Sleep Disturbances Following Traumatic Brain Injury in Older Adults: A Comparison Study.

OBJECTIVES: To compare the prevalence of sleep disturbances in older adults with traumatic brain injury (TBI) with that of age- and gender-matched controls and to determine the risk factors for post-TBI sleep disturbances and the effects of post-TBI disturbances on quality of life (QOL). DESIGN: Cross-sectional case-comparison study. PARTICIPANTS: Eighty older adults (aged ≥65 years) with first-time TBI more than 3 months since injury and 80 older adults controls without TBI who completed sleep and health-related QOL questionnaires. RESULTS: Older adults with TBI showed a higher prevalence of obstructive sleep apnea (OSA), insomnia, and daytime sleepiness than older adult controls. Being male, having higher levels of depression and pain, and the presence of insomnia were significantly correlated with the risks of OSA, insomnia, and daytime sleepiness following TBI, respectively. Both OSA and insomnia were significantly correlated with low QOL in older adults with TBI. CONCLUSIONS: Sleep disturbances are highly prevalent in older adults with TBI. Gender differences, depression severity, and pain level are correlated with the occurrence of post-TBI sleep disturbances. Both OSA and insomnia are regarded as major contributors to low QOL in older people with TBI. Interventions targeted at post-TBI sleep disturbances may improve QOL of older adults.

Exploring the Influencing Factors of Health Literacy among Older Adults: A Cross-Sectional Survey.

Background and Objectives: To investigate the health literacy (HL) among older adults in Taiwan, we referenced an existing integrated model of HL to confirm the influencing factors of HL in older adults. We propose this study to examine the personal, situational, and socioenvironmental factors influencing HL among older adults. Materials and Methods: A cross-sectional survey was conducted at a district hospital and affiliated community center in northern Taiwan from August 2016 to May 2017. This study used the Mandarin Chinese version of the European Health Literacy Survey Questionnaire (EU-Q47). We designed three models based on the three domains of HL. Model 1 assesses personal factors. Model 2 incorporates situational factors. Model 3 adds the socioenvironmental factor. Results: We recruited 161 participants aged over 65 years. Most adults in this study had limited overall HL. The final regression model revealed that age >85 years, unknown insurance status, and dominant spoken dialect of Hakka or Taiwanese were significantly associated with higher scores of HL. Conclusions: Our study results may help clinicians with early identification of older adults at high risk for poor HL and help health administrators establish geriatric policies and health education plans.

Trajectories of Sleep and Its Predictors in the First Year Following Traumatic Brain Injury.

OBJECTIVES: To examine how sleep patterns change over the first year following traumatic brain injury (TBI) and to determine whether specific demographic and disease characteristics predict the trajectories of sleep. DESIGN: Prospective study. PARTICIPANTS: Fifty-three patients with first-ever mild to severe TBI. MAIN MEASUREMENTS: Sleep measured by actigraphy for 7 consecutive days in the first, third, sixth, and twelfth months following TBI: Chinese versions of Beck Anxiety Inventory and Beck Depression Inventory-II (CBDI-II) measured at the same time points. Data were analyzed with a linear mixed model. RESULTS: Sleep efficiency (the ratio of sleep time to the total time spent in bed) showed a significant upward trend during the study period. Scores on the Chinese version of the Beck Anxiety Inventory and the CBDI-II as well as the use of analgesics significantly predicted the slope of change in sleep efficiency over time. CONCLUSIONS: Poor sleep efficiency is a common symptom in the first year among patients with first-ever TBI. Healthcare providers should consider both mental health and pain issues when dealing with sleep complaints in patients with TBI.

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

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

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

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

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

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

Job satisfaction and perceptions of quality of patient care, collaboration and teamwork in acute care hospitals.

AIM: This paper is a report of a study conducted to compare levels of job satisfaction and perceptions of the quality of patient care, collaboration and teamwork among healthcare professionals in four acute care hospitals and to determine the factors associated with job satisfaction for physicians, nurses and other healthcare professionals. BACKGROUND: Positive inter-professional relationships improve quality of patient care and staff job satisfaction. Understanding how healthcare professionals perceive their relationships with each other, and identifying factors that affect their job satisfaction and perceptions of the quality patient care, inform quality improvements. METHOD: This cross-sectional survey study was conducted in four hospitals in Taiwan. Data were collected in 2007 and analysed using descriptive statistics, one-way anova with the Games-Howell post hoc test and stepwise regression analysis. RESULTS: The survey was completed by 1475 respondent, giving a response rate of 52.2% (180 physicians, 1019 nurses and 276 other healthcare professionals). Physicians were more satisfied with their jobs (F = 26.75, P < 0.05) than either nurses or other healthcare professionals. Conversely, nurses perceived more positive collaborative relationships than did physicians or other healthcare professionals (F = 279.51, P < 0.05). Stepwise regression analysis demonstrated that perceptions of quality of patient care and collaborative relationships were the most important predictors of job satisfaction for healthcare providers. CONCLUSION: These findings provide important clues for improving interdisciplinary collaboration and ensuring quality patient care through good job satisfaction and teamwork among healthcare professionals in acute care hospitals.

Preceptors' Subjective Competency Ratings in Acute Care Hospitals in Taiwan.

