CE: Original Research: Physical Activity Among Chinese American Immigrants with Prediabetes or Type 2 Diabetes.

: Background: Although the benefits of aerobic exercise and strength training for patients with type 2 diabetes have been studied extensively, research on physical activity among Chinese American immigrants diagnosed with prediabetes or type 2 diabetes has been limited. PURPOSE: We sought to learn more about this population's knowledge of physical activity, the types and intensity levels performed, and the barriers to such activity. DESIGN AND METHODS: A concurrent mixed-methods design was used. The short version of the International Physical Activity Questionnaire-Chinese was used to quantitatively measure participants' levels of exercise intensity. Semistructured face-to-face interviews were conducted to obtain qualitative information regarding participants' knowledge about physical activity, the types performed, and the barriers to such activity. RESULTS: A total of 100 Chinese American immigrants were recruited for the study from January to July 2012 in New York City. On average, participants had lived with a diagnosis of prediabetes or type 2 diabetes for 3.3 years and had lived in the United States for 21.5 years. Energy expenditure was measured in metabolic equivalent of task (MET) units; intensity was measured in cumulative MET-minutes per week. The mean total intensity score was 2,744 MET-minutes per week. This was achieved mainly through walking. The mean intensity score for walking was 1,454 MET-minutes per week; the mean duration was 79 minutes per day. Vigorous physical activity was least common. The mean intensity score for vigorous physical activity was 399 MET-minutes per week, and the mean duration was 17 minutes per week. Regarding types of physical activity, the most common were housekeeping, walking up stairs, and taking walking or stretching breaks every hour during the workday. Based on the interviews, three themes emerged regarding barriers to moderate or vigorous physical activity: insufficient education about physical activity, health concerns about physical activity, and work-related barriers to physical activity. CONCLUSIONS: The majority of Chinese American immigrants with prediabetes or type 2 diabetes do not engage in sufficient physical activity, performing at a rate significantly below that of the general U.S. POPULATION: Increases in the intensity and duration of physical activity should be promoted as part of diabetes management for Chinese American immigrants.

Social support and factors associated with self-efficacy among acute-care nurse practitioners.

AIMS AND OBJECTIVES: To investigate the relationship of nurse practitioners' social support as well as other factors associated with perceived self-efficacy. BACKGROUND: There is a growing demand for nurse practitioners in Taiwan, for whom self-perceived efficacy is associated with performance. Nevertheless, research on the self-efficacy and social support of nurse practitioners is limited. DESIGN: This is a cross-sectional survey study. METHODS: Questionnaires were distributed to nurse practitioners in seven hospitals in northern Taiwan from May 2015 to March 2016. In total, data from 335 (78% return rate) certified nurse practitioners were analysed. Social support was measured by the Multidimensional Scale of Perceived Social Support (MSPSS) and the Job Content Questionnaire (JCQ), and perceived self-efficacy was measured by the General Self-Efficacy Scale (GSE). Data were analysed by ANOVAs with post hoc test and multiple linear regression. RESULTS: The mean score for self-efficacy was 27.60 ± 6.17. Support scores were 11.574 ± 2.37 for supervisors, 12.795 ± 1.92 for coworkers and 64.07 ± 10.16 for family, friends and significant others. nurse practitioners in the high monthly salary group had significantly higher self-efficacy than nurse practitioners in the medium and low monthly salary group (F = 8.99; p < .01). Social support from coworkers (ß = 0.18, p < .01) and family, friends and significant others (ß = 0.15, p < .01) and a higher monthly salary were significant factors. CONCLUSIONS: The self-efficacy of nurse practitioners in hospitals in Taiwan is insufficient. Monthly salary and levels of social support were found to contribute to nurse practitioners' self-efficacy. Thus, to enhance nurse practitioners' self-efficacy and work performance, nursing leaders should address these issues. RELEVANCE TO CLINICAL PRACTICE: The findings inform hospital administrators to be aware of the importance of salary in relation to nurse practitioners' perceptions of social support and self-efficacy.

[Factors and Medical Costs Associated With Fall Events in Hospitalized Patients].

