Experiences and perspectives related to shared decision-making among outpatients with degenerative joint disease in Taiwan: a qualitative study

OBJECTIVES

Various treatment options are available for degenerative joint disease (DJD). During clinical visits, patients and clinicians collaboratively make decisions regarding the optimal treatment for DJD; this is the essence of shared decision-making (SDM). Here, we collated and assessed the SDM-related experiences and perspectives of outpatients with DJD in Taiwan.

DESIGN

In-depth interviews and thematic analysis.

SETTING

Primary care clinics of a regional teaching hospital in Taiwan, October 2021-May 2022.

PARTICIPANTS

21 outpatients with at least three visits for DJD and who were aware of SDM.

RESULTS

Four main themes emerged in this study: first, equipping themselves with knowledge: outpatients obtained disease-related and treatment-related knowledge in various ways-seeking relevant information online, discussing with family and friends, learning from their own experiences or learning from professionals. Second, shared or not shared: physicians had different patterns for communicating with patients, particularly when demonstrating authority, performing mutual discussion, respecting patient preferences or responding perfunctorily. Third, seldom saying no to physician-prescribed treatment plans during clinical visits: most patients respected physicians' professionalism; however, some patients rejected physicians' recommendations indirectly, whereas some responded depending on their disease prognosis. Fourth, whose call?-participants decided to accept or reject a treatment plan independently or by discussing it with their families or by obeying their physicians' recommendations.

CONCLUSIONS

In general, patients with DJD sought reliable medical information from various sources before visiting doctors; however, when having a conversation with patients, physicians dominated the discussion on treatment options. The patient-physician interaction dynamics during the SDM process determined the final medical decision, which was in accordance with either patients' original autonomy or physicians' recommendations. To alleviate medical paternalism and physician dominance, patients should be empowered to engage in medical decision-making and share their opinions or concerns with their physicians. Family members should also be included in SDM.

Training perinatal nurses in palliative communication by using scenario-based simulation: A quasi-experimental study

AIM

This study aimed to assess the impact of two educational modules on enhancing the communication confidence, competence and performance of perinatal nurses in the context of palliative care.

BACKGROUND

Concerns have arisen regarding the preparedness of perinatal nurses in delivering palliative care, especially in terms of deficiencies in communication skills and negative attitudes toward making life-support decisions for parents facing neonates with terminal conditions. Bridging this gap necessitates improved perinatal palliative care education for healthcare providers. Research has shown that simulation-based teaching effectively enhances procedural competence, communication skills and confidence among healthcare professionals. However, comprehensive curricula focusing on perinatal palliative communication remain limited.

DESIGN

This study used a quasi-experimental design employing a two-group repeated measure approach. It involved a purposive sample of 79 perinatal nurses from a hospital in northern Taiwan.

METHODS

A palliative communication course specifically designed for registered nurses in perinatal units was developed. Participants were allocated to either the experimental group (Scenario-Based Simulation, SBS) or the control group (traditional didactic lecture). Communication confidence and competence were assessed before and immediately after the course through structured questionnaires. Learning satisfaction was collected post-intervention and participants underwent performance evaluation by standardized parents one week later.

RESULTS

A significant training gap in palliative care exists among nurses in OB/GYN wards, delivery rooms and neonatal critical care units, highlighting the need for continuing education. All 79 participants completed the training course. Following the intervention, nurses in the SBS group (n=39) exhibited significant improvements in self-reported confidence (p <0.05), competence (p <0.01) and performance (p <0.001) in neonatal palliative communication compared with the traditional didactic lecture group (n=40). The SBS group also received higher satisfaction ratings from nurse learners (p <0.001).

CONCLUSIONS

The research findings support scenario-based simulation as a more effective educational approach compared with traditional didactic lectures for enhancing communication confidence and competence. These results were further reinforced by evaluation from standardized patients, highlighting the value of direct feedback in enhancing nurses' performance. Tailoring SBS designs to diverse nursing contexts and incorporating a flipped approach can further enrich the overall learning experience. Given its high effectiveness and positive reception, we recommend integrating this educational module into palliative care training programs for perinatal nurses.

Effects of an Interactive e-Book on Enhancing Nursing Students' Knowledge, Confidence, and Learning Self-efficacy of Nursing Skills: A Randomized Controlled Trial

BACKGROUND

Interactive e-books offer multimedia and interactive features that make them particularly suitable for learning nursing skills and also allow for easy content updating, ensuring that students learn the most current skills based on the latest clinical guidelines.

PURPOSE

To examine the effectiveness of an interactive e-book in increasing nursing students' knowledge, confidence, and learning self-efficacy of performing nasogastric tube feeding.

METHODS

A randomized controlled trial was conducted with 62 nursing students, with the experimental group using an interactive e-book for learning whereas the comparison group using a printed textbook.

RESULTS

The experimental group demonstrated significantly greater knowledge and confidence improvements than the comparison group, but no significant difference was found in learning self-efficacy. The experimental group was significantly more satisfied with the learning materials than the comparison group.

CONCLUSIONS

Interactive e-books are more effective in enhancing nursing students' knowledge and confidence in performing nursing skills than printed textbooks.

Insomnia complaints correlated with higher risk of cognitive impairment in older adults following stroke: a National Representative Comparison Study

Although associations among insomnia, cognitive impairment, and stroke have been demonstrated, whether insomnia increases the risk of cognitive impairment after stroke remains unclear. The aim of this study was to examine whether insomnia complaints moderated the association between stroke and cognitive impairment in older adults. This study was a secondary data analysis that used data from the National Health Interview Survey 2009. A total of 447 older adults with a mean age of 74.63 years (50.1% men) were included. Self-reported insomnia and stroke occurrence were determined using a questionnaire. Cognitive impairment was assessed using the Mini-Mental State Examination. We used multivariate logistic regression to analyze the association between insomnia complaints and cognitive impairment. Participants were categorized into four groups: those with stroke and insomnia (58), those with stroke without insomnia (91), those without stroke with insomnia (116), and those without stroke or insomnia (182). The prevalence of insomnia complaints was 38.9%, and the frequency of poststroke cognitive impairment was 50.3%. After controlling for potential confounders, participants with stroke (with or without insomnia) had a significantly higher risk of cognitive impairment than those without stroke or insomnia (adjusted odds ratios: 4.16 and 2.91, 95% confidence intervals: 1.91-9.07 and 1.56-5.43, respectively). Stroke with or without insomnia complaints was associated with a higher risk of cognitive impairment relative to older adults without stroke or insomnia. The risk of cognitive impairment was the highest among participants with both stroke and insomnia.

