[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.

Depression in older residents with stroke living in long-term care facilities.

BACKGROUND: Stroke is the third leading cause of death in Taiwan. Poststroke older adults are often admitted to long-term care facilities. The impacts of the two concurrent life events of stroke and relocation may increase the risk of depression in stroke survivors. Depression in elderly stroke survivor residents of long-term care facilities has not been studied. PURPOSE: This study explores the factors associated with depression in older residents with stroke living in long-term care facilities. METHODS: A cross-sectional design was used. Twenty-three institutions in southern Taiwan participated in this study, including seven nursing homes, 11 intermediate-care facilities, and five domiciliary-care facilities. Purposive sampling enrolled 111 participants who met the following inclusion criteria: 65 years or older, experienced a stroke that did not cause cognitive defects, and capable of verbal communication. Data were collected using a sociodemographic data questionnaire, Barthel's Index, and the Taiwan Geriatric Depression Scale. RESULTS: Depression was experienced by 41 of the 111 participants (36.9%). Prevalence of depression was 45.7% in nursing homes, 36.2% in intermediate-care facilities, and 22.2% in domiciliary-care facilities. Participants living in nursing homes and intermediate-care facilities and illiterate participants with low Barthel's Index scores showed more depressive symptoms. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Healthcare providers should conduct depression screening for elderly residents with stroke on admission to long-term care facilities. Regular assessment and monitoring of depressive symptoms, especially in residents with less formal education and limited physical functions, are important in nursing homes and intermediate-care facilities.

Trajectories and predictors of functional decline of hospitalised older patients.

AIMS AND OBJECTIVES: To delineate the trajectories of functional status over four time points and to examine predictors of functional decline (FD) in hospitalised older patients. BACKGROUND: About 30-60% of the older patients develop new dependence in activities of daily living (ADL) during a hospital stay, which results in progressive disability after discharge. The functional trajectories and risk factors of FD among hospitalised older patients require identification. DESIGN: A cohort study. METHODS: The study consecutively recruited 273 patients aged 65 and older admitted to a medical centre in southern Taiwan. Functional trajectory, by ADL score, was observed at four time points: two weeks before admission, admission, discharge and three months after discharge. The ADL score two weeks before admission was used as a baseline functional status. RESULTS: Eighty-three (30·4%) patients experienced FD at three months after discharge. Functional trajectory as shown by ADL scores indicated that all 273 patients dropped steeply at admission and that two-thirds were gradually restored three months after discharge. Logistic regression revealed that the number of falls in the past year, Instrument Activities of Daily Living (IADL) status before admission, comorbidity and ADL decline between preadmission and discharge were significant predictors of FD three months after discharge. The ADL score decline during hospitalisation was the mediator of FD three months after discharge. CONCLUSIONS: Findings indicate that the ADL function of those hospitalised older patients who reported having fallen more often in the previous year had more comorbidity, had a lower IADL score, and had more ADL score decline before admission and discharge would continue to decline after discharge. RELEVANCE TO CLINICAL PRACTICE: Clinical nurses can integrate the finding of this study with Comprehensive Geriatric Assessment to tailor intervention to restore older patient's physical function during hospitalisation.

Nurses' physical restraint knowledge, attitudes, and practices: the effectiveness of an in-service education program.

BACKGROUND: Physical restraints are commonly used to reduce treatment interference risk and protect patient safety. However, nurses still hold misconceptions about the use of physical restraints in acute care settings. Teaching nursing staff accurate knowledge and proper skills, cultivating positive attitudes, and rectifying irregularities in physical restraint use are all necessary to improve patient care. PURPOSE: The aim of this study was to examine the effectiveness of a short-term in-service education program in improving nurses' knowledge, attitudes, and self-reported practices related to physical restraint use. METHODS: Convenience sampling was used in this quasi-experimental study at two different branches of one hospital in southern Taiwan. The two branches were randomly assigned as either the intervention or control group. Fifty-nine nurses at one branch were assigned to the intervention group, and 70 nurses in the other branch were assigned to the control group. The developed 90-minute in-service education program was given to nurses in the intervention group. The questionnaire included demographic data and three scales (Knowledge of Physical Restraint Use, Attitudes of Physical Restraint Use, and Practice of Physical Restraint Use). These scales were used to measure critical study variables prior to and 2 weeks after the intervention. RESULTS: Results found a significant improvement in the intervention group in terms of knowledge (p = .000), attitudes (p = .007), and self-reported practices (p = .048) related to physical restraint use after program completion. However, there were no significant differences in participant attitudes toward the use of physical restraints between intervention and control groups after program completion. CONCLUSIONS AND IMPLICATIONS FOR PRACTICES: Physical restraint knowledge and skills improved after the 90-minute in-service education program. Findings highlight the need to provide a short-term in-service education program on physical restraint use in acute care settings.

