Effectiveness of a needs-tailored nurse-led recovery program for community-dwelling people with schizophrenia: a cluster-randomized controlled trial.

BACKGROUND: Meeting people's needs is positively correlated with their recovery. However, recovery services rarely include nurse-led programs tailored to the needs of these people. This study aimed to evaluate the effectiveness of a new needs-tailored recovery program by using a cluster-randomized controlled trial design. METHODS: We conducted a parallel randomized controlled trial in two community psychiatric departments, employing nurse-level clustering for intervention delivery and selecting participants through convenience sampling. The participants were people diagnosed with schizophrenia that were receiving homecare services. The experimental group (n = 82) received needs-tailored recovery program for six months. The control group (n = 82) received traditional homecare. Data were collected at baseline, post-intervention, and the three-month follow-up (the study ran from February to December 2021). The outcomes were recovery, needs, hope, empowerment, psychotic symptoms, and medication adherence. We used repeated measures ANOVA tests to examine the effect of the group × time interaction. RESULTS: The participants in the experimental group demonstrated statistically significant improvements in recovery, hope, and medication adherence compared to the control group, both immediately post-intervention and at the three-month follow-up. Moreover, they exhibited statistically significant reductions in needs compared to the control group at the three-month follow-up (p < .05). While the interaction effect for psychotic symptoms was not significant, the time effect was significant (p < .05). No significant interaction or time effect was observed for empowerment. CONCLUSION: The findings increase our understanding of recovery-oriented care that prioritizes therapeutic alliance, integrated needs assessment, individual goals, hope, and empowerment. TRIAL REGISTRATION: The Clinicaltrials.gov identifier NCT05304780 retrospectively registered on 03/31/2022.

[Community Psychiatric Mental Health Nursing: Practice and Challenges].

Due to the rising incidence of social risk incidents, the Mental Health Act was amended to provide community treatment and community support for patients with mental illness. Community mental health centers have added a public sector function to follow-up with the care of mentally ill patients using case management as an integrated service model. Under this amendment, the unique role and task of community psychiatric mental healthcare should be framed and developed. The National Health Research Institutes have advocated recovery-oriented case management as a mental health policy. Thus, in line with this policy, the authors developed a need-tailored recovery program led by nurses that has demonstrated significant effectiveness with regard to the recovery of mentally ill patients. Also, a mobile-care platform was subsequently developed to assess the care needs of community-dwelling patients with mental illness, implement recovery-oriented care, and evaluate its effectiveness, which may be incorporated into evidence-based community psychiatric mental healthcare guidelines. To improve the practice of community psychiatric mental health nursing, this article addresses key community nursing contexts, including: psychiatric home treatment and care, community mental health centers, the needs-tailored recovery-oriented case management model, and the roles and certification of community psychiatric mental health nurses promoted by the psychiatric mental health nurses association. Finally, future challenges and strategies are proposed to improve the quality of community psychiatric mental healthcare and to assist patients move from mental disorder to recovery.

[Empowering Persons With Mental Illness to Begin the Recovery Journey: An Example of Overcoming Internalized Stigma].

Internalized stigma is a significant obstacle encountered on the journey to recovery for persons with mental illness. Services provided through the empowerment model of care have been shown to be effective in overcoming this obstacle. However, the mental health care system in Taiwan continues to focus on providing care using the medical or rehabilitation model. In this article, the related consequences and psychological effect mechanism of internalized stigma in persons with mental illness are presented and evidence-based interventions for internalized stigma are demonstrated. Next, we share the clinical experiences to advocate for the use by professionals of the empowerment model. Self-efficacy and empowerment may mediate the psychological effects of internalized stigma on quality of life and depression, while social networks and peer support may buffer its negative consequences. Related evidence-based interventions include psycho-education, motivation enhancement, self-help or peer-delivered services, and cognitive behavioral model and goal-oriented skill training. Empowerment model services are based on scientific evidence that are practiced under the rubric of self-determination and constructed in supportive environments. When examining psychiatric symptoms in persons with mental illness, professionals may concurrently evaluate for issues related to internalized stigma and encourage those patients with internalized stigma to self-determine and participate in therapy. In psycho-education and skill training therapies, professionals may also apply the lived experiences of peers with recovery to identify and share important knowledge and life skills. When connecting patients to community resources, professionals should encourage stakeholders to help persons with mental illness put their decisions into practice.

