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AIMS AND OBJECTIVES To investigate the relationship of nurse practitioners' social support as well as other factors associated with perceived self-efficacy. BACKGROUND There is a growing demand for nurse practitioners in Taiwan, for whom self-perceived efficacy is associated with performance. Nevertheless, research on the self-efficacy and social support of nurse practitioners is limited. DESIGN This is a cross-sectional survey study. METHODS Questionnaires were distributed to nurse practitioners in seven hospitals in northern Taiwan from May 2015 to March 2016. In total, data from 335 (78% return rate) certified nurse practitioners were analysed. Social support was measured by the Multidimensional Scale of Perceived Social Support (MSPSS) and the Job Content Questionnaire (JCQ), and perceived self-efficacy was measured by the General Self-Efficacy Scale (GSE). Data were analysed by ANOVAs with post hoc test and multiple linear regression. RESULTS The mean score for self-efficacy was 27.60 ± 6.17. Support scores were 11.574 ± 2.37 for supervisors, 12.795 ± 1.92 for coworkers and 64.07 ± 10.16 for family, friends and significant others. nurse practitioners in the high monthly salary group had significantly higher self-efficacy than nurse practitioners in the medium and low monthly salary group (F = 8.99; p

Aims and objectives To evaluate the accuracy of the inpatient fall risk screening tool and to identify the most critical fall risk factors in inpatients. Background Variations exist in several screening tools applied in acute care hospitals for examining risk factors for falls and identifying high-risk inpatients. Design Secondary data analysis. Methods A subset of inpatient data for the period from June 2011–June 2014 was extracted from the nursing information system and adverse event reporting system of an 818-bed teaching medical centre in Taipei. Data were analysed using descriptive statistics, receiver operating characteristic curve analysis and logistic regression analysis. Results During the study period, 205 fallers and 37,232 nonfallers were identified. The results revealed that the inpatient fall risk screening tool (cut-off point of ≥3) had a low sensitivity level (60%), satisfactory specificity (87%), a positive predictive value of 2·0% and a negative predictive value of 99%. The receiver operating characteristic curve analysis revealed an area under the curve of 0·805 (sensitivity, 71·8%; specificity, 78%). To increase the sensitivity values, the Youden index suggests at least 1·5 points to be the most suitable cut-off point for the inpatient fall risk screening tool. Multivariate logistic regression analysis revealed a considerably increased fall risk in patients with impaired balance and impaired elimination. The fall risk factor was also significantly associated with days of hospital stay and with admission to surgical wards. Conclusions The findings can raise awareness about the two most critical risk factors for falls among future clinical nurses and other healthcare professionals and thus facilitate the development of fall prevention interventions. Relevance to clinical practice This study highlights the needs for redefining the cut-off points of the inpatient fall risk screening tool to effectively identify inpatients at a high risk of falls. Furthermore, inpatients with impaired balance and impaired elimination should be closely monitored by nurses to prevent falling during hospitalisations.

Nurses' turnover intention is not dichotomous; it may reflect intent to leave the profession, intent to leave a type of facility, or intent to leave a specific workplace. In a latent class analysis (LCA) of data from 186 licensed nurses (RNs and LPNs) recruited from 25 nursing homes (NHs) in Taiwan, we classified nurses into turnover intention subgroups based on seven questionnaire items and used a multilevel contrast analysis to characterize the subgroups according to demographic and facility factors, job demand, and job satisfaction. A multilevel probit model was used to examine how job demand and job satisfaction influenced subgroup membership. Three turnover subgroups were identified: high turnover intention (12%), middle turnover intention (57%), and low turnover intention (31%). The high turnover intention subgroup comprised the youngest nurses and had the lowest percentage of registered nurses (RNs); nurses in this subgroup had worked the longest at the current NH and had the greatest likelihood of working at a for-profit facility. Nurses in the middle turnover intention subgroup had the lowest likelihood of working at a for-profit facility. Nurses in the low turnover intention subgroup were primarily RNs and had the shortest work experience in the current facility. Nurses in the high and middle turnover intention subgroups reported lower intrinsic job satisfaction than those with low turnover intention. Extrinsic job satisfaction mediated the relationship between job demand and turnover intention subgroup assignment. The results of this LCA can help target interventions to address heterogeneity of turnover intention and ultimately lessen turnover.

Summary Background Although the benefits of preceptor training programs on the performance of nurse preceptors have been reported, research related to nurse preceptors' perceptions of and experiences with preceptor training courses is relatively limited. Objectives To explore nurse preceptors' perceptions of preceptor training courses and obtain information on their experiences in working as preceptors. Design A mixed method design was conducted. Participants and settings Nurse preceptors who currently work at one of eight hospitals in northern Taiwan were recruited to participate in this study. Methods A questionnaire survey and focus group interviews were conducted. A training course perception scale was developed and generated based on the current nurse preceptor training programs offered in eight hospitals. Focus group interviews were conducted to obtain additional information on nurse preceptors' experiences in working as preceptors. The survey data were analyzed using descriptive statistics. Interview data were transcribed and analyzed using a qualitative content analysis approach. Results The results from the surveys of 386 nurse preceptors revealed that most courses included in the current preceptor training programs did not fulfill the learning needs of nurse preceptors and were clinically impractical. The most necessary and clinically useful course was the communication skills course, whereas the least useful course was the adult learning theory and principles course. Three themes were identified as problems based on the three focus group interviews conducted with 36 nurse preceptors: inadequate training was received before nurses were appointed as nurse preceptors, the courses were more theoretical rather than practical, and the preceptors experienced stress from multiple sources. Conclusions The results revealed that the current preceptor training courses are impractical; therefore, the content of preceptor training courses must be altered to fulfill nurse preceptors' training needs. Furthermore, problems identified through the focus group interviews reinforce the survey results.

