[A pilot study of the professional autonomy, job satisfaction, and related factors of nurses at a regional hospital].

BACKGROUND: Professional autonomy often causes confusion in nursing staffs that limit their ability to perform to the best of their professional capabilities. Moreover, heavy and busy workloads reduce the energy available for work resulting in lower working efficiency and lower job satisfaction. PURPOSE: This study explores the status and factors related to professional autonomy and job satisfaction in nurses. METHODS: A cross-sectional design was used to target the nurses employed at a regional hospital in southern Taiwan. Data on locus of control, professional autonomy, and job satisfaction were collected for analysis. RESULTS: Data were collected from 207 nurses, with 196 valid responses (response rate: 94.69%). One hundred and forty-six subjects (74.5%) were found to have an internal locus of control personality type. Scores for both professional autonomy and job satisfaction were above the "moderate" level (averages: 3.37 and 3.32, respectively, on a maximum scale of 5). Social demographic differences contributed to the variance in professional autonomy and job satisfaction among participants. Professional autonomy was found to be positively associated with job satisfaction. CONCLUSIONS: The findings of this study indicate that nurses with an internal locus of control personality exhibit higher professional autonomy and job satisfaction and that higher professional autonomy is associated with higher job satisfaction.

Psychometric properties of the Chinese version of the Michigan Alcoholism Screening Test (MAST-C) for patients with alcoholism.

PURPOSE: The aim of this study was to examine the psychometric properties of the Chinese version of the Michigan Alcoholism Screening Test (MAST-C). DESIGN & METHODS: The sensitivity, specificity, and positive and negative predictive values for the MAST-C were examined in this study. FINDINGS: The MAST-C had an internal consistency of 0.83 and a test-retest reliability of 0.89. It had a good content validity index of 0.92. Factor analysis identified four factors and the optimal cutoff point for the MAST-C was a score of 6/7, which yielded a sensitivity of 0.92, a specificity of 0.83, a positive predictive value of 0.92, and a negative predictive value of 0.83. PRACTICE IMPLICATIONS: The MAST-C provides a fast, accurate, and sensitive method for clinically diagnosing alcoholism and clinical management.

High risk sexual behaviors for HIV among the in-school youth in Swaziland: a structural equation modeling approach.

BACKGROUND: Global efforts in response to the increased prevalence of the human immunodeficiency virus (HIV) are mainly aimed at reducing high risk sexual behaviors among young people. However, knowledge regarding intentions of young people to engage in protective sexual behaviors is still lacking in many countries around the world, especially in Sub-Saharan Africa where prevalence of human immunodeficiency virus is the highest. The objective of this study was to test the theory of planned behavior (TPB) for predicting factors associated with protective sexual behaviors, including sexual abstinence and condom use, among in-school youths aged between 15 and 19 years in Swaziland. METHODS: This cross-sectional survey was conducted using a anonymous questionnaire. A two-stage stratified and cluster random sampling method was used. Approximately one hundred pupils from each of four schools agreed to participate in the study, providing a total sample size of 403 pupils of which 369 were ultimately included for data analysis. The response rate was 98%. Structural equation modeling was used to analyse hypothesized paths. RESULTS: The TPB model used in this study was effective in predicting protective sexual behavior among Swazi in-school youths, as shown by model fit indices. All hypothesized constructs significantly predicted intentions for abstinence and condom use, except perceived abstinence controls. Subjective norms were the strongest predictors of intention for premarital sexual abstinence; however, perceived controls for condom use were the strongest predictors of intention for condom use. CONCLUSIONS: Our findings support application of the model in predicting determinants of condom use and abstinence intentions among Swazi in-school youths.

A comparison of the effects of fixed- and rotating-shift schedules on nursing staff attention levels: a randomized trial.

