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Aims: Psychological insulin resistance is a common barrier to initiation and persistence with insulin therapy that affects approximately 42.7% of people living with type II diabetes mellitus, which may negatively impact self‐management. This study aimed to assess patients' levels of psychological insulin resistance and to identify factors associated with self‐management in patients with type II diabetes mellitus treated with insulin therapy. Methods: We adopted a cross‐sectional design. Subjects from the metabolism and endocrinology outpatient departments of a regional teaching hospital in central Taiwan were recruited by consecutive sampling. Patients were assessed for psychological insulin resistance and self‐management using the barriers to insulin treatment questionnaire and the partners in health scale. Results: A total of 222 patients with type II diabetes mellitus were recruited. Patients had an average psychological insulin resistance score of 3.14 (maximum of 8). Positive self‐management was associated with insulin therapy injection by patient, fewer expectations regarding positive insulin‐related outcomes, no diabetes‐related complications, less fear of injection and self‐testing, no hypoglycaemia within the previous year, and younger age. Conclusion: Insulin therapy injection by patient and no diabetes‐related complications were the most common factors associated with overall self‐management and with each domain of self‐management in patients with type II diabetes mellitus treated with insulin therapy. Insulin therapy education should be offered to improve patients' beliefs about insulin therapy and enhance patients' ability to perform self‐management. Summary statement: What is already known about this topic? Psychological insulin resistance is a common psychological barrier to initiation and persistence with insulin therapy.Psychological insulin resistance causes poor glycaemic control and diabetes‐related complications.Psychological insulin resistance may negatively impact self‐management in patients with type II diabetes mellitus. What is the contribution of this paper? Positive self‐management was associated with insulin therapy injection by patient, fewer expectations regarding positive insulin‐related outcomes, no diabetes‐related complications, less fear of injection and self‐testing, no hypoglycaemia within the previous year, and younger age.Insulin therapy injection by patient and no diabetes‐related complications were the most common factors associated with overall self‐management and with each domain of self‐management in patients with type II diabetes mellitus treated with insulin therapy.Patients with poor self‐management had statistically significantly higher levels of overall psychological insulin resistance, fear of injections and self‐testing, expectations regarding positive insulin‐related outcomes, and stigmatization by insulin injections, compared to those with appropriate self‐management. What are the implications of this paper? Knowing in advance the factors associated with diabetes self‐management will allow healthcare professionals prevent psychological insulin resistance in patients with type II diabetes mellitus treated with insulin therapy.Healthcare professionals can design and provide patient‐centred diabetes education based on education level to enhance self‐management. [ABSTRACT FROM AUTHOR]

Aims: To assess the effectiveness of an unsupervised home‐based pulmonary rehabilitation with self‐management program in patients with chronic obstructive pulmonary disease (COPD). Background: A few recent studies have shown that unsupervised home‐based pulmonary rehabilitation can improve the clinical outcome of patients with COPD. More studies are needed to prove its benefits. Design: This study used a quasi‐experimental design. Methods: Seventy‐two admitted COPD patients were assigned to experimental group or control group through purposeful sampling. Data were collected from March 2016 to November 2017 in the Thoracic Intensive Care Unit of a Medical Center in Taiwan. The Medical Research Council dyspnea scale, the COPD Self‐Efficacy Scale and the Clinical COPD Questionnaire were measured before education and at the first, second and third months after discharge. Results: The Medical Research Council dyspnea scale and COPD Self‐Efficacy Scale results in the experimental group were significantly improved compared with the control group in the third month after discharge. The Clinical COPD Questionnaire score continued to improve in both groups in the third month after discharge, and there was no difference between the two groups. Conclusion: A short‐term unsupervised home‐based pulmonary rehabilitation with self‐ management program had significant benefits for patients with COPD. The long‐term effects need to be confirmed. Summary statement: What is already known about this topic? The literature emphasizes the importance of alternative supervision of home‐based pulmonary rehabilitation rather than center‐based pulmonary rehabilitation for patients who find this inconvenient to access.Few studies have shown that unsupervised home‐based pulmonary rehabilitation can improve the clinical outcome of patients with chronic obstructive pulmonary disease (COPD). What this paper adds? This study demonstrates that a short‐term unsupervised home‐based pulmonary rehabilitation with self‐management program can improve dyspnea during physical activity, self‐care efficacy in certain activities and quality of life after discharge in patients with COPD. The implications of this paper: The findings of this study can be used as the basis for providing a short‐term unsupervised home‐based pulmonary rehabilitation with self‐management program for patients with COPD after discharge.We recommend that patients with COPD undergo unsupervised home‐based pulmonary rehabilitation with self‐management for 3 months after discharge, especially if regular hospital visits for this are not convenient.The effect of longer‐term unsupervised home‐based pulmonary rehabilitation can be further studied in the future. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: People diagnosed with serious mental illness have a high risk of diabetes and are more likely to develop type 2 diabetes at ages below 60 years.Effective diabetes self‐care behaviours among people diagnosed with serious mental illness can improve glycaemic control and reduce vascular complications.Few studies have investigated diabetes self‐care behaviours and their associations with health literacy and self‐efficacy in people diagnosed with serious mental illness. What the paper adds to existing knowledge?: Diabetes self‐care behaviours in people diagnosed with serious mental illness were suboptimal; the least frequently performed self‐care activities were self‐monitoring of blood glucose.Factors associated with diabetes self‐care behaviours are gender, age, communicative and critical health literacy and self‐efficacy.Self‐efficacy is the strongest predictor of self‐care behaviours among people diagnosed with comorbid serious mental illness and type 2 diabetes. What are the implications of practice?: Mental health nurses should assess diabetes‐specific health literacy of people diagnosed with serious mental illness to ensure that they possess the knowledge and skills related to diabetes self‐care.When treating young people and those with newly diagnosed type 2 diabetes, nurses should incorporate strategies to minimise their perceptions of diabetes‐related distress and increase their confidence in managing comorbid diabetes. Introduction: People diagnosed with serious mental illness (SMI) experience greater challenges in managing their type 2 diabetes mellitus (T2DM) than do those diagnosed with T2DM alone. Aim: This study investigated diabetes self‐care activities and the factors associated with these activities in people diagnosed with SMI in a hospital setting. Methods: A cross‐sectional correlational study was conducted among 126 people diagnosed with comorbid SMI and T2DM in Taipei, Taiwan, between October 2020 and April 2021. Data were collected using self‐report questionnaires and a chart review. Three‐step hierarchical multiple regression analysis was used to identify factors associated with diabetes self‐care behaviours. Results: Diabetes self‐care behaviours in people diagnosed with SMI were suboptimal overall. Hierarchical multiple regression analyses revealed that age (β = 0.18, p =.037) and self‐efficacy (β = 0.27, p =.004) significantly associated with diabetes self‐care behaviours. Discussion: Self‐efficacy is the strongest predictor of self‐care behaviours among people diagnosed with comorbid SMI and T2DM. Implications for Practice: Mental health professionals should focus on enhancing confidence in managing comorbid diabetes in people diagnosed with comorbid SMI, especially young people and those with newly diagnosed T2DM. [ABSTRACT FROM AUTHOR]

Aim: Repeated occupational exposure and increased stress and fatigue levels contribute to a high risk of coronavirus disease 2019 (COVID‐19) infection among frontline nurses. This study aimed to explore the relationships among teamwork, work environment and resources, work–life balance, stress perception and burnout among nurses working at a dedicated infectious disease control hospital. Methods: The participants were 389 nurses at a dedicated infectious disease control hospital in Taipei City, Taiwan. This study adopted survey design with a questionnaire using the Safety Attitude Questionnaire. Results: The work–life balance among nurses at the dedicated hospital significantly mediated the effects of teamwork and work environment and resources on burnout. In addition, stress perception had interaction effects on work–life balance and burnout. Conclusion: This study's results provide important recommendations for managing teamwork, work environment and resources, work–life balance, stress perception and burnout prevention in nurses to help them better prepare and cope with emergencies. Findings can serve as a reference for developing relevant hospital management policies. Summary statement: What is known about the topic? Organizational changes, information scarcity and shortages of personal protective equipment were the primary factors driving uncertainty when the pandemic began.Work environments can significantly affect burnout, job satisfaction and perceived stress among nurses.Teamwork is an important factor affecting nurse burnout. What this paper adds? Repeated occupational exposure and increased stress and fatigue levels contribute to a high risk of COVID‐19 infection among frontline nurses.Healthcare systems should emphasize the issues of teamwork, work environment and resources and work–life balance among nurses to help them prepare for and cope with emergencies.Nurse supervisors should constantly monitor for burnout among subordinates and eliminate their stressors. The implications of this paper: When teaching nursing management skills during an epidemic, it is essential to focus on strengthening the nursing supervisors' communication role, particularly during an outbreak.To reduce nurse burnout, key leadership and culture aspects in the work environment include prioritizing infection control measures, providing social support, encouraging strong multidisciplinary teamwork, ensuring adequate resources are available and receiving support from hospital superiors and the government. By addressing these factors, healthcare organizations can create a positive work environment that supports nurses' well‐being and promotes better patient outcomes.To manage nurses in the postpandemic era, healthcare organizations can implement routine training programs, new models of cross‐teamwork, emergency response plans, effective systematic monitoring and mental health intervention programs. These strategies can help promote collaboration, support nurses' mental health and ensure preparedness for future crises. Healthcare organizations can create a more effective healthcare system by adopting these measures. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Because the definition of spirituality is complex and has cultural and individual dimensions, it is important to be receptive to individual differences in the perception of spirituality during clinical practice of mental health nurses.Although enhancing spiritual care is beneficial to patients diagnosed with mental illnesses, the extrinsic (e.g., education) and intrinsic factors that would affect nurses' attitudes towards spiritual care have not been investigated.Notwithstanding the known impact of certain intrinsic factors (e.g., personality‐related) of mental health nurses on their coping strategies as well as their emotional and mental health, the link to their spiritual care attitudes has received little attention. What this paper adds to existing knowledge?: This paper is the first to identify the beneficial impacts of extrinsic factors including postgraduate education, working experience, participation in palliative care education programmes, and spiritual care experience on spiritual care attitudes among mental health nurses.Certain intrinsic factors, including those personality‐related such as "Extraversion," "Openness/Intellect," "Conscientiousness," and "Agreeableness," were also associated with higher awareness of providing spiritual care among mental health nurses. What are the implications for practice?: The finding of an association of certain intrinsic factors with more positive attitudes towards spiritual care could encourage further studies to explore possible links between these factors and attitudes of spiritual care.Those less aware of the patients' spiritual needs may benefit through participating in relevant education and on‐the‐job training programmes that involves actual practice and collaboration in a multidisciplinary team. Introduction: Although enhancing spiritual care can facilitate the communication of mental health nurses with patients diagnosed with mental illnesses, extrinsic and intrinsic factors that may influence their spiritual care attitudes remain unclear. Aim: To conduct a questionnaire‐based survey on mental health nurses from eight hospitals. Method: A total of 239 psychiatric nurses were assessed based on (1) "big‐five Mini‐Markers" questionnaire and (2) spiritual care attitudes scale on three components (i.e., core values, growth, and nursing) to investigate the associations of spiritual care attitudes with social/occupational characteristics and personality. Results: A positive attitude was significantly associated with working experience, higher educational level, previous participation in palliative care education programmes, spiritual care experience, and personality factors including "Extraversion," "Openness/Intellect," "Conscientiousness," and "Agreeableness." Discussion: Despite demonstrating impacts of intrinsic factors (e.g., personality) on mental health nurses' spiritual care attitudes, other modifiable extrinsic factors (e.g., education) were important in enhancing their awareness towards spiritual care. Implications for Practice: Our findings encourage further studies to explore possible links between intrinsic factors and attitudes of mental health nurses towards spiritual care as well as suggest benefits of continuing education and on‐the‐job training that involves actual practice and collaboration in a multidisciplinary team to provide spiritual care. [ABSTRACT FROM AUTHOR]

