[Effectiveness of Nursing Leadership Training Programs: Mixed-Methods Research].

BACKGROUND: Taiwan Nurses Association (TWNA) has recommended nursing leader applicants to the International Council of Nurses (ICN) Global Nursing Leadership Institute since 2009, held the Nightingale Nursing Leadership Institute Training Program since 2011, and co-hosted the ICN Leadership for Change Program with ICN since 2015. The TWNA actively cultivates nursing leaders with vision and an international perspective. PURPOSE: To investigate the professional efficacy of nursing leaders who had attended these leadership training programs. METHODS: A mixed-methods research design was adopted. One hundred and sixty-seven nursing leaders who had attended at least one of the three leadership training programs were enrolled as participants. Data collected from online surveys were used in the quantitative analysis. Data collected from the content analysis of achievement reports and focus groups were used in the qualitative analysis. RESULTS: Diligence in work and listening were the highest-scoring items in the leadership and communication skills categories for the three leadership training programs. The results of the content analysis found that the achievement reports of the Nightingale Nursing Leadership Institute and Leadership for Change programs were mostly concerned with the professional issues in organizations. The impact of leadership training and suggestions for future program planning were discussed in the focus groups. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results of this study support that these training programs have been successful in promoting a commitment to organizational improvement among program participants and have increased the professional impact of nursing on society.

Effects of Mobile Application Program (App)-Assisted Health Education on Preventive Behaviors and Cancer Literacy among Women with Cervical Intraepithelial Neoplasia.

OBJECTIVE: This study aimed (1) to study the effects of health education on preventive behaviors and cancer literacy among women with cervical intraepithelial neoplasia (CIN); (2) to compare the effects of mobile application program (App)-assisted health education with traditional book-form health education. PARTICIPANTS: A total of 132 women ages 20 to 69 years women. METHODS: This prospective longitudinal study enrolled 132 CIN women who were evaluated three times. Propensity score matching was used by controlling subjects' age strata, body mass index, education level, occupation, and type of surgery. RESULTS: The influences of various educational tools were investigated. Four domains were assessed, including health behavior, attitude towards behavior change, self-efficacy of behavior, and cervical cancer (CCa) literacy. Significant improvements in behavior change and CCa literacy due to a health education program were observed (p ≤ 0.002). The App combined with a traditional booklet had the highest score for behavior change and was significantly greater than the booklet-only learning (p = 0.002). The App-assisted form, either App alone or combined with booklet, had a significantly better impact on health promotion when compared to the booklet alone (p = 0.045 and 0.005, respectively). App-only learning had the highest score of CCa literacy (p = 0.004). CONCLUSION: Health education interventions can have positive effects in terms of change of behavior and CCa literacy. App-assisted learning could be used as a supportive technology, and App learning alone or combined with a traditional booklet may be an innovative model of clinical health promotion for women with CIN.

Commonalities in Nursing Perspectives Among 6 Countries/Regions.

The purpose of this article is to identify the commonalities in nursing perspectives among 6 countries/regions (United States, South Korea, Taiwan, Japan, Hong Kong, and Thailand). Nine leaders from the 6 countries/regions reflected on what nursing perspectives were in their own countries/regions and provided exemplars/cases from their own experiences and literature reviews. The data were analyzed using a content analysis. Seven themes were extracted: (a) "embedded in cultural and historical contexts"; (b) "based on philosophical pluralism"; (c) "women-centered perspectives"; (d) "care-oriented holistic views"; (e) "ethical and humane views"; (f) "respecting and advocating"; and (g) "considering diversities."

[The Key Role of Taiwanese Nurses in Combating COVID-19 Pandemic].

As the COVID-19 pandemic continues to rage worldwide, Taiwan has achieved outstanding performance in controlling the spread of the outbreak domestically, earning global appreciation. Nurses on the frontlines deserve much of the credit for the ongoing success in fighting against this outbreak in Taiwan. Taiwan's success to date is grounded in proactive preparedness and deployment by the government and effective teamwork among government agencies, medical institutions, enterprises, and the public. Comprehensive containment strategies and preparedness have allowed nurses to effectively perform their duties and combat the pandemic. Nurses safeguard the public's health a myriad of ways, including implementing quarantine measures at air and seaports, conducting fever screenings, delivering inpatient isolation treatments, performing case contact tracing, providing community care services, and operating special chartered-flight services. The Taiwan Nurses Association (TWNA) provides vital lead in this pandemic response, advocating for the safety, health and wellbeing of nurses; highlighting the contributions and value of nurses; and enhancing the professional image and status of nurses. Furthermore, through its global platform, TWNA shares with peer organizations worldwide the content and efficacy of actions taken by the national government, the contributions of healthcare workers, and the support and encouragement received from the public in COVID-19 containment to demonstrate values of Taiwan and nursing.

