Effectiveness of Implementing Modified Early Warning System and Rapid Response Team for General Ward Inpatients.

This retrospective study assessed the effectiveness and impact of implementing a Modified Early Warning System (MEWS) and Rapid Response Team (RRT) for inpatients admitted to the general ward (GW) of a medical center. This study included all inpatients who stayed in GWs from Jan. 2017 to Feb. 2022. We divided inpatients into GWnon-MEWS and GWMEWS groups according to MEWS and RRT implementation in Aug. 2019. The primary outcome, unexpected deterioration, was defined by unplanned admission to intensive care units. We defined the detection performance and effectiveness of MEWS according to if a warning occurred within 24 h before the unplanned ICU admission. There were 129,039 inpatients included in this study, comprising 58,106 GWnon-MEWS and 71,023 GWMEWS. The numbers of inpatients who underwent an unplanned ICU admission in GWnon-MEWS and GWMEWS were 488 (.84%) and 468 (.66%), respectively, indicating that the implementation significantly reduced unexpected deterioration (p < .0001). Besides, 1,551,525 times MEWS assessments were executed for the GWMEWS. The sensitivity, specificity, positive predicted value, and negative predicted value of the MEWS were 29.9%, 98.7%, 7.09%, and 99.76%, respectively. A total of 1,568 warning signs accurately occurred within the 24 h before an unplanned ICU admission. Among them, 428 (27.3%) met the criteria for automatically calling RRT, and 1,140 signs necessitated the nursing staff to decide if they needed to call RRT. Implementing MEWS and RRT increases nursing staff's monitoring and interventions and reduces unplanned ICU admissions.

[The Correlates and Predictive Factors of Work Stress, Job Satisfaction, and Resilience in Nurses in the Post-COVID-19 Era].

BACKGROUND: Individuals in the asymptomatic incubation period of COVID-19 are highly contagious. This threat of asymptomatic transmission contributes to increased stress among nursing staffs and undermines their resilience. PURPOSE: This study was designed to explore the correlates and predictive factors of resilience in the contexts of work stress and job satisfaction among nursing staffs. METHODS: A cross-sectional study design was employed on a convenience sample of 408 nurses. The survey included a demographic datasheet, the Nurse Occupational Stressor Scale, Job Satisfaction Scale, and Resilience Scale. Inferential statistics were conducted using independent sample t test, Pearson correlation analysis, and stepwise multiple linear regression. RESULTS: The participants were an average 32.6 years old. The average resilience score indicated a "moderate" resilience level. Resilience was treated as the dependent variable, while the demographic variables, Nurse Occupational Stressor Scale score, and job satisfaction dimension scores were treated as independent variables. Stepwise regression analysis was used to identify the key predictors of resilience, which included professional autonomy and development (ß = .468, p <.001), occupational hazards (ß = .163, p <.001), interpersonal interaction and collaboration (ß = .223, p < .001), self-perceived economic status (ß = -.093, p < .05), supervisor's leadership style (ß = -.118, p < .05), and marital status (ß = .078, p < .05). The model explained 39.4% of the total variance. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results of this study support healthcare providers promoting resilience in several specific ways. Healthcare organizations should enhance professional competence through professional education and training programs; improve workplace safety; foster an atmosphere conducive to team cooperation; provide job support through mentorship and apprenticeship systems and caring leadership from nursing supervisors; continuously conduct caring and stress-relief activities; and utilize online self-report health questionnaires to enable nursing staff facing psychological and emotional challenges to seek professional counseling and support. Enhancing resilience strategies on a long-term basis can improve the mental health of nursing staff, which may be expected to enhance the quality of patient care.

[The Effectiveness of Abdominal Massage on Neurogenic Bowel Dysfunction in Patients With Spinal Cord Injury: A Systematic Review].

