Burnout and Mental Health and Well-Being of School Nurses After the First Wave of the COVID-19 Pandemic: A National Cross-Sectional Survey.

The aim of this study was to examine the associations between job stressors, COVID-19-related concerns, burnout, and mental health and well-being among school nurses, and whether any of these associations are mediated by burnout. Based on stratified proportional sampling, data collection was conducted by an online questionnaire distributed to 600 school nurses in Taiwan. A total of 256 participants aged between 27 and 62 years (mean = 47.08; standard deviation = 7.28) returned questionnaires. Results showed that burnout was the main mediating variable that fully mediated the relationship between COVID-19-related concerns and mental health and well-being. The effects of job stressors on mental health and well-being included direct negative effects (ß = -.29) and indirect negative effects (ß = -.67) through mediating factors. School health managers should be more aware of burnout and mental health and well-being among school nurses under the impact of COVID-19.

Factors Associated With Follow-Up Visits in Parents With Myopic Children Wearing Orthokeratology Lens.

BACKGROUND: Orthokeratology (Ortho-k) is an effective method for slowing the progression of myopia and correcting refractive error in school children. Although parents of children aged < 10 years play a major role in Ortho-k lens care, they have a generally low level of compliance in performing regular follow-up visits. PURPOSE: This study was developed to analyze the associations between follow-up visits by parents of Ortho-k lens wearers aged < 10 years and, respectively, the Ortho-k-related knowledge of these parents and information resources promoting Ortho-k use. METHODS: A cross-sectional study design was used. Parents of children who wear Ortho-k lenses were recruited through a private Facebook group with 3,500 members in 2020 that was created in 2018 for information sharing and exchange among parents of these children. The following data were collected: demographics of the parents and their children, four-item Ortho-k-related knowledge, information resources that prompted the decision to use Ortho-k, and the regularity of follow-up visits. These data were presented in terms of means, standard deviations, and percentages. Logistic regression was performed to compute the odds ratios ( OR s) and 95% confidence intervals (CIs). RESULTS: The study showed that 83.11% had regular follow-up visits. The correct response rate on Ortho-k-related knowledge was > 80%. However, 15.51% of the participants did not recognize axial length as an indicator for monitoring myopia progress, and 10.76% did not know that at least 6 hours of nighttime sleep is required for myopia control with Ortho-k. The most common information resource leading to Ortho-k use was self-acquisition from Internet sources. The spherical equivalent refraction of < -2.0 D was 2.58 times higher in participants with regular follow-up visits than in their peers with irregular follow-up visits ( OR = 2.58, 95% CI [0.22, 5.63]). In addition, acknowledgment of "There is no need to change the Ortho-k lenses regularly as long as there is no discomfort" was 7.19 times higher in participants with regular follow-up visits than in their peers with irregular follow-up visits ( OR = 7.19, 95% CI [1.26, 13.93]). However, participants with regular follow-up visits did not receive Internet ophthalmology advertisements prompting their decision to use Ortho-k 2.62 times higher than their peers with irregular follow-up visits ( OR = 2.62, 95% CI [0.04, 4.29]). CONCLUSIONS: The results support that both information sources and knowledge of Ortho-k use influence the frequency of follow-up visits among parents of Ortho-k lens wearers aged < 10 years. Related support from health professionals in terms of providing appropriate information and guidance is recommended to promote higher rates of regular follow-up visit attendance.

Cultural competence among pre-graduate nursing students, new graduate nurses, nurse mentors, and registered nurses: A comparative descriptive study.

