Frailty and Quality of Life among Older Adults in Communities: The Mediation Effects of Daily Physical Activity and Healthy Life Self-Efficacy.

As the global population ages, frailty, which has been shown to affect and predict the quality of life (QoL) of older adults, has become a central issue. The aim of this study was to explore the mediating effects of daily physical activity (DPA) and healthy life self-efficacy (HLSE) on the relationship between frailty and QoL in older adults using a serial multiple mediation model. The cross-sectional study was conducted among 210 community-dwelling older adults in Taiwan. Data were collected using the Taiwanese version of the Tilburg Frailty Indicator, the EuroQoL visual analog scale, the Kihon Checklist, and the Chronic Disease Self-Efficacy Scales. The PROCESS macro for SPSS based on the bootstrap method was used to determine the mediating effects of DPA and HLSE on the relationship between frailty and QoL. The results showed that frailty was found to have both direct and indirect effects on QoL. As predicted, DPA and HLSE partially mediated the relationship between frailty and quality of life (DPA: B = −0.71, p < 0.001; HLSE: B = −0.32, p < 0.001). In addition, serial mediation analyses indicated that the association between frailty and QoL was partially mediated by DPA and HLSE in a sequential manner (B = −0.16, p < 0.001). The serial mediation has a causal chain linking DPA and HLSE, with a specified direction of causal flow. According to the results of the serial multiple mediation model, the elderly should be encouraged to continue their activities in daily life, which not only improves self-efficacy and confidence in maintaining health but also reduces the negative impact of frailty on QoL.

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.

The Effectiveness of the Integrated Care Model among Community-Dwelling Older Adults with Depression: A Quasi-Randomized Controlled Trial.

Depression is the second-leading cause of disability among older patients worldwide. This study examined the effectiveness of the Integrated Care Model (ICM) intervention in decreasing depression, suicide ideation, and psychological symptoms and improving life satisfaction among old patients with depression living in communities. The participants were allocated to either the intervention (n = 67) or control group (n = 76) from July 2018 to November 2018. All participants received the usual geriatric care for three months in eastern Taiwan. Additionally, participants in the intervention group were treated according to the ICM, including the assessment and management of health problems, improvements in spiritual and mental wellbeing, helping with activities of daily life and mobility, providing social welfare resources, and prevention of elder abuse. The patients in the experimental group showed significant improvement in the group-by-time effect on the Center for Epidemiologic Studies Depression Scale, the Brief Symptom Rating Scale, suicide ideation measures, and the Life Satisfaction Index over 18 weeks. The ICM should be included in routine geriatric care and adopted in hospitals, long-term care facilities, and communities.

Psychometric Properties of the Taiwanese Version of the Tilburg Frailty Indicator for Community-Dwelling Older Adults.

Screening the frailty level of older adults is essential to avoid morbidity, prevent falls and disability, and maintain quality of life. The Tilburg Frailty Indicator (TFI) is a self-report instrument developed to assess frailty for community-dwelling older adults. The aim of this study was to explore the psychometric properties of the Taiwanese version of TFI (TFI-T). The sample consisted of 210 elderly participants living in the community. The scale was implemented to conduct a confirmatory factor analysis (CFA) test for validity. The models were evaluated through sensitivity, specificity, area under the curve, and receiving operating characteristic (ROC) curve. CFA was performed to evaluate construct validity, and the TFI-T has a goodness of fit with the three-factor structure of the TFI. Totally, the 15 items of TFI-T have acceptable internal consistency (Cronbach's alpha = 0.78), and test-retest reliability (r = 0.88, p < 0.001). The criterion-related validity was examined, the TFI-T correlation with the Kihon Checklist (KCL) score (r = 0.74; p < 0.001). The cutoff of 5.5 based on the Youden index was considered optimal. The area under the ROC curve analysis indicated that the TFI-T has good accuracy in frailty screening. The TFI-T exhibits good reliability and validity and can be used as a sensitive and accurate instrument, which is highly applicable to screen frailty in Taiwan among older adults.

