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Improving nutritional intake contributes to maintaining the health and quality of life of the older population and reducing individual and societal healthcare costs. We collaborated with two community service hubs and a public health center in Taipei's Daan District to develop a personalized community-based health and nutrition program using service design. The design was validated through a model encompassing perceived usefulness, service experience, perceived value, and behavioral intention, analyzed using PLS-SEM modeling on 76 individuals. The results showed bidirectional influences among these factors. This study provides practical recommendations for formulating public health policies and health promotion programs for older adults. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, the well-being of older adults has been highlighted as a significant public health concern. In this study, we investigated the role of psychological resilience in mediating the relationship between positive self-perceptions of aging (SPA) and the subjective well-being (SWB) of community-dwelling older adults in Taiwan during the pandemic. We collected data through face-to-face interviews conducted from October 2021 to February 2022, involving 1,095 participants aged 50 years or above residing in a southern city in Taiwan. More than half of the study participants were female, aged 65 or older, and had less than a high school education. More than two thirds were married and/or living with partners. More than a third had two or more noncommunicable diseases. We calculated scores for SWB, positive SPA, and psychological resilience and examined correlations among the outcome and predictor variables. Our findings indicated that higher positive SPA was significantly associated with better SWB among community-dwelling older adults in Taiwan and that this association was mediated by psychological resilience. Specifically, after controlling for covariates, structural equation modeling (SEM) analysis revealed a significant main effect of positive SPA on SWB (b = 0.412, β = 0187, and p < 0.001), while bootstrap mediation analysis showed a statistically significant indirect mediating effect from positive SPA on SWB via psychological resilience (0.597, 95% bootstrap CIs = [0.445, 0.749], and p < 0.001). These findings highlight the potential importance of cultivating positive self-perceptions of aging and implementing resilience-centered interventions to promote well-being among Chinese older adults in the community. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) refers to permanent damage to the kidneys that occurs gradually over time. Further progression may be preventable depending on its stage. Purpose: This study was developed to evaluate the effect of a health literacy education program (HLEP) on mental health and renal functioning in patients with CKD. Methods: A single-blind, randomized controlled trial study was conducted. Data were collected from March 25 to December 18, 2021. Participants were randomly assigned to either the experimental group (n = 42), which received multidisciplinary care and HLEP, or the control group (n = 42), which received multidisciplinary care only. Data were collected at baseline (T1), Month 3 (T2), and Month 6 (T3), and the data included patient characteristics, estimated glomerular filtration rate, and responses to the Mandarin Multidimensional Health Literacy Questionnaire and Beck Depression Inventory. Results: After 6 months of the HLEP intervention, the results of generalized estimating equations analysis showed that, compared with the control group, the experimental group had significantly higher health literacy at Month 3 (β = −3.37, 95% CI [−5.68, −1.06]), significantly improved depression at Month 3 (β = −2.24, 95% CI [−4.11, −0.37]) and Month 6 (β = −4.36, 95% CI [−6.60, −2.12]), and a significantly higher estimated glomerular filtration rate at Month 6 (β = 5.87, 95% CI [1.35, 10.38]). Conclusions/Implications for Practice: The findings of this study may provide a reference for healthcare providers to educate patients with Stage 3–4 CKD using the HLEP. Positive effects on health literacy, depression, and renal function in patients with Stage 3–4 CKD were observed in the short term. Findings from this study may facilitate the implementation of multidisciplinary and nurse-led strategies in primary care to reinforce patients' health literacy, self-care ability, and adjustment to CKD as well as delay disease progression. [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]

Aims and Objectives. The purpose of this study was to investigate the prevalence of job burnout among Taiwanese nurses, specifically exploring the mediating role of workplace social support in the association between nurses' stressors and this burnout. Background. Nurses confront high-stress, high-stakes work environments due to evolving disease patterns and growing healthcare needs. The nurse-patient ratio in Taiwan is higher than in other countries, necessitating effective strategies to mitigate nurse burnout and enhance the quality of patient care. Design. A cross-sectional study design was employed. Methods. From January to April 2019, 500 nurses were recruited from a medical center in Kaohsiung City, southern Taiwan. Participants completed a questionnaire addressing workplace social support, stressors faced by nurses, and job burnout. Data were analyzed using descriptive statistics, one-way analysis of variance, t-test evaluations, Pearson's correlation analyses, and a structural equation model with maximum likelihood estimation. Results. The findings revealed that a portion of nurses experienced high rates of personal burnout (7.20%), work-related burnout (5.00%), and client-related burnout (4.80%). The relationships among workplace social support, nurses' stressors, and job burnout were all substantial, exhibiting correlation coefficients ranging from −0.318 to 0.828. The direct effect of nurse stress on job burnout was 0.551, comprising 90.7% of the cumulative effect. In contrast, the indirect effect of nurse stress on job burnout, considering workplace social support, amounted to 9.3% of the total effect, with a value of 0.056. Conclusions. The study underscored the importance of addressing job burnout among nurses in Taiwan. Workplace social support may function as a mediating factor in the relationship between nurses' stressors and job burnout. Implications for Nursing Management. The results suggest that healthcare administrators should prioritize workplace social support initiatives. These efforts could help identify and address nurses' stressors, promote work-life balance, and reduce nurse-patient ratios and work overload. [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]

The purpose of this study was to examine the association between age-friendliness of a city, loneliness and depression moderated by internet use among older people during the coronavirus disease 2019 (COVID-19) pandemic. The survey was from 'The 2020 Survey of Needs Assessment for a Safe Community and Age-Friendly City' in Xinyi District, Taipei, which was conducted by face-to-face interviews with community-based older adults who were aged 65 and above from one district of Taipei City from May to June 2020 (n  = 335). Partial least square structural equation modeling and the SPSS PROCESS macro were used for data analysis. Two domains of an age-friendly city (housing and community support and health service s) were found to be associated with reduced loneliness, while one (respect and social inclusion) was associated with decreased depression. The age-friendliness of cities mitigates depression through moderator (internet use) and mediation (loneliness) mechanisms. Although some age-friendly domains of the city reduced loneliness and depression directly, the age-friendliness–loneliness-depression mechanism held true only for older adults who used the internet and not for nonusers. Maintaining the age-friendliness of an environment is beneficial to mental health, and internet use is a necessary condition to gain optimum benefits from age-friendly initiatives. Policy suggestions are discussed. [ABSTRACT FROM AUTHOR]

BACKGROUND: Women with newly diagnosed ovarian cancer who receive chemotherapy experience distressing symptoms and reduced quality of life (QOL). Previous study results identifying changes in symptom distress and QOL over time are limited. OBJECTIVES: This study examined the trajectory of symptom distress and QOL among women with newly diagnosed ovarian cancer from before their first chemotherapy appointment to two weeks after completing six cycles of chemotherapy. METHODS: A longitudinal design was used to examine symptom distress and QOL in 36 participants across eight time points. Generalized estimating equation analyses identified how participants’ symptom distress and QOL changed over time. FINDINGS: Psychological symptom distress was highest at baseline and then decreased. Physical symptom distress increased at the second chemotherapy cycle. Similar results were found for QOL, with the lowest QOL reported after the fifth cycle. [ABSTRACT FROM AUTHOR]