Aim: This quasi‐experimental study aimed to explore effects of walking exercise on disease activity, sleep quality, and quality of life among individuals with systemic lupus erythematosus. Methods: After recruiting people with systemic lupus erythematosus from a hospital in Taiwan between October 2020 and June 2021, participants were free to opt to receive one walking exercise programme plus standard care for 3 months or to membership of a control group receiving routine care. Primary outcomes included Systemic Lupus Erythematosus Disease Activity Score, the Pittsburgh Sleep Quality Scale, and a quality‐of‐life scale for patients with systemic lupus erythematosus, namely, LupusQoL. These scales were administered first, at baseline and later, within 1 week following completion of the intervention. Between‐group effects were compared using generalized estimating equations with adjustment for baseline variables. Results: The experimental and control groups each included 40 participants. Multivariate analysis indicated that adding the walking exercise programme into routine care elevated sleep quality and LupusQoL (the latter in the subscales of physical health, planning, and intimate relationships), except for disease activity. Conclusion: Findings of this study supported the addition of walking exercise as part of routine care for people with systemic lupus erythematosus and may be a reference in the provision of adequate care for these patients. Summary statements: What is already known about this topic? Systemic lupus erythematosus is a lifelong autoimmune disease that affects any organs throughout the body, thus insidiously causing negative impacts on the affected patients.Today, use of exercise programmes such as walking exercise has been studied as a remedy for many medical conditions, but its effectiveness in minimizing the symptoms of distress among people with systemic lupus erythematosus is unknown. What this study adds? Participants with systemic lupus erythematosus who opt to receive the walking exercise programme for 3 months in addition to routine care experience improved sleep quality and quality of life compared with those receiving routine care alone. The implications of this paper: In accordance with the belief that "an ounce of prevention is worth a pound of cure," early implementation of an exercise programme should be considered in addition to routine care for patients with systemic lupus erythematosus.Evidence from this research could provide empirically informed and robust data for healthcare policymakers and in turn might help to reduce the incidence of morbidity among patients with systemic lupus erythematosus. [ABSTRACT FROM AUTHOR]

Aim: The aim of this work is to explore the effectiveness of a mobile app to support oral mucositis care to improve the nutritional status and reduce the occurrence of oral mucositis of patients with head and neck cancer undergoing concurrent chemoradiotherapy. Background: Concurrent chemoradiotherapy is the optimal treatment for head and neck cancer, but oral mucositis and malnutrition are common complications. Design Quasi‐experimental study using a pre‐post design was used in this work. Method: Participants were recruited from a major regional hospital in Taiwan from July 2018 to July 2020. There were 32 participants in each group: the mobile app group (Intervention Group) or routine care (Control Group). The primary outcome measure was Patient‐Generated Subjective Global Assessment (PG‐SGA). We also collected data on grade of oral mucositis, painNnumeric Rating Scale (NRS), weight loss, haemoglobin (Hb), albumin and quality of life (QoL). Result: The PG‐SGA score was significantly lower in the intervention than the control group at all three time points. Hb and albumin decreased less significantly in the intervention than the control group after 2 months. The oral mucositis grade was significantly less severe in the intervention than the control group at all three time points; for the NRS, at T2 and T3. Conclusion: Using the mobile app effectively improved nutritional status, alleviated the side effects, and improved the QoL of head and neck cancer patients with concurrent chemoradiotherapy. Summary statement: What is already known about this topic? Oral mucositis leads to malnutrition and hinders treatment in cancer patients.An oral health care mobile application ('app') is an easy‐to‐access health care resource What this paper adds? A mobile app improved oral mucositis, pain sensation score, nutrition status and QoL for patients with head and neck cancer undergoing concurrent chemoradiotherapy.A mobile app could increase the accessibility of a large amount of care information to patients. The implications of this paper: A mobile app could be used to establish an efficient communication platform; to provide feedback for patient self‐management to alleviate the feeling of suffering, and could enhance patients' competency to manage their oral mucositis. [ABSTRACT FROM AUTHOR]

Aim: To explore the significance of culture, professional support in the community, social interactions and intrapersonal determinants of adults' preferences for life‐sustaining treatments and palliative care. Methods: A cross‐sectional design with a Social Ecological Model was used. Between 1 October 2012 and 31 December 2012, 474 adults aged ≥20 years living in a city of Southern Taiwan completed the survey. Data were analysed using hierarchical multiple regression. Results: The life‐sustaining measures model was significant with 15.3% (p < 0.0001) of the variance in the Modified Emmanuel Medical Directives being explained by variables of death of self and healthcare services' support. The palliative care model was significant with 18% (p < 0.0001) of the variance in the Modified Hospice Attitude Scale being explained by variables of palliative care knowledge, death of self and social interactions. However, cultural value adherence did not predict adults' preferences for life‐sustaining measures and community resources support did not predict palliative care preference. Conclusions: Findings enhance our understanding of the significance of different societal levels on adults' preferences for end‐of‐life care. Palliative care knowledge, fear of death, healthcare services' support and social interactions are essential factors that need to be taken into consideration when it comes to discussion about life‐sustaining treatments and palliative care. Summary statement: What is already known about this topic? End‐of‐life (EOL) preferences can be shaped not just by knowledge, values and individuals' attitudes but rather a host of social influences.Few studies with theoretical frameworks or models in the literature are available to provide a comprehensive understanding of factors contributing to responses at the EOL. What this paper adds? The findings advance the knowledge of the influence of social interactions, healthcare services' support, palliative care understanding and fear of death on adults' preferences for life‐sustaining treatments and palliative care.The identified relationships in the context of life‐sustaining treatments and palliative care provide practical guidelines, which can help to inform appropriate supportive interventions for EOL care planning. The implications of this paper: Healthcare services that provide a mediating structure where a person belongs should focus on enhancing community resources regarding EOL healthcare planning, knowledge about palliative care and reinforcing life and death education.The social support network and emotional ties with a person's significant others should also be taken into consideration to facilitate EOL healthcare planning and to promote good quality of life at EOL. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Individuals diagnosed with substance use disorders may perceive stigma and suffer from mental health problems.Perceived stigma is related to poor mental health among individuals diagnosed with substance use disorders.The social support deterioration deterrence model proposes that stressors (e.g. perceived stigma) negatively affect mental health via reduced perceived social support. To the best of the present authors' knowledge, the model has never been tested in the context of perceived stigma among individuals diagnosed with substance use disorders. What the paper adds to existing knowledge?: The paper used structural equation modelling to show that the social support deterioration deterrence model could explain the relationship between perceived stigma and depression among individuals diagnosed with substance use disorders.Perceived support from family and perceived support from friends are mediators in the association between perceived stigma and depression among individuals diagnosed with substance use disorders. What are the implications for practice?: Psychosocial interventions to increase perceived support from family and friends would be helpful in addressing perceived stigma effects on mental health. Introduction: Although the relationship between perceived stigma and mental health outcomes is documented in the existing literature, very few studies have investigated the mechanism linking perceived stigma and mental health outcomes among individuals diagnosed with substance use disorders. To the best of the present authors' knowledge, the social support deterioration deterrence model has never been tested in the context of perceived stigma among individuals diagnosed with substance use disorders. Aim/Question: Guided by the social support deterioration deterrence model, the present study investigated the mediating role of perceived support from three types of social network members (i.e. significant others, family members, and friends) in the association between perceived stigma and depression in individuals diagnosed with substance use disorders. Method: The study employed a cross‐sectional survey design comprising 300 participants diagnosed with substance use disorders in Taiwan. Results: Results of a structural equation modelling analysis indicated that perceived stigma was significantly associated with depression. The relationship between perceived stigma and depression was partially mediated by perceived family support and perceived friend support. Discussion: Consistent with the prediction of the social support deterioration deterrence model, the negative effect of perceived stigma on depression for individuals diagnosed with substance use disorders is through the mediating effect of social support. Implications for practices: Based on the present study's results, psychosocial interventions to increase perceived support from family and friends would be helpful in addressing negative effects of perceived stigma on mental health among individuals diagnosed with substance use disorders. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to evaluate the effects of an intervention involving earplug placement during nocturnal sleep in non‐ventilated intensive care unit patients. Methods: A randomized controlled trial was conducted in 107 adult patients between January 2017 and December 2018. Participants in the intervention group (n = 55) slept with earplugs between 10 pm and 7 am on the second night of their intensive care unit stay. In the control group, participants slept with no earplugs. Outcome parameters included sleep, urinary 6‐sulfatoxymelatonin levels, relaxation responses measured using the Richards–Campbell Sleep Questionnaire, liquid chromatography‐mass spectrometry results and vital signs. Urine was collected between 10 pm and 7 am. Results: Overall, 28.03% of participants showed virtually no 6‐sulfatoxymelatonin excretion in the collected urine. Outcome parameters were not significantly different between the groups, indicating that wearing earplugs alone did not affect sleep quality, urinary 6‐sulfatoxymelatonin and vital signs. Conclusions: The effects of using earplugs alone on sleep quality, urinary 6‐sulfatoxymelatonin and relaxation responses in patients admitted to the intensive care unit were inconclusive. Additional research is required before earplugs alone can be widely used to improve sleep quality. Summary statement: What is already known about this topic? Excessive noise exposure causes numerous adverse health outcomes, which not only contributes to noise‐induced stress and hearing loss but also affect patients' sleep.Wearing earplugs might be a practical nonpharmacological strategy used by nurses to improve ICU patients' quality of sleep. What this paper adds? Wearing earplugs alone did not affect patients' urinary 6‐sulfatoxymelatonin level in the ICU.Wearing earplugs alone did not increase patients' subjective sleep quality in the ICU. The implications of this paper: The findings of the present study on the effects of using earplugs alone on sleep quality, urinary MT6s level and vital signs in ICU patients extend the literature, particularly with respect to the limited research on using earplugs alone.Prolonged effect of earplug intervention on sleep quality is unknown. A longer intervention may help elicit any difference in sleep quality. [ABSTRACT FROM AUTHOR]

