Physical activity patterns, sleep quality, and stress levels among rotating-shift nurses during the COVID-19 pandemic.

AIM: To examine the associations between physical activity patterns, sleep quality, and stress levels among rotating-shift nurses during the COVID-19 pandemic. BACKGROUND: Stress adversely impacts hospital nurses, particularly those on rotating shifts. The effects of physical activity patterns and sleep quality on the stress levels of these nurses during the COVID-19 pandemic warrant investigation. METHODS: A multicenter cross-sectional study was conducted with 550 eligible registered hospital nurses, randomly selected from four hospitals during the COVID-19 pandemic in Taiwan. The work schedule type of these nurses was categorized into rotating shifts (working at least two shifts in a month, involving day, evening, and night shifts) or fixed-day shifts (working only the day shift). Data were collected on sociodemographic characteristics, physical activity patterns (sedentary or active), sleep quality (poor or adequate), and stress levels for analysis. RESULTS: Rotating-shift nurses with active physical activity patterns exhibited lower stress levels compared with those with sedentary patterns. Nurses who experienced adequate sleep quality had lower stress levels compared with those with poor sleep quality among rotating and fixed-day shift nurses. CONCLUSIONS: Active physical activity patterns and adequate sleep quality were associated with lower stress levels among rotating-shift nurses during the pandemic. Promoting active physical activity and enhancing sleep quality are essential strategies for reducing stress in these nurses. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Strategies aimed at promoting physical activity and improving sleep quality should be integral components of health promotion programs and policymaking efforts directed at nursing leaders, to foster a healthy and supportive work environment and enhance the welfare of rotating-shift hospital nurses. REPORTING METHOD: The study is reported using the statement of Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).

Determinants of nurses' readiness for disaster response: A cross-sectional study.

Reducing the impacts of disasters is imperative in these times when disasters continually threaten people's lives. Given that the readiness for disaster response of nurses are essential in mitigating damage, however, studies on the determinants of nurses' readiness for disaster response remain inconclusive and require further research, especially with various populations. This study therefore aimed to investigate factors associated with readiness for disaster response among Taiwanese hospital nurses. A cross-sectional study was conducted on 365 eligible and registered nurses at a medical centre in northern Taiwan. The Readiness for Disaster Responses Scale including four subscales: personal preparedness, self-protection, emergency response, and clinical management were used for assessment. Analyses were performed using multiple linear regression models. Our study results showed that the length of nursing work was positively associated with nurses' readiness for disaster responses (ß = 0.28, p < .001). Nurses with a master's degree and working in intensive care units or emergency rooms had higher readiness for disaster responses (ß = 0.13, p = .032; ß = 0.14, p = .024) than those with a bachelor's degree and working in other units/specialties (i.e., outpatient department, operating rooms, etc.). Furthermore, nurses with previous disaster training were associated with greater readiness for disaster responses (ß = 0.24, p < .001). This study findings indicate that the identified determinants of hospital nurses' readiness for disaster responses can be taken into consideration in the future recruiting of nurses for deployment to disaster response assistance and the designing of disaster training programmes specifically for nurses.

Perception of the factors contributing to family happiness among caregivers of stroke survivors in a suburban community in Thailand: A qualitative study.

Introduction: Caring for stroke survivors in primary care settings substantially impacts family life and health. Caregivers of stroke survivors have different challenging experiences in providing care in relation to family happiness. This study aimed to explore family happiness and its contributing factors among family members caring for stroke survivors in suburban Thailand. Method: Qualitative semi-structured interviews and observations were conducted among 54 family caregivers in suburban Thailand communities from January to July 2020. Interviews and focus group discussions were digitally recorded, independently transcribed and analysed using ATLAS.ti 8.0. Qualitative data analysis method was used. Results: Family happiness was found to help a family function and be satisfied with caring. The analysis revealed three themes for achieving family happiness: 1) ideal caregiver characteristics: virtue, love and gratitude, experience in caring, good health and self-care ability, good management of emotions and freedom to manage problems and obstacles; 2) family function: family structure, roles and duties, relationships and management of family problems; and 3) resource support: financial, health and environmental supports. Conclusion: The findings demonstrate how life adaptations can improve family happiness within families of stroke survivors. Understanding caregivers' perceptions of their experiences in caring for stroke survivors is a challenge for healthcare providers; overcoming this could transform an unpleasant life into caregiving happiness. Appropriate and practical support from healthcare authorities could empower families of stroke survivors to succeed in caregiving and achieve family happiness.

