[Testing Effectiveness of Localized Cognitive Stimulation Training With Musical Rhythm Courses Among Older People in Day Care Centers: A Pilot Study].

BACKGROUND: Staff caregivers of day care centers provide many activities for older people. However, there is a lack of a systematic curriculum based on Taiwanese culture to improve cognitive function, self-care ability, and depressive mood status in these individuals. PURPOSE: This study was designed to test the effectiveness of a series of localized cognitive stimulation training courses implemented by direct caregivers and aimed at improving cognitive function, self-care ability, and depressive mood in older people at day care centers. METHODS: This cluster-randomized controlled trial research was conducted over a four-month period. The participants were randomly assigned to the experimental, comparison, or control groups based on their day care center affiliation. The experimental group received a series of localized cognitive stimulation training sessions with musical rhythm courses from day care center direct caregivers. The cognitive function, self-care ability, and depression mood state of the three groups were then tested. RESULTS: The experimental group reported statistically significant changes in average scores for attention, feeding, and depressive mood. After controlling for time and degree of participation in activities, the comparison group reported a lower average score for cognitive function at timepoint 3. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results of this study support caregivers at day care centers implementing a series of localized cognitive stimulation training course interventions to prevent declines in activities of daily living and cognitive function and ameliorate depressive mood in older adults. In the future, a larger sample size should be used to improve the effectiveness of the intervention.

A Feasibility Evaluation of the Need-Centered Watch-Assess-Need Intervention-Think Education and Training Program for Behavioral and Psychological Symptoms of Dementia.

BACKGROUND: Despite the high prevalence of dementia among residents living in long-term care facilities in Taiwan, most care providers in these facilities have not received adequate training to deal with the behavioral and psychological symptoms of dementia (BPSD). An original care and management model for BPSD has been developed, and model-based recommendations for an education and training program have been made. However, empirical testing has not yet been conducted to determine the efficacy of this program. PURPOSE: This study was designed to evaluate the feasibility of using the Watch-Assess-Need intervention-Think (WANT) education and training program for BPSD in long-term care settings. METHODS: A mixed-method design was used. Twenty care providers and 20 corresponding care receivers (residents with dementia) from a nursing home in southern Taiwan were enrolled. Data were collected using a variety of measurement tools, including the Cohen-Mansfield Agitation Inventory, Cornell Scale for Depression in Dementia, Attitude towards Dementia Care Scale, and Dementia Behavior Disturbance Self-efficacy Scale. Qualitative data, including care-provider perspectives on the efficacy of the WANT education and training program, were also collected. Repeated measures were conducted on the results of quantitative data analysis, whereas content analysis was performed on the results of qualitative data analysis. RESULTS: Findings indicate that the program relieves agitated behavior (p = .01), alleviates depression in those with dementia (p < .001), and enhances care-provider attitudes toward dementia care (p = .01). However, no significant improvement was found in self-efficacy among the care providers (p = .11). In terms of qualitative outcomes, care providers indicated they perceived improved self-efficacy in managing BPSD, improved ability to view problems from a more need-centered perspective, improved attitudes toward dementia and patients' BPSD, and decreased care burden and stress. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The study found the WANT education and training program to be feasible in clinical practice. Because of this program's simple and easy-to-remember characteristics, it is recommended that it be vigorously promoted to care providers in both long-term institutional and home care settings to help them effectively address the BPSD.

Effectiveness of a Problem-Based Geropsychiatric Nursing Clinical Internship Program.

Clinical internships that effectively incorporate the care of older adults with mental health disorders are sparse in many countries, including Taiwan. This study investigated the effectiveness of a problem-based geropsychiatric clinical internship program for nursing students in Taiwan. We conducted a quasi-experimental study among 126 nursing students. Experimental and control groups received problem-based geropsychiatric and general psychiatric practice sessions, respectively. Knowledge, attitude, skills, and self-reflection were evaluated before (T1) and after (T2) measurements. There were no significant differences between the groups in knowledge, attitude, skills, and self-reflection at T1. At T2, knowledge was significantly higher in the experimental group (t = 2.39, p = 0.02). Attitude, skills, and self-reflection ability did not differ between the groups at T2. Our results showed that clinical problem-based approaches can be applied in geropsychiatric mental health nursing internship programs. The problem-based approach was helpful in improving nursing students' knowledge about psychiatric symptoms and the health problems of older adults with mental illness. However, it did not significantly enhance or change the attitudes, skills, or the ability to self-reflect among students.

