[The Development of Psychiatric and Mental Health Nursing in Taiwan: Reflection From the Perspective of Recovery].

Evidence-based nursing science has identified psychological recovery, partnership, and medication adherence as factors that have influenced the development of mental health care. This article discusses the process by which mental health care has developed from a medical / rehabilitation-focused model to a model that focuses on patient empowerment. The current model aims to assist patients to achieve self-awareness and to develop coping skills that enhance their motivation to transform. Medical advances have improved the control of psychiatric symptoms. Following the introduction of 2nd generation antipsychotics, patients were invited to establish decisions related to these prescription medications. Under the principles of patient-centered service, Taiwanese mental health professionals have changed their relationship with patients from a therapeutic model to a mutual-partnership model. Furthermore, investigations of the therapeutic care of patients with mental illness have used the needs of patients as their starting point and emphasized various aspects of patient and caregiver needs. Taiwanese mental health professionals are searching for a model of mental health care that is superior to the traditional operative framework of medical authority.

Evaluating the suicide risk-screening scale used by general nurses on patients with chronic obstructive pulmonary disease and lung cancer: a questionnaire survey.

AIM: The aim of this study was to evaluate the interview version of the screening of risk for suicide with redefined items for the hospitalised patients. BACKGROUND: Patients hospitalised in general hospitals with physical illnesses performed suicidal acts more rapidly after admission. DESIGN: A two-hour screening skills training course was provided to general nurses caring for hospitalised patients. The patients were rated by trained nurses according to the screening of risk for suicide. Then, patients did self-rating of repulsion of life scale and symptom distress. The participants were 54 trained nurses and 205 patients, 76 of whom had chronic obstructive pulmonary disease and 129 had lung cancer. METHODS: The trained nurses used the screening of risk for suicide to screen patients and compared their results with their trainers within 24 hours for inter-rater consistency, followed by patients' self-rating. RESULTS: The inter-rater reliability between nurses and their trainers was 0·85. The screening of risk for suicide rated by nurses correlated significantly with repulsion to life and symptom distress rated by patients. There were 26·3% (20) of patients with chronic obstructive pulmonary disease and 14·0% (18) of patients with lung cancer who showed moderate-to-high suicide risk, most of them having poor social support. The nurse's score on patient with chronic obstructive pulmonary disease was higher than patient's self-rating. CONCLUSIONS: The screening of risk for suicide was useful in alerting the general nurses to high-risk patients and the nurse' screening collected more in-depth data than patients' self-rating. It is suggested that this suicide risk-screening training should incorporate into continuing education in general hospital and the use of Screening of Risk for Suicide incorporating into new patient nursing assessment. RELEVANCE TO CLINICAL PRACTICE.: The two-hour suicide risk-screening training could renew the general nurse skill of risk screening for the hospitalised patients.

The assessment of stability and reliability of a virtual reality-based intravenous injection simulator.

The aim of this study was to validate the feasibility of a virtual reality-based (without haptic feedback) intravenous injection system as an effective tool for computer-assisted instruction and training. The stability and reliability of the system were assessed. A personal computer, a needle/catheter device, and a data acquisition interface are included in this system. Using Virtual Reality Modeling Language, an interactive virtual environment was developed. Ten participants, ranging from 20 to 28 years of age, were recruited for this study. The self-learning and training procedures encompassed an intravenous catheterization process. The experimental results showed that after a few trials, the change in task time was not obvious in each trial, and the error frequency decreased slightly with more trials. High intraclass correlation coefficients also were obtained for task time and error frequency by analyzing the test-retest reliability. These results indicated that the system was stable and that the system reliability was acceptable.

Prevalence of psychiatric morbidity and psychological adaptation of the nurses in a structured SARS caring unit during outbreak: a prospective and periodic assessment study in Taiwan.

To assess the rapidly changing psychological status of nurses during the acute phase of the 2003 SARS outbreak, we conducted a prospective and periodic evaluation of psychiatric morbidity and psychological adaptation among nurses in SARS units and non-SARS units. Nurse participants were from two SARS units (regular SARS [N=44] and SARS ICU [N=26]) and two non-SARS units (Neurology [N=15] and CCU [N=17]). Participants periodically self-evaluated their depression, anxiety, post-traumatic stress symptoms, sleep disturbance, attitude towards SARS and family support. Results showed that depression (38.5% vs. 3.1%) and insomnia (37% vs. 9.7%) were, respectively, greater in the SARS unit nurses than the non-SARS unit nurses. No difference between these two groups was found in the prevalence of post-traumatic stress symptoms (33% vs. 18.7%), yet, three unit subjects (SARS ICU, SARS regular and Neurology) had significantly higher rate than those in CCU (29.7% vs. 11.8%, respectively) (p<0.05). For the SARS unit nurses, significant reduction in mood ratings, insomnia rate and perceived negative feelings as well as increasing knowledge and understanding of SARS at the end of the study (all p<0.001) indicated that a gradual psychological adaptation had occurred. The adjustment of nurses in the more structured SARS ICU environment, where nurses care for even more severely ill patients, may have been as good or better than that of nurses in the regular SARS unit. Occurrence of psychiatric symptoms was linked to direct exposure to SARS patient care, previous mood disorder history, younger age and perceived negative feelings. Positive coping attitude and strong social and family support may have protected against acute stress. In conclusion, the psychological impact on the caring staffs facing future bio-disaster will be minimized with lowered risk factors and a safer and more structured work environment.