BACKGROUND: This study focused on developing a Subjective Competency Scale (SCS) in acute care hospitals and identified factors that affect preceptors' competency to precept new graduate nurses (NGNs). METHOD: This study was conducted in two stages that included collecting information on preceptor training courses and conducting a cross-sectional questionnaire survey. A total of 350 preceptors completed the survey in 2011. The validity and reliability of the SCS were determined. RESULTS: An SCS was developed using 22 items and five factors: teaching/assessment skills, interpersonal/communication skills, confidence/self-assurance, problem-solving/stress-coping skills, and self-reflection. These explained 69.73% of the variance. Cronbach's alpha for these five factors of scale ranged from .715 to .889. Preceptors' subjective competency was correlated positively with age, years as a nurse, years as a preceptor, willingness to be a preceptor, and self-rated relationship with NGNs (p < .001). CONCLUSION: The SCS exhibited high validity and reliability; therefore, it can be used for future preceptors' subjective competency assessment and evaluation. [J Contin Educ Nurs. 2019;50(2):69-78.].

A Feasibility Randomized Controlled Crossover Trial of Home-Based Warm Footbath to Improve Sleep in the Chronic Phase of Traumatic Brain Injury.

INTRODUCTION: Sleep disturbance is a common complaint after traumatic brain injury (TBI). The aim of this study was to examine the effects of a home-based warm footbath intervention on sleep in patients with TBI. METHODS: This was a randomized controlled crossover study, and 23 adults with TBI were recruited and randomized to receive first a 30-minute, 41°C warm footbath and then a usual care, or vice versa, with each lasting 3 days and separated by a 3-day washout. Sleep efficiency, sleep onset latency (SOL), total sleep time, and wake after sleep onset (WASO) were assessed by actigraphy. RESULTS: We found that home-based warm footbath significantly had a reduced SOL (difference, -5.11 minutes) and a suppressed WASO (difference, -2.57 minutes) compared with those of usual care, but not in sleep efficiency and total sleep time. No adverse effect was reported. CONCLUSIONS: This study suggested that home-based warm footbath is practical and effective in relieving post-TBI sleep disturbances, particular in SOL and WASO. Nurses can use home-based warm footbath as an effective intervention for management of sleep disturbances after TBI.

Daytime sleepiness is independently associated with falls in older adults with dementia.

AIM: To examine whether elderly people with dementia have a higher prevalence of falls and sleep disturbances than those without dementia, and to determine the subjective sleep characteristics associated with falls in older adults with dementia. METHODS: This was a cross-sectional, population-based study derived from the data in the 2009 Taiwan National Health Interview Survey. A total of 123 older adults with dementia (aged 65 years or older), and 246 older adults without dementia who were randomly selected from the database were included. The occurrence of falls and subjective sleep characteristics (e.g. sleep hours, insomnia symptoms, daytime sleepiness, difficulty in breathing during sleep and daytime naps) were evaluated using the responses to the survey questions. RESULTS: The prevalence of falls in older adults with dementia were approximately twofold higher than that for those without dementia (27.6% vs 15.3%, P = 0.006). Older adults with dementia had longer sleep hours, and increased daytime sleepiness, daytime naps and difficulty in breathing during sleep (all P < 0.05) than those without dementia. Among older adults with dementia, daytime sleepiness was the only sleep characteristic that was significantly correlated to an increased risk of falls (adjusted odds ratio 5.56, 95% confidence interval 1.95-15.91) despite controlling for possible risk factors. CONCLUSIONS: Older adults with dementia had a higher prevalence of falls and sleep disturbances than that observed for those without dementia. Daytime sleepiness was an independent risk factor of falls in elderly people, with dementia after accounting for a range of covariates. Geriatr Gerontol Int 2016; 16: 850-855.

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

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

Y-27632, a ROCK Inhibitor, Promoted Limbal Epithelial Cell Proliferation and Corneal Wound Healing.

Transplantation of ex vivo cultured limbal epithelial cells is proven effective in restoring limbal stem cell deficiency. The present study aimed to investigate the promoting effect of Y-27632 on limbal epithelial cell proliferation. Limbal explants isolated from human donor eyes were expanded three weeks on culture dishes and outgrowth of epithelial cells was subsequently subcultured for in vitro experiments. In the presence of Y-27632, the ex vivo limbal outgrowth was accelerated, particularly the cells with epithelial cell-like morphology. Y-27632 dose-dependently promoted the proliferation of in vitro cultured human limbal epithelial cells as examined by phase contrast microscopy and luminescent cell-viability assay 30 hours after the treatment. The colony forming efficacy determined 7 days after the treatment was enhanced by Y-27632 also in a dose-dependent manner. The number of p63- or Ki67-positive cells was dose-dependently increased in Y-27632-treated cultures as detected by immunofluorescent staining and western blotanalysis. Cell cycle analysis by flow cytometric method revealed an increase in S-phase proliferating cells. The epithelial woundclosure rate was shown to be faster in experimental group received topical treatment withY-27632 than the sham control using a rat corneal wounding model. These resultsdemonstrate that Y-27632 can promote both the ex vivo and in vitro proliferation oflimbal epithelial cell proliferation. The in vivo enhanced epithelial wound healingfurther implies that the Y-27632 may act as a new strategy for treating limbal stem cell deficiency.