The mediating effect of sleep quality and fatigue between depression and renal function in nondialysis chronic kidney disease: a cross-sectional study.

BACKGROUND: Depressive symptoms, fatigue, and poor sleep quality are associated with renal function deterioration in patients with nondialysis chronic kidney disease (CKD-ND). This study was designed to examine whether fatigue and sleep quality are mediators of the association between depression and renal function. METHODS: This study adopted a cross-sectional study design. Patients with CKD-ND aged 20 years or older were recruited by purposive sampling at a medical center in Central Taiwan from December 2020 to July 2021. Data were collected using the Emotional and Social Support Scale, Fatigue Scale, Beck Depression Inventory-II (BDI-II), and Pittsburgh Sleep Quality Index. Medical records were reviewed to obtain the estimated glomerular filtration rate (eGFR) for the next month. The relationships among variables were analyzed using structural equation modeling to assess the goodness-of-fit of the model. Then, the bootstrapping method was used to analyze the mediated effect. RESULTS: Two hundred forty-two participants (mean age 70.5 years and 53% males) were included in the analysis. About 39% of the participants met the criteria for depressive symptoms in BDI-II, and 91% reported having sleep disturbances. Participants' degree of fatigue was not high (20.4 ± 13.3). The average eGFR was 25.45 mL/min/1.73 m 2 (± 13.36). The results showed that fatigue, sleep quality, and eGFR were significantly correlated with depression. The total effect size was - 0.8304 (95% confidence interval [CI], - 0.9602 to - 0.7006), and the indirect effect size was - 0.1738 (95% CI, - 0.2812 to - 0.0651), which was a statistically significant difference, indicating that the model has a mediating effect. According to mediation analysis, fatigue and sleep quality had a significant indirect effect on the relationship between depression and renal function (95% CI, - 0.0587 to - 0.0039). CONCLUSIONS: The findings suggest that fatigue and poor sleep quality may mediate the association between depression and renal function.

Peritoneal dialysis after shared decision-making: the disparity between reality and patient expectations.

BACKGROUND: The current health policy in Taiwan favors peritoneal dialysis (PD) at home. Policy objectives may make healthcare providers give more consideration to the introduction of PD treatment. This study aimed to explore the process of information acquisition and consideration during shared decision-making (SDM) for patients undergoing PD and compare their quality of life expectations before and after PD at home. METHODS: In this qualitative study, 15 patients undergoing PD for < 12 months were purposively recruited from one large PD unit in Taichung, Taiwan. Data were collected between August 2020 and December 2020 using a semi-structured interview. All transcripts were evaluated using thematic analysis. RESULTS: Three themes and seven subthemes were identified following data analysis: 1. sources for information on dialysis treatment, including (a) effect of others' experiences and (b) incomplete information from healthcare providers (HCPs); 2. considerations for choosing PD, including (a) trusting physicians, and (b) maintaining pre-dialysis life; and 3. disparity between pre-and post-PD reality and expectation, including (a) limitation by time and place, (b) discrepancies in expected freedom and convenience, and (c) regret versus need to continue. CONCLUSION: HCPs played an important role in SDM, providing key information that influenced the process. Patients undergoing initial PD at home exhibited a disparity between expectation and reality, which was exacerbated by incomplete information.

Exploration and forecasting of behaviours and factors relating to fruit and vegetable intake among seniors in the community.

OBJECTIVE: The present study investigated the current status of fruit and vegetable intake among seniors and assessed the relationship between personal background factors, social psychological factors and environmental factors of the study participants and their fruit and vegetable consumption behaviour. DESIGN: Research data were collected through individual interviews using a questionnaire developed by the authors. SPSS for Windows 15·0 statistical software was used to process and analyse the data. SETTING: Elderly individuals sampled from all twenty-nine administration units of Keelung City's Renai District were interviewed. SUBJECTS: Study participants included 398 residents aged 65 years or older. RESULTS: On average, study participants ate five daily servings of fruits and vegetables on 2·86 d/week. The important variables influencing fruit and vegetable consumption were education level, outcome expectancy, social support, self-efficacy, frequency of dining out and role modelling. Educated participants consumed more fruits and vegetables than those without education. Outcome expectancy, social support, self-efficacy and role modelling had positive impacts on fruit and vegetable intake, but frequency of dining out had a negative impact on fruit and vegetable intake. The significant predictors of fruit and vegetable intake behaviour were education level, outcome expectancy, social support and frequency of dining out. Among those variables, social support was the most influential factor. CONCLUSIONS: Our findings supported the conclusion that health education strategies to increase fruit and vegetable intake among seniors should include the variables of social support and outcome expectancy.