A comparison of the cost-effectiveness of hospital-based home care with that of a conventional outpatient follow-up for patients with mental illness.

The purpose of this study was to compare the outcomes of a hospital-based home-care model with those of a conventional outpatient follow-up for mentally ill patients in Taiwan by means of cost-effectiveness analysis. The study design was a two group posthoc design. We interviewed 40 mentally ill patients who were followed up in the psychiatric outpatient department. Another 40 mentally ill patients who participated in a hospital based home care program were also interviewed. The outcome measures we used for interviews were disease maintenance behavior, psychotic symptoms, social function, service satisfaction, and cost. The cost for each patient was the sum of costs for all direct mental health services. The cost-effectiveness ratio showed that the costs of the hospital-based home care model (4.3) were lower than those of conventional outpatient follow-up (13.5) and that over a one-year period, the hospital-based home care model was associated with improvements in mental conditions, social functional outcomes, and service satisfaction. The improved outcomes and the lower costs in the hospital-based home care program support the view that it is the most cost-effective of the two. Policy makers may consider this analysis as they allocate resources and develop policy for the care of mentally ill patients.

The effects of a research utilization in-service program on nurses.

The objective of this quasi-experimental design study was to evaluate an 8-week course of research utilization training provided for nurses. Eighty-nine nurses participated in the complete study. Age and education background of the nurses in the control group matched that of the participants in the experimental group. The research instruments included a scale of attitudes toward nursing research, a scale of perceived support for nursing research, a research participation questionnaire, and a research utilization questionnaire. Repeated measures analysis of covariance and the Mann-Whitney U test were adopted for statistical analysis. The results showed that there were significant differences in attitudes between the two groups toward research and perceived support of institutions. Participation in research also differed significantly when analyzed at posttests 2 and 6 months after the course. There was no significant difference in research utilization. These results suggest that continuous consultation and assistance should be provided to the nurses after the course, so as to implement the results of research utilization.

Evaluation of computer-assisted multimedia instruction in intravenous injection.

The purpose of this study was to develop a computer-assisted multimedia training course for intravenous injection and evaluate its effect on the knowledge and self-perceived performance of intravenous injection for novice nurses. Eighty-one novice nurses randomly assigned to the experimental group and control group participated a designed training procedure and took pretest and posttests. The test results were analyzed using statistical methods. From the study it could be concluded that the training course had a significant effect on the intravenous injection's knowledge. Besides, a high rate of satisfaction for the multimedia program showed the self-developed program was successful.

Comparing the working time between Bar-Code Medication Administration system and traditional medication administration system: an observational study.

BACKGROUND: The medical institutions had paid attention to the medication error via Bar-Code Medication Administration system (BCMA) to improve the accuracy of the medication process for patient safety. Yet, the working time of drug delivery was under investigated. OBJECTIVES: Comparing the working time of oral drugs between Bar-Code Medication Administration system and traditional medication administration system. METHODS: Purposive sampling, observational and questionnaire study design was used. Participants were invited from a medical center in North Taiwan, 51 nurses from three neurosurgical wards who were using the BCMA system; 51 nurses from three neurological wards who were using traditional medication administration record (MAR). The working time of oral medication administration including order transcribing, verifying, drug giving, and renew in BCMA and traditional group were observed and recorded. RESULTS: (1) Working time for oral medication administration reduced from 36.49 to 18.42 s after BCMA implementation. (2) In the same period, working times for oral drug administration were 62.89 and 56.07 s before and after BCMA implementation in the traditional group. (3) Most nurses (66.7%) felt BCMA could save their oral drug administration time under 50%. (4) Frequent crash of the wireless network, which extended the oral drug administration time was the major threat in the process of BCMA implementation. (5) 93.5% nurses think that BCMA could enhance patient oral medication safety and promote quality of oral medication. CONCLUSIONS: The results demonstrated that implementation of BCMA for oral medication could reduce half of the time for oral medication delivery. Nurses coordinated the hardware and software by accommodating the new facilities and operating BCMA system. The stability of wireless Internet was the main threat. However, 93.5% nurses think that BCMA could enhance patient oral medication safety in spite of making more effort in learning new technology.

Integrated model of simulated occupant injury risk and real medical costs.

