Cross-cultural translation and validation of the Chinese version Distress Tolerance Scale for adolescents with chronic physical disease.

INTRODUCTION: Chronic physical disease (CPD) makes life filled with many negative events in adolescents, but not all adolescents experiencing negative life events proceed to develop emotional distress, only those with low emotional distress tolerance (EDT). A valid and reliable scale to measure EDT in CPD adolescents is important for caring for their emotional distress. Therefore, the purpose of this study is to translate the 15-item English version Distress Tolerance Scale (DTS) into a Chinese version and then validate the scale for measuring EDT of adolescents with CPD. METHODS: The 15-item English version DTS was translated into a Chinese version using the translation guidelines for cross-cultural research. Two cohorts of adolescents with CPD were recruited from four hospitals in southern Taiwan, with the first cohort including 124 adolescents with CPD employed to conduct exploratory factor analysis, corrected item-total correlation and reliability testing, while the second cohort, consisting of 238 adolescents with CPD, was utilized to examine confirmatory factor analysis and concurrent validity. RESULTS: The two-factor nine-item Chinese version DTS for Adolescents with CPD (C-DTS-A) was developed. Lower scores of the C-DTS-A were significantly associated with higher diabetes distress, poorer self-management, and worse glycaemic control; their correlation coefficients sequentially were -.40, .17 and -.23. Cronbach's α and the test-retest reliability of the two-factor C-DTS-A ranged from .81 to .87 and from .79 to .89, respectively. CONCLUSION: The two-factor nine-item C-DTS-A with good cross-cultural translation quality was a reliable and valid scale to assess EDT for adolescents with CPD.

Translation and adaptation of Shared Care Instrument-Revised for the older adults and their caregivers in Taiwan.

BACKGROUND: The aging population in Taiwan has resulted in an increase in the dependent population and the care load on caregivers. Shared care is an interpersonal process in which support is "traded" to "handle" chronic illnesses by home-care patients and family caregivers. The scale of shared care has received little attention in the Taiwanese cultural context. Thus, this study examined the reliability and validity of the Taiwanese versions of Shared Care Instrument-Revised (SCI-R). METHODS: The content validity, construct validity, and discriminant validity were used to test the validity of the translated questionnaires. The Cronbach's α was used to examine reliability. A total of 500 older adults and their caregivers were recruited from three counties in Taiwan. RESULTS: The reliability and validity of the Chinese version of the scale were within the acceptable range. The Cronbach's α was between 0.838 and 0.95. However, the scale's reliability was higher than that of the original version. This might be because of the inclusion of participants with less severe diseases than the participants in the original study, high social expectations in the Chinese traditional culture, and a large number of similar items. Future research should simplify the items and consider adopting diverse participant selection criteria. CONCLUSIONS: The results of this study can be used to understand shared care in Taiwan.

SOURCE, a learned resourcefulness program to reduce caregiver burden and improve quality of life for older family caregivers.

