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.

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.

[Percutaneous endoscopic gastrostomy (PEG): overview and nursing care].

The dramatic increase in the elderly population in Taiwan has made dysphagia an increasingly prevalent problem in long-term care. While tube feeding is mandatory for patients unable to take food orally, this approach increases recurrent aspiration pneumonia and malnutrition risks. Percutaneous endoscopic gastrostomy (PEG) is currently the most effective and prevalent approach to enteral nutrition. This article introduces the definition, indications, contraindications, complications, advantages and disadvantages of PEG and its clinical nursing care protocols. The author hopes that this narrative description of a nurse's experience providing appropriate nursing care to a PEG patient will help enhance reader understanding of PEG care.

Altered heart rate variability and pulse-wave velocity after spinal cord injury.

BACKGROUND: Heart rate variability (HRV) and pulse-wave velocity (PWV), indicators of cardiac function, are altered in patients with spinal cord injury (SCI), suggesting that autonomic cardiac function and arterial stiffness may underlie the high risk of cardiovascular complications in these patients. No study has simultaneously investigated HRV and PWV in the same patients. AIM: To evaluate cardiovascular complications in SCI patients by comparing HRV and PWV between patients with and without SCI. METHODS: In this cross-sectional pilot study, patients with (n = 60) and without SCI (n = 60) were recruited from December 7, 2019 to January 21, 2020. Each participant received a five-minute assessment of HRV and the cardiovascular system using the Medicore HRV Analyzer SA-3000P. Differences in HRV and PWV parameters between participants with and without SCI were statistically examined. RESULTS: We observed a significant difference between participants with and without SCI with respect to the standard deviation of all normal-to-normal intervals, square root of the mean sum of squared successive risk ratio interval differences, physical stress index, total power, very-low frequency, low frequency, high frequency, and arterial elasticity. CONCLUSION: Patients with SCI have weaker sympathetic and parasympathetic activity as well as lower arterial elasticity compared to those without, suggesting that SCI may increase cardiac function loading.

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.

The lived experience of moving forward for clients with spinal cord injury: a Parse research method study.

BACKGROUND: Most people with spinal cord injuries take a long time to recover and return to their previous life activities. Moving forward is connected with the choices people make about what is important, what to do, and how to live life in ways they value. Parse's Theory of Humanbecoming is a human science theory, and its overall aims are to improve the quality of life for clients and their families. METHOD: The Parse research method was used to explore the lived experience of moving forward for 15 clients with spinal cord injuries recruited from two Spinal Injury Associations in Taiwan in 2007. Data were collected and analysed through the processes of participant selection, dialogical engagement, extraction-synthesis and heuristic interpretation, as proposed by Parse. FINDINGS: The core concepts found were confronting difficulties, going on and finding self-value and confidence, and co-creating successes amid opportunities and restrictions. Thus, the structure of the lived experience of moving forward is confronting difficulties, going on and finding self-value and confidence to affirm one's self while co-creating successes amid opportunities and restrictions. CONCLUSION: This study contributes to nursing theory-guided knowledge development from a humanbecoming perspective on the experience of moving forward among clients with spinal cord injury, and informs rehabilitation nurses who use the Humanbecoming theory as a guide to practice to promote moving forward.

Translation and back-translation in qualitative nursing research: methodological review.

AIMS: To examine the effects of the procedure of translation and the techniques used on the collection and interpretation of original language qualitative data for English presentation. BACKGROUND: Nursing and health research increasingly use qualitative research for a broadened perspective on practice and research. In numerous qualitative nursing research papers, data are collected in the original language (example Chinese) and the findings are presented in English. No standardised procedures exist for evaluating the influences of translation on the trustworthiness of qualitative data in nursing research. DESIGN: Translation and back-translation related literature review was conducted. METHODS: This is a methodological review paper. Discussion. This paper discusses the factors influencing the quality of translation including translator, back-translation, culture and language. Additionally, the translation procedures reported in the literature and the author's experiences are considered. CONCLUSIONS: The translation procedures described in qualitative nursing research can be summarised as: 1 Verbatim transcription of the content in original language, and then analysis of content; 2 Two bilingual translators are necessary to translate the emerged concepts and categories; 3 Back translate is employed; 4 An expert panel committee is involved in reaching final agreement on the translation. RELEVANCE TO CLINICAL PRACTICE: Development of the translation procedures could provide qualitative nursing researchers with a guide when collecting data in one language and presenting results in another language. In this way, the necessary rigour in qualitative nursing research could be achieved.

[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.

[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.

Living with a relative who has a spinal cord injury: a grounded theory approach.

