[Complementary Therapy: Application of Photobiomodulation in Self-Care and Patient Care].

Photobiomodulation (PBM), also known as low-level laser therapy, is a non-invasive light therapy that applies near-infrared light sources near target tissues. PBM allows photons to penetrate tissues and interact with cells, promoting photophysical and chemical changes that result in desired changes at the molecular, cellular, and tissue levels (Oliveira et al., 2022; Shetty et al., 2023). This complementary therapy has garnered significant research attention both domestically and internationally. The results of recent research indicate non-invasive transcranial light stimulation can enhance high-frequency oscillations such as α and ß waves, leading potentially to improved cognitive and neurological functions, memory, attention, and emotional status in healthy adults (Shetty et al., 2023). This mode of therapy is recommended as a non-pharmacological intervention for pain relief (Ross, 2022) and has been found to improve oral pain and quality of life in patients with burning mouth syndrome and in those undergoing hematopoietic stem cell transplantation (Camolesi et al., 2022; Chan et al., 2023). Also, PBM has been promoted as a method of enhancing wound healing (Oliveira et al., 2022) and of reducing the respiratory disturbance index in patients with obstructive sleep apnea (de Camargo et al., 2020). Researchers in Taiwan have also applied PBM to alleviate the pain associated with heel prick blood sampling in newborns and suggested using low-level laser therapy as a pain relief measure for full-term newborns undergoing invasive procedures (Wu et al., 2023). For the column in this issue, we have invited domestic nursing and optoelectronic scholars who have conducted extensive research in the field of PBM to explain the related mechanisms, share research findings, and introduce PBM devices that may be used in clinical, home, and school settings. Considering the impact of shift work on sleep among healthcare professionals, we also hope to provide nurses with different insights and options for self-care and patient care through the research and product introductions provided. Finally, an article on assessing aging and promoting health from a traditional Chinese medicine perspective is included to offer nursing professionals a holistic approach to self-care and preventive concepts based on natural rhythms.

[Pathophysiology and Assessment of Delirium in Patients Who are Critically Ill in the Intensive Care Unit].

Delirium is a common clinical problem among adult patients receiving care in intensive care units (ICU). In recent years, several guidelines for the diagnosis, treatments, and care of ICU adult patient's delirium have been published with the objective of assisting clinical care teams to address the issue of delirium more effectively. In order to improve the understanding of delirium among ICU nursing staffs, the prevalence and common types of delirium in adult ICU settings are introduced in this article. In addition, recently published articles are synthesized to demonstrate the pathophysiological mechanisms of delirium, introduce the predictive assessment model of risk factors and two commonly used behavioral screening assessment tools, and describe the approach to conducting physiological assessments in delirium patients with acute and critical illnesses.

NASA Mission X Program for Healthy Eating and Active Living among Taiwanese Elementary School Students.

PURPOSE: This study assessed the effects of an intervention program adapted from the NASA Mission X (MX) program on children's Healthy Eating Active Living (HEAL) knowledge and behaviors and anthropometry. METHODS: This clustered randomized control trial recruited 8 elementary schools in remote rural areas of Northern Taiwan. The intervention was the 8-week MX program. All the 3rd and 4th graders were invited to the study (n = 245). Children's weight, height, HEAL knowledge and behaviors were measured pre- and post-intervention. RESULTS: The intervention group had significantly more improvements than control group in physical activity knowledge score (+0.91 vs. +0.25, p = 0.002), diet knowledge score (+0.62 vs. +0.17, p = 0.044), and score of interests in NASA and space exploration (+0.34 vs. -0.07, p < 0.0001). BMI increased from 18.4 to 18.6 (p < 0.05) for the control group but did not change for the intervention group. The changes in BMI between groups did not differ significantly. CONCLUSION AND PRACTICE IMPLICATIONS: This randomized controlled trial showed that the NASA MX program was feasible and acceptable among children in Taiwan, and improved children's HEAL knowledge. (ClinicalTrials.gov registration: NCT03355131).

