Risk factors of post-traumatic stress symptoms in patients with cancer.

AIMS AND OBJECTIVES: To determine the level of post-traumatic stress symptoms and to identify demographics, disease history and clinical symptoms that were associated with post-traumatic stress symptoms among patients with gynaecological, breast or colorectal cancer in Taiwan. BACKGROUND: Literature indicated that 7·3-35·2% of patients with cancer had experienced level of post-traumatic stress symptoms. However, the post-traumatic stress symptoms among patients with cancer in Taiwan was not documented. DESIGN: A cross-sectional study. METHODS: A total of 347 participants recruited from two general hospitals in southern Taiwan. They completed the Chinese version of Davidson Trauma Scale and a profile describing their demographics and clinical symptoms. Disease history was collected from medical records. RESULTS: Approximately 21·6% of participants reported higher score on Chinese version of Davidson Trauma Scale (Mean ± SD = 22·85 ± 24·12). The top four scores on Chinese version of Davidson Trauma Scale were painful memories, insomnia, shortened lifespan and flashbacks. The risk factors of post-traumatic stress symptoms were suicidal intention (OR = 2·29, 95% CI = 1·86-2·82), chemotherapy (OR = 2·13, 1·18-3·84), metastasis (OR = 2·07, 1·29-3·34), cancer-specific symptoms (OR = 1·21, 1·15-1·27) and high education (OR = 1·75, 1·10-2·78). CONCLUSION: To prevent post-traumatic stress symptoms, patients with cancer should be routinely screened by psychiatrists for post-traumatic stress symptoms, for ongoing symptom control and suicidal intention. Patients with cancer who are at risk of suicidal behaviour should be enrolled in suicide prevention programmes. RELEVANCE TO CLINICAL PRACTICE: Nurses need to assess post-traumatic stress symptoms of patients with cancer, particularly those who with high education, suffered from complications of chemotherapy, metastasis and cancer-specific symptoms and suicidal intention.

Pelvic floor muscle exercise for fecal incontinence quality of life after coloanal anastomosis.

AIMS AND OBJECTIVES: To assess the efficacy of pelvic floor muscle exercise for enhancing fecal incontinence quality of life after coloanal anastomosis in colorectal cancer patients. BACKGROUND: Methods of improving incontinence have been evaluated in many countries, but never in a Taiwan population. DESIGN: A longitudinal experimental study. METHODS: Fifty-two colorectal cancer patients who had received colostomy closure and coloanal anastomosis surgery were recruited from a general hospital in southern Taiwan and randomly assigned to an experimental group (n = 26) or a control group (n = 26). Both groups received routine postoperative care. However, the experimental group received private consultations, educational DVDs and pamphlets to instruct them in performing pelvic flow muscle exercise. In all participants, the Fecal Incontinence Quality of Life Scale was used to measure quality of life before discharge and at one, two, three, six and nine months after discharge. Generalised estimating equations were used to compare longitudinal effects between the two groups. RESULTS: The generalised estimating equations revealed that all participants had significantly improved Fecal Incontinence Quality of Life Scale scores at two, three, six and nine months after discharge. Compared to the controls, however, the experimental group had significantly higher scores at two, three, and six months after discharge. CONCLUSIONS: Patient education in pelvic floor muscle exercise positively affects Fecal Incontinence Quality of Life Scale scores in patients who have received coloanal anastomosis. RELEVANCE TO CLINICAL PRACTICE: Early education in pelvic floor muscle exercise can improve management of fecal incontinence symptoms after coloanal anastomosis and can improve quality of life.

Sexual dysfunction in males following low anterior resection.

AIMS AND OBJECTIVES: The purpose of this study was to explore the prevalence of sexual dysfunction in males one year after undergoing low anterior resection and to determine whether health care professionals discuss sexual issues with patients after surgery. BACKGROUND: Sexual dysfunction in males may be a complication after low anterior resection for rectal cancer, but few studies have explored this issue in Taiwan. DESIGN: A descriptive comparison study design. METHODS: A descriptive comparison design was used, and a group of 133 participants underwent a low anterior resection procedure for rectal cancer. The results were compared with those of a group of males who underwent colectomy (n = 58) for colon cancer. The following instruments were used: the five-item version of the International Index of Erectile Function, personal demographics and medical variables. RESULTS: The results showed that the prevalence of erectile dysfunction among the low anterior resection patients was 97·0% (129/133), and the erectile dysfunction prevalence was 75·9% (44/58) for the males who underwent colectomy. The generalised linear model showed that after controlling for hypertension and stoma, the low anterior resection group had worse sexual function than those in the colectomy group, and stoma was also a factor that impacted patients' sexual function. The results also revealed that only 32·8-35·3% of health care providers talked about sexual dysfunction with people who have rectal cancer prior to surgery. CONCLUSION: This study demonstrated that men who have undergone low anterior resection have a high risk of sexual dysfunction and that health care professionals infrequently discuss these issues with patients. RELEVANCE TO CLINICAL PRACTICE: When patients are diagnosed with rectal cancer and before they undergo surgery, an assessment and discussion of sexual function issues should be incorporated into standard care. Continued follow-up after hospital discharge and evaluations of sexual function are vital factors for male postoperative rectal cancer patients.

