Development and Validation of the Interprofessional Collaboration Practice Competency Scale (IPCPCS) for Clinical Nurses.

Interprofessional collaborative practice is a core competency and is the key to strengthening health practice systems in order to deliver safe and high-quality nursing practice. However, there is no Interprofessional Collaboration Practice Competency Scale (IPCPCS) for clinical nurses in Taiwan. Therefore, the purposes of this study were to develop an IPCPCS and to verify its reliability and validity. This was a psychometric study with a cross-sectional survey using convenience sampling to recruit nurses from the seven hospitals of a medical foundation. A self-designed structured IPCPCS was rolled out via a Google survey. The data were analyzed using descriptive statistics, principal-axis factoring (PAF) with Promax rotation, Pearson correlation, reliability analysis, and one-way ANOVA. PAF analysis found that three factors could explain 77.76% of cumulative variance. These were collaborative leadership and interprofessional conflict resolution, interprofessional communication and team functioning, and role clarification and client-centered care. The internal consistency of the three factors (Cronbach's α) was between 0.970 to 0.978, and the Pearson correlation coefficients were between 0.814 to 0.883. Significant differences were presented in the IPCPCS score by age, education level, total years of work experience, position on the nursing clinical ladder, and participation in interprofessional education. In conclusion, the three factors used in the IPCPCS have good reliability and construct validity. This scale can be used as an evaluation tool of in-service interprofessional education courses for clinical nurses.

Professional Accountability of Caring for Patients with COVID-19: A Phenomenographic Study.

The purpose of this study was to explore nurses' care experiences for COVID-19 patients during the pandemic in Taiwan. The qualitative approach of phenomenography was used. Thirty-four nurses were recruited from two assigned hospitals in which COVID-19 patients were treated in Taiwan from July to May 2021. The method of data collection in the study involved a semi-structured interview and drawing. Interviews were audio-recorded and transcribed verbatim. Phenomenographic analysis was used to analyze the qualitative data. Four categories of description of experiences of caring for COVID-19 patients were identified: facing uncountable stresses from all sides, strict implementation of infection control interventions to provide safe care, confronting ethical dilemmas and making difficult decisions, and reflecting on the meaning of care in nursing. Professional accountability was the core theme found to represent the central meaning of nurses caring for COVID-19 patients. Nurses were under enormous stress while caring for COVID-19 patients during the pandemic and were negatively affected physically, psychologically, and socially. Professional accountability in caring for COVID-19 patients can be enhanced through adequate support from nursing managers and by in-service training designed to update knowledge and skills related to infection control intervention.

Self-efficacy of caring for patients in the intensive care unit with delirium: Development and validation of a scale for intensive care unit nurses.

BACKGROUND: Improving the self-efficacy of intensive care unit nurses for delirium care could help them adapt to the changing situation of delirium patients. Validated measures of nurses' self-efficacy of delirium care are lacking OBJECTIVES: The objective of this study was to develop a Delirium Care Self-Efficacy Scale for assessing nurses' confidence about caring for patients in the intensive care unit and to examine the scale's psychometric properties. METHODS: Draft scale items were generated from a review of relevant literature and face-to-face interviews with intensive care unit nurses; content validity was conducted with a panel of five experts in delirium. A group of nurses were recruited by convenience sampling from intensive care units (N = 299) for item analysis of the questionnaire, assessment of validity, and reliability of the scale. Nurse participants were recruited from nine adult critical care units affiliated with a hospital in Taiwan. Data were collected from August 2020 to July 2021. RESULTS: Content validity index was 0.98 for the initial 26 items, indicating good validity. The critical ratio for item discrimination was 14.47-19.29, and item-to-total correlations ranged from 0.67 to 0.81. Principal component analysis reduced items to 13 and extracted two factors, confidence in delirium assessment and confidence in delirium management, which explained 66.82% of the total variance. Cronbach's alpha for internal consistency was 0.94 with good test-retest reliability (r = 0.92). High scale scores among participants were significantly associated with age (≥40 years), work experience in an intensive care unit (≥10 years), delirium education, and willingness to use delirium assessment tools. CONCLUSIONS: The newly developed Delirium Care Self-Efficacy Scale demonstrated acceptable reliability and validity as a measure of confidence for intensive care nurses caring for and managing patients with delirium in the intensive care unit.