Nursing students' critical thinking and associated factors in Vietnam: A multicenter cross-sectional study

AIMS

This study aimed to evaluate the critical thinking abilities of senior nursing students in Vietnam and determine factors associated with their critical thinking disposition and skills.

BACKGROUND

Assessing critical thinking competence is crucial for determining senior nursing students' preparedness for entering the healthcare workforce and can be used to examine current nursing education's ability to cultivate nursing students' critical thinking. However, little research was found on critical thinking among Vietnamese nursing students.

DESIGN

A multicenter cross-sectional research design.

METHODS

A convenience sample of 533 senior nursing students from six universities in Vietnam participated in this study. All participants completed the online questionnaires, including basic information, a subscale of the Motivated Strategy for Learning Questionnaire (MSLQ), Critical Thinking Disposition Scale (CTDS), and Critical Thinking Self-Assessment Scale (CTSAS).

RESULTS

The mean score for the CTDS was 42.81 (standard deviation (SD) = 5.29), while the mean score for the CTSAS was 168.29 (SD = 44.43). Results of the multiple linear-regression analysis showed that an increase in self-study hours per day (B = 0.41, p = 0.007), higher self-efficacy in learning and performance (B = 0.26, p < 0.001), and a more-supportive environment (B = 0.97, p < 0.001) were predictors of critical thinking disposition. Moreover, an increase in self-study hours per day (B = 4.09, p = 0.001), higher self-efficacy in learning and performance (B = 2.65, p < 0.001), a more-supportive environment (B = 7.74, p < 0.001), and more experience with research (B = 7.03, p = 0.03) were predictors of critical thinking skills.

CONCLUSIONS

This study revealed that senior nursing students in Vietnam possess a moderate level of critical thinking abilities. Those students who dedicate more hours to self-study, demonstrate higher self-efficacy in learning and performance, experience a supportive environment, and engage in more research activities exhibit better critical thinking disposition and skills. The findings highlight the ongoing need to enhance critical thinking disposition and skills of nursing students in Vietnam. It is suggested that nursing faculty members should develop the appropriate strategies to improve nursing students' critical thinking disposition and skills.

Assessment of the psychometric properties of the Vietnamese version of the Critical Thinking Disposition Scale

BACKGROUND

The Critical Thinking Disposition Scale is a valid and reliable tool for assessing an individual's attitudes towards critical thinking. However, it is unclear if the scale can be used with Vietnamese nursing students.

OBJECTIVES

This study aimed to translate the scale into Vietnamese and examine the psychometric properties of the Vietnamese version of the Critical Thinking Disposition Scale (CTDS-V).

SETTINGS

Data were collected from senior nursing students at four universities in southern Vietnam in October and December 2022.

PARTICIPANTS

In total, 398 senior nursing students participated in this study.

METHODS

A cross-cultural adaptation of the CTDS-V was carried out with participants obtained through convenience sampling. Data were collected through an online survey. The study evaluated the validity of the CTDS-V by examining the content validity, concurrent validity, and construct validity, employing both Exploratory and Confirmatory Factor Analyses. The study also reported the internal consistency reliability using Cronbach's alpha and test-retest stability of the CTDS-V.

RESULTS

The CTDS-V had a good content validity index with a score of at least 0.85 for each item and an excellent overall content validity index of 0.96. Exploratory Factor Analysis identified two factors, critical openness, and reflective scepticism, with 11 items. Confirmatory Factor Analysis provided an acceptable fit model and supported the factor structure of the original scale. Cronbach's alpha coefficient of the scale was 0.88, and those of the two subscales were each 0.84. The test-retest stability of the CTDS-V was good with an intraclass correlation coefficient of 0.98 (95 % confidence interval = 0.96, 0.99).

CONCLUSIONS

This study indicated that the CTDS-V is a valid and reliable tool for assessing the critical thinking disposition of nursing students. The scale is short, rendering it feasible for regular use in education and research.

Community-based exercise and nutritional interventions to improve frailty syndrome among older adults: A quasi-experimental study

This study aimed to explore the efficacy of single and combined effects of exercise and branched-chain amino acid (BCAA) supplements on improving frailty and quality of life in older adults. In total, 120 study participants were allocated into a combined exercise-and-BCAA supplementation group, an exercise-only group, a BCAA supplementation-only group, and a control group. Results showed that Fried's frailty score significantly decreased in the combined exercise-and-BCAA supplementation group (β= -1.73, p<0.001), exercise-only group (β= -1.68, p<0.001), and BCAA supplementation-only group (β= -0.73, p=0.005) compared to the control group. Moreover, the combination of exercise and BCAA supplements and the exercise-only program produced significant improvements in frailty compared to the BCAA supplement-only group and control group (p<0.05). Exercise should be a critical approach for older adults to improve frailty. Healthcare professionals in geriatric care should incorporate exercise programs as frailty management and prevention for older adults.

Prevalence of Stress and Anxiety Among Nursing Students: A Systematic Review and Meta-analysis

BACKGROUND

There is variability in the reported prevalence of stress and anxiety among nursing students across studies, and few studies have investigated the pooled prevalence of stress and anxiety of these students.

PURPOSE

To investigate the prevalence and associated factors related to stress and anxiety among nursing students.

METHODS

Various electronic databases were searched up to October 26, 2022. A random-effects model and a moderator analysis were used to examine the overall prevalence and related factors. Begg's test was adopted to examine publication bias.

RESULTS

In total, 121 studies were included in the meta-analysis. Most nursing students experienced moderate stress (42.1%) and mild to moderate anxiety (19.4%-25.1%). Third- and fourth-year nursing students had severe stress levels compared with those in the first and second years (29.0% vs 15.1%).

CONCLUSIONS

Nurse educators should design appropriate curricula to strengthen student knowledge and provide regular assessments and supportive interventions to reduce stress and anxiety.

Questionnaire-free machine-learning method to predict depressive symptoms among community-dwelling older adults

The 15-item Geriatric Depression Scale (GDS-15) is widely used to screen for depressive symptoms among older populations. This study aimed to develop and validate a questionnaire-free, machine-learning model as an alternative triage test for the GDS-15 among community-dwelling older adults. The best models were the random forest (RF) and deep-insight visible neural network by internal validation, but both performances were undifferentiated by external validation. The AUROC of the RF model was 0.619 (95% CI 0.610 to 0.627) for the external validation set with a non-local ethnic group. Our triage test can allow healthcare professionals to preliminarily screen for depressive symptoms in older adults without using a questionnaire. If the model shows positive results, then the GDS-15 can be used for follow-up measures. This preliminary screening will save a lot of time and energy for healthcare providers and older adults, especially those persons who are illiterate.

