Quality of Work Life, Nurses' Intention to Leave the Profession, and Nurses Leaving the Profession: A One-Year Prospective Survey.

PURPOSE: To examine the associations among quality of work life, nurses' intention to leave the profession, and nurses leaving the profession. DESIGN: A prospective study design was used. METHODS: Participants were 1,283 hospital nurses with a purposive sampling in Taiwan. The self-reported questionnaire consisted of three questionnaires: the Chinese version of the Quality of Nursing Work Life scale, an intention-to-leave profession questionnaire, and a demographic questionnaire. Records of nurses leaving the profession were surveyed 1 year later. Data were analyzed by descriptive statistics and inferential statistics. FINDINGS: As many as 720 nurses (56.1%) had tendencies to leave their profession. However, only 31 nurses (2.5%) left their profession 1 year later. Nurses' intention to leave the profession mediated the relationship between the milieu of respect and autonomy, quality of work life, and nurses leaving the profession. CONCLUSIONS: The milieu of respect and autonomy describing the quality of work life predicts the nurses' intention to leave the profession, and together these predict nurses leaving the profession. CLINICAL RELEVANCE: This study illustrates that nurse managers could provide effective interventions to ameliorate the milieu of respect and autonomy aspect of quality of work life to prevent nurses from leaving their profession.

Cultural perspectives of older nursing home residents regarding signing their own DNR directives in Eastern Taiwan: a qualitative pilot study.

BACKGROUND: Chinese tradition and culture developed from Taoism, Confucianism, and Buddhism and have influenced ethnic Chinese for thousands of years, particularly thoughts on death. Many ethnic Chinese, particularly older people, refrain from discussing death-related concerns, making it difficult to obtain advance directives, including do-not-resuscitate (DNR) directives, signed independently by older people. This study explored the attitudes of older nursing home residents in Taiwan toward signing their own DNR directives. METHODS: This study adopted purposive sampling and collected data through in-depth interviews. The data were analysed using qualitative inductive content analysis, and the study location was a nursing home in Eastern Taiwan. RESULTS: A total of 11participants were recruited from a sample of 12 eligible participants. Most of the older residents in this study refused to make decisions independently regarding DNR directives. Content analysis of the interviews revealed four themes concerning refusing to sign DNR directives independently: not going against nature, accepting the results of cause and effect, viewing the family as a decision-making system, and practising self-effacement. Chinese cultural aspects, including Taoist, Buddhist, and Confucian philosophy, affected the autonomy of the older residents, and they relied on others to make decisions for them. CONCLUSIONS: Professionals must respect this family-oriented decision-making thinking of older residents because it reflects personal choice. Otherwise, healthcare providers may play a mediating role in coordinating and communicating between older residents and their families regarding EOL-care-related concerns, replacing the traditional practice of holding a family meeting.

The Lived Experiences of People With Chronic Obstructive Pulmonary Disease: A Phenomenological Study.

PURPOSE: This study explored the lived experiences of people with chronic obstructive pulmonary disease (COPD) following hospitalization for acute exacerbation or pneumonia. DESIGN AND METHOD: A phenomenological approach was adopted to collect data through semistructured interviews. Fourteen participants were recruited from a medical center in northern Taiwan. Data were collected from January 2013 to January 2014. Giorgi's phenomenological methodology was adopted to analyze the interview content. FINDINGS: Three phenomenological themes emerged: trapped in an invisible cage, torments in the winter, and striving for wellness. CONCLUSIONS: This study sought to elucidate the lived experiences of people with COPD, who perceived themselves as feeling an overwhelming sense of confinement. The interviewees displayed positive attitudes, indicating that people with COPD are willing to cope with their disease. Health practitioners should focus on educating people with COPD about their needs, encouraging them to be more positive, and assisting them in engaging in self-management. CLINICAL RELEVANCE: People with COPD can cope with the disease and seek alternative methods to improve their health. These positive attitudes could be used to encourage self-management in the future.

Fever presentation and associated factors in patients with healthcare-associated bacteraemia.

