Reasons for Altering Bladder Management and Satisfaction with Current Bladder Management in Chronic Spinal Cord Injury Patients.

Patients with spinal cord injury (SCI) often require bladder management. However, patients routinely change their bladder management for better satisfaction. The reasons for altering a bladder management method in SCI patients remain insufficiently understood. The purposes of this study are to assess current satisfaction with bladder management and the reasons for changing bladder management in SCI patients. A prospective cross-sectional survey with a convenience sampling method was used. The study was conducted from January 2018 to December 2019. The inclusion criteria included an age ≥18 years and a diagnosis of SCI more than one year previously. The questionnaires were self-administered and collected from eligible patients during a free clinic service. A total of 515 SCI participants were enrolled. Two hundred and eighty-three (55.0%) participants had experienced changing their bladder management. The most used method of current bladder management was self-voiding. About 84.7% of participants reported being satisfied with their current bladder management. Bladder management changes were most often made due to frequent urinary tract infections. Furthermore, the participants dissatisfied with their management had more urological complications. This study indicates that appropriate bladder management can improve the subjective satisfaction of patients. For long-term care, preventing urinary tract infections is a helpful strategy for patients' satisfaction with bladder management.

Familiarity, Attitude, and Confidence of Health Literacy Practice among Community Healthcare Providers in Taiwan.

Health literacy (HL), which is a determinant of individuals' health as well as a personal and public asset, can be improved by community healthcare providers (CHPs) with the capability of providing HL services. The purpose of this study was to explore CHPs' familiarity with and attitudes toward HL and their confidence in implementing HL practices. A cross-sectional online survey was conducted involving a total of 104 CHPs from 20 public health centers in Taiwan. It was based on a structured questionnaire involving self-evaluation by participants. The scores for familiarity, attitudes, and confidence in implementing HL practices were mean = 4.36, SD = 1.99; mean = 7.45, SD = 1.93; and mean = 6.10, SD = 1.77 (out of 10 points), respectively. The results of the multiple regression analysis showed that the two independent variables of familiarity and attitude could predict confidence in implementing HL practices (R2 = 0.57, F(2101) = 58.96, p < 0.001). The CHPs surveyed were not especially familiar with HL; thus, they recognized its importance, but they lacked confidence in implementing HL practices. Increasing practitioners' familiarity with HL may therefore boost their confidence in implementation. The research results can serve as a reference when planning HL education and training.

Discrepancy Among Self-Reported Adherence, Prescription Refills, and Actual Anticoagulant Control.

BACKGROUND: Patients must adhere to their prescribed warfarin regimens and regularly monitor the anticoagulation effect to maintain therapeutic levels. The ability to evaluate regimen adherence accurately is crucial to the success of patient coaching. However, prevention of thromboembolic events is challenging when the association between medication adherence and the actual amount of anticoagulant agent taken cannot be determined. PURPOSE: This study used self-reported medication taken and prescription refills to (a) verify warfarin medication adherence and (b) assist clinicians to determine the discrepancy between medication adherence and anticoagulant control efficacy. METHODS: This study was conducted at a national-university-affiliated hospital in Yilan County, Taiwan. Structured questionnaires and medical record reviews were adopted. A 100-point visual analog scale was used to measure the reported adherence of participants, whereas medication refill adherence was compared against self-reported adherence. Finally, degree of adherence was evaluated based on time in therapeutic range. RESULTS: This study included 192 participants. Half (n = 94, 49%) were women, and the mean age was 69.6 years. Mean scores were 92.2% for the visual analog scale and 87.3% for medication refill adherence. Medication adherence correlated significantly with age, as reflected in the visual analog scale scores (p < .05). The participants who were receiving polypharmacy with five types of medicines or less attained higher visual analog scale scores, whereas participants who were on warfarin for 2-12 months exhibited higher medication refill adherence. Time in therapeutic range correlated negatively with age, although stability improved with therapy duration. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Despite their high self-reported adherence levels, patients of advanced age require careful monitoring of their time in therapeutic range. The participants in this study who were on warfarin for a relatively longer time exhibited higher stability in the therapeutic range, despite their low medication refill adherence. The results of this study suggest that patient age, duration of warfarin therapy, and polypharmacy are factors associated with medication adherence. The findings may facilitate future assessments of warfarin adherence in patients as well as the implementation of more effective clinical nursing procedures and management practices.

