[A Delphi Method Survey of the Core Competences of Post-Acute-Care Nurses in Caring for Acute Stroke Patients].

BACKGROUND: Post-acute care (PAC) service is becoming increasingly important in Taiwan as a core focus of government policies that are designed to ensure continuity of care. PURPOSE: In order to improve PAC nursing education and quality of care, the present study applies a modified Delphi method to identify the core competences of nurses who provide PAC services to acute stroke patients. METHODS: We surveyed 18 experts in post-acute care and long-term care anonymously using a 29-question questionnaire in order to identify the essential professional skills that are required to perform PAC effectively. The results of this survey indicate that the core competences of PAC may be divided into two categories: Case Management and Care Management. Case Management includes Direct Care, Communication, Health Care Education, Nursing Consulting, and Family Assessment & Health Care. Care Management includes Interdisciplinary Teamwork, Patient Care Management, and Resource Integration. The importance and practicality of each item was evaluated using a 7-point Likert scale. RESULTS: The experts required 2 rounds to reach a consensus about the importance and 3 rounds to determine the practicality of PAC core competences. This process highlighted the differing points of view that are held by professionals in the realms of nursing, medicine, and national health policy. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The PAC in-job training program in its current form inadequately cul-tivates core competence in Care Management. The results of the present study may be used to inform the development of PAC nurse orientation training programs and continuing education courses.

Percutaneous endoscopic gastrostomy placement: caregiver decision making in Taiwan.

BACKGROUND/PURPOSE: To explore Taiwanese caregivers' decision making experiences of accepting a percutaneous endoscopic gastrostomy tube for their family member. METHODS: A phenomenological approach was used for the interview and analysis. Semi-structured, in-depth interviews were conducted with a purposive sample of 26 caregivers of patients who had percutaneous endoscopic gastrostomy tube in southern Taiwan. RESULTS: Five themes were recognized to reflect caregivers' decision making experiences with a percutaneous endoscopic gastrostomy: awareness of suffering, awareness of options, uncertainty, opportunity, and contentment with the decision. CONCLUSION: Caregivers' decisions to proceed with a percutaneous endoscopic gastrostomy procedure were mediated by desires to relieve patients' suffering. To empower caregivers to make enteral feeding decisions, nurses must provide sufficient information about percutaneous gastrostomy tubes and their care, support decision making and help to identify an opportunity for gastrostomy tube placement.

[Regaining dignity: the experience and process of reconstructing normal defecation functions through an anal sphincter-saving operation].

BACKGROUND: Resection through an anal sphincter-saving (ASS) operation may affect a low rectal cancer patient'snormal defecation function. The long and complex reconstruction process following such a procedure makes understanding the patient rehabilitation experience necessary in order to develop an effective educational strategy that addresses patient needs. PURPOSE: This study investigated the defecation reconstruction experience of low rectal cancer patients after ASS. METHODS: Researchers used a case study method and purposive sampling. Participants were followed for a period of 6 to 8 months and interviewed between 5 and 7 times. RESULTS: Eleven themes emerged from content analysis. Before temporary colostomy take-down: anal leakage and discomfort, dignity impairment, struggling to locate the contracting muscle, restoring anal strength. After colostomy take-down: loss of defecating control again and damage to peri-anal skin, perceived effects and insistence on persisting with training, faith in effectiveness, trying to comply, trying to restrict medication use, maintaining a hygienic self-image and dignity, promoting quality of life, and a chance to regain a normal life. CONCLUSIONS / IMPLICATIONS: Participants described the rehabilitation exercise as beneficial to controlling the defecation and expressed their intent to continue such. Participant experiences can assist stoma nurses to provide better physical and psychological care to ASS patients.

[Historical changes in community concepts and the effect of such on community health nursing praxis].

In the 21st century, many healthcare programs are delivered in community settings. As such, successfully recruiting target members of the community to participate in programs represents a key challenge for the nursing profession. Although the "community" is not a new concept, its meaning has changed over the past century or more of public healthcare, which has had a profound effect on community health nursing praxis. This article describes changes in community concepts through history in order to define the significance of community participation in today's community health nursing practice.

Multidisciplinary collaboration reporting child abuse: a grounded theory study.

