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Background The Physical Health Attitude Scale (PHASe) is a reliable and valid scale for assessing mental health nurses’ attitude towards providing physical healthcare to patients diagnosed with serious mental illness. Aims To psychometrically evaluate the Chinese adaptation of the PHASe. Methods A total of 520 mental health nurses from 11 hospitals across Taiwan participated in this study. Brislin’s translation model was utilized for the validation process. Both exploratory factor analysis and confirmatory factor analysis were used to establish the construct validity of the scale, and Cronbach’s alpha and composite reliability were used to determine reliability. Results The four-factor 17-item Chinese version of the PHASe demonstrated satisfactory fit with significant factor loadings. Each factor had adequate internal consistency (Cronbach's alpha = 0.70 to 0.80). Known-group validity was supported by the significant differences between groups with different attitudes. Conclusions Our findings suggest that the Chinese version of PHASe is acceptable for evaluating nurses’ attitude towards providing physical health care both within culturally Chinese societies and in cross-cultural studies.

The prevalence of chronic diseases (such as diabetes, obesity, cancer, heart disease, and chronic obstructive pulmonary disease) continues to increase among patients with mental illness. This cross-sectional study investigated the factors affecting nurses' views on the provision of physical healthcare to patients with comorbid mental illness and chronic disease. In total, 369 nurses working in mental health were assessed for the physical healthcare attitudes and practices using the Physical Health Attitude Scale for Mental Health Nurses. The results of generalized linear modelling indicated that nurses' involvement in physical healthcare was associated with psychiatric mental health nurse credentials (B = 1.560, 95% CI = 0.292-2.828, P = 0.016) and their confidence in delivering physical healthcare was associated with prior physical healthcare training (B = 0.639, 95% CI = 0.104-1.174, P = 0.019). In addition, the frequency with which the nurses engaged in physical healthcare practices was associated with working in a community unit (B = -7.416, 95% CI = -9.652 to -5.180, P 0.001), involvement in physical healthcare (B = 0.349, 95% CI = 0.162-0.535, P 0.001), and confidence in delivering physical healthcare (B = 1.148, 95% CI = 0.776-1.519, P 0.001). Our findings suggest that interventions aiming to help nurses assess and improve their own physical healthcare practices should consider nurses' background and patients' physical health needs in various settings and focus on cultivating an organizational culture that gives nurses confidence in providing physical healthcare.

Background Longitudinal integrated clerkships (LICs) are a model of clinical education growing rapidly in Western contexts. LICs use educational continuity to benefits students’ clinical learning and professional identity formation. Patient-centered care is a core component of medical professionalism in the West. To support patient-centered care, education leaders in Taiwan restructured clinical education and implemented the first longitudinal integrated clerkship in East Asia. We aimed to investigate patients’ perceptions of longitudinal relationships with the LIC students within Taiwan’s Confucian cultural and social context. Methods We invited patients or their family members who were cared for longitudinally by a LIC student to participate in the study. Participating patients or their family members undertook semi-structured interviews. We analyzed data qualitatively using a general inductive approach to identify themes in the patients’ descriptions of their experiences interacting with the LIC students. Results Twenty-five patients and family members participated in interviews: 16 patients and 9 family members. Qualitative analysis of interview transcripts identified three themes from patients’ experience receiving care from their LIC students: care facilitation, companionship, and empathy. To provide care facilitation, LIC students served as a bridge between the physicians and patients. Students served patients by reminding, consulting, tracking disease progression, and researching solutions for problems. To provide companionship, students accompanied patients interpersonally like a friend or confidant who listens and provides a presence for patients. To provide empathy, patients reported that students showed sincere concern for patients’ experience, feelings, and mood. Conclusion In our study, Taiwanese patients’ perspectives of LIC students suggested the value of care facilitation, companionship, and empathy. We discuss these themes within the context of Confucian culture and the Taiwanese context of care.

Background: Due to globalization, the frequency to stay in other countries has increased, resulting in more chances to nursing staff to communicate with foreign patients in English. However, English is not the native language in many countries, including Taiwan. Many nurses cannot communicate with foreign patients efficiently. Aim: This study aimed to identify the clinical English Communication Abilities of nurses and their willingness and requirements to improve, negative communication situations, and their influential factors. Methods: A questionnaire to conduct a descriptive, exploratory, cross-sectional survey was applied to 273 clinical nurses at a teaching hospital in Taiwan. Results: Most nurses stated that their English Communication Abilities was insufficient to cope with clinical requirements and were willing to improve this ability. In negative communication situations, the major problems included the nurses felt that they had to spend more time, were more stressed, and were not able to perform at a professional level when interacting with foreign patients, which would reduce interaction with patients. The factors that impact these problems include frequency of self-study and clinical English communicative abilities. English handout containing hygiene instructions was considered the most useful resource to facilitate clinical English conversation. Conclusions: Inadequate English Communication Abilities results in more time spent when communicating with foreign patients. Nurses who have better English Communication Abilities or have set hours for studying English may reduce the frequency of negative situations while communicating in English. Periodical advanced study of English might reduce the negative situation of nurse–patient communicated in English. To provide high-quality international medical service, the hospital managers have to offer appropriate assist strategies to improve nurses' clinical English communication abilities.

Purpose An exploration of concurrent chemoradiation therapy care process from the perspective of patients with head and neck cancer can provide an insight to their lived experience and the difficulties they encounter in daily life towards a deeper understanding of this phenomenon to shape nursing service delivery. The aims of this study were to explore the lived experiences of patients with head and neck cancer while receiving concurrent chemoradiation therapy. Methods Data were generated from individual in-depth interviews with fifteen head and neck cancer patients, according to the semi-structured interview guidelines, at the out-patient radiation oncology department, Chulabhorn Cancer Center, Bangkok, Thailand. Results By using Graneheim and Lundman's content analysis, three categories from the data analysis of patients with head and neck cancer receiving concurrent chemoradiation therapy were isolated: 1) overwhelming information, 2) unpleasant symptom cluster, and 3) strategy for adherence to treatment regimen. Conclusion The findings help to provide a better understanding of the lived experiences of patients with head and neck cancer during concurrent chemoradiation therapy, in terms of their suffering from various unpleasant side effects and how these impact their life along the treatment journey. This perspective on the care process in these patients enhances the development of a nursing care model based on patient-centered care toward positive patient outcomes.

