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Background: The aging population in Taiwan has resulted in an increase in the dependent population and the care load on caregivers. Shared care is an interpersonal process in which support is "traded" to "handle" chronic illnesses by home-care patients and family caregivers. The scale of shared care has received little attention in the Taiwanese cultural context. Thus, this study examined the reliability and validity of the Taiwanese versions of Shared Care Instrument-Revised (SCI-R)., Methods: The content validity, construct validity, and discriminant validity were used to test the validity of the translated questionnaires. The Cronbach's α was used to examine reliability. A total of 500 older adults and their caregivers were recruited from three counties in Taiwan., Results: The reliability and validity of the Chinese version of the scale were within the acceptable range. The Cronbach's α was between 0.838 and 0.95. However, the scale's reliability was higher than that of the original version. This might be because of the inclusion of participants with less severe diseases than the participants in the original study, high social expectations in the Chinese traditional culture, and a large number of similar items. Future research should simplify the items and consider adopting diverse participant selection criteria., Conclusions: The results of this study can be used to understand shared care in Taiwan., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: To explore the relationship between walking activity and sleep quality among elderly., Design: A cross-sectional, correlation study with purposive sampling was conducted on participants with a walking habit but not regular moderate-intensity exercise., Methods: Data were collected by structured questionnaires, including the Walking Activity Questionnaire and the Pittsburgh Sleep Quality Index., Findings: The total walking time per week and frequency of walking per day were significant predictors of sleep quality., Conclusions: Walking can help older community-dwelling adults improve their sleep quality., Clinical Evidence: Walking more than once per day and total walking time per week ≥210 minutes were associated with good sleep quality.

Frailty is a key predictor of readmission among older patients. However, studies on the factors associated with readmission of frail older patients are lacking. This study aims to examine factors associated with 14-day hospital readmission in frail older patients. A retrospective case-control study was conducted. Patients were eligible for inclusion if they were age 65 and over and if their Clinical Frailty Scale (CFS) score was above 4. A total of 210 frail older patients were included. Patients who had partners, experienced a fall within 6 months before hospitalization, had pressure injuries, received surgery or chemotherapy, and received rehabilitation therapy from a physical therapist during hospitalization had increased odds of being readmitted to the hospital within 14 days. Moreover, patients receiving comprehensive geriatric assessment (CGA) services during hospitalization showed a significantly reduced risk of readmission. Adapting CGA and developing continuity care plans from hospitals to the community are crucial., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Introduction: Although Muslims constitute nearly one fourth of the global population, many non-Muslims are not familiar with Islam. To address this unique need from such a specific cultural context, the present study aimed to examine the spiritual needs and influencing factors of Indonesian Muslims with cancer. Method: A cross-sectional research design with 122 cancer patients was conducted by using the Bahasa-version Spiritual Needs Questionnaire. Results: The degree of spiritual needs was generally high. Religious needs were the strongest aspect, and "praying five times a day" was the highest scoring item. Gender ( p = .04), age ( p = .01), and duration of being diagnosed with cancer ( p = .01) were associated with spiritual needs. Female gender ( p = .005) and older age ( p < .001) were predictors of spiritual needs. Discussion: As expected to provide cultural-congruent spiritual interventions, nurses could meet Muslim patients' need to pray five times a day during hospitalization, thus help them manage and endure the illness.

Aim: To examine the effects of a simplified reablement program on physical function and quality of life in hospitalized older patients., Methods: The randomized controlled trial enrolled 114 older patients aged ≥65 years who, 2 weeks before admission, had been able to walk independently. Patients randomized to the reablement group received supervision and assistance to carry out the simplified reablement program 30 min daily during their hospital stay. Patients in the reminding group received only oral encouragement to continue the reablement program for 30 min daily. The control group received only usual care that included medical intervention consistent with the patient's diagnosis. The main outcome was improvement in physical function, including the modified version of the Katz Activities of Daily Living (ADL) score, Timed Up and Go test (TUG) and Hand Grip Strength (HGS). Secondary outcomes included the EuroQoL 5 Dimension (EQ-5D) Questionnaire and Visual Analog Scale (VAS)., Results: The intervention had no significant effect on the Katz ADL score. However, a significant within-group improvement in TUG occurred in the reminding group and reablement group. In addition, a significant time-dependent improvement in HGS occurred only in the reablement group. With respect to secondary outcomes, the EQ5D score improved significantly only in the reablement group at 3 months after discharge., Conclusions: The simplified reablement program may be beneficial to optimize physical function and improve quality of life in hospitalized older patients. It is recommended that health professionals should assist or encourage older patients to do simplified reablement during their hospital stay. Geriatr Gerontol Int 2020; 20: 436-442., (© 2020 Japan Geriatrics Society.)

Background: Functional decline is a common complication in hospitalized older adults, and decline in the ability to walk is often the first change in physical functioning in this population. Decline in walking ability leads to a loss of independence in the activities of daily living in older adults after discharge from the hospital., Purpose: To explore the factors associated with the recovery of walking ability in older adults after discharge from the hospital., Methods: This study used a longitudinal research design. Potential participants were recruited from a tertiary medical center in southern Taiwan. Patients were eligible for inclusion if they were at least 65 years old and were affected by a decline in walking ability at discharge. The data collected at discharge included: demographic information, Charlson Comorbidity Index, Modified Katz Index of Independence in Activities of Daily Living (walking item), Mini Nutritional Assessment, Mini-Mental State Examination, and ambulation during hospital stay. The follow-up data collected at three months after discharge included: Modified Katz Index of Independence in Activities of Daily Living (walking item), exercise habit, rehabilitation, and social support., Results: A total of 78 older adults were enrolled as participants. Three-quarters (75.64%) of the participants had regained their ability to walk at three months after discharge. Moreover, nutritional status, cognitive function, and exercise habit were significantly associated with the recovery of walking ability. The results of multiple logistic regression analysis showed having an exercise habit to be significantly associated with the recovery of walking ability at three months after discharge (OR = 10.212, p = .004)., Conclusions / Implications for Practice: In addition to treating the acute medical issues of older patients, healthcare professionals should screen and provide them with appropriate nutritional, cognitive, and physical care plans. Moreover, emphasizing the importance of an exercise habit in nursing discharge plans is also important. This effort may help older adults recover their walking ability and maintain their independence.

Older ICU survivors are often challenged with clusters of geriatric syndromes and functional decline. The purpose of this study was (a) to assess patterns of geriatric syndromes and functional status from admission to 6 months post discharge and (b) to examine the predictors of longitudinal functional status. This is a prospective cohort study. Demographic information, clinical variables, geriatric syndromes, and functional status were collected longitudinally. A total of 192 medical ICU older adult survivors were included in the analysis. Factors associated with reductions in functional status over 6 months were (a) institutionalized prior to hospitalization, (b) pressure sore before admission, (c) existing delirium, (d) impaired mobility at baseline, (e) increased APACHE II score upon ICU admission, and (f) use of mechanical ventilation during the ICU stay. Importantly, overweight was the only factor that was associated with increased functional level over 6 months.