Mediating effect of empowerment on the relationship between global function and personal recovery among community-dwelling patients with schizophrenia: a cross-sectional study.

BACKGROUND: Functional degradation among community-dwelling patients with schizophrenia can negatively influence their recovery. Given the importance of patient empowerment during recovery, this study examined the mediating effect of empowerment on the relationship between global function and personal recovery among community-dwelling patients with schizophrenia. METHODS: This cross-sectional study recruited community-dwelling patients with schizophrenia from northern and central Taiwan. Questionnaires with verified reliability and validity were provided and collected on site by trained nurses. Global function, empowerment, and personal recovery were measured using the Global Assessment of Functioning (developed by the American Psychiatric Association), Empowerment Scale, and Questionnaire on the Process of Recovery, respectively. The causal steps approach proposed by Baron and Kenny and the Sobel test were utilized to verify the mediation effect. The causal steps approach tested the four following pathways (regression coefficients): global function on empowerment (Path a), global function and empowerment as predictors of personal recovery (Path b), global function on personal recovery (Path c), and global function and empowerment on personal recovery (Path c'). RESULTS: A total of 373 participants completed the survey. After controlling for factors associated with recovery, Paths a (ß = .24, p < .001), b (ß = .68, p < .001), and c (ß = .19, p < .001) were found to be significant; however, Path c' was not significant (ß = .03, p = .452). Empowerment was determined to exert "full mediation" over the effects of global function on personal recovery, and the Sobel test indicating significant mediation (Z = 3.61, p < .001). CONCLUSIONS: Empowerment fully mediates the association between global function and personal recovery. This study suggested that offering empowerment-oriented care services may be more effective than global function improvement in recovery among these patients.

A dementia care training using mobile e-learning with mentoring support for home care workers: a controlled study.

BACKGROUND: Caring of older adults with dementia at home can be challenging for home care workers. There is a need to develop suitable training for home care workers to improve the quality of dementia care. We evaluated a 12-week dementia care training including mobile e-learning, social networking, and mentoring support group meetings on the dementia care knowledge, attitude, and competence of home care workers. METHODS: This controlled study involved 140 home care workers from two home care agencies, which were selected from 12 home care agencies in eastern Taiwan. The two home care agencies were randomly allocated either the intervention group or the control group. The intervention group received mobile e-learning, mentor-led online social support networking, and monthly face-to-face mentoring support group meetings. Participants in the control group received 8-h conventional lectures. The primary outcomes were knowledge, attitude, and competence in dementia care. Questionnaires consisting of the Dementia Knowledge Assessment Scale, Approaches to Dementia Questionnaire, and Sense of Competence in Dementia Care Staff scale were administered to the participants at three time points (baseline, end of the 12-week intervention, and 12 weeks after the end of the intervention). RESULTS: Generalized estimating equation analyses showed that the intervention significantly improved the knowledge, attitude, and competence of home care workers on dementia care. The effects remained significant even 12 weeks after the end of the intervention. CONCLUSIONS: A 12-week dementia care training program consisting of mobile e-learning, social networking, and face-to-face mentoring support group meetings were found to a feasible approach in improving the knowledge, attitude, and competence of home care workers. Mobile e-learning and online environment provides a platform that is self-directed, flexible, accessible, and cost-effective for training home care workers. The findings provide a call to action for nurse educators and policy makers to re-design existing dementia care training for home care workers to meet the critical home care needs of a growing dementia population. TRIAL REGISTRATION: ClinicalTrials.gov. NCT03822286 . Registration date: 27/01/2019. Posted date: 31/01/2019.

