Blended Learning for Enhancing Nursing Students' Confidence in Managing Psychiatric Nursing Problems.

ABSTRACT: The purpose of the study was to understand the effectiveness of a blended learning model for improving nursing students' confidence in the management of psychiatric care problems. A pretest-posttest design was used with 94 third-year student participants. Students' self-confidence in managing problem behaviors improved from pretest scores. The experimental group demonstrated significant improvement (p < .05) in areas including distinguishing between delusion and disturbance, distinguishing and controlling behavioral disturbance, practicing gentle and firm interactions, showing empathy, interview guiding, accepting the responsibility of the team, and confidently enforcing constraints. Audiovisual teaching materials provided in the intervention had significant effects.

[The Intrinsic Problem of Labeling in Healthcare].

While everyday prejudice and stereotypes may seem harmless, they can cause problems for interpersonal interactions and have drastic consequences for professional caregivers. American sociologist Goffman (1963) defined "stigma" as an individual being disqualified from complete social acceptance. Stigmatization and social stigma convey long-discounted stereotypes and social discrimination in specific ways, resulting in an individual being psychologically categorized as unwelcome or an outcast and, in turn, notable differences between their virtual and actual social identity. Link and Phelan (2001) defined stigmatization as the simultaneous occurrence of four processes: (1) distinct labeling; (2) stereotyping labels with unwelcome attributes; (3) separating "us" from "them" by framing labeled individuals as different; and (4) discriminating against labeled individuals. Evidently, stigmatization is a complex and multifaceted social process that comprises labeling, stereotyping, separating, depriving (of status), and discriminating through the exercise of power (Link & Phelan, 2001). Stigmatized individuals often perceive themselves as different from and devalued by others (Jacoby et al., 2005). Stigmatizing others may provide individuals with a higher perceived locus of control, stronger self-esteem, and reduced anxiety (Heatherton et al., 2000). Stigmatization significantly impacts the physical and mental health of victims. For example, it can make patients stressed, prolong the length of their hospitalization, and increase their likelihood of receiving a depression diagnosis (Budhwani & De, 2019). The main causes of social stigmatization are ignorance, lack of understanding, misinformation, and misunderstanding (Kok et al., 2018). The research has demonstrated that healthcare professionals may stigmatize and discriminate against the patients for which they are caring, hurting the dignity of their patients (Alenezi, 2022) and leading to a lack of trust in patient-physician relationships, reducing patients' opportunities to receive adequate care (Tyerman et al., 2021), hindering their treatment and recovery, and resulting in lower-quality healthcare and prognoses (Copeland, 2021). Therefore, reducing stigmatization in healthcare institutions is necessary to improve healthcare services and boost trust between patients and healthcare teams. During the COVID-19 pandemic, frontline healthcare workers stigmatized and discriminated against many patients during their process of care, harming the mental health of these patients (Tsukuda et al., 2022). These pandemic-era experiences highlight the need for healthcare workers to reflect empathetically on their behavior from various perspectives. Given that empathy and attitude are linked to each other, Economou et al. (2020) argued that anti-stigmatization efforts should prioritize and strengthen healthcare workers' perspective-taking abilities. The nursing-development process should focus on reestablishing behavioral and professional norms to eliminate labeling, instill empathy, emphasize relationships, and develop moral maturity to mitigate stigmatization among patients (Copeland, 2021). The Lancet, a prestigious medical journal, created The Lancet Commission to end stigma and discrimination in mental health with the assistance of over 50 renowned healthcare experts. Strategies for countering stigmatization include the incorporation of relevant training programs and educational interventions aimed at improving how students understand disease and reducing discriminatory behavior against patients. The healthcare sector must focus on the impacts of stigmatization on both healthcare providers' behaviors and treatment quality rather than merely assessing the knowledge and attitudes of healthcare providers (Thornicroft et al., 2022). This approach can help ensure patients receive high-quality healthcare that promotes their recovery, is tailored to their needs, and is free from discrimination and stigmatization.

The experiences of family caregivers in response to a dementia diagnosis disclosure.

BACKGROUND: Dementia is a serious disease that can lead to disability because it impacts the individual's memory, cognition, behavior, and capacity to perform activities of daily living. While most people prefer to receive a full diagnostic disclosure, the actual care requirements of family caregivers of persons with dementia are often unknown after a dementia diagnosis is disclosed. The primary aim of this study was to explore the experiences of family caregivers in response to a dementia diagnosis disclosure and analyze the care needs of caregivers. METHODS: A qualitative study conducted in accordance with COREQ guidelines. The grounded theory approach was undertaken in 20 family caregivers of persons with dementia, who were selected using purposive sampling. Data were analysed using the constant comparative method. RESULTS: The core category of this study was "diagnostic disclosure: Start the long road of care challenges", which was defined as describing the experiences of family caregivers of persons with dementia after first being informed of diagnosis. Five major categories describing the experiences of family caregivers following a dementia diagnosis was developed: 'deciding to seek medical attention,' 'the moment of disclosure,' 'conveying information,' 'maintaining the persons' functioning,' and 'receiving support and living well with dementia.' Subcategories within each major category also emerged. CONCLUSIONS: Clear diagnostic disclosure is important for ensuring that positive developments can occur in response to disclosure. Healthcare professionals must develop strategies to prevent disclosure from triggering overreactive emotions from persons with cognitive impairments, assist them in understanding their illness in a tactful manner, and ensure that they understand how to cooperate in any subsequent care plans.

