Evaluation of an inpatient fall risk screening tool to identify the most critical fall risk factors in inpatients.

AIMS AND OBJECTIVES: To evaluate the accuracy of the inpatient fall risk screening tool and to identify the most critical fall risk factors in inpatients. BACKGROUND: Variations exist in several screening tools applied in acute care hospitals for examining risk factors for falls and identifying high-risk inpatients. DESIGN: Secondary data analysis. METHODS: A subset of inpatient data for the period from June 2011-June 2014 was extracted from the nursing information system and adverse event reporting system of an 818-bed teaching medical centre in Taipei. Data were analysed using descriptive statistics, receiver operating characteristic curve analysis and logistic regression analysis. RESULTS: During the study period, 205 fallers and 37,232 nonfallers were identified. The results revealed that the inpatient fall risk screening tool (cut-off point of ≥3) had a low sensitivity level (60%), satisfactory specificity (87%), a positive predictive value of 2·0% and a negative predictive value of 99%. The receiver operating characteristic curve analysis revealed an area under the curve of 0·805 (sensitivity, 71·8%; specificity, 78%). To increase the sensitivity values, the Youden index suggests at least 1·5 points to be the most suitable cut-off point for the inpatient fall risk screening tool. Multivariate logistic regression analysis revealed a considerably increased fall risk in patients with impaired balance and impaired elimination. The fall risk factor was also significantly associated with days of hospital stay and with admission to surgical wards. CONCLUSIONS: The findings can raise awareness about the two most critical risk factors for falls among future clinical nurses and other healthcare professionals and thus facilitate the development of fall prevention interventions. RELEVANCE TO CLINICAL PRACTICE: This study highlights the needs for redefining the cut-off points of the inpatient fall risk screening tool to effectively identify inpatients at a high risk of falls. Furthermore, inpatients with impaired balance and impaired elimination should be closely monitored by nurses to prevent falling during hospitalisations.

[Reliability and Validity Testing of the Taiwanese Inpatient Nursing Care Satisfaction Scale: A Pilot-Study].

BACKGROUND: Inpatient nursing care satisfaction is an important indicator of medical care quality. However, no reliable and validated tool is currently available in Taiwan to measure the satisfaction of inpatients with nursing care. PURPOSE: This pilot study developed a reliable and validated scale for measuring inpatient nursing care satisfaction in Taiwan. METHODS: First phase: literature review and expert focus group discussion constructs the content of the questionnaire to be used to assess inpatient nursing care satisfaction. Second phase: experts were requested to validate questionnaire content. Third phase: convenience sampling was used to recruit 766 inpatients from 6 hospitals to complete the validated questionnaire. The data collected from the questionnaire were analyzed using item analysis, construct validity, and internal consistency. The results of analysis were used to determine the reliability and validity of the developed scale. RESULTS: The 20-item Taiwanese inpatient nursing care satisfaction scale was developed, with a CVI (content validity index) of expert validity of .97, item discrimination CR (critical ratio) of 28.61-50.25 (p < .001), and item-total correlation of .68-.84 (p < .001). Two factors, including "professional knowledge & skill" and "environmental control" were extracted by exploratory factor analysis after the deletion of 5 items, with item factor loadings ranging from .61 to .84. The factors explained 71.40% of total variance. The internal consistency of the two categories of Cronbach's α was .94-.97 coefficient and the overall internal consistency coefficient was .97. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: This study confirms the validity of the developed Taiwanese inpatient nursing care satisfaction scale and suggests that this instrument is reliable for measuring the satisfaction of inpatients with nursing care in Taiwan.

Comparisons of self-ratings on managerial competencies, research capability, time management, executive power, workload and work stress among nurse administrators.

AIMS: To assess the level of and the differences in managerial competencies, research capability, time management, executive power, workload and work-stress ratings among nurse administrators (NAs), and to determine the best predictors of managerial competencies for NAs. BACKGROUND: Although NAs require multifaceted managerial competencies, research related to NAs' managerial competencies is limited. METHOD: A cross-sectional survey was conducted with 330 NAs from 16 acute care hospitals. Managerial competencies were determined through a self-developed questionnaire. Data were collected in 2011. RESULTS: All NAs gave themselves the highest rating on integrity and the lowest on both financial/budgeting and business acumen. All scores for managerial competencies, research capability, time management and executive power showed a statistically significant correlation. The stepwise regression analysis revealed that age; having received NA training; having completed a nursing project independently; and scores for research capability, executive power and workload could explain 63.2% of the total variance in managerial competencies. CONCLUSION: The present study provides recommendations for future administrative training programmes to increase NAs' managerial competency in fulfilling their management roles and functions. IMPLICATIONS FOR NURSING MANAGEMENT: The findings inform leaders of hospitals where NAs need to develop additional competencies concerning the type of training NAs need to function proficiently.

