Association between self-efficacy, spiritual well-being and the willingness to provide spiritual care among nursing staff in Taiwan: a cross-sectional study.

BACKGROUND: Spiritual care plays a significant role in holistic patient care, addressing not only physical ailments but also attending to patients' emotional and spiritual well-being. While the importance of spiritual care in nursing is widely recognized, there is often a gap in understanding nurses' willingness to provide such care. This cross-sectional study aimed to explore the association between self-efficacy, spiritual well-being, and willingness to provide spiritual care among nursing staff. METHODS: The study conducted a cross-sectional survey of full-time registered nurses at a hospital in Taiwan from January 2019 to December 2019. A sample comprising 168 nurses was selected for participation in the study through a random sampling method. In addition to collecting demographic variables, the assessment tools used in the study include the General Self-Efficacy Scale (GSES) for measuring self-efficacy, the Spiritual Index of Well-Being Chinese Version (SIWB-C) for evaluating spiritual well-being, and the Spiritual Care Needs Inventory (SCNI) to gauge willingness to provide spiritual care. RESULTS: Most participants in the study were female, accounting for 98.2% (n = 165). The mean age of all 168 nurses was 37.1 ± 9.3 years. Additionally, most participants held a Bachelor's degree (79.2%, n = 133) and possessed clinical experience was 10.5 ± 9.3 years. Through logistic regression analysis, it was found that regardless of whether participants have received sufficient spiritual care training, both GSES and SIWB-C remain influential factors in determining the provision of spiritual care. CONCLUSIONS: Collaboration between healthcare management and nursing staff is essential for fostering a healthcare environment that not only appreciates the physical and spiritual dimensions of patient care but also prioritizes the enhancement of nurses ' self-efficacy and well-being.

Effects of oral stimulation with breast milk in preterm infants oral feeding: a randomized clinical trial.

OBJECTIVES: This study was performed to evaluate the effect of oral stimulation with breast milk for preterm infants. METHODS: A total of 68 subjects form neonatal intensive care unit were randomly assigned into control group (n=20), premature infant oral motor intervention (PIOMI) group (n=25) and premature infant oral motor intervention with breast milk (BM-PIOMI) group (n=23). RESULTS: BM-PIOMI group had significant shorter initiation of oral feeding (IOF) time compared to PIOMI group (2.95 days, 95% CI [0.42-5.48]) or control group (9.79 days, 95% CI [7.07-12.51]). BM-PIOMI group had significant sooner transition time from IOF to full oral feeding (FOF) compared to control group (6.68 days, 95% CI [2.2-11.16]), but not to PIOMI group (2.09 days, 95% CI [-2.07 to 6.25]). Length of hospital stay (LOS) did not show statistical different between three groups (control 38.85 ± 14.40 vs. PIOMI 38.48 ± 11.76 vs. BM-PIOMI 38.04 ± 12.2). Growth mixture model identified improvement in non-nutritive sucking (NNS) score in BM-PIOMI group compared to control and PIOMI group (0.8293, p<0.0001, and 0.8296, p<0.0001, respectively). CONCLUSIONS: Oral stimulation with breast milk can better promotes the oral feeding process of premature infants than the simple oral stimulation, by shorten IOF time and improve early NNS score, but does not shorten transition time from IOF to FOF and LOS.

Effectiveness of palliative care consultation service on caregiver burden over time between terminally ill cancer and non-cancer family caregivers.

PURPOSE: The responsibility of taking care of terminal patients is accepted as a role of family members in Taiwan. Only a few studies have focused on the effect of palliative care consultation service (PCCS) on caregiver burden between terminal cancer family caregivers (CFCs) and non-cancer family caregivers (NCFCs). Therefore, the purpose of this study is to address the effect of PCCS on caregiver burden between CFC and NCFC over time. METHODS: A prospective longitudinal study was conducted in a medical center in northern Taiwan from July to November 2017. The participants were both terminally ill cancer and non-cancer patients who were prepared to receive PCCS, as well as their family caregivers. Characteristics including family caregivers and terminal patients and Family Caregiver Burden Scale (FCBS) were recorded pre-, 7, and 14 days following PCCS. A generalized estimating equation model was used to analyze the change in the level of family caregiver burden (FCB) between CFC and NCFC. RESULTS: The study revealed that there were no statistically significant differences in FCB between CFC and NCFC 7 days and 14 days after PCCS (p > 0.05). However, FCB significantly decreased in both CFC and NCFC from pre-PCCS to 14 days after PCCS (ß = - 12.67, p = 0.013). PPI of patients was the key predictor of FCB over time following PCCS (ß = 1.14, p = 0.013). CONCLUSIONS: This study showed that PCCS can improve FCB in not only CFC but also NCFC. We suggest that PCCS should be used more widely in supporting family caregivers of terminally ill patients to reduce caregiver burden.