Patient falls are a common, adverse event in hospitals that may result in economic and care burdens on the patient and his/her family afterward.To analyze the factors that relate to falls among inpatients and to estimate the associated days of hospitalization and medical costs.The present study used a retrospective matched case-control design to analyze inpatient fall data for 2009 to 2011 from a regional teaching hospital in northern Taipei. We matched fallers and controls according to gender, age ∓ 5 years, and ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) code. Data were analyzed using descriptive and inferential statistics.A total of 160 inpatients participated in the present study (80 fallers in the fall group and 80 nonfallers in the control group). The results revealed that fallers had more previous fall experiences and longer hospital stay than nonfallers. Multiple logistic regression analysis revealed that the risk factors that were significantly associated with inpatient falls included: no family accompaniment, use of more than 3 fall-related medications, and no intravenous catheter placement. Results further found that medical costs increased with the degree of injury. Third-degree injuries bore the highest post-fall medical costs of all of the injury-degree categories. The average medical cost for patients with third-degree injuries was 18,257 New Taiwan dollars.The findings provide a reference for hospitals to promote patient safety, to prevent the occurrence of inpatient falls, and, ultimately, to reduce fall-associated medical costs.住院病人跌倒事件之原因分析及醫療成本.跌倒是醫院中常見的不良事件，但病人一旦跌倒後，可能會造成個人、家庭在經濟和照護上的負擔。.分析住院病人發生跌倒之原因及跌倒後之住院天數與醫療處置費用。.本研究為回溯性配對個案控制設計。資料來源為北部某區域醫院，2009年至2011年間住院且發生跌倒的病人，而對照組為無跌倒的病人，以性別、年齡∓ 5歲、主診斷ICD-9-CM（International Classification of Diseases, Ninth Revision, Clinical Modification）相同者為配對條件。資料統計方法包括描述性與推論性統計。.本研究共收160位住院病人（跌倒組80位及對照組80位）。結果發現住院期間跌倒的病人，有過去跌倒經驗與平均總住院天數較對照組多。經多項式羅吉斯迴歸分析後，與住院病人跌倒之三個危險因子為：無陪伴者、有使用易跌倒藥物≥三類及無點滴注射者。本研究也發現，隨著跌倒後之傷害級數增加，其醫療處置成本支出也隨之增加，其中，又以三級傷害程度的醫療處置費用最多，佔75.6%，其平均每位跌倒的醫療成本約新台幣18,257元。.本研究結果能作為未來醫院在推動病人安全與預防病人跌倒之參考，以減少額外的醫療成本支出。.

Aims and objectives To evaluate the effectiveness of an accessibility-enhanced multimedia informational educational programme in reducing anxiety and increasing satisfaction with the information and materials received by patients undergoing cardiac catheterisation. Background Cardiac catheterisation is one of the most anxiety-provoking invasive procedures for patients. However, informational education using multimedia to inform patients undergoing cardiac catheterisation has not been extensively explored. Design A randomised experimental design with three-cohort prospective comparisons. Methods In total, 123 consecutive patients were randomly assigned to one of three groups: regular education; (group 1), accessibility-enhanced multimedia informational education (group 2) and instructional digital videodisc education (group 3). Anxiety was measured with Spielberger's State Anxiety Inventory, which was administered at four time intervals: before education (T0), immediately after education (T1), before cardiac catheterisation (T2) and one day after cardiac catheterisation (T3). A satisfaction questionnaire was administrated one day after cardiac catheterisation. Data were collected from May 2009–September 2010 and analysed using descriptive statistics, chi-squared tests, one-way analysis of variance, Scheffe's post hoc test and generalised estimating equations. Results All patients experienced moderate anxiety at T0 to low anxiety at T3. Accessibility-enhanced multimedia informational education patients had significantly lower anxiety levels and felt the most satisfied with the information and materials received compared with patients in groups 1 and 3. A statistically significant difference in anxiety levels was only found at T2 among the three groups (p = 0·004). Conclusions The findings demonstrate that the accessibility-enhanced multimedia informational education was the most effective informational educational module for informing patients about their upcoming cardiac catheterisation, to reduce anxiety and improve satisfaction with the information and materials received compared with the regular education and instructional digital videodisc education. Relevance to clinical practice As the accessibility-enhanced multimedia informational education reduced patient anxiety and improved satisfaction with the information and materials received, it can be adapted to complement patient education in future regular cardiac care.

Despite the fact that regular physical activity is known to improve physical health and reduce absenteeism and perceived job strain, healthcare professionals currently perform inadequate physical activity.To understand and compare the differences in stages of physical activity among nurses, physicians, and allied healthcare professionals.A cross-sectional questionnaire was used to survey nurses, physicians, and allied healthcare professionals who worked at four branches of a hospital in Taiwan. Data were collected using the physical activity stage of change questionnire. Data were analyzed using descriptive analysis, Chi-square test of homogeneity of proportions and a posteriori comaparisons, and multinominal logistic regression analysis.Of the 3,260 questionnaires administrated, 2,001 valid questionnaires were returned for an effective response rate of 61.4%. In total, 1,497 (74.8%) of the nurses, 241 (12.0%) of the physicians, and 263 (13.1%) of the allied healthcare professionals completed the questionnaire. The results revealed that most of the physicans and allied healthcare professionals were in the preparation stage, while most of the nurses were in the precontemplation stage. Multinominal logistic regression analyses showed that, using the precontemplation stage as a reference value, the odds of being in the contemplation stage were lower among participants who were nurses or male or who had a master's or doctoral degree (p.05). Further, the odds of being in the preparation stage were lower among nurses (p.01). The odds of being in the maintenance stage were higher among participants that: lived in the Taitung area, were male, or were single (p.01).The findings provide valuable references for future hospital leaders to develop effective individual physical activity programs for healthcare professionals.比較護理人員、醫師及其他醫事人員身體活動階段之差異.規律的身體活動雖然可促進醫事人員的健康、降低曠班及工作緊張感，但大部分醫事人員的活動量是不足的。.瞭解與比較護理人員、醫師及其他醫事人員之身體活動階段的差異。.本研究設計採橫斷式問卷調查法，以臺灣某醫院四院區之護理人員、醫師及其他醫事人員為研究對象。以身體活動階段問卷表為研究工具。資料統計分析方法包含：描述性統計分析、卡方百分比同質性考驗及事後比較、多項式邏輯斯迴歸分析。.本研究共發出問卷3,260份，有效回收問卷2,001份，有效問卷回收率為61.4%。本研究共收集1,497名（74.8%）護理人員、241名（12.0%）醫師及263名（13.1%）其他醫事人員。研究結果顯示，醫師與其他醫事人員的身體活動階段均以準備期居多；而護理人員身體活動階段則以無意圖期居多。以無意圖期為參考值，多項式邏輯斯迴歸分析醫事人員身體活動階段傾向之可能因素顯示，護理人員、男性、具碩博士學歷者，其身體活動階段處於意圖期的勝算較低（p.05）；護理人員處於準備期的勝算較低（p.01）。臺東院區、男性及未婚者處於維持期的勝算較高（p.01）。.本研究結果可作為未來醫院領導者發展醫事人員個別化身體活動計畫方案之參考，以促進其健康。.