The Outcomes of an Interprofessional Simulation Program for New Graduate Nurses.

This study explored the learning outcomes of an interprofessional simulation program for new graduate nurses during their training program. It was a single-group, pre-test and post-test research design. Ninety-three new graduate nurses participated in the study. The Nursing Competence Instrument and program satisfaction survey questionnaires were used to evaluate the learning outcomes of the program. Data were collected between 1 July 2019 and 30 June 2020 in a medical center in Taiwan. It was found that four nursing core competencies were significantly higher after the simulation, including advancing career talents (t = 10.12, p < 0.0001), integrating care abilities (t = 10.19, p < 0.001), dealing with tension (t = 6.87, p < 0.0001), and leading humanity concerns (t = 6.86, p < 0.001). The average satisfaction score for the interprofessional simulation training among nurses was 4.42 out of 5. In conclusion, interprofessional simulation education can help novice nurses improve their nursing core competencies. The results of this study provide an important indicator for hospitals and governments when making policy and training programs for new graduate nurses.

Factors Associated with Surgical Smoke Self-Protection Behavior of Operating Room Nurses.

Surgical smoke has been proven to be harmful and carcinogenic to humans as well as increasing the risk of acquiring infectious diseases. The operating room nurses' willingness to use protective equipment against surgical smoke was low. The factors associated with personal protective behavior in the operating room against surgical smoke were sparsely explored. The purpose of this study is to determine factors associated with surgical smoke self-protection behavior of the operating room nurses. This was a descriptive correlational study using a convenience sample from a medical center in northern Taiwan. The self-designed questionnaires included personal characteristics and perceived attributes. The data were analyzed by descriptive and linear regression. Attendance at in-service education with regard to surgical smoke, the attitude to surgical smoke, and surgical smoke self-protection barriers were significant factors found in multivariate linear regression after controlling the covariates. The overall model was significant and accounted for 14.2% of variances. In summary, attending in-service education, attitude and barriers in executing self-protective behaviors were significant factors. It is important to promote operating room nurses' health through providing correct surgical smoke knowledge, self-protection strategies to improve attitudes toward surgical smoke, improving the hospital's environment by adding surgical smoke evacuation equipment, and standardizing the operating procedures.

Post-Discharge Depression Status for Survivors of Extracorporeal Membrane Oxygenation (ECMO): Comparison of Veno-Venous ECMO and Veno-Arterial ECMO.

Extracorporeal membrane oxygenation (ECMO) is one of the common invasive treatments for the care of critically ill patients with heart failure, respiratory failure, or both. There are two modes of ECMO, namely, veno-venous (VV) and veno-arterial (VA), which have different indications, survival rates, and incidences of complications. This study's aim was to examine whether depression status differed between patients who had received VV-ECMO or VA-ECMO and had been discharged from the hospital. This was a descriptive, cross-sectional, and correlational study of patients who had been discharged from the hospital at least one month after receiving ECMO at a medical center in northern Taiwan from June 2006 to June 2020 (N = 142). Participants were recruited via convenience and quota sampling. Data were collected in the cardiovascular outpatient department between October 2015-October 2016 (n = 52) and September 2019-August 2020 (n = 90). Participants completed the Hospital Anxiety and Depression Scale-Depression (HADS-D) as a measure of depression status. Post-discharge depression scores for patients who received VV-ECMO (n = 67) was significantly higher (p = 0.018) compared with participants who received VA-ECMO (n = 75). In addition, the mode of ECMO was a predictor of post-discharge depression (p = 0.008) for participants who received VV-ECMO. This study concluded that patients who received VV-ECMO may require greater mental health support. Healthcare professionals should establish a psychological clinical care pathway evaluated by multiple healthcare professionals.

Health-related outcomes of extracorporeal membrane oxygenation in adults: A cross-sectional study.