[Current Status and Prospects of Community Psychiatric Home Care].

Psychiatric home care is an effective model for providing care to community-based patients with psychosocial needs who are unable to receive continuous treatment / rehabilitation in mental health hospitals. Moreover, this model has been shown to effectively reduce rehospitalization and promote recovery in these patients. Three psychiatric home care models are described in this article: medical-based home care; prevent recurrence public health home care; and preventing disability long-term care home care. Furthermore, the resources required to provide psychiatric home care are estimated and current psychiatric home care-related problems, dilemmas, and prospects are summarized. Building an accessible psychiatric home care network may be accomplished by promoting evidence-based home care case management practices and ensuring psychiatric case management nurses are properly certified. This network will help improve significantly the quality of care received by community-dwelling patients with mental illness.

[New Opportunities for Healthcare Driven by Smart Technology].

Taiwan officially entered the era of negative population growth in 2020, with the number of births falling below the number of deaths. Taiwan society is facing the severe problems of low birthrate and aging population, which will exacerbate the social gap in medical resources. Fortunately, rapid progress in developing smart technologies (Button et al., 2014) should bring new opportunities for healthcare. Therefore, the focus of and approach to healthcare should be adjusted (While & Dewsbury, 2011). On the one hand, applying smart technology in medical / nursing staff education offers myriad opportunities for improvement (Car et al., 2019), including using virtual reality in training, using mobile technology tools in education, and using Internet of Things technology to assist medical/nursing staff in the clinical-care process. Moreover, smart education technology will play an important, auxiliary role in the healthcare field in terms of mobile applications, robot practice, simulation experience, digital medicine, and telemedicine and influence the future of medical/nursing health care education (Bajpai et al., 2019). On the other hand, using smart technology to promote healthcare through various innovative healthcare design activities will help develop older-adult-friendly technology products, systems, services, and even living environments (Wang et al., 2015). These include remote home care systems, smart homes, rehabilitation systems, environment-assisted living, intelligent mobile assistance systems, communication platforms and social networks, accompanying robots, and interactive entertainment technology, among others. Smart technology will provide family members and professional medical staffs with more-convenient and efficient healthcare support, maximize the effectiveness of healthcare resources, and drive the development of related industries (Insel, 2017). The title of this column is interdisciplinary applications of healthcare and technology: education, research, and practice. In using smart technology to support healthcare, key research and practical issues will be how to apply related innovations to promote medical education, combine clinical research, and effectively integrate smart technology into healthcare.

[Current Status and Prospects for Information Communication Technology (ICT) in Allied Health Education].

In this article, technologies that have been widely adopted and used in the field of allied health education in recent years are identified and introduced. These technologies may be distinguished based on education content and approach into the following three categories: online-offline digital education, which uses massive open online courses, CD-ROM, and similar learning tools; mobile learning, which uses mobile phones, tablets, and other devices to connect to the Internet of things; and digital simulation education, which uses virtual reality, virtual patient simulation, serious gaming, and gamification. Preliminary positive findings regarding the effectiveness of using the above technologies have been reported in the literature. Therefore, to better understand the impact of new technology, it is recommended that relevant medical/nursing educators should continue introducing practical courses to evaluate their impact on learning. However, funding limitations and the declining birthrate / population aging are two key threats to education that remain to be effectively addressed and overcome.

Effectiveness of Needs-oriented Hospital Discharge Planning for Caregivers of Patients With Schizophrenia.

