Activities of daily living trajectories among institutionalised older adults: A prospective study.

AIMS AND OBJECTIVES: To examine activities of daily living trajectory groups among older residents in Taiwan, and to determine the relative risks of demographic characteristics and health status in explaining the trajectory group of activities of daily living. BACKGROUND: Activity of daily living is a crucial indicator of health status for institutionalised older adults. activities of daily living is a dynamic process and has differences in trajectory groups. DESIGN: This study was a 3-year longitudinal analysis of long-term care facility residents in Taiwan. METHODS: A total of 364 older residents completed the entire research process. We used group-based trajectory modelling and multinomial logistic models for statistical analysis. RESULTS: The result of this study revealed that three activities of daily living trajectory groups among older residents exhibited high dependency with gradually declining function (Group 1, 22.53%), low dependency with gradually declining function (Group 2, 43.13%) and persistent independent function (Group 3, 34.34%). Compared with Group 3, Group 1 was related to the following potential risk factors: older age, female, nonmainland China born and a married status. After considering resident health status in the analysis, three significant factors emerged for Group 1: the number of chronic diseases (odds ratio = 2.45), depressive symptoms (odds ratio = 1.71) and cognitive status (odds ratio = 83.11). Compared with Group 3, Group 2 was related to older age. After adding resident health status to the analysis, two significant factors of Group 2 emerged: the number of chronic diseases (odds ratio = 1.68) and depressive symptoms (odds ratio = 1.74). CONCLUSION: The findings of this study indicated that health factors, including the number of chronic diseases, cognitive status and depressive symptoms, were more likely to contribute to the development of a decline pattern of activities of daily living. RELEVANCE TO CLINICAL PRACTICE: Appropriate exercise programmes and physical activities, according to residents' personal characteristics and activities of daily living status, is crucial for improving physical functioning, alleviating depression and cognitive defects in institutionalised older adults.

[The Computer Competency of Nurses in Long-Term Care Facilities and Related Factors].

BACKGROUND: It is important for nurses who work in long-term care facilities (LTCFs) to have an adequate level of computer competency due to the multidisciplinary and comprehensive nature of long-term care services. Thus, it is important to understand the current computer competency of nursing staff in LTCFs and the factors that relate to this competency. PURPOSE: To explore the computer competency of LTCF nurses and to identify the demographic and computer-usage characteristics that relate significantly to computer competency in the LTCF environment. METHODS: A cross-sectional research design and a self-report questionnaire were used to collect data from 185 nurses working at LTCFs in Taipei. RESULTS: The results found that the variables of the frequency of computer use (ß = .33), age (ß = -.30), type(s) of the software used at work (ß = .28), hours of on-the-job training (ß = -.14), prior work experience at other LTCFs (ß = -.14), and Internet use at home (ß = .12) explain 58.0% of the variance in the computer competency of participants. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results of the present study suggest that the following measures may help increase the computer competency of LTCF nurses. (1) Nurses should be encouraged to use electronic nursing records rather than handwritten records. (2) On-the-job training programs should emphasize participant competency in the Excel software package in order to maintain efficient and good-quality of LTC services after implementing of the LTC insurance policy.

Development of a performance scale for nurses in community-based long-term care facilities in Taiwan.

BACKGROUND: There is a lack of reliable and valid performance assessments for nurses in long-term care facilities in Taiwan. PURPOSE: This study develops a performance assessment instrument for nurses working in long-term care facilities. METHODS: A participatory action research approach was used to validate the performance assessment instrument. After 19 experts evaluated the results from the focus groups, field testing of the instrument was carried out among 190 nurses working in long-term care facilities. Factor analysis was employed to establish the construct validity of the scale. RESULTS: The final scale consisted of 11 categories with 69 items. The overall scale reliability had a Cronbach's alpha of .98, and the values of the Cronbach's alphas for the various categories ranged from .84 to .97. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The performance scale evaluated in this article has acceptable reliability, content validity, and construct validity. This scale can be used as an objective tool for measuring the performance of nurses working in long-term care settings.

Medication use in community-residing older adults in Taiwan: a comparison between conventional and complementary and alternative medications.

