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Background/Aim: An evaluation of precision healthcare interventions among patients with diabetes in a small sample through a pilot test before being tested in a larger sample is needed. Thus, the purpose of this study was to evaluate the feasibility of a precision healthcare programme. It also assesses the programme's outcome among patients with diabetes in Indonesia. Methods: Data were collected during December 2020. The researchers first gathered data about participant characteristics. Furthermore, the strategies of precision healthcare were implemented in sixty respondents to evaluate the feasibility and outcome of the programme in a month. Results: The participants mentioned that they can follow all procedures of precision healthcare. However, they asked the researcher to provide a guide and monitoring book which provides safe choices information on diet, exercise, glucose monitoring and drug medication. Moreover, participants mentioned that they could complete all questionnaires but needed a company of a research assistant. The benefits of a month of precision healthcare were improved diabetes self-care activity, blood pressure and blood glucose level. However, the body weight, body mass index (BMI), triglyceride, cholesterol and triglyceride glucose index were not significantly improved. Conclusion: A pilot test is needed to ensure the feasibility of the implementation strategy with the culture and background of diabetic patients in Indonesia. Improving diabetes self-care activity stabilised blood pressure and blood glucose during a month, so it can be assumed that precision healthcare approaches were potentially being applied in Indonesia. On the other hand, it is needed more than a month to improve body weight, BMI, triglyceride, cholesterol and triglyceride glucose index. Thus, testing the precision healthcare approach in a larger sample with long time series for patients with diabetes in Indonesia through a randomised controlled trial (RCT) is needed.

The purpose of this study was to investigate the efficacy of decision support intervention on treatment knowledge, decision self-efficacy, decisional conflict, and decision satisfaction in patients with hepatocellular cancer. The study was a randomized controlled trial. In all, 69 patients with hepatocellular carcinoma (HCC) were recruited and randomly assigned to a decision support group or a control group. Data were collected at baseline, post-test, and follow-up using self-report questionnaires. After controlling for baseline scores, the between-group difference (95% confidence interval [CI]) for treatment-related knowledge in post-test scores was 11.9 (6.1, 17.8). After controlling for baseline scores, the between-group difference (95% CI) for decisional conflict was −7.0 (−12.0, −2.0). There was no statistically significant between-group difference in decision self-efficacy and decision satisfaction. Findings supported the efficacy of decision support intervention to improve treatment knowledge and reduce decisional conflict but had no significant effect on decision self-efficacy and decision satisfaction in patients with HCC.

Background: Evidence supports anticoagulants' efficacy in reducing the risk of stroke in patients with atrial fibrillation. However, poor anticoagulant adherence increases the risks of stroke and bleeding.Aim: The study aims to test the efficacy of a health belief model-based intervention for improving the primary outcome, adherence to anticoagulant therapy, and the secondary outcomes, knowledge, beliefs, and self-efficacy of anticoagulant therapy.Methods: The study is a parallel randomized trial with a 1:1 allocation ratio. A convenience sample of 72 patients treated with anticoagulants for atrial fibrillation was recruited from cardiology clinics in Taiwan. They were randomly assigned to either the control or intervention groups. The health belief model-based intervention comprises a 60-minute individual face-to-face instruction and six follow-up telephone calls. A blinded outcome assessor collected self-report data from both groups at baseline (T1), 12th week (T2), and 24th week (T3).Results: A generalized estimating equation showed significant group-by-time interaction effects on both adherence to and knowledge of anticoagulant therapy. The intervention group showed significantly greater improvements in adherence (ß = -1.25, 95% CI: -2.46 to -0.04) and knowledge (ß = 17.93, 95% CI: 4.63–31.23) across the three time points than the control group did. However, there was no significant between-group difference in self-efficacy, perceived benefit, or perceived barriers to adherence.Conclusion: The study results support the intervention's efficacy on improving adherence to and knowledge of anticoagulant therapy among patients with atrial fibrillation, but no effect on other essential concepts health belief model.

Transitioning to advanced practice, novice nurse practitioners need to take on new roles, learn new practice areas, and develop new skills. This process requires breaking old practices and work habits and facing new challenges.To explore the nature of nurse practitioners' work experiences during the first year of transition from registered nurse to nurse practitioner.This qualitative study was based on Husserl's phenomenological methodology. A purposive sample of 16 first-year nurse practitioners was recruited. Data were collected through in-depth interviews and analyzed by thematic content analysis. The approaches of LincolnGuba were applied to improve the validity of the study.Results showed that the first-year experience of transitioning from registered nurse to nurse practitioner fell into two overarching themes: challenge and adjustment. The challenge consists of five subthemes: "facing the expectation-reality gap," "managing others' expectations," "striving to acquire professional skills," "handling situational variability," and "bearing emotional burdens" subthemes. The adjustment includes five subthemes: "finding resources," "gaining experiences," "building relationships," "relieving stress," and "overcoming obstacles."Novice nurse practitioners face many challenges as they adjust to a new role during their first year on the job. New nurse practitioners develop coping strategies to help themselves adjust to their work. They also gradually gain new resources and experiences to help them stay positive in stressful situations and restore work-life balance. The challenges of transitioning from a registered nurse to a nurse practitioner cannot be overlooked. Novice nurse practitioners need appropriate support measures to adapt to advanced practice roles.

