Effects of Case Management in Trauma Patients in Taiwan: A Randomized, Longitudinal Study.

BACKGROUND: Case management can improve trauma patient outcomes from the acute to rehabilitation phases. However, a lack of evidence on the effects of case management in trauma patients makes it difficult to translate research findings into clinical practice. OBJECTIVE: To examine the effects of case management on illness perception, coping strategies, and quality of life in trauma patients followed up to 9 months post-hospital discharge. METHODS: A four-wave longitudinal experimental design was used. Patients with traumatic injury hospitalized at a regional hospital in southern Taiwan from 2019 to 2020 were randomly assigned to a case management (experimental) or a usual care (control) group. The intervention was implemented during hospitalization with a phone call follow-up about 2 weeks post-discharge. Illness perception, coping strategies, and health-related quality-of-life perceptions were measured at baseline, 3 months, 6 months, and 9 months after discharge. Generalized estimating equations were used for analysis. RESULTS: Findings showed a significant difference in illness perception at 3 and 6 months and coping strategies used at 6 and 9 months after discharge between the two groups. No significant difference in the quality of life over time between the two groups was found. CONCLUSION: Although case management appears to help patients with traumatic injuries decrease illness perception and better cope with their injury, it did not significantly improve their quality of life 9 months after discharge. It is recommended that health care professionals develop long-term case management strategies for high-risk trauma patients.

Patient participation in healthcare activities: Nurses' and patients' perspectives in Taiwan.

Patient participation in healthcare activities is key to producing successful patient-centered care. However, little is known about both nurses' and patients' perspectives regarding patient participation in East Asia. This paper compared and contrasted perspectives of patient participation in healthcare activities between nurses and patients, using a qualitative study with a purposive sample of 39 nurses and 15 patients. A semi-structured interview was applied to focus groups for nurses, and to face-to-face interviews for patients. Content analysis was utilized to analyze the data, and common themes and subthemes were identified showing three similarities (authoritative culture, participation behaviors, and obstacles to participation), and two differences (sources of acquiring patient-related health information, and responsible party). Nurses and patients did not entirely view participation in healthcare activities congruently. Relevant clinical practices are also suggested, including respecting patients' autonomy, nurses' using layman's language for explanations, patients' understanding the meaning behind their participation behaviors, recognizing obstacles faced in enhancing patient participation with adjusted nursing workload, actively providing needed health information, and leading patients to realize that they will be responsible for their health behaviors after discharge.

Effects of simulation-based learning on nursing students' perceived competence, self-efficacy, and learning satisfaction: A repeat measurement method.

BACKGROUND: Simulation-Based Learning is beneficial to nursing education. Nevertheless, recent studies have shown a side effect of being overwhelmed by repeated exposures to simulation. Thus, how many times simulation scenarios should be provided to students remains a question for nursing faculty. OBJECTIVES: The objectives of this study were to (1) explore the changes in nursing students' perceived competence, self-efficacy, and learning satisfaction after repeated exposures to simulations, and (2) determine the acceptable frequency of SBL in the 'Integrated Care in Emergency and Critical Care' course. DESIGN: A one-group repeated measurement experimental design with self-administered questionnaires in a convenient sample of senior nursing undergraduate students was used. SETTINGS: Department of Nursing at a nonprofit university in southern Taiwan. PARTICIPANTS: Seventy-nine out of 84 senior nursing students who enrolled in the course in 2019 volunteered to complete all measurements. METHODS: After taking the baseline measurements (T0), students were exposed to 75-min simulation scenarios from Time 1 (T1) to Time 3 (T3) three weeks apart throughout the semester. Students' nursing competence, self-efficacy, and learning satisfaction were measured immediately after each exposure. Descriptive statistics, t-test and repeated measurement analysis of variance were used for data analysis. RESULTS: There were statistically significant improvements from T0 to T3 (p < .001) in nursing competence, self-efficacy, and learning satisfaction scores after repeated exposures to simulation. When comparing scores from T1 to T2 and from T2 to T3, there was no significant difference. CONCLUSION: Simulation based learning is effective in improving nursing students' perceived competence, self-efficacy, and learning satisfaction. While the primary changes occur at the first simulation effort, it is the accumulated multiple exposure experiences collectively improve students' learning outcomes. Multiple instructional strategies besides simulation are recommended to maintain nursing students' learning interests to achieve optimal learning outcomes of the course across a semester.

