Effects of Resourcefulness on Sleep Disturbances, Anxiety, and Depressive symptoms in Family Members of Intensive Care Unit Patients.

The study aimed to investigate the relationships among psychological distresses, resourcefulness, sleep disturbances, anxiety and depressive symptoms in family members of intensive care unit (ICU) patients. A cross-sectional, descriptive correlational design was employed. Using structural equation modeling (SEM) approach, relationships among factors, mediators, and outcomes were analyzed. The SEM explained 59% of the variances in depressive symptoms and 36% in anxiety. Family members with greater learned resourcefulness had fewer sleep disturbances, depressive and anxiety symptoms. Nursing professionals need to detect psychiatric disease of family members and must be especially vigilant with people who have low resourcefulness and sleep disturbances.

[The Effects of a Mobile Application Social Support Program on Postpartum Perceived Stress and Depression].

BACKGROUND: Postpartum depression is a common health problem for women following childbirth. Using effective social support to reduce postpartum depression has become an important issue. The current popularity of smartphones offers new possibilities for interventional methods. PURPOSE: To investigate the effects of mobile-application-based social support programs on perceived stress and postpartum depression in postpartum women. METHODS: The present study employs an experimental research design. 126 smartphone users at 36 weeks' gestation were assigned randomly to the intervention (n = 61) or the control (n = 65) group. The intervention group received a social-support intervention via the mobile application Line twice per week for a period of 4 weeks after childbirth. The control group did not receive the intervention. The Perceived Stress Scale-Chinese version and Edinburg Postnatal Depression Scale were used to evaluate the outcome. RESULTS: Participants in the intervention group had significantly lower perceived stress (F = 27.25, p < .001) and postpartum depression (F = 35.73, p < .001) than their control group peers. CONCLUSIONS: Social-support programs that are delivered via mobile applications such as Line may significantly reduce the perceived stress and postpartum depression of women during the early postpartum period. The results support the implementation of mobile-application-based social support programs in postpartum care.

The validation and application of the Chinese version of perceived nursing work environment scale.

AIMS AND OBJECTIVES: To improve the development of the Chinese version of Perceived Nursing Work Environment (C-PNWE) scale by examination and application and to explore the nurses' perception of their working environment in a hospital. BACKGROUND: The C-PNWE scale was translated and revised from the PNWE scale. The least of perfection is that the development of C-PNWE ignored that the psychometric properties of the PNWE instrument were established of critical care nurses and further application and testing of the PNWE in various patient care settings were recommended. DESIGN: This is a cross-sectional design. Nurses from different departments of a hospital were sampled by convenience sampling and investigated by self-administrated questionnaire. METHODS: Data obtained through questionnaires were analysed by descriptive statistical analyses and profile analyses using the Statistical Package for the Social Sciences (SPSS) Chinese version 17.0 software. RESULTS: The coincident and level profile analyses indicated that these groups can merge into one group, and the profile of measurement result of this merged group would not exhibit flatness. Among six dimensions of C-PNWE scale, the Staffing and Resource Adequacy got the lowest average score. Among 41 items, 'Opportunity for staff nurse to participate in policy decisions' got the lowest mean. CONCLUSIONS: The C-PNWE scale shows good psychometric properties and can be used to explore nurses' perspectives of the nursing practice environment in China. And the situation of nurses' perceived working environment in China needs further study. RELEVANCE TO CLINICAL PRACTICE: Shaping nursing practice environments to promote desired outcomes requires valid and reliable measures to assess practice environments prior to, during and following efforts to implement change. The C-PNWE scale can be a useful measurement tool for administrators to improve the nursing work environment in China.

The training in SHARE communication course by physicians increases the signing of do-not-resuscitate orders for critical patients in the emergency room (cross-sectional study).

BACKGROUND: Communication skills may be an important skill for the front-line emergency physicians. AIM: This study aimed to investigate the effect of training in a SHARE communication course by emergency physicians on patient notification and signing of do-not-resuscitate (DNR) orders for critical patients in the emergency room. DESIGN: From a total of 29 attending physicians in the emergency department, 19 physicians had been trained in the SHARE communication course. An observation form designed based on the SHARE training was completed by two observers who noted the communication process between physicians and patients and family members during patient notification and signing a DNR order. To assess the influence of physicians trained in a SHARE communication course on the signing of DNR orders, a propensity score-matched population was created to reduce the potential selection bias of patients and family members. SETTING: Level 1 trauma medical center in southern Taiwan. RESULTS: There were 145 individuals enrolled in the study, of which 93 signed the DNR order, and 52 did not sign it. Analysis from 23 matched pairs from this population revealed that significantly more family members would sign a DNR order if the physician had been trained in the SHARE communication course than when they did not receive this training (78.3% vs. 39.1%, respectively, p = 0.017). The overall score of the observation form for physicians was higher in those individuals who had signed a DNR order than in those who did not sign it (29.48 ±â€¯3.72 vs. 26.13 ±â€¯3.52, respectively, p = 0.003), especially when the physician had chosen a quiet environment (1.35 ±â€¯0.65 vs. 0.87 ±â€¯0.69, respectively, p = 0.020), understood the patient's wishes and confirmed them (1.78 ±â€¯0.42 vs. 1.30 ±â€¯0.70, respectively, p = 0.008), and expressed concern (1.48 ±â€¯0.79 vs. 0.96 ±â€¯0.77, respectively, p = 0.028). In addition, a feedback survey about the feelings experienced by these physicians during the process of patient notification did not reveal a significant difference during the communication with those who had or had not signed DNR orders. CONCLUSION: The training in a SHARE communication course can improve the communication skills of emergency physicians in patient notification and signing of DNR orders for critical patients.

