Innovative digital technology adapted in nursing education between Eastern and Western countries: a mini-review.

Advanced digital technologies have overcome the limitation of on-site teaching, especially after the COVID-19 epidemic. Various newly-developed digital technologies, such as e-learning, virtual reality, serious games, and podcasts, have gained renewed interest and come into the spotlight. Podcasts are becoming increasingly popular in nursing education as they provide a convenient and cost-effective way for students to access educational content. This mini-review article provides an overview of the development of podcasts in nursing education in Eastern and Western countries. It explores potential future trends in the use of this technology. The literature review demonstrates that nursing education in Western countries has already integrated podcasts into curriculum design, using the podcast to convey nursing education knowledge and skills and to improve students' learning outcomes. However, few articles address nursing education in Eastern countries. The benefits of integrating podcasts into nursing education appear far greater than the limitations. In the future, the application of podcasts can serve not only as a supplement to instructional methodologies but also as a tool for clinical practicing students in nursing education. In addition, with the aging population increasing in both Eastern and Western countries, podcasts have the potential to serve as an effective delivery modality for health education in the future, particularly for the older adult, whose eyesight declines with age, and those populations with visual impairments.

The development of new remote technologies in disaster medicine education: A scoping review.

Background: Remote teaching and online learning have significantly changed the responsiveness and accessibility after the COVID-19 pandemic. Disaster medicine (DM) has recently gained prominence as a critical issue due to the high frequency of worldwide disasters, especially in 2021. The new artificial intelligence (AI)-enhanced technologies and concepts have recently progressed in DM education. Objectives: The aim of this article is to familiarize the reader with the remote technologies that have been developed and used in DM education over the past 20 years. Literature scoping reviews: Mobile edge computing (MEC), unmanned aerial vehicles (UAVs)/drones, deep learning (DL), and visual reality stimulation, e.g., head-mounted display (HMD), are selected as promising and inspiring designs in DM education. Methods: We performed a comprehensive review of the literature on the remote technologies applied in DM pedagogy for medical, nursing, and social work, as well as other health discipline students, e.g., paramedics. Databases including PubMed (MEDLINE), ISI Web of Science (WOS), EBSCO (EBSCO Essentials), Embase (EMB), and Scopus were used. The sourced results were recorded in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart and followed in accordance with the PRISMA extension Scoping Review checklist. We included peer-reviewed articles, Epubs (electronic publications such as databases), and proceedings written in English. VOSviewer for related keywords extracted from review articles presented as a tabular summary to demonstrate their occurrence and connections among these DM education articles from 2000 to 2022. Results: A total of 1,080 research articles on remote technologies in DM were initially reviewed. After exclusion, 64 articles were included in our review. Emergency remote teaching/learning education, remote learning, online learning/teaching, and blended learning are the most frequently used keywords. As new remote technologies used in emergencies become more advanced, DM pedagogy is facing more complex problems. Discussions: Artificial intelligence-enhanced remote technologies promote learning incentives for medical undergraduate students or graduate professionals, but the efficacy of learning quality remains uncertain. More blended AI-modulating pedagogies in DM education could be increasingly important in the future. More sophisticated evaluation and assessment are needed to implement carefully considered designs for effective DM education.

Challenges of Using Instant Communication Technology in the Emergency Department during the COVID-19 Pandemic: A Focus Group Study.

A record outbreak of community-spread COVID-19 started on 10 May 2021, in Taiwan. In response to the COVID-19 pandemic, care facilities have adopted various protocols using instant communication technology (ICT) to provide remote yet timely healthcare while ensuring staff safety. The challenges of patient evaluation in the emergency department (ED) using ICT are seldom discussed in the literature. The objective of this study was to investigate the factors influencing the utility of ICT for patient assessment in emergency settings during the pandemic. The patient flow protocol and the ED layout were modified and regionalized into different areas according to the patient's risk of COVID-19 infection. Nine iPads were stationed in different zones to aid in virtual patient assessment and communication between medical personnel. A focus group study was performed to assess and analyze the utility of the ICT module in the ED. Eight emergency physicians participated in the study. Of them, four (50%) had been directly involved in the development of the ICT module in the study hospital. Three main themes that influenced the application of the ICT module were identified: setting, hardware, and software. The setting theme included six factors: patient evaluation, subspecialty consultation, patient privacy and comfortableness, sanitation, cost, and patient acceptability. The hardware theme included six factors: internet connection, power, quality of image and voice, public or personal mode, portable or fixed mode, and maintenance. The software theme included six factors: platform choices, security, ICT accounts, interview modes, video/voice recording, and time limitation. Future studies should focus on quantifying module feasibility, user satisfaction, and protocol adjustment for different settings.