Aims To assess the level of and the differences in managerial competencies, research capability, time management, executive power, workload and work-stress ratings among nurse administrators (NAs), and to determine the best predictors of managerial competencies for NAs. Background Although NAs require multifaceted managerial competencies, research related to NAs’ managerial competencies is limited. Method A cross-sectional survey was conducted with 330 NAs from 16 acute care hospitals. Managerial competencies were determined through a self-developed questionnaire. Data were collected in 2011. Results All NAs gave themselves the highest rating on integrity and the lowest on both financial/budgeting and business acumen. All scores for managerial competencies, research capability, time management and executive power showed a statistically significant correlation. The stepwise regression analysis revealed that age; having received NA training; having completed a nursing project independently; and scores for research capability, executive power and workload could explain 63.2% of the total variance in managerial competencies. Conclusion The present study provides recommendations for future administrative training programmes to increase NAs’ managerial competency in fulfilling their management roles and functions. Implications for Nursing Management The findings inform leaders of hospitals where NAs need to develop additional competencies concerning the type of training NAs need to function proficiently.

shen h.-c., chiu h.-t., lee p.-h., hu y.-c. & chang w.-y. (2011) Hospital environment, nurse–physician relationships, and quality of care: questionnaire survey. Journal of Advanced Nursing 67(2), 349–358. Abstract Aim. This paper is a report of a study conducted to (a) to compare hospitalized patients’ and nurses’ perceptions of the hospital environment, nurse–physician relationships and quality of care; (b) to determine which factors best predict the quality of care from hospitalized patients' and nurses' perspectives; and (c) to assess the relationships among all variables. Background. Quality of care is a function of many factors and includes elements of the hospital environment and nurse–physician relationships. However, comparisons between patients’ and nurses’ perceptions are relatively limited. Methods. This was a cross-sectional study, and 575 patients and 220 nurses across 13 units completed questionnaires. Data were collected in 2009 and analysed using descriptive statistics, independent t-tests, stepwise regression and path analysis. Results. Overall, patients’ mean scores were statistically significantly higher than those of nurses on perception of hospital environment (3·05 vs. 2·65 points), nurse–physician relationships (7·88 vs. 6·53 points) and quality of care (7·91 vs. 6·63 points) (P

Aims. (1) To understand nurses’ subjective perceptions of the current nursing workforce in their emergency departments, (2) to examine the relationship between nurses’ workforce perceptions and its impact on the managerial outcomes and (3) to analyse the correlation between nurses’ characteristics and the scores on workforce perception. Background. While the association between workforce perceptions and nurse outcomes is well-documented, few studies have examined how emergency department nurses perceive current workforce and related outcomes. Design. A cross-sectional questionnaire survey. Method. A self-reported workforce perception questionnaire was used to survey 538 registered nurses in the emergency departments of 19 hospitals in northern Taiwan, during May to October 2006. Data were analysed using descriptive statistics, chi-square test, independent t-test, Pearson correlation and one-way anova. Results. The mean score of workforce perception was 6·28 points (total = 10 points). Both overtime (p = 0·02) and number of callbacks on days off (p = 0·01) were significantly correlated to current nursing workforce and hospital level. Older nurses tended to have more emergency department experience (r = 0·37; p = 0·01) and those with more emergency department experience tended to have vacation accumulation (r = 0·09; p = 0·04), overtime (r = 0·10; p = 0·03) and better perception of their emergency department’s current workforce (r = 0·09; p = 0·05). Conclusions. Although nurses’ perceptions were found to be only moderate, overtime and number of callbacks on days off are potential problems that should be addressed by nursing leaders to benefit future emergency nurses. Relevance to clinical practice. The findings can help drive strategies to ensure adequate staffing, to stabilise the nursing workforce and to prevent nurses from burnout factors such as working long hours, unpredictable schedules and a stressful work environment that may impact both the quality of emergency care and the quality of the nurses’ work environment.

Title. Job satisfaction and perceptions of quality of patient care, collaboration and teamwork in acute care hospitals. Aim. This paper is a report of a study conducted to compare levels of job satisfaction and perceptions of the quality of patient care, collaboration and teamwork among healthcare professionals in four acute care hospitals and to determine the factors associated with job satisfaction for physicians, nurses and other healthcare professionals. Background. Positive inter-professional relationships improve quality of patient care and staff job satisfaction. Understanding how healthcare professionals perceive their relationships with each other, and identifying factors that affect their job satisfaction and perceptions of the quality patient care, inform quality improvements. Method. This cross-sectional survey study was conducted in four hospitals in Taiwan. Data were collected in 2007 and analysed using descriptive statistics, one-way anova with the Games-Howell post hoc test and stepwise regression analysis. Results. The survey was completed by 1475 respondent, giving a response rate of 52·2% (180 physicians, 1019 nurses and 276 other healthcare professionals). Physicians were more satisfied with their jobs (F = 26·75, P

Aims and objectives. This study performed a meta-analysis of seven parallel-group comparison studies evaluating the efficacy of tuina in treating cervical spondylosis. Background. Tuina is a form of Chinese manipulative therapy. It has been used as a modality for the treatment of symptoms associated with such a musculoskeletal condition as cervical spondylosis. However, evidence regarding the efficacy of tuina for cervical spondylosis has yet to be determined. Design. Systematic review. Methods. Cochrane library, Pubmed, MEDLINE, EBM review, ProQuest Medical Bundle and SCOPUS databases were searched using the following medical subject headings or key words: tuina, tuinaology, manual medicine, massotherapy, cervical spondylopathy, cervical spondylosis and cervical vertebrae. Chinese research papers were searched through the Chinese electronic periodical services and Wangfane database. The publication date was limited from 1996–2007. Studies were selected if they were written in English or Chinese, used tuina as a stand-alone modality, used a parallel-group comparison design and explicated raw data regarding symptoms relief. Two independent reviewers reviewed the selected studies based on the evidence rating system of the US Preventive Services Task Force. Studies with an evidence rating of II-2 fair or above were included in this review. Results. The direction of the effect size for the improvement of blood flow velocity of vertebral artery and basilar artery was not consistent across studies. Moreover, the pooled effect size was negligible. No evidence supported that tuina could improve headache and vertigo. A small effect of tuina on the viscosity of blood and plasma was found. Conclusion. Based on the results of this systematic review, a definitive conclusion regarding the effects of tuina on cervical spondylosis remains to be determined. Relevance to clinical practice. The efficacy of tuina is not supported by parallel-group comparison studies.

