Glycaemic control mediates the relationships of employment status and self-stigma with self-care behaviours in young adults with type 2 diabetes.

AIMS AND OBJECTIVES: To investigate the relationships of sociodemographic factors, self-stigma, glycaemic control (measured by glycated haemoglobin (A1C)) and self-care behaviours in young adults with type 2 diabetes. BACKGROUND: Young adults aged 25-44 years are in their most productive period. Once diagnosed with diabetes, this population tends to experience poor glycaemic control and perform poorly in self-care activities. Such patterns may raise perceptions of self-stigma and further decrease motivations to engage in self-care behaviours in patients with diabetes. DESIGN: A cross-sectional, correlational research design. METHODS: The STROBE guidelines for cross-sectional studies were followed. A convenience sample of 115 participants was recruited from a medical centre in southern Taiwan. Instruments included the Self-Stigma Scale-Chinese version and the Diabetes Self-Care Behaviours Scale. Data were analysed using a three-step hierarchical regression analysis and the Sobel test. RESULTS: The average age of the participants was 36.7 years. Marital status, employment status, self-stigma and A1C were significantly associated with self-care behaviours, and these four variables explained 43.6% of the variance in self-care behaviours. However, A1C (ß = -.58, p < .001) was found to be the only determinant of self-care behaviours in the last regression model. The Sobel test showed that A1C had mediating effects on self-stigma and self-care behaviours as well as employment status and self-care behaviours. CONCLUSION: This study supports the interactive relationship among self-stigma, employment status, glycaemic control and self-care behaviours in young adults with type 2 diabetes. Strategies aimed at optimising glycaemic control can help reduce the effects of self-stigma perceptions and employment status on the self-care behaviours of such patients. RELEVANCE TO CLINICAL PRACTICE: More effective educational programmes should be designed to improve glycaemic control, lower the effects of employment and decrease perceptions of self-stigma to further motivate young adults to engage in better diabetes self-care behaviours.

[Metamorphosis of Nurses: The Development and Breakthroughs of Advanced Practice Registered Nurses].

BACKGROUND: The introduction and development of the advanced practice registered nurse (APRN) is a global trend in nursing. However, the development of APRNs in Taiwan remains uncertain and lacks necessary consensus. PURPOSE: This research study aimed to explore the views and suggestions of nursing experts in industry, government, and academia regarding the development of APRNs (clinical nurse specialists, case managers, certified clinical registered nurse anesthetists, and certified nurse-midwives) in Taiwan. METHODS: Data were collected from March to August 2017. Sixty-four experts participated in one of six focus group discussions held in northern, central, and southern Taiwan. These group discussions were recorded and transcribed verbatim with the consent of the participants. Content analysis was used to analyze the transcribed data. RESULTS: The comments and suggestions raised during the discussions were categorized into four major themes: professional development of necessity, core competencies, accreditation, and future promotion-related issues. Each theme was further divided into several subthemes. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The opinions of relevant experts regarding the current status of development of the roles, practical scope, and management and suggestions for APRNs were summarized to facilitate the future development of APRNs in Taiwan in terms of education, core competencies, certification, and practical scope. Furthermore, the results may be referenced in the establishment of a nursing consensus model and as a basis for promoting APRNs.

The Influence of Preoperative Anxiety, Optimism, and Pain Catastrophizing on Acute Postoperative Pain in Patients Undergoing Cardiac Surgery: A Cross-sectional Study.

BACKGROUND: Acute postoperative pain (APOP) may cause complications and delay healing. Analgesics alone cannot completely relieve APOP. Preoperative anxiety, optimism, and pain catastrophizing are predictors of APOP. No study author has examined the mediating effect of pain catastrophizing on APOP in patients undergoing cardiac surgery. OBJECTIVE: The aims of this study were to investigate the relationship between preoperative anxiety, optimism, pain catastrophizing, confounding factors (age, sex, type of surgery, and preoperative pain), and APOP and to examine the mediating effect of pain catastrophizing. METHODS: The authors of this cross-sectional study used a convenience sampling method and included 100 adults undergoing cardiac surgery in a southern Taiwanese medical center. The patients were asked to complete the State-Trait Anxiety Inventory-State subscale, Pain Catastrophizing Scale, and Life Orientation Test-Revised questionnaires before surgery. Postoperatively, the patients were asked to report their pain intensity on a numerical rating scale. Results were analyzed using SPSS version 22. RESULTS: Patients had a mild level of anxiety, a moderate level of optimism, and pain catastrophizing before surgery, as well as a moderate level of APOP. Men reported lower levels of APOP than women (z = -2.0, P < .05). APOP was significantly associated with preoperative anxiety (r = 0.48, P < .01), optimism (r = -0.45, P < .01), and pain catastrophizing (r = 0.65, P < .01). Only pain catastrophizing was a significant predictor of APOP (ß = 0.60, P < .001) and fully mediated the relationship between anxiety and APOP (z = 4.92, P < .001). The final model explained 42% of the variance in APOP. CONCLUSIONS: Pain catastrophizing should be assessed before surgery. Reducing pain catastrophizing would decrease APOP and improve the quality of pain management.