Psychometric properties of the Chinese version of Spiritual Index of Well-Being in elderly Taiwanese.

BACKGROUND: Spiritual well-being has become an increasingly important issue for the elderly people. The 12-item Spirituality Index of Well-Being (SIWB) is a well-validated instrument for assessing a patient's current spiritual state. However, the psychometric properties of the SIWB in the Chinese elderly populations are not known. Therefore, this study translated the SIWB into Chinese and evaluated its psychometric properties. METHODS: The English version of the SIWB was first translated into Chinese based on the Brislin's translation model. The psychometric properties of the translated version of the SIWB (SIWB-C) was evaluated in 416 elderly Taiwanese recruited using a purposive sampling procedure from a medical center, a long-term care institution, and a community health center. Convergent validity was accessed using Pearson's correlation coefficients of the SIWB-C, the EQ-5D-3 L health-related quality of life scale, and the Geriatric Depression Scale-5 (GDS-5). Exploratory factor analysis with Varimax rotation was performed to determine the construct validity. Confirmatory factor analysis was conducted for verification of the quality of the factor structures and demonstrating the convergent validity of the SIWB-C. An internal consistency test based on the Cronbach's alpha coefficient and a stability test based on the Guttman split-half coefficient were also performed. Test-retest reliability was evaluated with intraclass correlation coefficient. RESULTS: Exploratory factor analysis confirmed the original two-dimensional structure of the scale. Confirmatory factor analysis indicated a well-fitting model and a fine convergent validity of the SIWB-C. The Cronbach's alpha coefficient and the Guttman split-half coefficient for the SIWB-C were 0.94 and 0.84, respectively. The correlations between the SIWB-C with EQ-5D-3 L and GDS-5 were 0.22 (p < 0.01) and 0.45 (p < 0.05), respectively. The intraclass correlation coefficient of the SIWB-C over a test-retest interval of two weeks was 0.989. CONCLUSIONS: The SIWB-C was found to be a potential useful measure of subjective spiritual well-being in elderly Taiwanese. Its application in assessing the spiritual well-being in Mandarin-speaking elderly population warrants further investigation.

Path modeling of knowledge, attitude and practice toward palliative care consultation service among Taiwanese nursing staff: a cross-sectional study.

BACKGROUND: The Taiwanese government has promoted palliative care consultation services (PCCS) to support terminally ill patients in acute ward settings to receive palliative care since 2005. Such an intervention can enhance the quality of life and dignity of terminally ill patients. However, research focusing on the relationship between the knowledge, attitude and practice of a PCCS using path modelling in nursing staff is limited. Therefore, the aim of this study was to elucidate the effect of path modeling on the knowledge, attitude and practice toward PCCS in Taiwanese nursing staff. METHODS: This was a cross-sectional, descriptive study design using convenience sampling. Data collected included demographics, knowledge, attitude and practice as measured by the PCCS inventory (KAP-PCCSI). Two hundred and eighty-four nursing staff from a medical center in northern Taiwan participated in the study in 2013. We performed descriptive statistics, regression analysis, and path modeling using SPSS 19.0 and set p < 0.05 as the statistical significance threshold. RESULTS: The results showed that the identical factor significantly associated with knowledge, attitude, and practice toward PCCS among nurses was the frequency of contact with PCCS. In addition, higher level of knowledge toward PCCS was associated with working in haematology and oncology wards, and participation in education related to palliative care. A more positive attitude toward PCCS was associated with working in a haematology and oncology ward, and experience of friends or relatives dying. Higher level of practice toward PCCS was associated with nurses who participated in education related to palliative care. In the path modeling, we found that holders of a master's degree indirectly positive affected practice toward PCCS. Possession of a bachelor degree or above, being single, working within a haematology and oncology ward, and frequency of contact with PCCS positively affected practice toward PCCS. CONCLUSIONS: Based on this study, it is proposed that consultation with PCCS has a positive impact on the care of terminally ill patients. Encouragement of staff to undertake further education can improve the practice of ward staff providing palliative care.

