Character Strengths Use in Diabetes Self-management Scale: Development and psychometric testing.

AIMS: To develop and psychometrically test Character Strengths Use in Diabetes Self-management Scale in people with type 2 diabetes. DESIGN: Cross-sectional design. METHODS: Based on literature reviews and examination by experts, a 20-item scale was developed and administered to 350 participants with type 2 diabetes who were enrolled from two endocrine clinics by convenience sampling in Taiwan. Item analysis, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), concurrent and predictive validity as well as reliability were used to examine the psychometric characteristics of the scale. Data were collected from November 2021 to March 2022. RESULTS: EFA and CFA supported a 12-item scale with three factors, namely learning proactively, taking on challenges and thinking positively, fit the data well. The total score of the 12-item scale significantly and positively correlated with diabetes-specific quality of life, and significantly and negatively correlated with baseline and 9-month haemoglobin A1c levels. Cronbach's α for overall scale and subscales ranged between .78 and .91. CONCLUSION: The 12-item Character Strengths Use in Diabetes Self-management Scale demonstrated satisfactory validity and reliability in people with type 2 diabetes. IMPACT: Nurses could apply this new scale to identify the degree of using character strengths in self-management in people with type 2 diabetes; accordingly, character strength-based interventions could be provided to improve self-management in such patients with diabetes. Furthermore, the 12-item Character Strengths Use in Diabetes Self-management Scale has the potential to be used to measure the effectiveness of strength-based interventions in people with Type 2 diabetes. PATIENT OR PUBLIC CONTRIBUTION: Five patients with type 2 diabetes were invited to take the original 20-item scale to evaluate the clarity, readability and comprehensiveness of the 20 items.

Factors affecting spiritual care competency of mental health nurses: a questionnaire-based cross-sectional study.

BACKGROUND: Although providing spiritual care is an important part of holistic nursing care for psychiatric patients, factors associated with spiritual care competency in mental health nurses remain unclear. The aim of our study was to explore a possible association of personal and external factors with spiritual care competency in mental health nurses. METHODS: This prospective questionnaire-based cross-sectional study was conducted by inviting mental health nurses from mental health hospitals and tertiary referral centers. Personality traits and spiritual care competency were assessed by using [1] "big-five Mini-Markers" questionnaire, and [2] spiritual care competency scale, respectively. From the 250 mental health nurses being invited, 239 valid questionnaires were valid for final analysis. Statistical analyses including descriptive statistics, ANOVAs, t-tests, and hierarchical multiple regression models were used to investigate the associations between personal/external factors and their spiritual care competency in mental health nurses. RESULTS: The mean age of the 239 participants was 35.96 ± 8.11 and the mean years of working experience was 9.41 ± 7.06. Over 90% of them had no experience of providing spiritual care. There were significant positive correlations of spiritual care competency with the experience of delivering spiritual care (p < 0.001), previous participation in spiritual care education programs (p = 0.045), a longer working experience (p = 0.014), and a higher education level (postgraduate vs. college, p = 0.006), as well as the personality components of "Conscientiousness" (p < 0.001), "Agreeableness" (p < 0.001), "Extraversion" (p = 0.03), and "Openness/Intellect" (p < 0.001). CONCLUSIONS: Both personal and external factors may be related to the self-perception of spiritual care competency among mental health nurses. These findings may help mental health nurses understand the possible positive and negative associations of their personality components with their spiritual care abilities. Moreover, our identification of the positive impacts of educational programs and previous experience of spiritual care on spiritual care competency may underscore the importance of tailoring appropriate training programs to cater for the individual needs of mental health nurses.

[Nutritional Care of Older Adult Residents Living in Long-Term Care Facilities].