[Effectiveness of an Online Objective Structured Video Examination in Promoting Self-efficacy of Medication Administration and Recognition of Medication Errors Among Nurses].

BACKGROUND: Failure to follow the "Five Rights" and interruptions during medication administration are the two most common factors underlying nurse-related medication errors. PURPOSE: This study was designed to examine the effectiveness in terms of improving nurses' medication administration self-efficacy and recognition of medication errors of an online objective structured video examination (OSVE) intervention focused on the "Five Rights" and "management of interruptions during medication administration". METHODS: A quasi-experimental pretest-posttest research design with a respondent-driven sampling method was employed. One hundred and twelve nurses finished the online survey. Instruments included the self-efficacy of medication administration questionnaire and four online medication error OSVEs addressing the issue of medication error recognition. The intervention was an acute medication behavior OSVE. Paired t-tests were used to assess the pre-test / post-test differences between variables. RESULTS: The mean age of the 112 survey respondents was 27.21 years, and the mean years of working experience was 4.67. The mean self-efficacy of medication administration score, which was 38.88 (SD = 4.45) at baseline, increased significantly to 41.69 (SD = 4.58) at post-test (t = 7.11, p < .001). Similarly, the mean score for recognition of medication errors was 10.71 (SD = 7.16) at pre-test and significantly higher (15.32; SD = 4.94) at post-test (t = 5.90, p < .001). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The online OSVE may be used to improve the recognition of medication errors and self-efficacy of medication administration in nurses. Future research is needed to examine the effect of this intervention in enhancing the safety of medication administration in actual clinical practice settings.

[Factors Related to Prodromal Symptoms in Patients With Acute Myocardial Infarction].

BACKGROUND: Prior to acute myocardial infarction (AMI), patients may experience different prodromal symptoms (PSs) that may delay their seeking medical treatment prior to hospitalization. PURPOSE: This study was designed to identify the relationship between PSs and demographics, including gender and age, acute symptoms, and pre-hospital delay time, in patients with AMI. METHODS: A cross-sectional study design was applied, and a convenience sampling approach was used to recruit 121 patients in the emergency room of a medical center located in southern Taiwan. Instruments, including a demographic and disease variables datasheet, acute symptoms of AMI, McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS), and pre-hospital delay time, were used. Chi-square, Fisher exact, and Spearman correlation coefficients tests were used to examine the respective relationships between the targeted variables and PSs. Binary logistic regression analysis was used to determine the important determinants of PSs. RESULTS: Most (83.5%) of the participants had experienced PSs. The MAPMISS score was significantly associated with age (ρ= -.20, p < .05) and marital status (Z = 2.23, p < .05). Three prodromal symptoms, including pain or discomfort in left breast, pain or discomfort in the legs, and change in headache intensity, were significantly different between male and female participants. Only one symptom, pain or discomfort in the central high chest area, differed significantly among age groups. Binary logistic regression analysis found that participants in the 40-60 years old age group were 3.19 times more likely to develop PSs than their peers in the 65 years old and older group. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results of this study suggest that PSs should be incorporated into medical education to increase the cognition and awareness of healthcare professionals toward PSs and to improve patient education overall in order to strengthen public awareness regarding the relationship between PSs and AMI and subsequently increase the timeliness of their seeking appropriate medical help.

Effects of illness representation-focused patient education on illness representations and self-care in patients with heart failure: A randomised clinical trial.