BACKGROUND: Family members often undertake caregiving responsibilities over long periods of time, which could lead to caregiving burden. A theory-based and culturally sensitive learned resourcefulness program may help family caregivers mitigate stress by learning and using self-help strategies. OBJECTIVES: This study's aim is to use rigorous methods to investigate the effects of a learned resourcefulness program called SOURCE (Chen et al., Geriatric Nursing, 2021, 45, 1129) to reduce caregiver burden and improve quality of life (QOL) for family caregivers. SOURCE is an acronym for the six self-help behaviors at the core of this theory-based learned resourcefulness program, developed by the Principal Investigator (PI) in collaboration with other researchers (Chen et al., Geriatric Nursing, 2021, 45, 1129). These behaviors are: seeking problem-solving strategies, organizing daily actions, using self-regulation, reframing positive situations, changing negative self-thinking, and exploring new thinking and skills. METHODS: We used a quasi-experimental design with repeated measures for this study. The potential subjects were family caregivers whose family member was receiving home care. PI recruited 94 family caregivers (60 years old or older) who were caring for disabled and/or ill family members who also were 60 years old or older and living at home at the time of the study. The PI recruited these caregivers through the home care services department of a hospital and two community healthcare centers in Taiwan. The experimental group (n = 46) received the four-week in-person SOURCE while their family member continued to receive home care services, whereas the control group (n = 48) did not receive the SOURCE program while their family member received home care services. We collected data from the participants using the Caregiver Burden Scale, EuroQol-5 Dimension, and Rosenbaum's Self-Control Scale at baseline (T0, Week 1), after the intervention (T1, Week 5), and at follow-up (T2, Week 9). We analyzed the data using paired-sample t-tests and used the generalized estimating equation method to compare paired data between the baseline and follow-up. RESULTS: Of the 94 recruited family caregivers, 90.4% (n = 85) completed the study. We found no significant differences between the experimental and control groups in terms of demographic, caregiver burden, and QOL variables at baseline. Compared to the control group, the experimental group had significantly improved caregiver burden scores (indicating a reduction in caregiver burden) at the end of the intervention and at follow-up. The experimental group had significantly improved QOL scores at follow-up only. The experimental group also showed high levels of adherence to and satisfaction with the intervention. The paired-sample t-test results show significantly improved learned resourcefulness between T0 and T1 and between T0 and T2 (t = -5.84, p < 0.001; t = -6.77, p < 0.001) for the experimental group. CONCLUSION: The SOURCE program helped family caregivers develop and use self-help behaviors during their daily caregiving tasks. The family caregivers reported satisfaction with the program as well as reduced caregiver burden and improved QOL after the program ended. IMPLICATIONS FOR PRACTICE: The SOURCE program can be implemented to improve family caregivers' caregiver burden and QOL. Community health nurses can improve self-help abilities of family caregivers by helping them to acquire abilities and skills that allow them to effectively handle stress and reduce their caregiver burden.

The Effects of Sequencing Strategies in Teaching Methods on Nursing Students' Knowledge Acquisition and Knowledge Retention.

Background: No existing research has determined which teaching sequence strategy is the best for nursing students. Purpose: To find out which sequence is most effective in knowledge acquisition and knowledge retention and to further verify knowledge acquisition between problem-based learning (PBL) and lecture-based learning (LBL). Methods: This was a quasi-experimental design with a comparison of two nursing student groups selected from students in their final program year who were invited to participate. Generalized estimating equation was used to compare Group I (LBL-PBL-clinical practicum) and Group II (PBL-LBL-clinical practicum) by using knowledge acquisition and knowledge retention as outcome variables. Findings: Fifty-six senior students joined this study. Group I was significantly better than Group II on both knowledge acquisition (ß = 7.05, p = 0.04) and knowledge retention (ß = 9.40, p = 0.03). Discussion: The sequence of LBL-PBL-clinical practicum or policy of allowing practicum and courses in the same semester might be the best strategy to enhance knowledge retention.

Effects of Extended Viewing Distance on Accommodative Response and Pupil Size of Myopic Adults by Using a Double-Mirror System.