BACKGROUND: Patients with critical illness may face challenges after hospital discharge; therapeutic outcomes of extracorporeal membrane oxygenation (ECMO) are typically measured by survival rate. However, ECMO is an integral part of treatment in critical care medicine, which requires an outcome measure beyond survival. Post-discharge health-related quality of life (HRQoL) is such an indicator. OBJECTIVES: To measure HRQoL in adult patients who had previously undergone ECMO and explore influential factors related to HRQoL. METHODS: This cross-sectional descriptive study used a convenience sample of patients discharged between April 2006-April 2016 after at least one month following ECMO. The study was conducted from October 2015 to October 2016, which included data collected from structured questionnaires: the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised and Short-Form Survey-36-v2. Stepwise linear regression determined predictor variables of physical and mental HRQoL. RESULTS: Age of participants (N = 144) ranged from 24 to 81 years; long-term survival rate was 28.6% after a median follow-up of 1060 days (range = 44-3150 days). Mean scores for physical and mental components of HRQoL were 46.32 and 50.39, respectively. Level of HRQoL was low to moderate. Employment affected all physical components of HRQoL; depression was the main predictor for physical and mental components. Self-perceived health status and anxiety were also factors that influenced HRQoL. CONCLUSIONS: Variables of employment, self-perceived health status and mental health influenced HRQoL. Early assessment of these factors by healthcare professionals can allow integration of multidimensional interventions following hospital discharge, which could improve HRQoL for patients weaned from ECMO.

Flexible Textile-Based Pressure Sensing System Applied in the Operating Room for Pressure Injury Monitoring of Cardiac Operation Patients.

Pressure injury is the most important issue facing paralysis patients and the elderly, especially in long-term care or nursing. A new interfacial pressure sensing system combined with a flexible textile-based pressure sensor array and a real-time readout system improved by the Kalman filter is proposed to monitor interfacial pressure progress in the cardiac operation. With the design of the Kalman filter and parameter optimization, noise immunity can be improved by approximately 72%. Additionally, cardiac operation patients were selected to test this developed system for the direct correlation between pressure injury and interfacial pressure for the first time. The pressure progress of the operation time was recorded and presented with the visible data by time- and 2-dimension-dependent characteristics. In the data for 47 cardiac operation patients, an extreme body mass index (BMI) and significantly increased pressure after 2 h are the top 2 factors associated with the occurrence of pressure injury. This methodology can be used to prevent high interfacial pressure in high-risk patients before and during operation. It can be suggested that this system, integrated with air mattresses, can improve the quality of care and reduce the burden of the workforce and medical cost, especially for pressure injury.

Relationship among upgrades in academic qualifications, practice accreditations, self-efficacy, outcome expectations and nurses' career interest.

AIMS: This study examined the relationship among upgrades in academic qualifications, practice accreditations, self-efficacy, outcome expectations and nurses' career interest. BACKGROUND: Interest in the nursing career could help retain nurses in the nursing profession. A global nurse shortage warrants further research to understand what drives interest in the nursing career. METHODS: A cross-sectional design was employed. Data were collected in a medical centre in Northern Taiwan between February and March 2017, using employee records and a survey instrument. Proportionate random sampling was used to identify full-time registered nurses, of whom 524 provided useable responses. Employee records were used to measure nurses' upgrades in academic qualifications and practice accreditation. RESULTS: Upgrades in academic qualifications and upgrades in practice accreditation are positively related to outcome expectations. Both self-efficacy and outcome expectations are positively related to career interest. CONCLUSION: The pursuit of upgrades in academic qualifications and practice accreditation could enhance nurses' outcome expectations, thus enhancing their interest in a nursing career. IMPLICATIONS FOR NURSING MANAGEMENT: Hospital managers could develop policies, procedures and programmes to encourage nurses to enhance their academic qualifications or practice accreditation, helping enhance their interest in remaining in the nursing career.

Changes in quality of life and health status in patients with extracorporeal life support: A prospective longitudinal study.

