Transforming outcome expectations into retention among hospital nurses: A cross-sectional study.

AIM: To examine the main effects and interaction effects of outcome expectations (e.g., anticipated satisfactory salary and benefits), nurse identity (a sense of membership in the nursing profession), and information-access efficiency of the electronic medical record system (how the system enables nurses to quickly retrieve the needed information) on nurses' retention. DESIGN: This study uses a cross-sectional survey and adopts proportionate random sampling to recruit a representative sample of nurses of a medical centre in Taiwan. METHODS: This study successfully obtained completed questionnaires from 430 nurses during December 2021 to January 2022. Data are analysed by using hierarchical regressions. RESULTS: Positive outcome expectations and identification as a member in the nursing profession are associated with retention. Information-access efficiency strengthens the link between outcome expectations and retention, while nurse identity weakens this link. CONCLUSION: Outcome expectations can help retain nurses, particularly those who perceive high levels of information-access efficiency and possess weak nurse identity. That is, outcome expectations have a complementary role with nurse identity in retaining nurses. IMPLICATIONS FOR THE PROFESSION: Nurse managers should devise means to build positive outcome expectations for nurses. In addition, either strengthening nurses' identification with the nursing profession or improving the information-access efficiency of the electronic medical system may also help retain nurses. IMPACT: This study examined how to transform outcome expectation to nurse retention, offering nurse managers to devise new means to retain nurses. REPORTING METHOD: STROBE statement was chosen as EQUATOR checklist. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Factors affecting quality of life among patients with corrosive injury.

This study aimed to investigate the factors influencing quality of life (QOL) among patients with corrosive injuries, considering the rising incidence of such cases, particularly in developing countries. Corrosive ingestion is a serious global public health problem and a common form of self-harm. This was a cross-sectional study using purposive sampling. A total of 82 patients with corrosive injuries who were admitted to the gastroenterology ward of a medical center in Taiwan between June 2018 and July 2020 completed the Perceived Stress Scale, Coping Strategy Scale, and World Health Organization Quality of Life Scale. We used an independent t-test and analysis of variance to examine the distribution and differences in demographic and disease characteristics, perceived stress, and the coping strategy scale. Multiple linear regression was then used to analyze the main predictors of QOL. The mean patient age was 58.2 (standard deviation = 2.4) years. A significant difference was observed between patients with a history of mental illness and perceived stress (P < .05). The patients were highly stressed and used emotional coping strategies to solve problems. Stress perception was significantly negatively correlated with overall QOL. Multiple linear regression analysis showed that a history of mental illness was a significant factor for overall QOL. The results of this study suggest that a history of mental illness significantly affects the QOL of patients with corrosive gastrointestinal injuries, and regular assessment and monitoring are essential.

Professional engagement: Connecting self-efficacy to actual turnover among hospital nurses.

AIMS: To examine how nurses' self-efficacy impacts professional engagement (professional opportunities exploration and workplace improvement participation), nurses' turnover intention and further on actual turnover. BACKGROUND: The problem of nursing shortage has become a common global issue. Nurses' self-efficacy could reduce nurses' turnover intention. However, whether professional engagement could connect nurses' self-efficacy and their actual turnover remains unknown. DESIGN: This study adopts a three-wave follow-up design. METHODS: This study uses proportionate random sampling to survey nurses in a large medical centre in Taiwan. Totally, 417 participants were enrolled from December 2021 to January 2022 (first wave) and followed up from February 2022 to March 2022 (second wave). The data of nurses' actual turnover (or not) were traced in May 2022 (third wave). STROBE statement was chosen as the EQUATOR checklist. RESULTS: Self-efficacy was positively linked to outcome expectation, which is positively linked to professional opportunities exploration. Self-efficacy was positively linked to career interest and workplace improvement participation. Professional engagement was negatively linked to nurses' intention to leave the target hospital, which was positively linked to actual turnover. CONCLUSION: This study uniquely finds that professional engagement is the key to the mechanism underlying the influence of nurse' self-efficacy on their actual turnover. IMPACT: Our findings impact nursing management that professional engagement is as well important as nurses' self-efficacy, with an aim to maintain the professional nursing workforce. PATIENT OR PUBLIC CONTRIBUTION: Nurses complete the questionnaires, return them to the investigators and permit investigators to check their personnel data.

