The effects of web-based situational learning on nursing students' transfer of learning in clinical practice.

BACKGROUND: Transferring what has been learned in the classroom to clinical application is the main goal of nursing education. Our previous intervention study, in which a web-based interactive situational teaching strategy in a nursing ethic course was conducted as an experimental group, and the students in the class who were taught using a traditional teaching strategy was treated as the comparative group. The results, which were evaluated immediately after the class, showed that the web-based interactive situational teaching enhanced the students' competency in ethical reasoning and problem solving compared to traditional teaching. PURPOSE: This study followed the previous study and aimed to compare the effects of the learning transfer between the two groups in clinical performance as reflected in their internship scores, clinical practice, and self-efficacy assessment. It also explored the factors influencing this transfer. METHOD: A predictive correlation-based research design was adopted to compare the students' internship scores, clinical judgment abilities, and self-efficacy in clinical internships between two groups. The students' self-efficacy was measured using a self-administered structured questionnaire, while their internship scores and clinical judgment abilities were evaluated by their clinical instructors. The data obtained were statistically analyzed using SPSS 23 software. RESULTS: The nursing students who participated in the web-based interactive situational teaching course did not significantly outperform those who received traditional teaching in their clinical judgment and internship scores. The main variable that significantly affected the clinical self-efficacy of nursing students was the degree of support from the internship instructors. CONCLUSION: Nursing students' clinical performance is affected by multiple factors and is not solely determined by the curriculum or teaching strategies. The degree of instructor support during the internship process significantly affected the students' self-efficacy in clinical performance.

Study on the Correlation between Continuity of Care and Quality of Life for Patients with Coronary Heart Disease.

Background: As coronary heart disease (CHD) is a highly complex disease, complex continuity of care (CoC) service should be provided for the patients, and the quality of life (QoL) needs to be regarded as an important measuring indicator for the health-care outcome. Purpose: To understand the general situation of CHD QoL and important predictors. Method: A cross-sectional study design was adopted from August 2019 to July 2020 by structured questionnaires. A total of 163 patients were enrolled, and data were statistically analyzed using SPSS 25.0. Result: The average score of the QoL questionnaire is 56.56/80, and the CoC is 4.32. The overall regression model can explain 58.7% of the variance regarding QoL. Patients' instrumental activities of daily living (IADLs) (26.1%), age (18.1%), living situation (7%), information transfer (4.8%), main source of income (1.8%), and risk of disability are significantly different from their overall QoL in depression (0.9%). Conclusions: In order to improve the QoL of patients, it is suggested that medical teams should assess the needs of patients immediately upon hospitalization, provide patients with individual CoC, encourage them to participate in community health promotion activities, and strengthen the function of IADL to improve the QoL of patients.

Continuity of Care and the Quality of Life among Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study in Taiwan.

BACKGROUND: Understanding factors associated with the quality of life (QoL) of patients with type 2 diabetes (T2DM) is an important health issue. This study aimed to explore the correlation between continuity of care and quality of life in patients with T2DM and to probe for important explanatory factors affecting quality of life. METHODS: This study used a cross-sectional correlation research design. Convenience sampling was adopted to recruit 157 patients, aged 20-80 years and diagnosed with T2DM in the medical ward of a regional hospital in central Taiwan. RESULTS: The overall mean (standard deviation, SD) QOL score was 53.42 (9.48). Hierarchical regression linear analysis showed that age, depression, two variables of potential disability (movement and depression), and the inability to see a specific physician or maintain relational continuity with medical providers were important predictors that could effectively explain 62.0% of the variance of the overall QoL. CONCLUSIONS: The relationship between patients and physicians and maintaining relational continuity with the medical providers directly affect patients' QoL during hospitalization and should be prioritized clinically. Timely interventions should be provided for older adult patients with T2DM, depression, or an inability to exercise to maintain their QoL.

[Evaluating the Health and Social Care Competences of Nursing Students Using Skills Competition].

