Factors associated with poor sleep quality in patients with pre-dialysis chronic kidney disease: A systematic review.

AIMS: To determine factors associated with poor sleep quality among patients with pre-dialysis chronic kidney disease. DESIGN: This is a systematic review study guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements and checklist. DATA SOURCES: Empirical evidence was sought in major electronic databases, including Embase, MEDLINE, CINAHL and Airiti library from March to September 2022. REVIEW METHODS: Studies investigating factors associated with poor sleep quality among adult patients with chronic kidney disease were included. Study participants who received renal replacement therapy and had sleep disorders and serious illnesses such as cancer were excluded. Of the 526 studies that resulted from the search after removing duplicate articles, 20 studies were assessed for quality by using Joanna Briggs Institute and Newcastle-Ottawa Scale by two doctorial prepared nursing scientists. RESULTS: A total of 20 studies were included in this review. The prevalence of poor sleep quality in these studies ranged from 11% to 97.5%. Demographics (older age and female), physiological conditions (higher body mass index, higher hip circumferences, higher systolic blood pressure, poor cardiovascular function, dyspnoea, pain, cramps, itchiness or moderate to extreme pruritus, lower fasting plasma glucose, electrolyte imbalance, higher total cholesterol and gastrointestinal symptoms), depression, smoking, arousal-related and cognitive arousal behaviours were associated with poor sleep quality. CONCLUSION: Poor sleep quality was prevalent and influenced kidney function, increased mortality as well as decreased quality of life in patients with pre-dialysis chronic kidney disease. This review synthesizes factors associated with poor sleep quality. Managing these factors can mitigate and prevent poor sleep quality. IMPACT: Healthcare providers, especially nurses, can assess the risk factors of poor sleep quality and reinforce patients' self-management. Future research should elucidate the assessment and management of risk factors and transfer these into widespread use in the routine care of patients with chronic kidney disease.

[Applying an Exercise Snack-Based Health Promotion Strategy].

Lack of time, lack of access to equipment, and environmental constraints are generally perceived as barriers to regular physical activity. Moreover, insufficient activity is known to promote sedentary behavior, which is a factor in many chronic diseases, negatively affects mental health, and reduces quality of life. Exercise snacks, defined as short and efficient bursts of exercise, are convenient and easy to implement, reduce sedentary time, increase physical activity, and promote the development of good exercise habits. Previous studies have found exercise snacks to be safe and feasible for the elderly, promoting physical function and reducing the incidence of falls and metabolic diseases. Exercise snacks have also been found to be effective in healthy adults as well as in patients with obesity and diabetes, helping decrease blood sugar and promoting cardiorespiratory fitness. Depending on the participant's age and tolerance, exercise snack patterns may be extended and distinguished into two forms: 10-minute bouts of gentle intermittent exercise twice a day and 60-second bouts of vigorous exercise 3 to 8 times a day. The main considerations for exercise snacks include: multi-joint exercise is better than single-joint exercise, lower body exercise is better than upper body exercise, and dynamic and rapid movement that pushes away from the ground promotes osteogenesis and helps prevent osteoporosis and fractures. Exercise snacks may be applied in healthcare practice and related research to promote health and improve quality of life for all.

Self-report instruments for measuring patient dignity: A psychometric systematic review.

