A preliminary study of the effectiveness of cancer communication skills training for interdisciplinary staff.

BACKGROUND: Studies have emphasized that the disclosure of a diagnosis and prognosis is the doctor's responsibility, but little attention has been given to the importance of interdisciplinary cooperation. OBJECTIVE: Therefore, this study examined and compared the effectiveness of cancer communication skills training (CST) for doctors and interdisciplinary staff in Taiwan. METHODS: This study utilized a quasi-experimental design. The participants were 124 oncology professionals who participated in cancer CST. These 124 professionals included a group of 65 doctors and a group of 59 interdisciplinary professionals, both of which received the same CST. After the participants have received CST, the changes in their disease disclosure skills were evaluated. RESULTS: Significant pretest-posttest differences were observed in the overall truth-telling scores for both groups (doctors: t = 6.94, P < 0.001; interdisciplinary professionals: t = 7.71, P < 0.001) and in different constructs. However, in many items, the doctors demonstrated no progress after receiving the training (P > 0.05), whereas the interdisciplinary professionals demonstrated significant progress (P < 0.05). In particular, the doctors' scores for 'disclosing information in a monotonous tone' showed significant retrogression (P < 0.05). There were no significant differences in the overall truth-telling scores of the two groups with regard to pre- and post-CST (P > 0.05 and P > 0.05, respectively), and there were also no significant differences in the four sub-scales' scores. CONCLUSION: The CST for interdisciplinary professionals improved their cooperation and communication skills.

Substantial effects of empowerment case management on physical health of type 2 diabetic patients.

AIMS AND OBJECTIVES: To evaluate the effects of empowerment case management on the physical health of patients with type 2 diabetes. BACKGROUND: Diabetes is a global health issue. Case management is often used on diabetes management at various levels. Empowerment has been used for chronic situation management, but its effects have not been widely studied in diabetic populations. DESIGN: Purposive sampling was used to recruit 125 participants with type 2 diabetes aged 18 years or older from a regional teaching hospital in Taiwan. METHODS: Empowerment case management was applied for 42 participants, while the other 83 received normal case management. Survey items included demographics, preprandial (AC) and postprandial (PC) blood sugar levels, glycated haemoglobin (HbA1C), systolic and diastolic blood pressure, total cholesterol, and the presence or absence of acute and chronic complications. Descriptive statistics and a generalised estimating equation were used to analyse the model's effects on the two groups. RESULTS: The PC blood sugar levels of patients receiving empowerment case management declined at 3 months (B = -34.26, p < .01), and this decrease was maintained at 6 months (B = -83.66, p < .001). As of 6 months after starting the intervention, patients receiving empowerment case management enjoyed better physical health. These patients' AC blood sugar levels (B = -50.16, p < .001), HbA1C (B = -0.98, p < .001), systolic blood pressure (B = -8.24, p < .001), diastolic blood pressure (B = -5.73, p < .01) and total cholesterol (B = -13.74, p < .05) all experienced a continuous drop and were controlled well, and no diabetes-related acute or chronic complications were observed either. Patients with type 2 diabetes who received empowerment case management managed their physical health better. Moreover, its greatest effect was that patients were able to form exercise groups and continue to maintain their health. CONCLUSIONS: Empowerment case management was shown to have a substantial effect on the physical health and self-care of patients with diabetes, thus making it a suitable intervention tool for managing diabetes cases. RELEVANCE TO CLINICAL PRACTICE: The study results showed that empowerment case management is suitable for managing diabetes cases. It has a substantial effect on the maintenance of physical health, occurrence of complications and effectiveness of self-care among patients with diabetes. For better care outcomes, empowerment case management should be integrated into the guidelines of diabetes management.

Activities of daily living trajectories among institutionalised older adults: A prospective study.