An estimated one-fifth to one half (17.5%-50.5%) of the older adult residents living in long-term care facilities are either malnourished or at risk of malnourishment. Malnutrition in older adults is related to frailty, sarcopenia, anemia, falls, morbidity, and mortality. Monitoring nutritional status and instituting appropriate nutritional care plans in long-term care facilities can help prevent the development of disabilities in older adult residents and reduce long-term healthcare expenditures. In this article, after introducing the primary diagnostic tests for malnutrition, the three main nutritional care principles are presented in the following categories: non-specific health problems, specific-health problems, and dehydration are presented. Next, the behavioral-environmental factors of nutritional care are defined. Finally, the related challenges and practical recommendations are discussed.

Effects of nurse-led lower extremity strength training on knee function recovery in patients who underwent total knee replacement.

AIMS AND OBJECTIVES: To examine the effects of lower extremity muscle strength training on knee function recovery and quality of life in patients who underwent total knee replacement. BACKGROUND: Patients with knee osteoarthritis after surgery experience decreased knee function that impacts their quality of life. However, patients typically lack a long-term, home-based and continuous leg exercise training method and rarely have studies explored the effects of exercise training on knee function recovery and quality of life. DESIGN: A experimental and longitudinal study design. METHODS: The simple randomised sampling (based on patients' admission priority order) was used to collect participant data. Outcome measurements included the Knee Injury and Osteoarthritis Outcome Score. Participants were randomised to receive and starting lower extremity muscle strength training before surgery (training group, n = 100) or to receive usual care (nontraining group, n = 100). Data were collected and followed up with the patients before surgery (T1) and at 2 weeks (T2), 1 month (T3), 2 months (T4) and 3 months (T5) after discharge. RESULTS: The Knee Injury and Osteoarthritis Outcome Score subscale scores showed that both groups of patients experienced knee function and quality of life decreases 2 weeks after total knee replacement, but all subscale scores gradually increased from the first month to the third month after total knee replacement. Both groups and times were significantly different, but the training group's knee function and quality of life recovered earlier and better than the nontraining group does. CONCLUSIONS: This study confirmed that lower extremity muscle strength training helps to improve quality of life and knee function in patients who undergo total knee replacement. Healthcare staff should include this training in presurgical nursing care and in patients' discharge plans as a continuous, daily rehabilitation activity at home. RELEVANCE TO CLINICAL PRACTICE: When patients are diagnosed with knee osteoarthritis and undergo surgery, a presurgical exercise education and discussion of knee function rehabilitation should be part of standard care.

[Spiritual Care of Patients With Depression].

Spiritual care is a component of holistic care. Patients with depression often experience body-mind-spirit health problems and may suffer from spiritual crises, particularly during the acute stage of a diseases, due to low self-esteem, negative attitudes toward life goals, daily life issues, and beliefs caused by physical, psychological, and occupational dysfunctions. Nonetheless, psychical care is the main treatment for patients with depression. This paper focuses on patients with depression and addresses the concepts of spiritual needs and spiritual care, identifying the factors that influence spiritual needs, the essentials of spiritual intervention, and the health effects of spiritual intervention outcomes on patients with depression. Courses that teach practical spiritual interventions are recommended for nurses. These courses should address topics such as individual approaches, building trusting relationships, setting diverse goals for spiritual interventions based on disease stage, and spiritual interventions involving the body-mind-spiritual aspects for patients with depression.

Associations of changes in psychosocial factors and their interactions with diabetes distress in patients with type 2 diabetes: a longitudinal study.

AIM: To assess the associations of changes in self-management behaviours, diabetes self-efficacy, resilience, social support, patient empowerment and their interactions with changes in diabetes distress in patients with type 2 diabetes mellitus. BACKGROUND: Many patients with type 2 diabetes mellitus experience diabetes distress. Few longitudinal studies have investigated the associations of changes in various psychosocial factors with changes in diabetes distress in patients with type 2 diabetes mellitus. DESIGN: This study adopted a longitudinal design. Data were collected at baseline and 12 months later. METHODS: Overall, 304 patients with type 2 diabetes were recruited from four hospitals in southern Taiwan by convenience sampling. A self-report questionnaire and medical record were used to collect demographic data, clinical indicators, self-management behaviours, diabetes self-efficacy, resilience, social support, patient empowerment, and diabetes distress. Data were collected from February 2014-March 2015. RESULTS/FINDINGS: An increase in resilience or diabetes self-efficacy significantly associated with a decrease in diabetes distress, whereas an increase in patient empowerment significantly associated with an increase in diabetes distress. The interactions between increase in patient empowerment and increase in self-management behaviours significantly associated with decrease in diabetes distress. CONCLUSION: Nurses could endeavour to improve the diabetes self-efficacy and resilience to reducing diabetes distress. Arbitrarily empowering patients may increase diabetes distress. Increasing self-care management behaviours and patient empowerment might need to be simultaneously addressed to reduce the diabetes distress in patients with type 2 diabetes.

