Comparisons for Effectiveness of Aromatherapy and Acupressure Massage on Quality of Life in Career Women: A Randomized Controlled Trial.

OBJECTIVES: This study was aimed to compare the effectiveness of aromatherapy and acupressure massage intervention strategies on the sleep quality and quality of life (QOL) in career women. DESIGN: The randomized controlled trial experimental design was used in the present study. One hundred and thirty-two career women (24-55 years) voluntarily participated in this study and they were randomly assigned to (1) placebo (distilled water), (2) lavender essential oil (Lavandula angustifolia), (3) blended essential oil (1:1:1 ratio of L. angustifolia, Salvia sclarea, and Origanum majorana), and (4) acupressure massage groups for a 4-week treatment. The Pittsburgh Sleep Quality Index and Short Form 36 Health Survey were used to evaluate the intervention effects at pre- and postintervention. RESULTS: After a 4-week treatment, all experimental groups (blended essential oil, lavender essential oil, and acupressure massage) showed significant improvements in sleep quality and QOL (p < 0.05). Significantly greater improvement in QOL was observed in the participants with blended essential oil treatment compared with those with lavender essential oil (p < 0.05), and a significantly greater improvement in sleep quality was observed in the acupressure massage and blended essential oil groups compared with the lavender essential oil group (p < 0.05). CONCLUSIONS: The blended essential oil exhibited greater dual benefits on improving both QOL and sleep quality compared with the interventions of lavender essential oil and acupressure massage in career women. These results suggest that aromatherapy and acupressure massage improve the sleep and QOL and may serve as the optimal means for career women to improve their sleep and QOL.

[The Learning Effectiveness of Nurses Participating in a Simulated Radiation Therapy Skin Care Workshop].

BACKGROUND: The skin reaction rate is 60-95% in cancer patients that receive radiation therapy. This therapy is likely to cause physical and mental discomfort and prolong treatment for patients. The current emphasis on lectures rather than practice to help nurses learn proper skin care practices likely imposes difficulties for nurses to handle various clinical situations. PURPOSE: To investigate the learning effectiveness of a simulated radiation therapy skin care workshop for nurses. METHODS: A total of 34 nurses at a hospital in one health system in northern Taiwan who had never used radiation therapy to provide care to patients were enrolled in this quasi-experimental study. A single group pretest, posttest and post-posttest (6 weeks after intervention) approach was used. At the simulated radiation therapy skin care workshop, we used teaching strategies including Ausubel's direct instruction teaching method and practice on simulated wounds on pig skins. Outcomes were evaluated using "the questionnaire of radiation therapy skin care" and "direct observation of procedural skills checklist". RESULTS: The results from the simulated radiation therapy skin care workshop were analyzed using GEE (generalized estimating equation). The post-posttest and posttest scores increased significantly; knowledge mean score 3.14 (< .001) vs 2.64 (< .001), attitude mean score 2.06 (p < .05) vs 2.24 (p < .001), and skill mean score 2.79 (p < .001) vs 1.68 (p < .001). CONCLUSIONS: The simulated radiation therapy skin care workshop demonstrated significant and positive effects on learning outcomes. Therefore, we recommend incorporating this workshop into clinical nursing education and training strategies in the future.

Maternity staff perspectives regarding resource demands of breastfeeding supportive practices in accordance with the Baby-Friendly Hospital Initiative accreditation: a Q methodology approach.

AIM: To explore the resource demands of implementing the Baby-Friendly Hospital Initiative among maternity staff. BACKGROUND: Implementing the Baby-Friendly Hospital Initiative is the most recognized global strategy for ensuring that hospital routines support breastfeeding. The maternity services of Baby-Friendly Hospital Initiative accredited hospitals are evaluated according to the Ten Steps to Successful Breastfeeding. DESIGN: Q methodology was applied to investigate the perspectives of 60 maternity staff in Northern Taiwan. METHODS: Data were collected from May - December 2014. An online Q-sort platform was designed for the participants to perform sorting. The Q-sorts were subjected to factor analysis by using PQ Method software. Factors were extracted using principal component analysis with a varimax rotation. A combination of eigenvalues and a scree plot were employed to determine the number of retained factors. RESULTS: Four factors retained in the final model accounted for 56% of the total variance: (1) emphasis on implementing an institutional policy; (2) emphasis on providing supportive practices for breastfeeding mothers; (3) emphasis on establishing continual breastfeeding support; and (4) emphasis on managing breastfeeding supportive practices concerning a designated time period. The participants that were associated with Factors 1 and 3 emphasized the necessity of allocating resources to Steps 1, 2 and 10 of the Ten Steps. The participants associated with Factors 2 and 4 emphasized allocating resources to Steps 2-5 and 7. CONCLUSIONS: This study revealed the various perspectives of maternity staff regarding the resource demands of implementing the Baby-Friendly Hospital Initiative. These perspectives may serve as a reference for decision-makers in prioritizing resource allocation.