Testing of applicability of mutuality scale with Mexican American caregivers of older adults.

By 2050, Mexican Americans (MAs) will become the largest aged minority subgroup in the United States. Although older MAs often depend on family for care, no standard instrument is available to scale the motive for filial obligation. Building on previous work, the purpose of this study is to establish psychometric properties of the bilingual Mutuality Scale (MS) for use with MA family caregivers of older adults. A methodological design with a convenience sample is used. Through Principal Axis Factoring with Oblimin(©) rotation, a two-factor structure emerge--interaction between the caregiving dyad and reaction from the care recipient--which accounted for 63% of the variance in MS scores. Cronbach's alphas are .87 in both cases and test-retest estimates across three weeks are r = .93 and .94, respectively. Despite needing further refinement, the MS shows potential to measure the motive involved in older adult care, which may be useful in designing culturally relevant interventions for the MA population.

Effect of acculturation and mutuality on family loyalty among Mexican American caregivers of elders.

PURPOSE: Informal family care for elders is conventional in Mexican American communities despite increasing intergenerational gaps in filial values. In our study, we explored whether acculturation and dyadic mutuality, as perceived by Mexican American family caregivers, explain the caregivers' expectations of family loyalty toward elderly relatives. DESIGN: A nonexperimental, correlational design with convenience sampling was used in El Paso, Texas, from October 2007 to January 2008. METHODS: Three bilingual promotoras collected data from 193 Mexican American adult caregivers of community-dwelling elders using three scales designed for Mexican Americans: the Acculturation Rating Scale for Mexican Americans II-Short Form, the Mutuality Scale, and the Expectations of Family Loyalty of Children Toward Elderly Relatives Scale. Confirmatory factor analysis was used to analyze the data. FINDINGS: Acculturation had a marginal effect (r = .21, p < .05), but mutuality presented a strong correlation (r = .45, p < .001) with the expectations of family loyalty toward elderly relatives. There was no significant correlation between acculturation and mutuality (r = .05). CONCLUSIONS: Although Mexican American caregivers with strong Mexican orientation may have high expectations of family loyalty toward elderly relatives, mutuality exhibits more significant effects on expectations. Among Mexican Americans, mutuality between the caregiving dyad, as perceived by caregivers, may be a better predictor of filial values than caregivers' acculturation alone. CLINICAL RELEVANCE: It may be useful to incorporate the dual paradigm of acculturation and mutuality into immigrant family care for elderly relatives.

Medication administration hassles for Mexican American family caregivers of older adults.

In order to take their medications at home, elders rely increasingly on their family, but little is known about the factors influencing this task. This study explored the effects of acculturation and social exchange on the hassles that Mexican American (MA) family caregivers face in administering medication to their elders. A descriptive, correlational design, with a convenience sample of 239 MA adult caregivers of elders who were on a daily prescription that was recruited in Dallas, Texas and San Diego, California, USA, was used. The caregivers' scores on the medication administration hassles scale were significantly affected by acculturation and social exchange factors that explained 36% of the variance in the scores; the social exchange block had a larger influence than did the acculturation block. Caregiving might be an outcome of dynamic family exchange relationships between the caregiving dyad. The results can help healthcare professionals to detect potentially at-risk MA families and provide them with culturally appropriate nursing interventions.

Lessons learned in instrument pilot testing with Mexican American caregivers of elders.

Given the fast-growing Mexican American (MA) population, it is common for investigators to be pressured into using Spanish translated instruments developed for English-speaking populations. However, these translated instruments may have limited relevance for data collection without adequate assessment and vetting. The purpose of this paper is to present lessons learned from the pilot testing of instruments designed for use with Mexican Americans. Pilot testing of two instruments was conducted with 22 Mexican American family caregivers of older adults. Issues that emerged were classified into three categories-instrumentation, methodology, and demographic data. Within the area of instrumentation, six issues were identified-level of abstraction, concreteness, pronoun use, clarity, exclusiveness, and response format. Methodological concerns were focused on test-retest administration and inclusion criteria. Issues within the demographic data were concerned with marital status, country of birth, household size and income, and validity of self-rated scales. By addressing those concerns, investigators may be more likely to have culturally sensitive measures and greater generalization to relevant MA populations.

