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

This study aimed to explore the effectiveness of gong meditation on nurses' perceived stress and occupational burnout during the COVID-19 pandemic.Nurses play an important role in hospitals, and they currently encounter additional stress due to the COVID-19 pandemic.In this experimental study, participants were provided intervention with seven sections of gong meditation, and each session lasted for approximately 50-60 min. Data were collected from July 2020 to February 2021. Eighty nurses were randomly assigned to the experimental or control group, and 79 completed all the processes of our protocol. Generalized estimating equations (GEE) were used in data analysis.Compared with the control group, the experimental group experienced significant improvements in stress and occupational burnout.Gong meditation can effectively alleviate stress and occupational burnout among nurses during the COVID-19 pandemic.Gong meditation can be provided by hospital managers to all nurses to reduce their stress, occupational burnout and subsequent mental health problems. Additionally, we suggest that gong meditation can be used as an effective intervention for individuals in other occupational fields, as it is accessible and inexpensive intervention.

Author(s): Hsu, Hsin-Tien; Chiang, Yen-Chiu; Lai, Yu-Hung; Lin, Li-Yuan; Hsieh, Hsiu-Fen; Chen, Jyu-Lin | Abstract: BackgroundChronic kidney disease (CKD) is a common chronic disease. As this disease is extremely complex, multidisciplinary care (MDC) is needed to provide complete and continuous care.AimA systematic literature review was performed to examine the constituents of MDC, the content of MDC interventions, and the health outcomes in CKD patients receiving MDC.MethodsSearches of five Chinese and English databases for studies of CKD patients who had received MDC from 2007 to 2019 revealed 11 studies, which comprised 16,066 CKD patients. The Physiotherapy Evidence Database scale (Physiotherapy Evidence Database, 2017) was used to appraise study quality for randomized controlled trials, and the Joanna Briggs Institute Critical Appraisal tools (Joanna Briggs Institute, 2017) were for cohort studies.ResultsThe MDC teams that provided comprehensive medical care for these patients included nephrologists, nurses, surgeons, general practitioners, pharmacists, psychotherapists, social workers, nutritionists, and other specialists. The literature review revealed that MDC for CKD slows the decline in estimated glomerular filtration rate and decreases patient mortality, the risk of renal replacement therapy, the need for emergent dialysis, and annual medical costs. Analyses of biochemical markers in the CKD patients showed that MDC improves control of serum levels of calcium and phosphate, improves control of parathyroid hormone, and reduces proteinuria and fasting blood glucose values. However, further studies are needed to determine the effects of MDC on all-cause mortality, blood pressure control, hospitalization rate, hospitalization for cardiovascular or infection events, medications use, and other biochemical markers in CKD patients.Linking evidence to actionCross-disciplinary collaboration of healthcare professionals is needed to ensure that patients undergo regular follow-up and periodic assessment of clinical status, in addition to ensuring that relevant resources and assistance are provided in a timely manner. A follow-up period of at least 2nyears is also needed to ensure sufficient time to observe MDC results.

With 16.15% of its total population aged 65 or above, Taiwan is already an aging society. Frailty is a natural consequence of aging, which may decrease physical strength and deteriorate physiological functioning. We examined the mediating effects of cognitive function, social support, activities of daily living (ADL), and depression in the relationship between age and frailty in older people living in the community. This cross-sectional study used a structured questionnaire to collect data from a convenience sample of 200 pre-frail to mildly frail older adults in southern Taiwan. Structural equation modeling was used for data analysis, with data collected from July to November 2020. ADL mediated the relationship between age and frailty, while cognitive function also mediated the relationship between age and frailty, indicating that ADL and cognitive function were significant determinants of frailty. The path from age to frailty was significant, indicating that age was a significant determinant of frailty. The standardized total effect of age affected frailty through the mediating roles of ADL and cognitive function. Age, depression, ADL, and cognitive function explained 59% of the variance in frailty among older adults. ADL and cognitive function are significant mediators of frailty among older adults.