PURPOSE: Sleep deficit affects neurobehavioral functioning, reduces attention and cognitive function, and negatively impacts occupational safety. This study investigated selective attention levels of nursing staff on different shifts. METHODS: Using a prospective, randomized parallel group study, selective attention was measured using the d2 test in 62 nursing staff in a medical center in Taiwan. FINDINGS: There were significant differences in selective attention indicators (E%) between the fixed-day-shift group (control group) and rotating-shift group (experimental group): The percentage of errors (E%) for night-shift workers in the rotating-shift group was higher than that of fixed-day-shift workers, while the total number of items scanned minus error (TN - E) and concentration performance (CP) scores were higher for fixed-day-shift workers. Within the experimental group, the error rate on night shift was 0.44 times more than that on day shift and .62 times more than on evening shift; the TN-E on night shift was 38.99 items less than that on day shift, and the CP was 27.68 items less on night shift than on day shift; indicating that staff on the night shift demonstrated poorer speed and accuracy on the overall test than did the staff on day shifts. CONCLUSIONS: Inadequate sleep and a state of somnolence adversely affected the attention and operation speed of work among night-shift workers. More than 2 days off is suggested when shifting from the night shift to other shifts to provide adequate time for circadian rhythms to adjust.

Support groups for caregivers of intellectually disabled family members: effects on physical-psychological health and social support.

AIMS: This study aimed to examine the effectiveness of support groups for people caring for family members with intellectual disability with the goal of improving their physical-psychological health and social support. BACKGROUND: Little is known about how differences in the support group context influence either the nature of the social support available to caregivers of family member with intellectual disabilities or the effects on caregivers' physical-psychological health in eastern cultures. DESIGN: An experimental, preintervention postintervention control group design was used in this study. METHODS: The experimental group received intervention consisting of eight weekly support group meetings for caregivers of people with intellectual disabilities. A total of 72 participants were recruited by permuted block randomisation and evaluated before intervention, after intervention and at four-week follow-up. Participants were blinded to the arrangement. Longitudinal effects were analysed by means of generalised estimating equations. RESULTS: (1) Physical-psychological health (somatic, depressive and anxiety symptoms) of participants in the experimental group was significantly improved after the intervention and four-week follow-up. (2) After the support group, the experimental group scored better than the control group on measures of social support (positive social interaction, emotional, informational and material social support). At four-week follow-up, the differences between the two groups persisted except for positive social interaction support, suggesting a continued positive effect of the support group on caregivers of family members with intellectual disabilities. CONCLUSIONS: The results of this study confirm the experimental hypotheses that caregivers benefit from participating in support group interventions. RELEVANCE TO CLINICAL PRACTICE: The support group is an effective alternative intervention for promoting caregivers' physical-psychological health status as well as their social support. Therefore, the support group should become a routine component of the caregiver of people with intellectual disabilities.

The effect of cognitive behavioral group therapy for depression: a meta-analysis 2000-2010.

OBJECTIVE: The goals of the meta-analysis were to investigate the overall effectiveness of cognitive behavioral group therapy (CBGT) for depression and relapse prevention in depression from 2000 to 2010, and to investigate how the variables (episode, residual symptoms, group size, control group, group manual, therapist experience, therapy frequency, session length, and take-home assignment) of a CBGT study could affect the effect size. METHOD: This study collected actual study designs sought of CBGT for depression published from 2000 to 2010. These studies were then cross-referenced using Medical Subject Headings (MeSH) with the following keywords: group therapy, cognitive therapy, cognitive behavioral therapy, cognitive behavioral group therapy, psychotherapy, depression, relapse, and recurrence. The quality of the studies was evaluated using Cochrane Collaboration Guidelines. The effect size of CBGT on depression and relapse prevention in depression used the formula devised by Hedges and Olkin (1985). RESULTS: The study investigated the results of 32 studies on the effect of CBGT for depression. The CBGT had an immediate (g=-0.40) and continuous effect over 6 months (g=-0.38), but no continuous effect after 6 months (g=-0.06). The CBGT lowered the relapse rate of depression (RD = 0.16). Variables significantly different from each other in terms of immediate effect were: CBGT versus usual care, therapy sessions lasting longer than 1 hour, and take-home assignments. Preintervention severity of depression and patient turnover rate were found to be significantly related to the size of the immediate effect. The relapse rate after 6 months was significantly related only to "participants have no residual symptoms/participants did not mention residual symptoms." CONCLUSIONS: Researchers and clinicians should take note that CBGT had a moderate effect on the level of depression and a small effect on the relapse rate of depression. The results of this study suggest that the patient should receive a course of therapy at least every 6 months.