BACKGROUND: Patient falls are a common, adverse event in hospitals that may result in economic and care burdens on the patient and his/her family afterward. PURPOSE: To analyze the factors that relate to falls among inpatients and to estimate the associated days of hospitalization and medical costs. METHODS: The present study used a retrospective matched case-control design to analyze inpatient fall data for 2009 to 2011 from a regional teaching hospital in northern Taipei. We matched fallers and controls according to gender, age ∓ 5 years, and ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) code. Data were analyzed using descriptive and inferential statistics. RESULTS: A total of 160 inpatients participated in the present study (80 fallers in the fall group and 80 nonfallers in the control group). The results revealed that fallers had more previous fall experiences and longer hospital stay than nonfallers. Multiple logistic regression analysis revealed that the risk factors that were significantly associated with inpatient falls included: no family accompaniment, use of more than 3 fall-related medications, and no intravenous catheter placement. Results further found that medical costs increased with the degree of injury. Third-degree injuries bore the highest post-fall medical costs of all of the injury-degree categories. The average medical cost for patients with third-degree injuries was 18,257 New Taiwan dollars. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The findings provide a reference for hospitals to promote patient safety, to prevent the occurrence of inpatient falls, and, ultimately, to reduce fall-associated medical costs.

Evaluation of an inpatient fall risk screening tool to identify the most critical fall risk factors in inpatients.

AIMS AND OBJECTIVES: To evaluate the accuracy of the inpatient fall risk screening tool and to identify the most critical fall risk factors in inpatients. BACKGROUND: Variations exist in several screening tools applied in acute care hospitals for examining risk factors for falls and identifying high-risk inpatients. DESIGN: Secondary data analysis. METHODS: A subset of inpatient data for the period from June 2011-June 2014 was extracted from the nursing information system and adverse event reporting system of an 818-bed teaching medical centre in Taipei. Data were analysed using descriptive statistics, receiver operating characteristic curve analysis and logistic regression analysis. RESULTS: During the study period, 205 fallers and 37,232 nonfallers were identified. The results revealed that the inpatient fall risk screening tool (cut-off point of ≥3) had a low sensitivity level (60%), satisfactory specificity (87%), a positive predictive value of 2·0% and a negative predictive value of 99%. The receiver operating characteristic curve analysis revealed an area under the curve of 0·805 (sensitivity, 71·8%; specificity, 78%). To increase the sensitivity values, the Youden index suggests at least 1·5 points to be the most suitable cut-off point for the inpatient fall risk screening tool. Multivariate logistic regression analysis revealed a considerably increased fall risk in patients with impaired balance and impaired elimination. The fall risk factor was also significantly associated with days of hospital stay and with admission to surgical wards. CONCLUSIONS: The findings can raise awareness about the two most critical risk factors for falls among future clinical nurses and other healthcare professionals and thus facilitate the development of fall prevention interventions. RELEVANCE TO CLINICAL PRACTICE: This study highlights the needs for redefining the cut-off points of the inpatient fall risk screening tool to effectively identify inpatients at a high risk of falls. Furthermore, inpatients with impaired balance and impaired elimination should be closely monitored by nurses to prevent falling during hospitalisations.

[Comparison of Stages of Physical Activity Among Nurses, Physicians, and Allied Healthcare Professionals].

BACKGROUND: Despite the fact that regular physical activity is known to improve physical health and reduce absenteeism and perceived job strain, healthcare professionals currently perform inadequate physical activity. PURPOSE: To understand and compare the differences in stages of physical activity among nurses, physicians, and allied healthcare professionals. METHODS: A cross-sectional questionnaire was used to survey nurses, physicians, and allied healthcare professionals who worked at four branches of a hospital in Taiwan. Data were collected using the physical activity stage of change questionnire. Data were analyzed using descriptive analysis, Chi-square test of homogeneity of proportions and a posteriori comaparisons, and multinominal logistic regression analysis. RESULTS: Of the 3,260 questionnaires administrated, 2,001 valid questionnaires were returned for an effective response rate of 61.4%. In total, 1,497 (74.8%) of the nurses, 241 (12.0%) of the physicians, and 263 (13.1%) of the allied healthcare professionals completed the questionnaire. The results revealed that most of the physicans and allied healthcare professionals were in the preparation stage, while most of the nurses were in the precontemplation stage. Multinominal logistic regression analyses showed that, using the precontemplation stage as a reference value, the odds of being in the contemplation stage were lower among participants who were nurses or male or who had a master's or doctoral degree (p < .05). Further, the odds of being in the preparation stage were lower among nurses (p < .01). The odds of being in the maintenance stage were higher among participants that: lived in the Taitung area, were male, or were single (p < .01). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The findings provide valuable references for future hospital leaders to develop effective individual physical activity programs for healthcare professionals.