To investigate the factors affecting the quality of life among adults with comorbid serious mental illness and chronic diseases.Descriptive, cross-sectional study design.In total, 204 patients with serious mental illness were recruited from two hospitals. Self-reported data were collected using the Brief Psychiatric Rating Scale, Internalised Stigma of Mental Illness, Patient Activation Measure and brief version of the World Health Organization Quality of Life Instrument. Data were collected between July 2018 - January 2019. The structural equation model was applied to examine the associations among the study variables.Internalized stigma (β = -0.479, p = .002) had the greatest direct effect on quality of life, followed by patient activation (β = 0.238, p = .002), severity of comorbidities (β = -0.207, p = .002) and psychiatric symptoms (β = -0.186, p = .006). In addition, psychiatric symptoms directly influenced the severity of comorbidities, which in turn directly influenced internalized stigma and then in turn directly influenced patient activation and ultimately influenced quality of life.The relationship between internalized stigma and quality of life is significantly mediated by patient activation. This finding provides a theoretical basis for developing patient activation interventions for patients with comorbid mental and chronic diseases, which potentially improve the quality of life of this population.Multiple comorbidities cause impaired quality of life in patients with serious mental illnesses. We found that patient activation plays an important role in the management of chronic diseases for achieving more favourable quality of life, but this is negatively affected by internalized stigma. These findings can help mental health professionals develop tailored intervention strategies to enhance quality of life by promoting patient activation and reducing internalized stigma, psychiatric symptoms, and comorbidity severity in patients with comorbid serious mental illnesses and chronic diseases.目的: 探讨影响成年严重精神病兼慢性病患者生活质量的因素。 设计: 描述性横断面研究设计。 方法: 两所医院共计招募204名严重精神疾病患者。可通过简明精神病评定量表、精神病患者病耻感评估量表、患者激活措施和世界卫生组织生活质量量表的简要版本收集自我报告数据。数据收集时间为2018年7月至2019年1月。结构方程模型可用于检验不同变量之间的相关性。 结果: 内耻感 (β = −0.479, p = .002) 对生活质量的直接影响最大, 其次是患者激活度(β = 0.238, p = .002) 、并存病严重程度(β = −0.207, p = .002) 和精神症状 (β = −0.186, p = .006) 。此外, 精神症状直接影响并存病严重程度, 进而影响内耻感和患者的积极性, 最终影响其生活质量。 结论: 内耻感和生活质量的相关性可通过患者激活度来确定。这一发现为针对精神疾病兼慢性疾病患者的激活干预措施的开发提供理论基础, 可帮助改善相关人群的生活质量。 影响: 多种并存病可能导致严重精神疾病患者的生活质量下降。我们发现, 患者激活度在慢性病的治疗中起着重要的作用, 帮助提高患者的生活质量, 然而, 其可能受到内耻感的负面影响。此类发现可以帮助精神卫生专业人员制定针对性的干预策略, 提高患者的积极性, 减少严重精神疾病兼慢性病患者的内耻感、精神症状和并存病严重程度, 提高其生活质量。.

BACKGROUND Authors of several studies have reported differences in the prevalence of metabolic syndrome (MetS) between men and women. However, information is lacking on gender difference among military personnel. OBJECTIVE The aim of this study was to examine the prevalence of MetS and its component abnormalities among Taiwanese Air Force personnel by gender and age groups. METHODS A population-based study was conducted including 14 872 Taiwanese Air Force personnel. Data were retrieved from the military's Health Management Information System. Analyses were performed using Student t test, χ test, and linear-by-linear χ test. Statistical significance was defined as P < .05. RESULTS The MetS prevalence was 14.0% (15.1% in men and 5.3% in women). Metabolic syndrome was associated with age for both men and women (both Ptrend < .001), with a greater prevalence of MetS in men aged 18 to 44 years than in women, but not in the age group of 45 years or older. In men, MetS was most prevalent in those with increased waist circumference (78.2%), followed by those with elevated blood pressure (75.6%). By contrast, in women, it was most prevalent in those with increased waist circumference (86.5%), followed by those with reduced high-density lipoprotein cholesterol (84.3%). CONCLUSIONS Our findings suggest that military nurses and other health providers should consider the gender- and age-based MetS prevalence trend among Taiwanese Air Force personnel when designing interventions to identify vulnerable subgroups at a high risk of MetS. Health management programs should be adapted to minimize metabolic risks.

Patients on hemodialysis with multiple comorbidities have limited physical activity, resulting in poor health, low activity participation, and low quality of life. Accordingly, the nursing care provided to such patients should include regular physical activity training programs. Therefore, this cross-sectional descriptive study investigated whether patients on hemodialysis with and without comorbidities have different levels of physical activity and health-related quality of life (HRQoL); the correlations among the comorbidities, physical activity, and HRQoL of the two cohorts were also assessed. The 36-Item Short-Form Health Survey version 2 and International Physical Activity Questionnaire were employed to collect data from 120 patients on hemodialysis. An independent samples t-test and univariate and multivariate linear regression analyses were conducted. The overall HRQoL of patients with comorbidities was lower than that of patients without comorbidities (p = 0.008). Compared with patients who participated in low-intensity physical activity, the overall HRQoL of patients who participated in moderate-intensity physical activity was higher (p < 0.001). The overall HRQoL of patients with comorbidities who participated in low-intensity physical activity was lower than that of those who participated in moderate-intensity physical activity (p < 0.001). Moderate-intensity physical activity was correlated with higher HRQoL for patients with comorbidities. This finding supports the implementation of effective physical activity intervention measures. Furthermore, it supports the promotion of patient self-management and the implementation of regular exercise programs and lifestyle changes, and patients on hemodialysis can benefit from the future management of physical activities.

Background The Physical Health Attitude Scale (PHASe) is a reliable and valid scale for assessing mental health nurses’ attitude towards providing physical healthcare to patients diagnosed with serious mental illness. Aims To psychometrically evaluate the Chinese adaptation of the PHASe. Methods A total of 520 mental health nurses from 11 hospitals across Taiwan participated in this study. Brislin’s translation model was utilized for the validation process. Both exploratory factor analysis and confirmatory factor analysis were used to establish the construct validity of the scale, and Cronbach’s alpha and composite reliability were used to determine reliability. Results The four-factor 17-item Chinese version of the PHASe demonstrated satisfactory fit with significant factor loadings. Each factor had adequate internal consistency (Cronbach's alpha = 0.70 to 0.80). Known-group validity was supported by the significant differences between groups with different attitudes. Conclusions Our findings suggest that the Chinese version of PHASe is acceptable for evaluating nurses’ attitude towards providing physical health care both within culturally Chinese societies and in cross-cultural studies.