[Implementation of Trauma-Informed Healthcare].

Trauma that is rooted in extremely stressful events is an important factor affecting human health. Patients who have experienced trauma may present in a variety of different ways in healthcare settings. One of these ways is the exhibiting of strong emotional or behavioral reactions triggered by traumatic memories. Caring for patients affected by known or unknown trauma is a significant challenge for healthcare providers. The core of trauma-informed care includes understanding trauma; respecting, empathizing and responding to the needs and reactions of patients with trauma; and providing care in a manner that prevents re-traumatization. In this article, the impact of trauma on overall health is introduced followed by a presentation of trauma triggers in the healthcare context, underscoring the importance of prioritizing care for patients with a history of trauma. Lastly, the concept and principles of trauma-informed care are incorporated into healthcare practice, providing specific, practical application strategies for healthcare providers to use in clinical settings. Trauma-informed healthcare practice relies on healthcare providers and organizations working together. The principles include the self-awareness and self-care of healthcare providers, awareness of the patient's trauma reaction, ensuring patient safety, building trust and transparency in care, working collaboratively with the patient and the healthcare team, and providing choices and empowerment during the care process. This article provides a reference to healthcare providers for providing friendly and high-quality care to patients with trauma.

Exploring teachers' risk perception, self-efficacy and disease prevention measures during the outbreak of 2019 novel coronavirus disease in Taiwan.

BACKGROUND: The 2019 novel coronavirus disease pandemic (COVID-19) is one of the most serious health risks facing the global population. Teachers' responses are important in the management of the outbreak in schools. The purpose of this study is to examine teachers' risk perception, self-efficacy, response efficacy, and approach to disease prevention during the COVID-19 outbreak in Taiwan. METHODS: A descriptive, cross-sectional online survey was completed by 344 teachers across four levels of education. Pearson correlations between major variables were calculated. General linear model with a posthoc test was used to estimate the least squares means for each level of the independent variables and test the mean differences between the response scores. RESULTS: The teachers with a higher risk perception showed a stronger adoption of disease prevention measures, but they also showed lower self-efficacy. In addition, teachers with higher self-efficacy had higher response efficiency. Female teachers had relatively stronger adoption of disease prevention measures than their male colleagues, and age was associated with a 0.040 point increase in adoption scores. Elementary school teachers were significantly stronger in this regard than teachers at junior high schools, high schools and universities in terms of behavior scores. CONCLUSIONS: High implementation rate of Taiwanese teachers' disease prevention measures came from their higher risk perceptions. Among them, older female teachers, especially those who teach at elementary schools, are key to implementing disease prevention measures.

Factors associated with the intention to use adult preventive health services in Taiwan.

OBJECTIVE: This research aimed to examine the factors associated with the intention to use adult preventive health services in Taiwan. DESIGN AND SAMPLE: Using Andersen's behavioral model, we employed a cross-sectional descriptive design to investigate 500 samples from four communities in southern Taiwan. MEASURES: We used a self-reported survey to assess participants' intention to use adult preventive health services, and the predisposing, enabling, and need factors influencing their intention. RESULTS: Intention to use adult preventive health services was more significantly explained by predisposing and enabling factors than by need factors. In addition, a lack of fixed medical facilities (enabling factor) and Taiwanese origin (predisposing factor) were associated with decreased odds of intention to use adult preventive health services. An educational level of high school or below (predisposing factor), higher amounts of exercise (predisposing factor), and lower barriers to use preventive health services (predisposing factor) were associated with increased odds of intention to use adult preventive health services. CONCLUSION: The findings can assist public health nurses in identifying high-risk groups with lower intentions of using adult preventive health services. Additionally, community-based health education program can be developed to increase people's intention to use adult preventive health services.