BACKGROUND: After graduation, new nurses provide care directly to clients in the health and social care sectors. Nurses with higher levels of health and social care competences have been shown to provide better quality of care. The skills competitions organized and held by the Ministry of Labor follow international standards and address the general roles and functions of care providers worldwide. Using the results of these skills competitions to confirm the health and social care competences of nursing students important for nursing education. PURPOSE: This study was designed to assess the performance of nursing students in the skills competition and to identify the strengths and weaknesses of these students with regard to related competences in the context of current global standards. METHODS: This was a retrospective research study. Data were collected from the results of skills competitions using the Scenario-based Objective Structured Clinical Examination method. Descriptive statistics were used to analysis the data. RESULTS: The mean score for health and social care competence was 67.9 ± 12.9. The score for the home care dimension (65.1 ± 14.1) was the lowest dimension score. The most two improved of the six competence dimensions were problem solving/innovation and creativity (53.7 ± 3.9) and evaluating response to care (55.9 ± 4.0). The lowest health and social care item scores were practicing the five moments of hand hygiene (42.7%) and encouraging patient to discuss health problems (43.1%). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results showed that the competence level of the students was moderate. Nursing educators should develop appropriate education approaches for teaching and evaluation and improve the health and social care competences of nursing students.

Effectiveness of Motivational Interviewing in Regard to Activities of Daily Living and Motivation for Rehabilitation among Stroke Patients.

BACKGROUND: Stroke patients urgently need rehabilitation to enhance activities of daily living. This study aims to determine whether motivational interviewing (MI) improves the performance of activities of daily living and enhances motivation for rehabilitation among first-stroke patients. METHODS: A quasi-experimental design was used in this study. The study recruited 65 patients between March and October 2016. Before the intervention, all patients received routine care. The experimental group (n = 33) received weekly sessions of MI for 6 weeks, whereas the control group (n = 32) received individual attention from a research nurse weekly for 6 weeks. Structured questionnaires were used to collect data, including demographic data, activities of daily living data (Barthel index {BI} and instrumental activities of daily living {IADLs} scale), and rehabilitation motivation data. RESULTS: The BI and IADLs scores significantly improved with time in both the experimental and control groups. The generalized estimating equation approach showed that at 6 weeks and 3 months after the intervention, the rehabilitation motivation scores in the experimental group were respectively 3.10 and 2.54 points higher than those in the control group, with significant differences. CONCLUSIONS: MI could effectively enhance motivation for rehabilitation among stroke patients.

[A Reflection on Innovative Nursing Teaching Strategies Following an Experience Training Competitors for the Worldskills Competition].

Worldskills Competition provides students from around the world with an interactive platform for learning, training, and communication. Participating in Worldskills Competition and related teaching activities highlights the critical problems that affect new nursing graduates such as insufficient knowledge application and integration skills and inadequate adaptation and problem-solving abilities. This paper reflects on nursing courses to suggest improved teaching strategies and innovative teaching methods. Problem-based learning (PBL), simulation-based objective strcutured clinical examination (SOSCE), and mobile-assisted teaching are applied to guide students to learn, to increase the self-learning ability of students, and to enhance their problem-solving skills. It is hoped that these teaching methods improve the ability of participants, whether they are Worldskills competitors or new employees, to think strategically about and to resolve problems.

Clinical nursing instructors' perceived challenges in clinical teaching.

AIM: The purpose of this qualitative study was to explore the challenges in clinical teaching that are encountered by clinical instructors and to foster the relevant training. METHODS: Focus group methodology was used. The participants were 54 clinical nursing instructors who were recruited from middle Taiwan and participated in one of five focus groups of 2-3 h each. The data transcripts were analyzed by using qualitative content analysis. RESULTS: Five challenges emerged: (i) teaching outside one's area of expertise; (ii) building cooperative relationships with the clinical staff; (iii) the unit's use of students as nursing staff; (iv) inappropriate clinical practices by the clinical staff; and (v) clinical staff members' negative comments toward the students. These challenges revealed clinical nursing instructors' difficulties in balancing clinical teaching quality and their relationships with the clinical staff members. CONCLUSION: The identified challenges reflect the need to support clinical instructors and assist them to prepare for their role through training programs or policy changes.

Study on the Effects of Individualized Learning Therapy on Cognitive Function and Behavioral and Psychological Symptoms of Dementia in the Institutionalized Older Adults.

