Core Competence in Fundamental Nursing Practicum Scale: A validity and reliability analysis.

AIM: This study aimed to develop and examine the psychometric properties of validity and reliability of the Core Competence in Fundamental Nursing Practicum Scale. BACKGROUND: Fundamental nursing practicum is an initial practicum required for nursing students; however, no measurement tool is available to assess students' core competence during their first practicum. DESIGN: Cross-sectional design. METHODS: Nursing students from six nursing colleges in Southern Taiwan who completed their fundamental nursing practicum within 1 month were recruited. The initial 39-item Core Competence in Fundamental Nursing Practicum Scale was drafted and examined for its content, face and factorial validity. The data were randomly assigned into two subgroups and analyzed using exploratory and confirmatory factor analyses. Exploratory factor analysis was performed using principal-axis factoring and direct oblimin rotation and numbers of factors were extracted on the basis of eigenvalues > 1 and a scree plot. The exploratory factor analysis derived structure was then verified by a confirmatory factor analysis using maximum likelihood estimation. Reliability was examined in term of internal consistency. RESULTS: The exploratory factor analysis and confirmatory factor analysis samples comprised 405 and 513 students, respectively. Four items were omitted by content validity and another four items were omitted because of the ceiling effect. Six items were removed during the exploratory factor analysis because of their lower factor loadings (< 0.4). The final 25-item Core Competence in Fundamental Nursing Practicum Scale comprised 5 domains, namely communication (3 items), application of nursing process (6 items), basic biomedical science (4 items), nursing skills and ability to perform a care process (7 items), and professional attitude (5 items), which collectively explained 70.14% of total variance. The structure was then verified by a confirmatory factor analysis with satisfactory model fit. The Cronbach's alpha of the Core Competence in Fundamental Nursing Practicum Scale was 0.94. CONCLUSIONS: The 25-item Core Competence in Fundamental Nursing Practicum Scale reliably and validly measures nursing students' core competence during their fundamental nursing practicum. Instructors can use the scale to identify students' weak core competencies and refine their courses for novice nurses.

Efficacy of a Smartphone Application to Promote Maternal Influenza Vaccination: A Randomized Controlled Trial.

The maternal vaccine coverage rate has been low in Taiwan. We developed an "Influenza Vaccination Reminder Application" and evaluated its efficacy in improving vaccination intention among pregnant women in Taiwan. A randomized controlled trial was conducted to compare the positive change in vaccination intention between the experimental group and the control group. Pregnant women who were more than 20 years old and at less than 32 weeks of gestation were recruited from four regional hospitals in southern Taiwan during November 2020 to April 2021. Pregnant women were randomly assigned to the experimental group, to whom the "Influenza Vaccination Reminder Application" was provided for at least two months, while pregnant women in the control group received regular maternal education only. The differences in knowledge about influenza and its vaccines, attitudes towards maternal influenza vaccination, and behavior intention of influenza vaccination among pregnant women before and after the experiment intervention were compared between two groups. The results included 126 women in the experimental group and 117 women in the control group and showed that the "Influenza Vaccination Reminder Application" increased pregnant women's knowledge about influenza and vaccines (percentage increase in the experimental group and control group: 11.64% vs. 7.39%), strengthened their positive attitudes towards maternal influenza vaccination (percentage increase: 5.39% vs. 1.44%), and promoted positive behavioral intention toward influenza vaccination (proportion of participants with positive change in vaccination intention: 17.46% vs. 7.69%). The study supports use of "Influenza Vaccination Reminder Application" to promote the behavior intention of influenza vaccination among pregnant women in Taiwan.

Willingness to receive influenza vaccination during pregnancy and associated factors among pregnant women in Taiwan.