This study explored the gender differences in the relationship between walking activity and sleep disturbances. A cross-sectional study of 201 community-dwelling older adults with diabetes was conducted in southern Taiwan. Using the Taiwanese version of the International Physical Activity Questionnaire, self-administered short version (IPAQ-SS), information on physical activity and sleep disturbance conditions was collected. Among older female adults with diabetes, 54.2% reported sleep disturbance significantly higher than males (38.1%). Logistic regression analysis suggested that for women, in addition to the active group, older adults in the low-active, high-walking group exhibited a significantly lower rate of sleep disturbance than did those who walked less.

This study investigated the incidence, rationales, and associated factors of inappropriate urinary catheter use among hospitalized older patients by gender. A longitudinal study of 321 patients with urinary catheter was conducted. Demographic factors, present health factors, urinary catheter factors, and indications of catheter use were collected. A total of 53.7% of urinary catheter-days were inappropriate. For both men and women, there was no significant difference in the incidence and common rationales of inappropriate use. Women, however, have another associated factor with inappropriate use. More tailored alternatives are needed for women to increase comfort to avoid inappropriate catheter use.

Background: Communicating with patients, especially geriatric patients, is a challenge for medical professionals. Medical message receiving and expectations among hospitalized elderly patients have not been studied., Purpose: The aim of this study was to explore medical message receiving and expectations concerning medical information among hospitalized elderly patients in Taiwan., Methods: A descriptive study design was used. Convenience sampling was applied, and the research was conducted in a geriatric ward in a medical center in southern Taiwan. Patients were recruited who were 65 years or older and capable of verbal communication. Data were collected using a self-developed semistructured questionnaire. For each participant, data were collected in one regular ward round. The messages of the physician were recorded. During the first and fourth hours after the ward round, the researcher collected the medical messages that were conveyed by the physician in the ward round and that could be repeated by the patients. Open-ended questions were used to collect data about patient expectations of medical messages during the first hour after the ward round. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using content analysis., Results: Thirty patients participated in this study. All of the participants remembered the visit of the physician. Seventeen participants (56.6%), however, could not repeat the messages, and the total message repetition rate was 17.8% at the first hour after the ward round. By the fourth hour, the message repetition rate fell to 8.9%. Furthermore, three participants (10%) reported messages incorrectly. Participants reported the importance and necessity of physicians conveying medical messages. "Desire to know the reasons for discomfort" and "discharge date" were the messages most expected by the participants., Conclusions: This study suggests that most hospitalized elderly patients cannot repeat medical messages that are conveyed by their physicians. Written materials and the involvement of principal caregivers in the medical informing process may be necessary. Besides, before providing medical information, medical professionals should be cognizant of the key concerns of their patients.

This cross-sectional study was conducted to examine 256 Muslim nurses' perception of spirituality and spiritual care in Indonesia. The Spirituality and Spiritual Care Rating Scale (SSCRS) was translated and culturally adapted. Moderately high degrees in five domains and total SSCRS were found. Specialty, education level, clinical seniority, having spiritual training, and previous spiritual caring experience could impact on the SSCRS. Most nurses have cared for patients with spiritual needs, but denied having any formal training in providing spiritual care. Providing adequate curriculum and on-job training to equip nurses' knowledge and competence of spiritual care is urgent in Muslim healthcare environment.

Objectives: To investigate incidence, rationales, related factors and outcomes for changing from appropriate catheter placement to inappropriate use among hospitalized older patients in the emergency department., Methods: A secondary analysis was adopted from a longitudinal study that was designed to follow the lifecycle of the urinary catheter among hospitalized older patients. Patients aged 65 and older with a urinary catheter that had been placed in the emergency department were included. Demographic factors, present health conditions, conditional factors of catheter placement, and rationales for daily urinary catheter use were collected from the original data. Inappropriate urinary catheter days were evaluated as an outcome., Results: Appropriate urinary catheters were placed in the emergency department in 117 of the 156 patients (75%). Of these patients, 77 patients (65.8%) experienced a change from appropriate placement to inappropriate use, with a mean duration of 2.88±1.56 days. The common rationales were post-operation for hip fracture (36.3%) and no longer needing to monitor urine output (27.2%). A hierarchical regression model shows that a change from appropriate catheter placement to inappropriate use was associated with a diagnosis of urinary tract infection (OR = 0.15; 95% CI = 0.03-0.77; p = 0.02) and no record of the indication for catheter placement (OR = 4.76; 95% CI = 1.20-18.90; p = 0.02), and all variables together explained 35.9% of the variance. In addition, a change from appropriate placement to inappropriate use was further associated with prolonging inappropriate catheter-days (β = 5.34; 95% CI: 3.72-6.97; p <0.001)., Conclusions: The study highlights a considerable percentage of change from appropriate placement to inappropriate use. Efforts to construct reminder intervention, to improve the record of catheter placement and continued attention to catheter use are necessary to reduce inappropriate urinary catheter use.

Background: Respect for the autonomy of patients is essential in life-threatening medical decisions such as surgery. Even if a patient has the competency to make decisions, many obstacles exist that may influence his or her willingness to participate in the surgical decision-making process., Purpose: The aim of this study was to explore the perceived difficulties in surgical decision making and related factors among elective surgical patients., Methods: This was a cross-sectional correlational study. A convenience sampling method was used to recruit patients from a medical center in southern Taiwan. Patients who had received elective surgery, were older than 20 years old, and were competent to make medical decisions were invited to participate. A structured questionnaire was developed by the researchers to collect demographic data, decision patterns, and perceived difficulties in surgical decision making. Acceptable validity and reliability of the questionnaire were confirmed before data collection., Results: Over 80% of the participants made the surgical decision by themselves or in collaboration with their family or physician. Less than 15% expected to make the surgical decision by themselves. Illness-related suffering was the greatest difficulty that participants faced. The patients who tended toward passive decision making faced greater difficulties in the dimensions of "do not understand information," "physician's lack of concern," and "difficulty in freely communicating with the physician" than their active decision-making peers. Male participants reported having more difficulty in communicating with their physician than their female peers. Age, education, and marital status were not significantly associated with perceived difficulties in surgical decision making., Conclusions: Family participation in the medical decision-making process is expected by most patients. Although less than 20% of the participants in this study were categorized as passive decision makers, this group reported more difficulties than the active decision-making group. Healthcare professionals should be more active in communicating with patients who are largely silent during the decision-making process to elicit their preferences and needs with regard to surgical decisions.