Families of Patients With Cancer: Responses and Actions to People With Cancer Who Use Complementary and Alternative Medicine: A Qualitative Study in Taiwan

This study aims to explore how the families of patients with cancer respond to and act toward complementary and alternative medicine (CAM) use. A qualitative research design based on grounded theory was adopted in this study. Semistructured and face-to-face in-depth interviews were conducted. Each participant was involved in a one-to-one individual interview. Five categories emerged regarding how the families of patients with cancer responded to and acted toward CAM use: purposes of using CAM, CAM use between patients and families, role of family caregivers, actions when using CAM, and seeking religious practice. The core category following coding emphasized the paramount importance of patients' comfort. The findings revealed that the families of patients with cancer may respond and act differently regarding patients' use of CAM. During this process, patients may not inform family members that they are using CAM. Health care professionals should consider this in their interactions with family members.

Effects of board game play on nursing students’ medication knowledge: A randomized controlled trial

AIM

This study aimed to examine the effectiveness of an educational board game in improving nursing students' medication knowledge.

BACKGROUND

Maintaining patient safety is a core practice for nurses. Medication management is a central principle of patient safety. Nurses acquire pharmacology knowledge and medication safety skills in the classroom training. Thus, solidifying and strengthening nursing students' medication knowledge are crucial tasks for nursing faculty members. In recent years, board games, which offer both entertainment and competitive play, have been employed to educate students in a variety of disciplines and settings. Through board game play, students can learn in an enjoyable and fun atmosphere.

DESIGN

A randomized controlled trial design.

METHODS

A convenience sample of 69 nursing students was obtained from a university in Taiwan. Participants were randomly assigned either to an experimental (board game) group (n = 35) or a comparison group (n = 34) using block randomization. The experimental group engaged in board game play to learn about medications, whereas the comparison group attended a one-hour didactic lecture. Using questionnaires, data were collected before the intervention, immediately post intervention and one month post intervention.

RESULTS

Following the intervention, regardless of the learning method, both groups showed significant improvements in their immediate recall of medication information. However, when retested after one month, the experimental group obtained significantly higher scores than the comparison group. Moreover, students in the experimental group reported more satisfaction with the learning method than those in the comparison group.

CONCLUSIONS

The study results suggest that learning through board games could enhance nursing students' retention of knowledge. Students reported favorable reactions to using a board game learning method for increasing knowledge of medication. With respect to this finding, faculty members may consider employing board games as teaching tools in nursing and other health science courses. Moreover, the findings of this study can also provide additional information for nursing managers in hospital wards or long-term care facilities where nurses are trained to familiarize themselves with frequently administered medications.

TWEETABLE ABSTRACT

Board game play can enhance nursing students' retention of knowledge; students reported positive reactions to game-based learning for medication training.

Coping with the Experience of Bad Sleep and Fatigue Associated with the Nursing Clinical Practicum

Nursing students experience anxiety during clinical practicum, which may interfere with their learning of clinical practice. This study explored the practicum anxiety symptom experience of clinical nursing students. The methodology was mixed research design consist of questionnaire and a qualitative research design following a grounded theory approach. Research data were gathered via theoretical sampling from 37 female college nursing students practicing in a Central Taiwan hospital and analyzed using the content analysis method. The mean age of the subjects was 20.7 ± 1.35 years old. The practicum-related anxiety symptom experience was made up of core dimensions associated with the nursing clinical practicum, such as bad sleep and fatigue, and covered six themes. Students first encountered anxiety-inducing situations in the clinical setting, and then they began coping through self-adaptation and teachers' help. In cases of coping failure, students began to have a bad sleep in the night and then felt tired and fatigued all day. These themes became a repeating cycle during the clinical practicum. This conceptual model shows that students experienced bad sleep and fatigue as a result of anxiety symptoms during the clinical practicum. Bad sleep and fatigue are critical anxiety symptoms for nursing students in clinical practice. Nursing teachers should pay attention to bad sleep and fatigue in nursing students and help students to improve their mental and physical health.

Effects of yoga on menopausal symptoms and sleep quality across menopause statuses: A randomized controlled trial

This randomized controlled trial investigated the effects of yoga on menopausal symptoms and sleep quality across menopause statuses. Participants were randomly assigned to either the intervention or control group (n = 104 each), and those in the intervention group practiced yoga for 20 weeks. The participants completed the following questionnaires: the Depression, Anxiety, and Stress Scale; Multidimensional Scale of Perceived Social Support; Menopause Rating Scale; and Pittsburgh Sleep Quality Index. The results revealed that yoga effectively decreased menopausal symptoms, with the strongest effects noted in postmenopausal women (mean ± standard deviation: 14.98 ± 7.10), followed by perimenopausal women (6.11 ± 2.07). Yoga significantly improved sleep quality in postmenopausal and perimenopausal women after controlling for social support, depression, anxiety, stress, and menopausal symptoms (p < 0.001). However, yoga did not affect sleep quality in premenopausal women. Overall sleep quality significantly improved in postmenopausal and perimenopausal women. Our data indicate that yoga can help decrease menopausal symptoms, particularly in perimenopausal and postmenopausal women, and improve their health.

Older residents' perceptions of loneliness in long-term care facilities: A qualitative study

Loneliness is a negative emotional feeling often experienced by older residents in long-term care facilities (LTCFs). Previous studies have shown that loneliness is related to depression, inferior quality of life, cardiovascular disease, and suicidal thoughts. Thus, it is important to understand older residents' viewpoints about loneliness to provide better care in the long-term care context. This study aimed to explore residents' perceptions of loneliness in LTCFs. For this qualitative research, data were collected from two LTCFs in northern Taiwan, and purposive sampling was used. In-depth interviews with 16 older residents were conducted using a semi-structured interview guide. Content analysis was performed to analyse the data. Four themes with nine subthemes were generated. The themes were: being cut off from continually meaningful relationships, experiencing tears of pain, feeling alone, and lacking a sense of belonging. The findings of this study can provide information for health care professionals to better understand older residents' views on loneliness and remind them to re-examine care protocols for psychological health care. Thus, this study found that in order to prevent or alleviate older residents' feelings of loneliness, the LTCFs should maintain continually meaningful relationships, accompany them, and give them a sense of belonging. The consolidated criteria for reporting qualitative research (COREQ) guidelines were used to report this study.