Summary Objective To describe the Instructional System Design Processes (analysis, design, development, implementation, and evaluation) used to develop an e-learning education programme for staff nurses at a 700-bed teaching medical center in Taiwan. Background Evidence has shown that education via e-learning improves knowledge and skills; however, with cost constraints and limited resources, finding effective alternatives is critical for health professionals. Methods Five courses required for N2 to N3 level nurses were designed for both e-learning and traditional in-classroom programmes. Multiple-choice written test questions and a satisfaction questionnaire were used to compare outcomes between programmes. Nursing care skills were rated as pass or fail. Both programmes were begun at the same time and completed within a 3-month period. Results Forty-two staff nurses participated in this study. All nurses’ knowledge scores were >70 points (out of 100) and all passed nursing care skills. In five courses, only teaching and learning and communication were statistically significantly different ( p = 0.001). Nearly all nurses (97.6%) felt satisfied or very satisfied with the programmes. Conclusions Instructional System Design Processes provide an alternative delivery system for in-service nursing education which allows for individualized leaning.

The aim of this study was to describe registered nurses' experiences with an e-learning education program (ELEP) conducted at a 776-bed teaching medical center in Taipei. The study was completed in three stages: planning, implementation, and evaluation. Nurses who were registered were randomly assigned either to the ELEP or traditional in-classroom program (TICP). Data were analyzed using descriptive and inferential statistics. Forty-two nurses participated (22 in the ELEP and 20 in the TICP). Scores for participants were all70 points (out of 100) for both programs. Of the five courses, only teaching and learning and communication showed significant statistical difference between the two groups (p = .001). Nearly all participants (97.6%) felt satisfied with their program (both ELEP and TICP). All nurses passed the nursing care skill tests. Findings should help guide efforts to popularize e-learning education in Taiwan and help create alternative learning methods for future continuing nursing education programs.

Aims To investigate the mediating effect of work-to-family conflict on the relationship between job satisfaction and turnover intention among licensed nurses in long-term care settings. Background The considerable research on turnover in long-term care has primarily focused on the impact of job satisfaction on turnover intention. Given the well-documented high turnover rate in nursing home staffing, dissatisfaction is expected to continue. Alternatives (e.g. reduction in work-to-family conflict) for reducing turnover under the circumstance of job dissatisfaction have not been investigated extensively. Design A cross-sectional mailed survey. Methods A convenience sample comprising 200 nurses from 25 private nursing homes in Central Taiwan was created. Data were collected from nurses about their level of turnover intention, job satisfaction and work-to-family conflict in 2012. A composite indicator structural equation model was used to examine the mediation model of this study. Results Overall, 186 nurses (93%) returned the completed questionnaires. Consistent with published research from other countries, turnover intention in our study was significantly and negatively associated with job satisfaction and significantly and positively associated with work-to-family conflict. In addition, job dissatisfaction indirectly influenced turnover intention through high work-to-family conflict. Conclusion Findings from this study indicate the importance of work-to-family conflict to nurse turnover. While work setting has a strong, well-documented influence on job satisfaction, limiting job satisfaction efforts to work setting improvements may not yield the hoped-for results unless work-to-family conflict is also considered and addressed.

Nurses' turnover intention is not dichotomous; it may reflect intent to leave the profession, intent to leave a type of facility, or intent to leave a specific workplace. In a latent class analysis (LCA) of data from 186 licensed nurses (RNs and LPNs) recruited from 25 nursing homes (NHs) in Taiwan, we classified nurses into turnover intention subgroups based on seven questionnaire items and used a multilevel contrast analysis to characterize the subgroups according to demographic and facility factors, job demand, and job satisfaction. A multilevel probit model was used to examine how job demand and job satisfaction influenced subgroup membership. Three turnover subgroups were identified: high turnover intention (12%), middle turnover intention (57%), and low turnover intention (31%). The high turnover intention subgroup comprised the youngest nurses and had the lowest percentage of registered nurses (RNs); nurses in this subgroup had worked the longest at the current NH and had the greatest likelihood of working at a for-profit facility. Nurses in the middle turnover intention subgroup had the lowest likelihood of working at a for-profit facility. Nurses in the low turnover intention subgroup were primarily RNs and had the shortest work experience in the current facility. Nurses in the high and middle turnover intention subgroups reported lower intrinsic job satisfaction than those with low turnover intention. Extrinsic job satisfaction mediated the relationship between job demand and turnover intention subgroup assignment. The results of this LCA can help target interventions to address heterogeneity of turnover intention and ultimately lessen turnover.

Gaining an understanding of the distribution of physician incomes between different medical specialties could assist policymakers to predict the future medical manpower supply. The purpose of this study is to examine the differences in medical specialty-specific gross practice incomes between office-based physicians in Taiwan. The primary data source for the study, which includes 7444 office-based physicians, was provided by the Taiwan Department of Health, with the dependent variable of interest to this study being the annual gross income of physician practices, whilst the independent variable is physician specialty. The study controlled for physicians' age, gender, specialty-board status, type of practice, location of clinic and urbanization level of the community in which the practice was located. Multivariate regression analyses were carried out to explore the relationship between physician specialty and gross practice income. This study finds a significant relationship between the annual gross income of physician practices and the physician's medical specialty (P0.001). Of all physicians, those specializing in rehabilitation and orthopedics had the highest gross practice incomes; conversely, obstetricians and gynecologists had the lowest gross practice incomes. The regression analyses demonstrated that after adjusting for socio-demographic and professional characteristics, gross practice incomes of physicians were significantly related to their medical specialty. This study concludes that differences in the gross practice incomes of physicians were significantly related to medical specialties. Those physicians specializing in procedure-based specialties, such as rehabilitation and orthopedics, had higher practice incomes than their counterparts in other more diagnosis-oriented specialties such as family practice and pediatrics.

In the fast-changing arena of health care, it is important for public health nurses (PHNs) to receive professional training through continuing education (CE) to maintain practice competencies in the community. However, little information is currently known about needs for and barriers to CE for PHNs in role transition; therefore, the aim of this study was to identify CE needs and barriers for 21 PHNs in four Taitung Aboriginal townships where density of Aborigines is the highest in Taiwan. Focus group interviews were used to collect data. Interview data were then analyzed using the four step processes of data analysis suggested by Webb and Kevern (2001). The results indicated that CE for PHNs in Taitung was limited. Community assessment, psychological consultation, gerontological care, palliative care, statistical analysis and interpretation, and emergency care were identified by PHNs as CE needs. For CE barriers, about 98% of the PHNs indicated that long distance traveling was the main barrier. Family factors and inadequate support from administrative leaders were the next. It is concluded that establishing local nursing schools, using the Internet to provide CE, and planning computer systematic education courses may reduce barriers for PHNs in Taitung county.

