The impact of neuropsychological functions on self-care/self-management of type 2 diabetes in middle-aged people: a scoping review and meta-analysis.

INTRODUCTION: This study aimed to investigate the impact of neuropsychological functions on self-care/self-management in middle-aged individuals with type 2 diabetes (T2DM). AREAS COVERED: A comprehensive literature search was conducted from January 2012 to April 2023 across multiple databases. Ten articles were included in the scoping review, and 3 articles were included in the meta-analysis. The findings consistently indicated an association between reduced neuropsychological functions and poor self-care/self-management in this population. Memory functions, executive functions, and other domains were found to be significantly related to self-care/self-management, including diet management, exercise, blood glucose monitoring, and foot care. EXPERT OPINION: This study highlights the importance of considering neuropsychological factors in understanding and improving diabetes management outcomes. The findings underscore the need for comprehensive neuropsychological assessments and the development of targeted interventions to address specific vulnerable domains. Future research should focus on elucidating underlying mechanisms, addressing methodological inconsistencies, and exploring the effectiveness of interventions targeting neuropsychological impairments. Incorporating technology and personalized approaches into diabetes management can enhance self-care/self-management and clinical outcomes in individuals with T2DM.

Correlation Among Workplace Burnout, Resilience, and Well-Being in Nursing Staff: A Cross-Sectional Study in Taiwan.

BACKGROUND: Because nurses often work in medical environments characterized by high workloads and high levels of stress and pressure, they are particularly vulnerable to workplace burnout and their well-being may suffer. Related studies on burnout, resilience, and well-being have focused primarily on teachers, social workers, and students, with few studies addressing the situation faced by nursing staff. It is important to understand the factors affecting the well-being of nursing staff. PURPOSE: This study explores the status quo and correlations among nursing-staff demographic characteristics, workplace burnout, well-being-related resilience, and the predictive factors of well-being in nurses. METHODS: A cross-sectional, descriptive, correlational research design and purposive sampling were used in this study. Nursing staff who had worked for more than 6 months at a medical center in central Taiwan were recruited as participants, with data from 289 participants collected. A structured questionnaire was used to collect data on demographic characteristics, workplace burnout, resilience, and well-being. RESULTS: The average scores for workplace burnout, resilience, and well-being were 40.40/(0- to 100-point scale), 26.79/(10- to 50-point scale), and 43.25/(24- to 96-point scale), respectively. The result of the regression analysis explained about 51.6% of the variance in well-being. Furthermore, resilience (28.4%), self-perceived health (14.3%), workplace burnout (4.5%), exercise frequency (1.8%), job title (1.2%), interpersonal pressure relief resilience (0.9%), and marital status (0.5%) were other important predictive factors of well-being in the participants. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Medical institutions should provide appropriate resilience-enhancing countermeasures to reduce workplace burnout as well as pay greater attention to the exercise frequency, self-perceived health, job title, and marital status of their nurses to help them achieve physical, mental, and overall well-being.

Impact of a Care Task Design Program on Novice Nursing Students' Self-Reflection and Insight, Teamwork Skills, and Holistic Nursing Competency.

AIM: The aims of this study were to evaluate the effects of a self-appraisal of clinical simulation care tasks in novice nursing students and assess their self-reflection and insight, teamwork skills, and holistic nursing competence in four different periods. METHOD: A single group pre- and post-test design was conducted. Data were collected between September 2019 and February 2020. Nursing students who participated in the fundamental nursing laboratory courses in the second year of the nursing department at a medical university were invited to participate in the study. Data were collected at four time points using the Self-Reflection and Insight Scale, Holistic Nursing Competence Scale, and the Teamwork Skills Scale. A generalized estimating equation was used for all statistical analyses. RESULTS: Across the four measurements, the score of self-reflection and insight ranged from 76.68 to 78.00, teamwork skills from 68.83 to 71.21, and holistic nursing competence from 134.48 to 146.46. Student performance was above average on all research variables. The results confirm the hypotheses that the program improves self-reflection and insight, teamwork skills, and holistic nursing competencies in nursing students. CONCLUSION: These findings suggest that the program can be used to improve students' self-reflection, and it may also help to enhance their teamwork skills and holistic nursing competence.