AIMS AND OBJECTIVES: To examine the effect of an illness representation-focused patient education intervention on illness representations and self-care behaviours in patients with heart failure 3 months after discharge from the hospital. BACKGROUND: Few intervention studies have examined the effect of illness representation-focused interventions on illness representations and self-care in patients with heart failure. DESIGN: A randomised clinical trial based on the Consolidated Standard of Reporting Trials-CONSORT 2010-guidelines was employed. The Clinical Trial Registry number is TCTR20190903002. METHODS: One hundred and seven participants were randomly assigned to 2 groups, and 62 participants (n = 30 in the intervention group and n = 32 in the usual care group) completed the baseline and one- and three-month postdischarge follow-up assessments. The instruments included the Survey of Illness Beliefs in Heart Failure and the Self-care of Heart Failure Index. The intervention group received illness representation-focused patient education while hospitalised and telephone follow-ups after discharge. Data were analysed with linear mixed-effects model analysis. RESULTS: The 107 participants had a mean age of 62.17 years and a mean left ventricular ejection of 53.03%. At baseline, the two groups tended to have accurate illness beliefs but insufficient self-care confidence and self-care maintenance. The analysis showed no significant differences between groups in the illness representation total scores, dimension scores or self-care maintenance scores but did show a significant difference in the self-care confidence scores (F = 3.42, p < .05) over the three months. CONCLUSION: The study did not show an effect of the intervention on illness representations or self-care maintenance behaviours. However, the intervention did maintain participants' self-care confidence three months after discharge. RELEVANCE TO CLINICAL PRACTICE: It is necessary to conduct long-term follow-ups of patients' illness representations, discuss the implementation of self-care behaviours with patients, enhance patients' self-care confidence, and involve family members or caregivers in self-care practices when needed.

Gender differences? Factors related to quality of life among patients with Heart failure.

Heart failure (HF) is a chronic, progressive disease that substantially decreases patients' quality of life. Few studies have compared quality of life and its related factors across genders in patients with HF. To explore gender differences in quality of life and related factors among adult patients with HF. A comparative study was conducted with 245 HF patients recruited from a medical center and a regional teaching hospital in Taiwan from February 2009 to February 2011. Descriptive and inferential statistics were used, including stepwise multiple regressions. The mean quality of life scores of males were significantly higher than those of females (87.78 ± 13.99 vs. 84.49 ± 11.85). The factors significantly related to quality of life for the male HF patients, in descending order of strength of association were depressive symptoms, physical symptoms, and monthly family income-less than USD 1,000; for the females, the significantly related factors were physical symptoms, depressive symptoms, and monthly family income-less than USD 1,000. The amount variance for which quality of life accounted for male and female HF patients was similar (60% vs. 64%). The results could be used for health professionals to provide more appropriate assessments and care according to gender in the future.

The effect of transcutaneous electrical nerve stimulation on increasing salivary flow rate in hemodialysis patients.

OBJECTIVE: To evaluate the impact of a transcutaneous electrical nerve stimulation (TENS) program for hemodialysis on patients' dry mouth and salivary flow rates. SUBJECTS AND METHODS: A single-blinded repeated measures study design was used. A total of 80 subjects were randomly assigned to a treatment group receiving a 250 µs; 50 Hz TENS program and a control group receiving a 50 µs; 2 Hz TENS program at acupoints ST 6 and TE17 three times a week for 3 weeks. Whole salivary flow rate and dry mouth intensity were measured totally five times for both groups, at pretreatment, after three, six, nineTENS sessions, and 1 week after the treatment was completed. RESULTS: After six TENS sessions were completed, whole salivary flow rates increased stably until the end of nine TENS sessions for the treatment group. In the follow-up week after treatment, there was significant increase as well. However, significant improvement in dry mouth intensity was observed at all post-tests than that at pretreatment in both groups. CONCLUSION: Whole salivary flow rates and improvement in dry mouth intensity were only observed during and 1 week after the TENS sessions. Further studies are needed to evaluate whether this method can offer a long-term effective nonpharmacological therapy for dry mouth-disturbed hemodialysis patients.

Self-Management Behaviors in Relation to Psychological Factors and Interdialytic Weight Gain Among Patients Undergoing Hemodialysis in Indonesia.