Risk factors of post-traumatic stress symptoms in patients with cancer.

AIMS AND OBJECTIVES: To determine the level of post-traumatic stress symptoms and to identify demographics, disease history and clinical symptoms that were associated with post-traumatic stress symptoms among patients with gynaecological, breast or colorectal cancer in Taiwan. BACKGROUND: Literature indicated that 7·3-35·2% of patients with cancer had experienced level of post-traumatic stress symptoms. However, the post-traumatic stress symptoms among patients with cancer in Taiwan was not documented. DESIGN: A cross-sectional study. METHODS: A total of 347 participants recruited from two general hospitals in southern Taiwan. They completed the Chinese version of Davidson Trauma Scale and a profile describing their demographics and clinical symptoms. Disease history was collected from medical records. RESULTS: Approximately 21·6% of participants reported higher score on Chinese version of Davidson Trauma Scale (Mean ± SD = 22·85 ± 24·12). The top four scores on Chinese version of Davidson Trauma Scale were painful memories, insomnia, shortened lifespan and flashbacks. The risk factors of post-traumatic stress symptoms were suicidal intention (OR = 2·29, 95% CI = 1·86-2·82), chemotherapy (OR = 2·13, 1·18-3·84), metastasis (OR = 2·07, 1·29-3·34), cancer-specific symptoms (OR = 1·21, 1·15-1·27) and high education (OR = 1·75, 1·10-2·78). CONCLUSION: To prevent post-traumatic stress symptoms, patients with cancer should be routinely screened by psychiatrists for post-traumatic stress symptoms, for ongoing symptom control and suicidal intention. Patients with cancer who are at risk of suicidal behaviour should be enrolled in suicide prevention programmes. RELEVANCE TO CLINICAL PRACTICE: Nurses need to assess post-traumatic stress symptoms of patients with cancer, particularly those who with high education, suffered from complications of chemotherapy, metastasis and cancer-specific symptoms and suicidal intention.

Pelvic floor muscle exercise for fecal incontinence quality of life after coloanal anastomosis.

AIMS AND OBJECTIVES: To assess the efficacy of pelvic floor muscle exercise for enhancing fecal incontinence quality of life after coloanal anastomosis in colorectal cancer patients. BACKGROUND: Methods of improving incontinence have been evaluated in many countries, but never in a Taiwan population. DESIGN: A longitudinal experimental study. METHODS: Fifty-two colorectal cancer patients who had received colostomy closure and coloanal anastomosis surgery were recruited from a general hospital in southern Taiwan and randomly assigned to an experimental group (n = 26) or a control group (n = 26). Both groups received routine postoperative care. However, the experimental group received private consultations, educational DVDs and pamphlets to instruct them in performing pelvic flow muscle exercise. In all participants, the Fecal Incontinence Quality of Life Scale was used to measure quality of life before discharge and at one, two, three, six and nine months after discharge. Generalised estimating equations were used to compare longitudinal effects between the two groups. RESULTS: The generalised estimating equations revealed that all participants had significantly improved Fecal Incontinence Quality of Life Scale scores at two, three, six and nine months after discharge. Compared to the controls, however, the experimental group had significantly higher scores at two, three, and six months after discharge. CONCLUSIONS: Patient education in pelvic floor muscle exercise positively affects Fecal Incontinence Quality of Life Scale scores in patients who have received coloanal anastomosis. RELEVANCE TO CLINICAL PRACTICE: Early education in pelvic floor muscle exercise can improve management of fecal incontinence symptoms after coloanal anastomosis and can improve quality of life.

