Efficacy and safety of an extended-release sebacoyl dinalbuphine ester for laparoscopic cholecystectomy: A randomized controlled trial.

BACKGROUND: A long-acting κreceptor agonist parenteral analgesic may theoretically improve acute pain and reduce incidence of chronic postsurgical pain (CPSP) after laparoscopic cholecystectomy with minimal drug-related side effects of the traditional µreceptor opioids. METHODS: Eighty adult patients undergoing elective laparoscopic cholecystectomy were randomly assigned to receive single intramuscular injection of an extended-release sebacoyl dinalbuphine ester (SDE, Naldebain 150 mg; n = 40) or placebo (n = 40) after anesthesia induction. Standard multimodal analgesia (MMA) was administered for postoperative pain control. The primary endpoint was pain intensity within 7 days after surgery. The secondary endpoints were incidence CPSP at 3 months and adverse reactions up to 7 days after surgery. RESULTS: The highest visual analogue scale (VAS) and area under the curve of VAS 0 to 48 hours after operation were not different between the two groups and a similar proportion of patients requested rescue parenteral analgesics. Average pain intensities were also not different at 72 hours and 7 days after surgery. Incidence of CPSP was 22.5% and 13.1% in patients who received placebo and SDE treatment, respectively (P = .379). Significantly higher incidence of drug-related adverse events, including dizziness, nausea and injection site reactions, were recorded in the SDE group. CONCLUSION: A single dose of extended-release analgesic SDE given intraoperatively did not provide sufficient add-on effect for acute and chronic pain management after laparoscopic cholecystectomies in patients who received standard postoperative MMA. Intramuscular injection of 150 mg SDE in patients with average body mass causes adverse events that could have been overlooked. More clinical studies are warranted to determine the target populations who may benefit from SDE injections for improvement of acute and chronic postsurgical pain management.

Sleep disturbances, glycaemic control, stress, and coping among diabetic patients: A structural equation modelling approach.

BACKGROUND: Sleep disturbances are more prevalent in diabetic patients than in the general population and may consequently be comorbid with hyperglycaemia. OBJECTIVE: The two study aims were to (1) verify the factors associated with sleep disturbances and glycaemic control and (2) further understand the mediation effects of coping and social support in the relationship among stress, sleep disturbances, and glycaemic control. METHODS: A cross-sectional study design was used. Data were collected at two metabolic clinics in southern Taiwan. The study recruited 210 patients with type II diabetes mellitus who were aged 20 years or above. Demographic information and data on stress, coping, social support, sleep disturbances, and glycaemic control were collected. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality, and PSQI scores >5 were considered to indicate sleep disturbances. Structural equation modelling (SEM) approaches were employed to analyse the path association for sleep disturbances in diabetic patients. RESULTS: The mean age of the 210 participants was 61.43 (standard deviation, SD 11.41) years old, and 71.9 % reported sleep disturbances. The final path model had acceptable model fit indices. Stress perception was divided into stress perceived positively and negatively. Stress perceived positively was associated with coping (ß = 0.46, p < .01) and social support (ß = 0.31, p < .01), whereas stress perceived negatively was significantly associated with sleep disturbances (ß = 0.40, p < .001). CONCLUSIONS: The study shows that sleep quality is essential to glycaemic control, and stress perceived negatively might play a critical role to sleep quality.

Social functioning, depression, and quality of life among breast cancer patients: A path analysis.