BACKGROUND: The complexity of reporting child abuse requires multidisciplinary collaboration. The dynamics of a mulidisciplinary team in reporting child abuse which begins the process of child protection remains unclear. OBJECTIVE: To explore the experiences and perspectives of professionals working with other disciplines when reporting child abuse. DESIGN: A qualitative study with grounded theory was used. SETTING: Participants were recruited from hospitals, the Department of Child Welfare, and schools in Taiwan. PARTICIPANTS: Twenty-one professionals from four disciplines agreed to participate. The purposive sample included 5 physicians, 5 nurses, 6 social workers, and 5 teachers. METHOD: Individual interviews were conducted to explore the experiences in reporting child abuse of a purposive sample of 21 professionals including physicians, nurses, social workers, and teachers. Transcripts were analyzed using a grounded theory approach. Categorical themes were developed that reflected reporters' experiences and perspectives in reporting child abuse. RESULTS: The professionals involved in reported child abuse are described as participants in a relay race. Four themes emerged from the interviews: running the relay race of child protection; reporters as runners with expectations of runners' characteristics and the order of runners; carrying the baton of a mandatory report described using baton characteristics while running in space and time; and team chemistry including trust of and communication with teammates. Systems that encourage and promote team building and collaboration among child abuse reporters are needed. CONCLUSION: Success in the race to report child abuse across professional disciplines includes runners' skills, speed, a light and easy to carry baton, and team chemistry. As a team of child abuse reporters, when performance is enhanced by practice, the team's success will be measured as victories in child protection. The paradigm of individual disciplines developing their own goals, designing their own training, and practicing within their own regimen needs to be reframed.

Limited PEG tube use: the experience of long-term care directions.

AIMS AND OBJECTIVES: To describe long-term care nursing directors' experiences with percutaneous endoscopic gastrostomy to understand the limited use of it in Taiwanese long-term care facilities. BACKGROUND: Percutaneous endoscopic gastrostomy tubes, used in Western countries since 1980, have not been readily used in Taiwanese long-term care facilities since their introduction in 1995. Instead, nasogastric tubes are used for extended periods. The reasons for limited percutaneous endoscopic gastrostomy use among long-term care residents are unknown. DESIGN: A phenomenologic qualitative design using in-depth semi-structured interviews collected the percutaneous endoscopic gastrostomy use experiences of directors of long-term care facilities. The directors also provided descriptive data on the prevalence of feeding tubes among their residents. METHODS: Eight directors of long-term care facilities in southern Taiwan participated in tape-recorded interviews. Data were thematically analysed using the methods of Strauss and Corbin. Feeding tube prevalence data were analysed using descriptive statistics. RESULTS: Four themes emerged as contributing to limited percutaneous endoscopic gastrostomy use in long-term care facilities: acceptability, availability, affordability and accountability. Over one-third of the residents required feeding tubes with 97% of those having nasogastric tube. Nasogastric tubes were used for a year or more in over half of the patients requiring enteral feeding. CONCLUSION: Chinese cultural values play a significant role in influencing end-of-life care and decisions about percutaneous endoscopic gastrostomy use. Nursing directors in long-term care assume a gatekeeper role to promote acceptability, provide availability and ensure accountability of nutritional interventions. Policy makers must be engaged to promote the affordability of percutaneous endoscopic gastrostomy use among long-term care residents. RELEVANCE TO CLINICAL PRACTICE: To improve nutritional outcomes among long-term care residents, nurses must acknowledge the Chinese culture related to percutaneous endoscopic gastrostomy tubes. Professionals must provide sufficient information about the advantages of percutaneous endoscopic gastrostomy tubes and discuss with families the meaning of quality of life and suffering at the end-of-life.

[Concept analysis of child abuse].

Child abuse is a serious health problem, which threatens children and has a wide reaching effect on family and society. While the concept of child abuse and related factors have been widely explored in interdisciplinary studies, a definition of 'child abuse' that is both precise and consistent has yet to be given. Lack of such limits the ability of clinicians to identify child abuse in clinical settings, and creates difficulties in conducting rigorous scientific research studies. Therefore, the purpose of this paper was to analyze the concept of child abuse based on literature published between 1960 and 2008 (n = 32) using Walker and Avant's concept analysis model in which child abuse is determined along two dimensions. These dimensions include the objective physical dimension, which addresses children younger than 20 years of age who experience repeated injuries or whose history of injury is incompatible with the findings of physical examinations, and the subjective psychological dimension, which addresses children who were treated unfairly or malevolently and their subsequent subjective feelings. Antecedents consist of abuser, victim, and environmental characteristics. Consequences include both physical and psychological aspects. Nurses and other professionals should benefit from a clearer definition of child abuse in their clinical and research settings.