Aims: To examine the relationships among effort ensuring robots' smooth operation (EERSO), time pressure, missed care, and nurses' turnover intention, and how robot performance moderates such relations. Background: Robots may reduce nurses' workload but typically still require some effort of nurses for robots' smooth operation. However, the negative impact of EERSO on nurses' workplace outcomes is unknown. Methods: This study used a two‐wave follow‐up design. Data were collected in a medical center in Taiwan, with first wave collected in 2019 and second wave collected between 2019 and 2020. A total of 331 participants were followed through the two waves. Results: EERSO is positively linked to missed care and time pressure. Time pressure is also positively linked to missed care and turnover intention. Positive robot performance weakens the positive link between EERSO and time pressure. Conclusion: Using robots may help reduce nurses' workload, but it also requires nurses' efforts to maintain robots' continuous operation, that is, EERSO. It may adversely impact nursing professional workplaces. Implications for Nursing Management: Nurse managers should reduce nurses' time pressure whilst suggest hospital managers to seek robots that require minimal EERSO. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore the subgroups of symptom severity and impact of their trajectories on quality of life in lymphoma survivors. Methods: Secondary data were analysed from a prospective study with four‐time measures: before treatment (T1), during treatment (T2), treatment completion (T3) and 10 weeks after treatment (T4). Data were analysed using descriptive statistics, group‐based trajectory model and generalised estimation equation. Results: Fifty nine of 61 participants completed three‐time measure (mean age = 60.43 years, male‐predominant). The changes in symptom severity over time were divided into two subgroups: slight‐stable group (n = 54, 89%) and mild‐fickle group (n = 7, 11%). Pain, tiredness and sleeping trouble were the predominant symptoms. The quality of life change in the slight‐stable group was significantly better than that of the mild‐fickle group (B = 13.35, SE = 3.53, p < 0.001). The overall quality of life at T2, T3 and T4 was better than it was at T1. Conclusion: The different trajectories of symptom severity significantly influenced quality of life changes in lymphoma survivors. Healthcare providers must be aware that there is a group of lymphoma survivors with relatively severe symptoms when newly diagnosed, compared to the opposite. More attention must be paid to this group, in addition to providing in‐time symptom management. [ABSTRACT FROM AUTHOR]

Our study aimed to explore the impact of different home‐ and community‐based service (HCBS) use patterns on older adults' physical function. The cohort data were drawn from two national datasets, the National Ten‐Year Long‐Term Care Plan 1.0 database and the National Health Insurance Program claims data. Participants were care recipients ages 65 and over, first evaluated and prescribed HCBS from 2010 through 2013 and evaluated again after 6 months (n = 32,392). Latent class analysis was used to identify subgroups with different HCBS use patterns. Multiple regression was used to examine the impact of different HCBS use patterns on change over time in disability related to activities of daily living (ADLs) and instrumental activities of daily living (IADLs). The analysis was stratified by respondents' levels of disability. Four subgroups of HCBS recipients were identified, with patterns of home‐based personal care, home‐based personal care and medical care, home‐based medical care and community care services. Older adults in the Home‐based MpC had significantly more improvement in both ADL (p < 0.05) and IADL (p < 0.001) scores compared with adults in the other three groups, while the community care group regressed the most. In the stratified analysis of the severely disabled, the IADL outcome of the Home‐based MC group was better than the home‐based PC group (p < 0.001). Study findings shed light on the benefits of promoting the use of integrated HCBS that combines personal and medical care, especially for community care services. [ABSTRACT FROM AUTHOR]

Aim: The study aimed to explore and compare stress, coping, professional identity and work locus of control of new graduate nurses among Shanghai, Hong Kong and Taipei. Background: The transition from a student to a staff nurse role is recognized as a stressful experience and can be a rough journey. Many newly graduated nurses find it challenging to cope with their new roles in their first few months. Methods: A cross‐sectional research was used in the study. This study was completed in Shanghai, Hong Kong and Taipei with newly graduated nurses working in hospitals. A total of 591 graduate nurses who had worked within 1 year in hospitals were recruited using convenient sampling. Data were collected using a structured questionnaire, including demographics, the occupational stress scale, the Chinese trait coping style questionnaire, the nurse professional identity scale and the work locus of control scale (Chinese version). Results: The newly graduated nurses in Shanghai had significantly lower (p < 0.05) work stress score (2.65 ± 0.67) compared with their counterparts in Hong Kong (2.99 ± 0.69) and Taipei (2.94 ± 0.60). Newly graduated nurses in Shanghai tended to choose positive coping to deal with stressful situations, whereas those in Hong Kong would be more likely to adopt negative attitudes (p < 0.05). The newly graduated nurses in Taipei had the lowest level of professional identity (3.25 ± 0.55, p < 0.05), and their work control tended to be external (46.13 ± 6.20). In contrast, those in Shanghai (52.75 ± 6.04) and Hong Kong (59.41 ± 7.29) tended to be controlled internally. Conclusions: The study findings revealed the differences among newly graduated nurses in Shanghai, Hong Kong and Taipei with their level of stress, coping, professional identity and work locus of control. Proper leadership, mentoring for newly graduated nurses, and emphasis on first aid nursing training, emotional management and management of stress in newly graduated nurse transition programmes were suggested. Implications for Nursing Management: By comparing the results in the three regions, we recommend that nursing managers promote the right leadership style. In addition to coaching, nursing managers can assign additional mentors to newly graduated nurses to help them supplement their clinical knowledge and skills with psychological support. These mentors can come from senior nurses or nursing managers working on less demanding tasks. In addition to the existing post transfer training programmes, new graduate nurses should also focus on emergency nursing training, emotional management training and stress management training. [ABSTRACT FROM AUTHOR]

More and more countries have become greying societies along with the burgeoning of digital devices. The older generation suffers from a sharp digital divide. Although the information infrastructure is fully developed, the elderly, not having grown up with it, tend to lack digital literacy and hold less intention to learn to use digital technologies. In the past, it was cable TV which pervaded the market and because of its long history of development became indispensable in the lives of the elderly. Recently, the maturity of Smart TV, provides us with an appropriate digital learning tool to assist seniors in Taiwan to improve their digital literacy. This is done utilising a digital remote control, designed to be a mixture of new and old technologies that offers seniors a high degree of familiarity. The study explore the effects of technology anxiety, digital feedback, and familiar technological skills on the adoption of digital devices by the elderly. In addition, a learning strategy compatible with the existing living environment of the elderly is proposed. The findings and recommendations for an effective approach to this problem are discussed as well as limitations and future research directions. [ABSTRACT FROM AUTHOR]