OBJECTIVE: This study was aimed to assess the willingness to receive prenatal influenza vaccine and explore its associated factors among pregnant women in Taiwan. DESIGN AND SAMPLE: The study population included pregnant women who received prenatal care from five private hospitals/clinics during 2017-2018 influenza season. MEASUREMENTS: Collected data, including demographics, health-relevant factors, as well as knowledge and attitudes regarding influenza and its vaccine, were analyzed using chi-square tests, Fisher's exact test, and multivariate logistic regression analysis. RESULTS: A total of 498 pregnant women completed the questionnaires, 321 (64.5%) intended to receive prenatal influenza vaccine. Among those who were unwilling to be vaccinated, most (88%) had concerns about the adverse events of the vaccine. Four factors were independently associated with willingness, including hospital/clinic (aOR=6.57, 95% CI=1.96-22.04), previous influenza vaccination history (aOR=9.44, 95% CI=5.63-15.83), knowledge (aOR=2.64, 95% CI=1.25-5.55) about, and attitude (aOR=5.99, 95% CI=2.40-14.92) toward influenza vaccination. CONCLUSIONS: Pregnant women with insufficient knowledge, negative attitudes, or no experience of influenza vaccination, and in remote areas were less willing to receive maternal influenza vaccine. The adverse events and uncertainty regarding the safety of vaccines were the most important factors. The health-care providers should promote or explain risks and benefits of maternal influenza vaccination during prenatal care or outpatient consultation.

[The Perioperative Management of Pain in Patients Who Are Addicted to Heroin].

Heroin addicts admitted to the hospital for surgery should be treated as high-risk patients because these patients face a significantly higher risk of experiencing severe drug withdrawal symptoms and of pain management complications during hospitalization. The lack of proper pain management often suffered by heroin addicts during hospitalization has been attributed to care providers' insufficient knowledge regarding opioid medications and their addicting effects as well as fears that opioid medications may cause addiction symptoms to reemerge. The objective of this article is to illustrate the pain management process across the entire hospitalization period for heroin-addicted patients undergoing surgical procedures. This process includes management of the heroin-related physical and psychological reactions from surgery, of the mechanism of pain induced specifically from surgery, and of the heroin addiction during the surgical procedure and subsequent clinical management and nursing care. It is hoped that this article assists healthcare providers to better understand the need for the proper pain management and care of heroin-addicted surgical patients over the entire period of hospitalization and thus the enhancement of the overall quality and safety of patient care management procedures.

Depression in older residents with stroke living in long-term care facilities.

BACKGROUND: Stroke is the third leading cause of death in Taiwan. Poststroke older adults are often admitted to long-term care facilities. The impacts of the two concurrent life events of stroke and relocation may increase the risk of depression in stroke survivors. Depression in elderly stroke survivor residents of long-term care facilities has not been studied. PURPOSE: This study explores the factors associated with depression in older residents with stroke living in long-term care facilities. METHODS: A cross-sectional design was used. Twenty-three institutions in southern Taiwan participated in this study, including seven nursing homes, 11 intermediate-care facilities, and five domiciliary-care facilities. Purposive sampling enrolled 111 participants who met the following inclusion criteria: 65 years or older, experienced a stroke that did not cause cognitive defects, and capable of verbal communication. Data were collected using a sociodemographic data questionnaire, Barthel's Index, and the Taiwan Geriatric Depression Scale. RESULTS: Depression was experienced by 41 of the 111 participants (36.9%). Prevalence of depression was 45.7% in nursing homes, 36.2% in intermediate-care facilities, and 22.2% in domiciliary-care facilities. Participants living in nursing homes and intermediate-care facilities and illiterate participants with low Barthel's Index scores showed more depressive symptoms. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Healthcare providers should conduct depression screening for elderly residents with stroke on admission to long-term care facilities. Regular assessment and monitoring of depressive symptoms, especially in residents with less formal education and limited physical functions, are important in nursing homes and intermediate-care facilities.

[A project to reduce the incidence of facial pressure ulcers caused by prolonged surgery with prone positioning].