Several studies have reported on metabolic syndrome (MetS) based on cross-sectional designs, which cannot show a long-term result. Information is lacking on MetS and related factors based on a longitudinal cohort. This study aimed to examine the relationship between MetS and related factors for a total of six years among hospital employees. A population-based study was conducted, including 746 staff. A total of 680 staff without MetS in 2012 were enrolled in the analysis for repeated measurement of six years of the longitudinal cohort. Data were retrieved from the hospital’s Health Management Information System. Analyses were performed using Student’s t-test, chi-square test, logistic regression, and generalised estimating equations. Statistical significance was defined as p &lt, 0.05. Hospital employees aged between 31 and 40 (odds ratio (OR) = 4.596, p = 0.009), aged between 41 and 50 (OR = 7.866, p = 0.001), aged greater than 50 (OR = 10.312, p &lt, 0.001), with a body mass index (BMI) of 25.0~29.9 kg/m2 (OR = 3.934, p &lt, 0.001), a BMI ≥ 30 kg/m2 (OR = 13.197, p &lt, 0.001), higher level of white blood counts (β = 0.177, p = 0.001), alanine aminotransferase (β = 0.013, p = 0.002), and uric acid (β = 0.223, p = 0.005) were at risk of being diagnosed with MetS. The identification of at-risk hospital employees and disease management programs addressing MetS-related factors are of great importance in hospital-based interventions.

Rescue workers are a population at high-risk for mental problems as they are exposed to work-related stress from confrontation with traumatic events when responding to a disaster. A reliable measure is needed to assess rescue workers’ work-related stress from their surveillance of a disaster scene to help prevent severe PTSD and depressive symptoms. The purpose of this study was to develop and validate the Work-Related Stress Scale (WRSS) designed to measure stress in rescue workers after responding to traumatic mass-casualty events. An exploratory sequential mixed methods procedure was employed. The qualitative phase of the item generation component involved in-depth interviews of 7 experienced rescue workers from multiple specialties who had taken part in 1 or 2 mass-casualty events: the 2018 Hualien earthquake or the 2016 Tainan earthquake. In the quantitative phase, a modified Delphi approach was used to achieve consensus ratings by the same 7 raters on the items and to assess content validity. Construct validity was determined by confirmatory factor analysis using a broader sample of 293 rescue workers who had taken part in 1 of 2 mass-casualty events: the 2018 Hualien earthquake or the 2021 Hualien train derailment. The final WRSS consists of 16 items total and 4 subscales: Physical Demands, Psychological Response, Environmental Interruption, and Leadership, with aggregated alphas of 0.74–0.88. The WRSS was found to have psychometric integrity as a measure of stress in rescue workers after responding to a disaster.

BACKGROUND Motivational interviewing, as a counseling approach, could promote not only behavioral changes but also individuals' psychological adaptation. Previous studies provide evidence that motivational interviewing focused on increasing physical activity decreases the risk of metabolic syndrome in women. Its effects on sedentary behaviors, depressive symptoms, and health-related quality of life (HRQL) remain unknown. OBJECTIVES The aim of this study was to evaluate whether a 12-week motivational counseling program reduces sedentary behaviors and depressive symptoms and improves HRQL in Taiwanese women. METHODS A randomized controlled study was conducted. Participants (n = 115) were randomly assigned into 3 groups: experimental group (received a brochure on lifestyle modification combined with 12 weeks of motivational counseling), comparison group (received a lifestyle modification brochure), and usual care group (UCG). Outcome variables were measured at baseline and at 12 weeks post intervention by the International Physical Activity Questionnaire, Beck Depression Inventory, and Medical Outcomes Short Form-36 Health Survey. Generalized estimating equations were applied to analyze the intervention effects of groups by interaction of group and time. RESULTS Women in the experimental group not only reduced (P < .001) weekly sitting time by 374 minutes but also decreased (P < .05) depressive symptoms, as well as had greater overall HRQL including 8 subscales as compared with the UCG. As compared with the UCG, the women in the comparison group had no change in sedentary behaviors, but they had reduced depressive symptoms and improvement on some HRQL subscales. CONCLUSIONS Motivational counseling that incorporates behavioral change principles is effective in reducing sedentary behaviors and depressive symptoms and improving HRQL for women with metabolic syndrome.

Early rehabilitation exercise has been shown to reduce the onset of disability in patients following acute stroke. However, the clinical execution rate of early rehabilitation exercise for those patients remains low. Our medical team developed an early rehabilitation care plan for patients with acute stroke in 2013, at which time the execution rate of early rehabilitation exercise for these patients in our hospital was only 37.1%. The survey found that patients and caregivers had insufficient awareness of early rehabilitation exercise; hospital staffs lacked appropriate assistive devices, rehabilitation equipment, nursing guidance tools, and handover records; and new nursing staffs were insufficiently aware of the importance of early rehabilitation exercise. This care plan was developed to improve the execution rate of early rehabilitation exercise in patients with acute stroke to slow the progression of their disability.The project was designed to improve the knowledge of new nursing staffs regarding early rehabilitation care and the early rehabilitation exercise completion rate of nursing staffs to raise the execution rate of early rehabilitation exercise in patients with acute stroke.After completing the cause analysis, multiple strategies were pursued: (1) nursing education sheets with texts, illustrations, video, and posters were used; (2) group in-service educational training was organized; (3) an innovative transfer belt was designed; (4) facilities were set up to deliver virtual-reality (VR) training; (5) standard procedures on early rehabilitation exercise in patients with acute stroke were revised and implemented; (6) nursing handover procedures were revised; and (7) education courses on early rehabilitation exercise for post-stroke patients were developed.The accuracy of knowledge related to early rehabilitation exercise among new nursing staff improved from 31.3% to 80%; the completion rate for nursing education increased from 53.6% to 98%; and the early rehabilitation exercise execution rate increased from 37.1% to 82.8%.This project successfully increased the motivation and confidence of patients in rehabilitation and the rate of exercise program execution, which may be expected to impact positively on patients' quality of life.運用多元策略提升急性腦中風病人早期復健運動之執行率.早期復健運動雖能減緩急性腦中風病人的失能程度，然而臨床上多數腦中風病人執行早期復健運動的比率卻偏低，以本機構為例，醫療團隊在2013年發展一套腦中風病人早期復健運動照護計畫，惟追蹤執行率低，經調查發現病人及照顧者對早期復健運動認知不足、單位缺乏適當的復健器材與輔具、缺乏合適的護理指導工具及交接班紀錄、新進護理師對早期復健運動認知不足等，故成立專案期望提升病人早期復健執行率，減緩其失能程度。.專案目的為提升新進護理師對早期復健運動照護認知的正確率及護理人員對早期復健運動護理指導的完整率，進而提升急性腦中風病人早期復健運動執行率。.本專案經原因分析後介入多元策略之改善方案包含：(1)使用圖文並茂的海報、護理指導單張、影片；(2)舉辦團體衛教；(3)研發移位保護帶；(4)增設虛擬實境復健運動設施以結合虛擬實境訓練；(5)修改及實施急性腦中風病人早期復健運動照護作業流程；(6)改善護理交班機制；及(7)舉辦早期復健運動照護在職教育。.新進護理師對早期復健運動照護認知的正確率由31.3%提升至80%；早期復健運動護理指導完整率由53.6%提升至98.0%；急性腦中風病人早期復健運動執行率由37.1%提升至82.2%。.本專案小組藉由修訂照護流程，提供創意復健輔具與照護措施，並結合虛擬實境訓練於早期復健運動治療中，引發腦中風病人復健的興趣與自信，有效提升早期復健運動執行率，期能改善病人的生活品質。.