AIMS AND OBJECTIVES: To examine activities of daily living trajectory groups among older residents in Taiwan, and to determine the relative risks of demographic characteristics and health status in explaining the trajectory group of activities of daily living. BACKGROUND: Activity of daily living is a crucial indicator of health status for institutionalised older adults. activities of daily living is a dynamic process and has differences in trajectory groups. DESIGN: This study was a 3-year longitudinal analysis of long-term care facility residents in Taiwan. METHODS: A total of 364 older residents completed the entire research process. We used group-based trajectory modelling and multinomial logistic models for statistical analysis. RESULTS: The result of this study revealed that three activities of daily living trajectory groups among older residents exhibited high dependency with gradually declining function (Group 1, 22.53%), low dependency with gradually declining function (Group 2, 43.13%) and persistent independent function (Group 3, 34.34%). Compared with Group 3, Group 1 was related to the following potential risk factors: older age, female, nonmainland China born and a married status. After considering resident health status in the analysis, three significant factors emerged for Group 1: the number of chronic diseases (odds ratio = 2.45), depressive symptoms (odds ratio = 1.71) and cognitive status (odds ratio = 83.11). Compared with Group 3, Group 2 was related to older age. After adding resident health status to the analysis, two significant factors of Group 2 emerged: the number of chronic diseases (odds ratio = 1.68) and depressive symptoms (odds ratio = 1.74). CONCLUSION: The findings of this study indicated that health factors, including the number of chronic diseases, cognitive status and depressive symptoms, were more likely to contribute to the development of a decline pattern of activities of daily living. RELEVANCE TO CLINICAL PRACTICE: Appropriate exercise programmes and physical activities, according to residents' personal characteristics and activities of daily living status, is crucial for improving physical functioning, alleviating depression and cognitive defects in institutionalised older adults.

[The Computer Competency of Nurses in Long-Term Care Facilities and Related Factors].

BACKGROUND: It is important for nurses who work in long-term care facilities (LTCFs) to have an adequate level of computer competency due to the multidisciplinary and comprehensive nature of long-term care services. Thus, it is important to understand the current computer competency of nursing staff in LTCFs and the factors that relate to this competency. PURPOSE: To explore the computer competency of LTCF nurses and to identify the demographic and computer-usage characteristics that relate significantly to computer competency in the LTCF environment. METHODS: A cross-sectional research design and a self-report questionnaire were used to collect data from 185 nurses working at LTCFs in Taipei. RESULTS: The results found that the variables of the frequency of computer use (ß = .33), age (ß = -.30), type(s) of the software used at work (ß = .28), hours of on-the-job training (ß = -.14), prior work experience at other LTCFs (ß = -.14), and Internet use at home (ß = .12) explain 58.0% of the variance in the computer competency of participants. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results of the present study suggest that the following measures may help increase the computer competency of LTCF nurses. (1) Nurses should be encouraged to use electronic nursing records rather than handwritten records. (2) On-the-job training programs should emphasize participant competency in the Excel software package in order to maintain efficient and good-quality of LTC services after implementing of the LTC insurance policy.

Medication use in community-residing older adults in Taiwan: a comparison between conventional and complementary and alternative medications.

Older adults are at risk of problems of medication use including underuse, overuse, and misuse. The purposes of this study were to investigate the prevalence of the use of conventional and complementary and alternative medications (CAM) in older adults and to explore which factors related to their medication use. For this descriptive correlational study, 1,427 citizens who were 65 years old or older from two towns in Yilan County, Taiwan were interviewed by ten trained public health nurses between June and September, 2013. Instruments in this study were physical functional capacity, depressive symptoms, and medication use. Pearson product-moment correlation analysis and the Chi-square test were used to detect relationships among research variables. Of the 1,427 participants, 75.4 % used at least one type of conventional medication, and the average number of medications used was 2.9 (SD = 2.1). Polypharmacy (the use of five or more medications) was identified in 20.1 % of participants. Significant factors related to conventional medications use were older age (χ(2) = 41.7***), female (χ(2) = 7.6**), bad memory (χ(2) = 11.2**), defect cognition status (χ(2) = 7.8**), lost the interest to do anything depressive symptoms (χ(2) = 7.2**), and independent in their daily activities (χ(2) = 41.3***). We found that sociodemographic characteristics and factors pertaining to health status determine the difference between the use of conventional medications and CAM by rural older adults. Our study results suggested that health professionals in Taiwan must be educated and trained in how to integrate CAM into current conventional treatment.