The purpose of this study was to explore the correlations between patients’ opioid-taking self-efficacy, social support, and their pain management satisfaction, and to evaluate the effect of social support and opioid-taking self-efficacy in explaining the variance in pain management satisfaction. We used a cross-sectional and correlational research design and recruited 123 cancer patients via convenience sampling. We used the following instruments: the Opioid-Taking Self-Efficacy Scale, the Inventory of Socially Supportive Behavior, and the Chinese version of the Pain Treatment Satisfaction Scale. There were significant and negative correlations between opioid-taking self-efficacy and pain management satisfaction (r = − .43, p

Aims and objectives The primary aim of this study is to explore the influence of obesity, healthy lifestyle and sleep quality of endometrial cancer survivors on their fatigue level. Background As many as 30% of endometrial cancer survivors still suffer from fatigue 5 years after completing therapy. Fatigue may hinder cancer survivors from participating in daily activities or returning to their original roles and functions, thus affecting their health-related quality of life. Design This study adopted a cross-sectional correlational research design. The STROBE checklist for cross-sectional studies was used as a reference for reporting the study. Methods A consecutive sample of 134 endometrial cancer survivors was recruited from the outpatient clinics of a medical centre in Taipei, Taiwan. Data were collected using structured questionnaires. Results Study subjects scored 44 points (SD = 7.09) on average for the fatigue levels. Results of linear regression showed that sleep quality (s = -0.38), comorbidity index (s = -0.024) and age (s = 0.20) were important predictors of fatigue. However, differences in obesity, vegetable and fruit intake, physical activity did not lead to significant differences in fatigue level. Conclusions Survivors who had poorer sleep quality, higher comorbidity index and younger age reported higher fatigue. Relevance to clinical practice The study findings are relevant for assessing and preventing fatigue in endometrial cancer survivors. Those with poorer sleep quality, higher comorbidity index and younger age are at a greater risk for fatigue and deserve further attention. Although the study results failed to support the link between obesity, vegetable and fruit intake, physical activity and fatigue, the ratio of survivors who comply with recommended healthy lifestyles was low. Hence, it is of urgent necessity that this population receives the help to maintain a healthy lifestyle.

Background: Hepatocellular carcinoma (HCC) is a high incidence and high mortality disease. The choice of cancer treatment is extremely important and involves a high-risk, complex and difficult decision-making process. Although the guidelines use evidence for disease treatment, due to the individual patient factors and tumor stage differences, cancer treatment decisions by patients still lead to uncertainty. Objective: When people lack information or skills, they may make decisions that are not optimal. Clinically, we use educational programs to improve patient knowledge but there’s no relevant knowledge scale that can be used as an assessment tool. Therefore, it is necessary to develop a convenient and usable knowledge scale. Methods: Based on research purposes, literature review and what physicians believe patients need to know about liver cancer, we built a liver cancer knowledge scale. Results: The total number of participants is 102, of which 66 are male and 36 are female. There is satisfactory internal consistency reliability 0.745, test-retest reliability 1.0 and construct validity were noted CVI 0.96. There was adequate overall evidence for convergent (p = 0.001) and discriminatory validity (p < 0.005). Conclusions: This knowledge scale can provide hepatocellular carcinoma before and after treatment evaluation whether patients have sufficient knowledge.

This study explored the association between social support, resilience and coping strategies among patients with liver cancer and evaluated the extent to which patients' use of various coping strategies can be explained by social support and resilience.This cross-sectional study comprised 119 patients who experienced transarterial chemoembolization related to liver cancer and who completed the Social Support Scale, the Resilience Scale and the Ways of Coping Checklist-Revised.Results indicated a significant positive correlation between social support and use of problem-focused coping strategies and overall coping strategies. In addition, results showed a significant positive correlation between resilience and use of problem-focused strategies, emotion-focused strategies and overall coping strategies. Social support accounted for 14% of variance in use of problem-focused strategies and 7.6% of the variance in overall coping strategies. Resilience accounted for 30.5% of the variance in use of problem-focused strategies, 8.5% in use of emotion-focused strategies and 21.6% of overall coping strategies.Results of this study highlight the importance of social support and resilience in patients' coping strategies related to liver cancer treatment.

Nursing information system introduction is an important measure for hospital nursing departments to promote the clinical practice of nursing with both efficiency and quality. A comparison of two cross-sectional study designs was adopted, and the information systems success model, as proposed by DeLone and McLean (2003), was used to explore the effectiveness of the six dimensions of system quality, information quality, service quality, use, user satisfaction, and net benefits at 6 and 12 months after the introduction launch of the nursing information system in hospitals. Multiple regression analysis was used across the two cross-sectional studies. The research results found that the nursing information system conformed to the information systems success model, and half a year to 1 year after the introduction of the nursing information system, use affected the nursing information system net benefits via the mediator variable of user satisfaction; however, the effect of full mediation changed to partial mediation effect with time. The research results can be used as a reference for hospitals and nursing administrators for the newly developed nursing information system.

Background Although women with ovarian cancer experience depression and poor sleep quality, little is known about how various factors, particularly self-efficacy, might be associated with these conditions. Objectives The aim of this study was to examine the prevalence of and changes in depression and sleep quality and the factors associated with these conditions in a cohort of women with ovarian cancer before, during, and after chemotherapy. Methods A prospective repeated-measures design was adopted in this study. Participants were women with ovarian cancer who were expected to receive 4 to 6 cycles of chemotherapy and were recruited at a medical center in Taiwan. The participants were asked to complete a questionnaire that included the Symptom Distress Scale, Center for Epidemiologic Studies Depression Scale, General Self-efficacy Scale, and Pittsburgh Sleep Quality Index. The data were collected before, during, and after the course of chemotherapy. Results Overall, 24.6% to 36.9% of women were at risk for depression; 75.4% to 80.0% of women had poor sleep quality. There were no significant changes in depressive symptoms and sleep quality throughout the course of chemotherapy. More severe depressive symptoms were associated with higher levels of symptom distress and lower self-efficacy. Poorer sleep quality was associated with higher levels of symptom distress. Conclusions Among participants, more depressive symptoms and poorer sleep quality were associated with higher levels of symptom distress or lower self-efficacy. Implications for practice Healthcare providers should continuously assess depression and sleep quality in women with ovarian cancer. These symptoms may be improved by strengthening self-efficacy and relieving symptom distress.