INTRODUCTION: The purpose of this study was to develop an integrated methodology that links occupant injury risk functions, estimated in the laboratory, with real world medical treatment costs by using the abbreviated injury score (AIS). Using our model, the expected medical treatment costs for crash injuries to various body regions and of different severities can be investigated. METHODS: First, the simulation results are compared with NHTSA crash data. We used a modified kinematics simulation model that incorporates an F=E(b) function as a supplement to the previous Steffan's model to obtain a more accurate acceleration history a(t). Second, head injury criteria HIC(36) can be calculated from a(t), and we use the injury probability P as a function of HIC(36,) as proposed by Kuppa, to obtain the injury risk function for various AIS values. Third, medical treatment cost models for various AIS values can be calculated by using a regression cost model with real world data. Finally, the injury risk function and medical treatment cost models are linked through AIS values. We establish an integrated methodology and predict medical costs and car safety data using real world police reports, medical treatment costs, and laboratory simulation results. RESULTS: Using head injuries in frontal crashes as an example, we focus on simulation parameters for different vehicle models, with and without airbags. We specifically examine impact closing speed, Delta-V, and impact directions. CONCLUSION: Simulation results can be used to supplement insufficient real crash data, in particular DeltaV, and injury risk results from police crash reports. IMPACT ON INDUSTRY: The proposed integrated methodology may provide the vehicle industry with a new safety assessment method. Real crash data coupling provides consumers with more realistic and applicable information.

The use of virtual reality computer simulation in learning Port-A cath injection.

Cost-benefit management trends in Taiwan healthcare settings have led nurses to perform more invasive skills, such as Port-A cath administration of medications. Accordingly, nurses must be well-prepared prior to teaching by the mentor and supervision method. The purpose of the current study was to develop a computer-assisted protocol using virtual reality (VR) in performing Port-A cath as a training program for novice nurses. A pre-tested and post-tested control group experimental design was used in this study. Seventy-seven novice nurses were invited from one large medical center hospital in North Taiwan. Thirty-seven and forty nurses were randomly assigned to experimental and control groups. First, we designed a 40 minute port-A cath injection VR simulation. Then, the experimental group practiced this simulation two times over 3 weeks. The control group attended the traditional class. The post-test 1 was right after completion of the simulation practice. The post-test 2 was after the second simulation practice in 3 weeks. The results showed that most novice nurses lacked Port-A cath experience both in the classroom and during the period of their practice training. The knowledge score regarding the Port-A cath technique was significantly higher in the nurses that participated in the simulation training than in the control group. The novice nurses were most satisfied with the reduction in their fear of performing the Port-A cath technique and their enhanced clinical skills. VR simulation significantly reduced error rates and increased correct equipment selection, showing that nurses who participated in the simulation may be better prepared for inserting Port-A cath.

Patient falls and open visiting hours: a case study in a Taiwanese medical center.

This study investigated the linkages between patient falls and open visiting hours in an acute care setting in Taiwan. The activities of the accompanying family members/aides when patients fell were analyzed. More than 35% of the family members/aides who were watching patients were ineffective in preventing the falls.

Developing and validating a nursing website evaluation questionnaire.

AIM: The aim of this paper is to report on the development and validation of an evaluation questionnaire for nursing websites. BACKGROUND: Increasing numbers of the general public and health care professionals are using the Internet to access health and health care-related information. The quality of such websites, therefore, needs to be evaluated. METHODS: A total of 24 websites in the United States and Taiwan, including websites in 13 leading schools and 11 hospitals, were selected as test websites. A total of 120 participants with Master's degrees in either nursing or mechanical engineering were invited to examine the 24 websites using a nursing website evaluation questionnaire. A 32-item questionnaire was developed, covering overall impression, download and switch speed, accessibility and convenience, web page content, service function and compatibility with common browsers. Participants were requested to connect to the specific websites and browse the contents before filling in the questionnaire. The results were arranged into 12 different sequences and prepared on a CD using Macromedia Dreamweaver. Data were analysed using Cronbach's alpha, Guttman split-half reliability and factor analysis. FINDINGS: Internal consistency was good, with a Cronbach's alpha of 0.93 in Part I and a KR-20 (Kuder Richardson) of 0.85 in Part II. Four factors given in Part I were identified as content truth, accessibility and convenience, speed and connection, and overall impression. CONCLUSION: The nursing website evaluation questionnaire had good construct validity and internal consistency.

Audio-visual relaxation training for anxiety, sleep, and relaxation among Chinese adults with cardiac disease.

The long-term effect of an audio-visual relaxation training (RT) treatment involving deep breathing, exercise, muscle relaxation, guided imagery, and meditation was compared with routine nursing care for reducing anxiety, improving sleep, and promoting relaxation in Chinese adults with cardiac disease. This research was a quasi-experimental, two-group, pretest-posttest study. A convenience sample of 100 cardiology patients (41 treatment, 59 control) admitted to one large medical center hospital in the Republic of China (ROC) was studied for 1 year. The hypothesized relationships were supported. RT significantly (p <.05) improved anxiety, sleep, and relaxation in the treatment group as compared to the control group. It appears audio-visual RT might be a beneficial adjunctive therapy for adult cardiac patients. However, considerable further work using stronger research designs is needed to determine the most appropriate instructional methods and the factors that contribute to long-term consistent practice of RT with Chinese populations.