PURPOSE: To identify associations among social functioning, depression, and quality of life in breast cancer patients. METHOD: A cross-sectional study was conducted. A total of 180 breast cancer patients were recruited from the surgical units in southern Taiwan hospital in 2021. Path analysis was employed to analyze the relationships between background information and social functioning, depression, and quality of life. Structural equation modeling (SEM) was used for examining the path analysis in this study. RESULTS: The path model showed that respondents with a religious belief (ß = 0.18, p < .000) and less severe disease (ß = -0.29, p < .01) showed better social functioning. Income did not affect social functioning directly but was directly related to the social interaction dimension (ß = 0.30, p < .000). Moreover, younger age (ß = -0.29, p < .000, lower income (ß = -0.10, p < .05) and more severe disease (ß = 0.35, p < .000) increased the level of depression. Less severe disease would also result in a better quality of life (ß = -0.45, p < .000). Breast cancer patients with better social function levels have low levels of depression (ß = -0.82, p < .000) and better quality of life (ß = 0.76, p < .000). CONCLUSION: Age, religion, income, and severity are crucial predictors of social functioning, depression, and quality of life. Furthermore, severity variables which combined clinical variables to make this variable a stronger predictor for SF, depression, and QOL.

[Factors Associated With Catheter-Associated Urinary Tract Infection in Patients in the Intensive Care Unit].

BACKGROUND: Catheter-associated urinary tract infection (CAUTI) commonly occurs in intensive care units (ICU) and is associated with longer hospital stays and higher healthcare costs, morbidity, and mortality. PURPOSE: The purpose of this study was to examine the factors associated with CAUTI in ICU patients. METHODS: This study was a secondary analysis of data from a study on the usage of indwelling catheters in adult internal and surgical ICU patients at a teaching hospital in southern Taiwan conducted between January 1 and December 31, 2017. Descriptive analysis, the independent t test, chi-square test, and logistic regression were used to examine the factors associated with CAUTI. RESULTS: Of the 1,120 patients with an indwelling urinary catheter in the ICU, 330 revealed a positive urine culture result, indicating a 29.5% prevalence of CAUTI. The average duration of indwelling urinary catheter usage was 6.55 (SD = 4.89) days. The participants averaged 69.93 years old (SD = 15.19 years), and 627 (56.0%) were men and 493 (44.0%) were women. Being female, having diabetes, having a large indwelling urinary catheter, having a longer duration of indwelling urinary catheter usage, and being unable to remove the indwelling urinary catheter during the ICU stay were found to be associated with a significantly higher risk of CAUTI. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Women and patients with diabetes are particularly vulnerable to CAUTI. Thus, urinary catheters should be used with caution. Using smaller-sized urinary catheters and reducing the duration of urinary catheter use are suggested. The results of this study may be used to guide clinical practice to help reduce the incidence of CAUTI and enhance overall healthcare service quality.

Meaning in life as a mediator of the associations among depression, hopelessness and suicidal ideation: A path analysis.

WHAT IS KNOWN ON THE SUBJECT: The meaning in life consists of an individual's values, experiences, goals and beliefs. It has been shown to be negatively associated with depression, hopelessness and suicidal ideation. Depression and hopelessness are related to increased suicidal ideation. Meaning in life has been shown to be a protective factor against depression, hopelessness and suicidal ideation. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: A path model was developed to clarify the associations among meaning in life, depression, hopelessness and suicidal ideation. For clarity, the outcomes were depression and suicidal ideation, the independent variable was hopelessness, and the mediator was meaning in life. Hopelessness had a direct association with meaning in life, and meaning in life had a direct association with depression, supporting the mediating effect of meaning in life from hopelessness to depression. Meaning in life had the strongest association with depression, and depression had the strongest association with suicidal ideation. Meaning in life did not have a significant direct association with suicidal ideation; it did have an indirect association with suicidal ideation through depression. This study estimated that one-point increase in meaning in life score was associated with 0.47-point decrease in depression score and 0.13-point decrease in suicidal ideation score, respectively. WHAT ARE THE IMPLICATIONS FOR PRACTICE: Logotherapy is a meaning-centred therapy to find meaning in life. This study reveals that increased levels of meaning in life are associated with decreasing degrees of depression. Mental health nurses could help patients to find meaning in life by logotherapy and thus associated with reductions in depression. Mental health nurses could help patients to find hope by exploring meaning in life and promoting positive attitudes towards life from meaningless life to meaningful life, there is a reduction in depression, which in turn reduces suicidal ideation indirectly. ABSTRACT: Introduction Meaning in life can be good protective factor against depression, hopelessness and suicidal ideation. Aim To analyse the mediating effect of meaning in life on the associations among hopelessness, depression and suicidal ideation. Method A cross-sectional study was conducted among 90 patients diagnosed with depression. A structural equation modelling approach was applied for this path analysis to examine the mediating effect of meaning in life on the association among hopelessness, depression and suicidal ideation. Results The results showed that meaning in life mediated the association between hopelessness and depression. Hopelessness had a direct positive association with depression (ß = 0.23, p < .03), and meaning in life had a direct negative association with depression (ß = -0.51, p < .01) and indirect association with suicidal ideation through depression; this indirect association was -0.21 (p < .01). Discussion Meaning in life revealed strong mediating association with the relationship between hopelessness and depression. By reducing the level of depression, meaning in life demonstrated its mediator association with suicidal ideation. Implications for Practice Logotherapy is a meaning-centred therapy to find meaning in life. Mental health nurses could help patients to manage their depression through logotherapy, thus leading to reductions in suicidal ideation.