Factors associated with perceived stress of clinical practice among associate degree nursing students in Taiwan.

BACKGROUND: Clinical placements play an important role in helping nursing students to achieve clinical competence, but these placements can be highly challenging and stressful. It has been shown that stress can be either a trigger or aggravating factor for ill-health in general, but studies have seldom differentiated the impact of general health status on perceived stress. This study examined factors associated with perceived stress of clinical practice among nursing students with a particular focus on the effect of general health status on stress. METHODS: This was a cross-sectional quantitative study conducted among 724 associate nursing degree students in Southern Taiwan. RESULTS: Health status scores varied from 28 to 139, with an average of 68.40 (SD = 25.75). Health status was reported to be 'good' (scores 28-55) in 35.5% of participants, moderate (scores 56-83) in 24.6%, and poor (Scores ≧ 84) in 39.9% of participants. Perceived stress scores ranged from 0 to 95 points with an average score of 36.65 (SD ± 15.95). The classification and regression tree (CART) analysis showed health status as the most important factor linked to perceived stress with a Normalized Importance value of 100%. Those who reported general health status (measured through General Health Questionnaire (GHQ)-28) score of ≤34.5 perceived mild stress and those with a score of > 34.5-< 84.5 perceived moderate stress. A score of 84.5 was found to be the point of transition to perceptions of severe stress. When health status score was greater than 84.5, perceived stress was at a severe or extremely severe level. CONCLUSIONS: Our findings indicated health status as a potential measure to identify students who were most vulnerable to perceived stress. Given the cross-sectional design of this study and the bidirectional relationship between health and stress, more studies are needed to fully establish the predictive link between general health status and vulnerability to stress.

Developing an assessment tool for geropsychiatric mental healthcare knowledge and attitude evaluations in clinical practice for nursing students.

AIM: To develop an instrument to investigate geropsychiatric psychological symptoms, health problem nursing knowledge (GPN-K), geropsychiatric psychological symptoms and health problem nursing attitude scale (GPN-A) in clinical practice for nursing students. DESIGN: Instrument development and cross-sectional study for psychometric testing. METHODS: Construct validity was evaluated using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA), and internal consistency was calculated using Cronbach's α. RESULTS: A total of 300 students have completed the questionnaires (85.71% response rate). The CFA of GPN-K showed good fitness and validity. The Kuder-Richardson 20 (KR-20) value of the internal consistency reliability is 0.64. The GPN-A overall content validity index is 0.95. A three-factor structure was shown by exploratory factor analysis. The three factors are communication and care, helping others improve and problem evaluation tendency. The total variance explained is 59.01%. Cronbach's alpha of GPN-A equals 0.84, which represents good internal consistency.

Relocation experiences of the elderly to a long-term care facility in Taiwan: a qualitative study.

BACKGROUND: Relocation to a long-term care (LTC) facility is a major life change for most elderly people. Following relocation, many elderly experience difficulties in adapting to changes in the living environment. Taiwan is increasingly becoming an "aging society" and the numbers of those who relocate from family residences to long-term residential care facilities have increased over years. However, in-depth evidence on the experiences of the elderly of their stay in LTC facilities in Taiwan is relatively sparse. This study aimed to explore the relocation experiences of the elderly to a LTC facility to inform policy and practice to address their needs effectively. METHODS: A qualitative study, using semi-structured in-depth interviews, was conducted to explore the experiences of 16 elderly people who have relocated to and lived in a LTC facility in Taiwan for up to a period of 12 months. All interviews were recorded, transcribed, and analyzed using grounded theory approach. RESULTS: Participants' accounts reflected four interrelated key themes: wish to minimize the burden, but stay connected with the family; perceived barriers to adaptation; valuing tailored care; and acceptance and engagement. Each theme included interrelated subthemes that influenced one another and represented the different stages in the relocation journey. Most participants viewed relocation as a way of minimizing the burden of their care from family members, but desired to keep a close connection with family and friends. Participants recounted experiences of psychological resistance while making the decision to relocate. Fear of losing autonomy and the ability to perform self-care was a major reason for resistance to adapt. Provision of tailored care was accorded much value by the participants. The decision to accept the relocation and to adapt themselves to the new environment due to their needs for constant care was explicit in some accounts. CONCLUSIONS: Relocation to LTC facility is a dynamic process in the first year of moving into the facility, and involves a range of emotions, feelings and experiences. Adaptation of the elderly into the LTC facility can be maximized if the relocation is well planned with provisions for individually tailored care and family involvement.