Effects of Online Teaching during the COVID-19 Pandemic on Nursing Students' Intention to Join the Nursing Workforce: A Cross-Sectional Study.

Nursing education programs were interrupted and largely moved online as a result of the COVID-19 pandemic. The purpose of this study was to explore Taiwanese nursing students' perspectives on online teaching during the COVID-19 pandemic and whether changes in teaching models have affected their intention to join the nursing workforce. A multi-center cross-sectional survey was conducted. Nursing students at universities and those at 5-year junior colleges were recruited to participate in the study. Data were collected through an online questionnaire survey. A total of 687 students responded to the questionnaire. The results were analyzed using percentages, mean ranks, and nonparametric methods. The results showed that 78.6% of the students agreed that online teaching was more flexible; most students stated that technical problems with computer equipment and stability of the network were large challenges that impeded online teaching. Furthermore, up to 64.8% of the students considered that online courses had affected their preparations for future nursing jobs, especially in terms of a lack of proficiency in nursing skills and inadequacy in actual interactions with patients. Online teaching is a powerful tool for nursing education, but a thoughtful strategy and more proactive approach are necessary to overcome the existing challenges for online teaching.

The effects of narrative pedagogy on increasing nursing students' willingness to practice older people care: A mixed-methods research.

AIM: This study aims to discuss how narrative pedagogy of improving the positive attitude toward older people among nursing students and increasing students' willingness to practice older people's care. BACKGROUND: Considering the progress of population aging, the requirement for nursing manpower in older people care is on the rise. However, related studies have demonstrated that nursing students generally have a negative attitude toward older people, which affects students' willingness to engage in older people's care in the future. DESIGN: This study applied mixed method research design. For the quantitative study design, we have adopted a quasi-experimental study, pretest-posttest design. METHODS: The study adopted purposive sampling. A total of 87 nursing students in two classes of five-year junior college program in northern Taiwan were selected as the study subjects. The students were randomly allocated into an experimental group of 43 subjects and a control group of 44 subjects. The experimental group received narrative pedagogy of geriatric care course for 18 weeks with 2 h per week, the control group received general lectures. This study was conducted between October 2019 and February 2020. The quantitative data were collected using the structured questionnaire. The qualitative data were collected by individual interviews and students' reflective writing. RESULTS: The average scores of the older people's attitude (F=4.60, p < 0.05) and the willingness to care for the older people (F=4.19, p < 0.05) in the experimental group increased significantly, reaching a statistically significant level. According to the adjusted post-test score averages of the two groups, under the control of the pre-test, the Older Adults Attitude Scale (64.02 >60.22) and the post-test of the Older Adults Care Willingness Scale (11.63 >9.93) in the experimental group were significantly higher than those in the control group. In the qualitative analysis, four themes were emerged, which were negative stereotypes about the older people, myth-breaking for prejudice against the older people, new older people impression for replacement and rethinking for older people care. CONCLUSION: Narrative pedagogy is an effective teaching method, which can improve nursing students' older people's positive attitudes and increase students' willingness to practice older people's care.

The Effect of Integrating Service-Learning and Learning Portfolio Construction into the Curriculum of Gerontological Nursing.

BACKGROUND: With the rapid increase in the aging population, a greater number of older individuals will require nursing care in the future. Therefore, it is important for nurses to be willing to engage in gerontological nursing. Nursing students must increase their experience in providing care to older people during their education and must receive education that improves their attitudes toward aging; this will help provide care to the older people, develop positive attitudes toward aging, and increase their empathy and willingness to provide care to older people after graduation. Hence, studies focused on improving the attitude of nursing students toward aging are urgently required. METHODS: In this mixed-method experimental study, participants were interviewed individually and observed to better understand the connection between quantitative and qualitative data. Service learning and learning portfolio constructions were integrated in the gerontological nursing curriculum of an experimental group, whereas traditional gerontological nursing curriculum was provided to a control group. Quantitative data on the nursing students were collected using the attitudes toward aging scale (ATAS) and older people behavioral intention scale (OBIS) and analyzed using descriptive and inferential statistics. RESULT: From the pre- to the post-test, the average ATAS and OBIS scores of the experimental group increased significantly, reaching a statistically significant level. However, the results of the control group indicated that the educational intervention does affect the attitudes toward aging and older people behaviors. A qualitative analysis revealed that educational intervention can improve the students' attitudes toward aging and older people behavioral intention. CONCLUSION: Our study results showed that integrating community older people service and learning portfolio construction into the curriculum can effectively improve the attitudes of nursing students toward aging and older people's behaviors, thus providing substantial assistance to students intending to care for the older people in the future.