[Reducing occupational burnout and enhancing job performance in new nurses: the efficacy of "last mile" programs].

BACKGROUND: New nurses undergo a stressful and challenging transition process in the nursing workplace. Lack of patient care knowledge and skills and work adaption difficulties lead to a high turnover rate that drains essential new talent away from the nursing profession and further exacerbates professional staffing shortages in the healthcare sector. The "last mile" program is a program developed jointly by a nursing school and hospital as a mechanism to bridge classroom learning to clinical practice and smooth the transition of nursing students into nursing professionals. PURPOSE: The purpose of this study was to understand the effect of the "last mile" program on job performance and occupational burnout among new nurses. METHODS: We conducted a quasi-experimental study in 2009 on a convenience sample of new nurses in a medical center. Participants were assigned into two groups, namely those enrolled in the last mile program (n = 29) and those not enrolled in the program (n = 94). Research team members and several collaborative universities developed the last mile program used in this study; Seven experts established content validity; The last mile program included 84 hours of lecture courses and 160 hours of clinical practice. Data was collected using the nursing job performance scale developed in 2007 by Greenslade and Jimmieson and translated ÷ back translated into an equivalent Chinese version. Exploratory factor analysis showed all items aggraded into 8 factors, which could be divided into task performance and contextual performance concept categories. Task performance concepts included: social support, information, coordination of care, and technical care; Contextual performance concepts included: interpersonal support, job-task support, volunteering for additional duties and compliance. The Cronbach's α for the 8 factors were .70-.95. The occupational burnout inventory included the 4 subscales of personal burnout, work-related burnout, client-related burnout, and over-commitment, with associated Cronbach's α ranging from .84-.90. Data was collected at one, three, and six months after employment. Repeated measures ANOVA and an independent t-test were used to analyze data. RESULTS: The average age of the 123 participants surveyed was 23 years, with no differences identified between last-mile and non-last-mile groups in terms of education level, work unit, or other demographic variables. New nurses who participated in the last mile program achieved significantly higher performance scores for job-task support, volunteering for additional duties, and overall task and contextual performance than those who did not. Last-mile-program group participants also had significantly lower client-related burnout than their non-last-mile-program peers. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The last mile program facilitates new nurses' contextual performance and reduces incidence of care burnout. The cooperative education model linking universities and hospitals can be a positive component in a new nurse retention strategy for hospital administrators and educators.

Effectiveness of Elastic Band Exercises on the Functional Fitness of Older Adults in Long-Term Care Facilities.

BACKGROUND: Population aging has caused a rise in the institutionalization, disability, and mortality rates of older adults worldwide. Older adults are able to engage in muscle training. Elastic band exercises can safely and effectively improve the upper and lower muscle strength and balance of older adults. PURPOSE: This study was developed to examine the effects of a 3-month elastic band exercise program on the activities of daily living (ADLs), hand muscle strength, balance, and lower limb muscle strength of older adults living in institutional settings. METHODS: This was a randomized controlled trial. Sixty-one participants were randomly sampled from two long-term care facilities (LTCFs) in northern Taiwan (31 participants in the experimental group and 30 participants in the control group). Both groups underwent pretesting concurrently. The experimental group participated in 3 months of elastic band exercises, whereas the control group participated in the routine exercise program in their LTCFs. All of the participants were tested 1 and 3 months after the intervention. RESULTS: The average ADL, hand muscle strength, balance, and lower limb muscle strength scores of participants in the experimental group had improved significantly more than those of the control group at posttest (all p s < .05). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Elastic band exercises positively affect ADLs, hand muscle strength, balance, and lower limb muscle strength in older adults living in LTCFs. Moreover, the high benefit-to-cost ratio of these exercises helps lower the threshold of health promotion. We recommend including elastic band exercises in routine activities and designing different elastic band exercises for older adults at different proficiency levels. Furthermore, an elastic band exercise network should be established to improve the policy and implementation aspects of elastic band activities, raise awareness among community-dwelling and institutionalized older adults, and promote elastic band exercises to LTCFs nationwide.

Awareness of hypertension guidelines in Taiwanese nurses: a questionnaire survey.