Use of the measurement of medication administration hassles with Mexican American family caregivers.

AIMS AND OBJECTIVES: This study builds on earlier work on medication administration hassles, minor daily irritants experienced by family caregivers of older relatives, by investigating the feasibility of using the Family Caregiver Medication Administration Hassles Scale (FCMAHS) for use with Mexican American caregivers. BACKGROUND: Appropriate medication administration is a critical factor in the effective management of chronic illness. When medication regimens are managed on behalf of an older care recipient, especially those with numerous medications for a variety of conditions, the caregiving task is even more complex. Relying on family support is common for older Mexican Americans. Despite this, there is little known about how Mexican Americans are handling their caregiving duties at home. DESIGN: A non-experimental methodological design was used to assess the psychometric properties of the FCMAHS with Mexican Americans, chosen because they are a rapidly growing population in the US. METHODS: A purposive sample of 239 Mexican American adult caregivers, recruited in Dallas and San Diego, completed a brief biographical survey and the version of the FCMAHS created for Mexican Americans, i.e., the FCMAHS-MA. RESULTS: Principal axis factoring with orthogonal rotation was used to extract six factors which accounted for 53% of the variance in total scores - initial information seeking, safety issues, advanced information acquisition, scheduling, daily routine and prescription filling. Reliability estimates for the factors (alpha) ranged from 0.70-0.90. Test-retest reliability across a three-week interval was r = 0.64. CONCLUSIONS: The FCMAHC-MA shows promise as a guide for future caregiving intervention studies on family medication management for older relatives; however, it would benefit from refinement in future studies. RELEVANCE TO CLINICAL PRACTICE: Understanding family caregivers' hassles with medication administration is important because these hassles can accumulate and lead to caregiver strain. Culturally relevant intervention depends on accurate measurement of the hassles experienced by these caregivers.

Psychometric tests of Expectations of Filial Piety Scale in a Mexican-American population.

AIMS AND OBJECTIVES: This paper reports the development of the Expectations of Filial Piety Scale for use with Mexican-American parents regarding expectations they have of their adult children for care and support. BACKGROUND: Earlier work by the authors demonstrated that filial piety is a cross-cultural construct that can be used with Hispanic/Latino populations. More refined development of the construct required testing with more homogeneous subsets (i.e. Mexican-Americans) within the broad designation of Hispanic/Latino adults. DESIGN: Non-experimental methodological design for field testing of the instrument's psychometric properties. METHODS: A convenient sample of 80 Mexican-American adults in California and Texas completed a brief biographical survey and field tested the Expectations of Filial Piety Scale. RESULTS: Common factor analysis with orthogonal rotation was used to extract three factors, which accounted for 58% of the variance in scale scores. These factors included: I: respect for parents (24.05%); II: honouring parents (12.5%); and III: family unity (16.56%). Overall scale reliability was 0.87 with individual factor reliability coefficients ranging from 0.74 to 0.87 and test-retest correlation was 0.73. CONCLUSIONS: The results show that the Expectations of Filial Piety Scale is an internally consistent and reliable tool for use in studies of the Mexican-American population. Mexican elders historically underuse formal services; a large portion of this population will most likely depend on support from their family members when they reach advanced ages. There is a lack of culturally sensitive instruments to measure family values in caring for older adults in Mexican-Americans. RELEVANCE TO CLINICAL PRACTICE: This scale can enable case workers and nurses in long-term care settings to assess the elder's expectations for family support accurately and compare these expectations with available family support, children's intentions to care for a dependent parent or other family member and the need for supplemental care in Mexican-American families.

Factors associated with medication hassles experienced by family caregivers of older adults.

