Exploring the factors related to adolescent health literacy, health-promoting lifestyle profile, and health status.

BACKGROUND: Health literacy has been concerned a key factor for determining the use of health information and promoting health. The study aimed to explore adolescent health literacy, health-promoting lifestyle profile, and health status and related factors. METHODS: A cross-sectional study design was used; 918 first year junior college students were recruited in Taiwan. The measurements were the Chinese Health Literacy Survey Questionnaire (HLS-C-Q), the Chinese Health-Promoting Lifestyle Profile (HPLP-S), and the Health Status Questionnaire. RESULTS: The mean score for health literacy was 36.15 (±6.21), with 30.17% of the participants having insufficient or problematic health literacy. Further, 19.9% of participants were obese and 11.2% experienced emotional instability. Health literacy and health-promoting lifestyle profile showed significant positive and negative correlations with perceived health status and depression, respectively (p < 0.05). An exercise frequency of ≥3 times/week was a predictor of health literacy, health-promoting lifestyle profile, and emotional stability. CONCLUSIONS: Adolescent health literacy, health-promoting lifestyle profile, and health status require careful consideration. In adolescents, developing regular exercise may increase health literacy, thereby developing healthy lifestyle profiles and ameliorating obesity and depression-related issues.

Exploring the relationships among professional quality of life, personal quality of life and resignation in the nursing profession.

AIM: To explore the relationships between nurses' quality of life, personal quality of life, intention to stay (ITS) and resign and factors related to resignation. DESIGN: Prospective cohort design. METHODS: The participants were recruited from three different levels of hospital in central Taiwan. The survey instruments were structured questionnaires including demographics, Professional Quality of Life Scale, Short Form Health Survey (SF-36) and the Scale of ITS. The survey data were collected from December 2017-August 2018. Data on nurses' resignation were collected from the hospital systems 3 months after the survey. Descriptive analysis and multiple logistic regression were used to analyse the factors predicting participants' resignation. RESULTS: Five hundred and fifty-three participants were recruited. Forty-nine out of 553 participants resigned (8.9%). Higher scores in compassion satisfaction were related to a greater ITS (p < .05). Employment units, burnout and ITS were the predictors for resignation (p < .05). We also found that compassion satisfaction moderated the relationship between ITS and resignation. CONCLUSION: Compassion satisfaction of nursing professionals strengthened the effect of ITS on resignation. Programmes to reinforce satisfaction and stress management could be strategies for increasing nurses' professional quality of life and retention in clinical practice. IMPACT: The study was the first to explore the relationships between professionals' quality of life, personal quality of life, ITS and resign. The study showed that compassion satisfaction increased the effect between ITS and resignation. Sense of achievement and satisfaction were the most important factors influencing nurses to stay in clinical practice. It is important to enhance nurse compassion satisfaction in nursing career, their job identity and gratification. The effective supportive environment and self-reflection may enhance compassion satisfaction, ameliorate nurse retention and improve the quality of care.

HDAC1 and HDAC2 Double Knockout Triggers Cell Apoptosis in Advanced Thyroid Cancer.

Anaplastic thyroid carcinoma (ATC) and squamous thyroid carcinoma (STC) are both rare and advanced thyroid malignancies with a very poor prognosis and an average median survival time of 5 months and less than 20% of affected patients are alive 1 year after diagnosis. The clinical management of both ATC and STC is very similar because they are not particularly responsive to radiotherapy and chemotherapy. This inspired us to explore a novel and effective clinically approved therapy for ATC treatment. Histone deacetylase inhibitor (HDACi) drugs are recently FDA-approved drug for malignancies, especially for blood cell cancers. Therefore, we investigated whether an HDACi drug acts as an effective anticancer drug for advanced thyroid cancers. Cell viability analysis of panobinostat treatment demonstrated a significant IC50 of 0.075 µM on SW579 STC cells. In addition, panobinostat exposure activated histone acetylation and triggered cell death mainly through cell cycle arrest and apoptosis-related protein activation. Using CRISPR/Cas9 to knock out HDAC1 and HDAC2 genes in SW579 cells, we observed that the histone acetylation level and cell cycle arrest were enhanced without any impact on cell growth. Furthermore, HDAC1 and HDAC2 double knockout (KO) cells showed dramatic cell apoptosis activation compared to HDAC1 and HDAC2 individual KO cells. This suggests expressional and biofunctional compensation between HDAC1 and HDAC2 on SW579 cells. This study provides strong evidence that panobinostat can potentially be used in the clinic of advanced thyroid cancer patients.