Sexual dysfunction in males following low anterior resection.

AIMS AND OBJECTIVES: The purpose of this study was to explore the prevalence of sexual dysfunction in males one year after undergoing low anterior resection and to determine whether health care professionals discuss sexual issues with patients after surgery. BACKGROUND: Sexual dysfunction in males may be a complication after low anterior resection for rectal cancer, but few studies have explored this issue in Taiwan. DESIGN: A descriptive comparison study design. METHODS: A descriptive comparison design was used, and a group of 133 participants underwent a low anterior resection procedure for rectal cancer. The results were compared with those of a group of males who underwent colectomy (n = 58) for colon cancer. The following instruments were used: the five-item version of the International Index of Erectile Function, personal demographics and medical variables. RESULTS: The results showed that the prevalence of erectile dysfunction among the low anterior resection patients was 97·0% (129/133), and the erectile dysfunction prevalence was 75·9% (44/58) for the males who underwent colectomy. The generalised linear model showed that after controlling for hypertension and stoma, the low anterior resection group had worse sexual function than those in the colectomy group, and stoma was also a factor that impacted patients' sexual function. The results also revealed that only 32·8-35·3% of health care providers talked about sexual dysfunction with people who have rectal cancer prior to surgery. CONCLUSION: This study demonstrated that men who have undergone low anterior resection have a high risk of sexual dysfunction and that health care professionals infrequently discuss these issues with patients. RELEVANCE TO CLINICAL PRACTICE: When patients are diagnosed with rectal cancer and before they undergo surgery, an assessment and discussion of sexual function issues should be incorporated into standard care. Continued follow-up after hospital discharge and evaluations of sexual function are vital factors for male postoperative rectal cancer patients.

Comparison of professional values between nursing students in Taiwan and China.

BACKGROUND: People in both Taiwan and China originally descended from the Han Chinese, but the societies have been separated for approximately 38 years. Due to different political systems, variations exist in healthcare and nursing education systems in Taiwan and China. OBJECTIVE: The purpose of this study was to examine the professional values of nursing students in Taiwan and China. DESIGN: A cross-sectional design was applied in this study. The Nursing Professional Value Scale-Revised was used to measure the professional values of the students. The questionnaire was distributed to eligible undergraduate students in a classroom setting. ETHICAL CONSIDERATIONS: This study was approved by the Institutional Review Board at the first investigator's university. Participants were informed that completion and return of the questionnaire was voluntary, and confidentiality was ensured by keeping the responses anonymous. PARTICIPANTS: A convenience sample included 292 Taiwanese students and 654 Chinese students. FINDINGS: A total of 11 individual Nursing Professional Value Scale-Revised items showed significant differences between the two groups. These results reflect the differences in the perceived importance of these items between the groups. There was no significant difference between the two groups in the mean overall scores for the Nursing Professional Value Scale-Revised (p = .766) and three subscales (all p > .05). CONCLUSION: There are some differences in professional values between nursing students in Taiwan and China. Given the increasingly frequent and close interactions between Taiwan and China and the globalization of nursing, understanding these differences may help nursing educators identify students' perceptions of their professional values and support the development of strategies to improve weaknesses in professional values.

[Cancer-Related Posttraumatic Stress Symptoms in Patients With Cancer].