Purposes: This study discussed the accommodative response and pupil size of myopic adults using a double-mirror system (DMS). The viewing distance could be extended to 2.285 m by using a DMS, which resulted in a reduction and increase in the accommodative response and pupil size, respectively. By using a DMS, the reduction of the accommodative response could improve eye fatigue with near work. Method: Sixty subjects aged between 18 and 22 years old were recruited in this study, and the average age was 20.67 ± 1.09. There were two main steps in the experimental process. In the first step, we examined the subjects' refraction state and visual function, and then fitted disposable contact lenses with a corresponding refractive error. In the second step, the subjects gazed at an object from a viewing distance of 0.4 m and at a virtual image through a DMS, respectively, and the accommodative response and pupil size were measured using an open field autorefractor. Results: When the subjects gazed at the object from a distance of 0.4 m, or gazed at the virtual image through a DMS, the mean value of the accommodative response was 1.74 ± 0.43 or 0.16 ± 0.47 D, and the pupil size was 3.98 ± 0.06 mm or 4.18 ± 0.58 mm, respectively. With an increase in the viewing distance from 0.4 m to 2.285 m, the accommodative response and pupil size were significantly reduced about 1.58 D and enlarged about 0.2 mm, respectively. For three asterisk targets of different sizes (1 cm × 1 cm, 2 cm × 2 cm, and 3 cm × 3 cm), the mean accommodative response and pupil size through the DMS was 0.19 ± 0.16, 0.27 ± 0.24, 0.26 ± 0.19 D; and 4.20 ± 1.02, 3.94 ± 0.73, 4.21 ± 0.57 mm, respectively. The changes of the accommodative response and pupil size were not significant with the size of the targets (p > 0.05). In the low or high myopia group, the accommodative response of 0.4 m and 2.285 m was 1.68 ± 0.42 D and 0.21 ± 0.48 D; and 1.88 ± 0.25 D and 0.05 ± 0.40 D, respectively. The accommodative response was significantly reduced by 1.47 D and 1.83 D for these two groups. The accommodative microfluctuations (AMFs) were stable when a DMS was used; on the contrary, the AMFs were unstable at a viewing distance of 0.4 m. Conclusions: In this study, the imaging through a DMS extended the viewing distance and enlarged the image, and resulted in a reduction in the accommodative response and an increase in the pupil size. For the low myopia group and the high myopia group, the accommodative response and pupil size were statistically significantly different before and after the use of the DMS. The reduction of the accommodative response could be applied for the improvement of asthenopia.

Developing the Chinese version problem areas in diabetes-teen for measuring diabetes distress in adolescents with type 1 diabetes.

PURPOSE: To translate the 26-item English version Problem Areas in Diabetes-Teen (PAID-T) into a Chinese version and then to examine its psychometrical properties for measuring diabetes distress in adolescents with type 1 diabetes (T1D). DESIGN AND METHODS: The 26-item English version PAID-T was translated into a Chinese version guided by the translation model for cross-cultural research. A cross-sectional design was used and 203 adolescents with T1D were recruited from four hospitals in Taiwan. Content validity, exploratory factor analysis, and item analysis were used to ensure the item quality and build the factor structure of the Chinese version PAID-T. Confirmatory factor analysis, concurrent validity, and reliability testing were also used to examine its psychometric properties. RESULTS: The three second-order factors of the 18-item Chinese version PAID-T were developed. The correlation coefficients of the three-factor Chinese version PAID-T with self-management and glycosylated hemoglobin levels were all significant and ranged from -0.32 to -0.45 and 0.18 to 0.33 respectively. Cronbach's α and the test-retest reliability of the three-factor Chinese version PAID-T ranged from 0.85 to 0.93 and from 0.89 to 0.94 respectively. CONCLUSIONS: The Chinese version PAID-T with good translation quality was a reliable and valid scale to screen and assess diabetes distress for adolescents with T1D. PRACTICE IMPLICATIONS: Nurses could use the Chinese version PAID-T to track diabetes distress and tailor interventions for adolescents with T1D; also, the Chinese version PAID-T could facilitate the conducting of research on diabetes distress for adolescents with T1D.

Short-Term Changes of Frailty in Prematurely Aging Adults With Intellectual Disability.

The purpose of this study was to investigate short-term changes of frailty in adults and identify predictors of frailty and disability changes between baseline and the follow-up. A cohort study was conducted in 85 adults with intellectual disability (ID) in southern Taiwan. Variables of frailty phenotype, Barthel Index, fall, comorbidity, and hospitalization were measured at baseline and at a 9-month follow-up. Descriptive statistics, correlations, and generalized linear model technique were used for data analysis. The percentages of frailty and pre-frail conditions were high at baseline. Improvement or deterioration on frailty was noticed in 37.6% of participants. Disability and comorbidity were significant predictors to changes in frailty, and severity of ID and frailty conditions were significant predictors to changes in disability.

Effects of AR Picture Books on German Teaching in Universities.