Cognitive Behavioral Therapy plus Coping Management for Depression and Anxiety on Improving Sleep Quality and Health for Patients with Breast Cancer.

Cancer-related treatments may lead to side effects that undermine a patients' quality of life (QOL). Although cognitive behavioral therapy plus coping management (CBTM) may appear to improve health-related QOL in cancer patients, limited documentation exists on the effectiveness of psychosocial interventions for patients with breast cancer (BC) during recovery. The purpose of this study was to examine the effectiveness of CBTM for sleep quality, anxiety, depression, and health among patients with BC. An experimental study was conducted to assess the efficacy of a CBTM intervention (experimental group = 36, control group = 34). The experimental group received a 12-week CBTM intervention focused on their identity, challenges, the replacement of dysfunctional beliefs, coping skills, relaxation, and rehabilitation exercises, while the control group received usual care. The follow-up evaluations were performed immediately after the intervention (T1), and at one (T2) and three months (T3). The generalized estimating equation (GEE) model showed significant effects from the CBTM intervention over time. The experimental group showed significant improvement in sleep quality, anxiety and depressive symptoms, and significant increases in their mental and physical QOL from baseline, T1, T2, and T3-except for the mental and physical QOL showing no significant change at T3-while the control group receiving usual care showed no changes over time. The results suggest that CBTM increases sleep quality, reduces anxiety and depressive symptoms, and enhances health-related QOL for participants. CBTM is efficacious and can be provided by nurses to enhance patients' coping skills and consequently improve their QOL.

Nurses' knowledge, attitude, and competence regarding palliative and end-of-life care: a path analysis.

BACKGROUND: Nurses' knowledge regarding palliative and end-of-life (EOL) care has been documented, but the competence of nurses in Taiwan has not been deeply analyzed and may affect the use of EOL care. PURPOSE: We aimed to (1) assess the palliative care knowledge, competence and attitude of nurses in a general hospital and (2) examine the paths connecting nurses' demographic characteristics, previous experiences, knowledge, competence, and attitude. METHOD: A correlational, cross-sectional survey design was implemented to recruit 682 eligible nurses. The questionnaires included demographic information and palliative and EOL care knowledge, attitude, and competence scales. Path analysis was employed for statistical analysis using structural equation modeling. RESULTS: Overall, 76% of the questions assessing palliative and hospice knowledge were answered correctly. Nurses' palliative attitudes were divided into "positive perception" and "negative perception". "Positive perception" was highly correlated with competence (r = 0.48, p < 0.001), but "negative perception" was not significantly correlated with competence (r = -0.07, p = 0.25). "Positive perception" (ß =  -0.01, p = 0.84) and competence (ß =  0.02, p = 0.80) were not related to palliative knowledge. "Negative perception", however, was negatively associated with palliative knowledge (ß =  -0.20, p < 0.01). CONCLUSIONS: This study suggests continuing education to decrease nurses' "negative perception" attitude regarding the provision of information to patients and families to provide better palliative and EOL care. IMPLICATIONS FOR PRACTICE: Nurses' attitudes and competences with respect to palliative care and EOL care are critical. Areas for further research and advanced palliative and EOL care-related education and training are suggested and may be applied in future clinical interventions.