[Challenges to the Nursing Practicum During the COVID-19 Pandemic].

The COVID-19 pandemic has greatly impacted first-line medical staff as well as nursing-student clinical practicum programs. How to cooperate with the government's pandemic-prevention policies and reduce the gap between education and clinical practice represent significant challenges. In this paper, Chang Gung University of Science and Technology (CCUST) is used as an example to show how schools in Taiwan have effectively adapted the fundamentals of nursing practicum programs to the current pandemic using e-learning, group discussions, case analysis, clinical skill practice, and clinical case simulation scenario exercises. The program at CCUST both takes into account the safety of students and has achieved all critical nursing practice goals. After implementation of these adjustments, satisfaction among nursing students with the practicum environment and the clinical instructors was found to be significantly higher for the on-campus clinical practicum than for the off-campus clinical practicum. Furthermore, the results of qualitative data analyses show that nursing students in the on-campus practicum gained significant knowledge and experience and commented positively on their experience. For example, the students indicated that they were satisfied with the simulated clinical environment of the CCC, the teaching strategies and adaptability of the instructor, and the application of virtual reality scenario cases to enhance skill proficiency and learning outcomes. The adjusted nursing clinical practicum described in this paper may be used as a reference to ensure the quality of nursing clinical practicum programs is maintained during epidemics.

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 lived experiences of elderly dementia patients in Taiwan.

The lived experiences of elderly dementia patients are affected by their cultural beliefs. This study aims to explore the lived experiences of elderly dementia patients in Taiwan in order to understand how they view their lives given the cognitive impairments that they suffer from. A descriptive phenomenological approach was undertaken in 12 elderly dementia patients who were selected using purposive sampling. Data were analysed using Colaizzi's analysis method. Five main themes emerged from the narratives: (i) distress caused by inability to remember; (ii) counteracting memory loss; (iii) worry about being a burden to family; (iv) cherishing the current situation and gaining respect; and (v) adopting a dispassionate view about life and death. The traditions of filial piety in Chinese culture were reflected in the experiences of these elderly dementia patients. Elderly dementia patients experienced inconveniences in their daily lives due to marked impairments in memory functions, and they even doubted their own independent capabilities. To counteract their disease, many elderly dementia patients developed self-contained approaches to handle their loss of memories. While they were worried about being a burden to their families, they also valued their current situation. They were comforted by being taken care of by their children, and they adopted a dispassionate view about life and death issues. For the care of elderly dementia patients, besides reducing the inconveniences brought about by cognitive impairments, there is also a need to pay attention to the deterioration of their physical bodily functions in order to intervene in their lives holistically.

Regular Exercise and Depressive Symptoms in Community-Dwelling Elders in Northern Taiwan.

BACKGROUND: According to World Health Organization, depressive disorder will be a Top 2 disease in the world by 2020. In light of Taiwan's rapidly increasing elderly population, elderly psychological health is expected to become an increasingly important issue in healthcare. PURPOSE: This study examines the association between regular exercise and depressive symptoms in community-dwelling older adults by gender in northern Taiwan. METHODS: The participants were selected using a probability-proportional-to-size procedure from community-dwelling adults who were aged 65 years or older and living in northern Taiwan. A cross-sectional study and interviews were used to collect information about their exercise behaviors, depressive symptoms, and the factors influencing the depressive symptoms. Percentage, chi-square, t test, and logistic regression were used to analyze the data. RESULT: One thousand twenty elderly individuals completed the questionnaires. Among the participants with the average age of 73.5 years, 44.5% were men, and 55.5% were women. Two hundred seventeen of the participants (21.3%) had depressive symptoms. Five hundred eighty-five of the participants (57.4%) exercised regularly. The result of logistic regression showed that regular exercise was a significant predictor of depressive symptoms in elderly individuals (odds ratio = 3.54, 95% confidence interval [1.76, 7.12]). Other factors such as gender, chronicle diseases, and health status were not related to depressive symptoms. Moreover, both for male and female individuals, regular exercise was a significant predictor of depressive symptoms (odds ratio = 4.76, 95% confidence interval [1.65, 13.72] and odds ratio = 3.03, 95% confidence interval [1.18, 7.69], respectively). Other factors were not related to depressive symptoms. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: This study shows regular exercise to be a significant predictor of depressive symptoms in both men and women. Therefore, senior citizens should be encouragedto exercise regularly as a way to promote good mental health.

CE: Original Research: Examining the Links Between Lifestyle Factors and Metabolic Syndrome.