Randomized controlled trial of a six-week spiritual reminiscence intervention on hope, life satisfaction, and spiritual well-being in elderly with mild and moderate dementia.

OBJECTIVE: Reminiscence therapy has been reported to improve the well-being in patients with dementia. However, few studies have examined the effects of spiritual reminiscence, which emphasizes on reconnecting and enhancing the meaning of one's own experience, on patients with dementia. Therefore, this study aimed to investigate the effects of spiritual reminiscence on hope, life satisfaction, and spiritual well-being in elderly Taiwanese with mild or moderate dementia. METHODS: A randomized controlled trial was conducted on 103 patients with mild or moderate dementia recruited from a medical center in central Taiwan. The patients were randomly assigned to either a 6-week spiritual reminiscence group (n = 53) or control group (n = 50). The Herth Hope Index, the Life Satisfaction Scale, the Spirituality Index of Well-Being were administered before and after the 6-week period. RESULTS: The interaction terms between group and time for the three outcome measures were found to be significant (P < 0.001), indicating that the changes over time in them were different between the intervention and control groups. CONCLUSIONS: Findings of this randomized controlled trial showed that hope, life satisfaction, and spiritual well-being of elderly patients with mild or moderate dementia could significantly be improved with a 6-week spiritual reminiscence intervention.

Relationship between palliative care consultation service and end-of-life outcomes.

PURPOSE: Palliative care consultation service (PCCS) is currently utilized to provide care to terminal patients in Taiwan. However, there is little research on the relationship between PCCS and end-of-life outcomes. This study aimed to elucidate the association between PCCS and end-of-life outcomes in terminal cancer patients. METHODS: Retrospective chart reviews of terminal cancer patients who consulted the PCCS of a medical center in Taiwan from January 2007 to December 2012 were performed. Data on 1369 patients were recorded, which included details of outcomes such as discharge from hospital, transfer to hospice ward, and death after PCCS termination. Other variables such as demographics, disease-related information, symptoms, and psychosocial needs were also evaluated. Logistic regression models were employed to estimate the adjusted odds ratios and related 95% confidence intervals. RESULTS: The Eastern Cooperative Oncology Group performance status, timing of do-not-resuscitate (DNR) signature, constipation, and spiritual problems experienced by the patients were important predictors for terminal cancer patients who were discharged from the hospital or had expired at the time of PCCS termination. Age, gender, primary cancer diagnosis, timing of DNR signature, constipation, and other physical symptoms were the key predictors for patients who were transferred to the hospice ward or had expired. CONCLUSIONS: This study confirms the outcomes of PCCS and highlights the important predictors for patients at PCCS termination. These factors can be targeted to improve and enhance the quality of PCCS rendered in the future.

Blumea balsamifera Oil for the Acceleration of Healing of Burn Injuries.

Blumea balsamifera oil (BBO) is a main extract obtained from Blumea balsamifera (L.) DC (Ainaxiang) leaves, which are widely used as a traditional medicine by the Miao and Li Nations to promote skin trauma or burn injury healing. This study was initiated to investigate the healing efficacy in deep second-degree burn model in rats. The rats were treated by BBO for 21 consecutive days. The rate of healing, scabs dropped time and re-epithelialization time were observed every three days for 21 days after burn injury. The samples were collected from different treated rats by sacrificing the animals on the 1st, 2nd, 5th, 9th, 14th, and 21st day post-burn creation. Then, the water content of burn tissue was measured. Plasma interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-α) levels were evaluated, and the tissue expressions of basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF), and transforming growth factor-beta (TGF-ß) were determined along with skin histopathology. The results showed that the water content of tissue was significantly reduced, the scabs dropped time shortened, and healing accelerated after treatment with BBO in the burn injury rats. Furthermore, the expressions of growth factors were significantly increased in the tissue; however, the levels of inflammatory factors on plasma decreased. This study confirms the efficacy of BBO consumption on burn injuries.

Concordance between nurses' perception of their ability to provide spiritual care and the identified spiritual needs of hospitalized patients: A cross-sectional observational study.

