Nurse-led intervention to improve oral mucosal health of intubated patients in the intensive care unit: A prospective study.

BACKGROUND: This prospective study aimed to explore the effectiveness of an oral care intervention with Tegaderm on the oral mucosal health of intubated patients. METHODS: A total of 70 intubated patients were included and randomly assigned to 1 of 3 groups, clean water brushing teeth (n = 23), brushing teeth combined with mouthwash (BTM) (n = 23), and brushing teeth combined with mouthwash and Tegaderm (BTMT) (n = 24). The Oral Mucositis Assessment Scale (OMAS) was applied to evaluate the patient's oral mucosal health before and after oral care intervention. RESULTS: The BTMT group had lower OMAS scores in almost all regions of the oral cavity, compared to the brushing teeth and BTM groups. The general linear model for repeated measurement indicated the BTMT group had the lowest total OMAS scores from Day 2 to Day 4 after the initiation of baseline OMAS evaluation. Of the 3 intervention groups, the BTMT group had the shortest length of endotracheal intubation. The BTMT group had the lowest incidence rate of ventilator-associated pneumonia; however, no significant between-group differences were found. CONCLUSIONS: BTMT effectively reduced the decline in oral mucosal health that was caused by endotracheal intubation and shortened the length of endotracheal intubation.

Undergraduate nurses' reflections on visual thinking learning to construct inductive reasoning through situated patient pictures: A mixed-method study.

BACKGROUND/OBJECTIVE: Deductive logic has often been used to develop critical thinking. However, inductive logical thinking, essential to care decision-making, has yet to be emphasized. This study aimed to explore visual thinking learning among undergraduate nursing students by asking them to draw situated patient pictures in order to integrate theoretical knowledge and promote inductive logical thinking. METHODS: A mixed-methods research design was used to obtain quantitative and qualitative data from a convenience sample of 100 students. The study was conducted in a Taiwanese university from September 2022 to January 2023. In the quantitative component, learners' views of situated patient pictures were captured based on 15 paired identifiers and two questions: (a) What word should be used in describing the situated patient's picture? (b) How strongly do you feel about the selection? Written feedback was analyzed using qualitative content analysis. RESULTS: Quantitative analysis identified specific, unpretentious, humorous, harmonious, conservative, realistic, rational, entire, image performance, professional performance, understandable, expressive, static performance, rigorous, and profuse with a reasonable degree of choice. Qualitative analysis identified four stages in participants' development of inductive reasoning through situated patient pictures and visual thinking learning. These were: exploration, intuition, theme, and logic and creation. CONCLUSIONS: The results suggest that visual thinking learning is a practical pedagogical approach to increasing learners' communication abilities, group cooperation, theoretical knowledge integration, and logical thinking. Neither educators nor learners required any artistic skills. Nonetheless, participants demonstrated creativity and innovation through continuous visual thinking learning.

Professional Accountability of Caring for Patients with COVID-19: A Phenomenographic Study.

The purpose of this study was to explore nurses' care experiences for COVID-19 patients during the pandemic in Taiwan. The qualitative approach of phenomenography was used. Thirty-four nurses were recruited from two assigned hospitals in which COVID-19 patients were treated in Taiwan from July to May 2021. The method of data collection in the study involved a semi-structured interview and drawing. Interviews were audio-recorded and transcribed verbatim. Phenomenographic analysis was used to analyze the qualitative data. Four categories of description of experiences of caring for COVID-19 patients were identified: facing uncountable stresses from all sides, strict implementation of infection control interventions to provide safe care, confronting ethical dilemmas and making difficult decisions, and reflecting on the meaning of care in nursing. Professional accountability was the core theme found to represent the central meaning of nurses caring for COVID-19 patients. Nurses were under enormous stress while caring for COVID-19 patients during the pandemic and were negatively affected physically, psychologically, and socially. Professional accountability in caring for COVID-19 patients can be enhanced through adequate support from nursing managers and by in-service training designed to update knowledge and skills related to infection control intervention.

The Effectiveness of Home-Based Inspiratory Muscle Training on Small Airway Function and Disease-Associated Symptoms in Patients with Chronic Obstructive Pulmonary Disease.

