The Effects of the Situated Simulation Program on the Cultural Competence of Hemodialysis Nurses: A Quasi-Experimental Study.

The rise in the number of hemodialysis (HD) patients underscores the importance of culturally competent HD nurses. This study aimed to examine the effectiveness of a situated simulation program on HD nurses' cultural competence. This was a quasi-experimental pilot study with a total of 40 participants who met the inclusion criteria from an HD center in northern Taiwan. Participants took part in two separate 3 h education programs. The first program focused on the basic concepts of cultural competence, while the second program involved situated simulations utilizing the Gather-Analyze-Summarize (GAS) method of debriefing. The generalized estimating equations (GEEs) were employed to estimate the intervention effect. The baseline scores were divided into low-score and high-score groups using the median score for subgroup analysis. The subgroup analysis revealed that a significant group-time interaction was identified regarding cultural competence and subscale, verifying the situated simulation's immediate effect. In this study, an integration of the GAS method of debriefing and situated simulation teaching was implemented. The results showed that this approach empowered HD nurses with the ability to foster positive attitudes and demonstrate professional expertise in an organized manner when facing similar clinical scenarios in the future.

Translation and validation of the Chinese version of the stroke knowledge test for the hypertension patient.

The measurement of hypertensive patients' stroke knowledge is an important stroke prevention indicator of health care service quality. The aim of this study was to develop a Chinese version of the Stroke Knowledge Test and examine its psychometric properties, reliability, and validity for hypertensive patients. A sample of 200 hypertensive patients completed the Chinese version of the Stroke Knowledge Test, and 30 of the participants were retested after 2 weeks. The final Chinese version of the Stroke Knowledge Test included 20 items with acceptable content validity (I-CVI = 0.88 ~ 1.00, S-CVI/Ave = 0.97). These items showed satisfactory internal reliability consistency (Kuder Richardson-20 = 0.62) and test-retest reliability was 0.77. The 40% of the difficulty index was in the acceptable range, and 25% was in the difficult range, as well as the 90% items overall values for discrimination were ranged from 0.2 to > 0.4. Known-group validity testing was performed based on the education level, and the result exhibited significant difference (F = 21.21, p < 0.001). The Chinese version of the Stroke Knowledge Test demonstrated acceptable psychometric properties, thus providing a new tool for the future care of hypertensive patients in Taiwan. It also could be as a reference for healthcare providers to educate hypertensive patients on stroke prevention.

The effectiveness of simulation education program on shared decision-making attitudes among nurses in Taiwan.

BACKGROUND: Shared decision-making (SDM) is significantly associated with promoting the quality of end-of-life (EOL). The attitude of nurses toward the end of life can affect EOL care, but there are few SDM-related clinical learning programs focused on EOL. In this study, therefore, we evaluated the effectiveness of an EOL-simulation education program on attitudes toward SDM among nurses, using an objective structured clinical examination (OSCE). METHODS: We used a quasi-experimental study design to evaluate nurses working at a medical center in Taiwan. We recruited 100 nurses and assigned them to an experimental group (n = 50) and a control group (n = 50). The experimental group received the SDM attitude (SDMA) cultivation program, and the control group did not. After the intervention, all participants were examined in an OSCE to assess the efficacy of their learning. A p value of.05 was considered statistically significant. RESULTS: The average score of the experimental group was higher than that of the control group in the dimensions "empathic communication" and "mastery learning", but these differences were not significant. SDMA score is significantly and positively correlated with SDMA global score, standardized patient survey (SPS) score, and SPS global score (r = .92, .56, and .50, respectively; p < .01). CONCLUSIONS: Simulations concerning EOL care that incorporate SDM components would be effective for training clinical nurses. This study can serve as a reference for nursing-administration managers who may consider designing SDM-related education programs to improve the quality of clinical nursing care.

Development and testing of the shared decision-making attitudes scale among nurses in Taiwan: a cross-sectional scale development study.

