Spiritual care models of patients living with cancer in Taiwan.

BACKGROUND: Psychological, social and spiritual needs are often unmet during the care of patients with cancer in Taiwan. AIM: The purpose of this study was to confirm the spiritual care models including the spiritual distress symptoms (SDS), spiritual distress symptoms interventions (SDSI), and spiritual distress outcomes criteria (SDOC) of patients with cancer in the initial, relapse and terminal stages. METHOD: This cross-sectional survey collected data from 150 professional nurses about their perceptions of the SDS, SDSI and SDOC for patients with cancer. RESULTS: The significant total effects of SDS on SDOC by SDSI of the patients with cancer in the initial, relapse and terminal stages were found. Additionally, the direct effects of SDS on SDOC by SDSI of the patients with cancer from the initial, relapse to terminal stage were gradually enhanced. CONCLUSIONS: The relationship between spiritual distress symptoms, interventions and outcomes was significantly higher from the initial to relapse state until at the end of life, based on the perceptions of 150 professional nurses.

Correlates of perceived caring behaviour of formal caregivers in long-term care facilities: A cross-sectional survey.

BACKGROUND: Researchers have identified several factors that correlate with the caring behaviours of formal caregivers in long-term care facilities (LTCFs). However, a limited range of socio-demographic factors has been discussed, and no studies have discussed the combined effects of the institutional characteristics of the LTCF and the personal characteristics (i.e. bio-psycho-socio-spiritual attributes) of the formal caregiver on the caring behaviour. AIM: The aim of this study was to examine caring behaviours of formal caregivers for older residents of LTCFs and to explore factors that explain and predict the caring behaviours of them. METHODS: A valid sample of 224 formal caregivers (nurses and nurse aids) employed at 56 LTCFs (21 nursing homes and 35 assisted living facilities) was analysed. Hierarchical regression analysis with two-tailed significance test was used to investigate whether the caring behaviours of the caregivers were independently associated with the characteristics of the caregivers or the institutions. FINDINGS: Caring behaviours of the formal caregivers had significant positive associations with their job satisfaction (ß = 0.152, p < 0.05) and with their perceived satisfaction of LTCF residents (ß  = 0.214, p < 0.001).The organisational-level analysis revealed that caring behaviours had positive associations with accreditation level (ß = 0.163, p < 0.01) and with nurse-aid staffing level (ß = 0.126, p < 0.05). Additionally, the caring behaviour had positive associations with their attitude towards older adults (ß  = 0.193, p < 0.01) and with their self-transcendence (ß  = 0.184, p < 0.01). These two factors explained 42.2% of the variance in the caring behaviours of caregivers. CONCLUSION AND IMPLICATIONS: Caring behaviours were related to both personal characteristics (attributes, mindset) and organisational characteristics. By clarifying factors in the caring behaviours of caregivers, this study provides information that LTCFs can use to develop strategies for managing their caregivers and that policymakers can use to establish and implement healthcare policies for older populations.

Factors related to perceived caring among older people residing in long-term care facilities: a cross-sectional study.

BACKGROUND: Healthcare providers who exhibit caring behaviours promote quality of care. Theoretical and empirical models have promoted a three-dimensional paradigm of care perception. However, the perception of elderly residents in long-term care facilities related to caring has not been investigated. OBJECTIVES: This study explored factors related to the elderly's perception of healthcare providers' caring in long-term care facilities. METHODS: A cross-sectional survey was conducted among 461 elderly residents living in 57 long-term care facilities in southern Taiwan. A structured questionnaire included demographic information, facility characteristics and the 12-item Caring Scale for Institutionalized Elders. Hierarchical regression analysis was used to determine significant factors related to the elderly residents' caring perceptions. FINDINGS: A hierarchical regression model showed 49.9% of the variance in elderly's perception of caring. Significant related factors included resident's age, number of comorbidities, need for caring, time spent being cared for, bed-to-nurse staffing ratios and accreditation status. CONCLUSIONS: Improved Registered Nurse staffing ratios with a higher level of accreditation status yield better perceptions of caring among residential elderly. Those with comorbid diseases and fewer caring needs have a higher perception of healthcare provider caring. IMPLICATIONS: The related factors of elderly's perceived caring provide long-term care managers and nursing staff with beneficial information to develop strategies that can manage residents with high expected-care needs. Policies to improve the accreditation standards of long-term care facilities are needed.

Self-transcendence, caring and their associations with well-being.

AIMS: To examine the relationship between nursing staffs' self-transcendence and well-being in long-term care facilities and to investigate the mediating role of caring behaviours in the aforementioned relationship. BACKGROUND: Factors associated with the well-being of healthcare providers influence the quality of care delivered. Although an increasing number of studies have shed light on the relationship between self-transcendence and subjective well-being, little is known of the mediating effect of caring behaviour in this relationship. DESIGN: The cross-sectional design applied in this study included a questionnaire survey of long-term care facilities. METHODS: Structural equation modelling with maximum likelihood estimation was used for empirical analysis of survey data obtained from 276 nurses and nurse-aids in 55 long-term care facilities. A bootstrapping method was used to analyse mediating effects. RESULTS: Tests of the measurement model and hypothesized model showed an adequate goodness of fit to the sample data. The results showed that nursing staffs' self-transcendence was related to their caring behaviours and well-being. Moreover, caring behaviours partially mediated the relationship between self-transcendence and well-being. CONCLUSION: Our findings provide insight into the influence of self-transcendence and caring behaviours on the well-being of nursing staffs in long-term care settings. Further studies are needed to clarify the role of circumstances national wide.

