Comparing the effectiveness of board game-based and drill-based education programs in improving Taiwanese nurses' fire safety knowledge, attitudes, and behavior: A quasi-experimental study.

BACKGROUND: Fire education is currently dominated by drill-based programs, however only a limited number of participants may take part in fire drills. This gap could be addressed by the development of innovative board game-based educational programs. OBJECTIVE: This study sought to compare the effectiveness of board game-based and drill-based fire safety education programs in improving nurses' fire safety knowledge, attitudes, and behavior. METHODS: In this quasi-experimental study, 122 nurses were purposively sampled from a hospital in southern Taiwan. The participants were divided into two groups based on their willingness. Sixty-two nurses in the game-based group took part in an hour-long educational board game for fire safety; and 60 in the drill-based group took part in an hour-long fire drill organized by the hospital. The participants' pre- (T0) and post-intervention (T1) questionnaire scores on fire safety knowledge, attitudes, and behavior were recorded. The statistical methods included descriptive statistics and t-tests. RESULTS: After the interventions, both groups had improved safety knowledge, attitudes, and behavior. However, from T0 to T1, only fire safety knowledge was significantly higher in the game-based group than in the drill-based group, and there were no significant differences in fire safety attitudes and behavior between the two groups. CONCLUSIONS: A board game-based fire education program is similar to a tabletop exercise, and drill-based programs more accurately reflect actual circumstances. Both methods can be applied based on the educational objectives and actual educational settings. The results of this study may function as a reference for designing clinical, educational, and academic interventions for fire safety in healthcare settings.

Association between Self-Reported Survey Measures and Biomarkers of Second-Hand Tobacco Smoke Exposure in Non-Smoking Pregnant Women.

Second-hand tobacco smoke (SHS) causes adverse health outcomes in adults. Further studies are needed to evaluate psychosocial SHS exposure measures in comparison to SHS exposure biomarkers, particularly in pregnant women. This study aimed to compare self-reported SHS exposure to urinary cotinine levels in pregnant women. A cross-sectional correlation design was conducted using a convenience sample of 70 non-smoking pregnant women. Measures included self-reported questionnaires and laboratory confirmation of cotinine levels in the urinary samples. Multiple regression analysis was used to assess the correlation after controlling for potential confounding variables. The average level of urinary cotinine among non-smoking pregnant women was 6.77 ng/mL. Medium-strength correlations were found among psychosocial SHS exposure measures and urine cotinine levels. Questions regarding 'instances of smoking in front of the individual' and 'subjective perceived frequency of SHS exposure in past 7 days' are feasible items for pregnant women in clinics (particularly the first question). Hence, we suggest that these simple questions should be used to assist pregnant women in reducing the harm associated with SHS exposure.

Efficacy of medium-chain triglyceride oil massage on growth in preterm infants: a randomized controlled trial: A CONSORT-compliant article.

BACKGROUND: Medium-chain triglyceride (MCT) oil consists of 8-12 carbons with higher absorption and provides better calories than long-chain triglyceride oil. This study was to explore the effect of MCT oil massage on growth in preterm infants. METHODS: A prospective, single-blind, randomized (two treatments and one control) study was conducted. Preterm infants weighing between 1500 and 2000 g were recruited and randomly assigned to three groups: the MCT oil massage, massage alone and no massage groups. The standardized massage intervention consisted of two 5-min phases, including tactile and kinesthetic stimulation, which were given three times a day for 7 consecutive days. Premature infants in the oil massage group received massage with 10 mL/kg/day of MCT oil divided equally into three applications. Weight, length and head circumference were measured in the three groups at birth and on study days 1 to 7. RESULTS: Forty-eight neonates were evaluated with 16 in each of three groups. The linear mixed effect model was adjusted for other factors, and results showed that weight gain on the 4th day in the oil massage group was greater than that in the no massage group (P < .05). From the 5th to 7th day, weight gain in the oil massage group was greater than that in the other two groups (P < .05). Regarding head circumference and height, this study found that the MCT oil massage group did not have better results than the other two groups. No adverse events were noted in the massage groups. CONCLUSION: The results indicate that preterm infant daily massage with MCT oil is an effective intervention for weight gain that should be recognized as part of low-birth-weight infant developmental care. TRIAL REGISTRATION: clinicaltrials.gov identifier NCT04281563, Registered on 24 February 2020.

