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Aims: This study evaluates the effectiveness of an interactive E-book app training program in improving nurses’ knowledge, attitudes, and confidence to prevent and care for pressure injury. Design: Randomized experimental study. Methods: Participants were recruited from a teaching hospital in Taiwan. The study was carried out between 20 March 2014 to 1 April 2016. In total, 164 participants were randomly assigned to a pressure injury E-book app training program (n = 86) or a conventional education program (n = 78) with a one-month follow-up. Outcome variables were levels of pressure injury knowledge, attitudes, and confidence of pressure injury care. Results: Participants answered 51.96% of the pressure injury knowledge questions correctly before the intervention and 75.5% after the intervention. The pressure injury attitude score was slightly positive, with moderate confidence in pressure injury care. The knowledge, attitudes, and confidence of pressure injury care of the two groups in the pretest and posttest groups increased significantly. Analysis of covariance indicated that nurses in the pressure injury E-book app group had significantly greater improvement in knowledge, attitudes, and pressure injury care confidence as compared with the control group. Conclusion: The pressure injury E-book app interactive training program was effective in improving nurses’ knowledge and attitudes toward pressure injury care and in enhancing their confidence in pressure injury care; therefore, this program has potential for nurses’ in-service education in both Taiwan and worldwide. Impact: E-book apps allow individuals to control the time and place of learning. Direct observation of procedural skills can provide feedback to trainees on techniques to ensure learning effectiveness and pressure injury care quality.

Depression is the most common mental problem among the elderly, especially in long-term care facilities. The purpose of the present study was to examine the effects of group music intervention on depression for elderly people in nursing homes. Methods: A randomized control trial consisting of sixty-three elderly participants randomly and blindly assigned to a music group or control group was utilized. The music group received 20 sessions of group music intervention (two 30-min sessions per week for 10 weeks), and the control group received usual care with no music intervention. The Geriatric Depression Scale—Short Form (GDS-SF) and salivary cortisol at baseline, 5 weeks, and 10 weeks were collected for analysis. Results of the GEEs (generalized estimating equations) analysis indicated that after 20 sessions for 10 weeks of group music intervention, the groups showed a statistically significant difference in depression at 5 weeks and 10 weeks. There was no significant difference in the salivary cortisol concentration between the two groups. The results show that the group music intervention may effectively reduce the depression scores for elderly people in nursing homes. Conclusion: The group music intervention has positive effects on depression.

Hard-to-heal wounds (HHW) represent wound beds that are at high risk of stagnating during the inflammatory or proliferative phase because of various internal or external factors. A wound area reduction of less than 40% in 4 weeks is an indicator of HHW. With the acceleration of population aging, an increasing number of older adults are developing various chronic diseases with comorbidities. Although many older adults are affected by HHW, patients are regularly expected to recuperate at home or in long-term care institutions rather than in hospitals because of shortened hospitalization periods and changes in the medical insurance system. The provision of healthcare to patients with HHW in home settings is currently complicated by the lack of systematic nursing education on wound care, the lack of evidence-based guidelines for home wound care, and the inadequate wound care skills of nurses. HHW have major physical, psychological, and economic impacts on patients and their families and increase stress and frustration in nurses. Inappropriate wound care interventions increase medical expenditures and have multifaceted effects that are largely ignored by the medical care system. This phenomenon, which encompasses HHW, has been called a silent epidemic. In this paper, HHW are defined, the current status of home wound healing worldwide is analyzed, the relevant challenges and strategy implementations are discussed, and recommendations for the home care of HHW are provided.困難癒合傷口居家照護的困境與挑戰.困難癒合傷口（hard-to-heal wounds, HHW）乃傷口床（wound bed）因內在或外在因素影響，使其停滯在炎症期或增生期，當傷口床縮合小於40%或超過4星期未癒合者稱之。人口高齡化老年族群因共病性合併HHW人數有攀升趨勢，卻因當前醫療保險制度改變、醫院住院天數縮短，病人須出院返家或入住長照機構照護傷口；然護理人員缺乏系統性的傷口照護教育，對傷口評估與照護技能不足，缺乏實證居家傷口照護指引等，使得居家傷口照護面臨重大的挑戰。HHW不僅造成病人及家屬生理、心理、經濟等層面嚴重衝擊，也引發護理人員的壓力與無力感，不適切處置耗費醫療龐大支出，卻被醫療照護體系忽略它多面向的影響，此現象也被稱為無聲流行病學（silent epidemic）。本文依序說明HHW定義、分析當前全球困難癒合傷口的居家照護現況、面臨的挑戰及策略應用，進而提供居家HHW照護的依據。.

