Facilitating a change model in age-friendly hospital certification: Strategies and effects.

The ageing population is a powerful and transformative demographic force. The World Health Organization (WHO) has encouraged the development of an age-friendly hospital (AFH) network. However, no specific implementation strategies or best practices of AFH standards have been produced. This study sought to apply Kotter's change model to the elements included in a successful AFH certification process and to evaluate the changes in employees' knowledge of ageing and their attitudes toward the elderly. This was an observational study that utilized a pre- and posttest design, before and after an age-friendly hospital certification process was implemented. Participants were 163 hospital employees in Taiwan, who completed both pre- and postquestionnaires. The self-administered online questionnaire consisted of three sections: The Facts on Ageing Quiz, the Geriatric Attitudes Scale, and a demographic questionnaire. Following introduction of the intervention, the change process began, and later Kotter's model was brought in as a descriptive framework. The results showed that Kotter's eight-step framework is a good choice for thinking about how to change practice and make healthcare more age-friendly. Employee knowledge of ageing and their attitudes toward the elderly improved after this certification process. Appointing a chief executive officer, forming a steering committee, obtaining interdepartmental and interdisciplinary cooperation, and "soliciting support" for new policies from all employees, were identified as key factors influencing the success of age-friendly hospital (AFH) certification. This is the first study to apply Kotter's eight-step framework of organizational change to an AFH certification process.

The Relationship Between Health-Promoting Behaviors and Metabolic Syndrome in Community-Dwelling Older Adults.

BACKGROUND: Poor health-promoting behaviors increase the risk of chronic disease and disability in older adults. Nevertheless, the predictors of health-promoting behaviors and their relationship with metabolic syndrome have been poorly characterized in older Taiwanese adults. OBJECTIVE: To explore the determinants of health-promoting behaviors in community-dwelling older adults in Taiwan and the relationship of health-promoting behaviors with metabolic syndrome. METHODS: A cross-sectional design was used. A convenience sample of 200 community residents aged 60 years and over was recruited from two large communities in New Taipei City, Taiwan. Data collection included physical examination and a structured questionnaire including measures of health status, health-promoting behaviors, self-efficacy, social support, and metabolic syndrome. RESULTS: Metabolic syndrome was found in 60% of older Taiwanese adults. These participants had higher scores in interpersonal relationships but lower scores in physical activity. Half of the health-promoting behaviors were explained by behavior-specific cognitions and affect, and 44% of behavior-specific cognitions and affect was explained by the health status of the older adult. CONCLUSIONS: Physical activity should be promoted in older Taiwanese adults. Positive behavior-specific cognitions and affect and better health status might impact the health-promoting behaviors of these adults.

Nurse administrators' intentions and considerations in recruiting inactive nurses.

AIMS: To understand nurse administrators' intentions and considerations in recruiting inactive nurses and to examine predictors of intent to recruit. BACKGROUND: Few studies have provided insight into employer intentions and considerations in recruiting inactive nurses. METHODS: A census survey collected data from 392 nurse administrators via a mailing method. RESULTS: Overall, 89.0% of nurse administrators were willing to recruit inactive nurses. Stepwise regression analysis revealed that the only predictor of nurse administrators' intention to recruit was nurse turnover rate at the hospital. Nurse administrators perceived the most important recruiting considerations were inactive nurses' cooperation with alternating shifts, health status and nursing licence. The most frequent reasons for not recruiting were an inactive nurse's lack of understanding of the medical environment and poor nursing competence. CONCLUSIONS: Most hospital nurse administrators were willing to recruit inactive nurses. Inactive nurses who wish to return to work should be qualified, willing to work both day and night shifts, and in good health. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse administrators can reduce the nursing shortage by recruiting inactive nurses. Re-entry preparation programmes should be implemented that will provide inactive nurses with knowledge of the current medical environment and the skills required to improve their nursing competence.

Impact of hypoalphalipoproteinemia on quality of life in Taiwanese women with central obesity.

PURPOSE: To investigate the relationship between health-related quality of life (HRQoL) and different cutoff value of low level of high-density lipoprotein cholesterol (HDL-C) in Taiwanese women with different definition of obesity. METHODS: Prospective observational study in women with central obesity was conducted in Taipei City Hospital. A total of 572 women were screened at our clinic, and 227 of them with a body mass index ≧27 kg/m2 defined by the Department of Health in Taiwan and weight circumference ≧80 cm were eligible for the study. We defined two groups as group A-low HDL (HDL-C < 40 mg/dL) and group B-high HDL (HDL-C < 50 mg/dL) according to different definition of hypoalphalipoproteinemia in obese women. RESULTS: Significantly reduced HRQoL score was noted in group A-low HDL compared to group A-high HDL (HDL-C ≧ 40 mg/dL), but not between group B-low HDL and group B-high HDL (HDL-C ≧ 50 mg/dL). Positively correlation was noted between HDL-C level and physical domain of HRQoL score. HDL-C contributes independently to physical domain of HRQoL score after controlling for other factors. Decreased leptin and adiponectin level were noted in hypoalphalipoproteinemia groups. CONCLUSION: Taiwanese obese women with hypoalphalipoproteinemia have adverse impact on HRQoL, especially when the HDL-C level is lower than 40 mg/dL. Both hypoalphalipoproteinemia and hypertension accounted for a great variance to lower scores of physical domain of HRQoL with positively correlation with HDL-C level observed. Decreased leptin and adiponectin were also observed in hypoalphalipoproteinemia group, which implied increased cardiovascular risk. HDL-C level may deem as another indicator for HRQoL in women with central obesity.