OBJECTIVE: Shared decision-making (SDM) enhances medical care, but an appropriate tool for evaluating nursing staff's attitudes towards SDM in clinical practice is lacking. The objective of this study is to develop the Nursing Shared Decision-Making Attitude (NSDMA) scale and verify its psychometric properties. DESIGN: Instrument design study. PARTICIPANTS: A sample of 451 nursing staff. INTERVENTION: This study comprised two phases. In phase 1, qualitative research and expert content validity were adopted to develop the first draft of the scale. In phase 2, Taiwanese nursing staff were recruited through convenience sampling, and the sample was divided into a calibration sample and a validation sample. An objective structured clinical examination of SDM attitudes was administered to 100 nursing staff to determine the scale's cut-off score. MAIN OUTCOME MEASUREMENTS: Exploratory factor analysis and confirmatory factor analysis were used to obtain the underlying factors of the NSDMA scale; McDonald's omega value was used to determine the reliability; known-group validity was used to test the construct validity; and the receiver operating characteristic curve was adopted to determine the scale's cut-off score. RESULTS: In total, two factors were identified from the instrument results, which were termed 'empathic communication' and 'mastery learning'. The McDonald's omega value of the overall scale was 0.92. Known-group validity testing was performed based on the staff's participation in SDM courses and experience of SDM, and the results exhibited significant differences (t=5.49, p<0.001; t=2.43, p<0.05). Based on the receiver operating characteristic curve, the optimal cut-off for SDM attitudes was determined as 48.5 points. CONCLUSIONS: The NSDMA scale enables the evaluation of SDM attitudes among clinical nursing staff and nursing managers; the results may serve as a reference for incorporation of SDM into nursing policy formulation.

"Hesitating and Puzzling": The Experiences and Decision Process of Acute Ischemic Stroke Patients with Prehospital Delay after the Onset of Symptoms.

Despite campaigns to increase public awareness of stroke symptoms by advocating FAST (Face-Arms-Speech-Time), some stroke patients still show delays in the recognition of and response to stroke symptoms and miss the golden first 4.5 h to receive rt-PA (recombinant tissue plasminogen activator) treatment. The aim of this study was to explore how acute ischemic stroke patients with prehospital delay seek help and undergo the decision process before arriving at the hospital. A qualitative approach using a grounded theory was applied. There were 24 ischemic stroke patients recruited by purposive sampling. Our main findings were: "Hesitating and puzzling" was the core category to describe and guide the process of acute ischemic stroke patients with prehospital delay. During the process, "Awareness the sudden change of physical sensation and/or function" was the antecedent category. In the prehospital delay experience, the following five interaction categories were identified: (1) "Self-judgment and interpretation according to previous experience," (2) "Puzzling and doubting-it may only be a minor problem," (3) "Self-treatment or seeking medical attention nearby," (4) "Unexpected symptoms getting worse" needing immediate advanced medical help and (5) "Rushing to ER with different transportation-self-alerting that serious disease is coming." Eventually, the patients "Regret to delay seeking treatment and become a disable person." The process of prehospital delay provides some hidden cues for patients to increase their knowledge about strokes. The study emphasizes the importance of educating community residents about identifying stroke symptoms, breaking the myth of folk therapy, and seeking medical attention immediately. These results will assist healthcare providers by offering references for designing patient-centric educational strategies for preventing stroke prehospital delay to improve the quality of stroke medical care.

Shared clinical decision-making experiences in nursing: a qualitative study.

BACKGROUND: Shared decision making (SDM) is a patient-centered nursing concept that emphasizes the autonomy of patients. SDM is a co-operative process that involves information exchange and communication between medical staff and patients for making treatment decisions. In this study, we explored the experiences of clinical nursing staff participating in SDM. METHODS: This study adopted a qualitative research design. Semistructured interviews were conducted with 21 nurses at a medical center in northern Taiwan. All interview recordings were transcribed verbatim. Content analysis was performed to analyze the data. RESULTS: The findings yielded the following three themes covering seven categories: knowledge regarding SDM, trigger discussion and coordination, and respect of sociocultural factors. CONCLUSIONS: The results of this study describe the experiences of clinical nursing staff participating in SDM and can be used as a reference for nursing education and nursing administrative supervisors wishing to plan and enhance professional nursing SDM in nursing education.

Objective structural clinical examination for evaluating learning efficacy of Cultural Competence Cultivation Programme for nurses.

