < 0.05). With the aforementioned findings, the results of this study serve as references for the government in employing long-term care NAs and developing management policies. Training programs for NAs should be developed to improve the quality of care provided to older adults with disabilities.

Competing Interests: Declaration of Competing Interest There is no conflict of interest.

Background and Purpose: To date, there has been no policy analysis or review of the effectiveness of the current nurse practitioner (NP) scope of practice regulations in Taiwan. The purpose is of this article was to provide a policy analysis of NP scope of practice regulations in Taiwan., Methods: The Longest policy cycle model was used to analyze the NP scope of practice regulations. Policy formation, policy implementation, and policy modification are three steps in this model. Policy formation and policy implementation are described in the first two sections. Regarding policy modification, we used the data collected from a research grant to evaluate the implementation of the NP scope of practice regulations to present the effectiveness of the policy endorsement in Taiwan., Conclusions: The impact of health care services provided by NPs was positive from the viewpoint of the hospital. The top-ranking impact was reducing physicians' workload and increasing the effectiveness of communication and coordination among the team., Implications for Practice: The economic value of advanced practice nurses needs to be identified, as it can result in optimal professional growth. The Taiwan Association of Nurse Practitioners can design the metrics to measure NPs' contribution and to analyze the financial benefits bestowed by the NP profession based on the study results.

Taiwan is projected to become an aged society in 2018. In addition to establishing a comprehensive, long-term care system that is able to deal with the expected impacts of population aging, it is imperative that the government focus on improving the prevention of aging-related conditions. This article introduces the innovative preventive care policy promoted by Taiwan's Ministry of Health and Welfare and its preliminary results. Furthermore, the foundational ideas behind this policy and how it is being executed are explained. Medical and related professional groups participated in the research and development of the associated care plan and in the training of community-based trainers. Local governments integrate local resources in order to establish contracted community service bases and to provide professionally reviewed preventive care plans. A network of 850 contracted communities was established in 2017, and 17,117 participants have received services through this network to date. The Kihon checklist (KCL, the basic assessment tool for frailty used by the Japanese Ministry of Health, Labor and Welfare) was used before and after the intervention. Participants showed noticeably improved scores on the instrumental activities of daily living (IADL) and in the motor function, nutrition, oral function, socialization, dementia, depression, and lifestyle domains, with scores on the emotional happiness index showing especially strong improvement.

The atomic geometry, stability and electronic properties of self-organized Au induced nanowires on a Ge(0 0 1) surface are investigated based on the density-functional theory in the generalized gradient approximation and the stoichiometry of Au. According to the formation energy and the simulated STM image, the Ge atoms substituted by the Au atoms have been confirmed as occurring at a Au coverage lower than 0.25 Ml. The STM image with single and double dimer vacancies looks like the Au atoms have penetrated the subsurface. The energetically favorable dimer-row arrayed structures at 0.50 Ml and 0.75 Ml Au coverages have a 4  ×  1, 4  ×  2 or c(8  ×  2) transition symmetry, which comprise a flat Au-Au homodimer row and an alternating various buckling phase Ge-Ge or Au-Ge dimer row. The c(8  ×  2) zigzag-shaped protruding chains of shallow-groove STM images are highly consistent with the observations, but a long-range order dimer-row arrayed structure formation requires sufficient mobile energy to complete mass transport of the substituted Ge atoms in order to avoid the re-adsorption of these atoms; otherwise a deep-groove structure reconstruction is sequentially formed. A quasi-1D electron-like energy trough aligns in the direction perpendicular to the nanowire of the dimer-row arrayed structure in the c(8  ×  2) phase on a 0.75 Ml Au/Ge(0 0 1) surface, which is contributed by the Au-Ge dimer rows and the subsurface Ge atoms below them. The bottom energy of the energy trough is consistent with angle-resolved photo-emission spectroscopy studies (Schäfer et al 2008 Phys. Rev. Lett. 101 236802, Meyer et al 2011 Phys. Rev. B 83 121411(R)).