Background Enteral feeding tubes used to manage the nutritional status of esophageal cancer were evaluated regarding their effectiveness in patients receiving neoadjuvant therapy. Patients and methods A retrospective study evaluating patients with esophageal squamous cell carcinoma undergoing neoadjuvant therapy between 2001 and 2014 was conducted at a medical center. Hospital patients' records for enteral access (EA) insertion and treatment outcomes were statistically analyzed. Results Patients with EA at initial diagnosis had lower body mass index than the group without EA (p=0.012). Chemotherapy-related adverse events with grade 3-4 mucositis were significantly less frequent in the EA group (p=0.008), and grade 3-4 anemia was significantly more frequent (p=0.012). The 4-year mortality rate was 63.0% in the EA group and 67.7% in the group without EA (pnon-inferiority=0.035), which met the non-inferiority criterion with a non-inferiority margin of 10%. Conclusion Patients with esophageal squamous cell carcinoma with malnutrition status undergoing neoadjuvant therapy with EA showed an improved outcome at maintaining nutritional status, reduced severity of mucositis and improved survival rate.

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.

The objective of this paper is to systematically and critically review the available literature on the effects of subthalamic nucleus (STN) stimulation on the quality of life (QoL) of patients with Parkinson's disease (PD). A systematic review of the literature published from 1993 to May 2013 was conducted using PubMed, Cochrane Library, MEDLINE, EBSCO host, CINAHL, and CEPS + CETD, in addition to hand searching selected periodicals and checking reference lists. The review included randomized and nonrandomized controlled trials, published in English, comparing STN stimulation with the best medical therapy on the QoL of patients with PD. The time over which QoL was evaluated ranged from baseline to 24 months. Two reviewers independently assessed the study quality and the extracted data. Of the over 273 potential studies examined, we identified seven pertinent articles published between 2002 and 2013 involving 1193 participants. Six of the seven studies were randomized controlled trials (RCTs). Almost all reported statistically significant outcomes. All the studies using QoL outcome variables included the Parkinson's Disease Questionnaire-39 (PDQ-39) ( n = 7) and two also used the Short Form-36 (SF-36) questionnaire ( n = 2). There was significant improvement in QoL (PDQ-39) up to 6 months following STN-deep brain stimulation (DBS) in three RCTs and in one nonrandomized trial and up to 12, 18, and 24 months postoperatively in one RCT each, compared with no improvement in the medical therapy groups. There was a 22% improvement in the physical summary score on the SF-36 questionnaire versus no change in the drug-only group. The quality of the trials was limited by the potential for bias associated with inadequate concealment, no reported intention-to-treat analysis, and small sample size. Moreover, there were problems in some studies with confounding factors. The main points to emerge from this review of studies on STN-DBS in patients with PD demonstrate an overall positive effect on QoL. Based on these studies, the benefits may last for 2 years. The review clearly highlights the need for well-designed, methodologically standardized outcome measurement research into the effectiveness of STN stimulation in PD.

Pruritus, a distressing symptom that affects burn patients, not only interferes with activities of daily living but also causes disturbed sleep, which has been associated with anxiety, depression, and other types of negative moods. Furthermore, the uncontrolled scratching that often accompanies pruritus causes tissue damage and may damage or destroy the skin graft. In this paper, the authors first describe the definition and mechanism of pruritus and next use itching-assessment tools to identify the triggering factors. Finally, the authors propose a multifaceted approach to treating pruritus that includes using medication, topical emollients, massage therapy, skin moisture, relaxation techniques, and combined coping to relieve patient discomfort. The authors hope that this paper deepens and broadens the knowledge of health professionals on this issue and improves the quality of care that is available for burn patients who are in the rehabilitation stage.復健期燒傷病人搔癢之處置與照護.燒傷後癒合皮膚搔癢是燒傷病人公認最困擾症狀之一。它不僅干擾病人日常生活、造成睡眠紊亂、引發焦慮及憂鬱等負向情緒，持續不當地抓搔，還會造成皮膚完整性受損、甚至影響植皮手術的成功。本文依序說明搔癢定義與機轉、如何透過搔癢評估找到誘發因素，藉由藥物治療、皮膚滋潤、按摩治療、矽膠使用以及放鬆訓練，同時輔以搔癢因應訓練，協助病人緩解此擾人不適的症狀。藉此讓臨床照護人員能對於本議題有更深廣的認識，應用於燒傷後癒合皮膚搔癢護理，進而提高病人生活品質。.

