The experience of eating for older nursing home residents with dysphagia: A qualitative descriptive study.

BACKGROUND: Understanding the experience of eating for nursing home residents with dysphagia is essential for developing effective and holistic compensatory intervention programmes for older adults with dysphagia. However, there is a lack of studies on the experience of eating for older adults with dysphagia, especially for individuals in Asian cultures. OBJECTIVES: This study aimed to understand the experience of eating for older nursing home residents who have difficulty swallowing (dysphagia), which is often a problem for this population. METHODS: This qualitative descriptive study recruited older nursing home residents with dysphagia from facilities in central Taiwan. Residents were recruited by purposive sampling. Data were collected through individual in-depth semistructured face-to-face interviews. Interviews were audio-recorded and transcribed interview data were analysed with content analysis. RESULTS: A total of 20 residents participated in the study; the mean age was 78.7 years (standard deviation = 8.54 years); male and female residents were equally represented. The main core theme describing the experience of eating for nursing home residents with dysphagia was irregular coughing, which often occurred spontaneously. Three subthemes described how residents responded: making adjustments to eating and swallowing, receiving assistance from NH staff and fear of eating. CONCLUSIONS: Our findings can serve as an evidence-based reference for clinical care aimed at nursing home residents with dysphagia. Support programmes that provide safe swallowing skills and emotional support for managing dysphagia are recommended. IMPLICATIONS FOR PRACTICE: Nursing home residents with dysphagia should receive interventions focussed on self-supporting care, training in swallowing skills and emotional support.

The effect of a web-based self-care instruction on symptom experience and quality of life in living liver donors: A randomized controlled trial.

Objective: Living liver donors need help to manage symptom distress and improve their quality of life. This study aims to test the effectiveness of a web-based symptom self-care instruction on symptom experience and health-related quality of life of living liver donors. Methods: This study was a randomized controlled trial. Participants were recruited from January 2019 to August 2020. Participants in the experimental group had access to a web-based symptom self-care instruction, which included text and video. The control group received routine care. The primary outcomes were symptom distress and quality of life. Results: A total of 90 living liver donors recruited in this study were assigned randomly to the web group (n = 46) and control group (n = 44). The symptom distress was significantly negatively correlated with quality of life at each data collection time. There was an interaction effect with the participants in the web group experiencing more symptom distress at three months after surgery than the control group (B = 3.616, 95% CI: 7.163-3.990, p = 0.046). There was no significant effect on the quality of life. Conclusion: Patients in the web-based self-care group had higher symptom distress than those in the control group three months after surgery, but there was no difference in quality of life. Future studies could add some interactive elements to the website and include a larger sample size. Registration: This study was registered at the Chinese Clinical Trial Registry (ChiCTR1900020518).

Anxiety, pain intensity, and decision regret of living liver donors during postoperative period.

AIM: The aim of this study was to explore and examine the relationship between anxiety, acute pain intensity, and decision regret of living liver donors in the postoperative stage. METHODS: This is a prospective correlational study. Data were collected consecutively for one year (from September 2017 to September 2018) at a medical center in northern Taiwan. Information about anxiety and acute pain intensity was collected preoperatively and on postoperative day (POD) 3 and POD 7. Satisfaction with pain management and decision regret was inquired about on POD 7. RESULTS: Data of 57 consecutive living liver donors (56.1 % male, mean age 34.12 ± 9.92 years) were analyzed. Living liver donors experienced moderate anxiety and acute pain levels in the postoperative period. The mean score of decision regret was 12.63 (range 0-60), indicating a low level of regret. The acute pain intensity decreased significantly between POD 3 and POD 7 (p < .001); however, the anxiety level slightly increased (p = .031). Older and married living liver donors had higher anxiety levels. The satisfaction level of pain management was negatively correlated with the POD 7 acute pain intensity (r = -0.26, p = .049) and decision regret (r = -0.37, p = .005), but it was positively correlated with POD 7 anxiety (r = 0.38, p = .004). CONCLUSIONS: The postoperative period was hard for living liver donors as they would experience moderate acute pain and anxiety. Although the decision regret was low, the satisfaction level of pain management would negatively affect it. Therefore, the effectiveness of pain management and anxiety management should be continually ensured in the postoperative period.