BACKGROUND: The increasing number of elderly people affected by dementia in Taiwan has made dementia care a crucial issue of concern. This issue is particularly important in terms of the proper management of behavioral symptoms and improvement of the cognitive functions of those affected by this disease. PURPOSE: This study examined the effects of individualized learning therapy on cognition and neuropsychiatric symptoms among elderly people with dementia. METHODS: A quasi-experimental, pretest-posttest research design was adopted. We recruited elderly people with dementia at the only two institutions for elderly patients with dementia in Central Taiwan. These institutions were assigned randomly as the experimental or control group, with totals of 23 and 21 participants, respectively. The participants in the experimental group received individualized learning therapy for 30 minutes twice weekly for 3 months. The comparison group received usual care only. The cognitive function and neuropsychiatric symptoms of all participants were measured using the Mini-Mental Status Examination (MMSE) before the start of and immediately after the 12-week intervention and the Chinese version of the Neuropsychiatric Inventory (CNPI), which was administered once per week during the intervention. Independent t tests (or Mann-Whitney U tests), chi-square tests (or Fisher's exact tests), paired t test, and generalized estimating equations were used for data analysis. RESULTS: Participants in the experimental group had significantly higher MMSE scores (p < .01) and lower CNPI scores (p < .01) than their comparison group peers after the intervention. Furthermore, the neuropsychiatric symptoms in the experimental group such as hallucinations, bizarre behavior, depression, apathetic expression, irritability, and sleep disorder had significantly improved by the seventh week. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Individualized learning therapy may be an effective approach to improve cognitive function and reduce neuropsychiatric symptoms among older people with dementia. Therefore, future clinical application is warranted.

Identifying critical thinking indicators and critical thinker attributes in nursing practice.

BACKGROUND: Critical thinking is an essential skill in the nursing process. Although several studies have evaluated the critical thinking skills of nurses, there is limited information related to the indicators of critical thinking or evaluation of critical thinking in the context of the nursing process. PURPOSE: This study investigated the potential indicators of critical thinking and the attributes of critical thinkers in clinical nursing practice. Knowledge of these indicators can aid the development of tools to assess nursing students' critical thinking skills. METHODS: The study was conducted between September 2009 and August 2010. In phase 1, a literature review and four focus groups were conducted to identify the indicators of critical thinking in the context of nursing and the attributes of critical thinkers. In phase 2, 30 nursing professionals participated in a modified Delphi research survey to establish consensus and the appropriateness of each indicator and attribute identified in phase 1. RESULTS: We identified 37 indicators of critical thinking and 10 attributes of critical thinkers. The indicators were categorized into five subscales within the context of the nursing process toreflect nursing clinical practice: assessment, 16 indicators of ability to apply professional knowledge and skills to analyze and interpret patient problems; diagnosis, five indicators of ability to propose preliminary suppositions; planning, five indicators of ability to develop problem-solving strategies; implementation, five indicators of ability to implement planning; and evaluation, six indicators of ability to self-assess and reflect. CONCLUSION/IMPLICATIONS FOR PRACTICE: The study operationalized critical thinking into a practical indicator suitable for nursing contexts in which critical thinking is required for clinical problem solving. Identified indicators and attributes can assist clinical instructors to evaluate student critical thought skills and development-related teaching strategies.

Using standardized patient with immediate feedback and group discussion to teach interpersonal and communication skills to advanced practice nursing students.

BACKGROUND: Interpersonal and communication skills (IPCS) are essential for advanced practice nursing (APN) in our increasingly complex healthcare system. The Standardized Patient (SP) is a promising innovative pedagogy in medical and healthcare education; however, its effectiveness for teaching IPCS to graduate nursing students remains unclear. OBJECTIVES: We examined the effectiveness of using SP with SP feedback and group discussion to teach IPCS in graduate nursing education. DESIGN: Randomized-controlled study. PARTICIPANTS: First-year APN students in Taiwan. METHODS: Participants were randomly assigned to the experimental (SP assessments with SP feedback and group discussion) or control (SP assessments only) group. There were two outcome indicators: IPCS and student learning satisfaction (SLS). The IPCS were assessed before and after the study in interviews with the SPs. SLS was measured when the study ended. RESULTS: All participants expressed high SLS (94.44%) and showed significant (p ≤ 0.025) improvements on IPCS total scores, interviewing, and counseling. However, there were no significant differences between groups. Qualitative feedback from encounters with SPs is described. CONCLUSIONS: Using SPs to teach IPCS to APN students produced a high SLS. The students learned and significantly improved their IPCS by interviewing SPs, but future studies are needed to confirm the effectiveness of SP feedback and group discussions.