Health education and competency scale: Development and testing.

AIMS AND OBJECTIVE: To develop a tool for measuring competency in conducting health education and to evaluate its psychometric properties in a population of entry-level nurses. BACKGROUND: Until now, no generic instrument has been developed specifically for measuring competency in health education, which is an essential competency for nurses. Existing scales are either insufficient for psychometric evaluation or are designed specifically for senior nurses. To evaluate curricula and courses designed for entry-level nurses, educators require an instrument for measuring improvement in core competency from baseline to determine whether the minimum level of ability has been achieved. DESIGN: Item development for the survey instrument used for data collection in this study was based on the results of a literature review. METHODS: The self-evaluated Health Education Competency Scale developed in this study was used to survey 457 nursing students at two nursing schools and 165 clinical nurses at a medical centre in south Taiwan in 2016. The participants were randomly divided into two equal groups. One group was analysed by exploratory factor analysis with varimax rotation, and one group was analysed by confirmatory factor analysis. RESULTS: Factor analysis yielded a four-factor (assessment, pedagogy, motivation and empowerment) solution (18 items) that accounted for 75.9% of the variance. CONCLUSION: The total scale and subscales had good reliabilities and construct validity coefficients. For measuring competency in entry-level nurses, the Health Education Competency Scale had a good data fit and sound psychometric properties. RELEVANCE TO CLINICAL PRACTICE: The proposed scale can be used to assess health education competency for college nursing students and practising nurses. Furthermore, it can provide educators with valuable insight into the minimum competencies required for entry-level nurses to deliver quality health care to clients and can guide them in the practice of client-based teaching.

Development and Psychometric Evaluation of the Caring Scale for Institutionalized Elders.

BACKGROUND: A scale that measures the efficacy of care from the perspectives of institutionalized older adults is needed to meet the growing need for better caring knowledge and skills among nurses and caretakers working in long-term care facilities. The currently available tools are insufficient for measuring the caring-related interactions of caretakers with institutionalized older adults. PURPOSE: The aim of this study was to develop and explore the psychometric structure of a caring scale for institutionalized older adults. METHODS: The scale development process took place in two stages. In the first stage, a 34-item Caring Scale for Institutionalized Elders was generated using literature reviews and interviews with institutionalized older adults. Twenty-nine items were retained after item analysis and content validity testing, and then 19 items were retained after an exploratory factor analysis of 300 institution-dwelling older adults. The factor structure and reliability were further tested in 216 older adults using confirmatory factor analysis. The second stage provided evidence of the validity and reliability of the developed scale. This study was conducted between 2011 and 2013 in Taiwan. RESULTS: Confirmatory factor analysis indicated that a 12-item scale with a two-factor structure best fits the data (χ =106.990, df = 53, p < .001, χ/df ratio = 2.019, goodness-of-fit index = .926, comparative fit index = .958, Tucker-Lewis index = .948, root mean square error of approximation = .069). This scale had acceptable Cronbach's α values (range = .827-.907). CONCLUSIONS: This scale has satisfactory validity and reliability for measuring the efficacy of care that is provided to institutionalized older adults. Further studies are necessary to test the applicability of this scale to other populations.

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

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

Caring behaviors perceived by elderly residents of long-term care facilities: scale development and psychometric assessment.

BACKGROUND: To meet the growing need for relationship-centered nursing practice and for nursing school accreditation in Taiwan, nursing school curricula must include training in care for elderly populations in institutional settings. However, educators lack tools for evaluating student performance in such settings. The few tools currently available for measuring the caring in nurses perceived by elderly residents of long-term care facilities (LTCFs) are either inappropriate for education purposes or are culturally inappropriate for elderly populations in Taiwan. OBJECTIVES: To develop a scale for measuring the caring behaviors of caregivers or student volunteers as perceived by a Taiwanese population of elderly residents of LTCFs and to establish the psychometric characteristics of the scale. METHODS: This study was conducted in two phases. In Phase 1, the researchers comprehensively reviewed the literature on caring. Based on the review, an Elderly Resident-Perceived Caring Scale (EPCS) was developed to measure the caring behaviors perceived by LTCF residents. To establish content and face validity, the items on the scale were reviewed by six experts in two rounds of Delphi study and by four elderly laypersons. In Phase 2, a convenience sample of 297 elderly residents from 18 representative elderly care facilities (i.e., skilled nursing facilities, independent living facilities, and assisted living facilities) in Taiwan were recruited to test the construct validity and reliability of the EPCS. RESULTS: The 14-item, 2-dimension questionnaire developed in this study explained 64.33% of the variance in caring perceived by the residents. Factor I, Comforting, included 11 items. Factor II, Encouraging, included 3 items. Cronbach's α values were .924 for the total scale and .930 and .844 for the Comforting and Encouraging, respectively. CONCLUSION: The psychometric qualities of the EPCS were supported. However, further testing of the scale is needed to confirm its psychometric properties in a larger sample.