Development of a situational initiation training program for preceptors to retain new graduate nurses: Process and initial outcomes.

BACKGROUND: Most preceptor training programs consist of classroom-based courses, and only a few programs are conducted using films. Preceptors have identified most training courses as inapplicable in various clinical situations. OBJECTIVES: To describe the systematic development of a situational initiation training program (SITP) for preceptors and to evaluate its impacts on the stress levels of preceptors and new graduate nurses (NGNs), the preceptor-NGN relationship, support provided by preceptors to NGNs, and the intention to leave among NGNs during a 1-year preceptorship. DESIGN: The conceptual framework of development, implementation, and evaluation was used for program completion. PARTICIPANTS AND SETTINGS: Preceptors and NGNs working at a teaching medical center in Taipei participated. METHODS: The 1-day SITP workshop comprised four films, reflection time, and four classroom-based courses. Training outcomes were evaluated using a questionnaire survey for preceptors and NGNs at months 3, 6, 9, and 12 after employing the NGNs. Data were analyzed using descriptive statistics and analysis of variance with repeated measures. RESULTS: The annual turnover rate of NGNs was 10.5%. During the first preceptorship year, the NGNs reported moderate stress levels, good to excellent relationships with their preceptors, moderate to excellent support from their preceptors, and low intention to leave their current jobs. Similarly, preceptors reported moderate stress levels, except at month 12 (mean=4.8), and good to excellent relationships with their NGNs. The SITP considerably improved the preceptor-NGN relationship for both NGNs and preceptors, whereas no improvement was observed in the stress levels, except in the stress levels of preceptors. CONCLUSIONS: The SITP is clinically effective for preceptors; thus, nurse educators may apply the SITP for redesigning the existing preceptor training programs to develop highly skilled preceptors and improve training outcomes.

Evaluation of work stress, turnover intention, work experience, and satisfaction with preceptors of new graduate nurses using a 10-minute preceptor model.

BACKGROUND: Preparing new graduate nurses (NGNs) to achieve standards of nursing competence is challenging; therefore, this study developed and evaluated the effects of a 10-minute preceptor (10MP) model for assisting NGNs in their professional development and increasing their retention in hospitals. METHOD: A repeated-measures design study, with an intervention and a two-group comparison, was conducted. A total of 107 NGNs participated in the study. At day 7, work stress and work experience were moderately high for the NGNs in both the 10MP and traditional preceptor model (TPM) groups. RESULTS: The preceptorship program showed significant differences between groups (p = 0.001) regarding work stress at months 2 and 3 and work experience at months 1, 2, and 3. The 10MP group reported lower turnover intention and higher satisfaction with the preceptors than the TPM group. CONCLUSION: The 10MP model is effective at improving training outcomes and facilitating the professional development of NGNs.

Work-to-family conflict as a mediator of the relationship between job satisfaction and turnover intention.

AIMS: To investigate the mediating effect of work-to-family conflict on the relationship between job satisfaction and turnover intention among licensed nurses in long-term care settings. BACKGROUND: The considerable research on turnover in long-term care has primarily focused on the impact of job satisfaction on turnover intention. Given the well-documented high turnover rate in nursing home staffing, dissatisfaction is expected to continue. Alternatives (e.g. reduction in work-to-family conflict) for reducing turnover under the circumstance of job dissatisfaction have not been investigated extensively. DESIGN: A cross-sectional mailed survey. METHODS: A convenience sample comprising 200 nurses from 25 private nursing homes in Central Taiwan was created. Data were collected from nurses about their level of turnover intention, job satisfaction and work-to-family conflict in 2012. A composite indicator structural equation model was used to examine the mediation model of this study. RESULTS: Overall, 186 nurses (93%) returned the completed questionnaires. Consistent with published research from other countries, turnover intention in our study was significantly and negatively associated with job satisfaction and significantly and positively associated with work-to-family conflict. In addition, job dissatisfaction indirectly influenced turnover intention through high work-to-family conflict. CONCLUSION: Findings from this study indicate the importance of work-to-family conflict to nurse turnover. While work setting has a strong, well-documented influence on job satisfaction, limiting job satisfaction efforts to work setting improvements may not yield the hoped-for results unless work-to-family conflict is also considered and addressed.