This study examines the parallel multiple mediators of quality of sleep and occupational burnout between perceived stress and depressive symptoms in psychiatric nurses. Nurses are more likely to experience depression, anxiety, decreased job satisfaction, and reduced organizational loyalty as a result of the stressful work environment and heavy workload. A total of 248 psychiatric ward (PW) nurses participated in this cross-sectional survey study. Structural equation modelling was used for data analysis. In the model of parallel multiple mediators for depressive symptoms, quality of sleep and occupational burnout played mediating roles, and these two mediators strengthened the effect of stress on depressive symptoms, with the final model showing a good fit. Stress, occupational burnout, and quality of sleep explained 46.0% of the variance in psychiatric nurses’ depressive symptoms. Stress had no significantly direct effect on psychiatric nurses’ depressive symptoms, but it had a completed mediation effect on their depressive symptoms through occupational burnout and quality of sleep. This study showed that reduction of occupational burnout and improvement of quality of sleep play important roles against depressive symptoms among PW nurses. Healthcare managers should provide PW nurses with a better environment for improving quality of sleep and reducing occupational burnout.

Irritable bowel syndrome (IBS) is a common recurrent functional gastrointestinal disorder that impacts on patients physically and mentally. Studies on IBS have focused on adults, yet few studies have examined IBS among female university students. The aim of this study was to investigate the prevalence of IBS for female university students and its related factors. Using a cross-sectional study design, a total of 2520 female university students were recruited in southern Taiwan. The structured questionnaires, including the Rome III IBS diagnostic questionnaire, IBS symptom severity scale, Perceived Stress Scale, and World Health Organization Quality of Life BREF questionnaire (WHOQOL-BREF) were used for data collection. A total of 1894 female students complete the questionnaires. The response rate was 75.15%. The results indicated 193 female students with IBS and the prevalence of IBS was 10.1%. IBS female students had higher levels of stress and lower QOL than non-IBS female students. The risk factors for female university students developing IBS were dysmenorrhea, food avoidance, class absenteeism, and the lower physical domain of QOL. It is advised to consider these factors when providing students with counselling and relevant services in the expectation of alleviating their IBS symptoms, reducing the incidence rate of IBS, and further improving their QOL.

Objectives:The objectives of this study were to investigate the primary diagnoses and outcomes of emergency department visits in older people with dementia and to compare these parameters with those in older adults without dementia.Design and Setting:This hospital-based retrospective study retrieved patient records from a hospital research database, which included the outpatient and inpatient claims of two hospitals.Participants:The patient records were retrieved from the two hospitals in an urban setting. The inclusion criteria were all patients aged 65 and older who had attended the two hospitals as an outpatient or inpatient between January 1, 2009, and December 31, 2016. Patients with dementia were identified to have at least three reports of diagnostic codes, either during outpatient visits, during emergency department visits, or in hospitalized database records. The other patients were categorized as patients without dementia.Measurements:The primary diagnosis during the emergency department visit, cost of emergency department treatment, cost of hospital admission, length of hospital stay, and diagnosis of death were collected.Results:A total of 149,203 outpatients and inpatients aged 65 and older who were admitted to the two hospitals were retrieved. The rate of emergency department visits in patients with dementia (23.2%) was lower than that in those without dementia (48.6%). The most frequent primary reason for emergency department visits and the main cause of patient death was pneumonia. Patients with dementia in the emergency department had higher hospital admission rates and longer hospital stays; however, the cost of treatment did not show a significant difference between the two groups.Conclusions:Future large and prospective studies should explore the severity of disease in older people with dementia and compare results with older adults without dementia in the emergency department.