Active ageing is one of the most important issues taken up by the WHO in regard to ageing societies. "Prolonging Healthy Life Expectance" and "Decreasing the Depression Rate Among Older People" are critical indicators for "2020 Healthy People in Taiwan". This paper conducts a trial run of the program planning and evaluation of mental-social health promotion using focus group research that surveys 29 administrative districts and a depression survey that randomly samples older individuals in Taichung City. We also introduce how we apply local characteristics to develop the 3-level and innovative-action plans to meet the needs of self-identity and social participation for older people. For example, the "Learning Mobile Classroom" program promotes health promotion using activities that are tailored to the lifestyle and culture characteristics of target individuals. Another example is the "Seniors Show", which uses community groups and annual active-ageing shows to promote a positive concept of aging and to promote social participation for older people. Finally, the "Navigator APP of Active Ageing", created using a geographic information system, addresses the resource information needs of older people. This experience in Taichung City uniquely empowers older people, allowing them to take the initiative to make a difference not only for mental-social wellness but also for the hope of life and for graceful ageing.

Studies exploring the perceptions of patients whose lives are maintained by mechanical ventilation highlight the stressful nature of this type of experience. The objective of this meta-synthesis study was to describe the nature of the experience of adult ventilator-dependent patients. A systematic literature search of English and Chinese databases was undertaken, covering the period between 1970 and 2012. Qualitative research findings were extracted and pooled using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. A total of 1004 papers were identified from various database and hand searches. Nineteen papers were critically appraised and 16 met inclusion criteria. Five meta-synthesis themes emerged from the analysis: (1) the feelings of fear due to being dependent on a ventilator and the loss of control of life; (2) disconnection with reality; (3) impaired embodiment; (4) construction of coping patterns; (5) trust and caring relationship. Suggested implications for practice include enhancing the trust relationship with health professionals, as well as nursing actions throughout the suction procedure relating to release of patient's psychological distress and empowering their resilience factors., (© 2013 Wiley Publishing Asia Pty Ltd.)

Many city authorities around the world are enhancing infrastructures and services to make their cities age-friendly, a process that aims to make city services and facilities more accessible to an ageing population and increase opportunities available to older residents. The process of creating age-friendly environments is a key challenge for international policy makers. The purpose of the paper is to introduce age-friendly city ideals and practices and share the age-friendly city planning experience of Taichung city.

Children and adolescents with cancer are confronted with many challenges. This review considered studies that used qualitative methods to examine the body image experience of children and adolescents with cancer. A systematic literature search of English and Chinese databases was undertaken, covering the period between 1960 and October 2010. Qualitative research findings were extracted and pooled using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Eight papers met the inclusion criteria. The derived four metasyntheses included being distanced from the body, loss of self-identity, self-protective strategies and support, and getting rid of the shackles of the body. In conclusion, children and adolescents with cancer also experience various problems associated with changes in their body image. Repeated courses of treatment lead to loss of a normal, orderly life, and might even result in changes in interpersonal interactions. In response to body image change, individuals with cancer develop self-protective, coping strategies. Children and adolescents who experience life-threatening cancer come to face body image change positively, and might hold a confident attitude toward their future., (© 2012 Wiley Publishing Asia Pty Ltd.)

The purpose of this article is to address the trends and policy of elderly and long-term care in Taiwan. In response to the increasing demand of an aging society, healthcare professionals play crucial roles in elderly and long-term care and quality assurance of services. This article focuses on the current situation of elderly health care, demands of long-term care, long-term care policy in Taiwan, draft of the Long-term Care Services Act, and draft of the Long-term Care Insurance Act. After the 10-year long-term care project was proposed by the Taiwan government, the supply of health care services and demand for long-term care have created many challenges and opportunities for innovative health professional development. Challenges consist of low old dependency ratio caused by low birth rate, lack of elderly and long-term care related manpower, services and education reform related to long-term care for the future society, and interprofessional collaboration and team work of long-term care. Opportunities include expanding the roles and the career pathways of healthcare professionals, promoting the concepts of active aging and good quality of life, and developing industrial cooperation related to long-term care services. Under these circumstances, healthcare professonals are actively involved in practice, education and research of long-term care services that ensure elderly and disabled people can live a healthier and better life., (Copyright © 2012. Published by Elsevier B.V.)