[The helicopter emergency medical service and essential related nursing skills].

Nurses play a critical role in Taiwan's helicopter emergency medical service, an essential healthcare response service for residents of outlying islands. The care skillsets required of nurses in special care and urgent care environments are significantly more specialized than those in other professional care environments. This article discusses the development of the civil helicopter emergency medical service (HEMS) and elements essential to HEMS nursing care efficacy. These elements can be grouped under the categories of pre-flight preparation, assessment for flight-readiness and in-flight care, decision-making abilities, personal physical characteristics, training and experience. These categories should be referenced to improve the effectiveness of relevant education / training programs, enhance HEMS nurse readiness and effectiveness, and maximize the role of HEMS nurses in the civil helicopter medical service.

[Reducing high risk population screening discrepancies amongst nursing staff in discharge planning services].

BACKGROUND: High risk population numbers measured by nursing staff differ greatly from those measured by case managers due to differences in screening approaches used in discharge planning services. PURPOSE: This project intended to identify and analyze the relevant problems and develop an improvement plan to reduce the discrepancy. METHODS: The authors observed the clinical situation, interviewed nurses, and designed a questionnaire to evaluate the suitability of a designed screening table to collect nurses' opinions on a high risk population checklist. Based on collected data, we identified and analyzed the cause of the gap, then revised current measurement tools to improve efficacy. RESULTS: Strategies included providing in-service education related to discharge planning for nurses, revising discharge planning manuals, and re-developing the screening scale for high-risk populations. After implementation of the intervention, the difference of screening the high risk population between nursing staff and case manager decreased from 45.9% to 6.7%, and the hit rate on the discharge planning page on the e-learning web site increased to 89.8%. CONCLUSION/IMPLICATIONS FOR PRACTICE: Results showed that interventions enhanced nurse capabilities in screening high risk populations in the ward, and effectively elevated the accuracy of screening high-risk patients in discharge plans, thus elevating outpatient care quality. This project is suggested as a reference for hospitals developing training programs for discharge planning seed nurses in the wards. Once completed, these nurses can help expand the scope of discharge service to ensure medical resources are used more effectively.

Meet the real elders: reminiscence links past and present.

AIMS AND OBJECTIVES: This study was designed to develop an understanding of the process of reminiscence and the roles played by nurses in fostering reminiscence as a therapeutic intervention. BACKGROUND: Reminiscence therapy has been considered an effective nursing strategy for improving quality of life and preventing depression in nursing home settings. Until recently, however, there has been little attention to understanding the dynamics of reminiscence therapy and the interaction between a nurse and an older client during reminiscence. DESIGN: A qualitative research design employing participant observation and content analysis of recorded reminiscence therapy sessions was used in this study. METHODS: Participant observation was used to explore the process of individual reminiscence therapy and identify nursing roles in the process generated. Ten nursing home residents participated and data were collected over two months through interviews and observation. Content analysis was used to identify emerging themes. RESULTS: Reminiscence occurred in four stages: entrée, immersion, withdrawal and closure. Stimuli related to participants' past lives were helpful for initiating reminiscence. Nursing roles in each stage were identified. CONCLUSION: A tentative model of the process of reminiscence was derived from study findings. Further study is needed to validate the model in nursing practice with older clients. RELEVANCE TO CLINICAL PRACTICE: Reminiscence could be initiated by nursing staff at anytime during care of residents. Information about the reminiscence process and related nursing roles may be helpful in understanding and assisting adaptation in nursing home residents.

[Application of individual reminiscence therapy to decrease anxiety in an elderly woman with dementia].

