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AIMS AND OBJECTIVES To investigate the relationship of nurse practitioners' social support as well as other factors associated with perceived self-efficacy. BACKGROUND There is a growing demand for nurse practitioners in Taiwan, for whom self-perceived efficacy is associated with performance. Nevertheless, research on the self-efficacy and social support of nurse practitioners is limited. DESIGN This is a cross-sectional survey study. METHODS Questionnaires were distributed to nurse practitioners in seven hospitals in northern Taiwan from May 2015 to March 2016. In total, data from 335 (78% return rate) certified nurse practitioners were analysed. Social support was measured by the Multidimensional Scale of Perceived Social Support (MSPSS) and the Job Content Questionnaire (JCQ), and perceived self-efficacy was measured by the General Self-Efficacy Scale (GSE). Data were analysed by ANOVAs with post hoc test and multiple linear regression. RESULTS The mean score for self-efficacy was 27.60 ± 6.17. Support scores were 11.574 ± 2.37 for supervisors, 12.795 ± 1.92 for coworkers and 64.07 ± 10.16 for family, friends and significant others. nurse practitioners in the high monthly salary group had significantly higher self-efficacy than nurse practitioners in the medium and low monthly salary group (F = 8.99; p

Aims and objectives To evaluate the accuracy of the inpatient fall risk screening tool and to identify the most critical fall risk factors in inpatients. Background Variations exist in several screening tools applied in acute care hospitals for examining risk factors for falls and identifying high-risk inpatients. Design Secondary data analysis. Methods A subset of inpatient data for the period from June 2011–June 2014 was extracted from the nursing information system and adverse event reporting system of an 818-bed teaching medical centre in Taipei. Data were analysed using descriptive statistics, receiver operating characteristic curve analysis and logistic regression analysis. Results During the study period, 205 fallers and 37,232 nonfallers were identified. The results revealed that the inpatient fall risk screening tool (cut-off point of ≥3) had a low sensitivity level (60%), satisfactory specificity (87%), a positive predictive value of 2·0% and a negative predictive value of 99%. The receiver operating characteristic curve analysis revealed an area under the curve of 0·805 (sensitivity, 71·8%; specificity, 78%). To increase the sensitivity values, the Youden index suggests at least 1·5 points to be the most suitable cut-off point for the inpatient fall risk screening tool. Multivariate logistic regression analysis revealed a considerably increased fall risk in patients with impaired balance and impaired elimination. The fall risk factor was also significantly associated with days of hospital stay and with admission to surgical wards. Conclusions The findings can raise awareness about the two most critical risk factors for falls among future clinical nurses and other healthcare professionals and thus facilitate the development of fall prevention interventions. Relevance to clinical practice This study highlights the needs for redefining the cut-off points of the inpatient fall risk screening tool to effectively identify inpatients at a high risk of falls. Furthermore, inpatients with impaired balance and impaired elimination should be closely monitored by nurses to prevent falling during hospitalisations.

Nurses' turnover intention is not dichotomous; it may reflect intent to leave the profession, intent to leave a type of facility, or intent to leave a specific workplace. In a latent class analysis (LCA) of data from 186 licensed nurses (RNs and LPNs) recruited from 25 nursing homes (NHs) in Taiwan, we classified nurses into turnover intention subgroups based on seven questionnaire items and used a multilevel contrast analysis to characterize the subgroups according to demographic and facility factors, job demand, and job satisfaction. A multilevel probit model was used to examine how job demand and job satisfaction influenced subgroup membership. Three turnover subgroups were identified: high turnover intention (12%), middle turnover intention (57%), and low turnover intention (31%). The high turnover intention subgroup comprised the youngest nurses and had the lowest percentage of registered nurses (RNs); nurses in this subgroup had worked the longest at the current NH and had the greatest likelihood of working at a for-profit facility. Nurses in the middle turnover intention subgroup had the lowest likelihood of working at a for-profit facility. Nurses in the low turnover intention subgroup were primarily RNs and had the shortest work experience in the current facility. Nurses in the high and middle turnover intention subgroups reported lower intrinsic job satisfaction than those with low turnover intention. Extrinsic job satisfaction mediated the relationship between job demand and turnover intention subgroup assignment. The results of this LCA can help target interventions to address heterogeneity of turnover intention and ultimately lessen turnover.

