Experiences of family caregivers taking care getting lost of persons with dementia: a qualitative study.

BACKGROUND: Getting lost with family members who have dementia is a significant source of stress for family caregivers. In Taiwan, family caregivers develop strategies to deal with dementia persons who may get lost. This study aimed to explore the experiences of family caregivers caring for persons with dementia who have been lost outside the home. METHODS: A descriptive phenomenological method was used. The COREQ checklist was used to ensure the explicit reporting of data. A total of 20 family caregivers caring for persons with dementia who were lost outside their homes were selected from hospital outpatient clinics and a day care center in northern Taiwan using purposive sampling. Data were analyzed using the Giorgi analysis method. RESULTS: Five main themes emerged: (i) surprised persons with dementia lost outside, (ii) using strategies to prevent persons with dementia from getting lost, (iii) using strategies to find lost persons with dementia, (iv) exhaustion in long-term care persons with dementia, and (v) coping with the care load. It was found that family caregivers were surprised, nervous, and worried about persons with dementia being lost outside. They used the first strategy to supervise persons with dementia to prevent external losses. In addition, long-term supervision of persons with dementia led to mental exhaustion in the family caregivers. Finally, the family caregivers learned about loss prevention strategies and obtained family support and care replacement workers to reduce the care burden. CONCLUSIONS: It is essential to teach family caregivers early to prevent persons with dementia from losing external strategies. Nurses also provide long-term care services to reduce the care burden on family caregivers.

Effects of a collaborative health management model on people with congestive heart failure: A systematic review and meta-analysis.

AIM: To determine the effects of collaborative health management of congestive heart failure through the rigorous evaluation and extraction of evidence. BACKGROUND: Over the past two decades, cardiovascular disease has been the leading cause of death worldwide. Multidisciplinary team intervention for congestive heart failure has increased with population ageing and congestive heart failure incidence rate as well as cost of care. However, the effectiveness and feasibility of collaborative health management need to be explored. DESIGN: Systematic review and meta-analysis. METHODS: We conducted systematic literature searches in the Cochrane Library, PubMed, CINAHL and Medline for articles published between 2002 and 2022. After screening based on the inclusion and exclusion criteria, 13 articles were included in a rigorous review and evidence extraction process, evaluated methodological quality using the Jadad Quality Scale. Statistical heterogeneity was evaluated using Review Manager (RevMan Version 5.4) for the meta-analysis. RESULTS: In this study, a systematic review and meta-analysis were performed on 13 studies regarding the collaborative health management of people with congestive heart failure. The common result is that the collaborative health management model enables the enhancement of self-care and monitoring abilities, the strengthening of cardiac function, the alleviation of physiological and psychological symptoms and the improvement of readmission rates, mortality rate and quality of life. CONCLUSION: The congestive heart failure collaborative health management model could decrease the hospitalization rate related to congestive heart failure, all-cause mortality rate, and all-cause hospitalization rate, and improve the quality of life. IMPLICATIONS FOR PRACTICE: The collaborative health management model could effectively coordinate interdisciplinary team cooperation and provide information, which decreases hospitalization and mortality risks and improves their quality of life. NO PATIENT OR PUBLIC CONTRIBUTION: Our paper is a systematic review and meta-analysis, and such details do not apply to our work. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: The Collaborative Health Management Model provides in-depth insights, aiding in the design tailored to the specific circumstances of each country. Highlighting its critical role in the context of a global shortage of nursing staff, the model emphasizes the integration of multidisciplinary professional roles and the strengthening of collaboration as essential elements in addressing challenges posed by workforce shortages. Implementation of the Collaborative Health Management Model not only enhances patient care outcomes but also relieves pressure on healthcare systems, lowers medical costs, and addresses challenges arising from the shortage of nursing staff. Consequently, this model not only contributes to individual patient care improvement but also holds broader implications for enhancing the efficiency and sustainability of global healthcare systems. TRIAL AND PROTOCOL REGISTRATION: The detailed study protocol can be found on the PROSPERO website.