Job Demand and Job Satisfaction in Latent Groups of Turnover Intention Among Licensed Nurses in Taiwan Nursing Homes.

Nurses' turnover intention is not dichotomous; it may reflect intent to leave the profession, intent to leave a type of facility, or intent to leave a specific workplace. In a latent class analysis (LCA) of data from 186 licensed nurses (RNs and LPNs) recruited from 25 nursing homes (NHs) in Taiwan, we classified nurses into turnover intention subgroups based on seven questionnaire items and used a multilevel contrast analysis to characterize the subgroups according to demographic and facility factors, job demand, and job satisfaction. A multilevel probit model was used to examine how job demand and job satisfaction influenced subgroup membership. Three turnover subgroups were identified: high turnover intention (12%), middle turnover intention (57%), and low turnover intention (31%). The high turnover intention subgroup comprised the youngest nurses and had the lowest percentage of registered nurses (RNs); nurses in this subgroup had worked the longest at the current NH and had the greatest likelihood of working at a for-profit facility. Nurses in the middle turnover intention subgroup had the lowest likelihood of working at a for-profit facility. Nurses in the low turnover intention subgroup were primarily RNs and had the shortest work experience in the current facility. Nurses in the high and middle turnover intention subgroups reported lower intrinsic job satisfaction than those with low turnover intention. Extrinsic job satisfaction mediated the relationship between job demand and turnover intention subgroup assignment. The results of this LCA can help target interventions to address heterogeneity of turnover intention and ultimately lessen turnover.

Perceptions and experiences of nurse preceptors regarding their training courses: a mixed method study.

BACKGROUND: Although the benefits of preceptor training programs on the performance of nurse preceptors have been reported, research related to nurse preceptors' perceptions of and experiences with preceptor training courses is relatively limited. OBJECTIVES: To explore nurse preceptors' perceptions of preceptor training courses and obtain information on their experiences in working as preceptors. DESIGN: A mixed method design was conducted. PARTICIPANTS AND SETTINGS: Nurse preceptors who currently work at one of eight hospitals in northern Taiwan were recruited to participate in this study. METHODS: A questionnaire survey and focus group interviews were conducted. A training course perception scale was developed and generated based on the current nurse preceptor training programs offered in eight hospitals. Focus group interviews were conducted to obtain additional information on nurse preceptors' experiences in working as preceptors. The survey data were analyzed using descriptive statistics. Interview data were transcribed and analyzed using a qualitative content analysis approach. RESULTS: The results from the surveys of 386 nurse preceptors revealed that most courses included in the current preceptor training programs did not fulfill the learning needs of nurse preceptors and were clinically impractical. The most necessary and clinically useful course was the communication skills course, whereas the least useful course was the adult learning theory and principles course. Three themes were identified as problems based on the three focus group interviews conducted with 36 nurse preceptors: inadequate training was received before nurses were appointed as nurse preceptors, the courses were more theoretical rather than practical, and the preceptors experienced stress from multiple sources. CONCLUSIONS: The results revealed that the current preceptor training courses are impractical; therefore, the content of preceptor training courses must be altered to fulfill nurse preceptors' training needs. Furthermore, problems identified through the focus group interviews reinforce the survey results.

The effectiveness of an accessibility-enhanced multimedia informational educational programme in reducing anxiety and increasing satisfaction of patients undergoing cardiac catheterisation.