Empowerment of frail institutionalized older people for self-care: from administrators' and staff caregivers' perspectives.

PURPOSE: To investigate the perspectives of administrators and staff caregivers in empowering older people living in long-term care facilities to improve self-care abilities. METHODS: A phenomenology research design was employed to generate data. The purposive sampling method was used to recruit administrator (n = 7) and staff caregiver groups (n =11). Data were collected via face-to-face interviews, observations, and daily recording. The data were then analyzed via content analysis. RESULTS: The results showed that two elements were of critical importance: professional supports and teamwork. The following professional supports activities were found of positive impacts: allowing residents to perform self-care and improving their mood status. The teamwork was developed via a partnership between staff and family caregivers, and preventing and resolving conflicts in the workplace. CONCLUSION: The teamwork could not only reduce the burdens of both staff and family caregivers, but also improve the quality of life and the capacity of older residents. Thus, residents, staffs and family caregivers should work as a team and support older people to perform self-care.

Constant Daily Exercise to Keep the Doctor Away: A Study of Adherence to Physical Exercise Using a Gym in Individuals Older Than 55 Years.

The purpose of this study was to examine the role of using a gym as a mechanism for adherence to regular physical exercise among individuals with aged 55 and over. This was a grounded theory research design. Data were collected from face-to-face interviews and observations among 15 people who attended the gym regularly and then analysed via content analysis. Three categories emerged from the present study regarding the adherence to regular physical exercise: (1) meaningful starting points, (2) reinforcement by motivators, and (3) adherence through positive changes. Results of this study can help health policymakers, managers of gyms/fitness centres, and gym instructors to design and implement programs.

[Applying the ATDE Model to the Teaching of Nursing Innovative Works].

Cultivating the ability of students to think creatively is a goal of nursing education. Combining creative-thinking training with the innovative work of nurses is a great challenge for nursing educators. This article uses Dr. Chen Lung-An's ATDE model of creative-thinking teaching strategies (asking, thinking, doing, and evaluation) as a framework to guide learners to use existing knowledge and experiences in group communication and cooperation. Teachers create a friendly and supportive discussion environment and lead nursing students to apply creative thinking to complete innovative works. Subsequently, students are encouraged to participate in school-based innovation competitions and then to obtain domestic utility-model patents. This article shares the author's experience teaching nursing innovative works in order to provide a reference to educators who teach related courses / curriculums.

Effect of music care on depression and behavioral problems in elderly people with dementia in Taiwan: a quasi-experimental, longitudinal study.

OBJECTIVES: The purpose was to examine the effectiveness of music care on cognitive function, depression, and behavioral problems among elderly people with dementia in long-term care facilities in Taiwan. METHODS: The study had a quasi-experimental, longitudinal research design and used two groups of subjects. Subjects were not randomly assigned to experimental group (n = 90) or comparison group (n = 56). Based on Bandura's social cognition theory, subjects in the experimental group received Kagayashiki music care (KMC) twice per week for 24 weeks. Subjects in the comparison group were provided with activities as usual. RESULTS: Results found, using the control score of the Clifton Assessment Procedures for the Elderly Behavior Rating Scale (baseline) and time of attending KMC activities as a covariate, the two groups of subjects had statistically significant differences in the mini-mental state examination (MMSE). Results also showed that, using the control score of the Cornell Scale for Depression in Dementia (baseline) and MMSE (baseline) as a covariate, the two groups of subjects had statistically significant differences in the Clifton Assessment Procedures for the Elderly Behavior Rating Scale. CONCLUSION: These findings provide information for staff caregivers in long-term care facilities to develop a non-invasive care model for elderly people with dementia to deal with depression, anxiety, and behavioral problems.