In this paper, we discuss the teaching effects of augmented reality (AR) technology in German instruction. We conducted one prestudy and three formal studies on German learners in China's mainland and Taiwan region. In the formal studies, a total of 120 students participated in the survey, allowing us to compare the differences in interest in learning between AR picture books and traditional picture books. A total of 114 students took part in the survey, which enabled us to compare the contribution of AR picture books to teaching when students' satisfaction and German proficiency were different. To improve satisfaction, 514 students participated in the survey regarding the influence of the interactive narrative design effect and peer learning on satisfaction with using AR picture books. The results suggest that when learning German with AR picture books, satisfaction is the key construct that determines students' learning states.

Enzymatic Synthesis of Novel Vitexin Glucosides.

Vitexin is a C-glucoside flavone that exhibits a wide range of pharmaceutical activities. However, the poor solubility of vitexin limits its applications. To resolve this limitation, two glycoside hydrolases (GHs) and four glycosyltransferases (GTs) were assayed for glycosylation activity toward vitexin. The results showed that BtGT_16345 from the Bacillus thuringiensis GA A07 strain possessed the highest glycosylation activity, catalyzing the conversion of vitexin into new compounds, vitexin-4'-O-ß-glucoside (1) and vitexin-5-O-ß-glucoside (2), which showed greater aqueous solubility than vitexin. To our knowledge, this is the first report of vitexin glycosylation. Based on the multiple bioactivities of vitexin, the two highly soluble vitexin derivatives might have high potential for pharmacological usage in the future.

Pre-screening for osteoporosis with calcaneus quantitative ultrasound and dual-energy X-ray absorptiometry bone density.

Calcaneal quantitative ultrasonography (QUS) is a useful prescreening tool for osteoporosis, while the dual-energy X-ray absorptiometry (DXA) is the mainstream in clinical practice. We evaluated the correlation between QUS and DXA in a Taiwanese population. A total of 772 patients were enrolled and demographic data were recorded with the QUS and DXA T-score over the hip and spine. The correlation coefficient of QUS with the DXA-hip was 0.171. For DXA-spine, it was 0.135 overall, 0.237 in females, and 0.255 in males. The logistic regression model using DXA-spine as a dependent variable was established, and the classification table showed 66.2% accuracy. A receiver operating characteristic (ROC) analyses with Youden's Index revealed the optimal cut-off point of QUS for predicting osteoporosis to be 2.72. This study showed a meaningful correlation between QUS and DXA in a Taiwanese population. Thus, it is important to pre-screen for osteoporosis with calcaneus QUS.

Pilot test of a learned resourcefulness program for older family caregivers in Taiwan.

Learned resourcefulness, a theory-based education intervention, can be applied to provide strategies to improve the health status and reduce caregiver burden for older family caregivers. We developed a culturally relevant SOURCE program and designed a pilot study to its effect and feasibility for older family caregivers living in Taiwan. Using a quasi-experimental study with one-group, pre-test and post-test design, we recruited a convenience sample of 30 older family caregivers who received home-care services from a regional hospital in southern Taiwan. The older family caregivers participated in and completed the four-week SOURCE program. Effectiveness and feasibility data were collected after the completion of the program. Results indicated that the SOURCE program significantly improved caregiving burden (t = 3.05, p = .005) and revealed that the program was helpful and useful to older family caregivers. The next step will be to use the SOURCE program with more older family caregivers.

Measuring Nurses' Transition to Electronic Handover: Validation of the Perception and Adaptation Readiness of Electronic Handover Systems Scales.

The transition from traditional handover methods to electronic handover is extremely stressful to nurses. This psychometric evaluation study tested the validity and reliability of the perception and adaptation readiness of electronic handover system scales for hospital nurses. A total of 253 Taiwanese nurses from a medical center participated in this study from January to March 2018. The perception and adaptation readiness of electronic handover system scales were self-developed, and content validity was tested via content validity index of the scale. Exploratory factor analysis and confirmatory factor analysis were utilized to test construct validity, while reliability was tested by Cronbach's α coefficient. Four factors explained 50.77% of the total variance in the perception of electronic handover system scale. Three factors accounted for 53.43% of the total variance in the adaptation readiness of electronic handover system scale. The confirmatory factor analysis results indicated a three-factor construct for both scales. Cronbach's α coefficients were 0.83 and 0.91 for the perception and adaptation readiness of the electronic handover system scale, respectively. The scales could be used to assess nurses' perceptions and adaptation readiness of electronic handover, while the assessing result serves as a reference for implementing educational and supportive interventions to facilitate adaptation in nurses.