The Refined Middle-Range Theory on Women's Leadership in Asian Culture.

Introduction: Because virtually no theories were available to explain unique characteristics of Asian women's leadership in nursing, a middle-range theory on women's leadership in Asian culture was previously published. To reflect recent political and social changes in different countries, there is a necessity to refine the theory. The purpose of this article is to present the refined middle-range theory on Asian women's leadership in nursing. Methodology: Using an integrative approach, the theory was further developed based on two major sources: literature reviews and exemplars/cases from six different countries. Results: The Refined Middle-Range Theory on Women's Leadership in Asian Culture has two main domains: (a) leadership frames and (b) leadership contexts. The domain of leadership contexts has been extended with two additional main concepts including demographic contexts and health workforce/system contexts. Discussion: The refined theory is expected to guide Asian women's leadership in nursing across the globe.

[Toward 2020 the International Year of the Nurse and the Midwife: Linking Taiwan Nursing With the World].

To commemorate the 200th birthday of Florence Nightingale, the World Health Organization announced 2020 as the "International Year of the Nurse and the Midwife." Nursing is in the frontline of transformational care. The actions of nurses help bring positive changes to the world. Taiwan cannot stand outside of the global community. The Taiwan Nurses Association is also involved actively in international affairs. The expertise and enthusiasm of Taiwan's nurses may be highlighted by attending and responding to various meetings, conferences, and global nursing events organized by the International Council of Nurses (ICN) such as the Council of National Nursing Association Representatives (CNR), ICN Congress, and Nursing Now campaign. This article shares important information and insights on the 2019 ICN CNR meeting and the ICN Congress to expand the international perspective of nurses and to inspire and explore the future development of the nursing profession in Taiwan.

Risk factors associated with outcomes of peritoneal dialysis in Taiwan: An analysis using a competing risk model.

Peritoneal dialysis (PD) is one option for renal replacement therapy in patients with end-stage renal disease (ESRD). Maintenance of the PD catheter is an important issue for patient outcomes and quality of life. The aim of this retrospective cohort study is to clarify the risk factors of technique failure and outcomes at a single institute in Taiwan.The study enrolled ESRD patients who had received PD catheters in a tertiary hospital in northern Taiwan. Using a competing risks regression model, we reviewed clinical data and analyzed them in terms of the time to technical failure and clinical outcomes, including PD-related peritonitis and mortality.A total of 514 patients receiving PD between 2001 and 2013 were enrolled in the study. According to the multivariate analysis model, we found that diabetes mellitus was a risk factor for PD-related peritonitis (subdistribution hazard ratio [SHR] 1.47, 95% confidence interval [CI] 1.06-2.04, P = .021). Female gender and higher serum albumin levels were associated with lower risks of technique failure (SHR 0.67, 95% CI 0.48-0.94, P = .02; SHR 0.75, 95% CI 0.58-0.96, P = .023, respectively), but Gram-negative and polymicrobial infection increased the technique failure rate (SHR 1.68, 95% CI 1.08-2.61, P = .021; SHR 1.93, 95% CI 1.11-3.36, P = .02, respectively). Female gender was a risk factor associated with overall mortality (SHR 6.4, 95% CI 1.42-28.81, P = .016). Higher weekly urea clearance (Kt/V) and weekly creatinine clearance (WCCr) were associated with a lower risk of mortality (SHR 0.1, 95% CI 0.01-0.89, P = .04; SHR 0.97, 95% CI 0.96-0.99, P = .004, respectively).Diabetes mellitus is a risk factor contributing to PD-related peritonitis. Male patients and lower serum albumin levels were associated with higher rates of technique failure. Female gender, lower Kt/V, and WCCr are risk factors for overall mortality in PD patients.

The Global State of the Genetic Counseling Profession.

The profession of genetic counseling (also called genetic counselling in many countries) began nearly 50 years ago in the United States, and has grown internationally in the past 30 years. While there have been many papers describing the profession of genetic counseling in individual countries or regions, data remains incomplete and has been published in diverse journals with limited access. As a result of the 2016 Transnational Alliance of Genetic Counseling (TAGC) conference in Barcelona, Spain, and the 2017 World Congress of Genetic Counselling in the UK, we endeavor to describe as fully as possible the global state of genetic counseling as a profession. We estimate that in 2018 there are nearly 7000 genetic counselors with the profession established or developing in no less than 28 countries.