Medication errors in pediatric nursing: assessment of nurses' knowledge and analysis of the consequences of errors.

AIM: The purposes of this study were (i) to evaluate pediatric nurses' knowledge of pharmacology, and (ii) to analyze known pediatric administration errors. BACKGROUND: Medication errors occur frequently and ubiquitously, but medication errors involving pediatric patients attract special attention for their high incidence and injury rates. METHODS: A cross-sectional study was conducted. A questionnaire with 20 true-false questions regarding pharmacology was used to evaluate nurses' knowledge, and the known pediatric administration errors were reported by nurses. FINDINGS: The overall correct answer rate on the knowledge of pharmacology was 72.9% (n=262). Insufficient knowledge (61.5%) was the leading obstacle nurses encountered when administering medications. Of 141 pediatric medication errors, more than 60% (61.0%) of which were wrong doses, 9.2% of the children involved suffered serious consequences. CONCLUSIONS: Evidence-based results demonstrate that pediatric nurses have insufficient knowledge of pharmacology. Such strategies as providing continuing education and double-checking dosages are suggested.

Training effects of a 12-week walking program on Parkinson disease patients and community-dwelling older adults.

BACKGROUND: Introducing evidence-based exercise guidelines of Parkinson's disease (PD) into clinical practice and community settings has been highlighted. AIM: This study tested the feasibility and compared the weekly effects of a 12-week walking training program on PD patients and community-dwelling seniors. DESIGN: A prospective quasi-experimental design was used. PD patients in Hoehn and Yahr Stage I through III (PG) and community-dwelling adults older than 65 were recruited (CG). METHODS: In the outpatient department of a hospital, the information of personal data, coordination test, and walking ability of participants were collected first. They then participated in a 36-session, 12-week treadmill walking training program. RESULTS: Weekly data of step length and velocity in PG and CG were collected. The walking training program achieved significant velocity (χ² = 126.38, p < 0.001) and step length (χ² = 27.27, p = 0.001) improvements in PG. Differences in improvement between PG and CG in terms of velocity (χ² = 7.089, df = 1, p = 0.008) and step length (χ² = 7.718, df = 1, p = 0.005) were also identified. CONCLUSION: The applicability of this 12-week walking program both for PD patients and community-dwelling older adults was identified. Conducting the economic evaluation and neurology studies of the 12-week walking program and test the effects of five-week walking program are suggested.

Health services utilization and cost utility analysis of a walking program for residential community elderly.

Promoting the health and improving the ability and confidence of the elderly to live independently can reduce health care expenditures and increase the health of society as a whole. However, the evidence to promote physical activity in order to promote health among the aged population is weak, especially in regards to the economic evaluation of a walking program. These researchers confirmed that the cost utility of a 12-week walking training program is acceptable. Therefore, an outpatient clinic-based walking program for older adults is worth promoting. Cost utility analysis is the critical evaluation method in exercise programs. Health professionals are encouraged to apply the integrated indicators such as the Health Utility Index and the Incremental Cost Utility Ratio to clarify the effects of health-promotion interventions.

A feasibility study on the adoption of e-learning for public health nurse continuing education in Taiwan.

The purpose of this study is to investigate the feasibility of developing e-learning and to examine reasons for adopting or rejecting e-learning as an alternative way to conduct continuing education (CE) for public health nurses (PHNs). A nationwide-based cross-sectional study was conducted with a randomly selected sample of 233 PHNs in Taiwan. A structured questionnaire was used to collect data by mailing methods. The majority of PHNs (88.84%, n=207) showed an affirmative intention towards adopting e-learning as their one way of CE. Reasons for adopting e-learning included achieving life learning, fulfilling personal interests, time-saving, based on job needs, information diversity, flexible in time and space, self-regulatory learning, cost-effectiveness, less impact on family duties and life. Twenty-six PHNs (11.16%) who rejected e-learning as their way of CE indicated main reasons including poor computer competence, lack of personal computer and without internet access, heavy work load, heavy family duties, conflict with personal preference, heavy economic burden, lack of motivation, and low self-control. This study reveals a high feasibility of developing e-learning that coexists with other CE models (e.g. traditional instruction). Reasons analyses provide directions for decreasing barriers for developing a learning model of this new medium for nurses' CE.

[Care at school: health care needs and coping strategies among children whose mothers are foreign wives].

Families formed as a result of a marriage involving an immigrant are a new phenomenon in Taiwan. School children whose mothers are foreign wives are increasing. Because of differences in lifestyle and culture, and because of stereotyping, such families are vulnerable and prone to experiencing unequal treatment. How will they fare when their children start elementary school? This article explores the physical and psychosocial health needs and health care utilization of school-aged children whose mothers are foreign wives. It also explores factors which might arise in the case of these children because of social inequality. The authors emphasize the importance of school health and raise suggestions for school nurses. Such nurses should provide health promotion programs to promote the health of children whose mothers are foreign wives. This will enable these children to grow up happily and healthily, and develop into healthy, well-educated adults with a positive attitude and good health-related behavior.