Development and validation of a caregiving needs inventory for family members before their older relative's knee joint-replacement surgery.

PURPOSE: This study had two purposes: to develop an instrument for assessing family members' caregiving needs before their older relative's knee joint-replacement surgery and to determine instrument psychometrics. METHODS: In phase 1 of this validation study, we generated 34 items based on previous interviews with 138 family caregivers of patients with knee osteoarthritis (OA), an intensive literature review, and the authors' clinical experiences. In phase 2, we examined the content and face validities of the 34-item Family Members' Caring Needs Inventory (inventory) to develop a 32-item inventory. In phase 3, 150 family members of outpatients with knee OA were recruited from three hospitals in northern Taiwan and surveyed with the inventory to determine its internal consistency reliability and test-retest reliability. RESULTS: The final 30-item inventory had excellent content and face validities. Its factor analysis yielded a five-factor solution, accounting for 82.9% of the variance. The inventory had Cronbach's α = 0.97 and intraclass correlation coefficient = 0.93, indicating very high internal consistency reliability and test-retest reliability. CONCLUSIONS: The inventory was perceived as easy to complete and yielded highly acceptable validity and reliability levels. After cross-cultural adaptation, this tool may be used to assess family members' caregiving needs before their relative's knee-replacement surgery.IMPLICATIONS FOR REHABILITATIONThe role of family members and spouses in supporting patients with osteoarthritis (OA) is crucial.After cross-cultural adaptation, the Family Members' Caring Needs Inventory may be used by health care providers to assess and provide relevant information to meet the needs of family members caring for an older relative with knee OA.This assessment and specific caregiving information for family members of older knee OA patients may promote patients' quality of life and decrease their OA-related burden.

Resuming Normal Life as a Family Caregiver During Drip-Like Recovery of Older Persons With Cognitive Impairment Recovering From Hip Surgery: A Grounded Theory.

PURPOSE: This study was undertaken to develop a theoretical framework explaining family caregiving processes for older persons with cognitive impairment recovering from hip fracture surgery. DESIGN AND METHODS: In this grounded theory study, data were collected in audio-recorded face-to-face interviews with 21 family caregivers. Among these caregivers, 14 cared for hip-fractured persons with cognitive impairment, and seven cared for those without cognitive impairment. Caregivers were interviewed five times after patients' discharge: at 1 week and at 1, 3, 6, and 12 months. Data were analyzed by constant comparative analysis. FINDINGS: The core category explaining the family caregiving process for hip-fractured persons with cognitive impairment was "resuming normal life during drip-like recovery." This category captures the slowness of the recovery process, as slow as dripping water. During the early postoperative period, caregivers attempted to gain control of the postoperative situation, using various maintenance and improvement strategies to deal with the chaos in individuals and the family and to protect hip-fractured persons with cognitive impairment from further harm. The goal of recovery was to get back to their original life. CONCLUSIONS: Family caregivers of hip-fractured older persons with cognitive impairment needed to deal with more complex chaotic situations, exerted more efforts to administer safety measures, and required more time to achieve a stable life pattern. CLINICAL RELEVANCE: Since postoperative recovery was perceived as extremely slow, family caregivers of hip-fractured older persons with cognitive impairment should be patient regarding recovery and be informed before hospital discharge of different strategies to resume normal life during postoperative recovery.

Courses of Change in Good Emotional Preparedness for Death and Accurate Prognostic Awareness and Their Associations With Psychological Distress and Quality of Life in Terminally Ill Cancer Patients' Last Year of Life.