Background: Weight control is a widespread phenomenon among young adults, especially in women. Aim: This study aimed to determine the prediction factors of weight control intention in a young Chinese sample. Methods: A cross‐sectional study was conducted with 963 (276 male and 687 female; mean age 21.8 ± 4.4 years) adult students from a university in Taiwan. The data were collected from October 2016 to January 2017. Body mass index (BMI), the Chinese version of the Weight Self‐Stigma Questionnaire, the Body Areas Satisfaction Scale and the Media Influence Questionnaire were used as data collection instruments. Results: The participants with weight control intention had higher BMI, weight self‐stigma and media influence scores and lower body satisfaction scores than those without the intention. Female sex, BMI, weight self‐stigma, body satisfaction and media influence were significant predictors of weight control intention for all participants. Conclusion: Before conducting weight loss programmes, the perception of weight self‐stigma and the influence of social media on body image should be confirmed, particularly in women with intention to lose weight. SUMMARY STATEMENT: What is already known about this topic? Weight loss is a popular issue in the health field, owing to the effect of obesity on multiple aspects of life.Females have a higher intention than males to control their weight.People with obesity are more likely to internalize weight stigma from public attitudes and influences and are more dissatisfied than others with their body appearance. What this paper adds? Females have a higher perception of weight self‐stigma and are more dissatisfied than males with their body and the influence of social media on body image.The Chinese young adults with weight control intention had a higher body mass index, weight self‐stigma, body dissatisfaction and media influence than adults without weight control intention.Weight self‐stigma, body dissatisfaction, influence of mass media and body mass index may play synergistic roles in triggering weight control intention in Chinese young adults, particularly in women. The implications of this paper Nurses should pay attention to young adult females with normal BMI and intention to lose weight.Nurses and other healthcare professionals who conduct weight loss programmes should confirm with young adults, particularly with women, their perception of weight self‐stigma, body dissatisfaction and social media influence.Healthy and non‐prejudiced advice should be included in weight loss consultation. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Intellectual disability (ID) involves problems with general mental abilities and affects intellectual functioning and adaptive functioning.People diagnosed with ID present higher levels of functional disability, which means they usually have difficulty or the inability to independently perform basic activities of daily living.Little to no attention has been paid to the issues of the mental health of people diagnosed with ID. Specifically, healthcare workers' experiences of caring for patients with IDPD have been neglected. What does the paper add to existing knowledge?: The findings increase our understanding and partially address the knowledge gap regarding the situations and circumstances faced by healthcare workers in caring for patients diagnosed with intellectual disability co‐occurrent with psychiatric disorders (IDPD).In cases of insufficient staffing, healthcare workers may be forced to ignore the individualized needs of patients so as to facilitate management.Healthcare workers may also feel frustrated by not being able to anticipate or deal with patients' unexpected problem behaviours or accidents. They adapt by adjusting their expectations of their patients. What are the implications for practice?: Healthcare administrators need to understand the difficulties faced by staff in caring for patients diagnosed with IDPD, arrange appropriate in‐service education to increase the healthcare workers' knowledge and skills in caring for patients diagnosed with IDPD, and create warm and supportive environments for them.The government department responsible for the management of ID patient care institutions should be able to regularly monitor the overall staffing and quality of care in these institutions. Introduction: When intellectual disability co‐occurs diagnosed with psychiatric disorders (IDPD), the impact of the burden of illness on the affected individuals, their caregivers, their family and friends, and the services that provide for them is particularly high. The issues of the mental health of people diagnosed with ID have received little, if any, attention. One specific area of neglect is healthcare workers' experiences of caring for patients diagnosed with IDPD. Aim: The aim of this study was to understand healthcare workers' experiences of caring for patients diagnosed with IDPD. Methods: A qualitative descriptive research approach and semi‐structured interviews were used in this study. We interviewed 15 participants who had experience in caring for patients diagnosed with a dual diagnosis of IDPD. Findings: Four themes were found, as follows: (1) Negative impacts of insufficient staffing on the quality of care, (2) Constantly worrying about harmful incidents, (3) Discovering effective ways to provide individual patient care and (4) Adjusting expectations and attitudes towards patients. Participants' experiences revealed that they perceived the importance and effectiveness of providing individualized care for IDPD patients. However, when staffing is insufficient, they may be forced to ignore the individualized needs of patients so as to facilitate management. They may also feel frustrated by not being able to anticipate or deal with patients' unexpected problem behaviours or accidents. In addition, they adapt by adjusting their expectations of the patients. Discussion: The findings from this research help to fill the knowledge gap in our understanding of healthcare workers' experiences of and their perspectives on caring for patients diagnosed with IDPD. Implications for Practice: Healthcare administrators need to understand the difficulties faced by staff in caring for patients diagnosed with IDPD, arrange appropriate in‐service education to increase the healthcare workers' knowledge and skills in caring for patients diagnosed with IDPD, and create warm and supportive environments for them. The government department overseeing the management of institutions providing ID patient care should be empowered to conduct regular monitoring of the overall staffing and quality of care in such institutions. [ABSTRACT FROM AUTHOR]

Purpose During the survival period of breast cancer patients, an understanding of and ability to implement health knowledge may be important for survivors' physical and mental quality of life (QOL). This study aims to investigate the health literacy and predictors of QOL for survivors of breast cancer. Method: A cross‐sectional design was used, and convenience sampling was performed. Eighty‐six survivors with breast cancer were recruited from a general hospital in northern Taiwan from February to August 2017. Taiwan's health literacy scale and SF‐12 questionnaire were used for data collection. Results: The average health literacy score was 3.28. Education level and breast cancer stage were significant factors for the health literacy of survivors with breast cancer. Age, body mass index and health literacy were predictors of physical health‐related QOL. Health literacy also was a predictor of mental health‐related QOL. Conclusion: The results provide the factors associated health literacy as well as health‐related QOL. Nurses should understand the health literacy among survivors with breast cancer and improve health literacy to optimize their quality of life. SUMMARY STATEMENT: What is already known about this topic? Individuals with lower health literacy generally had fewer communications with medical personnel regarding their own risk of disease.Individuals with higher health literacy tend to have better social‐related QOL. What this paper adds? Survivors with early‐stage breast cancer tended to be younger (aged 60 years or less) had normal body mass index, continued working, had no other illnesses and better physical health.Survivors with normal body mass index who had not received chemotherapy had better mental health.Health literacy was the main predictor and accounted for 20% of the variance in physical health and for 18.8% of the variance in mental health. Implications of this paper: Nurses should understand the importance of health literacy, which is a key factor to improve QOL for survivors with breast cancer.Nurses should develop individualized care plans for survivors based on different levels of health literacy to improve the efficiency of the nurse–patient dialogue. [ABSTRACT FROM AUTHOR]

Aims: This study was to explore the student nurses' bullying, social support and their health status during clinical practicum programmes and the predictors of health status among student nurses during clinical practicum programmes. Methods: A cross‐sectional design with structured questionnaires was used, recruiting 200 student nurses in a 5‐year junior college programme in south Taiwan. Results: The significant predictors of nursing students' health status during clinical practicum programmes were 'whether experiencing bullying situations during clinical practicum' and 'low social support'. Conclusion: In order to prevent bullying during clinical practicum, encouraging nursing students to report all the clinical practicum bullying incidents, providing counselling to nursing students and arranging clinical practicum bullying prevention courses to students were important. Moreover, providing instructors and nursing staff with teaching, communication and feedback skills might help nursing students prevent bullying incidents during clinical practicum programmes. A longitudinal study design was suggested for the future study in order to assess the cause–effect relationship of the bullying and social support on health among students during clinical practicum SUMMARY STATEMENT: What is already known about this topic? Nurses' exposure to workplace bullying will result in their health problems. What this paper adds? Student nurses' exposure to bullying during clinical practicum and low social support might impact on their health status. The implications of this paper: Establishing supportive practicum environments is important to help nursing students prevent bullying incidents during clinical practicum programmes.Nurse educators might include the results of this study into the contents of the educational programmes to increase students' knowledge on student nurses' bullying and its risks. [ABSTRACT FROM AUTHOR]

Aims: This study aims to explore nurses' demographic data, assertiveness, psychosocial work condition, and workplace bullying, and find the predictors of workplace bullying. Methods: This study adopted a cross‐sectional design. A stratified sample comprising 241 nurses from a regi onal teaching hospitals in Taiwan was selected from the 10th to the 23rd September, 2018. Data were analysed by using the SPSS Statistics 17.0. Descriptive statistics (frequency, percentage, mean, and standard deviation), one‐way Anova, t test, Pearson's correlation, and multiple linear regressions were used. Results: The results showed that the participants with "past bullying experience," "lower self‐assertiveness," "higher work psychological demands," "lower workplace justice," "lower labour participation," and "lower overall social support" are more likely to experience workplace bullying. Conclusions: Hospital managers should pay attention to the problem of nursing workplace bullying. First of all, hospital managers should encourage curriculum on nursing workplace bullying and incorporate nursing workplace bullying prevention training courses in curriculum planning. SUMMARY STATEMENT: What is already known about this topic? Workplace bullying can cause physical and psychological disorders in nurses and affect patients' safety.Understanding the affecting factors related to workplace bullying may be beneficial for decreasing the incidence of workplace bullying in nurses. What this paper adds? Past bullying experience, self‐assertiveness, work psychological demands, workplace justice, labour participation, and overall social support were predictors of workplace bullying. The implications of this paper: The establishment of a friendly workplace environment is important, such as, building up justice policies and involving nurses' opinions whilst setting up all policies.Nurse managers may provide educational programs to nurses in order to improve their knowledge and skills to deal with workplace bullying. [ABSTRACT FROM AUTHOR]

Aim: The present study aimed to evaluate the effectiveness of individualized exercise counselling in changing exercise behaviour and relieving pregnancy‐related distress symptoms in pregnant women. Methods: A quasi‐experimental design and convenience sampling technique were used. Participants were recruited from the prenatal outpatient departments of medical centre hospitals in Taipei, Taiwan. The experimental group (n = 52) received face‐to‐face exercise counselling followed by 8 weeks of exercise sessions in their homes. The control group (n = 49) received no exercise counselling. Pregnancy‐related distress symptoms were assessed before and after 8 weeks in both groups. Results: The after‐counselling scores of total (t = 2.46, P < 0.05) and physical (t = 3.18, P < 0.01) distress symptoms were significantly lower than the before‐counselling scores in the experimental group. The total, physical and psychological distress scores significantly differed between groups and before and after counselling. The adjusted R2 values for total, physical and psychological distress symptoms ranged from 0.59 to 0.70. Participants' exercise habits increased from prepregnancy (19.2%) to after counselling (71.2%). Conclusion: Exercise counselling may effectively increase exercise habits and reduce pregnancy‐related distress symptoms among pregnant women. Women with higher pretest symptom distress scores also had higher posttest symptom distress scores. Based on our outcomes, health care providers should routinely provide exercise counselling to pregnant women. SUMMARY STATEMENT: What is already known about this topic? Previous studies have found that exercise can be very beneficial for pregnant women by relieving pregnancy‐related distress.Women also commonly reported that advice regarding exercise during pregnancy is generally vague (not individualized), constantly changing and often limited to a continuation of their previous routine or simply increased walking.Studies on the effectiveness of individual face‐to‐face exercise counselling for pregnant women for relieving their pregnancy‐related distress symptoms are limited. What this paper adds? Individual face‐to‐face exercise counselling can reduce pregnancy‐related symptoms in pregnant women.The pretest score was a significant factor that influenced the degree of relief from symptom distress. The implications of this paper: This study could help health care providers to provide pregnant women with exercise counselling as part of their routine prenatal care to relieve pregnancy‐related distress. [ABSTRACT FROM AUTHOR]