BACKGROUND Acute postoperative pain (APOP) may cause complications and delay healing. Analgesics alone cannot completely relieve APOP. Preoperative anxiety, optimism, and pain catastrophizing are predictors of APOP. No study author has examined the mediating effect of pain catastrophizing on APOP in patients undergoing cardiac surgery. OBJECTIVE The aims of this study were to investigate the relationship between preoperative anxiety, optimism, pain catastrophizing, confounding factors (age, sex, type of surgery, and preoperative pain), and APOP and to examine the mediating effect of pain catastrophizing. METHODS The authors of this cross-sectional study used a convenience sampling method and included 100 adults undergoing cardiac surgery in a southern Taiwanese medical center. The patients were asked to complete the State-Trait Anxiety Inventory-State subscale, Pain Catastrophizing Scale, and Life Orientation Test-Revised questionnaires before surgery. Postoperatively, the patients were asked to report their pain intensity on a numerical rating scale. Results were analyzed using SPSS version 22. RESULTS Patients had a mild level of anxiety, a moderate level of optimism, and pain catastrophizing before surgery, as well as a moderate level of APOP. Men reported lower levels of APOP than women (z = -2.0, P < .05). APOP was significantly associated with preoperative anxiety (r = 0.48, P < .01), optimism (r = -0.45, P < .01), and pain catastrophizing (r = 0.65, P < .01). Only pain catastrophizing was a significant predictor of APOP (β = 0.60, P < .001) and fully mediated the relationship between anxiety and APOP (z = 4.92, P < .001). The final model explained 42% of the variance in APOP. CONCLUSIONS Pain catastrophizing should be assessed before surgery. Reducing pain catastrophizing would decrease APOP and improve the quality of pain management.

Psychiatric ward (PW) nurses are at a higher risk to encounter workplace violence than are other healthcare providers, and many interventions have been developed to improve their mental health. We compared the effectiveness of biofeedback training (BT) and smartphone-delivered BT (SDBT) interventions on occupational stress, depressive symptoms, resilience, heart rate variability, and respiration rate in a sample of abused PW nurses. This was a quasi-experimental study. Structured questionnaires were administered before and six weeks after the intervention. Data were collected from April 2017 to October 2017. A total of 159 abused PW nurses were randomly assigned to BT, SDBT, and control groups, and 135 of them completed all processes of our protocol, with the study consisting of 119 females (88.1%) and 16 males (11.9%) and their age range being from 22 to 59 with the mean age of 35.61 and a standard deviation of 8.16. Compared to the controls, both the BT and the SDBT intervention groups experienced significant improvements in depressive symptoms, resilience, and respiration rate, and the SDBT group experienced significant reductions in occupational stress. Considering the cost, accessibility, restrictions time and space, SDBT be used as an effective intervention in people with resilience or occupational stress.

Aims We examined the possible factors that contributed to or prevented developing depressive symptoms among psychiatric nurses who suffered from workplace violence under Hill's ABC-X Model. Background Workplace violence-related depressive symptoms are some of the major causes leading to impaired quality of life of victims and a heavy burden on society. Design This is a cross-sectional and correlational study. Method All participants were recruited from psychiatric wards of six hospitals in Taiwan. The data were collected through structured questionnaires from October 2013–March 2014 and a total of 278 psychiatric wards nurses participated in this study and completed all questionnaires. Logistic regression was used to examine the relationships among types and severity of violence, social support and depressive symptoms. Results Of assaulted psychiatric ward nurses, 75.9% had depressive symptoms and those with higher family support had significantly lower depressive symptoms. Conclusions Family support plays the most important role among assaulted psychiatric ward nurses as a protective factor against developing depressive symptoms in this study.

PURPOSE: This study investigated the relationship among personality traits, social network integration (SNI), and resilience in emergency department (ED) nurses who had suffered from physical or verbal violence by patients or their families. DESIGN AND METHODS: A cross-sectional study with convenience sampling was conducted for exploring the related factors of resilience on abused nurses. A total of 187 participants met our inclusion criteria and completed all questionnaires. FINDINGS: Higher degrees of extraversion and peer support were associated with greater resilience among all abused nurses, whereas neuroticism was inversely associated with their resilience. CONCLUSIONS: Among all forms of SNI, only peer support was shown to enhance an individual's resilience. In addition, personality traits were associated with resilience, and religions did not play an important role in enhancing resilience among our participants. CLINICAL RELEVANCE: Through a clearer understanding of the role of peer support in resilience among ED nurses, healthcare managers should provide and enhance their peer support to intensify their resilience for prevention of consequences of workplace violence. Language: en