At least half of patients with cancer experience emotional distress (e.g., posttraumatic stress symptoms). Most of the studies on the emotional distress of Taiwanese cancer patients have focused on issues of depression rather than on posttraumatic stress disorder. The scope of the present article covers the definitions of cancer-related posttraumatic stress disorder (CR-PTSD) and cancer-related posttraumatic stress symptoms (CR-PTSS), identifies the differences and similarities between professional interview and self-administered measurement tools and their applications; analyzes the prevalence of CR-PTSD and CR-PTSS; identifies the possible contributing sociodemographic (younger age, female, low education, low socio-economic status), clinical (advanced stage, undergoing chemotherapy, just completed the therapy), and psychosocial (negative psychological traits, poor social support, and insufficient coping strategies) of CR-PTSD and CR-PTSS; and aggregates the effects of cognitive and psychosocial interventions on CR-PTSD and CR-PTSS. Furthermore, recommendations for clinical practice and research are discussed. This article is expected to provide practicing nurses with a basic concept of caring for emotional distress and to inspire researchers to conduct further study of issues related to CR-PTSD and CR-PTSS.

[Psychometric testing of the chinese version of the readiness for hospital discharge scale].

BACKGROUND: Little has been published in the literature regarding how patients self-evaluate their degree of readiness for hospital discharge. Furthermore, there is currently no self-evaluation tool available in Chinese able to assess the discharge readiness of patients. PURPOSE: This study was used to psychometrically test the Chinese version of the readiness for hospital discharge scale (RHDS_C). METHODS: This study used a cross-sectional design. Two samples were recruited in a two-stage process at two hospitals in Southern Taiwan. Two hundred and twenty-three patients with a diagnosis of either colorectal cancer or hepatic cancer were used to conduct an exploratory factor analysis (EFA) in the first stage of the study. Another 323 patients with a diagnosis of stroke were used conduct a confirmatory factor analysis (CFA). The instrument used was the Readiness for Hospital Discharge Scale (RHDS) developed by Weiss & Piacentine. RESULTS: RHDS_C consists of three subscales: personal status (4 items), coping ability (4 items), and expected support (4 items) adapted from the CFA. The assessed goodness-of-fit index (GFI = .92, AGFI = .88, NFI = .97) indicate the model fit the data well based upon the CFA. Criterion-related validity was supported by the correlation between the original RHDS and the RHDS_C (r = .96, p < .001). The Cronbach's alpha coefficients were .89 for the overall scale and .73, .90, and .89 for the 3 subscales, respectively. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: This study confirms the validity of the RHDS_C and suggests this instrument is able to reliably assess the readiness of patients for discharge from the hospital. We recommend the scale be applied in the clinical setting to evaluate the discharge readiness of hospital patients.

Cancer Fear, Emotion Regulation, and Emotional Distress in Patients With Newly Diagnosed Lung Cancer.

BACKGROUND: Research related to newly diagnosed lung cancer patients' emotional regulation strategies and how these strategies influence their emotional distress is scarce. OBJECTIVE: The aim of this study was to investigate the relationship between cancer fear, emotion regulation, and emotional distress in patients with newly diagnosed lung cancer. METHOD: A cross-sectional, correlation research design was conducted, using self-report questionnaires: the Cancer Fear Scale, the Emotion Regulation Questionnaire, and the Hospital Anxiety and Depression Scale. A total of 117 newly diagnosed lung cancer patients were sampled. RESULTS: Nearly 70% of newly diagnosed lung cancer patients had a high level of cancer fear; 56.4%, depression; and 45.3%, anxiety. Depression was positively associated with cancer fear ( r = 0.239, P < .01) and expressive suppression ( r = 0.185, P < .05), but negatively associated with cognitive reappraisal ( r = -0.323, P < .01). Anxiety was positively associated with cancer fear ( r = 0.488, P < .01) but negatively associated with cognitive reappraisal ( r = -0.214, P < .05). Cancer fear and cognitive reappraisal were significant explanatory factors and explained 25.2% of variance in anxiety. Cancer fear, expressive suppression, and cognitive reappraisal were significant explanatory factors and explained 16.7% of variance in depression. CONCLUSIONS: Newly diagnosed lung cancer patients with cancer fear and who used fewer cognitive reappraisal strategies or more expressive suppression had more emotional distress. IMPLICATIONS FOR PRACTICE: Clinicians should be attentive to patients' cancer fears and emotion regulation strategies as early as possible to prevent their emotional distress.