This study examined the typology of depressed mood trajectories and the associated factors over the first year postpartum among Taiwanese mothers. Data of 4332 mothers from a nationwide longitudinal study on child development and care were analyzed. Three classes of depressed mood trajectories were identified, two with lower initial scores and a decreasing trajectory and one with a higher initial score and an increasing trajectory. Subjective financial stress, perceived support, and marital satisfaction were significant in predicting mothers’ membership of the depressed mood trajectory classes. The results highlighted the individual susceptibility to the postpartum depressed mood among Taiwanese mothers. [ABSTRACT FROM AUTHOR]

The study aimed to apply the theory of planned behavior (TPB) to understand middle-aged women's behavior of physical activity (PA). We recruited 185 women between 45 and 64 years (mean: 53.2 ± 5.6) for this cross-sectional study. Participants complete demographic data and an exercise behavior questionnaire including attitudes, subjective norms, perceived behavioral control (PBC), and intention. Means, frequencies, and t-tests were used. To test TPB, we used structural equation modeling. Fit indices for this model demonstrate a good fit: chi-square and degree of freedom ratio X2/df = 2.14 (p =.34), goodness of fit =.97, comparative fit index =.99, root mean square error of approximation =.019, and Akaike information criterion = 28.14. Significant positive correlations between subjective norms and intention (ß=.18, p <.05) and between PBC and intention (ß=.48, p <.01). Women believed that close family and friends promoted their intention to perform PA. Increased PBC would positively enhance their intention. Findings showed that PBC was the strongest predictor. Enhancing women's PBC over their PA can improve their intention. Future researchers are encouraged to examine the barriers to and benefits of improving PBC so that a useful and effective intervention can be designed to promote PA. [ABSTRACT FROM AUTHOR]

Parties in a positive affective state generally boost creativity in social commerce. Superior institution-based trust may enhance multi-sided partners' positive affective reactions that lead to facilitate actively engagement for achieving the benefits of value co-creation. This study develops a conceptual model in which third-party assurance mechanisms and third-party logistics act as moderating constructs for examining the relation between agility and the network effect, both of which affect value co-creation. The results show that institution-based trust operates through the interaction between agility and multi-sided mechanisms in ensuring the value co-creation as it reinforces the network effects in the process. The findings of the study provide practical insights into how online merchants can reinforce the interaction between agility and multi-sided mechanisms so as to provide positive affective state and in turn enhance network effects and value co-creation that improves the social commerce platform as a whole. [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]

Aims and objectives: To explore the relationships among emotional distress, cognitive function and life satisfaction in people living with type 2 diabetes mellitus (T2DM), and to verify the mediating role of cognitive function. Background: People with T2DM face cognitive decline caused by age and disease complications. Emotional distress will reduce their life satisfaction, and cognitive function will also affect the life satisfaction, but whether cognitive function mediates the effect of emotional distress on life satisfaction has not been verified. Design: A cross‐sectional study. Methods: A total of 200 people living with T2DM in the community by convenience sampling were enrolled from November–December 2018. Data collection involved a demographic and disease characteristic questionnaire, Problem Areas in Diabetes Scale, Subjective and Objective Cognitive Function Evaluation and Life Satisfaction Questionnaire. Data analysis included descriptive statistics and structural equation modelling. This report followed the STROBE guideline. Results: The emotional distress and subjective memory complaints of cognitive function had a significant positive correlation, while both emotional distress and cognitive function showed significant negative correlations with life satisfaction. In addition, cognitive function completely mediated the relationship between emotional distress and life satisfaction. Conclusion: The cognitive function played a mediating role in life satisfaction and explains how emotional distress affects life satisfaction of people with T2DM. Therefore, it is suggested that diabetes nurses should early identify the decline of cognitive function, and to intervene at an early stage. Relevance to clinical practice: This study provides opinions on the mediating factors of cognitive function. Coping strategies and supporting resources to help the T2DM people to improve their life satisfaction are suggested. [ABSTRACT FROM AUTHOR]

Aims: To ascertain how professional turnover intention impacts nurse‐assessed care outcomes, including patient‐centered care and care quality. Background: Patient‐centered care and care quality are critical to care outcomes. However, we do not know whether care outcomes would be improved by reducing nurses' professional turnover intention. Design: We implemented a two‐wave correlational follow‐up design. Methods: This study was conducted in a large‐scale general in Taiwan during January and February 2018, and January and February 2019. We successfully obtained responses from 448 nurses in 2018 and subsequently followed up (in 2019). Most were women (97.5%), reflecting the profile of the local nurse population. Structural equation modeling was used to test hypotheses. Results: Our findings indicate that nurses' professional turnover intention is negatively related to nurse‐assessed, patient‐centered care. Nurses' professional turnover intention is also negatively related to all the five perceptions of nurse‐assessed care quality: that is, assurance, reliability, responsiveness, empathy, and tangibles. Moreover, years of working as a nurse is also positively related to nurse‐assessed, patient‐centered care and all the five perceptions of nurse‐assessed care quality. Conclusion: This study examined nurses' professional turnover intention as an antecedent of nurse‐assessed, patient‐centered care and care quality. Our study shows that professional turnover intention may predict care outcomes. Overall, our study suggests that professional turnover intention not only impacts workforce stability but also impacts health‐care outcomes. Impact: Our findings suggest that reduction of nurses' turnover intentions could benefit care outcomes. Hospital managers should know that nurses' turnover negatively impacts care outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To examine how robot‐enabled focus on professional task engagement and robot‐reduced nonprofessional task engagement are related to nurses' professional turnover intention. Design: We adopted a two‐wave study design. Methods: We collected the first wave of data in a large hospital in Taiwan during October and November 2019 and the second wave between December 2019 and February 2020. We used the data collected from 331 nurses who participated in both waves. Findings: We found that robot‐enabled focus on professional task engagement is positively related to nurses' overall job satisfaction and perceived health improvement. Robot‐reduced nonprofessional task engagement is positively related to nurses' perceived health improvement. Both overall job satisfaction and perceived health improvement are negatively related to nurses' professional turnover intention. Conclusions: Robots' ability to focus nurses' efforts in professional tasks may help improve nurses' health and overall job satisfaction, and by extension reduce their turnover intention. Clinical Relevance: Nurse managers could suggest hospitals introduce robots, particularly those that can share nurses' nonprofessional workload. This, meanwhile, could focus nurses' efforts on professional task engagement. [ABSTRACT FROM AUTHOR]

