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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Purpose/objectives: To explore the core constitutive patterns from the perspective of the older patient with terminal cancer, the major foci of spiritual needs, and professional actions that manifest tangibly as spiritual care., Design: Hermeneutic inquiry., Setting: Two leading teaching hospitals in Taiwan., Sample: 35 older patients with terminal cancer with a life expectancy of three months., Methods: Participatory observation and in-depth interviews were the major data collection strategies. Hermeneutic inquiry was used to disclose, document, and interpret participants' lived experiences., Main Research Variables: The perceptions of older Taiwanese patients with terminal cancer and their particular healthcare needs across various transition stages., Findings: Two constitutive patterns, "caring for the mortal body" and "transcending the worldly being," each with three themes and a related transformational process emerged from the data analysis. Two foci of spiritual needs were discovering patients' concerns about their dying bodies and their worldly being and facilitating the transcendence of the spiritual being from the physical realm., Conclusions: Caring for older Taiwanese patients with terminal cancer and helping them transcend the fear of the unknown when they give up worldly being can produce insights into patients' primary concerns, perceptions, and spiritual needs to help them achieve a "good" death., Implications for Nursing: The knowledge gained in this study and the six major spiritual care actions identified may empower oncology nurse educators to develop culturally valid spiritual care courses. Research-based guidance for nurse clinicians who are taking care of older Taiwanese patients with terminal cancer will be provided.

Quality of life is an important indicator for evaluating therapeutic outcomes and mortality in patients with end-stage renal disease. Few studies have explored the impact of symptom distress and social support on quality of life in this population. A correlational study was designed to examine the influence of symptom distress, social support and demographic characteristics on quality of life in renal transplant recipients. A convenience sample of 113 renal transplant recipients was recruited from a medical center in Southern Taiwan. A structured questionnaire was used to collect data. This four-part tool included: Quality of Life Index--Kidney Transplant Version III, Physical Symptom Distress Scale, Social Support Scale, and demographic characteristics. Data were analyzed by descriptive and inferential statistics (SPSS 10.1 statistical package). Percentage, rank, mean and standard deviation, t-tests, chi-square, ANOVA, Pearson's correlation and multiple regression were computed. Results showed that renal transplant recipients had a moderate quality of life. Social support and symptom distress, age, employment status, and household income significantly explained 28.8% of the variance in quality of life. Findings suggest implications for interventional programming and research aimed toward improving quality of life, including individual and family-based approaches designed to enhance recipients' social support and address effective management of symptoms. Recruiting a transplant clinical nurse specialist to design and implement an intervention program also is recommended.

Adherence with prescription medications among elderly patients with cardiac conditions is poor. Mechanisms underlying adherence behavior have not been fully investigated. The purpose of this study was to develop a substantive model that describes medication-taking behavior in elderly individuals with chronic diseases. The study was exploratory using grounded theory. Purposive sampling was used to recruit 19 elderly cardiac patients. Four major themes were delineated from the data to describe readiness to adhere: perceived effectiveness, perceived partnership, perceived reality, and interpersonal influences. To convert perceptions into actions, 2 influencing factors, facilitating and inhibiting factors, played pivotal roles. This model could provide a useful framework for health professionals to design valid interventions for elderly patients to increase medication adherence.

The purpose of this study was to evaluate the outcomes of a telephone call service (TCS) for ambulatory surgery patients. Three outcomes were evaluated: patient satisfaction, patients' perceptions of the value of a TCS intervention, and nurses' perceptions of difficulties in implementing it. The results indicated that patients were satisfied with the TCS intervention and were positive about its value. Nurses indicated that the main difficulties in implementing the TCS were their lack of knowledge in answering patients' questions and time limitations.

Aims and Objectives: Understanding the processes by which nurses administer medication is critical to the minimization of medication errors. This study investigates nurses' views on the factors contributing to medication errors in the hope of facilitating improvements to medication administration processes., Design and Methods: A focus group of nine Registered Nurses discussed medication errors with which they were familiar as a result of both their own experiences and of literature review. The group, along with other researchers, then developed a semi-structured questionnaire consisting of three parts: narrative description of the error, the nurse's background and contributing factors. After the contributing factors had been elicited and verified with eight categories and 34 conditions, additional Registered Nurses were invited to participate by recalling one of the most significant medication errors that they had experienced and identifying contributing factors from those listed on the questionnaire. Identities of the hospital, patient and participants involved in the study remain confidential., Results: Of the 72 female nurses who responded, 55 (76.4%) believed more than one factor contributed to medication errors. 'Personal neglect' (86.1%), 'heavy workload' (37.5%) and 'new staff' (37.5%) were the three main factors in the eight categories. 'Need to solve other problems while administering drugs,''advanced drug preparation without rechecking,' and 'new graduate' were the top three of the 34 conditions. Medical wards (36.1%) and intensive care units (33.3%) were the two most error-prone places. The errors common to the two were 'wrong dose' (36.1%) and 'wrong drug' (26.4%). Antibiotics (38.9%) were the most commonly misadministered drugs., Conclusions: Although the majority of respondents considered nurse's personal neglect as the leading factor in medication errors, analysis indicated that additional factors involving the health care system, patients' conditions and doctors' prescriptions all contributed to administration errors., Relevance to Clinical Practice: Identification of the main factors and conditions contributing to medication errors allows clinical nurses and administration systems to eliminate situations that promote errors and to incorporate changes that minimize them, creating a safer patient environment.