Adverse effects of non-intubated airway suctioning: a clinical data-based study.

AIMS AND OBJECTIVES: The purpose of this study was to investigate the adverse effects of non-intubated suctioning. BACKGROUND: Airway hygiene aims to maintain a patent airway to ensure adequate ventilation. Nasopharyngeal, oropharyngeal or nasotracheal suctioning may be used in patients who require airway suctioning but do not have an artificial airway. However, no studies till date provide insight into the adverse effects of non-intubated airway suctioning. DESIGN: A clinical data-based retrospective design. METHOD: Using institutional and clinical databases of three university hospitals in 2008-2016, we conducted a study with a propensity score matching method of 3,326 hospitalised patients who had undergone suction therapy with or without a tracheotomy. Conditional logistic regression analyses were performed to investigate the link between suctioning and the probabilities of adverse effects. STROBE checklist was used to report the current study. RESULTS: Patients who required nasopharyngeal, oropharyngeal or nasotracheal suctioning had a higher risk of gastrointestinal ulcers than tracheotomised patients (adjusted OR 1.99; 95% CI, 1.24-3.20). Patients who received non-intubated suction had a higher risk of developing pneumonia (adjusted OR 1.59; 95% CI, 1.26-2.00), and the risk of aspiration pneumonia was three times higher than tracheotomised patients (adjusted OR 3.04; 95% CI, 1.40-6.60). CONCLUSIONS: Non-intubated patients who require suctioning for airway clearing are more susceptible to gastrointestinal ulcers, pneumonia and aspiration pneumonia. The findings would facilitate in alerting healthcare professionals to this group of patients. However, more clinical research is needed to elucidate the mechanisms of adverse effects in non-intubated patients who require suctioning. RELEVANCE TO CLINICAL PRACTICE: The adverse effects of suctioning can easily be overlooked in debilitated patients with no intubation. Professionals must be aware of the discomfort and risks that patients may experience.

Factors Related to the Continuity of Care and Self-Management of Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study in Taiwan.

BACKGROUND: Most diabetic patients suffer from chronic diseases affecting their self-management status. This study aims to explore the relationship between the CoC and the self-management of patients with Type 2 Diabetes Mellitus (T2DM) and analyze the predictive factors affecting their self-management. METHODS: Structured questionnaires were used for data collection. Convenient sampling was adopted to recruit inpatients diagnosed with T2DM in the endocrine ward of a medical hospital in central Taiwan. RESULTS: A total of 160 patients were recruited. The average age of the patients is 66.60 ± 14.57 years old. Among the four dimensions of the self-management scale, the average score of the problem-solving dimension was the highest, and that of the self-monitoring of blood glucose was the lowest. The analysis results showed that the overall regression model could explain 20.7% of the total variance in self-management. CONCLUSIONS: Healthcare providers should attach importance to the CoC of T2DM patients and encourage patients to maintain good interaction with healthcare providers during their hospitalization. It is recommended to strengthen CoC for patients with diabetes who are single or with low educational levels in clinical practice to enhance their blood glucose control and improve diabetes self-management.

Continuity of Care and Self-Management among Patients with Stroke: A Cross-Sectional Study.

(1) Background: Stroke is an important topic in the healthcare industry. The objective of the present study was to investigate patients' sociodemographic characteristics, health status, continuity of care, self-management, and other predictors that affect their self-management. (2) Methods: This cross-sectional correlational study was carried out from March to September 2020, and included a total of 150 patients aged 20 and above who were diagnosed within the past 6 months. The research participants were selected from the Division of Neurology, Department of Internal Medicine/Department of Surgery, at a medical center in Central Taiwan. (3) Results: The mean self-management score of patients with stroke was 110.50 points (30-150 points). As shown in the stepwise regression analysis, the overall regression model explained approximately 44.5% of the variance in self-management. Educational level (10.8%), frequency of exercise per week (2.1%), time that patients were affected by stroke (2.4%), and continuity of care (29.2%) were the main predictors affecting the self-management of stroke patients. (4) Conclusions: To improve stroke patients' self-management, medical teams should provide appropriate continuity of care to those with lower educational levels, those without exercise habits, and those who experienced a stroke within the past six months.