BACKGROUND: Neurogenic bowel dysfunction is a common comorbidity in spinal cord injury patients that may result in fecal incontinence. Abdominal massage is one intestinal training method that is used to improve bowel movement and defecation. PURPOSE: To review the effectiveness of abdominal massage on neurogenic bowel dysfunction in patients with spinal cord injury. METHODS: A systematic review of Chinese and English-language articles was performed in six databases using the following key words: spinal cord injury, abdominal massage, neurogenic bowel dysfunction, and bowel training. Relevant studies published prior to June 2016 that met the inclusion and exclusion criteria were selected. The Downs and Black scale was used to appraise the quality of each of the included studies. Eight studies were included in the final analysis. RESULTS: Four of these studies indicated that abdominal massage significantly improved bowel functions and the regularity and frequency of bowel movements. Although two of the studies indicated that abdominal massage significantly reduced the use of glycerin and laxatives, the remaining six did not. The eight studies earned respective quality scores ranging between 13 and 25. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The current literature lacks consensus on the efficacy of abdominal massage in terms of improving bowel dysfunction in patients with spinal cord injuries. Future studies should use more stringent experimental designs such as randomized controlled studies to explore the correlations among massage time and frequency and bowel function improvements in order to provide guidelines for clinical care applications.

Improving self-perception and self-efficacy in patients with spinal cord injury: the efficacy of DVD-based instructions.

AIMS AND OBJECTIVES: We assessed the effects of a spinal cord injury home rehabilitation DVD on patients with spinal cord injury. BACKGROUND: Multimedia have been used widely in health care in the digital age. The provision of rehabilitation instructions is a major responsibility of the rehabilitation staff. DESIGN: This study adopted a quasi-experimental pretest-posttest control group design. METHODS: We collected data from a rehabilitation nursing ward at a medical centre between October 2011-April 2012. The participants were recruited before being discharged from the hospital. The experimental group (n = 28) received multimedia DVD instructions for three months, in addition to teaching sessions conducted by the researcher, whereas the control group (n = 31) received instructions without a DVD. Both groups completed the self-perception and self-efficacy scales used in this study before and after the intervention. RESULTS: The results indicated that, after the multimedia DVD intervention, the experimental group exhibited a considerably greater improvement in self-perception than did the control group. Although we recorded increased scores for both self-perception and self-efficacy for both groups, no marked differences emerged between the control and the intervention groups by using a generalised estimating equation. CONCLUSION: These results suggest that the home rehabilitation DVD is an effective instrument for improving self-perception and self-efficacy in patients with spinal cord injury. However, monitoring these patients over the long term is necessary. RELEVANCE TO CLINICAL PRACTICE: Our study results confirmed that the spinal cord injury home rehabilitation DVD is a practical health education tool. We plan to use the proposed DVD intervention with a larger number of hospitalised patients, and to continuously monitor their improvement.

Association Between Family Functioning and Health-related Quality of Life in Stroke Survivor-Informal Family Caregiver Dyads.

PURPOSE: Stroke survivors and their informal family caregivers may share the impact of the disease, which may affect family functioning and quality of life (QoL) for both. This study compared the perceptions of stroke survivors and informal family caregivers regarding family functioning and QoL and examined the QoL of those reporting effective versus ineffective family functioning. METHODS: A cross-sectional study design and convenience sampling were used. Stroke survivor-informal family caregiver dyads were recruited from a medical university hospital. We assessed participants' demographic and clinical variables, including disease severity, family functioning, and QoL. Independent t-test, paired t-test, Wilcoxon signed-rank test, and Mann-Whitney U test were used to analyze the data. RESULTS: Seventy-one stroke survivor-informal family caregiver dyads participated in the current study. Most stroke survivors and informal family caregivers reported effective family functioning, with no significant differences. However, significant differences existed in the seven domains (physical functioning, role-physical, bodily pain, general health, vitality, social functioning, and role-emotional) of QoL, except emotional health. Stroke survivors reporting ineffective family functioning had a significantly lower mental component summary score, unlike informal family caregivers. CONCLUSIONS: Our findings suggest that family functioning is crucial to ensure stroke survivors' QoL, particularly regarding their mental health. Health professionals should prioritize mental health assessments and provide appropriate care interventions for stroke survivors in the first 1-6 months after stroke onset.

