Development and validation of a brief version of the traditional Chinese Stressors in Nursing Students scale among college nursing students in Taiwan.

Objective: The 43-item Stressors in Nursing Students (SINS) scale has been evaluated among nursing students in several countries, including China, Hong Kong, Japan, Pakistan, and Spain. However, the original four-factor structure has not been consistently replicated in all of these populations. The aim of this study was to develop a brief version of the traditional Chinese SINS (TC-SINS) scale and to validate it in Taiwanese nursing students. Materials and Methods: Data obtained from a cross-sectional survey study of 814 nursing students in a nursing college and a university in Taiwan were randomly divided into two parts. The first part was used to conduct an exploratory factor analysis using principal axis factoring with oblique rotation. After the removal of cross-loading items, the resulting scale was validated with the data from the second part using confirmatory factor analysis. Results: A three-factor solution (social, clinical, and education) with 23 items accounting for 54.5% of variance was obtained in the exploratory factor analysis. The confirmatory factor analysis further reduced the number of items to 20. The goodness-of-fit indexes were good (Root Mean Square Error of Approximation = 0.075 and Comparative Fit Index = 0.90). Conclusions: The number of items in the TC-SINS could be reduced from 43 to 20, without sacrificing its psychometric properties. The brief version of TC-SINS might be able to reduce respondent burden.

Psychometric and Linguistic Evaluation of a Coping Scale for Breast Cancer Survivors in Taiwan.

BACKGROUND: Coping strategies are essential in dealing with threatening situations or difficulties for better psychological adjustments and quality of life. A short-form modified Ways of Coping Questionnaire (MWCQ) would be useful to quickly assess the coping strategies used by breast cancer survivors. OBJECTIVES: The aim of this study was to evaluate the psychometric properties of a Chinese version of a brief version of the MWCQ in breast cancer survivors. METHODS: A methodological, cross-sectional design was used in this study. The study has internal consistency reliability, face/content, construct, and convergent/divergent validity. Factor analysis and confirmatory factor analysis were used to examine the psychometric properties of the MWCQ-brief in a convenience sample of 207 women with breast cancer from 2 general hospitals in Taiwan. RESULTS: From the initial 35-item coping scale, factor analysis results supported a 24-item questionnaire, and the following 4 factors were extracted: effective coping, optimistic coping, unpractical coping, and escape coping. Confirmatory factor analysis results revealed an 18-item questionnaire with 3 factors extracted: active coping, avoidance coping, and minimizing the situation. CONCLUSIONS: The 24- and 18-item MWCQ-brief versions demonstrate fair psychometric properties to measure adaptability among women with breast cancer in Taiwan. This scale is simple but contains 4 or 3 concepts for coping that can be appropriately used to assess underlying states of adaptation in women with breast cancer. IMPLICATIONS FOR PRACTICE: The MWCQ-brief is a valid and reliable tool to understand the adaptability states of female breast cancer survivors by exploring reactions to the disease. Healthcare professionals can provide appropriate psychosocial interventions based on assessment results.

Advance Care Planning and Advance Directives: A Multimedia Education Program in Community-Dwelling Older Adults.

This community-based cluster randomized trial evaluated the efficacy of a 4-week multimedia educational intervention followed by telephone consultations at Weeks 12 and 24 on the selection of a hospice program for end-of-life care and completion of an advance directive (AD) in case of future advanced dementia. One hundred twenty-three cognitively intact older adults from five community centers in Taiwan were randomly assigned to two groups. The study showed that 100% of participants in the intervention group (two community centers, n = 52) selected hospice program care for end-of-life care and signed ADs, whereas those in the control group were less likely to do both (p < .001). Participants in the intervention group also had a positive change in knowledge, subjective norms, perceived behavioral control, and behavioral intention of advance care planning (ACP) for advanced dementia. The theoretically based multimedia educational program was effective in assisting ACP implementation and completing ADs among community-dwelling older adults.

Low interest in clinical practicum placement is associated with increased stress in nursing students in Taiwan: A cross-sectional survey study.