Community Health Nursing Competency and Psychological and Organizational Empowerment of Public Health Nurses: A Cross-Sectional Survey.

AIM: This study explored the effect of public health nurses' current community care nursing competency on the psychological and organizational empowerment of public health services in Taiwan. DESIGN: A cross-sectional nationwide survey design was used. METHODS: A self-developed structured questionnaire was administered to public health nurses. They were recruited using a purposive sampling technique, and they participated in community healthcare workshops. RESULTS: The mean score of Community Care Nursing Competence (CCNC) was 3.92 ± 0.83. The mean score in Community Empowerment (CE) was 3.66 ± 0.90. The study revealed that age and communication competence were crucial factors in public health nurses working in the community. With age and through the accumulation of practical experience, public health nurses' communication competence may also improve, which can further enhance their psychological and organizational empowerment in the nursing workplace.

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.

Factors Related to Care Competence, Workplace Stress, and Intention to Stay among Novice Nurses during the Coronavirus Disease (COVID-19) Pandemic.

The outbreak of coronavirus (COVID-19), a public health emergency of international concern, has made healthcare staff preparation and the nurturing of high-quality and adequate nursing professionals critical issues. This study aimed to explore registered nurses' competence in nursing care and their intention to stay in their current workplace. In this study, participants who had graduated from different nursing education systems were recruited. The results indicated that nurses' level of commitment to the workplace and clinical stress were positively correlated with the experience of working with patients. Stepwise regression analysis revealed the following significant predictors for intention to stay: clinical stress, frequency of caring for people with infections, and taking a course on infectious nursing. The novice nurses' competencies in the areas of pandemic disease care and care for infectious adults depended on the experience of nursing care and nursing competence in their professional careers, which may have impact on the nurses' intention to stay. Therefore, clinical stress, frequency of caring for patients, and taking nursing courses were correlated with novice nurses' intention to stay in their professional careers.

Illness Representation and Self-Efficacy: An Exploration of Fatigue Factors in Middle-Aged Stroke Survivors.

The purpose of this study is twofold: to examine the relationship between illness representation and self-efficacy and to test the determinants and the effect of self-efficacy, resilience, and stroke impact on fatigue in middle-aged stroke survivors. This study used a cross-sectional and quantitative approach. The instruments included the Chronic Disease Self-Efficacy Scale, Stroke Impact Scale, Resilience Scale, and Fatigue Impact Scale. Structural equation modeling (SEM) was performed to analyze the data. A total of 63 patients with stroke (39 male and 24 female) were recruited form a medical university hospital. The results showed that patients' illness representation had a significantly effect on self-efficacy for managing disease. In addition, SEM analysis demonstrated that self-efficacy, resilience and stroke impact influenced fatigue, explaining 20.6% of the variance in fatigue. It was concluded that to improve patient fatigue, we believe it is imperative to design interventions that improve patients' self-efficacy, promote patients' resilience, and better function.

Factors affecting preregistered nurses' willingness to serve in geriatric long-term care.

AIM: Rapidly ageing population leads to increased demands for long-term care. Taiwan's preparation for its ageing population focuses on engaging healthcare professionals. This study explored pre-registered nurses' current knowledge, experience in geriatric long-term care (GLTC) and willingness to serve in GLTC. DESIGN: A cross-sectional survey design and a self-developed structured questionnaire were used. METHODS: A probability proportionate to size sampling strategy was used to collect data from students in junior college and bachelor of nursing science programmes in Taiwan in 2017. Multiple regression was adopted to predict significant factors that influence nursing students' willingness to serve in GLTC. RESULTS: The willingness to serve in GLTC was positively correlated with their experience of living with older adults, practicum experience, taking GLTC-related courses and interest in GLTC. Willingness to serve older/disabled patients can be enhanced through school courses and practicum experiences, indicating the importance of GLTC-related courses in the training of the professional nursing workforce.