BACKGROUND AND RESEARCH OBJECTIVE: Nurses play an important role in hypertension prevention and management because of their unique positions in patient education. However, the effectiveness of patient education relies largely on the nurse's level of awareness of the current hypertension guidelines. The purpose of this study was to examine the level of awareness of hypertension guidelines and associated factors among nurses in Taiwan. SUBJECTS AND METHODS: A cross-sectional survey was conducted in 10 hospitals in northern Taiwan. The Hypertension Management Questionnaire was developed based on the Taiwan Hypertension Guidelines and the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. RESULTS: The survey return rate was 95.9%. A total of 1418 nurses were included in the analysis. Adequate guideline awareness was found in 49.5% of the total sample. Among the 7 dimensions of the Hypertension Management Questionnaire, the definition of hypertension, methods for blood pressure measurements, and impact of high blood pressure on cardiovascular disease had the lowest rates of correct answers. Multiple regression analysis revealed that the nurses' clinical experience, educational level, work setting, in-service education training on hypertension, and level of the hospital (R2 = 35.4%, F = 52.89, P < .001) independently predicted the nurse's level of awareness. CONCLUSIONS: A large proportion of the nurses in northern Taiwan had insufficient knowledge of the hypertension guidelines.

Association between serum bilirubin levels and progression of albuminuria in Taiwanese with type 2 diabetes mellitus.

BACKGROUND: To investigate the association between serum bilirubin (BIL) levels and the progression of albuminuria in type 2 diabetic Taiwanese. METHODS: Longitudinal data from January 2001 to June 2015 were retrospectively reviewed from Chang Gung Memorial Hospital in Taiwan. A total of 2877 type 2 diabetic patients with normal total BIL levels were divided into 4 groups according to BIL, with the highest BIL in the fourth group. The urinary albumin/creatinine ratio (UACR) trend and progression, as well as other laboratory measurements, were evaluated among the four groups. The cumulative incidence and Cox proportional hazard model analysis were performed to examine the relationship between BIL and the risk of albuminuria progression (AUPr). RESULTS: The mean duration of follow-up was 1.5 years (±1.37 years). The mean patient age, glycosylated hemoglobin level, and duration of diabetes were 62.52 years, 7.9%, and 3.94 years, respectively. A significant correlation was observed between BIL and both the UACR at baseline (P < 0.001) and the cumulative incidence of AUPr (log-rank test, P = 0.031). Hazard ratio (HR) analysis revealed that patients in the fourth BIL quartile had the lowest HR risk of AUPr among the four groups (adjusted HR = 0.70; 95% Confidence Interval = 0.56-0.89, P < 0.05). CONCLUSIONS: Higher serum BIL levels are associated with a lower risk of AUPr in type 2 diabetes patients in Taiwan.

Ameliorative effects of stabilized rice bran on type 2 diabetes patients.

BACKGROUND/AIM: While it has been demonstrated that rice bran might lower the cholesterol level in hypercholesterolemic individuals, its effects on the levels of adiponectin and glycated hemoglobin (HbA1c) in patients with type 2 diabetes mellitus remain unknown. METHODS: Twenty-eight volunteers with type 2 diabetes were randomly divided into 2 groups, one of which received a dietary supplement of 20 g of stabilized rice bran and the other placebo once daily for 12 weeks. Parameters such as the level of HbA1c, glucose, insulin, homeostasis model assessment for estimation of relative insulin resistance, high-density and low-density lipoprotein (LDL) cholesterol and adiponectin were evaluated. RESULTS: At the end of the study period, postprandial glucose and the area under the glucose curve of the rice bran group were significantly lower than baseline levels by 14.4 and 15.7%, respectively. Compared to baseline, the HbA1c values in the rice bran group were also significantly lower. Serum total cholesterol and LDL cholesterol concentrations in the rice bran group were 9.2 and 13.7% lower, respectively, than in the placebo group. The plasma free fatty acid and adiponectin concentrations were 20% lower and 40% higher in the rice bran group compared to the placebo group. CONCLUSIONS: This study demonstrated that stabilized rice bran can lower the level of HbA1c and blood lipids and increase blood adiponectin concentrations in type 2 diabetic subjects. In light of this, we conclude that stabilized rice bran may represent an important functional nutrient to ameliorate lipid and glycemic anomalies in type 2 diabetic subjects.

[Role transition and working adaption in new nursing graduates: a qualitative study].