The effect of music therapy on hospitalized psychiatric patients' anxiety, finger temperature, and electroencephalography: a randomized clinical trial.

PURPOSE: This study aimed to explore the effectiveness of music therapy in reducing anxiety in hospitalized psychiatric patients. METHODOLOGY: The authors used a randomized clinical trial design and randomly allocated the 24 enrolled participants to the experimental or the control group. Patients in the experimental group received music therapy in a therapy room at a set time for 30 min each morning for 11 days. The authors administered the Beck Anxiety Inventory (BAI) and measured skin temperature and brain waves to determine anxiety level before, during, and after music therapy. RESULTS: Experimental group participants had lower scores on the BAI than control participants, after the music therapy (z = -2.0, p < .05) and at 1-week follow-up (z = -2.2, p < .05), indicating that they were experiencing significantly less anxiety. The mean BAI anxiety score fell in the experimental group from 23.9 (SD = 9.9) at baseline to 13.9 (SD = 8.8), after music therapy, and 12.7. (SD = 10.5) at follow-up. The experimental group demonstrated a significant elevation in the average alpha electroencephalographic (EEG) percentage (from 38.1% to 46.7%) and a reduction in the average beta EEG percentage (from 61.9% to 53.4%) after the music therapy. After adjusting for change in patient finger temperature on the first day, mean change in finger temperature did not differ significantly between the experimental and control groups. CONCLUSIONS: Music therapy can relieve anxiety in hospitalized psychiatric patients and help them achieve a state of relaxation.

Reliability and validity of a Chinese version of the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF-C).

AIM AND OBJECTIVES: To examine the psychometric properties of the Chinese version of the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF-C) for use in Chinese-speaking countries. BACKGROUND: The assessment of fatigue is a challenging task for most researchers because culture may influence perceptions of meaning of fatigue. The lack of examination of the psychometric properties of the fatigue measures across studies limits the scientific rigour for generating additional research on the concept of 'fatigue.' DESIGN: A cross-sectional study. METHODS: The study recruited 107 cancer inpatients from two medical centres in Taiwan. The MFSI-SF-C was examined using a two step process: (1) Translation and back-translation of the instrument; and (2) Examination of internal consistency reliability, test-retest reliability, content validity and construct validity. RESULTS: The results showed that the Cronbach's α of MFSI-SF-C total scale and subscales ranged between 0·83-0·92. The content validity index was 0·93. The difference between the fatigue of cancer patients and the comparison group of healthy people in the community was significant. The results demonstrated good convergent validity when comparing fatigue with depression and quality of life. Factor analysis confirmed the four dimensions of fatigue: physical, emotional, mental and vigour. It showed moderate intercorrelation between subscales and high factor loadings also helped to clarify the psychometric meaning. CONCLUSIONS: The reliability and validity information presented in this article support the use of the Chinese version of the MFSI-SF as a research instrument for measuring fatigue in Chinese populations. This study also provides evidence that the MFSI-SF possesses robust psychometric properties. RELEVANCE TO CLINICAL PRACTICE: The MFSI-SF-C is an effective and comprehensive tool for measuring fatigue in Chinese patients with cancer.

The effect of shift rotation on employee cortisol profile, sleep quality, fatigue, and attention level: a systematic review.