Aims and Objectives: To inquire into the reasons for family involvement in adult patients' surgical decision-making processes from the point of view of the patients' family., Background: Making a patient the centre of medical decision-making is essential for respecting individual's autonomy. However, in a Chinese society, family members are often deeply involved in a patient's medical decision-making. Although family involvement has long been viewed as an aspect of the Chinese culture, empirical evidence of the reasons for family involvement in medical decision-making has been lacking., Design: A qualitative study., Method: In order to record and examine reasons for family involvement in adult patients' surgical decision-making, 12 different family members of 12 elective surgery patients were interviewed for collecting and analysing data., Results: Three major reasons for family involvement emerged from the data analyses: (1) to share responsibility; (2) to ensure the correctness of medical information; and (3) to safeguard the patient's well-being. These findings also reveal that culture is not the only reason for family involvement., Conclusions: Making decision to undergo a surgery is a tough and stressful process for a patient. Family may provide the patient with timely psychological support to assist the patient to communicate with his or her physician(s) and other medical personnel to ensure their rights. It is also found that due to the imbalanced doctor-patient power relationship, a patient may be unable, unwilling to, or even dare not, tell the whole truth about his or her illness or feelings to the medical personnel. Thus, a patient would expect his or her family to undertake such a mission during the informed consent and decision-making processes., Relevance to Clinical Practice: The results of this study may provide medical professionals with relevant insights into family involvement in adult patients' surgical decision-making., (© 2016 John Wiley & Sons Ltd.)

Nearly 90% of the older adult patients discharged from hospital with a cluster of geriatric syndromes. The patterns of geriatric syndromes in older adult ICU survivors are to be further explored. The aim of this study was to examine the risk factors and patterns of geriatric syndromes among older adult patients before admitting to ICU and throughout their hospitalization. A total of 137 older adult patients (age 76.9 ± 6.6; 52.6% male) participated in the study. The results showed significant increase in the occurrence of geriatric syndromes from T0 (upon ICU admission) to T1 (transition to inpatient care unit), with improvement at T2 (hospital discharge), but did not return to the baseline. The three most prevalent geriatric syndromes were: functional decline, urination incontinence, and defecation incontinence. Polypharmacy was associated with functioning decline. Patients with delirium were six times more likely to be re-admitted to ICU., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: We investigated the incidence and rationale for inappropriate reinsertion of urinary catheters and elucidated whether reinsertion is an independent predictor of adverse outcomes., Methods: A longitudinal study was adopted. Patients aged ≥65 years with urinary catheters placed within 24 hours of hospitalization were enrolled. Data collection, including demographic variables and health conditions, was conducted within 48 hours after admission. Patients with catheters in place were followed-up every day. If the patient had catheter reinsertion, the reinsertion information was reviewed from medical records. Adverse outcomes were collected at discharge., Results: A total of 321 patients were enrolled. Urinary catheters were reinserted in 66 patients (20.6%), with 95 reinsertions; 49.5% of catheter reinsertions were found to be inappropriate. "No evident reason for urinary catheter use" was the most common rationale for inappropriate reinsertion. Inappropriate reinsertion was found to be a significant predictor for prolonged length of hospital stay, development of catheter-associated urinary tract infections and catheter-related complications, and decline in activities of daily living., Conclusions: This study indicates a considerable percentage of inappropriate urinary catheter reinsertions in hospitalized older patients. Inappropriate reinsertion was significantly associated with worsening outcomes. Efforts to improve appropriateness of reinsertion and setting clinical policies for catheterization are necessary to reduce the high rate of inappropriate reinsertion., (Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Objective: The objective was to compare the effectiveness between a systematic assessment tool and a traditional assessment tool for discharge planning., Methods: This research adopted a two-group comparison study design, and convenience sampling was adopted to recruit patients requiring discharge-planning services at eight wards in a regional teaching hospital in Southern Taiwan. The postdischarge care requirements of two groups of patients were evaluated using a traditional assessment tool and a systematic assessment tool in different implementation periods, respectively. Sixty-eight patients were matched with similar age and with similar activity in daily living index scores to compare the effectiveness of the tools., Results: The systematic assessment tool exhibited higher assessment integrity and placement appropriateness, as well as lower rates of rehospitalization or mortality within discharge 14 days. The two groups exhibited no significant difference in inappropriate hospital days, primary decision-makers' satisfaction, and proportion of referral professionals who meet patient care requirements. However, the differences in three items of satisfaction exhibited moderate-to-large effect sizes, which may be of clinical importance., Conclusions: To meet the needs of primary decision-makers in a family, enhance their satisfaction, and provide effective discharge-planning services, clinicians should adopt the systematic assessment tool to assess the postdischarge care requirements of a patient, and the hospital should provide relevant facilities to assist in implementing all plans., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Widowhood, an unavoidable and stressful situation, has been associated with negative effects in elderly people during later life. This article reviews and summarizes the influences of widowhood on the health, daily life, and social life of elderly people. The influences of widowhood on elderly people may vary by gender, spousal relationship, and cohort background. In order to provide nursing care as early as possible, nurses must cooperate with professionals from social-welfare and / or community-support systems to identify high-risk widowed elderly. When nurses assess the influences of widowhood on elderly people, they should consider the interactions among gender, spousal relationship, and cohort background. Furthermore, nurses may apply various strategies based on the needs of elderly people to improve the health and quality of life of patients. Suggestions include providing appropriate nursing care, offering positive social support, adjusting daily-life routines, and arranging activity programs based on care-recipient interests and resources.

Background: The WHOQOL-BREF, a generic quality of life (QoL) instrument, has been widely used clinically and for research on older populations. However, its measurement equivalence/invariance (ME/I) has not been well examined for the elderly (≥ 65 years) across some different demographics., Methods: The data were derived from a cross-sectional study with a convenience sampling design in Taiwan. We enrolled 244 elderly participants: men = 143 (58.6%); educational level ≤ primary school = 121 (49.6%). The ME/I was examined using multiple group confirmatory factor analysis (MGCFA) across gender and educational level., Results: The fit indices were satisfactory for the configural models of gender and educational level (standardized root mean square residual [SRMR] = 0.0742 and 0.0770; root mean square error of approximation [RMSEA] = 0.0655 and 0.0686; comparative fit index [CFI] = 0.953). In addition, MGCFAs showed that ME/I was supported across gender (ΔSRMR = 0.001 to 0.019; ΔRMSEA = -0.003 to 0.001; ΔCFI = -0.003 to 0.000) and educational level (ΔSRMR = 0.002 to 0.006; ΔRMSEA = -0.002 to 0.004; ΔCFI = -0.007 to 0.000)., Conclusion: The WHOQOL-BREF Taiwan version is appropriate for combined use and for comparisons in older people across gender and different educational levels.

The purposes of the study were to explore the differences in perceived exercise barriers across three age groups of Taiwanese rural women (30-50, 51-70, and >70 years old) and to examine the associations between perceived exercise barriers and regular exercise behavior. A total of 227 women completed the Self-Reported Exercise Behavior and the Perceived Exercise Barrier Scale. Women older than 70 reported higher physical and psychological barriers and lower administrative barriers than did the younger group. Women who did not exercise regularly tended to have a higher perception of exercise barriers.

