Chewing Gum May Alleviate Degree of Thirst in Patients on Hemodialysis.

Background and Objectives: Fluid restriction commonly causes dry mouth in patients on hemodialysis (HD). The observed effects of chewing gum on the amount of saliva, interdialytic weight gain (IDWG), and degree of thirst in patients on HD have been inconsistent. We investigated whether chewing gum can modulate these three parameters in patients on HD. Materials and Methods: We used purposive sampling to enroll 37 patients on HD who were then randomly divided into the chewing gum group (n = 19) and the control (non-chewing gum) group (n = 18). The degree of thirst was assessed using a self-rated visual analog scale (VAS) and a summated xerostomia inventory (SXI), respectively. Results: The degree of thirst after dialysis was significantly lower in the chewing gum group than in the control group. The amount of saliva was higher in the chewing gum group than in the control group before dialysis, but the saliva amount was comparable between the groups after dialysis. Furthermore, the amount of saliva was not associated with IDWG in patients on HD before or after dialysis. Conclusions: Chewing gum may alleviate the feeling of thirst but may not affect the amount of saliva and IDWG in patients on HD. Therefore, we suggest that chewing gum may be a useful approach to improve dry mouth and thirst in patients on HD.

The Impact of Signing Do-Not-Resuscitate Orders on the Use of Non-Beneficial Life-Sustaining Treatments for Intensive Care Unit Patients: A Retrospective Study.

Background: Intensive care medical technology increases the survival rate of critically ill patients. However, life-sustaining treatments also increase the probability of non-beneficial medical treatments given to patients at the end of life. Objective: This study aimed to analyse whether patients with a do-not-resuscitate (DNR) order were more likely to be subject to the withholding of cardiac resuscitation and withdrawal of life-sustaining treatment in the ICU. Methods: This retrospective study collected data regarding the demographics, illness conditions, and life-sustaining treatments of ICU patients who were last admitted to the ICU between 1 January 2016 and 31 December 2017, as determined by the hospital's electronic medical dataset. Results: We identified and collected data on 386 patients over the two years; 319 (82.6%) signed a DNR before the end. The study found that DNR patients were less likely to receive cardiac resuscitation before death than non-DNR patients. The cardiac resuscitation treatments included chest compressions, electric shock, and cardiotonic drug injections (p < 0.001). However, the life-sustaining treatments were withdrawn for only a few patients before death. The study highlights that an early-documented DNR order is essential. However, it needs to be considered that promoting discussions of time-limited trials might be the solution to helping ICU terminal patients withdraw from non-beneficial life-sustaining treatments.

The Smoking Outcome Expectation Scale and Anti-Smoking Self-Efficacy Scale for Early Adolescents: Instrument Development and Validation.

Smoking-related outcome expectation and self-efficacy have been found to be associated with adolescent smoking initiation. There is, however, a lack of appropriate instruments to investigate early adolescents' smoking outcome expectations and antismoking self-efficacy. The purpose of this study was to develop and validate the Smoking Outcome Expectation Scale (SOES) and Anti-Smoking Self-Efficacy Scale (ASSES). A total of 232 fifth and sixth graders from four elementary schools in Taiwan participated in the study. Both scales had good content validity, internal consistency, and test-retest reliability. On the basis of exploratory factor analysis, the 6-item SOES with two factors accounted for 54.72% of total variance and the 15-item ASSES with three factors accounted for 56.49% of total variance. The SOES had convergent and discriminant validity and ASSES had convergent validity. The two scales could help school nurses to understand early adolescents' smoking outcome expectation and antismoking self-efficacy and to develop more appropriate antismoking curricula.

Understanding breast cancer screening practices in Taiwan: a country with universal health care.

While the incidence of breast cancer (BC) has been relatively low in Asian countries, it has been rising rapidly in Taiwan. Within the last decade, it has replaced cervical cancer as the most diagnosed cancer site for women. Nevertheless, there is a paucity of studies reporting the attitudes and practices of breast cancer screening among Chinese women. The aim of this study is to assess Taiwanese women's knowledge of and attitudes toward BC screening and to identify potential factors that may influence screening behavior. The study population consisted of a sample of 434 Taiwanese women aged 40 and older. Despite access to universal health care for Taiwanese women and the fact that a majority of the women had heard of the breast cancer screening (mammogram, clinical breast exams, etc.), the actual utilization of these screening modalities was relatively low. In the current study, the majority of women had never had mammograms or ultrasound in the past 5 years. The number one most reported barriers were "no time, " "forgetfulness, " "too cumbersome, " and "laziness, " followed by the perception of no need to get screened. In addition, the results revealed several areas of misconceptions or incorrect information perceived by study participants. Based on the results from the regression analysis, significant predictors of obtaining repeated screening modalities included age, coverage for screening, barriers, self-efficacy, intention, family/friends diagnosed with breast cancer. The findings from the current study provide the potential to build evidence-based programs to effectively plan and implement policies in order to raise awareness in breast cancer and promote BC screening in order to optimize health outcomes for women affected by this disease.