Bacteraemia is a systemic infection associated with strong febrile immune reactions. Fever definitions, fever intensity and other factors might affect the recognition, management and prognosis of patients with bacteraemia. A prospective observational design was used to study 412 consecutive Taiwanese patients with healthcare-associated bacteraemia. The study variables were fever intensity, factors related to fever intensity, the association of physical function to thermogenic capacity and the sensitivity of three definitions of fever for identifying patients with bacteraemia. Age, Charlson comorbidity index (CCI) score, chills and pathogen types were predictors of fever intensity. Barthel index score, CCI score and pathogen types were predictors of chills, an indicator of thermogenic capacity. The sensitivity of three fever definitions (basal body temperature plus 1°C, ≥ 38°C and ≥ 38.3°C) to identify patients with bacteraemia was 93.3%, 83.5% and 71.4%, respectively. Clinicians can target patients with factors associated with blunted febrile response to bacteraemia for closer monitoring.

Access site complications following transfemoral coronary procedures: comparison between traditional compression and angioseal vascular closure devices for haemostasis.

BACKGROUND: Vascular closure devices such as angioseal are used as alternatives to traditional compression haemostasis. Although the safety and efficacy of angioseal are confirmed, their use remains controversial because of the potential complications of these devices compared with those of traditional compression haemostasis. The aim of this study was to compare the access site complication rate, the predictive factors for these complications, and patient comfort levels after coronary procedures with traditional compression or angioseal haemostasis. METHODS: Data were collected from a cardiac unit in a medical center in northern Taiwan. A total of 130 adult patients were recruited and equally divided into two groups according to the method of haemostasis used after the coronary procedure: a traditional compression group and an angioseal group. We observed the incidence of access site complications, including bleeding, oozing, haematoma formation, and arteriovenous fistula formation. In addition, we used a 0-10 numeric rating scale to assess soreness, numbness, and back and groin access site pain after 1 h of catheter removal and immediately before getting out of bed. RESULTS: The overall incidence of complications was 3.8 % (n = 5), which was not significantly different between the two groups (p = .06). The propensity score--adjusted multivariate analyses revealed that the only independent predictor for access site complications was an age of >70 years (OR, 10.44; 95 % CI, 1.81-60.06; p = .009). Comfort levels were higher in the angioseal group than in the traditional compression group. CONCLUSIONS: Angioseal used after coronary procedures did not increase the incidence of complications relative to that associated with traditional compression haemostasis; however, it increased patient comfort levels. Health personnel should pay special attention to the predictive factor for access site complications after coronary procedures, such as age >70 years.

Quality of work life as a predictor of nurses' intention to leave units, organisations and the profession.

AIM: To examine the relationships between quality of work life (QWL) and nurses' intention to leave their unit (ITLunit), organisation (ITLorg) and profession (ITLpro). BACKGROUND: The high turnover rate among nurses presents a major challenge to health care systems across the globe. QWL plays a significant role in nurses' turnover. METHODS: A descriptive cross-sectional survey design was conducted via purposive sampling of 1283 hospital nurses and administering the Chinese version of the Quality of Nursing Work Life scale (C-QNWL), a three-ITL-type scale questionnaire, and a demographic questionnaire for individual- and work-related variables. Descriptive data, correlations, and ordinal regression models were analyzed. RESULTS: QWL predicted ITLpro and ITLorg better than ITLunit. Three QWL dimensions (work arrangement and workload, nursing staffing and patient care, and work-home life balance) were significantly predictive of all three ITL measures. However, the dimension of teamwork and communication was only predictive for ITLunit, not for ITLorg and ITLpro. CONCLUSIONS: Different patterns of QWL dimensions are predictive of ITLunit, ITLorg, and ITLpro. IMPLICATIONS FOR NURSING MANAGEMENT: The study provides important information to nurse administrators about the aspects of QWL that most commonly lead nurses to leave their units, organisations, and even the profession itself.

[An Investigation of the Role Responsibilities of Clinical Research Nurses in Conducting Clinical Trials].

BACKGROUND: Clinical research nurses (CRNs) play an important role in improving the quality of clinical trials. In Taiwan, the increasing number of clinical trials has increased the number of practicing CRNs. Understanding the role responsibilities of CRNs is necessary to promote professionalism in this nursing category. PURPOSE: This study investigates the role responsibilities of CRNs in conducting clinical trials / research. METHODS: A questionnaire survey was conducted in a medical center in Taipei City, Taiwan. Eighty CRNs that were registered to facilitate and conduct clinical trials at this research site completed the survey. RESULTS: "Subject protection" was the CRN role responsibility most recognized by participants, followed by "research coordination and management", "subject clinical care", and "advanced professional nursing". Higher recognition scores were associated with higher importance scores and lower difficulty scores. Participants with trial training had significantly higher difficulty scores for "subject clinical care" and "research coordination and management" than their peers without this training (p < .05). Participants who had participated in a long-term trial-training course earned higher importance scores for "CRN four-subthemes role responsibilities" (p <.05) and lower difficulty scores for "subject protection", "research coordination and management" (p <.005) than their short-term course peers. "Recognition of overall responsibilities" and "receiving trial training" were the significant predictors of difficulty in performing CRN role responsibilities, explaining 21.9% of the total variance. CONCLUSIONS: To further promote CRN as a professional career in Taiwan, the findings of this study recommend identifying the core competences of CRNs and adding CRN-related study materials into the advanced nursing curriculum. Long-term and systematic educational training may help CRNs understand the importance of their role responsibilities, better recognize their professional role, and reflect these responsibilities in clinical practice.