Use of dietary sodium intervention effect on neurohormonal and fluid overload in heart failure patients: Review of select research based literature.

AIM: This literature review analyzed ten articles investigating the effects of low dietary sodium intake on neurohormonal and fluid overload on heart failure (HF). BACKGROUND: Recommendations for low dietary sodium to HF patients has been debated in the past one to two decades. METHODS: This report presents a literature review of interventional studies from 2006 to 2015 investigating adult HF patients. RESULTS: The results of the neurohormonal outcome variables seem to be the primary consideration for recommending a low sodium diet to patients with HF. Most of articles in this review reported that 2.6-3 g/day of dietary sodium is effective for decreased BNP, renin, and aldosterone (neurohormonal) plasma levels in patients with HF. CONCLUSIONS: We have to provide the reason, effect, and amount of dietary sodium when providing dietary sodium recommendations to patients.

The family surrogates' psychological experience of making a do-not-resuscitate decision for older relatives: a qualitative study.

BACKGROUND: Many nursing home residents lack autonomous decision-making capacity and rely on family members to make do-not-resuscitate (DNR) decisions. Making DNR decisions can be difficult and complicated for surrogates. However, surrogates' psychological experience in making these decisions for older relatives is not well studied. AIM: To understand the surrogates' psychological experience of making DNR decisions for older relatives in a nursing home. METHODS: The study subjects of this qualitative study were family surrogates of older residents in a nursing home of Taiwan. A self-constructed, semi-structured interview guided in-depth interviews, which were recorded. Content analysis was used to discover themes from verbatim record. RESULTS: Four themes were revealed: lack of psychological preparation, considering issues when making a decision, ambivalent emotional responses and impact of cultural factors. Fifteen subthemes were also found. CONCLUSIONS: Surrogates who must decide whether to make a DNR decision for older relatives experience great emotional conflict. Understanding surrogates' struggles may assist nursing and care staff in managing this difficult situation.

[Self-Supporting Care Model for Older Adults].

Self-supporting care is an emerging concept in the geriatric care system of Taiwan. The traditional care model tends to prioritize aspects such as "safety" and "convenient and effective". For older adult patients, this situation has led to excessive restrictions, enforced bedrest, and the use of adult diapers, which seriously deteriorate quality of life. The present article introduces the development and current status of self-supporting care and international empirical research results from the perspective of holistic care for older adults as well as describes the intervention strategies that are currently used in Taiwan. We look forward to the caregivers of older adults being able to apply self-supporting care in their care settings, which is expected to enhance quality of life and dignity for older adults.

An Emerging Integrated Middle-Range Theory on Asian Women's Leadership in Nursing.

INTRODUCTION: Asian cultures reflect patriarchal cultural values and attitudes, which likely have influenced women leaders in their countries differently from women in Western cultures. However, virtually no leadership theories have been developed to reflect the experiences and development of nursing leaders from Asian cultures. The purpose of this article is to present an emerging integrated middle-range theory on Asian women's leadership in nursing. METHODOLOGY: Using an integrative approach, the theory was developed based on three major sources: the leadership frames of Bolman and Deal, literature reviews, and exemplars/cases from five different countries. RESULTS: The theory includes two main domains (leadership frames and leadership contexts). The domain of leadership frames includes human resources/networks, structure/organization, national/international politics, and symbols. The domain of leadership contexts includes cultural contexts, sociopolitical contexts, and gendered contexts. DISCUSSION: This theory will help understand nursing leadership in Asian cultures and provide directions for future nurse leaders in this ever-changing globalized world.

The relationship between family functioning and caregiving appraisal of dementia family caregivers: caregiving self-efficacy as a mediator.

OBJECTIVES: The aim of this study was to explore caregiving self-efficacy as a mediator for the association between family functioning and caregiving appraisal of dementia family caregivers in Taiwan. METHOD: This study adopted a cross-sectional correlational design. Purposive sampling was used to recruit 115 dyads of dementia patients and family caregivers from the outpatient neurological clinics of two hospitals in northern Taiwan. Data were gathered through interviews with a structured questionnaire, which included demographic characteristics for caregivers and patients, family functioning, caregiving self-efficacy, as well as positive and negative aspects of caregiving appraisal. RESULTS: Family functioning, patients' activities of daily living score, Neuropsychiatric Inventory caregiver distress, and three domains of self-efficacy were significantly associated with caregiver burden. Hierarchical multiple regression analyses indicated that self-efficacy for obtaining respite (SE-OR) significantly explained 20.5% of the variance in caregiver esteem. Caregiver perceived worsened health status, family functioning, and SE-OR significantly explained 59% of the variance in caregiver burden. The mediation test only supported the partially mediating role of SE-OR on the relationship between family functioning and caregiver burden, while the mediating effect of self-efficacy for responding to disruptive behaviours and controlling upsetting thoughts were insignificant. CONCLUSION: Our findings provided preliminary evidence for health professionals recommending that future studies should assess the family dynamic and health problems of caregivers, and develop appropriate family-centred interventions that focus on strengthening interfamily support and respite services to alleviate caregiver burden.