The mediating effects of job satisfaction on turnover intention for long-term care nurses in Taiwan.

AIM: This study explores the mediating effects of job satisfaction on work stress and turnover intention among long-term care nurses in Taiwan. BACKGROUND: Healthcare institutions face a nursing shortage, and it is important to examine the factors that influence turnover intention among nurses. Excessive levels of work stress may lead to employee dissatisfaction and a significant inverse relationship between work stress and job satisfaction, including subsequent effects on turnover among nurses. However, little is known about the mediating role of job satisfaction on work stress and turnover intention among long-term care nurses. METHODS: A cross-sectional survey and a correlation design were used. Multistage linear regression was used to test the mediation model. RESULTS: This study showed that job satisfaction significantly mediated the relationship between work stress and turnover intention. Thirty-eight percent of the variance in turnover intention explained by work stress was accounted for by the mediation pathway. CONCLUSION: The results of this study showed that higher job satisfaction significantly decreased work stress and turnover intention among long-term care nurses. IMPLICATIONS FOR NURSING MANAGEMENT: This study provides nursing administrators with a resource to build a supportive environment to increase nurses' job satisfaction and to decrease their stress and turnover.

The mediating effects of structural empowerment on job satisfaction for nurses in long-term care facilities.

AIMS: The purpose of this study was to explore the mediating effects of work empowerment on job satisfaction for nurses in long-term care facilities in Taiwan. BACKGROUND: Previous research has noted that job satisfaction is an important factor that reflects upon the work environment and the characteristics of the job itself. It is important to link work empowerment to job satisfaction among nurses. METHODS: This research study used a cross-sectional design. A total of 65 nurses participated in the study. Regression models and Sobel tests were fitted to evaluate the relationship between work empowerment and job satisfaction. RESULTS: Structural empowerment mediated the effects of psychological empowerment on job satisfaction (standardized ß = 0.46, Sobel test: z = 2.69, P = 0.007). CONCLUSIONS: Both psychological and structural empowerment positively correlated with job satisfaction among nurses in long-term care facilities. The structural empowerment had a mediating effect on job satisfaction. IMPLICATIONS FOR NURSING MANAGEMENT: The managers of long-term care facilities should create an empowering work environment for nurses by providing them with available resources and by involving them in the developmental goals of the facilities. The critical structural components of an empowered workplace can contribute to the psychological empowerment of nurses and increase their job satisfaction.

The effects of an educational training workshop for community leaders on self-efficacy of program planning skills and partnerships.

AIM: This aim of this study was to evaluate the effects of a 6-month educational workshop for community leaders designed to improve their confidence in health promotion programmes and to develop partnerships among the participants. BACKGROUND: It is important for public health nurses to work with community leaders to provide community-orientated services. However, only a few existing studies have reported the content and effects of training programmes aimed at enhancing the capabilities of community leaders. METHODS: A participatory action research design with pre- and post-test methods was applied in this study. Fifteen community leaders completed a 6-month educational workshop that was held in Tamsui, Taipei and Taiwan. It was designed to enable community leaders to improve their confidence in planning health programmes and developing group partnerships. Data were collected from April 2009 to October 2009, and descriptive statistics and Wilcoxon signed-rank test analyses were carried out. RESULTS: Participants demonstrated improvements in their self-efficacies of planning health programmes by completing a structured questionnaire after attending a 6-month educational workshop (Z =-2·90, P = 0·004). Their confidence in data collection, needs assessment and diagnosis, programme planning, and programme evaluation were significantly improved (Z = -3·1, P = 0·002; Z = -2·42, P = 0·016, Z = -2·84, P = 0·004, and Z = -2·68, P = 0·007, respectively). CONCLUSIONS: Providing training workshops for community leaders is a useful strategy for increasing their capabilities and confidence in planning health programmes. Nurses have a responsibility to advocate and provide training programmes for community leaders.