The mediating effect of self-efficacy in the relationship between mental health and quality of life in patients with hypertensive nephrology.

AIMS: To examine the factors associated with the quality of life and the mediating effect of self-efficacy in the relationship between mental health and quality of life among patients with hypertensive nephrology. DESIGN: A cross-sectional and correlational study using the Strengthening the Reporting of Observational Studies in Epidemiology checklist guidelines. METHODS: A total of 202 participants were collected from November 2019 to September 2020 from the outpatient department of nephrology of a regional teaching hospital in Taiwan using a convenience sampling method. The research tools included the World Health Organization-5 Well-Being Index, the Chronic Kidney Disease Self-Efficacy Instrument and the Medical Outcome Study Short Form-12. The mediating effect was statistically analysed by linear regression models and verified by Sobel testing. RESULTS: Mental health and self-efficacy were positively correlated with the overall quality of life. The results showed that the total explanatory variation of mental health and self-efficacy on the overall quality of life was 37.1%. Mental health was the most important explanatory factor, which could explain 27.1% of the variations in the overall quality of life alone. Moreover, self-efficacy was a partial mediator in the relationship between mental health and the quality of life among patients with hypertensive nephrology, with a total effect of 34.8%. CONCLUSIONS: The quality of life of this population can be improved by enhancing mental health, leading to an improvement in self-efficacy. Consequently, improved mental health and self-efficacy will improve the overall quality of life. IMPACT: Medical staff should be able to assess patients' mental health in providing referrals and assistance in a timely manner. If intervention programmes can be developed to improve patients' self-efficacy, their quality of life can also be improved.

Differences in self-care knowledge, self-efficacy, psychological distress and self-management between patients with early- and end-stage chronic kidney disease.

AIMS: The study compares the differences in self-care knowledge, self-efficacy, psychological distress and self-management between patients with early- and end-stage chronic kidney disease (CKD), and predicts the influential factors of self-management. DESIGN: A cross-sectional study. METHODS: A total of 185 subjects by using convenience sampling from one teaching hospital were collected. The research instruments included the Chronic Kidney Disease Self-Care Instrument Knowledge, the Chronic Kidney Disease Self-Efficacy Instrument, the Hospital Anxiety and Depression Scale, and the Chronic Kidney Disease Self-Management Instrument. Descriptive statistics is used frequency, percentage, mean and standard deviation. Inferential statistics is used independent t-test, one-way ANOVA and multiple linear regression analysis. STROBE checklist was used as the guideline for this study. RESULTS: Our results showed that a significant difference was found in the age (p = 0.005), systolic pressure (p = .006), self-care knowledge (p = .011) and depression level (p = .003) between patients with early- and end-stage CKD. Furthermore, patients with early-stage CKD have less self-care knowledge and lower depression levels compared with patients with end-stage CKD. However, self-efficacy is the most significant predictor of self-management for patients with early- and end-stage CKD. For patients with early-stage CKD, self-efficacy explained 69.1% of the variation in self-management. CONCLUSION: According to our results, the management of depression in patients with CKD may improve their outcomes. Improving self-care knowledge of patients with end-stage CKD may improve their self-management. Therefore, our findings suggest various interventions with different necessary and prioritised precision care at early- and late-stage of CKD. RELEVANCE TO CLINICAL PRACTICE: Nurses should strive to improve the self-care knowledge of patients with early-stage CKD to delay the progression of the disease to end-stage. Screening for depression among patients with end-stage CKD is relevant, and these patients should be referred to professional counsellors when necessary.

Effectiveness of a self-management program in enhancing quality of life, self-care, and self-efficacy in patients with hemodialysis: A quasi-experimental design.