Residents' Disaster Preparedness after the Meinong Taiwan Earthquake: A Test of Protection Motivation Theory.

Because effective preparations are required to mitigate disaster impacts before implementing effective interventions, it is important to understand why people do or do not act on disaster preparedness. This study explores factors influencing residents’ intentions and actual behaviors following the 2016 Kaohsiung Meinong earthquake in southern Taiwan. Protection Motivation Theory was used to develop a hypothesized model to test hypotheses regarding residents’ disaster preparedness, and structural equation modeling (SEM) was used to test the model. Data were comprised of 286 valid responses from seven major administration areas in Tainan, Taiwan. Self-efficacy, response-efficacy, and obstacles were significantly correlated with behavioral intentions and actual disaster preparedness behaviors. SEM results revealed that (a) the model fit the data well, (b) the relationship between risk perception and response-efficacy was fully mediated by behavioral intention, and (c) self-efficacy and obstacles were partially mediated by behavioral intention. Behavioral intent and actual disaster preparedness behavior are related but not equal. The main factors affecting actual disaster preparedness behavior are self-efficacy and obstacles. Therefore, strategies like drills or workshops can improve disaster-preparedness knowledge and capabilities and reduce difficulties of implementing disaster preparedness. To improve health and well-being, healthcare providers should promote disaster preparedness by interventions to increase self-efficacy during disasters.

Factors influencing medical staff's intentions to implement family-witnessed cardiopulmonary resuscitation: A cross-sectional, multihospital survey.

BACKGROUND: In Taiwan, the current status of family-witnessed resuscitation (FWR) and the factors associated with behavioural intentions to implement FWR have not been systematically examined using representative medical staff. AIM: We explored predictive factors for behavioural intentions to implement FWR among medical staff using constructs from the theory of planned behaviour. METHODS: A survey of 1605 medical staff from five hospitals in southern Taiwan was conducted. Data were collected using a researcher-made questionnaire containing theory of planned behaviour constructs and demographic items. The dependent variable was intention to implement FWR, and the independent variables were three theory of planned behaviour constructs (attitudes, subjective norms, and perceived behavioural control) and the demographic characteristics. A generalized estimating equation was used to identify factors associated with the behavioural intentions. RESULTS: In total, 1122 valid questionnaires revealed that only 3.7% of participants advocated FWR policies. The construct scores for intention to implement FWR were 2.96 (on a five-point Likert scale), and the theory of planned behaviour constructs that significantly predicted intention to implement FWR were positive attitudes and subjective norms ( p<0.001). Classification of hospitals ( p=0.018) and restrictive provisions for FWR ( p=0.004) were additional significant predictors of intention to implement FWR. Moreover, medical staff employed at regional hospitals demonstrated higher intentions, positive attitudes and subjective norms than did those employed at the medical centre. CONCLUSION: According to the findings of this study, it may be desirable for administrators to prioritize the implementation of the FWR policy in regional hospitals. We recommend affording the factors of positive attitudes and subjective norms high priority to improve the medical staff's behavioural intentions of FWR practice.

[Ethical Debates Related to the Allocation of Medical Resources During the Response to the Mass Casualty Incident at Formosa Fun Coast Water Park].

Disasters are unpredictable and often result in mass casualties. Limited medical resources often affect the response to mass casualty incidents, undermining the ability of responders to adequately protect all of the casualties. Thus, the injuries of casualties are classified in hopes of fully utilizing medical resources efficiently in order to save the maximum possible number of people. However, as opinions on casualty prioritization are subjective, disagreements and disputes often arise regarding allocating medical resources. The present article focused on the 2015 explosion at Formosa Fun Coast, a recreational water park in Bali, New Taipei City, Taiwan as a way to explore the dilemma over the triage and resource allocation for casualties with burns over 90% and 50-60% of their bodies. The principles of utilitarianism and deontology in Western medicine were used to discuss the reasons and rationale behind the allocation of medical resources during this incident. Confucianism, a philosophical mindset that significantly influences Taiwanese society today, was then discussed to describe the "miracles" that happened during the incident, including the acquisition of assistance from the public and medical professionals. External supplies and professional help (social resources) were provided voluntarily after this incident, which had a profound impact on both the immediate response and the longer-term recovery efforts.

