Efficacy of a multidimensional self-management intervention on low-education women with metabolic syndrome: a cluster randomized controlled trial.

Low-education women, a substantially older population, are subject to increased risks of metabolic syndrome and consequent cardiometabolic diseases; early detection and effective management were urgently needed. Ninety-nine women with metabolic syndrome, age 61 and education ≤ 6 years, from four community units were randomly assigned to either a self-management intervention (n = 51) or a control arm (n = 48). The intervention consisted of five dimensions, physical activity and diet modifications (daily exercise classes and two nutrition courses), goal setting, coaching and peer support, problem-solving, and self-monitoring. The control arm received an education leaflet. Assessments were performed at baseline, six months, and 18 months. Compared with the control, the intervention participants improved the overall rate of meeting the recommended servings for six health foods, including vegetables, dairy products, and nuts (except whole grains, fruits, and protein); the rate of meeting regular leisure-time physical activity; and criteria biomarkers-waist circumference, fasting blood glucose, high-density lipoprotein cholesterol (except blood pressure and triglycerides); as well as body weight and body mass index; consequently decreased the number of risk factors and rate of metabolic syndrome. In conclusion, the multidimensional self-management intervention improved physical activity, healthy eating, and metabolic syndrome risks among low-education women with metabolic syndrome.

The Experiences of Robot-Assisted Gait Training in Patients With Neurological Disorders: A Qualitative Study.

PURPOSE: The aim of this study was to explore the rehabilitation experiences and perceptions of patients with neurological disorders who have used the Lokomat Augmented Feedback module, a robot-assisted gait training device. DESIGN: A qualitative descriptive study was conducted. METHODS: Purposive sampling was employed to recruit participants with neurological disorders who have used the Lokomat. Semistructured face-to-face interviews were completed in northern Taiwan. Interviews were recorded and transcribed verbatim. Thematic analysis was used. RESULTS: Thirteen interviews were analyzed. Three themes were identified: learning to walk again, inspiring the fighting spirit, and the joys and worries of technological innovation. CONCLUSIONS: Strong positive emotions and logistical concerns were associated with the use of the Lokomat. CLINICAL RELEVANCE: Encouraging patients while also being transparent about the challenges involved in the rehabilitation process and helping set realistic goals is critical. Furthermore, attention directed toward anticipating and mitigating the physical strain associated with the Lokomat is important.

Effects of a simulation-based nursing process educational program: A mixed-methods study.

AIMS: To examine the effects of a simulation-based nursing process educational program on nursing students' confidence in communication and foundational understanding of the nursing process. BACKGROUND: The nursing process is a core component of patient-centered nursing care that is underpinned by effective communication. However, learning how to engage patients and carry out the distinct steps of the nursing process can be challenging if students are not able to apply knowledge to practice. Simulation-based learning programs can provide an immersive opportunity for students to enhance their understanding of the nursing process as well as improve their communication skills. DESIGN: A mixed methods randomized controlled trial METHODS: Two Fundamentals of Nursing classes were recruited from a university in northern Taiwan. The experimental group (n = 58) engaged with the simulation-based nursing process educational program, which consisted of an online interactive animation and a standardized patient simulation. The control group (n = 49) was assigned a case-study. Confidence in Communication surveys, assignment and examination scores, satisfaction questionnaires and post-simulation reflection logs were used for data collection. Data were analyzed using SPSS 22.0 and qualitative content analysis. RESULTS: Both groups showed statistically significant improvement in Confidence in Communication (p < .001). The experimental group performed better on the assignment than the control group (p < .001). No significant difference was seen between either groups' examination performances. The animation's high usage rate (mean 5.91 interactions per-user) and the results of the satisfaction questionnaires indicate the program's positive reception from the experimental group. The following themes emerged: effective communication skills, problem solving, confidence, feeling prepared and novel learning experience. CONCLUSION: The results demonstrate that the simulation-based nursing process educational program increased students' self-confidence in communication and non-verbal communication skills as well as foundational understanding of how to carry out the nursing process. The use of interactive simulation-based learning experiences is recommended to improve nursing students' understanding of how to apply abstract concepts into practice.