[The Design and Application of a Chatbot in Clinical Nursing Education]

The vigorous development of information and communication technology has enabled great progress in the application of mobile learning in clinical nursing education. Mobile learning allows students to use the internet and mobile devices to access convenient, immediate learning anytime and anywhere to achieve ubiquitous learning. Smartphones have become indispensable communication tools in our daily life. Smartphones equipped with chatbots may be used as mobile learning tools that are free of time and space limitations and promote instant responses and humanized interactions. These applications may help meet the preferences of a new generation of nurses. In this article, the concepts of mobile learning are introduced, the advantages and limitations of educational chatbots are discussed, suggestions for the application of chatbots in education are provided, and the author`s teaching plan for creating a chatbot via the LINE app is shared. Using chatbots allows nursing educators to integrate technology into clinical teaching, develop multiple innovative teaching materials, and create a fun environment to promote professional learning and facilitate self-growth in nursing staff.

Prevalence of Loneliness and Related Factors Among Older Adults in Taiwan: Evidence From a Nationally Representative Survey

BACKGROUND

Loneliness is a common problem among older populations, and very few studies have examined loneliness among older adults in Taiwan.

AIM

This study aimed to understand the prevalence of loneliness and factors associated with it among older adults in Taiwan.

METHODS

Data from the Taiwan Longitudinal Study of Aging collected in 2015 were analyzed and involved 4588 participants aged ≥65 years. The outcome variable was a self-reported loneliness question, and independent variables included demographic characteristics, a self-reported health status, physical function, number of comorbidities, cognitive function, and social support. A multivariate logistic regression was used to identify predictors of loneliness.

RESULTS

The prevalence of loneliness among older adults in Taiwan was 10.5%. The multivariate logistic regression showed that old persons who were male, lived alone, perceived that they had a poor health condition, had no spouse, had no job, and had poor emotional support had higher likelihood of feeling lonely.

CONCLUSIONS

This study investigated loneliness in a nationally representative sample of older adults and revealed that one-tenth of this older population might experience loneliness which requires immediate action. Special attention should be given to the aforesaid factors in older adults to identify problems and provide interventions as early as possible in order to prevent loneliness and thus reduce the resultant negative effects on physical and mental conditions. Appropriate interventions should be developed to prevent or ameliorate feelings of loneliness among older populations using rigorous research designs such as randomized controlled trials.

The effects of an immersive 3d interactive video program on improving student nurses' nursing skill competence: A randomized controlled trial study

BACKGROUND AND OBJECTIVE

Acquired accurate clinical nursing skills are among the most important core nursing competencies for nursing students, as nursing students' inadequate skill capacities might endanger patients safety. Therefore, it is essential to develop teaching strategies to strengthen students' nursing skills. This study examined the effects of an immersive three-dimensional (3D) interactive video program on improving nursing students' nasogastric tube feeding skill competence.

DESIGN

A randomized controlled trial research design.

SETTINGS AND PARTICIPANTS

Forty-five nursing students from a university in northern Taiwan.

METHODS

The students were randomly assigned to an intervention group (n = 22) and a comparison group (n = 23). The intervention group received the immersive 3D interactive video program on nasogastric tube feeding, whereas the comparison group watched a regular demonstration video. The questionnaire was used to collect data before the intervention, immediately after the intervention, and one month after the intervention.

RESULTS

Nursing students' knowledge and confidence in nasogastric tube feeding were significantly improved after the intervention in both groups. Although there were no significant differences in students' knowledge, skill, and confidence between the two groups, participants' average satisfaction score with the immersive 3D interactive video program in the intervention group was significantly higher than in the comparison group that watched a regular video (t = 2.302, p = 0.026).

CONCLUSIONS

The findings of this study showed that both immersive 3D interactive video program and regular demonstration video could improve nursing students' learning outcomes. The higher satisfaction score in the intervention group indicates that learning through immersive 3D interactive video is acceptable and satisfactory. This study provides useful information for nursing faculty members for designing and developing teaching methods for the acquisition of nursing skills. It can also serve as a reference for further studies relating to AR, VR, or immersive learning materials.

Psychometric properties of the Internalized Stigma of Mental Illness (ISMI) Scale in Indonesia

Objective: The Internalized Stigma of Mental Illness (ISMI) scale is widely used to examine internalized stigma among people with mental illness. However, an Indonesian version does not yet exist. We developed an Indonesian translation of the ISMI scale and assessed its psychometric properties. Method: We included 280 inpatients with mental illness diagnoses in 2 hospitals and a rehabilitation center. We followed the guidelines proposed by Sousa and Rojjanasrirat (2011) to translate the questionnaire. The reliability was evaluated by measuring the internal consistency (Cronbach's alpha) and test-retest reliability. Test validity was measured through exploratory factor analysis (EFA) to examine the structure of the scale and confirmatory factor analysis (CFA) to determine the model fits. Results: The EFA yielded 5 factors with Cronbach's alpha coefficients of .96 for the total scale and .95, .95, .93, .94, and .82 for the 5 subscales. The test-retest reliability indicated excellent results, demonstrated by the interclass correlation coefficient ranging between .76 and .92 for all ISMI scale items. The Kaiser-Meyer-Olkin test statistic was 0.95, and Bartlett's test of sphericity value was significant. Conclusions and Implications for Practice: The CFA indicated that the ISMI scale has an acceptable model fit. The Indonesian version of the ISMI scale demonstrated good psychometric properties for measuring internalized stigma of psychiatric patients in Indonesia. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

154 Enhancing Communication Between Foundation Doctors and Radiologists

Introduction

Facilitating radiological imaging for patients is an essential task for all Foundation Year (FY) doctors. Achieving competence in this task can expedite patient management. We evaluated the confidence and skills of FYs in facilitating radiological imaging before and after introduction of formal training.

Method

Surgical FYs working at a teaching hospital were surveyed to evaluate their baseline level of competence in booking and discussing imaging with radiology colleagues. Parameters were measured on a Likert scale, including confidence in discussing requests and satisfaction of their own performance following discussions. Eight radiology consultants were surveyed to evaluate their opinions on FYs’ communication and established areas for improvement. A teaching session was then delivered to improve communication skills. Furthermore, PACCSS poster was introduced to remind the FYs of the salient information required when discussing imaging.

Results

One month after the intervention, the participants were re-surveyed. This demonstrated a statistically significant improvement in self-reported confidence from 5.3/10 to 7.3/10 (p &lt; 0.001), and in satisfaction of own performance from 5.4/10 to 7.0/10 (p &lt; 0.001).

Conclusions

We identified deficiencies in surgical FY doctors’ confidence and skills in facilitating radiological imaging. There was a demonstrable benefit with focused training. Inter-specialty communication should be introduced into under- and post-graduate educational curriculum.