Effects of exercise interventions on frailty in pre-maturely aging adults with intellectual disabilities- a preliminary study.

BACKGROUND: Effects of exercise interventions targeting frail adults with intellectual disabilities (ID) are unknown. OBJECTIVE: This study compared the effects of a combined exercise, walking programs and no intervention on frailty and muscle mass in adults with ID and pre-frail or frail conditions. METHODS: This study was a quasi-experimental design, with 103 adults from six residential care and day-care centers in southern Taiwan completing study participation. A 10-week combined exercise and walking program were administered to the experimental (n = 36) and comparison (n = 32) groups respectively, with no intervention provided to the control group (n = 35). A questionnaire, measurements of frailty phenotype and a body composition machine were used to collect data. Descriptive statistics, chi-squared test, ANOVA and repeated measure ANOVA tests were conducted in the Chinese IBM SPSS 20.0. RESULTS: Significant differences on level of frailty among the three groups were revealed after interventions. Mean differences of muscle mass demonstrated significant changes between baseline and after interventions, although improvements of frailty score between baseline and after interventions were not significant. CONCLUSIONS: Our preliminary findings demonstrated the tendency of positive effects of combined exercise or walking programs in improving level of frailty and muscle mass in adults with ID. Early implementation of exercise interventions might be beneficial for prematurely aging adults with ID.

A psychometric evaluation of the Vietnamese version of the Evidence-Based Practice Attitudes and Beliefs Scales.

AIM: The aim of this study is to develop and to test the construct validity and reliability of the Vietnamese versions of the Evidence-Based Practice Attitude and Evidence-Based Practice Beliefs scales. METHODS: This is a psychometric evaluation study. Three hundred and fifty-three nurses and midwives were recruited from a national hospital in Vietnam from September to December 2018. Data were obtained from two scales. Content validity, face validity and construct validity measures were all conducted, whereas exploratory and confirmatory factor analyses were performed from data collected from two cohorts of participants. Cronbach's alpha coefficient represented reliability, and data were analysed in SPSS 20 and AMOS 24. RESULTS: The four-factor model developed with openness, requirements, appeal and divergence factors accounted for 55% of total variance in the Attitude scale. A three-factor model labelled as value beliefs, knowledge beliefs and resource beliefs with 59% of total variance was explained in the Beliefs scale. Cronbach's α coefficients were .72 for the Attitude scale and .81 for the Beliefs scale. CONCLUSIONS: The two scales could be used to assess Vietnamese nurses' attitudes and beliefs to adopt evidence-based practice enabling hospitals to align individual and organizational goals for developing evidence-based practice and enable comparison of the results with international samples.

[New thoughts on material basis and mechanism of Yin-tonifying traditional Chinese medicine in treatment of diabetes mellitus and its complications].

Diabetes mellitus is a serious chronic metabolic disease, and the patient's hyperglycemia is often accompanied by complications. In the circles of medical science, traditional Chinese medicine(TCM) has the earliest knowledge and research about diabetes. According to TCM, the clinical characteristics of diabetes mellitus were basically the same as "Xiaoke". TCM also believes that "Yin deficiency and dryness heat" was the main pathogenesis of diabetes. Therefore, Yin-tonifying TCMs is widely used in clinical treatment of diabetes mellitus, including Dendrobii Caulis, Lilii Bulbus, Ophiopogonis Radix, Polygonati Rhizome. The effective component for treating diabetes in the above Chinese materia medica is polysaccharides, which is used to treat complications of diabetes mellitus, like vascular disease, nephropathy, retinopathy, peripheral neuropathy. According to literature reports, except for specific some Yin-tonifying TCMs with effective ingredients for preventing and treating diabetes, other Yin-tonifying TCMs only contain water, alcohol extracts or polysaccharides in the treatment of diabetes. However, due to unclear material basis, dose-effect relationship and mechanism target of hypoglycemic drugs, Yin-tonifying TCMs are restricted in clinical application, with certain difficulties in in-depth studies. In this paper, the literatures related to the treatment of diabetes mellitus and its complications with Yin-tonifying TCM are analyzed and summarized, the existing problems are analyzed, and the research ideas and methods based on chromatographic technology and metabonomics are put forward, in order to provide reference for the application and development of Yin-tonifying TCM.