Gender differences and burden of chronic conditions: impact on quality of life among the elderly in Taiwan.

BACKGROUND: Multiple chronic conditions affect people's health-related quality of life (QoL) and the distributions of the conditions may differ between genders. Our goal was to examine gender differences in chronic conditions and QoL among community-living elderly in Taiwan and to examine whether differences in QoL between genders, if present, were attributable to the distribution of chronic conditions. METHODS: We used data from the Nutrition and Health Survey in Taiwan (NAHSIT, 2005-2008), which interviewed a representative sample of the Taiwanese population. The survey questions included the SF-36 questionnaire to assess participants' QoL and items for participants' medical history. We used multiple linear regressions to examine the difference in QoL between genders. RESULTS: We included 1179 elders for our analysis; men accounted for 52% (612/1179). The mean age was 73; women were slightly younger. The mean (standard deviation) of SF-36 physical and mental health component score (PCS and MCS) was 44.5 (11.1) and 55.6 (9.0), respectively, and women reported a significantly lower PCS than men (difference - 4.85, p < 0.001). Urinary incontinence, arthritis, stroke, and kidney disease were associated with a clinically meaningful decrease in PCS (≤ - 6.5 points). The difference in PCS between genders was not attenuated after we accounted for chronic conditions in regression analysis. CONCLUSIONS: Our findings suggest that women tend to report that their physical health-related QoL is poorer than that of men, and such a difference does not seem to be attributable to the distribution of chronic conditions. Elderly men and women may perceive health-related QoL differently.

[Spiritual Care for Patients and Their Families in the Intensive Care Unit].

To date, most of the literature in Taiwan on clinical spiritual care has focused either on improving the spiritual well-being of patients or on developing assessment tools suitable for use with end-stage cancer patients. Few articles have discussed spiritual care in the context of intensive care unit (ICU) patients and their family members. When ICU patients face life-threatening and complex physiological problems, spiritual care plays an important role in disease recovery and adaptation and impacts the satisfaction and medical decision-making of critical patients and their family members. This article describes the synergy model and spiritual care guidelines for ICU patients and their families. Furthermore, this article supplements two recent interventional studies that targeted ICU patients in intensive care unit with direct and easily understood instructions for self-implementation of the two dimensions, vertical and horizontal, of spiritual well-being. The author hopes to provide a practical reference for implementing spiritual care with ICU patients and their families in clinical practice.

Risk factors of post-traumatic stress symptoms in patients with cancer.

AIMS AND OBJECTIVES: To determine the level of post-traumatic stress symptoms and to identify demographics, disease history and clinical symptoms that were associated with post-traumatic stress symptoms among patients with gynaecological, breast or colorectal cancer in Taiwan. BACKGROUND: Literature indicated that 7·3-35·2% of patients with cancer had experienced level of post-traumatic stress symptoms. However, the post-traumatic stress symptoms among patients with cancer in Taiwan was not documented. DESIGN: A cross-sectional study. METHODS: A total of 347 participants recruited from two general hospitals in southern Taiwan. They completed the Chinese version of Davidson Trauma Scale and a profile describing their demographics and clinical symptoms. Disease history was collected from medical records. RESULTS: Approximately 21·6% of participants reported higher score on Chinese version of Davidson Trauma Scale (Mean ± SD = 22·85 ± 24·12). The top four scores on Chinese version of Davidson Trauma Scale were painful memories, insomnia, shortened lifespan and flashbacks. The risk factors of post-traumatic stress symptoms were suicidal intention (OR = 2·29, 95% CI = 1·86-2·82), chemotherapy (OR = 2·13, 1·18-3·84), metastasis (OR = 2·07, 1·29-3·34), cancer-specific symptoms (OR = 1·21, 1·15-1·27) and high education (OR = 1·75, 1·10-2·78). CONCLUSION: To prevent post-traumatic stress symptoms, patients with cancer should be routinely screened by psychiatrists for post-traumatic stress symptoms, for ongoing symptom control and suicidal intention. Patients with cancer who are at risk of suicidal behaviour should be enrolled in suicide prevention programmes. RELEVANCE TO CLINICAL PRACTICE: Nurses need to assess post-traumatic stress symptoms of patients with cancer, particularly those who with high education, suffered from complications of chemotherapy, metastasis and cancer-specific symptoms and suicidal intention.