Prevalence and characteristics of suicidal ideation among 2199 elderly inpatients with surgical or medical conditions in Taiwan.

BACKGROUND: Worldwide, the elderly are at a greater risk of suicide than other age groups. There is a paucity of research exploring risk factors for suicide in hospitalized elderly patients. Therefore, a study designed to explore the prevalence and characteristic of suicidal ideation (SI), such as QOL (quality of life), a wish to die (WTD), and other factors in elderly inpatients with medical or surgical conditions in Taiwan was warranted. METHODS: A total of 2199 hospitalized elderly patients over age 65 were enrolled. Demographic data, 5-item Brief Symptom Rating Scale (BSRS-5), and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) data were collected. Logistic regression models were used to find the SI-related factors for all participants and to investigate the covariates correlated with WTD in patients with SI. Receiver operating characteristic (ROC) curve analysis was used to find the most important items of the BSRS-5 predictive of SI in this population. RESULTS: SI was found in 3.1% (68/2199) of the elderly. The statistically significantly factors associated with SI were: BSRS-5 item 2 (depression) (odds ratio [OR] = 2.15, 95% confidence interval [CI] = 1.56-2.98), item 4 (inferiority) (OR = 1.62, 1.23-2.13), item 5 (insomnia) (OR = 1.52, 1.13-2.05), and physical domain of WHOQOL (OR = 0.84, 0.72-0.99). QOL15 (mobility) (OR = 0.64, 0.46-0.90) and QOL 16 (satisfaction with sleep) (OR = 0.62, 0.44-0.88) were also significantly associated with SI. The status of living alone (OR = 4.44, 1.24-15.87), QOL 26 (absence of negative feeling) (OR = 0.38, 0.15-0.98), and QOL 27 (being respected/accepted) (OR = 0.43, 0.20-0.92) were significantly associated with WTD among inpatients with SI. The ROC curve analysis revealed that depression, inferiority, and insomnia were the most important items in the BSRS-5 significantly associated with SI among the elderly inpatients. CONCLUSION: To provide physical recovery and maintain mental health for physically ill elderly inpatients, setting up a multi-faceted approach targeting the aforementioned determinants of SI and WTD for reducing the risk of suicide attempt, and exploring other factors correlated with suicidal behaviors, are important topics and directions for clinical practice and further research.

The Development and Psychometric Testing on Psychiatric Nurses of a Nurse Case Management Competence Scale in Taiwan.