Effectiveness of green tea mouthwash for improving oral health status in oral cancer patients: A single-blind randomized controlled trial.

BACKGROUND: Painful oral mucositis or trismus, caused by cancer therapy, reduces patients' willingness to maintain basic oral hygiene and eventually results in a poor oral health status. Using mouth rinses and cleaning the tongue are popular ways to improve the oral health status. OBJECTIVES: To evaluate the effectiveness of green tea mouthwash for improving the oral health status in oral cancer patients undergoing cancer treatment. DESIGN: This was a prospective, single-blind, randomized, controlled trial. SETTINGS: Patients were recruited from a major regional teaching hospital that provides specialist cancer care services in Chia-Yi, Taiwan, from July 2018 to June 2020. PARTICIPANTS: A total of 63 patients met the following criteria: > 20 years old; newly diagnosed with oral cancer by a physician; treated with oral surgery within one month prior; and completion of follow-up, with or without chemotherapy or radiation therapy. The exclusion criteria were mental illness; an acute and severe illness; complete edentulism; and inability to open the mouth more than 1 cm. METHODS: Patients were randomly assigned to 2 groups: the mouthwash with green tea (intervention) group or the tap water (control) group. After each teeth-brushing procedure, those in the intervention group rinsed the mouth with 100 ml of a green tea solution for 60 seconds, and those in the control group rinsed the mouth with 100 ml of tap water for 60 seconds. The primary outcome was the oral health status, which was evaluated according to the Oral Assessment Guide and measured at baseline and at every monthly outpatient follow-up until six months by the same nurse. RESULTS: There were 31 subjects in the intervention group and 30 subjects in the control group in the final analysis. The results of t-test showed that compared with baseline, the improvement in the oral health status in the intervention group was significantly better than that in the control group at 4 months after the intervention began. At 4 to 6 months after the intervention began, the oral health status score in the intervention group significantly decreased, by 1.71, 2.97 and 2.93 points, respectively, compared with that in the control group. CONCLUSIONS: The oral health status can be improved and maintained for a long time with the continuous use of green tea mouthwash. Green tea mouthwash is a simple, natural, effective and safe intervention that should be recognized as a nonpharmacological treatment option for protecting the oral mucosa. TRIAL REGISTRATION: clinicaltrials.gov identifier NCT04615780.

Influence of Environmental Tobacco Smoke and Air Pollution on Fetal Growth: A Prospective Study.

Exposure to air pollution during pregnancy leads to adverse pregnancy outcomes. Few studies have evaluated the influences of air quality, including environmental tobacco smoke (ETS) and particulate matter (PM), on fetal development, which this study examined. This longitudinal correlation study used multiple linear regression data analysis of PM2.5/PM10, self-reported ETS exposure, urinary cotinine level, maternal characteristics, and birth parameters (gestational week, body weight, body length, head, and chest circumferences) with the effect of air quality on fetal growth. The study included 74 pregnant women (mean age 31.9 ± 4.2 years, body mass index 23.6 ± 3.8 kg/m2, average gestational duration 38.5 ± 0.8 weeks). ETS exposure decreased birth length by ≥1 cm, and potentially is an independent risk factor for fetal growth restriction, and pregnant women should avoid indoor and outdoor ETS. However, neither PM2.5/PM10 nor ETS was associated with low birth weight or small for gestational age. This study adds to the evidence base that ETS exposure of nonsmoking pregnant women affects the fetal birth length. Family members should refrain from smoking near expectant mothers, although smoking in the vicinity of their residential surroundings potentially exposes mothers and their fetuses to ETS. Public pollution and childbirth education classes should include details of indoor ETS.

[Effects of the Otago Exercise Program on Lower Extremity Strength in Residents of a Long-Term Care Institution].

