Professional self-concept of BSN students: A cross-sectional correlational study.

BACKGROUND: Professional self-concept consists of one's judgments, attitudes about oneself professionally, and one's own perception as a professional. A positive professional self-concept can support students and new nurses throughout their nursing careers. OBJECTIVE: To describe levels of self-concept among pre-licensure undergraduate students. PARTICIPANTS/SETTING: The participants were nursing students in a Bachelor of Science in Nursing program in the United States. DESIGN/METHODS: This is a cross-sectional correlational study with self-report instruments, including demographics and the Professional Self-Concept of Nurses Instrument. Data (N = 103) were analyzed with SPSS/WIN 29.0. Descriptive statistics and professional self-concept scores were examined with independent t-tests, ANOVA, and Pearson's correlations. RESULTS: Most participants were female (n = 90), with a mean age of 20 years (SD = 1). The mean professional self-concept of nurses score was 78 (SD = 7), ranging from 27 to 108, and professional self-concept was positively correlated with receiving tutoring through the university's program, working as a tutor for nursing students or students in prerequisite classes, transferring into the nursing program, and participating in campus nursing organizations. Professional self-concept was negatively correlated with advancement in semesters of the nursing program, being a first-generation college student, having a family member who is a nurse, GPA, and having clinical-related work experience in healthcare. CONCLUSIONS: Higher levels of exposure to nursing may be related to lower professional self-concept. This is important to recognize and it may generalize to other nursing schools and health-related departments. Schools of nursing should enhance students' resilience by promoting self-concept. Our findings also shade light on self-care and the mental health of healthcare professionals.

Dispositional mindfulness: Is it related to knee osteoarthritis population's common health problems?

BACKGROUND: A growing body of research supports dispositional mindfulness as important in influencing physical and mental health as well as physical activities in patients with chronic illnesses. Knee osteoarthritis (OA), which often causes health problems, is one of the most common chronic illnesses, but less is known about dispositional mindfulness in relation to this condition. OBJECTIVE: To explore possible associations between dispositional mindfulness and physical and mental health as well as physical activity in knee OA patients. METHODS: For this cross-sectional study, we recruited a purposive sample of orthopedic clinic patients in hospitals in Southern Taiwan. Instruments included the Mindful Attention Awareness Scale (MAAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Health-related characteristics were also measured. Demographic statistics, bivariate correlations, and multiple linear regression informed our exploration of potentially related factors for dispositional mindfulness. RESULTS: Participants with knee OA (N = 250) were mostly elderly (88%), female (70.5%), and married (84%). Marital status, perceived health status, depression, and physical activity were associated with dispositional mindfulness. Better perceived health, lower depression, and greater physical activity were significantly associated with greater dispositional mindfulness. However, the severity of symptoms, fear of falling, and exercise self-efficacy did not reach statistical significance in relation to dispositional mindfulness. CONCLUSION: Greater emphasis should be placed on the cultivation of mindfulness to enhance individuals' perceived health, decrease their depressive mood, and promote their engagement in physical activity, which could indirectly alleviate their experience of pain and improve their physical function, yielding better quality of life and well-being. Future research should focus on interventions to apply dispositional mindfulness in order to determine whether dispositional mindfulness can effectively improve physical and mental health as well as physical activity in those with knee OA.

Determinants of quality of life in frontline healthcare providers caring for COVID-19 patients.