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitations, occurring mainly in the small airways. Weakness in the respiratory muscles contributes to dyspnea and a decreased exercise capacity in COPD patients. This study aimed to investigate the effectiveness of home-based inspiratory muscle training (IMT) on small airway function and symptoms in COPD patients. This research adopted a non-randomized controlled-study quasi-experimental design. The IMT program consisted of two 15 min sessions·d-1, 5 d·wk-1, with 40% of the maximal inspiratory pressure (PImax) on each participant's assessment results and lasted for 12 weeks. Small airway function was assessed using plethysmography at baseline and after 12 weeks. The modified British Medical Research Council (mMRC), COPD assessment test (CAT), PImax, and 6 min walking distance (6MWD) were recorded at baseline as well as four, eight, and twelve weeks. Twenty-three participants with at least moderate COPD were enrolled in IMT (n = 16) or in the control group (n = 7) in this study. The study participants were mostly male (82.6%), and the average age was 68.29 ± 10.87 years, with a mean body mass index (BMI) of 23.54 ± 4.79. After 12 weeks, the ratios of the first second of forced expiration to the forced vital capacity (FEV1/FVC%) (B coefficient [95% Wald confidence interval] of 5.21 [0.46 to 9.96], p = 0.032), forced expiratory flow (FEF25-75%) (0.20 [0.04 to 0.35] L/s, p = 0.012), and FEF50% (0.26 [0.08 to 0.43] L/s, p = 0.004) in the IMT group were significantly better than in the control group. The IMT group showed significantly lower CAT scores at week 8 (-5.50 [-10.31 to -0.695] scores, p = 0.025) than the control group. The mMRC grade, CAT score, PImax, and 6MWD were significantly improved compared to their values at baseline in the IMT group. Home-based IMT effectively improved post-bronchodilator small airway function and disease-associated symptoms in COPD patients.

Clinical Instructors' Perspectives on the Assessment of Clinical Knowledge of Undergraduate Nursing Students: A Descriptive Phenomenological Approach.

This study aimed to determine clinical instructors' perceptions of the assessments used to evaluate the clinical knowledge of undergraduate nursing students. This study uses a descriptive phenomenological approach. Purposive sampling was used to recruit sixteen clinical instructors for semi-structured interviews between August and December 2019. All interviews were audio recorded and transcribed verbatim. Data were analyzed using a modified Colaizzi's seven-step method. Four criteria were used to ensure the study's validity: credibility, transferability, dependability, and confirmability. Three themes were identified in the clinical instructors' views on evaluating the clinical performance of student nurses: familiarity with students, patchwork clinical learning, and differing perceptions of the same scoring system. The study results suggest a need for a reliable, valid, and consistent approach to evaluating students' clinical knowledge. If the use of patchwork clinical internships for student nurses is unavoidable, a method for assessing student nurses' clinical performance that requires instructor consensus is necessary.

Factors Associated with Return Visits by Elders within 72 Hours of Discharge from the Emergency Department.

Elders have a higher rate of return visits to the emergency department (ED) than other patients. It is critical to understand the risk factors for return visits to the ED by elders. The aim of this study was to determine the factors associated with return visits to the ED by elders. This study retrospectively reviewed the hospital charts of elders who returned to the ED within 72 h after discharge from ED. The risk factors identified in the Triage Risk Screening Tool were applied in this study. Of the elders discharged from the ED, 8.64% made a return visit to the ED within 72 h. The highest revisit rate occurred within 24 h after discharge. Factors associated with return ED visits within 24 h by elders were difficulty walking and having discharge care needs. The factor associated with ED return visits within 24-48 h was polypharmacy. Difficulty walking, having discharge care needs, and hospitalization within the past 120 days were associated with return visits made within 48-72 h following discharge. Identifying the reasons for return visits to the ED and providing a continuous review of geriatric assessment and discharge planning could reduce unnecessary revisits.

An Exploration of Psychological Resilience among Undergraduate Nursing Students Undertaking an Adult Nursing Virtual Practicum during the Coronavirus Pandemic in Taiwan: A Qualitative Study.