Nurses' perceptions regarding providing psychological care for older residents in long-term care facilities: A qualitative study.

AIMS AND OBJECTIVES: To explore nurses' perceptions regarding providing psychological health care for older residents in long-term care facilities (LTCFs). BACKGROUND: Loneliness and depressive symptoms are commonly observed among older residents living in LTCFs. Nurses are expected to provide holistic care including physical, psychological and social care for older residents in LTCFs to fulfil their needs. Therefore, understanding nurses' feelings and thoughts regarding providing care for older residents who feel lonely, sad, unhappy or depressed is important for delivering better care. DESIGN: A qualitative research design was employed. The Standards for Reporting Qualitative Research (SRQR) was used to enhance for reporting quality. METHODS: Purposive sampling and snowball sampling were applied in Northern Taiwan. One-to-one in-depth interviews were conducted using a semi-structured interview guide. Twenty-one nurses with a mean age of 38.4 years were interviewed. Content analysis was performed for data analysis. FINDINGS: Four themes were generated from the data: "insufficient psychological healthcare competency," "having a willing heart but not adequate support," "families playing an essential role in residents' mood" and "physical-oriented care model." CONCLUSIONS: Long-term care facilitie nurses felt that they were not adequately prepared for taking care of older adults' psychological problems before their nursing career or during their practice. Unreasonable nurse-to-resident ratios and an absence of care consensus among healthcare providers can make nurses feel that they have a willing heart but not adequate support. Family members are essential in older residents' emotional status within the Taiwanese cultural context. Physical care evaluation indicators emphasised by LTCF accreditation resulted in the current care practice model. IMPLICATIONS FOR PRACTICE: This study provides valuable information for LTCF nurses, managers and directors to develop appropriate strategies to assist nurses in providing better psychological health care for older residents. Evaluation indicators required by LTCF accreditation in Taiwan must be re-examined at the earliest stage.

WITHDRAWN: A Multifaceted Approach to Assessing the Medication Adherence of Patients on Warfarin Therapy.

Ahead of Print article withdrawn by publisher.

[Pelvic Health: Healthcare Needs From Medical and Women Perspectives].

The pelvis, one of the most important cavities in the human body, is involved in human reproduction health. The pelvis changes in females with age and reproduction-related changes in hormones. Women generally lack sufficient knowledge regarding their pelvic-health needs and feel embarrassed to seek pelvic-health-related medical advice. Conversely, medical care related to women's health focuses mainly on maternal health and cancer prevention. When facing the challenges of pelvic floor dysfunction, surgical procedures are the most common treatment modality. The present article aims to define pelvic health and to compare the differences in perspective on this issue between the medical and women. Lastly, suggestions for pelvic healthcare that focus on women's needs are made.

Inappropriate urinary catheter reinsertion in hospitalized older patients.

BACKGROUND: We investigated the incidence and rationale for inappropriate reinsertion of urinary catheters and elucidated whether reinsertion is an independent predictor of adverse outcomes. METHODS: A longitudinal study was adopted. Patients aged ≥65 years with urinary catheters placed within 24 hours of hospitalization were enrolled. Data collection, including demographic variables and health conditions, was conducted within 48 hours after admission. Patients with catheters in place were followed-up every day. If the patient had catheter reinsertion, the reinsertion information was reviewed from medical records. Adverse outcomes were collected at discharge. RESULTS: A total of 321 patients were enrolled. Urinary catheters were reinserted in 66 patients (20.6%), with 95 reinsertions; 49.5% of catheter reinsertions were found to be inappropriate. "No evident reason for urinary catheter use" was the most common rationale for inappropriate reinsertion. Inappropriate reinsertion was found to be a significant predictor for prolonged length of hospital stay, development of catheter-associated urinary tract infections and catheter-related complications, and decline in activities of daily living. CONCLUSIONS: This study indicates a considerable percentage of inappropriate urinary catheter reinsertions in hospitalized older patients. Inappropriate reinsertion was significantly associated with worsening outcomes. Efforts to improve appropriateness of reinsertion and setting clinical policies for catheterization are necessary to reduce the high rate of inappropriate reinsertion.

