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Diabetic foot ulcer (DFU) is one of the common complications of diabetes. DFU can cause a huge medical and financial burden due to infections, compromise the quality of life, and increase the mortality rate in patients. However, the consumption of medical resources for DFU is rarely mentioned. A retrospective cohort study was performed. Data were obtained from the National Health Insurance Research Database of Taiwan, and the prevalence and medical utilization data for DFU in 2001–2015 were extracted, followed by the analysis for high-risk populations. Between 2001 and 2015, there were 7511 new DFU patients. A higher proportion in these patients was male, elderly with a low education level, and low income. Between 2001 and 2015, the prevalence of DFU was 0.5–0.8%, and the number of DFU patients showed stable growth. Every year, 12.6–19.3% and 1.2–7.0% of patients underwent debridement and amputation, respectively. The hospitalization fees increased year on year. Our study showed that the DFU prevalence increased year on year, and the DFU medical expenditure increased. DFU tends to occur in males, patients with low socioeconomic status, low education level, those with multiple comorbidities, and old age. Therefore, DFU care and prevention require the entire healthcare system to jointly formulate a prevention plan.

Background Indonesians constituted 79% of foreign care workers for long-term care in Taiwan in 2015. Therefore, it is crucial to explore the effect of work stress and quality of life (QoL) on this population. Purpose This study aims to explore stress levels, social support requirements, and perceived QoL among Indonesian care workers (ICWs) who work in home care settings. Methods A cross-sectional design was used. Data were collected between 2014 and 2016 from a convenience sample of ICWs working in eastern Taiwan using a self-administered questionnaire that comprised the Stress Perception Scale (SPS), Social Support Scale (SSS), and World Health Organization Quality of Life-Brief scale. One hundred fifty-seven valid questionnaires were collected. The response rate was 80.51%. Data were analyzed using descriptive statistics, one-way analysis of variance, Pearson's correlation coefficient, and multiple regression analysis. Results The results found that the average SPS of the sample was 70.50, with low QoL scores and requirements for more social support. In addition, significant and positive correlations were found between QoL and SPS, SSS, duration of patient care, and hours of care per week. Stepwise regression analysis showed that the most predictive variables for QoL were time spent caring, preservice training, psychological stress, and emotional support, which together accounted for 60.9% of the total variance. Conclusions/Implications for Practice This study facilitated understanding of the stress on ICWs and the impact of social support on their QoL. The findings suggest that new immigrants in Taiwan should be introduced to foreign care workers or nursing attendants. Moreover, long-term-care-related teachers should work with home care institutions or agencies to develop a teaching model for innovative care skills to relieve the perceived stress of ICWs.

Aim. This study examined the effectiveness of multimedia learning education programmes (MLEPs) on knowledge, anxiety and pressure garment compliance behaviour of burn patients. Background. MLEPs are increasingly suggested as education methods that can be used by health professionals in daily practice. A systematic review of the effectiveness of computer-based education demonstrates its acceptability to patients. However, few studies have empirically tested this approach. Design. Experimental study. Methods. An experimental study was conducted at a burn centre of a medical centre in Taipei, Taiwan. Participants were randomly assigned to either experimental (n = 28) or control groups (n = 30). Both groups were given pre-tests and post-tests to measure their knowledge, anxiety and pressure garment compliance behaviour. Results. At two weeks, the results of this study showed that the MLEP had ‘statistically’ significantly improved patients’ burn knowledge, reduced individual anxiety and enhanced pressure garment compliance behaviour. Conclusion. This controlled study demonstrated that a two week MLEP can be a useful intervention to improve care compliance and reduce anxiety in patients undergoing burns rehabilitation period. Relevance to clinical practice. Burn injury patients undergoing rehabilitation are likely to benefit from multimedia learning education intervention programmes. More comprehensive health economic evaluation needs to be undertaken. Further studies exploring a longer term follow-up are also required.

Aims and objectives. The purpose of this study was to explore the experience of cancer patients living with a malignant fungating wounds. Background. Malignant fungating wounds are caused by cancerous cells invading skin tissue. These wounds can then bleed, become malodorous and painful causing physical and psychological distress. However, little is know about how individuals experience these lesions. Design. Qualitative. Methods. Ten in-depth interviews were conducted with patients in one medical teaching centre in Taiwan. Data were subject to a thematic analysis informed by elements of grounded theory. Results. Five key themes demonstrated an emerging model that offers an insight into how patients experience their wound. Firstly, ‘Declining physical well-being’ refers to the initial impact of the wound, this is linked to two further themes; ‘Wound related stigma’ and the ‘Need for expert help’. Another theme; ‘Strategies in wound management’ describes the initial, ineffective attempts by participants to manage their wound and the impact of professional help around wound management. This was linked to a fifth theme; ‘Living positively with the wound’ that reflected how patients adjusted to the presence of the wound – significantly influenced by the wound care they received. Conclusion. This study contributes to the understanding we have of how patients experience living with such wounds. It sets out the clear need for early use of wound specialists as part of the multi-disciplinary oncology team. Relevance to clinical practice. The results of this study provides a description of patient experiences that can help to guide nursing practice as well as an understanding of what a malignant fungating wound means to cancer patients and how it influences their lives.