Use, perceived effectiveness, and gender differences of pain relief strategies among the community-dwelling elderly in Taiwan.

Pain is a common problem among the elderly. The entire scope of chronic pain relief strategies used by community elderly is still unclear. A limited number of studies have investigated this issue from diverse culture perspectives. In the present study, we investigated the use and perceived effectiveness of pain relief strategies adopted by the elderly; gender differences between frequently used relief strategies were also explored. Two hundred nineteen participants living in Taiwan City, Taiwan, were recruited by a random sampling method and interviewed face to face. The prevalence of chronic pain among the elderly was 42.0% (n = 92). The elderly tended to adopt multiple strategies (mean ± SD = 9.08 ± 3.56; range = 2-18) to relieve their chronic pain. In three domains of pain relief strategies, conventional medicine was used more frequently than complementary and alternative medicine and psychologic approaches. Most pain relief strategies were ineffective. Among the 22 strategies used, no strategy was reported as "much improved" by a majority of users. The top five pain relief strategies used by men and women were the same. Elderly women tended to adopt more psychologic approaches, such as acceptance and ignoring to relieve pain, than men. The findings suggest that nurses should pay more attention to the issue of chronic pain relief and provide the elderly with more effective pain relief strategies.

Job stress and intention to quit in newly-graduated nurses during the first three months of work in Taiwan.

AIMS AND OBJECTIVES: To identify job stress and intention to quit in newly-graduated nurses during the first three months of their work at two different levels of hospitals and to understand factors that may influence their retention. BACKGROUND: Given the current nursing shortage, retention of newly-graduated nurses is crucial. Design. A cross-sectional research design was adopted. METHODS: Newly-graduated nurses' perceptions of job stress and intention to quit at different time periods during the first three months in addition to related factors were measured using structured questionnaires in two levels of hospitals in central Taiwan. RESULTS: Subjects experienced somewhat stressful conditions (Mean = 2.89, SD 0.62) and 31.5% intended to quit. Job stress was the highest at 0-1 month and the intention to quit was highest at 1-2 months. The intention-to-quit group had significantly higher job stress with regard to roles/interpersonal relationships than the intention-to-stay group [t(144) = 2.65, p = 0.009]. Logistic regressions indicated that higher job stress (odds ratio = 2.26; 95% CI 1.14-4.51), working at a medical centre (odds ratio = 3.61; 95% CI 1.10-10.92) and not having had a clinical practicum in the working hospital (odds ratio = 2.41; 95% CI 1.01-5.77) were significant predictors associated with the intention to quit. CONCLUSIONS: Newly-graduated nurses perceived moderate job stress which significantly influenced their intention to quit. Nursing administrators should assist newly-graduated nurses in role adaptation and interpersonal relationships particularly to those who had previously worked only in medical centres and had never done a clinical practicum in the hospital. RELEVANCE TO CLINICAL PRACTICE: Our findings provide concrete directions to nursing administrators in developing a stress-alleviation programme to decrease newly-graduate nurses' job stress, to facilitate them successful entry into practice and to decrease their intention to quit.

[The current status, feasibility and difficulties of tele-home care].

Tele-home care (THC) is an innovative nursing care mode and has been applied in home care services in European countries and America. It has shown tremendous effects and benefits in disease administration and care costs. In view of increases in medical expenditure, and increases in the aged, chronically diseased population, our government has been actively supporting long-term care networks and has listed THC as an important plan in the nation's development. However, whether this new medical electron technology is applicable to the home-care practice in Taiwan or what will be its impact on the competitive medical care market, have been little discussed. The purpose of this paper, therefore, was to introduce the THC experience from abroad in order to provide a new direction for the nursing staff. In this article, we will introduce and define THC, the equipment it requires, its application, feasibility and difficulties. In preparation for the advent of a scientific and technological 21st century, we hope that nursing staff will be able to consider alternatives to traditional forms of home care and give a try to this revolutionary care mode in order to provide continued care for patients and their families. Furthermore, we hope to encourage experts and scholars in the field of nursing and medical information to invest their effort and intelligence in the study of THC.