Creative approach for successful aging: A pilot study of an intergenerational health promotion program.

AIM: To develop and evaluate the effectiveness of an intergenerational health promotion program. METHODS: This was an action research project. A total of 34 participants attended the 12-week program and completed the pre-test and post-test. There were 16 middle-aged and nine older adults recruited from a district of Taipei, and nine young adults recruited from the principal investigator's university. The "Attitudes toward Aging Scale" and the "Spiritual Health Scale" were two assessment instruments used in the study. RESULTS: The results showed that there were significant improvements in the Attitudes toward Aging Scale for the young adult group (aged 18-29 years) and in the Spiritual Health Scale for the older adult group (aged 65-80 years). The evaluation showed that participants were satisfied with the program. CONCLUSIONS: The results of the present study provide future directions for successful aging and intergenerational learning. Geriatr Gerontol Int 2017; 17: 1799-1807.

The Relationships Among Sleep Quality and Chronotype, Emotional Disturbance, and Insomnia Vulnerability in Shift Nurses.

BACKGROUND: Shift work is a prominent feature of most nursing jobs. Although chronotype, emotional disturbance, and insomnia vulnerability are important factors for patients with insomnia in general, their effects on shift nurses are unknown. PURPOSE: This study explores the relationships between the sleep quality of shift nurses and the variables of chronotype, emotional disturbance, and insomnia vulnerability. METHODS: A survey was conducted with 398 shift nurses in a medical center. Chronotype, emotional disturbance, insomnia vulnerability, and sleep quality were evaluated using the Smith Morningness-Eveningness Questionnaire, the Brief Symptom Rating Scale, the Ford Insomnia Response to Stress Test, and the Pittsburgh Sleep Quality Index, respectively. RESULTS: On the Pittsburgh Sleep Quality Index, 70.1% of the participants scored higher than 5. Multiple regression analysis revealed that, together with night shift work (b [SE] = 1.05 [0.35], p = .003), higher levels of emotional disturbance (b [SE] = 0.30 [0.05], p < .001) and higher insomnia vulnerability (b [SE] = 0.18 [0.03], p < .001) were predictors of poor sleep quality and that chronotype was not a predictor of poor sleep quality. The multiple mediator model indicated that emotional disturbance significantly mediated an indirect effect of evening chronotype preference on poor subjective sleep quality (one subscale of the Pittsburgh Sleep Quality Index). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: In addition to shift patterns, emotional disturbance and high insomnia vulnerability are factors that may be used to identify shift nurses who face a higher risk of sleep disturbance. Because evening chronotype may indirectly influence subjective sleep quality through the pathway of emotional disturbance, further research into the mechanism that underlies this pathway is warranted.

Development and testing of a scale to assess fluid overload symptoms.

AIM: This study aimed to develop and test the reliability and validity of a scale about fluid overload symptoms in patients with heart failure. BACKGROUND: Fluid overload symptoms are a common cause of admission of patients with heart failure. An instrument that is quick to complete and easy to use for the measurement of fluid overload symptoms would be beneficial for early intervention and avoidance of hospital admission. METHODS: Fifty-six participants were recruited from cardiology wards. Internal consistency reliability was assessed using Cronbach's alpha coefficient. Validity was assessed using Pearson's correlation coefficient and exploratory factor analysis. RESULTS: This new instrument had a Cronbach's alpha of .81. Exploratory factor analysis revealed two factors (breathing symptoms and body fluid accumulation symptoms) with acceptable criterion validity. CONCLUSIONS: The fluid overload symptoms scale exhibits reliability with construct and criterion validity. It would be more beneficial if further testing is done.

Effectiveness of interactive discussion group in suicide risk assessment among general nurses in Taiwan: a randomized controlled trial.

