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 exergaming on cognitive functions and loneliness of older adults with cognitive frailty.

OBJECTIVES: Cognitive frailty combines physical frailty and cognitive impairment in the absence of dementia. The prompt detection of cognitive frailty and early implementation of preventive interventions may reduce the incidence of dementia. However, intervention studies of exergaming in older adults with cognitive frailty are scant. Therefore, we aim to investigate the effectiveness of exergaming on cognitive functions and loneliness among older adults with cognitive frailty. DESIGN: Quasi-experimental design. METHODS: Participants were recruited from four community settings. The experimental group participated in two 40-min group exergaming sessions weekly for eight weeks; the control group received usual care. The outcome measures were the Montreal Cognitive Assessment (MoCA) and the Chinese Version of the Loneliness Scale. Analyses of covariance were conducted to analyze whether exergaming influenced participants' cognitive functions and loneliness. In addition, the effect size of the posttest of the experimental group relative to its baseline value was calculated to determine the effectiveness of the intervention. RESULT: 69 older adults with cognitive frailty were included, and 35 and 34 were assigned to the experimental and control groups, respectively. The exergaming effectively improved the cognitive function of older adults with cognitive frailty. CONCLUSIONS: Exergaming interventions can effectively improve the cognitive functions of older adults with cognitive frailty but do not positively affect loneliness. We provide evidence to healthcare workers to apply exergaming interventions for older adults with cognitive frailty to improve cognitive function.

Prevalence of sarcopenia and its association with diet and physical activity in older adults with type 2 diabetes: A cross-sectional study.

This cross-sectional study explored the prevalence of sarcopenia in older adults with type 2 diabetes and investigated the effects of diet and physical activity on sarcopenia. In total, 577 older adults with diabetes were recruited from a teaching hospital in Taiwan. Diet and physical activity were assessed using self-rated questionnaires, including the Healthy Diet Inventory, the Mini Nutritional Assessment-Short Form, and the International Physical Activity Questionnaire-Short Form. Sarcopenia was defined in accordance with the Asian Working Group for Sarcopenia 2019 guidelines. In total, 51.12% of participants had either possible sarcopenia, sarcopenia, or severe sarcopenia. Participants who were female, old age, prolonged sedentary times, poor nutritional status, and lower level of moderate-to-vigorous physical activity were identified as risk factors for possible to severe sarcopenia. Older adults with diabetes and possible to severe sarcopenia had poor nutrition status and engaged in inadequate physical activity. The findings indicate that sarcopenia may be related to nutrition status and physical activity, especially in older adults with diabetes.

Development and validation of a new tool: The sarcopenia knowledge questionnaire.

We developed a new questionnaire-the Sarcopenia Knowledge Questionnaire (SKQ)-to evaluate the level of awareness about sarcopenia among older adults and tested the reliability and validity of this tool. A total of 293 older adults completed the questionnaire. The SKQ comprises three domains including 23 items: screening and diagnosis (10 items), sarcopenia outcomes (7 items), and lifestyle factors (6 items). The Cronbach's α value was 0.969, which indicated excellent internal consistency. The SKQ correlated well with the Mandarin Multidimensional Health Literacy Questionnaire (r = 0.511; p < 0.001), confirming its moderate convergent validity. The absolute values of the critical ratio ranged from 9.90 to 25.82 (p < 0.001), indicating satisfactory item discrimination. Thus, the SKQ appears to be a valid and reliable instrument for evaluating the knowledge of older adults about sarcopenia.

Lifestyle factors associated with muscle quality in community-dwelling older people with type 2 diabetes in Japan and Taiwan: a cross-sectional study.