Relationship of symptom stress, care needs, social support, and meaning in life to quality of life in patients with heart failure from the acute to chronic stages: a longitudinal study.

BACKGROUND: Patients with heart failure (HF) experience continuous changes in symptom distress, care needs, social support, and meaning in life from acute decompensation to chronic phases. The longitudinal relationship between these four factors and quality of life (QOL) was not fully explored. AIMS: To simultaneously investigate the relationship between all factors and QOL from hospitalization to 6 months after discharge, and the impact of the changes in these factors on QOL at different time points. METHODS: A longitudinal design with panel research (4 time points) was used. From January 2017 to December 2019, patients hospitalized due to acute decompensated HF were consecutively enrolled and followed up for 6 months. Patients were interviewed with questionnaires assessing symptom distress, care needs, social support, meaning in life and QOL at hospitalization and 1, 3 and 6 months after discharge. RESULTS: A total of 184 patients completed 6 months of follow-up. From baseline to 6 months, QOL continuously improved along with decreases in symptoms and care needs, but increases in social support and meaning in life. Better QOL was associated with younger age, higher education level, economic independence, less symptom distress and care needs, and stronger meaning in life (p < 0.05). Compared with hospitalization, decreases in care needs and increases in meaning in life at 1, 3 and 6 months were associated with an increase in physical QOL (p < 0.01). The decrease in care needs and increase in meaning in life at 3 months were associated with an increase in mental QOL (p < 0.05). The increase in social support at 6 months was associated with increases in both physical and mental QOL (p < 0.01). Changes in symptom distress were not correlated with changes in QOL from baseline to all time points. In the multivariable analysis, these findings were independent of age, educational level and economic status. CONCLUSIONS: Although symptom distress is associated with QOL after acute decompensated HF, QOL cannot be improved only by improvement in symptoms. With differential duration of improvement in each factor, the integration of alleviation in care needs and strengthening in social support and meaning in life might provide additional benefits in QOL.

Caring behaviours and stress perception among student nurses in different nursing programmes: A cross-sectional study.

Caring is central to providing high-quality nursing. Little research exists concerning the relationship between caring behaviours and stress perception among student nurses. This study aimed to explore this relationship among student nurses in different nursing programmes. A sample of 792 student nurses from three nursing education programmes in one academic institution completed Chinese versions of the Caring Behaviors Scale and the Nurse Stress Checklist to assess participants' caring behaviour and psychosocial responses to work-related stress, respectively. We found a statistically significant negative correlation between caring behaviour and stress perception among participants. The three most frequently reported caring behaviours were related to 'knowing the patient': (a) recognising that each patient holds unique values, (b) taking a patient's chief complaints seriously, and (c) stating that the family's best interests should be respected regarding health decisions. Completion of work, time limitations, and lack of personal interactions were sources of stress. Nursing education curricula involve the fundamentals of caring and the preparation of nursing students for clinical practice. The study recommends that nursing faculty and administrators should educate students in stress management in order to foster, support, and promote caring behaviours among nursing professionals.

A Multidisciplinary Program Reduces Over 24 Hours of Physical Restraint in Neurological Intensive Care Unit.