Exploring initial inappropriate use of urinary catheters among hospitalised older patients in Taiwan.

AIMS AND OBJECTIVES: To explore the incidence, associated factors and adverse outcomes for initial inappropriate use of urinary catheters in hospitalised older patients. BACKGROUND: Urinary catheters can lead to substantial complications. The related factors and adverse outcomes associated with initial inappropriate urinary catheter use among hospitalised older patients have not been studied. DESIGN: Prospective cohort study. METHODS: A total of 321 older patients admitted to the hospital in southern Taiwan having urinary catheters placed within 24 hours of admission were recruited. Demographic factors, voiding function history, health conditions and care conditions of catheter placement were collected through a review of medical records, interviewing participants or their primary caregivers. Catheter-associated urinary tract infection during hospitalisation, transfer to a nursing home, length of hospital stay and change in activities of daily living determined as outcomes. Criteria for urinary catheter placement were developed to identify inappropriate use. RESULTS: The incidence of initial inappropriate use of urinary catheters among hospitalised Taiwanese older patients was 38·3%. The rationale most often reported for initial inappropriate use was 'convenience of care' (49·6%). Factors associated with initial inappropriate use were, chronic constipation, urinary tract infection history, medical treatment diagnosis, cognitive impairment, depressive symptoms and independence in activities of daily living and, insertion of catheter during evening and night shifts and lack of nursing documentation of the rationale for catheterisation. Patients with initial inappropriate use showed greater decline in activities of daily living function between admission and discharge. CONCLUSION: Older patients with greater care needs may become the victims of initial inappropriate use of urinary catheters. Inappropriate use may devastate the activities of daily living in older patients. Nurses' awareness of indications for urinary catheters may prevent inappropriate use. RELEVANCE TO CLINICAL PRACTICE: A policy to strengthen nurses' awareness of the use of urinary catheters is needed in Taiwan.

Experience of pelvic floor muscle exercises among women in Taiwan: a qualitative study of improvement in urinary incontinence and sexuality.

AIMS AND OBJECTIVES: To gain an in-depth understanding of women's experiences of performing pelvic floor muscle exercises for urinary incontinence and the impact on their sexuality. BACKGROUND: Urinary incontinence is not a life-threatening disorder; however, it has been shown to have detrimental effects on quality of life in terms of psychological, social and sexual dysfunction. Pelvic floor muscle exercises is the first recommended strategy for managing mild to moderate urinary incontinence as it is noninvasive and cost effective. Pelvic floor muscle exercises reduce incontinence and strengthen the pelvic floor muscles, which positively affects sexual function in women. Currently, the data are scarce for qualitative literature regarding the subjective experiences of Taiwanese women undergoing pelvic floor muscle exercises and the impact on their urinary incontinence and sexuality. DESIGN: Qualitative exploratory study. METHODS: Semi-structured in depth interviews were undertaken with twelve women who had completed a pelvic floor muscle exercises program in Taiwan. Data were analysed using thematic analysis. RESULTS: Themes were related to Taiwanese women's initial feelings that urinary incontinence was inevitable and the effects on their sexuality. Three core themes were identified: perceptions of inevitability, developing awareness and gaining control and sexual taboo. Through developing awareness and control of their pelvic floor muscles women expressed improvement in urinary incontinence. Sexual enjoyment, body image, self confidence and sexuality were also enhanced. CONCLUSION: Pelvic floor muscle exercises had a positive effect on urinary incontinence and sexuality. The findings demonstrated that sex is a taboo topic for many Taiwanese women. With the sensitive management of pelvic floor muscle exercises programs this issue can be addressed. RELEVANCE TO CLINICAL PRACTICE: This study raises awareness of healthcare professionals by identifying how Taiwanese women perceive pelvic floor muscles. The positive impact of pelvic floor muscle exercises upon both urinary incontinence and sexuality within the Taiwanese context are addressed. Nurses may also, with greater confidence initiate discussion of women's sexual concerns as part of managing urinary incontinence.