Spiritual care is essential to the well-being of patients, and nurses provide spiritual care as a fundamental part of nursing practice. In this study, we investigated the spiritual care needs of hospitalized patients to determine whether the perceived knowledge of nurses corresponded with these spiritual care needs. A cross-sectional study was conducted on 1351 hospitalized patients and 200 registered nurses recruited from a medical center in central Taiwan. A questionnaire, including the 21-item Spiritual Care Needs Inventory (patient and nurse version) and basic demographic information, was distributed to eligible participants. The top three items of the spiritual care needs expressed by the hospitalized patients were respect for privacy and dignity, showing concern, and guidance in gaining a sense of hope in life; the percentages of nurses not knowing how to provide these spiritual care needs were 0%, 1%, and 15%, respectively. The spiritual care needs of patients showed a significant relationship with the knowledge of nurses, suggesting that the perceived knowledge of the nurses generally corresponded with the spiritual care items that the patients required most.

Hexavalent chromate bioreduction by a magnetotactic bacterium Magnetospirillum gryphiswaldense MSR-1 and the effect of magnetosome synthesis.

Magnetotactic bacteria (MTB) are receiving attention for heavy metal biotreatment due to their potential for biosorption with heavy metals and the capability of the magnetic recovery. In this study, we investigated the characteristics of Cr(VI) bioreduction and biosorption by an MTB isolate, Magnetospirillum gryphiswaldense MSR-1, which has a higher growth rate and wider reflexivity in culture conditions. Our results demonstrated that the MSR-1 strain could remove Cr(VI) up to the concentration of 40 mg L-1 and with an optimal activity at neutral pH conditions. The magnetosome synthesis existed regulatory mechanisms between Cr(VI) reduction and cell division. The addition of 10 mg L-1 Cr(VI) significantly inhibited cell growth, but the magnetosome-deficient strain, B17316, showed an average specific growth rate of 0.062 h-1 at the same dosage. Cr(VI) reduction examined by the heat-inactivated and resting cells demonstrated that the main mechanism for MSR-1 strain to reduce Cr(VI) was chromate reductase and adsorption, and magnetosome synthesis would enhance the chromate reductase activity. Finally, our results elucidated that the chromate reductase distributes diversely in multiple subcellular components of the MSR-1 cells, including extracellular, membrane-associated, and intracellular cytoplasmic activity; and expression of the membrane-associated chromate reductase was increased after the cells were pre-exposed by Cr(VI).

Peplau's interpersonal relationship theory combined with bladder function training on patients with prostate cancer.

BACKGROUND: Prostate cancer is a major disease impacting men's health worldwide. Peplau, who is known as "the mother of psychiatric society," developed an interpersonal relationship theory for nursing. Implementation of this theory in practice has been shown to positively impact patients' quality of life and reduce adverse symptoms after surgery. AIM: To investigate the effects of a nursing model based on Peplau's interpersonal relationship theory combined with bladder function training on patients with prostate cancer. METHODS: Eighty-nine patients with prostate cancer who underwent transurethral resection of the prostate (TURP) participated in this study. These patients were admitted to The First Affiliated Hospital of Soochow University or Dushu Lake Hospital Affiliated to Soochow University between January 2020 and April 2021. Patients were randomized into either the Peplau nursing group (n = 44) or a routine nursing group (n = 45). The routine nursing group received routine care and bladder function training, while the Peplau care group received care that integrated concepts from the Peplau interpersonal relationship theory as well as bladder function training. The urinary incontinence symptoms of the two groups were recorded, and the respective International Prostate Symptom Scores (IPSS), Functional Assessment of Chronic Illness Therapy- Spiritual Well-Being (FACIT-Sp) scores, and quality of life (QOL) scores for each group were compared before and after three months of nursing intervention. RESULTS: During the intervention period, the duration of urinary incontinence, frequency, number and amount of urinary incontinence were significantly greater in the routine nursing group compared to the Peplau care group (P < 0.05). The indicators of the routine nursing group were 7.13 ± 2.42 days, 8.23 ± 2.75 times, and 1.24 ± 0.42 L, while those of the Peplau care group were 4.74 ± 1.85 d, 4.21 ± 1.26 times, and 0.56 ± 0.11 L, respectively. After three months of intervention, the mean IPSS score of the routine nursing group was significantly reduced (P < 0.05), while the mean FACIT-Sp and QOL scores were significantly increased (P < 0.05). The mean IPSS score in the Peplau nursing group was significantly lower compared to the routine nursing group, while the FACIT-Sp and QOL scores were higher (P < 0.05). CONCLUSION: A nursing model based on Peplau's interpersonal relationship theory combined with bladder function training can significantly improve prostate function and urinary symptoms, resulting in the restoration of physiological function and improvement in the QOL of patients with prostate cancer following TURP.