Aims: To investigate the factors affecting the quality of life among adults with comorbid serious mental illness and chronic diseases. Design: Descriptive, cross‐sectional study design. Methods: In total, 204 patients with serious mental illness were recruited from two hospitals. Self‐reported data were collected using the Brief Psychiatric Rating Scale, Internalised Stigma of Mental Illness, Patient Activation Measure and brief version of the World Health Organization Quality of Life Instrument. Data were collected between July 2018 – January 2019. The structural equation model was applied to examine the associations among the study variables. Results: Internalized stigma (β = −0.479, p =.002) had the greatest direct effect on quality of life, followed by patient activation (β = 0.238, p =.002), severity of comorbidities (β = −0.207, p =.002) and psychiatric symptoms (β = −0.186, p =.006). In addition, psychiatric symptoms directly influenced the severity of comorbidities, which in turn directly influenced internalized stigma and then in turn directly influenced patient activation and ultimately influenced quality of life. Conclusion: The relationship between internalized stigma and quality of life is significantly mediated by patient activation. This finding provides a theoretical basis for developing patient activation interventions for patients with comorbid mental and chronic diseases, which potentially improve the quality of life of this population. Impact: Multiple comorbidities cause impaired quality of life in patients with serious mental illnesses. We found that patient activation plays an important role in the management of chronic diseases for achieving more favourable quality of life, but this is negatively affected by internalized stigma. These findings can help mental health professionals develop tailored intervention strategies to enhance quality of life by promoting patient activation and reducing internalized stigma, psychiatric symptoms, and comorbidity severity in patients with comorbid serious mental illnesses and chronic diseases. [ABSTRACT FROM AUTHOR]

Impulsive online buying is receiving more attention. This study finds that certain characteristics of online reviews lead consumers to buy impulsively online. Three constructs are used to investigate the inducements to engage in impulsive online buying, namely perceived enjoyableness of online reviews, reviewer reputation, and vividness of product presentation. We also examine the moderating effect of perceived price dispersion (PPD) on impulsive online buying using stratified sampling, with 419 respondents participating. Reputable reviewers in diversified online review websites increase consumer attraction to similar products through vivid product reviews that comprehensively inform consumers about products. Moreover, the effectiveness of PPD to trigger impulsive purchases depends on consumer trust in product reviews (for products of the same value). [ABSTRACT FROM AUTHOR]

Online product information (OPI), which is a combination of vendor-supplied product information (VSPI) and online reviews, has become of intense interest to business organizations in their attempt to understand the various ways in which OPI influences consumers. Based on the stimulus-organism-response (SOR) model, this study examined the relationship between mental evaluations of OPI (cognitive and affective evaluations) and the adoption of OPI for both search and experience products. This study used an experimental, custom-designed Web forum built specifically to collect data on how participants evaluated and adopted OPI relating to the purchase of cameras and books. Hypothesis testing was performed using PLS on data collected from 255 participants. Results showed that OPI adoption of information on search products was different from OPI adoption of information on experience products. Both cognitive and affective evaluations affected VSPI adoption, but only cognitive evaluations affected online review adoption. Additionally, VSPI adoption affected online review adoption. Theoretical and practical implications are discussed in the final section. [ABSTRACT FROM AUTHOR]

The epidemic prevention cloud allows infection control professionals to streamline many of their reporting procedures, thereby improving patient safety in a cost-effective manner. Based on task-technology fit and status quo bias perspectives, this study develops an integrated model to explain individuals' health information technology usage behaviour. We conducted a field survey in 30 Taiwan hospitals to collect data from infection control professionals with using experience of the epidemic prevention cloud. A total of 167 questionnaires were sent out, and 116 were returned from 18 hospitals. To test the proposed research hypothesis, we employed a structural equation model by the partial least squares method. The results found that both task – (p <.01) and technology-related characteristics (p <.001) influence task-technology fit. Task-technology fit has a positive effect on both utilisation (p <.001) and performance (p <.001), while it appears to have a negative effect on resistance to use (p <.001). Our results showed that resistance to use was caused by uncertainty costs (p <.01) and perceived value (p <.01). The results indicate the significant effect of utilisation on performance (p <.01). Further, the results indicate a significant negative effect of resistance to use on utilisation (p <.05). This study illustrates the importance of incorporating post-adoption resistance in technology adoption studies [ABSTRACT FROM AUTHOR]

Objective: Head and neck cancer (HNC) patients suffer from symptoms and fear of recurrence (FoR), which both affect their quality of life (QoL). Based on a self‐regulation model, the purpose of the study was to examine patients' FoR as a mediator of the relation between symptoms and QoL, and to identify which symptoms may trigger FoR. Methods: A cross‐sectional study was conducted, using convenience sampling. Structured questionnaires were used to collect data at a medical centre in Northern Taiwan. The analytic methods included descriptive statistics, structural equation modelling and linear regression. Results: A total of 103 participants were recruited. Patients experienced a medium level of symptom severity and QoL but a moderate to high level of FoR. Symptom severity, FoR and QoL were significantly correlated. FoR was a significant partial mediator between symptom severity and QoL. The significant factors of the overall FoR and the subscale of health worry were "pain in general" and "pain in the mouth, throat or neck." "Pain in general" was a significant factor for the subscale of cancer worry. Conclusions: This theory‐driven study supports a mediation model of FoR among HNC patients and provides a more comprehensive understanding of the antecedents and consequences of FoR. [ABSTRACT FROM AUTHOR]

Aims: This study examined the relationship among upgrades in academic qualifications, practice accreditations, self‐efficacy, outcome expectations and nurses' career interest. Background: Interest in the nursing career could help retain nurses in the nursing profession. A global nurse shortage warrants further research to understand what drives interest in the nursing career. Methods: A cross‐sectional design was employed. Data were collected in a medical centre in Northern Taiwan between February and March 2017, using employee records and a survey instrument. Proportionate random sampling was used to identify full‐time registered nurses, of whom 524 provided useable responses. Employee records were used to measure nurses' upgrades in academic qualifications and practice accreditation. Results: Upgrades in academic qualifications and upgrades in practice accreditation are positively related to outcome expectations. Both self‐efficacy and outcome expectations are positively related to career interest. Conclusion: The pursuit of upgrades in academic qualifications and practice accreditation could enhance nurses' outcome expectations, thus enhancing their interest in a nursing career. Implications for Nursing Management: Hospital managers could develop policies, procedures and programmes to encourage nurses to enhance their academic qualifications or practice accreditation, helping enhance their interest in remaining in the nursing career. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This study applied structural equation modelling to explore the relationships among agitated behaviours, depression, cognitive function and activities of daily living, as well as associations between these factors and urinary incontinence). Background: A high prevalence of urinary incontinence is found among institutional older adults with dementia. People with urinary incontinence suffer from increased financial burden and social isolation and experience reduced quality of life. Design: Cross‐sectional correlational research. The study complied with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Methods: In total, 226 older adults with dementia were recruited through convenience sampling at 15 long‐term care facilities in southern Taiwan. The urinary incontinence frequency, agitated behaviours, depression, cognitive function and activities of daily living were evaluated using bladder records, the Cohen‐Mansfield Agitation Inventory, the Cornell Scale for Depression in Dementia, the Mini‐Mental State Examination and the Barthel Index, respectively. Results: Activities of daily living performance was found to be significantly associated with urinary incontinence; however, age, cognitive function, depression and agitated behaviours were not significantly related to urinary incontinence. Age did not have effects on any of the variables tested in this model, whereas activities of daily living performance was significantly associated with cognitive function and depression. Results further showed that cognitive function and depression were mediators between activities of daily living and agitated behaviours. Conclusion: Enhanced activities of daily living independency directly reduced urinary incontinence, improved cognitive function, decreased degrees of depression and indirectly reduced agitated behaviours. Relevance to clinical practice: The findings could serve as a valuable reference for long‐term care facilities in providing effective urinary incontinence care and prevention to older adults with dementia. [ABSTRACT FROM AUTHOR]