BACKGROUND: Type 2 diabetes mellitus (T2DM), common in older people, is an important reason for muscle loss in Japanese and Taiwanese populations. However, little is known about the association between lifestyle behaviours and muscle quality. We aimed to compare the lifestyle behaviours of Japanese and Taiwanese older adults with T2DM and to the identify lifestyle factors associated with muscle quality. METHODS: This cross-sectional study was conducted among community-dwelling individuals with T2DM aged ≥65 years in Taiwan and Japan. Totally, 114 Japanese and 226 Taiwanese participants were enrolled in the study. Outcomes were measured by blood biochemical examinations, body composition analyses and structured self-reported questionnaires to assess lifestyle behaviours and muscle quality. Linear regression models were used to examine the relationship between lifestyle factors and muscle quality using SPSS version 27.0 with a statistical significance level of P < 0.05. RESULTS: Japanese subjects were more likely to be smokers and alcohol consumers, and they were less likely to have well-balanced diets and engage in more physical activity as compared to Taiwanese subjects. The muscle quality in the Japanese subjects was significantly poorer than that in the Taiwanese subjects. Physical activity, dietary habits and smoking were associated with muscle quality, after adjusting for age, gender and body mass index. CONCLUSIONS: Physical activity of insufficient intensity, unhealthy dietary habits and smoking could be risk factors for poor muscle quality. These findings can contribute to the development of effective strategies to improve muscle quality in community-dwelling older Asian people with T2DM.

[An Experience Applying Life Review and Resilience to a Geriatric Patient With Functional Limitations and Depression].

Negative self-values and attitudes during the process of adapting to disease tend to engender depression in the elderly. This case study describes a nursing experience with an elderly patient with depression related to a decline in activity and family role changes related to unexpected spinal infection. The nursing care in this study was provided between February 28th and April 25th, 2017. A comprehensive geriatric assessment was employed, with results showing that the patient was affected by negative self-identity and attitudes. The geriatric depression scale showed moderate depression. Life review strategy was employed in the interview to impart a positive influence on a different life stage and a resilience model was used to interpret the interview transcript. The protective factors were identified and used to develop an individualized nursing intervention that included promoting the support of the husband in order to enhance positive attitude, promoting interactions with the grandchildren in order to increase feelings of independence. Finally, the patient became cognizant of family support and expressed positive words and self-values, which improved depression symptoms. This case report provides a valuable nursing care experience as a reference for similar cases in the future.

[Exploration of the Association Between Workplace Bullying and Attitudes Toward Patient Safety in Female Nurses].

BACKGROUND: Workplace bullying is known to have a significant and detrimental effect on the physical and psychological outcomes of its victims. The reactions of victims to bullying may decrease clinical care outcomes and patient safety. PURPOSE: To explore the relationship between workplace bullying and the attitudes of female nurses toward the safety of their patients. METHODS: This cross-sectional survey study used convenience sampling. Participants included female nurses from a regional teaching hospital. The research tool was a three-part, structured questionnaire that included a basic personal information datasheet, negative behavior scale, and patient safety attitude scale. The researcher distributed 420 questionnaires and collected 329 valid samples (valid return rate: 78.3%). Data were analyzed using SPSS software version 22.0. RESULTS: The analysis found that 29.8% of the participants had suffered from various degrees of workplace bullying. The mean score for patient safety attitudes was 3.58 (standard deviation = 0.55). Workplace bullying and patient safety attitudes were negatively correlated (p < .1), and being a recipient of workplace bullying was identified as a significant predictor of attitudes toward patient safety. CONCLUSIONS: Based on the results, we suggest that supervisors should take the initiative to care for their nursing staffs and to provide them with training in conflict-oriented skills. Organization managers should set up relevant committee-notification mechanisms that construct the safe working environment necessary to reduce workplace bullying and to enhance the patient safety attitudes of nurses, which will indirectly improve the quality of patient care.

[Concept for Planning the Nurse-Patient Ratio and Nursing Fee Payment Linkage System].