Predicting medical professionals' intention to allow family presence during resuscitation: A cross sectional survey.

BACKGROUND: Family presence during resuscitation is an emerging trend, yet it remains controversial, even in countries with relatively high acceptance of family presence during resuscitation among medical professionals. Family presence during resuscitation is not common in many countries, and medical professionals in these regions are unfamiliar with family presence during resuscitation. Therefore, this study predicted the medical professionals' intention to allow family presence during resuscitation by applying the theory of planned behaviour. DESIGN: A cross-sectional survey. SETTINGS: A single medical centre in southern Taiwan. PARTICIPANTS: Medical staffs including physicians and nurses in a single medical centre (n=714). METHODS: A questionnaire was constructed to measure the theory of planned behaviour constructs of attitudes, subjective norms, perceived behavioural control, and behavioural intentions as well as the awareness of family presence during resuscitation and demographics. In total, 950 questionnaires were distributed to doctors and nurses in a medical centre. RESULTS: Among the 714 valid questionnaires, only 11 participants were aware of any association in Taiwan that promotes family presence during resuscitation; 94.7% replied that they were unsure (30.4%) or that their unit did not have a family presence during resuscitation policy (74.8%). Regression analysis was performed to predict medical professionals' intention to allow family presence during resuscitation. The results indicated that only positive attitudes and subjective norms regarding family presence during resuscitation and clinical tenure could predict the intention to allow family presence during resuscitation. CONCLUSIONS: Because Family presence during resuscitation practice is not common in Taiwan and only 26.19% of the participants agreed to both items measuring the intention to allow family presence during resuscitation, we recommend the implementation of a family presence during resuscitation education program that will enhance the positive beliefs regarding family presence during resuscitation as they are a significant predictor of the intention to allow family presence during resuscitation. In addition, written policies and protocols for family presence during resuscitation are also needed to increase support from subjective norms regarding family presence during resuscitation practice.

Effect of yelling on maximal aerobic power during an incremental test of cycling performance.

BACKGROUND: People experiencing strong feelings of fatigue during exercise sometimes subconsciously yell to refocus their efforts and, thus, maintain exercise performance. The present study examined the influence of yelling during high-intensity exercise by analysing cardiorespiratory reactions and integrated electromyography (iEMG) changes in the vastus lateralis during a cycle ergometer test. METHODS: A total of 23 moderately trained people were recruited. The cycling test began with a resistance of 25 W/min, which was gradually increased. During the experimental trial, the participants were required to yell at least 3 times when they felt exhausted; during the controlled trial, they were not allowed to produce any yelling sounds. The testing order was randomly assigned and the 2 trials were completed within an interval between 3-10 days. Two-way repeated measures ANOVA was applied to analyse the differences within and between the trials, and interaction of trial and time. RESULTS: The peak power and time to exhaustion (p < 0.01) in the yelling trial were higher than those in the control trial. However, the vastus lateralis iEMG values of both trials at peak power were not significantly different. During the yelling period at 90%-100% of the maximal effort, a significant time-by-trial interaction (p < 0.05) was observed in oxygen consumption (VO2), CO2 production, O2 pulse, ventilation, and respiratory rate. All the above measures showed a significant between-trial difference (p < 0.02). However, heart rate, respiratory exchange ratio, end-tidal oxygen pressure, and ventilatory equivalent for oxygen showed only significant between-trial difference (p < 0.05), but without interaction of trial and time. CONCLUSION: Yelling enhances the peak O2 pulse and VO2 and maintains CO2-exclusion efficiency during high-intensity exercise. It may enable maintaining muscle activation without stronger EMG signals being required during high-intensity exercise.

Immediate Effects of Smoking on Cardiorespiratory Responses During Dynamic Exercise: Arm Vs. Leg Ergometry.