The evidence of suicide prevention training for nurses is scarce. Strategies to enhance general nurses' ability in suicide risk assessment are critical to develop effective training programs in general medical settings. This study was aimed to examine the effectiveness of an interactive discussion group in a suicide prevention training program for general nurses. In this randomized study with two groups of pre-post study design, the sample was recruited from the Medical, Surgical, and Emergency/Intensive Care Sectors of a 2000-bed general hospital via stratified randomization. Among the 111 nurses, 57 participants randomly assigned to the control group received a two-hour baseline suicide gatekeeper lecture, and 54 participants assigning to the experimental group received an additional five-hour group discussion about suicide risk assessment skills. Using a case vignette, the nurses discussed and assessed suicide risk factors specified in a 10-item Chinese SAD PERSONS Scale during a group discussion intervention. The findings revealed that the nurses achieved significant and consistent improvements of risk identification and assessment after the intervention without influencing their mental health status for assessing suicide risks. The result suggested an effective approach of interactive group discussion for facilitating critical thinking and learning suicide risk assessment skills among general nurses.

A repeated measures study of changes in health-related quality of life during pregnancy and the relationship with obstetric factors.

AIMS: To examine changes in health-related quality of life throughout the course of pregnancy and among three pairs of consecutive periods (pre-pregnancy to early pregnancy, early to middle pregnancy and middle to late pregnancy), as well as to identify associated obstetric factors during the entire period of pregnancy. BACKGROUND: Only sparse data are available concerning the profiles of health-related quality of life throughout pregnancy. DESIGN: A within-subject comparison was undertaken. METHODS: In total, 358 women completed the Taiwanese version of the Medical Outcomes Study Short Form-36 Health Questionnaire and a demographic-obstetric questionnaire at three stages of pregnancy at a medical centre. The participants were recruited between 2009-2010. A generalized estimating equation regression model was employed for the repeated measures. RESULTS: The scores for physical component summary decreased significantly throughout early, middle and late pregnancy. The scores for mental component summary increased. The scores for physical, mental component summary and the eight domains of health-related quality of life decreased significantly from pre-pregnancy to early pregnancy. After adjusting for demographic and clinical factors, significant factors predicting physical component summary during pregnancy included stage of pregnancy and previous infertility. The factors predicting mental component summary included stage of pregnancy, parity and medical condition. CONCLUSIONS: The results revealed the dynamic pattern of perceived health status by the Taiwanese pregnant women in their surrounding socio-cultural context and identified the stage of pregnancy and obstetric factors predicting health-related quality of life.

[Patient safety as the first priority in healthcare].

Patient safety is an important issue in today's health care. This paper takes a human factor perspective to emphasize the importance of designing health care systems to account for caregiver personal characteristics and capabilities in order to compensate for individual caregiver limitations. This paper was designed to help nurses understand the impact of the human factor on patient safety. The authors hope that caregivers can use provided principles related to work systems, procedures, equipment and environments to improve patient safety and care systems.

Depressive symptoms as a predictor of sexual function during pregnancy.

INTRODUCTION: Biopsychological and sociocultural factors have been reported to be associated with sexual function in pregnancy. To date, very few studies have focused on the relationship between sexual function and depression during pregnancy. AIM: To determine whether depressive symptoms predict overall sexual function, desire, arousal, lubrication, orgasm, satisfaction, and pain during pregnancy by using the Female Sexual Function Index (FSFI). METHODS: Pregnant women undergoing prenatal examinations were randomly selected for this cross-sectional investigation. The study included 555 pregnant women who completed the Taiwanese versions of the Center for Epidemiologic Studies Depression Scale (CES-D), FSFI, and a demographic questionnaire during pregnancy. MAIN OUTCOME MEASURES: CES-D scores for depressive symptoms, scores for overall sexual function on the FSFI, and the FSFI domains: desire, arousal, lubrication, orgasm, satisfaction, and pain. RESULTS: After adjusting for demographic factors, CES-D scores during the first trimester negatively predicted overall sexual function (P=0.0004), arousal (P=0.0104), lubrication (P=0.0016), orgasm (P=0.0022), and pain (P<0.0001). Moreover, CES-D scores during the third trimester negatively predicted sexual desire (P=0.0005) and satisfaction (P<0.0001). Furthermore, gestational age negatively predicted overall sexual function, arousal, lubrication, orgasm, and pain (all P<0.0001). Parity was a positive predictor of overall sexual function, arousal, lubrication, and orgasm (all P<0.0005). Medical conditions were positive predictors of sexual desire (P=0.0023). CONCLUSIONS: The present study revealed that depressive symptom scores during early and late pregnancy were significant negative predictors of sexual function during pregnancy.