Health Needs Instrument for hospitalized single-living Taiwanese elders with heart disease: triangulation research design.

AIM: The aims of this study were (a) to explore the health needs of hospitalized Taiwanese older people with heart disease who live alone in the community; (b) to develop an instrument to assess their health needs and (c) to examine relationships among their health needs. DESIGN: Three phases were involved in this between-method triangulation design. METHODS: The first phase explored the contextual content of the health needs from the perspectives of a purposive sampling of 34 subjects by the use of an explorative qualitative method. The second phase developed the Health Needs Instrument (HNI) and established its reliability and validity. The last phase implemented the instrument in a cohort and examined their appraisals of each type of health need as well as the relationships among different types of health needs. RESULTS: The HNI encompasses the following five types of health needs: help in managing tangible things, psychological support, medical support, obtaining health information and participation in decision-making. In the last phase, a purposive sample of 54 subjects (48 men and 6 women) with an average age of 75.3 years was obtained. Subjects' health needs were ranked as obtaining health information (100%), participation in decision-making (96%), managing tangible issues (87%), medical support (86%) and psychological support (67%). Detailed items for each type of health need were revealed. By examining the relationship between their health needs, the psychological needs in confronting the subjects' physical discomfort had a significant correlation with medical support (r = 0.469, P < 0.01), with tangible needs after surgery or an invasive examination (r = 0.460, P < 0.01), with informational needs (r = 0.393, P = 0.034) and with tangible needs of maintaining daily living activities during the hospitalization period (r = 0.290, P = 0.034). The need for tangible help in maintaining daily living activities during the hospitalization period was significantly correlated with the need for medical support (r = 0.341, P = 0.012), with help in managing admissions and discharge procedures (r = 0.374, P = 0.05) and with help after an invasive examination or in the postsurgery period (r = 0.334, P = 0.013). CONCLUSION: Finally, a conceptual framework was developed to depict this phenomenon. With the help of this HNI, both Eastern and Western health care providers can be empowered to detect the complex health needs of this particular population earlier and more accurately in order to promote their well-being as well as their health-related quality of life. RELEVANCE TO CLINICAL PRACTICE: Empowering nurse clinicians to assess health needs of hospitalized single-living Taiwanese elders with heart disease.

The effectiveness of teaching strategies for creativity in a nursing concepts teaching protocol on the creative thinking of two-year RN-BSN students.

Because of changes in the medical environment, nurses must maintain the ability of divergent thinking to solve the health problems of patients. However, many nurses whose work in clinical practice has become routine have lost the ability of creativity. To cultivate nurses creativity should be a goal of nursing education. The purpose of this study is to evaluate a nursing concepts teaching protocol by utilizing teaching strategies directed toward creativity to promote creativity in two-year RN-BSN students. This study design is a time series and one group experiment utilizing multiple instances of treatment. Teaching strategies for creativity were applied to a teaching unit and 52 two-year RN-BSN students were tested for creativity before the end of each semester. This study was conducted from March, 1999 to May, 2000, but only 30 students completed all tests and reached a 58% return rate. Torrance s (1974) definitions of creativity includ fluency, flexibility, and uniqueness were followed and the instrument, a questionnaire on Creativity in the application of the Nursing Process Tool (CNPT), was designed based on Emerson (1988). The content validity of Chinese-version CNPT was.79. The inter-coder reliability between two researchers was.84 following a coding guide that ten nursing education experts had established. The results indicated that 30 two-year RN-BSN students had improved fluency and flexibility. The improvements reached a significant level after the third semester. Only uniqueness declined. It is suggested that nursing faculty apply teaching strategies uniqueness more often in a teaching protocol of nursing concepts. By utilizing teaching strategies of creativity in a teaching protocol of nursing concepts, it is expected that two-year RN-BSN students can acquire characteristics of creativity for problem-solving skills in clinical settings.

The efficacy of problem solving strategies utilized in professional nursing concepts course to improve problem solving abilities in students enrolled in a two-year baccalaureate nursing program.

Using problem solving strategies in professional nursing concepts course (PS-PNC) was a newly developed core course in a two-year baccalaureate nursing program in an institute of technology. The purpose of this study was to evaluate the efficacy of problem solving strategies used in this new course to improve students clinical problem solving abilities. Prior to the PS-PNC, 12 faculty who participated in the teaching received complete training, and then continued to receive supervision and to conduct group discussions during the whole period of the PS-PNC implementation. A one- group posttest design with repeated measures was used. In total 49 nursing students from one class agreed to be recruited as the study subjects. The PS-PNC was performed separately in three semesters. After each class learning, students would start their clinical practice, were advised by the same faculty group who participated in the PS-PNC, and were asked to submit three written nursing process recordings during each clinic. Assignments from the three practices were named post-test I, II, and III sequentially, and provided the data for this study. A coding strategy was developed by the investigators. Then, data were collected and analyzed by four selected faculty who had been involved in the PS- PNC. The overall score of problem solving indicated that the three post-tests significantly increased, meaning those students clinical problem solving ability improved. However, data on the sub-concepts of problem solving on nursing assessment, nursing diagnosis, nursing intervention, and nursing evaluation showed no constant improvement. It is inferred that teaching of professional nursing concepts utilizing problem-solving strategies may be useful for future nursing students but dignified control should be strengthened.