Psychometric properties of the Chinese-version Quality of Nursing Work Life Scale.

In this study, we developed and tested the psychometric properties of the Chinese-version Quality of Nursing Work Life Scale along seven subscales: supportive milieu with security and professional recognition, work arrangement and workload, work/home life balance, head nurse's/supervisor's management style, teamwork and communication, nursing staffing and patient care, and milieu of respect and autonomy. An instrument-development procedure with three phases was conducted in seven hospitals in 2010-2011. Phase I comprised translation and the cultural-adaptation process, phase II comprised a pilot study, and phase III comprised a field-testing process. Purposive sampling was used in the pilot study (n = 150) and the large field study (n = 1254). Five new items were added, and 85.7% of the original items were retained in the 41 item Chinese version. Principal component analysis revealed that a model accounted for 56.6% of the variance with acceptable internal consistency, concurrent validity, and discriminant validity. This study gave evidence of reliability and validity of the 41 item Chinese-version Quality of Nursing Work Life Scale.

[A project to improve the completion rate of discharge-planning services for organ-transplant patients].

BACKGROUND & PROBLEMS: The average score for satisfaction with self-care instructions among transplant patients was 84 out of 100 in a 2010 survey of patient satisfaction with discharge-planning services. This score was significantly below the hospital average of 90. In addition, discharged patients made more frequent telephone inquiries to healthcare providers to ask questions about post-organ-transplantation self-care. A follow-up study targeted a sample of 30 discharged transplantation patients using hospital medical record reviews and telephone inquiries. This survey found a transplant instruction completion rate of 75% during discharge preparation and 69% accuracy among participants in answering self-care knowledge questions. Both figures were lower than expected. PURPOSE: The goal of this project was to increase the instruction completion rate from 75% to 100% and the percentage of correct answers to self-care knowledge questions self-care knowledge from 69% to 95%. RESOLUTIONS: This study integrated all relevant nursing information into a standardized discharge-planning service booklet that was given to inpatients for reference. Furthermore, a self-care checklist was developed and introduced. Finally, a standard procedure for delivering nursing instructions and a regular audit and follow-up monitoring system were established. RESULTS: The nurses' instruction completion rate rose to 100% and the percentage of questions on self-care knowledge correctly answered by patients increased to 98%. CONCLUSIONS: Adopting a patient-centered philosophy of care and a model of interdisciplinary collaboration effectively integrated resources and promotes nursing quality and quality of life for transplant patients. The project effectively improved the completing rate for post-transplant discharge-planning service instructions and enhanced the self-care knowledge of transplant patients.

Predicting quality of work life on nurses' intention to leave.

PURPOSE: The purpose of this study was to explore the relationship between quality of work life (QWL) and nurses' intention to leave their organization (ITLorg). DESIGN: A descriptive cross-sectional survey design was conducted using purposive sampling of 1,283 nurses at seven hospitals in Taiwan. Data were collected from March to June 2012. METHODS: Three questionnaires, including the Chinese version of the Quality of Nursing Work Life scale (C-QNWL), a questionnaire of intention to leave the organization, and a demographic questionnaire, with two informed consent forms were delivered to the nurses at their workplaces. Descriptive data, Pearson's correlations, and the ordinal regression model were analyzed. FINDINGS: Over half (52.5%) of nurses had ITLorg. Seven QWL dimensions were significantly negatively correlated with ITLorg (r = -0.17 to -0.37, p < .01). Significant predictors (p < .05) of ITLorg (the pseudo R(2) = 0.282) were being single, having a diploma or lower educational level, working in a nonteaching hospital. Four of the QWL dimensions--supportive milieu with job security and professional recognition, work arrangement and workload, work or home life balance, and nursing staffing and patient care--were also predictors of ITLorg. Three QWL dimensions were not predictors of ITLorg. CONCLUSIONS: This study showed that individual-related variables (being single, having a diploma or lower educational level), a work-related variable (working at a nonteaching hospital), and the four QWL dimensions play a significant role in nurses' ITLorg. After the QWL dimensions were added to the regression, the variance explained by the model more than doubled. CLINICAL RELEVANCE: To reduce nurses' ITLorg, nursing administrators may offer more focused interventions to improve the supportive milieu with job security and professional recognition, work arrangement and workload, work or home life balance, and nursing staffing and patient care.