PURPOSE: The purpose of this study was to understand the influence of demographic and psychological factors on self-management behaviors and interdialytic weight gain (IDWG) as a fluid adherence marker among patients undergoing hemodialysis in Indonesia. DESIGN: A quantitative correlational study. METHOD: A convenience sample of 145 patients undergoing hemodialysis was recruited from the dialysis units in two hospitals in Jakarta from September to December 2015. Questionnaires were used to examine self-management behaviors, depression, anxiety, and stress. Data for IDWG were obtained by subtracting the individual's predialysis weight from his or her postdialysis weight from the previous session. Hierarchical multiple linear regression identified the predictors of IDWG. RESULTS: Self-advocacy was ranked the least performed self-management behavior, while medication adherence was ranked the most likely to be performed. Among the subscales of the Self-Management Behavior Indices, positive correlations were found between the communication dimension with all psychological factors (depression, anxiety, and stress), while self-advocacy had positive correlation with anxiety. Subjects gained a mean of 4.5% of their postdialysis weight, with over 50% exceeding the recommended 4% IDWG. Overall, 53.6% of the IDWG was explained by the weekly duration of hemodialysis, level of depression, communication, partnership in care, and self-advocacy. CONCLUSIONS: Self-management behaviors are potential predictors that can be modified by nephrology nurses in order to enhance clinical outcomes, with the specific outcome being IDWG. Self-management behaviors contribute to the promotion of appropriate IDWG. Depressed patients are less likely to adhere to weight gain restrictions. CLINICAL RELEVANCE: Education combined with training in self-management behaviors-particularly communication, becoming a partner in care, and advocating for care-may improve adherence to IDWG guidelines among Indonesian hemodialysis patients. Interventions targeting depressed patients are needed.

Factors associated with demoralisation syndrome in patients before and after cardiac surgery.

AIMS AND OBJECTIVES: To investigate the incidence of and contributors to demoralisation syndrome among patients before and after cardiac surgery. BACKGROUND: Demoralisation syndrome is a common but neglected phenomenon in nursing practice. Patients who require cardiac surgery experience demoralisation syndrome more often than they experience depression. DESIGN: A prospective correlational design was applied. METHODS: A convenience sample of 76 participants undergoing cardiac surgery was recruited from the cardiovascular wards of two medical centres in Taiwan. The instruments applied included the Demoralization Scale (DS), the Patient Outcome Questionnaire-9 (PHQ-9) and the Perception of Intensive Care Unit (ICU) Stay Questionnaire. RESULTS: High demoralisation was present in 44.7% of the participants before surgery but significantly decreased to 36.8% after surgery (p < .05); conversely, depression was present in 15.8% of participants before surgery and did not significantly decrease after surgery (rate after surgery, 9.2%; p > .05). A multiple regression analysis using the backward-selection method showed that depression (p < .001) and retirement (p < .05) were important predictors of pre-operative demoralisation syndrome (R2  = 0.250), whereas depression (p < .001) and perceptions of ICU stay (p > .05) remained in the regression model after surgery (R2  = 0.291). CONCLUSIONS: The study findings suggest that demoralisation syndrome is highly prevalent in patients undergoing cardiac surgery but is significantly reduced after cardiac surgery. Before surgery, depression and retirement were significant predictors of demoralisation. After surgery, depression was the only predictor. Although the perception of ICU stay was not an important predictor, it was significantly correlated with demoralisation. RELEVANCE TO CLINICAL PRACTICE: Before cardiac surgery, nurses should emphasise the importance of demoralisation development among patients who suffer from depressive symptoms and are retired. After cardiac surgery, continued follow-up is needed for the early detection and minimisation of the effect of depression and the development of demoralisation.

[Exploring the Care Needs of Primary Caregivers of Patients Awaiting Brain Tumor Surgery and Related Factors].

BACKGROUND: The prognosis of patients with brain tumor diagnoses is often uncertain. Therefore, the primary caregivers of these patients must not only adjust their lives to patient care but also often deal with patient anxiety and depression, which may significantly increase patient-care needs. PURPOSE: The present study explores the care needs of primary caregivers of patients awaiting brain tumor surgery and the factors that are associated with these needs. METHODS: A correlational research design was used. Convenience sampling was used to recruit 80 pre-brain-tumor operation patient/caregiver pairs. Data were collected using a questionnaire survey, which included Supportive Care Needs Survey-Partners & Caregivers 45 (SCNS-P&C45) and the Hospital Anxiety and Depression Scales (HADS). Descriptive and inferential statistics were used for data analysis. RESULTS: The information-needs and healthcare-service-needs subscales earned the highest subscale scores on the SCNS-P&C45. Higher anxiety perception (r = .37, p < .01) and higher depression status (r = .27, p < .05) were significantly correlated with increased care needs. In addition, decreased patient functional status was significantly associated with increased depression in the primary caregiver. Anxiety perception was the only significant predictor of care needs that was identified (R(2) = 12.8%). CONCLUSIONS: Healthcare providers should provide patient education on the disease and disease-related care information soon after a diagnosis of brain tumor in order to decrease the anxiety and depression perceptions of caregivers and to reduce the care needs of caregivers.