Aim: Different designs of electronic hand‐off systems might have different levels of effectiveness; this study validated the effectiveness of systems with an Identify, Situation, Background, Assessment and Recommendation (ISBAR) design to one without such a design. Background: Adverse consequences in hospital commonly occur when there are breakdowns in the transmission of information between team members. To ensure information accuracy and consistency, some Taiwan hospitals implemented electronic hand‐off systems. However, the effectiveness of such systems was not investigated. Methods: A quasi‐experiment was conducted to the nurses of two Taiwan case hospitals, one with ISBAR and the other with non‐ISBAR design systems and 200 questionnaires were used to collect data. Results: The respondent rate was 72%. Using system with ISBAR design, nurses can enhance their communication effectiveness and further increase their individual benefits at hand‐off. Using a non‐ISBAR hand‐off system, communication effectiveness depends solely on the nurses' individual cognitive and expressive ability. Conclusion: System with ISBAR design can ensure effective information transmission among nurses for care continuity and prevention of adverse events. Implications for Nursing Management: Ensuring the design of electronic systems is adequate, nursing managers can save nurses' time and effort while using the system to perform their regular work effectively and gain competitive advantage. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore how hemodialysis patients' quality of life is related to sociodemographic data and depression as predicting variables, and how it is affected by fatigue as a mediating variable. Participants were 405 patients who has been receiving hemodialysis treatment regularly. SPSS Amos path analysis was used to explore the causal relationship and the mediating effect of fatigue among the variables of sociodemographic characteristics, depression, and quality of life. Unstandardized estimates determined that while sociodemographic characteristics were a significant predictor of fatigue, they were not directly related to quality of life. The results showed that depression and fatigue in patients receiving hemodialysis are important factors that affect patients' quality of life to a greater (fatigue) or lesser (depression) extent. Depression can affect patients' quality of life either directly or indirectly via fatigue. In this study, we demonstrated that fatigue plays an important role in the relationships among sociodemographic characteristics, depression, and quality of life in patients receiving hemodialysis. The results of the study further suggest that comprehensive management programs should be applied with patients to reduce their fatigue, and ultimately to improve their quality of life. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to (a) test the hypothesized model for hospital nurses' voluntariness of incident reporting (VIR) and (b) determine the extent to which reporting culture factors, nursing safety practices and perceptions of work predict VIR. Design and Methods: A cross‐sectional survey was applied to 1,380 frontline nurses recruited from six teaching hospitals in Taiwan. Data were collected using self‐administered questionnaires. Correlation analyses and path analyses using structured equation modelling were used. Findings: More than half of the nurses did not display a voluntary attitude towards reporting. VIR was correlated with factors of reporting culture, nursing safety practices and perceptions of work. Through path analyses, the safety practices mediated on the relationship between the reporting culture and VIR. Conclusions: Nurses still have modest willingness of reporting. The factors of reporting culture and nursing safety practices are critical determinants of VIR. Within more behavioural involvement in the safety practices, the reporting culture can support nurses to report voluntarily. Implications for Nursing Management: Strengthening nurses' engagement in safety practices can advance the reporting voluntariness and agreement with reporting culture concurrently. Nurse leaders should continue to optimize workload management and job satisfaction, which is advantageous to the safety practices enacted. [ABSTRACT FROM AUTHOR]

Aims: This study examines how career barriers and supports (i.e., perceived discrimination, lack of advancement, human capital, and social capital) impact affective, normative, and continuance aspects of professional commitment and thus nurses' professional turnover intention. Background: Professional commitment is known to influence professional turnover intention. However, little is known about how career barriers and supports contribute to professional commitment and reduce professional turnover intention. Methods: This study adopted a cross‐sectional design and a survey to collect representative data in a major hospital in northern Taiwan. We used proportionate random sampling to ensure sample representativeness and obtained 524 responses. Results: Perceived discrimination and lack of advancement were negatively related to affective professional commitment. Human capital was positively related to affective, normative, and continuance professional commitment. Social capital was positively related to normative professional commitment. All aspects of professional commitment were negatively related to professional turnover intention. Conclusion: Career barriers and supports have an important influence on professional commitment. Reduced barriers and enhanced support may therefore help reduce nurses' professional turnover intentions. Implications for Nursing Management.: Nursing managers could aim to lessen career barriers while increasing career support for nurses, helping strengthen nurses' professional commitment and retention. [ABSTRACT FROM AUTHOR]

Aim: This study explores the impact of total quality management on patient‐safety‐culture attitudes among clinical nurses, focusing on the correlations between total quality management, work values, employee satisfaction, and patient‐safety‐culture attitudes. Background: Implementing total quality management can improve nurses' attitudes towards patient‐safety culture. Method: This hospital‐based, cross‐sectional survey used a convenience sample of 30 inpatient units and 12 intensive care units at five Taiwanese regional teaching hospitals with over 500 beds. Seven hundred questionnaires were distributed (140 to each hospital) during 25 June–5 July 2015. Data were collected using an anonymous, self‐administered, and structured questionnaire. The model was tested using structural equation modelling and serial mediation analysis. Results: Of 515 completed questionnaires (73.6% response rate), 23 were invalid and 492 were used (70.3% retrieved rate). The total effect of total quality management on patient‐safety‐culture attitudes was significant via work values, which had a direct influence on patient‐safety‐culture attitude. Total quality management affected employee satisfaction, which directly influenced patient‐safety‐culture attitudes. Conclusion: Total quality management creates a beneficial working environment and improves patient‐safety culture. Total quality management, work values, and employee satisfaction orientation are important predictors of nurses' attitudes toward patient‐safety‐culture attitudes. Implications for nursing management: Health care managers should cultivate nursing performance to achieve continuous quality improvement in nursing care. [ABSTRACT FROM AUTHOR]

Background: Coronary artery bypass grafting is one of the most common interventional revascularisation procedures used to treat coronary artery disease worldwide. With a wide variability in postoperative cardiac symptoms, identification of symptom trajectories during the 3-month postoperative recovery period may improve clinicians' abilities to support symptom recovery. Aims: To identify distinct trajectories of cardiac symptoms seen over time in a cohort of patients during the 3-month post-coronary artery bypass grafting period, and determine clinical characteristics associated with different symptom trajectories postoperatively. Methods: A prospective trial used the cardiac symptom survey to determine patient symptoms at baseline prior to surgery, and at 1 week, 6 weeks and 3 months following coronary artery bypass grafting. A latent class growth model and multivariate logistic regression analyses were used. Results: Data were obtained from patients (N=198) undergoing coronary artery bypass grafting in six medical centres of Taiwan, through patient medical records and interviews. Based on their frequency, trajectories were explored for the six most common postoperative symptoms including angina, dyspnoea, fatigue, depression, sleep problems and anxiety. We identified two to three distinct classes of trajectories for each symptom. Age, longer intensive care unit stay, fewer vessels bypassed, off-pump coronary artery bypass grafting, smoking history and lack of regular exercise were associated with worse symptom outcome trends over time. Conclusions: Using this unique trajectories-based research method, we are able to achieve a better understanding of symptom recovery patterns over time among coronary artery bypass grafting patients. Recognising risk factors and potential recovery patterns prior to surgery may allow healthcare providers to deliver targeted discharge planning and individualised care after coronary artery bypass grafting. [ABSTRACT FROM AUTHOR]