CONTEXT: Emotional preparedness for death is a distinct but related concept to prognostic awareness (PA). Both allow patients to prepare psychologically and interpersonally for death, but they have primarily been examined in cross-sectional studies. OBJECTIVES: To 1) explore the courses of change in good emotional preparedness for death and accurate PA and 2) evaluate their associations with severe anxiety symptoms, severe depressive symptoms, and quality of life in cancer patients' last year. METHODS: For this prospective, longitudinal study, we consecutively recruited 277 terminally ill cancer patients. Aims 1 and 2 were examined by univariate and multivariate generalized estimating equation analyses, respectively. RESULTS: The prevalence of good emotional preparedness for death was 54.43%-65.85% in the last year, with a significant decrease only 91-180 vs. 181-365 days before death (odds ratio [95% CI] = 0.67 [0.47, 0.97]). Good emotional preparedness for death was associated with a lower likelihood of severe anxiety symptoms (adjusted odds ratio [95% CI] = 0.47 [0.27, 0.79]) and severe depressive symptoms (0.61 [0.39, 0.95]), but not with quality of life (ß [95% CI] = 0.49 [-2.13, 3.11]). However, accurate PA improved substantially (55.12%-70.73%) as death approached and accurate PA was positively associated with severe depressive symptoms (2.63 [1.63, 4.25]). CONCLUSION: Good emotional preparedness for death and accurate PA remained largely stable and improved substantially, respectively, in cancer patients' last year. Both measures were significantly associated with psychological distress. Health care professionals should not only cultivate accurate PA but also promote cancer patients' emotional preparedness for death, which may improve their psychological well-being.

The effect of oral training on vital signs of premature infants.

AIMS AND OBJECTIVES: This study aimed to develop an applicable oral training protocol and test its effects on vital sign stabilisation in premature infants. BACKGROUND: Oral training improves the feeding behaviour of premature infants. However, the inconsistencies of oral training procedures in previous studies obscure the interventional effect of oral training on vital sign stabilisation in premature infants. DESIGN: True experimental design. METHODS: Sixty premature infants with a gestational age <33 weeks were recruited and randomly assigned to the oral training or control group. RESULTS: Heart rate, respiratory rate and oxygen saturation tended to improve in the oral training group compared to those in the control group. However, the intergroup differences with respect to vital signs before and after feeding were not statistically significant. CONCLUSIONS: Further studies comparing protocols with different measurement points and durations are suggested.

Self-care management and risk factors for depressive symptoms among elderly outpatients in Taiwan.

BACKGROUND: Early detection and appropriate treatment interventions for depressive symptoms in the elderly are important issues for healthcare systems. However, few studies to date have focused on understanding self-care strategies to manage depressive symptoms among elderly people worldwide. The purpose of this study was to explore self-care management strategies and risk factors for depressive symptoms among elderly outpatients in Taiwan. METHODS: A convenience sample of elderly persons (≥65 years old; N = 1054) was recruited from outpatient clinics of two hospitals in northern Taiwan. RESULTS: In our sample, the prevalence of depressive tendency was 16.3%. The majority of participants (70.1%) managed depressive symptoms with self-care strategies. The strategy most often used to relieve depressive symptoms was "take a walk." The main information source for self-care strategies was self-learning. Depressive tendency in this sample was shown by logistic regression analysis to be significantly predicted by gender, marital status, perceived income adequacy, perceived health condition, stroke, and cancer. CONCLUSION: Elderly people need to be made more aware of strategies to self-manage depressive symptoms. Healthcare providers can decrease/prevent the first risk factor for depressive symptoms (poor perceived health status) by improving elders' perceived health and promoting their actual health. The second risk factor (poor perceived income adequacy) can be decreased/prevented by carefully assessing patients' financial situation during clinic visits and providing suitable referral for further assistance.

Effects of a home-based aerobic exercise programme in children with type 1 diabetes mellitus.