The effectiveness of a clinical reasoning teaching workshop on clinical teaching ability in nurse preceptors.

AIM: To explore the effectiveness of a clinical reasoning teaching workshop (CRTW) in preceptors' teaching ability, self-efficacy of clinical reasoning teaching. BACKGROUND: Preceptors' teaching skills are crucial for training novice nurses. How to enhance preceptors' teaching ability is a pertinent concern in clinical practice. METHODS: This study comprised two stages. At stage I, we administered a pre- to post-test single group with 33 participants to investigate the changes in preceptors' knowledge and self-efficacy in clinical reasoning teaching after clinical reasoning teaching workshop. At stage II, a quasi-experimental design was adopted to assess the effectiveness of the clinical reasoning teaching workshop by comparing the preceptors' teaching ability by novice nurses. There were 22 nurses' preceptors who underwent the clinical reasoning teaching workshop and 70 nurses with preceptors who did not undergo clinical reasoning teaching workshop and matched with preceptors' age and working experience. RESULTS: After clinical reasoning teaching workshop, preceptors' knowledge and self-efficacy of clinical reasoning teaching ware increased significantly. Novice nurses (study group) scored their preceptors' teaching ability significantly higher than nurses' (control group). CONCLUSION: The clinical reasoning teaching workshop can enhance preceptors' teaching ability and confidence, thereby improving their teaching ability. IMPLICATIONS FOR NURSING MANAGEMENT: A well-designed workshop with appropriated teaching method can allow preceptors to learn effectiveness. Clinical reasoning teaching workshop can be used in the training of preceptors.

The Application of Non-Invasive Apoptosis Detection Sensor (NIADS) on Histone Deacetylation Inhibitor (HDACi)-Induced Breast Cancer Cell Death.

Breast cancer is the most common malignancy in women and the second leading cause of cancer death in women. Triple negative breast cancer (TNBC) subtype is a breast cancer subset without ER (estrogen receptor), PR (progesterone receptor) and HER2 (human epidermal growth factor receptor 2) expression, limiting treatment options and presenting a poorer survival rate. Thus, we investigated whether histone deacetylation inhibitor (HDACi) could be used as potential anti-cancer therapy on breast cancer cells. In this study, we found TNBC and HER2-enriched breast cancers are extremely sensitive to Panobinostat, Belinostat of HDACi via experiments of cell viability assay, apoptotic marker identification and flow cytometry measurement. On the other hand, we developed a bioluminescence-based live cell non-invasive apoptosis detection sensor (NIADS) detection system to evaluate the quantitative and kinetic analyses of apoptotic cell death by HDAC treatment on breast cancer cells. In addition, the use of HDACi may also contribute a synergic anti-cancer effect with co-treatment of chemotherapeutic agent such as doxorubicin on TNBC cells (MDA-MB-231), but not in breast normal epithelia cells (MCF-10A), providing therapeutic benefits against breast tumor in the clinic.

A rapid and quantitative method to detect human circulating tumor cells in a preclinical animal model.