AIMS AND OBJECTIVES: To evaluate the effectiveness of an accessibility-enhanced multimedia informational educational programme in reducing anxiety and increasing satisfaction with the information and materials received by patients undergoing cardiac catheterisation. BACKGROUND: Cardiac catheterisation is one of the most anxiety-provoking invasive procedures for patients. However, informational education using multimedia to inform patients undergoing cardiac catheterisation has not been extensively explored. DESIGN: A randomised experimental design with three-cohort prospective comparisons. METHODS: In total, 123 consecutive patients were randomly assigned to one of three groups: regular education; (group 1), accessibility-enhanced multimedia informational education (group 2) and instructional digital videodisc education (group 3). Anxiety was measured with Spielberger's State Anxiety Inventory, which was administered at four time intervals: before education (T0), immediately after education (T1), before cardiac catheterisation (T2) and one day after cardiac catheterisation (T3). A satisfaction questionnaire was administrated one day after cardiac catheterisation. Data were collected from May 2009-September 2010 and analysed using descriptive statistics, chi-squared tests, one-way analysis of variance, Scheffe's post hoc test and generalised estimating equations. RESULTS: All patients experienced moderate anxiety at T0 to low anxiety at T3. Accessibility-enhanced multimedia informational education patients had significantly lower anxiety levels and felt the most satisfied with the information and materials received compared with patients in groups 1 and 3. A statistically significant difference in anxiety levels was only found at T2 among the three groups (p = 0·004). CONCLUSIONS: The findings demonstrate that the accessibility-enhanced multimedia informational education was the most effective informational educational module for informing patients about their upcoming cardiac catheterisation, to reduce anxiety and improve satisfaction with the information and materials received compared with the regular education and instructional digital videodisc education. RELEVANCE TO CLINICAL PRACTICE: As the accessibility-enhanced multimedia informational education reduced patient anxiety and improved satisfaction with the information and materials received, it can be adapted to complement patient education in future regular cardiac care.

The development and psychometric testing of East Asian Acculturation Scale among Asian immigrant women in Taiwan.

OBJECTIVE: This is a report of development and psychometric testing of the East Asian Acculturation Measure-Chinese version (EAAM-C) scale. DESIGN: An instrument validation design with a cross-sectional survey was conducted. The process was carried in two phases. In Phase 1, Barry's East Asian Acculturation Measure was translated and back translated to evaluate its content, face validity, and feasibility validity. In Phase 2, the 16-item EAAM-C was pilot-tested among 485 female immigrants for test-retest reliability, internal consistency, theoretically-supported construct validity and concurrent validity. RESULTS: The pilot work and the survey results indicated the tools possessed adequate content and face validity. The Cronbach's Alphas for the EAAM-C was 0.72, and 0.76-0.79 for its subscales, and the correlation of test-retest reliability (at 3 weeks) was 0.75. After dropping one item, four theoretically-supported factors which explained 61.82% of the variance were abstracted using exploratory factor analysis: assimilation, integration, separation, and marginalization. Based on the underlying four-factor theoretical structures of the EAAM, the confirmatory factor analysis of the EAAM-C was further examined. The analysis revealed that the four-factor model was an acceptable fit for the data which demonstrated adequate finding in its construct validity. These factors were inter-correlated, and showed statistically significant correlation with the Chinese Health Questionnaire, indicating adequate concurrent validity. CONCLUSIONS: The scale shows acceptable validity and consistency, and suggests that immigrant acculturation is a complex construct. This quick evaluation instrument can be applied to assess clients' acculturation and in further developing certain interventions to improve their health.

Comparisons of self-ratings on managerial competencies, research capability, time management, executive power, workload and work stress among nurse administrators.

AIMS: To assess the level of and the differences in managerial competencies, research capability, time management, executive power, workload and work-stress ratings among nurse administrators (NAs), and to determine the best predictors of managerial competencies for NAs. BACKGROUND: Although NAs require multifaceted managerial competencies, research related to NAs' managerial competencies is limited. METHOD: A cross-sectional survey was conducted with 330 NAs from 16 acute care hospitals. Managerial competencies were determined through a self-developed questionnaire. Data were collected in 2011. RESULTS: All NAs gave themselves the highest rating on integrity and the lowest on both financial/budgeting and business acumen. All scores for managerial competencies, research capability, time management and executive power showed a statistically significant correlation. The stepwise regression analysis revealed that age; having received NA training; having completed a nursing project independently; and scores for research capability, executive power and workload could explain 63.2% of the total variance in managerial competencies. CONCLUSION: The present study provides recommendations for future administrative training programmes to increase NAs' managerial competency in fulfilling their management roles and functions. IMPLICATIONS FOR NURSING MANAGEMENT: The findings inform leaders of hospitals where NAs need to develop additional competencies concerning the type of training NAs need to function proficiently.

[The nurse administrator in transition: reflections and future perspectives].