Comparison of professional values between nursing students in Taiwan and China.

BACKGROUND: People in both Taiwan and China originally descended from the Han Chinese, but the societies have been separated for approximately 38 years. Due to different political systems, variations exist in healthcare and nursing education systems in Taiwan and China. OBJECTIVE: The purpose of this study was to examine the professional values of nursing students in Taiwan and China. DESIGN: A cross-sectional design was applied in this study. The Nursing Professional Value Scale-Revised was used to measure the professional values of the students. The questionnaire was distributed to eligible undergraduate students in a classroom setting. ETHICAL CONSIDERATIONS: This study was approved by the Institutional Review Board at the first investigator's university. Participants were informed that completion and return of the questionnaire was voluntary, and confidentiality was ensured by keeping the responses anonymous. PARTICIPANTS: A convenience sample included 292 Taiwanese students and 654 Chinese students. FINDINGS: A total of 11 individual Nursing Professional Value Scale-Revised items showed significant differences between the two groups. These results reflect the differences in the perceived importance of these items between the groups. There was no significant difference between the two groups in the mean overall scores for the Nursing Professional Value Scale-Revised (p = .766) and three subscales (all p > .05). CONCLUSION: There are some differences in professional values between nursing students in Taiwan and China. Given the increasingly frequent and close interactions between Taiwan and China and the globalization of nursing, understanding these differences may help nursing educators identify students' perceptions of their professional values and support the development of strategies to improve weaknesses in professional values.

Predicting health-promoting self-care behaviors in people with pre-diabetes by applying Bandura social learning theory.

AIMS: The aim of this study was to apply Bandura social learning theory in a model for identifying personal and environmental factors that predict health-promoting self-care behaviors in people with pre-diabetes. BACKGROUND: The theoretical basis of health-promoting self-care behaviors must be examined to obtain evidence-based knowledge that can help improve the effectiveness of pre-diabetes care. However, such behaviors are rarely studied in people with pre-diabetes. METHODS: This quantitative, cross-sectional survey study was performed in a convenience sample of two hospitals in southern Taiwan. Two hundred people diagnosed with pre-diabetes at a single health examination center were recruited. A questionnaire survey was performed to collect data regarding personal factors (i.e., participant characteristics, pre-diabetes knowledge, and self-efficacy) and data regarding environmental factors (i.e., social support and perceptions of empowerment process) that may have associations with health-promoting self-care behaviors in people with pre-diabetes. RESULTS: Multiple linear regression showed that the factors that had the largest influence on the practice of health-promoting self-care behaviors were self-efficacy, diabetes history, perceptions of empowerment process, and pre-diabetes knowledge. These factors explained 59.3% of the variance in health-promoting self-care behaviors. CONCLUSIONS: To prevent the development of diabetes in people with pre-diabetes, healthcare professionals should consider both the personal and the environmental factors identified in this study when assessing health promoting self-care behaviors in patients with pre-diabetes and when selecting the appropriate interventions.

Embracing diversity and transcultural society through community health practicum among college nursing students.

Based on 2015 annual report of foreign spouse populations were above 507,266 people in Taiwan. Most of them (68%) came from Mainland China, 29% from south-east Asia. 92% of foreign spouses were female (2015). Therefore, a challenge arises for nursing students to provide care to clients with multiple cultural variations in Taiwan. The study objectives were to explore the related factors of cultural care competence and estimate the effects of a short-term reinforced cultural course. The study used a quasi-experimental design. All participants were investigated to measure that changed in cultural competence before and after the community practice period. Of 95 participants, 46 experimental group students engaged with 3 times workshops. The study was conducted from May to August in 2015 at Southern Taiwan. The study results showed a significantly improvement of transcultural nursing competence from comparing control group with experimental group by ANCOVA analysis (p < .05). The study approved that the cultural workshop along with the community health nursing practice curriculum might develop students' transcultural nursing competence. In the future, in order to providing cultural sensitively care, a sustained transcultural curriculum should be advocated at Nursing schools in Taiwan.

Lifestyle in Visually Impaired or Blind Massage Therapists: A Preliminary Study.