Effectiveness of a self-management program in enhancing quality of life, self-care, and self-efficacy in patients with hemodialysis: A quasi-experimental design

BACKGROUND

Taiwan has the world's highest prevalence of end-stage kidney disease, as well as the world's third highest incidence. The study investigated the effectiveness of a self-management program for enhancing health-related quality of life, self-care behaviors, and self-efficacy in patients with end-stage kidney disease undergoing hemodialysis.

METHODS

This was a quasi-experimental design with convenient sampling, and allocated 32 participants in the control group (conventional program) and 32 participants in the experimental group (self-management program). The self-management program intervention lasted 4 weeks, and a posttest was administered 3 months later. The questionnaire included the 36-Item Short Form Health Survey, a Chronic Kidney Disease Self-Care Instrument, and a Chronic Kidney Disease Self-Efficacy Instrument.

RESULTS

Three months after the intervention, the self-management program had improved patients' health-related quality of life in the mental health components (p < .001), but not in the physical health components. The program also promoted patients' self-care behaviors (p < .001) and self-efficacy (p < .05).

CONCLUSIONS

This study's findings confirmed that self-management programs should be promoted in clinical practice where they will provide clinical care personnel with an alternative to conventional health education.

A qualitative exploration of the experiences of doctors, nurses and pharmacists regarding medication management in outpatient setting

AIM

To understand how the medications are managed by the multidisciplinary team and their suggestions for nursing management, and to develop a framework for safe medication management in hospital-based outpatient.

BACKGROUND

More than 80% of hospital-based outpatient visits involve medication prescriptions, indicating the importance of safe medication management there.

METHODS

This was a qualitative study with face-to-face interviews with physicians, nurses and pharmacists from 11 medical outpatient units.

RESULTS

Four themes elicited were categorized as follows: unclear professional roles and functions in outpatient medication management; intertwined communications; moving from data to wisdom; and ambiguous culture of safety. The resulting model is a collaboration of physicians, nurses, pharmacists, and patients and families integrated with hospital administrative support and information technology in a culture of safety.

CONCLUSIONS

Medication management in outpatient is critical but usually overlooked. Nursing leaders should develop a culture of safety and provide more support and training for nurses to provide comprehensive medication management for outpatients.

IMPLICATIONS FOR NURSING MANAGEMENT

It is important to develop outpatient nurses' role and competence in managing patient medication safety. Nurses in management would benefit from applying the 'framework of efficient and safe medication management for outpatients' to assess and identify weak areas for improvement.

Nurses' Late-Life Depression Knowledge and Attitudes Toward Depression: A Cross-Sectional Study

Depression in older population is more common now. Due to increasing numbers of older patients in hospitals, nurses have more opportunities to care for these patients. Therefore, nurses should have correct knowledge of late-life depression and more favorable attitudes about depression. The study aimed to understand hospital nurses' knowledge level of late-life depression and attitudes about depression. A cross-sectional research design was used. A convenience sample of 307 nurses from 3 hospitals in Taiwan was recruited. Nurses scored 55.15% in the Late-Life Depression Quiz. The average score of the Revised Depression Attitude Questionnaire was 71.76 (SD = 6.13). The study also found that hospital nurses had more favorable attitudes about depression when their late-life depression knowledge was higher; their interest level in providing care for older patients with depression was greater; they had ever taken care of older patients with depressive symptoms or depression; they had never received in-service training on depression in the past year; and they had ever attended lectures about depression in school. Hospital nurses' knowledge about late-life depression was limited, and they had neutral to slightly favorable attitudes about depression in Taiwan. It is suggested to carefully examine and evaluate in-service training related to depression for nurses in hospitals. In addition, developing appropriate interventions to increase hospital nurses' knowledge level of late-life depression and attitudes toward depression is recommended.

[Kahoot: Applications and Effects in Education]

Stimulating learning motivation and enhancing learning effectiveness are particularly difficult challenges for nursing educators in educating Generation Z learners, who are part of the first generation of true "digital natives". In response, teachers are beginning to integrate gamification techniques into their classrooms in order to motivate classroom participation and to conduct learning evaluation. Kahoot is a free, online quiz platform and instant feedback system that helps teachers create a fun competitive-gaming environment. Learners may access the platform using a mobile phone or tablet to answer multiple-choice questions. The platform may be introduced at different stages of learning activities or combined with the flipped classroom model in order to achieve various teaching goals. This article provides a brief introduction of the gamification of learning and then discusses the operational skills needed to use Kahoot and the effectiveness of this platform, including advantages, limitations, and user feedback. Finally, the authors share their Kahoot-related teaching designs and experiences. It is suggested that nurse educators may apply Kahoot in their innovative teaching practices.

Nurses' perceptions regarding providing psychological care for older residents in long-term care facilities: A qualitative study

AIMS AND OBJECTIVES

To explore nurses' perceptions regarding providing psychological health care for older residents in long-term care facilities (LTCFs).

BACKGROUND

Loneliness and depressive symptoms are commonly observed among older residents living in LTCFs. Nurses are expected to provide holistic care including physical, psychological and social care for older residents in LTCFs to fulfil their needs. Therefore, understanding nurses' feelings and thoughts regarding providing care for older residents who feel lonely, sad, unhappy or depressed is important for delivering better care.

DESIGN

A qualitative research design was employed. The Standards for Reporting Qualitative Research (SRQR) was used to enhance for reporting quality.

METHODS

Purposive sampling and snowball sampling were applied in Northern Taiwan. One-to-one in-depth interviews were conducted using a semi-structured interview guide. Twenty-one nurses with a mean age of 38.4 years were interviewed. Content analysis was performed for data analysis.

FINDINGS

Four themes were generated from the data: "insufficient psychological healthcare competency," "having a willing heart but not adequate support," "families playing an essential role in residents' mood" and "physical-oriented care model."

CONCLUSIONS

Long-term care facilitie nurses felt that they were not adequately prepared for taking care of older adults' psychological problems before their nursing career or during their practice. Unreasonable nurse-to-resident ratios and an absence of care consensus among healthcare providers can make nurses feel that they have a willing heart but not adequate support. Family members are essential in older residents' emotional status within the Taiwanese cultural context. Physical care evaluation indicators emphasised by LTCF accreditation resulted in the current care practice model.

IMPLICATIONS FOR PRACTICE

This study provides valuable information for LTCF nurses, managers and directors to develop appropriate strategies to assist nurses in providing better psychological health care for older residents. Evaluation indicators required by LTCF accreditation in Taiwan must be re-examined at the earliest stage.