BACKGROUND: Disrupted circadian rhythm, especially working night duty together with irregular sleep patterns, sleep deprivation, and fatigue, creates an occupational health risk associated with diminished vigilance and work performance. PURPOSE: This study reviewed the effect of shift rotations on employee cortisol profile, sleep quality, fatigue, and attention level. METHODS: Researchers conducted a systematic review of relevant articles published between 1996 and 2008 that were listed on the following databases: SCOPUS, OVID, Blackwell Science, EBSCO Host, PsycINFO, Cochrane Controlled Trials Register, and CEPS. A total of 28 articles were included in the review. RESULTS: Previous research into the effects of shift work on cortisol profiles, sleep quality, fatigue, and attention used data assessed at evidence Levels II to IV. Our systematic review confirmed a conflict between sleep-wake cycle and light-dark cycle in night work. Consequences of circadian rhythm disturbance include disruption of sleep, decreased vigilance, general feeling of malaise, and decreased mental efficiency. Shift workers who sleep during the day (day sleepers) experience cortisol secretion increases, which diminish the healing power of sleep and enjoy 1 to 4 hours less sleep on average than night sleepers. Sleep debt accumulation results in chronic fatigue. Prolonged fatigue and inadequate recovery result in decreased work performance and more incidents. Rotation from day shift to night shift and its effect on shift workers was a special focus of the articles retained for review. CONCLUSIONS: Disturbed circadian rhythm in humans has been associated with a variety of mental and physical disorders and may negatively impact on work safety, performance, and productivity.

Caregiver support groups in patients with dementia: a meta-analysis.

OBJECTIVES: Meta-analysis studies of specific types of support groups are limited. We conducted a review and assessment of the effectiveness of support groups for caregivers of demented patients, and examined the impact of support group characteristics. METHODS: A search of multiple, electronic databases including the Cochrane Library, Medline, PUBMED, and others was conducted; studies published between 1998 and 2009 were collected. Thirty quantitative journal articles that were true and quasi-experimental controlled trials on support groups for non-professional caregivers, including mutual support, psychoeducational, and educational groups were analyzed. Outcome indicators were psychological well-being, depression, burden, and social outcomes. RESULTS: Support groups showed a significant positive effect on caregivers' psychological well-being (Hedge's g = -0.44, 95% CI = -0.73, -0.15), depression (Hedge's g = -0.40, 95% CI = -0.72, -0.08), burden (Hedge's g = -0.23, 95% CI = -0.33, -0.13), and social outcomes (Hedge's g = 0.40, 95% CI = 0.09, 0.71). The use of theoretical models, and length and intensity of group sessions had a significant impact on the effect sizes for psychological well-being and depression. Ratio of female participation (for psychological well-being and depression) and average age (social outcomes) were significant predictor variables. CONCLUSIONS: Support groups benefit caregivers and findings of this meta-analysis serve as immediate guidance for group facilitators. Future research should include additional outcome variables with our defined factors on effectiveness collected as demographic characteristic data for comparison. A more comprehensive understanding of the effectiveness of support groups is indicated to enhance outcomes for caregivers and patients.

Reliability and validity of the Chinese Version of the Mood Disorder Questionnaire.

The purpose of this study was to examine the reliability, validity, sensitivity, and specificity of the Chinese Version of the Mood Disorder Questionnaire (MDQ-C). A total of 170 patients were administered the Mini International Neuropsychological Interview and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision as criterion standard by on-site psychiatrists. The Cronbach's alpha, test-retest reliability, and the content validity index of the MDQ-C were .83, .76, and .80, respectively. Factor analysis revealed that two factors, elevated mood overactivity and irritable behavior, explained 40.89% of the variance. On the basis of the sensitivity and specificity results, the optimal cutoff point was 6. The MDQ-C is an effective short and comprehensive tool with robust psychometric properties for diagnosis of bipolar disorders, specifically for patients with bipolar I.

Effectiveness of group music intervention against agitated behavior in elderly persons with dementia.