This article describes the current situation in Taiwan with regard to the nurse-patient ratio and nursing fee payments, reviews the related policies and results in developed countries, and then proposes a plan for improving the domestic situation. Direct relationships exist between patient nursing quality and patient safety and the nurse-patient ratio as well as between nursing fee payments and the nurse-patient ratio. Therefore, in order to enhance the quality and safety of nursing care, it will be necessary to develop and institute a payment linkage system that links nursing fee payments to the nurse-patient ratio. This process requires public consensus and planning in order to institute an equitable and effective payment linkage system in the future.

[Development and Testing of the Taiwanese Hospital Nurses' Job Satisfaction Scale].

BACKGROUND: In the context of professional nursing, the concept of job satisfaction includes the degree to which a nurse is satisfied with the nursing profession, his/her personal adaptation to this profession, and his/her current working environment. No validated scale that addresses the job satisfaction of nurses working in hospitals currently exists in Taiwan. PURPOSE: To develop a reliable and validated scale for measuring the job satisfaction of hospital nurses in Taiwan. METHODS: A three-phase, cross-sectional study design was used. First, a literature review and expert focus group discussion were conducted to develop the initial scale items. Second, experts were invited to validate the content of the draft scale. Finally, convenience sampling was used to recruit 427 hospital nurses from 6 hospitals. These nurses completed the scale and the results were analyzed using item analysis, factor analysis, and internal consistency analysis. RESULTS: The 31-item Taiwanese hospital nurse job satisfaction scale developed in the present study addresses 5 factors, including supportive working environment, professional autonomy and growth, interpersonal interaction and collaboration, leadership style, and nursing workload. The overall Cronbach's α was .96. The results indicate that the developed scale provides good reliability and validity. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: This study confirms the validity and reliability of the developed scale. It may be used to measure the job satisfaction of nurses working in hospitals.

Organisation-based self-esteem mediates the effects of social support and job satisfaction on intention to stay in nurses.

AIM: This study examined the effect of underlying contextual factors on the intention to stay in nurses. BACKGROUND: Workplace promotion, social support, work stress, job satisfaction and organisation-based self-esteem (OBSE) are psychosocial factors influencing the intention to stay in nurses. However, few studies have analysed the relationships among these factors. METHOD: A cross-sectional survey was conducted and a sample was recruited in convenience sampling method from a medical centre in Taiwan. A total of 791 nurses completed a self-report questionnaire over a 3-month period in 2013. RESULTS: Social support, work stress, job satisfaction and OBSE significantly affected the intention to stay in nurses. Furthermore, social support and job satisfaction showed a positive direct effect on the intention to stay and an indirect effect on the intention to stay; the indirect effect was mediated by OBSE. CONCLUSION: Organisation-based self-esteem mediates the effects of social support and job satisfaction on the intention to stay in nurses. IMPLICATIONS FOR NURSING MANAGEMENT: The results showing the influence of OBSE on the intention to stay in nurses can serve as insight for hospital managers to make decisions when encouraging and managing employees.

[The Comparison of the Difference Between the Emphasis on and the Receipt of Patient Privacy in the Hospital Setting].

BACKGROUND: Privacy is a unique privilege for humans. Enhancing the balance between the importance given to patient privacy and the receipt of this privacy by patients is one key approach to improving the relationship between patients and the hospital. PURPOSE: This study compared the difference between the importance of patient privacy and receipt of this privacy by patients as a reference for future patient privacy policy planning. METHODS: This study was a cross-sectional design. We randomly sampled three hospitals in northern Taiwan and investigated patients using a questionnaire. The questionnaire was self-designed and verified for reliability and validity. We used frequency and percentage to describe demographic data and used a t-test to compare the deviation between the emphasis on and receipt of patient privacy. RESULTS: There were 296 valid samples in this study and the effective rate was 84.57%. The highest degree of importance was information privacy and the lowest was physical privacy. Physical privacy (t = 3.04, p < .001) and mental privacy (t = 2.42, p < .01) exhibited significant differences between emphasis and receipt. Demographic data on gender, age, education level, marital status, and occupation. Type of hospital and ward level correlated with the emphasis and receipt of privacy. CONCLUSIONS: The importance of privacy for physical and mental wellbeing was higher than the actual receipt of this privacy among the patient sample. The importance of privacy for married individuals and young women with high education levels was higher, while males and less-educated individuals scored lower in terms of privacy receipt. Medical agencies must provide higher levels of physical and mental privacy in order to enhance patient satisfaction.