Aim: To investigate incidence, reasons, risk factors and outcomes for inappropriate use of urinary catheters in hospitalized elderly patients., Methods: The prospective study enrolled 321 patients aged 65 years and older with a urinary catheter placed within 24 h of hospitalization. Collected data included characteristics of patients and catheter use, reasons for urinary catheter use, mortality, length of hospital stay, time to first removal of catheter, catheter remaining in place at discharge, catheter-associated urinary tract infections and complications, change of activities of daily living, and new admission to nursing home after discharge., Results: The use of 418 urinary catheters was observed. Among these patients with a total of 1958 urinary catheter-days, 1035 (52.8%) urinary catheter-days were inappropriate in hospitalized elderly patients. Inappropriate catheter use occurred mostly in women and surgical patients, and was associated with initially inappropriate catheter use and lack of medical documentation. "Convenience of care" was the most common reason for inappropriate catheter use. Inappropriate use was a significant predictor for longer hospital stay, delayed timing of first removal of catheter, increased rate of catheterization in place at discharge, increased incidence of catheter-associated urinary tract infections and catheter-related complications, and decline in activities of daily living., Conclusions: The study highlights a considerable percentage of inappropriate use of urinary catheters and its association with adverse outcomes in hospitalized elderly patients. Efforts to improve quality of documentation by clinicians and to emphasize catheterization education for patients and caregivers are necessary to reduce the incidence of inappropriate urinary catheter use. Geriatr Gerontol Int 2015; 15: 1235-1241., (© 2014 Japan Geriatrics Society.)

Aims and Objectives: To explore the incidence, associated factors and adverse outcomes for initial inappropriate use of urinary catheters in hospitalised older patients., Background: Urinary catheters can lead to substantial complications. The related factors and adverse outcomes associated with initial inappropriate urinary catheter use among hospitalised older patients have not been studied., Design: Prospective cohort study., Methods: A total of 321 older patients admitted to the hospital in southern Taiwan having urinary catheters placed within 24 hours of admission were recruited. Demographic factors, voiding function history, health conditions and care conditions of catheter placement were collected through a review of medical records, interviewing participants or their primary caregivers. Catheter-associated urinary tract infection during hospitalisation, transfer to a nursing home, length of hospital stay and change in activities of daily living determined as outcomes. Criteria for urinary catheter placement were developed to identify inappropriate use., Results: The incidence of initial inappropriate use of urinary catheters among hospitalised Taiwanese older patients was 38·3%. The rationale most often reported for initial inappropriate use was 'convenience of care' (49·6%). Factors associated with initial inappropriate use were, chronic constipation, urinary tract infection history, medical treatment diagnosis, cognitive impairment, depressive symptoms and independence in activities of daily living and, insertion of catheter during evening and night shifts and lack of nursing documentation of the rationale for catheterisation. Patients with initial inappropriate use showed greater decline in activities of daily living function between admission and discharge., Conclusion: Older patients with greater care needs may become the victims of initial inappropriate use of urinary catheters. Inappropriate use may devastate the activities of daily living in older patients. Nurses' awareness of indications for urinary catheters may prevent inappropriate use., Relevance to Clinical Practice: A policy to strengthen nurses' awareness of the use of urinary catheters is needed in Taiwan., (© 2015 John Wiley & Sons Ltd.)

The elderly population is increasing rapidly in Taiwan. With the average life expectancy on the rise, the elderly have become major consumers of healthcare products and services. Factors that influence respect for autonomy, a core value of medical ethics, may be related to family, society, and the medical culture. Especially in patients who are already elderly, aging causes declines in physical, mental and societal capacities. Practicing a respect for patient autonomy is particularly challenging for healthcare professionals in Taiwan due the unique culture background of elderly Taiwanese patients. This article reviews and integrates the literature related to the issue of patient autonomy and elaborates on medical decision-making among elderly patients in Taiwan in the contexts of: the disadvantages faced by the elderly, the background of Chinese culture, and the current medical decision-making environment. A few suggestions are proposed to help preserve the medical-decision-making autonomy of elderly patients in Taiwan.

Background: Stroke is the third leading cause of death in Taiwan. Poststroke older adults are often admitted to long-term care facilities. The impacts of the two concurrent life events of stroke and relocation may increase the risk of depression in stroke survivors. Depression in elderly stroke survivor residents of long-term care facilities has not been studied., Purpose: This study explores the factors associated with depression in older residents with stroke living in long-term care facilities., Methods: A cross-sectional design was used. Twenty-three institutions in southern Taiwan participated in this study, including seven nursing homes, 11 intermediate-care facilities, and five domiciliary-care facilities. Purposive sampling enrolled 111 participants who met the following inclusion criteria: 65 years or older, experienced a stroke that did not cause cognitive defects, and capable of verbal communication. Data were collected using a sociodemographic data questionnaire, Barthel's Index, and the Taiwan Geriatric Depression Scale., Results: Depression was experienced by 41 of the 111 participants (36.9%). Prevalence of depression was 45.7% in nursing homes, 36.2% in intermediate-care facilities, and 22.2% in domiciliary-care facilities. Participants living in nursing homes and intermediate-care facilities and illiterate participants with low Barthel's Index scores showed more depressive symptoms., Conclusions/implications for Practice: Healthcare providers should conduct depression screening for elderly residents with stroke on admission to long-term care facilities. Regular assessment and monitoring of depressive symptoms, especially in residents with less formal education and limited physical functions, are important in nursing homes and intermediate-care facilities.

This study investigated the relationships between types of activity and quality of life (QOL) for older men and women at different ages. Based on cross-sectional data that included 220 community-dwelling elderly persons aged 65 and older in southern Taiwan, the results showed that the participation rates in many activities declined with age for both genders. Social activity and solitary leisure activity were significantly associated with QOL for old-old men, but not for young-old men. Only social activity was significantly associated with QOL for young-old women, but there was no significant association between any activity and QOL for old-old women.

Objectives: This study examines the relationship between transitions in volunteering activity and physical and psychological health outcomes among older adults in Taiwan., Method: We used 3 waves of a longitudinal survey from Taiwan (1999, 2003, and 2007) including 1,847 older adults aged 58-74. We categorized volunteer activity over time into 5 categories and used generalized estimating equations to examine the relationship between volunteer transition group membership and health outcomes., Results: Approximately, 3% of older volunteers kept volunteering and 7% stopped or started their volunteering over time. Engaging in any volunteering, including continuous volunteering, discrete volunteering, active-to-inactive volunteering, and inactive-to-active volunteering, was significantly associated with better self-rated health and higher life satisfaction when compared with the nonvolunteering group. Only those in the continuous volunteer group and those who shifted from inactive-to-active volunteering showed a positive association with better physical function and less depression, compared with the nonvolunteering group., Discussion: The results suggest that the positive relationship between volunteering and health may decline when older adults discontinue or withdraw from volunteering. More research is needed to explore the mechanism behind older people's desistance from, persistence in, and resumption of volunteer engagement.

