Sailing in a sea of perplexity: Family caregivers' experience of patients with delirium.

BACKGROUND: Family caregivers play an important role for patients admitted to the intensive care unit (ICU), and delirium is a common clinical syndrome. Little is known about the experiences of family caregivers when a relative is a patient with delirium, especially for caregivers in Asian cultures. AIMS AND OBJECTIVE: To understand the experience of family caregivers with a family member as a patient with delirium in the ICU in Taiwan. DESIGN: A descriptive qualitative study with in-depth face-to-face semi-structured interviews. METHODS: Interviews were conducted with 20 family caregivers of 20 patients with delirium in the ICU of a hospital in northern Taiwan. RESULTS: The core theme describing the phenomenon of family caregivers of a patient with delirium was "Sailing in a sea of perplexity," which described family caregivers' uncertainty of navigating the ICU and providing support for a relative. Three subthemes described the core theme: (a) perplexity of the ICU environment, (b) perplexity of making decisions, and (c) perplexity of Chinese cultural constraints. CONCLUSION: "Sailing in a sea of perplexity" underscores how uncertainty among family caregivers of patients with delirium in ICUs can lead to feelings of fear and anxiety. Therefore, nursing professionals should not only focus on patient care but also be sensitive to caregivers' feelings of uncertainty and their cultural beliefs. RELEVANCE TO CLINICAL PRACTICE: Unfamiliarity and lack of knowledge about intensive care and patient treatments were a source of family caregivers' perplexity. To reduce uncertainty, we recommend increased communication between staff and caregivers. Hospitals can also provide information on their websites, including treatment of delirium and visitation hours. Information access could be enhanced by developing a smartphone app linked to a QR code that families can scan to obtain information, which would be useful during restricted visitation.

Prevalence and Association of Pain Experiences, Medication Literacy, and Use of Medication among Children and Adolescents in Taiwan.

OBJECTIVE: This study assessed the prevalence of children's and adolescents' pain experiences and use of medicine and examined the relationships between pain experiences, medication knowledge, literacy, and use of medicine. METHOD: A probability-proportionate-to-size sampling method was used to systematically draw a random sample of schools. In 2014, a national representative sample of 2309 students from 35 primary schools (5th-6th grade), 2700 students from 30 middle schools, and 2013 students from 20 high schools completed the online survey. RESULTS: Overall, 85.6% of children and adolescents reported experiencing pain during the past year that included headache (63.0%), throat ache (59.3%), muscle ache (58.3%), stomach pain (42.9%), menstrual pain (girls: 42.1%), and dental pain (38.5%). Children and adolescents had taken cold/cough medicine (48.1%), acetaminophen (15.0%), antacids (14.8%), and nonsteroidal anti-inflammatory drugs (NSAIDs) (10.5%) in the past year. Multivariate analysis results indicated that after controlling for pain experiences children and adolescents who had lower levels of medication knowledge and literacy were more likely to use pain medication and antacids more frequently. In addition, children and adolescents who had lower medication knowledge, lower literacy, asked doctors to prescribe antacids, and co-administered with antacids were more likely to report long-term use of antacids. CONCLUSIONS: Lower levels of medication knowledge and literacy among children and adolescents were associated with more frequent use of pain medication and antacids.

Inappropriate self-medication among adolescents and its association with lower medication literacy and substance use.