Aim: Recurrent miscarriage is considered a major life event. The main purposes of this study were to compare the differences in stress, anxiety, social support, sleep quality and depressive symptoms in couples experiencing recurrent miscarriage compared to peers who experience full‐term normal childbirth in southern Taiwan. Methods: Convenience sampling and snowball sampling were used respectively to recruit 78 couples with and 80 couples without recurrent miscarriage from October 2014 to July 2015. Five structured questionnaires including Perceived Stress Scale, State‐ Anxiety Inventory, Interpersonal Support Evaluation List, Pittsburgh Sleep Quality Index and Edinburgh Depression Scale were administered. Results: Women who experienced recurrent miscarriage perceived significantly higher levels of stress, anxiety and depressive symptoms than their husbands. Women in the recurrent miscarriage group reported significantly greater depressive symptoms than women of the other group. A stepwise multiple regression analysis indicated key predictors of depressive symptoms among women of childbearing age, accounting for 62.9% of the variance, were anxiety, stress, social support and history of recurrent miscarriage. Conclusion: Women with recurrent miscarriage suffer mild to moderate depressive symptoms and a greater incidence of depression than their peers who experienced normal childbirth. Health professionals can use the knowledge gained from these findings to evaluate women with recurrent miscarriage for stress, anxiety and depressive symptoms and develop supportive interventions. SUMMARY STATEMENT: What is already known about this topic? Recurrent miscarriage is considered a major life event and, for some, a failure to fulfil a core responsibility for the family lineage.Research about the differences between genders in both the type and degree of emotional response to a miscarriage is limited. What this paper adds? Women with recurrent miscarriage suffer mild to moderate depressive symptoms and a greater incidence of depression than women without recurrent miscarriage.The key predictors of depressive symptoms among women of childbearing age were anxiety, stress, social support and history of recurrent miscarriage, accounting for 62.9% of the variance. The implications of this paper: This study highlights the need to increase healthcare professionals' awareness of the importance of evaluating stress, anxiety and depressive symptoms in women with recurrent miscarriage.It is recommended that future studies develop and test supportive care protocols for couples experiencing recurrent miscarriage. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: The meaning in life consists of an individual's values, experiences, goals and beliefs. It has been shown to be negatively associated with depression, hopelessness and suicidal ideation.Depression and hopelessness are related to increased suicidal ideation. Meaning in life has been shown to be a protective factor against depression, hopelessness and suicidal ideation. What the paper adds to existing knowledge: A path model was developed to clarify the associations among meaning in life, depression, hopelessness and suicidal ideation. For clarity, the outcomes were depression and suicidal ideation, the independent variable was hopelessness, and the mediator was meaning in life. Hopelessness had a direct association with meaning in life, and meaning in life had a direct association with depression, supporting the mediating effect of meaning in life from hopelessness to depression.Meaning in life had the strongest association with depression, and depression had the strongest association with suicidal ideation. Meaning in life did not have a significant direct association with suicidal ideation; it did have an indirect association with suicidal ideation through depression. This study estimated that one‐point increase in meaning in life score was associated with 0.47‐point decrease in depression score and 0.13‐point decrease in suicidal ideation score, respectively. What are the implications for practice: Logotherapy is a meaning‐centred therapy to find meaning in life. This study reveals that increased levels of meaning in life are associated with decreasing degrees of depression. Mental health nurses could help patients to find meaning in life by logotherapy and thus associated with reductions in depression.Mental health nurses could help patients to find hope by exploring meaning in life and promoting positive attitudes towards life from meaningless life to meaningful life, there is a reduction in depression, which in turn reduces suicidal ideation indirectly. Introduction: Meaning in life can be good protective factor against depression, hopelessness and suicidal ideation. Aim: To analyse the mediating effect of meaning in life on the associations among hopelessness, depression and suicidal ideation. Method: A cross‐sectional study was conducted among 90 patients diagnosed with depression. A structural equation modelling approach was applied for this path analysis to examine the mediating effect of meaning in life on the association among hopelessness, depression and suicidal ideation. Results: The results showed that meaning in life mediated the association between hopelessness and depression. Hopelessness had a direct positive association with depression (β = 0.23, p <.03), and meaning in life had a direct negative association with depression (β = −0.51, p <.01) and indirect association with suicidal ideation through depression; this indirect association was −0.21 (p <.01). Discussion: Meaning in life revealed strong mediating association with the relationship between hopelessness and depression. By reducing the level of depression, meaning in life demonstrated its mediator association with suicidal ideation. Implications for Practice: Logotherapy is a meaning‐centred therapy to find meaning in life. Mental health nurses could help patients to manage their depression through logotherapy, thus leading to reductions in suicidal ideation. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Sexual minority individuals are more likely to experience depressive disorders than heterosexual individuals.Factors associated with depressive symptoms among sexual minority individuals have been explored and examined; however, there is a limited evidence to understand the factors among sexual minority women in non‐western countries. What the paper adds to existing knowledge?: To the best our knowledge, this is the first study examining internalized homophobia, self‐esteem, social support and depressive symptoms among sexual minority women in Taiwan.Sexual minority women at risk of having depressive symptoms had a higher level of internalized homophobia, lower self‐esteem and fewer support from partners, friends, and families.Specifically, being single, being a student and having a higher personal income increased the risk of having depressive symptoms among sexual minority women. What are the implications for practice?: Mental health practitioners and nurses should be aware of and assess sexual minority women's level of internalized homophobia, self‐esteem, and received social support to reduce the risk of depressive symptoms and thus help prevent suicidal ideation.LGBT sex education and government involvement are essential to buffer the negative influences of a homophobic society on the mental health of sexual minority women. Introduction: Sexual minority women are more likely to report depressive symptoms than sexual minority men. However, there is a lack of evidence to understand factors associated with depressive symptoms among sexual minority women in non‐western countries. Aim: This study examined internalized homophobia, self‐esteem, social support and depressive symptoms among Taiwanese sexual minority women. Method: A total of 581 Taiwanese sexual minority women (Age range 20–48 years old, Mean 26.96, SD 5.718) completed an online survey. Results: Taiwanese sexual minority women at risk of having depressive symptoms had a higher level of internalized homophobia and lower self‐esteem. Perceived support from participants' partners, friends and families was related to lower risk of depressive symptoms. Being single, being a student and having a higher personal income were also found to increase the risk of having depressive symptoms among the women. Discussion: Mental health interventions are essential for sexual minority women with internalized homophobia and low self‐esteem. Implications for Practice: Mental health practitioners and nurses should be aware of and assess the concerns that sexual minority women have regarding healthcare services and provide culturally competent care to reduce the risk of depressive symptoms. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To develop a Chinese version of a chronic wound health‐related quality of life (QoL) instrument and to examine the psychometric properties of this instrument. Background: Existing QoL instruments are not tailored to the linguistic and cultural characteristics of Chinese‐speaking patients; a version addressing this gap will increase clinical understanding of their healthcare experience and may help guide chronic wound care. Design: A methodological study. Methods: The method advanced by DeVellis (2017) was used to develop the instrument. An initial pool of 38 items was created. To optimize scale length and test reliability and validity, exploratory and confirmatory factor analyses were conducted. A total of 23 items formed the final pool. After two rounds of expert discussions, the average content validity index of the final 23 items was.89. Results: A total of 226 patients completed the instrument and were divided into two groups for further analysis. Exploratory factor analysis revealed that 15 items remained in four factors (social activity restrictions, physical and psychological disturbance, wound burden and daily life limitation), which accounted for 64.87% of the variance. Confirmatory factor analysis revealed an acceptable fit of the hypothesized factor structure and the convergent and discriminant validities were achieved. Cronbach's α coefficients for each factor were.807,.773,.799 and.713, respectively. Conclusion: The Chinese version of a chronic wound health‐related QoL instrument consists of 15 items in four subscales and demonstrates good reliability and validity. Relevance to Clinical Practice: This instrument can be used intermittently or continuously to evaluate the treatment effect of chronic wounds by assessing health‐related QoL. Scholars in Chinese‐speaking regions may find this culturally compatible instrument useful when conducting studies related to chronic wounds. Patient or Public Contribution: Two hundred twenty‐six participants provided their perspectives on health‐related QoL. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This study aimed to investigate factors associated with facial pressure injury (FPI) in patients receiving non‐invasive positive pressure ventilation (NIPPV) during hospitalisation in the intensive care unit (ICU) and to identify predictors of FPI. Background: Non‐invasive positive pressure ventilation is a method of treating patients with acute and chronic respiratory failure. However, FPI may occur due to unsuitable nasal‐oral NIPPV masks and discomfort in contact with the skin surface. Design: A retrospective case–control study. Methods: From January 2018 to October 2020, a total of 397 patients admitted to a national hospital in Taiwan were enrolled. Patients received NIPPV and routinely used under‐mask prophylactic dressings during hospitalisation. Patients were divided into the non‐FPI group (n = 357) and the FPI group (n = 40). Demographic, clinical characteristics, acute physiology and chronic health evaluation II scores, and Braden Scale scores were collected from medical records. Logistic regression analysis was performed to examine the contribution of each factor to the FPI, and odds ratios were reported. The STROBE checklist was used in this retrospective case–control study. Results: There were significant differences between the groups in age, serum albumin, C‐reactive protein, body mass index (BMI), disease severity, Braden Scale score, length of stay, duration of mechanical ventilation and use of corticosteroids. Logistic regression analysis revealed that the risk factor for FPI was the Braden Scale score [OR = 1.630 (1.176–2.260)], BMI [OR = 0.396 (0.210–1.784)] and corticosteroids [OR = 0.394 (0.159–1.811)], which were predictors of FPI in patients with NIPPV. Conclusions: Facial pressure injury may still occur in patients who routinely use prophylactic dressings under NIPPV masks. This study provides information on continuing education training for FPI to more accurately identify high‐risk and timely preventive measures to reduce FPI. Relevance to Clinical Practice: Addressing FPI‐related factors to prevent facial skin damage and reduce comorbidities in patients using NIPPV masks. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Suicide is a global mental health issue. Taking care of suicidal individuals is a substantial challenge. Most studies emphasize the suicidal individual. Few studies have emphasized the family caregivers of suicidal individuals., No study has explored the relationship between family caregivers' caring stress with suicidal attitudes and suicide care ability., What this paper adds to existing knowledge? The main results indicated that the older family caregivers tended to have a more negative attitude towards suicidal individuals. Female family caregivers' stress was higher than that of male family caregivers., A mild level of caring stress would help family caregivers have a more positive attitude towards suicidal individuals. Furthermore, a positive attitude would help family caregivers improve their caring ability., What are the implications for practice? Mental health nurses could help family caregivers, especially female family caregivers, reduce their holistic caring burden by looking for support resources and enhancing their coping strategies., Mental health nurses could help family caregivers promote positive attitudes towards suicidal relatives by understanding suicidal individuals' suffering., Abstract Introduction Suicide is a global mental health issue. Family caregivers play a key role in preventing suicide attempts. Aims The aim of this study was to examine the relationship among stress due to the family caregiver's role, suicidal attitude of the family caregiver and suicide care ability among family caregivers. Additionally, instruments of caring stress, attitudes towards suicidal relatives and caring abilities used in the study were tested to measure construct validity. Methods A cross-sectional correlational study was conducted with 164 family caregivers of people who are suicidal. The following three questionnaires were used: the Caring Stress Scale, the Suicidal Attitudes Scale and the Suicidal Caring Ability Scale. Structural equation modelling was performed using SPSS AMOS 19.0 to examine the path relationships among variables. Results Bivariate analyses showed that age was negatively correlated with suicidal attitude. In the final path model, caring stress had a positive effect on suicidal attitudes. Suicidal attitude and suicide care ability were highly positively correlated. Gender had a direct effect on caring stress, which indicated that female family caregivers experienced more stress from their role. Implications for practice: Mental health nurses could help family caregivers become aware of the emotional pain that suicidal people experience and then promote their positive attitudes towards their suicidal relatives. Furthermore, family caregivers could increase their ability to care for their suicidal relatives, which could reduce the numbers of suicides. [ABSTRACT FROM AUTHOR]

Background: Low physical activity is common in systemic lupus erythematosus populations. Aim: To evaluate the effect of physical activity counselling on physical activity and the association between physical activity changes and changes in fatigue, quality of sleep, and quality of life in women with systemic lupus erythematosus. Methods: A randomized, controlled, single‐blind trial was conducted from March 2015 to August 2016. Seventy‐six women with systemic lupus erythematosus were randomly assigned to the intervention or control groups. The intervention group received three sessions of physical activity counselling at 1, 4, and 8 weeks and three telephone follow‐ups over 13 weeks. Outcome measures, which include daily steps, fatigue, quality of sleep, and the quality of life, were collected at baseline and 8 and 12 weeks. Results: The study showed that daily steps, quality of sleep, and vitality in the intervention group were significantly improved compared with those in the control group at weeks 8 and 12. Mental health was significantly improved only at week 8 in the counselling group. A positive correlation between physical activity changes and changes in vitality and mental health was observed. Conclusions: Physical activity counselling can improve physical activity. As physical activity increases, systemic lupus erythematosus women feel more energetic and happier. SUMMARY STATEMENT: What is already known about this topic? Patients with systemic lupus erythematosus (SLE) have inactive lifestyles, and few of them exercise regularly.Patients with SLE have poor aerobic fitness and muscle strength.Fatigue, poor sleep, and low quality of life are common in patients with SLE. What this paper adds? The five A's physical activity counselling model is feasible and can enhance SLE patients' physical activity levels.Vitality and mental health improvement are associated with an increase in physical activity. The implications of this paper: Health care professionals could provide physical activity counselling to SLE patients during every clinical visit.Health care professionals could encourage patients with SLE to use a pedometer as a monitor to record their daily steps. [ABSTRACT FROM AUTHOR]