Purpose The study explores the influences of nutrition-related factors (albumin, hemoglobin, and obesity) and lifestyles (physical activity, fruit and vegetable intake, smoking, and drinking) on the length of hospital stay in postoperative colorectal cancer patients. Methods This study is a cross-sectional design. A convenience sample of 106 preoperative colorectal cancer patients was recruited from a medical center in Taiwan. Data were collected using self-reported questionnaires and from patients' medical records. Results The median length of hospital stay was ten days with an interquartile range ( IQR) of 8–11.25 days. The results of the log-link Gamma generalized linear model showed that albumin ( B = −0.16, p = 0.007) and physical activity (B = −0.14, p = 0.001) were significant predictors of the length of hospital stay after controlling for demographics and disease characteristics. The influences of anemia, obesity, fruit and vegetable intake, smoking, and drinking on the length of hospital stay were insignificant. Conclusions Patients with hypoalbuminemia and a low level of physical activity undergo a more extended postoperative hospital stay. The study findings inform clinicians of the influencing factor of the patients' recovery and provide a foundation for developing interventions to decrease hospital stay length.

Pain is the most severe and commonest symptom for patients with cancer. Patients' pain management satisfaction is an essential indicator of quality care and further affects their willingness to seek care.This study aimed to examine the correlations between patients' prescribed opioids, pain management satisfaction, and pain intensity.This study adopted a cross-sectional correlation design, recruited a total of 123 patients with cancer pain through convenience sampling, and used two research scales, namely the Chinese version of the Pain Treatment Satisfaction Scale and the Brief Pain Inventory-Short Form.The findings indicated that the correlations of prescribed opioid dosage with pain management satisfaction (r = - .10, p .05) and pain intensity (worst pain, least pain, average pain, and pain right now; r = - .05 to .01, p .05) were nonsignificant. The correlations of pain management satisfaction with pain intensity (r = .24 to .32, p .01), pain interference (r = .32, p .01), and pain relief (r = - .25, p .01) were all significant, but that with the worst pain (r = .06, p .05) was nonsignificant.Medical professionals providing cancer pain management should focus on medicines strategies and individuals' pain relief requirements. In particular, patients with the worst pain require extra investigations into their needs, and their satisfaction with their level of pain should be further evaluated.

AIM The aim of this study was to develop and initially assess the psychometric properties of the Caregiver Caregiving Self-Efficacy Scale-Oral Cancer (CSES-OC). METHODS In total, 28 items in the Caregiver Caregiving Self-Efficacy Scale-Oral Cancer were originally employed for a reliability and validity test based on expert suggestions and qualitative findings. The Cronbach's alpha coefficient and test-retest reliability were evaluated with the pilot sample, which included 30 caregivers. The main test, which included 107 caregivers during May 2016 to 2018, was used to execute the exploratory factor analysis (EFA) and concurrent validity. RESULTS The results of the main test showed a Cronbach's alpha coefficient of .95 for the revised 18-item total scale after EFA. Four factors (acquiring resources, managing sudden and uncertain patient conditions, managing patient-related nutritional issues and exploring and making decisions on patient care) were classified from EFA of the Caregiver Caregiving Self-Efficacy Scale-Oral Cancer. The r coefficient was .59 (P

BACKGROUND Fever frequently occurs in patients with traumatic brain injury and can cause secondary damage to the brain. Critical care nurses play essential roles in assessing and managing fever in these patients. AIM The study aimed to (a) examine the fever causes in and condition of neurosurgical patients with traumatic brain injury in intensive care, (b) identify the factors associated with fever, and (c) determine the effects of fever on hospital stay and prognosis. STUDY DESIGN This study is a retrospective observational design. METHODS Data were collected through chart reviews of 93 traumatic brain injury patients admitted to a teaching hospital's intensive care unit for postoperative care. Fever was defined as at least one episode of body temperature >38°C. RESULTS Of the 93 patients, 76 developed a fever within 1-week post-craniotomy. Of these, 49 were infection-related and 27 were unexplained. Results of logistic regression showed that the preoperative Glasgow coma scale score (s = -.323; P = .013) and length of intubation (s = .480; P = .005) were the key predictors of unexplained post-craniotomy fever, and these two variables (s = -.494; P