Reciprocity of service learning among students and paired residents in long-term care facilities.

Many intergenerational service learning projects have been designed for service providers and recipients, few studies have analyzed the providers and recipients of such projects in terms of caring behavior. In accordance with the Taiwan Ministry of Education initiative to develop curricular service learning, a service learning project was initiated during a nursing school course before the students performed their clinical practicum. The aim of this mixed method design was to report the development of an intergenerational service learning project and to test its effects both on nursing students paired with residents and residents of facilities. A pre-and post-test with non-randomized control group design was used to evaluate the effects of the project on caring perceived by the residents, and a one-group pre- and post-test design was used to test its effects among nursing students. The analysis included valid questionnaires received from 59 eligible residents and 210 nursing stu`dents. The 20-hour project included pre-service training, service, and an end-of-project presentation. At post-test, the residents showed that perceived caring significantly differed between the intervention group and the control group (F=8.99; p=.004). Paired t test analysis of nursing students also showed significant increases in both caring and attitude scores after the project (t=8.56; p=.000; t=6.35; p=.000). The project significantly affected the caring perceived by the residents and the achievements of the junior nursing students. This experimental study provides information of interest to nursing educators, long-term care administrators, and researchers in elderly care.

Perspective of family caregivers on self-care independence among older people living in long-term care facilities: a qualitative study.

BACKGROUND: Long-term care facilities have difficulty facilitating elders' independent self-care. Promoting self-care independence among residents of long-term care facilities cannot be ignored and needs to be further understood. OBJECTIVES: To investigate how family caregivers' perceived building self-care independence among elders living in long-term care facilities. DESIGN: This study used a qualitative descriptive approach. The data were collected through face-to-face interviews with 44 elders' family caregivers. SETTINGS: The data was collected from family caregivers of elders living in long-term care facilities in southern Taiwan. PARTICIPANTS: Eligibility criteria for family-caregivers were: (1) residents' family members living in community settings, (2) able to speak Mandarin or Taiwanese, (3) willing to be tape-recorded during interviews, and (4) aged 18 and over. RESULTS: The findings showed that three interrelated factors promoted self-care independence among residents in long-term care facilities. They included: (1) family members' attitudes/behaviors and concerns, (2) residents' characteristics and attitudes, and (3) staff's attitudes/behaviors. Hence, to promote elders' self-care independence, family caregivers indicated that staff, family caregivers and elders should work together. This included: setting goals, building trustful relationships between staff and family caregivers, and routinely reporting the elder's condition to families. CONCLUSION: This study provided important information that, elders, family members, and staff caregivers of long-term care facilities should build a partnership and set a mutual goal, to improve self-care performance among residents in long-term care facilities.

The effectiveness of an exercise programme for elders with dementia in a Taiwanese day-care centre.

The purpose was to examine the effectiveness of an exercise programme for elders with dementia in Taiwan aimed to maintain their activities of daily living such as feeding, dressing, grooming, washing and toileting. This was a single study group, repeated measure research design. Twenty-six dementia elders were recruited from a day-care centre located in southern Taiwan. Caregivers of the day-care centre provided all subjects an exercise programme. The exercise programme consisted of stretching and walking five times per week, and leg-weight bearing at least three times per week for 20-30 min each. The data were obtained three times (baseline, 2 months post intervention and 4 months post intervention). Results showed slight changes in the scores of one-leg-standing, 30 s chair rise, functional reach and get up and go test but were not statistically significant. Results also indicated that scores in the performance of activities of daily living were significantly higher than at baseline and at 4 months post intervention. In conclusion, this study provides information for dementia day-care centres in Taiwan about how elders with dementia can maintain physical fitness and perform activities of daily living.

Effectiveness of transcutaneous electrical acupoint stimulation for improving depressive mood status among nursing home elders in Taiwan: a pilot study.