Aim: The purposes of this study were to describe the degree of knowledge and explore the factors associated with knowledge of infertility among women of childbearing age with breast cancer. Methods: In this cross‐sectional study, we recruited women of childbearing age with a diagnosis of breast cancer who had completed chemotherapy at a hospital in Taipei from 2015 through 2016. Face‐to‐face interviews were completed with 201 (62%) of 324 eligible women, asking about sociodemographic variables, disease and treatment characteristics, fertility intention, and infertility‐related knowledge. Results: The result showed one in 10 women had thought about becoming pregnant after completion of breast cancer chemotherapy. The mean score of infertility knowledge among participants was low, especially for general knowledge. Women with higher levels of education had better knowledge scores. Fertility intention score, especially for the domain of the pregnant risk, was negatively associated with infertility knowledge score. Conclusion: Women with breast cancer lacked knowledge about infertility and underestimated the possibility of infertility. We suggest future patient education on infertility after cancer treatment and about reproductive technology in oncologic practice before treatment begins. SUMMARY STATEMENT: What is known about this topic? Women with cancer diagnosed during the reproductive age are interested in a subsequent pregnancy.Less than half of childbearing‐age women with cancer have a comprehensive discussion about the potential impact of cancer therapy on fertility with the oncology physician.Reproductive‐age women with breast cancer have gaps in their knowledge of fertility planning as breast cancer survivors. What this paper adds? One in 10 women had thought about becoming pregnant after completion of breast cancer chemotherapy.Most women with breast cancer lack sufficient general and cancer‐specific knowledge about infertility.Factors associated with knowledge of infertility are fertility intention and education level. The implications of this paper: Results offer oncological nurses an understanding of fertility needs and infertility‐related knowledge in childbearing‐age women with breast cancer.Clinical nurses should continue to assess fertility willingness and knowledge of infertility in women with cancer both before and after cancer treatments.Comprehensive education about fertility and infertility in Taiwan is suggested. [ABSTRACT FROM AUTHOR]

Background: Fatigue is associated with multidimensional factors in heart failure patients. Investigating longitudinal changes in fatigue and its association in patients undergoing cardiac surgery is needed to create interventions for improving fatigue during recovery. Aims: This study examined the trajectory of fatigue and its associated factors over time in patients undergoing cardiac surgery. Methods: This longitudinal study enrolled 125 patients undergoing cardiac surgery in northern Taiwan. Patients completed questionnaires before surgery, at discharge, and at 1, 3 and 6 months post‐discharge. Fatigue was measured using the General Fatigue Scale. Generalised estimating equation models were fitted to identify variables associated with fatigue over time. This study complied with the STROBE checklist. Results: The sample (mean age = 60.70 ± 10.42) was mostly male (68%). High fatigue was found in 73.6% of patients before cardiac surgery and significantly decreased over the six months after discharge. NYHA III/IV, lower haemoglobin level, more symptom distress, poor sleep quality, higher anxiety and depression and lower social and family support were significantly associated with an increase in fatigue levels over time. Compared with before discharge, decreases in sleep quality at 1, 3 and 6 months were significantly associated with an increase in fatigue levels (p <.001). The increases in social support (B = 0.20, p =.016) and family support (B = 0.37, p =.002) at 6 months were significantly associated with an increase in the fatigue scores. Conclusion: Fatigue was common and associated with symptoms, sleep quality, emotion and social support in patients undergoing cardiac surgery. In addition to symptom management, improving sleep quality and social support are important to manage fatigue for the long‐term care of patients undergoing cardiac surgery. Relevance to clinical practice: Patient education on symptom management, sleep hygiene and family support is suggested to improve fatigue in patients recovering from cardiac surgery. [ABSTRACT FROM AUTHOR]

Aim: Human immunodeficiency virus (HIV) stigma in people living with HIV is associated with depression and poor treatment adherence. The current literature lacks a Chinese instrument to measure HIV stigma in Taiwan. Thus, the purpose of this study was to develop an abbreviated Chinese translation version of Berger's HIV Stigma Scale. Methods: The instrument development process was guided by Brislin's Translation Model of establishment of construct validity and convergent validity and verification of reliability. Results: This study recruited 540 HIV‐infected adults (January‐November 2015). Data analysis using confirmatory factor analysis resulted in an 18‐item abbreviated Chinese version of Berger's HIV Stigma Scale, consisting with four factors: personalized stigma (seven items), disclosure concerns (three items), negative self‐image (four items), and concerns with public attitudes toward people with HIV (four items). The final model demonstrated a good fit. A positive correlation between HIV stigma and depression was found. The Cronbach α for internal consistency was 0.92. Conclusion: The 18‐item abbreviated Chinese version of Berger's HIV Stigma Scale demonstrated adequate reliability and validity to assess HIV stigma among Chinese people living with HIV. It is a feasible tool that allows for rapid assessment of HIV‐related stigma. SUMMARY STATEMENT: What is already known about the topic? People living with HIV experience challenges including unemployment, unavailability of rental housing, isolation, and alienation by friends and families. Prolonged experience of stigma may result in poor adherence to antiretroviral therapy.Berger's HIV Stigma Scale is a commonly used, valid instrument to measure HIV‐related stigma in people living with HIV. What this paper adds? In Taiwan, there is a lack of self‐report instrument to assess HIV‐related stigma in people living with HIV. Therefore, the authors developed an abbreviated Chinese version of Berger's HIV Stigma Scale for Chinese people living with HIV and established the psychometric properties.This study used confirmatory factor analysis (CFA) to verify effectiveness and test construct validity of the 18‐item abbreviated Chinese version of Berger's HIV Stigma Scale.This study revised Berger's 40‐item HIV Stigma Scale to an abbreviated 18‐item abbreviated Chinese version of Berger's HIV Stigma Scale to increase validity and to allow for rapid and effective assessment of HIV‐related stigma in people living with HIV. The implications of this paper: The 18‐item abbreviated Chinese version of Berger's HIV Stigma Scale has adequate reliability and validity to be used for Chinese people living with HIV.The 18‐item abbreviated Chinese version of Berger's HIV Stigma Scale is a feasible tool that allows for rapid assessment of HIV‐related stigma in Chinese people living with HIV.The 18‐item abbreviated Chinese version of Berger's HIV Stigma Scale assists clinicians to explore HIV‐related stigma in Chinese people living with HIV and to evaluate effectiveness of interventions in reducing the stigma. [ABSTRACT FROM AUTHOR]

Aims: The aim of the study is to compare the efficacy of an 8‐week pelvic floor muscle training program with surface electromyography feedback, performed in different body positions (supine, sitting, and standing), in women with stress urinary incontinence. Design This is a prospective observational study performed January 2014 to May 2016. Methods: The training program was performed by 110 women with stress urinary incontinence, each completing 4 individual training sessions. The main outcome was the electromyography activity of the pelvic floor muscles and of the synergistic abdominal muscles. Outcome measures were evaluated at 4 time points, namely at baseline and at 2, 4, and 8 weeks of training. Results: A notable effect of training was identified at week 2, which was sustained through to week 8. Training yielded a significant improvement in increased sustained voluntary contraction of the pelvic floor muscles in all 3 positions. The efficacy of training was influenced by the duration of training, age, body mass index, and history of vaginal delivery. Conclusion: Training of the pelvic floor muscles, with positive reinforcement by surface electromyography feedback of the pelvic floor muscles and of the synergistic abdominal muscles, was effective for the treatment of stress urinary incontinence in women and should be considered as a feasible option by healthcare providers. SUMMARY STATEMENT: What is already known about this topic? In women with stress urinary incontinence, the sudden loss of urine negatively affects their quality of life.Conservative treatment remains the mainstay for managing this condition, for which pelvic floor muscle training is regarded an effective treatment.Biofeedback provides positive reinforcement during pelvic floor muscle training and can be achieved via several methods including electromyography, manometry, or ultrasonography. What this paper adds? An 8‐week training program, using surface electromyography as feedback, was effective in reducing female stress urinary incontinence; the effect was notable after 2, 4, and 8 weeks of training.The program was effective when performed in supine, standing, and sitting positions, with the greatest improvement obtained in the supine position.The duration of training, age, body mass index, and history of vaginal delivery were significant factors influencing training outcome. The implications of this paper: Health care professions should be adept at evaluating the severity of stress urinary incontinence symptoms to provide the best treatment.Nurses should acknowledge the benefits of the pelvic floor muscle training with bio‐assisted surface electromyography feedback and encourage patients with stress urinary incontinence to consider the program.Factors that might influence the efficacy of the training, namely age, body mass index, and history of vaginal delivery, should be considered during treatment counselling and treatment. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate the support needs identified by Taiwanese breast cancer diagnosed mothers for themselves and their 6–12‐year‐old children for implementation in a support group. Background: Mothers with dependent children are burdened with diverse child‐centered concerns while battling breast cancer. A better understanding of the concomitant support needs of mothers and their children can yield tailored support for ill mothers and their children. Design: A qualitative descriptive study employing content analysis of collected data. Methods: Between February and June of 2020, semi‐structured individual interviews were conducted with 20 mothers who had been diagnosed with breast cancer in the last 2 years. Qualitative content analysis was used. This study followed the COREQ guidelines. Results: Ill mothers favoured a hybrid format for support groups, consisting of mother‐only, child‐only, and mother–child group sessions. The content analysis yielded four themes for mother‐only group sessions: (1) learning to reach out to children; (2) dealing with negative emotions; (3) how to say goodbye to children; and (4) resetting for the future. Three themes related to child‐only group sessions emerged: (1) emotional and health education; (2) getting along with a sick mother; and (3) preparing for uncertainty. The core theme for mother–child group sessions was relationship enhancement. Conclusion: The findings revealed that mother‐reported support needs of ill mothers and their children included support for improving children's emotional well‐being and mothers' emotional coping, preparing for uncertainty, and promoting intimacy in the mother–child relationship. Relevance to clinical practice: A relation‐focused approach to psychosocial support group development that allows mother–child mutual influences on each other's coping to be addressed bilaterally is suggested. Patient or public contribution: Mothers diagnosed with breast cancer were interviewed for data collection and invited to review and validate the synthesised data for enhancing the credibility of the study. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This study examined the changes in patients' parental functioning and the associated factors, including manic, depressive symptoms and social support from before discharge to 6 months post‐discharge. Background: For parents with bipolar disorder and major depression, parenting is a recovery factor for patients, but little research examines the dynamic parental functioning from acute hospitalisation to a remission stage. Design: A longitudinal design was used. The STROBE Checklist were used in presenting this research. Methods: Participants were inpatients with bipolar disorder or major depression (n = 33) recruited within one week before discharge from the acute psychiatric ward in Taiwan. Data on parental functioning was collected four times: before discharge (T1), the 1st (T2), the 3rd (T3) and the 6th (T4) months of post‐discharge. Baseline parental functioning before admitting to the acute word was retrospectively assessed at T0. The questionnaires included positive and negative domains of parenting practice, hypomanic/manic symptoms, depressive symptoms and social support. Generalised estimating equations were applied for data analysis. Results: The negative parenting domains (poor monitoring, inconsistent discipline) decreased during hospitalisation but increased at one month post‐discharge, except corporal punishment at 3‐months discharge. The positive parenting domains (parental involvement and nurturance/responsiveness) did not recovery to baseline. While clinical symptoms remained stable during 6 months post‐discharge, social support decreased at 3 and 6 months post‐discharge. Higher depressive symptoms and low social support were associated with positive parenting domains but not related to negative parenting domains. Manic symptoms were not associated with positive or negative parenting domains. Conclusions: Positive parenting domains did not fully return to the usual situation during 6 months post‐discharge. Relevance to clinical practice: Parenting functioning recovery program targeting at the impacts of depressive symptoms on the parenting functioning and insufficient social support is needed from hospitalisation to post‐discharge. [ABSTRACT FROM AUTHOR]