AIMS: To synthesize and evaluate the psychometric properties of self-report instruments that measure patient dignity. DESIGN: A psychometric systematic review. DATA SOURCES: A comprehensive search of studies published from inception until February 17, 2022, was performed using PubMed, Embase, CINAHL, Web of Science, and Scopus. REVIEW METHODS: The methodological quality of the psychometric studies was evaluated following the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. RESULTS: Eleven self-report instruments that evaluate dignity were identified. For most instruments, psychometric properties, including reliability, cross-cultural validity, responsiveness, and measurement error, had not been adequately examined. The Patient Dignity Inventory (PDI), the Jacelon's Attributed Dignity Scale (JADS), and the Inpatient Dignity Scale (IPDS) had acceptable content validity, structure validity, and internal consistency to measure dignity among adult patients under palliative care, community-dwelling older adults, and inpatients receiving daily care. CONCLUSION: The PDI, the JADS, and the IPDS are recommended for future clinical practice and research to measure dignity among adult patients under palliative care, community-dwelling older adults, and inpatients receiving daily care. Early identification of patients' dignity-related problems in nursing care can prevent negative health outcomes and help develop a timely intervention to promote patients' health and recovery. IMPACT: Given that the psychometric properties of the existing self-report dignity instruments have not been systematically assessed, the present review utilized comprehensive methods according to COSMIN to evaluate and determine the most appropriate measure for research and practice. The PDI, the JADS, and the IPDS demonstrated satisfactory psychometric properties and are, thus, recommended for clinical and research applications. Nursing professionals can employ these instruments to assess and promptly identify dignity issues among both young and older adults in hospitals and communities.

Improving Leadership Competence Among Undergraduate Nursing Students: Innovative Objectives Development, Implementation, and Evaluation.

AIM: The aim of the study was to identify baccalaureate nursing leadership objectives and evaluate their effectiveness when embedded into an undergraduate nursing curriculum. BACKGROUND: The objectives of nursing leadership competencies cannot be met in one semester but must be gradually developed over successive courses. METHOD: A list of learning objectives for leadership competence was generated and reviewed by 12 experts using the Delphi method. The consensuses objectives were embedded into a four-year nursing baccalaureate curriculum in Taiwan. Nursing students (N = 120) who participated in the courses evaluated the embedded objectives of leadership competency introduced in their undergraduate nursing program. Leadership competence was improved among students on nine items (t = 2.282 to 5.741, p = .001 to .030) of the Nursing Leadership Competence Assessment Scale for Undergraduate Nursing Students. CONCLUSION: The results can serve as a reference for universities seeking to promote nursing leadership education.

Relationship between Walking Activity and Sleep Quality among Community-Dwelling Older Adults.

PURPOSE: To explore the relationship between walking activity and sleep quality among elderly. DESIGN: A cross-sectional, correlation study with purposive sampling was conducted on participants with a walking habit but not regular moderate-intensity exercise. METHODS: Data were collected by structured questionnaires, including the Walking Activity Questionnaire and the Pittsburgh Sleep Quality Index. FINDINGS: The total walking time per week and frequency of walking per day were significant predictors of sleep quality. CONCLUSIONS: Walking can help older community-dwelling adults improve their sleep quality. CLINICAL EVIDENCE: Walking more than once per day and total walking time per week ≥210 minutes were associated with good sleep quality.

[Developing and Evaluating the Effectiveness of a Leadership Integrated Educational Program for Master's Nursing Students in Taiwan].