Aim and objective To explore the disability, emotional distress and well-being of patients with lumbar spondylolisthesis. Background Few studies have investigated the correlations between disability, emotional distress and well-being of patients with lumbar spondylolisthesis. Design This study used a cross-sectional research design. Methods Participants were 133 patients aged over 50 years who were experiencing lumbar spondylolisthesis. The research instruments included a demographic information questionnaire; the Numeric Rating Scale (NRS); the Charlson Comorbidity Index (CCI); the Chinese versions of the Oswestry Disability Index (ODI), State-Trait Anxiety Inventory-State (STAI-S) and Center for Epidemiological Study-Depression (CES-D); and the Psychological Well-being (PWB) Scale. Emotional distress was measured by the STAI-S and CES-D. Pearson's correlations coefficient, multiple linear regression and a mediating effect model were introduced to explore correlations between the variables and predictors of psychological well-being, and details of the methods are reported in coherence to STROBE criteria. Results Eighty-six participants (64.6%) had moderate and severe anxiety, and 42 (31.6%) experienced depression. Participants reported medium to high levels of well-being; "satisfaction with interpersonal relationships" was rated the highest and "physical and mental health" the lowest. Disability, depression and anxiety had significant negative correlations with well-being. Depression and anxiety mediated the relationship between disability and well-being. Moreover, depression, family support, educational background and anxiety were predictors of well-being, accounting for 39.1% of the total variance. Conclusions Disability and emotional distress among patients with lumbar spondylolisthesis had a negative impact on well-being. Anxiety and depression were closely correlated with and substantially influenced well-being. Relevance to clinical practice Health professionals will enhance the understanding of important factors influencing well-being among patients with lumbar spondylolisthesis. This study suggests the conduct of depression and anxiety evaluations at outpatient clinics and prior to surgery, so that clinicians will be aware of the emotional distress status of patients with lumbar spondylolisthesis and, therefore, enhance their well-being.

Purpose Weight loss is a multifactorial condition that commonly affects patients receiving radiotherapy for head and neck cancers . The aims of this study were to 1) describe body weight changes over time in patients receiving radiotherapy for head and neck cancers and 2) explore the influence of pretreatment weight loss, body mass index (BMI) category, symptom burden, mucositis , and nutritional support on body weight changes over time. Methods Using a longitudinal design, this study investigated a consecutive cohort of head and neck cancer patients who were treated with radiotherapy between January 2015 to January 2016 in a Taiwan medical center (n = 128). Data regarding symptom burden, mucositis severity, and body weight were collected before radiotherapy (T1), one month after the initial radiotherapy (T2), at the completion of radiotherapy (T3), and one month after the completion of radiotherapy (T4). Results On average, the participants’ body weight decreased by 3.09 kg (SD = 2.79) from T1 to T2, 1.72 kg (SD = 2.06) from T2 to T3, and continued to decrease by 1.04 kg (SD = 2.87) from T3 to T4. The results of a generalized estimating equation showed that BMI category, symptom burden, mucositis, and nutritional support were directly and independently related to body weight changes over time in patients with head and neck cancers. Conclusions Head and neck cancer patients experience significant weight loss during and after radiotherapy. The study findings are relevant for assessing nutritional status and providing necessary support measures at critical moments for patients treated with radiotherapy.

Background The important role of self-efficacy in facilitating health behavior and, in turn, promoting health outcomes has been widely presumed in the theoretical literature. However, little research has focused on the mechanism by which self-care mediates the relationship between symptom-management self-efficacy and quality of life (QOL) in breast cancer patients. Objective The purpose of this study was to examine the relationship between symptom-management self-efficacy and quality of life in Taiwanese oncology outpatients with breast cancer and then proposes self-care as a mediator between these two factors. Methods This cross-sectional study enrolled 201 oncology outpatients at one teaching hospital in metropolitan Taipei City, Taiwan. The research instruments included the Symptom-Management Self-Efficacy Scale—Cancer (SMSES-Breast Ca.), the Self-Care Scale, and the European Organization for Research & Treatment of Cancer Quality of Life Group Questionnaire (EORTC-QLQ-C30). Results Symptom-management self-efficacy (SMSE) was directly associated with the QOL of the participants (β = 5.94, p < .001). Moreover, SMSE was indirectly associated with QOL through self-care. Self-care was found to mediate the relationship between symptom-management self-efficacy and global QOL (indirect effect = 0.54, 95% CI 0.12 to 1.18). The level of 95% CI was significant. Conclusions The present study supports that self-efficacy beliefs and self-care both significantly and positively influence the quality of life of patients.

Purpose The study purpose is to test the efficacy of a decision support intervention for reducing decisional conflict, increasing prostate biopsy knowledge, and enhancing decision self-efficacy in patients with elevated serum prostate-specific antigen. Method The study is based on a randomized pre-post test design. A convenience sample of men with elevated prostate-specific antigen was recruited and 1:1 randomized to the intervention and control groups. The intervention group received the decision support intervention and the control group received health education. Data were collected at the baseline and post-test by using self-reported questionnaires, including the Prostate Biopsy Knowledge Scale, the Decision Self-Efficacy Scale, the Decisional Conflict Scale, and questions regarding the prostate biopsy decision (post-test only). Data on prostate-specific antigen levels were collected from the patients’ medical records. Results A total of 110 patients participated in the study. At baseline, the intervention group had significantly higher knowledge scores than the control group. The analysis of the covariance model with the baseline score as a covariate was used to analyze the intervention effect. After controlling for the baseline scores, the mean differences (95% CI) between the two groups were 11.75 (11.17–12.32), 76.45 (72.52–80.37), and −23.53 (−26.31–20.20) for knowledge, decision self-efficacy, and decisional conflict, respectively. The between-group difference in willingness to accept prostate biopsy at the post-test was not statistically significant ( χ 2 = 1.704). Conclusions The decision support intervention significantly reduced patients' decisional conflict while improving their knowledge and self-efficacy. However, the intervention did not affect patients’ biopsy decision.