Evaluation of super-link system theory for spinal cord injury patients using participatory action research in a rehabilitation hospital.

PURPOSE: The purpose of this study was to integrate and evaluate the spinal cord injury rehabilitation nursing theory named Super-Link System Theory using participatory action research. METHOD: Data were collected from October 2007 to September 2008 in a rehabilitation hospital by means of interviews, participant observations, documentary resources, case conferences and reports, and participants' self-reflective inquiries. The Super-Link System Theory was introduced to 31 rehabilitation nurses. The nurses selected a key reference group including the researcher to facilitate the participatory action research process to implement and evaluate the theory. Data were analyzed using content analysis. RESULTS: The findings shows that several key concepts were clarified and specific nursing interventions were identified. Furthermore, an integrated link system from the hospital to the community through both rehabilitation nurses and discharge planners was established. CONCLUSION: The study demonstrated an evidence base for an evolving theory of care, and empowered nurses to make sustainable changes to their practice.

A study of factors affecting moving-forward behavior among people with spinal cord injury.

Enhancing self-efficacy, self-perception, and social support can be an effective way for people with spinal cord injury (SCI) to move forward. The purpose of this study was to explore relationships between "moving-forward behavior" and demographic and disease characteristics, self-efficacy, self-perception, and social support among people with SCI. The study was designed as a descriptive-correlation, cross-sectional study. The participants were selected using cluster random sampling (n = 210) through the Spinal Injury Association in Taiwan. A statistically significant relationship was found between moving-forward behavior and age (t = -2.30, p < .05), self-efficacy (gamma = -0.25, p < .01), and self-perception (gamma = -0.39, p < .01). Age (odds ratio [OR] = 0.964, p < .05) and self-perception (OR = 0.824, p < .05) were both significant predictors of moving-forward behavior.

Gender role moderates correlation between learning needs and behavioural intention of sexual health care in female nurses.

AIM: This study evaluated the correlation between learning needs and behavioural intention of sexual health care in female Registered Nurses and to assess the moderating effect of gender role on this relationship. DESIGN: In this cross-sectional questionnaire-based survey, a convenience sampling of female Registered Nurses was included from Chung Shan Medical University Hospital, Taiwan. METHODS: Three questionnaires were used to obtain self-reported data on learning needs, behavioural intention and gender role. RESULTS: Based on gender role scores, 11.8% of participants were feminine, 10.0% were masculine, 31.0% were androgynous and 47.2% were undifferentiated. Significant positive correlations between learning needs and behaviour intention were observed in the total population as well as in undifferentiated, feminine and androgynous nurses (all p < .05). Learning needs were positively associated with the behavioural intention of sexual health care in female nurses, which was moderated by gender role (F = 2.868, p = .036).

[A nurse's experience using the super-link system theory to help a T6 spinal cord injury patient return to school].

The subject of this article is a 20 year-old female with thoracic spinal cord injury with paraplegia suffered during a car accident. The article reports on the nursing experience in helping the patient manage her autonomic dysreflexia (AD), training the patient in self-catheterization, and using relevant social resources in order to achieve a successful return to her studies at school. The authors collected data using interviews, observations, and physical assessments between November 20 and December 30, 2008. The two nursing diagnoses of AD and inadequate preparation for a successful return to school during rehabilitation hospitalization were made during caring procedures. Holistic nursing assessment was employed and the Super-Link System Theory was applied to establish a link between the hospital and school. Individual nursing interventions used included understanding the inducement and treatment of AD, performing self-catheterization, and enhancing the support system by introducing successful clients and relevant social resources in order to transition the patient successfully to her new post-injury life. The patient consequently transitioned smoothly from rehabilitation hospital to school. The authors hope this case report will provide a useful reference for nurses charged with caring for patients with spinal cord injuries while still enrolled at school.