Construct Validity and Reliability of the Chinese Version Personal Adjustment and Role Skills Scale III for Adolescents With Chronic Disease.

PURPOSE: A valid and reliable scale to evaluate psychosocial adjustment in adolescents with chronic disease is prudent for improving their health outcome. This study aimed to develop a Chinese version Personal Adjustment and Role Skills Scale III for Adolescents (C-PARSIII-A) with chronic disease and to examine its construct validity and reliability. DESIGN AND METHODS: A cross-sectional design was conducted. A total of 145 participants were enrolled from a hospital in Taiwan. Content validity, exploratory factor analysis, and corrected item-total correlations were used to explore a factor structure with appropriate items in a C-PARSIII-A. Confirmatory factor analysis was conducted to confirm its factor structure. Cronbach's α and test-retest reliability were performed to examine the reliability. RESULTS: The 18-item C-PARSIII-A with six inter-correlated factors was developed. The standardized factor loadings of each item on its corresponding factor were statistically significant and higher than 0.50; composite reliability and average variance extracted were higher than 0.70 and 0.50 respectively. The correlation coefficients among the six factors in the C-PARSIII-A ranged from 0.10 to 0.84. Cronbach α and test-retest reliability of the C-PARSIII-A were 0.86 and 0.92 respectively. CONCLUSIONS: The six-factor 18-item C-PARSIII-A is supported by sufficient empirical evidence for construct validity and reliability to assess the psychosocial adjustment of adolescents with chronic disease. PRACTICE IMPLICATIONS: Nurses can use the C-PARSIII-A to perform assessment and follow-up on the psychosocial adjustment of adolescents with chronic disease, as well as develop interventions.

Decreased plasma riboflavin is associated with poor prognosis, invasion, and metastasis in esophageal squamous cell carcinoma.

BACKGROUND: Riboflavin deficiency confers a predisposition for esophageal cancer. The role of plasma riboflavin levels in development and prognosis of individuals with digestive tract inflammation and ulcer (DTIU), digestive tract polyps (DTPs), and ESCC is not well understood. METHODS: We performed a cross-sectional study, including 177 DTIU, 80 DTP, and 324 ESCC cases, to measure the plasma riboflavin levels among the three populations. Correlation between plasma riboflavin levels (categorized as ≥31.8, 6.5-31.8 and ≤6.5 nmol/L groups) and clinical characteristics, as well as survival of ESCC patients (556 cases) was analyzed. RESULTS: There was no difference in plasma riboflavin levels between DTIU, DTP, and ESCC cases (P > 0.05). Plasma riboflavin levels were inversely correlated with invasive depth (correlation coefficient = -0.09, P = 0.026) and lymph node metastasis (correlation coefficient = -0.11, P = 0.010) of ESCC, and ESCC patients with low riboflavin levels had poor recurrence-free survival (P = 0.035) and overall survival (P = 0.003). Decreased riboflavin was a prognostic factor for poor overall survival (HR = 1.91, 95% CI = 1.19-3.07, P = 0.007). CONCLUSIONS: Plasma riboflavin levels in DTIU, DTP, and ESCC patients are similar. Plasma riboflavin levels are associated with the development and prognosis of ESCC.

Perceptions and Experiences of Hospital Nurses During Transition to an Electronic Handover Informatics System.