Impacts of extrinsic and intrinsic factors on psychiatric nurses' spiritual care attitudes.

WHAT IS KNOWN ON THE SUBJECT?: Because the definition of spirituality is complex and has cultural and individual dimensions, it is important to be receptive to individual differences in the perception of spirituality during clinical practice of mental health nurses. Although enhancing spiritual care is beneficial to patients diagnosed with mental illnesses, the extrinsic (e.g., education) and intrinsic factors that would affect nurses' attitudes towards spiritual care have not been investigated. Notwithstanding the known impact of certain intrinsic factors (e.g., personality-related) of mental health nurses on their coping strategies as well as their emotional and mental health, the link to their spiritual care attitudes has received little attention. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper is the first to identify the beneficial impacts of extrinsic factors including postgraduate education, working experience, participation in palliative care education programmes, and spiritual care experience on spiritual care attitudes among mental health nurses. Certain intrinsic factors, including those personality-related such as "Extraversion," "Openness/Intellect," "Conscientiousness," and "Agreeableness," were also associated with higher awareness of providing spiritual care among mental health nurses. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The finding of an association of certain intrinsic factors with more positive attitudes towards spiritual care could encourage further studies to explore possible links between these factors and attitudes of spiritual care. Those less aware of the patients' spiritual needs may benefit through participating in relevant education and on-the-job training programmes that involves actual practice and collaboration in a multidisciplinary team. ABSTRACT: Introduction Although enhancing spiritual care can facilitate the communication of mental health nurses with patients diagnosed with mental illnesses, extrinsic and intrinsic factors that may influence their spiritual care attitudes remain unclear. Aim To conduct a questionnaire-based survey on mental health nurses from eight hospitals. Method A total of 239 psychiatric nurses were assessed based on (1) "big-five Mini-Markers" questionnaire and (2) spiritual care attitudes scale on three components (i.e., core values, growth, and nursing) to investigate the associations of spiritual care attitudes with social/occupational characteristics and personality. Results A positive attitude was significantly associated with working experience, higher educational level, previous participation in palliative care education programmes, spiritual care experience, and personality factors including "Extraversion," "Openness/Intellect," "Conscientiousness," and "Agreeableness." Discussion Despite demonstrating impacts of intrinsic factors (e.g., personality) on mental health nurses' spiritual care attitudes, other modifiable extrinsic factors (e.g., education) were important in enhancing their awareness towards spiritual care. Implications for Practice Our findings encourage further studies to explore possible links between intrinsic factors and attitudes of mental health nurses towards spiritual care as well as suggest benefits of continuing education and on-the-job training that involves actual practice and collaboration in a multidisciplinary team to provide spiritual care.

Psychometric Testing of the Newly Developed Competence Scale for Clinical Nurses.

BACKGROUND: Nursing competence is an essential element in ensuring high-quality nursing care and positive patient outcomes. Valid and reliable assessment tools for assessing nurse competence are needed to help nurse supervisors measure whether nurses are performing their job well and to provide a baseline for improving the competences of nurses. PURPOSE: This study was designed to develop and psychometrically validate the Competence Scale for Clinical Nurses (CSCN). METHODS: The CSCN was developed in three steps: (a) generalize assessment items from nursing competence-related scales and a review of the relevant literature, (b) determine the content validity of the developed scale, and (c) psychometrically test the developed scale. Five hundred nurses were recruited from a medical center in southern Taiwan. Exploratory and confirmatory factor analyses were executed to analyze construct validity and internal consistency reliability. RESULTS: The scale-content validity index was .87, as determined by five experts. Two thirds (63.29%) of the variance was explained by three factors: basic care skills (nine items), being dedicated to work (five items), and patient-centered and ethical considerations (four items). A second-order confirmatory factor analysis indicated that the data fit the model well. The Cronbach's alpha coefficients for each of the three factors and the total scale were .84-.91. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The 18-item CSCN is a feasible and time-efficient tool for assessing competence in clinical nurses. Nursing supervisors may use this tool to explore nurses' competency and routinely track the effect of continuing education on competence. Continuous evaluation of nurses' clinical-based competence using the CSCN is recommended.