Effectiveness of laptop-based versus smartphone-based videoconferencing interaction on loneliness, depression and social support in nursing home residents: A secondary data analysis.

INTRODUCTION: The worldwide coronavirus disease 2019 pandemic re-emphasises the importance of videoconferencing in supporting interactions between nursing home residents and their family and friends. However, there is a scarcity of comparative studies on how modalities of conferencing programs impact health outcomes. The purpose of this study was to compare laptop-based with smartphone-based videoconferencing programs on nursing home residents' perceptions of loneliness, depressive symptoms and social support. METHODS: This retrospective secondary analysis used data from two previous studies on the effectiveness of videoconferencing programs (laptop-based and smartphone-based) to improve outcomes of loneliness, depressive symptoms and social support (type and source) among nursing home residents. Generalised estimating equations compared differences from baseline measures with measures at 1 and 3 months between the two groups with and without adjusting for the effects of confounding variables. RESULTS: With the exception of age, there were no differences in demographics between participants in the laptop and smartphone groups. Neither changes from baseline in mean scores for loneliness nor depressive symptoms differed between groups. However, changes in mean scores from baseline between groups were significantly greater in the smartphone-based group compared with the laptop-based group for three types of social support: informational and appraisal at 1 and 3 months; and emotional at 3 months. Changes from baseline in mean scores for social support from friends (at 1 and 3 months) and other sources (at 3 months) were also significantly greater for the smartphone group compared with the laptop group. DISCUSSION: The two modalities of videoconferencing did not differ in effects on depressive symptoms or loneliness. However, smartphones had a greater effect on the type and source of social support compared with laptops. Whether the small screen of a smartphone reduces users' anxiety and allows them to talk more on screen is worth studying.

Depression in nursing home residents and its correlation with meaning of family involvement and depression of family.

OBJECTIVES: This study aimed to investigate the relationship between depression in older nursing home residents and family caregivers' (FCGs) depressive status and reasons for involvement with residents. DESIGN: This study employed a cross-sectional design. SETTING: Eight nursing homes in northern Taiwan. PARTICIPANTS: A total of 139 older resident-FCG pairs were recruited. MEASUREMENTS: Depression was measured with the Geriatric Depression Scale-Short Form for nursing home residents and the Center for Epidemiologic Studies Depression Scale-Short Form for family members. Depression and demographic data were collected with face-to-face interviews. The meaning ascribed to caregivers' nursing home visits was calibrated using the Family Meaning of Nursing-Home Visits scale. Multiple logistic regression was used to understand the factors related to residents' depressive symptoms. RESULTS: Depressive symptoms were present in 58.3% of the nursing home residents (n = 81). Depressive status of family members (Chi-square = 1.46, p = 0.23) or family's visiting frequency (Chi-square = 1.64, p = 0.44) did not differ between residents with or without depressive symptoms. Factors associated with an increased risk of residents having depressive symptoms were age, self-perceived health status, and having a caregiver motivated to visit to assuage their guilt. CONCLUSIONS: Visiting a family member to assuage their guilt was the only caregiver variable associated with depressive symptoms for nursing home residents. This finding suggests that developing interventions to improve personal relationships between nursing home residents and family members might facilitate the emotional support of caregivers and psychological support for older nursing home residents in Taiwan.

The impact of symptom distress on health-related quality of life in liver cancer patients receiving arterial chemoembolization: the mediating role of hope.