The purpose of this study was to test the effectiveness of transcutaneous electrical acupoint stimulation (TEAS) to improve depressive mood status among elders in a nursing home in Taiwan. This was an experimental, pre- and posttest study with 2 groups. Nine subjects in the experimental group received TEAS for 15 minutes, 5 times a week for 1 month. Seven subjects in the control group received social visits for 15 minutes, 5 times a week for 1 month. Results indicated that the posttest depression scores significantly differed between the 2 groups. Subjects in the experimental group showed a statistically significant improvement in depressive mood status, but changes in the depressive mood status of subjects in the comparison group were not statistically significant. In conclusion, TEAS can be a safe, easy, and noninvasive technique for nursing home staff to improve the depressive mood status of elders.

Enhancing three bliss concepts among nursing home elders in Taiwan.

AIMS: The purpose was to examine the effectiveness of the self-care self-efficacy enhancement programme (SCSEEP) to improve the three bliss concepts, life satisfaction, self-esteem and motivation in health behaviours, among Taiwanese nursing home elders. BACKGROUND: Promoting self-care is the most effective means for Chinese elders to achieve happiness and bliss. No studies have examined how to enhance bliss by improving self-care ability in older nursing home residents in Taiwan. DESIGN: This study used an experimental, longitudinal research design. The 101 subjects were recruited and randomly assigned to an experimental group (n = 55) and a comparison group (n = 46). METHODS: Subjects in the experimental group received the SCSEEP. Programme from nursing home staff. Subjects in the comparison group received care as usual. The programme was implemented immediately after staff received a SCSEEP. The training programme was based partly on the SCSEEP developed by the principal investigator. Activities used in the SCSEEP included performance accomplishment, vicarious experiences and verbal persuasion. FINDINGS: Results found that there was a significant positive correlation between life satisfaction and ADL performance (p = 0.019), self-esteem and ADL performance (p < 0.001) as well as levels of ADL performance and motivation in health behaviour (p = 0.003). Additionally, the repeated measures design revealed a significant difference between scores on four tests of life satisfaction (LS) (p < 0.001), self-esteem (p < 0.001) and motivation in health behaviours (p < 0.001) in two groups of subjects. CONCLUSIONS: The SCSEEP is valuable to prevent decline in life satisfaction, self-esteem and motivation in health behaviours among Taiwanese nursing home elders. RELEVANCE TO CLINICAL PRACTICE: The SCSEEP provides nursing home staff a series of interventions to improve self-care ability of Chinese nursing home which in turn enhances the three bliss concept.

Beliefs about self-care among nursing home staff and residents in Taiwan.

The purpose of this qualitative study was to investigate the beliefs about self-care among nursing home staff and residents. Subjects included 10 nursing home staff members and 10 residents. Results indicated 3 major themes: 1) the importance of performing self-care, 2) barriers to regaining self-care abilities, and 3) facilitators to regaining self-care ability. The importance of performing self-care was related to subjects' beliefs about being independent, to high-quality nursing care, and to negative feelings about asking for assistance. Barriers for elders to regaining self-care abilities were physical limitations, fear of falling, depressed mood, and staff-fostered dependency. However, facilitators for elders to regain self-care were increasing self-esteem, wishing to return home, and receiving support from staff and family members. The findings from this study will be useful for planning interventions to improve health and wellness among nursing home elders in Taiwan.

Improving activities of daily living for nursing home elder persons in Taiwan.