BACKGROUND: The role transition process is full of stresses and challenges for nurses. Between 35-61% nurses leave their job within the first year. Past cross-sectional quantitative studies have not provided deep descriptions of either the dynamic role transition or work adaption processes of new nurses. PURPOSE: The purpose of this study was to understand the role transition experience of new nurses as they transitioned into clinical practice during their first three months on the job. METHODS: A qualitative approach was used. Data were collected through a semi-structured interview from 50 new nurses. Data were analyzed using category-content analysis. RESULTS: Three stages were identified in the new nurse work adaption process over the first three-month period. These included (1) Understanding: New nurse knowledge and skills are insufficient to handle routine work, adapting to the role transition is difficult, feelings of anxiety emerge related to fears of incompetence, communication difficulties must be faced in the handover process, new nurses adopt feelings of attachment to their preceptors, they must work to adopt appropriate attitudes and approaches to nursing practice, and support is sought from family, teachers and friends; (2) Acclimation: Learning to care for patients independently, seeking role models, learning to adapt to night shifts, trying to identify with co-workers, and seeking support from colleagues, preceptors and head nurses; (3) Acceptance: Managing nursing work better in terms of time and organization, feeling gradual acceptance from co-workers, restoring personal enthusiasm for work, starting to consider other, non-work related matters, experiencing and appreciating the support of co-workers and head nurses. CONCLUSIONS/IMPLICATION: New nurses face a critical role transition process through their first three months on the job. Guidance and leadership from experienced nurses and multiple support systems can assist new nurses to acclimate to their role. Research results provide information for educators and administrators to better understand the adaption process of new nurses, and offer a reference for developing future strategies to improve nurse competency in handling their work.

The effect of ankle position on pelvic floor muscle contraction activity in women.

PURPOSE: Stress urinary incontinence is extremely common in women. Conservative management includes pelvic floor muscle exercises to increase strength and muscular contraction forces to improve incontinence. We examined the effects of passive and active ankle flexion on pelvic floor muscle activity during exercises. MATERIALS AND METHODS: A total of 31 married women performed random pelvic floor muscle contractions while standing, and in 8 passive and active positions while pelvic floor muscle activity was simultaneously measured by electromyography. RESULTS: All ankle positions resulted in greater pelvic floor muscle activity than the horizontal foot position. Significantly greater muscle activity was seen with ankles in the plantar position with raised arms (p = 0.0051). CONCLUSIONS: Pelvic floor muscle exercises performed with active ankle positions may increase the effectiveness of these exercises. Further studies are required to elucidate mechanisms for this finding.

An evaluation of a weight-loss program incorporating E-learning for obese junior high school students.

Obesity in adolescents is continuing to rise at an alarming rate and is becoming an important public health problem in Taiwan. Therefore, the aims of this study were (1) to evaluate the effectiveness of a Weight-loss E-learning Program (WEP) on obese Chinese adolescents and (2) to gauge this group's satisfaction with the WEP. The design was quasi-experimental, using purposive samples from two junior high schools in Taipei, Taiwan. Obese adolescents between 12 and 14 years of age with body mass indexes (BMI) over 25 kg/m2 were recruited. A 14-week WEP was developed to expedite weight loss for the selected adolescents. Data such as BMI, waist-to-hip ratio, waist circumference, hip circumference, mid-arm circumference, triceps skinfold, blood pressure, and physical fitness were collected through standardized instruments and methods before and after the WEP. The satisfaction of the subjects and four psychosocial variables were evaluated and taken into account by authoritative scales and questionnaires. In total, 37 adolescents participated in this study. After the WEP, we found significant decreases in BMI (p < 0.05), waist circumference (p < 0.05), and triceps skinfold (p < 0.001) in the sample population. Improvements were found in three of four tests of physical fitness (p < 0.001, p < 0.05, and p < 0.01, respectively). All psychosocial variables showed significant favorable changes (p < 0.01 for self-esteem scores, p < 0.001 for the other three variables) and satisfaction levels for the WEP ranged from 56.6% to 83.8% in four different criteria. The WEP was effective in helping obese Chinese adolescents lose weight. However, there is still room for improvement.

E-Learning education program for registered nurses: the experience of a teaching medical center.

The aim of this study was to describe registered nurses' experiences with an e-learning education program (ELEP) conducted at a 776-bed teaching medical center in Taipei. The study was completed in three stages: planning, implementation, and evaluation. Nurses who were registered were randomly assigned either to the ELEP or traditional in-classroom program (TICP). Data were analyzed using descriptive and inferential statistics. Forty-two nurses participated (22 in the ELEP and 20 in the TICP). Scores for participants were all > 70 points (out of 100) for both programs. Of the five courses, only teaching and learning and communication showed significant statistical difference between the two groups (p = .001). Nearly all participants (97.6%) felt satisfied with their program (both ELEP and TICP). All nurses passed the nursing care skill tests. Findings should help guide efforts to popularize e-learning education in Taiwan and help create alternative learning methods for future continuing nursing education programs.