Although rotating shifts have a negative health impact, their association with hospital nurses’ health risks remains controversial due to incomplete adjustment in lifestyle patterns and heterogeneity of work schedules. However, whether work schedule characteristics are associated with lifestyle patterns and perceived stress remains undetermined. We assessed the correlations of work schedule characteristics, lifestyle patterns, and perceived stress among hospital nurses. This cross-sectional study included 340 nurses from two hospitals. Final data from 329 nurses regarding work schedule characteristics, lifestyle patterns (physical activity, dietary behavior, and sleep pattern), and perceived stress were analyzed via linear regression models. Fixed-day-shift nurses had reduced perceived stress (β = 0.15, p = 0.007) compared with rotating-shift nurses. Additionally, among rotating-shift nurses, fixed-evening- and fixed-night-shift nurses had longer sleep duration (β = 0.27, p < 0.001; β = 0.25, p < 0.001) compared to non-fixed-rotating-shift nurses. Longer rotating-shift work was associated with healthier dietary behaviors (β = 0.15, p = 0.008), better sleep quality (β = −0.17, p = 0.003), lower perceived stress (β = −0.24, p < 0.001), and shorter sleep duration (β = −0.17, p = 0.003). Hospital nurses’ work schedule characteristics were associated with lifestyle patterns, dietary behavior, sleep pattern, and perceived stress. Fixed-shifts were beneficial for lifestyle and lower perceived stress. Longer rotating shifts could help nurses adjust their lifestyles accordingly.

Comorbidities cause psychological distress to patients on hemodialysis and cause their physical function to deteriorate. This study aims to examine whether physical patterns are associated with anxiety, depression and fatigue among patients with and without comorbidities who are on hemodialysis. To this end, a cross-sectional survey was administered to 120 patients on hemodialysis. Data were collected using the International Physical Activity Questionnaire—Short Form, Beck Depression Inventory—Second Edition, Beck Anxiety Inventory, and Brief Fatigue Inventory—Taiwan Version. An independent sample t test and generalized linear model analyses were conducted. The results revealed that patients with comorbidities exhibited more severe levels of depression (p < 0.001), anxiety (p < 0.001), and fatigue (p = 0.010) than patients without comorbidities. Additionally, patients on hemodialysis with a high physical activity level (≥600 metabolic equivalent of task per min/week) exhibited less depression (B = −4.03; p < 0.001; 95% confidence interval [CI] = −6.04, −2.03) and anxiety (B = −2.64; p = 0.002; 95% CI = −4.27, −1.00) severity than those with a low physical activity level; those who engaged in weekly physical activities exhibited less fatigue severity (B = −1.17; p = 0.001; 95% CI = −1.84, −0.49) and fatigue interference (B = −0.61; p = 0.015; 95% CI = −1.10, −0.12). For patients on hemodialysis, having comorbidities was correlated with more severe levels of depression, anxiety, and fatigue. Weekly moderate-intensity physical activities were revealed to be correlated with less severity levels of depression, anxiety, and fatigue. The study findings aid the development of interventions for promoting physical activity among patients on hemodialysis to prevent the exacerbation of complications caused by comorbidities and psychological distress.

Background: Patient-centered care is a core component of medical professionalism. East Asian cultures hold different conceptualizations of medical professionalism than Western cultures. To support patient-centered care, education leaders in Taiwan restructured clinical education and implemented the first longitudinal integrated clerkship (LIC) in East Asia. We aimed to investigate patients’ perceptions of longitudinal relationships with the LIC students within Taiwan’s Confucian cultural and social context.Methods: We invited patients or their family members who were cared for longitudinally by a LIC student to participate in the study. Participating patients or their family members undertook semi-structured interviews. We analyzed data qualitatively using a general inductive approach to identify themes in the patients’ descriptions of their experiences interacting with the LIC students.Results: Twenty-five patients and family members participated in interviews: 16 patients and 9 family members. Qualitative analysis of interview transcripts identified three themes from patients’ experience receiving care from their LIC students: care facilitation, companionship, and empathy. To provide care facilitation, LIC students served as a bridge between the physicians and patients. Students served patients by reminding, consulting, tracking disease progression, and researching solutions for problems. To provide companionship, students accompanied patients interpersonally like a friend or confidant who listens and provides a presence for patients. To provide empathy, patients reported that students showed sincere concern for patients’ experience, feelings, and mood.Conclusion: In our study, Taiwanese patients’ perspectives of LIC students suggested the value of care facilitation, companionship, and empathy. We discuss these themes within the context of Confucian culture and the Taiwanese context of care.

Background An increasing number of medical schools worldwide are implementing longitudinal integrated clerkships (LICs), but few schools in East Asia have done the same. The study explored and compared learning experiences and academic performances of LIC and traditional block rotation (TBR) students at a metropolitan tertiary teaching hospital in Taiwan.Methods This study employed qualitative and quantitative methods. We used semi-structured interviews to explore the learning experience of the medical students in their fifth-year clerkship and analyzed the data with a general inductive approach. We also compared the students’ academic performance, including the scores of their clinical performance, medical record writing, written tests, and the objective structured clinical exam.Results There were 12 LIC and 14 TBR students who participated in interviews. We identified four major themes in their learning experiences. (1) Clinical learning: the importance of active learning, the difference between textbook knowledge and clinical practice, and opportunistic (TBR) versus contextual (LIC) learning. (2) With patients: companionship with patients (TBR and LIC) and bridging the gap between physicians and patients (LIC). (3) With preceptors: apprenticeship (for LIC) and difficulty communicating with preceptors (for TBR). (4) Doctor-patient relationship: interaction and communication. Comparing the learning outcomes, the LIC students scored higher on preceptor-rated assessments, and both groups exhibited comparable performance on written tests and the objective structured clinical examination.Conclusion Although students’ learning experience differed in some respects according to their curricula, they had a comparable academic performance.