[Application of an improved model of a job-matching platform for nurses].

BACKGROUND: The three-month attrition rate for new nurses in Taiwan remains high. Many hospitals rely on traditional recruitment methods to find new nurses, yet it appears that their efficacy is less than ideal. To effectively solve this manpower shortage, a nursing resource platform is a project worth developing in the future. PURPOSE: This study aimed to utilize a quality-improvement model to establish communication between hospitals and nursing students and create a customized employee-employer information-matching platform to help nursing students enter the workforce. METHODS: This study was structured around a quality-improvement model and used current situation analysis, literature review, focus-group discussions, and process re-engineering to formulate necessary content for a job-matching platform for nursing. The concept of an academia-industry strategic alliance helped connect supply and demand within the same supply chain. RESULTS: The nurse job-matching platform created in this study provided job flexibility as well as job suitability assessments and continued follow-up and services for nurses after entering the workforce to provide more accurate matching of employers and employees. CONCLUSIONS: The academia-industry strategic alliance, job suitability, and long-term follow-up designed in this study are all new features in Taiwan's human resource service systems. The proposed human resource process re-engineering provides nursing students facing graduation with a professionally managed human resources platform. Allowing students to find an appropriate job prior to graduation will improve willingness to work and employee retention.

[Clinical nursing manpower: development and future prospects].

The significant changes in nursing manpower utilization in Taiwan over the past two decades are due in large part to the implementation of the National Health Insurance program and the rising need for long-term care. The changes have impacted clinical nursing manpower utilization in two important ways. Firstly, there has been a substantial increase in overall demand for nursing manpower. In particular, the need for clinical nurses has nearly quadrupled during this time period. Secondly, the level of difficulty involved in patient care has risen dramatically, with factors including increased disease severity and increased care quality expectations, among others. These changes, coupled with demands on nursing manpower imposed from other sectors, underpin and further exacerbate the problem of nursing manpower shortages throughout the healthcare system. To raise the quality of the nursing work environment, the Ministry of Health and Welfare (MOHW) brought together Taiwan's key professional nursing organizations to promote 10 care-reform strategies, establish the nursing-aid manpower system, and create the nursing classification system as an approach to effectively attract nurses to take positions in the medical system.

[The nursing shortage and nursing retention strategies in Taiwan].

A chronic shortage of working nurses has led hospitals in Taiwan to close wards and reduce bed numbers. Work overload and job stress are major causes of this shortage. The purpose of this study is to propose a solution to improve the nursing workload situation. We reviewed literature articles and conference presentations to synthesize relevant measures, which included reforming the current care model; using innovation to simplify nursing practice; and creating a culture of workplace respect and inter-team cooperation. Based on this, we proposed our nursing retention strategy after reviewing national Department of Health development policies on nursing manpower.

Influencing factors of participation in and satisfaction with elderly health checkups: a cross-sectional study.