Effectiveness of eAsthmaCare on Symptoms, Childhood Asthma Control Test, and Lung Function among Asthmatic Children.

A web-based self-health management system-eAsthmaCare, was developed as an intervention for asthmatic children. A randomized controlled trial was performed. Consent was obtained for 98 children with asthma to participate in the study and the pre- and post-test data collection process. The experimental group was given access to eAsthmaCare online management, the control group was subjected to general asthma management. The experimental and control groups' asthma symptoms, Childhood Asthma Control Test (C-ACT) scores, and lung function were evaluated, and their pre- and 3-month post-test results were compared. The following records were maintained: (1) medication record (2) daily asthma symptoms log (3) monthly C-ACT and lung function records. The C-ACT results indicated a p-value of < .01 for: overall improvements to childhood asthma symptoms, time effect, group and time interaction effects, and group and time interaction effects in relation to sleeping condition on the previous day; cough symptom time effect, and group and time interaction effects; the two groups' time effect in relation to cough symptoms; the two groups' time effect in relation to monthly activity restrictions (number of days); and the two groups' time effect in relation to nasal symptoms; the two groups' time effect; and group and time interaction effects (p < .01). In terms of the predictive values for lung function (FVC, FEV1, PEFR), the improvements in both groups were not statistically significant. The implementation of the eAsthmaCare intervention might have a positive impact on pediatric patients, making it an effective management tool for monitoring asthmatic children's physical function and discomfort.

Impact of Rotating Shifts on Lifestyle Patterns and Perceived Stress among Nurses: A Cross-Sectional Study.

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

Applicability of modified SWAT model (SWAT-Twn) on simulation of watershed sediment yields under different land use/cover scenarios in Taiwan.

Climate change leads to increasing intensity and frequency of extreme rainfalls, especially in Taiwan with steep slopes and rapid currents. Heavy rainfalls trigger serious erosion and landslides on hillslopes, which increase sand concentration in rivers, and thus affect the water quality of reservoirs and the ecohydrological functions of rivers. We take the Zhuoshui River basin as an example and applied the modified Soil Water Assessment Tool (SWAT) model, SWAT-Twn, to simulate sediment in the basin. In SWAT-Twn, estimation of sediment yield is carried out by integrating the Taiwan Universal Soil Loss Equation (TUSLE) and the landslide simulation. Results of daily streamflow simulation showed that the model performances were above the satisfactory level, while simulations of daily sediment loads showed that the SWAT-Twn model performed better than the official SWAT (SWAT664), in terms of PBIAS of - 46.6 to 16.0% (SWAT-Twn) and - 1.2 to - 107.0% (SWAT664). Two scenarios of land use/cover, scenario 1 with fixed land use/cover and scenario 2 with updated land use/cover in each year, were applied to simulate annual sediment in the river basin for investigating the effects of landslide area variation on sediments. Results of sediment simulation under the two scenarios showed that although updating landslide area may facilitate sediment yield simulation at the subbasin level, the sediment transport equation, Bagnold equation, does not reflect the variation in sediment loads in the watershed. With further modifications, SWAT-Twn is expected to be an effective tool for simulating the impacts of landslide on sediment loads in the watersheds with rainfall-induced landslide.

Effects of Individualized Aerobic Exercise Training on Physical Activity and Health-Related Physical Fitness among Middle-Aged and Older Adults with Multimorbidity: A Randomized Controlled Trial.

The presence of multimorbidity in middle-aged and older adults, which reduces their physical activity and quality of life, is a global health challenge. Exercise is one of the most important health behaviors that individuals can engage in. Previous studies have revealed that aerobic exercise training is beneficial for healthy middle-aged and older adults and those with various chronic diseases, but few studies have designed individualized aerobic exercise training for individuals with multimorbidity. Although individuals with multimorbidity are considerably less adherent to physical activity interventions, telephone-based motivational interviewing may help in strengthening motivation and promoting behavioral change for increasing physical activity and health-related physical fitness. This study aimed to examine whether a 12-week individualized aerobic exercise training in a rehabilitation center combined with telephone-based motivational interviewing is effective in promoting physical activity and health-related physical fitness among middle-aged and older adults with multimorbidity. A randomized controlled trial was conducted. Forty-three participants (aged > 40) were recruited and randomly assigned to the intervention group, comparison group, or control group. The participants' physical activity and health-related physical fitness were assessed at baseline and at 12 weeks. The results indicated that after individualized aerobic exercise training combined with telephone-based motivational interviewing, the participants reported increased total physical activity (Fin = 481.3, p = 0.011), vigorous-intensity physical activity (Fin= 298.9, p = 0.007), dominant and nondominant hand grip (kg) (Fin = 1.96, p = 0.019; Fin = 2.19, p = 0.027, respectively), FEV1/FVC (Fin = 0.045, p = 0.043), VO2 max (ml/kg/min) (Fin = 5.30, p = 0.001), VO2 max predicted (%) (Fin = 21.6, p = 0.001), work (watts) (Fin = 22.5, p = 0.001), and anaerobic threshold (L/min) (Fin = 0.165, p = 0.011). Twelve weeks of individualized aerobic exercise training in the rehabilitation center combined with telephone-based motivational interviewing can increase the total physical activity, vigorous physical activity, and cardiorespiratory fitness of middle-aged and older adults with multimorbidity.