This pilot study evaluated the effects of a healthy-lifestyle-promoting program, taught as part of an undergraduate community health nursing course, on the physical fitness and health choices of 42 Taiwanese nursing students. A convenience sample provided quantitative indexes of physical fitness and lifestyle before and after the course. Qualitative data, in the form of student diaries, were also analyzed. The findings indicated a positive change in physical fitness, exercise, and nutrition as a result of the program. Including lifestyle programs in nursing education may help promote the long-term health of future nurses who will serve as positive patient role models.

The purpose of this study was to examine factors affecting the development of nursing competence in the writing of N3 (clinical nurse level III) case reports. A cross-sectional survey was conducted in 13 hospitals in southern Taiwan from July to October, 2002. The subjects included 239 nurses who had passed N3 case report accreditation. The results show that (1) nurses rated their current competence at a fairly good level ( 5.57 +/- 0.74). There was no significant difference between nurses ' subjective self-evaluation and supervisors ' objective evaluation (5.57 +/- 0.74 vs 5.55 +/- 0.89; t = 0.162, p = 0.871). (2) The nurses ' self-rating, supervisors ', and colleagues ' evaluation all indicated moderate progress in nursing competence after writing N3 case reports. The progress scores rated by nurses themselves, supervisors and colleagues were not significantly different (4.89 +/- 1.35 vs. 4.84 +/- 1.57 vs. 4.84 + 1.26; F = 0.096, p =.909). This finding reveals that writing N3 case reports has a positive effect on nursing competence. (3) The results also indicate that ' Attitude toward N3 case report ', 'Writing difficulty ', ' Preparation for writing case report ' were the three predicting factors of progress in nursing competence, which accounted for 26.2 % of the total variance. Therefore we recommend that N3 advancement education should include guidance in alleviating writing difficulty and emphasis on implementing various types of preparation for writing case reports, as effective ways to improve nursing competence.

The purpose of this study was to compare the differences between head nurses expectations and new graduates perceptions of the entry-level skill competency. Subjects included 147 new graduates and 126 head nurses from four schools of nursing and their affiliated medical centers located in northern, central and southern Taiwan. The results showed that among 213 skills, 153 skills were reported by over 60% of head nurses to be performed precisely under clinical settings. In contrast to the graduates perceptions, over 60% of the graduates had confidence to perform only 82 skills precisely. The percentage of head nurses expectation and the perception of the graduates in skills that were reported to be performed precisely in clinical situations were significantly different in 145 skills (68%). For seventy-six skill items there was congruence between the percentage of head nurses expectations and new graduates perceptions. The percentage of the head nurses expectation were higher than the graduates perception in 55 skills. On the other hand, for 14 skills the percentage of graduates who perceived themselves as being able to perform them precisely was significantly higher than the percentage of head nurses. The results can be applied to improve nursing skills teaching and students pre-job preparation.

A novel and promising approach currently available is the grafting of fetal nigra tissues into the brain of a Parkinson's patient. However, the degree of success for such treatment has mainly been evaluated by histological, radiological and physical assessments, with little or no attention paid to its effects on the patient's psychosocial status. In order to provide a more comprehensive profile, a survey was conducted using questionnaires and interviews to examine the physio-psycho-social progress of six Parkinson's patients who underwent fetal tissue grafting in Taiwan. Results indicated that the physiological effects varied among patients. Noticeably an improvement in walking was the most gratifying, but progress in dressing and writing ability seemed disappointing. From the psychological point of view, depression was commonly felt by patients. Other feelings included fear, ambivalence, and change in body image. In addition, all six patients found that their relationship with spouse became worse; they also reduced social interaction to the minimum. From the findings, we also noticed that inadequate knowledge contributed to part of the results. Therefore, some nursing suggestions especially educating the patients and family about the facts and outcome of fetal tissue transplantation are highly recommended. These may help Parkinson's patients adjust better after undergoing this novel treatment.