BACKGROUND: Falls are a very common problem in older adults. Improving lower extremity muscle strength is the primary objective of fall-prevention programs. PURPOSE: The aim of the study was to evaluate the effects of the Otago Exercise Program (OEP) on the lower extremity muscle strength of residents living in a long-term care institution. METHODS: In this repeated measurement study, participants were allocated into either the experimental group (EG) or the control group (CG). All of the participants maintained normal activities, and EG participants were additionally enrolled in a 6-month group OEP led by a physiotherapist. The OEP, comprising warm-up exercises, strength training, balance training, and walking training, requires about 45 minutes per session, 3 times a week. A total of 78 OEP sessions were performed during the 6-month intervention. A 30-Second Sit-to-Stand Test and lower extremity muscle strength measurements were performed at baseline, after 3 months, and after 6 months. RESULTS: The twenty participants in this study had a mean age over 80 years and were recruited from a long-term care institution in southern Taiwan. There were ten participants in each group, and the mean total OEP session attendance for EG participants was 92.8%. Although the EG had lower extremity muscle strength than the CG at baseline, the EG had achieved significant improvements in the muscle strength values for the knee extensor, knee flexor, ankle plantar flexors, and dorsiflexors after 6 months (group x time interaction, p < .05). In addition, the results of the 30-second sit-to-stand test for the EG were poor at baseline and significantly better after 6 months, while the results for the CG worsened between baseline and 6 months. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results of this study support that participating in a group-based OEP three times per week over 6 months effectively improves lower extremity muscle strength in older adults. Therefore, OEP should be incorporated into fall-prevention programs organized in long-term care institutions.

Hearing loss is a risk factor of disability in older adults: A systematic review.

BACKGROUND AND OBJECTIVES: Hearing loss (HL) is a public health problem affecting older adults. HL is not only a health condition but also a complex, dynamic phenomenon related to disability. Previous studies identified associations between HL and undesirable outcomes; however, their correlation remains inconclusive. Hearing loss can have profound impact on daily life in the elderly, and an understanding of how HL contributes to disability is needed. A systematic review was conducted to comprehensively examine current evidence and determine the association between HL and disability regarding impairment, activity and participation in older adults. RESEARCH DESIGN AND METHODS: The Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines were applied in this systematic review. Quality assessment was conducted using the Newcastle-Ottawa Scale for longitudinal studies and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for cross-sectional studies. RESULTS: In this systematic review of 20 studies, HL was associated with mobility limitation, activity limitation and participation restriction. The severity of HL was associated with impaired mobility and physical performance, but the association was only found in persons with severe/major HL. HL was also associated with activities of daily living (ADL) dependency, however these findings were mainly based on cross-sectional studies. DISCUSSION AND IMPLICATIONS: HL is related to disability by impairment, activity limitations or participation restrictions in older adults. Future studies should include participation restrictions as a mediation factor to better understand this association. Consistent and accurate hearing measurements and hearing loss criteria are also required to determine the impact of HL on disability.

Generalist versus specialist nurses' knowledge, attitudes, and behavioral intentions toward promoting pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: A cross-sectional correlational study.

Pulmonary rehabilitation (PR) is an effective strategy to manage chronic obstructive pulmonary disease (COPD), though its utilization rate is low. One reason for this low utilization rate is that nurses do not provide COPD patients with enough health education to increase the patient's motivation for PR participation. This study examined knowledge, attitudes, and behavioral intention toward PR promotion. The study also investigated the correlates of behavioral intentions to promote PR among pulmonary nurses.A cross-sectional correlational design was used. Overall, 284 nurses (all women) from chest medicine and general internal medicine wards in 3 hospitals within Midwest Taiwan were recruited. Data were collected by anonymous, self-administered questionnaires. We aimed to understand if there would be differences in the Chest Medicine and Generalist nurses on these outcomes, given the specialty versus generalist nature of their practice. Results were analyzed using multiple linear regressions.Although the 2 groups of nurses (ie, Chest Medicine, General Medicine) showed no differences in PR knowledge, attitudes, or behavioral intentions, they lacked sufficient PR knowledge and skills. The accuracy rate of PR knowledge was approximately 12% and self-evaluated PR skills were less than 50%. Self-efficacy in promoting PR was above average (ie, 57%-60%), and the strength of attitudes and behavioral intentions was over 70%. A multiple linear regression revealed that behavioral intentions of nurses working in the chest medicine ward were influenced by behavioral attitudes, and also PR skills and self-efficacy (explanatory power 33.3%).Attitudes, skills, and self-efficacy heavily affected pulmonary nurses' ability to promote PR; however, PR knowledge and skills remain low. Therefore, future implementation of practical PR training courses is needed to strengthen nurses' behavioral intentions toward PR promotion.Improved pulmonary rehabilitation-related skill, attitudes, clinical experience of PR programs, and/or practical PR training are needed among both generalist and specialist nurses. Education courses and clinical practice training should be increased in the future to promote pulmonary rehabilitation of COPD patients.