Active Physical Activity Patterns Are Associated With Improved Quality of Life and Depression Status in Taiwanese Women With Metabolic Syndrome.

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

Spatiotemporal Variation of Sediment Export from Multiple Taiwan Watersheds.

Soil erosion and landslide triggered by heavy rainfall are serious problems that have threatened water resources in Taiwan watersheds. This study investigated the relationship among streamflow, sediment load, sediment concentration and typhoon characteristics (path and rainfall amount) during 2000-2017 for nine gauging stations in five basins (Tamshui River basin, Zhuoshui River basin, Zengwen River basin, Gaoping River basin, and Hualien River basin) representing the diverse geomorphologic conditions in Taiwan. The results showed that streamflow and sediment load were positively correlated, and the correlation was improved when the sediment load data were grouped by sediment concentration. Among these basins, the Zhuoshui River basin has the highest unit-discharge sediment load and unit-area sediment load. The soil in the upstream was more erodible than the downstream soil during the normal discharge conditions, indicating its unique geological characteristics and how typhoons magnified sediment export. The spatiotemporal variation in sediment loads from different watersheds was further categorized by typhoons of different paths. Although typhoon path types matter, the Zhuoshui and Hualien River basin were usually impacted by typhoons of any path type. The results indicated that sediment concentration, the watershed soil characteristics, and typhoons paths were the key factors for sediment loads. This study can be useful for developing strategies of soil and water conservation implementation for sustainable watershed management.

Motivational Counseling to Reduce Sedentary Behaviors and Depressive Symptoms and Improve Health-Related Quality of Life Among Women With Metabolic Syndrome.

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

Integrating Landscape Metrics and Hydrologic Modeling to Assess the Impact of Natural Disturbances on Ecohydrological Processes in the Chenyulan Watershed, Taiwan.

The Chenyulan watershed, located in the central mountain area of Taiwan, has been suffering from earthquakes, typhoons, and heavy rainfalls in recent decades. These sequential natural disturbances have a cumulative impact on the watershed, leading to more fragile and fragmented land cover and loss of capacity of soil water conservation. In this study, the Soil and Water Assessment Tool (SWAT) and a landscape metrics tool (FRAGSTATS) were used to assess the direct impact (e.g., by annual rainfall) and indirect impact (e.g., by landscape configuration and composition) of natural disturbances on the ecohydrological processes of the Chenyulan watershed. Six SPOT satellite images from 2008 to 2013 were analyzed by using the nearest feature line embedding (NFLE) approach and reclassified into six land cover types: forest, cultivated land, grassland, river, landslide, and built-up. Forest was found to have the largest patch size, indicating that it is more resilient to disturbances, while agricultural land tended to expand from the river side toward the hill. Two land cover change scenarios were compared in the SWAT model. The results showed that there was no significant difference in simulated streamflow during 2004⁻2015 and sediment loading during 2004⁻2009; however, the model performed better for sediment loading during 2010⁻2015 with dynamic land cover change (coefficient of determination (R²) = 0.66, Nash-Sutcliffe efficiency coefficient (NSE) = 0.62, percent bias (PBIAS) = 10.5%, root mean square error observation standard deviation ratio (RSR) = 0.62) than with constant land cover (R² = 0.61, NSE = 0.54, PBIAS = -17.3%, RSR = 0.68), indicating that long-term land cover change should be considered in hydrologic modeling. Changes in landslides during 2008⁻2013 were found to significantly affect ecohydrological processes, especially after 2011. In general, annual precipitation plays a dominant role, and landscape composition had by far the strongest influence on water yield and sediment yield compared to landscape configuration. The results can be useful for understanding the effects of land cover change on ecohydrological processes in the Chenyulan watershed and the potential impact of ecohydrological changes on the environment and public health.