OBJECTIVES: This study explored the effectiveness of group music intervention against agitated behavior in elderly persons with dementia. METHODS: This was an experimental study using repeated measurements. Subjects were elderly persons who suffered from dementia and resided in nursing facilities. In total, 104 participants were recruited by permuted block randomization and of the 100 subjects who completed this study, 49 were in the experimental group and 51 were in the control group. The experimental group received a total of twelve 30-min group music intervention sessions, conducted twice a week for six consecutive weeks, while the control group participated in normal daily activities. In order to measure the effectiveness of the therapeutic sessions, assessments were conducted before the intervention, at the 6th and 12th group sessions, and at 1 month after cessation of the intervention. Longitudinal effects were analyzed by means of generalized estimating equations (GEEs). RESULTS: After the group music therapy intervention, the experimental group showed better performance at the 6th and 12th sessions, and at 1 month after cessation of the intervention based on reductions in agitated behavior in general, physically non-aggressive behavior, verbally non-aggressive behavior, and physically aggressive behavior, while a reduction in verbally aggressive behavior was shown only at the 6th session. CONCLUSIONS: Group music intervention alleviated agitated behavior in elderly persons with dementia. We suggest that nursing facilities for demented elderly persons incorporate group music intervention in routine activities in order to enhance emotional relaxation, create inter-personal interactions, and reduce future agitated behaviors.

The effects of a support group on dementia caregivers' burden and depression.

OBJECTIVE: The aim of the study is to investigate the effects of a support group on depression levels and burden among dementia caregivers in Taiwan. METHOD: An experimental, pre-intervention postintervention control group design was used in this study. The experimental group received intervention consisting of a 12-week support group for dementia caregivers. A total of 85 subjects were evaluated before intervention, after intervention, and at 1-month follow-up. RESULTS: (a) The depression level of participants in the experimental group was significantly decreased after the intervention and at 1-month follow-up. (b) There was no significant difference in caregiver's burden after the support group intervention and 1-month follow-up. DISCUSSION: The improvement in dementia caregivers' depression levels shows that the support group was effective for reducing caregivers' depression although not effective for relieving their burden of care.

Psychometric properties of the Chinese version of the Bipolar Spectrum Diagnostic Scale.

AIM AND OBJECTIVES: The aim of this study was to test the psychometric properties of the Chinese version of the Bipolar Spectrum Diagnostic Scale (C-BSDS) in a Chinese population to serve as an aid to clinical diagnosis of bipolar disorders. BACKGROUND: Bipolar spectrum disorders are often misdiagnosed because of the wide range of symptoms seen in patients. The consequences of delayed diagnoses or misdiagnoses can be devastating. DESIGN: A cross-sectional research design. METHOD: Two hundred patients with affective disorders from a psychiatric outpatient clinic in Taiwan were enrolled. Internal consistency reliability and two-week test-retest reliability were performed to evaluate the reliability of the C-BSDS. Expert content validity and factor analysis were used for testing construct validity. To evaluate sensitivity and specificity, the Chinese version of the Mini International Neuropsychiatric Interview (MINI) was used as the gold standard for diagnosis. RESULTS: The internal consistency coefficient measured by intra-class correlation (ICC) was 0.81, the test-retest reliability coefficient was 0.85 and the expert validity was 0.85. For construct validity, 'irritable and hyper-energetic factors' and 'depressed and lack of energy factors' were extracted by factor analysis. These two factors reflected the structure of the original scale and accounted for 33.27% of the variance. The optimal cut-off was 12, which yielded a sensitivity of 74 and a specificity of 0.97 for detecting bipolar disorder and for bipolar II disorder these were 0.79 and 0.68, respectively. CONCLUSIONS: The C-BSDS showed good reliability and validity, and the results were consistent with the English version of the BSDS. Therefore, the C-BSDS is an effective tool for evaluation of a Chinese population. RELEVANCE TO CLINICAL PRACTICE: The BSDS can further increase the detection rate of bipolar disorders, especially bipolar II disorder, with satisfactory sensitivity and specificity. It can effectively assist with clinical screening of patients for bipolar spectrum disorders.