BACKGROUND: Extracorporeal life support (ECLS) provides emergency pulmonary and cardiac assistance for patients in respiratory or cardiac failure. Most studies evaluate the success of ECLS based on patients' survival rate. However, the trajectory of health status and quality of life (QOL) should also be important considerations. The study's aim was to explore changes in health status and QOL in adult patients weaned from ECLS who survived to hospital discharge over a one-year period. STUDY DESIGN: A prospective longitudinal study was conducted from April 2012 to September 2014. A convenience sample of patients who had undergone ECLS was followed for one-year after hospital discharge. Heath status was measured with a physical activity scale, the Centre for Epidemiologic Studies Depression scale, and a social support scale; we assessed quality of life with the physical and mental component summary scales of the Short-Form 36 Health Survey. Changes in depression, social support, physical activity and QOL were analysed with generalized estimating equations at 3-month intervals; participants' QOL at 12 months after discharge was compared with the general population. RESULTS: A total of 231 patients received ECLS during the study period. Sixty-five patients survived to hospital discharge (28% survival rate); 32 participants completed the study. Data showed scores for physical activity increased significantly over time (p < .001), while depression and social support significantly decreased (p < .05 and p < .001, respectively). Participants with veno-venous ECLS had higher scores for depression than participants with veno-arterial ECLS (p < .05). PCS scores significantly increased at 9, and 12 months after discharge (p < .05 and p < .001, respectively). There was no significant change in MCS scores. CONCLUSIONS: This was a preliminary study of patients with ECLS following hospital discharge over a one-year period. One year following hospital discharge survivors of ECLS continued to experience physical complications and some continued to have depressive symptoms; the level of social support was significantly lower after hospital discharge. Healthcare professionals should understand the trajectory of health status and QOL after discharge, which can help developing evidence-based interventions and improve QOL for survivors of ECLS.

Strong Hydrogen Bonding with Inorganic Pendant Polyhedral Oligomeric Silsesquioxane Nanoparticles Provides High Glass Transition Temperature Poly(methyl methacrylate) Copolymers.

We report a series of poly(methyl methacrylate) (PMMA) copolymers containing small amounts of methacrylamide (MAAM) and pendant polyhedral oligomeric silsesquioxane (POSS) methyl acrylate (MAPOSS) segments. The hydrogen bonding interactions of the MAAM monomer units and the inorganic POSS nanoparticle units improved the thermal and mechanical properties of the PMMA copolymers. For example, PMMA copolymerization with 5 wt% PMAAM and 5 wt% PMAPOSS monomers could enhance the glass transition temperature to 142°C, with higher modulus, higher water contact angle, and reasonably high transparency. Such copolymers have potential to replace PMMA homopolymers in optical applications.

Unusual Emission of Polystyrene-Based Alternating Copolymers Incorporating Aminobutyl Maleimide Fluorophore-Containing Polyhedral Oligomeric Silsesquioxane Nanoparticles.

In this study, we synthesized an unusual 2-aminobutyl maleimide isobutyl polyhedral oligomeric silsesquioxane (MIPOSS-NHBu) monomer lacking conventional fluorescent groups. We then prepared poly(styrene-alt-2-aminobutyl maleimide isobutyl POSS) [poly(S-alt-MIPOSS-NHBu)] and poly(4-acetoxystyrene-alt-2-aminobutyl maleimide isobutyl POSS) [poly(AS-alt-MIPOSS-NHBu)] copolymers through facile free radical copolymerizations using azobisisobutyronitrile as the initiator and tetrahydrofuran as the solvent. A poly(4-hydroxystyrene-alt-2-aminobutyl maleimide isobutyl POSS) [poly(HS-alt-MIPOSS-NHBu)] copolymer was prepared through acetoxyl hydrazinolysis of poly(AS-alt-MIPOSS-NHBu). We employed ¹H, 13C, and 29Si nuclear magnetic resonance spectroscopy; Fourier transform infrared spectroscopy; differential scanning calorimetry; and photoluminescence spectroscopy to investigate the structures and the thermal and optical properties of the monomers and novel POSS-containing alternating copolymers. Intramolecular hydrogen bonding between the amino and dihydrofuran-2,5-dione group and clustering of the locked C=O groups from the POSS nanoparticles in the MIPOSS-NHBu units restricted the intramolecular motion of the polymer chain, causing it to exhibit strong light emission. As a result, the MIPOSS-NHBu monomer and the poly(AS-alt-MIPOSS-NHBu) copolymer both have potential applicability in the detection of metal ions with good selectivity.

[The Effectiveness of Pulmonary Rehabilitation for Critical-Care Ventilator Patients: A Systematic Review].