BACKGROUND: Trans-hepatic arterial chemoembolization (TACE) is a treatment option for liver cancer patients. It can prolong patients' survival but can also cause symptom distress. Symptom distress (SDs) can directly impact quality of life (QOL) and may indirectly influence QOL by lessening hope. In this study, we wanted to explore the mediating effect of hope on the relationship between SDs and QOL among patients with liver cancer receiving TACE. METHODS: A cross-sectional study was conducted from December 20, 2017, to August 6, 2018, at a gastroenterology ward of a medical center. The participants were 92 liver cancer patients (69.6% male, mean age 67.8) who were admitted for TACE treatment. Information on SDs, hope, and QOL was collected by questionnaire on discharge day. Hayes' PROCESS model was used to test the mediating effect of hope on the relationship between SDs and QOL. RESULTS: The mean score and standard deviation (SD) of SDs, hope, and QOL were 32.08 (SD = 6.22), 27.09 (SD = 3.51), and 55.16 (SD = 17.33), respectively. SDs negatively impacts quality of life. The total effect of SDs on QOL was - 1.41 (95% confidence interval [CI]: - 1.96, - 0.86). The indirect effect via the mediation of hope was - 0.95 (95% CI: - 1.7, - 0.45). Hope partially mediated the effect of SDs on QOL. CONCLUSION: SDs after TACE is vital; it directly reduces a patient's overall QOL and can indirectly hinder it by reducing the patient's hope. In addition to symptom management, interventions that help patients maintain their hope are key to improving QOL among patients receiving TACE.

Smart clothes-assisted home-nursing care program for family caregivers of older persons with dementia and hip fracture: a mixed-methods study.

BACKGROUND: The purpose of this preliminary study was to explore whether a smart clothes-assisted home-nursing care program could benefit family caregivers and their care recipients. METHODS: Family caregivers in charge of a care recipient's living situation participated in this convergent parallel, mixed methods study. We recruited older persons with dementia (n = 7) and those discharged following hip-fracture surgery (n = 6) from neurological clinics and surgical wards of a medical center, respectively, along with their family caregivers: three spouses, eight sons, one daughter, and one daughter-in-law. Care recipients were asked to wear a smart vest at least 4 days/week for 6 months, which contained a coin-size monitor hidden in an inner pocket. Sensors installed in bedrooms and living areas received signals from the smart clothing, which were transmitted to a mobile phone app of homecare nurses, who provided caregivers with transmitted information regarding activities, emergency situations and suggestions for caregiving activities. Outcomes included changes from baseline in caregivers' preparedness and depressive symptoms collected at 1- and 3-months, which were analyzed with Friedman's non-parametric test of repeated measures with post-hoc analysis. Transcripts of face-to-face semi-structured interview data about caregivers' experiences were analyzed to identify descriptive, interpretative, and pattern codes. RESULTS: Preparedness did not change from baseline at either 1- or 3-months for family caregivers of persons with dementia. However, depressive symptoms decreased significantly at 1-month and 3-months compared with baseline, but not between 1-months and 3-months. Analysis of the interview data revealed the smart clothes program increased family caregivers' knowledge of the care recipient's situation and condition, informed healthcare providers of the care recipient's physical health and cognitive status, helped homecare nurses provide timely interventions, balanced the care recipient's exercise and safety, motivated recipients to exercise, helped family caregivers balance work and caregiving, and provided guidance for caregiving activities. CONCLUSIONS: Experiences with the smart clothes-assisted home-nursing care program directly benefited family caregivers, which provided indirect benefits to the care recipients due to the timely interventions and caregiving guidance from homecare nurses. These benefits suggest a smart-clothes-assisted program might be beneficial for all family caregivers.

Functional Status in Older Persons After Hip Fracture Surgery: A Longitudinal Study of Indonesian Patients.

BACKGROUND: Hip fractures are one of the most serious injuries affecting older adults. Evidence-based knowledge regarding the functional status of older persons after hip fracture can provide information critical for developing effective continuous-care and rehabilitation programs. PURPOSE: This study was developed to examine the post-hospital-discharge outcome measures and predictors of functional status in older adults in Indonesia after hip fracture surgery. METHODS: The functional status of 109 patients discharged from an orthopedic hospital in Indonesia after hip fracture surgery was evaluated in this prospective cohort study. Functional status was evaluated using measures of physical and independent activities of daily living (PADL and IADL, respectively) at 1, 3, and 6 months postdischarge. Predictors of changes in functional status, including age, length of hospital stay, comorbidity, prefracture walking ability, type of surgery, status of depression and nutrition, type of insurance, and residential status (urban vs. rural), were also examined. Data were analyzed using generalized estimating equations. RESULTS: Significant improvements in PADL were found at 3 and 6 months, and significant improvements in IADL were found at 6 months. Predictors of poor outcomes found in this study included age, a dependent prefracture walking ability, depression, and having public health insurance. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings of this study support the effectiveness of using presurgery assessments to identify individuals at a higher postdischarge risk of having poor PADL and IADL outcomes. Home nursing or subacute rehabilitation is recommended to improve and maintain functional status in older persons after hip fracture surgery. In addition, interventions and rehabilitation should take into consideration different recovery periods for PADL and IADL after hospital discharge after hip fracture surgery.

