[Work Environment-Mediated Job Burnout and Intention-to-Stay in Registered Nurses].

BACKGROUND: Nurse engagement and retention are critical issues affecting the quality of healthcare. Although the work environment is known to affect nursing performance and patient outcomes, little is known regarding the impact of this environment on nurse burnout and future work intention, especially in non-Western settings. PURPOSE: This study explored the extent to which Taiwanese nurses' perceptions of their practice environment mediates burnout levels and intention-to-stay. METHODS: This descriptive, correlational study, conducted between September and December 2020, recruited nurses employed at a regional teaching hospital located in a relatively rural region in Taiwan. The participants completed standardized questionnaires, including a demographic information form, the 31-item Practice Environment Scale of the Nursing Work Index (PES-NWI), the 22-item Maslach Burnout Inventory (MBI-HSS), and the 6-item Intention-to-stay (ITS) scale. The mediating effect among the variables related to intention-to-stay was examined using Model 4 of the PROCESS macro and tested using the bootstrapping method (repeated 5,000 times) with a p value < .05. RESULTS: The mean age of the 376 participants was 34.3 years (SD = 8.1). Nearly one-third (30.3%) scored > 27 on the emotional exhaustion subscale of the MBI-HSS, indicating they were "highly burned-out". Also, nearly one-third (30.6%) were uncertain about their intention to stay with their current employer. Burnout was associated with intention-to-stay (ß = -.088, p < .001), and holding a positive perception toward their practice environment was shown to mediate the relationship between burnout and intention-to-stay (ß = -.015; p < .001). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Targeted interventions and technical support that promote a collaborative climate and psychological empowerment in clinical practice may alleviate burnout and intention-to-leave in nurses and improve workplace quality.

Development and validation of a Dignity in Care Scale for Nurses.

BACKGROUND: Maintaining patient dignity is an important aspect of nursing care. No instrument is currently available to measure nurses' behaviours for maintaining patient dignity in clinical care. OBJECTIVES: To develop and test an instrument to measure activities nurses perform to maintain patient dignity in clinical care settings, guided by the literature and face-to-face interviews. RESEARCH DESIGN: A quantitative cross-sectional descriptive survey collected data from the developed scale, which was analysed by descriptive statistics and factor analysis. PARTICIPANTS AND RESEARCH CONTEXT: Convenience samples of nurses participated in the interviews (n = 40) and examined face validity of the scale (n = 20). A purposive sample of 610 nurses was recruited from four regional hospitals in the northern, southern and eastern areas of Taiwan to test the developed scale. ETHICAL CONSIDERATIONS: Research was approved by the Institutional Review Board of the study hospital. Information about the study was provided to nurses and those willing to participate provided written informed consent prior to data collection. FINDINGS: The 36-item Dignity in Care Scale for Nurses had acceptable content and face validity. Factor analysis identified six factors necessary for maintaining dignity of patient care: communication skills, confidentiality of patient information, prompt response to patient needs, respect for patient's autonomy, providing a safe environment and protecting the patient's well-being. The reliability coefficient for the total scale was 0.93; alpha coefficients for the subscales ranged from 0.70 to 0.94. DISCUSSION: The Dignity in Care Scale for Nurses was demonstrated to be a reliable and valid tool for assessing how nurses maintain dignity in care for patients in the clinical setting. The questionnaire can be used to provide feedback to nurses regarding patient dignity. CONCLUSION: Data gained from this instrument could be used to design nursing education programmes to help nurses enhance their abilities for maintaining patient dignity in clinical practice.

Primary family caregivers' observations and perceptions of their older relatives' knee osteoarthritis pain and pain management: a qualitative study.

AIM: To explore primary family caregivers' observations and perceptions of their older relatives' knee osteoarthritis pain and pain management. BACKGROUND: Osteoarthritis is one of the most common joint disorders in older people. Studies have mainly focused on spouses' or partners' perceptions of older individuals' osteoarthritis pain. DESIGN: Qualitative description. METHODS: Primary family caregivers of older outpatients with osteoarthritis (N = 28) were recruited by convenience from one medical centre in northern Taiwan and two regional hospitals in northern and eastern Taiwan in 2012. Data were collected in individual interviews using a semi-structured guide and analysed by content analysis. RESULTS: Primary family caregivers observed that their older relatives commonly mentioned that osteoarthritis pain interfered with their walking ability, daily activities, moods, sleep and social activities. Older adults commonly shared their pain with their family members. Participants observed that their older relatives with osteoarthritis used limited pain-management strategies to relieve pain, but participants provided few pain-management strategies to help their relatives. Most participants had limited knowledge about osteoarthritis pain. Some participants and their older relatives held negative attitudes towards using pain medicines. Most participants suggested that other families should bring their older relatives with osteoarthritis pain to see a doctor as soon as possible. CONCLUSION: Our results show that family caregivers were the main support for older people with osteoarthritis. Interventions should educate patients and family members about osteoarthritis causes, common misconceptions about osteoarthritis, osteoarthritis pain medicines and treatment and encourage family members' support.