BACKGROUND: Nursing students with master degrees have the strong potential to serve as future leaders in medical teams. Implementing a well-developed and integrated educational program for nursing leadership at the master's level can strengthen the leadership of advanced practice nurses and promote a positive nursing practice environment. PURPOSE: To develop a leadership integrated educational program for master's nursing students and conduct a preliminary evaluation of the effectiveness of this program in cultivating leadership competencies in these students. METHODS: Phase 1: A modified Delphi survey conducted on 14 experts with clinical or academic backgrounds was used to identify the teaching objectives and strategies of the leadership integrated educational program. Phase 2: These teaching objectives and strategies were embedded into nine compulsory courses within a current training program for master's nursing students at a national university. The core elements of the leadership integrated educational program were incorporated into each compulsory course. The objectives of each compulsory course directly reflected the objectives of the integrated program. The leadership integrated educational program was implemented for one academic year, and its effectiveness was evaluated using a quasi-experimental test with a single group pre- and post-test design. A self-developed, 10-item "Master Nursing Student's Leadership Competence Scale" covering four core elements was applied to measure the self-reported leadership competencies of the participants. A paired sample t-test was applied to analyze the differences in leadership competencies between pre- and post-intervention. RESULTS: A consensus on the teaching objectives and strategies of the leadership integrated educational program was achieved in the first round of the Delphi survey. The overarching teaching objective of the leadership integrated educational program was to "lead the healthcare team with the leadership and competencies, and demonstrate the advanced nursing practice skills for improving quality of care." In addition, the four core elements under the overarching goal, i.e., personal characteristics, leading people, business management, and vision building, were proposed. Forty-eight master's nursing students participated in this study. The results showed the average total score of leadership competency was 42.33 ± 12.16 (potential range: 10 - 70), indicating that the participants had a middle level of leadership competency prior to program participation. After participating in the Leadership Integrated Educational Program for one academic year, the average total score for leadership competency increased to 51.27 ± 9.74, indicating that the participants still had a middle level of leadership competency. Nevertheless, the 8.94 increase in the post-intervention score was statistically significant (p < .01). Moreover, the scores for each subscale (personal characteristics, leading people, business management, and vision building) had all increased significantly increased from 13.52 to 15.71, 12.65 to 15.35, 8.15 to 10.31, and 8.02 to 9.90, respectively (p < .01). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: This study offers proactive recommendations for reforming master's degree programs in nursing. The proposed multidisciplinary-expert-informed leadership integrated educational program may be used to strengthen leadership competencies in this student population. Furthermore, the findings provide a benchmark for developing an effective nursing leadership integrated educational program that may be incorporated into domestic master's degree programs.

Determinants of High-Sodium Food Intake Among Indonesian Patients With Hypertension.

BACKGROUND: Sodium restriction is difficult for most individuals with hypertension. Intention to limit sodium intake predicts behavior. Information on the determinants of intention to restrict sodium intake is limited. OBJECTIVES: The aims of this study were to identify (1) determinants of intention to restrict high-sodium food intake and (2) sources of sodium consumed by patients with hypertension in Indonesia. METHODS: A cross-sectional study was conducted among adult patients with hypertension (n = 206) attending cardiac clinics. A researcher-developed and tested, self-administered questionnaire that included questions about sodium restriction and a high-sodium food inventory was distributed. The quantile regression method was used to identify determinants of intention to restrict dietary sodium. RESULTS: The mean age of the patients with hypertension was 59 ± 10 years, and more than three-fourths were obese (n = 162, 78%). The determinants of intention to limit sodium intake included gender (ß = 0.737, P = .036), attitude (ß = -0.141, P = .050), and subjective norm (ß = -0.283, P = .005). Men reported higher sodium consumption, while attitudes and subjective norm were negatively correlated with sodium intake. These determinants predicted 13.2% of the variance in intention to restrict dietary sodium. Subjects reported frequently consuming snacks (n = 82, 39.7%) and seasoning condiments (n = 65, 31.6%). CONCLUSIONS: High-sodium snacks and condiments added while cooking were frequently consumed among patients with hypertension in Indonesia. Understanding the factors associated with intention to follow a low-sodium diet will assist nurses to design effective interventions that promote adherence to the low-sodium diet among those with hypertension.

[Nursing Education Strategies During the COVID-19 Epidemic].

The ongoing new coronavirus disease (COVID-19) pandemic, which arose at the end of 2019, poses a severe challenge to world public health systems. Frontline medical staffs bear a great burden to provide health care services. The Taiwan government has taken rapid and decisive actions to reduce the risk of community transmission and campus cluster infection. Nursing education includes both classroom teaching and clinical practicum components. In preparing for their practicum, students must learn not only fundamental nursing care knowledge but also basic knowledge on emerging infectious diseases. All schools nationwide have complied with the Ministry of Education order to postpone the opening of the fall semester in response to the rapid evolution of the COVID-19 pandemic. Campus epidemic prevention measures were implemented through student counseling networks, and flexible teaching strategies, including online teaching and distance teaching, were implemented to protect the learning rights of students. This paper explores the strategies implemented in response to emerging infectious diseases in nursing education based on the core values of professional nursing. Examining the precautions taken at campuses and teaching strategies adopted in response to the COVID 19 pandemic may provide valuable insights that may be applied to the future development of nursing education.