Mindfulness-based stress reduction (MBSR) is a potentially effective supplement for the treatment of insomnia; however, there is no comprehensive review of its mental health effects among insomnia patients. This study aimed to synthesize relevant quantitative evidence and evaluate MBSR application and effectiveness for insomnia patients' sleep quality and mental health.A systematic search through eight databases from the earliest available dates until August 2019 was conducted. Randomized controlled trials assessing the effects of MBSR on sleep quality, anxiety, and depression as outcome measures among insomnia patients comprising patients aged above 18 years were included in this meta-analysis. Each study's quality was assessed using the modified Jadad quality scale. The Review Manager 5.3 software was used to calculate the standardized mean differences (SMD) with 95% confidence intervals (CIs) for the data analyses.In total, data for 497 patients in seven randomized controlled trials were analyzed. The results revealed that compared to the control group, the MBSR group significantly improved in sleep quality (SMD = -0.69, 95% CI: -1.12~ - 0.26, Z = 3.16, p = .002), depression (SMD = -1.83, 95% CI: -2.81-0.84, Z = 3.63, p .001), and anxiety (SMD = -1.74, 95% CI: -2.90-0.59, Z = 2.96, p = .003). A sensitivity analysis was undertaken. After carefully reviewing included trials, we can reasonably conclude that these heterogeneities did not impair the overall effect size of MBSR in the results.MBSR significantly improved sleep quality and mental health. Future research is needed using standardized methods examining the long-term effects of MBSR on the mental health of individuals with insomnia.

The smartphone is a widely used and rapidly growing phenomenon worldwide, and problematic smartphone use is common in our society. This study&rsquo, s objective was to examine the gender difference of baseline and post-intervention skin conductance response (SCR) among smartphone users and explore the relationships among problematic smartphone use level, anxiety level, and SCR changes by evaluating SCR, the Zung Self-Rating Anxiety Scale score, and the Chinese version of the Smartphone Addiction Inventory (SPAI) score in a one-group baseline and post-test design. Sixty participants were recruited from two communities, and data were collected from April to June 2017. There was a significant difference in terms of SCR changes between young males and old males and between young females and old females. Additionally, the SCR changes in young females were significantly greater than those in young males with twofold mean difference. This study provides strong evidence supporting the effectiveness of SCR measurement for assessing problematic smartphone use (PSU) anxiety when users are in a withdrawal-like state. The SCR measurement can help healthcare providers identify cases with risk factors of PSU for early intervention.

Background Intimate partner violence (IPV) is known to cause physical suffering and psychological problems, which burden society. In addition, IPV-related psychological problems such as depressive symptoms may lead to disabilities, chronic mental illness, and an increased risk of suicide. Purpose This study was designed to explore the factors associated with depressive symptoms in women who were physically abused by intimate partners. Methods This cross-sectional study recruited 72 physically abused women from two domestic violence prevention centers in southern Taiwan. The questionnaires that were used to collect data included the Eysenck Personality Questionnaire, the Conflict Tactic Scale, and the Center for Epidemiologic Studies Depression Scale. Results Sixty-six of the participants (91.67%) met the inclusion criteria and completed all questionnaires. Fifty-five (83.3%) of the participants were found to have depressive symptoms. Depressive symptoms were positively associated in this sample with younger age, a lower level of extraversion, and a higher level of neuroticism. These three factors explained 59.5% of the total variance in depressive symptoms. Conclusions/Implications for Practice Youth and neuroticism were found to be significant risk factors for developing depressive symptoms in female victims of IPV, whereas extraversion was found to be a related protective factor. The results of this study indicate that clinical workers should provide female victims of IPV, especially relatively young victims, with services that help ameliorate neuroticism to reduce the risk of depressive symptoms.