Sailing in a sea of perplexity: Family caregivers' experience of patients with delirium.

BACKGROUND: Family caregivers play an important role for patients admitted to the intensive care unit (ICU), and delirium is a common clinical syndrome. Little is known about the experiences of family caregivers when a relative is a patient with delirium, especially for caregivers in Asian cultures. AIMS AND OBJECTIVE: To understand the experience of family caregivers with a family member as a patient with delirium in the ICU in Taiwan. DESIGN: A descriptive qualitative study with in-depth face-to-face semi-structured interviews. METHODS: Interviews were conducted with 20 family caregivers of 20 patients with delirium in the ICU of a hospital in northern Taiwan. RESULTS: The core theme describing the phenomenon of family caregivers of a patient with delirium was "Sailing in a sea of perplexity," which described family caregivers' uncertainty of navigating the ICU and providing support for a relative. Three subthemes described the core theme: (a) perplexity of the ICU environment, (b) perplexity of making decisions, and (c) perplexity of Chinese cultural constraints. CONCLUSION: "Sailing in a sea of perplexity" underscores how uncertainty among family caregivers of patients with delirium in ICUs can lead to feelings of fear and anxiety. Therefore, nursing professionals should not only focus on patient care but also be sensitive to caregivers' feelings of uncertainty and their cultural beliefs. RELEVANCE TO CLINICAL PRACTICE: Unfamiliarity and lack of knowledge about intensive care and patient treatments were a source of family caregivers' perplexity. To reduce uncertainty, we recommend increased communication between staff and caregivers. Hospitals can also provide information on their websites, including treatment of delirium and visitation hours. Information access could be enhanced by developing a smartphone app linked to a QR code that families can scan to obtain information, which would be useful during restricted visitation.

Motivations for Family Members' Visits to Nursing Home Residents With Dementia in Taiwan: A Qualitative Study.

PURPOSE: The purpose of this study was to explore what motivates family members to visit a relative with dementia who has been transferred to a nursing home in Taiwan. DESIGN AND METHODS: Data were collected for this qualitative descriptive study using audiotaped, semi-structured, in-depth, face-to-face interviews. A total of 20 family members of elderly nursing home residents participated in the study. Nursing home residents were from four nursing homes in Taiwan and had been diagnosed with probable or possible dementia by a psychiatrist or neurologist. Transcribed audiotaped interviews were analyzed using thematic analysis. FINDINGS: Most family members were the children of the residents (n =17, 85%). The theme describing the core motivation for family members' visits to nursing home residents was "to maintain the unforgotten family affection." This motivation comprised four relevant categories: hoping to slow degeneration, providing a congruous environment, honoring filial and karmic duty, and ensuring the quality of care. CONCLUSIONS: Motivations for Taiwanese family members' visits to nursing home residents with dementia were similar to those in Western cultures. However, "hoping to slow degeneration" and "providing a congruous environment" were unique categories. CLINICAL RELEVANCE: Nurses and policymakers could use these findings to design interventions that might increase holistic care for both family members and nursing home residents with dementia. Providing programming focused on family members' unique priorities could address swallowing difficulties, management of dementia symptoms, nutritional needs, and selection of residents' roommates. These programs could improve the quality of family members' visits as well as the quality of staff-family relationships.

Rethinking potentially inappropriate medication use in nursing homes within the Chinese population.