[Social Impacts of International Nursing Education].

The objective of international nursing education in Taiwan is to prepare nursing elites to improve the quality of global healthcare. Nurses are on the frontlines in terms of helping the public through increasingly frequent climate-change disasters, helping care for the rising populations of older adults and patients with chronic diseases, and dealing with the emergence of new infectious diseases. Advancing the knowledge and capabilities of global nursing elites is imperative. The main purpose of nursing education is to educate future nursing leaders. This paper describes the internationalization of nursing education in the Department of Nursing at National Cheng Kung University as well as the process of establishing the Asia-Pacific Nursing Education Alliance to highlight the international characteristics of nursing education, the related global social influence, and the pursuit of sustainable development goals.

Self-Management Behaviors in Relation to Psychological Factors and Interdialytic Weight Gain Among Patients Undergoing Hemodialysis in Indonesia.

PURPOSE: The purpose of this study was to understand the influence of demographic and psychological factors on self-management behaviors and interdialytic weight gain (IDWG) as a fluid adherence marker among patients undergoing hemodialysis in Indonesia. DESIGN: A quantitative correlational study. METHOD: A convenience sample of 145 patients undergoing hemodialysis was recruited from the dialysis units in two hospitals in Jakarta from September to December 2015. Questionnaires were used to examine self-management behaviors, depression, anxiety, and stress. Data for IDWG were obtained by subtracting the individual's predialysis weight from his or her postdialysis weight from the previous session. Hierarchical multiple linear regression identified the predictors of IDWG. RESULTS: Self-advocacy was ranked the least performed self-management behavior, while medication adherence was ranked the most likely to be performed. Among the subscales of the Self-Management Behavior Indices, positive correlations were found between the communication dimension with all psychological factors (depression, anxiety, and stress), while self-advocacy had positive correlation with anxiety. Subjects gained a mean of 4.5% of their postdialysis weight, with over 50% exceeding the recommended 4% IDWG. Overall, 53.6% of the IDWG was explained by the weekly duration of hemodialysis, level of depression, communication, partnership in care, and self-advocacy. CONCLUSIONS: Self-management behaviors are potential predictors that can be modified by nephrology nurses in order to enhance clinical outcomes, with the specific outcome being IDWG. Self-management behaviors contribute to the promotion of appropriate IDWG. Depressed patients are less likely to adhere to weight gain restrictions. CLINICAL RELEVANCE: Education combined with training in self-management behaviors-particularly communication, becoming a partner in care, and advocating for care-may improve adherence to IDWG guidelines among Indonesian hemodialysis patients. Interventions targeting depressed patients are needed.

Perception of Spirituality and Spiritual Care among Muslim Nurses in Indonesia.

This cross-sectional study was conducted to examine 256 Muslim nurses' perception of spirituality and spiritual care in Indonesia. The Spirituality and Spiritual Care Rating Scale (SSCRS) was translated and culturally adapted. Moderately high degrees in five domains and total SSCRS were found. Specialty, education level, clinical seniority, having spiritual training, and previous spiritual caring experience could impact on the SSCRS. Most nurses have cared for patients with spiritual needs, but denied having any formal training in providing spiritual care. Providing adequate curriculum and on-job training to equip nurses' knowledge and competence of spiritual care is urgent in Muslim healthcare environment.

Exploring the relationship between nursing hours per patient day and mortality rate of hospitalised patients in Taiwan.