Background: Attending health checkups as a primary prevention strategy benefits older adults in facilitating the identification of health issues and risk factors for disease. Little is known about factors influencing participation in and satisfaction with a free annual elderly health checkup program (EHCP) in Taiwan. This study aimed to extend current knowledge related to the uptake of this service and individuals' views of the service. Methods: This was a cross-sectional study using a telephone interview survey method to compare influencing factors and satisfaction between participants and non-participants of an EHCP. The individuals involved were older adults in Taipei, Taiwan. The random sampling method included 1,100 people, 550 older adults who had participated in the EHCP within the last 3 years, and 550 older adults who had not. A questionnaire containing personal characteristics and satisfaction with the EHCP was used. Independent t-test and Pearson's Chi-squared test were used to evaluate differences between the two groups. Associations between individual characteristics and health checkup attendance were estimated using log-binomial models. Results: Results showed that 51.64% of participants reported being satisfied with the checkups; however, only 41.09% of non-participants were satisfied. In the association analysis, age, educational level, chronic diseases, and subjective satisfaction were related to older persons' participation. Furthermore, having a stroke was associated with a higher attendance rate [prevalence ratio: 1.49; 95% confidence interval: (1.13, 1.96)]. Conclusions: The EHCP had a high proportion of satisfaction among participants, but the proportion was low among non-participants. Several factors were associated with participation and might lead to unequal healthcare service uptake. Health checkups need to increase among people at a young age, those with low educational backgrounds, and those without chronic diseases.

Translation and Validation of the Indicators of Quality Nursing Work Environments in the Portuguese Cultural Context.

The Indicators of Quality Nursing Work Environment scale (IQN-WE) with 65 items, developed by Chiou-Fen Lin, Meei-Shiow Lu, and Hsiu-Ying Huang in 2016, aimed to create a set of quality indicators of the nursing work environment. The translation and validation for the Portuguese cultural context of the IQN-WE scale was performed in this study. OBJECTIVES: culturally and linguistically adapt the IQN-WE scale, originating from the Portuguese version, and evaluate its psychometric characteristics. METHODS: it is a descriptive, cross-sectional, observational and quantitative study. The IQN-WE scale was validated in a sample of 542 nurses belonging to a hospital center in Portugal. The study obtained a response of 21.69%, of whom 78.0% were women and 22% men. The mean age of the sample was 39 years and a standard deviation of 8.1 years. All nurses who work have a bachelor's degree, and 13.5% have a master's degree. RESULTS: the study obtained an instrument with a total explained variance of 52.67% and KMO = 0.843. It found a strong-to-moderate linear correlation matrix between the dimensions. The pre-test and the team of experts ensured the content validity. The determination of internal consistency guaranteed reliability, with 0.95. Confirmatory factor analysis validated the construct. The factorial model presented a goodness of fit index, with five factors. CONCLUSION: the study achieved an instrument with 50 items in five dimensions: Team Support and Professional Development; Team Organization and Management; Safe Nursing Work Environment; Information Systems and Risk Control; Salary and Welfare. The IQN-WE-PT scale proved to be an appropriate instrument to be applied in health organizations in Portugal.

The relationship between organizational communication and missed nursing care in oncology wards in Taiwan.

AIM: Unfavourable communication increases missed nursing care. Oncology wards have more communication complexity than general wards; therefore, creating a positive communication environment is important for ensuring quality care. This study aimed to understand the relationship between organizational communication satisfaction and missed nursing care in Taiwan. DESIGN: This cross-sectional study was performed to measure organizational communication satisfaction and missed nursing care in six oncology wards at a stand-alone cancer centre hospital in Taipei, Taiwan in December, 2018. METHODS: The study collected data using the Communication Satisfaction Questionnaire and the MISSCARE survey. The data were analysed using descriptive statistics, t test, analysis of variance and Pearson product-moment correlation analysis in December 16, 2018. RESULTS: A total of 111 questionnaires were collected, and the response rate was 92.5%. The study showed that nurses tended to miss nursing care when they were dissatisfied with the unit's manpower status organizational communication environment, horizontal and diagonal communication and informal communication.

[Self-role perception of nurse practitioners in northern Taiwan].