[Patient involvement in medical decision making].

"Respect for autonomy", the primary principle of bioethics, is the basis of the process of informed consent. It is the responsibility of medical professionals to provide information when patients are involved in medical situations and decision making. However, many factors can potentially interfere with patient willingness to participate in decision making processes. This article organizes and discusses present knowledge on such factors. A thorough literature review was conducted to identify factors in terms of three aspects: interaction between health professionals and patients, family involvement, and patient characteristics. Patient involvement in medical decision making is a very complex issue. During the medical decision making process, health professionals must be aware of the social-cultural context of patients in order to create an environment in which patients feel comfortable to make decisions freely.

[Postmodernism and nursing knowledge development].

Postmodernism is a philosophical and social movement which stresses that ideas are temporary, research data should be considered only in context, reality is transcendent, grand theories are invalid, problems are deconstructed, and findings should have practical value. Manifestations of the postmodern paradigm are reflected in the epistemological shifts of nursing science and knowledge development in the professional community of nurses in Western countries. This article explores the context within which this movement emerged, delineates how it has deconstructed "language" and "subject" to frame a new paradigm and outlines related implications on nursing knowledge development. Both challenges and opportunities face the nursing profession as it evolves into a postmodern paradigm.

[Reflections on the development of indigenous nursing knowledge: an example from psychiatric mental health nursing].

An awareness of issues concerning the indigenous population has been present in the social and behavioral sciences in Taiwan since 1980. This paper attempts to make critical analyses and reflections on the development of current nursing knowledge in Taiwan. The needs and directions for nursing studies rooted in indigenous culture are discussed in detail.

A preliminary study of a healthy-lifestyle-promoting program for nursing students in Taiwan.

This pilot study evaluated the effects of a healthy-lifestyle-promoting program, taught as part of an undergraduate community health nursing course, on the physical fitness and health choices of 42 Taiwanese nursing students. A convenience sample provided quantitative indexes of physical fitness and lifestyle before and after the course. Qualitative data, in the form of student diaries, were also analyzed. The findings indicated a positive change in physical fitness, exercise, and nutrition as a result of the program. Including lifestyle programs in nursing education may help promote the long-term health of future nurses who will serve as positive patient role models.

A preliminary study on the health promotion outcomes of high-risk hypertensive freshmen.

This preliminary study identified the outcomes of a health promotion program encompassing health education (2 hours) and case management for 4 weeks applied to high-risk hypertensive freshmen (systolic blood pressure, > or = 160 mmHg, or diastolic blood pressure > or = 100 mmHg) at a university located in Southern Taiwan. Twenty-two freshmen participated and data were collected at baseline and 4 weeks later, after the program. Outcome indicators included biologic (blood pressure, body weight and body fat composition) and healthy lifestyle characteristics (assessed using the Health Promotion Lifestyle Profile [HPLP] and case management documentation). The Wilcoxon signed rank test showed that systolic blood pressure, body weight, and four subscales of the HPLP, health responsibility, interpersonal support, nutrition, and exercise, had improved significantly. This program could be used as a reference to refine further health promotion programs in the university.

Endemic hepatitis C virus infection in a seaboard village of southwestern Taiwan.

This study investigated the rate of Hepatitis C Virus (HCV) infection and identified the risk factors associated with a HCV infection at Ma-Sha-Gou, a seaboard village in southwestern Taiwan. In total, 240 subjects were sampled and stratified according to age and sex from 1,200 residents aged 20-64 years old. HCV-specific antibodies (anti-HCV Ab) in blood specimens were tested for HCV seropositive by the third-generation HCV ELISA system. The subjects, later identified as 152 seropositive and 88 seronegative, were selected for analysis of the correlates of HCV infection. They were interviewed to explore a variety of possible risk factors for HCV infection with a structured questionnaire. The results showed that the anti-HCV age-adjusted seroprevalence was 55.8%. Needle injection was significant to the increased anti-HCV seroprevalence, with multivariate age-adjusted odds ratio (OR) and confidence interval (CI) of 1.9 and 1.2-3.9 respectively. This study identifies Ma-Sha-Gou as an endemic area of HCV infection, in which needle injection from any medical activity was a possible transmission pathway in the village, and suggests the health authorities/community health nurses should give the residents a comprehensive community-based education program to interrupt HCV transmission.