lo s.-f., hayter m., hu w.-y., tai c.-y., hsu m.-y. & li y.-f. (2012) Symptom burden and quality of life in patients with malignant fungating wounds. Journal of Advanced Nursing68(6), 1312–1321. Abstract Aim. This study describes the relationship between symptoms and quality of life in patients with malignant fungating wounds. Background. 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. Methods. 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. Results. 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. Conclusion. 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.

lo s.-f., wang y.-t., wu l.-y., hsu m.-y., chang s.-c. & hayter m. (2011) Multimedia education programme for patients with a stoma: effectiveness evaluation. Journal of Advanced Nursing 67(1), 68–76. Abstract Aim. 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. Background. 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. Method. 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. Findings. 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. Conclusion. 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.

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.

Study aims. The purpose of this study was to compare the costs and effectiveness of enterostomal education using a multimedialearning education program (MLEP) and a conventional education service program (CESP).Background. Multimedia health education programs not only provide patients with useful information in the absence of healthprofessionals, 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.Design. This study used a randomised experimental design.Methods. 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 costsmeasures for each patient were: health care costs, MLEP cost and family costs.Results. Subjects in the MLEP group demonstrated significantly better outcomes in the effectiveness measures of KSC, ASC andBSC. Additionally, the total social costs for each MLEP patient and CESP patient were US$7396AE90 and US$8570AE54,respectively. The cost–effectiveness ratios in these two groups showed that the MLEP model was better than the CESP modelafter one intervention cycle. In addition, the Incremental Cost Effectiveness Ratio was 20AE99.Conclusion. This research provides useful information for those who would like to improve the self-care capacity of stomapatients. Due to the better cost–effectiveness ratio of MLEP, hospital policy-makers may consider these results when choosing toallocate resources and develop care and educational interventions.Relevance to clinical practice. This study provides a cost effective way of addressing stoma care in the post-operative period thatcould be usefully transferred to stoma care settings internationally.Key words: cost of care, experimental design, nurses, patient teaching, stoma care, Taiwan

Aim. The purpose of this study was to examine the efficacy of silver-releasing dressings in the management of non-healing chronic wounds. Background. Non-healing chronic wounds often have a negative physical impact on patients and place a financial burden on healthcare systems. Silver dressings are wound products designed to control infection and provide a wound environment conducive to healing. However, validation of the clinical efficacy of these dressings is lacking. Design. Systematic review and meta-analysis. Methods. A systematic search of the major electronic databases PubMed, CINAHL, Cochrane, MEDLINE, British Nursing Index, EBSCO, OCLC and Proquest between 1950‐June 2007 was conducted. Hand searches of selected periodicals, textbooks and checking reference lists and contacting experts was also performed. Results. Eight studies were selected from a potentially relevant 1957 references screened. Analysis incorporated data from 1399 participants in the eight randomised control trials. We found that silver dressings significantly improved wound healing (CI95: 0AE16‐0AE39, p < 0AE001), reduced odour (CI95 :0 AE24‐0AE52, p < 0AE001) and pain-related symptoms (CI95 :0 AE18‐0AE47, p < 0AE001), decreased wound exudates (CI95 :0 AE17‐0AE44, p < 0AE001) and had a prolonged dressing wear time (CI95 :0 AE19‐0AE48, p =0 AE028) when compared with alternative wound management approaches. An analysis of sensitivity in these studies by subgroup analysis generally supported these associations. Furthermore, studies indicated an improvement in quality of life (CI95 :0 AE04‐ 0AE33, p =0 AE013) using silver dressings in wound management with no associated severe adverse events. Conclusion. This meta-analysis confirms the effectiveness of silver dressings in wound healing and improving patients’ quality of life. However, it also highlights the need for additional well-designed randomised controlled trials to evaluate the effectiveness of silver-related dressings further. Relevance to clinical practice. The results of this study provide objective data on the effectiveness of silver-related dressing when applied to non-healing chronic wounds.

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.