Background: The nurse workload in Taiwan averages two to seven times more than that in the United States and other developed countries. Previous studies have indicated heavy nursing workload as an underlying cause of preventable patient death. No studies have yet explored the relationship between nurse staffing ratio and patient mortality in Taiwan., Purpose: This study explored the effect of nurse staffing ratios on patient mortality in acute care hospitals in Taiwan and considered the implications in terms of policy., Methods: Using stratified random sampling, 108 hospital nursing units in 32 of Taiwan's 441 accredited Western medicine district/regional hospitals and medical centers were included in the study. Variables were retrospectively measured from 108 wards by using monthly data during a 7-month period. A generalized estimating equation logistic model was used to obtain more precise estimates of the nurse staffing effect by controlling for hospital characteristic and patient acuity variables., Results: The population-averaged odds ratio for the incidence of death between the low and high patient-nurse ratio groups was 3.617 (95% CI = [1.930, 6.776]). The risk of death in the high patient-nurse ratio group was significantly higher than in the low patient-nurse ratio group., Conclusions: Nurse staffing levels affect patient outcomes. Faced with the problem of inadequate nurses for hospital healthcare needs, Taiwanese policymakers should work to implement a legislatively mandated minimum patient-nurse ratio on a shift-by-shift basis to regulate nurse staffing. In setting guidelines for nurse staffing, policymakers must consider nursing staff characteristics in addition to the number of nurses.

This article used both retrospective and prospective perspectives to rethink and reflect upon the opportunities and challenges of nursing professional development in Taiwan. The authors conducted a literature review on the 2011-2015 Strategic Directions for Strengthening Nursing and Midwifery Services (SDNM) initiated by the World Health Organization (WHO) and on analyses of nursing related polices and programs from done by Taiwan health administrative offices. It is important to record the contribution of nursing to Taiwan's healthcare delivery system. Such is especially in light of the Taiwan's centenary celebrations in 2011 and of the Department of Health's consolidation into the Ministry of Health and Welfare in 2012 due to central government reforms.

Executive Summary: Objectives: The objective of this study was to describe the body image experience of children and adolescents with cancer., Inclusion Criteria: This review considered studies that utilised qualitative methods to examine the experience of children and adolescents with cancer. The phenomena of interest were experiences of children and adolescents with cancer living in acute care, home, and community settings of any cultural context. The research was limited to studies published in Chinese or English only., Search Strategy: The search strategy sought to find both published and unpublished studies. CINAHL, MEDLINE, Mednar, Scius, ProQuest Dissertations and Theses, electronic theses and dissertations system and Chinese electronic periodical services were used to search the articles.Methodological quality: Each paper was assessed independently by two reviewers for methodological quality. The Joanna Briggs Institute Qualitative Assessment and Review Instrument was used to appraise the methodological quality of the articles. Any disagreements that arose between the reviewers were resolved through discussion with a third reviewer., Data Extraction and Synthesis: Qualitative research findings were extracted and pooled using the Joanna Briggs Institute Qualitative Assessment and Review Instrument., Results: Eight papers were included in the review. Four meta-syntheses emerged from the analysis: (1) Being kept away from body: Clinicians should be aware that children and adolescents with cancer feel that they are kept away from normal body, (2) Loss of self-identity: Clinicians should be aware that children and adolescents with cancer feel that they have lost their self-identity, (3) Self-protective strategies and support: Clinicians should understand the protective strategies that children and adolescents with cancer develop and utilise with support from family and friends, and (4) Getting rid of shackles of the body: There should be a strategy to facilitate the development of positive attitudes toward the illness and body image change in children and adolescents with cancer., Conclusion: Children and adolescents with cancer also experience various problems associated with body image change. Repeated courses of treatment lead to loss of a normal orderly life, and may even result in changes in interpersonal interactions. In response to body image change, self-protective coping strategies are developed. Children and adolescents who experience life-threatening cancer come to face body image change positively and may hold a confident attitude towards future life.The implications for practice include: (1) Clinicians should be aware that children and adolescents with cancer feel that they are kept away from normal body; (2) Clinicians should be aware that children and adolescents with cancer feel that they have lost their self-identity; (3) Clinicians should be understand the protective strategies that children and adolescents with cancer develop and utilise with support from family and friends; (4) There should be a strategy to facilitate the development of positive attitudes toward the illness and body image change in children and adolescents with cancer.The research tools concerning social support and guidance can be further developed in the future to increase the confidence and capacity of children and adolescents with cancer to face body image change and reduce psychological stress.