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.

The Difficulties and Needs of Organ Transplant Recipients during Postoperative Care at Home: A Systematic Review.

With recent advances in surgery and immunosuppressive drugs, organ transplantation has become a major treatment for irreversible organ failure. However, organ transplant recipients returning home after operation may face ongoing physiological, psychological, and social difficulties. To increase recipients' quality of life, postoperative care at home is critical. Thus, the aim of this systematic literature review was to explore recipients' difficulties and needs during postoperative care at home. Our search conformed to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and returned 23 relevant articles published from 1997-2020 in PubMed, MEDLINE, EBSCO, Cochrane, ProQuest, and CEPS, which were assessed using the Modified Jadad Scale or the 32 Consolidated Criteria for Reporting Qualitative Research (COREQ) appraisal indices and then synthesized through narration. The most common difficulties faced were psychological difficulties, followed by physiological, social, and other difficulties; the most common needs were psychological needs, followed by education and information training, social, and other needs. These results demonstrated that healthcare professionals can do more to provide patients with comprehensive care and promote successful self-management and quality of life at home. They also confirmed that collaboration between transplant teams, caregivers, and patients is necessary to optimize postoperative outcomes. We suggest that customized care may promote postoperative patients' self-management and quality of life at home.

Difficulties and Coping Strategies of Kidney-transplant Recipients During Their Dark Postoperative Recovery Stage After Returning Home.

INTRODUCTION: Kidney Transplantation (KT) is the best treatment for end-stage renal disease to prolong patients' lives. To improve patients' postoperative survival rate and quality of life, postoperative care at home is vital. We explored the difficulties faced and coping strategies used by KT recipients during their dark postoperative recovery stage at home. METHODS: This qualitative, exploratory study used a purposive sample, which was obtained from a leading medical center in Taiwan. We used a semi-structured interview guide to collect data through in-depth, face-to-face interviews. Data were content analyzed. RESULTS: Fifty individuals were approached and agreed to participate (30 men, 20 women). Participants' post-KT timeframe ranged from 2 to 28 years. Seven difficulties were reported: 1. physical discomfort and treatment side-effects; 2. concern about the impact of transplant failure; 3. uncertainty about the future; 4. unbearable economic pressure; 5. concerns about becoming a family burden; 6. feeling that life lacks a purpose; and 7. feeling isolated. Coping strategies included 1. seeking assistance from health care professionals, 2. thinking positively, 3. changing one's lifestyle, 4. setting goals to divert attention, 5. seeking psychological, and 6. seeking spiritual support. CONCLUSIONS: By elucidating KT recipients' adaptability and coping strategies, we hope to improve their quality of life at home. Health care professionals should be aware of the difficulties faced by patients during their dark postoperative recovery stage and promote effective coping strategies. This study informs future research and has implications concerning the effective coordination of transplant medical teams.

Adaptation Process of Male Kidney Transplant Recipients During the Difficult Postoperative Recovery Stage at Home.

BACKGROUND: Kidney transplantation is the main treatment for irreversible organ failure. It helps patients regain hope, prolongs their lives, and improves their quality of life. Because of cultural barriers, male kidney-transplant recipients in Taiwan may face a difficult adaptation process during postoperative care at home. METHODS: In this qualitative exploratory study, we employed purposive sampling of male kidney-transplant recipients that was obtained from a leading medical center in Taiwan. Semi-structured, face-to-face interviews were used to collect data, which were further content analyzed. RESULTS: All 30 qualified patients were approached and agreed to participate (age range = 29-67 years). Participants' post-kidney transplant time frame ranged from 2 to 22 years. We revealed several difficulties that participants experienced during their postoperative recovery: (1) physical and mental exhaustion and treatment side effects; (2) worry and uncertainty about rejection, graft failure, and the future; (3) fear of losing one's job and putting the family in financial trouble; and (4) impaired self-image and social barriers. Corresponding adaptation processes included (1) experiencing shock during the early post-transplantation stage, (2) re-identification of the transition period of self-value, (3) seeking support and thinking positively, (4) accepting one's new self-image, and (5) regaining autonomy. CONCLUSION: The current results can be used to improve the quality of care at home for male kidney-transplant recipients. Health care providers should assist patients in the adaptation process to reduce discomfort and relieve stress. This study can also serve as a reference for future research.