BACKGROUND: Excess disability among nursing home elder persons can be prevented or remediated. Because of self-selected disuse and caregiver support of dependency, nursing home residents are likely to develop excess disability. No study was found to test a theory-based program aimed at improving elder persons' self-care abilities for Taiwanese nursing home elder persons who are at risk for developing excess disability. OBJECTIVES: The purpose of this study was to test the effectiveness of a theory-based intervention program on self-care, specifically on activities of daily living (ADLs) performance among nursing home elder persons in Taiwan. A secondary aim was to determine the correlation between ADLs performance and three bliss concepts: life satisfaction, self-esteem, and motivation in health behavior. METHODS: This study used a quasi-experimental, two-group, pretest-posttest design. Forty-two qualified participants were recruited from two nursing homes located in southern Taiwan and assigned to either the experimental group (n = 21) or the comparison group (n = 21). Participants in the experimental group received the Self-Care Self-Efficacy Enhancement Program (SCSEEP), and those in the comparison group received biweekly social visits for 6 weeks. Levels of ADLs performance were measured by Tappen's Refined ADL Assessment Scale. Life satisfaction was measured by Adams' Life Satisfaction Index A. Self-esteem was measured by Rosenberg's Self-Esteem Scale. Motivation in health behavior was measured by Cox's Health Self-Determinism Index. RESULTS: Elder persons receiving the SCSEEP had significant improvement in feeding, dressing, grooming, and washing activities. Self-esteem (p = .011) and life satisfaction (p = .033) but not motivation in health behavior (p = .282) were positively correlated with levels of ADLs performance. DISCUSSION: The SCSEEP provides a theory-based intervention model for Taiwanese nursing home elder persons aimed at improving ADLs performance. Further research with a larger sample size is needed to determine the long-term maintenance and effectiveness of this theory-driven SCSEEP in specific culture groups.

The Self-Care Self-Efficacy Enhancement Program for Chinese nursing home elders.

The purpose of this article is to introduce a theory-based intervention program, the Self-Care Self-Efficacy Enhancement Program (SCSEEP), which was derived from Bandura's Social Cognitive Theory (SCT). The SCSEEP, based on the concept of "perceived self-efficacy" within the SCT, was designed to improve self-care ability in Chinese nursing home elders. The theory-based SCSEEP was tested during a pilot study involving 42 elders from 2 nursing homes in Taiwan. Following the study, basic activities of daily living performance improved significantly in treatment group residents. Many Chinese elders are placed in nursing homes in the United States; thus, the SCSEEP may also be used as a theory-based caring model to improve self-care performance in Chinese Americans.

The effectiveness of a health promotion programme for women in southern Taiwan.

The purpose of this study was to assess the effectiveness of an 8 week aerobic exercise class for women on changes in their physical activity behaviour. This was a descriptive, retrospective and comparison study. Because the data were collected after an 8 week aerobic exercise class, there were two groups of subjects. Subjects in the exercise group had attended exercise classes, but subjects in the control group had not. Results showed statistically significant differences between the two groups in the frequency/week of moderately intense exercise-related activities, caloric expenditure/week in all exercise-related activities and caloric expenditure/week in moderately intense exercise-related activities. However, there was no statistically significant difference in the frequency/week of all exercise-related activities. The result that women in the exercise group practised physical activities more than women in the control group might be related to their high exercise self-efficacy expectations.

A partnership model for the teaching nursing home project in Taiwan.

The purpose of this article is to describe the structure of a partnership model for a teaching nursing home program in Taiwan. Benner's model of "from novice to expert" was applied to the design of this program. Processes of developing this program began with nursing home administrators and faculty from a University in Taiwan setting mutual goals. Next, faculty members assessed quality of care and then used this knowledge to educate staff and conduct research. The goal of the education was not only to improve the quality of care provided within the nursing home, but to move the staff from novice to experts. Staff were also trained to become clinical health educators and preceptors for nursing students and other staff. In this partnership model, the training programs for clinical nurses, clinical nursing assistants, and healthcare educators were included.

Risks for unplanned hospital readmission in a teaching hospital in southern Taiwan.

The purpose of this study was to assess and analyse hospital readmission and its risk factors for patients who were visited by a discharge planning coordinator during hospitalization in a teaching hospital located in southern Taiwan. Results found that 67 patients (5.7%) were readmitted within 14 days of discharge during the data collection period. Twenty-eight patients (41.8%) were readmitted because of complications. Patients' previous diagnoses and complications were two major reasons for patients to be re-hospitalized within 14 days of discharge. In addition, significant predictors for unplanned hospital readmission within 14 days of discharge were patients who received care from home health care nurses or hospice home health care nurses.