Dignity in care in the clinical setting: a narrative review.

This review aimed to explore nursing literature and research on dignity in care of inpatients and to evaluate how the care patients received in the hospital setting was related to perceived feelings of being dignified or undignified. Studies conducted between 2000 and 2010 were considered, using Cumulative Index to Nursing and Allied Health Literature and MEDLINE, and the search terms 'patient dignity', 'dignity in care', 'human dignity and nursing' and 'dignity and nursing ethics'. Findings revealed, from the perspectives of nurses and patients, that dignity in care in the hospital setting is seen to be influenced by physical environment, staff attitude and behaviour, organisational culture and patient independence. This review can help nurses to better understand dignity in care, and for policy makers, there are implications about determining the physical environment, staff attitude and behaviour and organisational culture needed to promote patient dignity in nursing. By identifying the most important factors from patients' and nurses' perspectives that contribute to dignity in care, nursing interventions, such as campaigns and education in clinical practice, can be developed.

Hazardous alcohol-drinking problems among a Chinese hospital patient population.

AIM: The aims of this study were to explore: (1) the prevalence and predictors for hazardous alcohol-drinking problems; and (2) previous assessments and interventions for alcohol-drinking problems in hospitalized Chinese patients. BACKGROUND: Alcohol is legally accessible and widely used in Taiwan, but few studies have addressed alcohol-drinking problems in hospital settings. DESIGN: A cross-sectional design was used. METHOD: Self-report data were collected in 2009 from 484 patients at five randomly selected general teaching hospitals. FINDINGS: The prevalence of hazardous alcohol-drinking problems was 19·2%. Logistic regression analysis revealed that predictors for hazardous drinking problems were being male, smoking, and chewing betel quid. Only 29·1% of participants had been assessed for drinking problems in the past year. Only 38·7% of participants with drinking problems had received a drinking intervention in the past year. CONCLUSION: These findings suggest that alcohol problems in Taiwanese general teaching hospitals are insufficiently assessed and targeted with interventions. Targeting high-risk groups in general teaching hospitals is important to prevent patients' drinking problems.

Hazardous drinking problems in family members of problem-drinker patients in Chinese general hospitals.

OBJECTIVE: To explore (1) the prevalence and risk factors for hazardous alcohol-drinking problems and (2) previous assessments and interventions for alcohol-drinking problems among family members of Chinese problem-drinker patients. METHOD: Self-report data were collected from 517 family members of problem-drinker patients at five randomly selected general hospitals in Taiwan. RESULTS: Family members' prevalence of hazardous alcohol-drinking problems was 13.3%. Logistic regression analysis revealed that risk factors for hazardous drinking were male gender, low education level, heart disease, smoking, and chewing betel quid. Only 11.8% of participants had been assessed for drinking problems in the past year. Only 5.2% of participants with drinking problems had received a drinking intervention in the past year. CONCLUSION: Alcohol problems among family members of problem-drinker patients in Taiwanese general hospitals are insufficiently assessed and targeted with interventions. Targeting this high-risk group is important to prevent drinking problems in family members of problem-drinker patients.

An alcohol training program improves Chinese nurses' knowledge, self-efficacy, and practice: a randomized controlled trial.

BACKGROUND: Excessive alcohol use has been associated with health, social and legal problems. Helping health care providers to manage hazardous or harmful drinkers is an important worldwide issue. Alcohol is a legal and accessible substance in Taiwan and is viewed as an acceptable drink for relieving stress and enhancing socialization in Chinese culture. These cultural factors may contribute to drinking problems being easily ignored and to lack of alcohol training programs for health care providers. METHODS: For this randomized controlled clinical trial with 1- and 3-month posttests, six hospitals were randomly selected throughout Taiwan and were randomly assigned to an experimental or control group. In these hospitals, nurses were selected from the Emergency Department, psychiatric, and gastrointestinal medical-surgical units where most patients with alcohol problems are seen. For the experimental group, nurses received a 1.5-hour alcohol training program consisting of an introduction to alcohol, factors influencing alcohol drinking, impacts of high-risk drinking on a person, as well as introduction to and practice of the Alcohol Use Disorders Identification Test and brief alcohol intervention. The program also discussed Taiwanese nurses' perceived barriers and facilitators to intervening for problem alcohol use. Teaching strategies included lecture, discussion, demonstration, practice, role-playing, and sharing experiences. The control group did not receive any training. Data were collected at pretest, 1-month, and 3-month posttests using a self-report questionnaire on knowledge, self-efficacy, clinical practice scales, and a demographic form. RESULTS: The study was completed by 395 nurses, including 191 nurses in the experimental group and 204 nurses in the control group. Knowledge scores significantly improved in the experimental group at the 1- and 3-month posttests but not for the control group. Similarly, nurses' self-efficacy and clinical practice scores significantly improved in the experimental group at the 3-month posttest but not for the control group. CONCLUSIONS: Our results suggest that the alcohol training program could be used to enhance nurses' alcohol knowledge, self-efficacy, and clinical practice not only in Taiwan but also other countries.