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.

Interaction of Osteoarthritis and BMI on Leptin Promoter Methylation in Taiwanese Adults.

Leptin (LEP) regulates glucose metabolism and energy storage in the body. Osteoarthritis (OA) is associated with the upregulation of serum LEP. LEP promoter methylation is associated with obesity. So far, few studies have explored the association of BMI and OA with LEP methylation. We assessed the interaction between body mass index (BMI) and OA on LEP promoter methylation. Data of 1114 participants comprising 583 men and 558 women, aged 30-70 years were retrieved from the Taiwan Biobank Database (2008-2015). Osteoarthritis was self-reported and cases were those who reported having ever been clinically diagnosed with osteoarthritis. BMI was categorized into underweight, normal weight, overweight, and obesity. The mean LEP promoter methylation level in individuals with osteoarthritis was 0.5509 ± 0.00437 and 0.5375 ± 0.00101 in those without osteoarthritis. The interaction between osteoarthritis and BMI on LEP promoter methylation was significant (p-value = 0.0180). With normal BMI as the reference, the mean LEP promoter methylation level was significantly higher in obese osteoarthritic individuals (ß = 0.03696, p-value = 0.0187). However, there was no significant association between BMI and LEP promoter methylation in individuals without osteoarthritis, regardless of BMI. In conclusion, only obesity was significantly associated with LEP promoter methylation (higher levels) specifically in osteoarthritic patients.

A Chinese version of the Patient Continuity of Care Questionnaire: reliability and validity assessment.

AIMS AND OBJECTIVES: To examine the psychometric properties of the Chinese version of Patient Continuity of Care Questionnaire (PCCQ) to see whether the Patient Continuity of Care Questionnaire can be applied in Chinese context. BACKGROUND: The rapid increase in the number of older adults with chronic diseases has made caring for this vulnerable population a priority healthcare issue in Taiwan. The PCCQ has been widely used in international studies. However, research has not yet assessed the suitability and applicability of the PCCQ in Taiwan. DESIGN: A cross-sectional survey design was applied for the psychometric testing of the scale. METHODS: A total of 314 older Taiwanese adults with chronic diseases receiving discharge planning intervention were pooled from a hospital in Central Taiwan. After receiving permission from the author of the PCCQ, a Chinese translation and back translation were made. RESULTS: The scale was first rated by eleven experts with a Content Validity Index of 0·93. Two factors were extracted with the exploratory factor analysis, namely 'information transfer to patients' and 'relationships with providers during hospitalisation', with a total of 70·34% of the variance explained. CONCLUSIONS: The PCCQ - Chinese can be used to assist professionals to fully understand the continuity of care of the discharged patients under consideration. RELEVANCE TO CLINICAL PRACTICE: A PCCQ - Chinese version can be used as a guide for discharging preparation that enables patients to receive high-quality continuity of care and further to self-manage their conditions.

Effect of Continuity of Care on Quality of Life in Older Adults With Chronic Diseases: A Meta-Analysis.

As the population ages, continuity of care (CoC) has increasingly become a particular important issue. Articles published from 1994 to 2014 were identified from electronic databases. Studies with randomized controlled design and elderly adults with chronic illness were included if Short Form-36 (SF-36) was used as an outcome indicator to evaluate the effect of CoC. Seven studies were included for analysis with the sum of 1,394 participants. The results showed that CoC intervention can significantly improve physical function, physical role function, general health, social function, and vitality of QoL for elderly people with chronic disease.