This study aimed to understand the prevalence of Chinese medicine and other potentially inappropriate medications and to examine if there are relationships with emergency room visits, hospital admissions, and falls in a Chinese nursing home population. This cross-sectional descriptive study was a secondary analysis of data from 531 nursing home residents in Taiwan. Cox proportional hazard regression models were used in the analysis. Use of Chinese medicine in combination with Western medicine was observed in approximately 1% of residents. For every additional Chinese medicine used, the hazard ratio was 3.09 (p=.26) for emergency room visits and 3.22 (p=.21) for hospital admissions. For every additional nonsteroidal antiinflammatory agent used, the hazard ratio for falls was 5.42 (p=.006). Further studies with larger sample sizes are required to understand the appropriate time intervals required between administration of Chinese and Western medicine as well as to understand the drug-drug interactions.

"Tailoring homely meals": Family members' motivations underlying nursing home visits during residents' meals.

AIM: Elderly nursing home residents are often malnourished or at risk of malnutrition. Family members often visit residents during mealtimes, which might be an ideal opportunity for interventions targeted at improving the nutritional status of older residents. Therefore, this study aimed to explore motivations behind family member visits with nursing home residents during mealtime in Taiwan. METHODS: This phenomenological study was conducted with family members of residents from four nursing homes in Taiwan. Participants were purposively sampled. Data were collected with individual face-to-face interviews from 18 family members. Data from transcribed audio-recorded interviews were analyzed using the approach of van Manen. RESULTS: Analysis of the interview data identified the essence of motivations underlying family members' visits to nursing home residents during mealtimes, which we termed "tailoring homely meals." This referred to providing food tailored to residents' needs, providing a comforting family atmosphere, assisting residents during mealtime, and monitoring food consumption. CONCLUSIONS: The motivations of family members to visit during mealtime could guide healthcare professionals working with East Asian populations in developing interventions to reduce the possibility of malnutrition, while also improving their quality of life. We recommend providing the following for nursing home residents: a nutritious and balanced diet, supporting their independence and ability to feed themselves, and encouraging involvement of family members during mealtimes.

Effects of a smartphone-based videoconferencing program for older nursing home residents on depression, loneliness, and quality of life: a quasi-experimental study.

BACKGROUND: Smartphones can optimize the opportunities for interactions between nursing home residents and their families. However, the effectiveness of smartphone-based videoconferencing programs in enhancing emotional status and quality of life has not been explored. The purpose of this study was to evaluate of the effect of a smartphone-based videoconferencing program on nursing home residents' feelings of loneliness, depressive symptoms and quality of life. METHODS: This study used a quasi-experimental research design. Older residents from seven nursing homes in Taiwan participated in this study. Nursing homes (NH) were randomly selected as sites for either the intervention group (5 NH) or the control group (2 NH); NH residents who met the inclusion criteria were invited to participate. The intervention group was comprised of 32 participants; the control group was comprised of 30 participants. The intervention group interacted with their family members once a week for 6 months using a smartphone and a "LINE" application (app). Data were collected with self-report instruments: subjective feelings of loneliness, using the University of California Los Angeles Loneliness Scale; depressive symptoms, using the Geriatric Depression Scale; and quality of life using the SF-36. Data were collected at four time points (baseline, and at 1-month, 3-months and 6-months from baseline). Data were analysed using the generalized estimating equation approach. RESULTS: After the intervention, as compared to those in the control group, participants in interventional group had significant decreases in baseline loneliness scores at 1 months (ß = - 3.41, p < 0.001), 3 months (ß = - 5.96, p < 0.001), and 6 months (ß = - 7.50, p < 0.001), and improvements in physical role (ß = 36.49, p = 0.01), vitality (ß = 13.11, p < 0.001) and pain scores (ß = 16.71, p = 0.01) at 6 months. However, changes in mean depression scores did not significantly differ between groups. CONCLUSIONS: Smartphone-based videoconferencing effectively improved residents' feelings of loneliness, and physiological health, vitality and pain, but not depressive symptoms. Future investigations might evaluate the effectiveness of other media-based technologies in nursing homes as well as their effectiveness within and between different age cohorts.

Pain Quality by Location in Outpatients with Cancer.