Determinants of self-care decision-making in hospitalised patients with heart failure.

AIMS AND OBJECTIVES: To explore the important determinants of self-care decision-making in inpatients with heart failure. BACKGROUND: Self-care is a natural decision-making process that helps patients to improve clinical outcomes. However, patients with heart failure engage in insufficient self-care. More research studies are needed to identify the determinants of self-care decision-making. DESIGN: A cross-sectional correlational research design. METHODS: A questionnaire survey with a non-probability sampling was used. A total of 71 inpatients were interviewed at a medical centre in southern Taiwan. Instruments included a demographic and clinical questionnaire, the Dutch Heart Failure Knowledge Scale and the Self-Care of Heart Failure Index. RESULTS: Admission frequency was the only significant determinant of self-care maintenance. Heart failure knowledge, admission frequency and type of residence were important determinants of self-care management. Heart failure knowledge, having a spouse and admission frequency were important determinants of self-care confidence. CONCLUSIONS: The study findings support the presence of ongoing clinical challenges associated with poor heart failure knowledge and improper performance of self-care in patients. Admission frequency was correlated with three self-care variables, while heart failure knowledge was associated with self-care management and self-care confidence. RELEVANCE TO CLINICAL PRACTICE: More effective strategies, including pre-discharge education, consultation of successful cases, case sharing and patient support groups, should be designed to enhance patients' self-care decision-making. However, clinical nurses may not be able to actually perform this task or provide consultation services after hospital discharge due to their workload. Establishment of heart disease educators and professional consultation services may be helpful to improve patient education.

Staff nurse decisional involvement: an Internet mixed-method study in Taiwan.

AIM: (a) To explore staff nurses' actual decisional involvement and preferred level of decisional involvement, the decisional dissonance, and the attributing factors; and (b) to understand staff nurses' perceptions about the process of decisional involvement at their work place in Taiwan. BACKGROUND: Research related to nurses' decisional involvement was scarce and mainly emphasized the level of involvement without examining the possible attributing factors and the process of nurses' decisional involvement. METHOD: A two-phase internet mixed-method study design was used. A total of 125 staff nurses completed the internet survey using decisional involvement scale and 15 completed online forum discussion questions. RESULT: Nurses' actual decisional involvement was significantly lower than preferred decisional involvement. The attributing factor to nurses' actual decisional involvement included the level of education, type of hospital, work unit and workload. There were no differences of preferred decisional involvement among different demographic data. Regarding nurses' perceptions of decisional involvement, three themes were identified: dependent on administrators, fear of getting into trouble, and the power of consensus. CONCLUSIONS: The low level of actual decisional involvement and preferred decisional involvement might be associated with workload, management style and the fear of getting into troubles. IMPLICATION: The government, health care organisations, nursing leaders should reexamine the influence of work setting factors, workload and management style to nurses' actual decisional involvement.

The effect of health education on Taiwanese hypertensive patients' knowledge and cognition of stroke.

BACKGROUND: Hypertension is a risk factor for stroke. Increasing patient knowledge and cognition about stroke among hypertensive patients is essential. AIMS: To explore the effect of a health education intervention on the knowledge and cognition of stroke in hypertensive patients. METHODS: A quasi-experimental design was used with 103 patients with hypertension. The sample was recruited from a cardiologist's outpatient office at a medical center in Kaohsiung city, southern Taiwan. Half the patients (experimental group, n = 52) received health education, whereas the others received only conventional general outpatient care (control group, n = 51). All patients underwent a pretest followed by posttests at 4 and 8 weeks after the intervention. A stroke knowledge scale and stroke cognition scale were used for data collection. RESULTS: The experimental group scored significantly higher than the control group in level of knowledge and cognition of stroke. DISCUSSION: This study supports that a health education CD-ROM and printed information provided in the outpatient clinical improves knowledge of and cognition of stroke among hypertensive patients. IMPLICATIONS FOR PRACTICE: In outpatient clinical practice, nurses can help improve patients' knowledge and cognition of the risks of stroke by playing the health education CD-ROM and providing printed information during the patients' wait time before appointments. CONCLUSIONS: Further studies with a longer follow-up (6 months or 1 year) are needed to evaluate the long-term effects of health education on stroke knowledge and cognition among patients with hypertension. LINKING EVIDENCE TO ACTION: An outpatient health education program using a CD-ROM and printed information for hypertensive patients can improve the patients' knowledge and cognition of stroke.