Group integrative reminiscence therapy on self-esteem, life satisfaction and depressive symptoms in institutionalised older veterans.

AIMS AND OBJECTIVES: The purpose of this study was to use group integrative reminiscence as a nursing intervention to evaluate the immediate effects on self-esteem, life satisfaction and depressive symptoms for a special group named 'institutionalised older veterans' after a 12-week intervention. BACKGROUND: The study group comprised institutionalised older veterans with combat experience, including being wounded in war and who were twice forced to relocate. The group participants had lower life satisfaction, and greater use for mental health services and greater non-specific health complaints were reported from this group. Reminiscence therapy has been considered an effective nursing intervention, but the effects on institutionalised older veterans have not been studied. DESIGN: A quasi-experimental design and purposive sampling were conducted. METHODS: A total of 74 participants were studied with pre- and post-tests to measure the effect of group integrative reminiscence therapy. The activity was held once weekly for 12 weeks. The Life Satisfaction Index A, self-esteem scale and Geriatric Depression Scale Short Form were used as research tools, and the t-test, Fisher's exact test and generalised estimating equation were used for data analysis. RESULTS: All participants were male, with an average age of 81·34 years old, 91·9% unmarried and were in bad health. After 12 weeks of intervention, the reminiscence groups significantly improved their self-esteem and life satisfaction and decreased depressive symptoms compared with control groups. CONCLUSION: Group integrative reminiscence revealed immediate effects on improving the self-esteem and life satisfaction of institutionalised older veterans, and depressive symptoms were also decreased. Moreover, a sense of positive self-value and belonging to the institution was produced. RELEVANCE TO CLINICAL PRACTICE: Group integrative reminiscence is an applicable nursing intervention for vulnerable persons such as institutionalised older veterans. A structured protocol based on the characteristics of the residents and the aim of the intervention can lead nurses to provide appropriate reminiscent activities.

Mental Adjustment as a Predictor of Comprehensive Quality of Life Outcome among Patients with Terminal Cancer.

Using path modeling, this study aimed to explore whether mental adjustment was directly or indirectly related to comprehensive quality of life outcome (CoQoLO) among patients with terminal cancer. We conducted a cross-sectional designed study among patients with terminal cancer who underwent convenience sampling at our northern Taiwan clinic from August 2019 to August 2020. Patient characteristics data were collected via structured questionnaires, namely, the Mini-Mental Adjustment to Cancer Scale and the Comprehensive Quality of Life Outcome Inventory. Descriptive statistics and regression analyses were used to examine the relationship between mental adjustment and CoQoLO. Path analysis described the dependencies among variables. For the 117 enrolled patients analyzed, MAC (ß = 1.2, 95% confidence interval (CI) = 0.8-1.6, p < 0.001) and living with others (ß = 19.9, 95% CI = 4.1-35.7, p = 0.015) were significant predictors and correlated positively with a CoQoLO score. Path modeling showed that the patients' mental adjustment, economic status, perceived disease severity, palliative prognostic index, and symptom severity directly affected their CoQoLO. Our results indicate that the higher the mental adjustment, the better the CoQoLO among patients with terminal cancer. Thus, nurses need to assess mental adjustment levels when patients are hospitalized and accordingly develop interventions to improve the terminally ill patients' mental adjustment to the final stages of cancer, thereby helping them to achieve good CoQoLO.

Inpatient Hospice Palliative Care Unit and Palliative Consultation Service Enhance Comprehensive Quality of Life Outcomes in Terminally Ill Cancer Patients: A Prospective Longitudinal Study.

This study aimed to explore the effectiveness of an inpatient hospice palliative care unit (PCU) and palliative consultation service (PCS) on comprehensive quality of life outcome (CoQoLo) among terminally ill cancer patients. This was a prospective longitudinal study. Terminally ill cancer patients who met the inclusion criteria and received PCU or PCS in a northern Taiwanese medical center were recruited. The CoQoLo Inventory was used to measure CoQoLo level pre- and seven days following hospice care between August 2018 and October 2019. A total of 90 patients completed the study. No significant differences were found in CoQoLo levels between the PCU and PCS groups pre- and seven days following care. However, the CoQoLo level of patients significantly improved seven days following care in both PCU and PCS groups, compared with pre-hospice care. Patients' age, religious belief, marital status, closeness with family, palliative prognostic index (PPI), and symptom severity were significant concerning CoQoLo levels after adjusting for patients' baseline characteristics. PCU and PCS showed no difference in CoQoLo levels, but both of them can improve CoQoLo among terminally ill cancer patients. These patients could receive PCU or PCS to achieve a good CoQoLo at the end-of-life stage.