Cancer Impact, Complementary/Alternative Medicine Beliefs, and Quality of Life in Cancer Patients.

OBJECTIVES: The purpose of this study was to explore the relationships among cancer impact, belief in complementary and alternative medicine (CAM), CAM use, and quality of life (QOL). DESIGN: The study used a cross-sectional, descriptive correlational design with convenience sampling. A total of 122 cancer patients participated. Data were collected at a medical center in Chunghua, Taiwan. The questionnaires included the Chinese version of the Cancer Problem in Living Scale (CPILS), Complementary and Alternative Medicine Belief Inventory (CAMBI), Complementary and Alternative Medicine scale, and Chinese versions of QOL scales, including the Functional Assessment of Cancer Therapy-General (FACT-G). RESULTS: The mean age was 56.5 years, and most participants were male (n = 69, 56.6%), had completed high school or above (n = 56, 45.9%), and were married (n = 109, 89.3%). The most common type of cancer was oral (n = 17, 13.9%), followed by esophageal (n = 15, 12.3%) and colorectal (n = 13, 10.7%). Cancer patients, on average, use one or two types of CAM. The impact of cancer is significantly related to age (F = 7.12, p < 0.05), and income is related to QOL (F = 3.61, p < 0.05). Pearson correlations showed that the use of CAM was positively associated with belief in CAM (CAMBI) (r = 0.26, p = 0.01), and the impact of cancer was highly negatively associated with QOL (r = -0.71, p = 0.001). The predictors of QOL were the impact of cancer and use of CAM, and the impact of cancer accounted for 51% of the variance in QOL. CONCLUSION: This study supports research on the impact of cancer, belief in CAM, and use of CAM as related to QOL in cancer patients. These results can be used to provide options to clinicians and cancer patients.

[The Impact of Sunlight Exposure on the Health of Older Adults].

Appropriate exposure to sunlight not only contributes to the production of vitamin D, which has been associated with enhanced bone health, mood, and cognitive functions, but also regulates the secretion of melatonin, which has been associated with the mediation of circadian rhythms, improved sleep quality, and optimized physical and social activity in the elderly. However, damage to the skin, eyes, and immune system has also been widely associated with long-term exposure to sunlight. Several studies have shown that many elderly, especially those that reside in institutions, do not receive sufficient sunlight exposure. Institutionalized elderly tend to participate in indoor activities and spend significant periods of time alone and asleep in front of the television. Furthermore, factors such as poor health, environmental design, indoor/outdoor preference, and activity design may impact the access of institutionalized elderly to sunlight more than their non-institutionalized peers. Therefore, we suggest that in addition to obtaining sufficient levels of vitamin D from their diet and from supplements, the elderly should perform outdoor activities for 20-30 minutes a day for five days each week. Furthermore, we suggest that the environment of the care facility should be made be more accessible and that some activities should be held outdoors.

Course and predictors of depressive symptoms among family caregivers of terminally ill cancer patients until their death.

OBJECTIVE: Few studies have investigated the impact of providing end-of-life care on family caregivers' depressive symptoms over time, especially until the patient's death. The purpose of this study was to identify the course and predictors of depressive symptoms in caregivers of terminally ill cancer patients until they died. METHODS: For this prospective, longitudinal study of 193 caregivers, data were collected using the Center for Epidemiological Studies Depression Scale, Symptom Distress Scale, Medical Outcomes Study Social Support Survey, and Caregiver Reaction Assessment scale. The course and predictors of depressive symptoms were analyzed using the generalized estimating equation model. RESULTS: Caregivers' depressive symptoms increased as the patient's death approached. Spousal or adult child family caregivers suffered more depressive symptoms if they self-identified as lacking social support and confidence in offering substantial assistance for younger terminally ill cancer patients with higher levels of symptom distress. Caregivers were susceptible to higher levels of depressive symptoms if they were heavily burdened by caregiving, that is, experienced more disruptions in schedules, greater health deterioration, stronger sense of family abandonment, and lower caregiver esteem. CONCLUSIONS: Psychological well-being of caregivers of terminally ill cancer patients deteriorated in response to progression of the patient's disease and impending death. Effective interventions should be developed and provided to high-risk caregivers as identified in our study. Increasing caregivers' strength of perceived social support, facilitating their confidence in caregiving, and alleviating their subjective burden may lessen the development of depressive symptoms in caregivers of terminally ill cancer patients throughout the dying process.