BACKGROUND: Physical restraint (PR) has to be performed in a well-organized, structured, and careful manner. The safety and effectiveness of the PR procedure in clinical practice are crucial to patient care. PURPOSES: The aim of this study was to examine the effect in neurological intensive care units of a multidisciplinary PR reduction program on the overall incidence rate of PR, the monthly rate of PR, and the monthly rate of PR of more than and less than 24 hours, respectively, after controlling for associated factors. METHODS: A before-and-after study design was conducted in three neurological intensive care units (total of 45 beds) of a medical center in northern Taiwan. A multidisciplinary PR reduction program was implemented, with four phases of data collection. Data on the number and duration of PR were extracted from a database. In the first preintervention phase, data on the rate (number or frequency) and duration of PR were collected for 12 months before program implementation. The next three data collection phases were 1 month (introduction), 3 months (intermediate), and 6 months (maintenance) after program implementation. The chi-square test, one-way analysis of variance with Scheffe's post hoc tests, and logistic regression method were used for data analysis. RESULTS: The results showed that PR was used 72.8 mean times per month before program implementation. After implementation, the mean times per month fell to 40 after the first postimplementation month (introduction), 53.3 after 3 months (intermediate), and 36.2 after 6 months (maintenance). Implementation of the PR reduction program resulted in a decreased incidence rate of PR from 6.1% to 3.2% (event/total patient day) and a decrease in the percentage of patients who were restrained for more than 24 hours from 69.6% to 34.1%. The results of the logistic regression model showed that PR of more than 24 hours was significantly less in the postintervention phases: introduction phase (odds ratio [OR] = 0.31), intermediate phase (OR = 0.16), and maintenance phase (OR = 0.18). Moreover, PR of more than 24 hours was significantly higher in patients with endotracheal intubation (OR = 1.51) and nasogastric intubation (OR = 2.16) and with Glasgow Coma Scale scores of 6-8 (OR = 2.36), 9-12 (OR = 2.40), and 13-15 (OR = 2.15). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The results support that a multidisciplinary collaborative program has the potential to decrease the incidence of PR in neurological intensive care units. A standardized protocol and policies are essential for healthcare professionals to effectively use PR as well as to effectively improve the quality of care that is provided to intensive care patients.

End-of-Life Care Discussion for Residents With Dementia in Long-Term Care Facilities.

BACKGROUND: Healthcare professionals play an important role in end-of-life care decisions. Although the factors affecting end-of-life care in long-term care facilities have been well studied in Western contexts, few studies have examined factors affecting end-of-life care discussions for residents with dementia among multidisciplinary professionals in Asian or Taiwanese contexts. PURPOSE: The aim of this study was to explore the factors related to the end-of-life care discussions of registered nurses, social workers, and physicians with residents with dementia and their families. METHODS: This is a cross-sectional and correlational study. A stratified random sampling was conducted, and self-administered questionnaires were mailed to physicians, registered nurses, and social workers who work in long-term care facilities with accreditation ranks ≥ Grade A in Taiwan. RESULTS: Questionnaires were returned by 478 participants (response rate = 94.1%). Fewer than 10% of the participants reported often discussing end-of-life care with residents with dementia and their families. Physicians were significantly more likely to discuss life-sustaining treatment than nurses and social workers. The frequency of professionals discussing advance directives and life-sustaining treatment for residents with dementia was predicted by higher confidence in end-of-life care skills and greater perceived facility support. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Most professionals did not frequently discuss end-of-life care with residents with dementia and their caregivers. Discussions of end-of-life care in long-term care facilities should be promoted by enhancing the confidence of these professionals in providing end-of-life care and creating a supportive environment for end-of-life discussions and care.

A comparison of the caring behaviours of nursing students and registered nurses: implications for nursing education.