Aims and Objectives: This study presents a discussion of the physiological and psychological efficacy of a self-regulation protocol in lowering acute exacerbation symptoms in patients with chronic obstructive pulmonary disease., Background: Patients with chronic obstructive pulmonary disease are often troubled by acute exacerbation and must learn how to prevent this., Design: A two-group, pretest-post-test experimental design was used in this study., Methods: Data were collected between January-July 2008. Sixty-four participants were randomly assigned either to an intervention (n = 33) or to a comparison (n = 31) group. Both groups were assessed on four separate occasions, namely pretest, post-test 1 (5th week), post-test 2 (9th week) and post-test 3 (13th week). The intervention group received a four-week self-regulation protocol. The comparison group received the self-regulation guidebook only. The Borg Dyspnea Scale, the Symptom Distress Scale, the Pulmonary Functional Status Scale, the chronic obstructive pulmonary disease Self-Efficacy Scale and the peak expiratory flow were used to measure differences between pretest and post-test values., Results: On the 5th, 9th and 13th weeks after the self-regulation protocol intervention, we found significantly better scores in the four scales in the intervention group compared to those in the comparison group. On the 9th and 13th weeks, there was a significantly greater peak expiratory flow in the intervention group. The intervention group also showed a lower rate of unscheduled physician visits because of acute exacerbation than the comparison group., Conclusion: The findings indicate that the self-regulation protocol developed in this study could significantly assist participants to control their individual symptoms and avoid acute exacerbation., Relevance to Clinical Practice: Healthcare professionals could apply the protocol developed in this study to assist patients to learn the strategies of self-regulation to prevent their acute exacerbation symptoms., (© 2013 Blackwell Publishing Ltd.)

The practice of respecting patients' autonomy is rooted in the healthcare professionals' empathy for patients' situations, without which appropriate supports to the patients during the informed consent process may be remarkably moderated. The purpose of this study was to explore elective surgery patients' experiences during their decision-making process. This research was conducted using a phenomenological approach, and the data analysis was guided by Colaizzi's method. A total of 17 participants were recruited from a hospital in southern Taiwan. Two major themes emerged from the analyses: (a) a voluntary yet necessary alternative--to undergo a surgery and (b) alternatives compelled by the unalterable decision--the surgery. It was concluded that unless healthcare professionals can empathize with the distressed situation of their patients who are facing elective surgery, the practice of informed consent may become merely a routine. Nurses can be the best advocates for patients and facilitators to enhance communication between patients and healthcare personnel.

Purpose: Interventions targeting multiple risk behaviors have the potential to offer greater health benefits on public health. The purpose of this study was to evaluate the effects of a Workplace Multiple Cardiovascular Disease Risks Reduction Program (WMCVDRRP) on male participants at high risk for cardiovascular disease., Methods: One group pretest-posttest design was applied in this study. No control group was assigned as this study was the first one in Taiwan conducted to promote participants' health using WMCVDRRP and thus with the nature of a pilot study. The program design was based on the collaboration between the health clinic at the corporation and a nursing school targeting six health behaviors. Of the 465 individuals who participated, data from 283 participants were included in the analysis. The change in any of six health behaviors and eight physical indicators were tested as the effect of the WMCVDRRP., Results: Nearly 40% of the participants improved their regular exercise, diet control, stress management, and medication adherence. Although the improvement in drinking behaviors did not show statistical significance, 21% of the participants changed in alcohol consumption and 21% quit smoking. Eight physical indicators including systolic and diastolic blood pressure, total cholesterol, triglyceride, body mass index, waist-hip ratio, body fat, and muscle weight improved significantly., Conclusion: Dual collaboration between the industry and nursing schools could establish a cost-effective program to improve health behaviors and health status of participants., (Copyright © 2013. Published by Elsevier B.V.)

Aims and Objectives: To delineate the trajectories of functional status over four time points and to examine predictors of functional decline (FD) in hospitalised older patients., Background: About 30-60% of the older patients develop new dependence in activities of daily living (ADL) during a hospital stay, which results in progressive disability after discharge. The functional trajectories and risk factors of FD among hospitalised older patients require identification., Design: A cohort study., Methods: The study consecutively recruited 273 patients aged 65 and older admitted to a medical centre in southern Taiwan. Functional trajectory, by ADL score, was observed at four time points: two weeks before admission, admission, discharge and three months after discharge. The ADL score two weeks before admission was used as a baseline functional status., Results: Eighty-three (30·4%) patients experienced FD at three months after discharge. Functional trajectory as shown by ADL scores indicated that all 273 patients dropped steeply at admission and that two-thirds were gradually restored three months after discharge. Logistic regression revealed that the number of falls in the past year, Instrument Activities of Daily Living (IADL) status before admission, comorbidity and ADL decline between preadmission and discharge were significant predictors of FD three months after discharge. The ADL score decline during hospitalisation was the mediator of FD three months after discharge., Conclusions: Findings indicate that the ADL function of those hospitalised older patients who reported having fallen more often in the previous year had more comorbidity, had a lower IADL score, and had more ADL score decline before admission and discharge would continue to decline after discharge., Relevance to Clinical Practice: Clinical nurses can integrate the finding of this study with Comprehensive Geriatric Assessment to tailor intervention to restore older patient's physical function during hospitalisation., (© 2013 Blackwell Publishing Ltd.)

Background: Nursing workplaces in Taiwan are unable to retain talent. An examination of this problem has revealed that the causes of this phenomenon are that nursing education fails to cultivate the skills that meet workplace requirements and that there are gap between nursing education and clinical practice., Objectives: This paper is an action research that aims is to design educational programs that can close the gap between nursing education and clinical practice in Taiwan., Design: In this action research project, 4 action cycles were used to design educational programs including concept mapping and focused discussion strategies., Settings: Participants were invited to join the research in three teaching hospitals and one university., Participants: Two groups of participants, student nurses (SN) and nursing staff personnel (NS), were sampled and invited to participate in the research., Methods: Participant observation, focus groups, and qualitative interviews were used to collect data. Qualitative data were not only profiled by content analysis, but they were also compared continuously between the two groups as well as between the 4 cycles., Results: The qualitative data collected for the 135 participants were analysed. The themes of an effective nursing program were summarized., Conclusions: Many fundamental values of traditional Chinese education have gradually faded due to the Westernization of education. In this study, we discovered that Western educational models may play a critical role in improving traditionally taught nursing education programs., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background/purpose: To explore Taiwanese caregivers' decision making experiences of accepting a percutaneous endoscopic gastrostomy tube for their family member., Methods: A phenomenological approach was used for the interview and analysis. Semi-structured, in-depth interviews were conducted with a purposive sample of 26 caregivers of patients who had percutaneous endoscopic gastrostomy tube in southern Taiwan., Results: Five themes were recognized to reflect caregivers' decision making experiences with a percutaneous endoscopic gastrostomy: awareness of suffering, awareness of options, uncertainty, opportunity, and contentment with the decision., Conclusion: Caregivers' decisions to proceed with a percutaneous endoscopic gastrostomy procedure were mediated by desires to relieve patients' suffering. To empower caregivers to make enteral feeding decisions, nurses must provide sufficient information about percutaneous gastrostomy tubes and their care, support decision making and help to identify an opportunity for gastrostomy tube placement., (Copyright © 2012. Published by Elsevier B.V.)

