Experiences of Family Caregivers Providing Home Care to Older Patients With Cancer: A Qualitative Study.

BACKGROUND: Older patients with cancer receive anticancer therapy in outpatient settings, and care-related issues may occur after discharge, which often requires family caregivers (FCs) to play a significant role in providing cancer care at home. However, relatively few studies have been focused on exploring the care experiences of these FCs. PURPOSE: The aim of this study was to explore the care experiences of FCs caring for older family members with cancer at home. METHODS: A qualitative study design and in-depth individual interviews were used to explore the at-home care experiences of FCs of older patients with cancer. The research was conducted in chemotherapy outpatient settings of a medical center in northern Taiwan. Content analysis was used to analyze data. The analyses focused on first extracting meaningful units from the text and then inducting categories from these units and determining the major themes. RESULTS: Twenty FCs were interviewed. The three themes identified included (a) increased information needs and challenges in diet preparation and treatment decision making, (b) personal and patient-induced emotional stress, and (c) life rebalancing through the care experience. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings highlight the educational requirements, especially related to meeting personal dietary needs and obtaining psychological support, for FCs caring for older patients with cancer to help them rebalance their life.

Review the factors associated with dietary sodium adherence in patients with heart failure from selected research-based literatures.

BACKGROUND: Low-sodium dietary is an important measure to avoid heart failure patient's body fluid volume overload. There are still more than 50% of heart failure patients who are incapable of complying low-sodium dietary. This study utilized the systematic literature review method, with the purpose to understand the related factors towards the compliance behavior of low-sodium dietary of patients with heart failure. METHODS: This study typed keywords (congestive heart failure, adherence, compliance, low sodium diet, low salt diet, dietary sodium restriction) from computer databases (CINAHL, Cochrane, Medline, ProQuest Nursing Allied Health, PubMed, and ScienceDirect) and according to inclusion criteria were as follows: (1) Research objects were adult patients admitted to HF, (2) Research content were related to sodium diet compliance behavior. (3) Non-intervention research. Exclusion criteria were as follows: (1) participants who was pregnant women, (2) qualitative research, (3) studies on development of tool, (4) poster. Select needed 14 articles that meet the purposes of this study. In addition, the study also collected 4 more studies with the same purpose from the references that were included in the retrieved articles, and finally a total of 18 studies were included in the analysis of this study. Data analysis uses descriptive statistics (percentage, frequency distribution) and content analysis method. RESULTS: This study use a systematic literature review method, it was found that the results of the studies use nonintervention method, which explored the relevant factors of low-sodium dietary compliance in heart failure patients over the past 20 years, could be summarized in 4 dimensions as social and economic conditions, patient conditions, disease conditions and therapy conditions. CONCLUSIONS: Heart failure patients' compliance behavior toward low-sodium dietary is multi-dimensional. Therefore, this study recommends when the health care providers evaluating patients' compliance behavior of low-sodium dietary, it is necessary to consider more different aspects.

Anxiety and work stress among newly employed nurses during the first year of a residency programme: A longitudinal study.

AIM: To explore changes in anxiety and work stress among new nurses in the first year of a 2-year residency programme. BACKGROUND: Few studies have examined the anxiety and work stress of new nurses in a residency programme. METHODS: This longitudinal study examined levels of anxiety and work stress among newly employed nurses over 1 year at 1 week and 1, 2, 3, 6, 9 and 12 months. Participants were purposively sampled from a medical centre in Taiwan. The Beck Anxiety Inventory and the Nurse Stress Checklist were used to measure anxiety and stress, respectively. RESULTS: The nurses (N = 200) generally perceived mild levels of anxiety and moderate work stress. However, anxiety and stress peaked at the first and second months. Levels stabilized by the sixth month. General ward nurses perceived higher stress levels than did those in emergency or operating rooms. CONCLUSIONS: Stress and work anxiety for new nurses peaked at 1-2 months of employment. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers, preceptors and educators must work together with newly employed nurses in individualized learning and support, doing so to improve the transition experience and reduce levels of work stress and anxiety.

A Qualitative Study of Family Caregiver Experiences of Managing Incontinence in Stroke Survivors.

BACKGROUND: Incontinence is a common problem faced by family caregivers that is recognized as a major burden and predictor of institutionalization. However, few studies have evaluated the experiences of family caregivers caring for stroke survivors with incontinence. PURPOSE: To describe experiences of caregivers managing incontinence in stroke survivors. DESIGN: This qualitative descriptive study employed a grounded-theory approach. METHODS: Semi-structured in-depth interviews with ten family caregivers of stroke survivors with incontinence were conducted during 2011. Audiotaped interviews were transcribed and analyzed using content analysis. FINDINGS: Data analysis identified four themes: chaos, hypervigilance, exhaustion, and creating a new life. There were nine related subcategories: fluster, dirtiness, urgency, fear of potential health-hazard, physically demanding and time-consuming, mentally draining, financial burden, learning by doing, and attitude adjustment. Together, these described a process of struggling to cope with the care of stroke survivors with urinary/fecal incontinence. Of the four categories, "creating a new life" developed gradually over time to orient caregivers to their new life, while the other three categories occurred in a chronological order. CONCLUSION: The research highlighted unique caring experiences of family caregivers of stroke patients, which focused solely on the 'incontinence issue'. Understanding these experiences may help nurses provide better support and resources for family caregivers when caring for stroke survivors with incontinence.

Comparative study of an externship program versus a corporate-academic cooperation program for enhancing nursing competence of graduating students.