The development and validation of the Clinical Teaching Behavior Inventory (CTBI-23): Nurse preceptors' and new graduate nurses' perceptions of precepting.

BACKGROUND: Few studies have examined the perceptions of clinical teaching behaviors among both nurse preceptors and preceptees. PURPOSES: To develop a Clinical Teaching Behavior Inventory (CTBI) for nurse preceptors' self-evaluation, and for new graduate nurse preceptee evaluation of preceptor clinical teaching behaviors and to test the validity and reliability of the CTBI. METHODS: This study used mixed research techniques in five phases. Phase I: based on a literature review, the researchers developed an instrument to measure clinical teaching behaviors. Phase II: 17 focus group interviews were conducted with 63 preceptors and 24 new graduate nurses from five hospitals across Taiwan. Clinical teaching behavior themes were extracted from the focus group data and integrated into the domains and items of the CTBI. Phase III: two rounds of an expert Delphi study were conducted to determine the content validity of the instrument. Phase IV: a total of 290 nurse preceptors and 260 new graduate nurses were recruited voluntarily in the same five hospitals in Taiwan. Of these, 521 completed questionnaires to test the construct validity of CTBI by using confirmatory factory analysis. Phase V: the internal consistency and reliability of the instrument were tested. RESULTS: CTBI consists of 23 items in six domains: (1) 'Committing to Teaching'; (2) 'Building a Learning Atmosphere'; (3) 'Using Appropriate Teaching Strategies'; (4) 'Guiding Inter-professional Communication'; (5) 'Providing Feedback and Evaluation'; and (6) 'Showing Concern and Support'. The confirmatory factor analysis yielded a good fit and reliable scores for the CTBI-23 model. CONCLUSIONS: The CTBI-23 is a valid and reliable instrument for identifying the clinical teaching behaviors of a preceptor as perceived by preceptors and new graduate preceptees. The CTBI-23 depicts clinical teaching behaviors of nurse preceptors in Taiwan.

Effects of an 8-Week Outdoor Brisk Walking Program on Fatigue in Hi-Tech Industry Employees: A Randomized Control Trial.

Over 73% of hi-tech industry employees in Taiwan lack regular exercise. They are exposed to a highly variable and stressful work environment for extended periods of time, and may subsequently experience depression, detrimental to workers' physiological and mental health. In this cross-sectional survey, the authors explored the effect of an 8-week brisk walking program on the fatigue of employees in the hi-tech industry. The participants, from a hi-tech company in northern Taiwan, were randomly assigned to an experimental group (EG; 41 subjects, Mage = 33.34 ± 6.40) or control group (CG; 45 subjects, Mage = 29.40 ± 3.60). Following the 8-week brisk walking program, the EG showed significantly lower scores for subjective fatigue, working motivation, attention, and overall fatigue. The authors confirmed that the 8-week outdoor brisk walking program significantly improved the level of fatigue among employees of the hi-tech industry. The finding serves as an important reference for health authorities in Taiwan and provides awareness of workplace health promotion in the hi-tech industry.

Effects of a 12-week Pilates course on lower limb muscle strength and trunk flexibility in women living in the community.

Researchers in Taiwan studying regular adult physical activity found that among married women aged 26 to 55 years, 56% participated in physical activity, and that the convenience and safety of the activity were major factors contributing to their willingness to exercise. Muscle weakness and poor trunk flexibility are closely related to some chronic diseases in women. In this cross-sectional survey, we used the Polestar Pilates™ method to explore the effects of a 12-week Pilates course on the physical fitness of women living in the community. Fifty-three members of the experimental group (mean age: 42.30 ± 9.97) and 43 of the control group (mean age: 41.23 ± 9.83) were included. We confirm that a convenient Pilates exercise intervention can significantly improve muscle strength and trunk flexibility in women. Our findings serve as an important reference for health authorities in Taiwan and provide higher awareness of women's health and physical fitness, which can help prevent chronic and cardiovascular diseases.

[The effects of multimedia-assisted instruction on the skin care learning of nurse aides in long-term care facilities].