AIMS AND OBJECTIVES: To compare the respective views of nursing students and registered nurses on caring behaviours. BACKGROUND: Research has indicated that nursing includes not only technical skills and professional knowledge but also the expression of care. In addition to nursing care, nurses demonstrate the acts of supporting, negotiating, reinforcing and transforming. However, little research simultaneously investigates the caring behaviours of nursing students and registered nurses. DESIGN: A cross-sectional study was conducted. METHODS: A total of 657 subjects participated in this study. The research tool was a self-administered structured questionnaire. Data were analysed using descriptive statistics, one-way analysis of variance, t-test and chi-square test. RESULTS: The results showed that the most important caring behaviour is 'knowing the patient', while the least is 'advocating for the patient', which includes caring behaviours to respect the patient's and family's best interests, and voicing for them, possibly because this behaviour is more difficult for nurses to practice in the Taiwanese culture. Moreover, there was no significant difference in the caring behaviours between nursing students and registered nurses. However, age was found to be a significant difference in the caring behaviours of nursing students and registered nurses. CONCLUSION: Caring behaviour is essential in clinical practice. Based on the results, this study suggested that role models should be provided to nursing students to develop proper caring behaviours. Nursing faculty can boost nursing students' interests in learning caring behaviours by incorporating diverse teaching strategies to enhance the effectiveness of caring behaviours. RELEVANCE TO CLINICAL PRACTICE: Much attention should be focused on education about awareness of caring behaviour for both nursing students and nursing staff. This study addressed that nursing administrators and faculty members should emphasise the importance of the essence of caring. Consequently, nursing curricula and training of nurses need to be concerned with implementing caring behaviour in clinical practice.

Development of a Needs Scale for Nurses Receiving In-Service Palliative Care Education.

BACKGROUND: Nurses play pivotal roles on palliative care teams and are able to spend more time with patients and their families than are other healthcare professionals. As a consequence, assessing the needs for palliative care education in connection with in-service classes for nurses is clearly extremely important and can help in the planning of appropriate palliative care classes to enhance the quality of care. OBJECTIVES: The goals of this study were to investigate the content needs of nurses with regard to a palliative care in-service education program and to perform exploratory factor analysis on those needs. METHODS: This study used a cross-sectional questionnaire survey. A total of 614 questionnaires were distributed, and 600 valid questionnaires were returned (97.72%). Data analysis was performed by means of descriptive statistics, reliability analysis, factor analysis, and Pearson correlation. RESULTS: The 6 factors discovered by exploratory factor analysis were handling of pain and symptoms, ethical issues concerning terminal patients, hospice preparation and care, the concept of palliative care, communication and counseling, and cultural and spiritual factors, which together explained 77.22% of the variance. CONCLUSION: The results of this study shed light on the program needs for in-service education about palliative care and the 6 factors most associated with those needs. IMPLICATIONS FOR PRACTICE: In order to realize the whole-person concept of care, future efforts should target the planning of palliative care in-service education programs, strengthening of nurse training, coordination of administrative resources, and interteam cooperation.

An exploratory study of the relationship between learning styles and academic performance among students in different nursing programs.

Abstract Background: Learning style is a major consideration in planning for effective and efficient instruction and learning. Learning style has been shown to influence academic performance in the previous research. Little is known about Taiwanese students' learning styles, particularly in the field of nursing education. Aim: This purpose of this study was to identify the relationship between learning styles and academic performance among nursing students in a five-year associate degree of nursing (ADN) program and a two-year bachelor of science in nursing (BSN) program in Taiwan. Methods/Design: This study employed a descriptive and exploratory design. The Chinese version of the Myers-Briggs Type Indicator (MBTI) Form M was an instrument. Data such as grade point average (GPA) were obtained from the Office of Academic Affairs and the Registrar computerized records. Descriptive statistics, one-way analysis of variance ANOVA) and chi-square statistical analysis were used to explore the relationship between academic performance and learning style in Taiwanese nursing students. Results/Findings: The study sample included 285 nursing students: 96 students in a two-year BSN program, and 189 students in a five-year ADN program. Two common learning styles were found: introversion, sensing, thinking, and judging (ISTJ); and introversion, sensing, feeling, and judging (ISFJ). A sensing-judging pair was identified in 43.3% of the participants. Academic performance was significantly related to learning style (p < 0.05, d.f. = 15). Conclusion: The results of this study can help educators devise classroom and clinical instructional strategies that respond to individual needs in order to maximize academic performance and enhance student success. A large sample is recommended for further research. Understanding the learning style preferences of students can enhance learning for those who are under performing in their academic studies, thereby enhancing nursing education.

