Experiences of family caregivers taking care getting lost of persons with dementia: a qualitative study.

BACKGROUND: Getting lost with family members who have dementia is a significant source of stress for family caregivers. In Taiwan, family caregivers develop strategies to deal with dementia persons who may get lost. This study aimed to explore the experiences of family caregivers caring for persons with dementia who have been lost outside the home. METHODS: A descriptive phenomenological method was used. The COREQ checklist was used to ensure the explicit reporting of data. A total of 20 family caregivers caring for persons with dementia who were lost outside their homes were selected from hospital outpatient clinics and a day care center in northern Taiwan using purposive sampling. Data were analyzed using the Giorgi analysis method. RESULTS: Five main themes emerged: (i) surprised persons with dementia lost outside, (ii) using strategies to prevent persons with dementia from getting lost, (iii) using strategies to find lost persons with dementia, (iv) exhaustion in long-term care persons with dementia, and (v) coping with the care load. It was found that family caregivers were surprised, nervous, and worried about persons with dementia being lost outside. They used the first strategy to supervise persons with dementia to prevent external losses. In addition, long-term supervision of persons with dementia led to mental exhaustion in the family caregivers. Finally, the family caregivers learned about loss prevention strategies and obtained family support and care replacement workers to reduce the care burden. CONCLUSIONS: It is essential to teach family caregivers early to prevent persons with dementia from losing external strategies. Nurses also provide long-term care services to reduce the care burden on family caregivers.

Prevalence of sarcopenia and its association with diet and physical activity in older adults with type 2 diabetes: A cross-sectional study.

This cross-sectional study explored the prevalence of sarcopenia in older adults with type 2 diabetes and investigated the effects of diet and physical activity on sarcopenia. In total, 577 older adults with diabetes were recruited from a teaching hospital in Taiwan. Diet and physical activity were assessed using self-rated questionnaires, including the Healthy Diet Inventory, the Mini Nutritional Assessment-Short Form, and the International Physical Activity Questionnaire-Short Form. Sarcopenia was defined in accordance with the Asian Working Group for Sarcopenia 2019 guidelines. In total, 51.12% of participants had either possible sarcopenia, sarcopenia, or severe sarcopenia. Participants who were female, old age, prolonged sedentary times, poor nutritional status, and lower level of moderate-to-vigorous physical activity were identified as risk factors for possible to severe sarcopenia. Older adults with diabetes and possible to severe sarcopenia had poor nutrition status and engaged in inadequate physical activity. The findings indicate that sarcopenia may be related to nutrition status and physical activity, especially in older adults with diabetes.

Development and validation of a new tool: The sarcopenia knowledge questionnaire.

We developed a new questionnaire-the Sarcopenia Knowledge Questionnaire (SKQ)-to evaluate the level of awareness about sarcopenia among older adults and tested the reliability and validity of this tool. A total of 293 older adults completed the questionnaire. The SKQ comprises three domains including 23 items: screening and diagnosis (10 items), sarcopenia outcomes (7 items), and lifestyle factors (6 items). The Cronbach's α value was 0.969, which indicated excellent internal consistency. The SKQ correlated well with the Mandarin Multidimensional Health Literacy Questionnaire (r = 0.511; p < 0.001), confirming its moderate convergent validity. The absolute values of the critical ratio ranged from 9.90 to 25.82 (p < 0.001), indicating satisfactory item discrimination. Thus, the SKQ appears to be a valid and reliable instrument for evaluating the knowledge of older adults about sarcopenia.

Effects of exergaming on cognitive functions and loneliness of older adults with cognitive frailty.