OBJECTIVE: We wished to identify potential factors associated with medication administration hassles, daily irritants, among informal caregivers who provide long-term medication assistance to persons aged 55 or older. METHODS: A sample of 156 informal caregivers were recruited from seven states and several types of settings. The dependent variable was scores on the Family Caregiver Medication Administration Hassles Scale (FCMAHS). Independent variables included in the analyses were medication complexity; caregiver's gender, ethnicity, relationship to recipient, length of time in caregiving, education, and employment outside the home; care recipient's physical capacity and mental capacity; and whether the caregiver and care recipient live together. After preliminary analysis to reduce the number of independent variables, the remaining variables were included in a linear model (GLM procedure). Possible interactions and residuals were considered. RESULTS: Whites and Hispanics experience greater medication administration hassles than other groups, and perceived hassle intensity increases with medication complexity. Medication administration hassle scores increase with increasing education levels up to a high school degree, after which they remain consistently high. Caregivers whose care recipients have moderate levels of cognitive functioning have higher medication administration hassles scores than those whose care recipients have very high or very low cognitive functioning. CONCLUSION: The preliminary set of significant variables can be used to identify caregivers who may be at risk of experiencing medication administration hassles, increased stress, and potentially harmful events for their care recipients. PRACTICE IMPLICATIONS: Family caregivers are accepting complex caregiving responsibility for family members while receiving little or no support or assistance with caregiving hassles associated with this duty. The FCMAHS offers the means to monitor how caregivers are handling the daily irritants involved with medication administration so that educational interventions can be provided before hassles lead to more serious stress and strain.

Conceptualization and psychometric properties of the Caregiver Burden Scale in Taiwan.

Families in Taiwan bear a heavy burden in caring for their elders. This paper presents a conceptualization of caregiver burden and data on the psychometric properties of the Caregiver Burden Scale. A convenient sample of 148 Taiwanese caregivers of elders with a stroke was recruited. Factor analysis showed three factors, awareness of degeneration of both care receiver and giver; time and finance constraints and readjustment; and guilt and blame, which accounted for 55.85% of the variance; Cronbach's alpha was .92. Some aspects of caregiving unique to caregivers and issues in the measurement of burden in Taiwan are presented.

Helping family members manage medication administration hassles.

Managing the medication regimens of dependent older adults in the home is a complex issue for family caregivers. The tasks involved can include helping the older adults manage their own medications or may require involvement in the purchasing, scheduling, and administering of multiple medications for serious conditions. The hassles associated with this responsibility are now known to be associated with increased caregiver strain. In this article, we provide an overview of the body of research on medication administration hassles and offer a tool to assess family caregivers who are involved in this important aspect of care.

Effects of acculturation and social exchange on the expectations of filial piety among Hispanic/Latino parents of adult children.

This study explores the effects of acculturation and social exchange variables on the expectations of filial piety (values and beliefs about parents' care) among Hispanic/Latino parents of adult children. A convenience sample of 318 Hispanics/Latinos with adult children was assembled in Texas and North Carolina, USA, for face-to-face interviews in order to collect information about their families and to assess their expectations of filial piety by their adult children. The number of years in the USA, age, gender, the eldest child's age, and living with a person > or = 65 years of age had significant relationships to scores from a new Spanish version of the Expectations of Filial Piety Scale (EFPS). The significant variables explained 46.3% of the variance in the EFPS scores. A conceptual model that includes both acculturation and social exchange variables is a useful approach for understanding the expectations of filial piety by Hispanic/Latino parents of adult children.

Development of the Expectations of Filial Piety Scale--Spanish version.