BACKGROUND: Culture serves as an adhesive to bind the lives of people. There are no objective, useful tools to assess cultural competence and practice. In this study, we evaluated whether the cultural competence of nurses was strengthened through the Cultural Competence Cultivation Programme. METHODS: A quasi-experimental research design was used to evaluate nurses working at a medical centre in Taiwan. They were randomly allocated into an experimental group (n = 47), which received the Cultural Competence Cultivation Programme, or a control group (n = 50), which did not receive the educational programme. After the intervention, learning efficacy of the participants was assessed using an Objective Structured Clinical Examination (OSCE). The research data were statistically analysed on SPSS. RESULTS: The average score of the experimental group was significantly higher in the 'communication ability and skill' category. Furthermore, OSCE scores and Standardised Patient Survey assessment and total scores were significantly and positively correlated. CONCLUSION: The findings of this study can serve as a reference for designing future clinical education programmes.

Developing and validating the Nursing Cultural Competence Scale in Taiwan.

BACKGROUND: Culture influences personal health habits and behavior, and healthcare personnel possess different views of cultural perspectives. Currently, an appropriate instrument to assess cultural competence in clinical practice is limited. The present study aimed to develop and examine the psychometric properties of the Nursing Cultural Competence Scale (NCCS) for clinical nurses. METHODS: Developing and assessing the scale was carried out in two phases: Phase I involved a qualitative research to explore the themes of nurses' cultural competence and instrument development; Phase II established construct validity of the scale using a sample of 246 nurses in Taiwan. Data from the questionnaire were analyzed using exploratory factor analysis, confirmatory factor analysis, internal consistency and test-retest reliability. Analysis results were used to determine the reliability and validity of the developed scale. RESULTS: The results showed four factors including cultural awareness ability, cultural action ability, cultural resources application ability, and self-learning cultural ability were generated by exploratory factor analysis, and these factors explained 62.0% of total variance. Cronbach's α of the Nursing Cultural Competence Scale was .88, and test-retest reliability correlation was .70. CONCLUSIONS: The establishment of the tool will facilitate accurate monitoring of the cultural competence among nurses and nursing managers, which can inform the construction of nursing policies aimed at pledge cultural competence expansion.

Exploring the Relationship Between Professional Commitment and Job Satisfaction Among Nurses.

This cross-sectional study explored the relationship between professional commitment and job satisfaction among nurses. A total of 132 registered nurses were recruited from a hospital in northern Taiwan. A self-reported structured questionnaire was used to collect data. Findings revealed significant differences among nurses in willingness to make an effort and their marital status, appraisal in continuing their careers, job level, and goals and values related to working shifts. Significant differences were found between inner satisfaction and work sector and marital status. Nurses' professional commitment was strongly related to job satisfaction; aspects of professional commitment explained 32% of the variance in job satisfaction. Study results may inform health care institutions about the importance of nurses' job satisfaction and professional commitment so hospital administration can improve these aspects of organizational environment.

Effects of an anti-smoking program to prevent lung cancer among urban aboriginals in Taiwan.

BACKGROUND AND PURPOSE: Indigenous people who leave their hometowns and move to the city to earn a living became urban aboriginals. During the process of adapting to urban living situations, they may use various coping strategies such as smoking to overcome their stress. Therefore, it is crucial to provide health education including smoking prevention, increasing knowledge regarding of tobacco hazard, self-efficacy of anti-smoking, and adjusting smoking behavior so as to empower their anti-smoking motivation to prevent lung cancer. The purpose of this study was to explore the effectiveness of an anti-smoking program on urban aboriginals in Taiwan. METHODS: A quasi-experimental study design with purposeful sampling was employed. A total of 125 aboriginal subjects were recruited from two local churches at Shu Lin area in northern Taiwan. Subjects were divided into an experimental group (n =64 ) and a control group (n = 61). Both took pre-tests in order to set baseline values, and only the experimental group participated for 3-weeks in the anti-smoking program classes. Both groups took post-tests immediately after the intervention in order to evaluate the immediate effects of the teaching program, and a follow-up test was conducted four weeks after the intervention. Data were analyzed using descriptive statistics, one-way ANCOVA, and repeat measure ANCOVA. RESULTS: After controlling for confounding variables, the results showed that there were statistically significant differences in the self-efficacy of anti-smoking and smoking behavior between experimental and control groups in the immediately post-test and the follow-up test (p < 0.05). However, there was no significant differences in the recognition of hazards of smoking at eiter time point. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The findings of this study revealed that the anti-smoking program effectively improved self-efficacy of anti-smoking, and decreased the smoking behavior in urban aboriginals. They provide useful information as a reference regarding of aboriginal health promotion to health providers. It is imperative that anti-smoking be reinforced for those regular smokers to prevent induction of lung cancer.

Toxic leukoencephalopathy due to yam bean seeds poisoning.