Reactive oxygen species have been linked with neuropathological changes in the central nervous system. Epidemiological studies supported the beneficial effect of supplementation of antioxidants. Superoxide dismutase (SOD) is an endogenous enzyme which can scavenge reactive oxygen species. This study investigated the effect of supplementation with ascorbic acid (vitamin C) on the changes of SOD in cultured neurological cells. Rat brain astrocytes (RBA-1 cells) were incubated with vitamin C and divided into four groups: a control group (without vitamin C) and three treatment groups with vitamin C at 40, 80, and 160 µmol/l. After short-term (2 days) and long-term (7 days) incubation, SOD activity, SOD mRNA level by Northern blotting, and SOD protein amounts by Western blotting were measured. After 2 days of incubation, vitamin C resulted in a decrease in the activity of SOD in a concentration-dependent manner (Mn-SOD from 14.8 ± 1.2 to 13.2 ± 0.5 U/mg protein and Cu/Zn-SOD from 64.8 ± 1.2 to 51.7 ± 0.9 U/mg protein; p < 0.05), and vitamin C also attenuated the Cu/Zn-SOD mRNA level from 100 to 86.3 ± 6.7%; p < 0.01), whereas the protein amounts of these two SODs remained unchanged. After 7 days of incubation with vitamin C, the SOD activity of RBA-1 cells decreased significantly (Mn-SOD from 14.9 ± 0.3 to 11.8 ± 0.3 U/mg protein and Cu/Zn SOD from 61.8 ± 1.8 to 54.6 ± 0.9 U/mg protein; p < 0.01), and the mRNA level was also attenuated (Mn-SOD from 100 to 86.8 ± 8.7% and Cu/Zn-SOD from 100 to 84.7 ± 4.8%; p < 0.01). These results suggest that 2 and 7 days of incubation with relatively high concentrations of vitamin C may downregulate activity and gene expression of SOD in cultured RBA-1 cells.

The aims of the study were to examine the influence of upper extremity exercise on glucose response and to establish a predictive model of changes in serum glucose under different exercise intensities and durations. Thirty-three type 2 DM patients who met the selection criteria were selected. An arm cycle ergometer exercise test was conducted, and then 12 arm exercise sessions were arranged based on different exercise intensities (40%, 60%, and 80% of maximal workload) and exercise durations (10, 20, 30, and 40 min). Serum glucose levels were measured before and after each exercise session. Serum glucose levels significantly decreased after arm exercise regardless of different intensities or durations. However, no interaction effect (intensity x duration) or main effect in exercise intensity was observed, but a significant main effect in exercise duration was observed (F = 11.756, p

Background: Preparing new graduate nurses (NGNs) to achieve standards of nursing competence is challenging; therefore, this study developed and evaluated the effects of a 10-minute preceptor (10MP) model for assisting NGNs in their professional development and increasing their retention in hospitals. Method: A repeated-measures design study, with an intervention and a two-group comparison, was conducted. A total of 107 NGNs participated in the study. At day 7, work stress and work experience were moderately high for the NGNs in both the 10MP and traditional preceptor model (TPM) groups. Results: The preceptorship program showed significant differences between groups ( p = 0.001) regarding work stress at months 2 and 3 and work experience at months 1, 2, and 3. The 10MP group reported lower turnover intention and higher satisfaction with the preceptors than the TPM group. Conclusion: The 10MP model is effective at improving training outcomes and facilitating the professional development of NGNs. J Contin Educ Nurs. 2015;46(6):261–271.

Priority-setting for nursing research in the Republic of China The question of how public funds for research should be allocated has led to participatory priority-setting in prosperous democracies like Taiwan, Republic of China. Useful criteria for research priorities are scientific merit, social benefit and feasibility. Taking a health needs approach and using these criteria, nearly 200 nurses from service and education in a national forum participated in describing research priorities. Through the group method of idea-writing, for clinical nursing, of high priority were assessing quality, care of the elderly, and preventing infectious disease. For nursing education, research addressing advanced role preparation and bridging nursing education and practice were priorities. For nursing management, research of highest priority pertained to economic evaluation, personnel administration, and effectiveness. These suggestions from the deliberation of a committed group of nurses can help shape future national decisions about research funding and training.

To assess the level of and the differences in managerial competencies, research capability, time management, executive power, workload and work-stress ratings among nurse administrators (NAs), and to determine the best predictors of managerial competencies for NAs.Although NAs require multifaceted managerial competencies, research related to NAs' managerial competencies is limited.A cross-sectional survey was conducted with 330 NAs from 16 acute care hospitals. Managerial competencies were determined through a self-developed questionnaire. Data were collected in 2011.All NAs gave themselves the highest rating on integrity and the lowest on both financial/budgeting and business acumen. All scores for managerial competencies, research capability, time management and executive power showed a statistically significant correlation. The stepwise regression analysis revealed that age; having received NA training; having completed a nursing project independently; and scores for research capability, executive power and workload could explain 63.2% of the total variance in managerial competencies.The present study provides recommendations for future administrative training programmes to increase NAs' managerial competency in fulfilling their management roles and functions.The findings inform leaders of hospitals where NAs need to develop additional competencies concerning the type of training NAs need to function proficiently.

This is a report of development and psychometric testing of the East Asian Acculturation Measure-Chinese version (EAAM-C) scale.An instrument validation design with a cross-sectional survey was conducted. The process was carried in two phases. In Phase 1, Barry's East Asian Acculturation Measure was translated and back translated to evaluate its content, face validity, and feasibility validity. In Phase 2, the 16-item EAAM-C was pilot-tested among 485 female immigrants for test-retest reliability, internal consistency, theoretically-supported construct validity and concurrent validity.The pilot work and the survey results indicated the tools possessed adequate content and face validity. The Cronbach's Alphas for the EAAM-C was 0.72, and 0.76-0.79 for its subscales, and the correlation of test-retest reliability (at 3 weeks) was 0.75. After dropping one item, four theoretically-supported factors which explained 61.82% of the variance were abstracted using exploratory factor analysis: assimilation, integration, separation, and marginalization. Based on the underlying four-factor theoretical structures of the EAAM, the confirmatory factor analysis of the EAAM-C was further examined. The analysis revealed that the four-factor model was an acceptable fit for the data which demonstrated adequate finding in its construct validity. These factors were inter-correlated, and showed statistically significant correlation with the Chinese Health Questionnaire, indicating adequate concurrent validity.The scale shows acceptable validity and consistency, and suggests that immigrant acculturation is a complex construct. This quick evaluation instrument can be applied to assess clients' acculturation and in further developing certain interventions to improve their health.