Aim: To determine whether acupressure can prevent or relieve the adverse drug reactions (ADRs) of anti‐tuberculosis drugs. Background: People receiving drug treatment for TB often experience ADRs that may cause them to stop taking their medication. Acupressure is a form of traditional Chinese medicine that can be applied to alleviate or prevent disease symptoms. Design: A double‐blinded, repeated‐measures clinical trial in hospitals in Taiwan was carried out from April 2015 – May 2017. Methods: Convenience sampling was used to select 32 people (15 for the experimental group and 17 for the control group) aged >20 years who were taking anti‐tuberculosis drugs. The people were randomized to receive 4‐week of true acupressure and 4‐weeks of sham acupressure. Acupressure therapy was given by a researcher in all cases. Both groups received treatment once per day on weekdays, with 15 min for each acupressure session. Outcomes (gastrointestinal irritation and adverse skin reactions) were assessed according to the people feedback and the physicians' recordings during the treatment course, and during monthly follow‐up visits for 6 months thereafter. Results: Both groups typically experienced gastrointestinal irritation and adverse skin reactions within 2 months of beginning anti‐tuberculosis drug treatment. The 4‐weeks intervention involving relevant acupressure points successfully relieved both types of side effects in both immediate and delayed manner. Conclusions: When correctly implemented, acupressure can prevent and relieve the ADRs of anti‐tuberculosis drugs, and motivate people to complete their treatment course. [ABSTRACT FROM AUTHOR]

Aims: This study examined the changes and the predictors of suicide ideation/suicide attempt and the moderating effects of psychosocial factors on the suicide ideation/suicide attempts among human immunodeficiency virus (HIV)‐positive patients at 6–12 months post‐diagnosis. Background: Suicide behaviours are prevalent among newly diagnosed HIV‐positive patients, but the changes in suicide behaviours after diagnosis and the role of psychosocial factors in these behaviours are not well studied. Design: This study used a prospective longitudinal design. Methods: A total of 113 participants diagnosed as HIV‐positive for 6–12 months were recruited from the outpatient department. Data were collected from June 2015 – October 2016. They were asked to complete Beck's Scale for Suicide Ideation, the Beck Depression Inventory‐II, the Body Image Scale, the Meaning in Life Questionnaire and the Multidimensional Scale of Perceived Social Support at baseline, the third month and the sixth month. Results: The results showed the high occurrence rates for suicide ideation ranging from 27.2%, 21.6%, and 25.8% and suicide attempt ranging from 14.7%, 8.6%, and 13.3% at the baseline, the third month and the sixth month, respectively. The education level, social support from family and depressive symptoms were the predictors of suicide ideation. The history of depression disorders, depressive symptoms and social support from friends significantly predicted suicide attempt. Meaning in life‐presence moderated the relationship between depressive symptoms and suicide ideation. Conclusions: After diagnosed for 6–12 months, HIV‐positive patients remain the high‐risk group for suicide ideation and attempt. Suicide intervention targeting the risk and protective factors are required for HIV‐positive patients. [ABSTRACT FROM AUTHOR]

Background: Ensuring the delivery of quality care and patient safety requires that nurses improve their self-reflection and insight as well as their critical thinking. To understand the factors that influence self-reflection, insight, and critical thinking, more evidence-based research is needed. Purpose: The purpose of this study was to examine whether professional qualifications (i.e. age, years of job experience, and position on the clinical ladder) would affect self-reflection and critical thinking in the experienced registered nurses (RNs) group. Methods: This quantitative and correlational study included 597 RNs (297 novice nurses and 300 experienced nurses), recruited from one medical center hospital in central Taiwan, as participants. Data were collected on self-reflection and critical thinking, using the Chinese-version of the Self-Reflection and Insight Scale and the Taiwan Critical Thinking Disposition Inventory. A structural equation modeling approach was used to examine the relationships among variables. Findings: The results showed a non-significant mean difference in self-reflection with insight scores between the two groups. Experienced RNs had a significantly higher mean score for critical thinking. Further analysis of the data of experienced nurses revealed that self-reflection with insight significantly affected critical thinking (β = 0.24, t = 4.141, p <.001). Qualifications also affected self-reflection with insight (β = 0.11, t = 1.808, p >.05) and critical thinking (β = 0.18, t = 3.143, p <.001). The correlation between qualifications and self-reflection with insight, however, was non-significant. Discussion: Nurses who perceived that they had greater self-reflection and insight reported more critical thinking in clinical care practice. Nurses' qualifications had more of an effect on critical thinking than on self-reflection and insight. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to explore the mediating effects of work environment and burnout on the relationship between authentic leadership and the intention of nurses to leave their job. Background: Authentic leadership can contribute to a good work environment. Burnout is a critical factor that affects nurses‧ intent to leave. The mediating roles of work environment and burnout on the relationship between authentic leadership and intent to leave is unclear. Methods: A cross‐sectional design was used, and 946 nurses from three different levels of hospital (medical center, regional, and district), defined in terms of the number of beds and type of medical care provided, responded to four self‐report questionnaires. Results: Work environment and burnout mediated the effect of authentic leadership on intent to leave among nurses. The mediating effects of burnout on authentic leadership was present both for junior (β = 0.073) and senior (β = 0.081) nurses. Conclusion: Authentic leadership can affect nurses‧ intent to leave but the work environment and burnout are important mediators of this influence. Implications for Nursing Management: Administrators should adopt authentic leadership practices and make efforts to improve the work environment and decrease burnout in order to decrease nurses‧ intent to leave. [ABSTRACT FROM AUTHOR]