BACKGROUND: Taiwan has the world's highest prevalence of end-stage kidney disease, as well as the world's third highest incidence. The study investigated the effectiveness of a self-management program for enhancing health-related quality of life, self-care behaviors, and self-efficacy in patients with end-stage kidney disease undergoing hemodialysis. METHODS: This was a quasi-experimental design with convenient sampling, and allocated 32 participants in the control group (conventional program) and 32 participants in the experimental group (self-management program). The self-management program intervention lasted 4 weeks, and a posttest was administered 3 months later. The questionnaire included the 36-Item Short Form Health Survey, a Chronic Kidney Disease Self-Care Instrument, and a Chronic Kidney Disease Self-Efficacy Instrument. RESULTS: Three months after the intervention, the self-management program had improved patients' health-related quality of life in the mental health components (p < .001), but not in the physical health components. The program also promoted patients' self-care behaviors (p < .001) and self-efficacy (p < .05). CONCLUSIONS: This study's findings confirmed that self-management programs should be promoted in clinical practice where they will provide clinical care personnel with an alternative to conventional health education.

Effect of patient-centred self-management programme on mental health, self-efficacy and self-management of patients with hypertensive nephropathy: A randomised controlled trial.

AIM AND OBJECTIVES: To evaluate the effect of patient-centred self-management programme on mental health, self-efficacy and self-management of patients with hypertensive nephropathy. BACKGROUND: If the symptoms of hypertension are not well-controlled, deterioration of renal function will accelerate and evolve into hypertensive nephropathy. DESIGN: A randomised single-blind trial. This article follows the requirements of CONSORT statement. METHODS: The experimental group (n = 35) after pre-test used patient-centred self-management programme once a week for a total of 4 weeks and the intervention effect was measured after 3 months for post-test. Contrarily, the traditional care was employed for the control group (n = 35). The measuring outcomes included mental health, self-efficacy and self-management. Trial registry is listed under https://clinicaltrials.gov/ with Identifier No. NCT04633993. RESULTS: After the intervention, the average score of mental health for the experimental group was 20.79 (SD = 0.82) which was higher than the 19.27 points for the control group (SD = 0.77) and showed a significant difference (F = 8.31, p = .005, partial eta2  = 0.133). In terms of self-efficacy, the average score for the experimental group was 214.13 (SD = 6.40), which was higher than the 189.58 points for the control group (SD = 6.03) and exhibited a significant difference (F = 11.82, p = .001, partial eta2  = 0.197). Regarding self-management, the average score of the experimental group was 75.12 (SD = 2.29) which was significantly higher than the 68.80 points of the control group (SD = 2.43) (F = 11.17, p = .001, partial eta2  = 0.190). CONCLUSIONS: In addition to promoting mental health of individual cases, this intervention also increases their self-confidence in disease control and improves their self-management on diseases. RELEVANCE TO CLINICAL PRACTICE: The intervention provides an effective option for clinical care workers as a replacement for or supplement to the traditional care.

Use of the triglyceride-glucose index (TyG) in cardiovascular disease patients.

Da Silva et al. showed that the triglyceride-glucose (TyG) index was positively associated with a higher prevalence of symptomatic coronary artery disease (CAD). TyG has been used in healthy individuals as a marker of insulin resistance. The use of this index as a marker of atherosclerosis in cardiovascular disease (CVD) patients might be influenced by diabetes and the hyperlipidemic state that led to CVD. Certain considerations might be necessary before we conclude that the TyG index can be used as a marker of atherosclerosis in CVD patients. These factors can highlight the role of fasting blood glucose and triglyceride levels that are used in the TyG formula. Comparing the fasting blood glucose and/or triglyceride levels with the TyG index in these patients to show how much value the TyG index can add to clinical practice seems to be necessary. Conclusions of such studies might be biased by these facts. Stratification by CAD disease category cannot help achieve an understanding of the role of TyG in CVD. Correlations do not imply causation, so the use of the TyG index as an index in CAD patients is questionable.

Using the Cardio-Ankle Vascular Index (CAVI) or the Mathematical Correction Form (CAVI0) in Clinical Practice.

Tonhajzerova et al [...].

Anxiety and work stress among newly employed nurses during the first year of a residency programme: A longitudinal study.