[Introduction to Games for People With Dementia]

Dementia is typically classified into mild, moderate, and severe stages based on symptom severity. Prevention and early diagnosis is one of the care goals for dementia. Mild cognitive impairment (MCI) is a transitional stage between the cognitive changes of normal aging and dementia. Initiating an appropriate treatment regimen and methods at a sufficiently early stage has been shown to be effective in postponing the onset of dementia. Previous studies have confirmed the effectiveness of non-pharmacological treatments in improving the cognitive functions, reducing the onset of the behavioral and psychological symptoms of dementia, and training the physical functions of daily living in patients diagnosed with MCI. Game therapy, in addition to reminiscence therapy, music therapy, cognitive training, cognitive stimulation, and aromatherapy, is one of these non-pharmacological treatments. Moreover, game therapy may be used as a tool to screen individuals for symptoms of dementia. Using easily accessible, user-friendly, and affordable games, patients with dementia and their caregivers may receive their therapy in a more relaxed and enjoyable manner. Patients and their caregivers who perceive a prescribed therapy as a game are expected to exhibit higher motivation to use, which should result in better treatment outcomes. This paper will introduce and compare several games for people with dementia, providing valuable information for caregivers and healthcare professionals who are responsible for caring for patients with dementia.

Nurses' confidence in providing and managing care for older persons with depressive symptoms or depression in long-term care facilities: A national survey

The prevalence of depressive symptoms among older residents in long-term care facilities (LTCFs) is high. Nurses are the main healthcare providers in LTCFs and also the persons responsible for detecting changes in residents' mental function and providing subsequent care. Therefore, it is necessary to understand nurses' knowledge, attitudes, and confidence regarding care for older residents with depressive symptoms or depression. This study aimed to understand nurses' level of knowledge of late-life depression, attitudes towards depression, and confidence levels in caring for older adults with depressive symptoms or depression in LTCFs. A cross-sectional descriptive and correlational research design was used. A nationwide self-report survey was conducted in 2016. Ultimately, 556 valid questionnaires were returned. The study found that LTCF nurses' knowledge about late-life depression was poor, and they also lacked confidence in managing and caring for older persons with depressive symptoms or depression, but nurses' attitudes towards depression were neutral or slightly positive. Moreover, nurses who had greater confidence in providing care for older persons with depression were those with more positive attitudes towards depression, a greater interest level in taking care of older adults with depression, less late-life depression knowledge, longer nursing experience in LTCFs, and a greater interest level in late-life depression issues, and who had read late-life depression pamphlets or taken courses or classes in late-life depression. The findings suggest an urgent need to develop strategies to improve nurses' late-life depression knowledge and increase their confidence in providing care to older residents with depressive symptoms or depression.

Effects of a skill demonstration video delivered by smartphone on facilitating nursing students' skill competencies and self-confidence: A randomized controlled trial study

BACKGROUND

The correct and appropriate performance of nursing skills by students can ensure patient safety and care quality. However, developing appropriate teaching and learning strategies to enhance nursing students' nursing skills and knowledge are challenging tasks for nursing faculty members. Nowadays, smartphones are popular mobile devices that are used on campuses by students and could be considered a potential tool to deliver learning materials to nursing students.

OBJECTIVES

This study aimed to examine the effects of a skill demonstration video delivered by smartphone on facilitating nursing students' nursing skill competency and confidence.

DESIGN

A randomized controlled trial study design was used.

SETTINGS AND PARTICIPANTS

A convenience sample of nursing students at a university was recruited.

METHODS

After receiving a regular nursing skills lab demonstration, pre-test data were collected from nursing students in an intervention group (n = 44) and a comparison group (n = 43). Then, students in the intervention group downloaded the skill demonstration video onto their smartphones, while the comparison group did not. Post-test data were collected at 2 weeks after the intervention.

RESULTS

There were significant differences in students' urinary catheterization knowledge (F = 4.219, p = 0.04) and skills (F = 6.739, p = 0.013), but there was no difference in students' confidence level (F = 2.201, p = 0.142) between the two groups after the intervention. Furthermore, the average score of the satisfaction level regarding the intervention was 4.46 (SD = 0.43) on a scale of 1-5.

CONCLUSIONS

This study found that delivering learning materials through smartphones to nursing students is suitable. Although there was no significant difference in students' self-confidence level, students' knowledge and skills were improved by the intervention. Smartphones can serve as a supplemental tool for learning nursing skills.

Prevalence of depressive symptoms in older nursing home residents with intact cognitive function in Taiwan

The investigators aimed to explore the prevalence of depressive symptoms and associated factors among older residents with intact cognitive function in nursing homes in Taiwan. A cross-sectional descriptive and correlational research design was used. A convenience sample of 178 older residents without cognitive impairment was recruited from 36 nursing homes in Southern Taiwan. The questionnaires included demographic data; the Barthel Index, which assesses the ability to perform activities of daily living; and the Geriatric Depression Scale Short Form. Among older residents in nursing homes with intact cognitive function, 39.3% had depressive symptoms. Age, religion, previous living status, previous working status, being totally dependent in physical function, and being severely dependent in physical function were significant predictors of depressive symptoms among cognitively intact older residents. The findings highlight the critical mental healthcare issues among older residents with intact cognitive function in nursing homes. Practical strategies for preventing the occurrence of depressive symptoms and caring for those who have depressive symptoms should be developed, especially for younger or dependent older residents or residents who have never been employed, have no religious beliefs, or have lived alone before they moved into an institution.

Palliative care for advanced dementia: Knowledge and attitudes of long-term care staff

AIMS AND OBJECTIVES

To investigate the knowledge of and attitudes towards palliative care for advanced dementia and their associations with demographics among nursing staff, including nurses and nursing assistants, in long-term care settings.

BACKGROUND

Nursing facilities are places where persons with dementia die; therefore, providing quality end-of-life care to residents with advanced dementia is crucial. To date, little attention has been paid to palliative care practice for patients with advanced dementia.

DESIGN

A descriptive, cross-sectional, survey design was used.

METHODS

In total, a sample of 300 nurses (n = 125) and nursing assistants (n = 175) working in long-term care settings in Taiwan participated in this study. Two instruments were administered: demographic characteristics and responses to the Questionnaire of Palliative Care for Advanced Dementia. Descriptive statistics and multiple regression were used for data analysis.

RESULTS

Overall, the nurses and nursing assistants had moderate mean scores for both knowledge of and attitudes regarding palliative care for advanced dementia. Additionally, nursing staff who were nurses with greater work experience and those who had received palliative care and hospice training had greater knowledge of palliative care. In addition, nursing staff who had received dementia care training and who had worked in nursing homes had higher levels of positive attitudes towards palliative care.