Aim. This paper is a systematic review with the objective of determining the effectiveness of silver-releasing dressing in the management of infected chronic wounds. Background. Chronic wounds exhibit increased bacterial burdens which not only result in a negative physical impact on patients, impairing their quality of life, but also increase treatment costs. Silver dressings are wound products designed to control and inhibit infection and provide a wound environment conducive to healing. However, there is limited evidence on their effectiveness in doing so. Methods. A systematic review of literature from 1950–May 2007 was conducted using the PubMed, CINAHL, Cochrane, MEDLINE, British Nursing Index, EBSCO Host, OCLC, Proquest and PsychInfo databases. The review included randomised or non-randomised control trials, published in English or non-English, of silver-releasing dressings in infected chronic wounds. Results. Of the over 1957 potentially releasing studies examined, 14 pertinent articles involving 1285 participants were identified. Almost all the participants reported one or more statistically significant outcomes. The main points to emerge from this review of studies are that silver-releasing dressings show positive effects on infected chronic wounds. The quality of the trials was limited by the potential for bias associated with inadequate concealment, no detailed description of the outcome measurement and no reported intention-to-treat analysis. Moreover, problems existed in some studies with confounding factors. Conclusion. The review clearly highlights the need for well-designed, methodologically standardised outcome measurement research into the effectiveness of silver-releasing dressings. It also points to the need for a comprehensive assessment of wound bed status in further studies. Relevance to clinical practice. This review strengthens the case for the use of silver dressings when managing infected chronic wounds. They appear more effective and are tolerated well by patients. However, their use should be accompanied by a comprehensive wound assessment.

This case report describes how wound bed preparation was used in the management of a malignant fungating wound in a woman with breast cancer. The patient had received routine cancer chemotherapy, radiotherapy and conventional wound care in an oncology ward. Six months later she presented with a wound infection, malodour, bleeding related to dressing changes and heavy exudate, which had not responded to treatment. By applying wound bed preparation in accordance with the TIME paradigm — Tissue management, Infection and Inflammation control, Moisture balance, and protect wound Edges — the malignant fungating wound was successfully treated in two months.

Major burn injury is one of the most serious and often life-threatening forms of trauma. Burn patients not only suffer from the physical, psychological, social and spiritual impacts of their injury but also experience considerable changes in health-related quality of life. This paper presents a review of the literature on the implications of previous research and clinical care guidelines related to major burn injuries in order to help clinical practice nurses use evidence-based care guidelines to respond to initial injury assessments, better manage the complex systemic response to these injuries, and provide specialist wound care, emotional support, and rehabilitation services.嚴重燒傷病人護理處置.大面積燒傷是一嚴重創傷且具生命威脅的皮膚損傷，對於病人生理、心理、社會文化及靈性層面造成極大衝擊，甚而影響其健康生活品質感受。為此本文之目的在於增進護理人員對於複雜燒傷病理生理變化評估與處置的新知。本文系統性整理國內外燒傷照護的研究及臨床照護指引，內容涵蓋燒傷後立即性評估、燒傷後全身反應與護理、燒傷傷口照護與敷料應用、心理支持與復健計畫，期望提供臨床護理人員以實證為基礎的照護決策依據。.