Objective: The study was to determine whether a modified MNA (Mini Nutritional Assessment) which adopted population-specific anthropometric cut-points but without BMI could maintain its predicting ability in community-living elderly in Taiwan., Design: Purposive sampling., Setting: Community-living elderly., Participants: Three hundred and one (138 male and 163 female) > 65-year-old outpatients seeking free annual health examination at an area hospital in central Taiwan., Measurements: A structured questionnaire elicited personal data, lifestyle information and answers to the MNA. Laboratory results from health checkup provided the needed biochemical data. Each subject's nutritional status was assessed with the MNA in three versions: the original, the MNA-TI (with population-specific cut-points), and the MNA-TII (further eliminated the BMI question and redistributed its score to the MAC and CC questions)., Results: All three versions identified the same 0.7% elderly malnourished. The proportions predicted at risk of malnutrition were 16.6, 12.0 and 10% according to the original, MNA-TI and MNA-TII, respectively. Friedman Test and post hoc analysis indicated that the pattern predicted by the original MNA was different from that predicted by the two modified versions whereas the patterns predicted by the two modified versions were not different from each other., Conclusion: Adoption of population-specific anthropometric cut-points improves the predicting ability of the MNA in Taiwanese elderly, and the improved functionality is maintained in a version without BMI (but with adjusted MAC and CC scores). A MNA without BMI has greater applicability and can enhance professional efficiency of healthcare workers.

In terms of an interatomic pair potential, which well characterizes the dynamic properties of liquid Ga, we investigate again the origin of the well known high-q shoulder in the static structure factor of the liquid. Similar to the results of Gong's simulation at high temperature, dimers with extremely short bond lengths are indeed found in our model just above the melting point, but our results indicate that it is unlikely for the high-q shoulder to be produced by these dimers. Instead, based on our model, the high-q shoulder is resulted from some medium-range order, which is related to the structures beyond the first shell of the radial distribution function, caused by Friedel oscillations within a nanoscale range.

Objectives: The objective of this meta-synthesis study was to describe the nature of the experience of adult ventilator-dependent patients., Inclusion Criteria: This review considered studies utilized qualitative methods to examine the experience of adult with ventilator. The phenomena of interest were experiences of patients who were treated with ventilator for both short term and long term in ICU settings or home settings. The research was limited to studies published in Chinese or in English language., Search Strategy: The searching strategy sought to find both published and unpublished studies. The CINAHL, PubMed, MEDLINE, Cochrane Library, Chinese Periodicals Index and JIB website were used to search the articles. The preliminary keywords were drawn from the natural language terms of the topic, in the title, abstract and subject descriptors., Methodological Quality: Each paper was assessed independently by two reviewers for methodological quality. The Joanna Briggs Institute's Qualitative Assessment and Review Instrument were used to appraisal the methodological quality of the articles. Any disagreements that arose between the reviewers were resolved through discussion with a third reviewer., Data Synthesis: Qualitative research findings were pooled and the data analysis process involved synthesizing findings to generate a set of statements that represent the nature of the experiences of ventilator-dependent adult patients. The categories and themes/meta-syntheses were emerged from the analysis process., Results: A total of 997 papers were identified from various database and hand searches. Nineteen papers were critically appraised and 15 met inclusion criteria. Four papers were excluded because they did not meet the inclusion criteria. Five themes/meta-syntheses emerged from the analysis: 1). The feelings of fear due to being dependent on ventilator and the loss of control of life, 2). Disconnection with reality, 3). Impaired embodiment (body image and body boundary), 4). Construction of coping patterns, 5). Trust and caring relationship., Conclusion: The five themes/meta-syntheses derived from the review represent the patients' experiences in regarding the threatening of the integrity of self, self-other and self-environment relationships, the coping patterns and resilient resources to maintain their self-identify and the meaning of life. These findings also illustrate the resiliency factors for those patients to cope with this stressful situation.The implications to practice include enhancing the trust relationship with health professionals, as well as the nursing actions prior to suction, during the suction procedure and post suction in related to release their psychological distress and empower their resilience factors was suggested.Furthermore, the further research could focus on the development and implementation of support programs for the patients, families, and health professionals, as well as the research regarding the reduction of psychological distress and empower the coping patterns.