The growing complexity of Taiwan's healthcare system increasingly challenges nurse administrators. Multifaceted competencies and skills are essential for nurse administrators to manage organizational resources, ensure patient safety and maintain care quality. The author designed this paper to explore from a broad historical perspective the current challenges nurse administrators face. The paper provides recommendations to prepare and train future nurse administrators to fulfill their management roles confidently and competently.

This paper is a report of a study conducted to (a) to compare hospitalized patients' and nurses' perceptions of the hospital environment, nurse-physician relationships and quality of care; (b) to determine which factors best predict the quality of care from hospitalized patients' and nurses' perspectives; and (c) to assess the relationships among all variables.Quality of care is a function of many factors and includes elements of the hospital environment and nurse-physician relationships. However, comparisons between patients' and nurses' perceptions are relatively limited.This was a cross-sectional study, and 575 patients and 220 nurses across 13 units completed questionnaires. Data were collected in 2009 and analysed using descriptive statistics, independent t-tests, stepwise regression and path analysis.Overall, patients' mean scores were statistically significantly higher than those of nurses on perception of hospital environment (3·05 vs. 2·65 points), nurse-physician relationships (7·88 vs. 6·53 points) and quality of care (7·91 vs. 6·63 points) (P0·001). Both the hospital environment and nurse-physician relationships were statistically significant predictors of quality of care. Path analysis showed that quality of care was affected by the hospital environment, nurse-physician relationships and years of education for patients (P0·05). However, for nurses, quality of care was only directly affected by the hospital environment and nurse-physician relationships (P0·05).These findings may help nursing leaders to ensure future excellent patient care by helping them to see which areas need improvement. They may also help nursing leaders to develop strategies to meet patients' and nurses' expectations.

(1) To understand nurses' subjective perceptions of the current nursing workforce in their emergency departments, (2) to examine the relationship between nurses' workforce perceptions and its impact on the managerial outcomes and (3) to analyse the correlation between nurses' characteristics and the scores on workforce perception.While the association between workforce perceptions and nurse outcomes is well-documented, few studies have examined how emergency department nurses perceive current workforce and related outcomes.A cross-sectional questionnaire survey.A self-reported workforce perception questionnaire was used to survey 538 registered nurses in the emergency departments of 19 hospitals in northern Taiwan, during May to October 2006. Data were analysed using descriptive statistics, chi-square test, independent t-test, Pearson correlation and one-way anova.The mean score of workforce perception was 6.28 points (total = 10 points). Both overtime (p = 0.02) and number of callbacks on days off (p = 0.01) were significantly correlated to current nursing workforce and hospital level. Older nurses tended to have more emergency department experience (r = 0.37; p = 0.01) and those with more emergency department experience tended to have vacation accumulation (r = 0.09; p = 0.04), overtime (r = 0.10; p = 0.03) and better perception of their emergency department's current workforce (r = 0.09; p = 0.05).Although nurses' perceptions were found to be only moderate, overtime and number of callbacks on days off are potential problems that should be addressed by nursing leaders to benefit future emergency nurses.The findings can help drive strategies to ensure adequate staffing, to stabilise the nursing workforce and to prevent nurses from burnout factors such as working long hours, unpredictable schedules and a stressful work environment that may impact both the quality of emergency care and the quality of the nurses' work environment.

Background: Although the prevalence of obesity continues to increase worldwide, information related to obese school-aged children's perceptions of exercise remains limited. Purpose: This study aimed to explore perceptions of exercise held by obese school-aged children. Methods: This study used a qualitative research design. Using purposive sampling, 11 obese students who were 11 to 13 years old, currently enrolled at two primary schools, and in the precontemplation stage were recruited from a total population of 1, 714 to participate in the study. An interview guide with five open-ended questions was used to guide focus group discussions. Data were analyzed using content analysis to identify significant themes. Results: Six themes emerged from collected data, including (a) positive impressions about doing exercise, (b) recognition of negative effects associated with not doing exercise, (c) feelings of discomfort after exercise, (d) self-ambivalence, (e) false beliefs about exercise, and (f) making excuses for not doing exercise. Conclusions/Implications for Practice: Study findings provided information giving a better understanding of exercise perceptions among obese children. Such may be used to assist obese children to increase exercise levels as part of efforts to improve health in this vulnerable population.

This 3-year retrospective case-control study aimed to identify risk factors associated with unplanned endotracheal self-extubation (UESE) of hospitalized intubated patients and to compare unplanned and planned extubation groups' characteristics of patients and nurses, vital signs, serum laboratory values, Glasgow Coma Scale scores, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, and use of physical restraints and sedatives. The study found that most UESEs occurred during evening or night shifts or during shifts staffed by nurses with less experience and less education. Most of the self-extubated patients (80%) were physically restrained. Pulse rate and APACHE II score were both significant predictors of UESE. Efforts to prevent UESEs should include identification of patients at higher risk.

Background Although there is a significant correlation between the degree of family support and clinical outcome, little research has focused on the effectiveness of family partnership intervention care (FPIC) for patients with poorly controlled type 2 diabetes. Objectives This study aimed to compare FPIC with conventional care (CC) across a number of outcome measures in patients with poorly controlled type 2 diabetes. Design The study was performed using a randomized controlled trial design. Participants Patients with poorly controlled type 2 diabetes who were solely treated with oral antidiabetic agents and had at least two out of three hemoglobin A1C readings equal to or above 7% in the previous 12 months, were randomly assigned to the FPIC group ( n =28) and to the CC group ( n =28). Methods Baseline and 6-month follow-up scores were compared using the following outcome measures: (1) hemoglobin A1C, (2) BMI, (3) lipid profile, (4) family supportive behaviours, (5), knowledge of and attitudes toward diabetes, and (6) diabetes self-care behaviours. Descriptive and non-parametric statistics were employed to compare differences in outcome measures between the groups. Results There were no significant differences in the reduction of hemoglobin A1C levels ( p =0.46), lipid profile values ( p >0.05), and improvement of diabetes self-care behaviours ( p =0.61) between the groups at 6 months post-intervention. However, there were significant differences in the scores of family supportive behaviours ( p =0.031) and patients' knowledge of and attitudes toward diabetes between the groups ( p Conclusion These findings support the use of FPIC to enhance family supportive behaviours, and to improve patients' knowledge of and attitudes toward diabetes. Thus, the study is of value in helping policy decision-makers to develop more effective diabetes control intervention programmes.