OBJECTIVES: Cognitive frailty combines physical frailty and cognitive impairment in the absence of dementia. The prompt detection of cognitive frailty and early implementation of preventive interventions may reduce the incidence of dementia. However, intervention studies of exergaming in older adults with cognitive frailty are scant. Therefore, we aim to investigate the effectiveness of exergaming on cognitive functions and loneliness among older adults with cognitive frailty. DESIGN: Quasi-experimental design. METHODS: Participants were recruited from four community settings. The experimental group participated in two 40-min group exergaming sessions weekly for eight weeks; the control group received usual care. The outcome measures were the Montreal Cognitive Assessment (MoCA) and the Chinese Version of the Loneliness Scale. Analyses of covariance were conducted to analyze whether exergaming influenced participants' cognitive functions and loneliness. In addition, the effect size of the posttest of the experimental group relative to its baseline value was calculated to determine the effectiveness of the intervention. RESULT: 69 older adults with cognitive frailty were included, and 35 and 34 were assigned to the experimental and control groups, respectively. The exergaming effectively improved the cognitive function of older adults with cognitive frailty. CONCLUSIONS: Exergaming interventions can effectively improve the cognitive functions of older adults with cognitive frailty but do not positively affect loneliness. We provide evidence to healthcare workers to apply exergaming interventions for older adults with cognitive frailty to improve cognitive function.

Influencing factors of participation in and satisfaction with elderly health checkups: a cross-sectional study.

Background: Attending health checkups as a primary prevention strategy benefits older adults in facilitating the identification of health issues and risk factors for disease. Little is known about factors influencing participation in and satisfaction with a free annual elderly health checkup program (EHCP) in Taiwan. This study aimed to extend current knowledge related to the uptake of this service and individuals' views of the service. Methods: This was a cross-sectional study using a telephone interview survey method to compare influencing factors and satisfaction between participants and non-participants of an EHCP. The individuals involved were older adults in Taipei, Taiwan. The random sampling method included 1,100 people, 550 older adults who had participated in the EHCP within the last 3 years, and 550 older adults who had not. A questionnaire containing personal characteristics and satisfaction with the EHCP was used. Independent t-test and Pearson's Chi-squared test were used to evaluate differences between the two groups. Associations between individual characteristics and health checkup attendance were estimated using log-binomial models. Results: Results showed that 51.64% of participants reported being satisfied with the checkups; however, only 41.09% of non-participants were satisfied. In the association analysis, age, educational level, chronic diseases, and subjective satisfaction were related to older persons' participation. Furthermore, having a stroke was associated with a higher attendance rate [prevalence ratio: 1.49; 95% confidence interval: (1.13, 1.96)]. Conclusions: The EHCP had a high proportion of satisfaction among participants, but the proportion was low among non-participants. Several factors were associated with participation and might lead to unequal healthcare service uptake. Health checkups need to increase among people at a young age, those with low educational backgrounds, and those without chronic diseases.

Translation and Validation of the Indicators of Quality Nursing Work Environments in the Portuguese Cultural Context.

The Indicators of Quality Nursing Work Environment scale (IQN-WE) with 65 items, developed by Chiou-Fen Lin, Meei-Shiow Lu, and Hsiu-Ying Huang in 2016, aimed to create a set of quality indicators of the nursing work environment. The translation and validation for the Portuguese cultural context of the IQN-WE scale was performed in this study. OBJECTIVES: culturally and linguistically adapt the IQN-WE scale, originating from the Portuguese version, and evaluate its psychometric characteristics. METHODS: it is a descriptive, cross-sectional, observational and quantitative study. The IQN-WE scale was validated in a sample of 542 nurses belonging to a hospital center in Portugal. The study obtained a response of 21.69%, of whom 78.0% were women and 22% men. The mean age of the sample was 39 years and a standard deviation of 8.1 years. All nurses who work have a bachelor's degree, and 13.5% have a master's degree. RESULTS: the study obtained an instrument with a total explained variance of 52.67% and KMO = 0.843. It found a strong-to-moderate linear correlation matrix between the dimensions. The pre-test and the team of experts ensured the content validity. The determination of internal consistency guaranteed reliability, with 0.95. Confirmatory factor analysis validated the construct. The factorial model presented a goodness of fit index, with five factors. CONCLUSION: the study achieved an instrument with 50 items in five dimensions: Team Support and Professional Development; Team Organization and Management; Safe Nursing Work Environment; Information Systems and Risk Control; Salary and Welfare. The IQN-WE-PT scale proved to be an appropriate instrument to be applied in health organizations in Portugal.