[Predictors of functional decline and care for the hospitalized elderly].

The number of elderly patients in hospitals rises as a country's population ages. In Taiwan, roughly 27% of hospitalized patients are elderly. Previous studies have reported that 30% to 60% of hospitalized elderly patient experienced functional decline following discharge. This article reviews references on the predictors of functional decline in hospitalized elderly. Six predictors are summarized, including, senility, daily activity disturbance (activity of daily living, preadmission disability in instrument activity of daily life), cognitive impairment, diseases (diagnosis, depression, incontinence), and hospitalization (length of hospital stay, prior hospital utilization, and demographic characteristics [e.g., high body mass, low income, institutional resident]). Nursing interventions that have been shown to help moderate functional decline in elderly patients include the multidiscipline care model, creating an elder-friendly environment, and facilitating exercise programs. As healthcare costs are so high, the need to decrease negative outcomes in personal health is a pressing issue. Thus, identifying hospitalized elderly at risk and providing intervention to prevent disabilities is an important mission of healthcare providers.

Depressive symptoms among older residents at nursing homes in Taiwan.

AIMS AND OBJECTIVES: To examine the depressive symptoms of older residents at nursing homes and the relationship between their depressive symptoms and certain selected variables. BACKGROUND: Depression has become a major healthcare concern among the older people, but nursing home-based studies on risk factors of depression have still hardly been well performed in Taiwan. DESIGN: A cross-sectional design was developed and implemented. METHODS: A research sample of 138 older residents was recruited from eight nursing homes located in southern Taiwan. During face-to-face interviews, the Center for Epidemiological Studies Depression Scale, Social Support Scale, Chronic Condition Checklist and Socio-demographic Inventory were used for data collection. RESULTS: The results showed that 81.8% of those residents were identified as being depressed. It was further discovered that the length of residency, number of chronic conditions, perceived health status and the amount of social support from their family and relatives could explain 38.8% of the total variances in depressive symptoms. CONCLUSIONS: Our study suggests that, in Taiwan, older people who live in nursing homes suffer from more depressive symptoms than those in community dwellings. To maintain and improve the health status for the elderly as much as possible, it is suggested that healthcare providers at nursing homes should develop an effective health promotion program for these older peoples. RELEVANCE TO CLINICAL PRACTICE: There exists a high rate of depressive symptoms among older residents at nursing homes. It is imperative that a proper identification and its correspondent treatment for this health problem on the older residents are required. In late life, to maintain a higher level of quality of life, it is important to suggest that the health providers should regularly screen older people to increase the likelihood of diagnosis and improved treatment of late-life depressive symptoms.

Nurses' feelings and thoughts about using physical restraints on hospitalized older patients.

AIM: To explore nurses' feelings and thoughts about physically restraining older hospitalized patients. BACKGROUND: The use of physical restraints is still highly prevalent in hospitals; furthermore, older patients are most likely to be so restrained. Studies in acute care settings have focused mainly on nurses' knowledge, attitudes, or practice concerning physical restraints, on physical restraint reduction programmes, on nurses' perceptions about the use of physical restraints, or on elderly patients' experiences with physical restraints. To the best of our knowledge no studies have been conducted on hospital nurses' feelings and thoughts about the use of physical restraints in Taiwan. DESIGN AND METHODS: A qualitative approach was used to understand this phenomenon. Semi-structured interviews were carried out, from August 2002 to March 2003, with 12 nurses working in three hospitals. The interviews were audiotaped and transcribed verbatim; content analysis was used to analyse the data. RESULTS: Nurses reported a variety of emotional responses regarding the use of physical restraints, including sadness, guilt, conflicts, retribution, absence of feelings, security, and pity for the restrained older people. Rationalization, sharing with colleagues, and compensating behaviours were ways that nurses used to manage their negative feelings. CONCLUSIONS: Most nurses had negative feelings towards the use of physical restraints. Among these nurses there was a struggle between patients' autonomy and the practice of care. However, other nurses said they had 'no feelings' or 'feeling of security' while using physical restraints. RELEVANCE TO CLINICAL PRACTICE: The findings of this study may contribute to filling the gaps in nursing knowledge, to improving protocols for physical restraint use in hospitals, and may also assist nurse managers to create a supportive practice environment. It is recommended that in-service training programmes should cover misconceptions regarding physical restraint use, ethical issues and how to cope with feelings while using physical restraints.