BACKGROUND: As cancer metastasis is the deadliest aspect of cancer, causing 90% of human deaths, evaluating the molecular mechanisms underlying this process is the major interest to those in the drug development field. Both therapeutic target identification and proof-of-concept experimentation in anti-cancer drug development require appropriate animal models, such as xenograft tumor transplantation in transgenic and knockout mice. In the progression of cancer metastasis, circulating tumor cells (CTCs) are the most critical factor in determining the prognosis of cancer patients. Several studies have demonstrated that measuring CTC-specific markers in a clinical setting (e.g., flow cytometry) can provide a current status of cancer development in patients. However, this useful technique has rarely been applied in the real-time monitoring of CTCs in preclinical animal models. METHODS: In this study, we designed a rapid and reliable detection method by combining a bioluminescent in vivo imaging system (IVIS) and quantitative polymerase chain reaction (QPCR)-based analysis to measure CTCs in animal blood. Using the IVIS Spectrum CT System with 3D-imaging on orthotropic-developed breast-tumor-bearing mice. RESULTS: In this manuscript, we established a quick and reliable method for measuring CTCs in a preclinical animal mode. The key to this technique is the use of specific human and mouse GUS primers on DNA/RNA of mouse peripheral blood under an absolute qPCR system. First, the high sensitivity of cancer cell detection on IVIS was presented by measuring the luciferase carried MDA-MB-231 cells from 5 to 5x1011 cell numbers with great correlation (R2 = 0.999). Next, the MDA-MB-231 cell numbers injected by tail vein and their IVIS radiance signals were strongly corrected with qPCR-calculated copy numbers (R2 > 0.99). Furthermore, by applying an orthotropic implantation animal model, we successfully distinguished xenograft tumor-bearing mice and control mice with a significant difference (p < 0.001), whereas IVIS Spectrum-CT 3D-visualization showed that blood of mice with lung metastasis contained more than twice the CTC numbers than ordinary tumor-bearing mice. We demonstrated a positive correlation between lung metastasis status and CTC numbers in peripheral mouse blood. CONCLUSION: Collectively, the techniques developed for this study resulted in the integration of CTC assessments into preclinical models both in vivo and ex vivo, which will facilitate translational targeted therapy in clinical practice.

The effectiveness of a participatory program on fall prevention in oncology patients.

Falls are known to be one of the most common in patient adverse events. A high incidence of falls was reported on patients with cancer. The purpose of this study was to explore the effect of a participatory program on patient's knowledge and self-efficacy of fall prevention and fall incidence in an oncology ward. In this quasi-experimental study, 68 participants were recruited at a medical centre in Taiwan. A 20-min fall prevention program was given to patients. A questionnaire was used to evaluate the effectiveness of program after on day 3 of intervention. The data of fall incidence rates were collected from hospital record. Fall incidences with and without the program were used to compare the effectiveness of intervention. The patients' knowledge and self-efficacy of fall prevention are better than after intervention. A statistically significant difference in fall incidence rate was observed with (0.0%) and without (19.3%) the program. Our findings suggest that the fact of the bedside is that the most risk for falling in hospital must be communicated to the hospitalized patients. Educating patients about fall prevention and activities associated with falling increases their awareness of the potential of falling and promoting patient safety.

[Learning Portfolio: A New Strategy in Health Education].

Health education is the teaching by healthcare professionals of healthcare-related knowledge and skills to students in order that these students learn to help patients self-manage their disease and maintain health. This article introduces a new strategy in health education known as the learning portfolio and presents the theoretical basis and function of the learning portfolio and the current application of this approach in academic and health education. The learning portfolio is a learner-centric approach that collects evidence related to an individual's learning process systematically. This approach helps educators understand learner needs and conditions, while allowing the learner to observe his / her learning process in a manner that promotes self-reflection, continual inspection, and behavioral modification throughout the learning process. The results enhance the motivation of learners and strengthen their care confidence in accomplishing learning tasks.

Choline in pregnant women: a systematic review and meta-analysis.