AIMS AND OBJECTIVES: To investigate the factors affecting quality of life in healthcare providers who care for patients with COVID-19. BACKGROUND: Healthcare providers caring for COVID-19 patients during the pandemic suffered a deterioration in their quality of life. Several studies have explored their psychological impact of working with COVID patients, but none have examined the causes of this deterioration. DESIGN: A cross-sectional study. METHODS: In the current study, the authors investigated the factors affecting quality of life in 293 healthcare providers recruited from a medical centre in northern Taiwan who had recently cared for patients with suspected or confirmed COVID-19 by analysing their responses to an online self-report questionnaire, using bivariate correlations and structural equation modelling. Reporting of this research adheres to the STROBE guideline. RESULTS: The study identified an important sequence of factors that mediated the effects of perceived success of epidemic prevention policies, family relations problems and education level on quality of life in a sample of healthcare workers caring for COVID-19 patients. The mediators were use of approach-oriented coping strategies and current mental health status. Specifically, use of approach-oriented coping strategies was found to directly cause improved quality of life and indirectly cause improved mental health, whereas use of avoidant coping strategies was found to directly cause worsening of mental health. Poor mental health predicted poor quality of life. CONCLUSIONS: Results suggest that implementation of sound epidemic prevention policies that promote adoption of approach-oriented coping behaviour should lead to a better quality of life in the future for healthcare providers working in challenging circumstances. RELEVANCE TO CLINICAL PRACTICE: Assessment of these policies as well as the providers' family relations are necessary first steps to improving the success of approach-oriented coping behaviour in this population, which in turn can improve their mental health and quality of life. PATIENT OR PUBLIC CONTRIBUTION: Neither patients nor members of the public were involved in the design or execution of the study.

Resilience among nurses in long term care and rehabilitation settings.

BACKGROUND: Nurses practicing in long-term care or rehabilitation settings face unique challenges from prolonged or repeated exposure to stressors, given their extended time with patients. This puts them at risk for compassion fatigue, burnout, and secondary traumatic stress, which can lead to decreased resilience and sleep problems. AIM: The aim of this study was to examine relationships among resilience, professional quality of life, sleep, and demographics in nurses working in long-term care or rehabilitation settings, and to investigate whether demographics, professional quality of life, and sleep quality are significant predictors of nurses' resilience. METHODS: In this cross-sectional study, we used the following measures: demographics, the Connor-Davidson Resilience Questionnaire, the Pittsburgh Sleep Quality Index, and the Professional Quality of Life Scale (ProQOL). Data were analyzed with SPSS v25. Data analysis consisted of descriptive statistics, bivariate correlations, and multiple regression. RESULTS: Participants (N = 120) were mostly female (85%) and registered nurses (90%). Mean scores were 52.13 for resilience and 7.53 for sleep quality. Mean ProQOL subscale scores were 41.78 for compassion satisfaction, 22.28 for compassion fatigue, and 23.92 for secondary traumatic stress. Multiple regression models showed that compassion satisfaction, burnout, and secondary traumatic stress significantly predicted resilience (ß = 0.69, ß = -0.61, and ß = -0.34, respectively, all p < .05). CONCLUSIONS: Resilience is important in nurses' personal and professional lives because it helps to protect nurses from the negative consequences of stressors. Strategies, resources, and workplace support can promote self-care and resilience.

Integrating health literacy into a theory-based drug-use prevention program: a quasi-experimental study among junior high students in Taiwan.

BACKGROUND: In Taiwan, illegal drug use is a critical health problem during adolescence. Schools playa vital role in preventing students' illegal drug use. Accordingly, we developed and evaluated a school-based, drug-use prevention program integrating the theory of planned behavior (TPB) and health literacy for junior high school students. AIM: This study aimed to use a theory-based program to prevent students from illegal drug use in Taiwanese junior high school students. METHODS: We recruited 648 junior high school students aged around 13-14 years (grades 7 to 8 students) from 14 selected schools: N = 323 in the experimental group, N = 325 in the comparison group. The experimental group received 10 45-min sessions of a theory-based drug-use prevention program. The comparison group received traditional didactic teaching and drug refusal skill training. We used a generalized estimating equation (GEE) to analyze data. RESULTS: Results of paired t-tests indicated that drug-use health literacy and TPB-related variables improved in the experimental group. The GEE analyses indicated that participants in the experimental group also demonstrated significantly improved health literacy (p < 0.001) compared to the comparison group, especially for functional (p < 0.001) and critical health literacy (p = 0.017). The experimental group also showed significant post-intervention improvement in terms of subjective norm scores (p = 0.024). CONCLUSION: Study results demonstrated the effectiveness of a drug-use prevention program on health literacy and subjective norm through integrating the Theory of Planned Behavior and health literacy. The study supports that the future implementation of similar programs for junior high school students can integrate health literacy and subjective norms as two critical program components.