Aims and Objectives: This study aimed to explore patient perception of the meaning of family involvement in elective surgery decision making in Taiwan., Background: Informed consent is based on respecting patient autonomy. However in cultures where family plays a key role in medical decision making, a patient's perspective of family involvement has not been fully investigated., Design and Methods: Based on a phenomenological approach, this study conducted semistructured interviews to elicit the experiences of 10 elective surgery patients in southern Taiwan who had family present during their surgery decision making. An adapted version of Colaizzi's (1978) method was used to analyse narratives., Results: Three themes emerged from the elective surgery patients' perception of the meaning of family involvement in their surgery decision-making process: (1) Primacy of family well-being, (2) family as information broker, and (3) family as patient advocate. Patients articulated reciprocal relationships amongst family members, and they expressed overall family well-being as their ultimate concern when making their treatment decision. The essence of the elective surgery patients' perception of the meaning of family involvement in decision making was 'family as a whole'., Conclusions: Patients' concern for overall family well-being and their perspective that family plays a supportive role in transmitting information and acting as patient advocate during the decision-making process may both enhance and restrict individual patient autonomy. In cultures where family is central in decision making, appropriately involving the family in medical decisions should not be overlooked., Relevance to Clinical Practice: Understanding and acknowledging the important roles of family in medical decision making from the patients' perspective can enable health professionals to more effectively communicate with patients and their family. Then, health professionals can empower the individual who is making the medical decision based on his or her own needs., (© 2012 Blackwell Publishing Ltd.)

East Asia has historically unique concepts of health and well-being and thus is an appropriate setting for exploring the multicultural applicability of the North American Nursing Diagnosis Association's Nursing Diagnoses (NANDA ND) system. This study aimed to explore how NANDA ND affect the growth and quality of professional nursing from the perspective of Taiwanese nurses. Grounded theory was employed in this interview-based investigation of 53 Taiwan-licensed nursing professionals at various hospitals in Taiwan. Data were analyzed using constant comparative analysis until theoretical saturation was reached. The core concept, Struggling with (the NANDA ND notion that) One Size Fits All, emerged after ongoing analysis of the effects of NANDA ND on good nursing, patient welfare, and professional development. The preliminary theoretical framework developed from this study provides evidence that NANDA ND may be incompatible with the cultural beliefs of the traditional Chinese health care setting in Taiwan, which emphasize holistic harmony and balance.

Purpose: This study investigated patients' perceptions and expectations of their families' participation in the informed consent process of elective surgery., Methods: This is a survey study. Anonymous questionnaires that were mailed to potential participants included a demographic data sheet and a scale, measuring patients' perceptions of themselves and their families' participation level in the informed consent process. A convenience sample of patients who had undergone surgery and had been discharged within 4 months from a medical center in southern Taiwan (n = 1,737) were recruited., Results: One hundred and forty-five recipients replied, gaining a response rate of 10.0%, and 120 provided complete data. The mean age of the participants was 56.0 years (range 20-85, SD = 14.98), and more than half were female (54.2%). Twenty-one participants (17.5%) perceived having less family participation than their own participation in the surgery informed consent process, and 40% expected more family participation in the process. The mean scores of the self-rated participation level was significantly higher than that of the families (p < .001). Patients' expectations of family participation were significantly higher than their perceptions of family participation (p < .001). Eleven patients (9.2%) reported having more family participation than they expected. Participants received the most information about the disease during the informed consent process and the least information about alternatives to surgery. Age, gender, number of previous surgeries and admissions influenced the study participants' perceived level of participation in the informed consent process., Conclusion: This preliminary study demonstrates that patients' perceptions and expectations for family participation in the surgical informed consent process vary. Healthcare providers should be aware of patients' expectation to appropriately invite their family into the informed consent process., (Copyright © 2012. Published by Elsevier B.V.)

Aims and Objectives: This study examined health promotion behaviours of kidney transplant recipients, 1-5 years after transplant and identified the risk factors predicting non-adherence to post-transplant recommendations., Background: Non-adherence to health care recommendations and health promotion behaviours is one of the top three reasons for graft loss following kidney transplantation., Design: A cross-sectional study., Methods: Kidney transplant recipients (n=101) in southern Taiwan completed a self reported survey, the Kidney Transplant Health Promotion Behavior and Healthcare Provider Support survey., Results: Kidney transplant patients had better adherence with medication and least adherence with regular exercise health promotion behaviours. Age, post kidney transplant time, health care provider support and financial satisfaction accounted for 37·2% of the explained variance in monitoring and management for rejection and infection. Marital status, post kidney transplant time and gender accounted for 16·2% of the explained variance in infection prevention. Age was the sole predictor of exercise (odds ratio=1·08, p=0·025). Health promotion behaviours declined with time and perceived healthcare provider support decreased at the third (p=0·04) post kidney transplant year., Conclusion: In this study, young, single, males were identified as requiring specific strategies to improve post kidney transplant health promotion behaviours. The need for health promotion must be continually reinforce by healthcare providers throughout the lifespan of a kidney transplant recipient., Relevance to Clinical Practice: Understanding the changes of health behaviours of post kidney transplant recipients and their risk factors, healthcare providers can be more aware of the needs of patients in maintaining health promotion behaviours., (© 2011 Blackwell Publishing Ltd.)

Background/aims: In the recent years, there have been more and more patients with low rectal cancer who have received anal sphincter preserving surgery (ASPS). The defecation function greatly affects patient's postoperative social activity and quality of life. This study aimed to examine the effects of Kegel's exercise on postoperative anal defecation and quality of life of patients following sphincter preserving surgery., Methodology: A total of 34 patients received sphincter preserving surgery. 17 patients received instruction for Kegel's exercise postoperatively and 17 patients did not. Defecation function and quality of life were compared between the two groups by FACT-C questionnaire., Results: The response rate of FACT-C questionnaire was 64.7% (22 in 34 patients). These 22 patients were divided into two groups: exercise group (n=11) and the non-exercise group (n=11). No significant differences were found in the demographic data between the two groups. Although the defecation frequency of the exercise group was better than the non-exercise group, no statistical difference was found. The total scores of the quality of life of the exercise group were significantly higher than those in the non-exercise group (p=0.038)., Conclusions: This preliminary study found that Kegel's exercises may have a positive impact on the quality of life in patients undergoing anal sphincter preserving surgery.