CONCLUSIONS

This study indicates the need to provide nurses and nursing assistants with more information about palliative care practice for people with advanced dementia. Particularly, providing education to those who are nursing assistants, who have less working experience, who have not received palliative and dementia care training, and who have not worked in nursing homes can improve overall nursing staff knowledge of and attitudes towards palliative care.

RELEVANCE TO CLINICAL PRACTICE

Continuing education in principles of palliative care for advanced dementia is necessary for currently practicing nursing staff and should be developed according to their educational background and needs.

The care needs of postpartum women taking their first time of doing the month: a qualitative study

BACKGROUND

In contemporary Taiwan, after giving birth, many women undertake a traditional postpartum practice called 'doing the month', which occurs in the medical context of postpartum nursing centres instead of at home. Thus, healthcare workers must identify and address the care needs of new mothers in this setting to improve the care of new mothers and their baby and family.

AIM

To explore new mothers' care needs from their own perspectives during the period of doing the month.

METHODS

A qualitative study was performed. Eligible participants recruited through purposive sampling were interviewed comprehensively.

RESULTS

Twenty-seven primiparous women participated (mean age: 32 years; mean marriage length: 3.4 years). Four themes were identified: the need to increase energy to gain more yang force, the need to internalise mothering, the need to be supported by the family and friends, and the need to be understood.

CONCLUSIONS

For effective care, sufficient support and guidance must be provided to first-time mothers and their families, especially when mother-baby rooming-in is the standard of care.

Effects of Messages Delivered by Mobile Phone on Increasing Compliance With Shoulder Exercises Among Patients With a Frozen Shoulder

PURPOSE

The aim of this study was to examine the effects of reminders, encouragement, and educational messages delivered by mobile phone on shoulder exercise compliance and improvements in shoulder function among patients with a frozen shoulder.

DESIGN AND METHODS

A randomized controlled trial design was used. A convenience sample of patients with a frozen shoulder in an orthopedic outpatient clinic was recruited. All participants were instructed on how to do shoulder exercises and were provided with a printed pamphlet about shoulder exercises. Then, the intervention group received reminders, encouragement, and educational messages by mobile phone daily for the next 2 weeks, while the comparison group did not.

FINDINGS

The intervention group had higher compliance with shoulder exercises than did the comparison group (t = 2.263, p = .03) and had significant improvements in shoulder forward flexion (F = 12.067, p = .001), external rotation (F = 13.61, p = .001), and internal rotation (F = 5.903, p = .018) compared to those in the comparison group after the 2-week intervention.

CONCLUSIONS

The text messages significantly increased patient compliance with shoulder exercises and thus improved patients' shoulder range of motion.

CLINICAL RELEVANCE

Hospital or clinics can send appropriate messages to patients via text message platforms in order to remind and encourage them to do shoulder exercises.

A multi-perspective focus-group approach to revise items in a dietary self-efficacy scale for older Taiwanese adults

AIM

To revise items in the Cardiac Diet Self-Efficacy Scale, Chinese version (CDSE-C) using focus groups.

BACKGROUND

There is limited literature on using focus groups with older adults as well as nursing and nutrition professionals to revise a questionnaire.

METHODS

A qualitative research with multi-perspective focus-group approach was used from February through June 2009. Four serial focus groups were conducted including two focus groups of older adults from Taipei County (n = 6) and Yilan County (n = 6), one group of 5 nursing professionals, and one group of 4 nutritionists.

RESULTS

Serial focus group discussions added one category to the CDSE-C (reducing salt) and 3 items, resulting in an 18-item scale with six categories: healthy eating behaviors, reducing fat and cholesterol, resisting relapse, increasing fiber and vegetable, reducing sugar, and reducing salt.

CONCLUSIONS

This revised measure can serve as a reliable tool for assessing older Chinese adults' healthy eating self-efficacy to evaluate and improve nutritional status in this population.

Nutritional status and its health-related factors among older adults in rural and urban areas

AIM

To compare health-related characteristics, nutrition-related factors and nutritional status of older adults living in rural and urban counties of Taiwan.

BACKGROUND

The older adult population of Taiwan is increasing. Furthermore, older people living in rural areas have shorter life expectancy and more chronic diseases than their urban counterparts. However, little is known about the health-related characteristics, nutrition-related factors and nutritional status of older adults living in rural and urban areas of Taiwan, limiting nurses' ability to identify and care for older adults at risk of poor nutritional health.

DESIGN

Cross-sectional, comparative.

METHODS

Older adults were randomly selected from names of residents of an adjacent rural and urban area of northern Taiwan and having completing the 2009 health evaluation. From March-July 2010, older adult participants (N = 366) provided data on demographic and health-related information, nutritional self-efficacy, health locus of control and nutritional status. Data were analysed by descriptive statistics and compared using chi-square and t-test.

RESULTS

Older rural participants had significantly lower educational level, less adequate income, higher medication use, lower scores on self-rated health status and researcher-rated health status and lower self-rated healthy eating status than their urban counterparts. Moreover, rural participants had significantly lower nutritional self-efficacy, higher chance health locus of control and poorer nutritional status than their urban counterparts.

CONCLUSIONS

Our results suggest that nurses should assess older adults living in rural areas for nutritional health and nutrition knowledge. Based on this assessment, nurses should develop easy, practical and accessible nutritional programmes for this population.

Self-efficacy, professional commitment, and job satisfaction of diabetic medical care personnel

The purpose of this study was to investigate the relationships among the self-efficacy, professional commitment, and job satisfaction of diabetic health-care personnel. The research design was cross-sectional. Three teaching hospitals, one from each of northern, middle and southern parts of Taiwan, were selected for data collection and used questionnaires to collect data; 202 participants were recruited. The demographic data for job title and job satisfaction were not significantly different (F = 2.13, P = 0.090). Self-efficacy was significantly positively correlated with professional commitment (r = 0.29, P = 0.000) and with job satisfaction (r = 0.14, P = 0.041). A total of 34.1% of the variance in job satisfaction was explained by age, years of service in the medical or nursing field, the actual number of years caring for patients with diabetes, self-efficacy, and professional commitment. Understanding the self-efficacy and professional commitment of medical and nursing personnel can help increase job satisfaction and improve the quality of medical and nursing care.