BACKGROUND: The McGill Pain Questionnaire (MPQ) pain quality descriptors have been analyzed to characterize the sensory, affective, and evaluative domains of pain, but have not been differentiated by pain location. AIM: To examine MPQ pain quality descriptors by pain location in outpatients with lung or prostate cancer. DESIGN: Cross sectional. SETTINGS: Eleven oncology clinics or patients' homes. SUBJECTS: 264 adult outpatients (80% male; mean age 62.2 ± 10.0 years, 85% White). METHODS: Subjects completed a 100 mm visual analogue scale of pain intensity and MPQ clinic or home visit, marking sites where they had pain on a body outline and circling from 78 verbal descriptors those that described their pain. A researcher noted next to the descriptor spontaneous comments about sites feeling like a selected word and queried the subjects about any other words to obtain the site(s). RESULTS: Pain quality descriptors were assigned to all 7 pain locations marked by ≥ 20% of 198 lung or 66 prostate cancer patients. Four pain locations were marked with pain quality descriptors significanlty (p < .05) more frequently for lung cancer (53% chest-aching, burning; 58% back-aching, stabbing; 48% head-aching, sharp; and 19% arms-aching, stabbing) than for prostate cancer, which had significantly more frequent pain locations in the abdomen (64%-aching, burning) and lower back/buttocks (55%-aching, burning). CONCLUSIONS: This type of pain characterization is innovative and has the potential to help implement targeted treatments for patients with cancer and other chronic pain conditions.

Development, validation and testing of a nursing home to emergency room transfer checklist.

AIMS AND OBJECTIVES: To develop and test the feasibility of an instrument to support patients' nursing home to emergency room transfer. BACKGROUND: Transfers from a nursing home care facility to an acute care facility such as a hospital emergency room are common. However, the prevalence of an information gap for transferring residents' health data to acute care facility is high. An evidence-based transfer instrument, which could fill this gap, is lacking. DESIGN: Development of a nursing home to emergency room transfer checklist, validation of items using the Delphi method and testing the feasibility and benefits of using the nursing home to emergency room transfer checklist. METHODS: Items were developed based on qualitative data from previous research. Delphi validation, retrospective chart review (baseline data) and a 6-month prospective study design were applied to test the feasibility of using the checklist. Variables for testing the feasibility of the checklist included residents' 30-day readmission rate and length of hospital stay. RESULTS: Development of the nursing home to emergency room transfer checklist resulted in four main parts: (i) demographic data of the nursing home resident; (ii) critical data for nursing home to emergency room transfer; (iii) contact information and (iv) critical data for emergency room to nursing home transfer. Two rounds of Delphi validation resulted in a mean score (standard deviation) ranging from 4.39 (1.13)-4.98 (.15). Time required to complete the checklist was 3-5 min. Use of the nursing home to emergency room transfer checklist resulted in a 30-day readmission rate of 13.4%, which was lower than the baseline rate of 15.9%. CONCLUSIONS: The nursing home to emergency room transfer checklist was developed for transferring nursing home residents to an emergency room. The instrument was found to be an effective tool for this process. RELEVANCE TO CLINICAL PRACTICE: Use of the nursing home to emergency room transfer checklist for nursing home transfers could fill the information gap that exists when transferring older adults between facilities such as nursing homes and hospitals.

Predictors of decision ambivalence and the differences between actual living liver donors and potential living liver donors.