Objective: To determine whether a test of minimal chair height standing (MCHS) ability is an important predictor of fall risk in community-dwelling older people living in Taiwan, and whether poor performance in this test is associated with impaired sensorimotor functioning, balance, and mobility in this group., Design: Cross-sectional study., Setting: Community based., Participants: Community-dwelling participants (N=280; mean age, 74.9y)., Interventions: Not applicable., Main Outcome Measures: The MCHS test, which measures the lowest height from which a participant can stand; the Physiological Profile Assessment (PPA); and a range of functional balance and mobility tests., Results: In the 12 months before the study, 81 participants (28.9%) experienced 1 or more falls. The fallers had significantly higher MCHS scores compared with the nonfallers: 29.7±9.0 and 25.0± 9.2cm, respectively. Fallers also had significantly higher PPA fall risk scores than nonfallers and performed significantly worse in tests of reaction time, standing and leaning balance, and alternate stepping ability. Discriminant function analysis revealed that poor performance in the MCHS and high PPA scores were both independently and significantly associated with falls. These 2 variables correctly classified 64.5% of participants into faller and nonfaller groups. Participants who reported regular squatting performed significantly better in the MCHS test, and multiple regression analysis revealed that impaired knee extension strength, poor single-leg stance ability, and reduced leaning balance were independent predictors of poor MCHS., Conclusions: In this study, MCHS was an independent risk factor for falls. It is a functional test similar to deep squatting and underpinned by strength and balance. Because the MCHS is quick to administer, it may have scope for clinical application., (Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background and Aims: The Timed up and Go Test (TUG) is recommended as a screening tool for fall risk in older people. It is assumed that this general mobility test is underpinned by physiological factors such as strength, coordination and balance. However, no studies have examined the range of physiological and psychological factors which influence performance on this test. The aim of this study was to examine the relative contributions of a range of sensorimotor, balance and psychological factors to TUG performance in a large sample of older people., Methods: 280 community-dwelling people aged 65 plus years (mean age 74.9, SD=6.4) underwent the TUG test, as well as quantitative tests of vision, peripheral sensation, strength, reaction time, balance, fear of falling, pain and vitality., Results: The time required to complete the TUG was significantly related to limitations in instrumental activities of daily living and fear of falling. Many physiological and psychological factors were significantly associated with TUG performance in univariate analyses. Stepwise multiple regression analyses identified knee strength, postural sway, reaction time, edge contrast sensitivity, MMSE score, SF12 body pain and general health scores, number of medical conditions and age as significant and independent predictors of TUG performance. Of these measures, the lower limb strength measure explained most variance in TUG times. However, other sensorimotor, balance, psychological and health measures provided important independent information. The combined set of variables explained 43.5% of the variance in TUG times (multiple r=0.65)., Conclusions: Findings indicate that, in community-dwelling older people, TUG performance is influenced by lower limb strength, balance, reaction time, vision and pain, in addition to cognitive function and health status.

Background: Resection through an anal sphincter-saving (ASS) operation may affect a low rectal cancer patient'snormal defecation function. The long and complex reconstruction process following such a procedure makes understanding the patient rehabilitation experience necessary in order to develop an effective educational strategy that addresses patient needs., Purpose: This study investigated the defecation reconstruction experience of low rectal cancer patients after ASS., Methods: Researchers used a case study method and purposive sampling. Participants were followed for a period of 6 to 8 months and interviewed between 5 and 7 times., Results: Eleven themes emerged from content analysis. Before temporary colostomy take-down: anal leakage and discomfort, dignity impairment, struggling to locate the contracting muscle, restoring anal strength. After colostomy take-down: loss of defecating control again and damage to peri-anal skin, perceived effects and insistence on persisting with training, faith in effectiveness, trying to comply, trying to restrict medication use, maintaining a hygienic self-image and dignity, promoting quality of life, and a chance to regain a normal life. CONCLUSIONS / IMPLICATIONS: Participants described the rehabilitation exercise as beneficial to controlling the defecation and expressed their intent to continue such. Participant experiences can assist stoma nurses to provide better physical and psychological care to ASS patients.

This study explores the gender differences in the relationship between social activity and quality of life (QOL). A cross-sectional survey of 220 community-dwelling elderly people was conducted in southern Taiwan. Social activity was classified into six categories. The brief version of the World Health Organization QOL (WHOQOL-BREF) was used to measure QOL. Findings revealed that the associations of six types of social activities with QOL were weaker among women than men. The regression analyses further showed that for women, only religious activity was positively related to total QOL, while for men only involvement in formal group activity was positively related to total QOL.

Orthostatic hypotension (OH) is a common health problem that affects 6% to 30% of the community-dwelling elderly. OH prevalence has been found to increase with age, influence the individual's quality of life, and be associated with increased rates of morbidity and mortality. Referencing evidence-based reports, the aim of the present article was to construct an OH management protocol for the elderly with OH. Causes of OH can be generally divided into recoverable and unrecoverable types. Recoverable types refer to OH conditions in which the patient's original health status can be restored following treatment. If such cannot be achieved, medical staffs must consider the possibility of an underlying unrecoverable factor. To treat unrecoverable OH, non-pharmacological intervention should be applied first. If such fails, then pharmacological interventions should be considered. Whether recoverable or unrecoverable, OH treatment should control acute health problems and follow general prevention principles. Nursing staffs play a crucial role in OH treatment. This proposed protocol may assist clinical nursing staffs to provide more appropriate elderly care.

Background: Dyspnea is a frequent and devastating symptom among advanced cancer patients for which improved and low-cost palliative techniques are needed., Methods: A one-group repeated measures research design investigated the efficacy of guided imagery (GI) with theta music (M) on dyspnea in advanced cancer patients. The intervention consisted of four periods: (a) pretest; (b) intervention with peaceful non-M; (c) intervention with 10 min of GI with M (GI/M), with the first and last 3 min being M only (i.e., the middle 4 min was GI/M); and (d) posttest. Dyspnea outcome was measured with the Modified Borg Scale (MBS) for self-reported evaluation of dyspneic symptoms. Physiological parameters measured were pulse oxygen saturation (SpO(2)), end-tidal CO( 2) (EtCO(2)), heart rate (HR), and respiratory rate (RR). Posttest qualitative data were obtained via interview for subjective patient experience., Results: Participants included 53 patients, 33% with lung cancer. GI/M produced a significant decrease in MBS scores; 90% of the subjects gave positive qualitative reviews of GI/M. SpO(2) did not change significantly over time. GI/M significantly increased EtCO(2), decreased RR, and decreased HR., Discussion: This study demonstrates that GI/M is a useful intervention for palliative care of patients with dyspnea. M alone was demonstrated to be effective, while soothing non-M was not effective. GI/M was more effective than M alone. GI/M should be considered low-cost end-of-life palliative care for dyspnea.