AIMS: This paper reports a study which explored family carers' experiences of taking care of a relative who has a spinal cord injury. BACKGROUND: Spinal cord injury is one of the most disastrous injuries a person may experience. Although one family member experiences the injury, the entire family is affected. In Taiwan, family carers carry the primary responsibility of providing care on a 24-hour basis during the rehabilitation hospitalisation. However, very limited research exists regarding their experiences. DESIGN: This qualitative study has a cross-sectional and descriptive-explorative design. METHOD: Grounded theory was used to explore the psychosocial implications for family carer who has a relative with spinal cord injury. Data collection and analysis. Data were collected through in-depth, tape-recorded, semi-structured interviews and observation of a group discussion and two religious activities in a rehabilitation hospital in Taiwan. Fifteen family carers participated in this study comprising eight individual interviews and seven participating in the group discussion. Data collection and analysis occurred concurrently. RESULTS: The findings resulted in the core category 'living with a relative who has a spinal cord injury' and identified the experience of taking care of a relative who has a spinal cord injury. Three stages, including four categories: stage 1 'A catastrophic life event'; stage 2 'Confronting challenges'; and stage 3 'Family resilience' or 'Family breakdown'. CONCLUSIONS: This study shows that family carers experience a catastrophic life event, they have to confront challenges and the positive consequence is family resilience, the negative consequence is family breakdown. Relevance to clinical practice. Knowing how prospective family carers view their own situation and what they need is essential to provide effective nursing care for the family that has been changed dramatically by a spinal cord injury.

Using a synthesised technique for grounded theory in nursing research.

AIMS: To introduce a synthesised technique for using grounded theory in nursing research. BACKGROUND: Nursing increasingly uses grounded theory for a broadened perspective on nursing practice and research. Nurse researchers have choices in how to choose and use grounded theory as a research method. These choices come from a deep understanding of the different versions of grounded theory, including Glaser's classic grounded theory and Strauss and Corbin's later approach. DESIGN: Grounded theory related literature review was conducted. METHODS: This is a methodological review paper. RESULTS: Nursing researchers intent on using a grounded theory methodology should pay attention to the theoretical discussions including theoretical sampling, theoretical sensitivity, constant comparative methods and asking questions, keeping memoranda diagramming, identification of a core category and a resultant explanatory theory. A synthesised approach is developed for use, based on Strauss and Corbin's style of sampling and memoranda writing, but selecting theoretical coding families, that differ from the paradigm model of Strauss and Corbin, from the wide range suggested by Glaser. This led to the development of a multi-step synthesised approach to grounded theory data analysis based on the works of Glaser, Charmaz and Strauss and Corbin. CONCLUSIONS: The use of this synthesised approach provides a true reflection of Glaser's idea of 'emergence of theory from the data' and Strauss and Corbin's style of sampling and memoranda writing is employed. This multi-step synthesised method of data analysis maintains the philosophical perspective of grounded theory. RELEVANCE TO CLINICAL PRACTICE: This method indicates how grounded theory has developed, where it might go next in nursing research and how it may continue to evolve.

Beta1,4-N-acetylgalactosaminyltransferase III enhances malignant phenotypes of colon cancer cells.

The enzyme beta1,4-N-acetylgalactosaminyltransferase III (beta4GalNAc-T3) exhibits in vitro activity of synthesizing N,N'-diacetyllactosediamine, GalNAcbeta1,4GlcNAc. Here, we investigate the expression of beta4GalNAc-T3 in primary colon tumors and the effects of its overexpression on HCT116 colon cancer cells. Real-time reverse transcription-PCR showed that the expression of beta4GalNAc-T3 was up-regulated in 72.5% (n = 40) of primary colon tumors compared with their normal counterparts. beta4GalNAc-T3 overexpression resulted in enhanced cell-extracellular matrix adhesion, migration, anchorage-independent cell growth, and invasion of colon cancer cells. Moreover, beta4GalNAc-T3 overexpression increased tumor growth and metastasis and decreased survival of tumor-bearing nude mice. beta4GalNAc-T3 overexpression showed increased tyrosine phosphorylation of focal adhesion kinase and paxillin Y118 as well as increased extracellular signal-regulated kinase phosphorylation. These results suggest that up-regulation of beta4GalNAc-T3 may play a critical role in promoting tumor malignancy and that integrin and mitogen-activated protein kinase signaling pathways could be involved in the underlying mechanism.

[Clinical application of super-link system theory in spinal cord injury patients during rehabilitation stage].