Although high-technology wound dressings are widely used in clinical care worldwide, no evidence or discussions have been published regarding the efficacy of these dressings in preventing pressure ulcers.This study presents a repositioning of routine management combined with hydrocolloid dressing or foam dressing for pressure ulcer prevention.We used a quasi-experimental design and recruited a convenience sample of 90 from a surgical intensive care unit (SICU) at a medical center in Hualien County, Taiwan. Participants were allocated randomly to one of three groups: repositioning of routine management, hydrocolloid dressing, and foam dressing. Study instruments included a pressure ulcer risk table (Braden scale) and the pressure ulcer classification system of the European Pressure Ulcer Advisory Panel. An independent sample t-test, ANOVA, and Mann-Whitney U test were used to verify research hypotheses.The repositioning of routine management group had the highest pressure ulcer incidence rate, followed by the hydrocolloid-dressing group. The foam-dressing group recorded no pressure ulcers. Pressure ulcer occurrence grades were primarily level 1 and 2. There was no significance difference in pressure ulcer occurrence time between the repositioning of routine-management group and the hydrocolloid-dressing group. Finally, there were significant differences (p.05) among gender, hypertension history, and BMI regardless of pressure ulcer incidences.It is recommended that patients in high-risk groups in clinical settings adopt strategies including repositioning and regular visual skin examinations. Also, hydrocolloid or foam dressings may be used as appropriate to prevent sacral pressure ulcers.比較傷口敷料處置於壓瘡預防之成效傷口護理之高科技敷料於國內外臨床上廣為使用，但被用於預防壓瘡之成效，並無實證探討。探討常規翻身護理處置與合併使用親水性敷料或泡棉敷料後，對預防尾薦骨壓瘡發生之成效。採類實驗設計及方便取樣方式，以花蓮某醫院外科加護病患共90位為樣本，隨機分派至「常規翻身組」、「常規翻身合併使用親水性敷料組」或「常規翻身合併使用泡棉敷料組」。以Braden scale作為評估壓瘡風險工具，並採歐洲壓瘡諮詢委員會最新壓瘡分級標準用以每日檢視皮膚。資料分析以t檢定、ANOVA及曼—惠特尼U檢定。「合併使用泡棉敷料組」之病人並未發生任何壓瘡。餘發生壓瘡比率以「常規翻身組」最高，其次為「合併使用親水性敷料組」，發生壓瘡等級以一、二級居多；然此兩組在發生壓瘡的時間上未達顯著差異。檢視「有發生壓瘡組」與「無發生壓瘡組」之間，其性別、高血壓史及身體質量指數變項均達顯著差異（p.05）。建議對於臨床上高危險群病患，除了應採落實的更換姿位以及檢視皮膚之外，可視情況介入親水性敷料或泡棉敷料以預防尾薦骨壓瘡。

The Taiwan Join Commission on Hospital Accreditation identified pressure ulcers as an important clinical care indicator in 2011. Pressure ulcers are a particularly critical medical care issue in hospital intensive care units. Pressure ulcers can influence patient physiology in terms of greater perceived pain, elevated infection and sepsis incidence, increased unplanned surgical treatments, and reduced activities of daily living (ADL). Pressure ulcers can also affect psychology through induced depression, stress, and anxiety. They can also increase patient and societal costs and prolong hospital stay length. This article explores the prevention and management of pressure ulcer in serious illness patients and introduces effective assessment and management techniques. We hope this article raises clinical nurse awareness of this critical issue and helps decrease the incidence of pressure ulcer-related complications in order to enhance overall quality of care.

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.

Background: Hypertension is a major public health problem and a key risk factor of cardiovascular diseases. Increased physical activity has been recommended as an important lifestyle modification for the prevention and control of hypertension. However the optimal characteristics for a physical activity programme remain open to debate. Walking is recommended by healthcare professionals as a form of exercise for controlling hypertension and nurses find it difficult to provide advice about this form of physical activity. Studies testing the effect of walking on blood pressure have produced inconsistent findings. Objectives: To systematically review the evidence for the effectiveness of walking intervention on blood pressure. Methods: A systematic search of the literature was conducted using a range of electronic and evidence-based databases to identify studies. Criteria for study inclusion were a randomised controlled trial design with a non-intervention control group; study samples were aged 16 years and over; the intervention was predominantly focused on walking and blood pressure was an outcome. Data extraction and quality appraisal were carried out independently by two reviewers; a third reviewer was consulted when needed. Results: A total of 27 randomised controlled trials were included and nine of the 27 trials found an effect of walking intervention on blood pressure control. Walking intervention tends to be effective from studies with larger sample size. A beneficial effect of walking on blood pressure tended to employ moderate to high-intensity walking and a longer intervention period than those trials not showing the effect. Conclusions: The results of this review provide evidence of the beneficial effects of walking on lowering blood pressure. Recommendations on lowering blood pressure with a walking activity should address the issue of walking intensity to achieve a beneficial effect on lowering blood pressure. Future research investigating the effect of walking intensity on blood pressure levels and rigorous design of walking interventions to achieve better adherence and methodological quality is required.

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.