BACKGROUND: Nursing students often find themselves in a highly competitive environment, and stress is a commonly acknowledged experience in nursing students. OBJECTIVES: The aim of this study was to explore factors, particularly an interest in nursing and in clinical practicum placement, associated with stress in Taiwanese nursing students. DESIGN: Cross-sectional survey study. SETTINGS: A nursing college in central Taiwan and a university in eastern Taiwan. PARTICIPANTS: 814 nursing students. METHODS: Level of stress of the participants was measured using the 43-items Stressors in Nursing Students (SINS) scale, which was translated into a traditional Chinese version (TC-SINS). Simple and multiple linear regression analyses were used to evaluate factors significantly associated with stress. RESULTS: A total of 814 nursing students completed the questionnaire with a return rate of 83.6%. The mean age of the participants was 18.9 years and 94.8% was female. Regarding the students' interest in nursing, 2.6% expressed that they strongly or somewhat disagree. In addition, regarding the students' interest in clinical practicum placement, 7.2% indicated that they strongly or somewhat disagree. Results from multiple regression analysis showed that students who expressed somewhat or strong disagreement to interest in clinical practicum placement were significantly associated with a higher level of stress. Of the various strategies for stress relief, listen to music (75.2%) was the most popular choice, followed by talk to a friend (72.3%), and catch up on sleep (61.3%). A third of the participants used three strategies for stress relief. CONCLUSIONS: Low interest in clinical practicum placement was associated with increased stress levels in nursing students in Taiwan. Future studies should explore the underlying reasons for stress induced by clinical practicum placement, and possible solutions for stress reduction in nursing students.

[Self-Management Education in Rural Older Adults With Diabetes].

Diabetes is one of the most prevalent chronic diseases affecting public health. The Taiwan government implemented the Diabetes Shared Care Program to deliver continuous medical care and provide health education in order to help clients with diabetes learn self-management. However, rural older adults with diabetes often have poor access to medical resources and thus face obstacles to obtaining and using the services of this program. This paper introduces the current status of the Diabetes Shared Care Program, discusses the concept of self-management education and support for diabetes cases, and proposes community-based strategies, including (1) provide DSMES (diabetes self-management education and support) with multi-types of services, (2) increase non-professional personnel training, and (3) provide culture-congruent health education, in order to strengthen the diabetes self-management capabilities of rural older adults.

Nursing Students' Perceptions of a Silent Mentor Program in an Anatomy Course.

Anatomy is a core course in undergraduate nursing curriculum. In today's nursing profession, the integration of biosciences and humanities is increasingly emphasized. Anatomy is considered one of the most essential bioscience subjects for nursing practice. Thus, integrating a silent mentor program into the anatomy course can enrich the knowledge of undergraduate nursing students regarding biosciences and humanities and enhance their future patient-centered care competencies. This article aimed to understand the students' perceptions of integrating a silent mentor program into the anatomy course. Qualitative approach included four focus group interviews. Themes were developed using the analytic induction technique. Twenty-five second-year undergraduate nursing students from a university were recruited. Semi-structured interviews were used to guide four focus group interviews. Focus group interviews were digitally recorded, transcribed, and analyzed. According to the preliminary findings, nursing students regarded silent mentors not only as teaching tools but also as tools to learn more than anatomy. Students greatly respected the silent mentors and were highly engaged in the anatomy course. They expected to become better students or future nurses. Four themes were identified from the interviews: emotional transformation, caring spirit, course engagement, and self-expectation. The findings suggest that the silent mentor program offered students a beneficial learning experience and stimulated their developing competency in nursing humanities. How the silent mentor program can help students achieve optimum academic performance and how their positive experience of the program and humanistic spirit translates into clinical practice in future should be studied further.

Influence of work values and personality traits on intent to stay among nurses at various types of hospital in Taiwan.

AIM: In this study, the influence of work values and personality traits on the intent to stay at work was examined among nurses in Taiwan. BACKGROUND: No empirical studies in this area have been conducted in the nursing industry. METHODS: A cross-sectional predictive study was performed during 2012 with 1246 nurses recruited from three different types of hospital located in northeastern Taiwan. A structured questionnaire based on the 5-factor model was used. Multiple regression analyses were used to investigate the various factors associated with the intent to stay at work among nurses. RESULTS: The overall response rate was 85%. The nurses who had a high level of intent to stay at work were significantly more likely to be in senior roles; exhibited positive work values, conscientiousness, emotional stability; and worked at a non-religious hospital. CONCLUSION: Age, the role of work values, personality traits and type of hospital were crucial in enhancing the level of intent to stay at work. IMPLICATIONS FOR NURSING MANAGEMENT: The study findings provide evidence for managers to develop an optimal strategy for nurses with specific personality traits and highly positive work values, which can guide the recruitment and retention of nurses.

