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Nursing competence is an essential element in ensuring high-quality nursing care and positive patient outcomes. Valid and reliable assessment tools for assessing nurse competence are needed to help nurse supervisors measure whether nurses are performing their job well and to provide a baseline for improving the competences of nurses.This study was designed to develop and psychometrically validate the Competence Scale for Clinical Nurses (CSCN).The CSCN was developed in three steps: (a) generalize assessment items from nursing competence-related scales and a review of the relevant literature, (b) determine the content validity of the developed scale, and (c) psychometrically test the developed scale. Five hundred nurses were recruited from a medical center in southern Taiwan. Exploratory and confirmatory factor analyses were executed to analyze construct validity and internal consistency reliability.The scale-content validity index was .87, as determined by five experts. Two thirds (63.29%) of the variance was explained by three factors: basic care skills (nine items), being dedicated to work (five items), and patient-centered and ethical considerations (four items). A second-order confirmatory factor analysis indicated that the data fit the model well. The Cronbach's alpha coefficients for each of the three factors and the total scale were .84-.91.The 18-item CSCN is a feasible and time-efficient tool for assessing competence in clinical nurses. Nursing supervisors may use this tool to explore nurses' competency and routinely track the effect of continuing education on competence. Continuous evaluation of nurses' clinical-based competence using the CSCN is recommended.

Background: This study aimed to profile the clinical pictures and identify the risk factors of mortality among terminally ill patients who visited the emergency department (ED) and had signed do-not-resuscitate (DNR) consents. Methods: This prospective study employed purposeful sampling of 200 adult, nontrauma, terminally ill patients who visited the ED and signed a DNR consent between July 1, 2011, and March 31, 2012. Physiological variables were compared between fatal and survival patients using Student's t-tests after assessing the normality of the data distribution. Results: The Cox proportional regression analysis revealed that patients taking antiarrhythmic drugs and vasopressor had a 47.6-fold and 2.8-fold higher mortality, respectively, compared to nonusers and those who had a respiratory rate ≥28 breaths/min showed a 2.8-fold increase in their risk of death compared to those with a respiratory rate

The willingness to purchase a house is closely related to previous experiences with housing market changes. This paper establishes the variable effects of willingness to purchase a house based on experience to analyze how experience with the Lost Decade (1991 to 2001) in Japan has influenced its housing market. This study finds that when the regional house-price levels are less deviated from those of Tokyo, willingness to purchase a house is relatively higher, which inhibits the growth of rent prices. Grouping data into urban and non-urban areas shows that the negative impact of willingness to purchase a house is higher in non-urban areas. This indicates an urban–rural gap in the country and house prices in the urban areas can self-adjust so that willingness to purchase a house does not reflect significantly on the rental market. Experience with the cumulative house prices of each prefecture from 1985 to 2015 relative to the Tokyo standard is calculated for deviation to determine whether the cumulative experience of long-term past losses could be used to analyze divergence in the regional housing markets.

Pressure ulcers were an increasingly significant problem among patients in the authors' ward. The eight patients diagnosed with pressure ulcers (0.42% of all inpatients) during the first half of 2009 represented a 140% increase over the first half of 2008 (0.28% of all inpatients).This project was designed to reduce pressure ulcer incidence in the surgical intensive care unit (ICU) to 0.05%.Intervention measures included: 1) holding professional training on preventing pressure ulcers; 2) specifying appropriate patient turnover tools; 3) creating and distributing to nurses a proper turnover technique and positioning manual; 4) creating and distributing to nurses a comprehensive patient skin inspection checklist; and 5) organizing a permanent pressure ulcer care quality and audit committee.Pressure ulcer incidence fell from 0.42% to 0.04% following implementation of the methods.Results demonstrate the effectiveness of using the proposed methods to reduce pressure ulcer incidence and enhance nursing care quality.