Background Because patients in disaster areas require the most critical care, mobilising hospital nurses has become a pivotal strategy. Given the importance of disaster nursing training programmes, understanding how well prepared hospital nurses are to provide disaster care is vital. Objectives This paper analyses the perceived readiness of hospital nurses for a disaster response and the factors influencing their report for work outside the hospital environment. Design A cross-sectional research design was used. Settings This study was conducted at a military hospital in Taiwan. Participants A sample of 311 registered nurses participated in this study. Methods Data were collected on readiness for disaster responses using a 40-item researcher-designed, self-administered questionnaire found to have satisfactory reliability and validity. The questionnaire has four domains: personal preparation (16 items), self-protection (11 items), emergency response (6 items), and clinical management (7 items). Data were analysed using descriptive statistics, independent t-tests and generalised linear models. Results The majority of hospital nurses demonstrated poor readiness for disaster responses. Scores on the four domains were most associated with nurses' disaster-related training, experience in disaster response and emergency/intensive care experience. Conclusions Our results indicate that disaster-related training should be included in undergraduate programmes and continuing education courses to help hospital nurses recognise and improve their own readiness for disaster responses outside the hospital environment. Future research is needed to improve hospital nurses' disaster-response readiness in Taiwan and other countries., Highlights • Overall, Taiwanese hospital nurses perceived poor readiness for disaster responses outside the hospital environment. • Nurses' disaster readiness was associated with disaster-related training. • Nurses' disaster readiness was also related to disaster-response experience. • Nurses' disaster readiness was also related to emergency/intensive care experience.

Objectives To examine the mechanisms of coping strategies on nurses' psychological well-being, practice environments and safety attitudes. Methods A cross-sectional study design was used. Structural equation modeling was performed to analyze the results. Five hundred clinical nurses were randomly selected from a large group of 1,500 from a medical center with 1,350 beds in Taipei, Taiwan, from July to October 2015. Self-report questionnaires were administered to measure coping strategies (Brief COPE), psychological well-being (Ryff's Psychological Well-being Scale), nurses' practice environments (Practice Environment Scale of the Nursing Work Index), and safety attitudes (Safety Attitudes Questionnaire). Results Of the 500 participants who gave written consent, 474 (94.8%) filled out the questionnaire. Results showed that using more approach-oriented coping strategies and fewer avoidant coping strategies was associated with greater psychological well-being. Psychological well-being was directly associated with quality of nurses' practice environments and safety attitudes. The impact of psychological well-being on safety attitudes was mediated significantly by the quality of the practice environment. The use of approach-oriented coping strategies was significantly predictive of positive psychological well-being, a good practice environment, and good safety attitudes. Conclusions and clinical relevance This study found a distinct pathway for the relationships between clinical nurses' psychological well-being, practice environment, and safety attitudes. Psychological well-being in clinical nurses was higher for those with more approach-oriented coping strategies. Psychological well-being directly impacted safety attitudes, which mediated nurses' practice environments. The practical implications of the results suggest that interventions designed to promote positive psychological well-being may help improve nurses' practice environments, which, in turn, may result in better safety attitudes and nursing care outcomes.

BACKGROUND Metabolic syndrome (MetS), health-related quality of life (HRQL), and depression status are independently associated with cardiac health. Therefore, understanding the associations between MetS, HRQL, and depression status and determining factors related to improved HRQL and depression status in people with MetS may help in cardiovascular disease prevention. OBJECTIVE The aim of this study was to examine whether there are differences in HRQL and depression status between Taiwanese women with and without MetS and whether physical activity patterns are associated with HRQL and depression status in this population. METHODS A cross-sectional study of 326 Taiwanese middle-aged and older women (≥40 years) was conducted. Metabolic syndrome was determined based on the National Cholesterol Education Program Adult Treatment Panel III definition. Health-related quality of life and depression status were collected using the Short Form 36 Health Survey and Beck Depression Inventory. Univariate and multivariate linear regression analyses were conducted. RESULTS Women with MetS had lower HRQL (P < .001) and higher depression status (P = .002) than those without MetS. Participants with active physical activity patterns had higher HRQL (P < .001) and lower depression status (P = .046) than those with sedentary patterns. Among women with MetS, those with active physical activity patterns had higher HRQL (P = .001) and lower depression status (P = .007) than those with sedentary patterns. CONCLUSIONS Metabolic syndrome is related to lower HRQL and higher depression status in women 40 years and older. Active physical activity patterns are associated with better HRQL and reduced depression status in middle-aged and older women (≥40 years) with MetS.

The prevalence of metabolic syndrome and its components continue to increase among patients with serious mental illness. This cross-sectional study investigated whether metabolic syndrome prevalence and risk factors differ between male and female patients with serious mental illness. In total, 260 eligible patients were recruited from two hospitals. The data on demographic characteristics, lifestyle behaviour factors, biochemistry, and anthropometry were collected. Analyses were performed using multivariate logistic regression. Metabolic syndrome prevalence was 40.8% (35.1% in men and 46.8% in women). Among patients aged 40-49 years, metabolic syndrome prevalence was higher in men; however, the trend was reversed among patients aged 50 years or older. Notably, gender-specific metabolic syndrome risk factors were observed. In men, they included low education level, high body mass index (BMI), prolonged illness, comorbid physical illness, and diagnosis of bipolar disorder, whereas they included being married, old age, and high BMI in women. Our findings suggest that mental health professionals should consider the gender- and age-based metabolic syndrome prevalence trend in patients with serious mental illness when designing interventions for the study population to minimize metabolic syndrome prevalence.

Lifestyle modification is often difficult for middle-aged and older women living in the community who are at high risk of physical inactivity and metabolic syndrome.To examine the effects of telephone-based motivational interviewing in a 12-week lifestyle modification program on physical activity, MetS, metabolic risks (fasting plasma glucose, blood pressure, triglyceride, high-density lipoprotein, and central obesity), and the number of metabolic risks in community-living middle-aged and older women diagnosed with metabolic syndrome.A randomized controlled trial was conducted. Recruited were 328 middle-aged and older women from a community health center in Taiwan. Eligible women medically diagnosed with metabolic syndrome (n=115) were randomly assigned to one of three groups: The experimental group received an individualized telephone delivered lifestyle modification program that included motivational interviewing delivered by an experienced nurse. The brief group received a single brief lifestyle modification counseling session with a brochure. The usual care group received standard care. Physical activity was assessed with the International Physical Activity Questionnaire and metabolic risks were determined by serum markers and anthropometric measures at pre- and post-intervention. One hundred women completed the study and an intention-to-treat analysis was performed. Generalized estimating equations were used to examine the intervention effects.Women in the experimental group increased physical activity from 1609 to 1892 MET-min/week (β=846, p=.01), reduced the percentage of diagnosed with metabolic syndrome to 81.6% (β=-0.17, p=.003), and decreased the number of metabolic risks from 4.0 to 3.6 (β=-0.50, p.001), compared to the usual care group (4.4-4.6). There was not a reduction in the percentage of diagnosed with metabolic syndrome in the brief group, but they had fewer metabolic risks after 12 weeks (mean=4.0 vs. 4.6, β=-0.2, p=.02) compared to the usual care group.Motivational interviewing as a component of an individualized physical activity and lifestyle modification program has positive benefit in reducing metabolic risks in middle-aged and older women.