Hospital discharge planning for clients with schizophrenia reduces client rehospitalization rates and improves their medication adherence. The effectiveness of caregiver participation in hospital discharge planning has seldom been explored. The purpose of this study was to examine the effectiveness of caregiver participation in hospital discharge planning for clients with schizophrenia in reducing caregiver burden and improving health status. A quasi-experimental research design was adopted. The research location was in a psychiatric hospital in Northern Taiwan. The target population was caregivers of inpatients with schizophrenia. Nurses served as care coordinators and provided six-step hospital discharge planning services to caregivers. Structured questionnaires were employed to measure caregiver burden and health status. Intervention effect was tested using analysis of covariance in which outcome measure at pretest and selected demographic variables were treated as covariates. A total of 114 caregivers completed pretest and posttest evaluations, with 57 people in each group. A significant difference was found between the experimental and the control group regarding the caregiver burden and health status (P<0.001) The caregiver burden and health status of the experimental group improved more significantly compared with the control group. The caregiver-involved discharge planning process developed in this study effectively reduced the burden placed on caregivers and improved their health status. Mental health nurses can serve as the main care coordinators for assessment, planning, referral and provision of the required services. Caregiver-involved hospital discharge planning should become part of the routine care process.

Integrating Evidence-Based Community-Care Services to Improve Schizophrenia Outcomes: A Preliminary Trial.

This aim of this preliminary experimental study was to integrate effective evidence-based community-care services that are subjected to heavy caseloads, and to then examine the effects on individuals with schizophrenia. Using a cluster sampling method, four homecare nurses were randomly assigned to either the experimental group or the comparison group. The nurses in the experimental group applied the following six identified effective elements: (1) established an alliance with their patients; (2) assessed patient-care needs; (3) considered both medical and social-care practices; (4) addressed patients' self-management of medication and their daily tasks; (5) provided crisis intervention; and (6) coordinated resources. The patients comprised 85 individuals with schizophrenia. In the experimental group, psychiatric homecare nurses were randomly assigned to implement integrated, evidence-based community-care services during a six-month follow-up period. Patients in the comparison group continued to receive their customary community care. In the experimental group, patient satisfaction scores, medication attitudes, and general functioning levels were significantly higher than in the comparison group. These preliminary findings indicate a potentially effective model for community care in areas where intensive case management cannot be provided.

Hand hygiene compliance among the nursing staff in freestanding nursing homes in Taiwan: a preliminary study.

This study aimed to explore the hand hygiene compliance among the nursing staff in Taiwanese freestanding nursing homes. A descriptive observational research design was used. A total of 782 opportunities for hand hygiene were observed by one trained research assistant in two freestanding nursing homes. The hand-hygiene observation tool was used to assess hand hygiene practice. The overall hand hygiene compliance among nursing staff in nursing homes was only 11.3%. Results further showed that the compliance was greater after contact with body fluids (odds ratio = 6.9, confidence interval (CI) = 3.75-9.88, P = 0.000) and lower before the performance of aseptic procedures (odds ratio = 0.15, CI = 0.04-0.63, P = 0.003) when compared with other activities. Hand hygiene compliance was relatively low among the nursing staff in freestanding nursing homes in Taiwan. To comprehensively analyze this issue, further research involving a larger number of nursing homes and strategies to improve compliance with hand hygiene among the nursing staff at these institutions is needed.

The development and preliminary effectiveness of a nursing case management e-learning program.

The purpose of this article was to describe the development and preliminary effectiveness of a digital case management education program. The e-learning program was built through the collaboration of a nurse educator and an informatics professor. The program was then developed according to the following steps: (1) building a visual interface, (2) scripting each unit, (3) preparing the course material and assessment tests, (4) using teaching software to record audio and video courses, (5) editing the audio recordings, (6) using instructional media or hyperlinks to finalize the interactions, (7) creating the assessment and obtaining feedback, and (8) testing the overall operation. The digital program consisted of five learning modules, self-assessment questions, learning cases, sharing experiences, and learning resources. Forty nurses participated in this study and fully completed the questionnaires both before and after the program. The knowledge and confidence levels in the experimental group were significantly higher over time than those of the comparison group. The results supported the use of educational technology to provide a more flexible and effective presentation method for continuing education programs.

Examining Taiwanese psychiatric nurses' knowledge and confidence in case management.