BACKGROUND: The decision to become a living liver donor is a stressful event. Ambivalence in decision making may result in psychological distress. Thus, the purpose of this study was to provide a description of the ambivalence of potential living liver donors, to examine the predictors of ambivalence, and to compare the ambivalence of potential living liver donors with that of actual living liver donors. METHODS: This descriptive and correlational study was conducted in a medical center from August 2013 to December 2015. Self-reported questionnaires were used to collect data. A total of 263 potential living liver donors who were assessed for donation to their parents were included in this study. RESULTS: The mean age of the total sample was 30.7 years (SD = 6.39, range = 20-47), and males comprised 53.6% of the sample. The majority of the potential donors had a college education (70.8%) and were single (63.5%). Of the total sample, the mean score for ambivalence was 4.27 (SD = 1.87, range = 0-7). Multivariate analysis revealed that the Mental Component Summary (MCS) of quality of life (ß = -0.24, p < 0.01), family support (ß = -0.17, p = 0.007), and intimacy (ß = -0.13, p = 0.04) were significant protective predictors of ambivalence. Actual living liver donors had significantly lower ambivalence (3.82 versus 4.60), higher intimacy with recipients (3.55 versus 3.34), higher MCS (45.26 versus 42.80), and higher family support (34.39 versus 29.79) than did the remaining potential living liver donors. CONCLUSION: Ambivalence is common in potential living liver donors. The MCS of quality of life, family support, and intimacy were protective predictors in terms of ambivalence. Future research should explore other factors and design interventions targeted toward reducing ambivalence, promoting family support, and enhancing the mental dimensions of quality of life in potential living liver donors.

Development and psychometric testing of the triggers of Suicidal Ideation Inventory for assessing older outpatients in primary care settings.

OBJECTIVE: The purpose of this study was to develop an instrument for assessing triggers of suicidal ideation among older outpatients and determine its psychometrics. METHOD: Participants were recruited from older outpatients of two hospitals in northern Taiwan. The 34-item Triggers of Suicidal Ideation Inventory (TSII) was developed, and its items were validated by experts in two runs of Delphi technique survey. Pre-testing this TSII in 200 older outpatients resulted in a 12-item TSII, with three items not considered triggers but suggesting the need for further psychiatric assessment. The 9-item TSII was examined by criterion validity, construct validity, internal consistency reliability, and test-retest reliability. RESULTS: Factor analysis of the final version of TSII yielded a three-factor solution, accounting for 68.75% of the variance. Participants with depressive tendency tended to have higher TSII scores than participants with no depressive tendency (t = 8.62, p < 0.01), indicating good construct validity. TSII scores were significantly and positively correlated with Beck Scale for Suicide Ideation (r = 0.45, p < 0.01) and UCLA Loneliness (r = 0.55, p < 0.01) scores, indicating satisfactory criterion validity. The TSII had Cronbach's α and intraclass correlation coefficient of 0.70 and 0.99, respectively, indicating acceptable internal consistency reliability and excellent test-retest reliability. Receiver operating characteristic analysis revealed an area under the curve of 0.82, indicating excellent ability to detect triggers of suicidal ideation. With a cutoff point of 2, the sensitivity and specificity were 0.76 and 0.69, respectively. CONCLUSIONS: The TSII can be completed in 5 min, is perceived as easy to complete, and yielded highly acceptable parameters of validity and reliability. Copyright © 2016 John Wiley & Sons, Ltd.

Advance directives and mortality rates among nursing home residents in Taiwan: A retrospective, longitudinal study.

BACKGROUND: No data-based evidence is available regarding the best time for nursing home nurses to obtain residents' signatures on advance directives, especially for do-not-resuscitate directives, the most common type of advance directive. This information is needed to enhance the low prevalence of advance directives in Asian countries. OBJECTIVES: The purposes of this study were to understand (1) the timing between nursing home admission and signing a do-not-resuscitate directive, (2) the factors related to having a do-not-resuscitate directive, and (3) the association between having a do-not-resuscitate directive and nursing home residents' mortality in Taiwan. DESIGN: Retrospective, longitudinal design. SETTING: Six nursing homes in Taiwan. PARTICIPANTS: Nursing home residents (N=563). METHODS: Data were collected by retrospective chart review with 1-year follow-up. Factors related to having a do-not-resuscitate directive were analyzed by multiple logistic regression, while associations between signing a do-not-resuscitate directive (resuscitation preference) and mortality were examined by Cox proportional hazard regression models. RESULTS: The mean interval between nursing home admission and signing a do-not-resuscitate directive was 840.65days (2.30 years), which was longer than the time from admission to first transfer to hospital (742.4days). Having a do-not-resuscitate directive was related to whether the resident had a nasogastric tube (odds=2.57) and the number of transfers to hospital (odds=1.18). Among the 563 residents, 55 (9.77%) had died at the 1-year follow-up. Having a do-not-resuscitate directive was associated with a greater risk of death (unadjusted hazard ratio, 2.03; 95% confidence interval, 1.10-3.98; p=0.02), but this risk did not persist after adjusting for age (hazard ratio, 1.89; 95% confidence interval, 0.99-3.59; p=0.05). CONCLUSION: Early research recommendations to sign an advance directive, particularly a do-not-resuscitate order, on nursing home admission may not be the best time for Chinese nursing home residents. Our results suggest that the best time to sign a do-not-resuscitate directive is as early as possible and no later than 2 years (742days) after admission if residents had not already done so. Residents on nasogastric tube feeding should be particularly targeted for discussions about do-not-resuscitate directives.