Aim: To examine the mediating effect of sleep quality on the relationship between lower urinary tract symptoms and health‐related quality of life in women with type‐II diabetes. Design: A cross‐sectional study. Methods: A study questionnaire comprising three valid instruments was used to obtain data about lower urinary tract symptoms, sleep quality and physical and mental component summary health‐related quality of life between July 2017 and December 2018 (n = 343). Pearson's correlation coefficients were estimated initially to examine the relationships between the three variables. Multiple regression models were tested using a regression‐based approach Hayes PROCESS macro for SPSS to examine the significance of proposed mediation effects. Results: Most participants experienced at least one urinary symptom (n = 268, 78.1%). The total number of types of lower urinary tract symptoms experienced by participants was significantly inversely correlated with physical and mental component summary health‐related quality of life, and sleep quality. Participants' sleep quality was significantly correlated with physical and mental component summary health‐related quality of life. The relationships of lower urinary tract symptoms with physical and mental component summary health‐related quality of life were, respectively, fully and partially mediated by sleep quality. Conclusion: Sleep quality played a mediating role on the relationship between lower urinary tract symptoms and health‐related quality of life. Our findings could lead to improvements of diabetes care in nursing and healthcare practices. Impact Understanding the role of sleep quality in the adverse effects of lower urinary tract symptoms on health‐related quality of life contributes to the development and delivery of appropriate strategies to promote optimal health‐related quality of life. We recommended including assessments of lower urinary tract symptoms, sleep and health‐related quality of life in routine diabetes management. Nurses and healthcare professionals should concurrently reduce lower urinary tract symptoms and improve sleep to achieve this population's optimal health‐related quality of life. Patients or public contribution: We recruited a sample of older women with type‐II diabetes at the endocrinology and metabolism outpatient departments of two hospitals. Study participants provided responses on the study questionnaires. The two hospitals provided needed supports (e.g., height/weight scales, suitable places for interview) during the data collection process. [ABSTRACT FROM AUTHOR]

Aim and objectives: To explore factors associated with nurses' willingness and competency to provide anticipatory grief counselling for the family caregivers of patients with terminal cancer. Background: Family caregivers often experience anticipatory grief due to the imminence of a loved one's death. However, few studies have identified factors associated with nurses' willingness or competency to provide anticipatory grief counselling for the family caregivers of patients with terminal cancer. Methods: This descriptive correlational study recruited a convenience sample of nurses from cancer‐related wards at a regional teaching hospital in Taiwan. The Anticipatory Grief Counseling Willingness Scale and Anticipatory Grief Counseling Competency Scale were employed. This cross‐sectional study followed the STROBE checklist. Results: The nurses' average scores for willingness and competency to provide anticipatory grief counselling for the family caregivers of patients with terminal cancer were 44.28 ± 8.36 and 171.84 ± 30.83, respectively. Multivariate linear regression revealed that interest in participating in anticipatory grief counselling for the family caregivers of patients with terminal cancer was significantly associated with the nurses' willingness to provide such counselling. Similarly, their willingness to provide such counselling was significantly associated with their counselling competency. Conclusions: Nurses' willingness and competency to provide anticipatory grief counselling for the family caregivers of patients with terminal cancer can be enhanced through in‐service education programmes, including bedside teaching and scenario simulation. Relevance to clinical practice: To improve nurses' competency in anticipatory grief counselling for the family caregivers of patients with terminal cancer, factors related to nurses' willingness to provide such grief counselling must be addressed. Diverse strategies of in‐service education can be adopted to promote nurses' competency in anticipatory grief counselling. [ABSTRACT FROM AUTHOR]

Aim and Objectives: This study explored the effect of transdermal buprenorphine on quality of life and six symptoms in cancer patients with pain. Background: Transdermal opioids offer advantages over traditional routes of administration. The impact of transdermal buprenorphine on quality of life for patients with cancer in Asian populations is unknown. Design: This study employed a single‐arm observational repeated measures design. Cancer patients with pain were evaluated prior to treatment (baseline). Over a 4‐week treatment period, quality of life and symptoms were assessed at 2 and 4 weeks. This study adhered to the recommendations of STROBE guidelines. Methods: This multi‐site study was conducted in six hospitals located across northern, middle and southern Taiwan. Adult cancer patients whose pain was previously stable with opioid analgesics and, based on clinical judgement, were able to convert to transdermal buprenorphine treatment were invited to participate. Quality of life was measured with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ‐C30). Results: Generalised estimating equations showed participants who completed at least one follow‐up measurement (N = 80) over 4‐weeks had a significant improvement in overall quality of life. Functional status only improved for social functioning. However, symptom severity decreased significantly for nausea/vomiting, pain, insomnia and constipation. Conclusions: The study provides initial evidence supporting transdermal buprenorphine for providing beneficial effects of improving quality of life and reducing severity of symptoms in Asian patients with cancer. Relevance to clinical practice: The findings of this study can inform the clinical practice that the use of transdermal buprenorphine in cancer patients with pain may also reduce the severity of other symptoms and improve overall quality of life. Trial registration details: This study was registered in ClinicalTrials.gov. Identifier: NCT04315831. [ABSTRACT FROM AUTHOR]

Aims and objectives: To determine whether interventions that use the Specific Thematic Nursing Care Action Modules (STNC‐AM) platform improve patients' psychological health over a two‐month period. Background: Stroke survivors often are left with a disability after a stroke, which can have an impact on their physical and mental health. Therefore, it is necessary for stroke patients to have tailored programmes in the face of post‐stroke mental health concerns and the need for care information. Design: A non‐randomised controlled pilot study was conducted. Methods: Participants included 44 post‐stroke patients at a medical university hospital, between 1 August 2019–28 February 2021, of whom 24 were assigned to the control group and 20 were assigned to the intervention (STNC‐AM). Data were analysed on an intention‐to‐treat basis. We used the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist (case–control studies) for this study. Results: There were no statistical differences between the two groups at baseline. At the end of two months, however, the scores for resilience, depression and positive factors illness representation were statistically different between the two groups (p <.05). The results of the generalised estimating equation model analysis indicated that resilience and anxiety remained more significant in decreasing depression in the intervention group than in the control group. Conclusion: This preliminary trial suggests that, although action modules may be associated with a decrease in depression post‐stroke, part of this effect was likely associated with an increase in resilience and a decrease in anxiety of the patients. Relevance to clinical practice: The STNC‐AM platform provides a coaching platform that helps patients and caregivers to be effective and accessible. [ABSTRACT FROM AUTHOR]

Aims and objectives: This study investigated the factors of pressure injuries in patients in intensive care units (ICU). Background: Pressure injuries among patients in ICUs can be prevented by the early assessment of risk factors and taking appropriate preventative measures. Design: A retrospective study. Methods: ICU patients who suffered from pressure injuries between January 2016 and August 2018 at a hospital in Taiwan were selected. Patient medical histories and data associated with pressure injuries and medical treatment were collected from electronic medical records. A total of 256 patients were included in our analysis. The study adhered to the STROBE checklist. Results: A multivariate model of multinomial logistic regression analysis indicated that when compared to Stage 1 pressure injuries, Stage 2–4 pressure injuries were associated with albumin levels. Patients with lower albumin levels were at greater odds of Stage 2–4 pressure injuries than Stage 1 pressure injuries. In addition, when compared to unstageable pressure injuries or deep tissue injuries, Stage 1 pressure injuries were associated with the use of fentanyl and haemoglobin levels. Patients using fentanyl were more likely to suffer from unstageable pressure injuries, and those with lower haemoglobin levels were more likely to suffer from unstageable pressure injuries or deep tissue injuries. Conclusion: When patients were simultaneously on ventilators and taking midazolam or fentanyl, the incidence of pressure injuries with greater severity became higher. Furthermore, ICU patients with lower albumin and haemoglobin levels were more likely to suffer from pressure injuries of greater severity. Relevance to clinical practice: For critically ill patients on ventilators, it is recommended to devise a means of assessing each patient daily as well as systematically reduce their dosage of midazolam or fentanyl. Furthermore, regularly monitoring albumin and haemoglobin levels to understand their nutritional status is necessary. [ABSTRACT FROM AUTHOR]

Aims: To compare nurses' non‐optimal eating behaviours across different shifts, to examine whether non‐day shifts were related to deviation from optimal dietary behaviours compared with day shifts and whether such deviation was related to non‐optimal macronutrient intake. Design: This is a 4‐day intensive longitudinal study. Methods: A convenience sample of hospital nurses was recruited in Taiwan. From September 2018 through January 2019, 120 participants completed 4‐days of 24‐h dietary recalls. One‐way ANOVA and Kruskal–Wallis H test were used to compare differences in energy and macronutrient intake and frequency of meals and snacking, respectively. Generalized linear regressions examined (1) the associations between shiftwork schedules and non‐optimal eating behaviours and (2) associations between non‐optimal eating and high energy contribution of non‐optimal macronutrients. Results: Nurses consumed less energy on evening and night shifts compared with day shifts. However, energy intake from snacking was higher on evening and night shifts relative to day shifts. Nurses consumed less meals but had higher snacking frequency on non‐day shifts. In addition, high energy intake from snacking was positively associated with high energy intake from saturated fat. Conclusions: Nurses were more likely to have non‐optimal eating behaviours on non‐day shifts, which may contribute to an increased intake of saturated fat; thus, increasing their risk of chronic diseases. Strategies to improve non‐day shift nurses' non‐optimal eating behaviours may be beneficial to their health. Impact Shiftwork is known to affect nurses' eating behaviours; however, which shift is associated with unhealthy eating remains inconclusive. Despite lower energy intakes, nurses had higher intake by snacking on evening and night shifts. High snacking intake was associated with a high intake of saturated fat. Hospitals can increase the availability of healthy foods on evening or night shifts, which may improve non‐day shift nurses' non‐optimal eating behaviours. [ABSTRACT FROM AUTHOR]

Design: This study applied a cross‐sectional, descriptive correlational design. Aims and objectives: The purpose of the study was to examine the relationship between cognitive function and self‐reported antihypertensive medication adherence in middle‐aged and older hypertensive women. Background: Although medication adherence is an essential key for preventing complications from hypertension, poor medication adherence is common among middle‐aged and older hypertensive women. Taking medications involves a cognitive process. Little is known about the contribution of cognitive function to adherence to antihypertensive medication in middle‐aged and older women. Methods: This study used a convenience sample of 137 women aged ≥50 years recruited from a medical centre in southern Taiwan. Participants completed a survey of demographic and clinical information and self‐reported medication adherence, and received cognitive function tests. Hierarchical regression analyses were used to evaluate the association between cognitive function and medication adherence. This study followed the STROBE guidelines. Results: More than one‐fourth of the women (27%) reported poor adherence. Women with poor adherence appeared to have a significantly lower memory than women with good adherence. Memory was positively associated with antihypertensive medication adherence after controlling for age, blood pressure and duration of hypertension. Working memory, executive function and psychomotor speed were not significantly related to antihypertensive medication adherence. Conclusions: Reduced memory function was associated with poorer antihypertensive medication adherence among middle‐aged and older women. Middle‐aged and older women with hypertension and poor memory performance are at risk of poor medication adherence. Future prospective studies examining the causal relationship between cognitive function and antihypertensive medication adherence are warranted. Relevance to clinical practice: Nurses could evaluate the memory of middle‐aged and older hypertensive women when assessing antihypertensive medication adherence in clinical practice and provide relevant interventions. [ABSTRACT FROM AUTHOR]