Associations between chewing and swallowing problems and physical and psychosocial health status of long-term care residents in taiwan: a pilot study.

Oral health is often overlooked in institutional elder care but may have an impact on general health and ability to communicate. We aimed to determine the factor associated with chewing and swallowing problems among long-term care residents in Taiwan. Staff nurses trained to evaluate oral health assessed 781 residents using relevant sections of the Minimum Data Set 2.1 for nursing homes (Chinese version), including the Cognitive Performance Scale, Index of Social Engagement, and Activities of Daily Living Scale. Individuals with chewing and swallowing problems (n = 345) tended to be women (odds ratio [OR] = 1.51, P = .019) in smaller facilities (OR = 4.18, P < .001) with fewer natural teeth (OR = 0.54, P = .011); more broken, loose, or carious teeth (OR = 1.74, P = .042); and with more frequently inflamed gums (OR = 2.72, P = .025) than residents without chewing and swallowing problems (n = 436). Residents' chewing and swallowing problems were significantly associated with parenteral/enteral intake, oral health status, nutritional status, concomitant disease and infection, cognitive function, and social engagement.

Factors Related to Meaning in Life Among Residents of Long-Term Care Institutions.

BACKGROUND: Meaning in life plays an important role in, and is associated with all dimensions of, well-being. Finding meaning in life has been shown to increase life satisfaction in residents of long-term care (LTC) institutions, whereas social support has been found to relate positively with meaning of life. Interactions with LTC staff are the main source of social support for LTC residents. PURPOSE: The purpose of this study was to explore the factors related to meaning in life in LTC residents, especially those associated with interactions between nursing assistants and residents. METHODS: A cross-sectional study design was applied to interview participants from October 2015 through July 2016. One hundred fifty-four residents from six LTC institutions participated in this study. The Staff-Patient Interaction Scale and Meaning-in-Life Scale were used to collect data. The statistical methods of t test, Pearson's correlation, and stepwise regression of forward selection analysis were used to explore the factors related to meaning in life in the study population. RESULTS: The participants were found to perceive a moderate level of meaning in their lives, with a Meaning-in-Life Scale average total score of 42.75 (range: 17-63, SD = 10.19). Staff-patient interaction (ß = .50), financial support from government subsidies and social assistance (ß = -.41), and number of medical diagnoses (ß = -.18) were the three most important factors related to meaning in life, explaining 44.2% of the variance. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Improving the quality of interactions between nurse assistants and residents and health promotion may increase meaning in life in LTC residents.

Early postoperative intraperitoneal chemotherapy (EPIC) following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in 632 patients with pseudomyxoma peritonei of appendiceal origin: A single institution experience.

BACKGROUND: There is ongoing controversy concerning the indications and benefits of early postoperative intraperitoneal chemotherapy (EPIC) following cytoreductive surgery (CRS) and hyperthermic intra-peritoneal chemotherapy (HIPEC) in patients with pseudomyxoma peritonei. The main contra-indications preventing wide-spread use of EPIC are reports of an increased postoperative morbidity with no clear evidence of oncological benefit. This paper reports a single high volume institution experience with EPIC over a 25-year period. METHODS: This is a retrospective analysis of a single institution prospective database of patients undergoing CRS and HIPEC for appendiceal neoplasms from March 1994 to December 2019. Sub group analysis of patients who received EPIC with 5FU 15mg/m2 is reported and compared with patients who did not receive EPIC. RESULTS: Overall, 632/1564 (40%) received EPIC. Patients who received EPIC were younger (median age 55 (IQR 45-63) vs 59 (IQR 50-68)) with similar extent of disease to those who did not have EPIC. EPIC was more likely to be given after complete cytoreduction. The use of EPIC has reduced over the last 25 years from 78% of patients initially to 16% most recently. Length of stay in critical care and total hospital stay were longer in patients who received EPIC but surprisingly major morbidity (Clavien Dindo Grade >3) was lower (p = 0.001). CONCLUSION: EPIC can be administered safely following CRS and HIPEC for PMP of appendix origin when used in carefully selected patients in a high-volume centre. Randomised trials are needed to establish impact on disease free and overall survival to optimize selection criteria.