PURPOSE: This study compared the immediate effects of smoking on cardiorespiratory responses to dynamic arm and leg exercises. METHODS: This randomized crossover study recruited 14 college students. Each participant underwent two sets of arm-cranking (AC) and leg-cycling (LC) exercise tests. The testing sequences of the control trial (participants refrained from smoking for 8 h before testing) and the experimental trial (participants smoked two cigarettes immediately before testing) were randomly chosen. We observed immediate changes in pulmonary function and heart rate variability after smoking and before the exercise test. The participants then underwent graded exercise tests of their arms and legs until reaching exhaustion. We compared the peak work achieved and time to exhaustion during the exercise tests with various cardiorespiratory indices [i.e., heart rate, oxygen consumption (VO2), minute ventilation (VE)]. The differences between the smoking and control trials were calculated using paired t-tests. For the exercise test periods, VO2, heart rate, and VE values were calculated at every 10% increment of the maximal effort time. The main effects of the time and trial, as well as their trial-by-time (4 × 10) interaction effects on the outcome measures, were investigated using repeated measure ANOVA with trend analysis. RESULTS: 5 min after smoking, the participants exhibited reduced forced vital capacities and forced expiratory volumes in the first second (P < 0.05), in addition to elevated resting heart rates (P < 0.001). The high-frequency, low-frequency, and the total power of the heart rate variability were also reduced (P < 0.05) at rest. For the exercise test periods, smoking reduced the time to exhaustion (P = 0.005) and the ventilatory threshold (P < 0.05) in the LC tests, whereas no significant effects were observed in the AC tests. A trend analysis revealed a significant trial-by-time interaction effect for heart rate, VO2, and VE during the graded exercise test (all P < 0.001). Lower VO2 and VE levels were exhibited in the exercise response of the smoking trial than in those of the control LC trials, whereas no discernable inter-trial difference was observed in the AC trials. Moreover, the differences in heart rate and VE response between the LC and AC exercises were significantly smaller after the participants smoked. CONCLUSION: This study verified that smoking significantly decreased performance and cardiorespiratory responses to leg exercises. However, the negative effects of smoking on arm exercise performance were not as pronounced.

Incidence and related factors of violence in emergency departments--a study of nurses in southern Taiwan.

BACKGROUND/PURPOSE: Nurses in emergency departments are high-risk groups who are most likely to experience the offense of violent behaviors. In a comparison on the occurrence of verbal and physical abuses in emergency departments, this study aimed to analyze the correlation of staff properties and occupational conditions in an attempt to provide a reference on violence prevention. METHODS: Eleven hospitals in southern Taiwan were selected and a survey of 267 nurses was conducted. The results were analyzed by percentage, Pearsons chi2 test and logistic regression. RESULTS: The 236 valid questionnaires showed that nurses experienced significantly more verbal abuse (92%) than physical abuse (30%). The highest occurrence of verbal abuse was 49% in night shift, and the physical abuse was 44% in overnight shift. Long waiting (89%), difference in cognition (87%), and lack of communication (82%) were the common causes. The occurrences of verbal abuse and physical abuse were significantly correlated to less-informed (odds ratio [OR], 1.67 and 1.22, respectively) and basic-level nurses (OR, 2.30 and 1.34, respectively). In addition, younger age (OR, 2.80; p < 0.01) and single status (OR, 9.09; p <0.05) were correlated with occurrence of verbal abuse, but not of physical abuse. The test on occupational conditions showed a significant correlation (OR, 0.68/0.44; p < 0.005) between the occurrence of verbal/physical abuse and whether supervisors could provide enough training to cope with violence. CONCLUSION: This study suggested that a well-informed nurse should be arranged to take the night/overnight shifts in order to reduce the occurrence of abuses in emergency departments.

Influence of external and intracellular pH on propofol-induced responses in rat locus coeruleus neurons.