: Background: As it is in many other developed countries, obesity is a growing health concern in Taiwan, affecting nearly 20% of the adult population. Obesity can increase the risk of developing metabolic syndrome, diabetes, and cardiovascular disease. Recent data indicate that the prevalence of metabolic syndrome in Taiwan is 25.5%. Yet some overweight and obese individuals have normal metabolic profiles. It's not clear why some overweight or obese people remain metabolically healthy while others do not. PURPOSE: The purpose of this study was to examine lifestyle risk factors for metabolic syndrome in people who are overweight or obese. We were particularly interested in distinguishing those lifestyle factors associated with metabolic health in this population. METHODS: Data collected from community-based physical examinations in northern Taiwan were used for this cross-sectional study. A survey was conducted from 2013 to 2014. We collected data on demographic variables, clinically pertinent measures (weight; height; waist circumference; blood pressure; and levels of fasting blood glucose, triglycerides, and high-density lipoprotein cholesterol), and lifestyle factors (smoking, drinking, exercise, and dietary habits). To analyze the data, we used percentage, mean, standard deviation, χ test, independent t test, the Fisher exact test, phi correlation, and logistic regression. RESULTS: The overall prevalence of metabolic syndrome among all 734 participants was 36.4%. For the normal weight, overweight, and obese groups, the prevalence of metabolic syndrome was 12.4%, 36.4%, and 61.6%, respectively. The results of logistic regression showed, however, that obese individuals who exercised regularly and ate sufficient amounts of fruit were less likely to have metabolic syndrome, and that overweight individuals who were nonsmokers and ate sufficient amounts of vegetables were also less likely to have metabolic syndrome. CONCLUSIONS: Lifestyle factors may significantly affect the development of metabolic syndrome in people who are overweight or obese. Our findings indicate that practicing healthy lifestyle behaviors may be the best way to prevent metabolic syndrome. Public health interventions promoting smoking cessation, regular exercise, and good dietary habits can be created and conducted at relatively low cost. At the community level, all nurses can prioritize such interventions for their overweight and obese patients.

Effectiveness of community-based exercise intervention programme in obese adults with metabolic syndrome.

AIMS AND OBJECTIVES: The objective of this study was to change the anthropometric, clinical, biochemical indicators and the rate of metabolic syndrome among obese adults in community. BACKGROUND: Obesity is an indicator of metabolic syndrome and cardiometabolic diseases. Obesity increases national health care expenditure in Taiwan. The high prevalence of obesity is not only a public health issue but also an economic problem. Changes in lifestyle can help to prevent metabolic syndrome for individuals with obesity. DESIGN: A randomised controlled trial was applied. METHODS: In this randomised controlled trial by location, 136 metabolically abnormal obese individuals were included. The related indicators with metabolic syndrome were measured at baseline and after six months. The experimental group participated in a six-month community-based programme including provided exercise environments, exercise skills and volunteers' reminding. The control group was only provided environment and skills. RESULTS: One hundred and thirty-one participants completed this trail. In comparison with the baseline, the intervention group showed a significant increase in high-density lipoprotein cholesterol (2·34 mg/dl), and decrease in body weight (1·09 kg), waist circumference (3·63 cm), systolic blood pressure (10·52 mmHg), diastolic blood pressure (5·21 mmHg), fasting blood glucose (5·84 mg/dl) and body mass index (0·74 kg/m(2) ). In the control group, significant decrease in body mass index and waist circumference were discovered. Compared to the changes between the two groups, the results showed there were significant differences in waist circumference, systolic blood pressure, diastolic blood pressure and high-density lipoprotein cholesterol. CONCLUSIONS: The community-based intervention could help to improve high-density lipoprotein cholesterol, reduce body weight, body mass index, waist circumference, blood pressure and fasting blood glucose in metabolically abnormal obese. RELEVANCE TO CLINICAL PRACTICE: This community-based programme helped metabolically abnormal obese individuals become metabolically healthy. In the future, community nurses will work with village heads and volunteers. They can encourage residents in the communities to have healthy lifestyle. As a result, the goal of this programme will be successfully achieved with less time and effort.

The effects of aromatherapy in relieving symptoms related to job stress among nurses.

Workplace-related stress has become today's most serious occupational hazard. Aromatherapy is a simple, convenient and non-invasive method of stress relief. There is little research regarding the efficacy of aromatherapy by means of inhaling essential oil in reducing workplace stress-related symptoms among nurses. Therefore, this study was to examine the effectiveness of lavender oil inhalation in reducing job stress-related symptoms among nurses. The 53 nurses in the experimental group pinned small bottles containing 3% lavender oil on the clothes of their right chests, whereas 57 participants in the control group pinned bottles with no lavender oil. Aromatherapy was shown to be effective in the reduction of the number of stress symptoms for 3 or 4 days. The stress symptoms of the experimental group decreased from 6.1 to 2.8 after aromatherapy was carried out (P = 0.126, 0.159, 0.035 and 0.026). This represented a significant decrease in stress, whereas the stress symptoms in the control group increased from 5.6 to 5.8. Hospital staff managers are still encouraged to include aromatherapy concepts and techniques in the continuing education of nursing staff. Concurrently, future research should focus on the possible side effects of aromatherapy to assure safety.