This qualitative study aimed to explore the psychological resilience of undergraduate nursing students partaking in a virtual practicum during the coronavirus pandemic (COVID-19) in Taiwan. The virtual practicum, a form of online learning, creates challenges compared to the traditional teaching-learning experience of an actual clinical placement. Exploring how students overcome learning difficulties and build resilience is necessary for a new learning environment or for future online learning. Constructivist grounded theory and the Standards for Reporting Qualitative Research checklist were followed. Purposive and theoretical sampling were used to recruit 18 student nurses for data saturation. Semi-structured, face-to-face interviews were conducted individually to collect data. Initial, focused, and theoretical coding and constant comparative data analysis were performed. Credibility, originality, resonance, and usefulness guided the assessment of the study's quality. The core category of psychological resilience in the virtual practicum was constructed to reflect Taiwanese nursing students' progress and experiences of learning during the virtual practicum. This core category consisted of three subcategories: (i) learning difficulties within one's inner self; (ii) staying positive and confident; and (iii) knowing what is possible. The findings identified psychological resilience as an important factor for students to adjust to the adverse experiences of a rapidly changing learning environment, such as the virtual practicum. The substantive theory of psychological resilience provided a frame of reference for coping with possible future difficulties. Correspondingly, psychological resilience reflected individuals' potential characteristics and may help students to enter and remain in the nursing profession.

Family Caregivers' Experiences of Preventing Harm to Older People during Hospitalization: A Phenomenographic Study.

Hospital admission is associated with a high risk of harm, particularly for older people, and family members play a critical role in providing care. The aim of this study was to explore family caregivers' experiences in preventing harm to older people during hospitalization. The phenomenographic approach was applied. Thirty family caregivers were asked to describe their experiences of preventing harm to older people. Semi-structured interviews were audiotaped and transcribed. Participants described preventing harm as "essential care", "an important step toward recovery", "a load off the mind", "outcomes of collaboration among caregivers and health professionals", and "improvement in the quality of life after discharge". The core theme was to achieve the goal of integrated care for older people. The results can help improve caregiving processes and prevent harm to older people during hospitalizations. They can assist in developing strategies for the delivery of safe care for older people.

The Outcomes of an Interprofessional Simulation Program for New Graduate Nurses.

This study explored the learning outcomes of an interprofessional simulation program for new graduate nurses during their training program. It was a single-group, pre-test and post-test research design. Ninety-three new graduate nurses participated in the study. The Nursing Competence Instrument and program satisfaction survey questionnaires were used to evaluate the learning outcomes of the program. Data were collected between 1 July 2019 and 30 June 2020 in a medical center in Taiwan. It was found that four nursing core competencies were significantly higher after the simulation, including advancing career talents (t = 10.12, p < 0.0001), integrating care abilities (t = 10.19, p < 0.001), dealing with tension (t = 6.87, p < 0.0001), and leading humanity concerns (t = 6.86, p < 0.001). The average satisfaction score for the interprofessional simulation training among nurses was 4.42 out of 5. In conclusion, interprofessional simulation education can help novice nurses improve their nursing core competencies. The results of this study provide an important indicator for hospitals and governments when making policy and training programs for new graduate nurses.

Effectiveness of Interdisciplinary Teaching on Creativity: A Quasi-Experimental Study.

Little is known about the effectiveness of Interdisciplinary teaching (IDT) in higher education, particularly for healthcare education in Taiwan. It is vital to determine if IDT could enhance divergent creative thinking and team creativity among nursing students. A quasi-experimental study with a pretest-posttest design. Students enrolled in a capstone nursing course for the development of healthcare-related products were divided into two groups. The intervention group (n = 61) was taught creative thinking skills with IDT by faculty. The control group (n = 84) was taught by nursing faculty with traditional teaching. This study found that students who received the IDT intervention scored significantly higher on measures of creative thinking and team creativity compared with students in the control group. These findings suggest integrating IDT from nursing and design faculty into the teaching curriculum to foster students' creative thinking abilities when formulating interdisciplinary student teams to develop innovative, creative healthcare products.

Standard risk assessment forms help reduce preventable harm in older adult inpatients: A retrospective chart review study.