A qualitative study on shared decision-making of patients with chronic kidney disease.

AIM: This study aims to explore the change process among chronic kidney disease patients in shared decision-making. DESIGN: Qualitative research is the design applied. METHOD: Original transcripts from an earlier study involving a purposive sample of 31 patients with chronic kidney disease provided a source of information. The data collection was conducted from August 2017-January 2018. Data analysis applied the thematic analysis method. RESULTS: Three themes were identified: from avoidance to being forced to accept, decision-making process of action and facilitating factors. After making the psychological adjustments necessary for undergoing dialysis treatment, participants experience the process of decision-making action. The improvement of knowledge and ability increases the patient's self-determination consciousness and strengthens confidence in decision-making. The nurse and the patient's family are both important facilitating factors, and they assist through the entire SDM process.

Exploring the components of metabolic syndrome with respect to gender difference and its relationship to health-promoting lifestyle behaviour: a study in Taiwanese urban communities.

AIMS: The aim was to explore the prevalence of five components of metabolic syndrome with respect to gender and health-promoting lifestyle behaviours. BACKGROUND: Age- and gender-specific strategies might be useful as an approach to controlling metabolic syndrome. Prevention or delaying the onset of metabolic syndrome is of utmost importance in terms of chronic disease care in Taiwan. DESIGN: This was a cross-sectional study. METHOD: Participants self-completed a questionnaire and replied via mail. RESULTS: The overall prevalence rate of metabolic syndrome was 24.07%, with men showing a higher rate than women. High blood pressure was the first abnormal component. The genders were significantly different in the prevalence of high blood pressure, hypertriglyceridemia and decreased HDL-C. Age was also a significant determinant and positively correlated to the total Health-Promoting Lifestyle Profile II (HPLP II) scale score (r = 0.11*), nutrition (r = 0.14**), physical activity (r = -0.16**) and health responsibility (r = 0.12**). CONCLUSIONS: Young, employed adult men were most at risk for having metabolic syndrome. It would seem that it is essential to control blood pressure and abdominal obesity to prevent metabolic syndrome; however, accomplishing this by trying to improve the level of physical activity does not seem to be a viable solution. Moreover, lifestyle modification has been proposed using gender-, age- and location-specific interventions. Nurses should not only strive to investigate the factors that lead to the adoption of unhealthy lifestyle behaviours by using the system approach, but also to empower people to participate in designing health programmes. RELEVANCE TO CLINICAL PRACTICE: By understanding the components of metabolic syndrome, it will be possible to develop more effective strategies for its prevention. Based on this, it will help if healthcare providers focus their efforts on the specific components of metabolic syndrome and on the individuals who are at the greatest risk of developing metabolic syndrome.

Action research on neonatal nursing staff: Experiences caring for bubble continuous positive airway pressure patients.

The objective of this study was to understand the experiences of special care nursery (SCN) nurses tending patients on bubble continuous positive airway pressure (bCPAP). The action research (AR) method with focus group interview was used, and five focus-group interviews were conducted between November 2015 and January 2016. Twenty SCN nurses who had cared neonates on bCPAP for at least one shift were recruited and interviewed. Six themes were revealed in two stages. The first stage was "experience of change," three themes evolved: "resistance to change," "lack of confidence on new care model," and "request administrative supports and resources from the hospital level." The second stage was "willing to take challenge," three themes evolved: "pursuit of proficiency in bCPAP care," "mastering bPCAP: acquiring self-efficacy, becoming competent, and collaborating as a team," and "the development of creative care methods." In the future when confronted with nurses resisting to new policies or changes, administrators should embrace their emotions, address their insecurity and fear, and provide adequate training to improve confidence through familiarity. Application of this model can help with policy implementation, thereby improving the overall caring quality.