AIM: To explore changes in anxiety and work stress among new nurses in the first year of a 2-year residency programme. BACKGROUND: Few studies have examined the anxiety and work stress of new nurses in a residency programme. METHODS: This longitudinal study examined levels of anxiety and work stress among newly employed nurses over 1 year at 1 week and 1, 2, 3, 6, 9 and 12 months. Participants were purposively sampled from a medical centre in Taiwan. The Beck Anxiety Inventory and the Nurse Stress Checklist were used to measure anxiety and stress, respectively. RESULTS: The nurses (N = 200) generally perceived mild levels of anxiety and moderate work stress. However, anxiety and stress peaked at the first and second months. Levels stabilized by the sixth month. General ward nurses perceived higher stress levels than did those in emergency or operating rooms. CONCLUSIONS: Stress and work anxiety for new nurses peaked at 1-2 months of employment. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers, preceptors and educators must work together with newly employed nurses in individualized learning and support, doing so to improve the transition experience and reduce levels of work stress and anxiety.

Association of Kidney Function Tests with a Cardio-Ankle Vascular Index in Community-Dwelling Individuals with a Normal or Mildly Decreased Estimated Glomerular Filtration Rate.

Background and objectives: Chronic kidney disease (CKD) is an independent risk factor for cardiovascular disease (CVD). Previous studies reported controversial results about the independence of CKD as a risk factor for atherosclerosis. In this study, we tried to determine whether the estimated glomerular filtration rate (eGFR) and other renal function tests are independent factors associated with arterial stiffness in community-dwelling individuals with a normal (≥90) or slightly decreased eGFR (60-90). Materials and Methods: Data of 164 community individuals were analyzed, and demographic information, related disease history, atherosclerosis risk factors, certain laboratory tests, the estimated eGFR, and urine albumin creatinine ratio (UACR) were recorded for each individual. Results: The age, systolic blood pressure (SBP), hypertension (HTN), and cardio-ankle vascular index (CAVI) significantly differed between individuals with a normal and those with a slightly decreased eGFR. Blood urea nitrogen (BUN), glycated hemoglobin (HBA1c), and the eGFR significantly differed between the high- and low-CAVI groups and were also significantly correlated with the CAVI. The relationship between the eGFR and CAVI was shown to be independent of other atherosclerosis risk factors in a multiple linear regression model. Conclusions: We concluded that evaluations of the eGFR, HTN, body-mass index, and SBP can be used in a model for arterial stiffness risk assessments for community-dwelling individuals with a normal or slightly decreased eGFR.

Prediction of self-care behaviour on the basis of knowledge about chronic kidney disease using self-efficacy as a mediator.

AIMS AND OBJECTIVES: This study was to investigate: (1) the important factors in the self-care of chronic kidney disease (CKD) patients and (2) the mediating effects of self-efficacy on knowledge and self-care. BACKGROUND: Chronic kidney disease has become a major global health issue and is one of the top 10 leading causes of death in Taiwan where the dialysis population ranks first in the world. The number of patients with poor self-care behaviours continues to rise despite ongoing health education. Knowledge and self-efficacy are important factors that influence self-care behaviour; however, very few articles have examined the relationships among them. DESIGN: Cross-sectional and correlational design. METHODS: Subject recruitment was conducted by purposive sampling in the renal outpatient clinics and dialysis centres of two teaching hospitals in northern Taiwan. A total of 247 patients with chronic kidney disease (stages 1-5) were enrolled. RESULTS: (1) Knowledge was positively correlated with self-efficacy (r = 0·41, p < 0·01) and with self-care (r = 0·18, p < 0·01). Self-efficacy (r = 0·44, p < 0·01) as well as age (r = 0·15, p < 0·01) were positively correlated with self-care. (2) The relationship between knowledge and self-care was fully mediated by self-efficacy (z = 4·82, p < 0·001) and the effect was 50%. CONCLUSION: The results showed that self-efficacy was a crucial mediator between knowledge and self-care. In addition to providing knowledge to chronic kidney disease patients, healthcare professionals should also offer strategies that can enhance self-efficacy to increase self-care behaviours in chronic kidney disease patients and implement effective disease management. RELEVANCE TO CLINICAL PRACTICE: Incorporate self-efficacy strategies into the process of health education to improve knowledge and the effectiveness of self-care. The findings of this study provide evidence of effectiveness of the use of group activity through self-management and self-efficacy enhancement programmes and may influence the policy makers to consider adding or modifying the reimbursement criteria.