Repeated Hospital Transfers and Associated Outcomes by Residency Time Among Nursing Home Residents in Taiwan.

BACKGROUND: Nursing home residents' repeated transfers to hospital are costly and can lead to in-hospital complications and high mortality for frail residents. However, no research has examined the trajectory of residents' symptoms over their nursing home residency and its relationship to hospital transfer. AIM: The purpose of this retrospective chart-review study was to examine associations between nursing home residents' characteristics, including length of residency, and repeated hospital transfers as well as the trajectory of transfers during residency. DESIGN: For this retrospective study, we reviewed 583 residents' charts in 6 randomly selected nursing homes from northern Taiwan. Data were analyzed by descriptive statistics, chi-squared tests, and 1-way analysis of variance. RESULTS: About half of nursing home residents who had been transferred to hospital (n = 320) were transferred more than twice during their residency (50.97%). Residents who had been transferred 1, 2, 3, or ≥4 times differed significantly in length of residency (F = 3.85, P = .01), physical status (F = 2.65, P = .05), medical history of pneumonia (χ2 = 13.03, P = .01), and fractures (χ2 = 8.52, P = .04). Residents with different numbers of transfers differed significantly in their reasons for transfer, that is, falls (χ2 = 13.01, P = .01) and tube problems (χ2 = 8.87, P = .03). Among 705 total transfers, fever was the top reason for transfer, and transfer prevalence increased with nursing home residency. CONCLUSION: To decrease the chance of residents' hospital transfer, nursing home staff should be educated about recognizing and managing fever symptoms, infection-control programs such as influenza vaccination should be initiated, and fall-prevention/education programs should be started when residents first relocate to nursing homes.

Nursing home nurses' experiences of resident transfers to the emergency department: no empathy for our work environment difficulties.

AIMS AND OBJECTIVES: To explore the experiences of nursing home nurses when they transfer residents from nursing homes to the emergency department in Taiwan. BACKGROUND: The transfer of residents between nursing homes and emergency departments challenges continuity of care. Understanding nursing home nurses' experiences during these transfers may help to improve residents' continuity of care. However, few empirical data are available on these nurses' transfer experiences worldwide, and none could be found in Asian countries. DESIGN: Qualitative descriptive study. METHODS: Data were collected from August 2012-June 2013 in audiotaped, individual, in-depth interviews with 25 nurses at five nursing homes in Taiwan. Interview transcripts were analysed by constant comparative analysis. RESULTS: Analysis of interview transcripts revealed that the core theme of nursing home nurses' transfer experience was discontinuity in nursing home to emergency department transitions. This core theme comprised three themes: discontinuity in family involvement, discontinuity in medical resources and expectations, and discontinuity in nurses' professional role. CONCLUSIONS: Nursing home nurses need a working environment that is better connected to residents' family members and more immediate and/or easier access to acute care for residents. Communication between nurses and residents' family could be improved by using text messages or social media by mobile phones, which are widely used in Taiwan and worldwide. To improve access to acute care, we suggest developing a real-time telehealth transfer system tailored to the medical culture and policies of each country. This system should facilitate communication among nursing home staff, family members and hospital staff. RELEVANCE TO CLINICAL PRACTICE: Our findings on nurses' experiences during transfer of nursing home residents to the emergency department can be used to design more effective transfer policies such as telemedicine systems in Taiwan and other Asian countries or in those with large populations of Chinese immigrants.