BACKGROUND: The Nurse Practitioners (NP) is a position title introduced into the Taiwanese nursing care system in 2006. NP perception of themselves is critical to successful development of the NP position as well as to good coordination with other healthcare team members. Understanding NP self-perception can help determine self- or policy deficiencies and facilitate necessary changes to ameliorate such in order to advance the NP system in Taiwan. PURPOSE: This study investigated the self-role perception of NPs in northern Taiwan. METHODS: Researchers used a qualitative research design. Participants comprised ten nurses recruited from a general hospital in northern Taiwan. Data were collected using a semi-structured interview format and analyzed using qualitative content analysis. RESULTS: Two themes that evolved from data analysis included negative and positive self-role perception. Negative self-role perception included feelings of regret, helplessness, frustration and volatility. Positive self-role perception included feelings of enjoying success, reflecting on the present, connecting with nursing, happiness, and self-improvement. CONCLUSION: Enhancing clinical, educational, and policy requirements for NPs can promote positive self-role perception. Based on the medical culture in Taiwan, NPs receive clearly defined roles and clear and specific job descriptions to expand their role functions. Continued self-growth and mutual respect among team members are essential to improving professional cooperation and medical care quality.

The establishment of an ethical guideline for genetic testing through citizen consensus via the Internet in Taiwan.

BACKGROUND: With the rapid advance of genetics, the application of genetic testing has become increasingly popular. Test results have had a tremendous impact on individuals who receive the test and his or her family. The ethical, legal, and social implications (ELSI) of genetic testing cannot be overlooked. The Internet is a potential tool for public engagement. OBJECTIVES: This study aimed at establishing ethical guidelines for genetic testing in Taiwan through a participatory citizen consensus approach via the Internet. METHODS: The research method used was a citizen consensus conference modified by an Internet application and the Delphi technique. The citizen consensus conference is one of the public participation mechanisms. The draft ethical guidelines for genetic testing were written by an expert panel of 10. The Delphi technique was applied to a citizen panel recruited via the Internet until a consensus was reached. Our research population was restricted to people who had Internet access. RESULTS: Included in the citizen panel were 100 individuals. A total of 3 individuals dropped out of the process. The citizen panel was exposed to the issues through Internet learning and sharing. In all, 3 rounds of anonymous questionnaires were administered before a consensus was reached in terms of importance and feasibility. The result was ethical guidelines composed of 4 categories and 25 items. The 4 categories encompassed decision making (6 items), management of tissue samples (5 items), release of results (8 items), and information flow (6 items). On a scale of 1 to 10, the average (SD) importance score for the decision-making category was 9.41 (SD 0.58); for the management of tissue samples category, the average score was 9.62 (SD 0.49); for the release of results category, the average score was 9.34 (SD= 0.59); and for the information flow category, the average score was 9.6 (SD = 0.43). Exploratory analyses indicated that participants with higher education tended to attribute more importance to these guidelines. CONCLUSIONS: The resulting recommended ethical guidelines had 4 categories and 25 items. We hope through the implementation of these guidelines that mutual trust can be established between health care profession and the general public with respect to genetic tests.

A comparison of problem-based learning and conventional teaching in nursing ethics education.

The aim of this study was to compare the learning effectiveness of peer tutored problem-based learning and conventional teaching of nursing ethics in Taiwan. The study adopted an experimental design. The peer tutored problem-based learning method was applied to an experimental group and the conventional teaching method to a control group. The study sample consisted of 142 senior nursing students who were randomly assigned to the two groups. All the students were tested for their nursing ethical discrimination ability both before and after the educational intervention. A learning satisfaction survey was also administered to both groups at the end of each course. After the intervention, both groups showed a significant increase in ethical discrimination ability. There was a statistically significant difference between the ethical discrimination scores of the two groups (P < 0.05), with the experimental group on average scoring higher than the control group. There were significant differences in satisfaction with self-motivated learning and critical thinking between the groups. Peer tutored problem-based learning and lecture-type conventional teaching were both effective for nursing ethics education, but problem-based learning was shown to be more effective. Peer tutored problem-based learning has the potential to enhance the efficacy of teaching nursing ethics in situations in which there are personnel and resource constraints.