The effects of Tai-Chi in conjunction with thera-band resistance exercise on functional fitness and muscle strength among community-based older people.

AIMS AND OBJECTIVES: The aim of this study was to investigate the effects of Tai-Chi in conjunction with thera-band resistance exercise on functional fitness and muscle strength in community-based older people. BACKGROUND: Tai-Chi is known to improve functional fitness in older people. Tai-Chi is usually performed with free hands without resistance training and usually focuses on training lower limbs. To date, no study has examined the use of Tai-Chi in conjunction with thera-band resistance exercise in this population. DESIGN: Cluster randomised trial design. METHODS: Older people at six senior day care centres in Taiwan were assigned to thera-band resistance exercise or control group using a cluster randomisation. The thera-band resistance exercise group (n = 48) received sixty minute thera-band resistance exercise twice weekly for a period of 16 weeks. The control group (n = 47) underwent routine activities in the day care centre, receiving no Tai-Chi or resistance exercise. RESULTS: After receiving the thera-band resistance exercise, intervention participants displayed a significant increase in muscle strength of upper and lower extremities. Significant improvements were recorded on most measures of the Senior Fitness Test, with the exception of the chair-stand and back-scratch test. CONCLUSION: Thera-band resistance exercise has the potential to improve functional fitness and muscle strength in community-based older people. RELEVANCE TO CLINICAL PRACTICE: Thera-band resistance exercise potentially offers a safe and appropriate form of physical activity that nursing staff can easily incorporate into the daily routine of older people in day care centres, potentially improving functional performance and muscle strength.

Adverse events among nurse aides in long-term care facilities in Taiwan.

The study investigated the relationship between the incidence of adverse events and related factors among nurse aides in long-term settings in Taiwan. Of 213 nurse aides, 54.93% experienced an adverse event during the previous year. Four variables, including institution type, certification, years of work experience as a nurse aide, and job type, were found to be associated with the occurrence of adverse events. Findings suggested that health care managers provide training to nurse aides with a specific focus on maintaining quality care.

Psychometric testing of an instrument measuring core competencies of nursing students: an application of Mokken scaling.

Assessing the core competencies of nursing students provides information about students' learning outcomes for educational evaluation and improvement. The aim of this study was to develop the Nursing Students Core Competencies scale to measure 8 core competencies of nursing students in Taiwan. The study employed factor analysis and Mokken scaling analysis for psychometric testing of this instrument between a group of nursing graduates and their evaluators. The results indicated that the Nursing Students Core Competencies scale has demonstrated evidence of internal consistency, structural validity, unidimensionality, and a hierarchy of items for students' self-assessment and instructor's rating. The use of Mokken scaling analysis extends the knowledge of developing competence assessment tools; it can be used to reveal the domains or items of competency nursing students perceive that are easy or difficult, providing information for curricular design.

Psychometric testing of an instrument measuring nurse aides' patient safety attitudes.

AIM: To develop and test the patient safety attitude scale-nurse aide (PSAS-NA) scale in measuring nurse aides' attitudes to patient safety and event reporting. BACKGROUND: Although nurse aides are unlicensed personnel, their roles in delivering care can not be ignored. A measure specific to nurse aides is needed. METHODS: This is a cross-sectional design study. A literature review was conducted to generate items. Content validity, construct validity, convergent/divergent validity and internal consistency were examined. A convenient sample of 213 nurse aides working at two hospital-based long-term care institutions in Taiwan was recruited. RESULTS: From the initial 61-item scale, a 39-item instrument was retained by principal component analysis (PCA) and four factors were extracted: daily safety practice, organizational safety strategies, event reporting practice and event reporting conflict. Four factors accounted for 51.74% of the total variance. Cronbach's alpha ranged from 0.83 to 0.92. Event reporting conflict was significantly negatively correlated with event reporting practice (r = -0.16, P < 0.05). IMPLICATION FOR NURSING MANAGEMENT: The PSAS-NA can be used to assess nurse aides' attitudes to patient safety and event reporting. Health care mangers/supervisors can provide education and training programmes to nurse aides according to the assessment results.