In an intensive care unit (ICU), patients' families play a very important role; however, they often lack medical knowledge and are extremely anxious, which could affect their ability to take care of the patients. The effects of giving conventional paper‐based instruction are limited in terms of improving patients' families' understanding of the facilities and the rules in the ICU and in reducing their anxiety. Therefore, in this study, an interactive e‐book was developed to present the nursing education content to ICU patients' family members. An experiment was conducted to compare the learning performances and perceptions of the patients' family members learning with the interactive e‐book and those who learned with the conventional approach. The research results showed that the nursing e‐book significantly improved the learning performances of the ICU patients' family members, although their anxiety was not immediately reduced. Moreover, the family members perceived that the e‐book was useful and easy to use, and generally showed high satisfaction with its use. This reveals the potential of using interactive e‐books to improve the quality of nursing service in hospitals. [ABSTRACT FROM AUTHOR]

Purpose To compare the clinical outcomes of patients with and without early enteral nutrition after colorectal cancer surgery. Methods This is a retrospective comparative study using propensity score-matched cases. The study subjects were patients who received colorectal cancer resection surgeries during 2013 and 2018 in a Taiwan medical center. Data of the following variables were retrieved from subjects’ medical records: age, sex, diagnosis, pathological stage, surgical approach, comorbidity, risk of malnutrition, anesthesia duration, enteral nutrition, time to the first postoperative flatus, time to the first defecation, feeding associated symptoms, nutrition interruptions, time to achieve nutrition goals, postoperative complications, the length of hospital stay. Subjects who received enteral nutrition within 48 h after the surgery were considered as the early enteral nutrition group. Results After propensity score matching, 227 subjects in each group were included in the final analysis. The early enteral nutrition group showed better results in the time to first postoperative flatus (mean difference: 0.96, 95% confidence interval: 1.16 ~ −0.76), the time to achieve nutrition goals (mean difference: 1.26, 95% confidence interval: 0.65 ~ −1.87), and the length of hospital stay (mean difference: 1.53, 95% confidence interval: 2.56 ~ −0.42), compared with the delayed enteral nutrition group. There were no between-group differences in the incidences of vomiting, distension, ileus, anastomosis leak, infection, re-operation, and interruptions of enteral nutrition. Conclusions Enteral feeding after colorectal cancer surgery can accelerate the recovery of gastrointestinal tract activities, promote nutrient intake, and shorten the length of hospital stay without increasing postoperative complications.

Background: Nursing shortages are a significant problem experienced by medical institutions worldwide as well as Indonesia. Understanding nurses’ work environment is a proper strategy for enhancing the retention and overcoming shortages of nurses. The Quality Nursing Work Environment (QNWE) is a well-known tool that has been commonly used to evaluate the working atmosphere of nurses. However, the availability and validated version of the instrument for hospital nurses in Indonesia is not confirmed. Purpose: This study aims to confirm the psychometric evaluation of the Indonesian version of QNWE instruments in hospital settings. Methods: A cross-sectional study design and psychometric analyses were administered. The 65-item, eight-domain questionnaire was translated, adapted, and face-validated using content validity index (CVI) analysis. The construct validity and internal consistency of the translated version were tested using confirmatory factor analysis (CFA) and Cronbach's Alpha to 334 hospital nurses. The intraclass correlation coefficient (ICC) was employed to determine test-retest and interrater reliability analysis to 33 nurses and 10 ratters in the pilot testing. Results: The CVI of the QNWE-I scale ranged from 0.86 to 1.00. The CFA determined an adequate model fit of the instrument. As to overall reliability, test-retest reliability of 0.90, ICC analysis of 0.82, and Cronbach's alpha of 0.96; was confirmed. Conclusions: The psychometric evaluation of the QNWE-I showed excellent acceptability, validity, and reliability. Therefore, the QNWE-I can serve as a comprehensive instrument for assessing the quality of nurses' work environments in Indonesia.

Purpose Health self-management helps improve health-related quality of life and life satisfaction, as well as cancer survival. The study aim was to explore the essence of the health self-management experiences and support needs of colorectal cancer patients after surgeries. Methods The study was based on phenomenology research methodology. Purposive sampling was used to obtain a heterogeneous sample to provide rich information regarding the research questions. Participants were recruited from colorectal surgery outpatient clinics in a hospital in Taiwan. Data were collected by semi-structured in-depth interviews and analyzed by thematic content analysis. Strategies adapted from Lincoln and Guba were used to enhance the trustworthiness of the study. Results Ten participants, 5 males and 5 females, were interviewed. Their health self-management experience fell into 3 overarching themes and 9 related subthemes. Our results show that (1) seeking support when experiencing discomfort, (2) when life changes, re-adjust accordingly, and (3) staying positive and self-perseverance are the essences of the health self-management experiences and support needs of postoperative colorectal cancer patients. Conclusions Postoperative colorectal cancer patients experienced tremendous physical and psychosocial challenges after returning home from the hospital. Although burdened with multiple stressors, these patients were able to seek support, learning to practice self-care, facing cancer positively, and exhibit positive growth in life. Patients with colorectal cancer have to constantly adjust to the impacts of their diseases. The study results may provide as a reference for supporting postoperative adjustment and promoting health self-management among patients with colorectal cancer.