BACKGROUND: Psychiatric nurses in Taiwan are increasingly required to employ case management strategies for patients with severe mental illness. However, few studies have examined these nurses' knowledge of case management and identified their unmet educational needs. METHODS: A national cross-sectional survey was conducted to examine psychiatric nurses' knowledge of case management and confidence in their case management skills. Structured questionnaires were distributed at an arranged time and using an electronic survey tool. Overall, 424 psychiatric nurses were recruited. RESULTS: Participants' knowledge scores reflected substantial gaps (60% accuracy rate), particularly in basic concepts and case management processes. In addition, the nurses lacked confidence in applying their case management skills. The unmet educational needs of the nurses were related to the skills of assessing resource requirements, conducting referrals, collaborating with service providers, and linking patients to necessary resources. Additionally, 87% of the nurses had no previous education in case management. CONCLUSION: Strategies for enhancing continuing education in case management are required to improve nurses' knowledge of case management, address their unmet educational needs, and prepare them to serve as case managers.

Effects of empowerment-based illness management on the medication adherence and recovery of persons with schizophrenia: A systematic review and meta-analysis.

Medication adherence and recovery rates are <50% among persons with schizophrenia; therefore, this health concern needs attention. Empowerment is a vital element for behavioural change, but previous studies have presented different results and lack specific connotations about empowerment. Therefore, this study systematically reviewed and meta-analysed the effects of empowerment-based illness management on the medication adherence and recovery of persons with schizophrenia. The databases searched included the PROSPERO registration network, Cochrane Library, PubMed, Embase, CINAHL, PsycAricle, and Airiti Library. The research steps were based on PRISMA. RoB 2.0 was used for article quality evaluation, the effect size was calculated using RevMan software, and the random-effect model and standardized mean differences (SMD) were established. Eight randomized controlled trials (RCTs) involving 859 participants were used to investigate the effect of empowerment on medication adherence. The trials involved the use of effective strategies as inducing medication motivation, promoting self-medication management, and providing support resources. A moderate effect was observed (SMD = 0.58, 95% CI 0.18-0.99). Ten RCTs involving 1473 participants were used to investigate the effect of empowerment on recovery. These trials involved the use of such effective strategies as using self-strength, connecting external forces, understanding personal needs, and overcoming self-stigma. A moderate effect was observed (SMD = 0.55, 95% CI 0.10-0.99). Empowerment in illness management can effectively promote the medication adherence and recovery of persons with schizophrenia. In the future, nurses can use self-strength care to promote medication motivation and connect internal and external forces to assist a person's medication adherence and recovery.

A Systematic Review and Meta-Analysis of the Effectiveness of Adherence Therapy and Its Treatment Duration in Patients with Schizophrenia Spectrum Disorders.

Background: Adherence therapy (AT) is an intervention for improving medication adherence of people with schizophrenia spectrum disorders, but no systematic reviews have yet summarized the effectiveness and minimum treatment duration of AT. We here aimed to systematically examine the effectiveness of AT in improving outcomes versus treatment as usual (TAU) and its minimum effective duration for people diagnosed with schizophrenia spectrum disorders. Patients and Methods: Eligible randomized controlled trials were identified from four databases (Web of Science, PubMed, CINAHL and Cochrane Library) for the period 1 January 2006 to 1 January 2023. Of 1087 retrieved candidate studies, five studies with a total of 726 participants met the inclusion criteria. The search terms consisted of adherence therapy, compliance therapy, schizophrenia, schizoaffective disorder, schizophrenic disorder, medication adherence, and medication compliance (combined with OR and AND). Two investigators independently selected studies, extracted data, and conducted bias risk assessments. Random-effects models were used to analyze the pooled data. Results: Meta-analysis of the five selected studies showed that AT had a significantly greater positive effects than TAU on psychiatric symptoms, but no significant effects on adherence behaviors and attitudes. Conclusion: The AT had limited effects in terms of improving the attitudes and behaviors of people with schizophrenia spectrum disorders with respect to medication adherence, but did improve patients' psychiatric symptoms. The therapy should be performed by trained staff for maximum benefit, and the recommended duration of the intervention is 12 hours.