BACKGROUND: Prolonged of use mechanical ventilators results in respiratory muscle atrophy and difficulties in weaning, which increase mortality rates and psychlogical distress. While pulmonary rehabilitation has been shown to improve respiratory muscle strength, the effects of this intervention in critical-care patients who use mechanical ventilation remain uncertain. PURPOSE: The present paper uses a systematic review of the literature to evaluate the effects of pulmonary rehabilitation on the rate of ventilator weaning and on the physical performance of ventilator patients receiving critical care. METHODS: A systematic review was used. Searches were conducted in databases including: Cochrane Library, Embase, MEDLINE, PubMed and Airit Library. Keywords that were used included: "mechanical ventilation", "pulmonary rehabilitation", "exercise", "weaning", and "activities of daily living". The search focused on articles that were published prior to February 2015. Based on inclusion and exclusion criteria, 7 articles addressing relevant randomized controlled trials were extracted. RESULTS: All of the 7 studies supported that pulmonary rehabilitation interventions improve mechanical ventilation weaning and functional independence activities. Several studies were limited by small sample size and differences in the types of rehabilitations used. Thus, the generalizability of the findings of this review is limited. and further research is required to verify the effects of pulmonary rehabilitation. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The results of this systematic review support that pulmonary rehabilitation interventions improved the weaning rate, activities of functional independence, and maximal inspiratory pressure (MIP) in critical patients who had used mechanical ventilators for over 48 hours. Under hemodynamic-stablized and pressure-support mode, inspiratory muscle training is suggested as useful for patients with limited ability to participate in rehabilitation programs.

Living With Chronic Obstructive Pulmonary Disease: The Process of Self-Managing Chronic Obstructive Pulmonary Disease.

BACKGROUND: Disease self-management for patients with chronic obstructive pulmonary disease (COPD) is less well characterized than that for patients with other chronic diseases. A patient-centered perspective calls for qualitative research to investigate the process of self-management as a means of enhancing quality of life in patients with COPD. PURPOSE: This study explores the process of self-management for patients with COPD and the factors that impact the efficacy of this process. METHODS: A qualitative inquiry approach was used to collect data in the thoracic ward, outpatient department, and respiratory therapy room of a medical center in Taiwan. A convenience sample of 19 patients was collected. Qualitative content analysis was used to analyze data. RESULTS: Living with COPD is a process that involves self-regulation and selecting suitable healthcare behaviors. The related healthcare behaviors identified in this study include symptom management, exercise implementation, environmental control, emotional adjustment, maintenance of a healthy life style, and utilization of community and healthcare resources. The factors that were found to influence this process include the physical and psychological conditions of the patient, his or her disease-related cognition, and the social support that he or she receives. In this study, once participants became dissatisfied with the consequences of their healthcare behaviors, they chose a new set of healthcare behaviors and continued to engage in the process of self-regulation. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Patients naturally become experts with regard to their lives through a process of trial and error. Even so, healthcare professionals play a key role in the process of self-management and help patients with COPD cope with various problems in their daily lives. The findingsof this study contribute to the development of evidence-based self-management interventions that promote quality of life in patients with COPD.

Problems and health needs of adult extracorporeal membrane oxygenation patients following hospital discharge: A qualitative study.

OBJECTIVES: To explore problems and health needs of adult extracorporeal membrane oxygenation (ECMO) patients during a one-year period following hospital discharge. BACKGROUND: ECMO functions as life support during treatment of advanced cardiac and respiratory failure. Knowledge regarding the problems and health needs of discharged adult patients who have undergone ECMO is lacking. METHODS: This study used a qualitative descriptive interview design. Fourteen adult ECMO patients were recruited by purposive sampling prior to discharge. Data were generated from semi-structure in-depth interviews at 3-month intervals following hospital discharge. RESULTS: Four themes described problems and needs post-discharge: stress resulting from ECMO surgery; making health a priority; support from family friends and health care professionals; and emotional support. CONCLUSIONS: Multidisciplinary evidence-based interventions should be implemented prior to or soon after discharge to help with the physical, psychological and social problems that ECMO survivors experience, which can help improve their quality of life.