Hand hygiene compliance among the nursing staff in freestanding nursing homes in Taiwan: a preliminary study

This study aimed to explore the hand hygiene compliance among the nursing staff in Taiwanese freestanding nursing homes. A descriptive observational research design was used. A total of 782 opportunities for hand hygiene were observed by one trained research assistant in two freestanding nursing homes. The hand-hygiene observation tool was used to assess hand hygiene practice. The overall hand hygiene compliance among nursing staff in nursing homes was only 11.3%. Results further showed that the compliance was greater after contact with body fluids (odds ratio = 6.9, confidence interval (CI) = 3.75-9.88, P = 0.000) and lower before the performance of aseptic procedures (odds ratio = 0.15, CI = 0.04-0.63, P = 0.003) when compared with other activities. Hand hygiene compliance was relatively low among the nursing staff in freestanding nursing homes in Taiwan. To comprehensively analyze this issue, further research involving a larger number of nursing homes and strategies to improve compliance with hand hygiene among the nursing staff at these institutions is needed.

[Preliminarily application of content analysis to qualitative nursing data]

Content analysis is a methodology for objectively and systematically studying the content of communication in various formats. Content analysis in nursing research and nursing education is called qualitative content analysis. Qualitative content analysis is frequently applied to nursing research, as it allows researchers to determine categories inductively and deductively. This article examines qualitative content analysis in nursing research from theoretical and practical perspectives. We first describe how content analysis concepts such as unit of analysis, meaning unit, code, category, and theme are used. Next, we describe the basic steps involved in using content analysis, including data preparation, data familiarization, analysis unit identification, creating tentative coding categories, category refinement, and establishing category integrity. Finally, this paper introduces the concept of content analysis rigor, including dependability, confirmability, credibility, and transferability. This article elucidates the content analysis method in order to help professionals conduct systematic research that generates data that are informative and useful in practical application.

Glycogen synthase kinase-3β regulates anti-inflammatory property of fluoxetine

A selective serotonin reuptake inhibitor fluoxetine not only is widely used in the treatment of depression but also has an anti-inflammatory property. Glycogen synthase kinase-3beta (GSK-3β) is a vital factor in the inflammation process. How fluoxetine interferes with inflammation via a GSK-3β-dependent pathway remains unclear. The aim of this study is to investigate the effects of fluoxetine on lipopolysaccharide (LPS)-induced inflammation. Results showed that fluoxetine decreased mortality rate of the mice. It also inhibited LPS-induced release of nitric oxide (NO) and prostaglandin E2 (PGE2) in serum and RAW264.7 murine macrophages and expressions of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2). Upon LPS stimulation, fluoxetine caused a delay but increased in the phosphorylated levels of GSK-3β (ser9), whereas it did not affect LPS-induced activation of mitogen-activated protein kinase (MAPK) and generation of reactive oxygen species (ROS). Fluoxetine in combination with phosphatidylinositol 3-kinases/Akt inhibitors (LY294002 and Wortmannin) did not have a synergistic inhibition on LPS-induced NO release and PGE2 production. In addition, peroxisome proliferator-activated receptor γ (PPARγ) antagonist GW9622 showed no reverse effects of this inhibition of fluoxetine. GSK-3β knockdown blocked the inhibitory effects of fluoxetine on LPS-induced iNOS/NO release and COX-2/PGE2 production. These results indicated that GSK-3β regulated anti-inflammatory property of fluoxetine. However, Akt activation, ROS generation, and altered PPARγ activity were not involved in this inhibition of fluoxetine.

Amphotericin B up-regulates angiogenic genes in hepatocellular carcinoma cell lines

BACKGROUND

Amphotericin B (AmB) has a discordant influence on epirubicin (4'-epidoxorubicin) cytotoxicity in hepatocellular carcinoma (HCC). This indicates that the cellular function of HCC may be significantly influenced by AmB. Whether the influence of AmB on HCC has any possibility to influence cancer growth has not been studied. This study was to try and clarify this issue.

MATERIALS AND METHODS

Two HCC cell lines including one without augmentation of the epirubicin cytotoxicity by AmB (cell line A; HCC24/KMUH) and one with this effect (cell line B; HCC38/KMUH) were studied by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and whole human genome microarray (experimental group: 2.5 microg mL(-1) AmB).

RESULTS

Differential expressions of genes induced by AmB in two cell lines had no influence on cell proliferation as determined by MTT assay. Only cell line B showed up-regulation of genes related to oxidative stress, acute phase reaction, cytokine-cytokine receptor interaction and complement and coagulation cascades. Among the chemokine genes up-regulated by AmB, five genes (CCL2, CXCL1, CXCL5, CXCL6, IL8) were angiogenic. Cell line B also showed up-regulation of one angiogenic C10orf10 gene and down-regulation of one angiostatic chemokine gene (CXCL10). Up- or down-regulation of other genes in cell line A and B did not show any evidence to promote angiogenesis.

CONCLUSION

AmB has the capacity to concomitantly up-regulate angiogenic genes in HCC cells susceptible to AmB-induced oxidative stress.

Nurses' feelings and thoughts about using physical restraints on hospitalized older patients

AIM

To explore nurses' feelings and thoughts about physically restraining older hospitalized patients.

BACKGROUND

The use of physical restraints is still highly prevalent in hospitals; furthermore, older patients are most likely to be so restrained. Studies in acute care settings have focused mainly on nurses' knowledge, attitudes, or practice concerning physical restraints, on physical restraint reduction programmes, on nurses' perceptions about the use of physical restraints, or on elderly patients' experiences with physical restraints. To the best of our knowledge no studies have been conducted on hospital nurses' feelings and thoughts about the use of physical restraints in Taiwan.

DESIGN AND METHODS

A qualitative approach was used to understand this phenomenon. Semi-structured interviews were carried out, from August 2002 to March 2003, with 12 nurses working in three hospitals. The interviews were audiotaped and transcribed verbatim; content analysis was used to analyse the data.

RESULTS

Nurses reported a variety of emotional responses regarding the use of physical restraints, including sadness, guilt, conflicts, retribution, absence of feelings, security, and pity for the restrained older people. Rationalization, sharing with colleagues, and compensating behaviours were ways that nurses used to manage their negative feelings.

CONCLUSIONS

Most nurses had negative feelings towards the use of physical restraints. Among these nurses there was a struggle between patients' autonomy and the practice of care. However, other nurses said they had 'no feelings' or 'feeling of security' while using physical restraints.

RELEVANCE TO CLINICAL PRACTICE

The findings of this study may contribute to filling the gaps in nursing knowledge, to improving protocols for physical restraint use in hospitals, and may also assist nurse managers to create a supportive practice environment. It is recommended that in-service training programmes should cover misconceptions regarding physical restraint use, ethical issues and how to cope with feelings while using physical restraints.