Using Reflective Teaching Program to Explore Health-Promoting Behaviors in Nursing Students.

BACKGROUND: The attitudes of nurses toward health promotion affect patients. However, current classroom teaching does not provide nursing students with actual experiences. An experiential and reflective teaching design will help nursing students practice actual health behaviors and record their feelings. This will help nursing students better understand the difficulties and feelings experienced by nurses when encouraging patients to make behavioral changes in clinical settings. PURPOSE: This study aimed to explore the experiences and factors affecting health-promoting learning with reflective teaching in nursing students. METHODS: This explorative study integrated the "reflective assessment, engagement, and action-reflection" strategy of reflective teaching into the standard health-promotion teaching curriculum to understand the experiences of nursing students when executing health-promoting behaviors. Fifty-seven second-year nursing students from a university in northern Taiwan participated in this course, which was conducted between September 2017 and January 2018. The data were collected from the contents of the reflective journals written by the nursing students and analyzed using thematic analysis. RESULTS: The three health-promoting behaviors performed by most of the students were regular exercise, balanced and healthy diet, and adequate daily water intake. The feelings experienced by the nursing students during the execution of health-promoting behaviors included easier said than done, compromise and adjustment, and continuation of health behaviors. Accommodation, peer encouragement, and support were important, facilitating factors of health-promoting behaviors in this study. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The results of this study may serve as a reference for nursing lecturers when employing reflective teaching in the classroom. Reflective teaching designs for actual experiences help nursing students experience the crucial factors and benefits of executing health-promoting behaviors.

The efficacy of a flipping education program on improving self-management in patients with chronic obstructive pulmonary disease: a randomized controlled trial.

Purpose: Self-management is widely used among patients with a chronic disease to control their condition. However, the self-management programs are less distinctive for patients with chronic obstructive pulmonary disease (COPD) than those with other chronic diseases. This study examines the efficacy of a flipping education program on improving self-management in patients with COPD. Patients and methods: A single-blinded, randomized controlled trial was conducted at a medical center in northern Taiwan from January 2015 to May 2016. Sixty participants were randomized to an experimental group and a control group. The self-management program with flipped teaching, customized action plans, and scheduled telephone interviews was implemented in the experimental group for three months. Conventional patient education was implemented in the control group. Disease knowledge, self-efficacy, the patient's activation level, and the impact of COPD were assessed at baseline, 1 month, and 3 months after the intervention. SPSS 22.0 was used for data analysis. Results: The results showed that the patients who received the flipping education program of self-management had statistically significant improvements in their disease knowledge (p<0.05), self-efficacy (p<0.01), and activation levels (p<0.01) from baseline to the 1 month and 3 months follow-up compared to the control group. Conclusion: The findings supported that flipped teaching could be applied to patient education in adults and that a nurse case manager can feasibly use this flipping education program of self-management to motivate and support patients with COPD to acquire self-management skills, carry out their action plans, and help them achieve beneficial behaviors in their daily lives.

Gender differences in lifestyle and risk factors of metabolic syndrome: Do women have better health habits than men?

AIMS AND OBJECTIVES: To examine the gender-specific lifestyles of adults with metabolic syndrome in the Taiwanese community. BACKGROUND: Many studies show different prevalence of metabolic syndrome in males and females; however, few studies have investigated gender-specific lifestyle risk factors, which are important for effectively reducing prevalence. DESIGN: A cross-sectional study design was used. METHODS: Between 2012 and 2015, a total of 1,066 individuals were recruited in northern Taiwan. Data were collected by questionnaires and analysed by descriptive statistics, chi-square tests and logistic regression. This study followed the STROBE guidelines. RESULTS: The prevalence of metabolic syndrome was 40.8% in men and 36.0% in women. Women had healthier dietary habits, a higher rate of moderate-vigorous physical activity, and a lower rate of smoking and obesity than men. Men, who were overweight or obese, lacked vigorous physical activity, often consumed excess amounts of salt and fat, and seldom consumed appropriate amounts of protein tended to have metabolic syndrome. Women with an unhealthy metabolism tended to be overweight or obese and seldom consumed dairy products. CONCLUSIONS: Men, who had normal body weight, performed vigorous physical activity, seldom consumed excess amounts of salt and fat, and often consumed appropriate amounts of protein tended not to have metabolic syndrome. Women with a healthy metabolism were of normal body weight and often consumed dairy products. There exist gender differences in health habits with metabolic syndrome. RELEVANCE TO CLINICAL PRACTICE: Although the associated risk factors differed between men and women, controlling body weight and maintaining a healthy lifestyle may reduce the risk of metabolic syndrome.