BACKGROUND: While self-medication is common, inappropriate self-medication has potential risks. This study assesses inappropriate self-medication among adolescents and examines the relationships among medication literacy, substance use, and inappropriate self-medication. METHOD: In 2016, a national representative sample of 6,226 students from 99 primary, middle, and high schools completed an online self-administered questionnaire. Multiple logistic regression analysis was used to examine factors related to inappropriate self-medication. RESULTS: The prevalence of self-medication in the past year among the adolescents surveyed was 45.8%, and the most frequently reported drugs for self-medication included nonsteroidal anti-inflammatory drugs or pain relievers (prevalence = 31.1%), cold or cough medicines (prevalence = 21.6%), analgesics (prevalence = 19.3%), and antacids (prevalence = 17.3%). Of the participants who practiced self-medication, the prevalence of inappropriate self-medication behaviors included not reading drug labels or instructions (10.1%), using excessive dosages (21.6%), and using prescription and nonprescription medicine simultaneously without advice from a health provider (polypharmacy) (30.3%). The results of multiple logistic regression analysis showed that after controlling for school level, gender, and chronic diseases, the participants with lower medication knowledge, lower self-efficacy, lower medication literacy, and who consumed tobacco or alcohol were more likely to engage in inappropriate self-medication. CONCLUSION: Lower medication literacy and substance use were associated with inappropriate self-medication among adolescents.

Developing school-pharmacist partnerships to enhance correct medication use and pain medication literacy in Taiwan.

OBJECTIVE: To evaluate the effectiveness of the health promoting school (HPS)-community pharmacist partnership program that promotes students' correct medication use and enhances pain medication literacy in Taiwan. DESIGN: Pre- and post-studies and intervention/comparison group comparisons. SETTING: Primary and middle schools, along with their communities, in Taiwan. PARTICIPANTS: In 2013, baseline and follow-up self-administered, online surveys were received from 5,373 students enrolled in intervention primary and middle schools and from 4,643 students enrolled in comparison primary and middle schools. MAIN OUTCOME MEASURE: The level of medication literacy, including correct medication use knowledge, self-efficacy, and skills. RESULTS: The development and implementation of the HPS-community pharmacist partnership program in primary and middle schools significantly enhanced students' knowledge, self-efficacy, and skills in correct medication use and pain medication literacy (P <0.001). CONCLUSION: The HPS-community pharmacist partnership had a positive impact on enhancing correct medication use and pain medication literacy in Taiwan.

Potential drug-drug interactions in pediatric outpatient prescriptions for newborns and infants.

OBJECTIVES: To surveyed the quantities, types, and related information of potential drug-drug interactions (DDIs) and estimate the off-label use percentage of pediatric outpatient prescriptions for newborns and infants from the National Health Insurance Research Database (NHIRD) of Taiwan. BACKGROUND: Adverse drug reactions (ADR) may cause morbidity and mortality, potential drug-drug interactions (DDI) increase the probability of ADR. Research on ADR and DDI in infants is of particular urgency and importance but the related profiles in these individuals are not well known. METHODS: All prescriptions written by physicians in 2000 were analyzed to identify potential DDIs among drugs appearing on the same prescription sheet. RESULTS: Of a total of 150.6 million prescription sheets, with 669.5 million prescriptions registered in the NHIRD of Taiwan, six million (3.99%) prescription sheets were for 2.1 million infants with 19.4 million (2.85%) prescriptions. There were 672,020 potential DDIs in this category, accounting for 3.53% per prescription; an estimated one DDI in every three patients. The interactions between aspirin and aluminum/magnesium hydroxide were most common (4.42%). Of the most significant drug-drug interactions, the interaction of digoxin with furosemide ranked first (20.14%), followed by the interactions of cisapride with furosemide and erythromycin (6.02% and 4.85%, respectively). The interactions of acetaminophen and anti-cholinergic agents comprised most types of drug-drug interactions (6.62%). CONCLUSION: Although the prevalence rates of DDIs are low, life-threatening interactions may develop. Physicians must be reminded of the potential DDIs when prescribing medications for newborns and infants.

Medication events: the experience of the Taiwan patient-safety reporting system (TPR).

Since the IOM's report "To err is human" in 1999, patient safety has become an important issue internationally. Many countries have established reporting systems for patient safety. Department of Health, Executive Yuan, ROC (Taiwan) introduced a nationwide reporting system, "Taiwan Patient-safety Reporting system (TPR)" in December 2003. This study analyzes the 4-year data (2005-2008) of medication events from TPR.