AIM: To investigate the relationship between nursing hours per patient day and the inpatient mortality rate in Taiwan. BACKGROUND: Nursing hours per patient day has been associated with better patient outcomes. The literature is inconclusive on the relationship between nursing hours per patient day and the inpatient mortality rate, and no studies have yet examined this issue in Taiwan. METHODS: A retrospective longitudinal study analysed data from the 'Nursing Utilization of Resources, Staffing and Environment on Outcome Study: NURSE-outcome study'. Hierarchical regression estimated the relationship between nursing hours per patient day and in-hospital mortality rate after controlling for confounding variables. RESULTS: The mean nursing hours per patient day in Taiwan was 2.3, while the mean inpatient mortality rate was 0.73% higher nursing hours per patient day was associated with a lower inpatient mortality rate after controlling for confounding variables. The total explained variance of this study in inpatient mortality rate was 19.9%. Significant relationships to inpatient mortality were found in levels of hospitals, seasonal variation and nurses' work experience. CONCLUSION: Nursing hours per patient day affects the mortality rate among hospitalised patients in Taiwan. IMPLICATIONS FOR NURSING MANAGEMENT: According to the results, we suggested the government and managers in Taiwan double the nursing hours per patient day so that the inpatient mortality rate will decline by 1.1%. This might be the optimal nurse configuration that could provide a balance between cost-effectiveness and patient safety.

Insomnia, anxiety, and heart rate variability among nurses working different shift systems in Taiwan.

This cross-sectional comparative study investigated the levels of insomnia, anxiety, and heart rate variability of nurses members working different shift systems. One hundred and twenty-four participants were recruited from members of the nurses of two Taiwanese hospitals. Data were collected using the Chinese versions of the Athens Insomnia Scale and Beck Anxiety Scale questionnaires and electrocardiograms recorded immediately upon completion of each participant's work shift. A binary logistic regression model was used for analysis. Insomnia, anxiety, and abnormal parasympathetic activity were more acute in nurses who worked a rotating shift than in those performing day or night shift work. Logistic regression analysis showed that age significantly increased the incidence and level of insomnia. Age, years of service, and nurses' status as a parent significantly intensified incidences of anxiety and abnormal parasympathetic activity. Rotating shift work is one of the main factors causing adverse effects on the physical and psychological health of nurses; therefore, when a shift work system cannot be avoided, a practice of day and night shifts for nurses is preferable to rotating shifts.

[Applying the Strategies of Helping Relationship From Significant Others in Patients With Chronic Kidney Disease].

The absence of easily perceived symptoms in the early stages of chronic kidney disease (CKD) causes low levels of awareness and treatment of this disease. Therefore, adherence to measures that may prevent disease progression, i.e., lifestyle changes, regular clinic visits, and timely medication administration, is often low among early-stage CKD patients. However, continuous assistance from significant others through trusting, understanding, sharing, and coaching assistance may promote a healthy lifestyle and prevent progression of the disease. The necessary characteristics of significant others include dependability, credibility, and positivity. Significant others may use their understanding, caring, faith, and honesty to help patients face CKD and improve self-care efficacy. This article discusses the assistance that significant others may provide to CKD patients, including warning mechanisms, target setting, encouragement, and feedback. By developing the functions of supervision, companionship, and support, significant others may help patients live a healthier life and improve their medical compliance and thus postpone disease progression.

Is abnormal non-high-density lipoprotein cholesterol a gender-specific predictor for metabolic syndrome in patients with schizophrenia taking second-generation antipsychotics?

Evidence supports an association between metabolic syndrome (MetS) and schizophrenia. However, specific risk factors for MetS and gender differences in patients with schizophrenia taking second-generation antipsychotics (SGAs) have not been well explored. A cross-sectional cohort of 329 Han Chinese patients was recruited in a psychiatric hospital in central Taiwan. Using the definitions of the International Diabetes Federation for Chinese, the prevalence of MetS was 23.7% (men: 25.7%; women: 21.2%). Logistic regression analyses showed that patients with a BMI ≥ 24 and an abnormal non-high-density lipoprotein cholesterol (non-HDL-C) were significantly (p < 0.001) more likely to develop MetS. A BMI ≥ 24 was a significant risk factor in men (OR: 6.092, p < 0.001) and women (OR: 5.886, p < 0.001). An abnormal non-HDL-C was a significant specific risk factor for men with MetS (OR: 4.127, p < 0.001), but not for women. This study supports a greater prevalence of MetS in patients with schizophrenia taking SGAs than in the general population. Abnormal BMI and non-HDL-C were significantly associated with developing MetS, and an abnormal non-HDL-C was a specific risk factor for men. Future development of specific interventions and regular monitoring for MetS is imperative for early identification and prevention.