The purpose of this study was to share a nurse's experience assisting an older woman with dementia to manager her anxiety. The author provided nursing care to the subject from July 1st, 2007 to August 3rd, 2007. Diagnosis of anxiety was done using a comprehensive assessment approach encompassing five domains. Data were collected through observation, direct care, interviews with the subject and information provided by other nurse and family members. The author implemented a total of eight 30 minute therapy sessions, delivered twice per week using individual reminiscence theory. During the process, the author encouraged the subject to relate her own life story. To strengthen feelings of achievement and achieved self-assertion, listening, giving positive feedback, touching, and acceptance were used to persuade the subject to share her experiences. The process included four stages, including the initiation, immersion, withdrawal and closure stages. It was found that, after the eight sessions, the resident had a happier expression on her face, was willing to express herself more verbally, had more interaction with others, and required medication less frequently to help her sleep. Such implies that the resident's negative emotions and anxiety had improved. This experience may serve as a reference to elderly care institutions for assisting residents with anxiety.

Predictors of psychosocial adaptation among elderly residents in long-term care settings.

This cross-sectional descriptive study explored psychosocial adaptation and its determinants among elderly residents of long-term care facilities. A convenience sample of 165 elderly residents was recruited from two nursing homes and two assisted living institutions in the Taichung area. All residents who met the criteria for this study were interviewed individually from April through June 2006. A structured questionnaire was used to collect data on participant demographic characteristics, admission conditions, functional status, perceived family support, life attitudes, and psychosocial adaptation. The adaptation inventory incorporated three aspects of adaptation, including (1) sense of self-value, (2) sense of belonging and (3) sense of continuity. Findings, in general, did not indicate participants had achieved a high level of overall adaptation or significant adaptation in any of the three aspects targeted. Most participants were female. More than half were widowed and unable to fully finance their own institutional care. Nearly one-third was not admitted voluntarily. Having adequate funding for admission, voluntary admission, and number of roommates were the three most influential factors affecting overall adaptation, explaining 54% of variance. Study findings reflect the importance to residents' adaptation of self-determination, autonomy, and pre-institutionalization preparation and are intended to provide guidance for nursing intervention and social welfare policy making.

The effects of group reminiscence therapy on depression, self esteem, and life satisfaction of elderly nursing home residents.

The need to provide quality mental health care for elders in nursing home settings has been a critical issue, as the aging population grows rapidly and institutional care becomes a necessity for some elders. The purpose of this quasi-experimental study was to describe the effect of participation in reminiscence group therapy on older nursing home residents' depression, self-esteem, and life satisfaction. Purposive sampling was used to recruit participants who met the study criteria. Residents of one ward were assigned to the reminiscence therapy group intervention, while residents of the other ward served as controls. Nine weekly one-hour sessions were designed to elicit reminiscence as group therapy for 12 elders in the experimental group. Another 12 elders were recruited for a control group matched to experimental subjects on relevant criteria. Depression, self-esteem, and life satisfaction were measured one week before and after the therapy. The Statistical Package for the Social Sciences (SPSS, Version 10.0) was used to analyze data. Results indicated that group reminiscence therapy significantly improved self-esteem, although effects on depression and life satisfaction were not significant. Reminiscence groups could enhance elders' social interaction with one another in nursing home settings and become support groups for participants. The model we created here can serve as a reference for future application in institutional care.

Increasing asthma care knowledge and competence of public health nurses after a national asthma education program in Taiwan.

One of the responsibilities of a public health nurse is to provide asthma education to local residents. However, there have been no comprehensive education programs for public health nurses on asthma care in the past. This study aimed to determine level of competence of public health nurses on asthma care in order to improve their capability through a one-day national asthma education course. In addition to lectures on updated asthma management information, data was obtained through demonstrations and practice on inhalation techniques of various kinds of inhaled devices, including the ability to use and interpret the data of a peak flow meter. Two written examinations with the same questions were given to participants before and right after the lectures. All of the 560 public health nurses in the 392 public health bureaus were invited to join the program and 522 (93.2%) participated. Five hundred and six completed both the pre- and post-tests. Before the national education program, only 10.9% of the participants knew the purpose of the peak flow meter, while 62.6% had never heard of it. Initially, they showed less confidence on teaching patients on the use of inhaled devices (2.36 and 2.59 in 5 scales). Comparing the two tests, there was a significant increase in the public nurses' knowledge as regards: 1) the general concept of asthma, 2) prevention of trigger factors and environmental control, 3) proper medication knowledge, 4) peak flow meter (PEF) monitoring, and 5) intervention after acute exacerbation of asthma (p < 0.001). A well-designed course on asthma management is an efficient scheme to improve public health nurses' knowledge and confidence on asthma care.