In April 1998, four health care administrators from Beijing, China visited the United States. During their visit, they were interviewed by Wen-Yin Chang, a doctoral student in nursing administration, at the University of Illinois at Chicago. The four administrators were: Dr. Aiming Sun, Deputy Director- General, Department of Medical Administration, Ministry of Health; Dr. Yuxiu Gong, Chief Nursing Division, Department of Medical Administration, Ministry of Health; Ms. Hanjun Men, Nursing Division, Ministry of Health, and Ms. Jing Yang, Vice-director, Nursing Management, Ministry of Health. Interview comments were translated to English by Ms. Chang.

This randomized controlled study examined whether a 4-week blood pressure (BP) biofeedback program can reduce BP and BP reactivity to stress in participants with mild hypertension.Participants in the active biofeedback group (n=20) were trained in 4 weekly laboratory sessions to self-regulate their BP with continuous BP feedback signals, whereas participants in the sham biofeedback group (n=18) were told to manipulate their BP without feedback signals. BP, skin temperature, skin conductance, BP reactivity to stress, body weight, and state anxiety were assessed before training and repeated at the eighth week after the training.The decreases in systolic (12.6 +/- 8.8 versus 4.1 +/- 5.7) and mean BP (8.2 +/- 6.9 versus 3.3 +/- 4.9) from baseline at week 12 follow-up were significantly greater in the active biofeedback group compared with the sham biofeedback group (p=0.001 and 0.017, respectively). Results from analysis of covariance with the follow-up systolic blood pressure (SBP) (or mean arterial pressure [MAP]) as the dependent variable, baseline SBP (or MAP) as the covariate, and group as the independent variable showed that biofeedback training effectively lowered SBP and MAP (p=0.013 and 0.026, respectively). The pre-to-post differences in skin conductance and SBP reactivity were statistically significant for the biofeedback group (p=0.005 and 0.01, respectively), but not for the control group. For the sample as a whole and for the biofeedback group, the state anxiety score and body weight remained unchanged.BP biofeedback exerts a specific treatment effect in reducing BP in individuals with mild hypertension, possibly through reducing pressor reactivity to stress.

Although a nursing project is one of the important N4 professional competence training courses in the clinical ladder system, little research on its effectiveness can be found. This study therefore aimed to analyze the demographics, hospital characteristics, scores, and pass rates for the Taiwan Nurses Association's 2004 to 2005 nursing projects and to compare the differences between them. The design was retrospective content analysis and the data sources were nursing project reviewer sheets from the years 2004 and 2005. Data were analyzed using descriptive statistics, such as number, percentage, mean, standard deviation, and Chi-square test, or Fisher exact test. We analyzed 1,062 nursing projects. Of these, 423 projects had third reviewers. After that, 2,547 reviewer sheets were used as final samples. The average project score was 59.7 points (SD = 9.3 points) and the majority of the projects were categorized as administrative and from medical centers, or private hospitals in northern areas of Taiwan. The pass rate was found to be higher in public hospitals, however, than in private hospitals. Almost all the projects (n = 2,515; 98.7%) included reviewers'comments. There was no significant difference between project pass rate and clinical specialty, scope, hospital location, and level of hospital accreditation (p.05). A significant difference was found, however, between project scores and hospital characteristics (p = .01). These findings may serve as references in the development of future requirements for nursing projects in the clinical ladder system, to improve the quality and quantity of such projects.

Although the cost-effectiveness of telephone nursing consultation has implemented in many developed countries for more than 30 years, very few studies have been conducted in Taiwan. Therefore, the purposes of this study were 1) to develop a telephone nursing consultation program (TNCP) for discharged patients in the emergency department (ED), 2) to analyze what were the tope leading 20 problems or symptoms reported by patients while they visited the ED, 3) to compare the outcome differences before and after implementing the TNCP. The design was descriptive. A TNCP in the ED was implemented at a 700-bed of medical center in Taipei. The samples were selected for those who had visited and discharged from ED. Patients were excluded if a person with accident, life- treating situation, or having mental problems. Weekly meeting was arranged to allow questions to be answered and written protocols to be revised before implementations. All patients' charts in 2003 were reviewed to find top 20 signs and symptoms. The satisfaction questionnaire was developed by the primary investigator and included 10 questions on a 5-point Likert-type scale. All data were analyzed using the Statistical Package for the Social Science/PC+ (SPSS for Windows 12.0, Chicago, IL). Descriptive analyses such as number, mean, standard deviation, ratio, rank, and percentage were used to analyze nurses' demographics and level of satisfaction, number of ED or outpatient visits, and readmission rate within 21 days after patient called. One-way ANOVA was used to compare the differences between pre-TNCP and post-TNCP. At the implementing phase, 9 nurses (4 were university graduates and 5 junior college graduates) were initially chosen to be TNCP nurses for this study. A special training such as computer and communication skills, protocols and documentation used, and role-play was provided to those nurses before TNCP was implemented. The TNCP was decided to open from Monday to Sunday and between 9 AM to 9 PM based on nurses' workload and hospital financial abilities. The results were that the mean working experience for nurses was 6.7 years. The top leading 20 problems or symptoms reported by ED patients were included adult abdominal pain, child fever, adult fever, laceration, dyspnea, chest pain, dizziness, child abdominal pain, adult nausea and vomiting, child nausea and vomiting, abrasion, adult diarrhea, child diarrhea, headache, arm and hand problems, head injury, palpitation, urinary difficulty, abdominal distension, mouth problems. During 3- month study period, only 54 calls were received and yielded an utilization rate was 0.61%, which was low. On average, the consulting time was 6.1 minutes. The advises used by TNCP nurses were for home management (n=21 calls; 38.9%), for emergency visits within 2-4 hours (n=8 calls: 14.8%), and for outpatient visits within 24 hours (n=25 calls; 46.3%). The experiences about being a TNCP nurse, they reported that the TNCP was very useful to assist patients after they discharged from ED, and the protocols and documentations were friendly and easy to follow. Overall, about 85% of patients felt satisfied with the TNCP and the level of satisfaction was increased from 3.12 points to 3.18 points between pre-implementing and post- implementing of the TNCP. To conclude, the findings indicated that the TNCP was effective, not only can expand the roles and functions of nurses, but also improve ED patients' satisfaction. For the future, we hope the TNCP can be extended to all departments at study hospital and to develop a call center to serve more ED patients.