The Effects of an Educational Program on the Professional Quality of Life and Health of Nurses: A Cluster Experimental Design.

BACKGROUND: The complexity of the healthcare environment and intense workloads may negatively impact the health and professional quality of life (ProQOL) of nurses. Prior research has identified a significant association in nurses between ProQOL and health. Developing an intervention to improve the ProQOL and health of nurses may benefit the quality of nursing care. PURPOSE: The aim of this study was to explore the effects of a compassion fatigue Resiliency, mindfulness Respiration, and Relatives and friends' support (i.e., 3Rs) educational program on ProQOL, physical health, and mental health in nurses. METHODS: A cluster experimental design was used in this study to recruit registered nurses at two regional teaching hospitals in southern Taiwan as participants. The experimental group (n = 67) attended the 4-week (2-hours-per-week) 3R educational program. The control group (n = 57) received no intervention. The outcome variables, including compassion satisfaction, burnout, secondary traumatic stress, physical health, and mental health, were measured at baseline, at the end of the intervention (immediate effect), at 4 weeks postintervention (short-term effect), and at 12 weeks postintervention (medium-term effect). The study was conducted from May 2017 to December 2017. RESULTS: Increases in compassion satisfaction and mental health and decreases in secondary traumatic stress were significantly greater in the experimental group than in the control group between baseline and all three posttest time points. Moreover, burnout decreased and physical health improved more significantly in the experimental group than in the control group between the baseline and end of intervention time points (p < .001). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The 3R educational program intervention, integrating compassion fatigue resiliency, mindfulness respiration, and support from relatives and friends, had immediate and positive effects on ProQOL as well as physical and mental health. Moreover, the intervention was shown to have short-term and medium-term positive effects on compassion satisfaction, secondary traumatic stress, and mental health. Nursing managers may apply programs that integrate compassion fatigue resiliency, mindfulness respiration, and relatives and friends' support to improve ProQOL and health in nurses.

Impacts of multi-morbidity, hemoglobin levels, and frailty on functional disability of older adult residents of long-term care facilities: A structural equation analysis.

AIM: Previous studies have focused on the relationship between multi-morbidity, frailty, and anemia or functional disability alone rather than in combination. This study aimed to explore the impacts of multi-morbidity, hemoglobin levels, and frailty on functional disability simultaneously in older adult residents of long-term care facilities. METHODS: This was a cross-sectional study. Data were retrieved from the electronic health records of eight long-term care facilities. Data from a total of 352 subjects aged at least 60 years and residing in these facilities for at least 6 months were analysed. Analytic datasets included the Barthel Index of Activities of Daily Living, the Frailty Phenotype Criteria, the number of chronic diseases, hemoglobin levels, age, and gender. RESULTS: The final model demonstrated acceptable goodness-of-fit indices, namely goodness-of-fit index, comparative fit index, and incremental fit index ≧0.90, root mean square error of approximation <0.08, and insignificance of χ2 (P > 0.05). Frailty, multi-morbidity, and hemoglobin levels all had direct associations with functional disability (all P < 0.001). Hemoglobin levels had a direct association with frailty (ß = -0.11). Multi-morbidity had an indirect association (ß = 0.04) with functional disability through hemoglobin levels. Hemoglobin levels had an indirect association (ß = 0.05) with functional disability through frailty. CONCLUSIONS: The impacts of multi-morbidity, hemoglobin levels, and frailty on functional disability were explored. A high-quality disease management program, interventions for the prevention of frailty, and the provision of continued education for staff about reducing progressive frailty and functional disability for older adult residents are recommended. Geriatr Gerontol Int 2021; 21: 532-537.

Functional Capacity and Life Satisfaction in Older Adult Residents Living in Long-Term Care Facilities: The Mediator of Autonomy.