BACKGROUND: Achieving and improving cultural competence in nursing is an ongoing process, beginning in the student period and continuing through the professional career. OBJECTIVES: The present study aims to compare pre-graduate students, newly graduated nurses, registered nurses, and nurse mentors in Taiwan in terms of their respective levels of cultural competence, and to determine associated influencing factors. DESIGN: A comparative cross-sectional study. SETTINGS: Three universities and three hospitals (one regional hospital and two teaching hospitals) in Taiwan. PARTICIPANTS: A total of 756 nurses/students (103 pre-graduate nurses, 321 newly graduated nurses, 101 registered nurses, and 231 nurse mentors). METHODS: The Cultural Competence Scale for Pre-Graduated Students to Licensed Professionals was used to measure the cultural competence level. One-way analysis of variance and hierarchical regression analysis were used for statistical analysis. RESULTS: For overall cultural competence and the subscales of knowledge, awareness, and skills, the pre-graduate students scored lower than the other three groups. Experience of caring for patients from diverse cultures and countries significantly influenced the cultural competence of all four groups. Ability to speak fluent English and receiving cultural competence education during nursing education only significantly influenced the cultural competence of the pre-graduate and new graduate nurses. Current job position and primary practice setting significantly influenced the cultural competence of the registered nurses and nurse mentors. CONCLUSION: Pre-graduate students, newly graduated nurses, registered nurses, and nurse mentors have differing levels of cultural competence and differing influencing factors. Cultural competence education that accords with the influencing factors for each nursing position would continuously cultivate nursing staff's cultural competence.

Factors Influencing Technology Integration in the Curriculum for Taiwanese Health Profession Educators: A Mixed-Methods Study.

In this study, we explored the considerations and the influencing factors for the technological integration of educational curricula based on the technological pedagogical content knowledge (TPCK) framework for health profession educators (HPEs). A mixed methodology was used that included semi-structured interviews with 15 HPEs and an online TPCK survey with a randomly selected sample of 319 HPEs from 217 Taiwanese universities. Five themes emerged, namely, supplementing traditional teaching methods, improving immediate educator-student interactions, tracking the learning process and improving the record-keeping, keeping up with technological trends, and advancing professional learning objectives for different student needs. The presence of pre-existing platforms and inspiration from colleagues and students were facilitators, whereas the risk of technological problems and the need to invest extra time into the preparation process were impediments to technology integration in the curriculum. Of the online respondents (n = 210), 64.2% have integrated at least one technological method into their curriculum. The logistic regression model revealed that gender, prior knowledge regarding how to incorporate technology with teaching, high mean TPCK scores, and relevant school policies were significant predictors of technology integration in the curriculum. Based on these results, recommendations for development in the health profession included efforts to equip HPEs with TPCK, in order to integrate technology into the curriculum effectively.

Effect of an Oral Health Programme on Oral Health, Oral Intake, and Nutrition in Patients with Stroke and Dysphagia in Taiwan: A Randomised Controlled Trial.

No previous studies have evaluated an oral health programme, before swallowing therapy, in patients with stroke and dysphagia in Taiwan. This randomised controlled trial evaluated the effect of an oral health programme (i.e., sputum assessment, Bass method-based tooth brushing, and tooth coating with fluoride toothpaste) before swallowing therapy. Sixty-six patients with stroke (23 female, 43 male) in our rehabilitation ward, who underwent nasogastric tube insertion, were assigned randomly to an oral care group (n = 33) and a control group (n = 33). Demographic data, oral health assessment, Functional Oral Intake Scale (FOIS) scores, Mini-Nutritional Assessment-Short Form (MNA-SF) scores, and nasogastric tube removal rates were compared between groups. We evaluated outcomes using generalised estimating equation analysis. Three weeks post-implementation, the oral care group had significant oral health improvements relative to the control group (95% CI =-2.69 to -1.25, Wald χ2 = 29.02, p < 0.001). There was no difference in the FOIS (95% CI = -0.16 to 0.89, Wald χ2 = 1.86, p>0.05), MNA-SF (95% CI = -0.35 to 0.53, Wald χ2 =-0.17, p>0.05), and nasogastric tube removal (p>0.05) between groups. The oral care group had a higher, but non-significant FOIS score (3.94 vs 3.52) (p > 0.05). Routine oral health programmes implemented during stroke rehabilitation in patients with dysphagia may promote oral health and maintain oral intake.

What to Build for Middle-Agers to Come? Attractive and Necessary Functions of Exercise-Promotion Mobile Phone Apps: A Cross-Sectional Study.