Patients with type 2 diabetes mellitus (T2DM) face a higher risk of diabetic foot neuropathy, which increases the risk of death. The early detection of factors that influence diabetic neuropathy reduces the risk of foot lesions, including foot ulcerations, lower extremity amputation, and mortality.To explore the demographic, disease-characteristic, health-literacy, and foot-self-care-behavior factors that affect diabetic foot neuropathy in patients with T2DM.A case-control study design was employed in which cases (Michigan Neuropathy Screening Instrument, MNSI) ≥ 2 were matched to controls based on age and gender in a medical center. A total of 114 patients diagnosed with T2DM in a medical center were recruited as participants. Data were collected using a structured questionnaire. The collected data were analyzed using Fisher's exact test, Mann-Whitney U test, and logistic regression.The results of multiple logistic regression showed that glycated hemoglobin (B = 1.696, p = .041) and communication and critical health literacy (B = -0.082, p = .034) were significant factors of diabetic foot neuropathy.The findings of this study suggest that nurses should assess the health literacy of patients with T2DM before providing health education and should develop a specific foot-care intervention for individuals with poor glycemic control.第二型糖尿病病人足部神經病變及其影響因素之研究.足部神經病變不僅是第二型糖尿病病人容易出現的合併症，並且容易增加死亡的風險。早期偵測造成糖尿病神經病變的因素應有助於避免後續足部潰瘍、下肢截肢及死亡率的發生。.探討人口學、疾病特性、健康素養以及足部自我照護行為等變項，是否為第二型糖尿病病人罹患足部神經病變的相關危險因素。.採病例對照研究，在北部一所醫學中心招募第二型糖尿病門診病人為研究對象，以兩側足部的密西根神經病變篩檢工具（Michigan Neuropathy Screening Instrument, MNSI）測得總分 ≥ 2分時為病例組，然後依病例組的年齡和性別進行配對，共有114位病人參與。以結構式問卷進行資料收集，並透過Fisher’s exact test、Mann-Whitney U test和logistic regression等統計方法進行資料分析。.研究結果顯示糖化血色素（B = 1.696, p = .041）及溝通和批判性健康素養（B = -0.082, p = .034）與第二型糖尿病病人發生足部神經病變有關。.建議護理師於衛教前，能先評估T2DM病人的健康素養，並且針對血糖控制較差者，發展適切的足部照護介入措施，以預防後續足部神經病變的發生。.

Background: Ventilator-associated pneumonia (VAP) occurs in patients requiring mechanical ventilators for more than 48 h. VAP is the most common nosocomial infection and the leading cause of complications and death in intensive care units (ICUs). Materials and Methods: Two historical comparison groups of 375 patients who used mechanical ventilators for more than 48 h in the medical ICU (MICU) from December 1, 2011 to May 31, 2012 and December 1, 2013 to May 31, 2014 were enrolled in this study. There were 194 adult patients in the control group that received traditional care, and there were 181 patients in the experimental VAP care bundle group. Our VAP care bundle entailed several preventive strategies including daily assessments of sedation, daily consideration of weaning and extubation by the doctors and respiratory therapists charged with the care of the patients, maintenance of the intra-cuff pressure values at approximately 20-30 cm H 2 O, hand hygiene, daily oral hygiene, personal protective equipment for suctioning, the placement of patients in semi-recumbent positions with the head of the bed elevated to at least 30°, aspiration of an endotracheal tube and oral cavity prior to position changes, daily cleaning of the ventilator and suction bottle with sterile distilled water, weekly replacement of the ventilator circuit and heater, sterilization of the circuit by pasteurization, and the use of an independent care room. The data were collected by reviewing the patients′ medical records and by retrieving information from the Nosocomial Infection Control Unit of one medical center in Northern Taiwan. Results: The incidence of VAP in the VAP care bundle group (0.281 cases per 1000 ventilator days) was significantly lower than that in the control group (0.495 cases per 1000 ventilator days). We estimated that the occurrence of VAP in the MICU increased the medical costs by an average of NT $68317 per patient. Conclusions: VAP care bundle is an effective strategy to reduce the incidence of VAP in the MICU and to reduce healthcare costs.

Background Metabolic syndrome (MetS) is primarily attributed to an unhealthy lifestyle, which is a modifiable risk factor. Researchers have been exploring various strategies, including lifestyle-modification programs (LMPs), to prevent the progression of MetS. However, the effectiveness of LMPs on metabolic risks and patient-reported outcomes (PROs) among adults with MetS remains inconclusive. Aim To evaluate the effectiveness of LMPs on the metabolic risks and PROs among adults with MetS. Methods A systematic review of randomized controlled trials published from January 1985 to June 2014 was conducted. The review extracted LMP interventions that included outcomes on the metabolic risks and PROs (quality of life and any other psychological health indicators). The quality of the included studies was assessed using the Cochrane Collaboration criteria. Results Among the five trials included, the most commonly applied intervention components were diet plans, supervised exercise, health education, individual counseling, behavioral modification, and motivational interviewing. Three fifths of the studies were nurse-led, and only one of the selected trials was theory-guided. LMPs can effectively reduce triglyceride levels, waist circumference, and systolic blood pressure. However, few trials consistently confirmed the benefits of metabolic risks, and none revealed a significant effect on high-density lipoprotein, fasting blood glucose, or any PRO, except quality of life. The duration of LMPs in the included trials ranged from 4 to 24 weeks, and durations of at least 12 weeks significantly improved quality of life. Linking Evidence to Action LMPs had positive effects on some metabolic risks and on quality of life, whereas longer-duration LMPs may have highly beneficial effects on quality of life. The essential elements of LMPs need to be evaluated more thoroughly to determine their effectiveness. Larger and more rigorous randomized controlled trials are required to assess the effectiveness of LMPs on metabolic risks and PROs among adults with MetS.

In the context of professional nursing, the concept of job satisfaction includes the degree to which a nurse is satisfied with the nursing profession, his/her personal adaptation to this profession, and his/her current working environment. No validated scale that addresses the job satisfaction of nurses working in hospitals currently exists in Taiwan.To develop a reliable and validated scale for measuring the job satisfaction of hospital nurses in Taiwan.A three-phase, cross-sectional study design was used. First, a literature review and expert focus group discussion were conducted to develop the initial scale items. Second, experts were invited to validate the content of the draft scale. Finally, convenience sampling was used to recruit 427 hospital nurses from 6 hospitals. These nurses completed the scale and the results were analyzed using item analysis, factor analysis, and internal consistency analysis.The 31-item Taiwanese hospital nurse job satisfaction scale developed in the present study addresses 5 factors, including supportive working environment, professional autonomy and growth, interpersonal interaction and collaboration, leadership style, and nursing workload. The overall Cronbach's α was .96. The results indicate that the developed scale provides good reliability and validity.This study confirms the validity and reliability of the developed scale. It may be used to measure the job satisfaction of nurses working in hospitals.發展臺灣醫院護理師工作滿意度量表與信效度檢測.工作滿意度是護理師對個人在護理專業表現、工作調適及對執業環境的滿意程度，然而目前缺乏從台灣醫療環境發展，並且適用於醫院評量護理師工作滿意度的工具。.發展醫院護理師工作滿意度量表，並進行信效度前驅檢測。.採三階段橫斷式研究設計，第一階段為文獻查證及專家會議討論，彙整題項並建構量表初稿；第二階段由專家進行內容效度測試；第三階段以方便取樣方式選取6家不同層級的醫院，由427位護理師完成測試，然後進行項目分析、建構效度及內在一致性檢定。.本量表共有31題，分為：支持性執業環境、專業自主與發展、人際互動與合作、主管的領導風格、以及護理工作的負荷等五個構面，整體量表內在一致性為.96。.本研究發展的量表具有合宜的信效度，可有效評估醫院護理師對工作的滿意度。.