An effective patient transfer, or handover, among healthcare professionals can help prevent communication-related medical errors, and a reliable electronic handover informatics system can standardize the handoff process. Adapting to a new handover system may cause stress for nurses. This descriptive qualitative study aimed to explore the perceptions and transition experiences of hospital nurses in adopting and adapting to a new handover informatics system. Thirty-eight nurses at a medical center in Taiwan participated in the study from December 2016 to January 2017. The researcher conducted five focus group interviews and analyzed all responses using content analysis. Results showed three major themes: "Perceptions of challenges and barriers related to the transition to a new handover informatics system," "Perceptions of benefits and strategies to the transition to a new handover informatics system," and "Suggestions for successful implementation of a new handover informatics system." Five subthemes emerged from the first theme, and six subthemes emerged from the second theme. The results of this study could enhance our understanding of nurses' perceptions and experiences with transition to a new handover informatics system and could provide a reference for hospitals to develop individualized strategies to facilitate the implementation of a handover informatics system.

The longitudinal learning outcomes of using different teaching sequences in a nursing administration project.

AIM: To examine the effects of using different teaching sequences on knowledge acquisition, knowledge retention, self-directed learning and teamwork in a nursing administration project. BACKGROUND: Compared to other professional courses, nursing administration is relatively difficult, and it is important for nursing administration students to spend long hours working in hospitals. As such, better teaching strategies utilizing proper sequencing may yield better learning outcomes for students. METHODS: A longitudinal quasi-experimental design was used. A total of 129 students were assigned to two groups with which different teaching sequences were used. The investigated learning outcomes were knowledge acquisition, knowledge retention, self-directed learning and teamwork. Generalized estimating equations were used to measure the learning outcomes. RESULTS: There was no significant difference between the two teaching sequences in terms of learning effects. One teaching strategy, problem-based learning (PBL), yielded effective student learning outcomes. CONCLUSION: PBL increased the students' self-directed learning and teamwork. This strategy can be applied to side-by-side co-teaching and post-graduate year training programmes. IMPLICATIONS FOR NURSING MANAGEMENT: The results from this study may help hospitals retain nurses and find potential nursing leaders. Instructors and nurse managers should discuss learning goals with students in advance to enhance the students' learning outcomes.

A cross-validation study of the incident-reporting attitude scale for staff in long-term care facilities-A cross-sectional study.

AIMS AND OBJECTIVES: To test the construct and concurrent validity and reliability of the incident-reporting attitude scale used for staff in long-term care facilities (IRA-LTC) by the two-phase cross-validation method. BACKGROUND: Lack of accurate measurement on incident-reporting attitude might hinder improvements of safety practice in long-term care facilities. DESIGN/METHODS: A two-phase cross-sectional questionnaire survey was conducted in Taiwan. A fixed proportion of long-term care facilities were randomly selected that included 20 and 15 long-term care facilities at phases one and two separately. Nursing and administrative staffs in these facilities were recruited at the first phase (N = 207) for testing the validity and reliability of the newly developed scale and for cross-validation of the scale at the second phase (N = 251). The scale of IRA-LTC was a self-developed structured questionnaire consisting of 31 items. The data were analysed using spss for Windows 20.0 and AMOS 24.0. Descriptive statistics, correlation analysis, Cronbach's α, exploratory and confirmatory factory analysis were carried to examine the homogeneity of items, reliability, construct and concurrent validity. The STROBE checklist was adhered (See Appendix S1). RESULTS: The IRA-LTC scale comprised two dimensions: "cognition and intention to report" and "barriers to report." The two-factor structure explained 60.20%-61.89% of the total variance at two phases. Validation of the initial factorial model gained at the first phase was satisfactorily supported at the second phase. Concurrent validity of the IRA-LTC scale was satisfied. Cronbach's α for the scale and subscales was 0.94-0.97. CONCLUSIONS: This IRA-LTC scale is valid and reliable and can be recommended to evaluate the incident-reporting attitude among all kinds of staff in long-term care facilities. RELEVANCE TO CLINICAL PRACTICE: Positive incident-reporting attitude can lead to positive incident-reporting behaviour. Using the IRA-LTC scale for assessing staff's incident-reporting attitude is recommended as the first step to enhance staff's safety performance in long-term care facilities.