Toxic leukoencephalopathy is attributed to exposure to a wide variety of agents, including systemic chemotherapy, cranial irradiation, illicit drug abuse, and toxins from the environment. Diagnosis of this disease requires documented exposure to a toxin, neurobehavioral deficits, and typical neuroimaging abnormalities. Intoxication by compounds extracted from yam bean seeds may mimic cyanide poisoning but fail to respond to antidotal therapy. We report a 54-year-old Chinese woman who developed disturbed consciousness after eating 40 pieces of yam bean seeds. Head computed tomography obtained 24 hours after the episode was normal. However, magnetic resonance imaging obtained 20 days after the episode revealed symmetrical faint high signal over the bilateral periventricular white matter on T1-weighted image, which turned into diffuse and symmetrical bright high signal on FLAIR. The diagnosis of this patient was toxic leukoencephalopathy by yam bean seeds intoxication. The changes in brain images after yam bean seeds intoxication have not ever been reported. Physicians in Asia and the Pacific islands should have a high index of suspicion when they care for patients with acute confusion and a high anion gap metabolic acidosis but normal serum cyanide level.

Spondylotic myelopathy in patients with cervical dystonia.

The treatment and outcome of cervical dystonia (CD) with myelopathy (CDM) varies among studies. We retrospectively reviewed the clinical features, neuroimages, methods of treatment, and modified Rankin scale (mRS) score of patients with CDM in our hospital. There were seven male and three female patients, with a mean age of 53 years. The mean age at onset of CD was 24.9 years, with a mean interval from dystonia to the diagnosis with myelopathy of 28.1 years. The dominant level of cord compression was at C3/C4 in seven patients, C4/C5 in one patient, and C5/C6 in two patients. Four of five patients with an initial mRS ≥ 3 remained moderately to severely disabled after surgery, with a follow-up periods of 3-5 years, and one of them experienced recurrent cage dislocation and neurological deterioration due to an unstable spine. Perioperative stabilization is important to minimize neurological sequelae. Whether surgical intervention improves the functional outcome of patients with moderate-to-severe disability demands further randomized controlled studies.

Transient global amnesia after taking sibutramine: a case report.

BACKGROUND: Sibutramine (Meridia in the United States, Reductil in Europe) is approved for weight reduction and weight maintenance. Although amnesia and seizure is listed as a reported adverse event of sibutramine in the US product information, our literature search in the PubMed website database found no published reports of theses adverse events. CASE REPORT: We report a 39-year-old healthy woman who had an episode of sudden memory loss lasting for several hours after taking sibutramine for 4 days. Cranial computed tomography scan, magnetic resonance imaging, and magnetic resonance angiography of the head all showed normal results. Electroencephalogram showed spike and wave complexes with phase reversal in the left mesial temporal area. Transient global amnesia was suspected clinically and transient epileptic amnesia provoked by sibutramine was also proposed. Three months after this episode, the follow-up electroencephalogram was normal. This patient did not take any anticonvulsant, and there were no more episodes of memory impairment. DISCUSSION: This case serves to emphasize that sibutramine which was used for weight reduction might induce transient global amnesia or provoke transient epileptic amnesia. Physicians should be careful to monitor for this adverse effect when sibutramine is prescribed.

Foot drop caused by a brain tumor: a case report.

Foot drop is commonly caused by lumbar radiculopathy, peroneal nerve injury, spinal stenosis and other systemic diseases. It is usually thought as peripheral etiology, but it could be attributed to a central lesion, too. However, central lesions are rarely reported. We report a case diagnosed as a left parasagittal parietal tumor, in which drop foot was the only abnormal neurologic finding.

Cavernous sinus syndrome due to sarcoidosis: a case report.