AIMS: To examine nurse documentation of assessments using standard risk assessment forms in older inpatients, and to determine the value of such assessment. DESIGN: Cross-sectional retrospective chart review. METHODS: This retrospective review of risk evaluation documentation in patients' medical records focused on skin, continence, medical complications, nutrition, cognition, mobility, medications and pain. RESULTS: A total of 1000 medical records from Taiwan hospitals were reviewed from January 2016 to December 2017, and 379 from Australian hospitals were reviewed from March 2011 to February 2012. Taiwanese patients with documented assessment of skin (aOR =2.94, 95%CI =1.88-4.54), nutrition (aOR =3.22, 95%CI =1.08-9.59), cognition (aOR =2.61, 95%CI =1.32-5.16) and pain (aOR =5.01, 95%CI=1.63-15.38) had significantly higher odds of developing new problems; while Australian patients with documented assessments of continence (aOR =11.55, 95%CI =1.48-90.45) and nutrition (aOR =12.90, 95%CI =1.67-99.06) had significantly higher odds of developing new problems. DISCUSSION: Nursing assessments and interventions documented in standard risk assessment forms help clinical nurses detect new preventable problems and prevent harm in older hospital inpatients across geographic locations and hospital types. Standard nursing forms can be used in clinical practice to guide proactive care by nurses to prevent harm during hospitalisation. IMPACT: Older inpatients are at risk of preventable harm and new health problems. The present study found that incorporating eight factors sensitive to nursing care into standard risk assessment forms can help reduce preventable harm in older inpatients. In addition, these forms guide assessment and intervention effectively in different countries.

How Emergency Nurses Develop Resilience in the Context of Workplace Violence: A Grounded Theory Study.

PURPOSE: To understand how emergency nurses develop resilience in the context of workplace violence. DESIGN: This study employed grounded theory methodology. Thirty nurses from three hospital emergency departments in Taiwan were interviewed between August and December 2018. METHODS: Semistructured interviews were used to collect data. Interviews were audio-recorded and transcribed verbatim. FINDINGS: The process through which emergency nurses who had experienced workplace violence developed resilience took place in three stages: the release of emotions after the assault; the interpretation of conflicting thoughts and actions; and the establishment of strategies to cope with workplace violence in the future. The core theme was the motivating role of professional commitment to emergency patient care. CONCLUSIONS: The results of this study can inform the development of support systems to enhance the resilience of nurses experiencing workplace violence by alerting healthcare administrators and governing institutions to their needs. CLINICAL RELEVANCE: Emergency nurses viewed professional growth and professional commitment as an invisible motivator in the development of resilience following an encounter with workplace violence.

Enhancing reflection on medical and surgical nursing among nursing students: A participatory action research study.

BACKGROUND: Medical and Surgical Nursing (MSN) is a core course in baccalaureate nursing programs that requires active and effective teaching and learning strategies to enhance students' engagement. OBJECTIVE: To develop and implement an effective learning process for students undertaking the MSN course. DESIGN: This participatory action research study used reflection as the center of action in the cycle of planning, acting, observing and reflecting and re-planning. SETTING: The study was conducted at a University in southern Taiwan. PARTICIPANTS: Thirty nursing students in their second year of a bachelor program in nursing, aged 19 to 20 years, were recruited via email and completed the study. METHODS: The data were collected from February to June 2019 through reflective workshops, group discussions, individual interviews, and field notes. A qualitative content analysis was performed. Four criteria were considered to ensure the trustworthiness of the study process: reliability, validity, transferability, and authentic citations. RESULTS: Four key themes - two challenges and two adaptive strategies - emerged in relation to the spiral process of improving teaching and learning in the MSN course. Participants experienced two main challenges: the large amount of multidisciplinary knowledge expected, and the rapid pace of the course. The two adaptive strategies were: recognizing their own unique way of learning and becoming an active learner and achiever. CONCLUSIONS: The project helped students to identify their own learning challenges, recognize the need to modify their attitudes and approaches to learning, improve teaching and learning in the MSN course, and identify the characteristics relevant to becoming an active learner and achiever.

Predictors of individually perceived levels of team creativity for teams of nursing students in Taiwan: A cross-sectional study.