Background:The blood glucose response to moderate-intensity exercise remains unclear for patients with type 2 diabetes (T2DM). In addition, little is known about determinants of blood glucose response to a 12-week moderate-intensity exercise training. Therefore, this study aimed to explore t

AIMS AND OBJECTIVES: To describe factors associated with the subjective quality of life of individuals who had attempted suicide. BACKGROUND: Although quality of life has been a focus of concern in mental health care, data are lacking on what life is like and what factors are related to an individual's quality of life after a suicide attempt. DESIGN: A cross-sectional, descriptive design was used. METHODS: Participants comprised a convenience sample of 103 individuals who had attempted suicide within the previous three months and received follow-up care from one suicide-prevention centre in northern Taiwan. Participants were assessed for depression and quality of life using the Beck Depression Inventory, Taiwan version and the World Health Organisation Quality of Life Instrument-BREF, Taiwan version, respectively. RESULTS: Almost half the participants (n = 49) had severe depression and one-third of them (n = 30) reattempted suicide while receiving follow-up care. Depression and quality-of-life scores were statistically significantly inversely correlated. participants' quality-of-life scores were most associated with their depressive level, reattempting suicide during suicidal follow-up care, high educational level and older age. CONCLUSIONS: The present study indicates that factors associated with quality of life decreased more in individuals with moderate/severe depression than in those with mild depression. In addition, individuals who reattempted suicide during follow-up care were more likely to suffer from poor life quality. RELEVANCE TO CLINICAL PRACTICE: Mental health professionals should include frequent evaluation of depressive status and quality of life in follow-up care for patients who have recently attempted suicide. Particularly, mental health professionals must treat suicidal individuals with a high tendency to reattempt suicide by establishing trust with them and allowing them to narrate their painful experiences during follow-up care. Language: en

Physical activity (PA) is associated with cardiovascular health in general populations, particularly in women. Middle-aged and older women are at high risk of less engagement in PA for unknown and complicated reasons. The aim of this study was to investigate whether PA was positively associated with socioeconomic status and psychosocial correlates of PA (self-efficacy and perceived benefits) but inversely correlated with perceived barriers in women (age >40 years). A cross-sectional survey of 326 community-dwelling women was conducted. Data on socioeconomic status, PA, and its psychosocial correlates (ie, perceived benefits/barriers and self-efficacy) were collected using self-report questionnaires. Analyses were performed by multiple linear regressions. Monthly income (β = .35, P = .015), employment status (β = .32, P < .001), and perceived barriers to PA (β = −.19, P = .008) were significantly associated with PA. More highly educated women participated in more (β = .13, P = .033) vigorous PA, women with fewer perceived barriers participated in more (β = −.14, P = .047) moderate-intensity PA, and employed women participated in more (β = .35, P < .001) walking. Significantly higher scores of perceived barriers, including “no trainer,” “feeling exhausted,” “lack of motivation,” and “lack of guidance,” were identified in women with low PA compared with those with moderate PA. Socioeconomic status and perceived barriers are associated with PA and its intensity level. Some specific barriers provide insights into the key factors that contribute to low PA in middle-aged and older women. These findings can be considered in future interventions to design PA promotion programs for this population to protect against cardiovascular diseases.

Inpatient nursing care satisfaction is an important indicator of medical care quality. However, no reliable and validated tool is currently available in Taiwan to measure the satisfaction of inpatients with nursing care.This pilot study developed a reliable and validated scale for measuring inpatient nursing care satisfaction in Taiwan.First phase: literature review and expert focus group discussion constructs the content of the questionnaire to be used to assess inpatient nursing care satisfaction. Second phase: experts were requested to validate questionnaire content. Third phase: convenience sampling was used to recruit 766 inpatients from 6 hospitals to complete the validated questionnaire. The data collected from the questionnaire were analyzed using item analysis, construct validity, and internal consistency. The results of analysis were used to determine the reliability and validity of the developed scale.The 20-item Taiwanese inpatient nursing care satisfaction scale was developed, with a CVI (content validity index) of expert validity of .97, item discrimination CR (critical ratio) of 28.61-50.25 (p.001), and item-total correlation of .68-.84 (p.001). Two factors, including "professional knowledgeskill" and "environmental control" were extracted by exploratory factor analysis after the deletion of 5 items, with item factor loadings ranging from .61 to .84. The factors explained 71.40% of total variance. The internal consistency of the two categories of Cronbach's α was .94-.97 coefficient and the overall internal consistency coefficient was .97.This study confirms the validity of the developed Taiwanese inpatient nursing care satisfaction scale and suggests that this instrument is reliable for measuring the satisfaction of inpatients with nursing care in Taiwan.建構本土化住院病人對護理照護滿意度量表與信效度前驅檢測.住院病人對護理人員照護滿意度為重要醫療服務品質指標，然目前仍缺乏本土化具信效度之住院病人對護理照護滿意度評量工具。.建構本土化住院病人對護理照護滿意度量表，並進行信效度前驅檢測。.量表發展第一階段以文獻查證及專家焦點團體討論方式，彙整住院病人對護理照護滿意度項目並建構量表初稿；第二階段再以專家效度修定量表；而第三階段以方便取樣方式選取6家醫院，完成收案766位住院病人，藉由項目分析、建構效度及內在一致性分析等進行量表信效度檢測。.本量表共20題，專家效度CVI（content validity index）值.97，題項鑑別度CR（critical ratio）值為28.61–50.25（p.001），題項與量表總分相關係數為.68-.84（p.001）。經探索性因素分析，將題項刪減5題後共萃取出兩個因素，分別命名為「專業知能」及「環境控制」，各題項因素負荷量為.61-.84，量表總解釋變異量為71.40%，各構面內在一致性Cronbach's α值為.94-.97，量表整體信度為.97。.本研究建構之台灣住院病人對護理照護滿意度量表具良好信效度，可有效評估台灣住院病人對護理人員護理照護的滿意度。.