The Effects of Shared Decision Making on Different Renal Replacement Therapy Decisions in Patients With Chronic Kidney Disease.

BACKGROUND: The prevalence and incidence of end-stage renal disease (ESRD) in Taiwan are the highest of any country in the world. The different renal replacement therapies that are adopted by patients with ESRD significantly affect their social roles and daily life. However, because of the complexities of different renal replacement therapies, patients may be unsure of which to choose. PURPOSE: The aim of this study was to explore the effectiveness of a shared decision-making (SDM) program regarding different renal replacement therapies for patients with chronic kidney disease. METHODS: A quasi-experimental design was conducted at two similar regional hospitals in Miaoli County, Taiwan. One hospital hosted the intervention group, and the other hospital hosted the control group. The 31 participants in the intervention group took part in a SDM program. The 36 control group participants took part in the pre-ESRD care program. Data collection included demographic and disease characteristics, decisional conflict scale, and decision self-efficacy scale. Results were analyzed using independent t test, Fisher's exact test, generalized estimating equation, and paired t tests. RESULTS: The study results revealed that the intervention group experienced a significant increase in decision self-efficacy and a significant decrease in decisional conflict at 1 month after receiving the SDM intervention in comparison to before and immediately after receiving the intervention. Moreover, the intervention group had higher decision self-efficacy and lower decisional conflict than the control group. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The SDM program may be an effective intervention for complex decision-making processes, such as the process involved in making renal replacement treatment decisions. The SDM program group intervention improved decisional conflict and decision self-efficacy. Thus, to improve patients' decision-making processes, the application of an SDM program focused on the personal values and opinions of patients with ESRD will be necessary. Physicians and case managers of patients with ESRD should act in complementary and cooperative roles in SDM programs.

The relationship between work empowerment and work stress perceived by nurses at long-term care facilities in Taipei city.

AIM: To explore the relationships between work empowerment, including both structural and psychological empowerment and work stress among nurses at long-term care facilities in Taiwan. DESIGN: Cross-sectional design with a descriptive correlation. METHODS: Work empowerment includes both psychological and structural empowerment; 178 nurses participated in the study. RESULTS: The results of this study showed that the average age of the subjects was 35.5 years and that 56.2% of subjects had less than two years work experience in the facility. The results indicated that there was a moderate level of psychological empowerment (mean 59.9, SD 8.1) and structural empowerment (mean 59.2, SD 11.1). A moderate level of work stress was also found with an average score of 72.3 (SD 14.4). Both psychological empowerment and structural empowerment were found to be significantly associated with total work stress (r = -0.4, r = -0.5, p < 0.001, respectively). The variables of age (standardised beta = -0.1), resources (standardised beta = -1.6), meaningful work (standardised beta = -0.4) and impact (standardised beta = -1.3) were significant predictors of work stress (R(2) = 0.32, F = 17.3, p<0.001). CONCLUSION: Both psychological empowerment and structural empowerment were found to be significantly associated with work stress among nurses in this study. The four significant predictors of job satisfaction were age, resources, meaningful work and impact. RELEVANCE TO CLINICAL PRACTICE: The managers of the facilities should provide available resources for nurses to accomplish work and to involve nurses in the development goals of the facilities to enhance their influence in the making of important changes within the organisation to decrease their work stress.

Relationship between organizational empowerment and job satisfaction perceived by nursing assistants at long-term care facilities.