Improving Medication Adherence in Community-Dwelling Patients with Schizophrenia Through Therapeutic Alliance and Medication Attitude: A Serial Multiple Mediation Model.

Background: Increased medication adherence improves patient outcomes and lowers the overall cost of care by preventing disease relapse and hospital readmission. Several systematic reviews have identified that insight, therapeutic alliance, and attitude towards medication affect medication adherence in patients with schizophrenia; however, no study has examined all the aforementioned variables together nor has discussed the chains of these mediators. Purpose: To examine the insight-medication adherence relationship among community-dwelling schizophrenia patients through a serial multiple mediation model of therapeutic alliance and medication attitude. Patients and Methods: This study with a cross-sectional correlational design included a convenience sample of community-dwelling schizophrenia patients from Taiwan (n = 229). From January 2017 to January 2018, data were collected by trained nurses using questionnaires. The PROCESS tool was used to analyse fine-grained chains. Results: In serial multiple mediation, the indirect effect of insight on medication adherence through therapeutic alliance and, subsequently, alteration of medication attitude was significant. However, the direct effect changed from significant to non-significant, indicating a complete mediating effect. Conclusion: In community-dwelling schizophrenia patients, the effects of therapeutic alliance and medication attitude on medication adherence are greater than that of insight. We recommend revising the strategy of community home visits by different psychiatrists or nurses in alternating shifts. Therapeutic alliance is the first step required to promote medication adherence. Based on this alliance, altering the patients' medication attitude may be more effective in improving medication adherence than merely enhancing insight.

Factors associated with personal recovery among psychiatric nursing home residents.

WHAT IS KNOWN ABOUT THE SUBJECT?: Poor recovery will cause harm to the quality of life and well-being of residents and that the scope of influence includes the self, family and society. No study to date has investigated empowerment and the other multiple factors associated with personal recovery among psychiatric nursing home residents. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: The factors associated with personal recovery are empowerment, social support and global functioning. This pioneer study contributes new evidence that personal recovery is mainly predicted by empowerment, social support and global function, with empowerment exhibiting the highest predictive value. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Strengthening empowerment in mental health nursing may contribute more to the personal recovery of psychiatric nursing home residents than improving global function or social support. Mental health professionals should shift to empowerment-oriented care to improve individuals' personal recovery, such as offering more opportunities to achieve autonomy, encouraging individuals' involvement in decision-making and promoting individuals' motivation for achieving their goals. ABSTRACT: Introduction Individuals diagnosed with mental illness have a need for recovery. No study to date has investigated empowerment and the other multiple factors associated with personal recovery among psychiatric nursing home residents. Aim The study aimed to identify the factors associated with personal recovery among psychiatric nursing home residents. Methods This was a cross-sectional study with convenience sampling. Participants were recruited from a psychiatric nursing home in Northern Taiwan between April and June 2018. Data were collected through self-reported, structured questionnaires with verified reliability and validity. Descriptive and hierarchical regression analyses were performed. The present study followed the STROBE guidelines. Results The study included 158 participants. The factors associated with recovery according to bivariate associations were religious belief, psychotic symptoms, global function, social support and empowerment. In the hierarchical regression, empowerment, social support and global function were the main predictive factors of recovery, with the explained variation reaching 40.8%. Empowerment exhibited the highest predictive value for the recovery. Implications for clinical practice Strengthening empowerment in mental health nursing may contribute more to the personal recovery of psychiatric nursing home residents than improving global function or social support.

Case management educational intervention with public health nurses: cluster randomized controlled trial.