Resiliency and Self-Care Behaviors in Health Professional Schools.

Background: Resilience is crucial for students in health schools as care becomes more complex and as the adjustment to meet patient, environmental, and professional demands with success can seem a daunting challenge. Self-care activities can support the development of resilience in the student population. The purpose of this study is to explore and describe self-care practices, health-promoting behaviors, and resilience among students, faculty, and staff of the health professional schools at a large metropolitan university. Method: This was a cross-sectional study of data from 148 participants. Analysis included descriptive statistics, t tests, analysis of variance, crosstabs, and Pearson correlations. Results: Resilience was lower among students than among faculty and staff. The most frequent self-care activities were humor and music. Resilience was significantly correlated with the self-care behaviors of praying (p = .006), healthy sleeping habits (p = .024), reading (p = .007), and mindful acceptance (p = .025); yoga and meditation were not significantly correlated with resilience.

Enhancement of power generation with concomitant removal of toluene from artificial groundwater using a mini microbial fuel cell with a packed-composite anode.

Composite beads are packed in the anode chamber of a microbial fuel cell (MFC), providing more area for microbial attachment and growth, increasing the efficiency of removal of toluene from toluene-contaminated groundwater. The composite beads were fabricated by integrating carbon coke (CC) with a relatively large specific surface area to which microorganisms easily adhere with conductive carbon black (CCB), which has low electrical resistance. Since the advantages of both are complementary, the power generation of MFC is improved. The single layer-packed anode MFC (SP-MFC) completely degraded 200 mg L-1 of toluene - 2.3 times faster than the non-packed anode MFC (NP-MFC). The high power density (44.9 mW m-3) and oxidation peak (1 mA), with low internal resistance (207 Ω) revealed that SP effectively improved the power generation efficiency. A composition ratio (CRCCB:CC) of composite beads of one to two yielded the best performance with a removal efficiency of 100 % - 76 % faster than CC. The closed circuit voltage of CR1:2 MFC reached 340 mV, which was 16 times that of CC; the power density and oxidation peak reached 103 mW m-3 and 1.38 mA, respectively. Therefore, CR1:2 effectively increased the overall removal efficiency and power generation of the MFC.

Clinical and microbiological characteristics of vancomycin-resistant Enterococcus faecium bloodstream infection in Central Taiwan.

Bloodstream infections (BSIs) due to vancomycin-resistant Enterococcus faecium (VREfae) remain a therapeutic challenge. This study aimed to evaluate mortality from BSIs due to VREfae in Central Taiwan.We retrospectively analyzed patients with significant VREfae BSIs in the Changhua Christian Hospital System between January 1, 2010 and December 31, 2014.Of the 152 patients with Enterococcal BSI, 56 patients (36.8%) were admitted to intensive care units (ICUs) at the onset of BSI and 20 (13.2%) patients were associated with polymicrobial bacteremia. VREfae BSI was observed in 36 (23.7%) patients. Van A (100%) is the prevalence genotype, and ST 17 (41.7%) is the predominant ST type among 36 VREfae isolates during the study period. The 30-day mortality rate was 13.2% (20/152). The multivariate logistic regression analysis showed that the onset of VREfae BSI in the ICU (odds ratio [OR] = 4.2, 95% confidence interval [CI] = 1.7-10.0, P = .002) was a significant risk factor for 30-day mortality, whereas an appropriate antimicrobial therapy was a protective factor for 30-day mortality (OR = 0.33, 95% CI = 0.14-0.79, P = .013).Our results underscore the need to assist patients who are admitted to ICUs with VREfae BSIs. We emphasize the use of an appropriate antimicrobial therapy for VREfae BSI with the aim to treat more patients with these infections.