Lifestyle factors associated with muscle quality in community-dwelling older people with type 2 diabetes in Japan and Taiwan: a cross-sectional study.

BACKGROUND: Type 2 diabetes mellitus (T2DM), common in older people, is an important reason for muscle loss in Japanese and Taiwanese populations. However, little is known about the association between lifestyle behaviours and muscle quality. We aimed to compare the lifestyle behaviours of Japanese and Taiwanese older adults with T2DM and to the identify lifestyle factors associated with muscle quality. METHODS: This cross-sectional study was conducted among community-dwelling individuals with T2DM aged ≥65 years in Taiwan and Japan. Totally, 114 Japanese and 226 Taiwanese participants were enrolled in the study. Outcomes were measured by blood biochemical examinations, body composition analyses and structured self-reported questionnaires to assess lifestyle behaviours and muscle quality. Linear regression models were used to examine the relationship between lifestyle factors and muscle quality using SPSS version 27.0 with a statistical significance level of P < 0.05. RESULTS: Japanese subjects were more likely to be smokers and alcohol consumers, and they were less likely to have well-balanced diets and engage in more physical activity as compared to Taiwanese subjects. The muscle quality in the Japanese subjects was significantly poorer than that in the Taiwanese subjects. Physical activity, dietary habits and smoking were associated with muscle quality, after adjusting for age, gender and body mass index. CONCLUSIONS: Physical activity of insufficient intensity, unhealthy dietary habits and smoking could be risk factors for poor muscle quality. These findings can contribute to the development of effective strategies to improve muscle quality in community-dwelling older Asian people with T2DM.

The relationship between organizational communication and missed nursing care in oncology wards in Taiwan.

AIM: Unfavourable communication increases missed nursing care. Oncology wards have more communication complexity than general wards; therefore, creating a positive communication environment is important for ensuring quality care. This study aimed to understand the relationship between organizational communication satisfaction and missed nursing care in Taiwan. DESIGN: This cross-sectional study was performed to measure organizational communication satisfaction and missed nursing care in six oncology wards at a stand-alone cancer centre hospital in Taipei, Taiwan in December, 2018. METHODS: The study collected data using the Communication Satisfaction Questionnaire and the MISSCARE survey. The data were analysed using descriptive statistics, t test, analysis of variance and Pearson product-moment correlation analysis in December 16, 2018. RESULTS: A total of 111 questionnaires were collected, and the response rate was 92.5%. The study showed that nurses tended to miss nursing care when they were dissatisfied with the unit's manpower status organizational communication environment, horizontal and diagonal communication and informal communication.

Satisfaction With the Quality Nursing Work Environment Among Psychiatric Nurses Working in Acute Care General Hospitals.

BACKGROUND: The objective of this study was to investigate the impact on patient care quality of a positive, high-quality environment that is tailored to the practice of nursing. This study enabled nurses to show their professional skills and knowledge, which may help enhance job satisfaction. To date, little research has been done to assess the relationship between the nursing work environment and the job satisfaction of psychiatric nurses employed in acute wards of general hospitals. PURPOSE: This study was designed to explain the relationship between job satisfaction and the perceived indicators of a quality nursing work environment (QNWE) after adjusting for demographic characteristics and work characteristics. METHODS: A cross-sectional correlational design was employed, and a stratified random sample of 185 psychiatric nurses (99% response rate) working in acute wards in Taiwan was surveyed in 2013. Nurses were asked to complete a self-administered questionnaire that included measures of perceived QNWE and job satisfaction and demographic variables. RESULTS: A statistically significant, positive relationship was found between perceived indicators of QNWE and job satisfaction (r = .813, p < .001). In the hierarchical multiple linear regression model, for the subdimensions of QNWE, the variables "perceived indicators of professional specialization and teamwork" and "support and caring" showed a significant and positive association with job satisfaction, after adjusting for personal demographic characteristics. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Job satisfaction is related to the perception of nurses regarding their work environment. Therefore, nursing managers should improve workplace satisfaction by supporting and caring for nurses and creating better career development and teamwork opportunities for nurses through job training and planning.