Pelvic floor muscle exercise for fecal incontinence quality of life after coloanal anastomosis.

AIMS AND OBJECTIVES: To assess the efficacy of pelvic floor muscle exercise for enhancing fecal incontinence quality of life after coloanal anastomosis in colorectal cancer patients. BACKGROUND: Methods of improving incontinence have been evaluated in many countries, but never in a Taiwan population. DESIGN: A longitudinal experimental study. METHODS: Fifty-two colorectal cancer patients who had received colostomy closure and coloanal anastomosis surgery were recruited from a general hospital in southern Taiwan and randomly assigned to an experimental group (n = 26) or a control group (n = 26). Both groups received routine postoperative care. However, the experimental group received private consultations, educational DVDs and pamphlets to instruct them in performing pelvic flow muscle exercise. In all participants, the Fecal Incontinence Quality of Life Scale was used to measure quality of life before discharge and at one, two, three, six and nine months after discharge. Generalised estimating equations were used to compare longitudinal effects between the two groups. RESULTS: The generalised estimating equations revealed that all participants had significantly improved Fecal Incontinence Quality of Life Scale scores at two, three, six and nine months after discharge. Compared to the controls, however, the experimental group had significantly higher scores at two, three, and six months after discharge. CONCLUSIONS: Patient education in pelvic floor muscle exercise positively affects Fecal Incontinence Quality of Life Scale scores in patients who have received coloanal anastomosis. RELEVANCE TO CLINICAL PRACTICE: Early education in pelvic floor muscle exercise can improve management of fecal incontinence symptoms after coloanal anastomosis and can improve quality of life.

Sexual dysfunction in males following low anterior resection.

AIMS AND OBJECTIVES: The purpose of this study was to explore the prevalence of sexual dysfunction in males one year after undergoing low anterior resection and to determine whether health care professionals discuss sexual issues with patients after surgery. BACKGROUND: Sexual dysfunction in males may be a complication after low anterior resection for rectal cancer, but few studies have explored this issue in Taiwan. DESIGN: A descriptive comparison study design. METHODS: A descriptive comparison design was used, and a group of 133 participants underwent a low anterior resection procedure for rectal cancer. The results were compared with those of a group of males who underwent colectomy (n = 58) for colon cancer. The following instruments were used: the five-item version of the International Index of Erectile Function, personal demographics and medical variables. RESULTS: The results showed that the prevalence of erectile dysfunction among the low anterior resection patients was 97·0% (129/133), and the erectile dysfunction prevalence was 75·9% (44/58) for the males who underwent colectomy. The generalised linear model showed that after controlling for hypertension and stoma, the low anterior resection group had worse sexual function than those in the colectomy group, and stoma was also a factor that impacted patients' sexual function. The results also revealed that only 32·8-35·3% of health care providers talked about sexual dysfunction with people who have rectal cancer prior to surgery. CONCLUSION: This study demonstrated that men who have undergone low anterior resection have a high risk of sexual dysfunction and that health care professionals infrequently discuss these issues with patients. RELEVANCE TO CLINICAL PRACTICE: When patients are diagnosed with rectal cancer and before they undergo surgery, an assessment and discussion of sexual function issues should be incorporated into standard care. Continued follow-up after hospital discharge and evaluations of sexual function are vital factors for male postoperative rectal cancer patients.

Patient-health care professional gender or race/ethnicity concordance and its association with weight-related advice in the United States.