Surviving a life-threatening crisis: Taiwan's nurse leaders' reflections and difficulties fighting the SARS epidemic.

AIM: This study explored Taiwan's nurse leaders' reflections and experiences of the difficulties they encountered and survival strategies they employed fighting the severe acute respiratory syndrome epidemic and the background context framing these phenomena. BACKGROUND: On several continents in 2002-2003, the highly infectious severe acute respiratory syndrome overwhelmed health care systems and health professionals who had to provide care in situations involving high personal risk and stress, some becoming infected and dying. Nurse leaders in Taiwan had to develop new strategies and support systems for nursing care. DESIGN: A two-step within-method qualitative triangulation research design. METHODS: Focus group in-depth interviews held with 70 nurse leaders from four Northern Taiwan hospitals involved in the severe acute respiratory syndrome epidemic. Participants then completed an open ended questionnaire. Content analysis was undertaken with data and stages and themes generated. Data were then analysed using Hobfall's concepts of conservation of resources to further discuss participants' reactions and actions in the severe acute respiratory syndrome crisis. RESULTS: Participants worked under incredible stress to lead the profession through a period of crisis. Five stages arose in the participants' involvement against severe acute respiratory syndrome over 12 weeks: facing shock and chaos; searching for reliable sources to clarify myths; developing and adjusting nursing care; supporting nurses and their clients; and rewarding nurses. CONCLUSION: Nurse leaders become important executors of intervention in this health disaster, requiring emotional intelligence to manage their internal conflicts and interpersonal relationships effectively. They developed sociopolitical and analytical abilities and crucial requirements for planning and implementing strategies in areas where none previously existed. Building support systems was an important resource for managing conflicts between familial and professional roles. Relevance to clinical practice. Findings will assist nurse leaders to prepare themselves and the profession to better deal with disaster management in similar infectious outbreaks in the future.

Dying and caring on the edge: Taiwan's surviving nurses' reflections on taking care of patients with severe acute respiratory syndrome.

In 2003, Taiwan's nurses were terrified by severe acute respiratory syndrome (SARS), and four of them sacrificed their life in the course of their work with SARS patients. This study attempted to identify the stage-specific difficulties encountered by Taiwan's surviving frontline nurses during the anti-SARS process. A two-step within-method qualitative triangulation research design was used to obtain the in-depth and confidential thoughts of 200 participants during the precaring, tangible caring, and postcaring stages. Six major types of stage-specific difficulties with and threats to the quality of care of SARS patients were identified according to each specific stage of the caring process. Four themes were further explored; these are discussed to provide a background context in obtaining better understanding of the multifaceted needs of nurses during this crisis. Consequently, a conceptual framework was developed to depict this complex phenomenon.

Factors associated with depressive distress among Taiwanese family caregivers of cancer patients at the end of life.