Dignity in care in the hospital setting from patients' perspectives in Taiwan: a descriptive qualitative study.

AIM: The aim of this study was to explore dignity in care from patients' perspectives in Taiwan. BACKGROUND: Dignity is a core element of nursing care. In nurses' clinical practice, maintaining the dignity of patients is an important issue because a lack of dignity in care can affect the health and recovery of patients. In Western countries, patient dignity has been well researched, but only one study has examined this topic in an Asian country. DESIGN: Descriptive qualitative methods were used in this study. METHODS: Interviews were conducted with 40 patients purposively sampled at a teaching hospital in eastern Taiwan from May-August 2009. Audiotaped interviews were transcribed verbatim, and data in transcripts were coded and analysed by content analysis. RESULTS: The major findings revealed that many hospitalised patients were satisfied with the maintenance of their dignity. Six themes that contribute to the preservation of their dignity were identified: sense of control and autonomy, being respected as a person, avoidance of body exposure, caring from the nursing staff, confidentiality of disease information and prompt response to needs. CONCLUSIONS: The findings can help nurses better understand dignity in care because it is described from the patient viewpoint. RELEVANCE TO CLINICAL PRACTICE: By identifying the most important factors from patients' perspectives that contribute to dignity, nursing interventions in clinical practice can be further developed and improved.

Maintaining patients' dignity during clinical care: a qualitative interview study.

AIM: This article is a report of a study undertaken to understand how nurses maintain patients' dignity in clinical practice. BACKGROUND: Dignity is a core concept in nursing care and maintaining patients' dignity is critical to their recovery. In Western countries, measures to maintain dignity in patients' care include maintaining privacy of the body, providing spatial privacy, giving sufficient time, treating patients as a whole person and allowing patients to have autonomy. However, this is an under-studied topic in Asian countries. METHODS: For this qualitative descriptive study, data were collected in Taiwan in 2009 using in-depth interviews with a purposive sample of 30 nurses from a teaching hospital in eastern Taiwan. The audiotaped interviews were transcribed verbatim and analysed using content analysis. FINDINGS: Nurses' measures to maintain dignity in patient care were captured in five themes: respect, protecting privacy, emotional support, treating all patients alike and maintaining body image. Participants did not mention beneficence, a crucial element achieved through the professional care of nurses that can enhance the recovery of patients. CONCLUSION: In-service education to help nurses enhance dignity in patient care should emphasize emotional support, maintaining body image and treating all patients alike. Our model for maintaining dignity in patient care could be used to develop a clinical care protocol for nurses to use in clinical practice.

The relationships among medicine symptom distress, self-efficacy, patient-provider relationship, and medication compliance in patients with epilepsy.

The purpose of this study was to investigate the relationships among medicine symptom distress, self-efficacy, patient-provider relationship, and medication compliance in patients with epilepsy. Patients with epilepsy (n=357) were recruited using convenience sampling from three medical centers in northern Taiwan. Results showed significant differences in relationships between medication compliance and the following factors: gender, employment status, comorbid chronic diseases, self-driving, daily drug dosing frequency, seizure after a missed dose, and self-efficacy. Logistic regression analysis indicated that comorbid chronic disease, self-driving, seizure after a missed dose, and self-efficacy were significantly associated with medication compliance. These data suggest that health care providers of patients with epilepsy pay more attention to treatment of comorbid chronic diseases, the safety issues of self-driving, seizures occurring after missed doses, and awareness of self-efficacy.

Facilitators and barriers to intervening for problem alcohol use.