BACKGROUND: New graduates report intense stress during the transition from school to their first work settings. Managing this transition is important to reduce turnover rates. This study compared the effects of an externship program and a corporate-academic cooperation program on enhancing junior college students' nursing competence and retention rates in the first 3 months and 1 year of initial employment. METHODS: This two-phase study adopted a pretest and posttest quasi-experimental design. All participants were graduating students drawn from a 5-year junior nursing college in Taiwan. There were 19 and 24 students who participated in the phase I externship program and phase II corporate-academic cooperation program, respectively. The nursing competence of the students had to be evaluated by mentors within 48 hours of practicum training and after practicum training. The retention rate was also surveyed at 3 months and 1 year after beginning employment. RESULTS: Students who participated in the corporate-academic cooperation program achieved a statistically significant improvement in nursing competence and retention rates relative to those who participated in the externship program (p < 0.01 and p < 0.05, respectively). CONCLUSIONS: The corporate-academic cooperation program facilitates the transition of junior college nursing students into independent staff nurses, enhances their nursing competence, and boosts retention rates.

The effectiveness of exercise on improving cognitive function in older people: a systematic review.

BACKGROUND: The well-documented physical benefits of exercise and the value of exercise for improving mental health have raised the profile and role of exercise in healthcare. However, studies evaluating the effects of exercise on neurocognitive function have produced equivocal results. PURPOSE: This study was designed to examine the effectiveness of exercise on improving cognitive function in older people. METHODS: Researchers used a narrative synthesis approach in this review and conducted a computer-based search in MEDLINE, CINAHL, Cochrane Library, and Airiti Library (Chinese) from 2006 to 2009 using the search terms exercise, physical activity, and cognition. Research quality appraisal was rated using Consolidated Standards of Reporting Trials criteria. RESULT: This review included 12 medium- to high-quality randomized controlled trials. Most studies examined used a 60-minute exercise regimen scheduled three times per week that was continued for 24 weeks. Of the 12 studies, 8 revealed that exercise can improve cognitive function. Five studies focused on healthy older people and three studied older people who had impaired cognition at baseline. Analysis of the studies showed simple, one-component exercise as better for older people with cognitive impairment and multicomponent exercise as better for those without such impairment. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: This systematic review demonstrated that an exercise regimen of 6 weeks and at least 3 times per week for 60 minutes had a positive effect on cognition. Whether multicomponent exercise is significantly more effective in improving cognitive function, particularly in healthy older people, should be tested using larger trials with more rigorous methodology.

Persistent cognitive decline in older hospitalized patients in Taiwan.

AIM: This paper is a report of a study conducted to determine the prevalence and predictors of persistent and transient cognitive decline in older hospitalized patients over 6 months after hospital discharge. BACKGROUND: Cognitive decline occurs in 16-35.5% of older hospitalized patients, but this decline may be persistent rather than transient. Distinguishing persistent from transient cognitive decline is clinically useful. METHODS: For this prospective cohort study, 291 older patients were recruited from five medical and surgical units at a tertiary medical centre in Taiwan between 2004 and 2006. Participants were assessed for cognitive status by scores on the Mini-Mental State Examination at admission, discharge, 3 and 6 months postdischarge. Persistent cognitive decline was defined as continuing score reduction and > or =3-point reduction 6 months postdischarge. Transient decline was defined as > or = 3-point reduction at some stage, with a total decline < 3 points 6 months postdischarge. Findings. The cognitive status of the majority of participants (57.4%, n = 167) decreased > or =3 points during follow-up. Of these decliners, 59 (35.3%) had persistent cognitive decline, with an average 5.32-point reduction 6 months postdischarge. Forty-six (27.5%) participants experienced transient cognitive decline. After multiple adjustments in logistic regression analysis, persistent decline was predicted by no in-hospital functional decline (OR = 0.16, P = 0.002), more re-admissions after discharge (OR = 2.42, P = 0.020), and older age (OR = 1.09, P = 0.048). CONCLUSION: A new perspective is needed on discharge planning on patients at risk for persistent cognitive decline. Nurses can oversee the delivery of care, identify cognitive decline, refer patients, and educate families on strategies to enhance cognitive functioning for their aging relatives.

Effects of a range-of-motion exercise programme.

AIM: This paper reports an evaluation of a range-of-motion exercise programme aimed at improving joint flexibility, activity function, perception of pain, and depressive symptoms in a sample of stroke survivors in long-term care facilities. BACKGROUND: The benefits of physical rehabilitation for stroke survivors have been well established. There is, however, little empirical data on the effects of a simple nurse-led range-of-motion exercise programme in improving function for these people. METHOD: A randomized controlled trial was conducted in 1999 with 59 bedridden older stroke survivors in residential care. Participants were randomly assigned to usual care or one of two intervention groups. The 4-week, twice-per-day, 6 days-per-week range-of-motion exercise protocols were similar in both intervention groups, and consisted of full range-of-motion exercises of the upper and lower extremities. To test the effect of different degrees of staff involvement, in intervention group I, a Registered Nurse was present to supervise participants performing the exercises, while intervention group II involved a Registered Nurse physically assisting participants to achieve maximum range-of-motion within or beyond their present abilities. RESULTS: Both intervention groups had statistically significant improvement in joint angles, activity function, perception of pain and depressive symptoms compared with the usual care group (P < 0.05). Post hoc comparison revealed that the joint angles in intervention group II were statistically significantly wider than in both the other groups (P < 0.01). CONCLUSIONS: A simple nurse-led range-of-motion exercise programme can generate positive effects in enhancing physical and psychological function of bedridden older people with stroke. Further studies are needed to investigate the long-term effects of the programme in maximizing function, reducing care utilization and enhancing quality of life for this population.