Substance use, gender, socioeconomic status and metabolic syndrome among adults in Taiwan.

OBJECTIVES: This study had two purposes: (1) To explore the mediating effects of substance use-as indicated by alcohol consumption, cigarette smoking, and betel-nut chewing-on the relationship between socioeconomic status (SES) and metabolic syndrome; and (2) to examine the way gender moderates any mediating effects of substance use. DESIGN AND SAMPLE: Secondary analyses were conducted on a cross-sectional national dataset. The data from 3,107 males and 3,081 females of Taiwanese were analyzed. MEASURES: The prevalence of metabolic syndrome, education level, occupation, age, body weight, body height, and behaviors were collected. RESULTS: In male subjects, SES had no direct effect on metabolic syndrome; however, cigarette smoking and betel-nut chewing, but not alcohol consumption, were found to have mediating effects on SES and metabolic syndrome. In females, SES was found to have a direct effect on metabolic syndrome; however, substance use had no mediating effects on the relationship between SES and metabolic syndrome. These differences, in males and females indicated that the mediating effect of substance use on the relationship between SES and metabolic syndrome is moderated by gender. CONCLUSIONS: Our study suggests that health care providers may need to provide gender-specific health promotion programs to prevent metabolic syndrome.

Effect of age on febrile response in patients with healthcare-associated bloodstream infection.

OBJECTIVE: This study aimed to determine the effect of age on febrile response in patients with healthcare-associated bloodstream infection (BSI). METHODS: This was a retrospective observational study using medical records as the primary source of data. Three indicators measured body temperature changes: basal body temperature (BBT), body temperature at infection onset (onset T), and maximum temperature (max T) during the infection period. RESULTS: In a sample of 230 patients there was no significant correlation between BBT or onset T and age. Max T was significantly correlated with age (r = -.191, p = .004). There was wide variation in onset T in all age groups. CONCLUSIONS: Age showed no effect on BBT and onset T, but blunted max T in patients with bacteremia. This variability in onset T in all age groups emphasizes the need for early recognition of subtle signs of infection and the need to use an individualized definition of fever.

[Conceptual model of teasing and bullying in adolescents].

Teasing and bullying incident levels have increased markedly in recent years according to international news reports. School and community-level action to stop and prevent bullying is a key focus of government education policy worldwide. Teasing is a usual facet of social interaction among youth and is related to bullying behavior. Although teasing and bullying are significant concerns, references for relevant concept analysis are lacking in the nursing field. To facilitate early screening to identify high-risk bullies and help victims effectively stop bullying events, concept analysis is needed to clarify and distinguish between the two concepts of teasing and bullying. The aim of this study is to integrate relevant published literature to determine the reasons for and relationships between teasing and bullying. We chose obesity as an example to construct a teasing and bullying conceptual model for adolescents and used this model to explore the related factors and health impacts of obesity. We found that both teaser intent and recipient perceptions correlated with bullying behavior. Duration and severity may induce teasing to become bullying. Because weight-based teasing is common among adolescents, we chose obesity as an example issue to demonstrate our adolescents teasing and bullying concept model. We then integrated the antecedent and consequential factors of teasing and bullying for obese adolescents. Weight-control strategies can stop school bullying if early interventions are performed in high-risk populations.

Nursing accreditation system and patient safety.

AIMS: This study investigated whether nursing accreditation level affects patient safety. BACKGROUND: The nursing accreditation system evaluates the capabilities of nursing professionals in Taiwan. While this system has been in place for years, few studies have investigated whether nursing accreditation level is associated with patient safety indicators. This study can help in understanding how nursing capabilities affect patient safety and can subsequently contribute to improvements in patient safety. METHODS: This study adopted a cross-sectional research design using questionnaires to collect responses from nurses working in two major medical centres in northern Taiwan. Regression analyses were conducted to test the study hypothesis. RESULTS: The analytical results show that nursing accreditation level is positively related to patient safety indicators. CONCLUSION: Health services managers should encourage nurses to advance their knowledge, skills, and professional capabilities because these may be positively related to patient safety. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers who seek to improve patient safety should consider encouraging nurses to advance their accreditation level.