The goal of International Perspectives is to share the views of nurse leaders, from countries other than the United States, on global healthcare issues. The focus is on identifying healthcare management problems and their implications, research priorities, policy development, and ethical-moral dilemmas faced by nurse administrators. You are encouraged to send the names and addresses of international nurse leaders who might be interested in participating, as well as your ideas for format and content of the department.

The performance of the emergency department significantly improved after implementing the balanced scorecard including hours of continuing education attended by the staff, staff job satisfaction, the rate of incomplete laboratory tests within 30 minutes, the average monthly inappropriate return rate, and hospital profit. The results can assist administrators plan for the future. Although this was a pilot program for implementing a balanced scorecard in an emergency department, the indicators used in this study may also be reasonable for a hospital that has limited resources.

Background. This work has been carried out keeping in view that although knowledge related to perimenopause is an important health issue for women worldwide, little information is known about mid-life Taiwanese women's knowledge of perimenopause. Objective. The aim of this paper was to explore the level of perimenopausal knowledge of mid-life women in northern Taiwan, to describe the relationship between demographic factors and women's knowledge, and to identify what information health providers need to offer them. Design. A cross-sectional descriptive survey was conducted. Method. The Perimenopausal Knowledge Questionnaire was used to collect data. The study was carried out in August 2000 to September 2001. A convenience sample was recruited from traditional Chinese medicine clinics, gynecology clinics and communities in northern Taipei. Results. Our findings indicated that the overall mean correct answer weighted Perimenopausal Knowledge score of these mid-life women was 46.31. The rank of weighted scores from highest to lowest was: (1) self-care during perimenopause, (2) the perception of perimenopause, (3) knowledge related to hormone replacement therapy and (4) body changes associated with the declined oestrogen in perimenopause. Only educational level was significantly associated with Perimenopause Knowledge level (P

Few studies were found that evaluated dissatisfaction with the National Health Insurance (NHI) by primary care physicians in Taiwan. Therefore, the purpose of this study was to identify factors related to dissatisfaction with the NHI among primary care physicians.A structured questionnaire was developed through a literature review, a panel discussion, and 5 focus group interviews. In total, 9336 primary care physicians were surveyed. A logistic regression analysis was employed to identify factors related to dissatisfaction with the NHI by primary care physicians.There were 1822 surveys returned, yielding a 19.5% response rate. They showed that 5.7% of respondents were very dissatisfied and 22.3% were dissatisfied with the current medical environment under the NHI. The dissatisfaction of primary care physicians was significantly related to age (OR = 1.029, p0.05) and dissatisfaction with the following aspects: malpractice claims (OR = 1.744, p0.001), complexity of medical claims (OR = 1.454, p0.01), excessive work hours (OR = 1.790, p0.001), decreased income (OR = 2.812, p0.001), difficulty in finding nurses (OR = 1.379, p0.05), and the separation of dispensing medicine from medical practice (OR = 1.389, p0.05).These results can provide valuable information to help policy makers identify areas for improvement and intervention in order to reduce levels of dissatisfaction of primary care physicians under the NHI.

Mild essential hypertensive patients comprise a large portion of the hypertensive population. Previous reports have shown that moderate-intensity regular exercise training in these patients usually reduces blood pressure. By designing programmed exercise to evaluate whether it is effective in reducing blood pressure in mild hypertensive patients and also has beneficial effects on other biochemical parameters. Twenty-three mild hypertensive Taiwanese patients (resting blood pressure 139.1 +/- 11.4/99.5 +/- 8.0 mmHg) were divided randomly into two groups: control (no exercise) and moderate-intensity exercise (average 6.4 +/- 0.7 METs). The training group exercised three times per week at the prescribed exercise intensity by using the Treadmill exercise test. Blood pressure, heart rate and other biochemical parameters were monitored regularly every 4 weeks for 12 weeks. After 12 weeks regular exercise training, the exercise group showed for significant resting blood pressure reduction. Mean maximal reduction of systolic pressure was 18 mmHg. Significant reduction of total cholesterol, low-density lipoprotein cholesterol (LDL-C) and triglyceride were found; elevation of high-density lipoprotein cholesterol (HDL-C) was also noted. These data suggest that after 12 weeks of exercise training in mild hypertensive patients, successful reduction of blood pressure and favorable changes of lipid profile will be noted.

BACKGROUND Cost analyses are needed to inform resource decisions. Oftentimes, however cost-benefit analysis (CBA), cost-effectiveness analysis (CEA), cost-minimization analysis (CMA), and cost-utility analysis (CUA) are performed using untested techniques and adhering to a variety of questionable principles. OBJECTIVES To analyze, compare, and present a set of useful principles for the main types and methods of cost analyses through a synthesis of current information in the published literature. METHODS The area of interest included all reports of cost research published as full articles in professional journals from January 1990 to August 1996 in the nursing, medical, and health services fields. In all, 88 sampled articles met the criteria for inclusion. A four-page data collection guide with 28 items grouped as demographics, cost-analysis types, methods, and principles was designed for the review. Incremental testing for interrater reliability using the kappa statistic for two raters was performed. Sampling, process-oriented, construct, and correlational validity were assessed. RESULTS The 88 articles included 4 from nursing, 59 from medical, and 25 from health services journals. Of these articles, 45 (51%) reported CBA, 36 (41%) CEA, 2 CMA, 4 CUA, and 1 both CBA and CEA. Three nursing studies were authored only by nurses. Three fourths of the medical and four fifths of the health services publications had interdisciplinary authorship. Existing databases were the primary source of data in 61 (69%) publications. Adherence to six main methodologic principles was apparent in 19 (22%) articles. None of the nursing studies adhered to all six principles, whereas 16% of the health services and 25% of the medical studies did. CONCLUSIONS Funded cost analyses of nursing interventions that adhere to the six known methodologic principles are needed to inform policy-level health care decisions. Because of the complexity of cost analysis methodology, including sensitivity analysis, future interdisciplinary efforts using existing databases may prove most effective. The six methodologic principles presented in this article can be useful for future nursing education and cost-analysis research designed to control cost and increase the quality of health care.