BACKGROUND: Although relationships among functional capacity, autonomy, and life satisfaction have been identified, little is known about how the mechanism of autonomy mediates functional capacity and life satisfaction in older adult residents of long-term care (LTC) facilities. PURPOSE: The objectives of the study were to examine the relationship between functional capacity and life satisfaction in older adult residents living in LTC facilities and to test the extent to which autonomy mediated that relationship. METHODS: A cross-sectional and correlational study was conducted with a convenience sample. Two hundred twenty-eight participants were recruited from 10 LTC facilities in Kaohsiung City. Four structured instruments were used to collect data: the life satisfaction questionnaire, the Chinese version of Perceived Enactment Autonomy Scale, the Barthel Activity Daily Living Index, and a personal profile datasheet. Descriptive statistics, t tests, analysis of variance, Pearson correlations, and both simple and hierarchical linear regression models were analyzed. RESULTS: Positive associations between life satisfaction and functional capacity (r = .183, p = .003) and autonomy (r = .469, p < .001) were identified. Autonomy and functional capacity were significantly correlated (r = .278, p < .001). After controlling for autonomy, the beta values reduced from .193 (p = .003) to .08 (p > .05), and the explained variance reduced from 3.7% to 0.1% between functional capacity and life satisfaction. The results indicate that autonomy is significant as a mediator. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: To improve the life satisfaction of older adult residents of LTC facilities, facility managers and staff should develop a self-support program that encourages older adult residents to participate in physical activities and maintain autonomy.

Lower urinary symptoms, resilience, and post-traumatic stress symptoms among rectal cancer patients after surgery.

AIM: Disturbance of urinary function is a common complication after rectal cancer surgery, and it may affect patients' psychological well-being, consequently may develop post-traumatic stress disorder. Personal resilience might increase people's ability to manage life's challenges. However, limited study to explore their relationships. This study examined the relationships among lower urinary symptoms, resilience, and post-traumatic stress symptoms (PTSS) in post-surgery patients with rectal cancer. METHODS: A cross-sectional study design was used and included 188 patients with diagnosed rectal cancer who had undergone surgery over 24 months and were recruited from a hospital in southern Taiwan. The outcome measurements included a resilience scale, International Prostate Symptom Score (IPSS), the Chinese Davidson Trauma Scale, personal characteristics, and disease-related variables. RESULTS: There were significant relationships among age at diagnosed, self-reported physical status, perceived satisfied with recovery, urinary tract symptoms, resilience, and overall PTSS. The stepwise regression demonstrated that five factors, self-reported physical status, resilience, urinary tract symptoms, age at diagnosed and gender, and together explained 27.7% of overall PTSS variance (10.7, 6.7, 3.7, 4.8 and 1.8% of variance, respectively). CONCLUSION: The study demonstrates that patients with diagnosed rectal cancers long-term outcomes of PTSS, urinary tract symptoms, and resilience after surgery; in addition, self-reported physical status, resilience, urinary tract symptoms, age at diagnosed and gender are the major predictors of PTSS. A better understanding of the long-term outcomes of post-surgery in rectal cancer patients and its related factors may help to decreasing the PTSS after surviving cancer.

The Effects of a Supportive Care Program on the Posttraumatic Stress Symptoms of Patients With Oral Cancer After Surgery.

This study aimed to estimate the effects of a supportive care program on the posttraumatic stress symptoms (PTSSs) of patients with oral cancer after surgery. Participants were divided into two groups. Outcome measurements included the Chinese version of the Davidson trauma scale to examine PTSSs at a clinical follow-up 1 week (T0), 1 month (T1), and 3 months (T2) after hospital discharge. The results indicated that the frequency and severity mean scores of PTSSs for the two groups at T0 were significantly higher than those at T1 and T2. Both the groups and times were significantly different; moreover, the supported group's PTSS score decreased more than that of the nonsupported group. These findings supported the effects of the supportive care program. Health care staff should be aware of the PTSS status of patients with oral cancer who undergo surgery and consider these issues in combination with patients' discharge care plans.