AIM: This paper is a report of a study conducted to determine the effectiveness of a community case management collaborative education intervention in terms of satisfaction, learning and performance among public health nurses. BACKGROUND: Previous evaluation studies of case management continuing professional education often failed to demonstrate effectiveness across a range of outcomes and had methodological weaknesses such as small convenience samples and lack of control groups. METHOD: A cluster randomized controlled trial was conducted between September 2005 and February 2006. Ten health centre clusters (five control, five intervention) recruited 163 public health nurses in Taiwan to the trial. After pre-tests for baseline measurements, public health nurses in intervention centres received an educational intervention of four half-day workshops. Post-tests for both groups were conducted after the intervention. Two-way repeated measures analysis of variance was performed to evaluate the effect of the intervention on target outcomes. RESULTS: A total of 161 participants completed the pre- and post-intervention measurements. This was almost a 99% response rate. Results revealed that 97% of those in the experimental group were satisfied with the programme. There were statistically significant differences between the two groups in knowledge (P = 0.001), confidence in case management skills (P = 0.001), preparedness for case manager role activities (P = 0.001), self-reported frequency in using skills (P = 0.001) and role activities (P = 0.004). CONCLUSION: Collaboration between academic and clinical nurses is an effective strategy to prepare nurses for rapidly changing roles.

The effect of a self-management program on renal function control in patients with hemodialysis in Taiwan: A longitudinal randomized controlled trial.

AIM: This study was designed to investigate the longitudinal effect of participating in a self-management program (SMP) on renal function control in patients receiving hemodialysis. METHODS: This randomized controlled trial enrolled a total of 58 patients at the hemodialysis center of a teaching hospital in Taiwan. The control group (n = 30) received the usual care and the experimental group (n = 28) received a 4-week SMP intervention. The results of the follow-up on the longitudinal data at 3, 6, and 9 months showed that the renal function indices, potassium and phosphorus levels, and interdialytic weight gain were significantly better than at the pre-test for the experimental group. RESULTS: In terms of the interaction between group and time, the potassium level dropped significantly below the pre-test value only after 3 months (B = -0.31, SE = 0.15, p = .044), suggesting that the post-test potassium level had significantly decreased after 3 months. In terms of the interaction between group and time, the phosphorus level dropped significantly below the pre-test value only after 6 months (B = -0.53, SE = 0.28, p = .050), suggesting that the post-test phosphorus level significantly decreased after 6 months. Finally, the intervention could effectively control the weight change between dialysis sessions for up to 9 months (B = -1.34, SE = 0.30, p < .001). CONCLUSIONS: The SMP intervention decreased potassium and phosphorus levels and helped control interdialytic weight gain in patients undergoing hemodialysis.

Mobile community learning programme's effectiveness in case management for psychiatric nurses: A preliminary randomised controlled trial.

BACKGROUND: The global health care system has applied case management (CM) as a care delivery service provided by nurses. Nurses require continuing education in CM to enhance their professional knowledge and competence. Mobile communities have been used to promote continuing education for medical professionals. However, limited studies have examined the effectiveness of such learning programmes in CM for psychiatric nurses. OBJECTIVE: To evaluate the effectiveness of a mobile community learning (MCL) programme in CM for psychiatric nurses. DESIGN: This study used an experimental two-group pre- and post-test design. SETTINGS AND PARTICIPANTS: Psychiatric nurses employed in a psychiatric teaching hospital situated in northern Taiwan were recruited. METHODS: Nurses were randomly allocated to the experimental or comparison group. The former participated in the learning intervention in CM. The CM knowledge index and a competence scale were used to determine outcomes. Pre-tests and 2-month post-tests were conducted. The MCL programme comprised five simulated learning modules, self-assessment questions, learning cases, learning resources and experience sharing. A two-way repeated-measures analysis of variance was performed to evaluate the effect of the intervention on target outcomes. RESULTS: The questionnaires were completed by 48 participants. The two groups possessed high homogeneity with regard to characteristics and pre-test outcomes. Differences between the two groups regarding CM knowledge (F = 22.99, p < .01) and competence (F = 6.33, p = .015) were significant. The programme had a positive benefit on the learning experience in the experimental group; the mean satisfaction score for the programme reached 4.27 (range, 1-5). CONCLUSIONS: MCL programmes for psychiatric nurses can effectively enhance CM knowledge and competence. However, these methods cannot completely replace the continuing education approach for achieving CM competence.