Older adults are at risk of problems of medication use including underuse, overuse, and misuse. The purposes of this study were to investigate the prevalence of the use of conventional and complementary and alternative medications (CAM) in older adults and to explore which factors related to their medication use. For this descriptive correlational study, 1,427 citizens who were 65 years old or older from two towns in Yilan County, Taiwan were interviewed by ten trained public health nurses between June and September, 2013. Instruments in this study were physical functional capacity, depressive symptoms, and medication use. Pearson product-moment correlation analysis and the Chi-square test were used to detect relationships among research variables. Of the 1,427 participants, 75.4 % used at least one type of conventional medication, and the average number of medications used was 2.9 (SD = 2.1). Polypharmacy (the use of five or more medications) was identified in 20.1 % of participants. Significant factors related to conventional medications use were older age (χ(2) = 41.7***), female (χ(2) = 7.6**), bad memory (χ(2) = 11.2**), defect cognition status (χ(2) = 7.8**), lost the interest to do anything depressive symptoms (χ(2) = 7.2**), and independent in their daily activities (χ(2) = 41.3***). We found that sociodemographic characteristics and factors pertaining to health status determine the difference between the use of conventional medications and CAM by rural older adults. Our study results suggested that health professionals in Taiwan must be educated and trained in how to integrate CAM into current conventional treatment.

The effects of depressive symptoms on quality of life among institutionalized older adults in Taiwan.

PURPOSE: To explore the effect of physical health status and depressive symptoms on quality of life (QOL) and to examine whether depressive symptoms mediate the effect of physical health status on the physical and mental components of QOL among institutionalized older adults. DESIGN AND METHODS: A cross-sectional study was used to assess 306 residents from 73 long-term care facilities in Taipei, Taiwan. FINDINGS: We found that depressive symptoms mediated the relationship between the number of chronic diseases and activities of daily living and physical components of QOL (z = -2.41, p = .016; z = 3.33, p < .001) as well as between the number of chronic diseases and mental components of QOL (z = -2.45, p = .014). PRACTICE IMPLICATIONS: Our findings indicate that alleviating depressive symptoms can improve the QOL of older adults in long-term care facilities.

The mediating effects of job satisfaction on turnover intention for long-term care nurses in Taiwan.

AIM: This study explores the mediating effects of job satisfaction on work stress and turnover intention among long-term care nurses in Taiwan. BACKGROUND: Healthcare institutions face a nursing shortage, and it is important to examine the factors that influence turnover intention among nurses. Excessive levels of work stress may lead to employee dissatisfaction and a significant inverse relationship between work stress and job satisfaction, including subsequent effects on turnover among nurses. However, little is known about the mediating role of job satisfaction on work stress and turnover intention among long-term care nurses. METHODS: A cross-sectional survey and a correlation design were used. Multistage linear regression was used to test the mediation model. RESULTS: This study showed that job satisfaction significantly mediated the relationship between work stress and turnover intention. Thirty-eight percent of the variance in turnover intention explained by work stress was accounted for by the mediation pathway. CONCLUSION: The results of this study showed that higher job satisfaction significantly decreased work stress and turnover intention among long-term care nurses. IMPLICATIONS FOR NURSING MANAGEMENT: This study provides nursing administrators with a resource to build a supportive environment to increase nurses' job satisfaction and to decrease their stress and turnover.

The mediating effects of structural empowerment on job satisfaction for nurses in long-term care facilities.

AIMS: The purpose of this study was to explore the mediating effects of work empowerment on job satisfaction for nurses in long-term care facilities in Taiwan. BACKGROUND: Previous research has noted that job satisfaction is an important factor that reflects upon the work environment and the characteristics of the job itself. It is important to link work empowerment to job satisfaction among nurses. METHODS: This research study used a cross-sectional design. A total of 65 nurses participated in the study. Regression models and Sobel tests were fitted to evaluate the relationship between work empowerment and job satisfaction. RESULTS: Structural empowerment mediated the effects of psychological empowerment on job satisfaction (standardized ß = 0.46, Sobel test: z = 2.69, P = 0.007). CONCLUSIONS: Both psychological and structural empowerment positively correlated with job satisfaction among nurses in long-term care facilities. The structural empowerment had a mediating effect on job satisfaction. IMPLICATIONS FOR NURSING MANAGEMENT: The managers of long-term care facilities should create an empowering work environment for nurses by providing them with available resources and by involving them in the developmental goals of the facilities. The critical structural components of an empowered workplace can contribute to the psychological empowerment of nurses and increase their job satisfaction.

Predictors of the utilization of long-term care (LTC) services among residents in community-based LTC facilities in Taiwan.

Identifying the utilization behaviors of LTC residents is necessary in order to forecast the demand and the level of resource use for health services. The purpose of this study is to understand the utilization behaviors and their predictors among residents of community-based LTC facilities in Taiwan. A prospective design was used in this study. Subjects were from six community-based LTC facilities in Beitou district of Taipei, Taiwan. A one-month time sheet was developed comprising subjects' socio-demographic characteristics, health status, and their use of LTC services. Among five types of LTC services examined in this study, assistance with activities of daily living (ADL) were the most commonly used (mean=67.3±46.0). ADL score was the strongest predictor of service utilization, accounting for 40% of the total variation in the utilization of personal assistance services (R2=0.396). The second most commonly used service was skilled-nursing services (mean=13.3±10.3). The most common skilled-nursing activities were administration of medication (mean=5.2±3.9) and measuring vital sign measurement (mean=3.4±2.3). The results provide useful information on how to allocate resources among staff in community-based LTC facilities.