Randomized, controlled trial of a brief family-centred care programme for hospitalized patients with bipolar disorder and their family caregivers.

Family interventions have been emphasized in the treatment of bipolar disorder (BPD) due to the bidirectional and entangled relationships between patients and the family system, and have benefits for patients' symptoms and health; however, the effects of family interventions on family function and caregivers' health-related outcomes have not been well investigated. This randomized, controlled trial with 47 hospitalized patients with BPD/family caregiver dyads at a medical centre in northern Taiwan compared the effects of a brief family-centred care (BFCC) programme with treatment as usual (TAU). All of the family caregivers in two groups were invited to attend a routine 60-min family discussion group about violence and suicide prevention. The TAU group without specific family interview for patient and family caregiver dyad. In the BFCC group, four 90-min BFCC programme sessions were additionally provided twice a week for each hospitalized family dyad. We hypothesized that, first, family caregivers in the BFCC group could increase their family function, and second, improve perceived health status and reduce caregiver's burdens compared to the TAU. The results showed that family caregivers in the BFCC group significant interaction effects in overall family function (P = 0.03) and subscale conflict (P = 0.04), communication (P = 0.01), and problem-solving (P = 0.04), but there were no significant interaction effects on the caregivers' perceived health status and caregivers' burdens. Our findings support both the feasibility of using the BFCC programme for inpatients and its specific benefits for family function. An intensive family intervention during hospitalization has been suggested in psychiatric practice to support patients with BPD and family caregivers.

Development of the Chinese-version of the exercise self-regulatory efficacy scale for patients with chronic obstructive pulmonary disease.

BACKGROUND: A valid and reliable instrument for assessing exercise self-regulatory efficacy (Ex-SRE) is lacking in Taiwan. OBJECTIVE: To develop and validate a Chinese-version of the Ex-SRE scale (Ex-SRES-Chinese). METHODS: Published guidelines were followed for cross-cultural adaptation of Ex-SRES-Chinese. Psychometric testing was conducted in 76 subjects with chronic obstructive pulmonary diseases (COPD). RESULTS: Ex-SRES-Chinese achieved clarity, culture appropriateness, and functional equivalence for measuring Ex-SRE. The scale-level content validity index of the Ex-SRES-Chinese was 0.99. The internal consistency reliability (Cronbach's α) was 0.925. Factor analysis identified a single factor with a high eigenvalue of 7.6 accounting for 47.5% of the total variance. The construct validity of Ex-SRES-Chinese was supported by higher Ex-SRE in subjects who exercise regularly in the past than those who did not (p = 0.033). In addition, Ex-SRE was positively associated with weekly exercise time (r = 0.58; p < 0.0001). CONCLUSIONS: Ex-SRES-Chinese is a useful cross-culturally adapted instrument with good psychometric properties for measuring Ex-SRE in COPD patients in Taiwan.

Academic and Demographic Predictors of NCLEX-RN Pass Rates in First- and Second-Degree Accelerated BSN Programs.

Relatively few studies have addressed predictors of first-attempt outcomes (pass-fail) on the National Council Licensure Examination-Registered Nurses (NCLEX-RN) for accelerated BSN programs. The purpose of this study was to compare potential predictors of NCLEX outcomes in graduates of first-degree accelerated (FDA; n=62) and second-degree accelerated (SDA; n=173) BSN programs sharing a common nursing curriculum. In this retrospective study, bivariate analyses and multiple logistic regression assessed significance of selected demographic and academic characteristics as predictors of NCLEX-RN outcomes. FDA graduates were more likely than SDA graduates to fail the NCLEX-RN (P=.0013). FDA graduates were more likely to speak English as a second or additional language (P<.0001), have lower end-of-program GPA and HESI Exit Exam scores (both P<.0001), and have a higher proportions of grades ≤ C (P=.0023). All four variables were significant predictors of NCLEX-RN outcomes within both FDA and SDA programs. The only significant predictors in adjusted logistic regression of NCLEX-RN outcome for the pooled FDA+SDA graduate sample were proportion of grades ≤ C (a predictor of NCLEX-RN failure) and HESI Exit Exam score (a predictor of passing NCLEX-RN). Grades of C or lower on any course may indicate inadequate mastery of critical NCLEX-RN content and increased risk of NCLEX-RN failure.

[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.

[Transformative Care Rooted in Evidence-Based Nursing].