Effects of Dispositional Resilience and Self-Efficacy on Practice in Advanced Care Planning of Terminally Ill Patients among Taiwanese Nurses: A Study Using Path Modeling.

This study aimed to expand on previous research elucidating the effects of dispositional resilience and self-efficacy on practice in advanced care planning (ACP) of terminally ill patients among Taiwanese nurses using path modeling. This cross-sectional study was conducted using cluster sampling. Data were collected using demographics, nurses' knowledge, attitude, and practice of ACP (KAP-ACP) inventory, Dispositional Resilience Scale, and General Self-Efficacy Scale. A total of 266 nurses from a tertiary medical center in northern Taiwan participated in this study in 2019. The results showed that gender and ward were significant K-ACP predictors among nurses. The ACP knowledge, ward, and experience of caring for terminally ill friends or relatives were significant A-ACP predictors, whereas ACP attitudes, dispositional resilience, self-efficacy, ward, and the frequency of caring for terminally ill patients were the key predictors of P-ACP. The path modeling showed that dispositional resilience; self-efficacy; medical, surgical, hematology and oncology wards; previous experience in caring for terminally ill friends or relatives; participating in the do-not-resuscitate signature; and the frequency of caring for terminally ill patients directly influenced ACP practices. We recommend that nurses enhance their dispositional resilience and self-efficacy, which may encourage them to appreciate the value of ACP practice of terminally ill patients and improve the quality of care.

[The role of the chinese medicine nurse in Taiwan: professional or assistant?].

Personal participation in first line Chinese medicine nursing practice made the author aware of a significant gap between learning and practice in traditional Chinese medicine nursing. For this paper, she interviewed physicians, nurses and patients, researched hospital system and regulatory requirements. She found that "an assistant" is what Chinese medicine physicians expect of nurses, while patients expect a nurse to be able to help them complete treatment while having a good attitude. In order to distinguish clearly nursing from medicine, nursing scholars, with the help of the Chinese Medicine Committee have designed a Chinese medicine nursing training program. Administration is the main content of front-line nurses in this field. They typically have limited responsibilities related to health problem assessment, prevention, or providing guidance / advice. This article raised difficulties and contradictions between the role and practice of Chinese medicine nurses. Three suggestions are provided, including: clearer demarcation of job responsibilities; renewed respect for nurses as professionals; and including traditional Chinese medicine nursing into the formal nursing curricula in order to support a better future for Chinese medicine nurses.

[Cultivating nursing core competencies in college students].

Departments of nursing in Taiwan junior colleges teach a comprehensive range of core competency skills; provide the healthcare system with entry level nursing professionals able to deliver complete care services; and help students prepare for and earn their nursing licenses. Framed by current junior college nursing department curricula and considerations of professional core competency, this paper examines the role of core nursing competencies in college education goals as they influence college curriculum design and clinical practicum programs. The achieved result should be a professional curriculum that incorporates general education, basic medical, and professional nursing elements that is capable of nurturing professional nursing school graduates able to execute their professional duties and earn the respect of patients, their families and society.

The Effect of Practice toward Do-Not-Resuscitate among Taiwanese Nursing Staff Using Path Modeling.

This study aimed to elucidate the predictors and the effects of path modeling on the knowledge, attitude, and practice toward do-not-resuscitate (DNR) among the Taiwanese nursing staff. This study was a cross-sectional, descriptive design using stratified cluster sampling. We collected data on demographics, knowledge, attitude, and practice as measured by the DNR inventory (KAP-DNR), Mindful Attention Awareness Scale, General Self-Efficacy Scale, and Dispositional Resilience Scale. Participants were 194 nursing staff from a medical center in northern Taiwan in 2019. The results showed that participation in DNR signature and education related to palliative care were significant positive predictors of knowledge toward DNR. The DNR predictors toward attitude included DNR knowledge, mindfulness, self-efficacy, dispositional resilience, and religious belief of nurses. Generally, the critical predictors of DNR practice were DNR attitude, dispositional resilience, and male nurses. In path modeling, we identified that self-efficacy, dispositional resilience, master's degree, and religious belief directly influenced practice constituting DNR. Based on the findings of this study, we propose that nurses should improve their self-efficacy and dispositional resilience through training programs. Encouraging staff to undertake further education and have religious beliefs can enhance the practice of DNR and provide better end-of-life care.