Predictors of Burnout Among Nurses in Taiwan.

Nurse burnout is a crucial issue for health care professionals and impacts nurse turnover and nursing shortages. Individual and situational factors are related to nurse burnout with predictors of burnout differing among cultures and health care systems. The predictors of nurse burnout in Asia, particularly Taiwan, are unknown. The purpose of this study was to investigate the predictors of burnout among a national sample of nurses in Taiwan. A secondary data analysis of a nationwide database investigated the predictors of burnout among 1,846 nurses in Taiwan. Hierarchical regression analysis determined the relationship between predictors and burnout. Predictors of Taiwanese nurse burnout were age, physical/psychological symptoms, job satisfaction, work engagement, and work environment. The most significant predictors were physical/psychological symptoms and work engagement. The variables explained 35, 39, and 18 % of the emotional exhaustion, personal accomplishment, and depersonalization variance for 54 % of the total variance of burnout. Individual characteristics and nurse self-awareness, especially work, engagement can impact Taiwanese nurses' burnout. Nurse burnout predictors provide administrators with information to develop strategies including education programs and support services to reduce nurse burnout.

[The effectiveness of far-infrared therapy in hemodialysis patients with arteriovenous fistula: a systematic review].

BACKGROUND: Over 85% of end-stage renal disease (ESRD) patients receive hemodialysis and 80% of hemodialysis patients in Taiwan contract arteriovenous fistula (AVF). Studies have shown that using far infrared therapy (FIR) improves AVF by improving blood flow. However, the systematic literature reviews have been insufficient to make definite conclusions regarding the effectiveness of this intervention. PURPOSE: This paper uses a systematic review of the literature to evaluate the FIR intervention and to explore its effectiveness. METHODS: Researchers searched the following five Chinese and English electronic databases for relevant articles: National Dissertations and Theses, Airiti Library, CINAHL, Cochrane Library, ProQuest, and PubMed/MEDLINE. Keywords including "far infrared therapy", "arteriovenous fistula", and "hemodialysis" were entered. The search was limited to articles published before February 2014. A total of 98 articles that matched the search criteria were extracted. Article topics were screened and repetitions of topics were removed. Three articles met the study inclusion criteria and were selected for further analysis. An assessment of the quality of these 3 studies using the Modified Jadad Scale earned a score of 3. RESULTS: Findings of this systematic review show that FIR interventions improve blood flow to and from the AVF and that the intervention decreases AVF malfunctioning. Currently, literature on this topic is limited in Taiwan. Therefore, more evidence is needed to validate the findings of the current study. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results of the current study support the ability of patients with FIR to improve their AVF functions as well as the immediate clinical applicability of the suggested intervention. Although current empirical evidence supports the effectiveness of gripping a ball in maintaining AVF functions, many hemodialysis patients, due to age or illness, are not physically capable of doing this exercise. Therefore, FIR is a very good alternative measure.

Toothbrushing versus toothbrushing plus tongue cleaning in reducing halitosis and tongue coating: a systematic review and meta-analysis.