The purpose of this paper is to introduce Super-Link System Theory, which is a theory of spinal cord injury rehabilitation. This theory has been developed using the grounded theory research method. By explaining the procedure for establishing a super-link system the paper explains the complex structure of this theory. Super-Link System Theory emphasizes that rehabilitation nurses 'build up their interpersonal relationships' with clients, family caregivers, the interdisciplinary team, and the community, and attempt to 'establish links' among them. They know these links have to be made with appropriate 'timing', and must be able to access the appropriate people when necessary. Super-link systems include the following four links: link to client with spinal cord injury, link to family caregiver, link to interdisciplinary rehabilitation team, and link to community. It can enable rehabilitation nurses to provide a better quality of nursing care to clients and their family caregivers, as well as promote their professional position in the interdisciplinary rehabilitation team.

Rebuilding Life: Investigating the Long-Term Homecare Needs of Clients With Spinal Cord Injuries.

BACKGROUND: Clients with a spinal cord injury (SCI) must learn to manage their disabilities and may never be able to resume their previous lifestyle. Therefore, receiving relevant information and support from care practitioners and institutions is essential for clients with long-term SCI. PURPOSE: This study investigated the long-term homecare needs of clients with SCIs. METHODS: A qualitative approach was used in this study. Data were collected from March to May 2013. Four SCI associations were selected using purposive sampling, and four focus group interviews were conducted in Northern, Central, Southern, and Eastern Taiwan. Each focus group was composed of 7-12 participants. In-depth interviews (1.5-2.5 hours) were conducted. A content analysis method was adopted for data analysis. RESULTS: Thirty-eight participants took part in the study. The long-term care needs of clients with SCI require the following dynamic processes for rebuilding their lives: physical care and complication prevention, life planning, social support, discovery of the value of existence, and sexual satisfaction. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The results reveal the long-term care needs of clients with SCI. Nurses are expected to provide client-centered care, emphasize prevention rather than treatment of complications, initiate life planning at the early stages of a client's rehabilitation, enhance a client's social support, encourage a client's search for companionship and search for the value of existence and a life purpose, and be attentive to the sexual concerns of people with physical disabilities.

Body Composition Outcomes of a Qigong Intervention Among Community-Dwelling Aging Adults.

Aging causes various changes in body composition, which are critical implications for health and physical functioning in aging adults. The aim of this study was to explore the body composition outcomes of a qigong intervention among community-dwelling aging adults. This was a quasi-experimental study in which 90 participants were recruited. Forty-eight participants (experimental group) attended a 30-min qigong program 3 times per week for 12 weeks, whereas 42 participants (control group) continued performing their usual daily activities. The experimental group achieved a greater reduction in the fat mass percentage at the posttest, and exhibited increased fat-free mass, lean body mass percentage, and lean body mass to fat mass ratio compared with the controls. No difference between the two groups in body mass index, fat mass, and lean body mass was observed. These results indicated that the qigong intervention showed beneficial outcomes of body composition among community-dwelling aging adults.

Nursing models and self-concept in patients with spinal cord injury--a comparison between UK and Taiwan.

The purpose of this study is to investigate rehabilitation nurses' care for patients with spinal cord injury (SCI). It also examines how rehabilitation nurses perceive their role in assessing the alteration of self-concept and the interventions they use in helping patients to develop a more positive perception of themselves. A critical review of common models in use was undertaken including Roper, Logan and Tierney's Activities of Living Model, Roy's Adaptation Model and Orem's Self-care Deficit Nursing Theory. A nursing framework has been developed for rehabilitation nursing. Data were collected by questionnaire. The findings indicate that rehabilitation nurses are aware of the alteration in self-concept for patients with SCI. Although nursing interventions include physiological, psychological and social aspects of care, nurses do not feel that current nursing models are useful in SCI nursing and tend to support the specially designed model.

Changes in the use of complementary and alternative medicine in Taiwan: a comparison study of 2007 and 2011.

OBJECTIVE: In this study, we explored the differences in the use of complementary and alternative medicine (CAM) based on data from 2007 and 2011 national surveys in Taiwan. RESEARCH DESIGN: Two cross-sectional, community-based epidemiological surveys were conducted in Taiwan. Participants 18 years and older were interviewed regarding their CAM use in the previous 12 months. Nationally representative random-household telephone surveys using a sampling method with a probability proportional to size were conducted in 2007 and 2011. The data were analysed to compare the results between surveys. RESULTS: We obtained a total of 1260 and 2266 valid responses in 2007 and 2011, respectively. The use of at least one or more CAM therapies during the previous year decreased from 48.9% in 2007 to 37.8% in 2011 (p < .001). In both surveys, the most common CAM therapies used were Chinese medicinal herbs followed by health supplement products and tuina. We observed the greatest relative increase in CAM use between 2007 and 2011 in health supplement products (12.8% vs. 16.0%) and massage (1.3% vs. 2.9%), whereas the largest relative decrease occurred for tuina (24.4-13.4%) and Chinese medicinal herbs (31.6-25.4%). CONCLUSION: Widespread CAM use reflects a more personal orientation towards maintaining health and selecting health care support services. Thus, a set of standards should be established for the safety and effectiveness of therapies, and consensus building is required to overcome the differences among practitioners from various backgrounds and traditions.