The Effects of Empowerment Education on Daily Dairy Intake in Community-Dwelling of Older Asian Women.

A scarcity in the intake of dairy products in older women begets a wide range of musculoskeletal problems, especially osteoporosis. However, dairy products are often not consumed in sufficient quantities in Eastern societies. This study used empowerment education to improve daily dairy intake in 68 older Asian women in the community through a quasi-experimental study design. The 34 participants in the experimental group took part in empowerment education programs that included lectures, sharing sessions, situation dramas, and cooking activities, for two hours per week for 6 weeks. The 34 participants in the control group had no interventions. The generalized estimating equation was used to evaluate the intervention's effectiveness. The test was conducted for the two groups at 1 and 12 weeks after the completion of the lessons. We used daily dairy intake self-efficacy, intention, and behavior scale to measure the outcome. The change in the experimental group's daily dairy intake self-efficacy and intention score at post-1 week and post-12 weeks was higher compared to the control group, but the dairy intake behavior was only changed at post-12 weeks. The empowerment education was effective in encouraging older women to change their dairy intake behavior and improved their dairy intake self-efficacy and intentions.

The Effects of a Social Participation App on Seniors.

BACKGROUND: Advancements in medical care have increased the average life span in many countries, resulting in a generally longer postretirement life span. However, retirees may find it difficult to adapt to retirement. Therefore, encouraging retirees to engage with society is important. PURPOSE: In this study, a senior social participation mobile software application (SSP-App) was developed to stimulate social participation among seniors with the goal of improving their social participation intentions and behaviors. METHODS: After developing the SSP-App based on user experiences, a quasi-experimental study was conducted. Participants were recruited from the Keelung Ren'ai Community Center. Next, Random Allocation Software Version 1.0.0 software was used to randomly allocate the participants into experimental and control groups. The 54 participants in the experimental group took part in an SSP-App program, whereas the 53 participants in the control group did not participate in any experimental treatment program. Measurements were conducted at Week 4 (T1) and Week 12 (T2) to evaluate the effects. Data were collected using a demographic datasheet, Geriatric Depression Scale-Short Form, Emotional and Social Support Scale, Social Participation Intention Scale, and Social Participation Behavior Scale. The generalized estimating equations method was used to determine intervention effectiveness. RESULTS: The SSP-App has six main functions, including an activity partner message board, an activity search function that provides information about different activities, a "Seniors Learning Kiosk" that provides useful information, transportation information, an activity planning and reminder system, and a "First-Aid Station." Most participants in the SSP-App precursor test expressed approval. At T1, effects were observed in social participation intention only. However, at T2, effects were observed in both social participation intention and social participation behavior. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The SSP-App developed in this study uses information and communication technology and multiple strategies covering information provision, social support, education, and reminders. Social participation obstacles must be overcome to effectively provide seniors with social participation opportunities and improve their social participation.

Applying artificial intelligence technology to support decision-making in nursing: A case study in Taiwan.

This study applied artificial intelligence to help nurses address problems and receive instructions through information technology. Nurses make diagnoses according to professional knowledge, clinical experience, and even instinct. Without comprehensive knowledge and thinking, diagnostic accuracy can be compromised and decisions may be delayed. We used a back-propagation neural network and other tools for data mining and statistical analysis. We further compared the prediction accuracy of the previous methods with an adaptive-network-based fuzzy inference system and the back-propagation neural network, identifying differences in the questions and in nurse satisfaction levels before and after using the nursing information system. This study investigated the use of artificial intelligence to generate nursing diagnoses. The percentage of agreement between diagnoses suggested by the information system and those made by nurses was as much as 87 percent. When patients are hospitalized, we can calculate the probability of various nursing diagnoses based on certain characteristics.