The purpose of this study was to examine the efficacy of silver-releasing dressings in the management of non-healing chronic wounds.Non-healing chronic wounds often have a negative physical impact on patients and place a financial burden on healthcare systems. Silver dressings are wound products designed to control infection and provide a wound environment conducive to healing. However, validation of the clinical efficacy of these dressings is lacking.Systematic review and meta-analysis.A systematic search of the major electronic databases PubMed, CINAHL, Cochrane, MEDLINE, British Nursing Index, EBSCO, OCLC and Proquest between 1950-June 2007 was conducted. Hand searches of selected periodicals, textbooks and checking reference lists and contacting experts was also performed.Eight studies were selected from a potentially relevant 1957 references screened. Analysis incorporated data from 1399 participants in the eight randomised control trials. We found that silver dressings significantly improved wound healing (CI(95): 0.16-0.39, p0.001), reduced odour (CI(95): 0.24-0.52, p0.001) and pain-related symptoms (CI(95): 0.18-0.47, p0.001), decreased wound exudates (CI(95): 0.17-0.44, p0.001) and had a prolonged dressing wear time (CI(95): 0.19-0.48, p = 0.028) when compared with alternative wound management approaches. An analysis of sensitivity in these studies by subgroup analysis generally supported these associations. Furthermore, studies indicated an improvement in quality of life (CI(95): 0.04-0.33, p = 0.013) using silver dressings in wound management with no associated severe adverse events.This meta-analysis confirms the effectiveness of silver dressings in wound healing and improving patients' quality of life. However, it also highlights the need for additional well-designed randomised controlled trials to evaluate the effectiveness of silver-related dressings further.The results of this study provide objective data on the effectiveness of silver-related dressing when applied to non-healing chronic wounds.

This paper is a systematic review with the objective of determining the effectiveness of silver-releasing dressing in the management of infected chronic wounds.Chronic wounds exhibit increased bacterial burdens which not only result in a negative physical impact on patients, impairing their quality of life, but also increase treatment costs. Silver dressings are wound products designed to control and inhibit infection and provide a wound environment conducive to healing. However, there is limited evidence on their effectiveness in doing so.A systematic review of literature from 1950-May 2007 was conducted using the PubMed, CINAHL, Cochrane, MEDLINE, British Nursing Index, EBSCO Host, OCLC, Proquest and PsychInfo databases. The review included randomised or non-randomised control trials, published in English or non-English, of silver-releasing dressings in infected chronic wounds.Of the over 1957 potentially releasing studies examined, 14 pertinent articles involving 1285 participants were identified. Almost all the participants reported one or more statistically significant outcomes. The main points to emerge from this review of studies are that silver-releasing dressings show positive effects on infected chronic wounds. The quality of the trials was limited by the potential for bias associated with inadequate concealment, no detailed description of the outcome measurement and no reported intention-to-treat analysis. Moreover, problems existed in some studies with confounding factors.The review clearly highlights the need for well-designed, methodologically standardised outcome measurement research into the effectiveness of silver-releasing dressings. It also points to the need for a comprehensive assessment of wound bed status in further studies.This review strengthens the case for the use of silver dressings when managing infected chronic wounds. They appear more effective and are tolerated well by patients. However, their use should be accompanied by a comprehensive wound assessment.

Malignant fungating wounds (MFW) are accompanied by odor, secretions, bleeding and pain. Cancer patients must not only suffer the physical, psychological, social and spiritual impacts on their disease, but also experience considerable change in health-related quality of life. Palliative health care aims to provide comprehensive services to patients and their families. To date, no study has adopted the standpoint of palliative health care to describe comprehensively the impacts of MFWs on cancer patients, with the result that health professionals are incapable of providing comprehensive care to such patients. This study illustrates the etiology of MFWs, their physical, psychological, social, and spiritual impacts on cancer patients, and wound care strategies. It aims to improve nurses' knowledge and understanding of how to assess and identify the etiology of MFWs, in the hope that such knowledge can be applied in clinical practice and as a reference for nurses organizing MFW plans, in order to provide better patient care.

The management of chronic diseases in the elderly population is a major challenge for professional nurses. Chronic wounds, such as pressure ulcers, diabetic foot ulcers, venous ulcers, and arterial ulcers are common problems among patients with chronic diseases. This article aims to improve the knowledge base of nurses who assess and identify the etiology of chronic wounds, in the hope that an improved pool of knowledge can be drawn upon and applied in clinical practice. The article discusses patient assessment, chronic wound assessment, assessment of healing, and wound classification systems that can provide a structured approach to the management of chronic wounds. It provides a rational and systematic approach to both assessment and management that is particularly useful in the management of non-healing wounds. It can be used as a source of reference for nurses in the organization of wound management plans and the provision of better care for patients.

Commentary on: JA Michaels, B Campbell, B King, et al.. Randomized controlled trial and cost-effectiveness analysis of silver-donating antimicrobial dressings for venous leg ulcers (VULCAN trial). Br J Surg2009;96:1147–56.