Developing a theory to guide nurse practitioners to accomplish [a] training programme: A grounded theory study.

BACKGROUND: Due to the lack of resident physicians in medical institutions, nurse practitioners must assist in clinical care. However, the quality of training courses in training hospitals is varied and, currently, there is no theory to guide nurse practitioners to complete training. OBJECTIVES: To develop a theory to guide nurse practitioners to accomplish training programme. DESIGN: This study adopted a qualitative grounded theory approach. SETTINGS: A regional teaching hospital in Taiwan. PARTICIPANTS: Seventeen nurse practitioners, who had passed the oral test within the past six months, were recruited until data saturation was achieved. METHODS: Data were collected using a semi-structured interview and data were collected between January 2018 and March 2019. Data were analysed using open, axial, and selective coding and using NVivo 11 to aid the process of coding. RESULTS: A substantive theory was formulated to help nurse practitioners complete their training programme. The core category was 'professional ability to improve nursing quality and excel'. Other important categories and subcategories were 'improving thinking ability' (improving critical thinking ability and differential diagnosis), 'improving clinical care ability' (improving clinical assessment and overall communication skills), and 'active learning' (multi-method learning, repeated practice, and self-improvement). CONCLUSIONS: The findings will facilitate the provision of guidance to nurse practitioner trainees in medical institutions. This will help them successfully complete their training, improve the passing rate for nurse practitioner selection, reduce the wastage of workforce training resources, and improve the quality of care that nurse practitioners provide. Hospitals could use this theory as a reference and create a warm and supportive training environment to help nurse practitioners complete their training programme and improve care quality.

Psychometric and Linguistic Evaluation of a Coping Scale for Breast Cancer Survivors in Taiwan.

BACKGROUND: Coping strategies are essential in dealing with threatening situations or difficulties for better psychological adjustments and quality of life. A short-form modified Ways of Coping Questionnaire (MWCQ) would be useful to quickly assess the coping strategies used by breast cancer survivors. OBJECTIVES: The aim of this study was to evaluate the psychometric properties of a Chinese version of a brief version of the MWCQ in breast cancer survivors. METHODS: A methodological, cross-sectional design was used in this study. The study has internal consistency reliability, face/content, construct, and convergent/divergent validity. Factor analysis and confirmatory factor analysis were used to examine the psychometric properties of the MWCQ-brief in a convenience sample of 207 women with breast cancer from 2 general hospitals in Taiwan. RESULTS: From the initial 35-item coping scale, factor analysis results supported a 24-item questionnaire, and the following 4 factors were extracted: effective coping, optimistic coping, unpractical coping, and escape coping. Confirmatory factor analysis results revealed an 18-item questionnaire with 3 factors extracted: active coping, avoidance coping, and minimizing the situation. CONCLUSIONS: The 24- and 18-item MWCQ-brief versions demonstrate fair psychometric properties to measure adaptability among women with breast cancer in Taiwan. This scale is simple but contains 4 or 3 concepts for coping that can be appropriately used to assess underlying states of adaptation in women with breast cancer. IMPLICATIONS FOR PRACTICE: The MWCQ-brief is a valid and reliable tool to understand the adaptability states of female breast cancer survivors by exploring reactions to the disease. Healthcare professionals can provide appropriate psychosocial interventions based on assessment results.

Nursing graduates' lived experiences of anxiety during their final year at University: a phenomenological study.