AIMS: To explore the effects of exercise programme on glycosylated haemoglobin and peak oxygen uptake in children and adolescents with type 1 diabetes mellitus. BACKGROUND: Regular exercise has been shown to be effective in blood glucose control, which includes improving glucose tolerance and insulin sensitivity, decreasing glycosylated haemoglobin levels and improving cardiorespiratory fitness. DESIGN: Quasi-experimental design with a twelve-week home-based aerobic exercise programme. METHOD: Twenty-eight participants completed the study: 12 in the home-based exercise group, 11 in the non-exercise control group and five in the self-directed exercise group. A mixed model was used to capture longitudinal change in glycosylated haemoglobin levels. RESULTS: The home-based aerobic exercise group showed no significant effect on glycemic control and peak oxygen uptake in this study across assessment times. However, a group difference in glycosylated haemoglobin levels at the nine-month follow-up was significant (general linear model: F = 4.06, p = 0.03). A Bonferroni test indicated that glycosylated haemoglobin levels in the home-based exercise group were higher than in the self-directed exercise group (p < 0.05) and higher in the control group than in the self-directed exercise group (p < 0.05) at the nine-month follow-up. Home-based aerobic exercise showed no significant effect on peak oxygen uptake in this study. CONCLUSIONS: A three-month home-based aerobic exercise programme has no significant effect on glycosylated haemoglobin and peak oxygen uptake levels in children with type 1 diabetes mellitus. RELEVANCE TO CLINICAL PRACTICE: Our exercise programme has designed that children can practice exercise at home and is a viable component of self-care intervention to improve patient's self-care skill and diabetes care control. However, how to encourage patients to adhere the exercise programme is a challenge for health care providers.

Pain prevalence, experiences, and self-care management strategies among the community-dwelling elderly in Taiwan.

The purpose of this study was to explore pain prevalence, experiences, and self-care management strategies among community-dwelling elderly in Taiwan. A convenience sample of elderly persons (n=1054) was recruited from outpatient clinics of two hospitals in northern Taiwan. Participants' pain prevalence was 50.0%, and the average number of pain sites was 3.9 (standard deviation [SD]=5.8). Knees were the most commonly described pain site, but the most painful site was the spinal cord area. The mean pain intensity was 3.1 (SD=1.8) and pain interference was 2.8 (SD=2.1). Most participants took prescribed medications to deal with pain; doctors were the main information source for this self-care strategy. Although participants reported using various self-care pain management strategies, most still reported moderate-to-severe worst pain. Moreover, our participants identified far fewer self-care strategies than U.S. elders with chronic pain. These findings suggest that community-dwelling elders in Taiwan know little about managing pain symptoms or ascribe a different meaning to pain than their U.S. counterparts. Because health care providers play an important role in helping the elderly to manage pain, the authors recommend training health care providers about Taiwanese elders' perceptions of pain, to perform regular pain assessments, and provide current knowledge about pain assessment and pain management strategies.

Food intake changes across the menstrual cycle in Taiwanese women.

BACKGROUND: Studies in Western countries have suggested that there are relationships among sex hormones, the neuropeptide leptin, women's food intake, and body weight changes across the menstrual cycle. However, data on this question are needed from other cultural groups. OBJECTIVES: To compare total food and macronutrient intake and serum estrogen, progesterone, and leptin levels in Taiwanese women of varying body size during three menstrual cycle phases. METHOD: A cross-sectional survey was conducted using a sample of 39 healthy Taiwanese women (aged 20-40 years) with regular menstrual cycles. Food journals covering 3 days, body weight, height, waist and hip circumferences, and serum samples for estrogen, progesterone, and leptin were collected at three time points during one menstrual cycle. Data were analyzed using the paired t test, mixed-model analysis, and Pearson's correlations. RESULTS: Regardless of body weight, women consumed more total calories (+160 kcal/day, p < .05) and more grams of protein (+6-8 g/day, p = .01) during the luteal phase and ovulation compared with the follicular phase. A higher percentage of energy was consumed as carbohydrates (CHOs) during the follicular phase (+5% of total energy intake, p < .01). No correlations were noted among serum sex hormone levels, serum leptin levels, food intake, and body weight. DISCUSSION: The findings support the hypothesis that Taiwanese women, as previously reported in women from mixed or Western cultural groups, experience menstrual-related variations in food intake. These changes, however, were not directly linked with serum sex hormone or leptin levels.