Dimensions of quality in long-term care facilities in Taiwan.

AIM: This article presents the results of a qualitative study designed to explore the perceptions of Taiwanese elders about the quality of their care while in residence at a long-term care facility. BACKGROUND: As the population of elders in Taiwan is increasing rapidly, quality long-term care has become both a necessity and social responsibility. Research related to quality of care has focused on structure, process and outcomes as well as perceptions of quality of care and life satisfaction. Few authors have considered residents' perspectives within a cultural context. METHOD: A convenience sample of 22 residents, aged between 61 and 86 years and living in four Taiwanese care facilities, participated in semi-structured interviews. The data were generated during 2001/2002 and were analysed using content analysis. RESULTS: Six key dimensions of quality care were elicited. The dimensions were: a caring attitude, respect for individual differences, emotional support, social interaction, a supportive environment, and accessible care. These dimensions are discussed within a cultural context supportive of family connectedness and filial piety, values underpinning care expectations of elders. CONCLUSIONS: The findings provide a foundation for increased understanding of the perceived gaps between residents' aspirations about quality care and priorities identified in other studies. Additional studies based on these data are planned in order to generate a culturally relevant, psychometrically sound resident assessment tool to evaluate the quality of care from a resident perspective in long-term care facilities in Taiwan.

A psychoeducational program for nursing staff managing problematic behaviors of elderly nursing home residents in Taiwan.

This quasi-experimental study assessed the influence of a psychoeducational train ing program on the knowledge, attitudes, and self-efficacy of nursing home staff (nursing aides [NAs] and registered nurses [RNs]) regarding elderly residents and the management of their problematic behaviors. The training, which was conducted in northern Taiwan, was based on self-directed learning theory. Participants were divided into experimental (n = 130) and control (n = 140) groups. Staff's knowledge, attitudes, and self-efficacy were assessed before, immediately after, and 3 months after the program. Total knowledge improved significantly in all participants. For RNs, attitudes toward residents with disruptive behaviors and self-efficacy in managing these behaviors also improved, but these improvements were not maintained. These findings indicate that cognition is not the only factor influencing attitudes and self-efficacy.

A comparison, by quantitative and qualitative methods, between the self-management behaviors of parents with asthmatic children in two hospitals.

This study compared the self-management behaviors of parents with asthmatic children staying in two hospitals and explored barriers to self-management behaviors by interviewing. 227 parents were recruited for quantitative analysis by completing a self-report structured questionnaire, 94 of these parents were from the Taipei area and 133 were from the Taoyuan area. Sixteen parents were interviewed from this population. The results indicated that the parents in theTaoyuan area had younger age, lower socioeconomic status (SES), and higher exercise limitations for children. Their knowledge, enabling factors, and self-management behaviors were also lower than their counterparts in the Taipei area. The determining factors of self-management behaviors were socioeconomic status, self-efficacy, sources of education, and perceived effectiveness (Adjusted R2= .593) in 227 parents. Six major themes about the influencing factors of self-management were deduced from the interview data: lack of understanding and dislike of the asthma label, less self-perceived severity, lack of understanding about asthma medication, lack of confidence in environmental controls, financial burden of anti-mite products, and doubt about effectiveness. Three major barriers to self-management behaviors of parents in the Taoyuan area were inconsistent use of alternative treatments, overdependence on medical service, and lack of use of peak flow meter. Parents with asthmatic children living in the Taoyuan area had poorer self-management behaviors than those in the Taipei area, and SES was one of the determining factors. The health beliefs of Taoyuan parents included many misconceptions. Conducting the educational needs assessment through quantitative and qualitative methods could provide proficiency information for designing educational content appropriate to specific populations.