BACKGROUND: Nursing students voiced that they were stressed or anxious during their final year at university. Further, they articulated that their anxiety affected their academic performance as well as their motivation to work on their clinical placement. OBJECTIVES: This study was designed to describe nursing graduates' perceptions of their lived experiences of anxiety during their final year. DESIGN: Phenomenology was chosen. SETTINGS: Three universities in Taiwan. PARTICIPANTS: A purposive sample of 18 nursing graduates with experiences of anxiety. METHODS: Data were collected using a semi-structured interview and analyzed utilizing Colaizzi's seven-step method. RESULTS: Four themes emerged from the findings. The first was: uncertainty about future employment. This included negative clinical practicum experiences impacted on future career choices and uncertainty about future workplace choices. The second theme was: emotional relationships and life experiences becoming chaotic. This included anxiety about the loss of established relationships and financial insecurities. The third theme was: three phases of anxiety experienced in preparation for the national examination. They comprised: feeling anxiety but not taking action to study; increasing anxiety and beginning to study and, exacerbated anxiety and cramming for the national examination. The fourth theme was: adjustment strategies. They involved; looking for support to release emotional stress; changing the situation and fine-tuning the stress; positive thinking and self-affirmations and also, self-reflecting and consolidating learning. CONCLUSIONS: Finding could inform nursing teachers on nurses' lived experiences of anxiety during their final year, especially that related to the national examination before registration. Further, findings could be used as a map to facilitate nursing teachers in the provision of suitable teaching and counselling for final year students to alleviate their anxiety.

Modeling Body-Mind-Spirit Well-Being and the Possibility of Relapse Intention in Adults Who Have a History of Substance Use in Taiwan.

BACKGROUND: Substance use is a global mental health issue. There has been limited research exploring the relationships among body, mind, and spirit well-being and the possibility of relapse across different categories of substance users. AIMS: The purpose of the current path analysis was to examine the relationship between body-mind-spirit well-being and the possibility of relapse intention as well as other relevant predictors in people who had a history of substance use. METHODS: A cross-sectional survey was used. Participants were recruited in Southern Taiwan between December 2015 and June 2016. Data were collected from 467 participants who had a history of using controlled substances. RESULTS: Path analysis results revealed that body-mind-spirit well-being was negatively predictive of the possibility of relapse intention. Out of several predictors, stress influence and duration of substance use had direct effects on body-mind-spirit well-being and the possibility of relapse intention, respectively. Stress influence and duration of substance use were associated with decreased body-mind-spirit well-being and increased relapse intention scores. In addition, no history of health problems and male gender were associated with increased body-mind-spirit well-being. CONCLUSIONS: Stress management and the duration of substance use play an important role in body-mind-spirit well-being and relapse intention in people with a history of substance use. Health care professionals could teach substance users coping strategies to address their stress and problems, which may improve their health and reduce the possibility of relapse intention.

The effect of music therapy on reducing depression in people with dementia: A systematic review and meta-analysis.

The aim of this study was to determine the effectiveness of music therapy on reducing depression for people with dementia during different intervention intervals. A systematic review with a meta-analysis of randomized controlled trials. The databases surveyed include AgeLine, CINAHL, MEDLINE, PsycINFO, PubMed, and Cochrane. Seven studies were included in this review. The result revealed that music therapy significantly reduced depression at six, eight, and 16 weeks. This study also supported that music therapy significantly improved depression when the results of six studies with medium-term interventions were pooled. However, no evidence of effect of music therapy on depression was observed at three, four, 12 weeks, and five months during intervention, and one and two months after the cease of music therapy. Music therapy without a music therapist involved did not significantly reduce depression at any time. Medium-term of music therapy might be appropriate in reducing depression for people with dementia.

Social support as a mediator between sleep disturbances, depressive symptoms, and health-related quality of life in patients undergoing hemodialysis.