BACKGROUND: Halitosis affects people of all ages. Among hospitalized patients, oral care includes toothbrushing and mouth rinses. Tongue cleaning is not included in most guidelines or nursing education curricula. OBJECTIVES: The aim of this study was to compare the effectiveness of two types of oral care, toothbrushing alone and toothbrushing plus tongue cleaning, on halitosis and tongue coating (TC). METHODS: A systematic review and meta-analysis of randomized controlled trials were conducted to compare toothbrushing and toothbrushing plus tongue cleaning during oral care to reduce halitosis and TC. The databases included PubMed, ProQuest, CINAHL, the Cochrane Central Register of Controlled Trials, experts, and bibliographic review. A quality assessment of study reports and methodology was conducted using the CONSORT checklist and the Jadad Scale. The measurement of volatile sulfide compounds (VSCs) evaluated halitosis, whereas TC was measured with assessment indexes. RESULTS: Seven experimental data sets were obtained from five randomized clinical trials. There were 188 male and 63 female subjects within an age range of 17-80 years. All intervention groups indicate a large effect size of toothbrushing plus tongue cleaning decreases volatile sulfur compounds and TC by 0.745 and 0.922, respectively, compared with toothbrushing only. DISCUSSION: The use of toothbrushing plus tongue cleaning compared with toothbrushing alone significantly reduced the indicators of halitosis and TC. However, there is insufficient evidence to recommend frequency, duration, or delivery method of tongue cleaning. Further research is needed to articulate a comprehensive clinical guideline. Oral care is an important nursing intervention. Tongue cleaning should be incorporated into current nursing procedures.

Examining factor structure of Maslach Burnout Inventory among nurses in Taiwan.

AIM: To investigate the factorial structure of a Chinese version of the MBI-HSS for nurses in Taiwan. BACKGROUND Previous studies have presented different factorial structures using the Maslach burnout inventory-human services survey (MBI-HSS). METHODS: Secondary data analysis was implemented to explore the factor structure of MBI-HSS using exploratory factor analysis. Confirmatory factor analysis was then performed to verify the modified structure for nurses in Taiwan. RESULTS: The EFA found that three factors explaining 57% of the variance were extracted, and 20 of the 22 items were retained. The goodness-of-fit test was performed using the CFA approach, and it was verified that the modified version of MBI-HSS is a suitable instrument for measuring burnout for nurses in Taiwan. CONCLUSIONS: A nationwide sample confirmed the factorial structure of MBI-HSS for nurses in Taiwan with a three-dimension, 20-item assessment, and the variance was not diminished in this sample. IMPLICATIONS FOR NURSING MANAGEMENT: These findings demonstrate that the modified version of MBI-HSS provides a suitable instrument for measuring burnout for nurses in Taiwan. Therefore, the modified version of MBI-HSS can be used to compare burnout of nurses across cultures, providing valuable information for policies or preventions in the future.

[Exploring the lived experiences of middle-aged males diagnosed with chronic kidney disease].

BACKGROUND: The majority of studies addressing chronic kidney disease (CKD) have been quantitative. The lived experiences of patients with early stage CKD have not been explored in the literature. Due to the lack of symptoms during the early stages of CKD, the progress of this disease is often ignored. PURPOSE: This study explores the lived experiences of middle-aged males diagnosed with CKD. Research focuses on the work experiences, interpersonal relationships, and dietary habits of this group. METHODS: This qualitative study used a narrative research method with purposive sampling. Ten middle-aged male patients were interviewed. We employed the 3 strategies of member checks, peer review, and debriefing in order to enhance the trustworthiness of the data analysis. RESULTS: Four major themes were identified: (1) keeping the same life pace as usual with concerns of deterioration; (2) continuing to support their family and play the role of father; (3) hoping to participate in family and friend relationships despite the illness; and (4) being challenged to maintain a healthy diet. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Although the physical status of participants was similar to the general middle-aged adult population, participants were concerned regarding disease deterioration. The results of this study suggest that health professionals: (1) provide appropriate information based on patients' personality, particularly at the first onset or apparent deterioration of the disease; (2) offer specialized healthcare information to patients relevant to their career choices; and (3) understand CKD-patient difficulties in daily life such as eating out habits and challenges faced in maintaining a healthy diet. Results may provide important information to healthcare providers in education planning and implementation and support programs for patients and families.