Postoperative exercise rehabilitation helps patients recover normal joint functions after total hip arthroplasty (total hip replacement surgery or THR) by strengthening the muscles that surround the replaced hip joint. However, the high cost of professionally supervised exercise rehabilitation programs limits access to program participation and, thus, to optimal recovery of normal joint functions. Therefore, the development of an effective home-based, self-monitored exercise rehabilitation program is critical to promote the optimal recovery of THR patients.This study tests the efficacy of a home-based resistance-band exercise program on mobility, functional exercise capacity, and health-related quality of life in THR patients.This study uses a preexperimental repeated measures design. A convenience sample of 30 patients who underwent total hip replacement for osteoarthritis was recruited. All patients participated in a 12-week home-based resistance training program. Data were collected at baseline and at 2, 6, and 12 weeks postoperation on the following dimensions: up-and-go time, timed walking distance, and quality of life. In addition, intervention-related adverse events and the exercise adherence rate were monitored. Generalized estimation equations were used to analyze changes in the outcome variables across time.The study included 21 women and nine men. The mean age of the participants was 67.9 years (SD = 8.1 years, range = 55-86 years). Results of the generalized estimation equations showed a statistically significant time effect for up-and-go time, 6-minute walking distance, and health-related quality of life. After 12 weeks of training, the participants' up-and-go time decreased 40.33% from the baseline measurements, with a mean change of 6.38 seconds (p.001). The 6-minute walking distance increased 41.34%, with a mean change of 117.12 meters (p.001). The score for health-related quality of life decreased 78.94%, with a mean change of 39.10 (p.001). The average exercise adherence rate was 72.63%. The average score for the feasibility of the intervention was 8.8 (range = 6-10).The results of this study support the hypothesis that a home-based resistance training program is safe, feasible, and effective for improving the mobility, functional exercise capacity, and health-related quality of life of THR patients. Considering the low cost and convenience of a home-based resistance training program, health professionals should consider this and similar exercise programs when providing guidance to THR patients.

ObjectiveTo investigate anticoagulant adherence and its associated factors, including demographics, clinical variables, atrial fibrillation (AF) severity, knowledge, satisfaction with services, perceived barriers, perceived benefits, symptom severity and self-efficacy in patients with AF.DesignThis is a cross-sectional study.Participants and settingA convenient sample of patients with AF were recruited from cardiology clinics of two teaching hospitals in Taiwan.MeasuresData were collected using the study questionnaires, including the AF-related symptom subscale of the AF Severity Scale, the Knowledge of Warfarin Anticoagulation Treatment Scale, the Satisfaction Scale about Service and Warfarin Treatment, the perceived benefits subscale of the Beliefs about Anticoagulation Survey, the Concerns about Anticoagulation Therapy Scale, The Self-efficacy for Appropriate Medication Use Scale and the short-form Adherence to Refills and Medications Scale.ResultsA total of 151 patients with AF participated in the study; 53 treated with warfarin and 98 treated with novel oral anticoagulants (NOACs). The difference in adherence to warfarin (mean=8.6; SD=1.6) and NOACs (mean=8.9; SD=2.0) was statistically insignificant. Multiple linear regression analysis showed that perceived barriers (β=0.18, p=0.017) and self-efficacy (β=−0.48, p(2,149)=38.11, pConclusionWe found no better adherence to NOACs compared with warfarin. Patients with greater self-efficacy and perceived fewer barriers showed better adherence to anticoagulation therapy.

Purpose The purpose of the study was to investigate the effects of a mouth-opening intervention for postoperative trismus and remote support provided via telephone following hospital discharge for intervention adherence in patients with oral cancer. Methods The study is a parallel randomized trial. Patients admitted at a general hospital for oral cancer surgery were recruited and randomly assigned to either the experimental or the active control group. Both groups underwent a 12-week intervention program, including warm compress , masticatory muscle massage, and jaw exercise. Subjects in the experimental group received additional support via telephone following hospital discharge. Data on intervention adherence maximum interincisal opening and mandibular function impairment were collected at baseline, week 4, and week 12. Results Sixty subjects (30 in each group) that completed the study were included in the analysis. At week 12, the intervention practice time in the experimental group was 299.67 min (95% CI: 223.44–357.89) more than that of the active control group. From baseline to week 12, the change in maximum interincisal opening was 10.30 mm (95% CI: 8.22–12.37) greater in the experimental than in the active control group. The change in mandibular function impairment score was −0.36 (95% CI: −0.44 to −0.28) greater in the experimental than in the active control group. Conclusions The study results support the effect of remote support via telephone for enhancing adherence to the intervention protocol, and the effect of the intervention program for alleviating trismus and mandibular function impairments in patients who receive curative surgery for oral cancer.

ObjectiveTo explore the influences of facial disfigurement and social support for psychosocial adjustment in patients with oral cancer.DesignA cross-sectional design was used for the study.Participants and settingA convenience sample of 77 patients with oral cancer was recruited from the otolaryngology and oral and maxillofacial surgery outpatient clinics of three general hospitals in Taiwan.MeasuresData were collected using the study questionnaires, including the Facial Disfigurement Scale, the Social Support Scale and the Psychosocial Adjustment to Illness Scale.ResultsThe mean score on the Psychosocial Adjustment to Illness Scale was 413.01 (SD=32.32); 71.4% of the participants were maladjusted. Results of multiple regression analysis showed statistically significant main effects of tumour site (beta=0.37), facial disfigurement (beta=0.35) and social support (beta=−1.01), and the interaction effect of facial disfigurement and social support (beta=0.79) (all pConclusionsThe level of psychosocial adjustment in patients with oral cancer was suboptimal. Poorer psychosocial adjustment was reported by patients with more severe facial disfigurement and less social support. Patients with cancers in other areas of the oral cavity also reported poorer psychosocial adjustment than patients with cancers in the buccal mucosa. Medical professionals may use these variables to identify higher risk groups for early intensive intervention.