This study describes the relationship between symptoms and quality of life in patients with malignant fungating wounds.Malignant fungating wounds are complex wounds that can bleed, become malodorous due to infection and are painful causing physical and psychological distress. However, there is a lack of literature on the impact that such wounds can have on quality of life.This was a descriptive, cross-sectional multi-centre study of patients with malignant fungating wounds. Participants were recruited from the palliative care, hospice, outpatient clinic and oncology units of three medical centres in Taiwan. Data were collected from February 2008 to August 2009. A structured questionnaire obtained socio-demographic information, medical details, wound assessment information and the Taiwanese version of the McGill quality of life questionnaire was administered by interview. McGill quality of life scores indicated that the participants had the lowest quality of life. The participant's age, dressing change frequency, pain, wound dressing comfort, wound symptom, bleeding and malodour had statistically significant negative correlations with quality of life. Multiple regression analysis showed that age, malodour, pain issues and psychological issues explained 87% of the total variance in quality of life. This study contributes to our understanding of the impact of malignant fungating wounds and how correct assessment and management is necessary to improve quality of life. Educational intervention research is needed for patients and caregivers in countries where this has not yet been performed. Further research should also identify whether nursing competence has a direct impact on quality of life.

Background: Alcohol intoxication is a serious health issue among Taiwan's indigenous Malayo-Polynesian groups. No published studies address the drinking perceptions and behaviors of Bunun women. Purpose: The purpose of this study was to describe the drinking perceptions and behaviors of Bunun women in Taiwan. Methods: This study used an ethnographic approach to study the residents of one township located in eastern Taiwan. Researchers used semistructured, in-depth interviews to collect data from 10 Bunun women in 2006. Results: Researchers identified six key culture themes from the data. These were (a) drinking to help make friends, (b) drinking to help solve emotional problems, (c) interpreting the meaning of drinking, (d) hurting the body due to alcohol abuse, (e) decreasing the bond of convention for drinking, and (f) establishing mechanisms to control drinking. Conclusions/Implication for Practice: The results of this study may help one to understand the alcohol use behavior and attitudes of indigenous women in Taiwan and contribute to better cross-cultural nursing clinical practice. This study is expected to enhance the quality of nursing care provided to Taiwan's indigenous people.

This paper is a report of an evaluation of the effectiveness of a multimedia education program in relation to stoma knowledge, self-care attitudes and behaviour with patients with a stoma in the postoperative period.Multimedia education programmes not only give patients with useful information in the absence of health professionals, but can also augment information given in traditional clinical practice. However, the literature on the effectiveness of different approaches to stoma education is limited.A randomized experimental study design was used. Participants were recruited from a surgical unit in a large hospital in Taiwan. A total of 102 patients with a stoma were randomly assigned to either the multimedia education programme (n=46) or a conventional stoma education programme (n=56) with a follow-up of 1 week. Outcome variables measured were levels of self-care knowledge, attitudes towards self-care and self-care behaviour.Patients who received the multimedia education programme improved their overall self-care knowledge, attitudes and behaviour statistically significantly when compared with those who received the conventional stoma education programme.Although further, longer-term follow-up will be useful, this study demonstrates that multimedia packages can enhance patient involvement in their stoma care and can augment stoma education - particularly in resource challenged healthcare environments.

The purpose of this study was to compare the costs and effectiveness of enterostomal education using a multimedia learning education program (MLEP) and a conventional education service program (CESP).Multimedia health education programs not only provide patients with useful information in the absence of health professionals, but can also augment information provided in traditional clinical practice. However, the literature on the cost-effectiveness of different approaches to stoma education is limited.This study used a randomised experimental design.A total of 54 stoma patients were randomly assigned to MLEP or CESP nursing care with a follow-up of one week. Effectiveness measures were knowledge of self-care (KSC), attitude of self-care (ASC) and behavior of self-care (BSC). The costs measures for each patient were: health care costs, MLEP cost and family costs.Subjects in the MLEP group demonstrated significantly better outcomes in the effectiveness measures of KSC, ASC and BSC. Additionally, the total social costs for each MLEP patient and CESP patient were US$7396·90 and US$8570·54, respectively. The cost-effectiveness ratios in these two groups showed that the MLEP model was better than the CESP model after one intervention cycle. In addition, the Incremental Cost Effectiveness Ratio was -20·99.This research provides useful information for those who would like to improve the self-care capacity of stoma patients. Due to the better cost-effectiveness ratio of MLEP, hospital policy-makers may consider these results when choosing to allocate resources and develop care and educational interventions.This study provides a cost effective way of addressing stoma care in the post-operative period that could be usefully transferred to stoma care settings internationally.