AIM AND OBJECTIVES: This correlation study examined the relationship among recently workplace violence, depressive tendency, social support, and resilience of victimised nurses, and we also tried to identify protective factors and potential targets for preventive interventions for these nurses. BACKGROUND: Workplace violence in hospitals negatively affects occupational health and safety of medical professionals, especially for emergency department nurses. DESIGN: A cross-sectional, correlation research design was applied. METHODS: Hierarchical regression was used to examine data which were collected from June 2013 to December 2013 from emergency departments in Taiwan. One hundred and eighty nurses were recruited from two hospitals. Structured interviews and questionnaires were applied to collect data, including the Social Support Scale, the Resilience Scale and the Center for Epidemiologic Studies Depression. RESULTS: A total of 159 (88·33%) nurses had suffered from physical or verbal violence by patients or their family. Resilience and peer support were significantly higher in the group without depressive tendency. Components of resilience of personal strength, social competence, structure style and religious beliefs were significant factors which accounted for 46·0% of variance in depressive tendency. Three of the five components of resilience: personal strength, social competence and structured style were found to have profounder effects against depressive tendency than peer support. CONCLUSIONS: Hospital managers should establish a safer working environment for emergency department nurses and reinforce their resilience against depression when they encounter workplace violence. RELEVANCE TO CLINICAL PRACTICE: This study showed that three of the five components of resilience: personal strength, social competence and structured style are protective factors against depressive tendency in victimised nurses. Improving these three components with coping and problem-solving skills by healthcare manager would be effective measures for enhancing their resilience in situations of workplace violence.© 2016 John Wiley & Sons Ltd. Language: en

The aim of the authors in this study was to identify factors associated with resilience that helped abused nurses face and cope with violent events. The data for this cross-sectional study were collected from June 2013 to December 2013; 272 participants were recruited from emergency rooms and psychiatric wards in four hospitals in central Taiwan. Among these participants, 230 (84.6%) met the inclusion criterion and completed all questionnaires; 69 (30%) of them reported having experienced only verbal violence; 46 (20%) reported having experienced only physical violence, and 115 (50%) reported having experienced a combination of verbal and physical violence. The following were positively associated with resilience score: having a college education or greater (exp(β) = 1.045, p = .018), extraversion (exp(β) = 1.012 per unit increase in the score, p < .001), family support (exp(β) = 1.004 per unit increase in the score, p = .031), peer support (exp(β) = 1.008 per unit increase in the score, p = .006), and lower level of neuroticism (exp(β) = 0.983 per unit increase in the score, p < .001); 43.6% of the variance in resilience was explained by the variables assessed. Adequate support and advanced education are important for abused nurses to enhance their resilience.

ObjectivesNurses are at high risk of dysmenorrhoea while working with patients. The study objectives were to: (1) describe the demographic and menstruation characteristics of dysmenorrhoea, knowledge about dysmenorrhoea and menstrual attitudes towards menstruation among dysmenorrhoeal and non-dysmenorrhoeal hospital nurses; (2) identify significant differences between the groups; and (3) examine factors influencing dysmenorrhoea.MethodsThis cross-sectional survey used a structured questionnaire, administered at two hospitals in southern Taiwan. Participants included hospital nurses at least 18 years of age who agreed to participate. All participants were recruited through random sampling. The questionnaire included demographic data, the Dysmenorrhoea Knowledge Scale and Menstrual Attitude Scale (MAS).ResultsA total of 420 nurses completed the questionnaire. Among them, 297 (70.7%) had experienced dysmenorrhoea in the past 6 months and 123 (29.3%) had not. Significant differences in age (PConclusionsThese findings could help nursing managers to create a caring and friendly work environment for hospital nurses at risk of dysmenorrhoea.