Patients with lumbar spondylolisthesis typically suffer from symptom discomfort and various degrees of disability for months or years prior to receiving surgical treatments. Knowing the factors that influence the disability status of these patients will help healthcare providers develop effective preventive measures.To explore preoperative disability and its important predictive factors in patients with lumbar spondylolisthesis.A predictive correlational design was used and a convenience sample of eighty-six lumbar spondylolisthesis preoperative patients were recruited from a medical center in northern Taiwan. Data were collected using a study questionnaire, which included the Oswestry disability index, the revised geriatric depression scale-short form, and a pain numeric rating scale.The average disability index of the participants was 48.52 (SD = 16.14). The multiple linear regression analyses identified lower back pain, depression, age, and gender as significant predictors of preoperative disability, collectively explaining 40.9% of the variation in disability severity. Being female, being older, having a higher degree of lower back pain, and having depression were significantly associated with preoperative disability.The results of the present study indicate that lumbar spondylolisthesis patients who are older in age, female, currently experiencing lower back pain, and suffering from depression face a higher risk of preoperative disability. Patients in these at-risk categories should be assessed actively and provided with appropriate patient education in order to enhance their quality of life.腰椎滑脫病人術前失能情形及其影響因素探討.腰椎滑脫的病人在接受手術治療前，大多經歷長達數月至數年的不適症狀，且有不同程度的失能情形，探討失能情形之影響因素，有助於發展有效之預防措施。.探討腰椎滑脫病人術前失能情形的重要預測因子。.本研究採預測相關性研究設計，以方便取樣，於臺灣北部某醫學中心招募86位腰椎滑脫術前病人。以問卷進行資料收集，內容包括疼痛數字等級量表、修正版簡式老年憂鬱量表及歐氏失能量表。.研究對象平均失能指數為48.52（SD = 16.14）分。多元線性迴歸分析結果顯示下背痛、憂鬱、年齡和性別為失能嚴重程度之重要預測因子，共可解釋40.9%之變異量。女性、年長、下背疼痛及憂鬱程度高的腰椎滑脫病人有較高的失能嚴重度。.女性、高齡、下背疼痛和憂鬱情緒的腰椎滑脫術前病人為失能的高危險群，應積極評估並給予適當的護理指導，以期得到較佳的生活品質。.

Effective pain management is crucial for patient recovery after total knee arthroplasty (TKA). Biofeedback therapy, which encourages relaxation and helps alleviate various conditions associated with stress, may help to decrease postoperative pain in patients undergoing TKA. A quasi- experimental design was used to investigate the efficacy of a biofeedback relaxation intervention in reducing pain associated with postoperative continuous passive motion (CPM) therapy. Sixty-six patients admitted to a general hospital in Taiwan for TKA were recruited and randomly assigned to the intervention or control group. The intervention group received biofeedback training twice daily for 5 days, concurrent with CPM therapy, whereas the control group did not receive the biofeedback intervention. Pain was measured using a numeric rating scale before and after each CPM therapy session on postoperative days 1 through 5. The CPM-elicited pain score was calculated by subtracting the pre-CPM pain score from the post-CPM pain score. Results of repeated-measures analysis of variance showed intervention group reported significantly less pain caused by CPM than did the control group (f = 29.70, p

As many as 50% of end-stage cancer patients will develop ascites and associated symptoms, including pain, tiredness, nausea, depression, anxiety, drowsiness, loss of appetite, dyspnea, perceived abdominal bloating, and immobility. Abdominal massage may stimulate lymph return to the venous system and reduce ascites-related symptoms. The purpose of this study was to test the effect of abdominal massage in reducing these symptoms and reducing ascites itself as reflected in body weight. For a randomized controlled design using repeated measures, a sample of 80 patients with malignant ascites was recruited from gastroenterology and oncology units of a medical center in northern Taiwan and randomly assigned to the intervention or the control group. A 15-minute gentle abdominal massage, using straight rubbing, point rubbing, and kneading, was administered twice daily for 3 days. The control group received a twice-daily 15-minute social interaction contact with the same nurse. Symptoms and body weight were measured in the morning for 4 consecutive days from pre- to post-test. In generalized estimation equation modeling, a significant group-by-time interaction on depression, anxiety, poor wellbeing, and perceived abdominal bloating, indicated that abdominal massage improved these four symptoms, with the greatest effect on perceived bloating. The intervention had no effect on pain, tiredness, nausea, drowsiness, poor appetite, shortness of breath, mobility limitation, or body weight. Abdominal massage appears useful for managing selected symptoms of malignant ascites.

Aims and objectives To explore decisional conflict and its influencing factors on choosing dialysis modality in patients with end-stage renal diseases. The influencing factors investigated include demographics, predialysis education, dialysis knowledge, decision self-efficacy and social support. Background Making dialysis modality decisions can be challenging for patients with end-stage renal diseases; there are pros and cons to both haemodialysis and peritoneal dialysis. Patients are often uncertain as to which one will be the best alternative for them. This decisional conflict increases the likelihood of making a decision that is not based on the patient's values or preferences and may result in undesirable postdecisional consequences. Addressing factors predisposing patients to decisional conflict helps to facilitate informed decision-making and then to improve healthcare quality. Design A predictive correlational cross-sectional study design was used. Methods Seventy patients were recruited from the outpatient dialysis clinics of two general hospitals in Taiwan. Data were collected with study questionnaires, including questions on demographics, dialysis modality and predialysis education, the Dialysis Knowledge Scale, the Decision Self-Efficacy scale, the Social Support Scale, and the Decisional Conflict Scale. Results The mean score on the Decisional Conflict Scale was 29.26 (SD = 22.18). Decision self-efficacy, dialysis modality, predialysis education, professional support and dialysis knowledge together explained 76.4% of the variance in decisional conflict. Conclusions Individuals who had lower decision self-efficacy, did not receive predialysis education on both haemodialysis and peritoneal dialysis, had lower dialysis knowledge and perceived lower professional support reported higher decisional conflict on choosing dialysis modality. Relevance to clinical practice When providing decisional support to predialysis stage patients, practitioners need to increase patients' decision self-efficacy, provide both haemodialysis and peritoneal dialysis predialysis education, increase dialysis knowledge and provide professional support.