A randomized controlled trial of the effects of listening to non-commercial music on quality of nocturnal sleep and relaxation indices in patients in medical intensive care unit.

AIM: The purpose was to examine the effects of non-commercial music on quality of sleep and relaxation indices, including heart rate, mean arterial pressure, and respiratory rate in patients in intensive care units. BACKGROUND: There is currently insufficient scientific knowledge for the effects of music on quality of sleep in critically ill patients. DESIGN: A randomized controlled trial. METHODS: Between January-December 2010, 28 patients aged 39-78 years were randomly assigned to music and control groups. Participants in the music groups listened to non-commercial music for 45 minutes at nocturnal sleep time. In the control group, participants slept with no music. Participants were assessed using vital signs monitors, standardized questionnaire, and polysomnography. Polysomnography sleep was recorded for the first 2 hours of the nocturnal sleep. General estimating equation was applied to analyse data. FINDINGS: Participants in the music group had shorter stage N2 sleep and longer stage N3 sleep in the first 2 hours of the nocturnal sleep and improved self-reported sleep quality, compared with those in the control group. The music group patients also had significantly lower heart rates than those in the control group. The intensive care units patients experienced fragmented sleep with a high frequency of awakenings and severe reduction in random eye movement sleep during the first 2 hours of the nocturnal sleep. CONCLUSION: The findings provided evidence for nurses to use soothing music as a research-based nursing intervention for intensive care unit patients' sleep improvement.

Construct validation of the Nurse Cultural Competence Scale: a hierarchy of abilities.

AIM: The aim of this study was to describe the development of a Nurse Cultural Competence Scale using Mokken scaling. BACKGROUND: The psychometrics of the present cultural competence assessment tools has been questioned. The levels of competence measured by existing tools are not capable of indicating individual differences. DESIGN: This study employed a cross-sectional design. A convenience sample of 172 on-the-job nursing students in a college of technology in Taiwan was recruited. METHODS: Based on previous literature, the Nurse Cultural Competence Scale comprising 41 items was developed to measure the concept of cultural awareness, cultural knowledge, cultural sensitivity and cultural skill. Mokken scaling analysis was conducted to investigate the unidimensionality and hierarchical nature of the scale. RESULTS: From the 41 items entered into the Mokken scaling procedure, 20 form a strong Mokken scale. The 20 items form a reliable and statistically significant scale which is negatively skewed. The ordering of the items from lowest to highest difficulty shows a hierarchy. RELEVANCE TO CLINICAL PRACTICE: Nursing managers and educators may use this scale to assess the levels of cultural competence of their members or students and then provide the education according to individual needs.

The effect of an intervention combining self-efficacy theory and pedometers on promoting physical activity among adolescents.

AIM: To study the effect of an intervention combining self-efficacy theory and pedometers on promoting physical activity among adolescents. BACKGROUND: The beneficial effects of regular physical activity on health in youths are well-documented. However, adolescence is found to be the age of greatest decline in physical activity participation. Physical activity participation among girls was generally less frequent and less intense than boys. Therefore, there is a strong need for effective interventions that can help promote physical activity in this population. DESIGN: An experimental design. METHODS: Two classes of female junior college students (mean age = 16) were randomly sampled from a total of four classes and, of those, one each was randomly assigned to either the intervention (n = 46) or the control group (n = 48). Self-efficacy was used as a core theoretical foundation of the intervention design, and pedometers were provided to the students in the intervention group. Distances between each domestic scenic spot were illustrated graphically in a walking log for students to mark the extent of their walking or running. Students in the control group participated in a usual physical education programme. The primary outcome was a change in the number of aerobic steps. The secondary outcomes were changes in cardiopulmonary endurance and exercise self-efficacy. RESULTS: At 12-week follow-up, the mean change in aerobic steps was 371 steps and 108 steps in the intervention and control group, respectively. The difference in mean change between the two groups was 467 steps. Effects of the intervention on changes of cardiopulmonary endurance and perceived exercise self-efficacy scores were not found. CONCLUSIONS: Among adolescent girls, a 12-week intervention designed on the theoretical foundation of self-efficacy theory and provision of pedometers was found to have an effect on increasing their physical activity. The intervention, using graphs of domestic scenic spots to represent the distance of walking or running as monitored by pedometers, might enhance motivation regarding physical activity. RELEVANCE TO CLINICAL PRACTICE: It is important for health professionals, including school health nurses, involved in the care of adolescent health, to design and provide a physical activity intervention combining self-efficacy theory and provision of pedometer to promote physical activity.