Patient falls are a common, adverse event in hospitals that may result in economic and care burdens on the patient and his/her family afterward.To analyze the factors that relate to falls among inpatients and to estimate the associated days of hospitalization and medical costs.The present study used a retrospective matched case-control design to analyze inpatient fall data for 2009 to 2011 from a regional teaching hospital in northern Taipei. We matched fallers and controls according to gender, age ∓ 5 years, and ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) code. Data were analyzed using descriptive and inferential statistics.A total of 160 inpatients participated in the present study (80 fallers in the fall group and 80 nonfallers in the control group). The results revealed that fallers had more previous fall experiences and longer hospital stay than nonfallers. Multiple logistic regression analysis revealed that the risk factors that were significantly associated with inpatient falls included: no family accompaniment, use of more than 3 fall-related medications, and no intravenous catheter placement. Results further found that medical costs increased with the degree of injury. Third-degree injuries bore the highest post-fall medical costs of all of the injury-degree categories. The average medical cost for patients with third-degree injuries was 18,257 New Taiwan dollars.The findings provide a reference for hospitals to promote patient safety, to prevent the occurrence of inpatient falls, and, ultimately, to reduce fall-associated medical costs.住院病人跌倒事件之原因分析及醫療成本.跌倒是醫院中常見的不良事件，但病人一旦跌倒後，可能會造成個人、家庭在經濟和照護上的負擔。.分析住院病人發生跌倒之原因及跌倒後之住院天數與醫療處置費用。.本研究為回溯性配對個案控制設計。資料來源為北部某區域醫院，2009年至2011年間住院且發生跌倒的病人，而對照組為無跌倒的病人，以性別、年齡∓ 5歲、主診斷ICD-9-CM（International Classification of Diseases, Ninth Revision, Clinical Modification）相同者為配對條件。資料統計方法包括描述性與推論性統計。.本研究共收160位住院病人（跌倒組80位及對照組80位）。結果發現住院期間跌倒的病人，有過去跌倒經驗與平均總住院天數較對照組多。經多項式羅吉斯迴歸分析後，與住院病人跌倒之三個危險因子為：無陪伴者、有使用易跌倒藥物≥三類及無點滴注射者。本研究也發現，隨著跌倒後之傷害級數增加，其醫療處置成本支出也隨之增加，其中，又以三級傷害程度的醫療處置費用最多，佔75.6%，其平均每位跌倒的醫療成本約新台幣18,257元。.本研究結果能作為未來醫院在推動病人安全與預防病人跌倒之參考，以減少額外的醫療成本支出。.