Sitting-Time and Exercise Predict Depressive Symptoms Among Taiwanese Middle-Aged Adults.

BACKGROUND: Exercise and sitting-time may influence depressive symptoms. OBJECTIVE: The purpose of this study was to examine the relationship between sitting-time, exercise, and depressive symptoms among middle-aged adults. DESIGN: Data from community-based physical examinations between 2013 and 2014 in northern Taiwan were used for this cross-sectional study. We collected demographic data and data on exercise behaviours, sitting-time, and depressive symptoms. RESULTS: A total of 655 participants completed this survey. Of these, 21.2% had depressive symptoms, 33.7% had regular exercise habits, and 24.1% reported a daily average sitting-time of more than 6 hours. Subjects who had regular exercise with lower sitting-time (odds ratio [OR] = 0.49), subjects who had regular exercise with higher sitting-time (OR = 0.55), and subjects who did not have regular exercise with lower sitting-time (OR = 0.34) had less prevalence of depressive symptoms compared to subjects without regular exercise and with higher sitting-time. CONCLUSIONS: Middle-aged adults must exercise regularly and reduce sitting-time to prevent depressive symptoms.

The Lived Experiences of People With Chronic Obstructive Pulmonary Disease: A Phenomenological Study.

PURPOSE: This study explored the lived experiences of people with chronic obstructive pulmonary disease (COPD) following hospitalization for acute exacerbation or pneumonia. DESIGN AND METHOD: A phenomenological approach was adopted to collect data through semistructured interviews. Fourteen participants were recruited from a medical center in northern Taiwan. Data were collected from January 2013 to January 2014. Giorgi's phenomenological methodology was adopted to analyze the interview content. FINDINGS: Three phenomenological themes emerged: trapped in an invisible cage, torments in the winter, and striving for wellness. CONCLUSIONS: This study sought to elucidate the lived experiences of people with COPD, who perceived themselves as feeling an overwhelming sense of confinement. The interviewees displayed positive attitudes, indicating that people with COPD are willing to cope with their disease. Health practitioners should focus on educating people with COPD about their needs, encouraging them to be more positive, and assisting them in engaging in self-management. CLINICAL RELEVANCE: People with COPD can cope with the disease and seek alternative methods to improve their health. These positive attitudes could be used to encourage self-management in the future.

[Factors associated with self-care behaviors in middle-aged adults and elderly with diabetes mellitus].

BACKGROUND: Adequate self-care behavior in diabetic individuals is essential to reduce the progress of the condition and reduce diabetes related complications. Continued research to understand the factors associated with self-care behaviors is needed in order to reduce health care costs and the social burdens associated with diabetes. PURPOSE: To investigate factors associated with self-care behaviors in individuals with diabetes in the community. METHODS: Researchers used secondary data analysis to assess survey data on diabetic individuals obtained from the Community Integrated Screening conducted by the Meishan Township Public Health Center and adult health examinations. Descriptive statistics and multiple linear regression analyses evaluated the independent factors associated with self-care behaviors. RESULTS: A total of ninety-seven individuals with Type 2 diabetes met the inclusion criteria. Mean age was 67.1 years and 37.1% was male. Results from multiple linear regression analysis indicated self-care behavior as poorer in individuals who drank alcohol during the past six months (p=.001), smoked cigarettes during the past six months (p=.015), and/or practiced religious or spiritual beliefs (p=.003). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Findings from this study can help understand factors affecting self-care behaviors in individuals with diabetes in the community. Medical and public health units should focus on providing effective advice on smoking and drinking cessation to individuals with diabetes. Units should also clarify potential conflicts between individuals' self-care behaviors and their religious or spiritual beliefs.