Aims and Objectives: To describe long-term care nursing directors' experiences with percutaneous endoscopic gastrostomy to understand the limited use of it in Taiwanese long-term care facilities., Background: Percutaneous endoscopic gastrostomy tubes, used in Western countries since 1980, have not been readily used in Taiwanese long-term care facilities since their introduction in 1995. Instead, nasogastric tubes are used for extended periods. The reasons for limited percutaneous endoscopic gastrostomy use among long-term care residents are unknown., Design: A phenomenologic qualitative design using in-depth semi-structured interviews collected the percutaneous endoscopic gastrostomy use experiences of directors of long-term care facilities. The directors also provided descriptive data on the prevalence of feeding tubes among their residents., Methods: Eight directors of long-term care facilities in southern Taiwan participated in tape-recorded interviews. Data were thematically analysed using the methods of Strauss and Corbin. Feeding tube prevalence data were analysed using descriptive statistics., Results: Four themes emerged as contributing to limited percutaneous endoscopic gastrostomy use in long-term care facilities: acceptability, availability, affordability and accountability. Over one-third of the residents required feeding tubes with 97% of those having nasogastric tube. Nasogastric tubes were used for a year or more in over half of the patients requiring enteral feeding., Conclusion: Chinese cultural values play a significant role in influencing end-of-life care and decisions about percutaneous endoscopic gastrostomy use. Nursing directors in long-term care assume a gatekeeper role to promote acceptability, provide availability and ensure accountability of nutritional interventions. Policy makers must be engaged to promote the affordability of percutaneous endoscopic gastrostomy use among long-term care residents., Relevance to Clinical Practice: To improve nutritional outcomes among long-term care residents, nurses must acknowledge the Chinese culture related to percutaneous endoscopic gastrostomy tubes. Professionals must provide sufficient information about the advantages of percutaneous endoscopic gastrostomy tubes and discuss with families the meaning of quality of life and suffering at the end-of-life., (© 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.)

Constipation is a common problem afflicting the elderly. When elderly patients complain of constipation to their healthcare providers, they are typically prescribed laxatives rather than given a clinical examination to explore the specific causes. This approach not only does not resolve the long-term problem of constipation, but may also lead to further complications (e.g., constipation alternating with diarrhea, abdominal distention, poor appetite, and ileus). Effective management of constipation in the elderly should in many cases be tailored to the symptoms and conditions of individual patients rather than simply applying evidence-based treatment. There is a lack of consistency amongst specialists on how best to deal with the problem of constipation. The aim of this article was to explore evidence-based management approaches to constipation in the elderly. A definition of constipation is given and relevant causes are first given. Pharmacological and non-pharmacological treatment approaches are then introduced with regard to effective approaches to conducting physical examinations, assessing patient medical history, and performing laboratory tests. In addition, this article also developed a constipation protocol as a reference tool in the clinical management of constipation in the elderly. The authors hope results can help reduce the problem of constipation in the elderly population.

To understand the gaps between current bioethics education and the requirements of practicing nurses, a semistructured questionnaire was used to invite the directors of nursing departments at all 82 teaching hospitals in Taiwan to participate in this survey. The response rate was 64.6%. Through content analysis we obtained information about previous bioethical training, required themes and content, recommended teaching strategies, and difficulties with education and its application. The results suggest that Taiwanese nursing personnel need to be instilled with both self-cultivation of morality and mental cultivation to acquire nursing virtues and the right attitudes toward bioethical issues. Good communication skills to prevent damage to the harmonious relationships between patients, their families and medical team members, policies that support the provision of systematic formal knowledge of ethics, small group training, and clarification of values were also shown to be important in bioethics education.

The article reports on the experience of the author in successfully using nursing interventions to relieve the back pain of a patient who received percutaneous coronary intervention (PCI) for acute myocardial infarction. Nursing interventions were administered over three days, from September 5-7, 2008. After PCI, the patient suffered from back pain, insomnia and anxiety due to prolonged immobility and restricted positioning. The author used nursing interventions, such as position changing, massage and in situ limb movements to relieve symptoms, and instructed family members to participate in caregiving. Back pain and quality of sleep significantly improved, which greatly relieved the patient's anxiety and improved sleep quality. This article suggests specific nursing intervention techniques to relieve back pain induced by prolonged immobility / restricted positioning.

This article reviewed and summarized the findings of previously published studies on the leisure activities of community elders over 55 years of age. A total of 17 related articles, published before 2008, were identified in the search of electronic databases, which included the Chinese Periodical Table of Contents Index Image System, CEPS, Medline and Ageline. Leisure activities measurements used in this study consisted of recoding activities either categorically or by frequency. The majority of research indicated that elderly engage in primarily static activities and that participation in leisure activities had positive effects on cognitive and psychological health. However, inconsistencies in results were found due to differences in measurement tools and sample populations used among studies, making it difficult to conduct a valid comparison of specific features of elderly leisure activities. Most current leisure activity studies utilize cross-sectional research methodologies with restricted topics, which result in limited applicability of research results. In conclusion, we suggest that future studies should develop instruments to assess leisure activities that correspond to local conditions identified through qualitative research. With such, researchers can study different age groups by applying relevant ageing theories to construct empirical data related to current elderly leisure activities.

"Respect for autonomy", the primary principle of bioethics, is the basis of the process of informed consent. It is the responsibility of medical professionals to provide information when patients are involved in medical situations and decision making. However, many factors can potentially interfere with patient willingness to participate in decision making processes. This article organizes and discusses present knowledge on such factors. A thorough literature review was conducted to identify factors in terms of three aspects: interaction between health professionals and patients, family involvement, and patient characteristics. Patient involvement in medical decision making is a very complex issue. During the medical decision making process, health professionals must be aware of the social-cultural context of patients in order to create an environment in which patients feel comfortable to make decisions freely.

Aims and Objectives: We aimed to encourage nurses to release information about drug administration errors to increase understanding of error-related circumstances and to identify high-alert situations., Background: Drug administration errors represent the majority of medication errors, but errors are underreported. Effective ways are lacking to encourage nurses to actively report errors., Methods: Snowball sampling was conducted to recruit participants. A semi-structured questionnaire was used to record types of error, hospital and nurse backgrounds, patient consequences, error discovery mechanisms and reporting rates., Results: Eighty-five nurses participated, reporting 328 administration errors (259 actual, 69 near misses). Most errors occurred in medical surgical wards of teaching hospitals, during day shifts, committed by nurses working fewer than two years. Leading errors were wrong drugs and doses, each accounting for about one-third of total errors. Among 259 actual errors, 83.8% resulted in no adverse effects; among remaining 16.2%, 6.6% had mild consequences and 9.6% had serious consequences (severe reaction, coma, death). Actual errors and near misses were discovered mainly through double-check procedures by colleagues and nurses responsible for errors; reporting rates were 62.5% (162/259) vs. 50.7% (35/69) and only 3.5% (9/259) vs. 0% (0/69) were disclosed to patients and families. High-alert situations included administration of 15% KCl, insulin and Pitocin; using intravenous pumps; and implementation of cardiopulmonary resuscitation (CPR)., Conclusions: Snowball sampling proved to be an effective way to encourage nurses to release details concerning medication errors. Using empirical data, we identified high-alert situations. Strategies for reducing drug administration errors by nurses are suggested., Relevance to Clinical Practice: Survey results suggest that nurses should double check medication administration in known high-alert situations. Nursing management can use snowball sampling to gather error details from nurses in a non-reprimanding atmosphere, helping to establish standard operational procedures for known high-alert situations.