Association Between the Communication Skills of Physicians and the Signing of Do-Not-Resuscitate Consent for Terminally Ill Patients in Emergency Rooms (Cross-Sectional Study).

BACKGROUND: The signing of do-not-resuscitate (DNR) consent is mandatory in providing a palliative approach in the end-of-life care for the terminally ill patients and requires an effective communication between the physician and the patients or their family members. This study aimed to investigate the association between the communication skills of physicians who participated in the SHARE (supportive environment, how to deliver the bad news, additional information, reassurance, and emotional support) model course on the patient notification and the signing of do-not-resuscitate (DNR) consent by the terminally ill patients at emergency rooms. METHODS: Between May 1, 2017 and April 30, 2018, a total of 109 terminally ill patients were enrolled in this study, of which 70 had signed a DNR and 39 had not. Data regarding the patients' medical records, a questionnaire survey completed by family members, and patient observation forms were used for the assessment of physicians' communication skills during patient notification. The observation form was designed based on the SHARE model. A multivariate logistic regression model was applied to identify the independent significant factors of the patient and family member variables as well as the four main components of the observation form. RESULTS: The results revealed that knowing how to convey bad news and providing reassurance and emotional support were significantly correlated with a higher rate of signing DNR consent. Additionally, physician-initiated discussion with family members and a predicted limited life expectancy were negative independent significant factors for signing DNR consent. CONCLUSION: This study revealed that good communication skills help to increase the signing of DNR consent. The learning of such skills from attendance of the SHARE model course is encouraged for the physicians in the palliative care of terminally ill patients in an emergency room.

Providers' responses to global budgeting in Taiwan: what were the initial effects?

Taiwan introduced National Health Insurance in 1995, providing comprehensive benefits to all of Taiwan's residents, with full access to providers and low co-payments. The programme quickly increased national health expenditure. To help contain these costs, Taiwan introduced global budgeting in 2000-02. Global budgeting may present incentives to hospitals to increase service volume to maximize revenue. We evaluated the response of hospitals to global budgeting by examining hospitalization for selected high-volume discretionary conditions, using National Health Insurance data from before and after the implementation of global budgeting. Hospitalization for these discretionary conditions increased significantly for children, adults of working age, and for some age groups of older adults. As there is no reason to believe that hospitalizations would have increased during the study period to fulfil unmet need, or as a function of either reduced outpatient access or notable increases in disease prevalence, results suggest that hospitals increased service volume to retain or expand their individual shares of the global budget. The increase in hospitalization for high-discretion conditions that we observed in this study may not be desirable, as hospitalization carries a substantial risk of iatrogenic morbidity, a risk that is particularly great for older people.

The relationship between survival after out-of-hospital cardiac arrest and process measures for emergency medical service ambulance team performance.

OBJECTIVE: International institutes have developed their own clinical performance indicators for ambulance services. It is unknown whether these process measures are related to survival of patients after out-of-hospital cardiac arrest (OHCA). We aimed to determine whether Emergency Medical Service (EMS)-related ambulance team process measures correlate with patient survival. METHODS: Four years of observational data were collected from an urban EMS OHCA registry. The two process measures were achieving an EMS response time ≤4 min and prehospital ROSC (return of spontaneous circulation). The outcome measure was survival to discharge. We used the GLMM (generalised linear mixed model) with stepwise selection to examine this process-outcome link at the patient and EMS team levels, respectively. RESULTS: We analyzed 3856 OHCA patients distributed across forty-three EMS ambulance teams. Survival to discharge was observed in 193 (5%) patients. The two EMS team process measures were positively associated with an improvement in survival at the patient level after case-mix adjustment. However, they were not associated with improvement in the risk-adjusted survival rate. CONCLUSIONS: The EMS team-level process measures proposed by international institutes may not predict the risk-adjusted survival rate. Using these measures to motivate EMS teams to improve their quality performance would be questionable. Increased efforts should be devoted to constructing more pivotal EMS team-level process measures that are tightly linked to survival.