Infection Control Programs and Antibiotic Control Programs to Limit Transmission of Multi-Drug Resistant Acinetobacter baumannii Infections: Evolution of Old Problems and New Challenges for Institutes.

BACKGROUND: Acinetobacter baumannii complex (A. baumannii) has been isolated worldwide. The rapid spread of multidrug-resistant A. baumannii complex (MDRAB) in clinical settings has made choosing an appropriate antibiotic to treat these infections and executing contact precautions difficult for clinicians. Although controlling the transmission of MDRAB is a high priority for institutions, there is little information about MDRAB control. Therefore, this study evaluated infection control measures for A. baumannii infections, clusters and outbreaks in the literature. METHODS: We performed a review of OVID Medline (from 1980 to 2015), and analyzed the literature. RESULTS: We propose that both infection control programs and antibiotic control programs are essential for control of MDRAB. The first, effective control of MDRAB infections, requires compliance with a series of infection control methods including strict environmental cleaning, effective sterilization of reusable medical equipment, concentration on proper hand hygiene practices, and use of contact precautions, together with appropriate administrative guidance. The second strategy, effective antibiotic control programs to decrease A. baumannii, is also of paramount importance. CONCLUSION: We believe that both infection control programs and antibiotics stewardship programs are essential for control of MDRAB infections.

Changing epidemiology of candidemia in a medical center in middle Taiwan.

BACKGROUND: Candidemia remains a major cause of morbidity and mortality in the health care setting, and the epidemiology of Candida infection is changing. METHODS: Clinical and laboratory data from patients with candidemia were collected retrospectively at a tertiary medical center in Taiwan from July 1, 2009 to June 30, 2012 (a 36-month period). Demographics, clinical characteristics, and drug susceptibility of the invading Candida species of patients at the onset of candidemia were analyzed and compared with previous study from January 1, 2001 to June 30, 2003 (a 30-month period). RESULTS: A total of 209 episodes of candidemia in 205 patients were identified in this study period. When compared with the previous study period, more patients were admitted for medical conditions at percentages ranging from 49.5% to 69.8%; the incidence rate of health care-associated candidemia increased from 0.76 to 1.14 per 1000 discharges; the proportion of Candida albicans in patients with candidemia decreased from 64.8% to 43.6% whereas the proportion of Candida glabrata increased greatly from 1.1% to 21.6% and the proportions of Candida tropicalis and Candida parapsilosis were slightly elevated (19.8-22.0% and 2.2-7.3%, respectively). All of the C. albicans isolates remained susceptible to fluconazole, whereas 66.7% of C. glabrata isolates were dose-dependent susceptible, and 4.4% of C. glabrata isolates and 11.6% C. tropicalis isolates were resistant. There was one C. glabrata and one Candida guilliermondii resistant to echinocandin. The predictors for 30-day mortality included the high Acute Physiology and Chronic Health Evaluation II (APACHE II) score, use of parenteral nutrition, underlying malignancy, liver cirrhosis, and neutropenia whereas candidemia by C. parapsilosis or C. glabrata is a favorable predictor when compared with C. albicans. CONCLUSION: The distribution of Candida species in candidemia was changed. Although C. albicans remained the major species, the isolation of non-C. albicans spp., especially C. glabrata, increased. Patients with candidemia still had high mortalities due to severity of illness and underlying conditions.

Filipina nurses' transition into the US hospital system.

Filipina nurses represent the majority of all internationally educated nurses recruited to work in the US. Although the hiring of Filipina nurses is not a new practice in US hospitals, very few studies have detailed how these nurses have adjusted to US nursing practices. This study examines how Filipina nurses transition into their role as nurses and adapt to nursing practice in the US. Following a qualitative approach, 31 Filipina nurses were interviewed as participants. The data were audio-taped and transcribed verbatim, using the method of constant comparison. Analysis revealed that transitioning from Philippine to US nursing practice formed the basis of the social adaptation process, which occurred in three stages: pre-arrival, early adaptation, and late adaptation. Participant-recommended strategies to address adaptation needs experienced at each of these stages are shared. All participants experienced challenges while adjusting to the US healthcare system and cultural landscape.