BACKGROUND & PROBLEMS: We observed in our institute a 13.6% incidence of prolonged surgery (>4 hours) induced facial pressure ulcers that required prone positioning. Causes identified included: (1) customized silicon face pillows used were not suited for every patient; (2) our institute lacked a standard operating procedure for prone positioning; (3) our institute lacked a postoperative evaluation and audit procedure for facial pressure ulcers. PURPOSE: We designed a strategy to reduce post-prolonged surgery facial pressure ulcer incidence requiring prone positioning by 50% (i.e., from 13.6% to 6.8%). RESOLUTIONS: We implemented the following: (1) Created a new water pillow to relieve facial pressure; (2) Implemented continuing education pressure ulcer prevention and evaluation; (3) Established protocols on standard care for prone-position patients and proper facial pressure ulcer identification; (4) Established a face pressure ulcers accident reporting mechanism; and (5) Established an audit mechanism facial pressure ulcer cases. RESULTS: After implementing the resolution measures, 116 patients underwent prolonged surgery in a prone position (mean operating time: 298 mins). None suffered from facial pressure ulcers. The measures effectively reduced the incidence of facial pressure ulcers from 13.6% to 0.0%. CONCLUSIONS: The project used a water pillow to relieve facial pressure and educated staff to recognize and evaluate pressure ulcers. These measures were demonstrated effective in reducing the incidence of facial pressure ulcers caused by prolonged prone positioning.

Factors associated with depressive symptoms among older adults living alone: an analysis of sex difference.

OBJECTIVES: The aim of this study was to explore the prevalence of depressive symptoms and the risk factors that correlated with depressive symptoms among elders living alone. METHODS: A cross-sectional design was implemented. The sample consisted of 117 women and 75 men aged 65 and older who living alone in Tainan, Taiwan. The Chinese version of Center for Epidemiological Studies Depressive Symptoms Scale was adopted to assess depressive symptoms. Logistic regression analyses were employed to determine the risk factors of depressive symptoms in the elderly women and men living alone. RESULTS: Results of this study showed that the elderly women had a 1.6-fold greater prevalence of depressive symptoms than did men. Women who were aged 85 and above, and less social support, had a significantly higher occurrence rate of depressive symptoms. The risk factors for depressive symptoms in elderly men living alone included educational level, religious beliefs, self-rated health status, number of chronic illnesses, and social support. CONCLUSIONS: Healthcare providers should reflect the sex difference on risk factors of depressive symptoms when planning mental health services for the elderly population.

Effects of altitude in high-rise building on the autonomic nervous modulation in healthy subjects.

This study intended to study the effects of altitude in the high-rise building on the automatic nervous modulation in healthy subjects. Heart rate variability (HRV) analysis was performed to assess the automatic nervous modulation of the subjects at three different altitudes in the air-conditioned high-rise building, i.e., the first basement (4 m beneath sea level), the 31st floor (133 m above sea level), and the 46 th floor (200 m above sea level). We found that the heart rate was significantly decreased, whereas the standard deviation of RR intervals (SD(RR)), total power and high frequency power were significantly increased when the subject was elevated to a higher altitude. The normalized low frequency power and low-/high-frequency power ratio on the 31st and 46 th floors were significantly different between genders; however, no such difference was found on the first basement. The age correlated significantly and positively with the percentage change in the SD(RR) and coefficient of variation of RR intervals when the subjects were elevated from the first basement to the 46 th floor. In conclusion, higher altitude in an air-conditioned high-rise building can lead to an increase in HRV/vagal modulation. The stay at a higher altitude in a high-rise building may lead to increased overall HRV and vagal modulation of a subject, especially for the elder people and the people who had a small HRV at ground level.

Quality of life in elders living alone in Taiwan.