AIM: This article is a report of a study exploring nurses' perceived facilitators and barriers to conducting brief interventions for problem alcohol use. BACKGROUND: Excessive alcohol use has been associated with health, social and legal problems. Healthcare providers worldwide need help to detect and intervene with hazardous/harmful drinkers. METHODS: For this cross-sectional study, ten hospitals were randomly selected throughout Taiwan during 2007. Nurses (N = 741) were selected from the emergency department, and psychiatric and gastrointestinal medical-surgical units where most patients with alcohol problems are seen. Data collected using facilitator and barrier scales and a demographic information form were analysed by descriptive statistics and stepwise, multiple linear regression analysis. RESULTS: Nurses identified the top facilitator to intervening for problem alcohol use as 'patients' drinking problems are related to their illness'. Top barriers were 'patients lack motivation to change' and 'patients express no interest in receiving intervention'. Perceived facilitators were associated with nurses' work unit, intention to intervene for problem alcohol use, and age. Perceived barriers were associated with work unit, experience in intervening for problem alcohol use, and having attended a training course. CONCLUSION: Source of perceived barriers reflected cultural influences. Taiwanese nurse education needs to be strengthened in terms of brief interventions for problem alcohol use. Emergency department nurses need to become more aware of their important role in alcohol intervention. Alcohol-related education is needed for the general population and hospital policymakers to enhance facilitators and reduce barriers to intervening for problem alcohol use.

Suicide experiences among institutionalized older veterans in Taiwan.

PURPOSE: Institutionalized veterans in Taiwan are a high-risk group for completing suicide due to their institutionalization and social minority status. The purpose of this study was to understand the suicide experiences, especially the triggers of suicide in this group. DESIGN AND METHODS: Data about suicide experiences were collected from 19 older (> or =65 years) residents who had attempted suicide in four veterans' homes in Taiwan from 2006 to 2007. Transcripts from 26 tape-recorded interviews were analyzed by thematic analysis. RESULTS: Five major themes related to suicide triggers were identified: illness and pain, death of close relatives or friends, conflicts with family members, disputes with friends or workers, and difficulty adapting to institutional life. IMPLICATIONS: Illness and physical limitation issues were similar to suicidal findings on older people in Western culture. However, the suicidal behavior of these institutionalized, older Taiwanese veterans was influenced by expectations that did not match current social changes, money management issues, death of significant others, and changes in living environment. We suggest that money problems with paraprofessional institutional workers could be minimized among older institutionalized veterans by providing a convenient means for them to withdraw or manage money. Institutional staff should also be educated about communicating with older people and about death and dying; older residents should be educated about current social changes and money management. The study themes may be used to develop a new model for predicting suicide in this population and could be incorporated into current suicide prevention programs in clinical practice.

Brief intervention for problem drinkers in a Chinese population: a randomized controlled trial in a hospital setting.

BACKGROUND: Alcohol is a legal and accessible substance in Taiwan. As excessive alcohol has been linked to health and social problems, it is necessary to develop a brief, rapid, and low-cost tool to help health care providers deal with persons in Taiwan whose alcohol consumption has become hazardous or harmful to their health. METHODS: A randomized controlled clinical trial with 6- and 12-month follow-ups was designed. Eighteen medical/surgical units at a medical center in northern Taiwan were randomly assigned to 2 groups: experimental (n = 9) and control (n = 9). Inpatients on the units were enrolled if they met the following criteria: were older than 18 years, had no severe psychiatric illness, and were not pregnant. The experimental group (n = 138) received the intervention, a 15-minute counseling visit in which nurses screened participants using the Alcohol Use Disorders Identification Test (AUDIT), provided a health promotion booklet for adults, and individually discussed the booklet contents with patients based on their drinking level (AUDIT score). The control group (n = 137) received no treatment. Patterns of alcohol consumption were determined by AUDIT scores at baseline, 6, and 12 months later. RESULTS: Alcohol use disorders identification test scores decreased significantly in both groups at 6 months after the intervention, but did not differ significantly between the 2 groups. However, 12 months after the brief alcohol intervention, experimental subjects' AUDIT scores were significantly better than those of the control group. CONCLUSIONS: Our brief alcohol intervention provided a 12-month benefit for problem drinkers in Taiwan.

Depressive symptoms, pain experiences, and pain management strategies among residents of taiwanese public elder care homes.

The purpose of this study was to explore depressive symptoms, pain experiences, and pain self-care management strategies among residents of public elder care homes in Taiwan. Random sampling was used to recruit participants (n=200). In this sample, the prevalence of depressive symptoms was 49.0%. Pain prevalence was significantly higher in the depressed group (59.2%) than in the non-depressed group (43.1%). Depressed participants tended to report more severe pain intensity, worst pain, average pain, and more interference with walking than the non-depressed group. Most participants (60.0%) took prescribed medications for dealing with pain. Self was the main information source for pain management strategies. Participants reported severe bouts of pain but used limited self-care pain management strategies. Due to the limited number of health care providers in elder care homes, the authors recommend increasing knowledge about depression, pain, and pain management strategies of both institutional health care staff and residents.