Predictors of physical activity in patients with heart failure: a questionnaire study.

BACKGROUND: Adequate physical activity is believed to help decrease readmission and improve quality of life for patients with heart failure (HF). OBJECTIVE: The aim of this study was to explore the predictors of physical activity level 1 month after discharge from hospital in Taiwanese patients with HF. METHOD: A prospective research design was used. Overall, 111 patients with HF from a medical center in Southern Taiwan were recruited. Symptomatic distress, self-efficacy for physical activity, physical activity knowledge, and demographic and disease characteristics of patients with HF were collected at their discharge. One month later, patients' total daily energy expenditure (DEE), DEE for low-intensity physical activities (PA(low) DEE; strictly <3 metabolic equivalents [METs]), DEE for high-intensity physical activities (PA(high) DEE; 3-5 METs), and DEE for intensive-intensity physical activities (PA(intensive) DEE; strictly >5 METs) were collected. RESULTS: The mean total DEE was 8175.85 ± 2595.12 kJ 24 h, of which 19.12% was for PAlow DEE, 7.20% was for PA(high) DEE, and only 1.42% was for PA(intensive) DEE. Body mass index (BMI), age, self-efficacy for instrumental activities of daily living, and educational level were predictors of total DEE of patients with HF 1 month after discharge. Self-efficacy for instrumental activities of daily living, gender, and BMI were predictors of PA(high) DEE. Age, BMI, and symptom distress were predictors of PA(intensive) DEE. CONCLUSIONS: Taiwanese patients with HF practiced lower intensity physical activities. Factors related to physical activity of patients with HF in Taiwan were similar to those of Western countries. Nurses should emphasize the importance of physical activity to patients with HF who are male, of older age, with lower educational level, or with lower BMI. Improving self-efficacy for instrumental activities and decreasing symptom distress should be incorporated into discharge planning programs for patients with HF.

Evaluating the acceptability and efficacy of a psycho-educational intervention for coping and symptom management by children with cancer: a randomized controlled study.

AIMS: To evaluate the acceptability and efficacy of a psycho-educational intervention designed to improve effective coping and reduce symptom severity in children with cancer. BACKGROUND: Cancer treatments increase survival rates and also cause physical and psychological effects on children with cancer. A psycho-educational intervention is used to assist children and adolescents with these effects and its efficacy has been described in several studies. DESIGN: A randomized controlled trial. METHODS: Participants being treated were recruited and randomly assigned to two groups from September 2011-February 2013 in Taiwan. The intervention group received a psycho-educational intervention in addition to standard care, while the control group received only standard care. Each participant was assessed using a paediatric cancer coping scale and perceived symptom severity was evaluated at three time points (baseline, 1 month and 3 months). A repeated-measures analysis of variance was used to estimate the effects of intervention. Qualitative findings were analysed using content analysis. RESULTS: No significant difference in coping scores was found between groups, but the experimental group reported significantly lower scores in gastrointestinal problems and pain. Most symptoms decreased significantly over time in both groups, except for gastrointestinal problems. The scores in pain, bone marrow suppression and body image showed significant interaction effects between groups on changes over time. Qualitative results reported that participants evaluated the intervention positively, especially about receipt of psychological support and learnt coping skills. CONCLUSIONS: The psycho-educational intervention administered was acceptable for children with cancer and was found to reduce gastrointestinal problems and pain.

[Concept analysis of medication adherence in patients with chronic disease].