BACKGROUND: Physical activity is important for middle-agers to maintain health both in middle age and in old age. Although thousands of exercise-promotion mobile phone apps are available for download, current literature offers little understanding regarding which design features can enhance middle-aged adults' quality perception toward exercise-promotion apps and which factor may influence such perception. OBJECTIVES: The aims of this study were to understand (1) which design features of exercise-promotion apps can enhance quality perception of middle-agers, (2) whether their needs are matched by current functions offered in app stores, and (3) whether physical activity (PA) and mobile phone self-efficacy (MPSE) influence quality perception. METHODS: A total of 105 middle-agers participated and filled out three scales: the International Physical Activity Questionnaire (IPAQ), the MPSE scale, and the need for design features questionnaire. The design features were developed based on the Coventry, Aberdeen, and London-Refined (CALO-RE) taxonomy. Following the Kano quality model, the need for design features questionnaire asked participants to classify design features into five categories: attractive, one-dimensional, must-be, indifferent, and reverse. The quality categorization was conducted based on a voting approach and the categorization results were compared with the findings of a prevalence study to realize whether needs match current availability. In total, 52 multinomial logistic regression models were analyzed to evaluate the effects of PA level and MPSE on quality perception of design features. RESULTS: The Kano analysis on the total sample revealed that visual demonstration of exercise instructions is the only attractive design feature, whereas the other 51 design features were perceived with indifference. Although examining quality perception by PA level, 21 features are recommended to low level, 6 features to medium level, but none to high-level PA. In contrast, high-level MPSE is recommended with 14 design features, medium level with 6 features, whereas low-level participants are recommended with 1 feature. The analysis suggests that the implementation of demanded features could be low, as the average prevalence of demanded design features is 20% (4.3/21). Surprisingly, social comparison and social support, most implemented features in current apps, were categorized into the indifferent category. The magnitude of effect is larger for MPSE because it effects quality perception of more design features than PA. Delving into the 52 regression models revealed that high MPSE more likely induces attractive or one- dimensional categorization, suggesting the importance of technological self-efficacy on eHealth care promotion. CONCLUSIONS: This study is the first to propose middle-agers' needs in relation to mobile phone exercise-promotion. In addition to the tailor-made recommendations, suggestions are offered to app designers to enhance the performance of persuasive features. An interesting finding on change of quality perception attributed to MPSE is proposed as future research.

Validation of the instrument of health literacy competencies for Chinese-speaking health professionals.

The study aimed to illustrate the constructs and test the psychometric properties of an instrument of health literacy competencies (IOHLC) for health professionals. A multi-phase questionnaire development method was used to develop the scale. The categorization of the knowledge and practice domains achieved consensus through a modified Delphi process. To reduce the number of items, the 92-item IOHLC was psychometrically evaluated through internal consistency, Rasch modeling, and two-stage factor analysis. In total, 736 practitioners, including nurses, nurse practitioners, health educators, case managers, and dieticians completed the 92-item IOHLC online from May 2012 to January 2013. The final version of the IOHLC covered 9 knowledge items and 40 skill items containing 9 dimensions, with good model fit, and explaining 72% of total variance. All domains had acceptable internal consistency and discriminant validity. The tool in this study is the first to verify health literacy competencies rigorously. Moreover, through psychometric testing, the 49-item IOHLC demonstrates adequate reliability and validity. The IOHLC may serve as a reference for the theoretical and in-service training of Chinese-speaking individuals' health literacy competencies.

Using the Five-Level Taiwan Triage and Acuity Scale Computerized System: Factors in Decision Making by Emergency Department Triage Nurses.

Triage classifies and prioritizes patients' care based on the acuity of the illness in emergency departments (EDs). In Taiwan, the five-level Taiwan Triage and Acuity Scale (TTAS) computerized system was implemented nationally in 2010. The purpose of this study was to understand which factors affect decision-making practices of triage nurses in the light of the implementation of the new TTAS tool and computerized system. The qualitative data were collected by in-depth interviews. Data saturation was reached with 16 participants. Content analysis was used. The results demonstrated that the factors affecting nurses' decision making in the light of the newly implemented computerized system sit within three main categories: external environmental, patients' health status, and nurses' experiences. This study suggests ensuring the patient's privacy while attending the triage desk, improving the critical thinking of triage nurses, and strengthening the public's understanding of the ED visits. These will make ED triage more efficient.