Effect of qigong training on fatigue in haemodialysis patients: A non-randomized controlled trial.

BACKGROUND: Fatigue is a debilitating symptom in haemodialysis patients. Qigong presents a potentially safe modality of treatment for chronic fatigue patients but has not yet been evaluated in haemodialysis patients. OBJECTIVE: The aim of this study is to investigate whether qigong exercise affects fatigue in haemodialysis patients. DESIGN: A 6-month non-randomized control trial with six measurement periods was conducted. The qigong group was taught to practice qigong three times per week for six months. The control group received usual routine care. Main outcome measure Fatigue, as measured by the "Haemodialysis Patients Fatigue Scale". RESULTS: A total of 172 patients participated in this study, with 71 patients in the qigong group and 101 patients in the control group. The results indicated that all patients experienced mild to moderate fatigue. There was no difference between the qigong and control groups in fatigue at baseline. However, fatigue was lower in the qigong group than in the control group at 8 weeks (43.5 vs. 53.9), 12 weeks (44.7 vs. 53.6), 16 weeks (43.2 vs. 50.8), 20 weeks (42 vs. 50.2), and 24 weeks (41.4 vs. 48.4). The results, based on the generalized estimating equation method, showed that fatigue was significantly lower in the qigong group than in the control group (odds ratio=0.004, p=0.005). CONCLUSION: Fatigue in the qigong group showed a continuous decrease, which was maintained until the end of data collection at 24 weeks. Thus, qigong presents a potentially effective and safe method to reduce fatigue in haemodialysis patients.

An exploratory study of the relationship between learning styles and academic performance among students in different nursing programs.

UNLABELLED: Abstract Background: Learning style is a major consideration in planning for effective and efficient instruction and learning. Learning style has been shown to influence academic performance in the previous research. Little is known about Taiwanese students' learning styles, particularly in the field of nursing education. AIM: This purpose of this study was to identify the relationship between learning styles and academic performance among nursing students in a 5-year associate degree of nursing (ADN) program and a 2-year bachelor of science in nursing (BSN) program in Taiwan. METHODS/DESIGN: This study employed a descriptive and exploratory design. The Chinese version of the Myers-Briggs type indicator Form M was an instrument. Data such as grade point average were obtained from the Office of Academic Affairs and the Registrar computerized records. Descriptive statistics, one-way analysis of variance and chi-square statistical analysis were used to explore the relationship between academic performance and learning style in Taiwanese nursing students. RESULTS/FINDINGS: The study sample included 285 nursing students: 96 students in a 2-year BSN program, and 189 students in a 5-year ADN program. Two common learning styles were found: Introversion, sensing, thinking, and judging; and introversion, sensing, feeling, and judging. A sensing-judging pair was identified in 43.3% of the participants. Academic performance was significantly related to learning style (p < 0.05, df = 15). CONCLUSION: The results of this study can help educators devise classroom and clinical instructional strategies that respond to individual needs in order to maximize academic performance and enhance student success. A large sample is recommended for further research. Understanding the learning style preferences of students can enhance learning for those who are under performing in their academic studies, thereby enhancing nursing education.

Comparison of differences and determinants between presence and absence of sleep disturbance in hepatocellular carcinoma patients.