BACKGROUND: Skin care is an important responsibility of nurse aides in long-term care facilities, and the nursing knowledge, attitudes, and skills of these aides significantly affects quality of care. However, the work schedule of nurse aides often limits their ability to obtain further education and training. Therefore, developing appropriate and effective training programs for nurse aides is critical to maintaining and improving quality of care in long-term care facilities. PURPOSE: This study investigates the effects of multimedia assisted instruction on the skin care learning of nurse aides working in long-term care facilities. METHODS: A quasi-experimental design and convenient sampling were adopted in this study. Participants included 96 nurse aides recruited from 5 long-term care facilities in Taoyuan County, Taiwan. The experimental group received 3 weeks of multimedia assisted instruction. The control group did not receive this instruction. The Skin Care Questionnaire for Nurse Aides in Long-term Care Facilities and the Skin Care Behavior Checklist were used for assessment before and after the intervention. RESULTS: (1) Posttest scores for skin care knowledge, attitudes, behavior, and the skin care checklist were significantly higher than pretest scores for the intervention group. There was no significant difference between pretest and posttest scores for the control group. (2) A covariance analysis of pretest scores for the two groups showed that the experimental group earned significantly higher average scores than their control group peers for skin care knowledge, attitudes, behavior, and the skin care checklist. CONCLUSIONS: The multimedia assisted instruction demonstrated significant and positive effects on the skin care leaning of nurse aides in long-term care facilities. This finding supports the use of multimedia assisted instruction in the education and training of nurse aides in long-term care facilities in the future.

[Self-directed learning in nursing students with different background factors].

BACKGROUND: Fostering self-directed learning skills in nursing students may provide a foundation for improving the specialty knowledge of these nurses. PURPOSE: This study examines the current status of nursing student self-directed learning behavior and explores how different background factors impact self-directed learning. METHODS: This research design used a cross-sectional survey and convenience sampling. A total of 550 questionnaires were distributed to participants in enrolled in nursing programs at a 2-year nursing program at an institute of technology in northern Taiwan and a 4-year nursing program at an institute of technology in southern Taiwan. A convenience sampling was used to collect data, with 537 valid questionnaires used in data analysis. RESULTS: Results indicated that the self-directed learning and self-management of nursing students between 20-21 years old was significantly higher than those of students between 18-19 years old. Self-directed learning, desire of learning and self-control in 2-year nursing students were significantly higher than in 4-year and extension education department nursing student participants. Two-year nursing students had the highest self-management scores, followed by extension education department participants and 4-year nursing students. Finally, participants who associated highly with the nursing profession earned the highest self-directed total score, followed by those participants who associated generally and those who associated mildly. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The results recommend that teachers at nursing institutes help students develop self-directed learning. Results also recommend teachers increase their students' association with the nursing specialty through understanding the impact of different background factors on self-directed learning.

[Cancer nursing care education programs: the effectiveness of different teaching methods].

BACKGROUND: In-service education affects the quality of cancer care directly. Using classroom teaching to deliver in-service education is often ineffective due to participants' large workload and shift requirements. PURPOSE: This study evaluated the learning effectiveness of different teaching methods in the dimensions of knowledge, attitude, and learning satisfaction. METHODS: This study used a quasi-experimental study design. Participants were cancer ward nurses working at one medical center in northern Taiwan. Participants were divided into an experimental group and control group. The experimental group took an e-learning course and the control group took a standard classroom course using the same basic course material. Researchers evaluated the learning efficacy of each group using a questionnaire based on the quality of cancer nursing care learning effectiveness scale. All participants answered the questionnaire once before and once after completing the course. RESULTS: (1) Post-test "knowledge" scores for both groups were significantly higher than pre-test scores for both groups. Post-test "attitude" scores were significantly higher for the control group, while the experimental group reported no significant change. (2) after a covariance analysis of the pre-test scores for both groups, the post-test score for the experimental group was significantly lower than the control group in the knowledge dimension. Post-test scores did not differ significantly from pre-test scores for either group in the attitude dimension. (3) Post-test satisfaction scores between the two groups did not differ significantly with regard to teaching methods. The e-learning method, however, was demonstrated as more flexible than the classroom teaching method. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Study results demonstrate the importance of employing a variety of teaching methods to instruct clinical nursing staff. We suggest that both classroom teaching and e-learning instruction methods be used to enhance the quality of cancer nursing care education programs. We also encourage that interactivity between student and instructor be incorporated into e-learning course designs to enhance effectiveness.

Effects of an exercise program on blood biochemical values and exercise stage of chronic kidney disease patients.