The effect of external and intracellular pH on propofol-induced responses in rat locus coeruleus neurons was examined using intracellular recording from in vitro brain slice preparations. Experimental variation of external pH from 7.34 to 6.81 did not affect the propofol-induced responses. In contrast, raising the external pH from 7.34 to 8.10 resulted in enhanced 100 microM propofol effects. The effects were 1.8 times greater on membrane hyperpolarization (pH 8.10: 11.8 +/- 1.3 mV; pH 7.34: 6.5 +/- 1.0 mV, n = 5) and 1.5 times greater on reduction in input resistance (pH 8.10: 38.2 +/- 6.3%; pH 7.34: 24.7 +/- 4.1%, n = 5). Cytosolic acidification was used in which 1/3 NaCl in artificial cerebrospinal fluid was replaced with weak organic acids--sodium acetate. It did not significantly affect the propofol-induced responses. On the other hand, intracellular alkalinization with 5 mM NH(4)Cl markedly suppressed the 100 microM propofol-induced membrane hyperpolarization (1.0 +/- 0.6 mV; control: 13.9 +/- 0.9 mV, n = 5) and reduction of input resistance (38.1 +/- 1.3%; control: 61.0 +/- 4.3%, n = 5). However, the presence of 3-5 mM ammonium acetate also showed the similarly suppressing effect on membrane hyperpolarization (1.7 +/- 0.6 mV; control: 9.2 +/- 1.8 mV, n = 5) and reduction of input resistance (28.5 +/- 8.5%; control: 37.0 +/- 6.3%, n = 5) caused by 100 microM propofol. We suggested that the main suppressing effect of NH(4)Cl results from ammonium ion, but not intracellular alkalinization. Furthermore, we examined the feature of pharmacological regulation of propofol-induced responses by pentobarbital or alphaxalone during pH changes. It appears that neither pentobarbital nor alphaxalone could allosterically modulate the propofol-induced responses, which had been affected by pH changes.

[The nursing process in helping a family with foreign mother and hearing impaired child].

This case report aims to present a nursing experience involving a child with severe hearing impairment and delayed language development. The patient was discovered during a home visit. At the time she was two and a half years old, but still had not developed any language behavior. She only used eye contact, physical touch, and body language to communicate with her family. She also did not respond to sound stimulation. The results of a Denver Developmental Screening Test (DDST) showed delayed development, especially of language. The child's mother is from Vietnam. The culture, education, language, and environment of Vietnam are totally different from Taiwan. In addition, the mother did not know how to raise her child. So the author tried to follow up on the case. Data were collected by home visits, phone calls, interviews, and communication with members of a professional health care team during the nursing care period (about six months). Data were recorded and it was written a processing analyzed. They revealed five health problems, as follows: (1) hearing impairment causing delayed language development; (2) poor family recognition deviation understanding of delayed development; (3) insufficient community resources; (4) low self-protection, limited capacity for caused by hearing impairment; (5) foreign mother's sense of helplessness about raising the child. The author provided supportive care to the patient and her family, counseled them, and transferred the child quickly to a treatment center. She also coordinated resources and the professional care team in assisting the parents in facing and adapting to the child's developmental delay. As a result, the parents gained knowledge and the ability to make judgments about developmental delay. This fostered a positive attitude on their part and acceptance of the child's admission to the treatment center. The child and family could deal with their problems appropriately because the nurse intervened at the appropriate time with the aim of reducing the obstacles to their doing so. This enabled the child's handicap to be minimized and her potential to be developed.

Imported malaria in southern Taiwan from 1991 to 2002: a single hospital's experience.

Malaria, a major public health problem worldwide, is a predominant infectious disease in most tropical and subtropical countries. Before 1965, Taiwan was a hyperendemic area, but most cases are now imported. We present our experience of dealing with various malaria infections. Charts of malaria patients visiting university hospitals in southern Taiwan between January 1991 and June 2002 were available for review. All diagnoses were made by positive blood smear and detailed history that included countries visited, paroxysm of symptoms, and medical treatment. Seventeen patients, 6 women and 11 men (mean age, 32.3 +/- 11.8 years), were enrolled. Six were infected with Plasmodium falciparum, eight with Plasmodium vivax, two with a combination of P. falciparum and P. vivax, and one with an unidentified infection. All Taiwanese patients infected with P. falciparum (n = 5) contracted the disease in Africa or Indonesia. All Taiwanese patients infected with P. vivax (n = 4) contracted the disease in Southeast Asia or Oceania. Fever and chills were the leading symptoms of malaria. P. falciparum infection was treated with quinine and doxycycline/tetracycline, with the addition of artesunate for cerebral malaria. P. vivax infection was treated with chloroquine and primaquine. Maintaining a high degree of suspicion in patients with a history of travel to malaria-endemic areas is the major cornerstone of malaria diagnosis. Erroneous diagnosis and improper treatment leads to greater morbidity and even mortality.