Eight forms of moving meditation for preventing falls in community-dwelling middle-aged and older adults.

BACKGROUND: In numerous countries worldwide, fall prevention among older adults is a major public health issue. For older adults, regular participation in moderate physical activity or exercise lowers the risks of falls. However, scant information is available regarding the prevention strategies that the most at-risk groups may undertake. The purpose of this study is to examine the effects of a fall prevention strategy, eight forms of moving meditation (EFMM), on community-dwelling middle-aged and older adults in Taiwan. METHODS: This was a quasi-experimental study; 84 participants were recruited from Taipei in Taiwan. For 12 weeks, participants in the experimental group performed 30-min EFMM 3 times per week. The measurements included a Functional Reach Test (FRT), Timed Get-up-and-Go Test (TGUG), and a One-Leg Stance Test (OLST) with eyes both opened and closed. All were conducted at the baseline and 12 weeks after intervention. RESULTS: The participants who performed EFMM showed a significant and positive performance on FRT, TGUG, and OLST with eyes opened and eyes closed compared to those in the control group. CONCLUSION: The results suggest that EFMM is an effective strategy for enhancing balance and functional mobility and preventing falls among community-dwelling middle-aged and older adults.

Estrogen receptor α (ESR1) over-expression mediated apoptosis in Hep3B cells by binding with SP1 proteins.

Previous studies have reported that estrogen receptors (ERs) are expressed in normal human liver, chronic hepatitis, and benign hepatic tumor tissues. However, decreased expression of ERs can be observed in hepatocellular carcinoma (HCC) and the role of ERs in HCC is not fully understood. Thus, the present study aimed to investigate the molecular mechanism induced by the overexpression of ERα (ERα (ESR1)) in Hep3B cells. We first detected the induction of apoptosis in ER-negative Hep3B cells using DNA fragmentation assay and flow cytometry. We found that ERα and ERα plus 17ß-estradiol treatment increased apoptosis in Hep3B cells. Additionally, western blotting showed increased expression of active caspase 3 and tumor necrosis factor α (TNFα (TNF)) in ERα-transfected cells. To further understand the importance of SP1-binding sites in the TNFα promoter, ERα-negative Hep3B cells were co-transfected with ERα and a wild-type TNFα plasmid or TNFα with deleted SP1 regions. Deletion of both distant and primal SP1 sites abolished the activity of ERα, and similar results were observed by blocking the expression of SP1 protein using mithramycin (MA). This result indicates that SP1 protein is essential for ERα-activated TNFα promoter activity. Co-immunoprecipitation assay further confirmed the binding interaction between ERα and SP1 in a ligand-dependent manner. In general, we demonstrate that the overexpression of ERα mediates apoptosis in ERα-negative Hep3B cells by the binding of ERα to SP1 protein. Additionally, this ERα-SP1 complex binds to the proximal and distal sites of the TNFα gene promoter and further induces the expression of active caspase 3 in a ligand-dependent manner.

Living with a spinal cord injury: a grounded theory approach.

AIMS: This paper reports a study which examined patients' experiences of suffering a spinal cord injury. BACKGROUND: Spinal cord injury has major bio-psycho-social and spiritual implications for patients. However, very limited research exists regarding the experience of patients with spinal cord injury in Taiwan or other countries worldwide. METHOD: Grounded theory was used to explore the psychosocial implications for patients of spinal cord injury. DATA COLLECTION AND ANALYSIS: Data were collected from October 2002 - March 2003 through tape-recorded, semi-structured interviews and complete observation of a group discussion focusing on patients with tetraplegia, in a rehabilitation hospital in Taiwan. The number of patients with spinal cord injury interviewed for this study was 15, involving 18 interviews. Data collection and analysis occurred concurrently. RESULTS: The findings resulted in the core category 'living with a spinal cord injury' and identify the experiences of suffering a spinal cord injury. Three stages were identified as the individual experience, including four categories: stage 1 A catastrophic life event, stage 2 Confront challenges and stage 3 Moving forward or Withdraw from society. CONCLUSIONS: This study shows that patients suffering a spinal cord injury have to find their own way and learn to live with their disability. Patients who did better in living with spinal cord injury point could move forward, otherwise, they may withdraw from society. RELEVANCE TO CLINICAL PRACTICE: Health professionals need to recognize patients' experiences, perceptions and needs, to provide better nursing care.