The aim of this follow-up study was to examine factors related to a suicide attempt within 3 months of a prior attempt. Participants were recruited from a suicide-prevention center. Of 96 suicidal individuals who had participated in the baseline study, only 51 completed all measures at follow-up assessment. Study results showed that suicidal individuals who reattempted suicide during the first 3 months of follow-up care exhibited lower mean scores on all four domains of the brief version of the World Health Organization Quality-of-Life Instrument at follow-up assessment than at baseline. In contrast, individuals who did not reattempt suicide had higher quality-of-life scores across all domains between baseline and 3 months. The reattempt and no-reattempt groups differed significantly in the physical health and environmental domains. These results can be used by nurses to develop their abilities to recognize and prevent suicide reattempts in high-risk groups.

Background The military is a unique occupational group and, because of this, military personnel face different kinds of stress than civilian populations. Sleep problems are an example. The purpose of this study was to investigate the relationship between sleep problems, depression level and coping strategies among military personnel. Materials and Methods In this cross-sectional study, military personnel completed the Beck Depression Inventory, the Pittsburgh Sleep Quality Index and the Jalowiec Coping Scale. Results An evaluation of the test scores showed that officers had better sleep quality and fewer depressive symptoms than enlisted personnel. Military personnel with higher educational levels and less physical illness also had fewer depressive symptoms. Officers and noncommissioned officers preferred problem-focused strategies. Those with higher Beck Depression Inventory and Pittsburgh Sleep Quality Index scores and those who drank alcohol frequently preferred affective-focused strategies. Conclusions Our results revealed that sleep quality, physical illness and alcohol consumption were associated with the mental health of military personnel. Treating these factors may improve the mental health of military personnel and enhance effective coping strategies.

Aim and objectives. This study presents the findings of a qualitative study exploring the experiences of undergraduate nursing students imagining the possibility of their own death during a workshop on life-and-death issues. Background. Didactic instruction in end-of-life care is a critical element of nursing education and for most health professions training in general. Properly implementing this often-overlooked educational process requires providing students with opportunities to reflect on death and dying along with guidance during nursing practice in coping with emotional reactions to caring for dying patients. Design. An interpretive descriptive design was adopted. Method. Data were gathered from the text of 20 students’ reflective journals and workshop evaluations and researchers’ field notes on observations during the workshop at a Taiwan university in August 2007. Results. Students experienced a process of dying, death and rebirth. Students not only expressed emotional responses that included surprise, reluctance to let go and gratitude but also realised the importance of cherishing the present, committing to the nursing profession and valuing their own lives. Conclusions. Students can learn their fear of death and possible emotional reactions towards dying patients through self-reflection during a workshop on life-and-death issues. The foundation for facilitating students’ self-awareness is a safe environment for them to gain experiential knowledge of the dying process and end-of-life care. Experiential education not only helps students grow personally but also increases their motivation to learn. Relevance to clinical practice. Students’ ability to recognise and manage their own emotional reactions towards death and dying patients should be included as part of end-of-life education. A workshop on life-and-death issues can help students discover that they are not alone and that they can support each other and learn how to manage their own emotions.

Aim. This paper is a report of a study of the factors that influence sleep quality and quality of life among shift-working nurses and the relationship between their sleep quality and quality of life. Background. Although shift-working nurses strive to adapt their life schedules to shift rotations, they tend to suffer from severe sleep disturbances and increased rates of cancer, cardiovascular diseases, digestive disease and irregular menstrual cycles. Poor sleep is also associated with medical errors and occupational injuries. Methods. A cross-sectional study was conducted in 2008 with a convenience sample of 435 female nurses from five regional hospitals in Taiwan. Data were collected on sleep quality and quality of life using the Pittsburgh Sleep Quality Index and World Health Organization Quality of Life Instrument-BREF Taiwan version respectively. Data were analysed using descriptive statistics, independent t-tests, analysis of variance and Pearson correlations. Findings. The majority of female shift workers (57%) had global sleep-quality scores >/=5, indicating poor sleep and all mean scores in four domains of the quality-of-life measure were statistically significantly lower than those of females in Taiwan's general population. Scores for poor sleep quality and quality of life were related to premenstrual dysphoria, occupational injury, illness and medication use. In addition, the associations between scores on the sleep-quality and quality-of-life scales were statistically significantly inversely correlated. Conclusion. Advice should be included in both undergraduate programmes and continuing education to help nurses to recognize and improve their own sleep quality and life quality managers should create a supportive environment to encourage shift-working nurses to engage in healthy behaviours. Language: en

In this article we present the findings of a qualitative study exploring what suicide survivors in Taiwan experienced after a family member’s suicide and how they adjusted to the perceived stigma. Fifteen suicide survivors participated in this study. We found that when a family member’s suicide death occurred, survivors first kept a low profile when holding the funeral, and then tried to expel the dead person from their family. They also wished that their grief and painful, shameful feelings could be buried with the dead person. These findings suggest that health care professionals need to work more closely with suicide survivors through understanding the survivors’ fear and pain from a sociocultural perspective, and to help them construct a new moral life.

The purpose of this interpretive phenomenological study is to describe the commonality of the lived experience of suicide survivors and how it influences their family relationships in Taiwan from a sociocultural perspective. Thirteen suicide survivors have participated in this study. Study results reveal that some survivors blame themselves, some blame others, and some are blamed by their family as part of their need to find a reason for the death. Consequently, family members ignore each other and treat each other as if they are invisible. These Chinese suicide survivors, unlike Western survivors, maintain their strained family connections because of strong cultural influences. Therefore, health professionals should acknowledge the experiences of living with an invisible family when supporting Chinese suicide survivors.

The tongue plays important roles in mastication, swallowing, and speech, but its sensorimotor function might be affected by endotracheal intubation. The objective of this pilot study was to describe disturbances in the sensorimotor functions of the tongue over 14 days following oral endotracheal extubation. We examined 30 post-extubated patients who had prolonged (≥48 h) oral endotracheal intubation from six medical intensive care units. Another 36 patients were recruited and examined from dental and geriatric outpatient clinics served as a comparison group. Tongue strength was measured by the Iowa Oral Performance Instrument. Sensory disturbance of the tongue was measured by evaluating light touch sensation, oral stereognosis, and two-point discrimination with standardized protocols. Measurements were taken at three time points (within 48 h, and 7 and 14 days post-extubation) for patients with oral intubation but only once for the comparison group. The results show that independent of age, gender, tobacco used, and comorbidities, tongue strength was lower and its sensory functions were more impaired in patients who had oral intubation than in the comparison group. Sensory disturbances of the tongue gradually recovered, taking 14 days to be comparable with the comparison group, while weakness of the tongue persisted. In conclusion, patients with oral endotracheal intubation had weakness and somatosensory disturbances of the tongue lasting at least 14 days from extubation but whether is caused by intubation and whether is contributed to postextubation dysphagia should be further investigated.