AIMS AND OBJECTIVES: The aim of this study was to identify and describe predictors of QOL of elders who live alone in Taiwan. BACKGROUND: Despite a growing population of elders who live alone, research on their quality of life, important for policy decisions and health care provider interventions is virtually absent. METHODS: A descriptive correlational design surveyed 192 Taiwanese elders living alone, selected at random from urban and rural areas. During home visits elders completed the WHO-QOL-BREF, Social Support Scale and Center for Epidemiological Studies Depression Scale (CES-D) in addition to providing demographic data. RESULTS: Multiple linear regressions showed that six variables predicted physical health and the psychological wellbeing QOL domains, accounting for 74.5 and 60.1% of the variance, respectively. Four variables predicted 46.7 and 34.3% of the environmental and the social relationship QOL domains, respectively. CONCLUSIONS: Elders who live alone in rural areas and suffer from depression are at high risk for a low quality of life. However, elders living alone reported a better quality of life than their institutionalized counterparts. Interventional research and policy decisions focused on treatment for depression and providing social support networks, as these elders age, will be particularly important. RELEVANCE TO CLINICAL PRACTICE: By understanding variables associated with elders' quality of life, nurses can coordinate interventions to improve their quality of life. Poorly educated rural women who live alone are particularly vulnerable. Nursing assessment of quality of life indicators and implementation of strategies for increased social support are needed for high-risk elders.

Depressive symptoms among older residents at nursing homes in Taiwan.

AIMS AND OBJECTIVES: To examine the depressive symptoms of older residents at nursing homes and the relationship between their depressive symptoms and certain selected variables. BACKGROUND: Depression has become a major healthcare concern among the older people, but nursing home-based studies on risk factors of depression have still hardly been well performed in Taiwan. DESIGN: A cross-sectional design was developed and implemented. METHODS: A research sample of 138 older residents was recruited from eight nursing homes located in southern Taiwan. During face-to-face interviews, the Center for Epidemiological Studies Depression Scale, Social Support Scale, Chronic Condition Checklist and Socio-demographic Inventory were used for data collection. RESULTS: The results showed that 81.8% of those residents were identified as being depressed. It was further discovered that the length of residency, number of chronic conditions, perceived health status and the amount of social support from their family and relatives could explain 38.8% of the total variances in depressive symptoms. CONCLUSIONS: Our study suggests that, in Taiwan, older people who live in nursing homes suffer from more depressive symptoms than those in community dwellings. To maintain and improve the health status for the elderly as much as possible, it is suggested that healthcare providers at nursing homes should develop an effective health promotion program for these older peoples. RELEVANCE TO CLINICAL PRACTICE: There exists a high rate of depressive symptoms among older residents at nursing homes. It is imperative that a proper identification and its correspondent treatment for this health problem on the older residents are required. In late life, to maintain a higher level of quality of life, it is important to suggest that the health providers should regularly screen older people to increase the likelihood of diagnosis and improved treatment of late-life depressive symptoms.

Developing an instrument to measure quality of life of patients with hyperhidrosis.

Quality of life (QOL) is an index of the state of wellness of an individual. The purpose of this study was to develop an instrument to measure quality of life of patients with hyperhidrosis. With a multi- dimensional model of QOL as the conceptual framework for instrument development, the study started from literature review which was followed by interviews with patients, staff nurses, and doctors to generate the original items for the instrument. The validity and reliability then were assessed. Six experts performed content validity (CVI =.70). Internal consistency and construct validity assessment followed. A quantitative research method was used in this study. During March 2002 to April 2003, 85 patients from the surgical outpatient clinic at a teaching hospital in southern Taiwan were purposively recruifed as subjects. Written consent was obtained before subjects answered a questionnaire that should take 8-10 minutes to finish. Data analysis was performed using SPSS for Windows 8.0. Mean, standard deviation, frequency, percentage, Cronbach ' s alpha, Pearson ' s correlation, and factor analysis were used to analyze the data. Exploratory factor analysis identified five factors. They were functional, social interaction, personal affective, psychological and physical function. The coefficients of Cronbach ' s alpha for these five factors ranged from 0.71 to 0.94. These five factors explained 68.90 % of the variance in QOL among the patients with hyperhidrosis. The results showed that the instrument had satisfactory validity and reliability. Implications of these results for future studies were discussed.