A preliminary reliability and validity study of the Chinese version of the self-efficacy for exercise scale for older adults.

BACKGROUND: Population ageing affects most undeveloped, developing and developed countries. Less than a quarter of older people undertake a level of physical activity worldwide that is sufficient to lead to health benefits. Understanding older people's confidence regarding engaging in exercise helps to structure physical activity interventions that motivate them to initiate and adhere to regular exercise. Estimates of the reliability and validity of the English version of the self-efficacy for exercise (SEE) scale has been widely tested and shown to be valid for use in various settings and among older people. The reliability and validity of a Chinese version of the SEE for older adults has not been tested. AIM: To undertake a preliminary assessment of the reliability and validity of the SEE scale when applied to the older Chinese adults. METHODS: The Chinese version of the self-efficacy for exercise (SEE-C) scale was tested on a sample of 192 older people from Taiwan with a mean age of 71.2 years recruited between October and December 2003. RESULTS: There was acceptable internal consistency of the SEE-C scale. The fit of the measurement model to the data for the SEE-C scale was acceptable. There was evidence of validity of the measure based on hypothesis testing: health status predicted exercise self-efficacy, and exercise self-efficacy predicted physical activity. Those who exercised regularly (n=102) had a higher mean SEE-C score (5.3) than those who did not (2.9, n=90). CONCLUSION: This preliminary validation study provided evidence for the reliability and validity of the Chinese version of the SEE scale. Future testing of the SEE-C scale needs to be carried out to see whether these results are generalisable to older Chinese people living in urban areas and with different characteristics. A test of the scale among younger adults for a wider use of the instrument is also warranted.

[Chemical toxicants and preconception health: the role of nurses].

The influence of chemical toxicants on human reproduction is often overlooked. However, couples previously exposed to toxicants face a higher risk of birth defects in their children. Through preconception care, nurses can provide prevention education to men and women of childbearing age and play a positive role in reducing rates of infertility and fetal harm due to chemical toxicity. This paper introduces chemical toxicants prevalent in the community, workplace, and home and also the impact of exposure to such on conception and fetal development. Working on primary prevention, secondary prevention, and sexual history collection, professional nurses can assess, counsel, educate, and provide relevant services to help prevent environmental exposure damage to reproductive functions and promote reproductive health.

The impact of learned resourcefulness on quality of life in type II diabetic patients: a cross-sectional correlational study.

It is well recognized that patients with diabetes encounter a host of daily self-care issues, including controlling blood sugar and preventing and managing complications, which impact significantly upon quality of life. Studies have indicated that learned resourcefulness has a potentially positive effect in dealing with psychosocial and health problems. The purpose of this study was to test the relationship between learned resourcefulness and quality of life in type II diabetic patients. The mediating and moderating effects of learned resourcefulness on the relationship between metabolic control and quality of life of diabetic patients was also examined. This cross-sectional and correlational study included a convenience sample of 131 type II diabetic patients recruited from three hospitals in southern Taiwan. Data were collected through questionnaires, which included the Rosenbaum's Self Control Schedule and World Health Organization's Quality of Life (Short Version). Multiple regression techniques were used to analyze outcome predictors. Study findings include identification of a mediating effect of learned resourcefulness between metabolic control and quality of life. While most DM patients were not satisfied with their health, we found that those with greater learned resourcefulness enjoyed a better quality of life. Learned resourcefulness, gender, and HbA1C explained 35.2% of variance in DM patient quality of life. Male diabetic patients enjoyed a better quality of life than females, even though levels of learned resourcefulness between the two groups were not significantly different. Results indicate that poor metabolic control of diabetic patients has a detrimental effect on quality of life, and when diabetic patients use more self-control skills, they may achieve better quality of life. Results suggest that nurses who use cognitive behavior coping strategies (resourcefulness) may help diabetic patients achieve better metabolic control and promote better quality of life.