Aim and Objectives: To determine whether a modified version of the Mini Nutritional Assessment (MNA) without body mass index (BMI) can effectively identify individuals at risk of malnutrition among patients with neuropsychiatric disorders., Background: Neuropsychiatric patients have an additional risk of nutritional disorder due to functional impairments and drug effects. However, their nutritional status is generally neglected. It is important to find a tool that is simple, easy to use and non-invasive., Design: The study involved 105 patients in the acute phase of confirmed neuropsychiatric disorders in an area hospital. All subjects were cognitively able to have effective verbal communication., Method: The study included serum biochemical and anthropometric measurements and an on-site, in-person interview using a structured questionnaire to elicit personal data, health condition and answers to questions in the MNA. Subjects' nutritional statuses were graded with a MNA that adopted population-specific anthropometric cut-off points or one further with the BMI question removed and its assigned score redistributed to other anthropometric questions., Results: Both versions of the modified MNA effectively graded the nutritional status of neuropsychiatric patients and showed good correlations with the major nutritional indicators such as BMI, calf circumference and the length of hospital stay., Conclusions: The MNA can effectively assess the nutritional status of neuropsychiatric patients and enhance timely detection and intervention of their nutritional disorders. A modified MNA without the BMI question can maintain the full functionality of the tool. The version does not require weight and height measurements and thus will enhance the usefulness of the instrument., Relevance to Clinical Practice: Neuropsychiatric patients are a high-risk group of nutritional disorders. The MNA, especially the one without BMI, has the potential to improve professional efficiency of the primary care workers.

The purpose of this article was to elaborate on the development of policies related to long-term care services in Taiwan and the current status of such. Using the framework of the Department of Health's long-term care projects, issues regarding how to assist nursing professionals cope with the demands of Taiwan's aging society and participate in the planning and implementation of long-term care services were raised and discussed. The demands of long-term care services are complex and multifaceted. An ideal long-term care services system should deliver care that is continuous and comprehensive. Recent developments and demands on long-term care services in Taiwan and supply issues related to nursing services have spurred significant discussion regarding the innovative potential and possibilities for the nursing profession. It is our belief that the commitment of Taiwan's nursing professionals will help secure the critical role of nursing in the national long-term care services system and quality healthcare.

The purpose of this article is to guide nurses towards an understanding of current policy making and policy development concerning nurse practitioners. The article outlines the planned blueprints for the establishment of nurse practitioners through a systematic analysis of the developmental context surrounding nurse practitioners in Taiwan, and discusses Taiwan's current nurse practitioner policy from the perspective of participation and observation. It is hoped that an understanding of the processes by which policy is formed will provide nurses with the knowledge and skills to participate in policy-making and raise the influence of the professional commitment involved in nursing.

The Cl abstraction by gas-phase H atoms from a Cl-terminated Si(100) surface was investigated by scanning tunneling microscopy (STM), high-resolution core level photoemission spectroscopy, and computer simulation. The core level measurements indicate that some additional reactions occur besides the removal of Cl. The STM images show that the Cl-extracted sites disperse randomly in the initial phase of the reaction, but form small clusters as more Cl is removed, indicating a correlation between Cl-extracted sites. These results suggest that the hot-atom process may occur during the atom-adatom collision.

The purpose of this paper is to propose a vision and appropriate policy development strategies for nursing manpower in Taiwan. Proposals are grounded in a comprehensive analysis of Taiwan's current nursing manpower policy problems based on the linkages between nursing education and nursing practice. Nursing manpower policy goes beyond concern for simple numbers to include other variables that affect nursing staffs such as workload, work environment, case complexity, skill level, nursing staff mix, and nursing care cost efficiency and effectiveness. Manpower, the most important and precious resource in the medical care system, is the critical factor affecting the system's capacity to deliver appropriate and effective care. In recent years, demand for nurses in developed countries has fallen short of domestic supply, which has raised international nursing migration levels. The International Council of Nurses pursues policy issues related to nursing manpower. Although it has not yet experienced a shortage of nurses, Taiwan still lacks comprehensive policy and management systems governing nursing manpower.

The "Nurses Law", promulgated in 1991, allows nurses to operate nursing care facilities (e.g., nursing homes, home care institutes). The opening in 1993 of Taiwan's first registered nursing home, the Chiang-Chin Foundation of Nursing Perspectives, under Dr. Min-Shih Du represents an important milestone in both nursing and long-term care in Taiwan. Using the oral history method, this research depicts and analyzes Chiang-Chin Foundation of Nursing Perspectives operation and management experiences over a period spanning 1993 through 2002. Research results can provide management knowledge and experience for nurses, managers, and administrators in the long-term care field. Results also provide reference for long-term care policy makers and nursing entrepreneurs, and may serve as a valuable record related to the development of nursing in Taiwan.