BACKGROUND: The complexity of healthcare and concurrent advances in technology have promoted Interprofessional Education (IPE) in healthcare schools to prepare students to collaborate on interdisciplinary teams. Since 2016, healthcare curricula in Taiwan have incorporated IPE-based capstone courses to enhance creativity. To better understand the predictors of team creativity could help educators improve IPE and outcomes for nursing students and patients. PURPOSE: To determine whether nursing students' demographic characteristics, individual creativity, and perceived team interaction behaviors, team swift trust, team conflict, and team task interdependence may predict high perceived team creativity in IPE settings. METHODS: A cross-sectional study design included nursing students (N = 99) at a science and technology university in Taiwan. Data from self-report questionnaires included variables for demographic characteristics, individual creativity, and perceived team characteristics. A hierarchical multiple regression analysis revealed predictors of high perceived team creativity. RESULTS: Nursing students who perceived high team creativity also perceived higher interaction behaviors and lower process conflict than those who perceived less creativity. Spontaneous communication and team task conflict predicted high perceived team creativity. CONCLUSIONS: Nursing educators could increase team creativity in IPE by encouraging spontaneous communication and constructive task-oriented conflict management. This may benefit patient outcomes in the future.

A spiritual education course to enhance nursing students' spiritual competencies.

The study aimed to determine the impact of an elective spiritual education course for nursing students on spiritual competencies. A convenience sample of nursing students (N = 92) was recruited from a baccalaureate school of nursing between February and July 2016. The intervention group (n = 45) was comprised of students enrolled in the elective spiritual education course which integrated non-Christian Eastern cultural beliefs; the control group was comprised of students not enrolled in the elective (n = 47). A quasi-experimental design examined pretest, posttest, and follow-up data from students' self-administered questionnaires. The intervention effect of the course was analyzed using generalized estimation equation. The results indicated posttest scores among nursing students in the intervention group were significantly better than the comparison group for spiritual health. Practicum stress and professional commitment were significantly better at follow-up. Spiritual care attitudes, caring behavior, and religious belief were significantly improved from pretest to posttest, and at follow-up for the intervention group compared with the control group. In conclusion, a spiritual education course should be considered as a regular course in the nursing curriculum, which could improve students' spiritual competencies, individual spiritual growth, and the ability to care for patients.

Conflict and interactions on interdisciplinary nursing student teams: The moderating effects of spontaneous communication.

BACKGROUND: Recently, empirical researchers have observed direct associations between conflict and interaction behaviors within organizational teams. However, research concerning indirect links between conflict and interaction behaviors on interdisciplinary teams in nursing school is scant, particularly in Taiwan. OBJECTIVES: The aim of this study was to explore the relationships among various types of conflict and interaction behaviors on interdisciplinary nursing education teams. DESIGN, SETTING, AND PARTICIPANTS: This study utilized a cross-sectional, quantitative, descriptive design. The authors collected survey data from 99 nursing students who participated in 18-week capstone courses of small interdisciplinary groups collaborating to design healthcare products in Taiwan during 2018 and 2019. METHODS: Questionnaires assessed the nursing students' perceptions about their teams' conflicts (of task, process, and relationship), and interaction behaviors (constructive controversy, helping behaviors, and spontaneous communication). The authors used descriptive statistics to compare demographics, conflict scores, and interaction behavior scores for collocated and distributed interdisciplinary teams. A Pearson's analysis identified correlations among the variables and their components, and the SPSS PROCESS macro showed moderating effects of spontaneous communication on the relationship between distributed team and conflict subscales. RESULTS: After confirming the distributed team experienced significantly more conflict than the collocated team, we found significant negative correlations between constructive controversy and both process conflict and relationship conflict on the distributed team. Another interaction behavior, spontaneous communication, had a moderating effect on the relationships between the distributed team and both task conflict and relationship conflict. CONCLUSION: In interdisciplinary educational settings for nursing students, spontaneous communication may moderate the types of conflict that distributed teams are more likely than collocated teams to experience. Constructive controversy may be especially effective at mitigating conflict on distributed teams. Nursing educators may refer to these insights to improve outcomes for educational interdisciplinary healthcare teams.

Workplace Violence Against Emergency Nurses in Taiwan: A Cross-Sectional Study.