Factors Influencing Implementation Of Shared Medical Decision Making In Patients With Cancer.

PURPOSE: Shared decision making promotes patient participation in medical decisions. This study aims to explore the decision-making situation and influencing factors in patients with cancer. PATIENTS AND METHODS: A cross-sectional descriptive study was conducted for patient with cancers in regional teaching hospitals in northern Taiwan using short-form Mandarin Health Literacy Scale (s-MHLS) and Shared Decision Making Questionnaire (SDM-Q-9), with total 120 cases collected from January 15 to April 30, 2018. RESULTS: Overall health literacy in patients with cancer is 86.52%, and degree of shared decision making is 89.63%; higher education level indicated better health literacy (p<0.001); health literacy is significantly correlated with Shared decision making (r=0.258, p=0.004). Increasing education level by one grade elevated health literacy by 0.623. Expanding health knowledge by one source increased health literacy by 0.307 points, one point increase in health literacy enhanced shared decision making by 0.128 points. Using path analysis, we found education level affects health literacy, which in turn influences shared decision making. CONCLUSION: Improving health literacy is indispensable to promote patient participation in shared decision making in the highly professional medical field. Education level directly affects health literacy; therefore, in the future, providing disease-matching health education is crucial for patients with lower education levels to enhance their health literacy. Health literacy directly affects shared decision making; therefore, more active assistance in achieving patient health literacy is crucial to implement shared decision making.

The Relationship Between Work Environment Satisfaction and Retention Intention Among Nursing Administrators in Taiwan.

BACKGROUND: Nursing administrators are essential to ensuring the quality of healthcare provided in hospitals. The nursing manpower shortage that has affected hospitals in Taiwan over the past decade has weighed particularly heavily on nursing administrators, who are expected to maintain high levels of nursing care quality in frequently understaffed healthcare settings. PURPOSE: The objective of this study was to explore the relationship between work environment satisfaction and nursing administrator retention in Taiwan. METHODS: This study used a cross-sectional, questionnaire-based survey to collect data from a sample population of nursing administrators. A set of indicators of quality nursing work environments was developed and included in the questionnaire. A total of 1,829 questionnaires were distributed, and the effective response rate was 95.57%. RESULTS: The average overall rate of satisfaction with the current work environment across all domains was 3.59 (SD = 0.61). The highest level of satisfaction was found in the domain of safe practice environment (M = 3.83, SD = 0.70), and the lowest was found in the domain of informatics (M = 3.38, SD = 0.91). Length of administrative position tenure was significantly correlated with retention. Each of the eight domains significantly influenced retention. The domain of support and caring was the most significant predictor of nursing administrator retention. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Length of administrator position tenure was significantly correlated with nursing administrator retention. Moreover, intention to stay among junior administrators was particularly affected by the support and caring domain. Therefore, it is recommended that nursing departments develop effective strategies to assist and encourage junior administrators to strengthen their career prospects and satisfaction.

[An Experience Applying Life Review and Resilience to a Geriatric Patient With Functional Limitations and Depression].

Negative self-values and attitudes during the process of adapting to disease tend to engender depression in the elderly. This case study describes a nursing experience with an elderly patient with depression related to a decline in activity and family role changes related to unexpected spinal infection. The nursing care in this study was provided between February 28th and April 25th, 2017. A comprehensive geriatric assessment was employed, with results showing that the patient was affected by negative self-identity and attitudes. The geriatric depression scale showed moderate depression. Life review strategy was employed in the interview to impart a positive influence on a different life stage and a resilience model was used to interpret the interview transcript. The protective factors were identified and used to develop an individualized nursing intervention that included promoting the support of the husband in order to enhance positive attitude, promoting interactions with the grandchildren in order to increase feelings of independence. Finally, the patient became cognizant of family support and expressed positive words and self-values, which improved depression symptoms. This case report provides a valuable nursing care experience as a reference for similar cases in the future.