Family caregivers in East Asian countries are known to have a strong sense of filial piety and a traditional caregiving ideology. They are generally presumed to be protected from psychological distress arising from caregiving. However, there is scant information regarding the impact of caregiving on Chinese/Taiwanese families. The purpose of this study was aimed at identifying those family caregivers of Taiwanese terminally ill cancer patients who are at risk of experiencing depressive distress from the following three categories of predisposing factors: 1) contextual factors; 2) stressors; and 3) appraisal of the caregiving situation. Of the 170 Taiwanese family caregivers of terminally ill cancer patients that participated in this survey, 129 (75.9%) were at an extraordinarily high risk of being distressed because of depressive symptoms (CES-D > 15). Results indicated that family caregivers were vulnerable to clinically depressive distress if they were the patient's spouse (adjusted odds ratio (AOR): 2.89; 95% confidence interval (CI): 1.19-7.01), or evaluated caregiving as imposing a greater negative impact on their own health (AOR: 1.27; 95% CI: 1.09-1.47). In contrast, if family caregivers felt very confident in their knowledge of how to take care of the patient at home (AOR: 0.35; 95% CI: 0.15-0.81), or were sufficiently aware of the patient's thoughts and feelings about disease experiences and symptoms (AOR: 0.47; 95% CI: 0.25-0.88), they were less likely to suffer from depressive distress. These finding have significant clinical implications when they are put into the context of Confucian cultures which place great emphasis on filial piety and familism. Interventions and policy should be developed to target spousal caregivers to enhance their confidence in caregiving and understanding of the patient's disease experiences. This will reduce the negative caregiving impact on the caregiver's health, which in turn may prevent the development of depressive distress among family caregivers.

The impact of the 9-21 earthquake experiences of Taiwanese nurses as rescuers.

The powerful earthquake of September 21, 1999 wrought incalculable havoc on lives and properties in Taiwan. Although the scars of the earthquake can never be erased, the calamity can lead to a more full understanding of the experiences, perceptions and reflections of nurses involved directly in post-rescue situations. The purpose of this study was to compare the impacts of rescue experiences on Taiwanese female and male nurses who worked as rescuers following the earthquake of 21 September. A purposive sample of 46 nurses (40 women, 6 men) (mean age 26) who worked in a renowned hospital with a reputation for high quality of emergency care in Northern Taiwan was obtained. Data were collected by in-depth semi-structured interviews and analyzed by a unique mode of between-method triangulation. The majority of the subjects (38 female, 6 male) reported various impacts from their rescue experiences. They are: (a) recognition of the impermanence of life and wishing to lead a more significant life (32 female, 3 male); (b) more caring relationships with others and for their homeland (19 female, 5 male); (c) a clearer concept of disaster care (19 female, 4 male); (d) a better appreciation of the value of nursing and their own self-worth (11 female, 3 male); (e) enhanced knowledge of the survivors' needs (3 female); and (f) enhanced ability to identify the factors hindering rescue operations (1 female, 2 male). However, one female nurse complained of having been bothered by feelings of fear of earthquake disasters resulting from her rescue experience. Rescue experiences help to strengthen most Taiwanese nurses' professional competency, reinforce their commitment to nursing, and lead them to have positive life goals. The relative weight of the impacts for male and female nurses were somewhat different. The vulnerability of nurses, which was manifested in the post-rescue stage, requires attention and long-term follow-up. A comprehensive and organized pre-rescue training program which recognizes the need to care for both acute and chronic post-disaster conditions, along with spiritual care for the survivors, as well as a "disaster reduction" course for health professionals are suggested.

Taiwanese nurses' most unforgettable rescue experiences in the disaster area after the 9-21 earthquake in Taiwan.

The purpose of this study was to reveal the most unforgettable rescue experiences of nurses at the central site of the 9-21 Taiwan earthquake during the crucial early recovery stage-the first 72h. A purposive sample of 46 nurses was obtained (40 women and 6 men, with an average age of 28). Data were collected using semi-structured interviews and analyzed by content analysis. The negative aspects of most unforgettable experiences reported by 87% of the subjects were primarily: (a) the prevalence of psychoneurotic syndromes (50%); (b) the severe destruction of geographic treasures (43%); (c) the buried-alive bodies of whole families or village populations (33%); (d) inadequate care for the children and teenagers that were left homeless (22%); (e) deterioration of the condition of patients with chronic health problems (15%); and (f) manifestation of the greedy or selfish nature of human beings (13%). Still 76% of the subjects reported the following positive aspects of their rescue experiences: (a) feeling rewarded from helping others (43%); (b) being deeply touched by residents' mutual support (33%); and (c) the good attitude and tangible help given by other health professionals (15%). This study highlights a need for long-term follow-up and attention of these nurse rescuers in the post-rescue stage. The implementation of a well designed "disaster reduction" course for the health professionals was also encouraged.