Efficacy of copper-silver ionization for controlling fungal colonization in water distribution systems.

The purpose of this study was to identify the prevalence of fungal colonization in water systems and to evaluate the effect of decreasing fungal colonization by a copper-silver ionization system. Environmental samples were collected for fungal culture prospectively during a 1-year period (2011-2012) at the study hospital. A total of 392 water samples were examined from five buildings on March 1, 2011 and February 29, 2012. Fungi were isolated in 13 (3.4%) of 392 water samples from five buildings. The prevalence of fungal colonization in buildings was decreased from 4.76% (9/189) to 1.97% (4/203), a reduction of more than 40%, in pre-ionization and post-ionization treatment (p < 0.001). Thirteen (3.4%) of 392 water samples yielded fungi including Fusarium species (n = 7), Penicillium species (n = 2), Scedosporium species (n = 2), Aspergillus species (n = 1), and one unidentifiable mold. The number of isolated Fusarium species in ionized water samples (0.5% (1/203)) was statistically lower than those in nonionized (3.2% (6/189)) (p = 0.003). Our finding may determine if this ionization method can be applied for control of waterborne fungi colonization in hospital water systems.

Laboratory identification, risk factors, and clinical outcomes of patients with bacteremia due to Escherichia coli and Klebsiella pneumoniae producing extended-spectrum and AmpC type ß-lactamases.

BACKGROUND: Extended-spectrum ß-lactamase (ESBL)-producing bacteria coexpressing AmpC type ß-lactamase (ACBL) are associated with the laboratory issue of false susceptibility to third-generation cephalosporins. This study was to evaluate laboratory tests and clinical significance of bacteremic isolates of Escherichia coli and Klebsiella pneumoniae with both ESBL and ACBL [dual-type lactamases (DTL)]. METHODS: From 2006 to 2009, 78 E coli and 12 pneumoniae bacteremic isolates with reduced susceptibility to cefotaxime (CTX) or ceftazidime (CAZ) were identified and relevant patients' data were collected for analysis. Phenotypic and genotypic characterizations of these selected isolates were determined by inhibitor-based assays and polymerase chain reaction-based genetic analyses, respectively. RESULTS: Among the 90 isolates, 47 had DTL production. There was an increasing annual prevalence from 29% in 2006 to 56% in 2009 (p=0.02). Phenotypic assays had a sensitivity and specificity of 57% (43/76) and 93% (13/14) for ESBL detection and 95% (58/61) and 34% (10/29) for ACBL, respectively. Among the DTL-producing isolates, phenotypic assays yielded a higher false negative rate of ESBL detection than that of ACBL detection (70% versus 6%), while all false negative ESBL results were associated with ESBL genes other than bla(CTx-M). The majority of the DTL-producing isolates were in the category of resistance to CTX (47/47, 100%) and CAZ (44/47, 94%) by the Clinical and Laboratory Standards Institute (CLSI) 2010 interpretive criteria, of which many were considered intermediate or fully susceptible to CTX (25/47, 53%) and CAZ (15/47, 32%) by the previous ones (CLSI-2009). The DTL-producing isolates exhibited a lower susceptibility rate to fluoroquinolones, aztreonam, and ß-lactam/lactamase inhibitors than those with either ESBL or ACBL alone. The use of indwelling catheters or nasogastric tubes was associated with bacteremia due to the DTL isolates, but the mortality rates were not different among those due to isolates with ESBL, ACBL, or both. By multivariate analysis, Pittsburg bacteremia score and Charlson comorbidity index were the significant predictors for all-cause mortalities. CONCLUSION: Bacteremic episodes due to DTL-producing E coli and K pneumoniae became increasingly prevalent and were often associated with coresistance to antibiotics other than ß-lactams, but they were not associated with a worse prognosis than those due to ESBL- or ACBL-producing bacteria.