[Exploration of the Association Between Workplace Bullying and Attitudes Toward Patient Safety in Female Nurses].

BACKGROUND: Workplace bullying is known to have a significant and detrimental effect on the physical and psychological outcomes of its victims. The reactions of victims to bullying may decrease clinical care outcomes and patient safety. PURPOSE: To explore the relationship between workplace bullying and the attitudes of female nurses toward the safety of their patients. METHODS: This cross-sectional survey study used convenience sampling. Participants included female nurses from a regional teaching hospital. The research tool was a three-part, structured questionnaire that included a basic personal information datasheet, negative behavior scale, and patient safety attitude scale. The researcher distributed 420 questionnaires and collected 329 valid samples (valid return rate: 78.3%). Data were analyzed using SPSS software version 22.0. RESULTS: The analysis found that 29.8% of the participants had suffered from various degrees of workplace bullying. The mean score for patient safety attitudes was 3.58 (standard deviation = 0.55). Workplace bullying and patient safety attitudes were negatively correlated (p < .1), and being a recipient of workplace bullying was identified as a significant predictor of attitudes toward patient safety. CONCLUSIONS: Based on the results, we suggest that supervisors should take the initiative to care for their nursing staffs and to provide them with training in conflict-oriented skills. Organization managers should set up relevant committee-notification mechanisms that construct the safe working environment necessary to reduce workplace bullying and to enhance the patient safety attitudes of nurses, which will indirectly improve the quality of patient care.

[Development and Testing of the Taiwanese Hospital Nurses' Job Satisfaction Scale].

BACKGROUND: 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. PURPOSE: To develop a reliable and validated scale for measuring the job satisfaction of hospital nurses in Taiwan. METHODS: 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. RESULTS: 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. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: 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.

[Concept for Planning the Nurse-Patient Ratio and Nursing Fee Payment Linkage System].

This article describes the current situation in Taiwan with regard to the nurse-patient ratio and nursing fee payments, reviews the related policies and results in developed countries, and then proposes a plan for improving the domestic situation. Direct relationships exist between patient nursing quality and patient safety and the nurse-patient ratio as well as between nursing fee payments and the nurse-patient ratio. Therefore, in order to enhance the quality and safety of nursing care, it will be necessary to develop and institute a payment linkage system that links nursing fee payments to the nurse-patient ratio. This process requires public consensus and planning in order to institute an equitable and effective payment linkage system in the future.

Organisation-based self-esteem mediates the effects of social support and job satisfaction on intention to stay in nurses.

AIM: This study examined the effect of underlying contextual factors on the intention to stay in nurses. BACKGROUND: Workplace promotion, social support, work stress, job satisfaction and organisation-based self-esteem (OBSE) are psychosocial factors influencing the intention to stay in nurses. However, few studies have analysed the relationships among these factors. METHOD: A cross-sectional survey was conducted and a sample was recruited in convenience sampling method from a medical centre in Taiwan. A total of 791 nurses completed a self-report questionnaire over a 3-month period in 2013. RESULTS: Social support, work stress, job satisfaction and OBSE significantly affected the intention to stay in nurses. Furthermore, social support and job satisfaction showed a positive direct effect on the intention to stay and an indirect effect on the intention to stay; the indirect effect was mediated by OBSE. CONCLUSION: Organisation-based self-esteem mediates the effects of social support and job satisfaction on the intention to stay in nurses. IMPLICATIONS FOR NURSING MANAGEMENT: The results showing the influence of OBSE on the intention to stay in nurses can serve as insight for hospital managers to make decisions when encouraging and managing employees.

The Psychometric Properties and the Development of the Indicators of Quality Nursing Work Environments in Taiwan.