BACKGROUND: Lifestyle is among the most important factors affecting individual health status. Limited access to health information may limit the ability of people with visual impairment or blindness to practice healthy lifestyles. However, no studies have investigated how lifestyle practices affect health specifically in visually impaired and blind populations. PURPOSE: The aim of this study was to investigate the lifestyle behaviors of visually impaired and blind massage therapists (VIBMTs) in Taiwan. METHODS: This exploratory study used a purposive sampling technique to recruit 50 VIBMTs who were employed at massage stations in southern Taiwan. All of the participants completed the Health-Promoting Lifestyle Profile II (HPLP-II) and a survey of demographic characteristics. Descriptive and inferential statistical tests, including the Mann-Whitney U test and the Kruskal-Wallis H test, were used. Statistical significance was defined as p < .05 in two-tailed tests. RESULTS: Fifty participants completed both the HPLP-II and the demographic survey. The mean subscale score for the HPLP-II was 2.52 ± 0.37. The lowest scores were on the physical activity (2.09 ± 0.67) and nutrition (2.35 ± 0.39) subscales, and the highest scores were on the spiritual growth (2.89 ± 0.56) and interpersonal relations (2.79 ± 0.46) subscales. Scores on the stress management and physical activity subscales were significantly higher in men than in women (p < .05). In addition, mean HPLP-II scores were significantly higher in VIBMTs who exercised regularly compared with those who did not (p < .05). Compared with nonsmokers, current smokers had significantly higher scores on the stress management subscale (p < .05). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The low physical activity scores in this population may be improved by developing physical activity programs for the home and workplace and by establishing community recreational and exercise facilities for visually impaired populations. The low scores for nutrition may be improved by establishing nutrition education programs that are designed specifically for VIBMTs to increase their consumption of fresh produce and other healthy foods and by requiring food manufacturers to use labels that may be easily read or understood by visually impaired populations.

Pediatric nurse practitioner salary and practice: results of a Midwest metropolitan area survey.

The St. Louis Association of Pediatric Nurse Practitioners has conducted a local biennial salary, practice, and benefits survey since the mid 1990s. This cross-sectional, descriptive study investigated demographic characteristics, salary, benefits, and practice patterns of pediatric nurse practitioners (PNPs) in the St. Louis area in fall, 2005. The survey was sent to 199 PNPs who lived within 100 miles of Saint Louis, with a return rate of 60%. The mean salary for full time PNPs engaged in practice was $72,788, which was a 6.3% increase from the 2003 survey results. PNPs with more years of experience received significantly higher salaries than those with less experience; however, there was no difference in salary based on type of practice (primary versus specialty care) or type of practice setting. Increasing numbers of PNPs are reporting their practice focus as specialty care (53%) rather than primary care (47%) in this region, with 70% of full time PNPs indicating specialty care. PNPs with less than 3 years experience were working equally in primary and specialty care. Practice challenges such as reimbursement and prescriptive issues were identified. Only 37% of PNPs indicated that they were credentialed by insurance plans. Nurse practitioners may find a local survey helpful as they negotiate changes in their salaries and benefits. Members of advance practice nursing organizations and educators may find the survey process useful as they observe local practice trends over time. It is essential that nursing education and continuing education conferences address the basic and continuing education needs of PNPs in both primary care and common specialty practices.

Empowerment Program for People With Prediabetes: A Randomized Controlled Trial.

BACKGROUND: Practicing a health-promoting lifestyle is believed to be effective for delaying or preventing the onset of diabetes. However, although empowerment interventions have proven effective for encouraging the adoption of a health-promoting lifestyle in people with diabetes, these interventions are rarely promoted to people with prediabetes. PURPOSE: The aims of this study were to develop an empowerment program for people with prediabetes and to examine its efficacy in terms of the adoption of a health-promoting lifestyle and improvements in blood sugar, body mass index, and self-efficacy. METHODS: A randomized controlled trial was conducted between May and December 2013. A convenience sample of people with a fasting blood sugar level of 100-125 mg/dl during the previous 3 months was recruited from the health examination center of a hospital in Kaohsiung, Taiwan. Participants were assigned to either the experimental group or the control group using block randomization with a block size of 8. The experimental group (n = 38) participated in a 4-month empowerment program (the ABC empowerment program), which encouraged participants to practice a health-promoting lifestyle in three phases: awareness raising, behavior building, and results checking. The control group (n = 40) received routine clinical care. Statistical analyses included descriptive statistics, independent t test, paired t test, and generalized estimated equations. RESULTS: After controlling for the differences at baseline and considering the interaction between group and time from baseline to 1 week and 3 months after completing the intervention, the generalized estimating equation showed significantly larger improvements in a health-promoting lifestyle, blood sugar, and self-efficacy in the experimental group than in the control group (p < .01). Furthermore, the experimental group achieved a larger reduction in body mass index than the control group at 3 months after completing the intervention (p = .001). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The empowerment program was shown to have short-term, positive effects on behavioral, physical, and psychosocial outcomes in a Taiwan population with prediabetes. The results of this study provide a useful reference not only for healthcare personnel when implementing empowerment interventions in people with prediabetes but also for nursing educators and healthcare policymakers.