Abstract Background Heart failure is a complex syndrome that causes substantial functional impairment and poor outcomes. Although multidisciplinary disease management programmes are effective, the role of additional outpatient-based exercise training and the effects of multidisciplinary disease management programmes for patients with contraindications to exercise training are unclear. Objectives To compare the effects of the multidisciplinary disease management programme with and without exercise training on heart failure-related rehospitalization, disease knowledge, and functional capacity. Design Secondary analysis of a randomized controlled trial. Participants and Setting Data for 212 patients hospitalized for heart failure at a local teaching hospital in Taiwan were analysed. Methods Patients' data were assigned to three groups: control (n = 71), multidisciplinary disease management programme without exercise training (n = 70) or multidisciplinary disease management programme with exercise training (n = 71). The multidisciplinary disease management programme included comprehensive assessments, individualized education, optimizing medications, pre-scheduled clinic visits, and encouraging regular physical activity at home. Outpatient-based exercise training was performed only in the multidisciplinary disease management programme with exercise training group. The control and the multidisciplinary disease management programme without exercise training groups were further divided into subgroups with and without contraindications to exercise training. Patients were followed up monthly for heart failure-related rehospitalizations for 1 year. Cox proportional hazard models and Kaplan-Meier analyses were used to identify the significant predictors of heart failure-related rehospitalizations. A generalized estimation equation model was used to analyse the secondary outcomes, including disease knowledge and 6-min walking distance at baseline and 6 and 12 months after discharge. Results At 12 months after discharge, the multidisciplinary disease management programme with and without exercise training groups had significantly lower heart failure-related rehospitalization rates and better disease knowledge compared with the control group (p < 0.01). Only the multidisciplinary disease management programme with exercise training group had a significant improvement in 6-min walking distance (p < 0.05). For patients with contraindications to exercise, the multidisciplinary disease management programme significantly reduced heart failure-related rehospitalization rates at 12 months after discharge (p < 0.05). For those without contraindications, the event-lowering effect was only noted for the multidisciplinary disease management programme with exercise training group (p < 0.05). Conclusions Outpatient-based exercise training is recommended to be incorporated into multidisciplinary disease management programmes for patients without exercise contraindications to improve disease outcomes and functional capacity. For patients with contraindications to exercise, a multidisciplinary disease management programme is recommended to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Aims: To examine the impact of burnout on self‐efficacy, outcome expectations, career interest and on nurses' intentions to leave the profession and to leave the organization. Background: Burnout is associated with nurse turnover. Research clarifying the underlying mechanism may provide a novel means to mitigate the impact of burnout on nurse turnover. Design: This study uses a cross‐sectional design and proportionate stratified sampling. Methods: Data were collected from a sample of nurses in one medical centre in northern Taiwan during February ‐ March 2017. This study included nurses employed full‐time at the medical centre. Burnout was measured using Maslach Burnout Inventory—Human Service Survey. Self‐efficacy, outcome expectations and career interest were measured using the scale of Cunningham et al. Intentions to leave were measured using the scales of Teng et al. Structural equation modelling was used to assess the proposed framework. Results: Burnout was negatively related to self‐efficacy and outcome expectations. Self‐efficacy was positively related to outcome expectations. Outcome expectations were also positively related to career interest. However, self‐efficacy was not related to career interest. Career interest was negatively related to the intention to leave the organization, which was further related to the intention to leave the profession. The model fitted the data acceptably. Conclusions: When nurses leave the profession, patient outcomes may be affected. Policy makers should evaluate whether the healthcare system can instil expectations for satisfaction, power and adequate compensation in the profession and thus retain nurses. [ABSTRACT FROM AUTHOR]

The study purpose was to examine the validities and reliabilities of the Chinese-versions Frommelt Attitudes Toward Care of the Dying Scale (Attitudes Scale) and Caregiving Behaviors Scale for End-of-Life Patients and Families (Behaviors Scale). The scales were tested in a convenience sample of 318 nurses with ≥6 months work experience at three hospitals. Cronbach’s alphas of the Attitudes and Behaviors Scales were .90 and .96, respectively. Each scale had Kaiser–Meyer–Olkin index >.85 and Bartlett’s test of sphericity >4000 (p < .001). Attitudes Scale loaded on three factors: respecting and caring for dying patients and families, avoiding care of the dying, and involving patients and families in end-of-life care. The Behaviors Scale loaded on two factors: supporting dying patients and families, and helping families cope with grief. Factor loadings for both scales were ≥.49. Both Attitudes and Behaviors Scales are reliable and valid for evaluating nurses’ attitudes and caregiving behaviors for the dying. [ABSTRACT FROM AUTHOR]

Objective Previous studies have shown inconsistent results with regard to the association between advanced parental age and autism spectrum disorder (ASD). The sociodemographic status of parents has been found to be associated with children with ASD, however. Therefore, a pathway analysis was undertaken of the roles of maternal age and education in ASD diagnosis and community screening, in a national birth cohort database, using a propensity score matching (PSM) method. Method The 6- and 66-month Taiwan Birth Cohort Study dataset was used (N = 20,095). The PSM exact matching method was used to select 1700 families (ratio of 1:4 between ASD diagnosis and control) from the Taiwan Birth Cohort Study dataset. Results (1) The results from the complete dataset and the PSM exact matching dataset both show that the risk of a child being diagnosed with ASD was increased by the mother being over 40 years old. (2) Although more children of mothers with lower-than-average education were positive on screening, more children of mothers with higher-than-average education were also diagnosed with ASD. Conclusions for Practice Advanced maternal age had a higher association with the diagnosis of ASD, and maternal educational disparity was found between ASD clinical diagnosis and community screening. Community and primary medical care services should pay more attention to children of parents with lower education during ASD screening to prevent delayed diagnosis. [ABSTRACT FROM AUTHOR]

Abstract: Aims: The aim of this study was to examine the structural relationships linking job stress to leaving intentions through job satisfaction, depressed mood and stress adaptation among hospital nurses. Background: High turnover among nurses is a global concern. Structural relationships linking job stress to leaving intentions have not been thoroughly examined. Design: Two nationwide cross‐sectional surveys of full‐time hospital staff in 2011 and 2014. Methods: The study participants were 26,945 and 19,386 full‐time clinical nurses in 2011 and 2014 respectively. Structural equation modelling was used to examine the interrelationships among the study variables based on the hypothesized model. We used cross‐validation procedures to ensure the stability and validity of the model in the two samples. Results: There were five main paths from job stress to intention to leave the hospital. In addition to the direct path, job stress directly affected job satisfaction and depressed mood, which in turn affected intention to leave the hospital. Stress adaptation mitigated the effects of job stress on job satisfaction and depressed mood, which led to intention to leave the hospital. Intention to leave the hospital preceded intention to leave the profession. Those variables explained about 55% of the variance in intention to leave the profession in both years. Conclusion: The model fit was good for both samples, suggesting validity of the model. Strategies to decrease turnover intentions among nurses could focus on creating a less stressful work environment, increasing job satisfaction and stress adaptation and decreasing depressed mood. Hospitals should cooperate in this issue to decrease nurse turnover. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to determine the effect of caring behaviours on critical thinking and to examine whether self‐reflection mediates the effect of caring on critical thinking. We also tested whether caring behaviours moderated the relationship between self‐reflection and critical thinking. Methods: For this descriptive, correlational, cross‐sectional study, we recruited 293 fifth‐year nursing students from a junior college in southern Taiwan. Data were collected in 2014 on critical thinking, caring behaviours and self‐reflection with insight using the Taiwan Critical Thinking Disposition Inventory, a Chinese version of the Caring Assessment Report Evaluation Q‐sort, and a Chinese version of the Self‐Reflection and Insight Scale, respectively. Relationships among variables were analysed by structural equation modelling, with the partial least squares method and Sobel test. Results: The results showed that caring behaviours significantly positively affected critical thinking (β = 0.56, t = 12.37, p < 0.001) and self‐reflection with insight (β = 0.54, t = 11.99, p < 0.001). Self‐reflection and insight significantly positively affected critical thinking (β = 0.34, t = 6.48, p < 0.001). Further, self‐reflection and insight mediated the relationship between caring behaviours and critical thinking. Caring behaviours did not, however, moderate the relationship between self‐reflection (β = 0.001, t = 0.021, p > 0.05) and critical thinking. Conclusion: Caring behaviours directly affect self‐reflection with insight and critical thinking. In addition, caring behaviours also indirectly affect critical thinking through self‐reflection and insight. [ABSTRACT FROM AUTHOR]