Biofeedback relaxation for pain associated with continuous passive motion in Taiwanese patients after total knee arthroplasty.

Effective pain management is crucial for patient recovery after total knee arthroplasty (TKA). Biofeedback therapy, which encourages relaxation and helps alleviate various conditions associated with stress, may help to decrease postoperative pain in patients undergoing TKA. A quasi- experimental design was used to investigate the efficacy of a biofeedback relaxation intervention in reducing pain associated with postoperative continuous passive motion (CPM) therapy. Sixty-six patients admitted to a general hospital in Taiwan for TKA were recruited and randomly assigned to the intervention or control group. The intervention group received biofeedback training twice daily for 5 days, concurrent with CPM therapy, whereas the control group did not receive the biofeedback intervention. Pain was measured using a numeric rating scale before and after each CPM therapy session on postoperative days 1 through 5. The CPM-elicited pain score was calculated by subtracting the pre-CPM pain score from the post-CPM pain score. Results of repeated-measures analysis of variance showed intervention group reported significantly less pain caused by CPM than did the control group (f = 29.70, p < 0.001). The study results provide preliminary support for biofeedback relaxation, a non-invasive and non-pharmacological intervention, as a complementary treatment option for pain management in this population.

[The Development of a Care Protocol for Postoperative Pressure Sore Prevention].

Pressure sores are a common complication caused by long periods of bed rest following major surgery. These sores may increase patient postoperative pain, increase the risk of infections, lengthen the pe-riod of hospitalization, and increase the duration and costs of nursing care. Therefore, maintaining the skin integrity of surgical patients is an important responsibility for operating room nurses and an indicator of nursing care quality. While pressure-sore risk assessment tools and interoperative strategies are available and used in foreign countries, there has been little related research conducted in Taiwan. After examining the relevant literature and considering the current postoperative pressure sore situation in Taiwan, the author developed a postoperative pressure sore care protocol as a reference for clinical staff. Protocol procedures include major breakthrough developments in areas such as post-survey risk assessment for pressure ulcers, pressure ulcer prevention strategies that take surgery-related risk factors into consideration, extra care and protection measures for surgical supine patients, and post-pressure sores. The developed postoperative pressure sore protocol may be incorporated into surgical care procedures during the post-surgical care period in order to effectively prevent the occurrence of post-surgery pressure ulcers. Furthermore, the developed protocol offers the potential to improve and strengthen the quality of surgical care in terms of both healthcare and post-surgical care.

The efficacy of a self-management programme for people with diabetes, after a special training programme for healthcare workers in Taiwan: a quasi-experimental design.

AIMS AND OBJECTIVIES: To analyse the efficacy of improving disease management after implementing a self-management programme for people with type 2 diabetes administered by healthcare workers who have received special training. BACKGROUND: The needs for diabetic care include increased training for healthcare providers to enhance their confidence and skills in managing patients, both physically and mentally. DESIGN: Quasi-experimental design. METHODS: This study recruited participants from outpatient clinics in 10 hospitals in Taiwan. In 2010, purposive sampling was used to recruit 228 participants from two medical centres, five regional hospitals and three district hospitals. Participants were enrolled in a 'diabetes self-management programme' (watching patient videos, reading a diabetes self-care handbook, participating in four consultation courses of diabetes self-efficacy improvement, telephone follow-up and positive reinforcement). Efficacy analysis of post-test diabetes outcome variables of the experimental group was carried out. Sex, age and pretest score were used as the control variables for ancova test. RESULTS: Patients in the experimental group had significant improvement in body mass index (p < 0·01), waistline circumference (p < 0·001), haemoglobin A1C levels (p < 0·001), degrees of anxiety and depression (p < 0·001), self-efficacy (p < 0·001) and levels of self-care (p < 0·001). CONCLUSION: Self-efficacy of people with diabetes can be effectively improved by planned implementation of a 'diabetes self-management programme' by trained healthcare workers. RELEVANCE TO CLINICAL PRACTICE: The diabetes care professionals are provided the self-management programme to strengthen the awareness and importance of self-management in diabetes care.