Factors Influencing Older Adults' End-of-Life Care Preferences.

The objective of this study was to explore factors influencing Taiwanese older adults' end-of-life (EOL) care preferences. A cross-sectional questionnaire survey was conducted in 2 geriatric wards of a veterans' hospital. Fifty-five older adults aged 65 years or older were included. Structured questionnaires were used to collect data regarding demographic characteristics, EOL care preferences, stages of change for advance care planning behaviors, and reluctance to burden others. The study revealed that nearly 60% of the participants preferred to let their spouses, adult children, or health care professionals make the decisions. Furthermore, 83.6% of the participants lived with their family members and were moderately to severely disabled with a certain degree of dependence on their family members. Sex, independence, discussion of advance care planning with family members, and completion of advance directives were significantly correlated with EOL care preferences. The regression model showed that the participants' discussion of advance care planning with their family members influenced their EOL care preferences. The results demonstrate that family is an essential consideration for older adults choosing EOL care. Accordingly, because Chinese culture focuses on family harmony, improving communication between older adults and their family members is crucial for promoting advance care planning.

The Differences and Perspectives Between Elderly Individuals and Their Surrogates Regarding End-of-Life Care: A Mixed Methods Study.

Background: Family members often take the place of decision-making for elderly individuals. Previous studies showed that family members could not predict elderly individuals' thoughts about end-of-life care. Objectives: The aims are to understand the differences and perspectives between elderly individuals and surrogates regarding end-of-life care. Design: A mixed methods study comprising a cross-sectional survey and field notes analysis. Setting: Two geriatric wards in a veterans hospital located in northern Taiwan. Subjects: Fifty-five pairs of elderly individuals and their surrogates. Measurements: Life support preferences questionnaire and field notes. Results: The quantitative data showed that the elderly individuals and their surrogates had proper consistency in cardiopulmonary resuscitation and surgery. However, their consistency was poor in antibiotics and nasogastric tube feeding. Four themes were identified in qualitative data: recognizing old age, struggling with hope and peace, worries and concerns, and control of life. Recognizing old age for both elderly individuals and their surrogates was critical. Elderly individuals and their surrogates may seek a ray of hope among aggressive treatments and struggle with hope and peace. A lot of worries and concerns were mentioned, including contextual concerns. Elderly individuals need to depend on their ability to control their life. Conclusions: The study highlights elderly individuals' and their surrogates' considerations for antibiotics and nasogastric tube feeding. Furthermore, elderly individuals expressed that it is different for making decisions for themselves or others; thus, future studies can further explore whether elderly individuals allow their surrogates leeway from their wishes.

[Therapeutic play in nursing care: one experience with a school-age liver transplant recipient].

This case report described an experience using therapeutic play in the care of a school-age living donor liver transplant recipient. A first intervention employed playing the patient's favorite game in order to create a therapeutic relationship. The author then introduced therapeutic play elements into the game to observe the patient's personal health behaviors, evaluate patient perception of hospitalization and assess the knowledge of self-care protocols. Therapeutic play was then used to raise patient familiarity with daily care specifics. The author found therapeutic play also helpful in persuading the patient to share deep feelings on the anxiety of separation from her parents while in the ICU. During the nursing process, the author recognized therapeutic play as an effective tool to communicate with children and improve treatment protocol compliance. The author recommends that nurses incorporate therapeutic play in clinical practice to reduce children's stress during hospitalization.

Shared risk factors for distinct geriatric syndromes in older Taiwanese inpatients.