[Factors associated with adherence to immunosuppressive therapy among transplant recipients].

Advancing medical technology has made organ transplantation an emerging surgical treatment option for organ failure. Patients who receive transplants must take immunosuppressive agents for the remainder of their life in order to maintain good graft function. Failure to take these agents may affect the function of the transplanted graft, reduce quality of life, and even cause death. Thus, encouraging patients to take immunosuppressive agents as directed is critical to minimizing the long-term medical burdens and social costs of organ transplantation. The purpose of this study is to explore the factors associated with adherence to immunosuppressive therapy among transplant recipients using the WHO adherence model. Findings are provided as a reference to health education and clinical care planners.

High classification of chronic heart failure increases risk of overactive bladder syndrome and lower urinary tract symptoms.

OBJECTIVE: To assess the urologic symptoms among patients with chronic heart failure (CHF) and to explore whether a higher classification of CHF increases the risk associated with overactive bladder syndrome (OAB) and lower urinary tract symptoms. METHODS: A total of 214 ambulatory patients with CHF (129 men and 85 women) and 378 age-matched subjects (222 men and 156 women) were enrolled in the present study. The urologic symptoms were evaluated using the Overactive Bladder Symptom Score (OABSS) and International Prostate Symptom Score (IPSS) from January to June 2010. RESULTS: Compared with the controls, the patients with CHF had a significantly greater mean OABSS (4.6±3.6 vs 3.4±3.1, P<.001), total IPSS (8.3±6.9 vs 6.9±7.6, P=.021), and storage IPSS (4.8±3.5 vs 3.7±3.3, P<.001). Of the patients with CHF, 34.1% had moderate/severe OAB symptoms (OABSS≥6), and 43.5% had moderate/severe lower urinary tract symptoms (IPSS≥8). Compared with patients who had New York Heart Association (NYHA) class I CHF, the patients with NYHA class III CHF had a significantly greater OABSS and total, storage, and voiding IPSSs. Patients with NYHA class II CHF did not. A greater body mass index and stroke were significantly associated with the OABSS and storage IPSS, and pulmonary disease was significantly associated with the voiding IPSS. CONCLUSION: The patients with CHF had more storage urinary symptoms suggestive of OAB than did the age-matched controls. Among the patients with CHF, greater NYHA class heart function was significantly associated with OAB and lower urinary tract symptoms.

[Introduction to nursing aesthetics].

Empirical, aesthetic, ethical, and personal knowing are the four fundamental patterns of knowledge inquiry. Of these, the aesthetic knowing pattern is least discussed in nursing literature. This article discusses the definition of nursing aesthetics; its utilization in practice; and correlations between aesthetics and clinical practice. One of the advantages inherent to nursing is its ability to deliver skillful care directly to patients. Skillful performance is essential to reduce discrepancies between goals and patterns. Aesthetic nursing addresses more than the form of nursing. It further addresses the crucial elements of nursing knowledge. The science of nursing is influential in its ability to attain harmony among abundant empiric content, power of beneficence, and pleasure of aesthetic experience. In clinical practice, nurses can employ aesthetic nursing through various channels to create meaning and promote the professional image of nurses. Concepts listed in this article may be utilized in clinical supervision, practice and education.