Aggregatibacter aphrophilus pyogenic liver abscess in an immunocompetent young woman.

Aggregatibacter aphrophilus (formerly Haemophilus aphrophilus/paraphrophilus) is a small Gram-negative coccobacillus with fastidious growth requirements. It is a normal commensal of the human oropharynx and upper respiratory tract, and it can infrequently cause invasive human diseases, including bone and joint infections and subacute infective endocarditis. Cases of liver abscess caused by Aggregatibacter aphrophilus have been sparsely recorded in the English-language literature, but have not yet been reported in Taiwan. Here we present a case of Aggregatibacter aphrophilus pyogenic liver abscess in an immunocompetent young woman. She recovered uneventfully after repeated percutaneous abscess aspiration and antibiotic treatment for 5 weeks.

Serotypes, surface proteins, and clinical syndromes of invasive Group B streptococcal infections in northern Taiwan, 1998-2009.

BACKGROUND: The incidence of invasive Group B streptococcal (GBS) infections is increasing in the elderly and immunocompromised adults in many countries worldwide. There are, however, few reports regarding the current status of the infection in northern Taiwan. This study investigated retrospectively the molecular epidemiology and clinical syndromes of the invasive GBS diseases in a tertiary care hospital in northern Taiwan over the past decade. METHODS: One hundred twenty episodes of invasive GBS disease were recorded at Cathay General Hospital, a tertiary care, teaching hospital in northern Taiwan, from January 1998 to June 2009. Clinical information was acquired from medical records. Capsular serotypes and alpha family of surface proteins were genotyped with multiplex and specific polymerase chain reaction. RESULTS: Of all episodes, 58.3% was found in the elderly (age ≥ 65), 36.1% in nonpregnant women and young adults (age 18-64), and 5.9% in the neonates (0-90 days). Case-fatality rate was 6.7%. Eighty-three (69%) of the invasive isolates were available for genotyping. In sharp contrast to the studies in southern Taiwan (1991-2004), Type Ib (26.5%) was the most frequent invasive isolate, followed by V (22.9%), III (18.1%), VI (12%), Ia (10.8%), II (6%), VIII (2.4%), and nontypable strain (1.2%). In particular, Serotype VI, which had been rarely implicated in invasive infection, emerged as a significant pathogen. A significant trend of increase in incidence was observed for the infection (p<0.0001), with concurrent increase of cases in the elderly and of Serotype Ib and VI. There was significant association with young adults of Type II and III and chronic skin conditions and older adults with Type Ia and V and chronic cardiovascular diseases. Type V was closely associated with skin and soft tissue infection. Recurrent episodes (10%) occurred most often in patients with concomitant malignancy, with an average of 314 days for recurrence. CONCLUSIONS: The incidence of GBS invasive infection among nonpregnant women and adults is rising in northern Taiwan, particularly in the elderly caused by Serotype Ib and VI. Population-based surveillance program should be implanted for assessment of the disease burden to the susceptible adult population.

Timing of impairment and health-promoting lifestyles in women with disabilities.

The purpose of this study was to develop a substantive theory to explain how the timing of impairment in women's lives influenced health-promoting lifestyles among 45 women age 43 to 79 years with impairments of varying onset across the life course. From this grounded theory exploration, we suggest that women created health-related lifestyles that were comprised of changing abilities, roles, and rituals in support of perceived self. The ultimate goal of a healthy lifestyle was healthy aging, which was self-determination in the support of positive relationships. Environment and resources had direct influence on the perceived self. Our proposed substantive theory provides an understanding of how women develop a healthy lifestyle after the onset of permanent sensory or physical impairment. It also takes steps toward an understanding of how timing of impairment influences the perceptions women have of themselves and their health behaviors.

Venous catheter-associated bacteremia caused by rapidly growing mycobacteria at a medical center in central Taiwan.