BACKGROUND: Case management is a complex process involving multiple activities. It is vital that nurses are competent in all related tasks for case management. A competence scale is a valuable tool for assessing task-related competency. PURPOSE: The aims of this study were to examine the reliability and validity of an assessment scale for nurse case management competence and to use this scale to assess the current competency of nurses. METHODS: A nurse case management competence scale was developed in three stages: (a) selection of assessment items according to standards of practice for case management and literature review, (b) determination of content validity using the Delphi technique with a panel of experts, and (c) psychometric testing of the developed competence scale using a cross-sectional design. Convenience sampling was used to recruit psychiatric nurses at seven psychiatric centers in Taiwan to complete the scale anonymously. An exploratory factor analysis was performed to analyze construct validity. Discriminant validity, internal consistency, and 2-week test-retest reliability were also examined. RESULTS: Two hundred eighty-five psychiatric nurses completed an assessment scale comprising 18 items (originally 25 items). The content validity index reached 0.96 after the Delphi technique was applied twice in the expert panel. Seventy-eight percent of the total variance was explained by two dimension factors: coordination facilitation competence and direct care competence. Participants who had undertaken case management courses had superior case management ability compared with those who had not, indicating that the scale possesses excellent discriminant validity. Cronbach's α and the test-retest results showed excellent reliability. Of the two competence factors, direct care competence (3.03) was better than coordination facilitation competence (2.81). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: There is a dearth of studies investigating the development and psychometric testing of case management competence scales. The results of this study provide evidence to support the reliability and validity of the developed case management competence scale among Taiwanese psychiatric nurses. It is a reliable and valid assessment instrument that may help identify educational needs and improve the case management competencies of nurses.

[A Concept Analysis for Mind-Body Interaction].

Mind-body interaction (MBI) refers the holistic association and interactive process between wisdom, thinking, belief, and physiological reaction, which critically affects health. The main goal of nursing is to maintain mind and body in a healthy state of well being. Few reports in the literatures have addressed the evaluation and application of MBI. Thus, a conceptual analysis of this subject is worth exploring in depth. This paper analyzes the MBI concept step by step based on the procedures of Walker and Avant. The result defines the characteristics of MBI as (1) being aware of psychosomatic effects, (2) interacting between psychology, neurology, immunology and others, and (3) turning out a bio-psycho-social status. Antecedents include geography, culture, race, gender, age, education, profession, values, personality, experience, and health status. Consequences of MBI include well-being, illness, and death. This paper provides new information on MBI that clarifies its meaning, provides comprehensive cognition, and suggests useful applications.

Using evidence-integrated e-learning to enhance case management continuing education for psychiatric nurses: a randomised controlled trial with follow-up.

BACKGROUND: E-learning is a flexible strategy to improve nurses' knowledge of case management, but there are methodological limitations in previous research into the effectiveness of such programs. PURPOSE: To describe the development and effectiveness of an evidence-integrated e-learning program in case management continuing education for Taiwanese psychiatric nurses. DESIGN: Multiple methods were adopted to develop the program and a randomised controlled trial with repeated measures was employed to evaluate it. METHODS: The e-learning program was developed in four stages: (1) systematic review of literature; (2) needs assessment through a national survey and focus group; (3) development of learning materials; and (4) pilot test. Following program development, psychiatric nurses were recruited and randomly allocated into an experimental or comparison group. The experimental group participated in an e-learning continuing education program. The case management knowledge index with sufficient reliability and validity and a satisfaction survey were used to determine the outcomes. A generalised estimating equation was used to assess the difference between the 2 groups before, after, and at 3 months follow-up. RESULTS: The learning material comprised 5 simulated learning modules, self-assessment questions, learning cases, sharing experiences, and learning resources. A total of 200 participants completed the 3 measurements. Knowledge scores in the experimental group significantly exceeded those in the comparison group after the program and at the 3-month follow-up. Participants reported positive learning perceptions. CONCLUSION: The program provides an evidence-based educational resource for nursing continuing education in case management.

[The development of psychiatric and mental health nursing in Taiwan].

Psychiatric mental health is critical to ensuring the health and wellbeing of individuals, families, and communities. While psychiatric mental health work continues to become increasingly complex and challenging, the demand for psychiatric nurses with evidence-based skills continues to grow. Psychiatric mental health nurses (PMHNs) are the primary providers of professional psychiatric mental health care services. PMFNs emphasize humanistic values and focus on servicing patient and family needs. In Taiwan, the Psychiatric Mental Health Nursing Association constructs the competence-credentialing model for psychiatric mental health nursing that underpins the values, attitudes, and beliefs of PMHNs and ensures that the mental health nursing practice promotes public health and wellbeing. In addition, this association promotes advanced psychiatric nursing education, research, and practice, influences the national health agenda, and discusses and disseminates information on psychiatric mental health care issues in order to influence the direction, nature, and quality of psychiatric and mental health care.