Information processing view explains the fit between information processing need and information processing capability to achieve optimal performance. This research observes that the model of users’ needs-functional capabilities fits by two perspectives of holistic and reductionistic in the context of social media usage. Through an online survey of 310 Facebook users in Taiwan, the findings provide the holistic and reductionistic perspectives of the fit between users’ needs and functional capabilities as having a significant impact on users’ cognitive absorption. Thus, social media providers must emphasise managing the fit between users’ needs and functional capabilities for their products and services development. [ABSTRACT FROM PUBLISHER]

This study was designed to construct a model based on the concept of psychological well-being, in order to verify the relationship between Taiwanese elderly volunteering and their psychological well-being. Research data were collected via a questionnaire administered to the target population of this study, senior residents of Pingtung County aged 65 or more. The data were then tested and verified by confirmative factor analysis and structural equation modeling. The overall model showed higher levels of psychological well-being for the elderly who participated in volunteer work than those who did not, which again confirmed the positive relation between volunteer work and psychological well-being. [ABSTRACT FROM AUTHOR]

Numerous location-based services (LBS) studies have suggested that the risk of disclosing personal privacy hinders consumers from adopting LBS, whereas scant attention has focused on clarifying how to mitigate the perceived privacy risk of using LBS. This quantitative study focuses on the effects of consumer quality perceptions (i.e. information quality, system quality, and service quality) on their trust in LBS, which consequently affects perceived privacy risk and continued usage intention towards LBS. Research data were collected through a market survey website; 1399 valid questionnaires were collected. Structural equation modelling analysis was applied to the data. The results revealed that information quality, system quality, and service quality were positively related to perceived trust. Perceived trust also correlated negatively with perceived privacy risk, but positively with continued usage intention. A managerial implication drawn from the findings is that LBS providers should develop more useful user interfaces or provide timely, personalised services to reduce perceived privacy risk and strengthen LBS continued usage intention. [ABSTRACT FROM PUBLISHER]

Background: Peer support groups for people with diabetes are increasingly considered a part of the healthcare system. Understanding the functions of peer support groups assist healthcare professionals to provide critical assistance. Purpose: The purpose of this study was to develop and assess the psychometric properties of the Functions of Diabetes Peer Support Group (F-DPSG) scale. Methods: This study used a cross-sectional design. A 16-item F-DPSG scale was developed and administered to 589 patients with Type 2 diabetes who were selected from 34 diabetes peer support groups in Taiwan. Construct validity was evaluated using exploratory and confirmatory factor analyses and by examining the correlation with the score of the Chinese Diabetes Management Self-Efficacy Scale. Reliability was tested using internal consistency and test--retest reliability. Results: The 16-item F-DPSG scale, including four subscales, was supported by a second-order confirmatory factor analysis, with the following fit indices: χ&178;/ ratio = 2.60, comparative fit index = .94, normed fit index = .91, and root mean square error of approximation = .07. The four subscales were "enhancing self-care practice." "obtaining knowledge and skills," "psychological support," and "collective identification." The score of the F-DPSG scale correlated significantly with the score of the Chinese Diabetes Management Self-Efficacy Scale (r = .45, p G .001). The Cronbach's α and test-retest reliability of the F-DPSG global scale and subscales were all above .70. Conclusions/Implications for Practice: The F-DPSG scale showed satisfactory reliability and validity. Healthcare providers may use the F-DPSG scale to assess the functions of peer support groups for people with diabetes and to provide necessary assistance. [ABSTRACT FROM AUTHOR]

Background: Stigma affects patients with schizophrenia and may influence perceptions of the illness, whic hmay affect how family members interact with and care for these patients. Purpose: The aims of this study were to (a) explore the relationship between perceptions of schizophrenia and the negative emotions of family members within the context of an affiliate stigma model, and (b) validate the proposed affiliate stigma model. Methods: A cross-sectional design was used. Eligibility for participation was limited to the relatives of patients with schizophrenia. The participants were recruited from two regional psychiatric hospitals in central Taiwan. The study was approved by an Institutional Review Board, and all potential participants signed informed consent before enrollment. Sixty-two participants completed the set of self-administered questionnaires, including (a) a demographic questionnaire, (b) Affiliate Stigma Scale, and (c) the Illness Perception Questionnaire for Schizophrenia-Relatives version. Canonical correlations and structural equation modeling in STATISTICA 6.0 were used to validate the model of illness perceptions and negative emotions. Results: (a) There were three domains of perception regarding schizophrenia for the relatives of patients: disease chronicity, disease in control, and disease treatability. The correlation between these dimensions and negative emotion was r = .42. (b) The adjusted goodness of fit for the proposed affiliate stigma model was .79. Conclusions: The results of this study suggest that the affiliate stigma model is an appropriate resource for developing practical disease management strategies for the relatives of patientswith schizophrenia. [ABSTRACT FROM AUTHOR]

This research explored the test-taking strategies associated with the Test of English for International Communication Speaking Test (TOEIC-S) and their relationship with test performance. Capitalizing on two sets of TOEIC-S and a custom-made strategy inventory, the researcher collected data from a total of 215 Taiwanese English learners consisting of 84 males and 131 females with an average age of 20.1 years (SD = 2.6). Quantitative data analysis gave rise to three major findings. First, TOEIC-S test-taking strategy use constituted a multi-faceted construct that involved multiple types of strategic behaviors. Second, these strategic behaviors matched those allowing test-takers to communicate both in real life and in the workplace. Third, communication strategy use and cognitive strategy use both contributed significantly to TOEIC-S performance. [ABSTRACT FROM AUTHOR]

Posting behaviour on social networking sites (SNS) has become a method enabling unsatisfied users to vent emotions. Based on social cognition theory (SCT), personal outcome expectations and selfefficacy affect posting behaviour for venting emotions on SNS. However, perceived social support (PSS) may alter the relationships within the SCT model. Thus, this study aimed to explore the moderating effect of PSS on the relationships between variables in the SCT model for venting emotions on SNS. In total, 310 unsatisfied customers in Taiwan were investigated, and structural equation modelling was performed to test the hypotheses. The results indicated that personal outcome expectations and self-efficacy were positively associated with posting behaviour which, in turn, increased venting emotions on SNS. Moreover, PSS moderated the relationships between variables in the SCT model. [ABSTRACT FROM AUTHOR]