BACKGROUND: Chronic kidney disease (CKD) patients face a relatively high risk of cardiovascular disease morbidity and mortality. A healthy lifestyle facilitated by participation in a regular exercise regimen may prevent or retard conditions commonly associated with CKD, including hypertension, hyperlipidemia, and diabetes. PURPOSE: This study examined the effect of a tailored exercise program on blood biochemical values and other exercise-related variables in CKD patients. METHODS: A total of 94 subjects diagnosed with CKD by a nephrology outpatient clinic at a medical center in northern Taiwan participated in this quasi-experimental study. Subjects were randomly divided into an experimental group (n = 45) or a control group (n = 49). Experimental group subjects agreed to join a 3-month exercise program. Individual guidance was given remotely to the experimental group over the telephone during the second and the third months following initiation of the exercise intervention. Both groups completed the pretest and posttest forms of the Stages of Exercise Questionnaire, and blood biochemical data were obtained from patient medical files. Data were analyzed using analysis of covariance. RESULTS: The preexercise cholesterol values (from 198.03 +/- 43.52 to 160.97 +/- 37.39 mg/dl) of the experimental group differed significantly from their postexercise values. Also, the number of subjects in the experimental group who reported exercising regularly rose from 57.8% pretest to 75.6% posttest. However, changes in red blood cell count, hemoglobin, hematocrit, and blood sugar were all insignificant in the experimental group. No significant change in any of these items was detected in the control group. The cholesterol value of the experimental group (158.75 mg/dl) was significantly lower than that of the control group (177.29 mg/dl) after applying analysis of covariance, using the pretest results of both groups as the covariate. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The developed exercise program was found to reduce cholesterol levels in CKD patients effectively, to encourage more patients to do exercise regularly, and to offer clinical nursing staff an approach to encourage and teach CKD patients to exercise.

The job self-efficacy and job involvement of clinical nursing teachers.

This paper explored the present status of self-efficacy and job involvement of clinical nursing teachers and investigated the predictive power of teachers' personal background variables on such, as well as the relationship between self-efficacy and job involvement. A total of 419 participants in the survey sample were chosen among clinical nursing teachers at 19 public and private institutes of technology and junior colleges in Taiwan in 2004. The self-developed structural questionnaire was categorized into three sections, including personal background data, job self-efficacy related to the clinical teaching inventory and job involvement related to clinical teaching inventory. Of the total 419 questionnaires distributed for this cross-sectional survey, 266 valid copies were registered, at a recovery rate of 63%. Findings indicated that both the job self-efficacy and job involvement of clinical nursing teachers are at a medium to high level and that significant differences exist in job self-efficacy and job involvement based on differences in age, marital status, teaching seniority, teacher qualifications, and job satisfaction. Second, samples have significantly different performance in self-efficacy due to differences in education level attained and the medical institution to which nursing teachers had been assigned. Self-efficacy and job involvement are significantly positively correlated. These results can serve as a reference for the cultivation of nursing teachers and reform of clinical nursing education in the future.

Physical activities and correlates of clinical nurses in Taipei municipal hospitals.

The purpose of this study was to investigate the physical activity profiles of clinical nurses in Taipei municipal hospitals. This study also explored the factors that influence physical activity, including personal background and social psychological factors. A total of 400 Taipei municipal hospital clinical nurses were selected using a randomized procedure to participate in a 3-day physical activity record assignment and fill in a structured questionnaire. Study results indicate that energy expenditure for clinical nurses on working days are higher than that on non-working days. Non-working days of clinical nurses are characterized by a lack of physical activity. Nurses who were required to take turns working in three shift rotation cycles, those with education at the junior college level or below, and those who were married tended to spend more energy on physical activity. Social psychological factors affecting the physical activities of clinical nurses include mainly exercise self-efficacy. Heavy work loading, poor health conditions, laziness, and lack of time tended to lower exercise self-efficacy. On non-working days, perceived barriers to exercise are the main issue area affecting moderate-to-vigorous physical activity. Nurses with greater perceived barriers to exercise spend less energy on physical activity. The main influencing factors for perceived barriers to exercise include laziness and lack of time.

Impact of a transtheoretical model on the psychosocial factors affecting exercise among workers.

The purpose of this study was to investigate the effects of exercise intervention on improvement of perceived exercise benefit, perceived exercise barrier, and exercise self-efficacy. A quasi- experimental design was utilized and purposive sampling was conducted at a telecom worksite in southern Taiwan. One hundred and ninety-three subjects were assigned to an experimental and a control group. The experimental group, which consisted of 133 subjects, participated in a program of exercise intervention. The intervention program applied a transtheoretical model to aid subjects in developing effective approaches within different stages of the exercise change. It included written materials and teaching activities for the different stages of exercise. The control group, which consisted of 60 subjects, had no treatment. All subjects completed a structured questionnaire, including perceived exercise benefits, perceived exercise barriers, exercise self-efficacy, and stages of exercise, pre-test and post-test. Statistical analyses included Chi-square test, paired t-test, analysis of covariance, one-way ANOVA, and Scheffe's post hoc comparison. After the exercise intervention, the results post-test of the experimental group showed that (1) perceived exercise benefit, perceived exercise barriers, and exercise self-efficacy improved significantly, and (2) perceived exercise benefit and exercise self-efficacy were significantly higher than those of the control group post-test while perceived exercise barriers were significantly lower than those of the control group post-test.