Resilience among caregivers of children with chronic conditions: a concept analysis.

The purpose of this concept analysis is to uncover the essential elements involved in caregivers' resilience in the context of caring for children with chronic conditions. Walker and Avant's methodology guided the analysis. The study includes a literature review of conceptual definitions of caregiver resilience in caring for children with chronic conditions. The defining attributes and correlates of caregiver resilience are reviewed. Concept analysis findings in a review of the nursing and health-related literature show that caregiver resilience in the context of caring for chronically ill children can be defined within four main dimensions, ie, disposition patterns, situational patterns, relational patterns, and cultural patterns. Empiric measurements of the impact of caregiver resilience applied to caregivers with children with chronic conditions are also reported in the analysis. The findings of this concept analysis could help nurses and health care providers to apply the concept of caregiver resilience in allied health care and be applied to further studies.

Longitudinal interrelationships between frequent geographic relocation and personality development: results from the Amsterdam Growth and Health Longitudinal Study.

This study is part of the Amsterdam Growth and Health Longitudinal Study, which was undertaken to assess the long-term interrelationships between cumulative frequency of geographic relocation (CFGR) and the development of personality characteristics (i.e., Inadequacy, Rigidity, Social Inadequacy, Dominance, Self-sufficiency, Self-esteem, and Hostility). We found that participants who had more mobility experiences had lower consistency in their personality characteristics (the exception being Rigidity). Residential mobility from different life stages was positively associated with the continuity and change of Inadequacy and Dominance. In addition, young adults with higher Rigidity personality experienced fewer geographic moves during the transition from young adulthood to mid-life. Our study provides evidence that CFGR in different life stages may be associated with the development of personality characteristics from young adulthood to mid-life in different ways. Increased awareness of the potential interrelationships between frequent geographic relocation and personality development may have positive consequences for adult psychological health.

Psychometric properties of the Chinese version of the Life Attitude Schedule (LAS-C) in a sample of Taiwanese adolescents.

BACKGROUND: Although prior research has proposed that several risk factors are conceptually and positively related to suicidal behavior, researchers have also suggested that suicide may be multifaceted. The Life Attitude Schedule (LAS) measures a broad range of suicide-related behaviors, including life-enhancing and life-threatening behaviors. OBJECTIVE: This study aimed to translate the LAS into Chinese and evaluate the psychometric properties of the new version (LAS-C). DESIGN: A cross-sectional and descriptive design was used. SETTING: Data were collected from high schools in the city of Taipei in northern Taiwan. PARTICIPANTS: A convenience sample of 1492 high school students was recruited from five high schools in Taipei. METHODS: We used the Multi-Health Systems (MHS) translation policy to guide the translation process. Reliability was evaluated by internal consistency (represented by Cronbach's α coefficients) and test-retest (represented by intraclass correlation). Validity was demonstrated by content, convergent, divergent, concurrent, and contrast group comparison. Confirmatory factor analysis was further used to examine the theoretical model and to support construct validity. RESULTS: The Cronbach's α coefficient for the whole scale of the LAS-C and its subscales ranged from 0.70 to 0.91. The Intraclass Correlation Coefficient (ICC) ranged from 0.76 to 0.89 on the whole scale and its subscales, and were all statistically significant, at least at the p<0.05 level, indicating good stability over a three-week period. Validity was supported by a Content Validity Index (CVI) of 0.99, convergent, divergent, current, and contrast group comparison validity. Confirmatory factor analysis supported the theoretical model, further providing solid evidence of construct validity. CONCLUSIONS: The LAS-C has proper psychometric properties. Future studies must be conducted to shorten the items to form a briefer version.