BACKGROUND AND PURPOSE: Infections due to rapidly growing mycobacteria (RGM) are increasing worldwide, especially in immunocompromised hosts, but data on the clinical features of patients with RGM bacteremia are limited in Taiwan. This study was performed to determine the features associated with RGM. METHODS: The medical records of 12 patients with RGM bacteremia admitted to the Changhua Christian Hospital, Changhua, Taiwan, from April 2001 to March 2003 were retrospectively studied. Clinical data were reviewed and antimicrobial susceptibility testing of blood isolates by the agar disk elution method was performed. RESULTS: RGM bacteremia was caused by Mycobacterium fortuitum in 5 patients, Mycobacterium smegmatis in 3, Mycobacterium flavescens in 2, and Mycobacterium abscessus in 2. There were 5 men and 7 women (age range, 4-75 years). All patients had underlying diseases and all of the infections were associated with an indwelling vascular catheter. The time to onset of bacteremia ranged from 1 to 24 months. Fever (n = 11) was the most common presenting symptom. Susceptibility testing revealed a different antibiogram for each species of RGM. The rate of relapsing bacteremia was significantly higher in patients with delayed catheter removal and for whom the catheter was not removed (6/8; 75%) than in patients with timely catheter removal (0/4; 0%) [p = 0.03]. CONCLUSIONS: RGM bacteremia is rare but should be considered in immunocompromised patients with an indwelling venous catheter and undifferentiated fever. Identifying RGM at the species level and performing susceptibility testing are useful for guiding management. The catheter should be removed as soon as possible.

A synthesis of the literature on Asian nurses' work experiences in the United States.

Nursing shortages in the United States have underscored the need for foreign nurse recruitment. The major population of foreign nurse recruits has long been Asian. When employing foreign nurses, fair employment practices and quality of care must be ensured; however, few empirical studies were found on this topic. Thus, the purpose of this article is to synthesize the extant literature about Asian nurses' work experiences in and adaptation to the U.S. health care system. The author searched four major bibliographic databases, as well as the ProQuest Dissertation and Thesis Database and analyzed eight empirical studies based on four predetermined inclusion criteria. The major themes identified in the selected scholarly works were: (a) overcoming language barriers, (b) dealing with discrimination, (c) adopting U.S. nursing practices, (d) adjusting to U.S. social customs, (e) becoming accustomed to U.S. culture, and (f) reconciling work ethics. Additional research studies, using both quantitative and qualitative approaches, are necessary to gain in-depth knowledge related to this phenomenon.

Data management and security in qualitative research.

Qualitative research provides rich data on phenomena important to nursing and may offer in-depth information for critical care nurses in providing care to their patients. Data management, which encompasses topics such as human subjects' protection, confidentiality, data storage and record keeping, data ownership, and data sharing, is a critical process in qualitative research that deserves researchers' attention. Thus, the purpose of this article is to synthesize existing research studies on qualitative data management.

The efficacy of hyperbaric oxygen therapy in improving the quality of life in patients with problem wounds.

The unpredictable course followed by severe, chronic, non-healing wounds not only restricts the daily activities of affected patients, but also impairs their quality of life (QOL). Hyperbaric oxygen therapy (HBOT) treatment for such wounds elevates tissue oxygen content, increases cellular repair functions and the probability of wound healing, and improves the patient's QOL. This was a longitudinal, prospective study, and used a purposive sampling method. A total of 15 patients receiving HBOT at a medical center were enrolled. Data were collected by questionnaire before and after HBOT. The questionnaire included basic patient characteristics, self-perceived wound severity, wound physiological indices, and a QOL scale. The overall QOL score of the subjects after HBOT was higher than before HBOT. After HBOT, there was a positive correlation between the QOL of patients with problem wounds and the scoring of the Strauss wound classification system. After HBOT, there was a negative correlation between the QOL of patients with problem wounds and their self-perceived severity of the wound. The results were then used to provide suggestions for nursing care and additional research directions in order to effectively assist patients with problem wounds receiving HBOT, with the goal of achieving an optimal QOL.