AIM: The purpose of this study was to understand the relationships between organizational empowerment and job satisfaction among nursing assistants at long-term care facilities in Taiwan. BACKGROUND: Nursing assistants are the major manpower at long-term care facilities. The responsibilities of nursing assistants are complex and numerous and affect their job satisfaction. We assumed that a well-organized and pleasant work environment is an important characteristic of organizational empowerment and ought to enhance the nursing assistants' job satisfaction. However, little information exists that can be used by long-term care facilities managers when they strive to increase the nursing assistants' job satisfaction by modifying the regulations or interventions from an organizational perspective. METHODS: We used a cross-sectional design with a descriptive correlation approach to understand the relationship between organizational empowerment and job satisfaction among nursing assistants at long-term care facilities in Taiwan. A total of 28 long-term care facilities and 114 nursing assistants participated in the study. RESULTS: The results indicated that, where there was a moderate level of organizational empowerment, a higher level of job satisfaction was found. Organizational empowerment was significantly associated with total job satisfaction (r = 0.366, p < 0.01). The variables of nationality (Vietnamese), resources, opportunity and informal power were significant predictors of job satisfaction (R(2) = 0.318, F = 12.24, p < 0.001). CONCLUSION: Organizational empowerment is significantly associated with job satisfaction among nursing assistants in this study. RELEVANCE TO CLINICAL PRACTICE: Nursing assistants need to receive more assistance and resources from their co-workers to enhance their job satisfaction. The manager should initiate regular meetings and activities for staff who work in long-term care facilities that will allow sharing, communication and support among the staff in terms of ideas, information and feelings.

[The process of empowering community development: the experience of a community in Taipei city].

Community participation and development are the most difficult aspects of building healthy communities. They are also, however, the most essential parts of the process. It has been established that empowerment can ultimately enhance individual self-efficacy, influence organizational and social structures, and increase the sense of community and citizen's capabilities. This article demonstrates the experience of one community in Taipei City during a lengthy period of organization and development. It illustrates the different stages involved in community development and the functions of community health professionals. It seeks to provide insight into the importance of using empowerment in promoting communities' capabilities and the fact that only by developing organic communities that are rich in the energy of life can we develop sustainable communities.

The influence of different dialysis modalities on the quality of life of patients with end-stage renal disease: A systematic literature review.

OBJECTIVES: This study aims to generate evidence regarding the relationships of different dialysis modalities with HR-QOL. DESIGN: A systematic review was conducted to investigate the HR-QOL of patients treated with different dialysis modalities. METHODS: A literature search was conducted for English language articles in the CINAHL, Medline and PubMed databases published from January 1990 through May 2016. Specifically, we sought articles that would compare the HR-QOL of hemodialysis (HD) and peritoneal dialysis (PD) patients in terms of physiological, psychological and social functioning, as well as disease symptoms. Thirty-four articles met the study inclusion criteria and were included into the analysis. RESULTS: The research results indicated no significant differences in HR-QOL between HD and PD treatment. However, a higher percentage of patients who received PD had a better HR-QOL in terms of physiological, psychological, social and disease symptoms. CONCLUSIONS: Despite the fact that the results of this study showed no difference in HR-QOL between HD and PD treatment, its review of relevant references can serve as a reference for health professionals. However, patients' conditions must still be taken into account when making suggestions about which dialysis modality a patient should use.

The health status and health promotion behavior of low-income elderly in the Taipei area.

The purpose of this study was to understand health promotion behaviors and their correlated factors among low-income elderly in the Taipei area. This study used a cross-sectional design with a descriptive correlation approach. A total of 89 low-income elderly from Peitou District of Taipei participated in the study. Structured questionnaires, the primary sources of measurement, were read to study subjects by a trained research assistant. The mean age of low-income elderly in the study was 76.85 year-old. A plurality were single (41.6%) and 31.5% lived alone. Subject IADLs (instrumental activities of daily living) were not as good as their ADLs (activities of daily living). Their psychosocial health status was worse than their physical health status. Among health promotion behaviors, regular exercise appears to be the most prevalent. The most significant factor among subjects for failing to follow health-promoting behaviors was their IADLs. Homebound elderly who lived alone and had poor IADL were less likely to have health promoting behaviors. A proposal to encourage health promotion behaviors for low-income elderly derived from study results is the initiation of formal personal assistance programs to remedy the inability of many elderly, especially those living alone, to leave the home due to ADL-related or other limitations.