BACKGROUND: The hemodialysis regimen is an inevitable and mandatory treatment for patients with end-stage renal disease (ESRD). During the dialysis journey, patients may experience maladaptation in terms of sleep disturbances, depressive symptoms, and reduced health-related quality of life (HRQOL). Psychosocial resources such as social support may have beneficial influences on health outcomes, but studies have rarely analyzed the integrated relationships among risk factors which include pain, sleep disturbances, duration since diagnosis and various health outcomes in Taiwan. This study aimed to bridge this gap by investigating the relationships among related risk factors, social support, sleep disturbances, depressive symptoms, and HRQOL, which is composed of physical quality of life (PQOL) and mental quality of life (MQOL), in ESRD patients. METHOD: A correlational design was used, and 178 patients aged 20 years or older were recruited via convenience sample. The relationships among the risk factors, the mediators, depressive symptoms, PQOL, and MQOL were analyzed using structural equation modeling. RESULTS: The findings showed that more than 70% of the participants reported poor sleep quality, and 32% reported depressive symptoms. When participants had greater pain and more sleep disorders, they were more likely to be depressed. When participants had more appraisal support; they had better PQOL and fewer depressive symptoms. Overall, the structural equation model explained 31.8% of the variance in self-reported depressive symptoms, 29.4% of the variance in PQOL, and 5.7% of the variance in MQOL. Moreover, appraisal support enhanced PQOL and reduced depressive symptoms by exerting its two mediating effects on sleep disturbances. CONCLUSION: Our findings indicate that patients with ESRD who have more social support have better PQOL and MQOL and fewer depressive symptoms than those with less social support.

Relationships among personality, coping, and concurrent health-related quality of life in women with breast cancer.

BACKGROUND: Theory has suggested that personality plays an important role related to health behavior and results in health outcomes, but inconsistent with the findings exist. Moreover, limited research has focused on style of coping with personality traits and health-related quality of life (HRQOL) for patients with breast cancer. We tested how ways of coping and personality traits are associated with HRQOL in patients with breast cancer, after controlling for age, education, disease severity, and sleep disorders. METHODS: In a cross-sectional study of 207 patients with breast cancer, they completed a set of questionnaires at two general hospitals. The measures used were demographic and individual characteristics, personality traits, ways of coping, and health surveys. We used correlations and hierarchical regressions to determine all relationships among factors, sleep disorders, personality, coping, and HRQOL. RESULTS: Most participants were reported as having stage II (77, 37.2%) breast cancer. About 60% patients with breast cancer have poor sleep and sleep disorders having a negative association with HRQOL. Participants using more active coping, with lower neuroticism, and higher agreeableness traits are more likely to have a better physical quality of life (PQOL). In the PQOL regression model, clinical conditions (duration since cancer diagnosis; sleep disorders) and two personality traits (neuroticism and agreeableness) significantly explained 23% of variance. Moreover, fewer sleep disorders and two personality traits (neuroticism and conscientiousness) significantly explained 31% of variance in the mental quality-of-life (MQOL) regression model. CONCLUSIONS: A high prevalence of sleep disorders for patients with breast cancer has occurred and sleep disorders were negatively associated with PQOL and MQOL. In addition, neuroticism was positively related to sleep disorders and could be relevant to psycho-educational interventions.

Development and Psychometric Testing of the Suicidal Recovery Ability Scale (SRAS) for Assessing Individuals Who Have Attempted Suicide.

Assessing the recovery ability of individuals who have attempted suicide is crucial for psychiatric health nurses. The purpose of this study was to develop and test a psychometric Suicidal Recovery Ability Scale (SRAS). Confirmatory factor analysis (CFA) indicated that three subscales with 15 items best fit the data. The global SRAS score showed significant negative correlation with the Beck Hopelessness Scale (BHS) score. The Cronbach's α and test-retest reliability scores for the global SRAS and the subscales all exceeded 0.70. Nurses can use the SRAS to assess the recovery ability of individuals who have attempted suicide and provide proper care to help them.

Development and psychometric testing the Health of Body, Mind and Spirit Scale for assessing individuals who have drug abuse histories.