Neurosarcoidosis, rare in patients with sarcoidosis, may present with protean manifestations according to the regions of involvement from peripheral nerves to the central nervous system. Cavernous sinus is rarely involved by sarcoidosis, and it can result in different cavernous sinus syndromes based mainly on the involvement of the trigeminal nerve. We report a 54-year-old man with pulmonary sarcoidosis and cavernous sinus syndrome and review the clinical course, laboratory findings, and neuroradiologic features of the condition. This patient presented with complete ophthalmoplegia of left eye. Magnetic resonance imaging revealed a lesion with gadolinium-enhancement in the left cavernous sinus. Serial chest examinations showed bilateral hilar enlargement. Pulmonary sarcoidosis was diagnosed according to the findings of lymph nodes biopsies. Elevated erythrocyte sedimentation rate and serum angiotension converting enzyme level were observed. After steroid administration, his ocular palsy ameliorated in a few days and cavernous sinus lesion completely disappeared within 3 months after treatment. Although rare, neurosarcoidosis should be considered in the differential diagnosis of cavernous sinus syndromes with neuro-ophthalmologic signs. For early diagnosis of neurosarcoidosis, it requires a high index of suspicion for searching sarcoidosis at sites outside the nervous system. Corticosteroid treatment is generally followed by improvement in clinical status, but there is a high rate of progression and recurrence after the treatment.

Reversible myelopathy on magnetic resonance imaging due to cobalamin deficiency.

Subacute combined degeneration (SCD) is known as myelopathy due to vitamin B12 deficiency. SCD always involves the posterior and lateral columns of the spinal cord, with the neuropathologic change showing vacuolation of the white matter. We describe 2 patients who presented with ataxic gait, impaired proprioception over limbs, and even mental change due to vitamin B12 deficiency. Magnetic resonance imaging (MRI) of the cervical spine showed increased signal intensity on T2-weighted imaging, and laboratory data showed low serum vitamin B12 level. The 2 patients were treated with vitamin B12 injection intramuscularly. There was clinical improvement after treatment along with normalization of the MRI.

Delayed reversible motor neuronopathy caused by electrical injury.

Electrical injury may cause central nervous system (CNS) complications and peripheral nerve disorders. Delayed neurologic complications are rarely reported. A case of delayed reversible motor neuronopathy caused by low-voltage electrical injury is reported due to its rarity. A 22-year-old female received an electric shock of 110 volts while pushing up a metal gate during a rainy morning on April 16, 2005. She initially suffered loss of consciousness for several hours, and then became quadriplegic, from which she completely recovered 10 days later. After return to work for 1 month, she developed weakness and numbness of bilateral upper limbs. Nerve conduction velocity study and bilateral median nerve somatosensory evoked potential were normal. Magnetic resonance imaging of the brain and cervical spine were also normal. Electromyography showed mild denervation, reduced interference and polyphasia over the upper arms, suggestive of anterior horn cell lesion. After rest and rehabilitation for 2 weeks, the patient completely recovered her muscle power over proximal upper limbs and partially over the distal upper limbs. Follow-up at the outpatient clinic 4 months later showed total recovery of muscle power. Low-voltage electrical current can cause acute transient quadriplegia and delayed motor neuronopathy. The mechanism of this patient's recovery from electric shock, followed by deterioration 1 month later, and then recovery after rest is unclear. We considered whether the mechanism of weakness after electric injury, with initial recovery followed later by the development of weakness, might be due to overuse, just like in post-poliomyelitis syndrome. This needs further investigation.

Mechanisms of cough syncope as evaluated by valsalva maneuver.

Successful treatment of cough syncope depends on the correction of various pathogenetic mechanisms among different patients. The valsalva maneuver (VM), which elicits hemodynamic responses mimicking coughs, has potential for investigating the individual pathogenesis of cough syncope. Eighteen consecutive patients suffering from cough-induced syncope were examined. All patients were asked to cough and to perform VM several times under continuous cerebral blood-flow velocity and blood pressure (BP) monitoring by transcranial Doppler and finger plethysmography. Eight patients demonstrated abnormal VM characterized by the absent BP overshoot following the relief of straining. Patients demonstrating abnormal VM had delayed BP recovery after cough (median, 16.4; range, 8.7-25.6 seconds) compared to those demonstrating normal VM (2.6, 1.3-3.8 seconds, p < 0.001). Seven of the 10 patients exhibiting normal BP overshoot during VM had stenotic arterial lesions in the cerebral or coronary circulation, whereas only one of the eight patients demonstrating absent BP overshoot had coronary artery disease (70% vs. 12.5%, p = 0.025). Other clinical profiles, body mass index, frequency of obstructive pulmonary disease and valsalva ratio did not differ between patients featuring normal and absent BP overshoot. In conclusion, the pathogenesis of cough syncope could be different between patients with normal and abnormal VM responses. Patients who had no BP overshoot during VM sustained prolonged hypotension after cough. The VM helps in discriminating among pathogenic mechanisms and guiding investigation and treatment for cough syncope patients.