CONTEXT: Choline is a critical nutrient. Inadequate choline intake during pregnancy increases the risk of adverse maternal and offspring health. OBJECTIVE: A systematic review and meta-analysis were conducted to examine the current recommendations for choline intake by pregnant women, estimate the overall prevalence of pregnant women with adequate choline intake, and explore associations between maternal choline level and adverse pregnancy outcomes (APOs). METHODS: Choline recommendations for pregnant women were assessed from eight nutrient guidelines of the United States, United Kingdom, Canada, Australia, Asia, International Federation of Gynecology and Obstetrics, and World Health Organization. Data on the prevalence of pregnant women with adequate choline intake and the association between maternal choline level and APOs were collected from 5 databases up to May 2023. Meta-analyses with random effects and subgroup analyses were performed for the pooled estimate of prevalence and association. RESULTS: Five recent nutrition guidelines from the United States (United States Department of Agriculture), United States (Food and Drug Administration), Canada, Australia, and the International Federation of Gynecology and Obstetrics have emphasized the importance of adequate choline intake for pregnant women. Of 27 publications, 19 articles explored the prevalence and 8 articles explored the association. Meta-analysis of 12 prevalence studies revealed a concerning 11.24% (95% confidence interval, 6.34-17.26) prevalence of pregnant women with adequate choline intake recommendations. A meta-analysis of 6 studies indicated a significant association between high maternal choline levels and a reduced risk of developing APOs, with an odds ratio of 0.51 (95% confidence interval, 0.40-0.65). CONCLUSION: The existing guidelines highlight the importance of choline in supporting maternal health and fetal development during pregnancy. Furthermore, a high maternal choline level was likely to be associated with a lower risk of APOs. However, 88.76% of pregnant women do not achieve the optimal choline intake. Therefore, specific policies and actions may be necessary to improve choline intake in pregnant women's care and support the well-being of pregnant women. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CDR42023410561.

The attitudes of neonatal professionals towards end-of-life decision-making for dying infants in Taiwan.

The purposes of research were to describe the neonatal clinicians' personal views and attitudes on neonatal ethical decision-making, to identify factors that might affect these attitudes and to compare the attitudes between neonatal physicians and neonatal nurses in Taiwan. Research was a cross-sectional design and a questionnaire was used to reach different research purposes. A convenient sample was used to recruit 24 physicians and 80 neonatal nurses from four neonatal intensive care units in Taiwan. Most participants agreed with suggesting a do not resuscitate (DNR) order to parents for dying neonates (86.5%). However, the majority agreed with talking to patients about DNR orders is difficult (76.9%). Most participants agree that review by the clinical ethics committee is needed before the recommendation of 'DNR' to parents (94.23%) and nurses were significantly more likely than physicians to agree to this (p=0.043). During the end-of-life care, most clinicians accepted to continue current treatment without adding others (70%) and withholding of emergency treatments (75%); however, active euthanasia, the administration of drug to end-of-life, was not considered acceptable by both physicians and nurses in this research (96%). Based on our research results, providing continuing educational training and a formal consulting service in moral courage for neonatal clinicians are needed. In Taiwan, neonatal physicians and nurses hold similar values and attitudes towards end-of-life decisions for neonates. In order to improve the clinicians' communication skills with parents about DNR options and to change clinicians' attitudes for providing enough pain-relief medicine to dying neonates, providing continuing educational training and a formal consulting service in moral courage are needed.

To explore the neonatal nurses' beliefs and attitudes towards caring for dying neonates in Taiwan.

(1) To explore attitudes and beliefs of neonatal nurses toward nursing care for dying neonates; (2) to estimate the influence of neonatal nurses' personal and professional characteristics on their attitudes towards end-of life care for dying infants. A cross-sectional design was used. A questionnaire was used to collect data from 80 neonatal nurses. Research setting was four level III NICUs at four medical centers around the central region of Taiwan. Research participants were neonatal nurses who had worked for at least 1 year in one of level III NICUs and had been directly involved with the care of dying infants. Research participants were 80 neonatal nurses (response rate 100 %). Research findings identified eight barriers hindering neonatal palliative care practice. These barriers were insufficient communication due to the lack of an in-service educational program; the lack of available counseling help for neonatal clinicians; inability to express personal opinions, values and beliefs towards neonatal palliative care; insufficient staffing; the lack of unit policies/guidelines for supporting palliative care; the technological imperative; parental demands and personal beliefs about death and previous experience caring for dying infants. Further studies are needed to explore each barrier and to provide in-service neonatal palliative care educational programs that are needed to decrease these barriers.

The effectiveness of a health education intervention on self-care of traumatic wounds.