Development of a new prototype for an educational partnership in nursing.

The purpose of this 2-year study was to evaluate a new educational partnership for a nurse-managed community center in Taiwan. This project provided care to senior residents in an apartment complex and was integrated into a nursing educational program in Taiwan. In collaboration with these organizations, an educational partnership model was developed and evaluated. Three goals were accomplished: to provide health care to elderly residents, practical learning experience for nursing students, and practical experience for nursing faculty. The findings indicated that teachers, students, and residents in the apartment complex presented a high level of satisfaction with this model. The model created a vivid, practical, community-based resource and applied the principles of service-learning into practical nursing education in Taiwan. The model not only facilitated the empowerment of involved organizations, but also served as a reference for developing other community center-based nursing educational partnerships.

[A study of stress, learned resourcefulness and caregiver burden among primary caregivers of schizophrenic adolescents].

The purpose of this study was to examine the moderating effects of learned resourcefulness on the relationships between stressful life events, psychiatric care activities, and the burden faced by primary caregivers of schizophrenic adolescents. A total of 81 primary caregivers (M = 47.9 years) were interviewed and completed questionnaires at a certain point in time. Hierarchical regression analyses were used to examine the moderating effects of learned resourcefulness. Results showed that 24.5% of the variance (F((5,75)) = 6.20, p < .001) in primary caregivers' burden was explained by the variable of psychiatric care activities and the interaction between the stressful life events and learned resourcefulness. The learned resourcefulness moderated the adverse effects of stressful life events on primary caregivers' burden. The variable of psychiatric care activities, moreover, still had a direct negative effect on caregivers' burden. The results of this study suggest that nursing interventions which focus on teaching and reinforcing the skills of resourcefulness, may help caregivers to cope with stressful life experiences and buffer the caregivers' burden.

[The challenge facing nursing education: to develop clinical performance examination strategies in nursing practice].

The clinical performance examinations of qualified health professionals have become a central professional and corporate issue. Nursing experts have to face trends in nursing care delivery toward a clinical competence-based care model that assesses the professional skills and efficacy of nursing professional and students. Objective, structured clinical examination standards and strategies can be effective vehicles for nursing education and practice, promoting the mastery of clinical nursing skills and fostering an evidenced-based practice approach to clinical care.

Acupoints massage in improving the quality of sleep and quality of life in patients with end-stage renal disease.

BACKGROUND: Traditional Chinese acupressure is a noninvasive technique that employs pressure and massage to acupoints in order to stimulate the balance of life energy that promotes health and comfort. Sleep disturbance is common in patients with end-stage renal disease but no intervention studies have addressed this problem. Aim. The purpose of the present study was to test the effectiveness of acupoints massage for patients with end-stage renal disease and experiencing sleep disturbances and diminished quality of life. METHODS: The study was a randomized control trial. A total of 98 end-stage renal disease patients with sleep disturbances were randomly assigned into an acupressure group, a sham acupressure group, and a control group. Acupressure and sham acupressure group patients received acupoints or no acupoints massage three times a week during haemodialysis treatment for a total of 4 weeks. The measures included the Pittsburgh Sleep Quality Index, Sleep Log, and the Medical Outcome Study - Short Form 36. FINDINGS: The results indicated significant differences between the acupressure group and the control group in Pittsburgh Sleep Quality Index subscale scores of subjective sleep quality, sleep duration, habitual sleep efficiency, sleep sufficiency, and global Pittsburgh Sleep Quality Index scores. Sleep log data revealed that the acupressure group significantly decreased wake time and experienced an improved quality of sleep at night over the control group. Medical Outcome Study - Short Form 36 data also documented that acupressure group patients experienced significantly improved quality of life. CONCLUSION: This study supports the effectiveness of acupoints massage in improving the quality of sleep and life quality of end-stage renal disease patients, and offers a noninvasive therapy for sleep-disturbed patients.