The growing complexity of Taiwan's healthcare system increasingly challenges nurse administrators. Multifaceted competencies and skills are essential for nurse administrators to manage organizational resources, ensure patient safety and maintain care quality. The author designed this paper to explore from a broad historical perspective the current challenges nurse administrators face. The paper provides recommendations to prepare and train future nurse administrators to fulfill their management roles confidently and competently.

Hospital environment, nurse-physician relationships and quality of care: questionnaire survey.

AIM: This paper is a report of a study conducted to (a) to compare hospitalized patients' and nurses' perceptions of the hospital environment, nurse-physician relationships and quality of care; (b) to determine which factors best predict the quality of care from hospitalized patients' and nurses' perspectives; and (c) to assess the relationships among all variables. BACKGROUND: Quality of care is a function of many factors and includes elements of the hospital environment and nurse-physician relationships. However, comparisons between patients' and nurses' perceptions are relatively limited. METHODS: This was a cross-sectional study, and 575 patients and 220 nurses across 13 units completed questionnaires. Data were collected in 2009 and analysed using descriptive statistics, independent t-tests, stepwise regression and path analysis. RESULTS: Overall, patients' mean scores were statistically significantly higher than those of nurses on perception of hospital environment (3·05 vs. 2·65 points), nurse-physician relationships (7·88 vs. 6·53 points) and quality of care (7·91 vs. 6·63 points) (P < 0·001). Both the hospital environment and nurse-physician relationships were statistically significant predictors of quality of care. Path analysis showed that quality of care was affected by the hospital environment, nurse-physician relationships and years of education for patients (P < 0·05). However, for nurses, quality of care was only directly affected by the hospital environment and nurse-physician relationships (P < 0·05). CONCLUSION: These findings may help nursing leaders to ensure future excellent patient care by helping them to see which areas need improvement. They may also help nursing leaders to develop strategies to meet patients' and nurses' expectations.

Risk factors associated with unplanned endotracheal self-extubation of hospitalized intubated patients: a 3-year retrospective case-control study.

This 3-year retrospective case-control study aimed to identify risk factors associated with unplanned endotracheal self-extubation (UESE) of hospitalized intubated patients and to compare unplanned and planned extubation groups' characteristics of patients and nurses, vital signs, serum laboratory values, Glasgow Coma Scale scores, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, and use of physical restraints and sedatives. The study found that most UESEs occurred during evening or night shifts or during shifts staffed by nurses with less experience and less education. Most of the self-extubated patients (80%) were physically restrained. Pulse rate and APACHE II score were both significant predictors of UESE. Efforts to prevent UESEs should include identification of patients at higher risk.

Factors that influence the accuracy of triage nurses' judgement in emergency departments.

OBJECTIVES: To gain an understanding of the accuracy of acuity assessment made by emergency department (ED) triage nurses, to compare the differences between the characteristics of triage nurses according to hospital variables and the accuracy of acuity ratings, and to explore the influence of nursing variables on the judgement of triages. METHODS: A cross-sectional questionnaire survey was conducted at the EDs of hospitals in northern Taiwan. Ten adult emergency case scenarios and a demographic sheet with high validity were developed to survey 279 triage nurses. Data were collected from April to October 2006. All data were analysed using percentage, mean, SD, independent t test, one-way ANOVA and a stepwise logistic regression analysis. RESULTS: The average score of rating accuracy was 5.62 points (out of a possible total of 10 points), which was considered low. Approximately 24.3% (n=68) of nurses' triage ratings were under-triaged and 19.7% (n=55) were over-triaged. Factors included years of ED experience, hours of triage education, level of hospital and triage mode of delivery. These factors were identified as significantly affecting the accuracy of nurses' judgement (p<0.05; adjusted R(2)=40.0%). CONCLUSION: The scores of accuracy ratings for triage nurses can be improved if factors contributing to inaccuracy can be altered. The findings of this study can be used to guide improvements.

Comparison of family partnership intervention care vs. conventional care in adult patients with poorly controlled type 2 diabetes in a community hospital: a randomized controlled trial.