BACKGROUND: The nursing shortage in medical institutions in Taiwan averaged 9% in 2012, considerably higher than the 5% indicated in the literature. As a result, many hospitals have been forced to close wards or reduce beds. Despite the acute need, the percentage of registered nurses who are employed as nurses in Taiwan (60.4%) is considerably lower than those in Canada or the United States. This low rate may be because of the poor working environment for nurses in Taiwan. PURPOSE: This study aimed to develop a set of nursing work environment quality indicators for Taiwan and to test the reliability and validity of the resulting survey tool. METHODS: Multiple methods were used in this study. In Phase 1, we organized an expert panel, reviewed the literature, and conducted seven rounds of expert panel discussion and six focus group discussions with nursing directors. The goal was to draft indicators representing a quality nursing work environment to fit current conditions in Taiwan. In Phase 2, we conducted an expert review for content validity, held three public hearings, and conducted a survey. Four hundred twenty-seven questionnaires were sent out, with 381 returned. The goal was to test the content validity, construct validity, and internal consistency reliability. RESULTS: The study produced a set of indicators of a quality nursing work environment with eight dimensions and 65 items. The content validity index for importance and suitability dimensions were 1.0, whereas the internal consistency was 0.91. The eight dimensions were safe practice environment (16 items), quality and quantity of staff (four items), salary and welfare (seven items), professional specialization and teamwork (seven items), work simplification (five items), informatics (five items), career development (nine items), and support and caring (12 items). The overall load for the indicators was 77.57%. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The developed indicators may be used to evaluate the quality of nursing work environments. Furthermore, the indicators may be used in hospital surveys to establish baseline conditions and for outcome research that measures improvement in nursing work environments after interventions.

[The Comparison of the Difference Between the Emphasis on and the Receipt of Patient Privacy in the Hospital Setting].

BACKGROUND: Privacy is a unique privilege for humans. Enhancing the balance between the importance given to patient privacy and the receipt of this privacy by patients is one key approach to improving the relationship between patients and the hospital. PURPOSE: This study compared the difference between the importance of patient privacy and receipt of this privacy by patients as a reference for future patient privacy policy planning. METHODS: This study was a cross-sectional design. We randomly sampled three hospitals in northern Taiwan and investigated patients using a questionnaire. The questionnaire was self-designed and verified for reliability and validity. We used frequency and percentage to describe demographic data and used a t-test to compare the deviation between the emphasis on and receipt of patient privacy. RESULTS: There were 296 valid samples in this study and the effective rate was 84.57%. The highest degree of importance was information privacy and the lowest was physical privacy. Physical privacy (t = 3.04, p < .001) and mental privacy (t = 2.42, p < .01) exhibited significant differences between emphasis and receipt. Demographic data on gender, age, education level, marital status, and occupation. Type of hospital and ward level correlated with the emphasis and receipt of privacy. CONCLUSIONS: The importance of privacy for physical and mental wellbeing was higher than the actual receipt of this privacy among the patient sample. The importance of privacy for married individuals and young women with high education levels was higher, while males and less-educated individuals scored lower in terms of privacy receipt. Medical agencies must provide higher levels of physical and mental privacy in order to enhance patient satisfaction.

[Application of an improved model of a job-matching platform for nurses].

BACKGROUND: The three-month attrition rate for new nurses in Taiwan remains high. Many hospitals rely on traditional recruitment methods to find new nurses, yet it appears that their efficacy is less than ideal. To effectively solve this manpower shortage, a nursing resource platform is a project worth developing in the future. PURPOSE: This study aimed to utilize a quality-improvement model to establish communication between hospitals and nursing students and create a customized employee-employer information-matching platform to help nursing students enter the workforce. METHODS: This study was structured around a quality-improvement model and used current situation analysis, literature review, focus-group discussions, and process re-engineering to formulate necessary content for a job-matching platform for nursing. The concept of an academia-industry strategic alliance helped connect supply and demand within the same supply chain. RESULTS: The nurse job-matching platform created in this study provided job flexibility as well as job suitability assessments and continued follow-up and services for nurses after entering the workforce to provide more accurate matching of employers and employees. CONCLUSIONS: The academia-industry strategic alliance, job suitability, and long-term follow-up designed in this study are all new features in Taiwan's human resource service systems. The proposed human resource process re-engineering provides nursing students facing graduation with a professionally managed human resources platform. Allowing students to find an appropriate job prior to graduation will improve willingness to work and employee retention.