A comparison of glycated albumin and glycosylated hemoglobin for the screening of diabetes mellitus in Taiwan.

OBJECTIVE: Glycated albumin (GA) values reflect an average plasma glucose level over approximately 2-4 weeks, and the assay is stable and can be run on serum or plasma. The aim of this study was to determine the universality and the clinical utility of GA in screening for diabetes mellitus. METHODS: Subjects consisted of 2192 male and female residents in Yi-lan County, Northern Taiwan (mean age 60.1 years), of whom 54.2% (n = 1188) had previously been diagnosed and treated for diabetes. Fasting blood samples were obtained to measure HbA1c, plasma glucose, serum GA, insulin, and measures of kidney and liver function. The reference values for these parameters were determined. Data from patients with diabetes and non-diabetic controls were also compared. RESULTS: Mean GA values were 13.8% in controls and 18.1% in diabetic subjects (31.2% higher, p < 0.0001), while mean HbA1c values were 5.6% in controls and 7.2% in diabetic subjects (29.2% higher, p < 0.0001). The 95th percentile values for GA and HbA1c in controls were 16.1% and 6.2%, respectively. Our suggested GA and HbA1c cut-points for prediabetes at the 75th percentile of the normal population would be 14.6% and 5.8%, respectively. For both parameters, values greater than these cut-points provided a reasonable degree of specificity and sensitivity for risk of having diabetes, while a GA value of 16.5% corresponds to an HbA1c level of 6.5%, diagnostic of diabetes. CONCLUSION: These data indicate that GA values can be used as a surrogate parameter for HbA1c in screening for prediabetes and diabetes mellitus.

Prevalence and impact on quality of life of lower urinary tract symptoms among a sample of employed women in Taipei: a questionnaire survey.

BACKGROUND: Previous studies about the prevalence and impact of lower urinary tract symptoms (LUTS) were focused on urinary incontinence or overactive bladder in the general population. Little research has been focused on the role that the workplace has in employed women's experiences with LUTS or the impact of LUTS on their health-related quality of life (HRQL). OBJECTIVES: To estimate the prevalence of LUTS among employed female nurses in Taipei and to compare the HRQL for nurses with and without LUTS. DESIGN: This study was a cross-sectional, questionnaire survey. SETTINGS: Three medical centers and five regional hospitals in Taipei were selected randomly. PARTICIPANTS: In the selected hospitals, 1065 female nurses were selected randomly. Data analyses were based on 907 usable surveys. All participants were native Taiwanese; most of the female nurses were 26-35 years of age (mean=31.02, SD=6.32), had normal body mass index, and had never given birth. Most nurses' bladder habits were poor or very poor and their personal habits of fluid consumption at work were inadequate. METHODS: Data were collected using the Taiwan Nurse Bladder Survey and the Short Form 36 Taiwan version. Chi-square tests were used to compare the prevalence rates of different LUTS for nurses in different age groups. Student's t-tests were conducted to compare the mean scores of HRQL for nurses with and without LUTS. RESULTS: Based on 907 usable surveys, 590 (65.0%) experienced at least one type of LUTS. The prevalence for different LUTS ranged from 8.0% to 46.5%. Nurses who reported LUTS also reported lower HRQL, more so on physical health than mental health, than nurses who did not report LUTS. CONCLUSIONS: Although most of the nurses in this study were young (< or =35 years) and nulliparous, LUTS were common among this group. The high prevalence rate of LUTS leads to concerns about nurses' possible dysfunctional voiding patterns and possible effects of working environment and poor bladder and personal habits on LUTS. Study results showed a possible negative impact of LUTS on nurses' physical health. Designing a continence-related education program for this group is essential for delivering information about LUTS prevention and management.

Risk factors for peripheral intravenous catheter infection in hospitalized patients: a prospective study of 3165 patients.

We conducted a prospective study of 6538 polyurethane peripheral intravenous (IV) catheters in 3165 hospitalized adult patients using semiquantitative culture techniques. We found that extending the scheduled catheter replacement interval from 48 to 72 hours to 72 to 96 hours was not a risk factor for local catheter infection, but that catheter insertion by personnel other than IV therapists and the use of continuous infusion to maintain catheter patency were 2 independent risk factors for infection.