BACKGROUND: Identifying shared common risk factors of geriatric syndromes is clinically useful in designing a unified approach to optimizing geriatric care. OBJECTIVES: The purpose of this study was to identify older Taiwanese inpatients' common shared risk factors among seven distinct geriatric syndromes: malnutrition, depression, cognitive impairment, functional dependence, incontinence, pressure ulcers, and dehydration. METHOD: A cross-sectional, hospital-wide survey was conducted to enroll inpatients (N = 455) older than 65 years and admitted to 24 medical and surgical units in a 2,200-bed urban academic medical center in northern Taiwan. Malnutrition was defined as a Mini-Nutritional Assessment score less than 17.5, depression was defined as a Geriatric Depression Scale score more than 10, cognitive impairment was considered a Mini-Mental State Examination score less than 20, and functional dependence was defined as a Barthel Index score less than 50. Incontinence, pressure ulcers, and dehydration were extracted from patients' medical records. RESULTS: Participants had a mean age of 75.3 years (SD = 6.1 years, range = 65-92 years). The prevalence of geriatric syndromes ranged from 5% (pressure ulcers) to 33% (malnutrition). The selected geriatric syndromes were shown through logistic regression analysis to be predicted by female gender (odds ratio [OR] = 1.57-2.75), functional status (OR = 0.94-0.99), cognitive status (OR = 0.82-0.95), nutritional status (OR = 0.74-0.93), and depressive symptoms (OR = 1.07-1.26), supporting the notion of shared risk factors in geriatric syndromes. CONCLUSIONS: The findings support the theory that common geriatric syndromes have a shared set of risk factors-female gender, depressive symptoms, and functional, cognitive, and nutritional status. Revising care to target these shared risk factors in preventing common geriatric syndromes is theoretically sound.

Self-efficacy, self-care behaviours and quality of life of kidney transplant recipients.

AIM: This paper is a report of an exploration of the effects of self-efficacy and different dimensions of self-management on quality of life among kidney transplant recipients. BACKGROUND: Self-efficacy is an important factor influencing self-management. Patients with higher self-efficacy have better self-management and experience better quality of life. Self-efficacy influences the long-term medication-taking behaviour of kidney transplant recipients. METHOD: A longitudinal, correlational design was used. Data were collected during 2005-2006 with 150 adult kidney transplant recipients on self-efficacy, self-management and quality of life using a self-efficacy scale, self-management scale and the Medical Outcomes Scale SF-36 (Chinese), respectively. Relationships among variables were analysed by path analysis. RESULTS: Participants with higher self-efficacy scored significantly higher on the problem-solving (beta = 0.51), patient-provider partnership (beta = 0.44) and self-care behaviour (beta = 0.55) dimensions of self-management. Self-efficacy directly influenced self-care behaviour and indirectly affected the mental health component of quality of life (total effect = 0.14). Problem-solving and partnership did not statistically significantly affect quality of life. Neither self-efficacy nor self-management had any effect on the physical health component of quality of life. CONCLUSION: Transplant care teams should incorporate strategies that enhance self-efficacy, as proposed by social cognitive theory, into their care programmes for kidney transplant recipients. Interventions to maintain and improve patients' self-care behaviour should continue to be emphasized and facilitated. Support to enhance patients' problem-solving skills and the partnership of patients with health professionals is needed.

A systematic review of body temperature variations in older people.

AIM: The purpose of this systematic review was to determine the extent to which the research literature indicates body temperature norms in the geriatric population. OBJECTIVES: The specific questions addressed were to examine normal body temperature values in persons 60 years of age and older; determine differences in temperature values depending on non-invasive measurement site and measurement device used; and, examine the degree and extent of temperature variability according to time of day and time of year. BACKGROUND: The traditional 'normal' temperature of 98.6 degrees F/37 degrees C may in fact be lower in older people due to the ageing process. Age-associated changes in vasomotor sweating function, skeletal muscle response, temperature perception and physical behaviours may influence the ability to maintain optimum temperature. DESIGN: A systematic literature review. METHODS: A search of multiple databases yielded 22 papers which met inclusion criteria. Studies were included which focused on temperature measurement, sampled persons 60 years of age and older, collected data from non-invasive temperature measurement sites and which used a prospective study design. Studies were independently appraised using a structured appraisal format. RESULTS: Temperature normal values by site were rectal 98.8 degrees F/37.1 degrees C, ear-based 98.3 degrees F/36.8 degrees C, urine 97.6 degrees F/36.5 degrees C, oral 97.4 degrees F/36.3 degrees C and axillary 97.1 degrees F/36.2 degrees C. Temperature exhibited a 0.7 degrees F/0.4 degrees C diurnal and 0.2 degrees F/0.1 degrees C circannual variation. CONCLUSIONS: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C, ear-based 0.3 degrees F/0.2 degrees C, oral 1.2 degrees F/0.7 degrees C, axillary 0.6 degrees F/0.3 degrees C lower than adults' acceptable value from those traditionally found in nursing textbooks. RELEVANCE TO CLINICAL PRACTICE: Given the fact that normal body temperature values were consistently lower than values reported in the literature, clinicians may need to re-evaluate the point at which interventions for abnormal temperatures are initiated.