This study aimed at developing predictive models for Salmonella, Listeria, and E. coli in lettuce iceberg (Lactuca sativa) locally grown in Taiwan. The models were developed under constant temperature levels (5, 10, 15, 20, and 25°C) and validated under dynamic temperature conditions (18°C for 4 h, 7°C for 48 h, 23°C for 4 h). The result showed that (1) all strains were unable to grow at 5°C except for standard strain of Listeria obtained from the BCRC and (2) the growth rate of locally isolated strains of Salmonella and Listeria was higher than the standard one at certain temperature levels and lower than the growth rates of E. coli. The findings in this study enhance our understanding about the growth variability between Salmonella, Listeria, and E. coli strains on vegetables locally grown in Taiwan and may be used to improve the management of proper storage temperature in the lettuce supply chain in this country. Considering the temperature recommendation for refrigerated food in Taiwan, the findings in this study therefore recommend that fresh vegetables (e.g., lettuce) should be stored at 5°C or lower to prevent the rapid growth of these microorganisms. Finally, the developed models can be used in the assessment of the microbiological risk of Salmonella, Listeria, and E. coli contamination in lettuce locally grown in Taiwan. Practical Application: This study developed predictive models describing the growth of Salmonella, Listeria, and E. coli in lettuce locally grown in Taiwan. The models developed in this study can be used in quantitative microbial risk assessment. [ABSTRACT FROM AUTHOR]

Aims: The study compares the differences in self‐care knowledge, self‐efficacy, psychological distress and self‐management between patients with early‐ and end‐stage chronic kidney disease (CKD), and predicts the influential factors of self‐management. Design: A cross‐sectional study. Methods: A total of 185 subjects by using convenience sampling from one teaching hospital were collected. The research instruments included the Chronic Kidney Disease Self‐Care Instrument Knowledge, the Chronic Kidney Disease Self‐Efficacy Instrument, the Hospital Anxiety and Depression Scale, and the Chronic Kidney Disease Self‐Management Instrument. Descriptive statistics is used frequency, percentage, mean and standard deviation. Inferential statistics is used independent t‐test, one‐way ANOVA and multiple linear regression analysis. STROBE checklist was used as the guideline for this study. Results: Our results showed that a significant difference was found in the age (p = 0.005), systolic pressure (p =.006), self‐care knowledge (p =.011) and depression level (p =.003) between patients with early‐ and end‐stage CKD. Furthermore, patients with early‐stage CKD have less self‐care knowledge and lower depression levels compared with patients with end‐stage CKD. However, self‐efficacy is the most significant predictor of self‐management for patients with early‐ and end‐stage CKD. For patients with early‐stage CKD, self‐efficacy explained 69.1% of the variation in self‐management. Conclusion: According to our results, the management of depression in patients with CKD may improve their outcomes. Improving self‐care knowledge of patients with end‐stage CKD may improve their self‐management. Therefore, our findings suggest various interventions with different necessary and prioritised precision care at early‐ and late‐stage of CKD. Relevance to clinical practice: Nurses should strive to improve the self‐care knowledge of patients with early‐stage CKD to delay the progression of the disease to end‐stage. Screening for depression among patients with end‐stage CKD is relevant, and these patients should be referred to professional counsellors when necessary. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To investigate the characteristics and prevalence of demoralisation syndrome among heart transplantation patients in Taiwan. Background: Patients with end‐stage heart failure who have undergone cardiac transplantation are at risk of demoralisation syndrome. Demoralisation syndrome has been studied in cancer populations, but our understanding of the syndrome among heart transplant recipients is limited. Design and Methods: The study adopted a cross‐sectional design and analysed the baseline data from a longitudinal study with cardiac transplant patients at a heart centre in northern Taiwan. A structured questionnaire, namely the Demoralization Scale‐Mandarin Version (DS‐MV), was used to assess demoralisation syndrome. Hierarchical regression was applied to determine the predictors of demoralisation. Reporting was consistent with the STROBE checklist. Results: There were a total of 84 participants with an average age of 51.9 years and a time since heart transplantation of around 4.1 years. Among them, the prevalence of demoralisation syndrome was 35.8%, and 57.1% coped well with stress. In addition, on the DS‐MV, participants tended to choose sentences with positive rather than negative wording. Our data showed that cardiac transplant recipients with stress have higher possibility suffering from demoralisation syndrome; poor renal function and those who cannot relive from stress are predictors for loss of meaning. Conclusions: Chinese individuals tend to hide their weaknesses; nevertheless, demoralisation syndrome among cardiac transplant recipients, as related to stress status and kidney function, is still remarkable. Relevance to clinical practice: Since demoralisation is preventable, further research on this phenomenon in the cardiac transplant population is warranted and needs to be developed. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To examine the current status of dementia care competence of nurses working in acute care settings as well as the relationship between competence and demographic attributes. Background: Most people with dementia are older individuals when they are admitted to unfamiliar acute care settings for treatment, and they are prone to displaying BPSD. If nurses working in acute care settings are not sufficiently competent in dementia care, providing proper patient care is difficult. Design: The study used a one‐sample descriptive‐correlation design. Methods: This study enrolled nurses at two medical centres in southern Taiwan as the research participants and performed a stratified random sampling according to the units where they served. The Dementia Care Competence Scale was used for data collection. An independent samples t test, ANOVA and Pearson's product–moment correlation were performed for data analysis (See STROBE). Results: A total of 308 valid questionnaires were collected. The results showed that dementia care competence of nurses working in acute care settings was moderate. In particular, they had insufficient knowledge of the special needs related to dementia and lacked the skills and patience necessary for identifying, preventing and managing BPSD. Additionally, although the nurses tended to have a positive attitude, they seldom communicated with people with dementia. This study also found that dementia care competence was better in nurses who were older, who had more seniority, who had taken care of people with dementia for a longer period of time and who had received training in dementia care. Conclusions: Dementia care training topics for nurses working in acute care settings should include palliative care for dementia, skills for managing behavioural and psychological symptoms of dementia and communication techniques for improving person‐centred care. Nurses should also be encouraged to maintain a warm, friendly attitude when providing patient care. Relevance to Clinical Practice: Continuing education in managing behavioural and psychological symptoms of dementia is necessary for currently practicing acute care nursing staff and should be developed according to the staff's educational background and needs. [ABSTRACT FROM AUTHOR]

Aims: To examine the psychometrics and measurement invariance of the Short‐Form Health Literacy 12‐item questionnaire (HL‐SF12) among Vietnamese and Indonesian married immigrants. Design: A cross‐sectional survey design. Methods: In total, 1171 Vietnamese and Indonesian married immigrants were enrolled between September 2019 and December 2019. An exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to verify the structural validity of the suggested factor structure. The multiple‐group CFA (MGCFA) used a series of hierarchical nested‐in models as a measurement invariance test which confirmed the adequacy of the model fit at each stage. Results/Findings The Kaiser–Meyer–Olkin coefficient was 0.898, and the Bartlett test of sphericity was statistically significant (χ2[66] = 1965.97, p < 0.01). According to a scree plot and Kaiser's criterion for eigenvalues of >1, the EFA explained 61.6% of the total variance and confirmed three theoretically supported factors of health care, disease prevention and health promotion. The 12 items showed factor loadings of >0.4 and four items were in each subscale. The CFA showed adequate structural validity, including a relative chi‐squared/degrees of freedom (X2/df) of 2.01, a comparative fit index (CFI) of 0.98 and a root mean square error of approximation (RMSEA) of 0.04 (95% confidence interval [0.03, 0.05]) in married immigrants. For the measurement invariance, a change in the goodness‐of‐fit measures did not exceed 0.02 for the RMSEA or 0.01 for the CFI. The results indicated Cronbach's α values of 0.87 for the HL‐SF12 scale in Vietnamese and Indonesian combined samples (n = 1171). A t‐test showed that the HL‐SF12 and its three subscales were unable to significantly differentiate between Vietnamese and Indonesian groups (all p > 0.05). Conclusions: The HL‐SF12 scale showed acceptable theoretically supported structural validity, equivalent measurement invariance and reliable internal consistency among Vietnamese and Indonesian married immigrants. Measurements of immigrants' HL using the HL‐SF12 could be integrated into future immigrant health policies. Impact As the first study of the measurement invariance of the HL‐SF12 instrument among immigrants. Related factors of immigrants' HL can be further explored to increase immigrants' health and empowerment. [ABSTRACT FROM AUTHOR]

Aims: To describe a nurse‐led multicentre randomized controlled trial protocol developed to evaluate the effectiveness and cost‐effectiveness of a Chinese iSupport for Dementia program in Australia and Greater China including mainland China, Taiwan, Hong Kong and Macau. Design: A multicentre randomized controlled trial following the SPIRIT checklist. Methods: Participants in the study will be recruited from Australia and Greater China and will be randomly assigned to the intervention group or the usual care group. Interventions will include self‐learning of the iSupport program, virtual peer support and nurse program facilitator support for 6 months. Primary outcome measures will be the 12‐Item Short‐Form Health Survey. Secondary outcome measures will include: Revised Scale for Caregiving Self‐efficacy; Quality of Social Support Scale; Revised Memory and Behaviour Problem Checklist; the Quality of Life in Alzheimer's Disease‐Proxy; usages of care services; and cost‐effectiveness of the intervention. Outcomes will be measured at baseline, 6 months and 9 months from the baseline. Caregivers' experiences of the peer support will be explored. This project was funded by the National Foundation for Australia‐China Relations, Australian Government (Project ID: NFACR216). The total amount is $440,000 Australian dollars (or £ 236,231). Discussion: Approximately, 20% of people living with dementia in the world live in Australia and Greater China. Older Chinese are usually cared for by family caregivers at home due to the influence of Confucianism. However, free and online psychoeducation programs for this large cohort of caregivers are not available or accessible. The World Health Organization iSupport for Dementia is an evidence‐based online psychoeducation program for caregivers. Implementing a culturally adapted Chinese iSupport program will address this gap in supporting caregivers. Impact This study will provide research evidence on effectiveness and cost‐effectiveness of an online psychoeducation program for caregivers. Findings will inform policy and practice development. [ABSTRACT FROM AUTHOR]