Family caregivers face multiple challenges when caring for patients with oral cancer at home. Understanding the difficulties they face may assist health professionals to better organise and provide support for family caregivers of oral cancer patients. The aim of this study was to describe the caregivers' primary tasks and the difficulties they encounter when caring for a family member with oral cancer. This qualitative study included a purposeful sample of 22 primary family caregivers ranging in age from 25 to 71 years old. The researchers used face-to-face, semi-structured and tape-recorded interviews to collect data and employed qualitative content analysis to elicit caregiving-related themes. Six task-related themes and associated challenges were identified. These included managing the patient's nutritional issues, investigating and making decisions about patient care, managing sudden and unpredictable changes in the patient's condition, managing emotional distress, adjusting their attitudes towards patient care, and seeking resources. Family caregivers handle such essential tasks when they care for patients in home settings and they face specific challenges related to them. This study identified several challenges related to each task. From the outset, healthcare providers should actively offer caregiving information and strategies. Health professionals can incorporate strategies for supporting caregivers' ability to carry out these tasks into their treatment model and can help caregivers manage difficulties that can impede them from doing so.

Aims and objective: The aim of this study was to compare the efficacious treatment in intensive care unit patients: high frequency chest wall oscillation (HFCWO¸VEST) versus chest physiotherapy (CPT).Background: Patients with lung disease often have respiratory infections and hospitalization caused by sputum retention. Intensive care unit patients usually have intubated and ventilator and this make it difficult to clean the airway. Methods: A comparison study with random sampling was carried out 559 patients in the intensive care unit were recruited in the study. Patients either received HFCWO therapy using the vest system (n=208) or received CPT (n=351). The primary outcomes were length of stay in intensive care unit and the duration of mechanical ventilation, comfortable with therapy and lung condition were compared between the two groups. Result: The patients treated by the high frequency chest wall oscillation, their duration of mechanical ventilation (p=0.014), chest X-ray (p

Objective To investigate the associations between frailty, physical activity and depression in community-dwelling geriatric women. Design A cross-sectional research design. Setting Community geriatric women in Illan County, Taiwan. Study participants Of note 216 participants, 65 years and older with full mobility, independent and able to communicate in Mandarin or Taiwanese Hokkien. Main outcome measures An average weekly physical activity score International Physical Activity Questionnaire-Short Form (IPAQ-SF) and Taiwan Geriatric Depression Scale. Classification and regression tree (CART) analysis was used to perform decision analysis. Results The average IPAQ-SF score for the 216 participants was 9109.52. When an IPAQ-SF score of 4452 or below was obtained by participants, 38% of them encountered depression-like syndromes, regardless of their frailty status. Diabetes, high risk of metabolic syndrome and lower education were the risk factors found to cause depression among participants with low physical activity levels. Conclusions As women have a longer life expectancy and experience twice the rates of depression of men particularly after menopause, healthcare providers should emphasize exercise and lifestyle changes in order to improve the quality of health in geriatric women.

Aims and objectives To test the efficacy of narrowband ultraviolet B phototherapy in reducing renal pruritus. Background Renal pruritus is a disabling symptom affecting approximately 50% of patients undergoing maintenance haemodialysis. Managing refractory pruritus can be a great challenge for healthcare providers and patients as well. For patients who do not respond to conventional treatments, ultraviolet B phototherapy is considered the treatment of choice. Few investigators, however, have studied the efficacy of narrowband ultraviolet B phototherapy in this condition. Design The study was based on a quasi-experimental design with repeated measures. Methods A convenience sample of 42 haemodialysis patients with pruritus was recruited from haemodialysis units of a general hospital in Taipei, Taiwan. Two groups were created according to the dates of haemodialysis. The intervention participants received narrowband ultraviolet B phototherapy three times a week for two weeks. The control participants were maintained on their prior pruritus treatment. The pruritus intensity was measured with a numerical rating scale at baseline and on alternating days for seven times. Data were collected during the year 2008. Results The generalised estimating equation showed statistically significant group-by-time interactions in pruritus intensity. Using the control group as the reference group and baseline as the reference time, the intervention group had significantly lower pruritus intensity than the control group: 3·14 (p

The use of endovascular aneurysm repair (EVAR) as a treatment for abdominal aortic aneurysm (AAA) has started to become popular in Taiwan. Quality of life is considered an indicator of clinical outcome, and self-management and health literacy have been identified as significant contributors to quality of life. However, the research on these three variables, and relationships among them in AAA patients who have undergone EVAR, is limited.The purpose of this study is to examine the relationship between self-management, health literacy and quality of life in AAA patients who have undergone EVAR in Taiwan.This study uses a cross-sectional design with convenience sampling. A total of 105 patients were sampled in the outpatient clinic when they returned for a follow-up visit to a veterans' general hospital in Taiwan between May 2011 and June 2012. Four questionnaires (demographic, self-management, health literacy, quality of life) were used to collect data. Regarding the relationship among these variables, Pearson correlations and hierarchical logistic regression were used to analyze the relationship.Self-management has a 73% mediation effect and an indirect effect of 13.51 on the relationship between health literacy and quality of life, while education and exercise habit has a 57% mediation effect and an indirect effect of 6.20 on this same relationship.These findings can be used to identify specific populations who have more risk for worse outcomes. They can then be provided with education to promote exercise behavior and to enhance self-management to achieve better quality of life.