Pharmacotherapy plays an important role in the management of chronic diseases. However, many patients with chronic disease do not adhere to their medication regimen. This results in worsening symptoms and frequent re-hospitalizations. As a result, healthcare providers may view these patients as bad. Medication adherence is a complex concept. Analyzing this concept may assist nurses to improve patient-centered care. This paper uses Walker & Avant's method to conduct a concept analysis of medication adherence. Results show the defining attributes of medication adherence as: (1) knowing and agreeing to the medication; (2) communicating and negotiating the regimen; and (3) active, continuous involvement in and appraisal of the treatment effect. Identified antecedents of medication adherence included the patient having: (1) a prescribed medication regimen; (2) cognitive and action abilities in her / his role as a patient; and (3) level of preparation for medication treatment. Identified consequences of medication adherence include: (1) improving symptom control; (2) decreasing re-hospitalizations and mortality; (3) reducing medical care costs; (4) restoring self-esteem; and (5) diminishing depression. It is hoped that this concept analysis provides a reference for nurses to achieve a better understanding of medication adherence and further improve nursing practice.

Psychometric evaluation of a new instrument to measure disease self-management of the early stage chronic kidney disease patients.

AIMS AND OBJECTIVES: This study aims to develop a valid and reliable chronic kidney disease self-management instrument (CKD-SM) for assessing early stage chronic kidney disease patients' self-management behaviours. BACKGROUND: Enhancing early stage chronic kidney disease patients' self-management plays a key role in delaying the progression of chronic kidney disease. Healthcare provider understanding of early stage chronic kidney disease patients' self-management behaviours can help develop effective interventions. A valid and reliable instrument for measuring chronic kidney disease patients' self-management behaviours is needed. DESIGN: A cross-sectional descriptive study collected data for principal components analysis with oblique rotation. METHODS: Mandarin- or Taiwanese-speaking adults with chronic kidney disease (n=252) from two medical centres and one regional hospital in Southern Taiwan completed the CKD-SM. Construct validity was evaluated by exploratory factor analysis. Internal consistency and test-retest reliability were estimated by Cronbach's alpha and Pearson correlation coefficients. RESULTS: Four factors were extracted and labelled self-integration, problem-solving, seeking social support and adherence to recommended regimen. The four factors accounted for 60.51% of the total variance. Each factor showed acceptable internal reliability with Cronbach's alpha from 0.77-0.92. The test-retest correlations for the CKD-SM was 0.72. CONCLUSION: The psychometric quality of the CKD-SM instrument was satisfactory. Research to conduct a confirmatory factor analysis to further validate this new instrument's construct validity is recommended. RELEVANCE TO CLINICAL PRACTICE: The CKD-SM instrument is useful for clinicians who wish to identify the problems with self-management among chronic kidney disease patients early. Self-management assessment will be helpful to develop intervention tailored to the needs of the chronic kidney disease population.

Integrated immediate postmortem and acute bereavement care: Competency-based entrustable professional activities for nursing.

BACKGROUND: Integrated immediate postmortem and acute bereavement care alleviates emotional distress due to losing a loved one; however, the provision of effective nursing care remains insufficient. Therefore, preparing nursing students with such skills is essential in end-of-life care education, and entrustable professional activities (EPAs) offer potential to address this gap. OBJECTIVES: To establish EPAs concerning immediate postmortem and acute bereavement care with a seven-category description for EPAs, milestones, and assessment tools. DESIGN: We used a modified Delphi method and four-step consensus-building approach to i) identifying the list of possible EPA items related to immediate postmortem and acute bereavement care based on a literature review and clinical experiences, ii) select an expert panel, iii) pool, review, and revise the EPAs, and iv) validate EPA quality using the Queen's EPA Quality rubric. Data analysis was performed via modes and quartile deviations. RESULTS: The following four major EPA components were identified: i) cultural and religious ritual assessment; ii) death preparation; iii) postmortem care; and iv) acute bereavement care. Three essential competencies were identified as highly correlated: general clinical skills, communication and teamwork capabilities, and caring. Consensus was achieved after three survey rounds. A 100 % questionnaire response rate was obtained. In the third round, all items received 4 or 5 points from >95 % of the panel members and were found to meet the quartile deviation cutoff score of <0.6, indicating that a high consensus level was established. The average Queen's EPA Quality rubric score was 62.5, with an average item score of 4.46, which was higher than the cut-off score of 4.07. Three major parts of EPAs were developed: task descriptions, milestones, and the assessment tool. CONCLUSION: The development of EPAs assessments concerning immediate postmortem and acute bereavement care may guide nursing curricula planning to bridge the gap between competencies and clinical practice.