Using chest vibration nursing intervention to improve expectoration of airway secretions and prevent lung collapse in ventilated ICU patients: a randomized controlled trial.

BACKGROUND: Almost 80% of patients in the intensive care unit are intubated and on mechanical ventilation. Thus, their airway clearance ability is compromised and their risk of lung collapse increased. A variety of interventions are used to enhance airway clearance with the goal of preventing atelectasis and infection. The purpose of this study was to evaluate the effect of a chest vibration nursing intervention on the expectoration of airway secretions and in preventing lung collapse among ventilated critically ill patients. METHODS: This was a randomized, single-blind experimental study. A total of 95 patients were enrolled from 2 ICUs and randomly assigned into either the experimental group (n = 50) or control group (n = 45). Patients in the control group received routine positioning care, which consisted of a change in body position every 2 hours. Patients in the experimental group received routine positioning care plus the use of chest vibration nursing intervention for 72 hours. This intervention consisted of placing a mechanical chest wall vibration pad on the patients back for 60 minutes when the patient was in a supine position. The chest vibration intervention was performed 6 times a day. Outcome variables were dry sputum weight (DSW) per 24 hours and lung collapse index (LCI); these were measured at 24, 48 and 72 hours. RESULTS: Patients who received the chest vibration nursing intervention had greater DSW and lower LCI after 24 hours. Pre-test DSW and group could explain 48.2% of the variance in DSW at 24 hours. The LCI at 24, 48 and 72 hours were all significantly improved in the intervention group compared to the control group. The previous LCI measured was the most significant predictor of the next LCI measured. A significant difference was found between the control and experimental groups in their 24-, 48- and 72-hour DSW and LCI after vibration, when monitored by the generalized estimating equation in time sequence. CONCLUSION: The results suggest that chest vibration may contribute to expectoration and thus improve lung collapse among ventilated patients in an ICU. Chest vibration nursing intervention is a safe and effective alternative pulmonary clearance method and can be used on patients who are on ventilators in ICUs.

[Effect of perioperative dexamethasone on nausea, vomiting and pain after total knee arthroplasty].

OBJECTIVE: To investigate the effect of perioperative dexamethasone on nausea, vomiting and pain after unilateral total knee arthroplasty and to evaluate its safety. METHODS: From February 2014 to June 2016, 100 patients with unilateral advanced osteoarthritis treated by total knee arthroplasty were divided into two groups: 50 patients in dexamethasone group including 27 males and 23 females, aged (72.30±7.02) years, were given intravenous drip of dexamethasone 10 mg before operation; 50 patients in saline group, including 26 males and 24 females, aged (71.30±6.08) years, were given the same amount of saline at the corresponding time. The VAS scores of pain at rest and at 45 degrees of knee flexion were recorded at 2, 4, 6, 8, 12, 24, 36 and 48 h after operation. Vomiting, antiemetic drugs and opioids were recorded at 0 to 24 h and 24 to 48 h after operation. The side effects and complications were recorded. RESULTS: All the 100 patients were followed up for an average of 14.5 months. VAS score of pain at rest in dexamethasone group was lower than that in saline group at 8, 24 and 48 h after operation (P<0.05); VAS score of dexamethasone group at 45 degrees after knee flexion was lower than that of saline group at 8 and 48 h after operation(P<0.05); VAS score of dexamethasone group at rest and 45 degrees after knee flexion was lower than that of saline group(P<0.05). The dosage of opioids and total opioids in dexamethasone group was lower than that in saline group at 0 to 24 h, 24 to 48 h after operation (P<0.05). The proportion of nausea and vomiting occurred at 0 to 24 h and 24 to 48 h after operation, and the proportion of antiemetic required at 0 to 24 h after operation had statistical significance between two groups(P<0.05). The total antiemetic dosage of dexamethasone group was less than that of saline group(P<0.05). As of the last follow-up, no complications such as infection, gastrointestinal ulcer and bleeding occurred in the two groups. CONCLUSIONS: Preoperative systemic application of dexamethasone can effectively reduce pain and nausea and vomiting after TKA without increasing postoperative complications.