AIMS AND OBJECTIVES: To develop the Health of Body, Mind and Spirit Scale (HBMSS), which was designed to assess drug abusers' health condition. BACKGROUND: Helping drug abusers to become healthy is important to healthcare professionals. However, no instrument exists to assess drug abusers' state of health. DESIGN: A cross-sectional questionnaire survey was implemented to examine the validity of the HBMSS. METHODS: Data were collected from 2015-2016 at one drug abuse prevention centre in Taiwan. Participants (N = 320) who had abused drugs were invited to complete a preliminary 64-item version of the HBMSS. An item analysis, criterion-related validity analysis (using the Relapse Prediction Scale [RPS] score), split-half reliability testing and confirmatory factor analysis (CFA) were conducted to examine the psychometric properties of the HBMSS. RESULTS: The final version of the HBMSS contained 15 items that were divided into three subscales: the health of the body, mind and spirit. Cronbach's α and split-half reliability coefficients were all above .85. The factor loading of each item was between .74-.95. The HBMSS had satisfactory criterion-related validity with the RPS score (r = -.50, p < .001). A second-order CFA was conducted on the HBMSS. The fit indexes were good, χ2  = 184.060, df = 94, χ2 /df = 1.958 (p = .000). CONCLUSIONS: The entire HBMSS and the subscales had satisfactory reliability and validity. RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals could use the HBMSS to evaluate the condition of the health of individuals with a drug abuse history.

Factors predicting recovery from suicide in attempted suicide patients.

AIMS AND OBJECTIVES: The aim of this study was to explore the factors predicting suicide recovery and to provide guidance for healthcare professionals when caring for individuals who have attempted suicide. BACKGROUND: The high rate of suicide is a global health problem. Suicide prevention has become an important issue in contemporary mental health. Most suicide research has focused on suicidal prevention and care. There is a lack of research on the factors predicting suicidal recovery. DESIGN: A cross-sectional design was adopted. METHODS: A correlational study with a purposive sample of 160 individuals from a suicide prevention centre in southern Taiwan was conducted. The questionnaires included the Brief Symptom Rating Scale-5, Suicidal Recovery Assessment Scale and Beck Hopelessness Scale. Descriptive statistics and linear regressions were used for the analysis. RESULTS: The mean age of the participants was 40.2 years. Many participants were striving to make changes to create a more stable and fulfilling life, had an improved recovery from suicide and had a good ability to adapt or solve problems. The linear regression showed that the Beck Hopelessness Scale scores (ß = -.551, p < .001) and Brief Symptom Rating Scale-5 (ß = -.218, p = .003) and past suicidal behaviour (ß = -.145, p = .008) were significant predictors of individuals' recovery from suicide. They accounted for 57.1% of the variance. CONCLUSIONS: Suicidal individuals who have a lower level of hopelessness, a better ability to cope with their mental condition and fewer past suicidal behaviours may better recover from suicide attempts. RELEVANCE TO CLINICAL PRACTICE: The nurses could use the results of this study to predict recovery from suicide in patients with attempted suicide.

The Effects of Muscle Relaxation and Therapeutic Walking on Depression, Suicidal Ideation, and Quality of Life in Breast Cancer Patients Receiving Chemotherapy.

BACKGROUND: The suicide rate of cancer patients is high in Taiwan. Breast cancer has a high incidence rate and is the leading cause of cancer in women. There is a lack of research examining breast cancer-related depression, suicidal ideation, and quality of life. OBJECTIVES: This study evaluated the effects of muscle relaxation and therapeutic walking on depression, suicidal ideation, and quality of life in breast cancer patients receiving chemotherapy. METHODS: An experimental approach was adopted. A group of 87 breast cancer patients receiving chemotherapy were randomly assigned into an experimental group (n = 44) or a control group (n = 43). The subjects in the experimental group received 2 interventions for 3 months. This study used 3 instruments, including (1) the Center for Epidemiological Studies Depression Scale, (2) the Beck Scale for Suicidal Ideation, and (3) the World Health Organization Questionnaire on Quality of Life. RESULTS: The results showed no significant difference in any outcome variable in the pretest. The results of the posttest indicated that the 2 groups scored significantly differently only on the Center for Epidemiological Studies Depression Scale (U = 638.00, P < .05). The breast cancer patients who participated in the 3 month muscle relaxation and therapeutic walking interventions had a lower level of depression (RE¯ = 37.00) than those who did not (RC¯ = 51.16). CONCLUSION: The muscle relaxation and therapeutic walking program was effective in the reduction of breast cancer patients' depression. IMPLICATIONS FOR PRACTICE: Nursing staff could teach muscle relaxation and therapeutic walking to breast cancer patients to reduce their depression.