BACKGROUND: Although there is a significant correlation between the degree of family support and clinical outcome, little research has focused on the effectiveness of family partnership intervention care (FPIC) for patients with poorly controlled type 2 diabetes. OBJECTIVES: This study aimed to compare FPIC with conventional care (CC) across a number of outcome measures in patients with poorly controlled type 2 diabetes. DESIGN: The study was performed using a randomized controlled trial design. PARTICIPANTS: Patients with poorly controlled type 2 diabetes who were solely treated with oral antidiabetic agents and had at least two out of three hemoglobin A1C readings equal to or above 7% in the previous 12 months, were randomly assigned to the FPIC group (n=28) and to the CC group (n=28). METHODS: Baseline and 6-month follow-up scores were compared using the following outcome measures: (1) hemoglobin A1C, (2) BMI, (3) lipid profile, (4) family supportive behaviours, (5), knowledge of and attitudes toward diabetes, and (6) diabetes self-care behaviours. Descriptive and non-parametric statistics were employed to compare differences in outcome measures between the groups. RESULTS: There were no significant differences in the reduction of hemoglobin A1C levels (p=0.46), lipid profile values (p>0.05), and improvement of diabetes self-care behaviours (p=0.61) between the groups at 6 months post-intervention. However, there were significant differences in the scores of family supportive behaviours (p=0.031) and patients' knowledge of and attitudes toward diabetes between the groups (p<0.05). CONCLUSION: These findings support the use of FPIC to enhance family supportive behaviours, and to improve patients' knowledge of and attitudes toward diabetes. Thus, the study is of value in helping policy decision-makers to develop more effective diabetes control intervention programmes.

Nurses' perception of nursing workforce and its impact on the managerial outcomes in emergency departments.

AIMS: (1) To understand nurses' subjective perceptions of the current nursing workforce in their emergency departments, (2) to examine the relationship between nurses' workforce perceptions and its impact on the managerial outcomes and (3) to analyse the correlation between nurses' characteristics and the scores on workforce perception. BACKGROUND: While the association between workforce perceptions and nurse outcomes is well-documented, few studies have examined how emergency department nurses perceive current workforce and related outcomes. DESIGN: A cross-sectional questionnaire survey. METHOD: A self-reported workforce perception questionnaire was used to survey 538 registered nurses in the emergency departments of 19 hospitals in northern Taiwan, during May to October 2006. Data were analysed using descriptive statistics, chi-square test, independent t-test, Pearson correlation and one-way anova. RESULTS: The mean score of workforce perception was 6.28 points (total = 10 points). Both overtime (p = 0.02) and number of callbacks on days off (p = 0.01) were significantly correlated to current nursing workforce and hospital level. Older nurses tended to have more emergency department experience (r = 0.37; p = 0.01) and those with more emergency department experience tended to have vacation accumulation (r = 0.09; p = 0.04), overtime (r = 0.10; p = 0.03) and better perception of their emergency department's current workforce (r = 0.09; p = 0.05). CONCLUSIONS: Although nurses' perceptions were found to be only moderate, overtime and number of callbacks on days off are potential problems that should be addressed by nursing leaders to benefit future emergency nurses. RELEVANCE TO CLINICAL PRACTICE: The findings can help drive strategies to ensure adequate staffing, to stabilise the nursing workforce and to prevent nurses from burnout factors such as working long hours, unpredictable schedules and a stressful work environment that may impact both the quality of emergency care and the quality of the nurses' work environment.

Perceptions of exercise in obese school-aged children.

BACKGROUND: Although the prevalence of obesity continues to increase worldwide, information related to obese school-aged children's perceptions of exercise remains limited. PURPOSE: This study aimed to explore perceptions of exercise held by obese school-aged children. METHODS: This study used a qualitative research design. Using purposive sampling, 11 obese students who were 11 to 13 years old, currently enrolled at two primary schools, and in the precontemplation stage were recruited from a total population of 1,714 to participate in the study. An interview guide with five open-ended questions was used to guide focus group discussions. Data were analyzed using content analysis to identify significant themes. RESULTS: Six themes emerged from collected data, including (a) positive impressions about doing exercise, (b) recognition of negative effects associated with not doing exercise, (c) feelings of discomfort after exercise, (d) self-ambivalence, (e) false beliefs about exercise, and (f) making excuses for not doing exercise. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Study findings provided information giving a better understanding of exercise perceptions among obese children. Such may be used to assist obese children to increase exercise levels as part of efforts to improve health in this vulnerable population.