AIMS AND OBJECTIVES: To explore the effectiveness of wound care programme for emergency traumatic patient in Taiwan. BACKGROUND: Wound care is one of the most major issues for trauma patients at home. Wound infection has been alerted mostly on medical treatment. Little is known about how healthcare education impact patient care of traumatic wound after discharged from emergency department. DESIGN: A quasi-experimental design was used by using two groups post-test. METHODS: Random sampling was used to recruited participants, 89 participants in each group in emergency department at a medical centre in Taiwan. A 25-minute wound care programme was given to patients in the intervention group. A questionnaire was used to evaluate the effectiveness of the programme after 72 hours as patient followed up in out-patient department. The data of wound infection were collected from patient's medical record by followed 2 weeks after injured. RESULTS: After wound care programme, the knowledge, skills of wounds care, the satisfaction of health education in experimental group are better than the control group (p < 0·05). Wound infection rate in experimental group (9%) is lower than control group (20·2%), and statistically significant (p < 0·05). CONCLUSION: The wound care programme could increase the knowledge, skills of wound care of emergency patient and reduce the wound infection rate. RELEVANCE TO CLINICAL PRACTICE: Wound care requites technical knowledge; thus, practical demonstration of teaching and self-practice is more effectiveness for patients in learning their wound care. An appropriated health programme can improve the patients' wound care and care quality.

The Treatment Experience of Anorexia Nervosa in Adolescents from Healthcare Professionals' Perspective: A Qualitative Study.

Anorexia nervosa (AN) is a serious psychiatric illness with a high mortality rate and a poor outcome. AN in adolescents can be difficult to treat. The prognosis of patients with AN depends highly on how early specialized AN treatment starts. Therefore, the purpose of this study was to explore the experiences of healthcare professionals in treating adolescents with AN. A qualitative study approach was conducted. Through semi-structured interviews, 16 healthcare professionals, including 10 nurses, 3 dieticians and 3 physicians from the paediatric ward at a university-affiliated medical centre in central Taiwan, shared their experiences. Recorded interviews were transcribed and analyzed by content analysis. Five themes and ten subthemes were identified: 1. Building a trusting relationship first: (a) spending time to build trust with the client and (b) establishing a relationship with the client's parents; 2. The key to treatment success: (a) Clients' awareness of the illness and (b) parents' support for clients; 3. Consistency of team treatment goals: (a) maintaining stable vital signs and (b) achieving caloric intake; 4. Empowerment with knowledge about anorexia: (a) continuing education for healthcare professionals and (b) interdisciplinary collaborative care; and 5. Using different interaction strategies: (a) the hard approach and (b) the soft approach. In conclusion, the findings will provide important information for healthcare professionals to apply in monitoring the psychological and emotional states of adolescents with AN. The findings indicate that healthcare professionals should invite parents to participate in the treatment, support and guide them in their adolescent care, develop scales of family stress and support for AN in adolescents, develop interventions, and establish an early therapeutic alliance.

Effectiveness of Health Coaching in Smoking Cessation and Promoting the Use of Oral Smoking Cessation Drugs in Patients with Type 2 Diabetes: A Randomized Controlled Trial.

INTRODUCTION: This study looked into the effectiveness of a 6 month health coaching intervention in smoking cessation and smoking reduction for patients with type 2 diabetes. METHODS: The study was carried out via a two-armed, double-blind, randomized-controlled trial with 68 participants at a medical center in Taiwan. The intervention group received health coaching for 6 months, while the control group only received usual smoking cessation services; some patients in both groups participated in a pharmacotherapy plan. The health coaching intervention is a patient-centered approach to disease management which focuses on changing their actual behaviors. By targeting on achieving effective adult learning cycles, health coaching aims to help patients to establish new behavior patterns and habits. RESULTS: In this study, the intervention group had significantly more participants who reduced their level of cigarette smoking by at least 50% than the control group (p = 0.030). Moreover, patients participating in the pharmacotherapy plan in the coaching intervention group had a significant effect on smoking cessation (p = 0.011), but it was insignificant in the control group. CONCLUSIONS: Health coaching can be an effective approach to assisting patients with type 2 diabetes participating in a pharmacotherapy plan to reduce smoking and may help those who participate in pharmacotherapy plan to quit smoking more effectively. Further studies with higher-quality evidence on the effectiveness of health coaching in smoking cessation and the use of oral smoking cessation drugs in patients with type 2 diabetes are needed.