As clinical scientists on the interdisciplinary healthcare team, nurses use the art and science of current nursing knowledge to provide evidence-based healthcare to each patient and his/her family. Nurses not only comprise the largest contingent of medical personnel and provide 24-hour patient care but are also professional scientists that develop unique nursing knowledge through reflective practice. Five strategies for expanding the body of current evidence-based nursing scientific knowledge include: (1) reflecting empirically on the practice-service domain, (2) developing nursing knowledge using rigorous methodology, (3) emancipating nursing knowledge using innovative transformation, (4) using collaborative interdisciplinary healthcare that is based in patient-centered care, and (5) initiating innovative transformation in nursing education. Nurses are critical healthcare providers that make important contributions to today's healthcare system. Nursing scientists provide frontline, evidence-based transforming care that deserves to be respected and valued on an equal basis with the care and services that are provided by other medical personnel.

Influence of Socioeconomic Status and Perceived Barriers on Physical Activity Among Taiwanese Middle-Aged and Older Women.

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

[Precision Nursing: Individual-Based Knowledge Translation].

U.S. President Obama announced a new era of precision medicine in the Precision Medicine Initiative (PMI). This initiative aims to accelerate the progress of personalized medicine in light of individual requirements for prevention and treatment in order to improve the state of individual and public health. The recent and dramatic development of large-scale biologic databases (such as the human genome sequence), powerful methods for characterizing patients (such as genomics, microbiome, diverse biomarkers, and even pharmacogenomics), and computational tools for analyzing big data are maximizing the potential benefits of precision medicine. Nursing science should follow and keep pace with this trend in order to develop empirical knowledge and expertise in the area of personalized nursing care. Nursing scientists must encourage, examine, and put into practice innovative research on precision nursing in order to provide evidence-based guidance to clinical practice. The applications in personalized precision nursing care include: explanations of personalized information such as the results of genetic testing; patient advocacy and support; anticipation of results and treatment; ongoing chronic monitoring; and support for shared decision-making throughout the disease trajectory. Further, attention must focus on the family and the ethical implications of taking a personalized approach to care. Nurses will need to embrace the paradigm shift to precision nursing and work collaboratively across disciplines to provide the optimal personalized care to patients. If realized, the full potential of precision nursing will provide the best chance for good health for all.

Effects of telephone-based motivational interviewing in lifestyle modification program on reducing metabolic risks in middle-aged and older women with metabolic syndrome: A randomized controlled trial.

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

Evaluating the effectiveness of a family empowerment program on family function and pulmonary function of children with asthma: A randomized control trial.

BACKGROUND: Empowerment can be an effective strategy for changing an individual's health behaviours. However, how to empower whole families to manage their children's asthma is a challenge that requires innovative nursing intervention based on family-centred care. AIMS: To evaluate the effectiveness of a family empowerment program on family function and pulmonary function of children with asthma compared to those receiving traditional self-management only. DESIGN: A randomized control trial. METHODS: Sixty-five families were recruited from one asthma clinic in a medical centre in Taiwan. After random assignment, 34 families in the experimental group received the family empowerment program consisting of four counselling dialogues with the child and its family. We empowered the family caregiver's ability to manage their child's asthma problems through finding the problems in the family, discovery and discussion about the way to solve problems, and enabling the family's cooperation and asthma management. The other 31 families received the traditional care in asthma clinics. The Parental Stress Index and Family Environment Scale of family caregivers, and pulmonary function, and asthma signs of children with asthma were collected at pre-test, 3-month post-test, and one-year follow-up. We utilized the linear mixed model in SPSS (18.0) to analyze the effects between groups, across time, and the interaction between group and time. RESULTS: The family empowerment program decreased parental stress (F=13.993, p<.0001) and increased family function (cohesion, expression, conflict solving, and independence) (F=19.848, p<.0001). Children in the experimental group had better pulmonary expiratory flow (PEF) (F=26.483, p<.0001) and forced expiratory volume in first second (FEV1) (F=7.381, p=.001) than children in the comparison group; however, no significant change in forced expiratory volume in first second (FEV1)/forced vital capacity (FVC) was found between the two groups. Sleep problems did not show significant changes but cough, wheezing, and dyspnoea were significantly reduced by family caregiver's observations. CONCLUSION: We empowered families by listening, dialogues, reflection, and taking action based on Freire's empowerment theory. Nurses could initiate the families' life changes and assist children to solve the problems by themselves, which could yield positive health outcomes.