The relationship between work empowerment and work stress perceived by nurses at long-term care facilities in Taipei city.

AIM: To explore the relationships between work empowerment, including both structural and psychological empowerment and work stress among nurses at long-term care facilities in Taiwan. DESIGN: Cross-sectional design with a descriptive correlation. METHODS: Work empowerment includes both psychological and structural empowerment; 178 nurses participated in the study. RESULTS: The results of this study showed that the average age of the subjects was 35.5 years and that 56.2% of subjects had less than two years work experience in the facility. The results indicated that there was a moderate level of psychological empowerment (mean 59.9, SD 8.1) and structural empowerment (mean 59.2, SD 11.1). A moderate level of work stress was also found with an average score of 72.3 (SD 14.4). Both psychological empowerment and structural empowerment were found to be significantly associated with total work stress (r = -0.4, r = -0.5, p < 0.001, respectively). The variables of age (standardised beta = -0.1), resources (standardised beta = -1.6), meaningful work (standardised beta = -0.4) and impact (standardised beta = -1.3) were significant predictors of work stress (R(2) = 0.32, F = 17.3, p<0.001). CONCLUSION: Both psychological empowerment and structural empowerment were found to be significantly associated with work stress among nurses in this study. The four significant predictors of job satisfaction were age, resources, meaningful work and impact. RELEVANCE TO CLINICAL PRACTICE: The managers of the facilities should provide available resources for nurses to accomplish work and to involve nurses in the development goals of the facilities to enhance their influence in the making of important changes within the organisation to decrease their work stress.

Relationship between organizational empowerment and job satisfaction perceived by nursing assistants at long-term care facilities.

AIM: The purpose of this study was to understand the relationships between organizational empowerment and job satisfaction among nursing assistants at long-term care facilities in Taiwan. BACKGROUND: Nursing assistants are the major manpower at long-term care facilities. The responsibilities of nursing assistants are complex and numerous and affect their job satisfaction. We assumed that a well-organized and pleasant work environment is an important characteristic of organizational empowerment and ought to enhance the nursing assistants' job satisfaction. However, little information exists that can be used by long-term care facilities managers when they strive to increase the nursing assistants' job satisfaction by modifying the regulations or interventions from an organizational perspective. METHODS: We used a cross-sectional design with a descriptive correlation approach to understand the relationship between organizational empowerment and job satisfaction among nursing assistants at long-term care facilities in Taiwan. A total of 28 long-term care facilities and 114 nursing assistants participated in the study. RESULTS: The results indicated that, where there was a moderate level of organizational empowerment, a higher level of job satisfaction was found. Organizational empowerment was significantly associated with total job satisfaction (r = 0.366, p < 0.01). The variables of nationality (Vietnamese), resources, opportunity and informal power were significant predictors of job satisfaction (R(2) = 0.318, F = 12.24, p < 0.001). CONCLUSION: Organizational empowerment is significantly associated with job satisfaction among nursing assistants in this study. RELEVANCE TO CLINICAL PRACTICE: Nursing assistants need to receive more assistance and resources from their co-workers to enhance their job satisfaction. The manager should initiate regular meetings and activities for staff who work in long-term care facilities that will allow sharing, communication and support among the staff in terms of ideas, information and feelings.

The health status and health promotion behavior of low-income elderly in the Taipei area.

The purpose of this study was to understand health promotion behaviors and their correlated factors among low-income elderly in the Taipei area. This study used a cross-sectional design with a descriptive correlation approach. A total of 89 low-income elderly from Peitou District of Taipei participated in the study. Structured questionnaires, the primary sources of measurement, were read to study subjects by a trained research assistant. The mean age of low-income elderly in the study was 76.85 year-old. A plurality were single (41.6%) and 31.5% lived alone. Subject IADLs (instrumental activities of daily living) were not as good as their ADLs (activities of daily living). Their psychosocial health status was worse than their physical health status. Among health promotion behaviors, regular exercise appears to be the most prevalent. The most significant factor among subjects for failing to follow health-promoting behaviors was their IADLs. Homebound elderly who lived alone and had poor IADL were less likely to have health promoting behaviors. A proposal to encourage health promotion behaviors for low-income elderly derived from study results is the initiation of formal personal assistance programs to remedy the inability of many elderly, especially those living alone, to leave the home due to ADL-related or other limitations.