Risk Factors and Coping Style Affect Health Outcomes in Adults With Type 2 Diabetes.

OBJECTIVE: Most psychosocial interventions among individuals with Type 2 diabetes mellitus (T2DM) target depressive symptoms (DSs) rather than causal antecedents that lead to DSs or affect health-related quality of life (HrQoL). This research investigated a conceptual model of the effects of risk factors and coping styles on HrQoL and DSs in patients with T2DM. METHOD: A descriptive, correlational design was used with a convenience sample of 241 adults with T2DM aged ≥ 20 years recruited from a hospital metabolic outpatient department. Data were collected using a demographic questionnaire, the modified Ways of Coping Checklist, the Center for Epidemiological Studies Depression Scale, the Short Form 36 Health Survey, and physiological examination. HbA1C was collected from participants' medical records. Structural equation modeling techniques were used to analyze relationships among risk factors, mediators, and HrQoL. RESULTS: Younger age, more education, and longer duration of diabetes predicted better physical quality of life. Duration of diabetes and three coping styles predicted DSs. Longer duration of diabetes and lower fasting glucose predicted better mental quality of life. Three coping styles acted as mediators between risk factors and health, that is, active and minimizing styles promoted positive outcomes, while avoidance promoted negative outcomes. CONCLUSIONS: This integrated model provides a holistic picture of how risk factors and coping style influence HrQoL and DSs in individuals with T2DM. Nurses could use active coping strategies in cognitive behavioral therapy to enhance glycemic control in patients with T2DM.

Factors associated with treatment restriction orders and hospice in older nursing home residents.

AIM: The purpose of the study is to examine factors associated with do-not-resuscitate orders, do-not-hospitalise orders and hospice care in older nursing home residents at admission. BACKGROUND: Although hospice care is viewed as the 'gold standard,' geographic availability and financial reimbursement limits its use. Treatment restriction orders may represent alternative approaches to defining wishes for end-of-life care. DESIGN: A descriptive correlational study design was employed to examine the use of four care directives and hospice in newly admitted older people NH residents using Maryland Minimum Data Set 2.0 and the On-Line Survey Certification and Reporting in 2000. Analyses reflected 10,023 unduplicated admission records from 77 NHs. RESULTS: The prevalence of do-not-resuscitate and do-not-hospitalise orders at admission was 28 and 3.4%, respectively. A very small percentage of residents received hospice care on admission (1.7%). Appropriately, health-related characteristics had a strong influence on use of do-not-resuscitate orders, do-not-hospitalise orders and hospice care. However, identified predictors were varied among do-not-resuscitate orders, do-not-hospitalise orders and hospice care. Moreover, multivariate logistical modelling found that non-Medicare insurance significantly influenced the likelihood of do-not-resuscitate orders, do-not-hospitalise orders and hospice uses; White race increased the likelihood of having a do-not-resuscitate and do-not-hospitalise order. Treatment restriction orders were associated with an increased of likelihood of hospice use. CONCLUSIONS: As policy and reimbursement barriers to hospice use are likely to persist, treatment restriction orders should be used to focus communication with residents, families and providers, with the ultimate goal of more widespread implementation of hospice care principles. RELEVANCE TO CLINICAL PRACTICE: White race was consistently associated with increasing the likelihood of having do-not-resuscitate and do-not-hospitalise orders, supporting the importance of cultural sensitivity in advanced care planning. With the association between do-not-hospitalise orders and hospice use, treatment restriction orders should be used as potential triggers to prompting end-of-life care.