BACKGROUND: Hepatocellular carcinoma patients often experience sleep disturbance after undergoing transcatheter arterial chemoembolization (TACE). OBJECTIVE: The objectives of this study were to (1) examine and compare symptom distress, depression, and sleep quality in hepatocellular carcinoma patients undergoing TACE with sleep disturbance versus without sleep disturbance and (2) examine the determinants of sleep disturbance in these patients. METHODS: Hepatocellular carcinoma patients undergoing TACE were recruited. The patients were evaluated 1 week (T1) and 1 month (T2) after receiving TACE in terms of performance status, symptom distress, depression (T1), and sleep disturbance (T2). Logistic regression was used to determine the predictive factors of sleep disturbance. RESULTS: Patients with sleep disturbance reported significantly higher overall symptom distress and depression and lower sleep quality than patients without sleep disturbance. The 5 leading causes of symptom distress in both groups were fatigue, pain, poor appetite, chest tightness, and fever. Older age, greater symptom distress, and higher levels of depression were significantly associated with sleep disturbance. CONCLUSIONS: The results of this study show significant associations among symptom distress, depression at baseline, and sleep problems 1 month after undergoing TACE. Clinicians should be aware of the possibility of lasting sleep disturbance in hepatocellular carcinoma patients undergoing TACE. IMPLICATIONS FOR PRACTICE: In clinical care, symptom management, psychological consultation, and relaxation training may promote sleep quality.

Prevalence and correlates of supportive care needs in oral cancer patients with and without anxiety during the diagnostic period.

BACKGROUND: Many oral cancer patients experience profound anxiety and supportive care needs during the diagnostic phase. OBJECTIVE: The purposes of this study were to (1) examine and compare levels of disease impact, symptom distress, supportive care needs, and prevalence of unmet care needs in oral cancer patients with and without anxiety during the diagnostic period and (2) examine and compare the correlates of supportive care needs of patients in these 2 groups. METHODS: A total of 165 oral cancer patients from the otolaryngology inpatient wards of a medical center in northern Taiwan participated in this study: 65 with anxiety and 100 without anxiety. A cross-sectional survey was conducted using a variety of questionnaires. RESULTS: Patients with anxiety experienced higher levels of disease impact, intrusion, and avoidance than patients without anxiety. Both groups had moderate-to-severe levels of symptom distress and high supportive care needs, with the highest prevalence of unmet needs being in the area of health system and information, followed by psychological care. In patients with anxiety, overall supportive care needs were correlated to religious beliefs and symptom distress. In patients without anxiety, overall care needs were associated with time since diagnosis and symptom distress. Religion was most highly correlated with each need domain. CONCLUSION: Assessment and screening for anxiety should be increased in head and neck cancer care outpatient settings to determine patients' mood during the diagnostic stage. IMPLICATIONS FOR PRACTICE: Provision of extensive information, satisfactory consultation, and spiritual encouragement are necessary to improve the quality of health care.

Support needs of patients with oral cancer and burden to their family caregivers.

Oral cancer patients' supportive care needs during the postoperative period can impact their family caregivers' burden. The purposes of this study were to (1) examine patients' perceived levels of supportive care needs, (2) examine caregivers' perceived levels of caregiving burden, and (3) examine the predictive factors for caregivers' caregiving burden with newly diagnosed oral cancer patients during the postoperative period. A cross-sectional, correlational study was conducted. One hundred twenty-two pairs of eligible patients and caregivers were recruited from the otolaryngology and plastic/reconstructive inpatient wards in a medical center in northern Taiwan. A set of questionnaires was used to assess patients' needs, including the Karnofsky's Performance Status Index, Cancer Needs Questionnaire Short Form, Head and Neck Specific Needs Questionnaire, and Background Information Form; the caregivers' burden was evaluated using the Caregiver Reaction Assessment, Inventory of Socially Supportive Behavior, and Characteristics of Care Experiences Form. In general, patients reported having high overall supportive care needs with the highest level in the "health system and information" domain among 6 needs domains. Caregivers had moderate levels of caregiving burden, with the highest level in the "self-esteem" domain among 5 caregiving experience domains. Factors significantly related to those burdens across 5 domains of caregiving burden were caregivers' social support, patients' physical and daily living needs, patients' health system and information needs, and patients' psychological needs. Postoperative oral cancer patients experienced relatively high unmet supportive care needs, and caregivers perceived moderate levels of caregiving burden. Healthcare professionals should systematically assess patients' and caregivers' problems and provide timely supportive care clinically.