Factors influencing peritoneal dialysis patients' psychosocial adjustment.

AIMS AND OBJECTIVES: The specific aims of this study were as follows: (1) to describe psychosocial adjustment in adults with end-stage renal disease who underwent maintenance peritoneal dialysis; (2) to explore the influence of demographics, clinical variables, symptom distress and social support on psychosocial adjustment and (3) to determine predictive factors of psychosocial adjustment. BACKGROUND: Proper psychosocial adjustment is important for patients with end-stage renal disease to cope with multiple stressors of their disease and to balance their lives within the restrictions imposed by peritoneal dialysis treatment. Knowledge on psychosocial adjustment in patients receiving long-term peritoneal dialysis has been limited. DESIGN: The study was based on a predictive correlational design. METHOD: One hundred peritoneal dialysis patients were recruited from outpatient peritoneal dialysis clinics of a general hospital in Taipei, Taiwan. Data were collected with the study questionnaires, including the Physical Symptom Distress Scale, the Social Support Scale and the Psychosocial Adjustment to Illness Scale - self-report. RESULTS: The mean score on the Psychosocial Adjustment to Illness Scale was 359.7 (SD = 40.0), indicating that these participants were moderately struggling in adjusting to their illness. Symptom distress, family social support and financial status explained 38.3% of the variance in psychosocial adjustment (F3,96 = 21..5, p < 0.001). CONCLUSIONS: The level of psychosocial adjustment in peritoneal dialysis patients is suboptimal. Overall, the patients with high physical symptom distress, weak family social support and poor financial status reported deficient psychosocial adjustment to their illness. IMPLICATIONS FOR PRACTICE: The findings of this study are relevant to the understanding of preconditions that enable peritoneal dialysis patients to successfully adjust to the disease and its diverse consequences. Patients with insufficient income, higher symptom distress and less family social support have a greater risk of psychosocial maladjustment. Medical professionals may use these variables to identify higher risk groups for early intensive intervention.

Efficacy of narrowband ultraviolet phototherapy on renal pruritus.

AIMS AND OBJECTIVES: To test the efficacy of narrowband ultraviolet B phototherapy in reducing renal pruritus. BACKGROUND: Renal pruritus is a disabling symptom affecting approximately 50% of patients undergoing maintenance haemodialysis. Managing refractory pruritus can be a great challenge for healthcare providers and patients as well. For patients who do not respond to conventional treatments, ultraviolet B phototherapy is considered the treatment of choice. Few investigators, however, have studied the efficacy of narrowband ultraviolet B phototherapy in this condition. DESIGN: The study was based on a quasi-experimental design with repeated measures. METHODS: A convenience sample of 42 haemodialysis patients with pruritus was recruited from haemodialysis units of a general hospital in Taipei, Taiwan. Two groups were created according to the dates of haemodialysis. The intervention participants received narrowband ultraviolet B phototherapy three times a week for two weeks. The control participants were maintained on their prior pruritus treatment. The pruritus intensity was measured with a numerical rating scale at baseline and on alternating days for seven times. Data were collected during the year 2008. RESULTS: The generalised estimating equation showed statistically significant group-by-time interactions in pruritus intensity. Using the control group as the reference group and baseline as the reference time, the intervention group had significantly lower pruritus intensity than the control group: 3·14 (p < 0·001) at time seven, 1·71 (p < 0·001) at time six and 1·24 at time five (p < 0·001). The group-by-time interactions were statistically significant after four sessions of narrowband-UVB irradiation. CONCLUSION: The study findings support the efficacy of narrowband ultraviolet B phototherapy in alleviating renal pruritus. RELEVANCE TO CLINICAL PRACTICE: Clinicians may consider prescribing phototherapy for haemodialysis patients who have intractable renal pruritus and do not respond to conventional treatments.

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.