Aims and objectives: This study's purpose was to identify the correlates of sleep quality in older adults with chronic disease. Background: Sleep quality is a common problem in older adults that may be affected by physical and mental status. Design: A cross‐sectional correlational design was employed. Methods: The study was conducted between July 2019 and April 2020 in a teaching hospital of southern Taiwan. The Geriatric Depression Scale, Pittsburgh Sleep Quality Index and Numerical Rating Scale were used to assess depression, sleep quality and physical pain respectively. Results: Of the 120 older adults (age >65 years) with chronic disease, the average Pittsburgh Sleep Quality Index score was 5.67. A total of 45.8% subjects had sleep disturbance. Older adults who were living with a partner and those who urinated at night were significantly more likely to report sleep disturbance. The presence of sleep disturbance was associated with greater levels of depression and higher levels of physical pain. Conclusion: Living with a partner, nocturia, physical pain and depression were associated with the presence of sleep disturbance in older adults with chronic disease. Relevance to clinical practice: The results of this study can help healthcare providers understand the factors associated with sleep disturbance in older adults with chronic disease, thereby facilitating the early resolution of sleep disturbance issues in this population. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effectiveness of a musical fitness programme (MFP) intervention in improving neuropsychiatric symptoms, depression, upper‐limb muscle strength and cognition of older adults with cognitive impairment in long‐term care (LTC) facilities. Background: Because of population ageing, the number of older adults with cognitive impairment has been increasing. The effectiveness of medications in treating cognitive impairment is limited; therefore, the global trend has been for non‐pharmacological treatments. However, intervention studies of MFPs on older LTC residents with cognitive impairment are scant. Design: This study adopted a quasi‐experimental design in accordance with the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) checklist. In total, 84 older adults with cognitive impairment were recruited from seven LTC facilities. The MFP was implemented from July–November 2019. Methods: The intervention group received the MFP, which was 50 min per session, twice a week for 12 weeks, whereas the comparison group received usual care. Neuropsychiatric inventory nursing home version, the Cornell scale for depression in dementia Chinese version, 30‐s arm curl test and Mini‐Mental State Examination were the outcome measures. Data were analysed using Chi‐square test, t test and repeated measure analysis of variance. Results: After the intervention, the scores of neuropsychiatric inventory and the Cornell depression exhibited significant differences over time between two groups (F = 3.6, p =.029; F = 5.96, p =.003, respectively). Nevertheless, 30‐s arm curl test and Mini‐Mental State Examination demonstrated non‐significant between‐group differences. Conclusion: The MFP can effectively reduce neuropsychiatric symptoms and depression in older adults with cognitive impairment in LTC facilities. To ensure a more robust evidence base, more research is warranted. Relevance to clinical practice: The MFP is a non‐pharmacological treatment that can be implemented to promote psychological well‐being among older adults with cognitive impairment in LTC facilities, and to indirectly reduce nursing staff burden. To assist nursing staff in providing this intervention, on‐the‐job training is needed. [ABSTRACT FROM AUTHOR]

Aims and objectives: The aims of the study were to (i) estimate the prevalence of frailty among older adults with type 2 diabetes, and (ii) investigate risk factors associated with frailty in the study group. Background: The high prevalence of frailty among older adults and its adverse health impacts including higher risks for physical disabilities and a higher mortality rate is quickly evolving to become an important public health issue. Design: A cross‐sectional design. Methods: Data were collected from the Clinical Diabetes Centre of our study group. Frailty was assessed using the Chinese version of the Tilburg frailty indicator. Other questionnaires included Activities of Daily Living, Mini‐Mental State Examination, Taiwan Geriatric Depression Scale and Instrumental Activities of Daily Living. Multivariable logistic regression was established to identify factors associated with frailty. The STrengthening the Reporting of OBservational studies in Epidemiology checklist was used preparing the manuscript. Results: A total of 248 subjects were recruited in this study, a total of 66 participants had frailty (26.6%). Our results showed that factors including age, number of chronic diseases, cerebrovascular accident, renal diseases, frequency of falling, frequency of hyperglycaemia, Activities of Daily Living, depression, Mini‐Mental State Examination, and Instrumental Activities of Daily Living ≧1 task disability were correlated with frailty in older adults with type 2 diabetes. After adjusting for confounding factors, multivariate logistic regression analyses showed a significant increase in the probability of frailty by 1.72‐times when comparing type 2 diabetes subjects with depression to those without depression. Conclusion: This study revealed that depression is a significant factor associated with the occurrence of frailty among older adults with type 2 diabetes. Relevance to clinical practice: Our results provided strong clinical evidence showing depression as an important factor associated with the risk of frailty in older individuals with type 2 diabetes. We recommend early detection via routine screenings for symptoms of depression during diabetes care to achieve early prevention or the delay of frailty and its implicated adverse health consequences. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate the relationships of sociodemographic factors, self‐stigma, glycaemic control (measured by glycated haemoglobin (A1C)) and self‐care behaviours in young adults with type 2 diabetes. Background: Young adults aged 25–44 years are in their most productive period. Once diagnosed with diabetes, this population tends to experience poor glycaemic control and perform poorly in self‐care activities. Such patterns may raise perceptions of self‐stigma and further decrease motivations to engage in self‐care behaviours in patients with diabetes. Design: A cross‐sectional, correlational research design. Methods: The STROBE guidelines for cross‐sectional studies were followed. A convenience sample of 115 participants was recruited from a medical centre in southern Taiwan. Instruments included the Self‐Stigma Scale–Chinese version and the Diabetes Self‐Care Behaviours Scale. Data were analysed using a three‐step hierarchical regression analysis and the Sobel test. Results: The average age of the participants was 36.7 years. Marital status, employment status, self‐stigma and A1C were significantly associated with self‐care behaviours, and these four variables explained 43.6% of the variance in self‐care behaviours. However, A1C (β = −.58, p <.001) was found to be the only determinant of self‐care behaviours in the last regression model. The Sobel test showed that A1C had mediating effects on self‐stigma and self‐care behaviours as well as employment status and self‐care behaviours. Conclusion: This study supports the interactive relationship among self‐stigma, employment status, glycaemic control and self‐care behaviours in young adults with type 2 diabetes. Strategies aimed at optimising glycaemic control can help reduce the effects of self‐stigma perceptions and employment status on the self‐care behaviours of such patients. Relevance to clinical practice: More effective educational programmes should be designed to improve glycaemic control, lower the effects of employment and decrease perceptions of self‐stigma to further motivate young adults to engage in better diabetes self‐care behaviours. [ABSTRACT FROM AUTHOR]

Aims: To examine the association of the timing and consistency of parent bedtime routines with infant night‐time sleep duration and variability. Design: This was a prospective observational study conducted between November 2012 and November 2016. Methods: Three hundred and twenty healthy 6‐month‐old infants were recruited from the well‐child clinics of a university‐affiliated hospital in northern Taiwan. Participating families provided sociodemographic, health and bedtime routine information. Infants wore an actigraph on the ankle for a week. General linear model analysis was performed with the frequency and timing of bedtime routines treated as the primary predictor variables of interest. Results: One hundred and ninety‐seven (61.6%) parents started the bedtime routine for infants after 9 PM, with 162 (50.6%) not having the exact same bedtime routine every night. In both crude and adjusted analyses, starting a bedtime routine after 9 PM was associated with shorter infant night‐time sleep duration (b = −23.55, p < 0.01). Infants with a bedtime routine of <3–4 nights per week were associated with more variable night‐time sleep duration than a bedtime routine of 5–6 nights per week (b = −7.81, p < 0.05) or every night (b = −8.47, p < 0.05). Conclusion: A bedtime routine of at least 5 nights a week and initiated no later than 9 PM was associated with longer and less variable night‐time sleep in infancy. Findings suggest that a consistent bedtime routine implemented in accordance with age‐appropriate bedtimes should be addressed as part of anticipatory guidance in the well‐child clinics. Future studies should include infant sleep variability as an outcome in addition to the conventional mean‐level sleep variable analyses to more thoroughly characterize bedtime routine effects. [ABSTRACT FROM AUTHOR]

Aims: Nursing students in Taiwan often study in interdisciplinary teams that must create healthcare products. Creativity is imperative for the students' success, but studies have not explored the relational precursors to team creativity in nursing education. Therefore, the relationship was examined between task interdependence, interaction behaviours (constructive controversy, helping behaviours and spontaneous communication) and creativity for nursing students on interdisciplinary teams in Taiwan to investigate whether high task interdependence moderates the correlations between interaction behaviours and creativity. Design: Descriptive, cross‐sectional, quantitative study. Methods: Participants were nursing students (N = 99) attending interdisciplinary capstone courses in 2‐ or 4‐year nursing programmes at a university for science and technology in Taiwan. Self‐report questionnaires were used to collect the students' demographics and perceptions of their teams' task interdependence, interaction behaviours and creativity between January 2018 and January 2019. Pearson's correlation coefficient revealed variable associations. SPSS PROCESS macro displayed moderating effects. Results: Task interdependence had significant positive correlations with all three interaction behaviours and team creativity. Each interaction behaviour also had significant positive correlations with team creativity. High task interdependence negatively moderated the relationships between team creativity and (a) constructive controversy, and (b) spontaneous communication, but not (c) helping behaviours. Conclusion: The empirically validated moderation model and study results suggest that nursing educators can foster creativity in their students by encouraging task interdependence and helping behaviours, and teaching students to build constructive controversy and spontaneous communication into their collaborative plans. Impact: In Taiwan, nursing students must demonstrate creativity in interdisciplinary capstone courses. Their ability to do so requires them to cooperate with students in other disciplines who have unique skills or knowledge. This study provides insights into the relational factors that may improve creativity for nursing students on interdisciplinary teams. [ABSTRACT FROM AUTHOR]

Aim and objectives: The aim of this study was to develop a theory to help guide patients with end‐stage renal disease to adapt to peritoneal dialysis. Background: Taiwan ranks first worldwide in end‐stage renal disease incidence and dialysis prevalence. Many patients cannot accept long‐term dialysis treatment and thus face several physical and psychological suffering. No theory has yet been developed to help guide patients with end‐stage renal disease to adapt to peritoneal dialysis. Design: A grounded theory approach was used in this study. Methods: A theoretical sampling was performed after interviewing 25 patients who had adapted to peritoneal dialysis at a medical centre in Taiwan from January 2018 to September 2018; data saturation was achieved. Data were analysed using open, axial and selective coding and while using the constant comparison technique. COREQ reporting guidelines were utilised. Results: A substantive theory was developed to help guide patients with end‐stage renal disease to adapt to peritoneal dialysis. The core category that emerged from the data collected was 'Confronting peritoneal dialysis to live and co‐exist with peritoneal dialysis'. Other key categories linked to and embraced in this core category were as follows: positive self‐regulation, regulation of daily life and the process of adaptation to dialysis method. Conclusion: The results could help healthcare professionals to better understand the process of end‐stage renal disease patients' adaptation to peritoneal dialysis, thereby facilitating patients' adaptation to dialysis in their daily life, enhancing their quality of life and improving the quality of medical care. Relevance to clinical practice: Healthcare professionals could use this theory as reference when providing care for peritoneal dialysis patients to assist them in adapting to life with peritoneal dialysis as soon as possible through positive self‐regulation, daily life adjustments and the process of adapting to the dialysis method. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the practice related to mobile instant messaging applications usage among home healthcare providers in Taiwan; and based on the unified theory of acceptance and usage of technology and perceived risk theory to examine the influencing factors. Background: Previous work has indicated the potential for using mobile instant messaging applications in chronic disease, disasters and public health emergencies. However, few studies have conducted to understand how healthcare professionals use them. Design: A cross‐sectional design was used in the study. Methods: A wide‐ranging empirical investigation was conducted in Taiwan. A total of 102 home agencies participated in this study, and 331 valid data were collected. The ODS guideline was followed. Results: 69% of the participants had used mobile instant messaging applications, with high functionality and interesting value can integrate various messages and contribute to adoption. Performance expectancy, effort expectancy, and social influence were significantly positively correlated with behavioral intention. The perceived risk had a significant negative correlation with performance expectancy and use behavior. Among the relevant influencing factors, different types of organization, job position, and institutional policy were related to significant differences in use behaviors. Conclusions: Our research reported on mobile instant messaging applications usage and behavioral intention among home healthcare providers. This study also highlighted the need to establish regulations within the applications and improve safety and security guidelines. Further research may extend the understanding of the organizations' influencing factors. Relevance to clinical practice: This study may help programmers, managers and policymakers improve their strategies for expanding usage of mobile instant messaging applications. [ABSTRACT FROM AUTHOR]