INTRODUCTION: Workplace violence against emergency nurses is common worldwide. This study aimed to gain a more thorough overview of the point prevalence of workplace violence against emergency nurses and the preventive measures used in emergency departments in Taiwan. METHODS: In this multicenter, descriptive, cross-sectional study, the questionnaire, Violence Against Nurses Working in Emergency Departments, was used to collect data from 407 nurses working at 5 emergency departments in Taiwan from May to October 2015. RESULTS: The results revealed that 378 emergency nurses (92.9%) experienced workplace violence over the last 2 years. The average visual analog scale score (1-10) of security effectiveness in preventing workplace violence was 5.0 (SD = 1.97). The average visual analog scale score of perceived safety level in terms of workplace violence was 4.38 (SD = 2.06). The average visual analog scale score of meeting nurses' needs was 5.72 (SD = 2.23). DISCUSSION: This questionnaire survey revealed that the current preventive measures for workplace violence against emergency nurses in Taiwan were not effective. The relevant measures should be improved, thereby reducing the prevalence and severity of workplace violence against emergency nurses.

Exploration of the Association Between Religious Affiliation and Attitude Toward Spiritual Care in Clinical Nurses.

BACKGROUND: Religion is an important cultural asset that is known to affect the thoughts, behaviors, and lifestyles of individuals. However, the impact of religious affiliation, religious activities, and religious beliefs on the attitudes of nurses toward providing spiritual care to their patients is an issue that has been inadequately explored. PURPOSES: The aim of this study was to explore the relationship between religion (including religious affiliation, religious activities, and religious beliefs) and attitude toward spiritual care in clinical nurses. METHODS: This study used a cross-sectional correlation study design. Six hundred nineteen nurses were included as participants. The measurements used included a questionnaire on religious affiliation, religious activities, and religious beliefs; the Spiritual Health Scale-Short Form; the Spiritual Care Attitude Scale; and a sociodemographic datasheet. The study employed hierarchical regression modeling to establish the relationships between the aspects and degrees of religious belief and practice as well as the attitudes of participants toward spiritual care. RESULTS: Most of the participants participated infrequently in religious activities. After controlling for demographic variables and spiritual health, religious belief was found to be an important factor impacting participants' attitudes toward providing spiritual care. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings indicate that religious belief is an important factor impacting the attitudes of nurses toward providing spiritual care and that the religious/spiritual beliefs of nurses may impact on their fitness to provide spiritual care to patients. Education on religion may be needed to improve the attitude of nurses toward providing spiritual care.

Family needs during critical illness in the Emergency Department: A retrospective factor analysis of data from three countries.

AIMS AND OBJECTIVES: To examine underlying factor structure of the Critical Care Family Needs Inventory-Emergency Department across three countries to identify similarities and differences. BACKGROUND: Understanding family needs assists nurses to provide family-centred care to deliver optimal outcomes for critically ill patients and their families in Emergency Departments. DESIGN: Retrospective secondary analyses of data collected in three cross-sectional surveys. METHODS: Convenience samples involved recruitment of family members accompanying a critically ill relative into four Emergency Departments in Australia (2), South Africa (1) and Taiwan (1). Item-matched raw data from 374 responses to 40 items from the surveys were collated and analysed using confirmatory factor analysis methods. Reporting adhered to an adapted STROBE checklist. RESULTS: The factor structure of the 40-item Critical Care Family Needs Inventory-Emergency Department differed between countries. Analyses of the Australian data revealed a four-factor solution comprised of 18 items across four categories of family need (support, communication, participation and comfort); the Taiwanese data also demonstrated a four-factor solution comprised of 13 items (support, communication, participation and comfort); alternatively, the South African data revealed a two-factor solution comprised of nine items (communication and participation). Fifteen items did not match across the countries. However, loading for four items common across all three countries was related to family participation (3) and communication (1). CONCLUSIONS: The findings suggest family members from different countries responded to Critical Care Family Needs Inventory-Emergency Department items in different ways. Consistent with concepts of family-centred care, the study identified participation and communication needs that were common across the countries. The outcomes illustrate the challenge of providing appropriate care for family members during critical illness of a relative in the ED. RELEVANCE TO CLINICAL PRACTICE: Family perceptions of important needs during critical illness in the Emergency Department differ across countries; hence, the Critical Care Family Needs Inventory-Emergency Department has limited utility. Participation and communication needs emerged as common family needs.