Nurse staffing, direct nursing care hours and patient mortality in Taiwan: the longitudinal analysis of hospital nurse staffing and patient outcome study.

BACKGROUND: Studies over the past decades have shown an association between nurse staffing and patient outcomes, however, most of these studies were conducted in the West. Accordingly, the purpose of this study aimed to provide an overview of the research/evidence base which has clarified the relationship between nurse staffing and patient mortality of acute care hospital wards under a universal health insurance system and attempted to provide explanations for some of the phenomena that are unique in Taiwan. METHODS: Through stratified random sampling, a total of 108 wards selected from 32 hospitals in Taiwan were collected over a consecutive seven month period. The mixed effect logit model was used to explore the relationship between nurse staffing and patient mortality. RESULTS: The medians of direct-nursing-care-hour, and nurse manpower were 2.52 h, and 378 persons, respectively. The OR for death between the long direct-nursing-care-hour (> median) group and the short direct-nursing-care-hour (≦median) group was 0.393 (95% CI = [0.245, 0.617]). The OR for death between the high (> median) and the low (≦median) nurse manpower groups was 0.589 (95% CI = [0.381, 0.911]). CONCLUSIONS: Findings from this study demonstrate an association of nurse staffing and patient mortality and are consistent with findings from similar studies. These findings have policy implications for strengthening the nursing profession, nurse staffing, and the hospital quality associated with nursing. Additional research is necessary to demonstrate adequate nurse staffing ratios of different wards in Taiwan.

Exploring Perceived Stress in Mothers with Singleton and Multiple Preterm Infants: A Cross-Sectional Study in Taiwan.

OBJECTIVE: The aim of this study was to explore mothers' perceived level of stress one month after hospital discharge following the birth of singleton and multiple preterm infants. DESIGN: A cross-sectional design was used to compare mother's perceived stress in two groups of postpartum mothers and the relationship of the theoretical antecedents and these variables. SETTING: A neonatal intensive care unit in a medical center in Taiwan. PARTICIPANTS: Mothers of 52 singletons and 38 multiple premature infants were recruited. One month after the infant was discharged, the participants completed a self-reported questionnaire that included demographic data about the mother and infant, the 21-item Social Support Scale, and the 15-item Perceived Stress Scale. This was returned by email or completed at the outpatient unit. ANALYSIS: Descriptive and inferential analysis. RESULTS: The mean social support scores were 76.6 and 76.5 (out of 105) for mothers with singleton and multiple birth infants, respectively. The most important supporter was the husband. The mean perceived stress scores of 25.8 and 31.0 for mothers with singleton and multiple birth infants, respectively, were significantly different (p = 0.02). Sleep deprivation and social support were predictive indicators of perceived stress in mothers with preterm infants. CONCLUSIONS: We suggest that the differences in stress and needs of mothers with singleton and multiple births should be recognized and addressed in clinics. The findings of this study serve as a reference for promoting better preterm infant care.

Gender Impact on Diabetes Distress Focus at Medical Communication Concerns, Life and Interpersonal Stress.

INTRODUCTION: along with the rapidly aging population in many countries around the world, the global prevalence of diabetes and suffering from diabetes-related depression have risen in middle-aged and elderly adults. However, given that psychological stress is deeply influenced by culture, gender inequality in these statistics is often exhibited and increases with age. The aim of this study was to explore the gender difference in diabetes distress among middle-aged and elderly diabetic patients. METHODS: 395 participants from four hospitals were recruited for a cross-sectional survey. The Taiwan Diabetes Distress Scale (TDDS) was used to measure diabetes distress. Linear regression was conducted to assess the gender difference in different types of diabetes distress. RESULTS: there was significant gender difference in each diabetes distress domain. In particular, men who had received diabetes education in the past six months seemed to be more concerned about diabetes complications and felt pressured to communicate with doctors. In addition, women seemed to be more affected by diabetes distress because of their marital status, especially for married women. CONCLUSIONS: diabetes distress seems to have significant gender differences; however, more longitudinal research is needed on the causal relationship between gender and diabetes distress.