Despite the fact that regular physical activity is known to improve physical health and reduce absenteeism and perceived job strain, healthcare professionals currently perform inadequate physical activity.To understand and compare the differences in stages of physical activity among nurses, physicians, and allied healthcare professionals.A cross-sectional questionnaire was used to survey nurses, physicians, and allied healthcare professionals who worked at four branches of a hospital in Taiwan. Data were collected using the physical activity stage of change questionnire. Data were analyzed using descriptive analysis, Chi-square test of homogeneity of proportions and a posteriori comaparisons, and multinominal logistic regression analysis.Of the 3,260 questionnaires administrated, 2,001 valid questionnaires were returned for an effective response rate of 61.4%. In total, 1,497 (74.8%) of the nurses, 241 (12.0%) of the physicians, and 263 (13.1%) of the allied healthcare professionals completed the questionnaire. The results revealed that most of the physicans and allied healthcare professionals were in the preparation stage, while most of the nurses were in the precontemplation stage. Multinominal logistic regression analyses showed that, using the precontemplation stage as a reference value, the odds of being in the contemplation stage were lower among participants who were nurses or male or who had a master's or doctoral degree (p.05). Further, the odds of being in the preparation stage were lower among nurses (p.01). The odds of being in the maintenance stage were higher among participants that: lived in the Taitung area, were male, or were single (p.01).The findings provide valuable references for future hospital leaders to develop effective individual physical activity programs for healthcare professionals.比較護理人員、醫師及其他醫事人員身體活動階段之差異.規律的身體活動雖然可促進醫事人員的健康、降低曠班及工作緊張感，但大部分醫事人員的活動量是不足的。.瞭解與比較護理人員、醫師及其他醫事人員之身體活動階段的差異。.本研究設計採橫斷式問卷調查法，以臺灣某醫院四院區之護理人員、醫師及其他醫事人員為研究對象。以身體活動階段問卷表為研究工具。資料統計分析方法包含：描述性統計分析、卡方百分比同質性考驗及事後比較、多項式邏輯斯迴歸分析。.本研究共發出問卷3,260份，有效回收問卷2,001份，有效問卷回收率為61.4%。本研究共收集1,497名（74.8%）護理人員、241名（12.0%）醫師及263名（13.1%）其他醫事人員。研究結果顯示，醫師與其他醫事人員的身體活動階段均以準備期居多；而護理人員身體活動階段則以無意圖期居多。以無意圖期為參考值，多項式邏輯斯迴歸分析醫事人員身體活動階段傾向之可能因素顯示，護理人員、男性、具碩博士學歷者，其身體活動階段處於意圖期的勝算較低（p.05）；護理人員處於準備期的勝算較低（p.01）。臺東院區、男性及未婚者處於維持期的勝算較高（p.01）。.本研究結果可作為未來醫院領導者發展醫事人員個別化身體活動計畫方案之參考，以促進其健康。.

Aims To investigate the mediating effect of work-to-family conflict on the relationship between job satisfaction and turnover intention among licensed nurses in long-term care settings. Background The considerable research on turnover in long-term care has primarily focused on the impact of job satisfaction on turnover intention. Given the well-documented high turnover rate in nursing home staffing, dissatisfaction is expected to continue. Alternatives (e.g. reduction in work-to-family conflict) for reducing turnover under the circumstance of job dissatisfaction have not been investigated extensively. Design A cross-sectional mailed survey. Methods A convenience sample comprising 200 nurses from 25 private nursing homes in Central Taiwan was created. Data were collected from nurses about their level of turnover intention, job satisfaction and work-to-family conflict in 2012. A composite indicator structural equation model was used to examine the mediation model of this study. Results Overall, 186 nurses (93%) returned the completed questionnaires. Consistent with published research from other countries, turnover intention in our study was significantly and negatively associated with job satisfaction and significantly and positively associated with work-to-family conflict. In addition, job dissatisfaction indirectly influenced turnover intention through high work-to-family conflict. Conclusion Findings from this study indicate the importance of work-to-family conflict to nurse turnover. While work setting has a strong, well-documented influence on job satisfaction, limiting job satisfaction efforts to work setting improvements may not yield the hoped-for results unless work-to-family conflict is also considered and addressed.

Nurses' turnover intention is not dichotomous; it may reflect intent to leave the profession, intent to leave a type of facility, or intent to leave a specific workplace. In a latent class analysis (LCA) of data from 186 licensed nurses (RNs and LPNs) recruited from 25 nursing homes (NHs) in Taiwan, we classified nurses into turnover intention subgroups based on seven questionnaire items and used a multilevel contrast analysis to characterize the subgroups according to demographic and facility factors, job demand, and job satisfaction. A multilevel probit model was used to examine how job demand and job satisfaction influenced subgroup membership. Three turnover subgroups were identified: high turnover intention (12%), middle turnover intention (57%), and low turnover intention (31%). The high turnover intention subgroup comprised the youngest nurses and had the lowest percentage of registered nurses (RNs); nurses in this subgroup had worked the longest at the current NH and had the greatest likelihood of working at a for-profit facility. Nurses in the middle turnover intention subgroup had the lowest likelihood of working at a for-profit facility. Nurses in the low turnover intention subgroup were primarily RNs and had the shortest work experience in the current facility. Nurses in the high and middle turnover intention subgroups reported lower intrinsic job satisfaction than those with low turnover intention. Extrinsic job satisfaction mediated the relationship between job demand and turnover intention subgroup assignment. The results of this LCA can help target interventions to address heterogeneity of turnover intention and ultimately lessen turnover.