AIMS: This paper reports the development of the Expectations of Filial Piety Scale for use with Hispanic/Latino parents regarding their expectations of care and support from their adult children. BACKGROUND: Filial piety, a term used to describe a set of family values in relation to parental care and respect, has strong cultural underpinnings. To date, there have been no measures of this construct for use with Hispanic/Latino populations. METHODS: A convenience sample of 318 Hispanic/Latino adults in North Carolina and Texas in the United States of America completed a brief biographical survey and field-tested a new Spanish version of the Expectations of Filial Piety Scale in 2003. RESULTS: Principal component factor analysis with orthogonal rotation (varimax method) was used to extract four factors, which accounted for 60% of the variance in scale scores. These factors were: I, respect for parents (23.6%); II, honouring parents (12.5%); III, supporting parents (11.9%); and IV, family unity (11.7%). Overall scale reliability was 0.82, with individual factor reliability coefficients ranging from 0.66 to 0.84. CONCLUSIONS: Increasingly, large numbers of Hispanic/Latino elders will look to their families for support as they reach advanced ages. Culturally relevant translations of family caregiving constructs, such as filial piety, will be essential nursing tools for clinical practice and in developing contemporary family caregiver research agendas.

Conceptualizing and critiquing culture in health research.

Given the growing diversity of U.S. society, the federal mandates for health research with multicultural populations, and persistent confusion about the concept of culture, the purpose of this article is to present various definitions and biases of culture as found in current nursing research. By addressing various definitions and biases, the debates can help investigators become more culturally sensitive, avoid serious pitfalls, and eventually ensure the provision of culturally competent health care. Authors familiar with concepts of culture in research recommend investigators use culture in their health research, including strengthening research designs, embedding culture into research models, using culture-sensitive instruments, employing emic perspectives, and replicating interventions across diverse and changing populations.

Love and load--the lived experience of the mother-child relationship among young adult traumatic brain-injured survivors.

This study aims to describe the meaning of the experience of the relationship between young adult traumatic brain injury (TBI) survivors and their mothers using a phenomenological approach. Informants included 9 males and 3 females who were at least 2 years post-TBI, and their mothers, who were their primary caregivers after the injury. TBI informants were 18 to 25 years of age, had motor vehicle accident-induced injury, experienced post-traumatic amnesia longer than 24 hours, and were able to participate in a verbal interview. In addition, all informants currently were living with their mothers, who also participated in this study. Survivors acquired the sense of being abnormal from various sources, including social pressures, dynamics within the family, and intrapersonal changes. Mothers adopted both positive and negative actions during the period of uncertainty and often struggled to balance protecting their children and letting them become independent. They also struggled to maintain harmonious relationships with people both inside and outside of the family. Sometimes, survivors' parents marital relationships were at risk. Health professionals should design more appropriate long-term community interventions to help TBI survivors and their families decrease the burden of injury and the resulting stress, increase survivors' self-esteem, and improve quality of life of both survivors and their families, serving as a foundation for further TBI care.

Relocation to a long-term care facility: working with patients and families before, during, and after.

Permanent relocation of a dependent older adult to a long-term care facility can occur for a number of reasons, including the need for postacute care or a higher level of care than can be provided in a less-restrictive environment, and/or the inability of family members or others to care for the individual in a noninstitutional setting. Outcomes of institutional placement may be either negative, such as the older adult experiencing relocation stress syndrome, or positive, such as improved management of chronic illnesses and reversal of functional decline. This article offers a review of the factors that predict when and where older adults will relocate for institutional long-term care, an overview of individual transitions to institutional care, and suggestions for seamless transitions during the preinstitutionalization, transitional, and postinstitutionalization phases of relocation, which are guided by a transactionist approach to stress and coping.

The role of caregiver gender and caregiver burden in nursing home placements for elderly Taiwanese survivors of stroke.

The role of caregiver gender in caregiver burden and the association between the level of caregiver burden and institutionalization of elderly stroke survivors in Taiwan were explored using a correlational, descriptive design. The convenience sample was composed of 78 male and 69 female primary caregivers of stroke survivors. Simple multiple regression and t tests were used to test the research questions. Women perceived caregiving as more burdensome than men did. Caregiver burden was most strongly associated with the characteristics of the care recipients and with institutionalization. The proposed model explained 45% and 28% of the variance in caregiver burden for male and female caregivers, respectively. It is recommended that the professional nursing role in Taiwan be expanded to include postdischarge care, respite, and home-care services to allow families to keep their elderly at home as long as possible and to provide culturally sensitive care to families that might be traumatized by having to violate ethnic Chinese cultural norms by institutionalizing family members.