A New Learning Approach to Improve Nurses' Knowledge of and Skills in Diabetes Care.

BACKGROUND: Patients' knowledge of how to care for their diabetes mellitus (DM) is critically influenced by health education, which is mostly provided by nurses. Therefore, effectively increasing nurses' knowledge of and skills in diabetes care is crucial. The aim of this study was to explore the effectiveness of the Diabetes Conversation Map™ Program (DCMP) in improving nurses' knowledge of DM care and skills in insulin injection. METHOD: A quasi-experimental design was adopted that used a pre-test and a posttest. A total of 18 nurses were included in the intervention group, while 19 nurses were in the control group receiving conventional teaching. A structured questionnaire regarding knowledge of and skills in DM care was administered before the program and then one month after. RESULTS: Knowledge of DM and skills in insulin injection improved significantly in the intervention group compared to the control group (p < .001 vs. p < .01). CONCLUSION: The DCMP can be used to increase nurses' knowledge of DM and their skills in caring for DM. It leads to more effective learning than conventional teaching. [J Contin Educ Nurs. 2022;53(2):90-96.].

Effectiveness of Digital Flipped Learning Evidence-Based Practice on Nurses' Knowledge, Attitude, and Practice: A Quasi-Experimental Trial.

Background: Evidence-based care has become critical in raising the quality of medical facilities. The implementation of evidence-based practice helps medical practitioners make better clinical decisions. Objective: The objective of this study was to investigate whether the innovative flipped teaching model could be as effective as the conventional teaching model in terms of knowledge, attitude, and practice and to confirm the continuous effect. Design: A quasi-experimental design using the flipped and conventional learning groups concurrently with repeat measurements was used. Setting: The setting was a 475-bed regional teaching hospital in Taiwan, from March to July 2020. Participants: The study included 114 licensed nurses who had worked longer than three months, with 57 participants each in two groups. Methods: The participants were assigned to two groups using a block randomization method. All participants completed questionnaires related to knowledge, attitude, and practice of EBP at four-time points: pre-test (T0) and immediately after intervention (T1), at month 1 (T2), and at month 3 (T3). Analysis of repeated generalized estimating equations was used. Results: The flipped and conventional learning groups had significant differences in knowledge, attitude, and practice at the T0 and T1 (p < 0.05). The flipped group was higher than the conventional group at T3 in the knowledge score (p = 0.001) and lower than the conventional group at T2 in the attitude score (p = 0.010). There were no significant differences between the two groups' practice scores at different time points. There were no significantly different score changes for knowledge, attitude, and practice (p > 0.05). The interaction term only at T3 vs. T0 in the knowledge score was slightly different (p = 0.049) in primary outcome. Conclusion: The intervention methods of both groups were effective. Flipped learning is more flexible and has more time for discussion, which nurses favor. Under the policy promoted in the hospital, EBP combined with the nursing advancement system was standardized, and conventional learning also improved the learning effect.

Exploring and Developing a New Culturally-Appropriate Diabetes Distress Scale in Taiwan.

Introduction: The aim of this study was to develop and validate a new diabetes distress scale suitable for Chinese and Taiwanese culture. Methods: This study collected the current diabetes distress measurement tools, re-organized current definitions about the domains of diabetes distress, and then developed a new tool. Three hundred and ninety-five participants from four hospitals in northern Taiwan were recruited by cluster randomized sampling for validity test. Results: We found the new diabetes distress scale had appropriate reliability and validity, including an acceptable model fit for the 12-item scale. Conclusions: This new diabetes distress scale might be more directly related to emotional distress issues blood glucose control, improve the clinical conspicuity of diabetes distress, and even benefit the overall care of diabetic patients in Taiwan. Further studies about the validity and reliability of this new tool in a nationwide setting are needed.