Background: An increasing number of survivors of intimate partner violence (IPV) have begun to seek help from hospital emergency departments. This study was conducted to develop a list of requisite clinical competencies for emergency nurses to provide adequate care for women experiencing IPV. Method: An e-mail survey using the Delphi technique was administered, involving three rounds of questionnaires from 30 participants. Participants were asked to score the importance of each item on a 4-point Likert scale. Results: The study identified three dimensions, comprising 38 items of competencies related to care for individuals experiencing IPV, including Knowledge (10 items), Attitudes (11 items), and Practice (17 items). Conclusion: The emergency department is where direct medical treatment and care is provided for those who have experienced IPV. The study findings can provide a reference for the development of in-service educational programs in hospitals and can guide future policy making. J Contin Educ Nurs . 2015;46(6):272–278.

Background The demand for long-term care for older adults has escalated sharply. A good policy dedicated to the welfare of older adults has improved their quality of life. The purpose of this study was to explore the social welfare utilization and needs of older adults and compare their differences among age groups, genders, and functional dependency levels. Methods Three hundred eighty-four stratified, random-sampled Taiwanese community-dwelling older adults were recruited for this survey research. Participants rated their utilization of and needs for the 30 social welfare services provided by the government on a Likert-type scale. Results The most widely used and needed social welfare services by the older adults were senior monetary stipend and a subsidy for the national health insurance premium. Young-old, male, and functionally independent older adults had more knowledge of the social welfare services than their counterparts. Conclusions While designing a comprehensive social welfare system, differing needs of different age groups, genders, and functional dependency levels should be taken into consideration.

Forensic nursing is a new nursing specialty that provides forensic nursing service to domestic violence victims and offenders. Development of the role of forensic nurses has become urgent and necessary. The high rates of domestic violence and sexual assault in Taiwan suggest that forensic nurses have an important role to play in domestic healthcare. This article highlights the significance of forensic nursing in Taiwan in the future in terms of its origin, definitions, models, roles and functions, training and education, and previous studies. Through cooperation among academia, government, industry, and law enforcement agencies, it is expected that forensic nursing will be a positive and important area of expansion for professional nursing.從家暴與性侵害防治政策談刑事護理的發展刑事護理是國際新興的一種護理專業，在於提供暴力受害者與犯罪者有關的護理實務與法律的專業服務。護理師的發展已被視為迫切需要，以扮演協助處理受害者及犯罪者的重要角色。透過刑事護理師的協助，家庭暴力或性侵害的受害者，或是精神障礙引發的犯罪者等，都可以獲得專業的照護。在家庭暴力及性侵害事件頻傳的台灣，刑事護理師角色的未來發展有其必要性。本文從刑事護理師的緣起、刑事護理師的定義、刑事護理師的模式、刑事護理師的角色功能、刑事護理師的教育訓練以及刑事護理師相關研究經驗，提出刑事護理師未來在台灣發展的意涵。期待未來透過學術界、政府政策、產業界以及警政單位的攜手合作，刑事護理師能成為台灣未來護理專業的角色拓展及新的契機。

Background: Domestic violence has a history that stretches back before recorded time. It frequently has a lasting and traumatic impact on victims, families, and communities. According to the official statistics of many countries, most domestic violence victims are women who were assaulted by intimate male partners. This issue is gaining increasing attention in Taiwan's current society. Purpose: The purpose of this study was to gain an empathic understanding of domestic violent abuse experienced by women in southern Taiwan. Perspectives were provided through the personal descriptions and views of the women interviewed. Methods: P.F. Colaizzi's (1976) descriptive phenomenological method was applied to conduct this study. A total of eight abused women from the southern Taiwan Domestic Violence and Sexual Assault Prevention Center participated in this study and associated in-depth interviews, which were tape-recorded, transcribed, and reviewed for accuracy by the interviewee. Verbatim manuscript transcriptions were then analyzed. Finally, major themes from extracted data were summarized. Results: The following four themes emerged: feeling sorry about their marriage, living in an unsafe environment, economic difficulties, and enduring unhappy lives. Conclusions/Implications: These results may help health professionals understand the assault experiences and the nature of domestic violence from victims' viewpoints. This may also help health professionals obtain a comprehensive assessment and develop appropriate interventions for these abused women.