OBJECTIVE: Examine association between adult patients' and health care providers' (HCPs) gender or race/ethnicity concordance and patients' reported receiving weight-related advice from HCP's in USA. METHODS: Using Medical Expenditure Panel Survey (MEPS) 2004-2007 data, studied prevalence of weight-related advice (on exercise and diet) given to patients and its association with patients/HCPs concordance in gender (n=9,686) and race/ethnicity (n=8,825). RESULTS: Overall, 46% of patients received HCP advice on diet and 49% on exercise. Overweight females seeing female HCPs were more likely to receive exercise advice than those seeing male HCPs (OR=1.44 [95% CI: 1.10-1.89]). Race/ethnicity concordance was associated with lower odds of advice-receiving in certain populations (OR=0.80 [0.67-0.97] for exercise and OR=0.42 [0.19-0.91] for diet among white patients, OR=0.47 [0.23-0.98] for exercise among Hispanic overweight patients). CONCLUSIONS: Patient/HCP gender or race/ethnicity concordance was not positively associated with HCPs providing weight-related advice. Patients with female HCPs or with racial/ethnic discordant HCPs (especially black or Asian HCPs) were more likely to receive advice. PRACTICE IMPLICATIONS: Health care providers need be empowered, particularly white and male HCPs, to improve delivery of weight-related advice. It may reflect better of receiving weight-related advice based on patients' recall.

Nursing Job Rotation Stress Scale development and psychometric evaluation.

AIM: The aim of this study was to develop and assess the reliability and validity of the Nurse Job Rotation Stress Scale (NJRS). METHODS: A convenience sampling method was utilized to recruit two groups of nurses (n = 150 and 253) from a 2751 bed medical center in southern Taiwan. The NJRS scale was developed and used to evaluate the NJRS. RESULTS: Explorative factor analysis revealed that three factors accounted for 74.11% of the explained variance. Confirmatory factor analysis validity testing supported the three factor structure and the construct validity. Cronbach's alpha for the 10 item model was 0.87 and had high linearity. CONCLUSION: The NJRS can be considered a reliable and valid scale for the measurement of nurse job rotation stress for nursing management and research purposes.

Effect of Relaxation With Guided Imagery on The Physical and Psychological Symptoms of Breast Cancer Patients Undergoing Chemotherapy.

BACKGROUND: Breast cancer patients frequently experience psychological distress during the chemotherapy period. OBJECTIVES: This study aimed to evaluate the effect of relaxation with guided imagery on patients with breast cancer. PATIENTS AND METHODS: A two-group, pretest-posttest, quasi-experimental design with a randomized controlled trial was conducted. Sixty-five breast cancer patients from one medical center in Taiwan were enrolled in the study. These patients were randomly assigned to the experimental group (n = 32) or to the control group (n = 33). Both groups received chemotherapy self-care education, but the experimental group also received relaxation with guided imagery training. The training on relaxation with guided imagery was conducted before chemotherapy, and the patients were supplied with a compact disc detailing the performance of relaxation with guided imagery for 20 minutes daily at home for 7 days after chemotherapy. RESULTS: The experimental group showed significant decreases in insomnia (-0.34 ± 0.83, P < 0.05), pain (-0.28 ± 0.58, P < 0.05), anxiety (-3.56 ± 2.94, P < 0.00), and depression (-2.38 ± 2.70, P < 0.00) between the pretest and the posttest. Comparing the two groups, statistically significant differences were found in the overall symptom distress (B = 0.11, P < 0.05), insomnia (B = 0.50, P <0.05), depression (B = 0.38, P < 0.05), and numbness in physical symptoms (B = 0.38, P < 0.05), as well as in anxiety (B = 3.08, P < 0.00) and depression (B = 1.86, P < 0.00) in psychological distress. One week of relaxation with guided imagery can significantly improve the overall symptoms of distress, insomnia, depression, physical symptoms, and anxiety, and can decrease psychological distress. CONCLUSIONS: Relaxation with guided imagery had a positive effect on mediating anxiety and depression in breast cancer patients.